A mixed-methods study of pharmacy instructors\u27 early experiences with a teaching electronic medical record

Introduction As use of electronic medical records (EMRs) increases in healthcare, multiple accreditation organizations recommend training future clinicians on EMRs as part of the academic curriculum. Therefore, some pharmacy programs now utilize an academic EMR. Our objective was to examine pharmacy instructors\u27 early experiences with a commercially available teaching EMR (tEMR) in order to identify current and future priorities along with benefits and barriers to academic EMR use in pharmacy education. Methods We conducted semi-structured interviews and a web-based survey with pharmacy instructors. Interview and survey data analyses consisted of hybrid inductive/deductive approaches to coding data and descriptive statistics, respectively. We mapped themes to the Pharmacists\u27 Patient Care Process (PPCP). Results Seven instructors participated in interviews, and 10 completed the survey. We identified 25 interview themes that were generally congruent with survey responses. A noted benefit of the tEMR was providing a large repository of real-life patient data. Instructors\u27 current priorities for tEMR activities primarily aligned with “collect,” “assess,” and “plan” steps of the PPCP. One reported barrier was insufficient training regarding the tEMR capabilities. Instructors offered innovative ideas for future academic EMR use, including pharmacokinetics, incident reporting, and longitudinal cases. Conclusions Study findings are most applicable to pharmacy programs in the early stages of academic EMR adoption. We identified opportunities for pharmacy programs to facilitate innovative, future use of academic EMRs, including curriculum planning, so pharmacy students gain experience using EMR functions for each PPCP step and develop more advanced EMR skills

Experimental Elucidation of the Life Cycle of \u3ci\u3eDrepanocephalus Spathans\u3c/i\u3e (Digenea: Echinostomatidae) with Notes on the Morphological Plasticity of \u3ci\u3eD. Spathans\u3c/i\u3e in the United States

The echinostomatid Drepanocephalus spathans (syn. Drepanocephalus auritus) parasitizes the doublecrested cormorant Phalacrocorax auritus. In North America, the marsh rams-horn snail Planorbella trivolvis and ghost rams-horn snail Biomphalaria havanensis serve as snail intermediate hosts, both of which inhabit catfish aquaculture ponds in the southeastern United States. Studies have demonstrated D. spathans exposure can be lethal to juvenile channel catfish Ictalurus punctatus. Two studies were undertaken to elucidate the life cycle of D. spathans to establish a developmental time line. In both studies, D. spathans cercariae collected from naturally infected P. trivolvis individuals were used to infect channel catfish fingerlings, which were then fed to double-crested cormorants (DCCOs) that had been pharmaceutically dewormed. In study 1, laboratory-reared P. trivolvis and B. havanensis individuals were placed in aviary ponds with experimentally infected DCCO and examined bi-weekly for release of cercariae. Trematode eggs were observed in the feces of exposed birds 3 days post-infection. Birds were sacrificed 18 days post-exposure (dpe), and gravid adults morphologically and molecularly consistent with D. spathans were recovered. Snails from the aviary pond were observed shedding D. spathans cercariae 18–54 dpe. In study 2, trematode eggs were observed in the feces of exposed DCCOs beginning 8 dpe. Once eggs were observed, birds were allowed to defecate into clean tanks containing naı¨ve laboratory-reared P. trivolvis individuals. Additionally, eggs from experimental DCCO feces were recovered by sedimentation and placed in an aquarium housing laboratory-reared P. trivolvis individuals. Birds in study 2 were sacrificed after 60 days, and gravid D. spathans specimens were recovered. Snails from the experimental DCCO tanks shed D. spathans cercariae 89–97 dpe. Lastly, trematode eggs were isolated and observed for the hatching of miracidia, which emerged on average after 16 days at ambient temperatures. No D. spathans adults were observed in control birds fed non-parasitized fish. This is the first experimental confirmation of the D. spathans life cycle, resolving previously unknown developmental time lines. In addition, the effects of fixation on adult trematode morphology were assessed, clarifying reports of pronounced morphological plasticity for D. spathans

Estimating the malaria risk of African mosquito movement by air travel

BACKGROUND: The expansion of global travel has resulted in the importation of African Anopheles mosquitoes, giving rise to cases of local malaria transmission. Here, cases of 'airport malaria' are used to quantify, using a combination of global climate and air traffic volume, where and when are the greatest risks of a Plasmodium falciparum-carrying mosquito being importated by air. This prioritises areas at risk of further airport malaria and possible importation or reemergence of the disease. METHODS: Monthly data on climate at the World's major airports were combined with air traffic information and African malaria seasonality maps to identify, month-by-month, those existing and future air routes at greatest risk of African malaria-carrying mosquito importation and temporary establishment. RESULTS: The location and timing of recorded airport malaria cases proved predictable using a combination of climate and air traffic data. Extending the analysis beyond the current air network architecture enabled identification of the airports and months with greatest climatic similarity to P. falciparum endemic regions of Africa within their principal transmission seasons, and therefore at risk should new aviation routes become operational. CONCLUSION: With the growth of long haul air travel from Africa, the identification of the seasonality and routes of mosquito importation is important in guiding effective aircraft disinsection and vector control. The recent and continued addition of air routes from Africa to more climatically similar regions than Europe will increase movement risks. The approach outlined here is capable of identifying when and where these risks are greatest

Study on Dead-Reckoning Translation in High-Level Architecture

In HLA, the concept of dead reckoning (DR) is extended to attribute extrapolation. The federation can use any formula that is agreed upon by the participating federates. If a non-DIS-standard DR algorithm is chosen, a DIS-compatible simulator has to modify its software to join the federation. The cost can be significant for this kind of modification. This paper suggests the use of dead-reckoning translators to solve this problem. To assist the study, a software tool, Dead Reckoning Translator Simulation Program (DRTSP), was designed and developed. It is a MATLAB-based program using the Graphic User Interface to provide a user-friendly environment. A sample flight trajectory recorded from a flight simulator is used to test the algorithms. The output of the program is the number of PDUs (updates) and the errors of each dead-reckoning algorithm. Conclusions, drawn from the results of the numerical experi ments, show translators lead to better results, especially using SIMNET DR. © 1997, Sage Publications. All rights reserved

\u3ci\u3eClinostomum album\u3c/i\u3e n. sp. and \u3ci\u3eClinostomum marginatum\u3c/i\u3e (Rudolphi, 1819), parasites of the great egret \u3ci\u3eArdea alba\u3c/i\u3e L. from Mississippi, USA

Members of the genus Clinostomum Leidy, 1856, colloquially known as yellow grubs, are cosmopolitan parasites of piscivorous birds, freshwater snails, fish and amphibians. In the southeastern United States, piscivorous birds present a continuous challenge for producers of farm-raised catfish. Ciconiiform birds are common hosts of Clinostomum spp. in North America and are endemic on most commercial catfish operations. The great egret Ardea alba L. is an avian predator often found foraging on commercial catfish operations, but to date the trematode fauna of great egrets preying on catfish ponds remains mostly understudied. Thirteen great egrets were captured from commercial catfish ponds in northeast Mississippi, and examined for trematode infections. Two morphologically distinct Clinostomum spp. were observed in the great egrets sampled, one morphologically consistent with Clinostomum marginatum (Rudolphi, 1819) and one morphologically unique species. These morphological descriptions were supplemented with molecular sequence data (c.4,800 bp of ribosomal DNA and c.600 bp of mitochondrial DNA). Gene sequences confirmed the identification of C. marginatum. However, the second species differed significantly from its congeners in both morphology and DNA sequence. Given these distinct morphological and molecular characters we propose this second species as Clinostomum album n. sp