Introduction to Treating Patients Exposed to Chemical, Biological, Radiological, and Nuclear (CBRN) Threats: A Military Medical Case-Based Curriculum.

Introduction: Ensuring proficiency in responding to, evaluating, and treating chemical, biological, radiological, and nuclear (CBRN) casualties is a critical component of military medical student education. To meet this objective, we developed a case-based CBRN curriculum that can serve as a model to address potential curricular gaps for civilian prehospital, UME, and GME programs. Methods: The curriculum was administered in two sessions, 1 month apart, each with individual student preparation, including an optional asynchronous online module and a review of clinical practice guidelines. Session one consisted of a 2-hour introductory lecture, followed by a student reflection. Session two consisted of a 1-hour small-group case study, designed as a multimodal exercise with a corresponding computer-based worksheet and knowledge check. Results: Forty-five teams consisting of three to four second-year medical students (N = 170) completed the sessions and course survey. Sixty-four percent of student teams were extremely or quite satisfied with what they learned, 62% found the materials very or quite relevant to their needs, and 69% rated the instructional materials as extremely or quite understandable. Student feedback included designating additional time for worksheet completion. Discussion: A case-based training on CBRN patient care earned positive ratings for the clarity of instruction, the impact on students as learners, and the feasibility of the training. Future training evolutions could track student completion of prework, extend the allotted time for activity completion, and evaluate curricular effectiveness through pre-post measurement of students' confidence in their ability to care for a CBRN patient.

Mixtures of Sweeteners and Maltodextrin Enhance Flavor and Intake of Alcohol in Adolescent Rats.

Sweet flavorants enhance palatability and intake of alcohol in adolescent humans. We asked whether sweet flavorants have similar effects in adolescent rats. The inherent flavor of ethanol in adolescent rats is thought to consist of an aversive odor, bitter/sweet taste, and burning sensation. In Experiment 1, we compared ingestive responses of adolescent rats to 10% ethanol solutions with or without added flavorants using brief-access lick tests. We used 4 flavorants, which contained mixtures of saccharin and sucrose or saccharin, sucrose, and maltodextrin. The rats approached (and initiated licking from) the flavored ethanol solutions more quickly than they did unflavored ethanol, indicating that the flavorants attenuated the aversive odor of ethanol. The rats also licked at higher rates for the flavored than unflavored ethanol solutions, indicating that the flavorants increased the naso-oral acceptability of ethanol. In Experiment 2, we offered rats chow, water, and a flavored or unflavored ethanol solution every other day for 8 days. The rats consistently consumed substantially more of the flavored ethanol solutions than unflavored ethanol across the 8 days. When we switched the rats from the flavored to unflavored ethanol for 3 days, daily intake of ethanol plummeted. We conclude that sweet and sweet/maltodextrin flavorants promote high daily intake of ethanol in adolescent rats (i.e., 6-10 g/kg) and that they do so in large part by improving the naso-oral sensory attributes of ethanol.