Evaluation of a virtual interprofessional oral-systemic health simulation experience in nursing, dentistry, medicine, and pharmacy education.

PURPOSE: The annual teaching oral-systemic health (TOSH) virtual clinical simulation and case study activity exposes interprofessional teams of nurse practitioner, nurse midwifery, dental, medical, and pharmacy students to a virtual clinical simulation experience that uses oral-systemic health as a clinical exemplar for promoting interprofessional core competencies. The present study examines changes in participating students' self-reported interprofessional competencies following participation in virtual TOSH from 2020 to 2022. These findings are also compared to those from in-person TOSH (2019) to examine the equivalence of student outcomes of both the in-person and virtual programs. METHODS: A pre- and post-test evaluation design was used to examine the effectiveness of exposure to the TOSH program on self-reported attainment of interprofessional competencies for participating students using the interprofessional collaborative competency attainment scale. RESULTS: Analysis of pre- and post-surveys demonstrated statistically significant improvement in students' self-rated interprofessional experience competencies following the virtual TOSH program, which aligns with results from the in-person cohorts. Similar findings between the in-person and virtual cohorts indicated no statistically significant difference between the two formats. CONCLUSION: These findings demonstrate the success of TOSH in promoting attainment of interprofessional competencies among future health professionals. We encourage administrators and faculty who lead health professional programs to take advantage of using virtual simulations as an integral component of interprofessional oral health clinical experiences where students from different health professions learn from and about each other in assessing and treating patients across the lifespan.

Orbitofrontal cortex reflects changes in response-outcome contingencies during probabilistic reversal learning.

In a continuously changing environment, in which behavioral outcomes are rarely certain, animals must be able to learn to integrate feedback from their choices over time and adapt to changing reward contingencies to maintain flexible behavior. The orbitofrontal region of prefrontal cortex (OFC) has been widely implicated as playing a role in the ability to flexibly control behavior. We used a probabilistic reversal learning task to measure rats' behavioral flexibility and its neural basis in the activity of single neurons in OFC. In this task, one lever, designated as 'correct', was rewarded at a high probability (80%) and a second, spatially distinct lever, designated as 'incorrect', was rewarded at a low probability (20%). Once rats reached a learning criterion for reliably selecting the correct lever, reward contingencies of the two levers were switched, and daily sessions were conducted until rats reliably selected the new correct lever. All rats performed the initial Acquisition and subsequent Reversal successfully, with more sessions needed to learn the Reversal. OFC neurons were recorded during five behavioral sessions spanning Acquisition and Reversal learning. The dominant pattern of neural responding in OFC, identified by principal component analysis of the population of neurons recorded, was modulated by reward outcome across behavioral sessions. Generally, activity was higher following rewarded choices than unrewarded. However, there was a correlation between reduced responses to reward following incorrect choices and the establishment of the preference for the correct lever. These results show how signaling by individual OFC neurons may participate in the flexible adaptation of behavior under changing reward contingencies.

A physiologically-inspired model of numerical classification based on graded stimulus coding.

In most natural decision contexts, the process of selecting among competing actions takes place in the presence of informative, but potentially ambiguous, stimuli. Decisions about magnitudes - quantities like time, length, and brightness that are linearly ordered - constitute an important subclass of such decisions. It has long been known that perceptual judgments about such quantities obey Weber's Law, wherein the just-noticeable difference in a magnitude is proportional to the magnitude itself. Current physiologically inspired models of numerical classification assume discriminations are made via a labeled line code of neurons selectively tuned for numerosity, a pattern observed in the firing rates of neurons in the ventral intraparietal area (VIP) of the macaque. By contrast, neurons in the contiguous lateral intraparietal area (LIP) signal numerosity in a graded fashion, suggesting the possibility that numerical classification could be achieved in the absence of neurons tuned for number. Here, we consider the performance of a decision model based on this analog coding scheme in a paradigmatic discrimination task - numerosity bisection. We demonstrate that a basic two-neuron classifier model, derived from experimentally measured monotonic responses of LIP neurons, is sufficient to reproduce the numerosity bisection behavior of monkeys, and that the threshold of the classifier can be set by reward maximization via a simple learning rule. In addition, our model predicts deviations from Weber Law scaling of choice behavior at high numerosity. Together, these results suggest both a generic neuronal framework for magnitude-based decisions and a role for reward contingency in the classification of such stimuli.

A pear-derived kairomone with pheromonal potency that attracts male and female codling moth, Cydia pomonella (L.).

Ethyl (2E, 4Z)-2,4-decadienoate, a pear-derived volatile, is a species-specific, durable, and highly potent attractant to the codling moth (CM), Cydia pomonella (L.), a serious pest of walnuts, apples, and pears worldwide. This kairomone attracts both CM males and virgin and mated females. It is highly attractive to CM in both walnut and apple orchard contexts, but has shown limited effectiveness in a pear orchard context. Rubber septa lures loaded with ethyl (2E, 4Z)-2,4-decadienoate remained attractive for several months under field conditions. At the same low microgram load rates on septa, the combined gender capture of CM in kairomone-baited traps was similar to the capture rate of males in traps baited with codlemone, the major sex pheromone component. The particular attribute of attracting CM females renders this kairomone a novel tool for monitoring population flight and mating-ovipositional status, and potentially a major new weapon for directly controlling CM populations.

Volatile components of green walnut husks.

Volatiles were isolated from whole green mature walnuts (Hartley variety) with husks still intact using dynamic headspace sweeping with trapping on Tenax. A total of 45 volatile compounds were identified by GC-MS. Major volatiles identified included (E)-4, 8-dimethyl-1,3,7-nonatriene, pinocarvone, pinocarveol, myrtenal, myrtenol, (E,E)-4,8,12-trimethyl-1,3,7,11-tridecatetraene, caryophyllene epoxide, verbenol, verbenone, and terpinolene. Green walnuts that had been infested with codling moth showed appreciably higher amounts emitted for (E)-4,8-dimethyl-1,3,7-nonatriene, (E, E)-4,8,12-trimethyl-1,3,7,11-tridecatetraene, alpha- and beta-pinenes, sabinene, (E)-beta-ocimene, (E,E)-alpha-farnesene, and linalool. The infested nuts also emitted benzyl methyl ether, isobutyl cyanide, and 1-nitro-3-methylbutane, compounds not found with the healthy nuts. Volatiles from uninfested green walnuts at the maturity stage where the husk was just beginning to split were also analyzed and compared.

Epicuticular flavonoids of some Scrophulariaceae.

Twenty-two species of Scophulariaceae have been found to accumulate flavonoid aglycones externally on their leaves and stems. They belong to the genera Anarrhinum, Antirrhinum, Asarina, Calceolaria, Mimulus, and Odontites. Most of the flavonoids are methylated flavones and flavonols, some with 6-O and/or 8-O-substitution. One of them is the natural isobutyryl ester of a rare flavone.

A prospective study of gastric cancer. 'Real' 5-year survival rates and mortality rates in a country with high incidence.

A consecutive prospective series of gastric cancer patients treated in our department from January 1982 to December 1990 is presented. There was complete follow-up (100%) for a minimum of 5 years or until death. Of the 286 patients, 222 (78%) were operated. Of these, 134 (60%) were resected; 91 with curative intent (68% of resected, 32% of all cases). The cancers were of the intestinal type (differentiated) in 63%, diffuse (undifferentiated) in 22%, and indeterminate in 15% (Laurèn classification). The tumor was located in the upper third, in the middle third and in the lower third in 33. 6, 22 and 34.6%, respectively, and involved all of the stomach in 9. 8% of the cases. The gastric and lymphatic resection was performed according to The General Rules for Gastric Cancer Study in Surgery and Pathology of the Japanese Research Society for Gastric Cancer (D2 type of lymph node dissection). The operative mortality for curative resections was 6.5% (9.5% for total gastrectomy and 4.1% for subtotal gastrectomy). The operative mortality for total gastrectomy decrease from 14.3% in the first 4 years of the study to 7.1% in the last 5 years. Patients dying in the immediate postoperative period were not considered for the analysis of survival rates in operated cases. The 5-year survival rate was 12.2% for all cases (35/286). No patient without surgery or operated but not resected lived for 2 years. The 5-year survival rate in resected cases was 30% (35/118). 41.2% for curative resections (35/85) and 0% for palliative resections (0/33). The 5-year survival rate according to depth of penetration in the stomach wall for curative resections was 94.1% (16/17) in early gastric cancer (mucosal and submucosal limit), 44.4% (8/18) in tumors with muscular involvement, and 22% (11/50) with serosal extension. Early gastric cancer represented 19% (17/91) of the curative resections (6% of all cancers). The 5-year survival rate for all curative resections was 51% (24/47) for subtotal gastrectomies and 29% (11/38) for total gastrectomies. The distribution of early and advanced cancers in each group was 13/47 in subtotal gastrectomies and 4/38 in total gastrectomies. The 5-year survival rate for curative resections in advanced cancer (early gastric cancer excluded) was 35% (12/34) for subtotal gastrectomies and 21% (7/34) for total gastrectomies. In our community gastric cancer continues to be a highly lethal disease with an overall mortality from the disease or its therapy of 88% by 5 years, with the majority of cases presenting late, being only one third of all patients amenable to curative resections. However, long-term results have improved substantially since previous studies. The increased number of curative resections and its better survival rates, the increased number of early gastric cancers and an important decrease in operative mortality for total gastrectomies accounts for these results. Decreased survival rates in patients with cancers in the two upper thirds of the stomach, independent of the depth of the involvement, was seen.

Structure-activity requirements for flavone cytotoxicity and binding to tubulin.

A series of 79 flavones related to centaureidin (3,6,4'-trimethoxy-5, 7,3'-trihydroxyflavone, 1) was screened for cytotoxicity in the NCI in vitro 60-cell line human tumor screen. The resulting cytotoxicity profiles of these flavones were compared for degree of similarity to the profile of 1. Selected compounds were further evaluated with in vitro assays of tubulin polymerization and [3H]colchicine binding to tubulin. Maximum potencies for tubulin interaction and production of differential cytotoxicity profiles characteristic of 1 were observed only with compounds containing hydroxyl substituents at C-3' and C-5 and methoxyl groups at C-3 and C-4'.

A new model for risk stratification and delivery of cardiovascular rehabilitation services in the long-term clinical management of patients with coronary artery disease.

This model for risk stratification includes variables that classify patients for Risk of Event similar to current models of risk stratification, as well as variables that stratify patients for Risk of Progression of Atherosclerosis by established risk factors. Categories of risk are established using accepted data from the literature for each risk factor that targets regression or plaque stabilization as the goal for Low Risk. A case-rate charging system and the proposed removal of time restrictions for length of cardiovascular rehabilitation fit neatly into the present climate for health care. Health maintenance organizations will be seeking programs that use similar models to address cost issues inherent in cardiovascular rehabilitation programs under current fee-for-service models. Improved outcomes will also be targets for these programs and case-management lends itself to disease management, thus, improved outcomes. Tracking outcomes becomes even more important to both the provider and the insurer because results drive referrals. Likewise, removal of the time restriction for cardiovascular rehabilitation allows programs to individualize care and to target risk factors that are not only most deleterious, but also where patients show readiness for change. The changing environment of health care virtually mandates change in cardiovascular rehabilitation. It is imperative that programs manage the disease process, are effective in achieving outcomes that affect both patient function and the disease process, and are cost effective. This model for risk stratification and delivery of services addresses these requirements and provides a beginning for implementing these changes in cardiovascular rehabilitation.

Treatment of neonatal immune thrombocytopenia with high dose intravenous gamma-globulin.

Five term neonates diagnosed with immune thrombocytopenia were treated with 1 g/kg/day intravenous gamma-globulin. Clinical and laboratory evidence of thrombocytopenia resolved completely in 4 of the 5 patients after a single dose. Only 1 patient received a second dose of the drug. This treatment protocol requires less gamma-globulin than other protocols to safely reduce length of hospitalization.

Structure-activity relationship of flavones as growth inhibitors of the navel orangeworm.

A series of flavones with widely varying degrees of substitution was fed to neonate larvae of the navel orangeworm. Growth of navel orangeworm larvae is inhibited by 5-methoxy flavones and flavone itself; 5-hydroxy flavones do not inhibit growth. Host resistance of citrus fruit to attack by the navel orangeworm might be due to the 5-methoxy flavones that occur in the peels.

6-Epicastanospermine, a novel indolizidine alkaloid that inhibits alpha-glucosidase.

A second indolizidine alkaloid, epimeric with castanospermine, has been isolated from seeds of the Australian tree Castanospermum australe. The structure was established as 6-epicastanospermine by proton and carbon-13 nuclear magnetic resonance spectroscopy and mass spectrometry. 6-Epicastanospermine was found to be a potent inhibitor of amyloglucosidase, (an exo-1,4-alpha-glucosidase), a weak inhibitor of beta-galactosidase, and not to inhibit beta-glucosidase and alpha-mannosidase. These results indicate that glycosidase inhibitory activity cannot be predicted by comparison of the structure and stereochemistry with the appropriate sugars, since 6-epicastanospermine is an analog of mannose and not of glucose. The inhibition of amyloglucosidase was found to be competitive and to be more effective at higher pH values. Castanospermine and 6-epicastanospermine differed in their effect upon the mung bean processing enzymes, glucosidase I and II, in that the former is a potent inhibitor whereas the latter is a very poor inhibitor. Subtle alterations in stereochemistry of these alkaloids can therefore produce significant changes in their biological activity.