Outpatient inhaled corticosteroid use in bronchopulmonary dysplasia.

RATIONALE: In the outpatient setting, inhaled corticosteroids (ICS) are frequently given to children with bronchopulmonary dysplasia (BPD) for treatment of respiratory and asthma-associated symptoms. In this study we sought to determine if correlations existed between ICS use and ICS initiation and patient characteristics and outpatient respiratory outcomes. METHODS: This study included children with the diagnosis of BPD (n = 661) who were seen in outpatient pulmonary clinics at the Children's Hospital of Philadelphia between 2016 and 2021. Chart review was used to determine patient demographics, use and timing of ICS initiation, asthma diagnosis, and acute care usage following initial hospital discharge. RESULTS: At the first pulmonary visit, 9.2% of children had been prescribed an ICS at NICU discharge, 13.9% had been prescribed an ICS after NICU discharge but before their first pulmonary appointment, and 6.9% were prescribed an ICS at the completion of initial pulmonary visit. Children started on an ICS as outpatients had a higher likelihood of ER visits (adjusted odds ratio: 2.68 ± 0.7), hospitalizations (4.81 ± 1.16), and a diagnosis of asthma (3.58 ± 0.84), compared to children never on an ICS. Of those diagnosed with asthma, children prescribed an ICS in the outpatient setting received the diagnosis at an earlier age. No associations between NICU BPD severity scores and ICS use were found. CONCLUSIONS: This study identifies an outpatient BPD phenotype associated with ICS use and ICS initiation independent of NICU severity score. Additionally, outpatient ICS initiation correlates with a subsequent diagnosis of asthma and acute care usage in children with BPD.

Crop cover and nutrient levels mediate the effects of land management type on aquatic invertebrate richness in prairie potholes.

Aquatic invertebrates provide important ecosystem services, including decomposition and nutrient cycling, and provide nutrition for birds, fish, amphibians, and bats. Thus, the effects of agricultural land management practices on aquatic invertebrates are relevant to farmers, wildlife biologists, and policymakers. Here, we used data on aquatic invertebrates (159 taxa, 73 to species, 75 to genus/family) collected in 40 wetlands in the Canadian prairies to test for direct and indirect relationships among land management types (perennial cover, organic, minimum tillage, conventional), landscape structure (cropland and wetland cover within the surrounding landscape), and water quality (total nutrient levels, turbidity) on species richness of invertebrates using structural equation modelling. Additionally, we assessed variation in community composition within and among wetlands in different land use management types using a direct gradient analysis and variance partitioning. The direct effects of land management type were not supported but we found strong supportive evidence that effects of land management on richness were significantly mediated through cropland cover, nutrient levels, and turbidity. After controlling for these indirect effects, aquatic invertebrate richness decreased along a gradient from the lowest to the highest farming intensity, i.e., richness decreased from perennial cover sites to organic to minimum tillage to conventional sites. Support was also found for negative effects of nutrient levels and turbidity on richness. We did not find significant support for differences in gamma diversity or a simple test (homogeneity of multivariate dispersions) of differences in turnover among land management types; however, land management had a significant effect in distance-based redundancy analysis. Taken together, these results suggest that focusing conservation efforts on reducing cropland erosion and nutrient inputs to wetlands and creating more permanent cover may be effective strategies for conserving richness of aquatic invertebrates in agricultural landscapes in this region.

Farm management and landscape context shape plant diversity at wetland edges in the Prairie Pothole Region of Canada.

Evaluating the impacts of farming systems on biodiversity is increasingly important given the need to stem biodiversity loss, decrease fossil fuel dependency, and maintain ecosystem services benefiting farmers. We recorded woody and herbaceous plant species diversity, composition, and abundance in 43 wetland-adjacent prairie remnants beside crop fields managed using conventional, minimum tillage, organic, or perennial cover (wildlife-friendly) land management in the Prairie Pothole Region. We used a hierarchical framework to estimate diversity at regional and local scales (gamma, alpha), and how these are related through species turnover (beta diversity). We tested the expectation that gamma richness/evenness and beta diversity of all plants would be higher in remnants adjacent to perennial cover and organic fields than in conventional and minimum tillage fields. We expected the same findings for plants providing ecosystem services (bee-pollinated species) and disservices (introduced species). We predicted similar relative effects of land management on alpha diversity, but with the expectation that the benefits of organic farming would decrease with increasing grassland in surrounding landscapes. Gamma richness and evenness of all plants were highest for perennial cover, followed by minimum tillage, organic, and conventional sites. Bee-pollinated species followed a similar pattern for richness, but for evenness organic farming came second, after perennial cover sites, followed by minimum tillage and conventional. For introduced species, organic sites had the highest gamma richness and evenness. Grassland amount moderated the effect of land management type on all plants and bee-pollinated plant richness, but not as expected. The richness of organic sites increased with the amount of grassland in the surrounding landscape. Conversely, for conventional sites, richness increased as the amount of grassland in the landscape declined. Our results are consistent with the expectation that adopting wildlife-friendly land management practices can benefit biodiversity at regional and local scales, in particular the use of perennial cover to benefit plant diversity at regional scales. At more local extents, organic farming increased plant richness, but only when sufficient grassland was available in the surrounding landscape; organic farms also had the highest beta diversity for all plants and bee-pollinated plants. Maintaining native cover in agroecosystems, in addition to low-intensity farming practices, could sustain plant biodiversity and facilitate important ecosystem services.

Ambient Air Pollution and Outpatient Morbidities in Bronchopulmonary Dysplasia.

Rationale: Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. Although socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status. Furthermore, AAP exposure is known to have a detrimental effect on respiratory health in children. Objectives: To assess if AAP exposure is linked to BPD morbidity in the outpatient setting. Methods: Participants with BPD were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021 (N = 800) and divided into low, moderate, and high AAP exposure groups, based on publicly available U.S. Environmental Protection Agency data. Clinical data were obtained by chart review and caregiver questionnaires. Results: Non-White race, home ventilator use, and lower median household income were associated with higher degrees of air pollution exposure. After adjustment for these factors, moderate and high air pollution exposure were associated with requiring systemic steroids (odds ratio, 1.78 and 2.17, respectively) compared with low air pollution. Similarly, high air pollution exposure was associated with emergency department visits (odds ratio, 1.59). Conclusions: This study demonstrates an association between AAP exposure and BPD morbidity after initial hospital discharge. AAP exposure was closely linked to race and median household income. As such, it supports the notion that AAP exposure may be contributing to health disparities in BPD outcomes. Further studies directly measuring exposure and establishing a link between biomarkers of exposure and outcomes are prerequisites to developing targeted interventions protecting this vulnerable population.

Impact of a Simulation Exercise on Student Perceptions of Poverty and Interprofessional Socialization.

OBJECTIVE: This study aimed to evaluate the impact of an interprofessional poverty simulation exercise by determining if participating students demonstrated changes in attitude toward poverty (ATP) and perceptions of interprofessional socialization. METHODS: The Community Action Poverty Simulation from the Missouri Community Action Network was provided to 512 interprofessional health care students during 9 simulation exercises over a 3-year period. Primary participating professions were pharmacy, occupational therapy, and nursing. Student simulation roles were assigned to ensure a mix of professions in simulated families and debriefing groups. Debriefing sessions included questions related to interprofessional interactions. Students completed surveys before and following participation in the simulation, which included the ATP Short Form scale and the Interprofessional Socialization and Valuing Scale-9A. RESULTS: Statistically significant improvements in ATP were demonstrated for the overall score and 15 items of the 21-item ATP Short Form scale. The domains of stigma and structural perspective showed statistically significant improvement, while the personal deficiency domain did not. Statistically significant improvements in student perceptions related to interprofessional socialization were demonstrated for the overall score and 7 items of the 9-item Interprofessional Socialization and Valuing Scale-9A scale. CONCLUSION: This interprofessional poverty simulation positively altered student ATP and enhanced interprofessional socialization. The Community Action Poverty Simulation augmented with debriefing questions related to interprofessional interactions served as an effective interprofessional education experience for pharmacy, occupational therapy, and nursing students.

Support for an area-heterogeneity tradeoff for biodiversity in croplands.

Rapid expansion of the human population poses a challenge for wildlife conservation in agricultural landscapes. One proposal for addressing this challenge is to increase biodiversity in such landscapes by increasing crop diversity. However, studies report both positive and negative effects of crop diversity on biodiversity. One possible explanation, derived from the "area-heterogeneity tradeoff hypothesis," is that the effect of crop diversity on biodiversity depends on a tradeoff between increasing the number of crop types in a landscape and decreasing the amount of each single crop type. This should cause positive effects of increasing crop diversity at low to intermediate crop diversity and negative effects at intermediate to high crop diversity. We also propose two factors that could change the point at which the effect of increasing crop diversity shifts from positive to negative. First, we predicted that this shift would occur at a lower crop diversity when the surrounding landscape contains less semi-natural habitat and at a higher crop diversity when the landscape contains more semi-natural habitat. This should increase the likelihood of detecting negative effects of crop diversity when semi-natural cover is low and positive effects when it is high. Second, we predicted that the shift from a positive to negative effect would occur at a lower crop diversity when it is measured locally than when it is measured at greater distances from the site, making detection of negative crop diversity effects more likely when measurements are at local extents. We tested these predictions using data on the biodiversity of herbaceous plants, butterflies, syrphid flies, woody plants, bees, carabid beetles, spiders, and birds at 221 crop field edges in Eastern Ontario, Canada. We found support for an area-crop diversity tradeoff. Semi-natural cover and measurement extent influenced the biodiversity-crop diversity relationship, with positive effects when semi-natural cover was high and negative effects when semi-natural cover was low and when crop diversity was measured at local extents. The results suggest that policies/guidelines designed to increase crop diversity will not benefit biodiversity in the landscapes where conservation action is most urgently needed, that is, in landscapes with high agricultural use and low semi-natural cover.

Outpatient respiratory outcomes in children with BPD on supplemental oxygen.

INTRODUCTION: Preterm children with bronchopulmonary dysplasia (BPD) frequently require supplemental oxygen in the outpatient setting. In this study, we sought to determine patient characteristics and demographics associated with need for supplemental oxygen at initial hospital discharge, timing to supplemental oxygen liberation, and associations between level of supplemental oxygen and likelihood of respiratory symptoms and acute care usage in the outpatient setting. METHODS: A retrospective analysis of subjects with BPD on supplemental oxygen (O2 ) was performed. Subjects were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021. Data were obtained by chart review and caregiver questionnaires. RESULTS: Children with BPD receiving ≥1 L of O2 were more likely to have severe BPD, pulmonary hypertension, and be older at initial hospital discharge. Children discharged on higher levels of supplemental O2 were slower to wean to room air compared to lower O2 groups (p < 0.001). Additionally, weaning off supplemental O2 in the outpatient setting was delayed in children with gastrostomy tubes and those prescribed inhaled corticosteroids, on public insurance or with lower household incomes. Level of supplemental O2 at discharge did not influence outpatient acute care usage or respiratory symptoms. CONCLUSION: BPD severity and level of supplemental oxygen use at discharge did not correlate with subsequent acute care usage or respiratory symptoms in children with BPD. Weaning of O2 however was significantly associated with socioeconomic status and respiratory medication use, contributing to the variability in O2 weaning in the outpatient setting.

Are weak dispersers more vulnerable than strong dispersers to land use intensification?

Ecologists often state that weak dispersers are particularly at risk from land use intensification, and that they therefore should be prioritized for conservation. We reviewed the empirical evidence, to evaluate whether this idea should be used as a general rule in conservation. While 89% of authors predicted that weak dispersers are more vulnerable to land use intensification (80 out of 90 papers), only 56% of reported tests (235 out of 422) were consistent with this prediction. Thirty per cent of tests (128 out of 422) were consistent with the opposite prediction, that strong dispersers are more vulnerable to intensification, and 60% of articles (45 out of 75) had at least one test where strong dispersers were most vulnerable. The likelihood of finding that weak dispersers are more vulnerable to intensification than strong dispersers varied with latitude, taxonomic group and type of land use intensification. Notably, the odds of finding that weak dispersers are more vulnerable to intensification than strong dispersers was higher if the study was nearer to the equator. Taken together, our results show that the prediction that weak dispersers are more vulnerable than strong dispersers to intensification is not sufficiently supported to justify using weak dispersal as a general indicator of species risk in human-modified landscapes.

Protecting boreal caribou habitat can help conserve biodiversity and safeguard large quantities of soil carbon in Canada.

Boreal caribou require large areas of undisturbed habitat for persistence. They are listed as threatened with the risk of extinction in Canada because of landscape changes induced by human activities and resource extraction. Here we ask: Can the protection of habitat for boreal caribou help Canada meet its commitments under the United Nations Convention on Biological Diversity and United Nations Framework Convention on Climate Change? We identified hotspots of high conservation value within the distribution of boreal caribou based on: (1) three measures of biodiversity for at risk species (species richness, unique species and taxonomic diversity); (2) climate refugia or areas forecasted to remain unchanged under climate change; and, (3) areas of high soil carbon that could add to Canada's greenhouse gas emissions if released into the atmosphere. We evaluated the overlap among hotspot types and how well hotspots were represented in Canada's protected and conserved areas network. While hotspots are widely distributed across the boreal caribou distribution, with nearly 80% of the area falling within at least one hotspot type, only 3% of the distribution overlaps three or more hotspots. Moreover, the protected and conserved areas network only captures about 10% of all hotspots within the boreal caribou distribution. While the protected and conserved areas network adequately represents hotspots with high numbers of at risk species, areas occupied by unique species, as well as the full spectrum of areas occupied by different taxa, are underrepresented. Climate refugia and soil carbon hotspots also occur at lower percentages than expected. These findings illustrate the potential co-benefits of habitat protection for caribou to biodiversity and ecosystem services and suggest caribou may be a good proxy for future protected areas planning and for developing effective conservation strategies in regional assessments.

Multi-objective optimization can balance trade-offs among boreal caribou, biodiversity, and climate change objectives when conservation hotspots do not overlap.

The biodiversity and climate change crises have led countries-including Canada-to commit to protect more land and inland waters and to stabilize greenhouse gas concentrations. Canada is also obligated to recover populations of at-risk species, including boreal caribou. Canada has the opportunity to expand its protected areas network to protect hotspots of high value for biodiversity and climate mitigation. However, co-occurrence of hotspots is rare. Here we ask: is it possible to expand the network to simultaneously protect areas important for boreal caribou, other species at risk, climate refugia, and carbon stores? We used linear programming to prioritize areas for protection based on these conservation objectives, and assessed how prioritization for multiple, competing objectives affected the outcome for each individual objective. Our multi-objective approach produced reasonably strong representation of value across objectives. Although trade-offs were required, the multi-objective outcome was almost always better than when we ignored one objective to maximize value for another, highlighting the risk of assuming that a plan based on one objective will also result in strong outcomes for others. Multi-objective optimization approaches could be used to plan for protected areas networks that address biodiversity and climate change objectives, even when hotspots do not co-occur.

Body size responses to the combined effects of climate and land use changes within an urban framework.

Alterations in body size can have profound impacts on an organism's life history and ecology with long-lasting effects that span multiple biological scales. Animal body size is influenced by environmental drivers, including climate change and land use change, the two largest current threats to biodiversity. Climate warming has led to smaller body sizes of many species due to impacts on growth (i.e., Bergmann's rule and temperature-size rule). Conversely, urbanization, which serves as a model for investigating the effects of land use changes, has largely been demonstrated to cause size increases, but few studies have examined the combined influences of climate and land use changes on organism size. We present here the background theory on how each of these factors is expected to influence body size, summarize existing evidence of how size has recently been impacted by climate and land use changes, and make several recommendations to guide future research uniting these areas of focus. Given the rapid pace of climate change and urbanization, understanding the combined effects of climate and land use changes on body size is imperative for biodiversity preservation.

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study-confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon's canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.

Squamous Cell Carcinoma Metastasis to the Supraclavicular Artery Island Flap Donor Site.

A rare complication of flap reconstruction following oncologic ablation is metastasis to the donor site. We present a novel case of cutaneous squamous cell carcinoma (SCCA) recurrence at the right upper-extremity donor site following tonsillar SCCA resection with supraclavicular artery island flap reconstruction. Following surgery, the patient presented with cutaneous recurrence at the right upper-extremity donor site. Biopsy confirmed metastasis from the oropharyngeal primary. The patient developed two subsequent right upper-extremity recurrences before he died. The most likely mechanism of metastasis is direct implantation via contamination. This case demonstrates the importance of maintaining separate surgical fields and instruments during oncologic ablation and reconstruction. Laryngoscope, 131:E440-E442, 2021.

Chlorine Disinfection of Legionella spp., L. pneumophila, and Acanthamoeba under Warm Water Premise Plumbing Conditions.

Premise plumbing conditions can contribute to low chlorine or chloramine disinfectant residuals and reactions that encourage opportunistic pathogen growth and create risk of Legionnaires' Disease outbreaks. This bench-scale study investigated the growth of Legionella spp. and Acanthamoeba in direct contact with premise plumbing materials-glass-only control, cross-linked polyethylene (PEX) pipe, magnesium anode rods, iron pipe, iron oxide, pH 10, or a combination of factors. Simulated glass water heaters (SGWHs) were colonized by Legionella pneumophila and exposed to a sequence of 0, 0.1, 0.25, and 0.5 mg/L chlorine or chloramine, at two levels of total organic carbon (TOC), over 8 weeks. Legionella pneumophila thrived in the presence of the magnesium anode by itself and or combination with other factors. In most cases, 0.5 mg/L Cl2 caused a significant rapid reduction of L. pneumophila, Legionella spp., or total bacteria (16S rRNA) gene copy numbers, but at higher TOC (>1.0 mg C/L), a chlorine residual of 0.5 mg/L Cl2 was not effective. Notably, Acanthamoeba was not significantly reduced by the 0.5 mg/L chlorine dose.

Examining Land Use Changes to Evaluate the Effects of Land Management in a Complex, Dynamic Landscape.

Anthropogenic alterations to landscapes have increased as the human population continues to rise, leading to detrimental changes in natural habitats. Ecological restoration assists in recovery by altering habitats to improve conditions and foster biodiversity. We examined land cover changes over time within a complex, dynamic region in the Midwest to assess the long-term effects of conservation. We used Landsat 8 bands for a 15-class land cover map of Oak Openings Region using supervised classification. We validated our map and achieved an overall accuracy of 71.2% from correctly classified points out of total visited points. Change over 10 years, from 2006 to 2016, was explored by comparing class statistics from FRAGSTATS between our map and original land cover map. We found that natural land, i.e., forest and early successional, covered 33%, with 10% permanently protected, while human-modified land, i.e., agricultural and developed, covered 67% of the region. Over 10 years, natural classes increased, and cultural classes decreased by 5.8%. There were decreases for the three forest communities and increases for the two early successional communities. These changes are likely the result of natural recovery and disturbance, and conservation efforts by the Green Ribbon Initiative. Changes in habitat also came with distribution changes, e.g., increased fragmentation for some classes, which was readily visible. Our useful method measured functionality by emphasizing changes in composition and configuration. Our approach provides a tool for assessing cumulative regional-scale effects from site-level management and conservation. This large-scale view for conservation is needed to effectively mitigate future changes.

The SHAPE Framework: Empowering Millennials to Lead the Future of Health Care.

Members of Generation Y (or Millennials) now make up more than 50% of those in the workplace. They are expected to comprise greater than 75% by 2025. The Millennial generation has brought new idiosyncrasies to the workplace, and most literature has focused on ways to manage these differences. The Baby Boom generation is retiring at an increasing pace, leaving ongoing leadership needs in the care of Millennials. Conversations must now shift from how to lead the Millennials to preparing them to lead others. The SHAPE framework highlights some of the idiosyncrasies of this generation and ways they can be leveraged when approaching the challenges of health care today.

Addressing Falls Among Older Oncology Patients Through Complexity Science.

Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.

Polyelectrolyte Coatings Can Control Charged Fluorocarbon Nanodroplet Stability and Their Interaction with Macrophage Cells.

Fluorocarbon nanodroplets, ∼100 to ∼400 nm in diameter, are of immense interest in a variety of medical applications including the imaging and therapy of cancer and inflammatory diseases. However, fluorocarbon molecules are both hydrophobic and lipophobic; therefore, it is challenging to synthesize fluorocarbon nanodroplets with the optimal stability and surface properties without the use of highly specialized surfactants. Here, we hypothesize that we can decouple the control of fluorocarbon nanodroplet size and stability from its surface properties. We use a simple, two-step procedure where standard, easily available anionic fluorosurfactants are used to first stabilize the fluorocarbon nanodroplets, followed by electrostatically attaching functionalized polyelectrolytes to the nanodroplet surfaces to independently control their surface properties. Herein, we demonstrate that PEGylated polyelectrolyte coatings can effectively alter the fluorocarbon nanodroplet surface properties to reduce coalescence and its uptake into phagocytic cells in comparison with non-PEGylated polyelectrolyte coatings and uncoated nanodroplets, as measured by flow cytometry and fluorescence microscopy. In this study, perfluorooctyl bromide (PFOB) was used as a representative fluorocarbon material, and PEGylated PFOB nanodroplets with diameters between 250 and 290 nm, depending on the poly(ethylene glycol) block length, were prepared. The PEGylated PFOB nanodroplets had superior size stability in comparison with uncoated and non-PEGylated polyelectrolyte nanodroplets in saline and within macrophage cells. Of significance, non-PEGylated nanodroplets were rapidly internalized by macrophage cells, whereas PEGylated nanodroplets were predominantly colocalized on the cell membrane. This suggests that the PEGylated-polyelectrolyte coating on the charged PFOB nanodroplets may afford adjustable shielding from cells of the reticuloendothelial system. This report shows that using the same fluorosurfactant as a base layer, modularly assembled PFOB nanodroplets tailored for a variety of end applications can be created by selecting different polyelectrolyte coatings depending on their unique requirements for stability and interaction with phagocytic cells.