Serum and blubber of pup harbor (Phoca vitulina), grey (Halichoerus grypus) and harp (Phoca groenlandica) seals from the Estuary and the Gulf of St. Lawrence were analyzed for polybrominated diphenyl ethers (PBDEs). Concentrations of ∑PBDEs (on lipid weight basis) in tissues of harbor seal pups inhabiting the St. Lawrence Estuary were about five times higher than in those from a colony located in the northern Gulf. Harp seal pups have the lowest levels of ∑PBDEs among the seal species born in the Gulf of St. Lawrence. Lipid normalized concentrations of ∑PBDEs in serum and blubber were strongly correlated, suggesting that the blood collection as a less invasive method could be used to monitor ∑PBDEs in pups. This study shows that fluvial inputs of PBDEs are important to the St. Lawrence marine ecosystem and that inhabiting harbor seal pups have a substantial exposure to PBDEs at a critical developmental stage. In addition, the observed difference in PBDE levels between harp and grey or harbor seal pups from the Gulf of St. Lawrence is explained by the difference in diets of their mothers which is linked with their residency time in the Gulf and their seasonal migration pattern.

Seven mother-pup pairs of harp seal (Phoca groenlandica) were sampled during the lactation season near Magdalen Islands, QC, Canada. The blubber and serum of pups and mothers as well as the milk of mothers were analyzed for polybrominated diphenyl ethers and several chlorinated persistent organic pollutants (POPs) to evaluate their transfer prior to weaning. Principal component analysis demonstrated significant variations in contaminant distribution patterns between seal tissues of mothers and pups. The selectivity in the transfer of POPs between mothers and pups appeared mainly driven by their log K(ow) (octanol/water partition coefficient). The most selective transfer step for the POPs examined occurred between the blubber and the serum of the mother. A novel approach to examine temporal changes of POP concentrations in tissues of seals which take into account the contamination of mothers was developed. A general decrease of POP concentrations in pup tissues throughout lactation may suggest a growth dilution. A concomitant rise of POP concentrations was observed in maternal blubber and serum and in milk as lactation progresses. The intensive offloading of contaminants via lactation constitutes a major but selective excretory route for reproductive female seals and also a significant route of exposure for suckling pup seals.

We examined the capacity of harp seals (Pagophilus groenlandicus) to use spatial context (i.e., their tank) as a conditional cue to solve a two-choice visual discrimination reversal task. Seals were trained to touch one of two 3D objects. Two of four seals experienced a context shift that coincided with each of five reversals in the reward value of the two stimuli (i.e., a reversal of S+ and S-); these seals solved the six discriminations in significantly fewer trials than did seals that did not experience a context shift with the contingency reversal. Thus, harp seals use contextual cues when encoding information. The findings are discussed in terms of harp seals' adaptations to the pack-ice environment, the constraints of the learning tasks, and the nature of the subjects that were raised in captivity.

Blubber samples from adult male harbour seals (Phoca vitulina) from the St Lawrence Estuary, and from grey (Halichoerus grypus), harp (Phoca groenlandica) and hooded (Cystophora cristata) seals from the Gulf of St Lawrence, were analysed for polychlorinated biphenyls (PCB) and organochlorinated pesticides (OCP). All seals were between 5 and 19 years of age, and mean ages were not statistically different among the seal species. Mean concentrations of sigmaPCB and mirex were significantly higher in harbour seals, while sigmaDDT concentrations were significantly higher in hooded seals than in the other species examined. Harbour and hooded seals had similar concentrations of sigmaCHLOR, which were higher than in grey and harp seals. SigmaHCH concentrations were significantly higher in harp seals than in harbour and hooded seals and they were significantly higher in harbour and grey seals than in hooded seals. Harp and grey seals had similar levels of HCB, which were significantly higher than in either hooded or harbour seals. Patterns of PCB congeners and individual OCPs varied considerably between the four species. In PCA plots harbour, harp and hooded seals were well separated from each other, while grey seals were separated from the other species by a smaller degree. Between species variations may be explained by their dissimilar migratory patterns, habitat use and proximity to sources of industrial and agricultural pollution, their dietary regime (trophic level and individual prey items) as well as possible variations in the seals' abilities to eliminate these compounds.

Congener-specific transfer of polychlorinated biphenyls (PCBs) and chlorinated pesticides from female to pup was studied in harp seals from eastern Canada. Possible effects on hepatic cytochrome P450 enzymes (CYP450) due to contaminant mobilization from blubber lipids in females and ingestion of contaminated milk in pups were studied. Contaminant transfer from blubber to milk in females favored the more polar compounds (lower chlorinated PCBs, toxaphenes, hexachlorocyclohexanes, and hexachlorobenzene) relative to more lipophilic compounds (higher chlorinated PCBs, dichlorodiphenyltrichloroethane [DDT], chlordane). In spite of substantial contaminant mobilization from blubber in females and ingestion of contaminated milk by pups, CYP450 activities were low in all animals. Possibly, increased plasma estradiol concentrations, involved in breeding after lactation, suppressed CYP450 directly. Although the pups were exposed to contaminants in milk, CYP450 activities were low, resulting in low contaminant metabolism. This was confirmed by similar contaminant patterns in milk and pups. A strong positive relation between CYP1A-like activities and body weight in the pups suggested not yet fully developed CYP1A enzymes. A negative association between CYP3A and pesticides in females and pups was hypothesized to be a result of metabolic inactivation of CYP450. The CYP450 enzyme activities were considered unsuitable indicators for contaminant mobilization and transfer in harp seals.

A simple fugacity-based bioaccumulation model is presented for harp seals (Phoca groenlandica), which feed primarily on polar cod (Boreogadus saida) and a pelagic crustacean (Themisto libellula). Using concentration data reported for 15 polychlorinated biphenyl (PCB) congeners and 27 pesticides in the food and blubber of harp seals from the Barents Sea, the model was used to determine biomagnification factors and metabolic half-lives as well as rates of contaminant uptake and loss processes in seals, including a discussion of uncertainty in biomagnification factors and half-lives. Examination of the model output shows considerable, but highly variable, biomagnification attributable to differences in metabolic rates. It is suggested that two biomagnification factors can be defined and should be used in such assessments, one based on concentration ratios and the other on fugacity ratios or lipid-normalized concentrations. A maximum biomagnification factor specific to the seal is deduced using biomagnification data for the most persistent substances, and from this, metabolic half-lives are estimated for all substances. The approach can be applied to other biomagnification situations, thus quantifying metabolic half-lives as a function of the properties of the bioaccumulating substance and ultimately its molecular structure and the physiological characteristics of the consuming animal.

OBJECTIVE

To determine whether data on research studies held by the UK Health Research Authority (HRA) could be summarised automatically with minimal manual intervention. There are numerous initiatives to reduce research waste by improving the design, conduct, analysis and reporting of clinical studies. However, quantitative data on the characteristics of clinical studies and the impact of the various initiatives are limited.

METHODS

Feasibility study, using 1 year of data.

METHODS

We worked with the HRA on a pilot study using research applications submitted for UK-wide ethical review. We extracted into a single dataset, information held in anonymised XML files by the Integrated Research Application System (IRAS) and the HRA Assessment Review Portal (HARP). Research applications from 2014 to 2016 were provided. We used standard text extraction methods to assess information held in free-text fields. We use simple, descriptive methods to summarise the research activities that we extracted.

METHODS

Not applicable-records-based study INTERVENTIONS: Not applicable.

UNASSIGNED

Feasibility of extraction and processing.

RESULTS

We successfully imported 1775 non-duplicate research applications from the XML files into a single database. Of these, 963 were randomised controlled trials and 812 were other studies. Most studies received a favourable opinion. There was limited patient and public involvement in the studies. Most, but not all, studies were planned for publication of results. Novel study designs (eg, adaptive and Bayesian designs) were infrequently reported.

CONCLUSIONS

We have demonstrated that the data submitted from IRAS to the HRA and its HARP system are accessible and can be queried for information. We strongly encourage the development of fully resourced collaborative projects to further this work. This would aid understanding of how study characteristics change over time and across therapeutic areas, as well as the progress of initiatives to improve the quality and relevance of research studies.

Levels of p,p'-DDT, p,p'-TDE, p,p'-DDE, dieldrin, polychlorinated biphenyls (PCBs), and HCB were determined in certain tissues of 31 harp seals (P hagophilus groenlandicus) taken from the Gulf of St. Lawrence during 1971 and 1973. The seals ranged in age from less than two weeks to 18 years. Mean concentrations of PCBs and sigma DDT in the various tissues were about the same sigma DDT levels were 1.64--9.88 ppm in adult seal blubber and 1.08--3.73 ppm in seal pup blubber. Organochlorine levels in harp seal samples taken in 1973 were similar to those reported by other workers for samples collected in the Gulf of St. Lawrence during 1967-71.

Objectives: First Nations may have a higher risk of contaminant exposure from the consumption of traditional foods. The objective of this study was to measure concentrations of metals and organochlorines in traditional foods commonly consumed by First Nations in Canada and estimate the risk from dietary exposure.

Methods: Data were collected from the participatory First Nations Food, Nutrition and Environment Study (2008-2018). Traditional food samples were collected by community members and concentrations of metals and organochlorines were measured. The population-weighted mean daily contaminant intake from traditional food items was estimated. Hazard quotients (HQs) were calculated by dividing contaminant intake with the toxicological reference values (TRVs).

Results: A total of 2061 food samples (different parts and organs) from 221 species were collected. The highest concentrations of cadmium were found in the kidneys of land mammals: moose kidney was the most significant contributor to intake. The meat of land mammals and birds had the highest lead concentrations and were the most significant contributors to intake. Arsenic was highest in seaweed, and prawn was the most significant contributor. Mercury and methyl mercury were highest in harp seal meat, with walleye/pickerel contributing most to intake. Harp seal meat also had the highest p,p'-DDE and PCB concentrations, and ooligan grease and salmon were the most significant contributors to intake. The percentage of adults eating traditional food who exceeded the TRVs was 1.9% for cadmium, 3.7% for lead, 13.6% for arsenic, 0.7% for mercury, and 0% for p,p'-DDE and PCBs. All median HQs, and most 95th percentile HQs, were less than 1.

Conclusion: These results can be used as a baseline of contaminant levels and exposure in traditional foods for future monitoring programs and to support risk assessment programs.

RéSUMé: OBJECTIFS: Les Premières Nations peuvent avoir un risque plus élevé d’exposition aux contaminants en raison de la consommation d’aliments traditionnels. L’objectif de cette étude était de mesurer les concentrations de métaux et d’organochlorés dans les aliments traditionnels couramment consommés par les Premières Nations au Canada et estimer le risque d’exposition alimentaire. MéTHODES : Les données ont été recueillies dans le cadre de l’Étude sur l’alimentation, la nutrition et l’environnement des Premières Nations (2008–2018), une étude participative. Des échantillons d’aliments traditionnels ont été prélevés par les membres de la communauté et les concentrations de métaux et d’organochlorés ont été mesurées. L’apport quotidien moyen pondéré pour la population de contaminants provenant du système alimentaire traditionnel a été estimé. Les quotients de risque (QR) ont été calculés en divisant l’apport par les valeurs toxicologiques de référence (VTR). RéSULTATS: Un total de 2 061 échantillons d’aliments (différentes parties et organes) de 221 espèces ont été collectés. Les concentrations les plus élevées de cadmium ont été trouvées dans les reins des mammifères terrestres : le rein d’orignal était le principal contributeur aux apports en cadmium. La viande de mammifères terrestres et d’oiseaux présentait les concentrations de plomb les plus élevées et était le principal contributeur aux apports en plomb. La concentration en arsenic était la plus élevée dans les algues tandis que la crevette était le contributeur le plus important pour ce contaminant. Les concentrations de mercure et de méthylmercure étaient les plus élevées dans la viande de phoque du Groenland, le doré jaune et le brochet contribuant le plus aux apports de ces contaminants. La viande de phoque du Groenland présentait également les concentrations les plus élevées de p,p′-DDE et de BPC, et la graisse d’eulikan et le saumon en étaient les principaux contributeurs. Le pourcentage d’adultes consommant des aliments traditionnels qui dépassaient les VTR était de 1,9 % pour le cadmium, 3,7 % pour le plomb, 13,6 % pour l’arsenic, 0,7 % pour le mercure et 0 % pour le p,p′-DDE et les PCB. Tous les QR médians et la plupart des QR du 95e centile étaient inférieurs à 1. CONCLUSION: Ces résultats peuvent être utilisés comme référence pour les futurs programmes de surveillance et pour soutenir les programmes d’évaluation des risques.

Keywords: Canada; First Nations; Metals; Persistent organic pollutants; Traditional foods.

The objective of this study was to characterize pathologic changes associated with experimental infection of harp seals (Phoca groenlandica) with the lungworm Otostrongylus circumlitus (Metastrongyloidea: Crenosomatidae). The leukocyte differential cell count in samples obtained by unguided bronchoalveolar lavage (BAL) and the intensity of the histologic lesions in the lungs were assessed in seven harp seals experimentally exposed to 300 infective, third-stage O. circumlitus larvae. Seven unexposed harp seals were used as controls. First-stage larvae were observed in the feces of three of the seven exposed seals at 38, 42, and 45 days postexposure (dpe). Adult nematodes were found in the right primary bronchi of two of these three seals at necropsy 53 dpe. Fifty-six BALs were performed on the 14 seals. No statistical difference was observed between the exposed and control seals and among the four sampling times in percentage of neutrophils and macrophages in the BAL fluid. A significant difference was observed between the exposed and control seal groups in the percentage of eosinophils (P<0.0001), the count of eosinophils having increased by a factor of 70.4 in exposed seals. Significant statistical differences were observed between exposed and control seals in intensity of interstitial inflammation (P=0.001), bronchitis (P=0.02), bronchiolitis (P=0.04), alveolitis (P=0.03), and interstitial granulomatous inflammation (P=0.04). Our findings showed that harp seals are susceptible to infection with O. circumlitus. However, parasitic infections were transient and of low intensity, at least under our experimental conditions.

Schimke immunoosseous dysplasia (SIOD) is an autosomal recessive disease characterized by skeletal dysplasia, focal segmental glomerulosclerosis, renal failure and immunodeficiency. In this work, we report the molecular studies undertaken in a severely affected SIOD patient that died at six years old due to nephropathy. The patient was screened for mutations using a targeted skeletal dysplasias panel. A homozygous novel missense mutation was identified, c.1615C>> G (p.[Leu539Val]) that was predicted as mildly pathogenic by in silico pathogenicity prediction tools. However, splicing prediction software suggested that this variant may create a new splicing donor site in exon 9, which was subsequently confirmed using a minigene assay in HEK293 cells. Thus, the splicing alteration, c.1615C>> G; r.1615c>> g, 1615_1644del; (p.[Leu539_Ile548del]), results in the loss of 10 amino acids of the HARP-ATPase catalytic domain and the RPA-binding domain. Several studies have demonstrated a weak genotype-phenotype correlation among such patients. Thus, the molecular characterization has helped us to understand why a predicted weakly pathogenic missense mutation results in severe SIOD and should be considered in similar scenarios.

The data on mean age of death of 8,775 musicians (7,371 males and 1,404 females)--composers, conductors, singers, pianists, violinists, etc.) are presented in the paper. Women lived longer than men in any studied categories (p < 0.02). The 3 first places of long-livers among men were belonging to conductors (71.1 yrs., n = 1,435), players on chello (70.0 yrs, n = 260) and on violin (70.0; n = 735). Rock-musicians, and author's song singer lived less than other categories (45.0 yrs, n = 421; 54.0 yrs, n = 428, respectively). Among women leading long-livers were harp-players (80.9 yrs., n = 32), clavesin-players (79.9 yrs, n = 17), and conductors (79.6 yrs., n = 24). The mean age of death in women rock-musicians was 37.7 yrs. (n = 37), in author song's singers--49.6 yrs. (n = 67), in guitarists--54.4 yrs. (n = 9). Relative number of nonagenarians (90+) was much higher among women as compared to men. The values were as 43.75% of harp-players, 29.17% of conductors, 19.50% of violinists among women and nobody from rock-musicians and guitar players survived 90 yrs. In men, 7.30% violinists, 6.62% of conductors and 6.54% of cello-players survived 90+ years. Honors give advantage for survival--"People artists" men-composers survived 8.7 yrs longer than ordinary composers, whereas women-composers with this honor lived 18.1 yrs longer than non awarded composers. Opera singers ,"People artists"-men live longer 5.3 yrs, and women-by 6.6 yrs longer than their no-honored colleagues. For estrada singers these differences were 8.0 yrs for men and 20.1 yrs. for women.

Lungworms of the genera Parafilaroides and Otostrongylus are responsible for parasitic bronchopneumonia, the foremost disease of eastern Atlantic common seals (EACS, Phoca vitulina vitulina) in the Dutch North Sea. Recently, there have been increased reports of lungworm cases and observations of unusually long Parafilaroides sp. adults in this location. The initial aim of this study was to confirm the identity of the Parafilaroides species infecting this population. Parafilaroides are usually small and delicate, making them difficult to extract from host tissue, and there is often difficulty accessing fresh specimens for morphological study. The large size of the Dutch worms and the accessibility of specimens from numerous animals enabled the description and measurement of many intact specimens (N = 64) from multiple host animals (N = 20). Species identity was confirmed by targeted sequencing of ribosomal and mitochondrial DNA amplicons from a subset of worms. Worm morphology was consistent with descriptions for P. gymnurus, but the mature females were 1.9-fold and 3.4-fold longer than those recovered from French EACS (P ≤ 0.001) and Canadian western Atlantic common seals (Phoca vitulina concolor; P ≤ 0.0001). They were also significantly longer than mature female P. gymnurus described from other seal species, with the exception of those from harp seals of Les Escoumins, Quebec. We suggest that intraspecific genetic differences in P. gymnurus and the environment within the host could contribute to the variation reported here. This study is the first to describe P. gymnurus using morphological and molecular methods and should serve as a reference for identification of the species.

The 1988 and 2002 phocine distemper virus (PDV) outbreaks in European harbour seals Phoca vitulina are among the largest mass mortality events recorded in marine mammals. Despite its large impact on harbour seal population numbers, and 3 decades of studies, many questions regarding the spread and temporal origin of PDV remain unanswered. Here, we sequenced and analysed 7123 bp of the PDV genome, including the coding and non-coding regions of the entire P, M, F and H genes in tissues from 44 harbour seals to shed new light on the origin and spread of PDV in 1988 and 2002. The phylogenetic analyses trace the origin of the PDV strain causing the 1988 outbreak to between May 1987 and April 1988, while the origin of the strain causing the 2002 outbreak can be traced back to between June 2001 and May 2002. The analyses further point to several independent introductions of PDV in 1988, possibly linked to a southward mass immigration of harp seals in the winter and spring of 1987-1988. The vector for the 2002 outbreak is unknown, but the epidemiological analyses suggest the subsequent spread of PDV from the epicentre in the Kattegat, Denmark, to haul-out sites in the North Sea through several independent introductions.

Background: Health-related quality of life (HRQL), fatigue, anxiety, and depression are crucial for the living kidney donor (LKD). Follow-up data for HRQL of LKDs comparing surgical techniques, especially regarding hand-assisted retroperitoneoscopic donor nephrectomy (HARP), are sparse. The aim of this study was to evaluate the influence of abdominal wall trauma minimized by HARP in comparison to open anterior approach donor nephrectomy (AA) on HRQL and additional psychosocial aspects of LKDs during the long-term follow-up.

Material and methods: This is a cross-sectional study comparing psychosocial aspects of LKD between HARP and AA.

Results: This study included 100 LKDs (68 HARP, 28 AA, and 4 were excluded secondary to incomplete data). The time to follow-up was 22.6 ± 11.7 (HARP) vs 58.7 ± 13.9 (AA) months (P < .005). Complications ≥3a° due to Clavien-Dindo classification was 0% in both groups. There were higher scores in all physical aspects for HARP donors vs AA donors at that time (physical function: 89.8 ± 14.6 vs 80.0 ± 19.9, P = .008, and the physical component score: 53.9 ± 7.6 vs 48.6 ± 8.5, P = .006). One year later (follow-up time + 12 months), HRQL for HARP donors was still higher. Mental items showed no significant differences. HARP donors showed better physical scores compared to the age-matched nondonor population (AA donors had lower scores). Neither the Multidimensional Fatigue Inventory-20 (MFI-20) or the Hospital Anxiety and Depression Scale (HADS) showed any differences between the 2 groups. Fatigue scores were higher for HARP and for AA compared to the age-matched population.

Conclusions: LKDs undergoing HARP showed better physical performance as part of HRQL in the long-term follow-up.

BACKGROUND

Hospitalized patients experience symptoms including pain and anxiety that may negatively affect their well-being and overall quality of life (QOL), even when medical interventions are deemed successful.

OBJECTIVE

The objective of the study was to assess the efficacy of prescriptive live therapeutic harp sounds on patient symptoms and QOL.

METHODS

The study was a two-period, two-treatment arm crossover, randomized clinical trial. Individuals were randomized to harp music and standard care for the first 24 hours of the hospital stay, followed by 24 hours of only standard care, or vice versa. The harp intervention was 30-40 minutes of prescriptive live therapeutic harp sounds in the form of solo harp pieces and improvisations. Patients recorded well-being and symptom scores on linear analogue scales. Entry criteria included at least 18 years and a score of 3 or below on a 1-5 linear analogue scale indicating compromised overall QOL.

RESULTS

Ninety-two eligible patients participated in the clinical trial. All the QOL variables had significantly higher percentages of patients with improvements during the harp treatment than during standard care. Five symptoms--fatigue, anxiety, sadness, relaxation, and pain--were significantly improved following therapeutic harp treatment. Approximately 30% to 50% of patients showed a significant increase in the QOL measures after harp treatment.

CONCLUSIONS

There is evidence of strong positive effects on the QOL of hospitalized patients who received therapeutic harp sound treatment along with standard care.

The paper describes the investigation of the actual food consumption in 102 adult residents of both sexes in settlements Harp, Aksarka and Beloyarsk in Yamal-Nenets Autonomous District - YNAD. The dietary intake of individuals were studied by 24-hour recall methodology adopted for Russian features in the Institute of Nutrition of RAMS. An assessment of differences of the actual consumption of energy and nutrients for newcomers and indigenous populations were performed.

Tracheal replacement has been a challenging problem for thoracic surgeons for over half of a century. We evaluated the in-vivo performance of a new tracheal bioprosthesis derived from Harp seal (Phoca groelandica) trachea that was fixed and preserved in 0.625% buffered glutaraldehyde solution for 3 months. Ten young male pigs weighing 27-32 kg (mean, 28.7 kg) underwent replacement of a tracheal segment with this new bioprosthesis. The length of replaced trachea was 1.8-2.4 cm (mean, 2.17 cm), representing 2-3 cartilage rings. All pigs survived the operation uneventfully. No immunosuppression drugs were used. The pigs eventually developed dyspnea and were euthanized on postoperative day 17-39 (mean, 30.8 days). Macroscopic and histological analysis showed an intact bioprosthesis but near-total occlusion of the native trachea by a ring of inflammatory infiltration at the site of distal anastomosis. More experiments involving a different concentration of the preservation agent, different management, and perhaps the use of bioengineering techniques are needed to improve the performance of this novel bioprosthesis.

The fatty-acid composition of retinyl esters in the livers of two species of phocid seal, the harp seal (Phoca groenlandica, n = 20) and the hooded seal (Cystophora cristata, n = 15), and one species of otariid seal, the California sea lion (Zalophus californianus, n = 6), was determined. Vitamin A ranged in concentration from 4 to 1024 nmol retinol/g liver for the phocids and from 381 to 979 nmol/g liver for the otariids. In most of the livers, retinyl palmitate was not the principal ester, and the palmitate + stearate + oleate trio of retinyl esters represented less than 50% of the total. In all samples, the retinyl esters contained 20:1, 20:4, 20:5, and 22:6 in unusually large amounts. Retinyl esters tended to be richer than whole-liver lipids in 20:5 + 22:6, whereas whole-liver lipids were richer in 18:0 and 18:2. Therefore, the pool of acyl donors used for the esterification of retinol may be distinct from that used for other lipids. Birth-to-weaning changes were seen only in the harp seals. In the pups, the hepatic vitamin-A concentration increased 454%, while the proportion of 18:0 and 20:1 in the retinyl esters rose and that of 14:0 + 16:1 and 20:4 fell. Concomitantly, in their mothers, the proportion of 20:4 increased but that of 16:0 and 18:0 decreased.

It was interesting to read your story about preceptorships (news, 29 March). No other profession, especially graduate professions, expects their graduates to be fully functioning on graduation. Most big companies provide bespoke schemes that ease the graduate into the organisation. The reticence is appalling and mainly from those who harp back to the good old days of their training without removing their rose-tinted glasses. People forget that the title staff nurse was originally associated with a continued fourth year after qualifying. If you didn't do it you don't get your hospital badge. The compulsory year only disappeared to ensure a more disposable workforce.

Introduction: Healthcare professionals (HCPs) experience difficulties in timely recognising and directing palliative care (PC) needs of their patients with chronic heart failure (CHF). The aim of this study was to develop a comprehensive tool to enable HCPs in timely recognising and directing PC needs in CHF.

Methods: A four-stage mixed-method study was performed. Stage 1: identification of needs and questions of patients and families; stage 2: prioritisation and refinement of the needs and questions; stage 3a: testing and online feedback on V.1; stage 3b: selecting and refining care recommendations; stage 4: testing and review of V.2. Iterative reviews followed each step in the development process to ensure a wide range of stakeholder input. In total, 16 patients, 12 family members and 54 HCPs participated.

Results: A comprehensive set of 13 PC needs was identified, redefined and tested. The resulting tool, called Identification of patients with HeARt failure with PC needs (I-HARP), contains an introduction prompt with open questions to start the conversation, 13 closed screening questions with additional in-depth questions, and recommendations on actions for identified needs.

Conclusion: I-HARP contains an evidence-based set of questions and palliative CHF care suggestions for HCPs in the Netherlands. The resulting tool, approved by HCPs, patients and family members, is a promising guidance for HCP to timely recognise and direct PC needs in CHF.

Keywords: communication; heart failure.

Fish oil, rich in omega-3 (n-3) polyunsaturated fatty acids (PUFAs), has been reported to attenuate nephrotoxicity induced by ciclosporin (cyclosporine A). Harp seal oil is a rich source of n-3 PUFAs. This study investigated the ability of dietary seal oil to reduce nephrotoxicity caused by ciclosporin. Sprague-Dawley rats were maintained on a standard diet (with sunflower oil as lipid, SFO) or a diet enriched with seal oil (with 85% seal oil and 15% sunflower oil as lipid, SO) for four weeks before and four weeks after intravenous administration of ciclosporin (15 mg kg(-1) daily). Kidney function was assessed by measuring blood urea nitrogen, creatinine clearance, urinary N-acetyl-1-beta-D-glucosaminidase, 6-keto-prostaglandin F(1alpha), thromboxane B(2) and malondialdehyde. Systolic blood pressure (SBP) was monitored. Ciclosporin concentrations in blood were measured using liquid chromatographytandem mass spectrometry (LC-MS/MS). The fatty acid compositions of the diets and erythrocyte membranes were analysed by gas chromatography (GC). The results showed that nephrotoxicity was induced by ciclosporin in rats maintained on both SO and SFO diets. However, rats fed on SO diet endured less toxicity than those on SFO diet. The n-3 and n-6 PUFAs in the erythrocyte membrane of rats maintained on SO diet were found to be 10.79% and 11.93%, while those in rats maintained on SFO diet were found to be 1.67% and 22.71%, respectively. In conclusion, dietary supplementation of seal oil was found to reduce ciclosporin-induced nephrotoxicity in rats.

The development and ultimate operation of a nanocomposite high-aspect-ratio photoinjection (HARP) device is presented in this work. The device makes use of a nanocomposite material as the optically active layer and the device achieves a large optical penetration depth with a high aspect ratio which provides a strong actuation force far away from the point of photoinjection. The nanocomposite material can be continuously illuminated and the position of the microdroplets can, therefore, be controlled to diffraction limited resolution. The nanocomposite HARP device shows great potential for future on-chip applications.