Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland.

BACKGROUND: Migration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students' experiences and perceptions of cross-cultural care. METHODS: Final-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher's Exact Test was employed to compare differences within self-identified ethnicity groups and gender. RESULTS: Whilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%). CONCLUSIONS: A large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.

The Cannabinoid Receptor Type 1 Positive Allosteric Modulator ZCZ011 Attenuates Naloxone-Precipitated Diarrhea and Weight Loss in Oxycodone-Dependent Mice.

Opioid use disorder reflects a major public health crisis of morbidity and mortality in which opioid withdrawal often contributes to continued use. However, current medications that treat opioid withdrawal symptoms are limited by their abuse liability or lack of efficacy. Although cannabinoid 1 (CB1) receptor agonists, including Δ9-tetrahydrocannabinol, ameliorate opioid withdrawal in both clinical and preclinical studies of opioid dependence, this strategy elicits cannabimimetic side effects as well as tolerance and dependence after repeated administration. Alternatively, CB1 receptor positive allosteric modulators (PAMs) enhance CB1 receptor signaling and show efficacy in rodent models of pain and cannabinoid dependence but lack cannabimimetic side effects. We hypothesize that the CB1 receptor PAM ZCZ011 attenuates naloxone-precipitated withdrawal signs in opioid-dependent mice. Accordingly, male and female mice given an escalating dosing regimen of oxycodone, a widely prescribed opioid, and challenged with naloxone displayed withdrawal signs that included diarrhea, weight loss, jumping, paw flutters, and head shakes. ZCZ011 fully attenuated naloxone-precipitated withdrawal-induced diarrhea and weight loss and reduced paw flutters by approximately half, but its effects on head shakes were unreliable, and it did not affect jumping behavior. The antidiarrheal and anti-weight loss effects of ZCZ0111 were reversed by a CB1 not a cannabinoid receptor type 2 receptor antagonist and were absent in CB1 (-/-) mice, suggesting a necessary role of CB1 receptors. Collectively, these results indicate that ZCZ011 completely blocked naloxone-precipitated diarrhea and weight loss in oxycodone-dependent mice and suggest that CB1 receptor PAMs may offer a novel strategy to treat opioid dependence. SIGNIFICANCE STATEMENT: Opioid use disorder represents a serious public health crisis in which current medications used to treat withdrawal symptoms are limited by abuse liability and side effects. The CB1 receptor positive allosteric modulator (PAM) ZCZ011, which lacks overt cannabimimetic behavioral effects, ameliorated naloxone-precipitated withdrawal signs through a CB1 receptor mechanism of action in a mouse model of oxycodone dependence. These results suggest that CB1 receptor PAMs may represent a viable strategy to treat opioid withdrawal.

Determination of the radiochemical purity of (99m) Tc medronate injection by thin layer chromatography on iTLC-SG: effect of medronate concentration on the value measured.

BACKGROUND: When using iTLC-SG thin layer chromatography plates to measure radiochemical impurities in (99m) Tc medronate, falsely high values were obtained for (99m) Tc pertechnetate impurity. Preliminary investigations indicated that the mass of (99m) Tc medronate applied to the plate influences the value. AIM: The goal of this study was to determine if the concentration of medronate influences the value obtained for (99m) Tc pertechnetate impurity. EXPERIMENTAL: (99m) Tc medronate was prepared at two concentrations: 4 mg/mL and 0.2 mg/mL. Impurity levels were measured using three stationary phases: dried and undried iTLC-SG and 54SFC paper. Two mobile phases were used: methyl ethyl ketone to detect (99m) Tc pertechnetate and sodium acetate 136 g/L to detect hydrolysed and colloidal (99m) Tc. Sample spot drying and volume were also investigated. RESULTS: With 4 mg/mL samples, the three stationary phases measured similar impurity levels (p > 0.05). With the 0.2 mg/mL samples, higher levels of (99m) Tc pertechnetate were measured with iTLC-SG than with paper (p < 0.05). Neither sample spot drying nor volume was found to affect impurity levels measured. CONCLUSIONS: When using iTLC-SG to measure the radiochemical purity of (99m) Tc medronate, an artefactually high level of (99m) Tc pertechnetate impurity is measured when the medronate concentration in the sample is low. The iTLC-SG stationary phase may be unsatisfactory for measuring the radiochemical purity of (99m) Tc medronate.

Diacylglycerol Lipase-ß Knockout Mice Display a Sex-Dependent Attenuation of Traumatic Brain Injury-Induced Mortality with No Impact on Memory or Other Functional Consequences.

Background: The endogenous cannabinoid system modulates inflammatory signaling in a variety of pathological states, including traumatic brain injury (TBI). The selective expression of diacylglycerol lipase-ß (DAGL-ß), the 2-arachidonylglycerol biosynthetic enzyme, on resident immune cells of the brain (microglia) and the role of this pathway in neuroinflammation, suggest that this enzyme may contribute to TBI-induced neuroinflammation. Accordingly, we tested whether DAGL-ß-/- mice would show a protective phenotype from the deleterious consequences of TBI on cognitive and neurological motor functions. Materials and Methods: DAGL-ß-/- and -ß+/+ mice were subjected to the lateral fluid percussion model of TBI and assessed for learning and memory in the Morris water maze (MWM) Fixed Platform (reference memory) and Reversal (cognitive flexibility) tasks, as well as in a cued MWM task to infer potential sensorimotor/motivational deficits. In addition, subjects were assessed for motor behavior (Rotarod and the Neurological Severity Score assays) and in the light/dark box and the elevated plus maze to infer whether these manipulations affected anxiety-like behavior. Finally, we also examined whether brain injury disrupts the ceramide/sphingolipid lipid signaling system and if DAGL-ß deletion offers protection. Results: TBI disrupted all measures of neurological motor function and reduced body weight, but did not affect body temperature or performance in common assays used to infer anxiety. TBI also impaired performance in MWM Fixed Platform and Reversal tasks, but did not affect cued MWM performance. Although no differences were found between DAGL-ß-/- and -ß+/+ mice in any of these measures, male DAGL-ß-/- mice displayed an unexpected survival-protective phenotype, which persisted at increased injury severities. In contrast, TBI did not elicit mortality in female mice regardless of genotype. TBI also produced significant changes in sphingolipid profiles (a family of lipids, members of which have been linked to both apoptotic and antiapoptotic pathways), in which DAGL-ß deletion modestly altered levels of select species. Conclusions: These findings indicate that although DAGL-ß does not play a necessary role in TBI-induced cognitive and neurological function, it appears to contribute to the increased vulnerability of male mice to TBI-induced mortality, whereas female mice show high survival rates irrespective of DAGL-ß expression.

Preparation of 99m Tc-MAG3: the effect on radiochemical purity of using sodium chloride injection from plastic ampoules that have been exposed to light.

OBJECTIVE: To determine the circumstances under which sodium chloride injection (SCI) that has been exposed to fluorescent light then used to prepare 99m Tc-MAG3 causes low radiochemical purity (RCP). METHODS: Two brands of SCI in plastic ampoules (Braun and Steri-Amp) and one in glass vials (Drytec) were exposed to light for up to 7 days then used to prepare 99m Tc-MAG3. RCP was measured by liquid chromatography. To study the effect on the labelling reaction, the reconstituted MAG3 kit was analysed before and after boiling and the formation of the 99m Tc-tartrate intermediate was investigated. Exposed water from plastic ampoules was analysed by mass spectrometry. RESULTS: After no exposure, each brand resulted in high RCP 99m Tc-MAG3 (>94%). Drytec SCI produced high RCP throughout (96.7 +/- 0.3%, n=5, 7 days). The RCP produced by Steri-Amp and Braun fell to 85.2 +/- 5.2% and 93.5 +/- 1.6% after exposure for 2 and 4 days, respectively. The chromatogram before boiling contained peaks corresponding to 99m Tc-tartrate and 99m Tc-pertechnetate. After boiling with unexposed SCI, these were minimal and a 99m Tc-MAG3 peak dominated. After boiling with exposed SCI, 99m Tc-pertechnetate and 99m Tc-MAG3 peaks were present. Measurements on tartrate showed a high level of 99m Tc-tartrate before and after boiling with unexposed SCI but a high level of 99m Tc-pertechnetate after boiling with exposed SCI. Mass spectrometry showed that compounds leach into the solution upon exposure to light. CONCLUSION: Preparing 99m Tc-MAG3 using SCI from plastic ampoules that have been exposed to light causes reduced RCP. Exposure of plastic ampoules to light causes leaching of many compounds into the solution. An unknown leached compound destabilizes the 99m Tc-tartrate intermediate complex.

Preparation of 99mTc-Nanocoll for use in sentinel node localization: Validation of a protocol for supplying in unit-dose syringes.

OBJECTIVES: To determine if 99mTc-Nanocoll is affected by storage in a syringe, passage through an R-Lock or mixing with Patent Blue V dye. METHODS: A Nanocoll kit was reconstituted at 280 MBq/5 ml. Samples of 0.5 ml were drawn into 3 ml Plastipak syringes. After 1 h and 6 h, adsorption of 99mTc on a syringe was measured and the following tests of quality were performed on samples from the kit and a syringe: 99mTc-pertechnetate impurity by thin-layer chromatography, the percentage of 99mTc on particles >100 nm by Nuclepore filtration and particle size by photon correlation spectroscopy. These tests were also applied to samples that had been passed through an R-Lock or mixed with Patent Blue V. Each experiment was performed five times. RESULTS: In all samples, adsorption of 99mTc on syringes was <1%, 99mTc-pertechnetate impurity was <2%, >95% of 99mTc was labelled to particles <100 nm in diameter, the mean particle diameter was 6.6 nm and the particles had a diameter of <12 nm. All tests showed no significant difference (P > 0.05, n = 5) between 99mTc-Nanocoll from the original kit and a syringe at either 1 h or 6 h. Similar results were obtained with samples that had been passed through an R-Lock or mixed with Patent Blue V. CONCLUSIONS: A capped 3 ml Plastipak syringe is a suitable container in which to supply 99mTc-Nanocoll. Neither passage through an R-Lock nor mixing with Patent Blue V affects the quality of 99mTc-Nanocoll.

Preparation of 99mTc-MAG3: radiochemical purity is affected by the residence time of sodium chloride injection in a three-part syringe.

BACKGROUND: Routine technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) radiochemical purity measurements have revealed occasional unacceptably low values. Preliminary investigations suggested a causal link with the residence time of sodium chloride injection in the syringe used to reconstitute the MAG3 kit. OBJECTIVES: To investigate the cause of this phenomenon, determine how it can be avoided and establish whether it occurs with other 99mTc radiopharmaceuticals. METHODS: 99mTc-MAG3 was prepared by drawing sodium chloride injection into a lubricated, three-part, 10 ml Plastipak syringe and using it to reconstitute a MAG3 kit immediately or after a 15 min incubation period. The radiochemical purity was measured by high-performance liquid chromatography. The experiment was repeated using lubricant-free, two-part, Norm-Ject syringes and lubricated, two-part, Monoject syringes (15 min incubation only). To investigate the influence of Plastipak's rubber components on the radiochemical purity, samples were prepared using sodium chloride injection that had been incubated with lubricated or lubricant-free rubber plunger ends. Similar experiments were performed to determine the effect of Plastipak on 99mTc-exametazime, 99mTc-sestamibi and 99mTc-tetrofosmin. RESULTS: The radiochemical purities of 99mTc-MAG3 prepared with sodium chloride injection incubated for 0 and 15 min in Plastipak syringes were 96.4+/-0.5% and 89.4+/-5.5%, respectively. The difference was significant (P<0.05, n=10). With Norm-Ject syringes, the radiochemical purities were 96.5+/-0.5% and 96.6+/-0.5%, respectively. The difference was not significant (P>0.05, n=10). With Monoject syringes, the radiochemical purity was 96.6+/-0.4% (n=10). 99mTc-MAG3 prepared using sodium chloride injection treated with lubricated and unlubricated syringe rubber plunger ends had radiochemical purities of 85.3+/-6.6% and 82.1+/-6.5% (n=5), respectively. The radiochemical purities of other 99mTc radiopharmaceuticals prepared using sodium chloride injection incubated for 0 or 15 min in Plastipak syringes were as follows: 99mTc-exametazime, 95.3+/-0.6% and 94.5+/-1.8%; 99mTc-sestamibi, 98.0+/-0.6% and 97.7+/-0.6%; 99mTc-tetrofosmin, 96.5+/-0.2% and 97.0+/-0.4%. None of the differences was significant (P>0.05, n=5). CONCLUSIONS: A lipophilic impurity, originating from the rubber plunger of a three-part Plastipak syringe, is formed in 99mTc-MAG3 when the sodium chloride injection used to reconstitute the kit is in the syringe for a prolonged time. The effect is eliminated by using a two-part syringe or by injecting the sodium chloride injection into the kit immediately. The phenomenon does not occur with 99mTc-exametazime, 99mTc-sestamibi or 99mTc-tetrofosmin.

A comparison of techniques for analysing 90Y-Zevalin thin-layer chromatography plates.

OBJECTIVES: To simulate 90Y-Zevalin thin-layer chromatograms representing a range of radiochemical purities, to compare the radiochemical purities obtained with five techniques used to quantify 90Y on the plates and to measure the reproducibility of the five techniques at the minimum acceptable radiochemical purity of 95%. METHODS: Yttrium-90 solutions were pipetted onto the origin and solvent front lines of thin-layer chromatography (TLC) plates to simulate radiochemical purities of 90%, 92%, 94%, 95%, 96%, 98% and 100%. Each plate was analysed using three TLC scanners (Bioscan AR2000, Bioscan Mini-scan and an instrument constructed in-house) and two cut-and-count techniques: one using a sodium iodide well detector and the other a liquid scintillation counter. The reproducibility of each technique was measured by analysing the 95% plate 10 times. RESULTS: The radiochemical purities measured by the five techniques agreed well. The means of the seven results obtained with each agreed within 0.7%. The reproducibility of each technique was excellent. The coefficient of variation for 10 measurements was < or =0.3%. The signal to background ratios were satisfactory, ranging from 24 to 2.1 x 10(5). CONCLUSION: Each technique is suitable for analysing 90Y-Zevalin TLC plates.

CB1 receptor antagonism in the granular insular cortex or somatosensory area facilitates consolidation of object recognition memory.

Cannabinoid agonists typically impair memory, whereas CB1 receptor antagonists enhance memory performance under specific conditions. The insular cortex has been implicated in object memory consolidation. Here we show that infusions of the CB1 receptor antagonist SR141716 enhances long-term object recognition memory in rats in a dose-dependent manner (facilitation with 1.5, but not 0.75 or 3 µg/µL) when administered into the granular insular cortex; the SR141716 facilitation was seen with a memory delay of 72 h, but not when the delay was shorter (1 h), consistent with enhancement of memory consolidation. Moreover, a sub-group of rats with cannulas placed in the somatosensory area were also facilitated. These results highlight the robust potential of cannabinoid antagonists to facilitate object memory consolidation, as well as the capacity for insular and somatosensory cortices to contribute to object processing, perhaps through enhancement of tactile representation.

Effect of chronic exposure to rimonabant and phytocannabinoids on anxiety-like behavior and saccharin palatability.

The acute effects of cannabinoid compounds have been investigated in animal models of anxiety-like behavior and palatability processing. However, the chronic effects of cannabinoids in such models are poorly understood. Experiment 1 compared the effects of both acute and chronic (14 days) exposure to the CB(1) receptor inverse agonist/antagonist, rimonabant, and the cannabis-derived CB(1) receptor neutral antagonist, tetrahydrocannabivarin (THCV), on: 1) time spent in the open, lit box in the Light-Dark (LD) immersion model of anxiety-like behavior and 2) saccharin hedonic reactions in the taste reactivity (TR) test of palatability processing. Experiment 2 compared the effects of chronic administration of cannabis-derived Δ(9)-tetrahydrocannabinol (Δ(9)-THC), cannabidiol (CBD) and cannabigerol (CBG) in these models. Tests were administered on Days 1, 7 and 14 of drug administration. In Experiment 1, rimonabant, but not THCV, produced an anxiogenic-like reaction in the LD immersion test and reduced saccharin palatability in the TR test; both of these effects occurred acutely and were not enhanced by chronic exposure. In Experiment 2, Δ(9)-THC also produced an acute anxiogenic-like reaction in the LD immersion test, without enhancement by chronic exposure. However, Δ(9)-THC enhanced saccharin palatability in the TR test on Day 1 of drug exposure only. CBD and CBG did not modify anxiety-like responding, but CBG produced a weak enhancement of saccharin palatability on Day 1 only. The results suggest that the anxiogenic-like reactions and the suppression of hedonic responding produced by rimonabant, are mediated by inverse agonism of the CB(1) receptor and these effects are not enhanced with chronic exposure.

Effect of 99Tc on the radiochemical purity of 99mTc radiopharmaceuticals.

OBJECTIVE: The longer the time between elutions of a technetium-99m (Tc) generator, the greater the Tc : Tc ratio in the eluate. Information is limited on how this affects the radiochemical purity (RCP) of Tc radiopharmaceuticals. The aim was to determine whether the RCPs of Tc radiopharmaceuticals are affected when prepared using Tc-pertechnetate from a generator that remained uneluted for 7 days. METHODS: Eight Tc radiopharmaceuticals were investigated: albumin nanocolloid, macrosalb, medronate, mertiatide, pentetate, sestamibi, succimer and tetrofosmin. Five samples of each were prepared with eluate from a generator that had been previously eluted within 24 h (control). These were compared with five samples adulterated with Tc to replicate the Tc : Tc ratio present in eluate from a generator that has remained uneluted for 7 days (test). The RCP of each sample was measured 1 h after preparation and at the product's expiry. RESULTS: Significant differences (P<0.05) were found between the RCPs of control and test samples of albumin nanocolloid, mertiatide and sestamibi 1 h after preparation. In each, the test sample had lower RCP, but was satisfactory. Similar results were found for macrosalb with added Tc, but the RCPs of the test samples were unsatisfactory at 83.9±4.2%. The RCPs of all control and test samples were satisfactory at expiry. CONCLUSION: Seven of the eight radiopharmaceuticals tested can safely be prepared using eluate from a generator that has remained uneluted for 7 days. Under these conditions, care must be taken when preparing Tc-macrosalb, as its RCP remains unsatisfactory up to 2 h after preparation.

Preparation of 99mTc radiopharmaceuticals: the effect on radiochemical purity of using sodium chloride injection from plastic ampoules that have been exposed to light.

OBJECTIVE: To determine whether radiochemical purity is affected when 99mTc radiopharmaceuticals are prepared using sodium chloride injection from plastic ampoules that have been exposed to light. METHODS: Sodium chloride injection from plastic ampoules that were either exposed to light for 7 days or protected from light was used in the preparation of nine common 99mTc radiopharmaceuticals: albumin nanocolloid, exametazime, macrosalb, mebrofenin, medronate, pentetate, sestamibi, succimer and tetrofosmin. Five different batches of ampoules (exposed and unexposed) were used for each radiopharmaceutical. Radiochemical purity was measured by established analytical methods (thin-layer chromatography, liquid chromatography and nuclepore filtration) as specified in the European Pharmacopoeia or by the manufacturer. Analysis was performed within 1 h of preparation and at the products' expiries. RESULTS: The radiochemical purity of each 99mTc radiopharmaceutical was satisfactory when unexposed sodium chloride injection was used in its preparation. There was a significant difference between exposed and unexposed results (P < 0.05) for 99mTc exametazime (69.0 ± 9.3% vs. 88.6 ± 0.8%), 99mTc albumin nanocolloid (94.3 ± 1.1% vs. 98.8 ± 0.4%) and 99mTc macrosalb (84.0 ± 4.1% vs. 98.0 ± 2.2%) after preparation. Unsatisfactory radiochemical purity was the result of 99mTc pertechnetate impurity. The radiochemical purities of 99mTc albumin nanocolloid and 99mTc macrosalb increased over time and were satisfactory at their expiries. CONCLUSION: When 99mTc albumin nanocolloid, 99mTc macrosalb and 99mTc exametazime are prepared using sodium chloride injection from plastic ampoules that have been exposed to light, radiochemical purity is adversely affected. The other 99mTc radiopharmaceuticals tested are unaffected.