Augmented Reality Application of Schizocosa ocreata: A Tool for Reducing Fear of Arachnids Through Public Outreach.

This study aims to create a mobile application for public interaction around the subject of wolf spiders, specifically the brush-legged wolf spider. The hope is that the public will have a reduced level of fear towards arachnids when given a chance to view arachnids in a digital setting. To assist this, the application employs augmented reality animation, which has been shown to have a positive impact on the viewer's interest and learning. With the opportunity to view a digital spider interacting with surfaces in a repeatable and informative manner, viewers may find that their fears are more understood and can be controlled for both their benefit and that of the local arachnids. In order to accommodate multiple audiences, the application was set up to have a more cartoonish and simpler text as well as a realistic and advanced text. The area of information covered the brush-legged wolf spider's anatomy, mating behaviour, and general safety practices for handling and avoiding wolf spiders. The modelling and animation were created using Zbrush and Blender, respectively. The programming and application creations used were Unity with Android and AR plugins.

Vibration-guided mate searching in treehoppers: directional accuracy and sampling strategies in a complex sensory environment.

Animal movement decisions involve an action-perception cycle in which sensory flow influences motor output. Key aspects of the action-perception cycle involved in movement decisions can be identified by integrating path information with measurement of environmental cues. We studied mate searching in insects for which the primary sensory cues are mechanical vibrations traveling through the tissues of living plants. We mapped search paths of male thornbug treehoppers locating stationary females through an exchange of vibrational signals. At each of the males' sampling locations, we used two-dimensional laser vibrometry to measure stem motion produced by female vibrational signals. We related properties of the vibrational signals to the males' movement direction, inter-sample distance and accuracy. Males experienced gradients in signal amplitude and in the whirling motion of the plant stem, and these gradients were influenced to varying degrees by source distance and local stem properties. Males changed their sampling behavior during the search, making longer inter-sample movements farther from the source, where uncertainty is higher. The primary directional cue used by searching males was the direction of wave propagation, and males made more accurate decisions when signal amplitude was higher, when time delays were longer between the front and back legs, and when female responses were short in duration. The whirling motion of plant stems, including both the eccentricity and the major axes of motion, is a fundamental feature of vibrational environments on living plants, and we show for the first time that it has important influences on the decisions of vibrationally homing insects.

Project GIVE: using a virtual genetics service platform to reduce health inequities and improve access to genomic care in an underserved region of Texas.

BACKGROUND: The utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley (RGV) at the Texas-Mexico border is predominantly Hispanic/Latino with a high poverty rate and very limited access to genetic services. Funded by the National Center for Advancing Translational Sciences, Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to reduce the time to diagnosis and increase provider knowledge of genomics in this region, with the goal of improving pediatric health outcomes. We describe our experience of establishing a virtual pediatric genomic service in this region to expeditiously identify, recruit, and evaluate pediatric patients with undiagnosed diseases. METHODS: We have utilized an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform called Consultagene to receive referrals from healthcare providers in the RGV. Using this portal, genetic services, including virtual evaluation and genome sequencing (GS), are being delivered to children with rare diseases. The study has also integrated effective methods to involve and educate community providers through in-person meetings and Continuing Professional Education (CPE) events. RESULTS: The recruitment efforts have proven highly successful with the utilization of Consultagene in this medically underserved region. The project's ongoing engagement efforts with local healthcare providers have resulted in progressively more referrals to the study over time, thus improving inclusion and access to genomic care in the RGV. Additionally, the curated CPE content has been well received by healthcare providers in the region. CONCLUSIONS: Project GIVE study has allowed advanced genetic evaluation and delivery of GS through the virtual Consultagene portal, effectively circumventing the recognized socioeconomic and logistical barriers to accessing genetic services within this border community.

Demise of the USMLE Step-2 CS exam: Rationalizing a way forward.

The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship.

Reducing Time to Diagnosis of Rare Genetic Diseases in a Medically Underserved Hispanic Population- Lessons Learned for Meaningful Engagement.

Background: The utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley at the Texas-Mexico border is predominantly Hispanic with a high poverty rate and an increased prevalence of birth defects, with very limited access to genetics services. The cost of a diagnosis is often times out of reach for these underserved families. Funded by the National Center for Advancing Translational Sciences (NCATS), Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to shorten the time to diagnosis and alleviate healthcare inequities in this region, with the goal of improving pediatric health outcomes. Methods: Utilizing Consultagene, an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform, we designed the study to recruit 100 children with rare diseases over a period of two years from this region, through peer-to-peer consultation and referral. Conclusions: Project GIVE study has allowed advanced genetic evaluation and delivery of genome sequencing through the virtual portal, effectively circumventing the recognized socioeconomic and other barriers within this population. This paper explores the successful community engagement process and implementation of an alternate genomics evaluation platform and testing approach, aiming to reduce the diagnostic journey for individuals with rare diseases residing in a medically underserved region.

A case-control study of colorectal cancer detection by quantification of DNA isolated from directly collected exfoliated colonocytes.

This pilot study aimed to assess an original test based on the analysis of exfoliated colonocytes as a new approach to colorectal cancer (CRC) detection. DNA was isolated from exfoliated cells collected from the surface of the rectal mucosa by a standardized minimally invasive procedure in a case-control trial involving 66 patients with CRC diagnosis and 110 healthy volunteers (age 50-70). PicoGreen staining and quantitative real-time PCR (QRTPCR) were used for DNA quantification. Mean DNA scores in microg/ml obtained for the control and cancer groups were 2.1 (95% CI 1.7-2.5) and 9.0 (CI 6.7-11.2) respectively (p < 0.001) for PicoGreen and 0.8 (CI 0.6-0.9) and 3.8 (CI 1.9-5.7) respectively (p = 0.003) for QRTPCR. The PicoGreen assay better detected CRC presence. At DNA score cut-off point of 2.5 microg/ml this assay gave sensitivities of 77.8% (CI 52.4-93.6) for proximal tumours, 91.4% (CI 76.9-98.2) for distal CRC and 86.8% (CI 74.7-94.5) for all CRC with specificity at 74.0% (CI 64.0-82.4). Increasing the cut-off point to 5.0 microg/ml resulted in sensitivities of 38.9% (CI 17.3-64.3) for proximal tumours, 71.4% (CI 53.7-85.4) for distal CRC and 60.4% (CI 46.0-73.5) for all CRC. Specificity for this cut-off point increased to 94.8% (CI 88.3-98.3). The new procedure of exfoliated cell collection from the surface of the rectal mucosa is a simple, safe and well-tolerated technique providing high quality cells. These early results suggest that exfoliated cell collection in combination with DNA quantification can potentially be employed as a tool for CRC early detection.

General practitioners and long-term neurological conditions.

PURPOSE: General practitioners (GPs) can have a significant role to play in the management of individuals with long-term neurological conditions (LTNC). This paper looks at various roles and responsibilities of GPs in the management of these patients. METHOD: This paper is based on a Medline literature search using the key words 'general practitioner;''rehabilitation;''long-term;' and 'neurological'. RESULTS: The findings are broadly divided into diagnostic, supportive and palliative roles. CONCLUSION: GPs have a lot to offer individuals with LTNC, but recent changes in the way they work, especially in the UK, may hamper their role.

A non-destructive virtual dissection by micro-CT reveals diagnostic characters in the type specimen of Caloptilia stigmatella (Lepidoptera: Gracillariidae).

Nearly a century ago, wing venation was introduced in gracillariid taxonomy as a means to diagnose closely related genera and species groups. Recent advances in non-destructive virtual micro-dissections suggest promising approaches with which to revisit the relevance of wing venation characters on historic primary type specimens. Many unique type specimens in Gracillariidae and other microlepidoptera groups preserved in museum collections are in poor condition, and over the course of history have suffered loss or damage to their abdomens. Consequently, genitalia morphology is not available for diagnoses and comparisons. In this paper we emphasize the need to include the type species and type specimens into the broader context of taxonomic studies on micro-moths in general and the family Gracillariidae in particular. The genus Caloptilia has a world-wide distribution and has been the subject of research for more than 200 years, yet the generic boundaries and groupings within the genus are still unresolved due to the lack of a reliable set of taxonomic characters obtained from the primary types. We describe a method of virtual descaling of the fore- and hindwings using the unset micro-moth type specimen of Caloptilia stigmatella Fabricius, 1781, in order to demonstrate that the study of historic and fragile type specimens and diagnoses of their internal morphological characters becomes possible by applying new and non-destructive technology.

Establishing the NeuroRecovery Network Community Fitness and Wellness facilities: multi-site fitness facilities provide activity-based interventions and assessments for evidence-based functional gains in neurologic disorders.

BACKGROUND: Physical fitness is a necessity for those living with a spinal cord injury, yet access to fitness facilities, equipment, and specially trained fitness experts are limited. METHODS: This article introduces the concept of a network of fitness facilities specially geared towards individuals with spinal cord injury and other neurological disorders. RESULTS: The Community Fitness and Wellness branch of the NeuroRecovery Network was created to provide a continuum of care after traditional rehabilitation for individuals living with a spinal cord injury and other neurological disorders. Community Fitness and Wellness facilities translate activity-based interventions performed during rehabilitation into a community setting as well as provide other fitness and wellness opportunities. Community Fitness and Wellness facilities are staffed by professionals with training on the specialized needs of individuals living with spinal cord injury or other neurological disorders. Standardized assessments evaluate functional, health, and quality of life gains at regular intervals. A national database gathers information on standardized interventions and assessment outcomes providing a mechanism for evaluation of interventions performed in the community setting. CONCLUSIONS: The establishment of Community Fitness and Wellness facilities allows for the quick translation and evaluation of novel, effective approaches from research to individuals in the community. Implications for Rehabilitation Fitness needs of individuals with spinal cord injury living in the community necessitate the use of special equipment and trained staff. Community Fitness and Wellness Programs offer specially trained staff and adaptive equipment providing a continuity of care for those with spinal cord injuries and other neurological disorders.

Pain experienced by electric-powered chair users: a pilot exploration using pain drawings.

BACKGROUND AND PURPOSE: Many wheelchair users experience pain or discomfort, and little is known about its severity or nature. The present study explored the feasibility of using visual analogue scales and pain drawings to assess the intensity and distribution of pain in users of electric-powered indoor and outdoor wheelchairs, and its changes over time. METHOD: Five electric-powered indoor and outdoor chair (EPIOC) users, mean age 62 years (range 43-84 years) completed pain drawings and visual analogue scales two-hourly during one day. RESULTS: Pain intensity increased throughout the day in all users. It was most severe in the neck, back and buttocks. Pain drawings gave visual impact to the extent of the pain. CONCLUSIONS: Visual analogue scales and pain drawings may be useful in assessing pain experienced by EPIOC users, which may be severe and appears to increase in severity and distribution during the day.

Development of the OnTrack Diabetes Program.

BACKGROUND: Type 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes. OBJECTIVE: The objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes. METHODS: Semistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program. RESULTS: A separate paper describes the protocol for a randomized controlled trial to provide this required evaluation. CONCLUSIONS: Development of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users' experiences and examining the program's effectiveness and cost-effectiveness in randomized controlled trials. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ACTRN): 12614001126606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001126606 (Archived by WebCite at http://www.webcitation.org/6U0Fh3vOj).

Endoscopy in primary care--a survey of current practice.

BACKGROUND: Long waiting lists in district general hospitals and savings from fundholding led to the setting up of a number of endoscopy units in primary care. Concerns have been expressed over safety, supervision and cost effectiveness. Increasingly, general practitioners (GPs) are being encouraged to become specialists and offer intermediate care. Endoscopy is frequently cited as an example of intermediate care that could be offered by primary care specialists. This is the first survey of such a service. AIM: To examine whether endoscopy in primary care can be considered to be a safe procedure. DESIGN OF STUDY: A questionnaire-based survey. SETTING: Twenty-eight general practice units performing endoscopy in primary care. METHOD: Units performing endoscopy in primary care were identified using the Primary Care Society of Gastroenterology (PCSG) database and following an appeal in the GP press. A postal questionnaire was sent to each unit covering its history, throughput, and case-mix, experience of endoscopists, supervision, audit and CME, equipment, waiting times and complication rates. RESULTS: Of the 28 units identified, 27 (96%) replied to the questionnaire, 13 units provided both upper and lower bowel examination, six oesophago-gastro-duodenoscopy (OGD) only, and eight lower bowel only. Units had been openfor an average of five years (range = 2 to 18 years), and 41 doctors and 68 nurse assistants provided the service. The average experience of endoscopists was 16 years (range = 6 to 25 years), and 36,455 procedures had been performed by the time of the survey (24,195 OGD and 12,260 lower bowel examinations). Ninety-six per cent of the units undertook audit. Urgent waiting times were 1.2 weeks and routine 3.4 weeks (range = 1.0 to 6.0). The annual throughput of 22 units in the past year was 8,478 procedures (4506 OGD, 3,972 lower bowel examinations). Out of 24,195 OGDs there were three reported complications (one perforation of pharyngeal pouch, treated conservatively, one chest pain after over-insufflation, and one slow recovery after intravenous sedation); there was no mortality. Out of 12,260 lower bowel procedures there was one perforated caecal carcinoma after flexible sigmoidoscopy (died), three perforations at colonoscopy and seven other minor complications. CONCLUSIONS: Endoscopy in primary care appears to be a safe procedure. This good safety record is probably attributable to careful case selection and minimal use of intravenous sedation.