Peer Instruction as an Alternative Active Learning Pedagogy Across the Pharmacy Curriculum.

OBJECTIVE: The objective of this study was to determine if peer instruction (PI) is a useful active learning pedagogy to increase correct responses to pharmacotherapy concepts throughout didactic education in a Doctor of Pharmacy curriculum. METHODS: Peer instruction was implemented into 3 pharmacy practice courses spanning 3 years of didactic pharmacy education at Cedarville University: Introduction to Self-Care (PHAR 6112) in the first professional year, Respiratory Module (PHAR 6261) in the second professional year, and Special Populations Module (PHAR 7343) in the third professional year. ConcepTests, which are multiple-choice questions written to help students apply previous knowledge to new scenarios, were re-polled based on a PI algorithm after peer discussion. Changes in students paired before and after peer discussion ConcepTest responses were analyzed using a McNemar test and descriptive statistics. RESULTS: A total of 52 first-year students, 43 second-year students, and 49 third-year students participated in each respective course. Across all courses, an increase in the percentage of correct responses to ConceptTests after peer discussion was observed from the first polling (51.2%) to the second polling (90.4%). This increase in the percentage of correct responses was observed across all years of the curriculum, with greater increases in cohorts with previous participation in PI-based sessions. CONCLUSION: The use of PI fostered improvement in the percentage of correct responses to ConcepTests focused on pharmacotherapy concepts throughout the first 3 years of didactic education. This pedagogy may be an effective and useful active learning strategy in pharmacy education that does not require significant classroom infrastructure changes.

Community pharmacies and the empowerment of self-care in the United States.

Background: As part of self-care, patients prevent diseases or conditions, maintain, or enhance their current health status, and address current health challenges. As a key member of the healthcare team, the role of the pharmacist in relation to self-care is important, given the ease of access to pharmacists in a variety of care settings. Objectives: To describe the structure and function of self-care within community pharmacies throughout the United States (U.S.). Methods: The literature within the U.S. was reviewed related to self-care definitions and practice, the role and training of the pharmacist, and challenges and opportunities for pharmacists. Results: Within the U.S., self-care is broader than simply products found in the "over-the-counter" (OTC) section of pharmacies; it includes pharmacists involvement in disease prevention, evaluation and maintenance of current health status, and assistance in managing health challenges. There is growing recognition of the significance of pharmacists in aiding patients in self-care, due to publication of outcomes related to pharmacist-provided self-care support. Accreditation standards require student pharmacists to develop knowledge and competency related to the broadest definition of self-care; resources exist related to curricular content and student evaluation and assessment support. The evolving role of the pharmacist in relation to self-care has presented challenges in terms of recognition and renumeration for services and workload issues. Efforts are currently underway to address these challenges. Conclusions: Spiraling health care costs, poor health outcomes, and continued health disparities indicate a need to better support U.S. patients on their health care journey, which often begins with self-care. There is a plethora of opportunities for pharmacists to advocate for expanding roles related to self-care, including participation in national efforts to recognize the outcomes of pharmacists in self-care.

Displacement experiments provide evidence for path integration in Drosophila.

Like many other animals, insects are capable of returning to previously visited locations using path integration, which is a memory of travelled direction and distance. Recent studies suggest that Drosophila can also use path integration to return to a food reward. However, the existing experimental evidence for path integration in Drosophila has a potential confound: pheromones deposited at the site of reward might enable flies to find previously rewarding locations even without memory. Here, we show that pheromones can indeed cause naïve flies to accumulate where previous flies had been rewarded in a navigation task. Therefore, we designed an experiment to determine if flies can use path integration memory despite potential pheromonal cues by displacing the flies shortly after an optogenetic reward. We found that rewarded flies returned to the location predicted by a memory-based model. Several analyses are consistent with path integration as the mechanism by which flies returned to the reward. We conclude that although pheromones are often important in fly navigation and must be carefully controlled for in future experiments, Drosophila may indeed be capable of performing path integration.

Implementation of a pharmacist-led spirometry clinic.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions, with spirometry serving as the gold standard for diagnosis. However, a lack of available resources, providers, and time limits appropriate diagnosis of COPD and disease staging. These factors culminate in suboptimal therapeutic management of the disease and often pharmacotherapy regimens that are not supported by Global Initiative for Chronic Obstructive Lung Disease guidelines. OBJECTIVES: The primary objective of the study was to develop and implement a pharmacist-led spirometry clinic to assess the confirmation of COPD diagnosis and pharmacotherapy management. PRACTICE DESCRIPTION: Two federally qualified health centers (FQHCs) in Ohio: Family Health Services of Darke County (FHS) and Rocking Horse Community Health Center (RHCHC). Both FQHCs have clinical pharmacists on staff who provide disease state management services for chronic disease states through a collaborative practice agreement. PRACTICE INNOVATION: At each FQHC, a pharmacist-led COPD and spirometry management service was implemented. This service consisted of disease state education, therapy modifications, and spirometry services for annual and confirmation of diagnosis for COPD patients. EVALUATION METHODS: A retrospective chart review was conducted. Data collection occurred from December 2021 to May 2022. Patients included were 18 years and older with a confirmed diagnosis of COPD. Therapies before spirometry services, COPD assessment test scores, age, gender, and history of exacerbations within the last 12 months were collected. RESULTS: Eight patients at FHS and 1 patient at RHCHC were included in the data analysis. Two patients had their disease state confirmed after postbronchodilator spirometry. Five pharmacotherapy modifications were made for patients evaluated in the analysis. CONCLUSION: Pharmacists in FQHC's are crucial resources to design, implement, and lead spirometry services for the management of COPD within the primary care setting, therefore increasing adherence to guideline recommendations.

Real-Time Tracking of Multiple Moving Mosquitoes.

Tracking mosquitoes in real time, as opposed to recording video files and performing the tracking step later, is useful for two reasons. The first is efficiency. Real-time tracking requires less storage because video images do not need to be saved and followed by a tracking step. The second is that tracking data can be used to interact with the animal in some way, such as triggering the approach of a looming object. In this protocol, we discuss the use of Braid, free software for performing real-time, multicamera, multianimal tracking. We describe a setup with four cameras capable of tracking the three-dimensional (3D) position of mosquitoes at 100 frames per second in a volume of 30 cm × 30 cm × 60 cm with millimeter accuracy. The specific hardware configuration is flexible and can be substituted using different or additional components to adjust the tracking parameters as needed.

A Rapid, Highly Sensitive and Open-Access SARS-CoV-2 Detection Assay for Laboratory and Home Testing.

RT-qPCR-based diagnostic tests play important roles in combating virus-caused pandemics such as Covid-19. However, their dependence on sophisticated equipment and the associated costs often limits their widespread use. Loop-mediated isothermal amplification after reverse transcription (RT-LAMP) is an alternative nucleic acid detection method that overcomes these limitations. Here, we present a rapid, robust, and sensitive RT-LAMP-based SARS-CoV-2 detection assay. Our 40-min procedure bypasses the RNA isolation step, is insensitive to carryover contamination, and uses a colorimetric readout that enables robust SARS-CoV-2 detection from various sample types. Based on this assay, we have increased sensitivity and scalability by adding a nucleic acid enrichment step (Bead-LAMP), developed a version for home testing (HomeDip-LAMP), and identified open-source RT-LAMP enzymes that can be produced in any molecular biology laboratory. On a dedicated website, rtlamp.org (DOI: 10.5281/zenodo.6033689), we provide detailed protocols and videos. Our optimized, general-purpose RT-LAMP assay is an important step toward population-scale SARS-CoV-2 testing.

Diurnal and nocturnal mosquitoes escape looming threats using distinct flight strategies.

Flying insects have evolved the ability to evade looming objects, such as predators and swatting hands. This is particularly relevant for blood-feeding insects, such as mosquitoes that routinely need to evade the defensive actions of their blood hosts. To minimize the chance of being swatted, a mosquito can use two distinct strategies-continuously exhibiting an unpredictable flight path or maximizing its escape maneuverability. We studied how baseline flight unpredictability and escape maneuverability affect the escape performance of day-active and night-active mosquitoes (Aedes aegypti and Anopheles coluzzii, respectively). We used a multi-camera high-speed videography system to track how freely flying mosquitoes respond to an event-triggered rapidly approaching mechanical swatter, in four different light conditions ranging from pitch darkness to overcast daylight. Results show that both species exhibit enhanced escape performance in their natural blood-feeding light condition (daylight for Aedes and dark for Anopheles). To achieve this, they show strikingly different behaviors. The enhanced escape performance of Anopheles at night is explained by their increased baseline unpredictable erratic flight behavior, whereas the increased escape performance of Aedes in overcast daylight is due to their enhanced escape maneuvers. This shows that both day and night-active mosquitoes modify their flight behavior in response to light intensity such that their escape performance is maximum in their natural blood-feeding light conditions, when these defensive actions by their blood hosts occur most. Because Aedes and Anopheles mosquitoes are major vectors of several deadly human diseases, this knowledge can be used to optimize vector control methods for these specific species.

The olfactory gating of visual preferences to human skin and visible spectra in mosquitoes.

Mosquitoes track odors, locate hosts, and find mates visually. The color of a food resource, such as a flower or warm-blooded host, can be dominated by long wavelengths of the visible light spectrum (green to red for humans) and is likely important for object recognition and localization. However, little is known about the hues that attract mosquitoes or how odor affects mosquito visual search behaviors. We use a real-time 3D tracking system and wind tunnel that allows careful control of the olfactory and visual environment to quantify the behavior of more than 1.3 million mosquito trajectories. We find that CO2 induces a strong attraction to specific spectral bands, including those that humans perceive as cyan, orange, and red. Sensitivity to orange and red correlates with mosquitoes' strong attraction to the color spectrum of human skin, which is dominated by these wavelengths. The attraction is eliminated by filtering the orange and red bands from the skin color spectrum and by introducing mutations targeting specific long-wavelength opsins or CO2 detection. Collectively, our results show that odor is critical for mosquitoes' wavelength preferences and that the mosquito visual system is a promising target for inhibiting their attraction to human hosts.

Review of Methods for Animal Videography Using Camera Systems that Automatically Move to Follow the Animal.

Digital photography and videography provide rich data for the study of animal behavior and are consequently widely used techniques. For fixed, unmoving cameras there is a resolution versus field-of-view tradeoff and motion blur smears the subject on the sensor during exposure. While these fundamental tradeoffs with stationary cameras can be sidestepped by employing multiple cameras and providing additional illumination, this may not always be desirable. An alternative that overcomes these issues of stationary cameras is to direct a high-magnification camera at an animal continually as it moves. Here, we review systems in which automatic tracking is used to maintain an animal in the working volume of a moving optical path. Such methods provide an opportunity to escape the tradeoff between resolution and field of view and also to reduce motion blur while still enabling automated image acquisition. We argue that further development will be useful and outline potential innovations that may improve the technology and lead to more widespread use.

Effect of peer instruction pedagogy on concept mastery in a first professional year pharmacy self-care course.

INTRODUCTION: As active learning is being encouraged in pharmacy education, valid active learning pedagogies should be investigated. Peer instruction pedagogy has yet to be explored in the pharmacy education setting. Peer instruction assesses student understanding of a topic through multiple choice questions called ConcepTests. When the class scores below a threshold, students are given time to discuss the ConcepTest. They are then given an opportunity to repeat the same ConcepTest. METHODS: Peer instruction pedagogy was implemented in the 2017 fall semester of PHAR 6112: Introduction to Self-Care. Changes in student responses were recorded via Turning Technologies software to identify if peer instruction increased the number of students who answered ConcepTests correctly. Changes in responses were analyzed via a paired t-test and McNemar test. Students were also surveyed on their perceptions of the pedagogy. RESULTS: A total of 51 questions proceeded through the entirety of the peer instruction algorithm. Peer instruction was associated with an increase in correct response (P < .001). Students' total number of correct responses to ConcepTest questions increased by an average of 16.1 (31.5%) following peer instruction (P<.001). Over 86% of students would recommend that other instructors use ConcepTests. CONCLUSIONS: Peer instruction resulted in an increase in correct responses to session ConcepTests. This pedagogy has potential as an active learning method to deliver pharmacy material.

A neurodevelopmental origin of behavioral individuality in the Drosophila visual system.

The genome versus experience dichotomy has dominated understanding of behavioral individuality. By contrast, the role of nonheritable noise during brain development in behavioral variation is understudied. Using Drosophila melanogaster, we demonstrate a link between stochastic variation in brain wiring and behavioral individuality. A visual system circuit called the dorsal cluster neurons (DCN) shows nonheritable, interindividual variation in right/left wiring asymmetry and controls object orientation in freely walking flies. We show that DCN wiring asymmetry instructs an individual's object responses: The greater the asymmetry, the better the individual orients toward a visual object. Silencing DCNs abolishes correlations between anatomy and behavior, whereas inducing DCN asymmetry suffices to improve object responses.

Eight practices for data management to enable team data science.

INTRODUCTION: In clinical and translational research, data science is often and fortuitously integrated with data collection. This contrasts to the typical position of data scientists in other settings, where they are isolated from data collectors. Because of this, effective use of data science techniques to resolve translational questions requires innovation in the organization and management of these data. METHODS: We propose an operational framework that respects this important difference in how research teams are organized. To maximize the accuracy and speed of the clinical and translational data science enterprise under this framework, we define a set of eight best practices for data management. RESULTS: In our own work at the University of Rochester, we have strived to utilize these practices in a customized version of the open source LabKey platform for integrated data management and collaboration. We have applied this platform to cohorts that longitudinally track multidomain data from over 3000 subjects. CONCLUSIONS: We argue that this has made analytical datasets more readily available and lowered the bar to interdisciplinary collaboration, enabling a team-based data science that is unique to the clinical and translational setting.

Morphology, muscle capacity, skill, and maneuvering ability in hummingbirds.

How does agility evolve? This question is challenging because natural movement has many degrees of freedom and can be influenced by multiple traits. We used computer vision to record thousands of translations, rotations, and turns from more than 200 hummingbirds from 25 species, revealing that distinct performance metrics are correlated and that species diverge in their maneuvering style. Our analysis demonstrates that the enhanced maneuverability of larger species is explained by their proportionately greater muscle capacity and lower wing loading. Fast acceleration maneuvers evolve by recruiting changes in muscle capacity, whereas fast rotations and sharp turns evolve by recruiting changes in wing morphology. Both species and individuals use turns that play to their strengths. These results demonstrate how both skill and biomechanical traits shape maneuvering behavior.

T cell developmental arrest in former premature infants increases risk of respiratory morbidity later in infancy.

The inverse relationship between gestational age at birth and postviral respiratory morbidity suggests that infants born preterm (PT) may miss a critical developmental window of T cell maturation. Despite a continued increase in younger PT survivors with respiratory complications, we have limited understanding of normal human fetal T cell maturation, how ex utero development in premature infants may interrupt normal T cell development, and whether T cell development has an effect on infant outcomes. In our longitudinal cohort of 157 infants born between 23 and 42 weeks of gestation, we identified differences in T cells present at birth that were dependent on gestational age and differences in postnatal T cell development that predicted respiratory outcome at 1 year of age. We show that naive CD4+ T cells shift from a CD31-TNF-α+ bias in mid gestation to a CD31+IL-8+ predominance by term gestation. Former PT infants discharged with CD31+IL8+CD4+ T cells below a range similar to that of full-term born infants were at an over 3.5-fold higher risk for respiratory complications after NICU discharge. This study is the first to our knowledge to identify a pattern of normal functional T cell development in later gestation and to associate abnormal T cell development with health outcomes in infants.

Virtual reality for freely moving animals.

Standard animal behavior paradigms incompletely mimic nature and thus limit our understanding of behavior and brain function. Virtual reality (VR) can help, but it poses challenges. Typical VR systems require movement restrictions but disrupt sensorimotor experience, causing neuronal and behavioral alterations. We report the development of FreemoVR, a VR system for freely moving animals. We validate immersive VR for mice, flies, and zebrafish. FreemoVR allows instant, disruption-free environmental reconfigurations and interactions between real organisms and computer-controlled agents. Using the FreemoVR platform, we established a height-aversion assay in mice and studied visuomotor effects in Drosophila and zebrafish. Furthermore, by photorealistically mimicking zebrafish we discovered that effective social influence depends on a prospective leader balancing its internally preferred directional choice with social interaction. FreemoVR technology facilitates detailed investigations into neural function and behavior through the precise manipulation of sensorimotor feedback loops in unrestrained animals.

Mechanical Constraints on Flight at High Elevation Decrease Maneuvering Performance of Hummingbirds.

High-elevation habitats offer ecological advantages including reduced competition, predation, and parasitism [1]. However, flying organisms at high elevation also face physiological challenges due to lower air density and oxygen availability [2]. These constraints are expected to affect the flight maneuvers that are required to compete with rivals, capture prey, and evade threats [3-5]. To test how individual maneuvering performance is affected by elevation, we measured the free-flight maneuvers of male Anna's hummingbirds in a large chamber translocated to a high-elevation site and then measured their performance at low elevation. We used a multi-camera tracking system to identify thousands of maneuvers based on body position and orientation [6]. At high elevation, the birds' translational velocities, accelerations, and rotational velocities were reduced, and they used less demanding turns. To determine how mechanical and metabolic constraints independently affect performance, we performed a second experiment to evaluate flight maneuvers in an airtight chamber infused with either normoxic heliox, to lower air density, or nitrogen, to lower oxygen availability. The hypodense treatment caused the birds to reduce their accelerations and rotational velocities, whereas the hypoxic treatment had no significant effect on maneuvering performance. Collectively, these experiments reveal how aerial maneuvering performance changes with elevation, demonstrating that as birds move up in elevation, air density constrains their maneuverability prior to any influence of oxygen availability. Our results support the hypothesis that changes in competitive ability at high elevations are the result of mechanical limits to flight performance [7].

Ultra-high bandwidth quantum secured data transmission.

Quantum key distribution (QKD) provides an attractive means for securing communications in optical fibre networks. However, deployment of the technology has been hampered by the frequent need for dedicated dark fibres to segregate the very weak quantum signals from conventional traffic. Up until now the coexistence of QKD with data has been limited to bandwidths that are orders of magnitude below those commonly employed in fibre optic communication networks. Using an optimised wavelength divisional multiplexing scheme, we transport QKD and the prevalent 100 Gb/s data format in the forward direction over the same fibre for the first time. We show a full quantum encryption system operating with a bandwidth of 200 Gb/s over a 100 km fibre. Exploring the ultimate limits of the technology by experimental measurements of the Raman noise, we demonstrate it is feasible to combine QKD with 10 Tb/s of data over a 50 km link. These results suggest it will be possible to integrate QKD and other quantum photonic technologies into high bandwidth data communication infrastructures, thereby allowing their widespread deployment.

Automatic Segmentation of Drosophila Neural Compartments Using GAL4 Expression Data Reveals Novel Visual Pathways.

Identifying distinct anatomical structures within the brain and developing genetic tools to target them are fundamental steps for understanding brain function. We hypothesize that enhancer expression patterns can be used to automatically identify functional units such as neuropils and fiber tracts. We used two recent, genome-scale Drosophila GAL4 libraries and associated confocal image datasets to segment large brain regions into smaller subvolumes. Our results (available at https://strawlab.org/braincode) support this hypothesis because regions with well-known anatomy, namely the antennal lobes and central complex, were automatically segmented into familiar compartments. The basis for the structural assignment is clustering of voxels based on patterns of enhancer expression. These initial clusters are agglomerated to make hierarchical predictions of structure. We applied the algorithm to central brain regions receiving input from the optic lobes. Based on the automated segmentation and manual validation, we can identify and provide promising driver lines for 11 previously identified and 14 novel types of visual projection neurons and their associated optic glomeruli. The same strategy can be used in other brain regions and likely other species, including vertebrates.

Burst muscle performance predicts the speed, acceleration, and turning performance of Anna's hummingbirds.

Despite recent advances in the study of animal flight, the biomechanical determinants of maneuverability are poorly understood. It is thought that maneuverability may be influenced by intrinsic body mass and wing morphology, and by physiological muscle capacity, but this hypothesis has not yet been evaluated because it requires tracking a large number of free flight maneuvers from known individuals. We used an automated tracking system to record flight sequences from 20 Anna's hummingbirds flying solo and in competition in a large chamber. We found that burst muscle capacity predicted most performance metrics. Hummingbirds with higher burst capacity flew with faster velocities, accelerations, and rotations, and they used more demanding complex turns. In contrast, body mass did not predict variation in maneuvering performance, and wing morphology predicted only the use of arcing turns and high centripetal accelerations. Collectively, our results indicate that burst muscle capacity is a key predictor of maneuverability.

Developmentally determined reduction in CD31 during gestation is associated with CD8+ T cell effector differentiation in preterm infants.

Homeostatic T cell proliferation is more robust during human fetal development. In order to understand the relative effect of normal fetal homeostasis and perinatal exposures on CD8+ T cell behavior in PT infants, we characterized umbilical cord blood CD8+ T cells from infants born between 23-42weeks gestation. Subjects were recruited as part of the NHLBI-sponsored Prematurity and Respiratory Outcomes Program. Cord blood from PT infants had fewer naïve CD8+ T cells and lower regulatory CD31 expression on both naïve and effector, independent of prenatal exposures. CD8+ T cell in vitro effector function was greater at younger gestational ages, an effect that was exaggerated in infants with prior inflammatory exposures. These results suggest that CD8+ T cells earlier in gestation have loss of regulatory co-receptor CD31 and greater effector differentiation, which may place PT neonates at unique risk for CD8+ T cell-mediated inflammation and impaired T cell memory formation.