Pharmacy Students’ Ability to Identify Plagiarism After an Educational Intervention

Objective. To determine if an educational intervention in a doctor of pharmacy (PharmD) degree program increases pharmacy students’ ability to identify plagiarism.Methods. First-year (P1), second-year (P2), and third-year (P3) pharmacy students attended an education session during which types of plagiarism and methods for avoiding plagiarism were reviewed. Students completed a preintervention assessment immediately prior to the session and a postintervention assessment the following semester to measure their ability.Results. Two hundred fifty-two students completed both preintervention and postintervention assessments. There was a 4% increase from preintervention to postintervention in assessment scores for the overall student sample (p<0.05). The mean change was greatest for P1 and P2 students (5% and 4.8%, respectively).Conclusion. An educational intervention about plagiarism can significantly improve students’ ability to identify plagiarism.     

Targeting the Complement Serine Protease MASP-2 as a Therapeutic Strategy for Coronavirus Infections

MASP-2, mannose-binding protein-associated serine protease 2, is a key enzyme in the lectin pathway of complement activation. Hyperactivation of this protein by human coronaviruses SARS-CoV, MERS-CoV and SARS-CoV-2 has been found to contribute to aberrant complement activation in patients, leading to aggravated lung injury with potentially fatal consequences. This hyperactivation is triggered in the lungs through a conserved, direct interaction between MASP-2 and coronavirus nucleocapsid (N) proteins. Blocking this interaction with monoclonal antibodies and interfering directly with the catalytic activity of MASP-2, have been found to alleviate coronavirus-induced lung injury both in vitro and in vivo. In this study, a virtual library of 8736 licensed drugs and clinical agents has been screened in silico according to two parallel strategies. The first strategy aims at identifying direct inhibitors of MASP-2 catalytic activity, while the second strategy focusses on finding protein-protein interaction inhibitors (PPIs) of MASP-2 and coronaviral N proteins. Such agents could represent promising support treatment options to prevent lung injury and reduce mortality rates of infections caused by both present and future-emerging coronaviruses. Forty-six drug repurposing candidates were purchased and, for the ones selected as potential direct inhibitors of MASP-2, a preliminary in vitro assay was conducted to assess their interference with the lectin pathway of complement activation. Some of the tested agents displayed a dose-response inhibitory activity of the lectin pathway, potentially providing the basis for a viable support strategy to prevent the severe complications of coronavirus infections.     

Monoclonal antibodies recognizing epitopes on the extracellular face and intracellular N-terminus of the human erythrocyte anion transporter (band 3) and their application to the analysis of South East Asian ovalocytes

This report describes the production and characterization of 13 rodent monoclonal antibodies to the human erythrocyte anion transport protein AE1 (syn. band 3). Eleven antibodies (4 murine and 7 rat) recognize epitopes dependent on the integrity of the third extracellular loop of the protein. Two antibodies (1 murine and 1 rat) recognize epitopes on the N-terminal cytoplasmic domain. Quantitative binding studies using radioiodinated IgG and Fab fragments of antibodies to extracellular epitopes on AE1 ranged from 77,000 to 313,000 (IgG) and from 241,000 to 772,000 (Fab) molecules bound at saturation. The results indicate that the epitopes recognized by different antibodies vary in their accessibility and suggest that there is heterogeneity in the organization of individual AE1 molecules in the red blood cell membrane. Quantitative binding studies on South East Asian ovalocytes using several antibodies to AE1 and an anti-Wrb show a marked reduction in the number of antibody molecules bound at saturation. These results are consistent with the existence of highly cooperative interactions between transmembrane domains of AE1 in normal erythrocytes and the disruption of these interactions in the variant AE1 found in South East Asian ovalocytes.     

Maternal administration of granulocyte colony-stimulating factor improves neonatal rat survival after a lethal group B streptococcal infection

Maternally administered recombinant human granulocyte colony- stimulating factor (rhG-CSF) has been shown to cross the placenta and induce a peripheral neutrophilia and increases in the marrow and spleen neutrophil storage pools in fetal and newborn rats. In the present study, we have used this model system to investigate the efficacy of prenatally administered rhG-CSF on neonatal defense to a lethal challenge with Group B-beta hemolytic Streptococcus (GBS). Pregnant rats were injected with rhG-CSF twice daily beginning 6 days before parturition. At birth, all pups were infected with a dose of GBS that is lethal for 90% of infected pups (LD90). Survival was monitored daily for 5 days. Survival of infected pups from saline-treated mothers beyond 60 hours after infection was 10%. No difference in survival was observed among pups from mothers treated 2 and 4 days before parturition. In contrast, we determined that survival was 82.5% among infected pups from mothers treated for 6 days before parturition with rhG-CSF. Our results demonstrate that maternal administration of rhG- CSF augments neonatal defenses against a lethal bacterial challenge.     

Granulocyte-macrophage colony-stimulating factor augmentation of T-cell receptor-dependent and T-cell receptor-independent thymocyte proliferation

The effects of granulocyte-macrophage colony-stimulating factor (GM- CSF) are not confined to cells of the myeloid lineage. GM-CSF has been shown to have effects on mature T cells and both mature and immature T- cell lines. We therefore examined the GM-CSF responsiveness of murine thymocytes to investigate whether GM-CSF also affected normal immature T lymphocytes. The studies presented here indicate that GM-CSF augments accessory cell (AC)-dependent T-cell receptor (TCR)-mediated proliferation of unseparated thymocyte populations. To identify the GM- CSF responsive cell type, thymic AC and T cells were examined for GM- CSF responsiveness. We found that GM-CSF augmentation of TCR-induced thymocyte proliferation appears to be mediated via augmentation of AC function, and not via direct effects on mature single-positive (SP) thymocytes. Enriched double-negative (DN) thymocytes were also tested for GM-CSF responsiveness. GM-CSF induced the proliferation of adult and fetal DN thymocytes in an AC-independent and TCR-independent single- cell assay. Thus, in contrast to the SP thymocytes, a DN thymocyte population was directly responsive to GM-CSF. GM-CSF therefore may play a direct role in the expansion of DN thymocytes and an indirect role in the expansion of SP thymocytes.     

Hematopoietic growth factors for graft failure after bone marrow transplantation: a randomized trial of granulocyte-macrophage colony- stimulating factor (GM-CSF) versus sequential GM-CSF plus granulocyte- CSF

Delay in hematologic recovery after bone marrow transplantation (BMT) can extend and amplify the risks of infection and hemorrhage, compromise patients' survival, and increase the duration and cost of hospitalization. Because current studies suggest that granulocyte- macrophage (GM) colony-stimulating factor (CSF) may potentiate the sensitivity of hematopoietic progenitor cells to G-CSF, we performed a prospective, randomized trial comparing GM-CSF (250 micrograms/m2/d x 14 days) versus sequential GM-CSF x 7 days followed by G-CSF (5 micrograms/kg/d x 7 days) as treatment for primary or secondary graft failure after BMT. Eligibility criteria included failure to achieve a white blood cell (WBC) count > or = 100/microL by day +21 or > or = 300/microL by day +28, no absolute neutrophil count (ANC) > or = 200/microL by day +28, or secondary sustained neutropenia after initial engraftment. Forty-seven patients were enrolled: 23 received GM-CSF (10 unrelated, 8 related allogeneic, and 5 autologous), and 24 received GM- CSF followed by G-CSF (12 unrelated, 7 related allogeneic, and 5 autologous). For patients receiving GM-CSF alone, neutrophil recovery (ANC > or = 500/microL) occurred between 2 and 61 days (median, 8 days) after therapy, while those receiving GM-CSF+G-CSF recovered at a similar rate of 1 to 36 days (median, 6 days; P = .39). Recovery to red blood cell (RBC) transfusion independence was slow, occurring 6 to 250 days (median, 35 days) after enrollment with no significant difference between the two treatment groups (GM-CSF: median, 30 days; GM-CSF+G- CSF; median, 42 days; P = .24). Similarly, platelet transfusion independence was delayed until 4 to 249 days (median, 32 days) after enrollment, with no difference between the two treatment groups (GM- CSF: median, 28 days; GM-CSF+G-CSF: median, 42 days; P = .38). Recovery times were not different between patients with unrelated donors and those with related donors or autologous transplant recipients. Survival at 100 days after enrollment was superior after treatment with GM-CSF alone. Only 1 of 23 patients treated with GM-CSF died versus 7 of 24 treated with GM-CSF+G-CSF who died 16 to 84 days (median, 38 days) after enrollment, yielding Kaplan-Meier 100-day survival estimates of 96% +/- 8% for GM-CSF versus 71% +/- 18% for GM-CSF+G-CSF (P = .026). These data suggest that sequential growth factor therapy with GM-CSF followed by G-CSF offers no advantage over GM-CSF alone in accelerating trilineage hematopoiesis or preventing lethal complications in patients with poor graft function after BMT.(ABSTRACT TRUNCATED AT 400 WORDS)     

Tau mutants bind tubulin heterodimers with enhanced affinity

Tau is a microtubule binding protein that forms pathological aggregates in the brain in Alzheimer’s disease and other tauopathies. Disease etiology is thought to arise from loss of native interactions between tau and microtubules, as well as from gain of toxicity tied to tau aggregation, although neither mechanism is well understood. Here we investigate the link between function and disease using disease-associated and disease-motivated mutants of tau. We find that mutations to highly conserved proline residues in repeats 2 and 3 of the microtubule binding domain have differential effects on tau binding to tubulin and the capacity of tau to enhance tubulin polymerization. Notably, mutations to these residues result in an increased affinity for tubulin dimers while having a negligible effect on binding to stabilized microtubules. We measure conformational changes in tau on binding to tubulin that provide a structural framework for the observed altered affinity and function. Additionally, we find that these mutations do not necessarily enhance aggregation, which could have important implications for tau therapeutic strategies that focus solely on searching for tau aggregation inhibitors. We propose a model that describes tau binding to tubulin dimers and a mechanism by which disease-relevant alterations to tau impact its function. Together, these results draw attention to the interaction between tau and free tubulin as playing an important role in mechanisms of tau pathology.Tau is a microtubule (MT)-associated protein that plays a critical role in the pathology of several neurodegenerative disorders including Alzheimer’s disease, frontotemporal dementias, and traumatic brain injury (1). Normally, tau is found primarily in the axons of neurons where it regulates the dynamic instability of MTs (2, 3) and plays an important role in axonal transport (4, 5). Both in vitro and in vivo measurements find that tau increases the rate of MT polymerization, as well as decreasing rates of catastrophe (2, 6, 7). In disease, tau is found as aggregated, filamentous deposits that are the defining feature of a diverse class of neurodegenerative diseases, called tauopathies (1, 8). Pathological mutations to tau are thought to alter the native interactions of tau with MTs, in addition to increasing the propensity of tau to aggregate (9–11). Although the precise cause or mechanism by which tau contributes to toxicity in disease is unknown, both a loss of native function and a gain of toxic function are implicated (1, 12, 13).Tau consists of a C-terminal microtubule binding domain (MTBR) composed of imperfect repeats (R1–R4; Fig. 1A) (14), a flanking proline-rich region that enhances MT binding and assembly (3), and an N-terminal projection domain with putative roles in MT spacing (15) and membrane anchoring (16). Alternative splicing results in the expression of six isoforms of tau in the adult human brain, with zero, one, or two N-terminal inserts and three or four MT binding repeat units. The repeat units contain an 18-residue imperfect repeat sequence, which terminates with a highly conserved proline-glycine-glycine-glycine (PGGG), and are linked by a 13–14 residue interrepeat sequence (Fig. 1C). Early biochemical studies depicted the conserved regions as binding weakly to MTs, with the interrepeats acting as spacers between them (14, 17). More recently, it was shown that the interrepeats are also directly involved in binding and polymerization (18, 19), with the N-terminal proline-rich region playing a regulatory role (20). Tau binds MTs with a biphasic pattern indicative of two distinct binding sites on the MT lattice with unequal affinities (21, 22). Binding to MTs is negatively regulated by phosphorylation on sites in the MTBR and adjacent regions (23). Tau derived from aggregates in the brain is hyperphosphorylated (24), suggesting a role for aberrant phosphorylation in disease.Open in a separate windowFig. 1.Schematic of tau constructs and an MTBR repeat. The functional domains of tau are indicated on the longest full-length isoform with alternatively spliced regions marked by dashed lines (A). The interrepeat regions that link the conserved repeat sequences are indicated by cross-hatching. On the fragments used in this study (B), K16 (residues 198–372) and K18 (residues 244–372), the residues mutated to cysteine for attachment of fluorophores (residues 244, 322, and 354), and proline to leucine/serine mutation sites (301 and 332) are indicated. A schematic of a repeat within the MTBR (C) illustrates interrepeat and repeats sequences, with the conserved residues shown.Attempts to obtain resolution structural information of tau have been hindered by the fact that it is intrinsically disordered under physiological conditions (25) and remains largely disordered even on binding to MTs. Contrasting models derived from cryo-EM suggest tau binds either along the outer protofilament ridge (26) or to the inner surface (27) of MTs. The MTBR carries a net positive charge, and binding of tau to the acidic carboxy termini of α and β tubulin has been observed both in the context of MTs (28) and for the isolated peptides corresponding to these tubulin sequences (29, 30). In addition, a secondary binding site has been mapped to an independent region within the C-terminal third of tubulin (30). Cleavage of the C-terminal tail of tubulin is sufficient to increase polymerization rates (30), and it has been suggested that tau may promote MT polymerization through a similar charge neutralization mechanism.The MTBR also plays a central role in tau pathology in that it forms the core of the aggregates found in disease (31) and contains the minimum sequence necessary to recapitulate relevant features of aggregation in vitro (32). Moreover, the majority of mutations to tau implicated in tauopathies are either point mutations within the MTBR or mutations that interfere with alternative splicing, altering the normal ∼1:1 ratio of 3R:4R tau (8, 9). Notable among the point mutants is P301L (tau_P301L) (Fig. 1B), implicated in frontotemporal dementia with Parkinsonism-17, which provided one of the first genetic links between tau and neurodegenerative disease (33). The P301L variant has emerged as a particularly reliable model for tau-based neurodegenerative disease, having successfully reproduced aspects of pathology in animal models of Alzheimer’s disease and other tauopathies (34).Although significant work has focused on tau interactions with MTs, very little is known about the mechanistic details of tau-mediated MT polymerization, including interactions of tau with tubulin dimers during the assembly process. Although many alterations to tau implicated in disease have been shown to affect MT polymerization both in vitro and in vivo, virtually nothing is known about the mechanism by which these changes occur. Tau_P301L exhibits impaired tubulin polymerization (35), as well as increased aggregation propensity relative to WT protein (tau_WT) (32) and thus serves as a model for both loss of function and gain of toxic function aspects of disease. This mutation is in the highly conserved PGGG sequence of R2 (Fig. 1C). To broaden our understanding of the impact of this point mutation on pathology, we designed a tau variant with the analogous proline to leucine substitution in the PGGG sequence of R3, tau_P332L, as well as a double mutant, tau_P301L/P332L. We use single molecule fluorescence to investigate structural and functional aspects of the interaction between tau and tubulin. In combination with ensemble polymerization and aggregation assays, this work provides insight into the relationship between functional and dysfunctional roles of tau.     

Characterization of Adverse Events Detected in a Large Health Care Delivery System Using an Enhanced Global Trigger Tool over a Five‐Year Interval

Objective

To report 5 years of adverse events (AEs) identified using an enhanced Global Trigger Tool (GTT) in a large health care system.

Study Setting

Records from monthly random samples of adults admitted to eight acute care hospitals from 2007 to 2011 with lengths of stay ≥3 days were reviewed.

Study Design

We examined AE incidence overall and by presence on admission, severity, stemming from care provided versus omitted, preventability, and category; and the overlap with commonly used AE-detection systems.

Data Collection

Professional nurse reviewers abstracted 9,017 records using the enhanced GTT, recording triggers and AEs. Medical record/account numbers were matched to identify overlapping voluntary reports or AHRQ Patient Safety Indicators (PSIs).

Principal Findings

Estimated AE rates were as follows: 61.4 AEs/1,000 patient-days, 38.1 AEs/100 discharges, and 32.1 percent of patients with ≥1 AE. Of 1,300 present-on-admission AEs (37.9 percent of total), 78.5 percent showed NCC-MERP level F harm and 87.6 percent were “preventable/possibly preventable.” Of 2,129 hospital-acquired AEs, 63.3 percent had level E harm, 70.8 percent were “preventable/possibly preventable”; the most common category was “surgical/procedural” (40.5 percent). Voluntary reports and PSIs captured <5 percent of encounters with hospital-acquired AEs.

Conclusions

AEs are common and potentially amenable to prevention. GTT-identified AEs are seldom caught by commonly used AE-detection systems.     

Measuring insight through patient self-report: An in-depth analysis of the factor structure of the Birchwood Insight Scale

Little research has focused on item analysis and factor structure of the most commonly used measures of insight. We examined the factorial structure of the Birchwood Insight Scale (BIS), a brief, easy-to-administer, self-report measure. We studied the BIS in 327 first-episode psychosis patients, including a test sample (n=163) and a validation sample (n=164). We then used data from 100 patients with chronic serious mental illnesses as a second, external validation sample. Exploratory factor analysis was conducted with the test subsample, and confirmatory factor analyses with the two validation samples. Confirmatory factor analyses (in both the first-episode psychosis validation sample and the chronic serious mental illness sample) indicated that a single-factor solution, with seven items loading on a single factor—with item 1 (“Some of your symptoms are made by your mind”) eliminated—was the best-fitting model. Seven of the eight original BIS items loading on a single factor fit the data well in these samples. Researchers using this efficient measure of patient-reported insight should assess the item distributions and factor structure of the BIS in their samples, and potentially consider eliminating item 1.