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Virtual field trips are transforming education in biology and other place-based disciplines – and not just since Covid-19 has imposed social distancing constraints. Efficient methods for content creation, combined with affordable immersive technology, provide the opportunity to integrate immersive experiences into ever-larger classes. However, many aspects of how immersive experiences can enrich and improve learning in place-based education are still not well understood. We present an empirical study, conducted in a large undergraduate ecology class, comparing students, that experienced an immersive virtual version of a field trip to a biological preserve as preparation for a later actual field trip to the site, with a control group that visited the real site but without having had the virtual experience. Within the virtual experience group, we also varied the quality of the headset. The VR field trip was well received for raising spatial awareness and also motivation and interest. Students ranked it higher than any traditional means with regard to achieving a high level of preparedness for the actual field trip. In contrast, no statistically significant evidence was found for differences in perceived learning outcome and enjoyment of the actual field trip. [ABSTRACT FROM AUTHOR]

Background and Purpose: Vancomycin is one of the most common clinical antibiotics, yet acute kidney injury is a major limiting factor. Common combinations of antibiotics with vancomycin have been reported to worsen and improve vancomycin‐induced kidney injury. We aimed to study the impact of flucloxacillin and imipenem–cilastatin on kidney injury when combined with vancomycin in our translational rat model. Experimental Approach: Male Sprague–Dawley rats received allometrically scaled (1) vancomycin, (2) flucloxacillin, (3) vancomycin + flucloxacillin, (4) vancomycin + imipenem–cilastatin or (5) saline for 4 days. Kidney injury was evaluated via drug accumulation and urinary biomarkers including urinary output, kidney injury molecule‐1 (KIM‐1), clusterin and osteopontin. Relationships between vancomycin accumulation in the kidney and urinary kidney injury biomarkers were explored. Key Results: Urinary output increased every study day for vancomycin + flucloxacillin, but after the first dose only in the vancomycin group. In the vancomycin + flucloxacillin group, urinary KIM‐1 increased on all days compared with vancomycin. In the vancomycin + imipenem–cilastatin group, urinary KIM‐1 was decreased on Days 1 and 2 compared with vancomycin. Similar trends were observed for clusterin. More vancomycin accumulated in the kidney with vancomycin + flucloxacillin compared with vancomycin and vancomycin + imipenem–cilastatin. The accumulation of vancomycin in the kidney tissue correlated with increasing urinary KIM‐1. Conclusions and Implications: Vancomycin + flucloxacillin caused more kidney injury compared with vancomycin alone and vancomycin + imipenem–cilastatin in a translational rat model. The combination of vancomycin + imipenem–cilastatin was nephroprotective. [ABSTRACT FROM AUTHOR]

Disasters are immense and shocking events which, in their wake, require the collective efforts of an entire community to achieve a successful recovery. Engaging and educating a broader swath of a given community well in advance of a disaster contributes significantly to better sharing of resources and an overall efficient and effective emergency response. This research first examines traditional methods used in emergency response, as well as computer simulationbased emergency drills. It next reviews the use of gaming in emergency response training, from board games to computer games utilizing simulation technologies. We demonstrate that alternate reality games, which are driven by transmedia storytelling and intensely devoted to establishing interactions across real and fictional worlds, has the potential to suit the needs of emergency response training well, yet is still lacking. The potential merits of using an alternate reality game for emergency response training are as follows: they could fulfill the need for environment-specific training material, overcome the lack of regular and mandatory training for students along with inappropriate scheduling of training workshops, and turn text-heavy paper-based or digital training materials into an entertaining and engaging experience.

Study Objective: In critically ill patients, adequacy of early antibiotic exposure has been incompletely evaluated. This study characterized factors associated with inadequate cefepime exposure in the first 24 h of critical illness. Design: Prospective cohort study. Setting: Academic Medical Center. Patients Critically ill adults treated with cefepime. Patients with acute kidney injury or treated with kidney replacement therapy or extracorporeal membrane oxygenation were excluded. Intervention: None. Measurements A nonlinear mixed‐effects pharmacokinetic (PK) model was developed to estimate cefepime concentrations for each patient over time. The percentage of time the free drug concentration exceeded 8 mg/L during the first 24 h of therapy was calculated (%ƒT>8; appropriate for the susceptible breakpoint for Pseudomonas aeruginosa). Factors predictive of low %ƒT>8 were explored with multivariable regression. Main Results In the 100 included patients, a one‐compartment PK model was developed with first‐order elimination with covariates for weight and estimated glomerular filtration rate based on creatinine and cystatin C (eGFRSCr‐CysC). The median (interquartile range) %ƒT>8 for cefepime in the first 24 h of therapy based on this model was 85% (66%, 100%). Less than 100% ƒT>8 during first 24 h of therapy occurred in 70 (70%) individuals. Lower Sequential Organ Failure Assessment score (p = 0.032) and higher eGFRSCr‐CysC (p < 0.001) predicted a lower %ƒT>8. Central nervous system infection source was protective (i.e., associated with a higher %ƒT>8; p = 0.008). Conclusions: During early critical illness, cefepime concentrations were inadequate in a significant proportion of patients. Antimicrobial optimization is needed to improve the precision of pharmacotherapy in the critically ill patients. [ABSTRACT FROM AUTHOR]

Objective To investigate and describe the variability in cefepime exposures among 'real-world', critically ill patients by using population pharmacokinetic modelling and simulations, and with translation of these findings to visualizations. Methods A cohort of adult medical ICU patients who received cefepime with therapeutic drug monitoring was studied. Two compartment models were developed to estimate cefepime clearance (Model 1) and simulate cefepime exposures among 1000 patients, each with identical creatinine clearance of 60 mL/min and receiving a regimen of cefepime 1 gram IV over 30 minutes, every 8 hours (Model 2). Variability in the relationship between cefepime clearance and creatinine clearance (CrCL) was visualized, and a random, representative sample of 10 simulated patients was utilized to illustrate variability in cefepime exposures. Results A total of 75 adult medical ICU patients (52% female) and 98 serum cefepime samples were included in the study. Population parameter estimates for cefepime displayed a wide range of variation in Model 1 (CV: 45% to 95%), with low bias at the individual level at 0.226 mg/L but high bias in the population model 10.6 mg/L. Model 2 displayed similar fits, demonstrating that correcting for individual patient creatinine clearance slightly improves the bias of the population model (bias = 4.31 mg/L). Among 10 simulated patients that a clinician would deem similar from a dosing perspective (i.e. equivalent creatinine clearance), maximum concentrations after three simulated doses varied more than 8-fold from 41.2 to 339 mg/L at the 5th and 95th percentiles, and clearance profiles were highly different. Conclusion Creatinine clearance estimates alone are inadequate for predicting cefepime exposures. Wide variations in cefepime exposure exist among ICU patients, even for those with similar kidney function estimates. Current population adjustment schemes based solely on creatinine clearance will result in unintended high and low exposures leading to safety and efficacy concerns, respectively. [ABSTRACT FROM AUTHOR]