Control of Escherichia coli in Fresh-Cut Mixed Vegetables Using a Combination of Bacteriophage and Carvacrol.

The continual emergence of antibiotic-resistant bacteria and the slow development of new antibiotics has driven the resurgent interest in the potential application of bacteriophages as antimicrobial agents in different medical and industrial sectors. In the present study, the potential of combining phage biocontrol and a natural plant compound (carvacrol) in controlling Escherichia coli on fresh-cut mixed vegetable was evaluated. Four coliphages, designated Escherichia phage SUT_E420, Escherichia phage SUT_E520, Escherichia phage SUT_E1520 and Escherichia phage SUT_E1620, were isolated from raw sewage. Biological characterization revealed that all four phages had a latent period of 20-30 min and a burst size ranging from 116 plaque-forming units (PFU)/colony forming units (CFU) to 441 PFU/CFU. The phages effectively inhibited the growth of respective host bacteria in vitro, especially when used at a high multiplicity of infection (MOI). Based on transmission electron microscopy analysis, all phages were classified as tailed phages in the class of Caudoviricetes. Additionally, next generation sequencing indicated that none of the selected coliphages contained genes encoding virulence or antimicrobial resistance factors, highlighting the suitability of isolated phages as biocontrol agents. When a phage cocktail (~109 PFU/mL) was applied alone onto fresh-cut mixed vegetables artificially contaminated with E. coli, no bacteria were recovered from treated samples on Day 0, followed by a gradual increase in the E. coli population after 24 h of incubation at 8 °C. On the other hand, no significant differences (p < 0.05) were observed between treated and non-treated samples in terms of E. coli viable counts when carvacrol at the minimum inhibitory concentration (MIC) of 6.25 µL/mL was applied alone. When a phage cocktail at an MOI of ~1000 and MIC carvacrol were applied in combination, no E. coli were recovered from treated samples on Day 0 and 1, followed by a slight increase in the E. coli population to approximately 1.2-1.3 log CFU/mL after 48 h of incubation at 8 °C. However, total elimination of E. coli was observed in samples treated with a phage cocktail at a higher MOI of ~2000 and carvacrol at MIC, with a reduction of approximately 4 log CFU/mL observed at the end of Day 3. The results obtained in this study highlight the potential of combined treatment involving phage biocontrol and carvacrol as a new alternative method to reduce E. coli contamination in minimally processed ready-to-eat foods.

Design, implementation, and evaluation of Students as Partners interactive feedback model.

In September of 2020, a group of dental students (DDS) and motivated faculty at the University of Western Ontario came together in response to the pandemic and established a real-time feedback model. The goal of this model was to address technical challenges following the quick transition from in-person courses to a fully online format for student learning. This initial offering formed the foundation of the Students as Partners (SaP) program to identify and address technical and curricular issues. We used an action research approach to evaluate and refine the innovation's delivery. Preliminary data from the first cycle suggested that students were unaware of the impact of their feedback and the actionable items from their feedback. Thus, for the second iteration we focused on making the entire process more transparent by using Padlet as a way to streamline posting and responding to feedback. To evaluate the refined system, we distributed surveys to student and faculty participants to obtain feedback on their awareness and satisfaction and effectiveness of the program. For students who utilized the system, the majority indicated that they were informed of changes based on their feedback. Furthermore, students reported that our innovation provided a platform for the student voice. Faculty impressions were generally positive, and the majority of faculty respondents indicated that they implemented changes to their content/curriculum based on feedback. These results demonstrate that the SaP program's real-time feedback system closed the feedback loop and facilitated real-time improvements based on actionable feedback. To our knowledge, this is the first study to design, implement, and evaluate a real-time feedback system for the purpose of modifying how an instructor teaches.NEW & NOTEWORTHY Course feedback surveys at the end of term infrequently result in beneficial change. However, student feedback should be considered to develop meaningful learning. In response to this problem, we report on a novel Students as Partners innovation to address instructional issues in real time with a virtual bulletin board application embedded in the learning management system. Students and instructors valued the system's ability to close the feedback loop and provide transparent, actionable change.

Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study.

BACKGROUND: Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications. AIM: To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting. METHOD: Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC). RESULTS: 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)). CONCLUSION: This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.

Permanent Supportive Housing for Those Experiencing Chronic Homelessness with High Health or Social Support Needs: A Scoping Review.

Some populations have increased risks of experiencing chronic homelessness related to complex health and social needs combined with system failures. Permanent supportive housing (PSH) may improve housing and health outcomes for this population. To understand the scope of the literature on PSH, this scoping review uses Arksey and O'Malley's methodological framework enhanced by Levac and the Joanna Briggs Institute. A search was conducted across multiple databases for existing research on PSH. Forty-one studies were included, and five themes were generated: PSH sustains housing for most people; PSH is costly to implement, but costs can be recouped; PSH facilitates belonging and safety; single-site programs have social challenges but also provide efficiency and improve social networks; and visible on-site staff fundamentally helps those with highest support needs. Permanent supportive housing has been shown to be effective for those with the highest health and social support needs and is required to help prevent and end homelessness.

At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area.

Background: Unbiased assessment of the risks associated with acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical to informing mitigation efforts during pandemics. The objective of our study was to understand the risk factors for acquiring coronavirus disease 2019 (COVID-19) in a large prospective cohort of adult residents in a large US metropolitan area. Methods: We designed a fully remote longitudinal cohort study involving monthly at-home SARS-CoV-2 polymerase chain reaction (PCR) and serology self-testing and monthly surveys. Results: Between October 2020 and January 2021, we enrolled 10 289 adults reflective of the Boston metropolitan area census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared with Whites, Black non-Hispanic participants had a 2.2-fold greater risk of acquiring COVID-19 (hazard ratio [HR], 2.19; 95% CI, 1.91-2.50; P < .001), and Hispanics had a 1.5-fold greater risk (HR, 1.52; 95% CI, 1.32-1.71; P < .016). Individuals aged 18-29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities were associated with an increased risk of acquiring COVID-19. Individuals with medical risk factors for severe disease were at a decreased risk of SARS-CoV-2 acquisition. Conclusions: These results demonstrate that race/ethnicity and socioeconomic status are the biggest determinants of acquisition of infection. This disparity is significantly underestimated if based on PCR data alone, as noted by the discrepancy in serology vs PCR detection for non-White participants, and points to persistent disparity in access to testing. Medical conditions and advanced age, which increase the risk for severity of SARS-CoV-2 disease, were associated with a lower risk of COVID-19 acquisition, suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics.

Grade-focused interactions in higher education: has the pursuit for good grades replaced learning?

Undergraduate science students face immense pressure, both internally and externally, to achieve certain grades. Grade-focused interactions between students and instructors have anecdotally been reported to be increasing. However, no empirical study has yet evaluated students' grade perceptions or the prevalence of these interactions. If we want to change students' grade fixation, we first need to understand it. The purpose of this research study was to investigate the prevalence of and factors that contribute to students' grade-focused interactions. Using a mixed-methods approach via surveys and a quasi-experimental intervention with focus groups and audio recordings of student-instructor interactions, we found that students' perceptions of grades are relatively fixed. Furthermore, although >25% of our respondents reported negotiating a grade, there were no significant perceptual differences or academic values held between students who self-reported engaging in grade-focused interactions and those who did not. Our findings suggest that unless institutional and professional program requirements change, the pressure faced by students and their preoccupation with grades will not change either.NEW & NOTEWORTHY Undergraduate science students face immense pressure to perform academically; this pressure may be linked to grade-focused interactions, which have been anecdotally reported among educators. This study evaluated the prevalence of and motivations underlying this behavior. One-quarter of our study participants self-reported negotiating a grade. The vast majority of respondents perceived that they lost grades (rather than earned them); an intervention to change this "grade loss" mentality failed to have any impact on students' behavior.

Waterborne disease outbreaks in treated recreational water facilities: a Socio-Ecological Model perspective.

Treated recreational water facilities, including swimming pools and water play parks, have often been implicated in infectious disease outbreaks. Addressing this problem is complex due to the multiple and interrelated factors contributing to outbreaks in these settings. These factors may relate to inappropriate behaviours of users and operators, lack of and inconsistent regulation of these facilities, insufficient facility maintenance, and problems associated with the design of these facilities. Given the complexity of this issue, we argue that the Socio-Ecological Model (SEM) provides a useful framework to help identify the multi-level influences and factors that have implications for designing interventions to prevent this public health problem, whilst assisting in guiding future research in this area. We apply the SEM to the current literature to help identify the influences and factors contributing to infectious disease outbreaks in treated recreational water facilities to support this argument. We also identify several gaps in the existing research that would benefit from further examination to help prevent infectious disease outbreaks in treated recreational water facilities such as public swimming pools and water play parks.

Feasibility and lessons learned on remote trial implementation from TestBoston, a fully remote, longitudinal, large-scale COVID-19 surveillance study.

Longitudinal clinical studies traditionally require in-person study visits which are well documented to pose barriers to participation and contribute challenges to enrolling representative samples. Remote trial models may reduce barriers to research engagement, improve retention, and reach a more representative cohort. As remote trials become more common following the COVID-19 pandemic, a critical evaluation of this approach is imperative to optimize this paradigm shift in research. The TestBoston study was launched to understand prevalence and risk factors for COVID-19 infection in the greater Boston area through a fully remote home-testing model. Participants (adults, within 45 miles of Boston, MA) were recruited remotely from patient registries at Brigham and Women's Hospital and the general public. Participants were provided with monthly and "on-demand" at-home SARS-CoV-2 RT-PCR and antibody testing using nasal swab and dried blood spot self-collection kits and electronic surveys to assess symptoms and risk factors for COVID-19 via an online dashboard. Between October 2020 and January 2021, we enrolled 10,289 participants reflective of Massachusetts census data. Mean age was 47 years (range 18-93), 5855 (56.9%) were assigned female sex at birth, 7181(69.8%) reported being White non-Hispanic, 952 (9.3%) Hispanic/Latinx, 925 (9.0%) Black, 889 (8.6%) Asian, and 342 (3.3%) other and/or more than one race. Lower initial enrollment among Black and Hispanic/Latinx individuals required an adaptive approach to recruitment, leveraging connections to the medical system, coupled with community partnerships to ensure a representative cohort. Longitudinal retention was higher among participants who were White non-Hispanic, older, working remotely, and with lower socioeconomic vulnerability. Implementation highlighted key differences in remote trial models as participants independently navigate study milestones, requiring a dedicated participant support team and robust technology platforms, to reduce barriers to enrollment, promote retention, and ensure scientific rigor and data quality. Remote clinical trial models offer tremendous potential to engage representative cohorts, scale biomedical research, and promote accessibility by reducing barriers common in traditional trial design. Barriers and burdens within remote trials may be experienced disproportionately across demographic groups. To maximize engagement and retention, researchers should prioritize intensive participant support, investment in technologic infrastructure and an adaptive approach to maximize engagement and retention.

Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study.

AIM: What effect does a novel education programme have on emergency hospital transfers of, and advance care planning decisions among, nursing home residents? FINDINGS: This education programme did not affect overall rates of emergency hospital transfer. It did increase advance care planning discussions, increase compliance with the results of these discussions and increase "DNR" orders among nursing home residents. MESSAGE: Novel tele-education programmes have the potential to improve advance care planning discussions in nursing homes.

At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area.

IMPORTANCE: Unbiased assessment of risks associated with acquisition of SARS-CoV-2 is critical to informing mitigation efforts during pandemics. OBJECTIVE: Understand risk factors for acquiring COVID-19 in a large, prospective cohort of adult residents recruited to be representative of a large US metropolitan area. DESIGN: Fully remote longitudinal cohort study launched in October 2020 and ongoing; Study data reported through June 15, 2021. SETTING: Brigham and Women’s Hospital, Boston MA. PARTICIPANTS: Adults within 45 miles of Boston, MA. INTERVENTION: Monthly at-home SARS-CoV-2 viral and antibody testing. MAIN OUTCOMES: Between October 2020 and January 2021, we enrolled 10,289 adults reflective of Massachusetts census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared to whites, Black non-Hispanic participants had a 2.2 fold greater risk of acquiring COVID-19 (HR 2.19, 95% CI 1.91-2.50; p=<0.001) and Hispanics had a 1.5 fold greater risk (HR 1.52, 95% CI 1.32-1.71; p=<0.016). Individuals aged 18-29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities, as measured by the area deprivation index as a marker for socioeconomic status by census block group, were associated with an increased risk in developing COVID-19. Individuals with medical risk factors for severe COVID-19 disease were at a decreased risk of SARS-CoV-2 acquisition. CONCLUSIONS: These results demonstrate that race/ethnicity and socioeconomic status are not only risk factors for severity of disease but are also the biggest determinants of acquisition of infection. Importantly, this disparity is significantly underestimated if based on PCR data alone as noted by the discrepancy in serology vs. PCR detection for non-white participants, and points to persistent disparity in access to testing. Meanwhile, medical conditions and advanced age that increase the risk for severity of SARS-CoV-2 disease were associated with a lower risk of acquisition of COVID-19 suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics. TRIAL REGISTRATION: N/A. QUESTION: What population and occupational groups in the United States are at increased risk for acquiring COVID-19? FINDINGS: In this remote, longitudinal cohort study involving monthly PCR and serology self-testing of 10,289 adult residents of the Boston metropolitan area, 9257 (90.0%) of TestBoston participants acquired evidence of immunity to SARS-CoV-2 through vaccination, infection, or both as of June 15, 2021. Residents identifying as Black, Hispanic/Latinx had an increased risk of acquisition of COVID-19. Healthcare workers were not at increased risk of SARS-CoV-2 acquisition. Individuals with medical risk factors for severe COVID-19 disease were at a decreased risk of SARS-CoV-2 acquisition. MEANING: These results demonstrate that race/ethnicity and socioeconomic status are not only risk factors for severity of disease but also are the biggest determinants of acquisition of infection. These findings highlight the need to address the consequences of structural racism during the development of mitigation programs for current and future pandemics.

Change the medium, change the message: creativity is key to battle misinformation.

Marshall McLuhan's groundbreaking work regarding the role of context and medium in communication is very relevant today. By limiting the medium of science communication to dense, jargon-rich academic journals, we restrict the impact of discovery to the scientific community. We are also allowing the propagation of misinformation, as the nonexpert is forced to resource unreliable media to answer their scientific queries. To compete with pseudoscience, we need to improve science literacy and make science accessible through the same media on which pseudoscience thrives. As scientists and educators, we believe it is our responsibility to reconceptualize science literacy as a lifelong process and take greater accountability over the future of science communication. We hypothesize that increasing the accessibility of scientific literature to the public through adopting mainstream media forms and increasing access to informal science education (ISE) opportunities will decrease the proliferation of pseudoscience. To accomplish this, we propose eight recommendations housed under three action areas: 1) modify undergraduate science education by increasing opportunities for informal science communication, 2) increase accessibility to informal science education, and 3) bridge the gap between formal and informal science learning opportunities.

Differences between Facebook and Instagram Usage in Regard to Problematic Use and Well-Being.

Although the association of well-being (e.g., self-esteem, depression symptoms, and loneliness) with Facebook usage (i.e., number of friends and frequency of use) has been investigated by many researchers, only a limited number of studies have scrutinised Facebook against Instagram use. The aim of this study is not only to address this literature gap but also to explore whether problematic use and well-being differ between Facebook and Instagram users in relation to the number of received "likes" and Facebook friends/Instagram followers, as well as the importance of these "likes" and friends/followers. Sixty-nine Facebook users and 66 Instagram users completed an online questionnaire, including self-esteem, loneliness, depression, and problematic Internet use items. Overall, Instagram users exhibited significantly higher problematic use behaviour compared to Facebook users. Age and importance of "followers" were negatively associated with problematic use of Instagram, whilst only the importance of "likes" was negatively associated with Facebook. The number of Facebook "friends" was positively associated with depressive symptoms, but this was not the case for the number of Instagram "followers". It is important to note that the number of "likes" was only negatively associated with self-esteem, but there was no association with loneliness. A potential explanation between the differences in the two platforms and well-being might be related to their different functionalities, for example, Instagram is an image-oriented platform that may boost users' self-esteem through post "likes" but only when the users are strongly connected.

Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru.

To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as "sex workers," 70% recently exchanged sex for money. Participants described nuanced risk-benefit analyses surrounding paid sexual encounters. Classification of clients as "risky" or "rewarding" incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.

The wisdom of mistrust: qualitative insights from transgender women who participated in PrEP research in Lima, Peru.

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) is a remarkable biomedical advance to prevent HIV, ongoing research on PrEP contributes to and interacts with a legacy of HIV experimentation on marginalized communities in resource-limited settings. This paper explores the complexity of PrEP research mistrust among Peruvian transgender (trans) women who completed a PrEP adherence intervention and those who refused participation (i.e. declined to enrol, voluntarily withdrew, and/or were lost to follow-up). METHODS: Data were derived from 86 trans women (mean age 29 years) participants in the formative (four focus groups (n = 32), 20 interviews) and the evaluation stages (34 interviews) of a social network-based PrEP intervention for trans women in Lima, Peru. The formative stage took place from May to July 2015, while the evaluative stage took place from April to May 2018. Audio files were transcribed verbatim and analysed via an immersion crystallization approach using Dedoose (v.6.1.18). RESULTS: Three paradoxes of trans women's participation in PrEP science as a "key" population emerged as amplifying mistrust: (1) increases in PrEP research targeting trans women but limited perceived improvements in HIV outcomes; (2) routine dismissal by research physicians and staff of PrEP-related side effects and the social realities of taking PrEP, resulting in questions about who PrEP research is really for and (3) persistent limitations on PrEP access for trans women despite increasing involvement in clinical trials, fostering feelings of being a "guinea pig" to advance PrEP science. CONCLUSIONS: Findings highlight the wisdom inherent in PrEP mistrust as a reflection of trans women's experiences that underscore the broken bonds of trust between communities, researchers and the research enterprise. PrEP mistrust is amplified through perceived paradoxes that suggest to trans women that they are key experimental participants but not target PrEP users outside of research settings. Findings highlight the urgent need to reframe mistrust not as a characteristic of trans women to be addressed through education and outreach, but as a systemic institutional- and industry-level problem replicated, manifested and ultimately to be corrected, through global HIV science.

Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC).

OBJECTIVES: To develop criteria for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults (≥65 years) with cancer who are receiving palliative care and have an estimated life expectancy of <1 year. MATERIALS AND METHODS: A two-round Delphi exercise was conducted using web-based questionnaires. A panel of 18 expert stakeholders with expertise in palliative care, oncology and/or geriatric medicine across Ireland and the United Kingdom rated their level of agreement with each statement using a 5-point Likert scale and had the option of adding free-text comments throughout the questionnaire. A priori decision rules were used to accept or reject criteria. RESULTS: Twenty-eight criteria were presented in Round 1. Group consensus was achieved for 15 criteria which were included in the final set of criteria. Following a review of the panel's ratings and additional comments for the remaining 13 criteria, four criteria were removed from Round 2. Group consensus was achieved for all nine criteria included in Round 2. The final set comprised 24 criteria relating to: anorexia-cachexia (n = 1); anxiety (n = 2); constipation (n = 5); delirium (n = 1); depression (n = 3); diarrhoea (n = 1); dyspnoea/breathlessness (n = 1); fatigue (n = 2); insomnia (n = 2); nausea and vomiting (n = 2); pain (n = 3); duplicate drug classes (n = 1). CONCLUSION: A consensus-agreed set of prescribing criteria has been developed for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults with cancer who are receiving palliative care and have an estimated life expectancy of less than one year. Future studies should examine the application and validity of these criteria.

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review.

Background: Patients receiving palliative care often have existing comorbidities necessitating the prescribing of multiple medications. To maximize quality of life in this patient cohort, it is important to tailor prescribing of medication for preventing and treating existing illnesses and those for controlling symptoms, such as pain, according to individual specific needs. Objectives: To provide an overview of peer-reviewed observational research on prescribing practices, patterns, and potential harms in patients receiving palliative care. Methods: A systematic scoping review was conducted using four electronic databases (PubMed, EMBASE, CINAHL, Web of Science). Each database was searched from inception to May 2020. Search terms included 'palliative care,' 'end of life,' and 'prescribing.' Eligible studies had to examine prescribing for adults (≥18 years) receiving palliative care in any setting as a study aim or outcome. Studies focusing on single medication types (e.g., opioids), medication classes (e.g., chemotherapy), or clinical indications (e.g., pain) were excluded. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, and the findings were described using narrative synthesis. Results: Following deduplication, 16,565 unique citations were reviewed, and 56 studies met inclusion criteria. The average number of prescribed medications per patient ranged from 3 to 23. Typically, prescribing changes involved decreases in preventative medications and increases in symptom-specific medications closer to the time of death. Twenty-one studies assessed the appropriateness of prescribing using various tools. The prevalence of patients with ≥1 potentially inappropriate prescription ranged from 15 to 92%. Three studies reported on adverse drug events. Conclusions: This scoping review provides a broad overview of existing research and shows that many patients receiving palliative care receive multiple medications closer to the time of death. Future research should focus in greater detail on prescribing appropriateness using tools specifically developed to guide prescribing in palliative care and the potential for harm.

Using online decision trees to support students' self-efficacy in the laboratory.

Failed experiments are a common occurrence in research, yet many undergraduate science laboratories rely on established protocols to ensure students are able to obtain results. While it is logistically challenging to facilitate students' conducting their own experiments in the laboratory, allowing students to "fail" in a safe environment could help with the development of problem-solving skills. To allow students a safe place to fail and encourage them to think through a laboratory protocol, online decision trees were created to lead students through protocols and give them timely feedback. The online decision trees present students with a scenario, then students execute a protocol by selecting options that will lead them down different paths and result in various realistic results from their experiments. They receive feedback and instructional tutorials throughout the simulation that are dependent on their choices. The significance of this new resource for student learning is that it allows students to practice their problem-solving skills and gain theoretical knowledge about the purpose of various experimental steps. The purpose of this research study was to evaluate whether online decision trees affected students' self-efficacy, metacognition, and motivation for completing a wet laboratory. A mixed-methods approach was used; three surveys were administered throughout the academic term. For survey 1, students completed the decision tree and survey before the wet laboratory. For survey 2, students completed the survey before the wet laboratory but completed the decision tree after the wet laboratory. Students' reported self-efficacy and intrinsic motivation were increased with the administration of the online decision trees before the wet laboratory, but their extrinsic motivation and metacognitive scores were unchanged. For survey 3, students provided written feedback about the impact of the online decision trees, and their responses highlighted the importance of the visual components of the approach.

Preventing and controlling Cryptosporidium spp. in aquatic facilities: environmental health practitioners' experiences in Victoria, Australia.

OBJECTIVE: To identify barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities as perceived by environmental health practitioners (EHPs). METHODS: A qualitative, constructivist study with a purposive sample of seven EHPs from Victoria, Australia, was conducted. A focus group discussion was guided by a semi-structured interview schedule using open-ended questions. The audio-recorded focus group was transcribed verbatim and analysed using thematic analysis. RESULTS: Five themes represented the perceived barriers and enablers: i) pool water testing methods; ii) resources and training for EHPs; iii) knowledge and behaviour of aquatic facility operators and swimming pool users; iv) regulation; and v) aquatic facility and swimming pool design. Two key barriers within these themes included aquatic facility regulation and unhealthy swimming behaviours. CONCLUSIONS: Several barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities were perceived by EHPs. Suggestions to overcome perceived barriers were also identified. Further research is required to determine the impact of these findings on the incidence of cryptosporidiosis associated with aquatic facilities. Implications for public health: The findings contribute to a greater understanding of the barriers and enablers to Cryptosporidium spp. prevention and control in aquatic facilities, which may improve the effectiveness of current prevention and control strategies.

Investigating the Effects of Time and Temperature on the Growth of Escherichia coli O157:H7 and Listeria monocytogenes in Raw Cow's Milk Based on Simulated Consumer Food Handling Practices.

Consumption of raw cow's milk (RCM) is increasing in popularity in developed countries despite the associated foodborne disease risks. While previous research has focused on consumer motivations for drinking RCM, there is limited research on how consumer handling practices may impact the microbiological safety of RCM. In this study, consumer handling practices associated with transport, storage, and freezing and thawing were simulated to investigate the impact of time and temperature variables on the concentrations of either Escherichia coli O157:H7 or Listeria monocytogenes in RCM. We found that the type of storage during simulated transport had a large (η2 = 0.70) and significant (p < 0.001) effect on both pathogens. The refrigeration temperature also had a large (η2 = 0.43) and significant (p < 0.001) effect on both pathogens during refrigerated storage. The interaction between pathogen species and initial pathogen inoculum level had a large (η2 = 0.20) and significant (p = 0.012) effect on the concentration of the pathogens during ambient temperature storage. We found that freezing and thawing practices did not have a significant effect on the pathogens (p > 0.05). However, we were able to recover L. monocytogenes, but not E. coli O157:H7, from RCM after freezing for 365 days. The results from this study highlight that consumer transport and storage practices can have significant effects on the growth of E. coli O157:H7 and L. monocytogenes in RCM. Consumer food handling practices should be considered when developing public health strategies aimed at reducing the risks of RCM consumption.

Internet search query analysis can be used to demonstrate the rapidly increasing public awareness of palliative care in the USA.

BACKGROUND: A lack of public awareness of palliative care (PC) has been identified as one of the main barriers to appropriate PC access. Internet search query analysis is a novel methodology, which has been effectively used in surveillance of infectious diseases, and can be used to monitor public awareness of health-related topics. OBJECTIVES: We aimed to demonstrate the utility of internet search query analysis to evaluate changes in public awareness of PC in the USA between 2005 and 2015. METHODS: Google Trends provides a referenced score for the popularity of a search term, for defined regions over defined time periods. The popularity of the search term 'palliative care' was measured monthly between 1/1/2005 and 31/12/2015 in the USA and in the UK. RESULTS: Results were analysed using independent t-tests and joinpoint analysis. The mean monthly popularity of the search term increased between 2008-2009 (p<0.001), 2011-2012 (p<0.001), 2013-2014 (p=0.004) and 2014-2015 (p=0.002) in the USA. Joinpoint analysis was used to evaluate the monthly percentage change (MPC) in the popularity of the search term. In the USA, the MPC increase was 0.6%/month (p<0.05); in the UK the MPC of 0.05% was non-significant. DISCUSSION: Although internet search query surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all.