A new Bradophila Marchenkov, 2002 (Copepoda, Cyclopoida, Bradophilidae) parasitic on a flabelligerid polychaete from the Chukchi Sea.

The cyclopoid copepod family Bradophilidae includes a few species of mesoparasitic copepods infecting flabelligerid polychaetes. It contains two species of Bradophila Levinsen, 1878, the type genus: B. pygmaea Levinsen, 1878 and B. minuta Boxshall, O'Reilly, Sikorski & Summerfield, 2019, both known from North Europe. Two other genera (i.e., Trophoniphila M'Intosh, 1885 and Flabellicola Gravier, 1918) have some affinities with this family including their host preference. Mesoparasitic copepods are highly specialized, morphologically reduced forms. Part of their body (endosoma) is partially lodged in the host body and the other part is external (ectosoma); both parts are connected by an intersomital stalk. Infection by these copepods can be readily detected by the presence of the egg-carrying ectosoma on the host external surface. From the analysis of flabelligerid polychaetes collected in 2012 from the Chukchi Sea, two ovigerous female individuals of a bradophilid copepod were recorded. These specimens were recognized as representative of an undescribed species of Bradophila. The new species, B. susanae n. sp., shows the generic diagnostic characters and differs from its two other known congeners in several respects, including the cuticular ectosomal ornamentation, body proportions, size of the intersomital stalk, position of the genital pore, and shape and arrangement of egg sacs. Also, the new species ectosomal size range (0.440 - 0.450 µm) falls between the size range of its two known congeners. Our finding expands the known host range of bradophilid copepods to include a new flabelligerid host, Bradabyssa nuda (Annenkova-Chlopina) from the Russsian Arctic region.

Teaching NICU Fellows How to Relay Difficult News Using a Simulation-Based Curriculum: Does Comfort Lead to Competence?

PROBLEM: Neonatal Intensive Care Unit (NICU) clinicians must frequently relay difficult news to patient families, and the need for formal training for NICU trainees to develop this skill has been established. Although previous studies have shown improved trainee self-efficacy and comfort in handling difficult conversations after formal communication training, it remains unclear whether these interventions lead to improved objectively assessed short-term and long-term performance. INTERVENTION: A simulation-based intervention emphasizing the SPIKES protocol for delivery of bad news was implemented for 15 fellows in the 3-year Baylor College of Medicine Neonatal-Perinatal Medicine fellowship program in the 2013-2014 academic year. Simulations involved video-recorded encounters between each fellow and a standardized parent (SP) involving communication of difficult news. Each fellow was evaluated before (preintervention), immediately after (postintervention), and 3-4 months after the intervention (follow-up) with an (a) evaluation of video-recorded sessions by two expert raters blinded to the timing of the encounter (blinded rater evaluation [BRE]), (b) Self-Assessment Questionnaire, (c) Content Test evaluating knowledge of taught concepts, and (d) SP evaluation (SPE). CONTEXT: The 1st- and 2nd/3rd-year fellows participated in the study at separate times in the academic year to accommodate their schedules. First-year fellows had had more prior communication training and less NICU clinical experience than the 2nd/3rd-year fellows at the time of their intervention. OUTCOME: Although all fellows displayed improved Self-Assessment and Content Test scores at postintervention with retention at the follow-up assessment, the BREs showed no statistically significant improvement in postintervention scores and showed a decline in follow-up scores. First-year fellows had higher BRE postintervention scores than the senior fellows. SPEs showed no difference in scores at all 3 assessment stages. LESSONS LEARNED: As previously described in the literature, trainee self-efficacy and knowledge may improve in the short term and long term with a simulation-based curriculum in communication of difficult news. However, these results may be inconsistent with those of objective evaluations by expert raters and standardized parents. The impact of the curriculum may be heightened if it reinforces previously learned skills, but the effect may wane over time if not reinforced frequently with additional formal training or in the clinical setting. The results of this study highlight the importance of objective assessments in evaluating the utility of a simulation-based communication curriculum and the need for longitudinal curricula to promote retention of the concepts and skills being taught.

Harnessing citizen science through mobile phone technology to screen for immunohistochemical biomarkers in bladder cancer.

BACKGROUND: Immunohistochemistry (IHC) is often used in personalisation of cancer treatments. Analysis of large data sets to uncover predictive biomarkers by specialists can be enormously time-consuming. Here we investigated crowdsourcing as a means of reliably analysing immunostained cancer samples to discover biomarkers predictive of cancer survival. METHODS: We crowdsourced the analysis of bladder cancer TMA core samples through the smartphone app 'Reverse the Odds'. Scores from members of the public were pooled and compared to a gold standard set scored by appropriate specialists. We also used crowdsourced scores to assess associations with disease-specific survival. RESULTS: Data were collected over 721 days, with 4,744,339 classifications performed. The average time per classification was approximately 15 s, with approximately 20,000 h total non-gaming time contributed. The correlation between crowdsourced and expert H-scores (staining intensity × proportion) varied from 0.65 to 0.92 across the markers tested, with six of 10 correlation coefficients at least 0.80. At least two markers (MRE11 and CK20) were significantly associated with survival in patients with bladder cancer, and a further three markers showed results warranting expert follow-up. CONCLUSIONS: Crowdsourcing through a smartphone app has the potential to accurately screen IHC data and greatly increase the speed of biomarker discovery.

Parent and grandparent neonatal intensive care unit visitation for preterm infants.

OBJECTIVE: Characterize family NICU visitation and examine associations with maternal health and social factors and infant health outcomes. STUDY DESIGN: Retrospective cohort study of 167 infants born ≤32 weeks at two urban NICUs 01/2019-03/2020. Average nurse-documented family member visitation and associations of visitation with maternal and infant factors and outcomes were compared. RESULTS: Mothers visited 4.4 days/week, fathers 2.6 days/week, and grandparents 0.4 days/week. Older maternal age, nulliparity, and non-English primary language were associated with more frequent family visitation. Mothers with depression or anxiety history visited less. Maternal depression and public insurance were associated with fewer father visits. Low parental visitation was associated with lower odds of feeding any maternal milk at discharge and low maternal visitation with 11.5% fewer completed infant subspecialty appointments in the year following discharge (95% CI -20.0%, -3.0%). CONCLUSION: Families with social disadvantage visited less often. Parental visitation was associated with infant feeding and follow-up.

Expanding the genotype-phenotype correlation in subtelomeric 19p13.3 microdeletions using high resolution clinical chromosomal microarray analysis.

Structural rearrangements of chromosome 19p are rare, and their resulting phenotypic consequences are not well defined. This is the first study to report a cohort of eight patients with subtelomeric 19p13.3 microdeletions, identified using clinical chromosomal microarray analysis (CMA). The deletion sizes ranged from 0.1 to 0.86 Mb. Detailed analysis of the patients' clinical features has enabled us to define a constellation of clinical abnormalities that include growth delay, multiple congenital anomalies, global developmental delay, learning difficulties, and dysmorphic facial features. There are eight genes in the 19p13.3 region that may potentially contribute to the clinical phenotype via haploinsufficiency. Moreover, in silico genomic analysis of 19p13.3 microdeletion breakpoints revealed numerous highly repetitive sequences, suggesting LINEs/SINEs-mediated events in generating these microdeletions. Thus, subtelomeric 19p13.3 appears important for normal embryonic and childhood development. The clinical description of patients with deletions in this genomic interval will assist clinicians to identify and treat individuals with similar deletions.

Toward an atlas of Salish Sea biodiversity: the flora and fauna of Galiano Island, British Columbia, Canada. Part I. Marine zoology.

Background: Based on records dating from 1859 to 2021, we provide an overview of the marine animal diversity reported for Galiano Island, British Columbia, Canada. More than 650 taxa are represented by 20,000 species occurrence records in this curated dataset, which includes dive records documented through the Pacific Marine Life Surveys, museum voucher specimens, ecological data and crowd-sourced observations from the BC Cetacean Sightings Network and iNaturalist. New information: We describe Galiano Island's marine animal diversity in relation to the Salish Sea's overall biodiversity and quantify the proportional contributions of different types of sampling effort to our current local knowledge. Overviews are provided for each taxonomic group in a format intended to be accessible to amateur naturalists interested in furthering research into the region's marine biodiversity. In summary, we find that the Pacific Marine Life Surveys, a regional community science diving initiative, account for 60% of novel records reported for Galiano Island. Voucher specimens account for 19% and crowd-sourced biodiversity data 18% of novel records, respectively, with the remaining 3% of reports coming from other sources. These findings shed light on the complementarity of different types of sampling effort and demonstrate the potential for community science to contribute to the global biodiversity research community. We present a biodiversity informatics framework that is designed to enable these practices by supporting collaboration among researchers and communities in the collection, curation and dissemination of biodiversity data.

Description of two new species of Paraonidae (Annelida) from the Gulf of Thailand, Western Pacific.

Two new species of Aricidea Webster, 1879 (Paraonidae), Aricidea (Acmira) anusakdiisp. nov. and Aricidea (Aricidea) thammapinanaesp. nov. were collected from 10-26.5 m depth, in soft bottoms with mud mixed with sand and shells at Songkhla Sea, the Gulf of Thailand between 2011-2018. Aricidea (Acmira) anusakdiisp. nov. is clearly distinguished from other species of the subgenus Acmira by having a rounded bilobed prostomium divided by a slight notch on the anterior margin; red pigments on the subdistal to the tip of each branchia (new character); two prebranchial chaetigers; 48-68 pairs of branchiae; and modified neurochaetae as strong curved spines with blunt shafts surrounded by pubescence from chaetigers 19-44. On the other hand, Aricidea (Aricidea) thammapinanaesp. nov. can be separated from other members of the subgenus Aricidea by the presence of a biarticulated median antenna; distinctive notopodial lobes as broad triangular with short distal protuberances on chaetiger 3, 4-8 pairs of branchiae; and modified neurochaetae as bidentate neurochaetae with a long pubescent subterminal arista on the concave side. All data have been archived and are freely available from the Dryad Digital Repository (https://doi.org/10.5061/dryad.hqbzkh1cn).

Relocation of Dodecaseta McCammon & Stull, 1978 (Annelida, Capitellidae) in Notodasus Fauchald, 1972.

The capitellid polychaete genus Dodecaseta McCammon & Stull, 1978 is relocated in Notodasus Fauchald, 1972. Two species are redescribed based on examination of type material and three new combinations are proposed: Notodasus oraria (McCammon & Stull, 1978), N. eibyejacobseni (Green, 2002). N. fauchaldi (Green, 2002). N. kristiani (García-Garza et al., 2009), is synonymized under N. oraria. Some comments on Dasybranchus lumbricoides Grube, 1878 are included.

Liquid Medication Dosing Errors by Hispanic Parents: Role of Health Literacy and English Proficiency.

OBJECTIVE: Hispanic parents in the United States are disproportionately affected by low health literacy and limited English proficiency (LEP). We examined associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents. METHODS: Cross-sectional analysis of data from a multisite randomized controlled experiment to identify best practices for the labeling/dosing of pediatric liquid medications (SAFE Rx for Kids study); 3 urban pediatric clinics. Analyses were limited to Hispanic parents of children aged ≤8 years with health literacy and LEP data (n = 1126). Parents were randomized to 1 of 5 groups that varied by pairing of units of measurement on the label/dosing tool. Each parent measured 9 doses (3 amounts [2.5, 5, 7.5 mL] using 3 tools [2 syringes in 0.2 or 0.5 mL increments, and 1 cup]) in random order. Dependent variable was a dosing error of >20% dose deviation. Predictor variables included health literacy (Newest Vital Sign) (limited = 0-3; adequate = 4-6) and LEP (speaks English less than "very well"). RESULTS: A total of 83.1% made dosing errors (mean [SD] errors per parent = 2.2 [1.9]). Parents with limited health literacy and LEP had the greatest odds of making a dosing error compared to parents with adequate health literacy who were English proficient (trials with errors per parent = 28.8 vs 12.9%; adjusted odds ratio = 2.2 [95% confidence interval 1.7-2.8]). Parents with limited health literacy who were English proficient were also more likely to make errors (trials with errors per parent = 18.8%; adjusted odds ratio = 1.4 [95% confidence interval 1.1-1.9]). CONCLUSIONS: Dosing errors are common among Hispanic parents; those with both LEP and limited health literacy are at particular risk. Further study is needed to examine how the redesign of medication labels and dosing tools could reduce literacy- and language-associated disparities in dosing errors.

Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment.

BACKGROUND AND OBJECTIVES: Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language. METHODS: Randomized controlled experiment in 3 urban pediatric clinics. English- or Spanish-speaking parents (n = 2110) of children ≤8 years old were randomly assigned to 1 of 5 study arms and given labels and dosing tools that varied in unit pairings. Each parent measured 9 doses of medication (3 amounts [2.5, 5, and 7.5 mL] and 3 tools [1 cup, 2 syringes (0.2- and 0.5-mL increments)]), in random order. Outcome assessed was dosing error (>20% deviation; large error defined as > 2 times the dose). RESULTS: A total of 84.4% of parents made ≥1 dosing error (21.0% ≥1 large error). More errors were seen with cups than syringes (adjusted odds ratio = 4.6; 95% confidence interval, 4.2-5.1) across health literacy and language groups (P < .001 for interactions), especially for smaller doses. No differences in error rates were seen between the 2 syringe types. Use of a teaspoon-only label (with a milliliter and teaspoon tool) was associated with more errors than when milliliter-only labels and tools were used (adjusted odds ratio = 1.2; 95% confidence interval, 1.01-1.4). CONCLUSIONS: Recommending oral syringes over cups, particularly for smaller doses, should be part of a comprehensive pediatric labeling and dosing strategy to reduce medication errors.

Development and larval feeding in the capitellid annelid Notomastus cf. tenuis.

Making inferences about the evolution of larval nutritional mode and feeding mechanisms in annelids requires data on the form and function of the larvae, but such data are lacking for many taxa. Though some capitellid annelids are known or suspected to have planktotrophic larvae, these larvae have not previously been described in sufficient detail to understand how they feed. Here we describe embryos and larvae of the capitellid Notomastus cf. tenuis from San Juan Island, Washington State. Fertilized oocytes average about 58 µm in equivalent spherical diameter. Early embryos undergo spiral cleavage and develop into larvae that feed for about 5 weeks before metamorphosis. Larvae of N. cf. tenuis capture food particles between prototrochal and metatrochal ciliary bands and transport them to the mouth in an intermediate food groove; this arrangement is typical of "opposed band" larval feeding systems. Surprisingly, however, larvae of N. cf. tenuis appeared to have only simple cilia in the prototrochal ciliary band; among planktotrophic larvae of annelids, simple cilia in the prototroch were previously known only from members of Oweniidae. The anteriormost tier of prototrochal cilia in N. cf. tenuis appears to be non-motile; its role in swimming or particle capture is unclear. Like some planktotrophic larvae in the closely related Echiuridae and Opheliidae, larvae of N. cf. tenuis can capture relatively large particles (up to at least 45 µm in diameter), suggesting that they may use an alternative particle capture mechanism in addition to opposed bands of cilia.

A Structured End-of-Life Curriculum for Neonatal-Perinatal Postdoctoral Fellows.

Death in tertiary care neonatal intensive care units is a common occurrence. Despite recent advances in pediatric palliative education, evidence indicates that physicians are poorly prepared to care for dying infants and their families. Numerous organizations recommend increased training in palliative and end-of-life care for pediatric physicians. The purpose of this study is to develop a structured end-of-life curriculum for neonatal-perinatal postdoctoral fellows based on previously established principles and curricular guidelines on end-of-life care in the pediatric setting. Results demonstrate statistically significant curriculum effectiveness in increasing fellow knowledge regarding patient qualification for comfort care and withdrawal of support (P = .03). Although not statistically significant, results suggest the curriculum may have improved fellows' knowledge of appropriate end-of-life medical management, comfort with addressing the family, and patient pain assessment and control.

Crowdsourcing the General Public for Large Scale Molecular Pathology Studies in Cancer.

BACKGROUND: Citizen science, scientific research conducted by non-specialists, has the potential to facilitate biomedical research using available large-scale data, however validating the results is challenging. The Cell Slider is a citizen science project that intends to share images from tumors with the general public, enabling them to score tumor markers independently through an internet-based interface. METHODS: From October 2012 to June 2014, 98,293 Citizen Scientists accessed the Cell Slider web page and scored 180,172 sub-images derived from images of 12,326 tissue microarray cores labeled for estrogen receptor (ER). We evaluated the accuracy of Citizen Scientist's ER classification, and the association between ER status and prognosis by comparing their test performance against trained pathologists. FINDINGS: The area under ROC curve was 0.95 (95% CI 0.94 to 0.96) for cancer cell identification and 0.97 (95% CI 0.96 to 0.97) for ER status. ER positive tumors scored by Citizen Scientists were associated with survival in a similar way to that scored by trained pathologists. Survival probability at 15 years were 0.78 (95% CI 0.76 to 0.80) for ER-positive and 0.72 (95% CI 0.68 to 0.77) for ER-negative tumors based on Citizen Scientists classification. Based on pathologist classification, survival probability was 0.79 (95% CI 0.77 to 0.81) for ER-positive and 0.71 (95% CI 0.67 to 0.74) for ER-negative tumors. The hazard ratio for death was 0.26 (95% CI 0.18 to 0.37) at diagnosis and became greater than one after 6.5 years of follow-up for ER scored by Citizen Scientists, and 0.24 (95% CI 0.18 to 0.33) at diagnosis increasing thereafter to one after 6.7 (95% CI 4.1 to 10.9) years of follow-up for ER scored by pathologists. INTERPRETATION: Crowdsourcing of the general public to classify cancer pathology data for research is viable, engages the public and provides accurate ER data. Crowdsourced classification of research data may offer a valid solution to problems of throughput requiring human input.

Disseminated Nocardia infection presenting as hemorrhagic pustules and ecthyma in a woman with systemic lupus erythematosus and antiphospholipid antibody syndrome.

BACKGROUND: Nocardia is an opportunistic pathogen that can cause disseminated infection in immunocompromised hosts. The most common type of skin lesion reported with disseminated Nocardia is a subcutaneous nodule; however, there are reports with unusual cutaneous presentations. Long term corticosteroid treatment is one of the largest risk factors for developing disseminated Nocardia. Initial treatment is empiric as each strain has unique susceptibilities and it takes weeks to speciate and test sensitivities. MAIN OBSERVATIONS: A 66-year-old female on long term corticosteroids for systemic lupus erythematosus (SLE) and antiphospholipid syndrome presented with a polymorphous skin eruption and systemic symptoms concerning for infection. Especially concerning were areas of hemorrhagic pustules on the lower legs, and two ecthymatous lesions on the thigh. Tissue culture Gram stain revealed Gram positive branching filamentous rods concerning for Nocardia. The patient improved with empiric treatment. CONCLUSIONS: This case of Nocardiosis had unusual cutaneous findings that could have misguided the clinician, but the tissue culture and Gram stain proved to be useful for rapid diagnosis and proper treatment.

Oxydromus Grube, 1855 reinstated over Ophiodromus Sars, 1862 (Polychaeta, Hesionidae).

The hesionid polychaete genera Oxydromus Grube, 1855 and Ophiodromus Sars, 1862 have been regarded as synonyms with the former considered as invalid since it was thought to be a junior homonym of Oxydromus Schlegel, 1854. However, Schlegel's name is an incorrect subsequent spelling for Ocydromus Wagler, 1830 (Aves, Gruiformes, Rallidae) and is not an available name. Consequently, Oxydromus Grube, 1855 must be reinstated for this hesionid polychaete genus. A check-list of valid species of Oxydromus including 30 new combinations is provided.

Parasabella Bush, 1905, replacement name for the polychaete genus Demonax Kinberg, 1867 (Annelida, Polychaeta, Sabellidae).

Parasabella Bush, 1905 is reintroduced as a replacement name for Demonax Kinberg, 1867 (Annelida: Polychaeta: Sabellidae) which is a junior homonym of Demonax Thomson, 1860 (Insecta: Coleoptera: Cerambycidae).

Privacy as an enabler, not an impediment: building trust into health information exchange.

Building privacy and security protections into health information technology systems will bolster trust in such systems and promote their adoption. The privacy issue, too long seen as a barrier to electronic health information exchange, can be resolved through a comprehensive framework that implements core privacy principles, adopts trusted network design characteristics, and establishes oversight and accountability mechanisms. The public policy challenges of implementing this framework in a complex and evolving environment will require improvements to existing law, new rules for entities outside the traditional health care sector, a more nuanced approach to the role of consent, and stronger enforcement mechanisms.