Culturable bacteria are more common than fungi in floral nectar and are more easily dispersed by thrips, a ubiquitous flower visitor.

Variation in dispersal ability among taxa affects community assembly and biodiversity maintenance within metacommunities. Although fungi and bacteria frequently coexist, their relative dispersal abilities are poorly understood. Nectar-inhabiting microbial communities affect plant reproduction and pollinator behavior, and are excellent models for studying dispersal of bacteria and fungi in a metacommunity framework. Here, we assay dispersal ability of common nectar bacteria and fungi in an insect-based dispersal experiment. We then compare these results with the incidence and abundance of culturable flower-inhabiting bacteria and fungi within naturally occurring flowers across two coflowering communities in California across two flowering seasons. Our microbial dispersal experiment demonstrates that bacteria disperse via thrips among artificial habitat patches more readily than fungi. In the field, incidence and abundance of culturable bacteria and fungi were positively correlated, but bacteria were much more widespread. These patterns suggest shared dispersal routes or habitat requirements among culturable bacteria and fungi, but differences in dispersal or colonization frequency by thrips, common flower visitors. The finding that culturable bacteria are more common among nectar sampled here, in part due to superior thrips-mediated dispersal, may have relevance for microbial life history, community assembly of microbes, and plant-pollinator interactions.

Cost-effectiveness and budget impact of adjunctive hyperbaric oxygen therapy for diabetic foot ulcers.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunct to standard methods of care for diabetic foot ulcers (DFU). Its use may decrease the risk of infection and lower extremity amputations (LEAs). As part of a Canadian assessment, we estimated the cost-effectiveness and budget impact of HBOT in this application. METHODS: We developed a decision model comparing adjunctive HBOT with standard care alone. The population was a 65-year-old cohort with DFU. The time horizon was 12 years taken from a Ministry of Health perspective. The health states were a healed wound with or without a minor LEA, an unhealed wound with no related surgery, and a major LEA. Efficacy data were based on outcomes reported in studies included in a literature review. Cost and capacity needs for treating DFU patients in Canada were estimated using prevalence data from the literature, and cost and utilization data from government records. RESULTS: The 12-year cost for patients receiving HBOT was CND$40,695 compared with CND$49,786 for standard care alone. Outcomes were 3.64 quality-adjusted life-years (QALYs) for those receiving HBOT and 3.01 QALYs for controls. Estimated cost to treat all prevalent DFU cases in Canada was CND$14.4-19.7 million/year over 4 years. If seven-person HBOT chambers were used, a further nineteen to thirty-five machines would be required nationally. CONCLUSIONS: Adjunctive HBOT for DFU is cost-effective compared with standard care. Additional HBOT capacity would be needed if it were to be adopted as the standard of care throughout Canada.

Implementation of an objective testing system in noninvasive cardiac imaging for evaluation of pediatric cardiology fellows.

INTRODUCTION: Current evaluation of pediatric cardiology fellow performance is subjective and qualitative. More objective tools are recommended by credentialing boards and may provide more effective evaluation and education. OBJECTIVE: A series of training level-specific multiple-choice tests were developed and evaluated for their effectiveness as evaluation and educational tools for pediatric cardiology fellows. METHODS: Imaging tests were created by 3 attending physicians and one sonographer with combined expertise in echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography. Test content was derived from educational materials, textbooks, journal articles, and lectures previously given to the fellows. The tests were computerized and installed on the hospital intranet. After completion of each test, a posttest session was conducted between the fellow and the director of echocardiography to review concepts surrounding incorrect answers. A survey of the test use was then completed by each fellow. RESULTS: Four progressively more difficult tests corresponding to each 1-month image rotation and an advanced fifth test for fellows intending to subspecialize in noninvasive cardiac imaging were created. Fifteen fellows took 39 tests (test 1, 15 fellows; test 2, 9 fellows; test 3, 9 fellows; test 4, 4 fellows; and test 5, 2 fellows). The difficulty level of the tests was similar relative to fellow academic level. The majority of fellows welcomed more objective data provided by the tests and 93% of the fellows stated the posttest session was educational. CONCLUSION: Implementation of a fellow testing system using training level-specific computerized questions and images provides objective data for fellow performance evaluations and is a unique and beneficial educational tool.

Development of an interactive model for teaching emergency pediatric radiography: preliminary report.

PURPOSE: The authors describe the development of an interactive digital teaching module designed to help prepare residents to diagnose emergency pediatric radiology cases. METHODS: Cases were identified using the authors' own dictation search software. Cases were selected that depicted common conditions that had been misdiagnosed by the radiology resident who had first interpreted them clinically. Normal cases involving similar anatomic regions were also collected. Images from these cases were captured from the picture archiving and communication system. "Hotspots" were superimposed on abnormalities to highlight them. Example dictations were captured. A simple user interface was developed for the teaching module, and a database was built to log all user responses. RESULTS: The system has been well received at the authors' institution. It has been incorporated into the standard orientation for all incoming residents. Residents' diagnostic performance has subjectively improved since the module was launched. CONCLUSIONS: The module is interactive, easy to use, and subjectively improves incoming residents' diagnostic accuracy. A prospective, controlled study assessing its impact on short-term and long-term diagnostic performance is under way.