Rejection of Lepeophtheirus salmonis driven in part by chitin sensing is not impacted by seawater acclimitization in Coho salmon (Oncorhynchus kisutch).

There is tremendous variation in life-history strategies among anadromous salmonids. Species that enter the ocean environment at small sizes (< 20 g) are likely under more physiological pressure from pathogens; however, little data is available on responses at these early stages. With this in mind, we performed salmon louse challenges with Coho salmon either immediately after seawater entry (SW; ca. 10 g) or after 30 days in SW (ca. 20 g). Irrespective of size or time in SW, parasites were rapidly rejected by the host, with > 90% of all parasites lost by 16 days post-infection (dpi). Rejection was concomitant with host epithelial granulomatous infiltrations that initially targeted the embedded frontal filament (4 dpi) and the entire parasite by 10 dpi. Illumina sequencing, followed by functional enrichment analysis, revealed a concerted defense response in the fin within 1 dpi that included multiple innate and adaptive immunity components. Strikingly, early indications of an allergic-type inflammatory response were associated with chitin sensing pathways orchestrated by early overexpression of the IgE-receptor, fcer1g. Additionally, there was profound overexpression of several classes of c-type lectin receptors, including dectin-2, mincle, and dc-sign at 1 dpi onward. These profiles and upregulation of cellular effector markers were corroborated by histopathological evaluation, revealing the simultaneous presence of mast cell/eosinophilic granular cells, sacciform cells, macrophages/histiocytes, and granulocytes in fin. At 10 dpi and concurrent with parasite expulsion, there was evidence of immunoregulation in addition to tissue remodelling pathways. At 16 dpi, the response was effectively abrogated. Simultaneous profiling of the parasite transcriptome revealed early induction of chitin metabolism and immunomodulation, toxin production and ECM degradation; however, after 7 dpi, these were replaced with overexpression of stress and immune defense genes. These data present the first evidence for Coho salmon demonstrating chitin- and sugar moiety-sensing as key drivers of salmon louse rejection.

Dreyfus and Dreyfus and Indicators of Behavioral Performance: A Study of Measurement Convergence.

INTRODUCTION: Assessment of efficacy of continuous professional development is an important part of continuing professional development programing as one of its goals is to increase the performance of the clinicians that serve the community. A frequently used and researched classification system for skill mastery is the Dreyfus and Dreyfus Model of Skill Acquisition. An alternative approach is the core competency framework that informs the assessment of residents and forms the foundation of the American Board of Medical Specialties Program for Maintenance of Certification. There are a number of methods of assessment of each competence. One of the most broadly employed and researched methods is a multisource assessment (360°) methodology. METHODS: Three hundred sixty-degree data were collected from 264 raters of physicians holding supervisory roles. Raters included the physicians' leaders, peers, and support/reports. The scale items were taken from an instrument developed for the assessment of interpersonal and communications skills, professionalism, and system-based practice. The Dreyfus scale was purposely built for this application. RESULTS: The Dreyfus scale was reduced to a single dimension, and raters assigned their score on that dimension as the indicator of their assessment of the physician's level of mastery. Results of a multivariate analysis of variance indicated a significant relationship between Dreyfus mastery score and competency items (P < .0001). DISCUSSION: These findings demonstrate a relationship between a measure of Dreyfus skill acquisition and measures based on the American Board of Medical Specialties/Accreditation Council for Graduate Medical Education six core competency framework. Results have implication for continuing professional development design and assessment.

Miller's Pyramid and Core Competency Assessment: A Study in Relationship Construct Validity.

INTRODUCTION: Continuous professional development relies on the link between performance and an educational process aimed at improving knowledge and skill. One of the most broadly used frameworks for assessing skills is Miller's Pyramid. This Pyramid has a series of levels of achievement beginning with knowledge (at the base) and ending with routine application in the clinical setting. METHODS: The purpose of this study was to determine the degree of convergence of two measurement methods, one based on Miller's framework, the second using the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties (ACGME/ABMS) Core Competency framework. The data were gathered from the faculty of a large, Midwestern regional health care provider and hospital system. Data from 264 respondents were studied. The 360° data were from raters of physicians holding supervisory roles in the organization. The scale items were taken from an instrument that has been validated for both structure and known group prediction. RESULTS: The Miller scale was purposely built for this application. The questions were designed to describe each level of the model. The Miller scale was reduced to a single dimension. This result was then regressed on the items from the 360° item ratings. Results of a multivariate analysis of variance isolated a significant relationship between the Miller's Pyramid score and the competency items (P < 0.001). DISCUSSION: These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.