An Exploration of Student Perception Toward Interprofessional High-Fidelity Clinical Simulation.

OBJECTIVES: Interprofessional education is recognized for its potential for collaboration and teamwork, reflecting clinical practice; however, existing literature for simulation-based interprofessional education does not include Physician Associate (PA) students. This initiative aimed to explore the students' perception of interprofessional clinical simulation for PA students and allied health professional (AHP) students as part of our program development. METHODS: A high-fidelity simulation session was designed and conducted for volunteering students from the PA, paramedic science, and physiotherapy courses. We used a mixed-method electronic questionnaire consisting of 15 statements rated on a numerical rating scale (0-5) and four open-ended questions with unlimited free-text responses to explore student perceptions. Inductive thematic analysis was used for qualitative analysis. The session design was underpinned by Allport's (intergroup) contact hypothesis with an emphasis on mutual intergroup differentiation. RESULTS: Forty-six students participated in the simulation teaching, with 48% (n = 22) providing feedback. Overall student perception was mainly positive toward the interprofessional simulation; however, some barriers to learning were recognized. Based on the evaluation of our initiative and existing literature, we propose 5 top tips to promote an effective learning experience for students. (1) Understand the importance of interprofessional collaboration. (2) Establish clear roles. (3) Plan the scenarios in advance. (4) Maintain equal status between groups. (5) Provide clear instructions and expectations. CONCLUSION: To our knowledge, this is the first study of high-fidelity interprofessional simulation involving PA and AHP students. We successfully explored student perception which highlighted aspects that can impact learning. This pilot study demonstrated that interprofessional simulation is a feasible and acceptable form of learning for our students and highlighted how to improve future interprofessional simulation teaching sessions.

Frost prediction using machine learning and deep neural network models.

This study describes accurate, computationally efficient models that can be implemented for practical use in predicting frost events for point-scale agricultural applications. Frost damage in agriculture is a costly burden to farmers and global food security alike. Timely prediction of frost events is important to reduce the cost of agricultural frost damage and traditional numerical weather forecasts are often inaccurate at the field-scale in complex terrain. In this paper, we developed machine learning (ML) algorithms for the prediction of such frost events near Alcalde, NM at the point-scale. ML algorithms investigated include deep neural network, convolution neural networks, and random forest models at lead-times of 6-48 h. Our results show promising accuracy (6-h prediction RMSE = 1.53-1.72°C) for use in frost and minimum temperature prediction applications. Seasonal differences in model predictions resulted in a slight negative bias during Spring and Summer months and a positive bias in Fall and Winter months. Additionally, we tested the model transferability by continuing training and testing using data from sensors at a nearby farm. We calculated the feature importance of the random forest models and were able to determine which parameters provided the models with the most useful information for predictions. We determined that soil temperature is a key parameter in longer term predictions (>24 h), while other temperature related parameters provide the majority of information for shorter term predictions. The model error compared favorable to previous ML based frost studies and outperformed the physically based High Resolution Rapid Refresh forecasting system making our ML-models attractive for deployment toward real-time monitoring of frost events and damage at commercial farming operations.

A reflective process led by a family physician to develop a renal-protection surveillance tool for HIV patients newly started on dolutegravir.

A group of Vanguard Community Health Centre doctors embarked on a Health System's Improvement (HSI) project with the aim of reducing harm to renal function in patients who were either commenced on or switched to a dolutegravir (DTG)-based antiretroviral therapy (ART) regimen since 2019, when the usual monitoring and evaluation of ART-regimen switches were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This intended harm-reduction exercise, involving a reflective process that was facilitated by the family physician, led to the development of a Vanguard Renal Protection Surveillance tool, which is now used at Vanguard to detect and prevent renal decline.

Demonstrating the potential of a novel spider venom-based biopesticide for target-specific control of the small hive beetle, a serious pest of the European honeybee.

The parasitic small hive beetle (Aethina tumida) feeds on pollen, honey and brood of the European honey bee (Apis mellifera); establishment in North America and Australia has resulted in severe economic damage to the apiculture industry. We report potential for the "in-hive" use of a novel biopesticide that is toxic to this invasive beetle pest but harmless to honeybees. Constructs encoding the spider venom neurotoxin ω-hexatoxin-Hv1a (Hv1a) linked to the N- or C-terminus of snowdrop lectin (GNA) were used to produce recombinant Hv1a/GNA and GNA/Hv1a fusion proteins. Both were similarly toxic to beetles by injection (respective LD50s 1.5 and 0.9 nmoles/g larvae), whereas no effects on adult honeybee survival were observed at injection doses of > 200 nmoles/g insect. When fed to A. tumida larvae, GNA/Hv1a was significantly more effective than Hv1a/GNA (LC50s of 0.52 and 1.14 mg/ml diet, respectively), whereas both proteins were similarly toxic to adults. Results suggested that the reduced efficacy of Hv1a/GNA against larvae was attributable to differences in the susceptibility of the fusion proteins to cleavage by gut serine proteases. In laboratory assays, A. tumida larval survival was significantly reduced when brood, inoculated with eggs, was treated with GNA/Hv1a.

Insecticidal effects of dsRNA targeting the Diap1 gene in dipteran pests.

The Drosophila melanogaster (fruit fly) gene Diap1 encodes a protein referred to as DIAP1 (D rosophila Inhibitor of Apoptosis Protein 1) that acts to supress apoptosis in "normal" cells in the fly. In this study we investigate the use of RNA interference (RNAi) to control two dipteran pests, Musca domestica and Delia radicum, by disrupting the control of apoptosis. Larval injections of 125-500 ng of Diap1 dsRNA resulted in dose-dependent mortality which was shown to be attributable to down-regulation of target mRNA. Insects injected with Diap1 dsRNA have approx. 1.5-2-fold higher levels of caspase activity than controls 24 hours post injection, providing biochemical evidence that inhibition of apoptotic activity by the Diap1 gene product has been decreased. By contrast adults were insensitive to injected dsRNA. Oral delivery failed to induce RNAi effects and we suggest this is attributable to degradation of ingested dsRNA by intra and extracellular RNAses. Non-target effects were demonstrated via mortality and down-regulation of Diap1 mRNA levels in M. domestica larvae injected with D. radicum Diap1 dsRNA, despite the absence of 21 bp identical sequence regions in the dsRNA. Here we show that identical 15 bp regions in dsRNA are sufficient to trigger non-target RNAi effects.

Systemic RNAi in the small hive beetle Aethina tumida Murray (Coleoptera: Nitidulidae), a serious pest of the European honey bee Apis mellifera.

BACKGROUND: Aethina tumida is a serious pest of the European honey bee (Apis mellifera) in North America and Australia. Here we investigate whether Laccase 2, the phenoloxidase gene essential for cuticle sclerotisation and pigmentation in many insects, and vacuolar-ATPase V-type subunit A, vital for the generation of proton gradients used to drive a range of transport processes, could be potential targets for RNAi-mediated control of A. tumida. RESULTS: Injection of V-ATPase subunit A (5 ng) and Laccase 2 (12.5 ng) dsRNAs resulted in 100% larval mortality, and qPCR confirmed significant decreases and enhanced suppression of transcript levels over time. Oral delivery of V-ATPase subunit A dsRNA in solutions resulted in 50% mortality; however, gene suppression could not be verified. We suggest that the inconsistent RNAi effect was a consequence of dsRNA degradation within the gut owing to the presence of extracellular nucleases. Target specificity was confirmed by a lack of effect on survival or gene expression in honey bees injected with A. tumida dsRNAs. CONCLUSION: This is the first study to show evidence for systemic RNAi in A. tumida in response to injected dsRNA, but further research is required to develop methods to induce RNAi effects via ingestion. © 2016 Crown copyright. Pest Management Science © 2016 Society of Chemical Industry.

Speech processing and production in two-year-old children acquiring isiXhosa: A tale of two children.

We investigated the speech processing and production of 2-year-old children acquiring isiXhosa in South Africa. Two children (2 years, 5 months; 2 years, 8 months) are presented as single cases. Speech input processing, stored phonological knowledge and speech output are described, based on data from auditory discrimination, naming, and repetition tasks. Both children were approximating adult levels of accuracy in their speech output, although naming was constrained by vocabulary. Performance across tasks was variable: One child showed a relative strength with repetition, and experienced most difficulties with auditory discrimination. The other performed equally well in naming and repetition, and obtained 100% for her auditory task. There is limited data regarding typical development of isiXhosa, and the focus has mainly been on speech production. This exploratory study describes typical development of isiXhosa using a variety of tasks understood within a psycholinguistic framework. We describe some ways in which speech and language therapists can devise and carry out assessment with children in situations where few formal assessments exist, and also detail the challenges of such work.

Global honey bee viral landscape altered by a parasitic mite.

Emerging diseases are among the greatest threats to honey bees. Unfortunately, where and when an emerging disease will appear are almost impossible to predict. The arrival of the parasitic Varroa mite into the Hawaiian honey bee population allowed us to investigate changes in the prevalence, load, and strain diversity of honey bee viruses. The mite increased the prevalence of a single viral species, deformed wing virus (DWV), from ~10 to 100% within honey bee populations, which was accompanied by a millionfold increase in viral titer and a massive reduction in DWV diversity, leading to the predominance of a single DWV strain. Therefore, the global spread of Varroa has selected DWV variants that have emerged to allow it to become one of the most widely distributed and contagious insect viruses on the planet.

Screening Commercially Available Entomopathogenic Biocontrol Agents for the Control of Aethina tumida (Coleoptera: Nitidulidae) in the UK.

The Small hive beetle, Aethina tumida, is an invasive pest of honey bees. Indigenous to sub-Saharan Africa, it has now become established in North America and Australia. It represents a serious threat to European honey bees. Commercially available entomopathogenic agents were screened for their potential to control beetle larvae. Entomopathogenic fungi investigated had minimal impact. The nematodes Steinernema kraussei and S. carpocapsae provided excellent control with 100% mortality of larvae being obtained. Sequential applications of the nematodes following larvae entering sand to pupate also provided excellent control for up to 3 weeks. The information gained supports the development of contingency plans to deal with A. tumida should it occur in the UK, and is relevant to the management of Small hive beetle where it is already present.

Insecticidal activity of scorpion toxin (ButaIT) and snowdrop lectin (GNA) containing fusion proteins towards pest species of different orders.

BACKGROUND: The toxicity of a fusion protein, ButalT/GNA, comprising a venom toxin (ButaIT) derived from the red scorpion, Mesobuthus tamulus (F.), and Galanthus nivalis agglutinin (GNA), was evaluated under laboratory conditions against several pest insects. Insecticidal activity was compared with SFI1/GNA, a fusion comprising a venom toxin (SFI1) derived from the European spider Segestria florentina (Rossi) and GNA, which has been previously demonstrated to be effective against lepidopteran and hemipteran pests, and to GNA itself. RESULTS: Injection assays demonstrated that both fusion proteins were toxic to lepidopteran larvae, dipteran adults, coleopteran adults and larvae and dictyopteran nymphs. ButalT/GNA was more toxic than SFI1/GNA in all cases. GNA itself made a minor contribution to toxicity. Oral toxicity of ButalT/GNA towards lepidopteran pests was confirmed against neonate Spodoptera littoralis (Boisd.), where incorporation at 2% dietary protein resulted in 50% mortality and > 85% reduction in growth compared with controls. ButaIT/GNA was orally toxic to Musca domestica L. adults, causing 75% mortality at 1 mg mL(-1) in aqueous diets and, at 2 mg g(-1) it was orally toxic to Tribolium castaneum (Herbst.), causing 60% mortality and a 90% reduction in growth. CONCLUSIONS: Toxicity of the ButaIT/GNA recombinant fusion protein towards a range of insect pests from different orders was demonstrated by injection bioassays. Feeding bioassays demonstrated the potential use of the ButaIT/GNA fusion protein as an orally active insecticide against lepidopteran, dipteran and coleopteran pests. These experiments provide further evidence that the development of fusion protein technology for the generation of new, biorational, anti-insect molecules holds significant promise.

Message for mums-to-be. Interview by Lynne Pearce.

A major campaign to help pregnant women stop smoking begins this week.

Birth, morphologic, and blood characteristics of free-ranging white-tailed deer neonates.

Winter severity is a primary factor influencing deer survival and reproduction in northern climates. Prolonged, harsh winters can adversely affect body condition of does, resulting in depressed morphologic development of neonates. In this study, we captured 59 white-tailed deer (Odocoileus virginianus) neonates (28 in 2001 and 31 in 2002), following two distinctly different winters, one severe and the other historically mild. Vaginal implant transmitters allowed exact age to be determined for 73% of the neonates; new hoof growth was used to estimate age (days) of the other 27%. Birthdate and morphologic measurements of neonates (i.e., birth mass, new hoof growth, hoof length) were compared by sex and capture year. For known-age neonates (n=43), there was a year-by-sex interaction effect (P=0.01) on birthdate, being later for females during spring 2001 compared with 2002, which was consistent with a significant (P=0.03) year-by-sex interaction for total hoof length (22.3 mm [SE=0.9] and 20.3 [SE=0.8] for females and males in 2001; 19.9 [SE=1.0] and 22.1 [SE=1.0] for females and males in 2002). Interestingly, there was no effect of year on birth mass or birthdate of known-age neonates. A year-by-sex interaction (P=0.04) was determined for birthdates of estimated age (5 yr old were born later (P<0.01) than fawns born to dams

The impact of parkinsonism on costs of care in patients with AD and dementia with Lewy bodies.

OBJECTIVE: To compare the annual direct costs for patients with Alzheimer's disease (AD) and no parkinsonism (AD), patients with AD and parkinsonism (AD/P), and patients with dementia with Lewy bodies (DLB). For the entire sample, the authors examined the incremental costs associated with increasing parkinsonism. METHODS: Cross-sectional comparisons of 1 year of direct costs were done. Fifteen patients met criteria for DLB, and 133 met criteria for probable AD, of whom 39 had signs of parkinsonism and 94 did not. Patients' caregivers reported on the patient's use of health care services, receipt of unpaid care, and comorbid medical conditions. Severity of cognitive impairment and parkinsonism were determined during patient examinations. Costs were estimated by multiplying utilization data by a unit cost for each type of care. Costs were compared after adjustment for covariates using multiple regression equations. RESULTS: After adjusting for important covariates, patients with AD/P or DLB had significantly higher annual direct costs than patients with AD. The average adjusted increases in costs above the AD baseline costs were 7,119 dollars (AD/P) and 13,754 dollars (DLB) for formal direct costs and 7,394 dollars (AD/P) and 19,564 dollars (DLB) for total direct costs. Models for the entire sample estimated that a 1-point increase in a parkinsonism scale would result in an annual increase of 784 dollars in formal costs and 827 dollars in total costs of care. CONCLUSIONS: Patients with Alzheimer's disease and parkinsonism or dementia with Lewy bodies have significantly higher formal and total direct costs of care than patients with Alzheimer's disease. Signs of parkinsonism in patients with degenerative dementias are significant independent predictors of costs of care.