Exploring the Nature of Arhopalus ferus (Coleoptera: Cerambycidae: Spondylidinae) Pheromone Attraction.

Cerambycid species of the Spondylidinae subfamily are distributed worldwide and are known for being prolific invaders that infest conifers. In New Zealand, Arhopalus ferus (Mulsant), the burnt pine longhorn beetle, is well-established and requires monitoring at high-risk sites such as ports, airports, and sawmills as part of the requirements to meet pine log export standards set by the New Zealand Ministry of Primary Industries (MPI). Currently, its surveillance relies on traps baited with host volatiles (i.e., ethanol and α-pinene). We used volatile collections from adult beetles, electroantennograms, and field trapping bioassays to identify the pheromones emitted by the burnt pine longhorn beetle A. ferus and their effects on its behaviour. We show that A. ferus males emit mainly (E)-fuscumol and geranylacetone, as well as the minor components, α-terpinene and p-mentha-1,3,8-triene, and that all four compounds elicit a dose-dependent response in antennae of both sexes. Traps baited with the binary combination of geranylacetone plus fuscumol captured significantly more female A. ferus than did unbaited traps in two of three field experiments. α-Terpinene did not affect A. ferus trap catches and effects of p-mentha-1,3,8-triene on trap catch were not determined. Our findings provide further evidence of the use of fuscumol and geranylacetone as aggregation-sex pheromones by longhorn beetles in the Spondylidinae subfamily, and suggest that their deployment in survey traps may improve the efficacy of A. ferus monitoring in New Zealand and elsewhere.

Light-Weight Portable Electroantennography Device as a Future Field-Based Tool for Applied Chemical Ecology.

Portable electroantennograms (pEAG) can further our understanding of odor plume dynamics and complement laboratory-based electroantennogram tools. pEAG's can help to address important questions such as the influence of plume structure on insect behavior, the active space of semiochemical-baited traps, and the impact of biotic and abiotic factors on this active space. Challenges associated with pEAGs include their miniaturization and sensitivity, confounding environmental odors, and processing of data. Here, we describe a pEAG built with modern engineering hardware and techniques that is portable in being both light in weight (516 g) and smaller (12 × 12 × 8 cm, volume 1152 cm3) than earlier models. It is able to incorporate insects of a range of sizes (4 to 30 mm antennal length), has wireless communication (communication range of 600 m urban, 10 km line of sight), a stand-alone power supply, and uses both antennae of the test insect. We report normalized antennal responses from Epiphyas postvittana in a dose response experiment where our pEAG compared favorably with traditional laboratory EAG equipment for this species. Dose-response comparisons between E. postvittana, Agrotis ipsilon, and Lymantria dispar dispar showed mean detection limits from a pheromone source dose of 100, 100, and 1 ng, respectively, for our pEAG. This pEAG should allow future real-time analysis of EAG responses in the field in research on how insects interact with odor plumes and the factors that influence the active space of semiochemical-baited traps.

Monitoring Patients on Metformin: Recent Changes and Rationales.

Objective: The Food and Drug Administration recently updated metformin prescribing recommendations for patients with diabetes and renal disease. The American Diabetes Association as well as the American Association of Clinical Endocrinologists and American Clinical Endocrinologists also recommend periodic monitoring of vitamin B12 levels for patients using metformin. A review of the literature was conducted to assess data to evaluate the recent updates to metformin usage and provide rationales for these recommendations. Data Sources: PubMed MESH terms "Diabetes Mellitus, Type 2" and "Renal Insufficiency, Chronic" and "Metformin" were searched with an English limitation from 1990 to May 2017. A MEDLINE search was conducted using the terms "metformin" and "renal disease" from 1990 to May 2017. A PubMed search was conducted using the MESH terms "vitamin b12 deficiency" and "metformin" from 1970 to May 2017. A MEDLINE search was conducted using terms "metformin" and "vitamin B12 deficiency" with an English limitation from 1970 to May 2017. Study Selection and Data Extraction: Retrospective and prospective clinical trials, meta-analyses, and systematic reviews were considered for inclusion. Citations from identified articles were also reviewed for inclusion. Data Synthesis: The incidence of metformin-associated lactic acidosis is minimal. Data indicate metformin-treated patients with an estimated glomerular filtration rate above 30 mL/min/1.73 m2 have a reduction in mortality. Additionally, data suggest metformin may lead to vitamin B12 deficiency. Conclusion: Data support recommendations for metformin use in patients with diabetes and renal insufficiency with an estimated glomerular filtration rate above 30 mL/min/1.73 m2. Data also suggest that baseline and periodic testing of vitamin B12 levels are warranted and supported by clinical guidelines due to the risk of vitamin B12 deficiency in metformin-treated patients.

Semaglutide for the Treatment of Type 2 Diabetes Mellitus.

Objective: To detail studies investigating the efficacy/safety of semaglutide as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in the treatment of type 2 diabetes mellitus. Data Sources: A literature search in MEDLINE and ClinicalTrials.gov (January 2013 to May 2018) using the terms semaglutide, SUSTAIN, oral, and PIONEER resulted in 10 published articles and 14 ongoing/unpublished articles. Study Selection and Data Extraction: All English language phase 2 and 3 clinical trials evaluating efficacy/safety of semaglutide were included. Data Synthesis: In 9 phase 3, multicenter SUSTAIN trials, the efficacy and safety of semaglutide have been compared with placebo and other pharmacologic therapy for diabetes (PTD). In these trials, semaglutide resulted in lower hemoglobin A1c (HbA1c; approximately -1.5%) and weight reductions (approximately -4.5 kg) as comparable with dulaglutide for HbA1c lowering (approximately -1.5%). Semaglutide also has cardiovascular (CV) outcomes data that show significant reduction in risk of death from CV causes, nonfatal myocardial infarction, or nonfatal stroke (hazard ratio = 0.74; 95% confidence interval = 0.58-0.95). A safety finding that emerged from the CV outcomes trial was an association of semaglutide treatment with an increased risk of retinopathy complications in patients with preexisting diabetic retinopathy. Phase 3 trial data assessing semaglutide oral formulation have shown similar HbA1c (approximately -1.5% for 14 mg dose) and body weight (approximately -4.1 kg for 14 mg dose) reductions as compared with placebo. Across these studies, semaglutide was generally well tolerated with the most common adverse event reported as gastrointestinal side effects as seen in all GLP-1 RAs. Conclusions: These results suggest that semaglutide may have a place in therapy as a GLP-1 RA add-on therapy with higher weight loss as compared with other GLP-1 RAs and PTD and CV benefit.

Olfactory Cues, Visual Cues, and Semiochemical Diversity Interact During Host Location by Invasive Forest Beetles.

Plant-feeding insects use visual and olfactory cues (shape, color, plant volatiles) for host location, but the relative importance of different cues and interactions with non-host-plant volatiles in ecosystems of varying plant biodiversity is unclear for most species. We studied invasive bark beetles and wood borers associated with pine trees to characterize interactions among color, host and non-host volatiles, by employing traps that mimic tree trunks. Cross-vane flight intercept traps (black, green, red, white, yellow, clear) and black funnel traps were used with and without attractants (α-pinene + ethanol), repellents (non-host green leaf volatiles, 'GLV'), and attractant/repellent combinations in four pine forests in New Zealand. We trapped 274,594 Hylurgus ligniperda, 7842 Hylastes ater, and 16,301 Arhopalus ferus. Trap color, attractant, and color × attractant effects were highly significant. Overall, black and red traps had the highest catches, irrespective of the presence of attractants. Alpha-pinene plus ethanol increased trap catch of H. ligniperda 200-fold but only 6-fold for H. ater and 2-fold for A. ferus. Green leaf volatiles had a substantial repellent effect on trap catch of H. ligniperda but less on H. ater and A. ferus. Attack by H. ligniperda was halved when logs were treated with GLV, and a similar effect was observed when logs were placed among broadleaved understory shrubs emitting GLV. Overall, H. ligniperda was most strongly affected by the olfactory cues used, whereas H. ater and A. ferus were more strongly affected by visual cues. Collectively, the results support the semiochemical diversity hypothesis, indicating that non-host plant volatiles from diverse plant communities or artificial dispensers can contribute to resistance against herbivores by partly disrupting host location.

Comparison of the Centers for Disease Control (CDC) recommendations and the risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) tool for guiding naloxone coprescribing.

PURPOSE: Patients treated with ongoing opioid therapy may be at an increased risk of respiratory depression or death, which may be mitigated through prompt administration of naloxone. The Centers for Disease Control (CDC) guidelines for prescribing opioids in primary care settings recommend patients treated with ongoing opioid analgesic therapy be offered a coprescription of naloxone based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. Opioid overdose risk is dose-dependent, yet other patient-specific factors contribute to this risk. The risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) incorporates additional risk factors to assess the risk of overdose or clinically relevant respiratory depression. OBJECTIVES: This study compared the frequency of meeting CDC, Veterans' Health Administration (VA) RIOSORD, or civilian RIOSORD criteria for naloxone coprescribing. METHODS: A retrospective chart review of 42 Federally Qualified Health Centers in Illinois was conducted for all CII-CIV opioid analgesic prescriptions. Ongoing opioid therapy was defined as patients who received seven or more CII-CIV opioid analgesic prescriptions during the 1-year study period. Patients aged 18-89, receiving opioids for nonmalignant pain, and meeting the criteria of ongoing opioid therapy were included in the analysis. RESULTS: A total of 41,777 controlled substance analgesic prescriptions were prescribed during the study period. Data from 651 individual patient charts were evaluated. Of those, 606 patients met inclusion criteria. From these data, 57.9 percent of patients (N = 351) met civilian RIOSORD criteria, 36.5 percent (N = 221) met VA RIOSORD criteria, and 22.8 percent (N = 138) met CDC guideline recommendations for naloxone coprescribing. The percentage of patients who met RIOSORD criteria compared to CDC criteria was significantly higher (p < 0.001). Of all patients meeting ongoing opioid therapy criteria, only seven had been coprescribed naloxone. CONCLUSION: Coprescribing of naloxone is significantly underutilized in patients treated with opioid therapy for nonmalignant chronic pain and should not solely be based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. As risk assessment improves, consideration of other risk-conferring variables, such as gabapentinoids, skeletal muscle relaxants, and sleep hypnotics, should be considered.

Effect of Host Volatile Release Rate and Racemic Fuscumol on Trap Catch of Hylurgus ligniperda, Hylastes ater (Coleoptera: Curculionidae), and Arhopalus ferus (Coleoptera: Cerambycidae).

Early detection of bark- and wood-boring beetles is critical to support the eradication of recently established populations in novel regions. Flight intercept traps baited with semiochemical lures are essential for surveillance and population monitoring of introduced insects. We present laboratory and field data to test potential improvements in trap sensitivity to detect Hylastes ater (Paykull), Hylurgus ligniperda (Fabricius) (Coleoptera:Scolytinae), and Arhopalus ferus (Mulsant) (Coleoptera:Cerambycidae). We evaluated the effects of type and permeability of plastic material on release rates of host-plant volatiles and the addition of the pheromone racemic E-fuscumol on beetle species catch within an exotic Pinus radiata (D. Don) plantation forest. We trapped 228,278 H. ligniperda, 91 H. ater, and 2,504 A. ferus over two experiments. Our results show strong attraction of H. ligniperda to host-plant volatiles with a positive relationship between increased release rates and trap catch. H. ater follows this trend, with attraction to ethanol and (-)-ß-pinene. H. ligniperda was more strongly attracted to host volatiles than H. ater, the average ratio between baited and unbaited traps being 51.25:1 and 3.75:1, respectively for each species. There was no effect of host-plant volatiles or release rate on A. ferus catch, but a weak attraction by A. ferus to racemic E-fuscumol. Overall, we demonstrate species-specific differences in Coleoptera attraction to host-plant volatile release rates and semiochemical blends. Results demonstrate mechanisms to improve trap catch of H. ligniperda and H. ater. Racemic E-fuscumol shows some promise for A. ferus, but further investigation is required to determine whether chirality affects attraction.

Bromocriptine mesylate for glycemic management in type 2 diabetes mellitus.

OBJECTIVE: To review the pharmacologic characteristics, safety, and efficacy of bromocriptine mesylate for glycemic control in patients with type 2 diabetes mellitus. DATA SOURCES: A Scopus and MEDLINE search (1950-June 2010) was conducted using the key words bromocriptine, diabetes, and circadian rhythm. Data were also received from the manufacturer. STUDY SELECTION AND DATA EXTRACTION: Available abstracts, studies, and review articles published in English with human data discussing bromocriptine treatment for type 2 diabetes mellitus were reviewed. DATA SYNTHESIS: Bromocriptine is an ergot derivative available for treatment of type 2 diabetes. The mechanism of action of this agent is unclear; however, activity as a dopamine D2 receptor agonist seems to provide the primary mechanism for utility in resetting the circadian rhythm in patients with type 2 diabetes. Other mechanisms, including α-1 antagonist, α-2 agonist, and serotonin and prolactin modulator, may also help to explain bromocriptine's glucose-lowering effects. Studies with bromocriptine have included 4328 patients with type 2 diabetes. The majority of available trials conducted enrolled patients for a study duration of 6-24 weeks. One trial evaluating the safety and efficacy of bromocriptine concluded after 52 weeks of follow-up. Endpoints of hemoglobin A1(c) (A1C) reduction and plasma glucose concentrations were the primary focus of all studies, with statistically significant differences found. Bromocriptine use resulted in a mean A1C reduction of 0.27% (range 0.1-0.6), while placebo resulted in a mean A1C increase of 0.48% (range 0.3-1.1). Incidence of adverse effects of nausea, vomiting, headache, and rhinitis was greater than that of placebo in clinical trials. Cardiovascular endpoints did not differ from those of placebo. CONCLUSIONS: Bromocriptine has demonstrated efficacy as an adjunctive agent in the management of type 2 diabetes. Caution may be warranted in the elderly population or patients at risk for suspected drug-drug interactions. Further studies of longer duration may help to define the role of bromocriptine in the management of diabetes.

Assessing empathy and self-efficacy levels of pharmacy students in an elective diabetes management course.

OBJECTIVE: To assess the impact of a 6-week patient/provider interaction simulation on empathy and self-efficacy levels of diabetes management skills in third-year pharmacy students. DESIGN: Pharmacy students enrolled in a diabetes elective course were paired to act as a patient with diabetes or as a provider assisting in the management of that patient during a 6-week simulation activity. After 3 weeks, students switched roles. The simulation was designed with activities to build empathy. ASSESSMENT: The Jefferson Scale of Empathy (JSE) and a self-efficacy survey were administered to assess change in empathy and confidence levels from baseline to the end of the activity. Completion of the activity resulted in significant improvement in total JSE scores. Additionally, significant improvements in overall self-efficacy scores regarding diabetes management were noted. CONCLUSION: The 6-week patient/provider interaction simulation improved empathy and self-efficacy levels in third-year pharmacy students.

Diabetes management in Commercial Driver License holders.

PURPOSE: The purpose of this study is to evaluate diabetes management in Commercial Driver License (CDL) holders, how prescribing habits change when treating this patient population, and health care providers' knowledge of regulations concerning insulin use in CDL holders. METHODS: A survey was posted on the American Association of Diabetes Educators (AADE) Communities of Interest websites and was open for 2 weeks. The anonymous survey collected demographic data and evaluated the perspectives of health care providers on diabetes management in CDL holders. Descriptive statistics were used to analyze the survey results. RESULTS: A total of 139 AADE members responded to the survey, and 22.2% were prescribing providers. Findings from the survey indicated an overall lack of knowledge by health care professionals regarding the current laws affecting diabetes management in CDL holders. Most participants emphasized the need for making decisions on CDL suspension on a case-by-case basis, and some expressed concern that current laws may not be appropriate. CONCLUSION: Additional diabetes education for health care providers who treat CDL holders is warranted as many health care providers were not familiar with current regulations and management strategies.

Role of clopidogrel in unstable angina and non-ST-segment elevation myocardial infarction: from literature and guidelines to practice.

Clinical trials are the backbone of treatment paradigm shifts and guideline development. In terms of acute coronary syndromes, the American College of Cardiology and the American Heart Association (ACC-AHA) have developed extensive guidelines to assist the practitioner in the appropriate use of drugs including antiischemic, anticoagulant, and antiplatelet agents. Clopidogrel, an adenosine 5'-diphosphate antagonist, is one such drug. Unfortunately, consensus guidelines are limited by the design of the clinical trials they reference. Clopidogrel trials have examined various outcomes in patients for a limited time frame, making longer term use of the drug difficult to justify. An ongoing study, estimated to be completed in 2005, is evaluating the long-term use of clopidogrel in high-risk patients. Aspirin, however, has become a lifelong therapy for many patients, based on clinical trials and medical experience. Patient-specific risk factors, the drugs' safety profiles, and costs, in addition to the ACC-AHA guidelines, must all be considered by clinicians when selecting the appropriate agent and its duration of use.

Aerial application of pheromones for mating disruption of an invasive moth as a potential eradication tool.

Biological invasions can cause major ecological and economic impacts. During the early stages of invasions, eradication is desirable but tactics are lacking that are both effective and have minimal non-target effects. Mating disruption, which may meet these criteria, was initially chosen to respond to the incursion of light brown apple moth, Epiphyas postvittana (LBAM; Lepidoptera: Tortricidae), in California. The large size and limited accessibility of the infested area favored aerial application. Moth sex pheromone formulations for potential use in California or elsewhere were tested in a pine forest in New Zealand where LBAM is abundant. Formulations were applied by helicopter at a target rate of 40 g pheromone per ha. Trap catch before and after application was used to assess the efficacy and longevity of formulations, in comparison with plots treated with ground-applied pheromone dispensers and untreated control plots. Traps placed at different heights showed LBAM was abundant in the upper canopy of tall trees, which complicates control attempts. A wax formulation and polyethylene dispensers were most effective and provided trap shut-down near ground level for 10 weeks. Only the wax formulation was effective in the upper canopy. As the pheromone blend contained a behavioral antagonist for LBAM, 'false trail following' could be ruled out as a mechanism explaining trap shutdown. Therefore, 'sensory impairment' and 'masking of females' are the main modes of operation. Mating disruption enhances Allee effects which contribute to negative growth of small populations and, therefore, it is highly suitable for area-wide control and eradication of biological invaders.