River zebrafish combine behavioral plasticity and generalized morphology with specialized sensory and metabolic physiology to survive in a challenging environment.

Phenotypes that allow animals to detect, weather, and predict changes efficiently are essential for survival in fluctuating environments. Some phenotypes may remain specialized to suit an environment perfectly, while others become more plastic or generalized, shifting flexibly to match current context or adopting a form that can utilize a wide range of contexts. Here, we tested the differences in behavior, morphology, sensory and metabolic physiology between wild zebrafish (Danio rerio) in highly variable fast-flowing rivers and still-water sites. We found that river zebrafish moved at higher velocities than did still-water fish, had lower oxygen demands, and responded less vigorously to small changes in flow rate, as we might expect for fish that are well-suited to high-flow environments. River zebrafish also had less streamlined bodies and were more behaviorally plastic than were still-water zebrafish, both features that may make them better-suited to a transitional lifestyle. Our results suggest that zebrafish use distinct sensory mechanisms and metabolic physiology to reduce energetic costs of living in fast-flowing water while relying on morphology and behavior to create flexible solutions to a challenging habitat. Insights on animals' reliance on traits with different outcomes provide a framework to better understand their survival in future environmental fluctuations.

Defining and supporting a professional role for pharmacists associated with traditional and complementary medicines: a cross-country survey of pharmacists.

Introduction: An estimated 80% of the world's population use traditional and complementary medicine (T&CM) products as part of their healthcare, with many accessed through pharmacy. This cross-cultural study posed a set of professional practice responsibilities and actions to pharmacists related to T&CM products, with a view toward developing consensus, safeguarding, and promoting the health of the public. Methods: Data were collected from 2,810 pharmacists across nine countries during 2022 via a cross-sectional online survey reported in accordance with the guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Of the 2,810 participants from nine countries, 2,341 completed all sections of the survey. Of these, most agreed (69%) that T&CM product use was common in the community they served, but most did not have adequate training to support consumer needs. Over 75% acknowledged that there were known and unknown safety risks associated with T&CM use. Of 18 professional responsibilities posed, 92% agreed that pharmacists should be able to inform consumers about potential risks, including T&CM side effects and drug-herb interactions. The provision of accurate scientific information on the effectiveness of T&CM products, skills to guide consumers in making informed decisions, and communication with other healthcare professionals to support appropriate and safe T&CM product use were all ranked with high levels of agreement. In order to effectively fulfill these responsibilities, pharmacists agreed that regulatory reforms, development of T&CM education and training, and access to quality products supported by high-quality evidence were needed. Conclusion: General agreement from across nine countries on eighteen professional responsibilities and several stakeholder actions serve as a foundation for the discussion and development of international T&CM guidelines for pharmacists.

Correlation between clinical outcomes and appropriateness grading for referral to myocardial perfusion imaging for preoperative evaluation prior to non-cardiac surgery.

BACKGROUND: In a previous study, we have found that referral to myocardial perfusion imaging(MPI) for preoperative evaluation of patients before non-cardiac surgery was the most common cause of inappropriate referral based on AHA/ACC Appropriate Use Guidelines, though 40% of scans graded as inappropriate had abnormal MPI results. The aim of this study was to correlate appropriateness grading with (1) the outcome of MPI scans, and (2) the clinical outcome of patients after surgery, so as to determine if the predictive value of MPI was related to appropriateness grading. METHODS: All consecutive patients referred to the MPI laboratory of our center from March 2009 to July 2009 for preoperative risk stratification were prospectively studied. Patients' medical records and stress data were collected, and all imaging results were recorded. Based on appropriate use criteria (AUC), MPI studies were classified into appropriate, inappropriate, uncertain or unclassified. MPI studies were classified on the basis of their results into normal or abnormal scans. Primary clinical outcome measured was the occurrence of any major cardiac and cerebrovascular event during follow-up up to 90 days. RESULTS: There were 176 referrals for preoperative evaluation. 39.8% (n 5 70) of these referrals were graded as inappropriate. Based on AUC, referrals for MPI in intermediate- and high-risk groups with poor functional class were graded as appropriate, while referrals for MPI in low-risk and intermediate risk groups with normal functional class were graded as inappropriate referrals. The overall event rate was 6.25%. Cumulative death rate at 90 days was 1.7%, non-fatal MI 4%, and occurrence of stroke occurred in 0.6%. The primary outcome was higher in the intermediate group with poor functional class (13%) and high-risk group (64%) than the low-risk and intermediate risk groups with good functional class (4%). In the high-risk group, an abnormal MPI scan was associated with an extremely high event rate (50%) that was significantly greater than the event rate in patients with a normal MPI result (14%) (P 5 .01). Although 40% of preoperative low-risk and intermediate risk patients had an abnormal MPI result, their over all event rates were low (0 and 4%, respectively), with no difference in the rate of events between patients with normal and abnormal MPI scans in the inappropriate group. CONCLUSIONS: In conclusion, in correlating the relationship between appropriateness grading by AUC with the outcome of MPI scans and subsequent event rates, we found that MPI results predicted outcome in appropriately tested patients, but not in patients whose tests were classified as inappropriate, in whom event rates were low, regardless of the results of testing. Our findings support the AUC recommendations for the selective role of testing in preoperative risk stratification,which use the type of surgery and functional class to determine the appropriateness of referral.

Spatiotemporal Foraging Dynamics of Solenopsis invicta (Hymenoptera: Formicidae) and its Potential Effects on the Spatial Structure of Interspecific Competition.

The ant communities on coffee farms in the West/Central Mountains of Puerto Rico are composed of mainly invasive species, although many have a long history of occupation and are effectively naturalized. The ecological forces that maintain such communities are thus of interest, and are evidently related to the spatial patterns in which they inevitably occur. Furthermore, the spatial patterns in which members of the native ant community forage almost certainly include limitations related to the structure of the networks of subterranean foraging tunnels that extend from the nest mounds of Solenopsis invicta. Here we explore some details of that structure. We ask, what is the pattern of foraging exit holes and the gaps between them, and how does that pattern change from farm to farm and from time to time? We encounter typical underground foraging trails punctuated by foraging exits, which, we propose, create a structure above ground of relatively small foraging exits in a matrix of effective foraging gaps. This pattern varies from nest to nest and farm to farm. Other ant species clearly occupy those gaps and seem to gain some of their resilience in the system from this peculiarity of S. invicta's foraging area structure.

Evaluation of the American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria for SPECT myocardial perfusion imaging in an Asian tertiary cardiac center.

BACKGROUND: Appropriate use criteria (AUC) for SPECT MPI have been published to address concern about the growth of cardiac imaging studies and the effective use of imaging, but there is no published data on its role outside the United States. METHODS: All consecutive patients referred to the MPI laboratory of our center from February 16 to June 19, 2009 were prospectively studied. Patients' medical records and stress data were collected and all imaging results were recorded. Based on AUC, MPI studies were classified into appropriate, inappropriate, uncertain, or unclassified. MPI studies were classified on the basis of their results into normal or abnormal scans. RESULTS: There were 1,623 patients (mean age 61 years ± 11, 61% males). Most common indications for SPECT were evaluation of ischemic equivalent for coronary artery disease (CAD), risk assessment post-revascularization, and preoperative evaluation for non-cardiac surgery. 10% of referrals were classified as inappropriate, 5% uncertain, and 3% unclassified. Women (48.4% vs 40.6% for men, P = .063) and asymptomatic patients (50.2% vs 14.3% for symptomatic, P < .001) had a higher proportion of inappropriate studies. The preoperative group had the highest proportion of inappropriate studies (59%). Appropriate referrals had a higher proportion of abnormal SPECT results than inappropriate referrals (40% vs 27%, OR 2.08, 95% CI 1.56-2.77, P < .001). CONCLUSIONS: The pattern of referrals for SPECT MPI in an Asian center appears to vary from published reports in the United States. Preoperative evaluation for low-risk surgery appears to be the most common source of inappropriate referrals in our institution. Inappropriate referrals have a higher proportion of normal studies, but 27% were still reported as abnormal.

Color preferences affect learning in zebrafish, Danio rerio.

Animals may exhibit preference for colors that match their environment or the resources in the environment. These preferences may impact ability to learn associations with these colors and revert the associations when the reward contingency is modified. We used zebrafish Danio rerio from four populations to test if color preferences impact associative and reversal learning ability. First, we tested if preference for blue or green impact associative ability. We subjected individual fish through eight trials to associate a social stimulus with blue or green. Next, we tested if preference for red or green impact associative reversal learning ability. We trained fish in groups of three to associate a social stimulus with red or green over three trials, and reversed the reward contingency during the following session. Results showed that zebrafish preferred green over blue and domesticated fish chose green more than blue when there was a reward attached. Zebrafish also preferred red over green. Fish from one wild population learned with both colors and reversed learning only from green to red and not vice-versa. Fish from another population showed an overwhelming preference for red irrespective of what was rewarded. Domesticated fish did not show reversal learning ability.

Veterans affairs primary care clinicians' attitudes toward chronic pain and correlates of opioid prescribing rates.

OBJECTIVES: The primary objective of this study was to identify veterans affairs (VA) primary care clinicians' attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates. DESIGN: Cross-sectional study of clinician survey and pharmacy data. PARTICIPANTS: Forty-five VA clinicians from five primary care clinics of one VA medical center. MEASURES: Survey of pain-related attitudes and behaviors, satisfaction with treatment resources, and job satisfaction; percentage of patients in clinicians' panels prescribed opioids (PCPO). RESULTS: Seventy-one percent of clinicians felt moderately or strongly confident in their ability to treat chronic pain, and 77% moderately or strongly agreed that skilled pain management is a high priority. However, 73% moderately or strongly agreed that patients with chronic pain are a major source of frustration and 38% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment. Fifty-two percent moderately or strongly agreed that their management is influenced by previous experiences with patients addicted to drugs. The mean PCPO was 16.5% (SD = 6.7). In bivariate comparisons, clinician panel size, job and resource satisfaction, and professional training were associated with opioid prescribing rates. CONCLUSION: High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.

Long-Term Prognostic Value of Appropriate Myocardial Perfusion Imaging.

Appropriate use criteria (AUC) for single-photon emission computed tomography myocardial perfusion images (SPECT-MPIs) were developed to address the growth of cardiac imaging studies. Long-term prognostic value of AUC in SPECT-MPI has not been tested in existing cohorts. We sought to determine the long-term prognostic value of MPI classified as appropriate. AUC was evaluated in a prospectively designed cohort of patients who underwent clinically indicated MPI. MPI studies were classified based on 2009 AUC for SPECT-MPI. Data regarding downstream coronary angiography (cath), revascularization and all-cause mortality, cardiac death, and nonfatal myocardial infarction (MI) were collected from national registries. Among n = 1,129 MPI scans that received an appropriate grading, 148 all-cause deaths, 109 MIs, 58 cardiac deaths, 152 caths, 113 revascularization procedures occurred over a mean follow-up period of 5.4 ± 1.2 years (0.9% cardiac death rate per year, 1.8% MI rate per year). Most of the scans were low-risk normal MPI scans (summed stress score ≤3; 74.1%). An abnormal scan was associated with higher rates of MI (19.5% vs 6.2%, hazard ratio 1.72, p = 0.017) and cardiac death (13.4% vs 2.3%, hazard ratio 2.12, p = 0.016). In conclusion, MPI scans classified as appropriate have long-term prognostic value, despite a high proportion of low-risk scans. This provides support for clinicians to consider the use of appropriate grading in addition to MPI scan results in patient management.

Lipophilic toxins in cultivated mussels (Mytilus galloprovincialis) from Baja California, Mexico.

Here, we report different lipophilic toxins (LTs) detected by LC-MS/MS in Mediterranean mussels (Mytilus galloprovincialis) collected through 2012 in Todos Santos Bay, northwest Baja California, Mexico. The concentration of okadaic acid (OA), dinophysistoxin 2 (DTX2), and pectenotoxin 2 (PTX2) reached 500 µg kg(-1) during July and increased to 1647 µg kg(-1) in October. These toxins were associated with the presence of Dinophysis fortii and Dinophysis acuminata and a strong stratification of the water column. Other LTs present were yessotoxins, with a maximum concentration of 1080 µg kg(-1) in June. Cyclic imines (13-desmethyl spirolide and gymnodimine) and azaspiracid 1 were also detected in the mussels but at low concentrations. Diarrhetic toxins concentrations evaluated by LC-MS/MS were compared with the results of two mouse bioassay protocols. Positive results were obtained with both MBA protocols in several samples that presented toxicities below 160 µg OA-eq kg(-1), as estimated by LC-MS/MS results whereas other samples returned negative MBA results in samples with concentrations above this level. Therefore, analytical methods need to be applied to confirm the presence of regulated LTs. This is the first report of LTs in mussels cultivated in Mexico. The occurrence of these toxins represents an emerging problem in the region.

Primary care provider preferences for working with a collaborative support team.

BACKGROUND: Clinical interventions based on collaborative models require effective communication between primary care providers (PCPs) and collaborative support teams. Despite growing interest in collaborative care, we have identified no published studies describing how PCPs prefer to communicate and interact with collaborative support teams. This manuscript examines the communication and interaction preferences of PCPs participating in an ongoing randomized clinical trial of a collaborative intervention for chronic pain and depression. METHODS: The trial is being conducted in five primary care clinics of a Veterans Affairs Medical Center. Twenty-one PCPs randomized to the study intervention completed a survey regarding preferences for interacting with the collaborative support team. RESULTS: A majority of PCPs identified email (95%) and telephone calls (68%) as preferred modes for communicating with members of the support team. In contrast, only 29% identified in-person communications as preferred. Most PCPs preferred that the care manager and physician pain specialist assess patients (76%) and make initial treatment changes (71%) without first conferring with the PCP. One-half wanted to be designated cosigners of all support team notes in the electronic medical record, one-half wanted to receive brief and focused information rather than in-depth information about their patients, and one-half wanted their practice nurses automatically included in communications. Panel size was strongly associated (p < 0.001) with preference for brief, to-the-point discussions about patients. CONCLUSION: The substantial variation in PCP communication preferences suggests the need for knowledge of these preferences when designing and implementing collaborative interventions. Additional research is needed to understand relationships between clinician and practice characteristics and interaction preferences.