Azteca ants repair damage to their Cecropia host plants

Some Azteca ants are well-known symbionts that defend their Cecropia host plants against herbivory, although there is considerable variability in behavior among colonies, conditions, and species. In exchange, ants receive food, and also shelter within the plants’ internodes. Here we demonstrate that ants repair damage to the host plant when their brood is directly threatened. Using comminuted plant fibers and an unidentified binding liquid (probably plant sap) ants generally began patching holes in the tree trunk immediately, and significantly reduced the size of the hole 2.5 hours after it was created, and they generally completed the repairs within 24 hours.

A Comparison of National Water Model Retrospective Analysis Snow Outputs at SNOTEL Sites Across the Western U.S.

This study compares the U.S. National Water Model (NWM) reanalysis snow outputs to observed snow water equivalent (SWE) and snow-covered area fraction (SCAF) at SNOTEL sites across the Western U.S. SWE was obtained from SNOTEL sites, while SCAF was obtained from MODIS observations at a nominal 500 m grid scale. Retrospective NWM results were at a 1000 m grid scale. We compared results for SNOTEL sites to gridded NWM and MODIS outputs for the grid cells encompassing each SNOTEL site. Differences between modeled and observed SWE were attributed to both model errors, as well as errors in inputs, notably precipitation and temperature. The NWM generally under-predicted SWE, partly due to precipitation input differences. There was also a slight general bias for model input temperature to be cooler than observed, counter to the direction expected to lead to under-modeling of SWE. There was also under-modeling of SWE for a subset of sites where precipitation inputs were good. Furthermore, the NWM generally tends to melt snow early. There was considerable variability between modeled and observed SCAF as well as the binary comparison of snow cover presence that hampered useful interpretation of SCAF comparisons. This is in part due to the shortcomings associated with both model SCAF parameterization and MODIS observations, particularly in vegetated regions. However, when SCAF was aggregated across all sites and years, modeled SCAF tended to be more than observed using MODIS. These differences are regional with generally better SWE and SCAF results in the Central Basin and Range and differences tending to become larger the further away regions are from this region. These findings identify areas where predictions from the NWM involving snow may be better or worse, and suggest opportunities for research directed towards model improvements.

Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders

The purpose of this study was to assess cost variability in the care of abdominal pain-associated functional gastrointestinal disorders (AP-FGIDS) in youth across health systems, races, and specific AP-FGID diagnoses. Patients, aged 8–17 years, with a priority 1 diagnosis corresponding to a Rome IV defined AP-FGID were identified within the Health Facts® database. Total costs were obtained across the continuum of care including outpatient clinics, emergency department, and inpatient or observation units. Cost variability was described comparing different health systems, races, and diagnoses. Thirteen thousand two hundred and fourteen patients were identified accounting for 17,287 encounters. Total costs were available for 38.7% of the encounters. There was considerable variability in costs within and, especially, across health systems. Costs also varied across race, urban vs. rural site of care, and AP-FGID diagnoses. In conclusion, there was considerable variability in the costs for care of AP-FGIDs which is sufficient to support multi-site studies to understand the value of specific tests and treatments. Significant differences in costs by race merit further investigation to understand key drivers.

From ideal to real: a qualitative study of the implementation of in situ Interprofessional Simulation-Based Education

Background: Despite the widespread adoption of interprofessional simulation-based education (IPSE) in healthcare as a means to optimize interprofessional teamwork, data suggest that IPSE may not achieve these intended goals due to a gap between the ideals and the realities of implementation. Methods: We conducted a qualitative case study that used the framework method to understand what and how core principles from guidelines for interprofessional education (IPE) and simulation-based education (SBE) were implemented in existing in situ IPSE programs. We observed simulation sessions and interviewed facilitators and directors at seven programs. Results: We found considerable variability in how IPSE programs apply and implement core principles derived from IPE and SBE guidelines with some principles applied by most programs (e.g., “active learning”, “psychological safety”, “feedback during debriefing”) and others rarely applied (e.g., “interprofessional competency-based assessment”, “repeated and distributed practice”). Through interviews we identified that buy-in, resources, lack of outcome measures, and power discrepancies influenced the extent to which principles were applied. Conclusion: To achieve IPSE’s intended goals of optimizing interprofessional teamwork, programs should transition from designing for the ideal of IPSE to realities of IPSE implementation.

Empirical audit and review and an assessment of evidentiary value in research on the psychological consequences of scarcity

Empirical audit and review is an approach to assessing the evidentiary value of a research area. It involves identifying a topic and selecting a cross-section of studies for replication. We apply the method to research on the psychological consequences of scarcity. Starting with the papers citing a seminal publication in the field, we conducted replications of 20 studies that evaluate the role of scarcity priming in pain sensitivity, resource allocation, materialism, and many other domains. There was considerable variability in the replicability, with some strong successes and other undeniable failures. Empirical audit and review does not attempt to assign an overall replication rate for a heterogeneous field, but rather facilitates researchers seeking to incorporate strength of evidence as they refine theories and plan new investigations in the research area. This method allows for an integration of qualitative and quantitative approaches to review and enables the growth of a cumulative science.

SP7.2.3 Documentation of risk discussions prior to elective inguinal hernia surgery, is it standardised for all?

Aims Obtaining consent is fundamental to surgical practice. Rising levels of litigation have led to increased scrutiny of the process. The Royal College of Surgeons (RCS) recommends a structured consent process enabling patients to make better informed decisions, increasing the legal robustness of the process. Our aim is to audit the documentation of risk discussions prior to elective inguinal hernia repair (EIHR). Methods Data was collected retrospectively for all patients who had undergone EIHR in a single surgical unit between January 2019 and 2020. Outpatient clinic letters and consent forms were reviewed. The grade of surgeon and documentation of consent discussions were recorded. The results were then analysed using basic statistical analysis. Results 146 patients (137 male and 9 female) were included in the audit, with an average age of 63 years (range 20-89 years). 77% of clinic letters recorded a consent discussion. Of these, chronic pain was the risk most commonly documented (62%), followed by recurrence (56%). 19.8% of clinic letters included the level of risk quoted. 86% of consent forms were legible. Documentation of risk was significantly more detailed on consent forms compared to clinic letters (p < 0.05). On these, infection was the most commonly documented (97%), followed by bleeding (91%). Overall, there was no significant difference in documentation relative to surgical grade. Conclusions This study has demonstrated considerable variability in consent process prior to EIHR. This can have both legal implications and impact upon patient experience. Adopting a strategy to ensure a consistent approach is essential.

Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview

Worldwide, more than 1.2 million adolescents and young adults (AYAs; those aged 15–39 years) are diagnosed with cancer each year. Although considerable variability exists according to cancer site and stage of disease, the 5-year relative survival at the time of diagnosis has been estimated at >80% for all AYA patients with cancer combined. Extensive survivorship research in recent decades has focused on patients diagnosed with cancer as children (<15 years) and older adults (>39 years), yet few studies to date have reported outcomes specifically for patients diagnosed as AYAs. With increasing incidence and improving survival for many tumor types, leading to the majority of AYA patients with cancer becoming long-term survivors, there is a critical need for research efforts to inform the survivorship care of this growing population. This article describes the population of AYA cancer survivors according to their epidemiology and late and long-term effects, the challenges and models of AYA survivorship care, as well as future opportunities for research and healthcare.

Developmental Considerations for the Use of Naltrexone in Children and Adolescents

Naltrexone (NTX) is a well-tolerated drug with a wide safety margin and mechanism of action that affords use across a wide variety of indications in adults and children. By antagonizing the opioid reward system, NTX can modulate behaviors that involve compulsivity or impulsivity, such as substance use, obesity, and eating disorders. Evidence regarding the disposition and efficacy of NTX is mainly derived from adult studies of substance use disorders and considerable variability exists. Developmental changes, plausible disease-specific alterations and genetic polymorphisms in NTX disposition, and pharmacodynamic pathways should be taken into consideration when optimizing the use of NTX in the pediatric population. This review highlights the current state of the evidence and gaps in knowledge regarding NTX to facilitate evidence-based pharmacotherapy of mental health conditions, for which few pharmacologic options exist.

Examining the Patterns of Virtual Visit Uptake Across Clinical Disciplines Using Hospital Administrative Data During the COVID-19 Pandemic: A Descriptive Study. (Preprint)

BACKGROUND The COVID-19 pandemic resulted in a dramatic and rapid shift away from physical visits, resulting in an instantaneous and unplanned adoption of virtual (phone and video) visits. OBJECTIVE Administrative data at a large urban Canadian university-affiliated hospital network was analyzed to understand how clinical disciplines adopted phone and video visits early in the pandemic and how their use of virtual visits grew, sustained or was abandoned through the pandemic. METHODS Virtual visit adoption by clinical discipline was compared during both the early pandemic (Apr-May 2020) and peak reopening time periods (Oct-Nov 2020) in an attempt to categorize clinical disciplines by their adoption of virtual visits, and thus understand how best to provide change management support. RESULTS At our largest academic site, for which we had full data, 50.8% of ambulatory visits were provided by phone or video during the pandemic (94.5% phone, 5.5% video). There was considerable variability across services in terms of how they adopted virtual visits in the early pandemic and peak reopening. Phone was the dominant modality, but video had high usage (up to 95% of virtual visits) in select disciplines. CONCLUSIONS We identified 4 patterns that provide opportunities for dedicated support in some disciplines: early sustained adoption, non-adoption, late growth, and late abandonment. The phone was the dominant modality (>90% of virtual visits) but video had high use in some disciplines necessitating targeted support. Additional high-quality research examining phone vs. video visits across disciplines and contexts is critical; until then both should be supported.

Dysbetalipoproteinemia: differentiating multifactorial remnant cholesterol disease from genetic apoE deficiency

Background Dysbetalipoproteinemia (DBL) is characterized by the accumulation of remnant lipoprotein particles and associated with an increased risk of cardiovascular and peripheral vascular disease (PVD). DBL is thought to be mainly caused by the presence of an E2/E2 genotype of the apolipoprotein E (APOE) gene, in addition to environmental factors. However, there exists considerable variability in the phenotype of these patients. Objective The objectives were to verify the proportion of DBL subjects diagnosed using the gold standard Fredrickson criteria who did not carry E2/E2 and to compare the clinical characteristics of DBL patients with vs without E2/E2. Methods A total of 12 432 patients with lipoprotein ultracentrifugation as well as APOE genotype or apoE phenotype data were included in the present retrospective study. Results Among the 12 432 patients, 4% (n=524) were positive for Fredrickson criteria (F+), and only 38% (n=197) of the F+ individuals were E2/E2. The F+ E2/E2 group had significantly higher remnant cholesterol concentration (3.44 vs 1.89 mmol/L) and had higher frequency of DBL-related xanthomas (24% vs 2%) and floating beta (95% vs 11%) than the F+ non-E2/E2 group (p&lt;0.0001). The F+ E2/E2 group had an independent higher risk of PVD (OR 11.12 (95% CI 1.87-66.05) p=0.008) events compared to the F+ non-E2/E2 group. Conclusion In the largest cohort of DBL worldwide, we demonstrated that the presence of E2/E2 was associated with a more severe DBL phenotype. We suggest that two dysbetalipoproteinemia phenotypes should be distinguished: the multifactorial remnant cholesterol disease and the genetic apoE deficiency disease.