Search

Patient case simulation software are described in pharmacy education literature as useful tools to improve skills in patient assessment (including medication history-taking and physical assessment), clinical reasoning and communication, and are typically well-received by students and instructors. The virtual interactive case (VIC) system is a web-based software developed to deliver deliberate practice opportunities in simulated patient encounters across a spectrum of clinical topics. This article describes the implementation and utilization of VIC in the undergraduate curriculum at one Canadian pharmacy school. Methods: At our facility, the use of VIC was integrated across the training spectrum in the curriculum, including core and elective didactic courses and practice labs, experiential learning, interprofessional education, and continuing education. Its use was evaluated through student and instructor surveys and qualitative student interviews). VIC is easy to navigate and created a positive and realistic learning environment. Students identified that it enhanced their ability to identify relevant patient information, accurately simulated hospital pharmacy practice and thereby helped them to prepare for their upcoming experiential courses. The use of VIC has expanded beyond its original intended purpose for individual student practice to become a valuable addition to pharmacy undergraduate education. Future plans include ongoing development of cases and exploration of further uses of VIC within the didactic curriculum, for remediation in experiential courses, and for pharmacist continuing education., Competing Interests: Gordon Tait managed the team of developers that created VIC. Sale of VIC licenses goes toward software maintenance. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: We aimed to evaluate the effect of the 2017 Canadian Cardiovascular Society (CCS) guidelines on troponin surveillance after noncardiac surgery., Methods: This was a single-centre, retrospective, observational study. Patients aged 40 yr or older undergoing intermediate- to high-risk elective noncardiac surgery between 2016 and 2021 were included. We compared the number and percentage of troponin tests ordered before and after the guidelines were published and compared patient characteristics, specifically cardiovascular comorbidity, using odds ratio's (OR) with 95% confidence intervals (CIs). Outcomes were myocardial injury, myocardial infarction (MI), and in-hospital mortality., Results: The cohort included 36,386 patients and the median age was 63 yr. Between 2016 and 2018, troponin surveillance was done in 2,461 (13%) of the 19,046 patients, compared with 2,398 (14%) of the 17,340 patients who had surgery between 2019 and 2021 (OR, 1.08; 95% CI, 1.02 to 1.15). Patients who had surgery in the second period had less cardiovascular comorbidity; the adjusted OR for troponin surveillance was 1.14 (95% CI, 1.07 to 1.21). In the two periods, troponin was elevated in 561 (2.9%) and 470 (2.7%) patients, an MI was documented in 54 (0.3%) and 36 (0.2%) patients, and 95 (0.5%) and 73 (0.4%) patients died, respectively. After adjustment for baseline differences in the two periods, the ORs for MI and mortality were 0.83 (95% CI, 0.54 to 1.27) and 0.88 (95% CI, 0.64 to 1.19), respectively., Conclusion: Although the odds of troponin ordering were slightly but significantly higher after publication of the CCS guidelines, the odds for detecting an MI and for mortality did not change., (© 2023. Canadian Anesthesiologists' Society.)

Drosophila suzukii Matsumura (Diptera: Drosophilidae) is a key pest of soft-skinned fruit such as blackberry and blueberry. Differing seasonal spray regimes are expected to have variable effects on D. suzukii populations. Semi-field cage trials were performed at three locations in the United States (Georgia, Oregon, and North Carolina) on blueberry and blackberry crops to evaluate this hypothesis. Insecticides with different efficacy rates (ZC - zeta-cypermethrin, SPI - spinetoram, CYAN - cyantraniliprole) were applied during field experiments conducted within large cages. Treatment schedules consisted of two insecticide applications which performed over three weeks. Seasonal treatment schedules were applied in the following order: ZC-CYAN and CYAN-ZC in rabbiteye and highbush blueberry with the addition of a ZC-SPI treatment applied in blackberry. In addition, a population model was applied to simulate the relative efficacy of the insecticide schedules in Oregon on D. suzukii population model based on previously published efficacy, biological, and weather parameters. Overall, all schedules resulted in reduced D. suzukii infestation compared to untreated control (UTC) treatments, with statistical differences in all three locations. The numerically lower infestation was found in some cases in ZC-CYAN schedule. Population modeling conducted exclusively for blueberry, and the simulations indicated no discernible differences between the two respective schedules (ZC-CYAN vs CYAN-ZC). The present study demonstrates that seasonal infestation of D. suzukii could be suppressed irrespective of application order. Additional research is required to assess the optimal timing and sequence of insecticide applications for controlling seasonal populations of D. suzukii in fruit crops. Such information could be invaluable for growers who are seeking to strategize their insecticide applications., (© The Author(s) 2023. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The invasion of Drosophila suzukii , spotted-wing drosophila, across Europe and the US has led to economic losses for berry and cherry growers, and increased insecticide applications to protect fruit from damage. Commercial production relies heavily on unsustainable use of conventional toxic insecticides. Non-toxic insecticide strategies are necessary to alleviate the disadvantages and non-target impacts of toxic conventional insecticides and improve Integrated Pest Management (IPM). A novel food-grade gum deployed on dispenser pads (GUM dispensers) was evaluated to mitigate D. suzukii crop damage in five commercial crops and nine locations. Trials were conducted at a rate of 124 dispensers per hectare in cherry, wine grape, blueberry, raspberry, and blackberry in California and Oregon, USA during 2019 and 2020. The majority of trials with the food-grade gum resulted in a reduction of D. suzukii egg laying in susceptible fruit. In some cases, such damage was reduced by up to 78%. Overall, results from our meta-analysis showed highly significant differences between GUM treatments and the untreated control. Modeling simulations suggest a synergistic reduction of D. suzukii damage when used in combination with Spinosad (Entrust SC) insecticide. These data illustrate commercial value of this tool as a sustainable alternative to manage D. suzukii populations within a systems approach., Competing Interests: The intellectual property was purchased by TerrAmor Inc. with GT and VW as shareholders. FP has conflict of interest as husband of GT. Author JK, CC, RK and MS were employed by Driscolls’ Inc.,. Author HT was employed by Naturipe Berry Growers, Inc.,. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tait, Zhu, Klick, Ganjisaffar, Castillo, Kennedy, Thomas, Adams, Pfab, Mermer, Mirandola, Xue, Zalom, Seagraves and Walton.)

Background: Canadian hematology residents are required to demonstrate competencies in transfusion medicine by the end of their 2-year training. Prior evaluation of final year trainees revealed significant variation in knowledge. To address the lack of standardization in serology teaching, an online educational immunohematology resource was created and evaluated., Study Design and Methods: All Canadian post-graduate trainees completing a residency program in adult hematology during the 2018/2019 academic year were invited to participate. Only trainees from one university were exposed to the program curriculum. A validated exam was administered to trainees at both exposed and unexposed sites at the start of the academic year as a pre-test and in the following year as a post-test. The effectiveness of the program was assessed by both comparing the degree of improvement from pre- to post-test, and by comparing performance on the post-test., Results: 57 trainees from 13 universities completed the pre-test, and 45 trainees from 14 universities completed the post-test. A strong trend towards better performance in the exposed vs non-exposed trainees on the post-test was observed, and the difference was more pronounced, and statistically significant, when analysis was limited to two questions relating to interpretation of an antibody investigation panel., Discussion: LearnSerology.ca is effective and may be potentially superior to traditional immunohematology teaching. The interactive capability of the platform can improve skills related to the resolution of red cell antibody panels., Competing Interests: Conflicts of Interest The authors declare that they have no conflicts of interest relevant to this manuscript., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The coronial jurisdiction is different in function, character and procedure to most other legal processes in Australia, being inquisitorial rather than adversarial. It is also, by virtue of its focus on the circumstances of death, situated at the intersection of trauma and grief on the one hand, and legal exploration and evidence-gathering, on the other. For families a coronial investigation offers the potential for resolution about a death, but it can also exacerbate grief and trauma, particularly in the public forum of an inquest. This article utilises interviews with legal professionals engaged in the coronial jurisdiction to explore their understanding of the issues that impact upon families during a death investigation. Our findings indicate that an ethics of care is evident in the court but that this remains contingent on adequate resourcing of the sector, and that this is increasingly the case as the jurisdiction becomes more specialised., Competing Interests: None.

Surface wax and other cellular building blocks play an important role in preserving fruit integrity from biotic and abiotic adversities. Huge energy expenses are made by plants to place these protective compounds onto the epidermal cuticle. Sprayable plant and fruit coatings have been developed to protect plant tissues from environmental stresses, pathogens, and arthropods. The aim of this study was to determine if an experimental cuticle supplement containing waxes can affect fruit quality parameters such as firmness and size of various crops. Cherry, blueberry, and winegrape plants treated with the cuticle supplement showed significant increases in berry firmness ranging from 4.6 to 11.6%. No quality benefits were however observed on blackberry. Cuticle supplement applications did not significantly affect berry size. Laboratory trials resulted in a 54% mean reduction in a model pest insect i.e., Drosophila suzukii egg laying on blueberry. Short-duration field trials over 72 ± 2 to 96 ± 2 h on commercial-standard blueberry bushes resulted in 50-93.4% reductions of D. suzukii damage. Longer-term field trials on cherry and blueberry challenged with egg-laying D. suzukii showed reductions of damage ranging from 45 to 95%, up to 30 d after initial cuticle supplement applications. These results indicate that the cuticle supplement significantly alters berry firmness and reduces D. suzukii damage under commercial production conditions. One factor that may contribute to this reduction includes improved fruit quality parameters. The current work serves to expand integrated pest management options to control D. suzukii populations in commercial field settings., (© The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Cape Fear River is an important source of drinking water in North Carolina, and many drinking water intakes in the watershed are affected by per- and polyfluoroalkyl substances (PFAS). We quantified PFAS concentrations and loads in river water upstream and downstream of a PFAS manufacturing plant that has been producing PFAS since 1980. River samples collected from September 2018 to February 2021 were analyzed for 13 PFAS at the upstream station and 43-57 PFAS downstream near Wilmington. Frequent PFAS sampling (daily to weekly) was conducted close to gauging stations (critical to load estimation), and near major drinking water intakes (relevant to human exposure). Perfluoroalkyl acids dominated upstream while fluoroethers associated with the plant made up about 47% on average of the detected PFAS downstream. Near Wilmington, Σ 43 PFAS concentration averaged 143 ng/L (range 40-377) and Σ 43 PFAS load averaged 3440 g/day (range 459-17,300), with 17-88% originating from the PFAS plant. LOADEST was a useful tool in quantifying individual and total quantified PFAS loads downstream, however, its use was limited at the upstream station where PFAS levels in the river were affected by variable inputs from a wastewater treatment plant. Long-term monitoring of PFAS concentrations is warranted, especially at the downstream station. Results suggest a slight downward trend in PFAS levels downstream, as indicated by a decrease in flow-weighted mean concentrations and the best-fitting LOADEST model. However, despite the cessation of PFAS process wastewater discharge from the plant in November 2017, and the phase-out of perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) in North America, both fluoroethers and legacy PFAS continue to reach the river in significant quantities, reflecting groundwater discharge to the river and other continuing inputs. Persistence of PFAS in surface water and drinking water supplies suggests that up to 1.5 million people in the Cape Fear watershed might be exposed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: To evaluate the perceptions and practices of Canadian cardiovascular anesthesiologists and intensivists towards intravenous albumin as a resuscitation fluid in patients undergoing cardiac surgery., Methods: We conducted a cross-sectional survey of cardiac anesthesiologists and intensivists involved in the care of cardiac surgical patients. The 22-item survey included seven open-ended questions and assessed practice patterns and attitudes towards albumin. Descriptive statistics were analyzed using counts and proportions. Qualitative data were analyzed to identify themes describing albumin use patterns in Canada., Results: A total of 133 respondents from seven provinces participated, with 83 (62%) using albumin perioperatively. The majority of respondents (77%) felt a low fluid balance in cardiac surgical patients was important, and that supplementing crystalloids with albumin was helpful for this objective (67%). There was poor agreement among survey respondents regarding the role of albumin for faster vasopressor weaning or intensive care discharge, and ≥ 90% did not feel albumin reduced mortality, renal injury, or coagulopathy. Nevertheless, cardiac surgical patients were identified as a distinct population where albumin may help to minimize fluid balance. There was an acknowledged paucity of formal evidence supporting possible benefits. Fewer than 10% of respondents could identify institutional or national guidelines for albumin use. A lack of evidence supporting albumin use in cardiac surgical patients, especially those at highest risk of complications, was a frequently identified concern., Conclusions: The majority of Canadian anesthesiologists and intensivists (62%) use albumin in cardiac surgical patients. There is clinical equipoise regarding its utility, and an acknowledged need for higher quality evidence to guide practice., (© 2022. Canadian Anesthesiologists' Society.)

Drosophila suzukii (Matsumura), spotted-wing drosophila, is a major pest in small fruit crops including highbush blueberry. Controlling D. suzukii is challenging and chemical control is the main method to manage D. suzukii populations. Growers have expressed interest in using micro-sprinklers as an alternative method to apply insecticides. The current study aimed to evaluate if insecticide applications using micro-sprinklers can be used as an alternative method to protect the fruit from D. suzukii egg-laying. Modeling was used as an additional tool to parameterize the relative insecticide efficacy on oviposition. Field measurements of different treatments were conducted over periods of eleven days on commercial-standard highbush blueberry. Cyantraniliprole and spinetoram were applied using both a micro-sprinkler and a backpack sprayer. Treatments of Chromobacterium subtsugae and zeta-cypermethrin were only applied using a backpack sprayer. Both cyantraniliprole and spinetoram treatments resulted in moderate suppression of D. suzukii egg-laying. No statistical significance was found between micro-sprinkler and backpack sprayer applications for these two insecticides. Zeta-cypermethrin treatments using a backpack sprayer resulted in the most significant suppression of D. suzukii egg-laying over eleven days, while C. subtsugae was less effective at preventing D. suzukii egg-laying. Modeling simulations estimate the impact of the control methods on D. suzukii populations dynamics and simulation outputs indicated that backpack sprayers reduced D. suzukii populations at more pronounced levels compared to micro-sprinkler applications. The present study indicates that there is an underlying value of micro-sprinkler systems as an alternative and rapid spray application technique to help suppress D. suzukii pest populations during high-pressure periods in highbush blueberry production., (© The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Sex pheromones are commonly used in traps to monitor populations and movements of male click beetles, but to date few attractants have been identified for females. Notable exceptions are plant-derived kairomones for female Agriotes brevis and A. ustulatus , allowing the monitoring of both males and females of these species with lures containing both pheromones and plant volatiles. The attractiveness of these plant volatiles for two congeners, A. obscurus and A. lineatus , which are agricultural pests in Europe and North America, was evaluated in the current study. Both the four-component MINIM plant-derived lure for A. brevis , and the blend of ( E )-anethol and ( E )-cinnamaldehyde for A. ustulatus , were not attractive to A. obscurus and A. lineatus , and instead appeared to reduce captures-both when compared to blank controls, and when blended with and compared to the sex pheromones of these species. This was most pronounced in A. obscurus , where ( E )-anethol and ( E )-cinnamaldehyde reduced male captures by 43 and 37%, respectively. Combining the pheromones of A. obscurus and A. lineatus reduced captures of these species by 77 and 19%, respectively, compared to these pheromones singly. This suggests that attractants for female click beetles can be highly species-specific, and that the blending of pheromones of congeneric species with each other, or with plant volatiles, can reduce captures. Further research into developing such attractants for economic species is urgently needed.

Background: Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records., Objective: This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives., Methods: An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions., Results: At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3% (967/1458) were male, 70.9% (1033/1458) were white, and 80.8% (1178/1458) had private insurance. Response rate was 26.8% (391/1458); 46.3% (180/389) were very satisfied with AHR, and 67.7% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9%), clinical vitals (264/391, 67.5%), and medications (253/391, 64.7%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration., Conclusions: Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information., (©Joshua Rolnick, Robin Ward, Gordon Tait, Neha Patel. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.01.2022.)

Drosophila suzukii (Matsumura) (Diptera: Drosophilidae) also known as spotted-wing drosophila (SWD), is a pest native to Southeast Asia. In the last few decades, the pest has expanded its range to affect all major European and American fruit production regions. SWD is a highly adaptive insect that is able to disperse, survive, and flourish under a range of environmental conditions. Infestation by SWD generates both direct and indirect economic impacts through yield losses, shorter shelf life of infested fruit, and increased production costs. Fresh markets, frozen berries, and fruit export programs have been impacted by the pest due to zero tolerance for fruit infestation. As SWD control programs rely heavily on insecticides, exceedance of maximum residue levels (MRLs) has also resulted in crop rejections. The economic impact of SWD has been particularly severe for organic operations, mainly due to the limited availability of effective insecticides. Integrated pest management (IPM) of SWD could significantly reduce chemical inputs but would require substantial changes to horticultural management practices. This review evaluates the most promising methods studied as part of an IPM strategy against SWD across the world. For each of the considered techniques, the effectiveness, impact, sustainability, and stage of development are discussed., (© The Author(s) 2021. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Mediterranean fruit fly (medfly), Ceratitis capitata, is a worldwide pest of agriculture able to use olfactory cues to locate habitat, food sources, mates and oviposition sites. The sensitivity of medfly olfaction has been exploited to develop olfactory-based attractants that are currently important tools for detection, control and eradication of its populations. Among these is Cera Trap ® (BIOIBERICA, S.A.U.), a cost-effective bait. Here we used coupled gas chromatography/electroantennographic detection (GC-EAD) and GC/mass spectrometry (GC-MS) approaches to characterize the medfly antennally-active compounds released by this lure. We identified GC peaks corresponding to chemicals belonging to six different classes including heterocyclic aromatic compounds, aliphatic alcohols, aldehydes, esters, sesquiterpene hydrocarbons, and aromatic alcohols. We tested ten potential candidate volatiles belonging to these classes and predicted to be emitted by the lure and found that they were eliciting electroantennographic responses in medfly adults. These results will help in unravelling the physiological mechanisms of odor perception in both sexes, especially in relation to Cera Trap ® attractant activity, which in the field has been shown to be female-specific. These findings and their developments will ultimately expand the toolbox for medfly control in the field.

Drosophila suzukii Matsumura is an economically important pest of small and stone fruits. Its establishment in the Americas and Europe marked an important turning point in crop management programs. Ten years after its first detection, an effective integrated pest management program has yet to be developed and pesticides are mainly used to control this pest. Here we test a new behavioral control tool, with the aim to develop an alternative pest control strategy. A food-grade gum matrix, was evaluated under controlled and open field conditions for its ability to attract the pest and protect the ripening fruit. Here, we report that the gum effectively reduces fruit infestation when used under managed conditions. We show that a single point source can affect D. suzukii behavior over a 3.6 m radius and last for up to 21 d. Open field data reveal that the efficacy of the gum is significantly impacted by water content. We discuss these results in respect to the future implications for D. suzukii management, along with important considerations on gum mechanism of action, possible application strategies and economic suitability for growers., (© The Author(s) 2020. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Drosophila suzukii is an invasive pest that prefers to lay eggs in ripening fruits, whereas most closely related Drosophila species exclusively use rotten fruit as oviposition site. This behaviour is allowed by an enlarged and serrated ovipositor that can pierce intact fruit skin, and by multiple contact sensory systems (mechanosensation and taste) that detect the optimal egg-laying substrates. Here, we tested the hypothesis that bristles present in the D. suzukii ovipositor tip contribute to these sensory modalities. Analysis of the bristle ultrastructure revealed that four different types of cuticular elements (conical pegs type 1 and 2, chaetic and trichoid sensilla) are present on the tip of each ovipositor plate. All of them have a poreless shaft and are innervated at their base by a single neuron that ends in a distal tubular body, thus resembling mechanosensitive structures. Fluorescent labelling in D. suzukii and D. melanogaster revealed that pegs located on the ventral side of the ovipositor tip are innervated by a single neuron in both species. RNA-sequencing profiled gene expression, notably sensory receptor genes of the terminalia of D. suzukii and of three other Drosophila species with changes in their ovipositor structure (from serrated to blunt ovipositor: Drosophila subpulchrella, Drosophila biarmipes and D. melanogaster). Our results revealed few species-specific transcripts and an overlapping expression of candidate mechanosensitive genes as well as the presence of some chemoreceptor transcripts. These experimental evidences suggest a mechanosensitive function for the D. suzukii ovipositor, which might be crucial across Drosophila species independently from ovipositor shape., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Drosophila suzukii (Matsumura) is a vinegar fly species that originates from Eastern Asia and has spread throughout Europe and the Americas since its initial detection in United States in 2008. Its relatively large, sclerotized, and serrated ovipositor enables the ability to penetrate ripening fruits, providing a protected environment for its egg and larval stages. Because the mechanism of oviposition site selection of D. suzukii is a matter of hypothesis, the aim of the present study was to elucidate behavioral and chemical aspects of short-range ovipositional site selection within the context of D. suzukii reproductive biology. The preference of D. suzukii to lay eggs on artificially pierced, previously infested, or intact fruits was tested. Video recordings and photographic evidence documented the release of an anal secretion over the fruit surface near the oviposition sites. Gas chromatographic analysis revealed the presence of 11 compounds detected only on the skin of egg-infested berries. Electroantennographic experiments with both sexes of D. suzukii highlighted the importance of six volatile compounds: methyl myristate, methyl palmitate, myristic acid, lauric acid, palmitic acid, and palmitoleic acid. Finally, a synthetic blend composed of the six compounds in a ratio similar to that found on the skin of egg-infested berries increased the oviposition rate of conspecific females. Data from our work suggest that the identified volatiles are cues for reproductive site selection. We discuss how these oviposition cues may affect the fitness of D. suzukii. The knowledge gained from this study may accelerate establishment of control strategies based on the interference and disruption of D. suzukii communication during the oviposition processes., (© The Author(s) 2020. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Organophosphate esters (OPEs) are a class of semi-volatile organic compounds (SVOCs) used as flame retardants, plasticizers, and anti-foaming agents. Due to stringent flammability standards in vehicles and the ability of OPEs to migrate out of end-use products, elevated concentrations of OPEs have been found in car dust samples around the world. As many residents of Southern California spend a significant amount of time in their vehicles, there is potential for increased exposure to OPEs associated with longer commute times. As approximately 70% of the University of California, Riverside's undergraduate population commutes, the objective of this study was to use silicone wristbands to monitor personal exposure to OPEs and determine if exposure was associated with commute time in a subset of these students. Participants were asked to wear wristbands for five continuous days and complete daily surveys about the amount of time spent commuting. Data were then used to calculate a participant-specific total commute score. Components of Firemaster 550 (triphenyl phosphate, or TPHP, and isopropylated triaryl phosphate isomers) and Firemaster 600 (TPHP and tert-butylated triaryl phosphate isomers) - both widely used commercial flame retardant formulations - were strongly correlated with other OPEs detected within participant wristbands. Moreover, the concentration of tris(1,3-dichloro-2-propyl) phosphate (TDCIPP) was significantly correlated with the concentration of several Firemaster 500 components and tris(2-chloroisopropyl) phosphate (TCIPP). Finally, out of all OPEs measured, TDCIPP was significantly and positively correlated with total commute score, indicating that longer commutes are associated with increased human exposure to TDCIPP. Overall, our findings raise concerns about the potential for chronic TDCIPP exposure within vehicles and other forms of transportation, particularly within densely populated and traffic-congested areas such as Southern California., Competing Interests: Declaration of Competing Interest We declare that we have no conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In an attempt to improve care while decreasing costs and postoperative pain, we developed a novel IoS mobile health application, NeuroPath. The objective of this innovative app is to integrate enhanced recovery after surgery (ERAS) principles, patient education, and real-time pain and activity monitoring in a home setting with unencumbered two-way communication., Methods: The NeuroPath application was built over 18 months, with support from Apple, Medable, the Department of Information-Technology and the Department of Neurosurgery. Target areas addressed by NeuroPath include patient prep for surgery, perioperative risk mitigation, activity monitoring, wound care, and opioid use management. These target areas are monitored through a provider app, which is downloaded to the care providers IPad Mini. The provider app permits real time viewing of wound healing (patient incision photographs), activity levels, pain levels, and narcotic usage. Participants are given a daily To-Do list, via the Care Card section of the interface. The To-Do list presents the patient with specific tasks for exercise, instructions to wash incision area, pre-operative instructions, directions for discussing medication with care team, among other patient specific recommendations., Results: Of the 30 patients enrolled in the pilot study, there was a range of activity on the app. Patients with high involvement in the app logged in nearly every day from a week pre-op to >45 days post-op. Data for patients that utilized the app and uploaded regularly show trends of appropriately healing wounds, decreasing levels of pain, increasing step counts, and discontinuation of narcotics., Conclusions: This pilot study of the NeuroPath app demonstrates its potential utility for improving quality of patient care without increased costs. Participants who regularly used the app showed consistent improvement throughout the post-operative recovery period (increasing ambulation, decreasing pain and guided reduction in narcotic usage)., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 mHealth. All rights reserved.)

Background: As health care costs rise, medical education must focus on high-value clinical decision making. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed to simulate real patient encounters to increase price transparency and reinforce cost consciousness. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed METHODS: The VIC modules were distributed to a sample of medical students and internal medicine residents, who were required to assess patients, order appropriate investigations, develop differential diagnoses and formulate management plans. Each action was associated with a time and price, with the totals compared against ideals. Trainees were evaluated not only on their diagnosis and patient management, but also on the total time, cost and value of their selected workup. Trainee responses were tracked anonymously, with opportunity to provide feedback at the end of each case., Results: Seventeen medical trainees completed a total of 48 VIC modules. On average, trainees spent CAN $227.52 and 68 virtual minutes on each case, which was lower than expected. This may have been the result of a low management score of 52.4%, although on average 92.0% of participants in each case achieved the correct diagnosis. In addition, 85.7% felt more comfortable working up similar cases, and 57.1% believed that the modules increased their ability to appropriately order cost-conscious rheumatology investigations., Discussion: Our initial assessment of the VIC rheumatology modules was positive, supporting their role as an effective tool in teaching an approach to rheumatology patients, with an emphasis on resource stewardship. Future directions include the expansion of cases, based on feedback, wider dissemination and an evaluation of learning retention., (© 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Invasive animals depend on finding a balanced nutritional intake to colonize, survive, and reproduce in new environments. This can be especially challenging during situations of fluctuating cold temperatures and food scarcity, but phenotypic plasticity may offer an adaptive advantage during these periods. We examined how lifespan, fecundity, pre-oviposition periods, and body nutrient contents were affected by dietary protein and carbohydrate (P:C) ratios at variable low temperatures in two morphs (winter morphs WM and summer morphs SM) of an invasive fly, Drosophila suzukii. The experimental conditions simulated early spring after overwintering and autumn, crucial periods for survival. At lower temperatures, post-overwintering WM lived longer on carbohydrate-only diets and had higher fecundity on low-protein diets, but there was no difference in lifespan or fecundity among diets for SM. As temperatures increased, low-protein diets resulted in higher fecundity without compromising lifespan, while high-protein diets reduced lifespan and fecundity for both WM and SM. Both SM and WM receiving high-protein diets had lower sugar, lipid, and glycogen (but similar protein) body contents compared to flies receiving low-protein and carbohydrate-only diets. This suggests that flies spend energy excreting excess dietary protein, thereby affecting lifespan and fecundity. Despite having to recover from nutrient depletion after an overwintering period, WM exhibited longer lifespan and higher fecundity than SM in favorable diets and temperatures. WM exposed to favorable low-protein diet had higher body sugar, lipid, and protein body contents than SM, which is possibly linked to better performance. Although protein is essential for oogenesis, WM and SM flies receiving low-protein diets did not have shorter pre-oviposition periods compared to flies on carbohydrate-only diets. Finding adequate carbohydrate sources to compensate protein intake is essential for the successful persistence of D. suzukii WM and SM populations during suboptimal temperatures., Competing Interests: The authors declare no competing interests.

Objective. To assess students' impressions on whether Virtual Interactive Cases (VICs) contribute to their learning experience. Methods. Ten fourth- year pharmacy students each independently completed the same four VICs followed by a semi-structured interview conducted by VIC project team members. The interviews were audio-recorded, transcribed, and coded for themes using qualitative research methods. Results. All participating students completed all the cases. Overall, students' feedback on VIC was positive. Five main themes emerged from the transcripts: VIC facilitated their skills in information gathering; they learned from the built-in, real-time, formative feedback; they had a fun and positive learning experience; VICs were realistic; and VIC system was user-friendly. Students also recommended that VIC be incorporated into classroom learning. Some students required additional explanation on the concept of time and costs associated with each action they selected, and the associated performance score. Conclusion. Pharmacy students' positive experiences with VICs support its use to bridge classroom learning with clinical practice.