Comparison of the effectiveness of exclusively facilitated clinical teaching as an alternative to traditional practice-based primary care placements.

INTRODUCTION: COVID-19 presented major challenges to undergraduate GP placement capacity and there was an increased reliance on clinical training using facilitated simulation. The authors present a novel comparison of the effectiveness and cost-effectiveness of delivering a one-week primary care course using entirely GP-facilitated clinical teaching outside the GP setting against traditional practice-based GP clinical education. METHODS: A one-week GP placement was redeveloped from a traditional teaching model (TT-M) to an exclusively facilitated teaching model (FT-M) delivered outside the GP practice setting, using principles of blended learning, flipped classroom methods, e-learning and simulation. Both teaching models, delivered in different locations during 2022 to pre-clinical students, were evaluated using student feedback surveys for attainment of learning outcomes and course satisfaction. RESULTS: The students reported their consultation skills and clinical knowledge (amalgamated mean score 4.36 for FT-M versus 4.63 for TT-M; P = 0.05), as well as preparation for the clinical phases (mean scores 4.35 for FT-M versus 4.41 for TT-M; P = 0.68), were well developed and similar for both courses. Students reported similar enjoyment across both teaching models (FT-M mean score 4.31 versus 4.41 for TT-M; P = 0.49). The costs for delivering teaching per 4-h session for 100 students were £1,379 and £5,551 for FT-M and TT-M, respectively. CONCLUSION: Delivery of a one-week primary care attachment to third year medical students using an FT-M was similarly effective and more cost effective than delivering it by a TT-M. FT-M potentially offers an important adjunct to clinical learning and resilience to capacity challenges for GP placements.

Legacy and emerging per- and polyfluoroalkyl substances (PFASs) in Australian biosolids.

Biosolids samples were collected from 19 Australian WWTPs during 2018 that cover a range of catchment types (urban, rural, industrial waste discharges) and treatment technologies. Samples were analysed for 44 PFAS using isotope dilution and alkaline extraction coupled with quantification with LC-MS/MS. The Σ44PFAS mean concentration was 260 ng/g dry weight (dw) and ranged between 4.2 and 910 ng/g dw. The dominant compound class detected were the di-substituted phosphate esters (Σ3PAPs mean 140 ng/g dw; range ND - 730 ng/g dw) which contributed 45% of the total mean Σ44PFAS mass, followed by perfluoroalkyl carboxylic acids (Σ11PFCAs mean 39 ng/g dw; range 2.3-120 ng/g dw) contributing 17%, and the perfluoroalkyl sulfonates (Σ8PFSAs mean 28 ng/g dw; range 0.9-220 ng/g) which contributed 16%. Using the population data supplied by the participating WWTPs, the mean annual estimated biosolids-associated PFAS contribution is 6 mg per person per year and ranged between 0.6 mg and 15 mg. A similar population normalised concentration regardless of WWTP, region or capacity suggests that the domestic environment provides the baseline PFAS loading. Statistically significant higher Σ44PFAS and PFOS concentrations were observed at urban locations. A weak correlation was observed between annual mass of PFAS associated with each individual WWTP and their percentage industrial waste contribution. This may be important for elevated PFAS concentrations observed in WWTPs with higher industrial waste inputs and requires further research.

Coastal urbanization influences human pathogens and microdebris contamination in seafood.

Seafood is one of the leading imported products implicated in foodborne outbreaks worldwide. Coastal marine environments are being increasingly subjected to reduced water quality from urbanization and leading to contamination of important fishery species. Given the importance of seafood exchanged as a global protein source, it is imperative to maintain seafood safety worldwide. To illustrate the potential health risks associated with urbanization in a coastal environment, we use next-generation high-throughput amplicon sequencing of the 16S ribosomal RNA gene combined with infrared spectroscopy to characterize and quantify a vast range of potential human bacterial pathogens and microdebris contaminants in seawater, sediment and an important oyster fishery along the Mergui Archipelago in Myanmar. Through the quantification of >1.25 million high-quality bacterial operational taxonomic unit (OTU) reads, we detected 5459 potential human bacterial pathogens belonging to 87 species that are commonly associated with gut microbiota and an indication of terrestrial runoff of human and agricultural waste. Oyster tissues contained 51% of all sequenced bacterial pathogens that are considered to be both detrimental and of emerging concern to human health. Using infrared spectroscopy, we examined a total of 1225 individual microdebris particles, from which we detected 78 different types of contaminant materials. The predominant microdebris contaminants recovered from oyster tissues included polymers (48%), followed by non-native minerals (20%), oils (14%) and milk supplement powders (14%). Emerging technologies provide novel insights into the impacts of coastal development on food security and risks to human and environmental health.

Dietary Uptake and Depuration Kinetics of Perfluorooctane Sulfonate, Perfluorooctanoic Acid, and Hexafluoropropylene Oxide Dimer Acid (GenX) in a Benthic Fish.

Per- and poly-fluoroalkyl substances (PFAS) are ubiquitously distributed throughout aquatic environments and can bioaccumulate in organisms. We examined dietary uptake and depuration of a mixture of 3 PFAS: perfluorooctanoic acid (PFOA; C8 HF15 O2 ), perfluorooctane sulfonate (PFOS; C8 HF17 SO3 ), and hexafluoropropylene oxide dimer acid (HPFO-DA; C6 HF11 O3 ; trade name GenX). Benthic fish (blue spot gobies, Pseudogobius sp.) were fed contaminated food (nominal dose 500 ng g-1 ) daily for a 21-d uptake period, followed by a 42-d depuration period. The compounds PFOA, linear-PFOS (linear PFOS), and total PFOS (sum of linear and branched PFOS) were detected in freeze-dried fish, whereas GenX was not, indicating either a lack of uptake or rapid elimination (<24 h). Depuration rates (d-1 ) were 0.150 (PFOA), 0.045 (linear-PFOS), and 0.042 (linear+branched-PFOS) with corresponding biological half-lives of 5.9, 15, and 16 d, respectively. The PFOS isomers were eliminated differently, resulting in enrichment of linear-PFOS (70-90%) throughout the depuration period. The present study is the first reported study of GenX dietary bioaccumulation potential in fish, and the first dietary study to investigate uptake and depuration of multiple PFASs simultaneously, allowing us to determine that whereas PFOA and PFOS accumulated as expected, GenX, administered in the same way, did not appear to bioaccumulate. Environ Toxicol Chem 2020;39:595-603. © 2019 SETAC.

Sources, presence and potential effects of contaminants of emerging concern in the marine environments of the Great Barrier Reef and Torres Strait, Australia.

Current policy and management for marine water quality in the Great Barrier Reef (GBR) in north-eastern Australia primarily focusses on sediment, nutrients and pesticides derived from diffuse source pollution related to agricultural land uses. In addition, contaminants of emerging concern (CECs) are known to be present in the marine environments of the GBR and the adjacent Torres Strait (TS). Current and projected agricultural, urban and industrial developments are likely to increase the sources and diversity of CECs being released into these marine ecosystems. In this review, we evaluate the sources, presence and potential effects of six different categories of CECs known to be present, or likely to be present, in the GBR and TS marine ecosystems. Specifically, we summarize available monitoring, source and effect information for antifouling paints; coal dust and particles; heavy/trace metals and metalloids; marine debris and microplastics; pharmaceuticals and personal care products (PPCPs); and petroleum hydrocarbons. Our study highlights the lack of (available) monitoring data for most of these CECs, and recommends: (i) the inclusion of all relevant environmental data into integrated databases for building marine baselines for the GBR and TS regions, and (ii) the implementation of local, targeted monitoring programs informed by predictive methods for risk prioritization. Further, our spatial representation of the known and likely sources of these CECs will contribute to future ecological risk assessments of CECs to the GBR and TS marine environments, including risks relative to those identified for sediment, nutrients and pesticides.

Classification of marine microdebris: A review and case study on fish from the Great Barrier Reef, Australia.

Marine debris, and in particular plastic pollution, is ubiquitous throughout global marine environments. Here, we present a classification of marine microdebris (i.e. debris between 0.1 µm and <5 mm) tailored to represent synthetic, semi-synthetic and naturally-derived items. The specific aim of this classification is to introduce a level of consistency in the higher-level characterisation of marine microdebris, thereby improving the overall reporting on marine microdebris contamination. We first conducted an extensive literature review on the accumulation of ingested debris in fish to identify discrepancies in marine microdebris reporting as a basis for the new classification. The review reveals the diverse nature of ingested marine microdebris, including items that are non-plastic but often incorrectly reported on as microplastics. We then applied our classification to a case study on wild-caught juvenile coral trout, Plectropomus spp., from the Great Barrier Reef World Heritage Area, Australia. This first report on accumulation of ingested marine debris in commercial fish on the reef demonstrates a high frequency of occurrence and a prevalence of semi-synthetic and naturally-derived fibres. Based on our findings, we offer recommendations on potential improvements for the classification presented, ultimately contributing to a more realistic assessment of the ecological risks of marine microdebris.

Validation of an optimised protocol for quantification of microplastics in heterogenous samples: A case study using green turtle chyme.

Quantifying the extent of microplastic (<5 mm) contamination in the marine environment is an emerging field of study. Reliable extraction of microplastics from the gastro-intestinal content of marine organisms is crucial to evaluate microplastic contamination in marine fauna. Extraction protocols and variations thereof have been reported, however, these have mostly focussed on relatively homogenous samples (i.e. water, sediment, etc.). Here, we present a microplastic extraction protocol for examining green turtle (Chelonia mydas) chyme (i.e. ingested material and digestive tract fluid), which is a heterogeneous composite of various organic dietary items (e.g. seagrass, jellyfish) and incidentally-ingested inorganic materials (sediment). Established extraction methods were modified and combined. This protocol consists of acid digestion of organic matter, emulsification of residual fat, density separation from sediment, and chemical identification by Fourier transform-infrared spectroscopy. This protocol enables the extraction of the most common microplastic contaminants>100 µm: polyethylene, high-density polyethylene, (aminoethyl) polystyrene, polypropylene, and polyvinyl chloride, with 100% efficiency. This validated protocol will enable researchers worldwide to quantify microplastic contamination in turtles in a reliable and comparable way. •Optimization of microplastic extraction from multifarious tissues by applying established methods in a sequential manner.•Effective for heterogenous samples comprising organic and inorganic material.

Ingestion of microplastic debris by green sea turtles (Chelonia mydas) in the Great Barrier Reef: Validation of a sequential extraction protocol.

Ocean contamination by plastics is a global issue. Although ingestion of plastic debris by sea turtles has been widely documented, contamination by microplastics (<5mm) is poorly known and likely to be under-reported. We developed a microplastic extraction protocol for examining green turtle (Chelonia mydas) chyme, which is multifarious in nature, by modifying and combining pre-established methods used to separate microplastics from organic matter and sediments. This protocol consists of visual inspection, nitric acid digestion, emulsification of residual fat, density separation, and chemical identification by Fourier transform infrared spectroscopy. This protocol enables the extraction of polyethylene, high-density polyethylene, (aminoethyl) polystyrene, polypropylene, and polyvinyl chloride microplastics >100µm. Two macroplastics and seven microplastics (two plastic paint chips and five synthetic fabric particles) were isolated from subsamples of two green turtles. Our results highlight the need for more research towards understanding the impact of microplastics on these threatened marine reptiles.

Effects of coal contamination on early life history processes of a reef-building coral, Acropora tenuis.

Successful reproduction and larval dispersal are important for the persistence of marine invertebrate populations, and these early life history processes can be sensitive to marine pollution. Coal is emerging as a contaminant of interest due to the proximity of ports and shipping lanes to coral reefs. To assess the potential hazard of this contaminant, gametes, newly developed embryos, larvae and juveniles of the coral Acropora tenuis were exposed to a range of coal leachate, suspended coal, and coal smothering treatments. Fertilisation was the most sensitive reproductive process tested. Embryo survivorship decreased with increasing suspended coal concentrations and exposure duration, effects on larval settlement varied between treatments, while effects on juvenile survivorship were minimal. Leachate exposures had negligible effects on fertilisation and larval settlement. These results indicate that coral recruitment could be affected by spills that produce plumes of suspended coal particles which interact with gametes and embryos soon after spawning.

Simulated coal spill causes mortality and growth inhibition in tropical marine organisms.

Coal is a principal fossil fuel driving economic and social development, and increases in global coal shipments have paralleled expansion of the industry. To identify the potential harm associated with chronic marine coal contamination, three taxa abundant in tropical marine ecosystems (the coral Acropora tenuis, the reef fish Acanthochromis polyacanthus and the seagrass Halodule uninervis) were exposed to five concentrations (0-275 mg coal l(-1)) of suspended coal dust (<63 µm) over 28 d. Results demonstrate that chronic coal exposure can cause considerable lethal effects on corals, and reductions in seagrass and fish growth rates. Coral survivorship and seagrass growth rates were inversely related to increasing coal concentrations (≥38 mg coal l(-1)) and effects increased between 14 and 28 d, whereas fish growth rates were similarly depressed at all coal concentrations tested. This investigation provides novel insights into direct coal impacts on key tropical taxa for application in the assessment of risks posed by increasing coal shipments in globally threatened marine ecosystems.

Assessing the ecological effects of human impacts on coral reefs in Bocas del Toro, Panama.

Environmental and biological reef monitoring was conducted in Almirante Bay (Bahía Almirante) in Bocas del Toro, Panama, to assess impacts from anthropogenic developments. An integrated monitoring investigated how seasonal temperature stress, turbidity, eutrophication and physical impacts threatened reef health and biodiversity throughout the region. Environmental parameters such as total suspended solids [TSS], carbon isotopes (δ(13)C), C/N ratios, chlorophyll a, irradiance, secchi depth, size fractions of the sediments and isotope composition of dissolved inorganic carbon [DIC] of the water were measured throughout the years 2010 and 2011 and were analysed in order to identify different impact sources. Compared to data from Collin et al. (Smithsonian Contributions to the Marine Sciences 38:324-334, 2009) chlorophyll a has doubled at sites close to the city and the port Almirante (from 0.46-0.49 to 0.78-0.97 µg l(-1)) and suspension load increased, visible by a decrease in secchi depth values. Visibility decreased from 9-13 m down to 4 m at the bay inlet Boca del Drago, which is strongly exposed to river run off and dredging for the shipping traffic. Eutrophication and turbidity levels seemed to be the determining factor for the loss of hard coral diversity, most significant at chlorophyll a levels higher than 0.5 µg l(-1) and TSS levels higher than 4.7 mg l(-1). Hard coral cover within the bay has also declined, at some sites down to <10 % with extremely low diversities (7 hard coral species). The hard coral species Porites furcata dominated the reefs in highly impacted areas and showed a strong recovery after bleaching and a higher tolerance to turbidity and eutrophication compared to other hard coral species in the bay. Serious overfishing was detected in the region by a lack of adult and carnivorous fish species, such as grunts, snappers and groupers. Study sites less impacted by anthropogenic activities and/or those with local protection showed a higher hard coral cover and fish abundance; however, an overall loss of hard coral diversity was observed.

Sources and spatial distribution of heavy metals in scleractinian coral tissues and sediments from the Bocas del Toro Archipelago, Panama.

Marine ecosystems worldwide are threatened by aquatic pollution; however, there is a paucity in data from the Caribbean region. As such, five heavy metals (arsenic, cadmium, copper, zinc, mercury) were measured in tissues of the scleractinian corals Porites furcata and Agaricia tenuifolia and in adjacent sediments in the Bocas del Toro Archipelago, Panama. Samples were collected from five reef sites along a gradient of distance from an international shipping port and were analysed using inductively coupled plasma optical emission spectrometry and atomic absorption spectrophotometry for mercury. Copper and zinc were the most abundant metals and ranged from 11 to 63 mg kg(-1) and from 31 to 185 mg kg(-1) in coral tissues, respectively. The highest concentration of each metal was measured in P. furcata tissues, with copper and mercury concentrations significantly higher in P. furcata than in A. tenuifolia at every site. These results suggest that P. furcata has a higher affinity for metal accumulation and storage than A. tenuifolia. With the exception of cadmium, metal concentrations in coral tissues were generally elevated at coral reefs in closer proximity to the port; however, this pattern was not observed in sediments. Hard coral cover was lowest at reefs in closest proximity to the port, suggesting that metal pollution from port-related activities is influencing hard coral abundance at nearby coral reefs.

Evaluation of an intervention program for anxious adolescent boys who are bullied at school.

PURPOSE: This study tested the efficacy of an intervention for anxious adolescent boys experiencing bullying at school. The cognitive-behavioral intervention focused on targeting individual factors that appear to increase an adolescent's vulnerability to bullying experiences such as anxiety, low self-esteem, and use of maladaptive coping strategies. METHODS: Adolescent boys reporting anxiety symptoms and the recent experience of being bullied at school (grades 7-10) were randomly assigned by group to intervention (n = 22) or wait-list (n = 24) conditions. Depressive and anxiety symptoms and bullying experiences were measured before and after the intervention, and at a 3-month follow-up for the intervention condition. RESULTS: The intervention was effective in significantly reducing adolescent's bullying experiences as well as their anxiety, depression, and the degree of distress associated with being bullied. Intervention gains were maintained at the 3-month follow-up. The intervention was not effective in enhancing adolescent's self-esteem or changing aggressive or avoidant responses to bullying situations. CONCLUSIONS: This study provides preliminary support for the value of individually focused interventions for boys in the effort to reduce the incidence of bullying within schools.