Adapting a community pharmacy intervention to improve medication safety.

BACKGROUND: Community pharmacies are an ideal location to address challenges of over-the-counter medication safety, yet many successful interventions are only tested in a few pharmacies without expansion, creating unrealized opportunities to improve patient care on a larger scale. Scaling up to numerous pharmacies can be challenging because each community pharmacy has unique needs and layouts and requires individualized adaptation. OBJECTIVES: This paper reports techniques for (a) adapting a community pharmacy intervention to fit the unique physical layout and patient needs of health system pharmacy sites without increasing staff workload, (b) identifying strategies to gather feedback on adaptations from stakeholders, and (c) developing materials to share with pharmacy champions for them to independently implement and sustain the intervention in their organization. PRACTICE DESCRIPTION: The study team collaborated with Aurora Pharmacy, Inc to develop an intervention designed to increase awareness of safe over-the-counter medication use for older adults. PRACTICE INNOVATION: Senior Safe, a community pharmacy-based intervention, was designed, implemented, and tested using the Exploration, Preparation, Implementation, and Sustainment implementation framework. EVALUATION METHODS: Senior Safe was adapted through pilot testing and a randomized control trial. Feedback was collected from key stakeholders, including pharmacy staff, older adults, and a research advisory group. RESULTS: A finalized version of Senior Safe, as well as an implementation package, was provided to Aurora Pharmacy to integrate into all 63 sites. CONCLUSION: This multiphase study illustrated that refining an intervention is possible and welcomed by pharmacy staff, but it requires time, resources, and funds to create an impactful, sustainable community pharmacy intervention.

Scratching beneath the surface: How organisational culture influences curricular reform.

INTRODUCTION: Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early-years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? METHODS: This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020-2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. RESULTS: The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements-Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)-and how these interact. However, it did not shed light on the influence of exogenous events on change. CONCLUSION: Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training.

Context matters in curriculum reform: An analysis of change in surgical training.

INTRODUCTION: Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. METHODS: Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. RESULTS: The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. CONCLUSIONS: Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.

"It's making me think outside the box at times": a qualitative study of dynamic capabilities in surgical training.

Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

Scotland's "Incentivised Laparoscopy Practice" programme: Engaging trainees with take-home laparoscopy simulation.

BACKGROUND: The transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement worldwide, as for example in our 2014-15 study of an Incentivised Laparoscopy Practice programme (ILPv1). Drawing on learning from our subsequent multi-centre study examining barriers and facilitators, we revised the programme for 2018 onwards. We now report on engagement with the 2018-2022 versions of this home-based simulation programme (ILP v2.1-2.3). METHODS: In ILP v2.1-2.3, three consecutive year-groups of new-start Core Surgical Trainees (n = 48, 46 and 53) were loaned portable simulators. The 6-month education programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review (but not mandatory for progression). ILP was set within a wider reform, "Improving Surgical Training". RESULTS: ILP v2.1-2.3 saw pass rates of 94%, 76% and 70% respectively (45/48, 35/46 and 37/53 trainees), compared with only 26% (7/27) in ILP v1, despite now including some trainees not intending careers in laparoscopic specialties. The ILP v2.2 group all reported their engagement with the whole simulation strategy was hampered by the COVID19 pandemic. CONCLUSIONS: Simply providing take-home simulators, no matter how good, is not enough. To achieve trainee engagement, a whole programme is required, with motivated learners, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a "reform within a reform, within a context."

The serum protein transthyretin as a platform for dimerization and tetramerization of antibodies and Fab fragments to enable target clustering.

Transthyretin (TTR) is an abundant homotetrameric serum protein and was selected here for engineering higher-valency molecules because of its compact size, simple structure, and natural propensity to tetramerize. To demonstrate this utility, we fused TTR to the C terminus of conatumumab, an antibody that targets tumor necrosis factor-related apoptosis-inducing ligand receptor 2, as heavy chains to form antibody dimers and Fab heavy chains to form Fab tetramers. Moreover, we used constant heavy domain 3 heterodimerization substitutions to create TTR-mediated conatumumab tetramers. The conatumumab-TTR fusions displayed substantially enhanced potency in cell-based assays, as well as in murine tumor xenograft models. We conclude that antibody-TTR fusions may provide a powerful platform for multimerizing antibody and Fab fragments to enhance the capabilities of human therapeutics that benefit from target clustering and higher-order antigen-binding valency.

Simulation for technical skill acquisition in open vascular surgery.

BACKGROUND: Simulation has an increasingly prominent role in modern vascular surgery training. However, it is important to understand how simulation is most effectively delivered to best use the time and resources available. The aim of this narrative review is therefore to critically appraise open technical skill acquisition in the operating room environment and provide recommendations for the future development of evidence-based simulation for open vascular surgery. METHODS: A systematic search strategy was used to retrieve relevant studies from PubMed, Medline, Web of Science, EMBASE, and the Cochrane databases in July 2019. Included papers were independently screened by two reviewers. Data were subsequently extracted using a standardized proforma and thematically analyzed. RESULTS: Thirteen studies were included. All demonstrated that simulation is effective in improving confidence and/or competence in performing open technical skills when assessed by previously validated metrics. However, not all participants or course schedules achieved equal benefit, with distributed practice for junior trainees over several weeks achieving a greater improvement in technical skill compared with senior trainees or longer course schedules for some tasks. CONCLUSIONS: Simulation can be an effective adjunct to traditional operative experience for technical skill acquisition in open vascular surgery. Future work should focus on developing models to address a wider range of training needs, as well as further defining the optimum schedule for the style, content, and timing of simulation for specific learner groups.

Moving forward through the in silico modeling of tuberculosis: a further step with UISS-TB.

BACKGROUND: In 2018, about 10 million people were found infected by tuberculosis, with approximately 1.2 million deaths worldwide. Despite these numbers have been relatively stable in recent years, tuberculosis is still considered one of the top 10 deadliest diseases worldwide. Over the years, Mycobacterium tuberculosis has developed a form of resistance to first-line tuberculosis treatments, specifically to isoniazid, leading to multi-drug-resistant tuberculosis. In this context, the EU and Indian DBT funded project STriTuVaD-In Silico Trial for Tuberculosis Vaccine Development-is supporting the identification of new interventional strategies against tuberculosis thanks to the use of Universal Immune System Simulator (UISS), a computational framework capable of predicting the immunity induced by specific drugs such as therapeutic vaccines and antibiotics. RESULTS: Here, we present how UISS accurately simulates tuberculosis dynamics and its interaction within the immune system, and how it predicts the efficacy of the combined action of isoniazid and RUTI vaccine in a specific digital population cohort. Specifically, we simulated two groups of 100 digital patients. The first group was treated with isoniazid only, while the second one was treated with the combination of RUTI vaccine and isoniazid, according to the dosage strategy described in the clinical trial design. UISS-TB shows to be in good agreement with clinical trial results suggesting that RUTI vaccine may favor a partial recover of infected lung tissue. CONCLUSIONS: In silico trials innovations represent a powerful pipeline for the prediction of the effects of specific therapeutic strategies and related clinical outcomes. Here, we present a further step in UISS framework implementation. Specifically, we found that the simulated mechanism of action of RUTI and INH are in good alignment with the results coming from past clinical phase IIa trials.

Development of BioRad NGC and GE ÄKTA pure systems for highly automated three column protein purification employing tandem affinity, buffer exchange and size exclusion chromatography.

Affinity purification, such as Protein A (ProA) followed by size exclusion chromatography (SEC) remains a popular method to obtain research scale proteins. With the need for higher throughput protein production increasing for discovery research, there is substantial interest in the automation of complex protein purification processes, which often start with a ProA step followed by SEC. However, the harsh elution conditions from ProA based chromatography can destabilize some proteins resulting in particulates, which in turn can cause column fouling and potential cross-contamination of subsequent purifications. We modified both Bio Rad NGC and ÄKTA Pure systems to run a three-column process (ProA to buffer exchange to SEC) enabling automated tandem affinity to SEC purification while minimizing the risk of SEC column fouling and subsequent cross-contamination. The intervening buffer exchange column, unlike the final SEC column, can be rapidly regenerated using harsh methods between runs, and these automated systems are capable of processing up to six samples per day without user intervention.

Engineering Bacterial Cellulose by Synthetic Biology.

Synthetic biology is an advanced form of genetic manipulation that applies the principles of modularity and engineering design to reprogram cells by changing their DNA. Over the last decade, synthetic biology has begun to be applied to bacteria that naturally produce biomaterials, in order to boost material production, change material properties and to add new functionalities to the resulting material. Recent work has used synthetic biology to engineer several Komagataeibacter strains; bacteria that naturally secrete large amounts of the versatile and promising material bacterial cellulose (BC). In this review, we summarize how genetic engineering, metabolic engineering and now synthetic biology have been used in Komagataeibacter strains to alter BC, improve its production and begin to add new functionalities into this easy-to-grow material. As well as describing the milestone advances, we also look forward to what will come next from engineering bacterial cellulose by synthetic biology.

Predicting the artificial immunity induced by RUTI® vaccine against tuberculosis using universal immune system simulator (UISS).

BACKGROUND: Tuberculosis (TB) represents a worldwide cause of mortality (it infects one third of the world's population) affecting mostly developing countries, including India, and recently also developed ones due to the increased mobility of the world population and the evolution of different new bacterial strains capable to provoke multi-drug resistance phenomena. Currently, antitubercular drugs are unable to eradicate subpopulations of Mycobacterium tuberculosis (MTB) bacilli and therapeutic vaccinations have been postulated to overcome some of the critical issues related to the increase of drug-resistant forms and the difficult clinical and public health management of tuberculosis patients. The Horizon 2020 EC funded project "In Silico Trial for Tuberculosis Vaccine Development" (STriTuVaD) to support the identification of new therapeutic interventions against tuberculosis through novel in silico modelling of human immune responses to disease and vaccines, thereby drastically reduce the cost of clinical trials in this critical sector of public healthcare. RESULTS: We present the application of the Universal Immune System Simulator (UISS) computational modeling infrastructure as a disease model for TB. The model is capable to simulate the main features and dynamics of the immune system activities i.e., the artificial immunity induced by RUTI® vaccine, a polyantigenic liposomal therapeutic vaccine made of fragments of Mycobacterium tuberculosis cells (FCMtb). Based on the available data coming from phase II Clinical Trial in subjects with latent tuberculosis infection treated with RUTI® and isoniazid, we generated simulation scenarios through validated data in order to tune UISS accordingly to STriTuVaD objectives. The first case simulates the establishment of MTB latent chronic infection with some typical granuloma formation; the second scenario deals with a reactivation phase during latent chronic infection; the third represents the latent chronic disease infection scenario during RUTI® vaccine administration. CONCLUSIONS: The application of this computational modeling strategy helpfully contributes to simulate those mechanisms involved in the early stages and in the progression of tuberculosis infection and to predict how specific therapeutical strategies will act in this scenario. In view of these results, UISS owns the capacity to open the door for a prompt integration of in silico methods within the pipeline of clinical trials, supporting and guiding the testing of treatments in patients affected by tuberculosis.

Barriers and facilitators to deliberate practice using take-home laparoscopic simulators.

BACKGROUND: Several regions in the UK and Ireland have delivered home-based laparoscopic simulation programmes in an attempt to progress surgical trainees' skills through deliberate practice. However, engagement with these programmes has been poor. This study aims to uncover the barriers to engagement with home-based simulation, with a view to developing an improved programme. METHODS: This was a qualitative study using focus groups with key stakeholders including junior surgical trainees, consultants/attendings and simulation faculty. Data were collected across four regions in three countries. Data were audio-recorded, transcribed and a thematic analysis was performed using NVivo software. RESULTS: Sixty-three individuals were interviewed in 12 focus groups (43 trainees, 20 trainers). Trainees cited competing commitments as a barrier to engaging with home-based simulation. They tended to focus on scoring 'points' towards career progression rather than viewing tasks as interesting, or associated with personal development. Their view was that this approach is perpetuated by the training system, which rewards trainees for publications and exams, but not for operative skill. Trainees were unsatisfied with metric feedback and wanted individual feedback from consultants (attendings). Trainees perceived consultants as lacking interest in the programmes and training in general. However, some consultants were unaware of the programmes being delivered and others felt lacking in confidence to deliver the necessary training. CONCLUSIONS: Scheduled simulation sessions which provide trainees with the opportunity for consultant feedback may improve engagement. Tackling the 'point-scoring' culture is more challenging. This could be addressed by modified assessment structures, greater recognition and accountability for trainers, and recognition and funding of simulation strategies including in-house skills sessions.

Engineering an IgG Scaffold Lacking Effector Function with Optimized Developability.

IgG isotypes can differentially bind to Fcγ receptors and complement, making the selection of which isotype to pursue for development of a particular therapeutic antibody important in determining the safety and efficacy of the drug. IgG2 and IgG4 isotypes have significantly lower binding affinity to Fcγ receptors. Recent evidence suggests that the IgG2 isotype is not completely devoid of effector function, whereas the IgG4 isotype can undergo in vivo Fab arm exchange leading to bispecific antibody and off-target effects. Here an attempt was made to engineer an IgG1-based scaffold lacking effector function but with stability equivalent to that of the parent IgG1. Care was taken to ensure that both stability and lack of effector function was achieved with a minimum number of mutations. Among the Asn297 mutants that result in lack of glycosylation and thus loss of effector function, we demonstrate that the N297G variant has better stability and developability compared with the N297Q or N297A variants. To further improve the stability of N297G, we introduced a novel engineered disulfide bond at a solvent inaccessible location in the CH2 domain. The resulting scaffold has stability greater than or equivalent to that of the parental IgG1 scaffold. Extensive biophysical analyses and pharmacokinetic (PK) studies in mouse, rat, and monkey further confirmed the developability of this unique scaffold, and suggest that it could be used for all Fc containing therapeutics (e.g. antibodies, bispecific antibodies, and Fc fusions) requiring lack of effector function or elimination of binding to Fcγ receptors.

Non-linearity of the collagen triple helix in solution and implications for collagen function.

Collagen adopts a characteristic supercoiled triple helical conformation which requires a repeating (Xaa-Yaa-Gly)n sequence. Despite the abundance of collagen, a combined experimental and atomistic modelling approach has not so far quantitated the degree of flexibility seen experimentally in the solution structures of collagen triple helices. To address this question, we report an experimental study on the flexibility of varying lengths of collagen triple helical peptides, composed of six, eight, ten and twelve repeats of the most stable Pro-Hyp-Gly (POG) units. In addition, one unblocked peptide, (POG)10unblocked, was compared with the blocked (POG)10 as a control for the significance of end effects. Complementary analytical ultracentrifugation and synchrotron small angle X-ray scattering data showed that the conformations of the longer triple helical peptides were not well explained by a linear structure derived from crystallography. To interpret these data, molecular dynamics simulations were used to generate 50 000 physically realistic collagen structures for each of the helices. These structures were fitted against their respective scattering data to reveal the best fitting structures from this large ensemble of possible helix structures. This curve fitting confirmed a small degree of non-linearity to exist in these best fit triple helices, with the degree of bending approximated as 4-17° from linearity. Our results open the way for further studies of other collagen triple helices with different sequences and stabilities in order to clarify the role of molecular rigidity and flexibility in collagen extracellular and immune function and disease.

Fibroblast growth factor receptor-Frs2α signaling is critical for nephron progenitors.

Previous studies using transgenic Pax3cre mice have revealed roles for fibroblast growth factor receptors (Fgfrs) and Fgfr substrate 2α (Frs2α) signaling in early metanephric mesenchyme patterning and in ureteric morphogenesis. The role of Fgfr/Frs2α signaling in nephron progenitors is unknown. Thus, we generated mouse models using BAC transgenic Six2EGFPcre (Six2cre) mediated deletion of Fgfrs and/or Frs2α in nephron progenitors. Six2cre mediated deletion of Fgfr1 or Fgfr2 alone led to no obvious kidney defects. Six2creFgfr1(flox/flox)Fgfr2(flox/flox) (Fgfr1/2(NP-/-)) mice generate a discernable kidney; however, they develop nephron progenitor depletion starting at embryonic day 12.5 (E12.5) and later demonstrate severe cystic dysplasia. To determine the role of Frs2α signaling downstream of Fgfr2 in Fgfr1/2(NP-/-) mice, we generated Six2cre(,)Fgfr1(flox/flox)Fgfr2(LR/LR) (Fgfr1(NP-/-)Fgfr2(LR/LR)) mice that have point mutations in the Frs2α binding site of Fgfr2. Like Fgfr1/2(NP-/-) mice, Fgfr1(NP-/-)Fgfr2(LR/LR) develop nephron progenitor depletion, but it does not start until E14.5 and older mice have less severe cystic dysplasia than Fgfr1/2(NP-/-) To determine the role of Frs2α alone in nephron progenitors, we generated Six2creFrs2'A(flox/flox) (Frs2a(NP-/-)) mice. Frs2a(NP-/-)mice also develop nephron progenitor depletion and renal cysts, although these occurred later and were less severe than in the other Six2cre mutant mice. The nephron progenitor loss in all Six2cre mutant lines was associated with decreased Cited1 expression and increased apoptosis versus controls. FAC-sorted nephron progenitors in Six2cre Frs2'A(flox/flox) mice demonstrated evidence of increased Notch activity versus controls, which likely drives the progenitor defects. Thus, Fgfr1 and Fgfr2 have synergistic roles in maintaining nephron progenitors; furthermore, Fgfr signaling in nephron progenitors appears to be mediated predominantly by Frs2α.

Automated high-throughput dense matrix protein folding screen using a liquid handling robot combined with microfluidic capillary electrophoresis.

Modern molecular genetics technology has made it possible to swiftly sequence, clone and mass-produce recombinant DNA for the purpose of expressing heterologous genes of interest; however, recombinant protein production systems have struggled to keep pace. Mammalian expression systems are typically favored for their ability to produce and secrete proteins in their native state, but bacterial systems benefit from rapid cell line development and robust growth. The primary drawback to prokaryotic expression systems are that recombinant proteins are generally not secreted at high levels or correctly folded, and are often insoluble, necessitating post-expression protein folding to obtain the active product. In order to harness the advantages of prokaryotic expression, high-throughput methods for executing protein folding screens and the subsequent analytics to identify lead conditions are required. Both of these tasks can be accomplished using a Biomek 3000 liquid handling robot to prepare the folding screen and to subsequently prepare the reactions for assessment using Caliper microfluidic capillary electrophoresis. By augmenting a protein folding screen with automation, the primary disadvantage of Escherichia coli expression has been mitigated, namely the labor intensive identification of the required protein folding conditions. Furthermore, a rigorous, quantitative method for identifying optimal protein folding buffer aids in the rapid development of an optimal production process.

Fibroblast growth factor receptor signaling in kidney and lower urinary tract development.

Fibroblast growth factor receptors (FGFRs) and FGF ligands are highly expressed in the developing kidney and lower urinary tract. Several classic studies showed many effects of exogenous FGF ligands on embryonic renal tissues in vitro and in vivo. Another older landmark publication showed that mice with a dominant negative Fgfr fragment had severe renal dysplasia. Together, these studies revealed the importance of FGFR signaling in kidney and lower urinary tract development. With the advent of modern gene targeting techniques, including conditional knockout approaches, several publications have revealed critical roles for FGFR signaling in many lineages of the kidney and lower urinary tract at different stages of development. FGFR signaling has been shown to be critical for early metanephric mesenchymal patterning, Wolffian duct patterning including induction of the ureteric bud, ureteric bud branching morphogenesis, nephron progenitor survival and nephrogenesis, and bladder mesenchyme patterning. FGFRs pattern these tissues by interacting with many other growth factor signaling pathways. Moreover, the many genetic Fgfr and Fgf animal models have structural defects mimicking numerous congenital anomalies of the kidney and urinary tract seen in humans. Finally, many studies have shown how FGFR signaling is critical for kidney and lower urinary tract patterning in humans.

Simulation-based education: understanding the socio-cultural complexity of a surgical training 'boot camp'.

OBJECTIVE: The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The effect of social and cultural influences on SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical boot camp (BC). METHODS: A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory and Bourdieu's concept of 'capital', to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with faculty members (n = 10, including the lead faculty member, session leaders and junior faculty members) and participants (n = 19 core surgical trainees and early-stage residents). RESULTS: Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytical themes. First, the complexity of the surgical training system and wider health care education context, and how this influenced the development of the BC. Second, participants' views of the BC as a vehicle not just for learning skills but for gaining 'insider information' on how best to progress in surgical training. Finally, the explicit aim of faculty members to use the Scottish Surgical Bootcamp to welcome trainees and residents into the world of surgery, and how this occurred. CONCLUSIONS: To the best of our knowledge, this is the first empirical study of a surgical BC that takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that a BC is as much about social and cultural processes as it is about individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.

Taxonomic revision of the native bee subgenus Parasphecodes Smith 1853 in Australia (Hymenoptera: Halictidae: Halictini: Lasioglossum Curtis 1833).

The Australian Lasioglossum Curtis 1833 subgenus Parasphecodes Smith 1853 is revised. Currently, Parasphecodes has 92 named, described species. The monotypic Lasioglossum subgenus Pseudochilalictus Michener 1965 is synonymised with Parasphecodes and its species, L. imitator Michener 1965, is recombined into Parasphecodes. The single known species from New Guinea, L. (Parasphecodes) permetallicum Michener 1965, is included in this revision. Eighteen new species are erected, 69 names are placed into synonymy, 20 new sex associations made and three species currently placed in Parasphecodes are recombined into the Lasioglossum subgenus Ctenonomia Cameron 1903. This revision resolved there are 40 valid species for Parasphecodes. Valid species for Lasioglossum (Parasphecodes) without synonymies are as follows: L. imitator, L. lichatus (Smith 1853), L. loweri (Cockerell 1905), L. olgae (Rayment 1935), L. permetallicum, L. turneri (Cockerell 1914d) and L. waterhousei (Cockerell 1915a). New synonymies proposed for Lasioglossum (Parasphecodes) are as follows: Lasioglossum (Pseudochilalictus Michener 1965) new synonymy = Lasioglossum (Parasphecodes); L. cirriferum (Cockerell 1910) new synonymy, L. insigne (Meyer 1920) new synonymy and L. grande (Meyer 1920) new synonymy = L. altichus (Smith 1853); L. paramelaenum (Cockerell 1922) new synonymy = L. atronitens (Cockerell 1914a); L. bribiense (Cockerell 1916) new synonymy, L. bribiensiforme (Cockerell 1930a) new synonymy, L. butleri (Rayment 1935) new synonymy, L. frenchi (Rayment 1935) new synonymy, L. frenchellum Michener 1965 new synonymy, L. sordidulum (Cockerell 1914c) new synonymy and L. patongensis (Rayment 1948) new synonymy = L. bryotrichum (Cockerell 1912a); L. fumidicaudum (Cockerell 1914b) new synonymy and L. noachinum (Cockerell 1914b) new synonymy = L. carbonarium (Smith 1853); L. cervicale (Cockerell 1915b) new synonymy and L. zamelanum (Cockerell 1930a) new synonymy = L. dissimulator (Cockerell 1914b); L. wilmatae (Cockerell 1929c) new synonymy = L. excultum (Cockerell 1913b); L. arciferum (Cockerell 1914b) new synonymy, L. atrorufescens (Cockerell 1914b) new synonymy, L. fulviventre (Friese 1924) new synonymy, L. leptospermi (Cockerell 1916) new synonymy, L. lichatinum (Cockerell 1922) new synonymy, L. leucorhinum (Cockerell 1926) new synonymy, L. proximum (Rayment 1947) new synonymy, L. testaciventre (Rayment 1953) new synonymy, L. tilachus (Smith 1853) new synonymy, L. tilachiforme (Cockerell 1907) new synonymy, L. tuchilas (Smith 1853) new synonymy, L. anhybodinum (Cockerell 1930a) new synonymy, L. hybodinum (Cockerell 1912a) new synonymy, L. tripunctatum (Cockerell 1929c) new synonymy and L. warburtoni (Cockerell 1906) new synonymy = L. hilactus (Smith 1853); L. frenchi (Cockerell 1904) new synonymy, L. schomburgki (Cockerell 1910) new synonymy, L. speculiferum (Cockerell 1912a) new synonymy, L. sextum (Cockerell 1910) new synonymy, L. solis (Cockerell 1922) new synonymy, L. vermiculatum (Cockerell 1914b) new synonymy and L. vulneratum (Cockerell 1910) new synonymy = L. hiltacus (Smith 1853); L. hirtiventre (Cockerell 1922) new synonymy, L. niveorufum (Friese 1924) new synonymy, L. submeracum (Cockerell 1930a) new synonymy and L. froggatti (Cockerell 1905) new synonymy = L. lacthius (Smith 1853); L. basilautum (Cockerell 1910) new synonymy, L. doddi (Cockerell 1914c) new synonymy, L. paracolletinum (Cockerell 1910) new synonymy, L. pilicolle (Friese 1924) new synonymy, L. scutellatum (Friese 1924) new synonymy and L. vau (Cockerell 1910) new synonymy = L. leichardti (Cockerell 1906); L. annexum (Cockerell 1922) new synonymy, L. latissimum (Cockerell 1915b) new synonymy, L. microdontum (Cockerell 1912a) new synonymy, L. recessum (Cockerell 1914d) new synonymy, L. longmani (Cockerell 1922) new synonymy, L. recantans (Cockerell 1912a) new synonymy and L. rufotegulare (Cockerell 1914e) new synonymy = L. melbournense (Cockerell 1904); L. trimaculatum (Friese 1924) new synonymy = L. musicum (Cockerell 1913a); L. gentianae (Rayment 1951) new synonymy = L. subrussatum (Cockerell 1922); L. fultoni (Cockerell 1914b) new synonymy, L. gibbosum (Friese 1924) new synonymy, L. niveatum (Meyer 1920) new synonymy, L. punctatissimus (Meyer 1920) new synonymy, L. rhodopterum (Cockerell 1914e) new synonymy, L. rubriventre (Friese 1924) new synonymy, L. subfultoni (Cockerell 1930a) new synonymy, L. tepperi (Cockerell 1905) new synonymy, L. notescens (Cockerell 1930a) new synonymy and L. rufulum (Friese 1924) new synonymy = L. sulthica (Smith 1853); L. submoratum (Cockerell 1930a) new synonymy and L. perustum (Cockerell 1914d) new synonymy = L. taluchis (Smith 1853). Eighteen new species are described as follows: L. acristum Walker & Sparks, L. altum Walker & Sparks, L. aspereticulum Walker & Sparks, L. atropum Walker & Sparks, L. bimelasmum Walker & Sparks, L. bipenicillum Walker & Sparks, L. bitrichum Walker & Sparks, L. blyscanatum Walker & Sparks, L. brevipectinatum Walker & Sparks, L. capronum Walker & Sparks, L. ferruginum Walker & Sparks, L. flexosum Walker & Sparks, L. laevidiscum Walker & Sparks, L. recavum Walker & Sparks, L. reticulum Walker & Sparks, L. rutrum Walker & Sparks, L. variegatum Walker & Sparks and L. wcisloi Walker & Sparks. New subgeneric classifications are as follows: L. (Pseudochilalictus) imitator = L. (Parasphecodes) imitator new status, Halictus clarigaster Cockerell 1918 = L. (Ctenonomia) clarigaster new status, Halictus forresti Cockerell 1906 = L. (Ctenonomia) forresti new status, and Halictus tribuarius Rayment 1935 = L. (Ctenonomia) tribuarium new status. These species names, all described by Smith 1853, are anagrams of Halictus. Therefore, they are nouns in apposition and should retain their original species designations as: Lasioglossum (Parasphecodes) altichus (Smith 1853), Lasioglossum (Parasphecodes) hilactus (Smith 1853), Lasioglossum (Parasphecodes) hiltacus (Smith 1853), Lasioglossum (Parasphecodes) lacthius (Smith 1853), Lasioglossum (Parasphecodes) lichatus (Smith 1853), Lasioglossum (Parasphecodes) sulthica (Smith 1853), Lasioglossum (Parasphecodes) talchius (Smith 1853), Lasioglossum (Parasphecodes) taluchis (Smith 1853), Lasioglossum (Parasphecodes) tilachus (Smith 1853) and Lasioglossum (Parasphecodes) tuchilas (Smith 1853). All 40 valid Parasphecodes species, as well as the three species recombined to Ctenonomia, are redescribed. For the Parasphecodes species, keys to both sexes, character groups, taxonomy, citations, species diagnoses, comments, descriptions, scanning electron micrographs, colour montage images, distribution maps, male genitalia and S7S8 line drawings are provided to assist with species identifications.