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Barry Swerdlow,1 Julie Soelberg,1,2 Lisa Osborne-Smith1,2 1Nurse Anesthesia Program, Oregon Health & Science University, Portland, OR, USA; 2Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USACorrespondence: Barry SwerdlowNurse Anesthesia Program, Oregon Health & Science University, SON 521 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USATel +1 503 494 6468Fax +1 503 346 8296Email swerdlow@ohsu.eduPurpose: The aim of the present study was to evaluate the feasibility, acceptability, and utility of synchronous online screen-based simulation (SBS) in anesthesia education.Methods: The investigational cohort consisted of 12 second-year nurse anesthesia students enrolled in a Doctor of Nursing Practice (DNP) program. Pairs of students worked with a single instructor online using the same SBS employing a cloud-based peer-to-peer platform and high-fidelity software involving a graphical avatar. During each session, the instructor initially manipulated the avatar through the software scenario with educational pauses to communicate learning content. Thereafter, students proceeded through the same SBS by stating their desired actions, which were then implemented by the instructor. At the conclusion of each session, students were evaluated by an integrated software scoring system, and thereafter they completed a questionnaire rating their distance SBS experience.Results: Synchronous online SBS was performed in this manner without difficulty; it was accepted by students as a valuable adjunct to their in-person mannequin-based simulation (MBS) training; and it was perceived as a useful addition to their anesthesia education. Students identified significant value in the isolation of the cognitive component of learning by this teaching methodology. Lack of haptic learning, however, also was seen as a disadvantage of SBS compared to MBS. Students’ criticisms of SBS were largely unrelated to use of this technique with synchronous online education, but rather related to general limitations associated with SBS technology. There was a positive correlation between the students’ mean post-SBS rating and the automated SBS score (r = 0.832).Conclusion: Synchronous online SBS can effectively supplement MBS in an anesthesia training program. Its major perceived advantage appears to be an ability to isolate and reinforce appropriate cognitive skills related to intraoperative care including crisis management. Students who had higher mean post-SBS ratings also had higher automated SBS scores.Keywords: simulation, anesthesia, distance education, screen-based, crisis management

Barry Swerdlow,1,2 Julie Soelberg,1,3 Lisa Osborne-Smith1,3 1Nurse Anesthesia Program, Oregon Health & Science University, Portland, OR, USA; 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 3Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USACorrespondence: Barry SwerdlowOregon Health & Science University, SON 521 3455 SW US Veterans Hospital Road, Portland, OR 97239, USATel +1 503 494 6468Fax +1 503 346 8296Email swerdlow@ohsu.eduAbstract: Screen-based simulation (SBS) using digital technology has been demonstrated to improve the cognitive and psychomotor skills of anesthesia trainees. As a method of education and evaluation, this form of simulation offers multiple advantages related to cost, availability, simplicity, repeatability, and scorability. Online use of SBS with software employing standard cloud-based peer-to-peer platforms allows for instruction at a distance of important anesthesia-related critical thinking skills including crisis management. Despite the fact that there are no studies concerning the application of SBS in anesthesia distance education, this form of instruction has increased as a result of quarantine measures associated with the coronavirus-2 pandemic that have disrupted traditional in-person mannequin-based simulation, and its usage likely will continue through the post-pandemic era for multiple reasons. Several options exist for asynchronous and synchronous teaching of anesthesia skills at a distance with SBS, and there are useful techniques that can assist in achieving these educational goals with this process.Keywords: simulation, anesthesia, distance education, screen-based, virtual, computer

Ascariasis affects more than 1 billion people worldwide, mainly in developing countries, causing substantial morbidity. Current treatments for Ascaris infection are based on mass drug administration (MDA) with synthetic anthelmintic drugs such as albendazole, however continual re-infection and the threat of drug resistance mean that complementary treatment options would be highly valuable. Here, we screened ethanolic extracts from 29 medicinal plants used in Africa (Ghana) and the Caribbean (US Virgin Islands) for in vitro anthelmintic properties against Ascaris suum, a swine parasite that is very closely related to the human A. lumbricoides. A wide variety of activities were seen in the extracts, from negligible to potent. Extracts from Clausena anisata, Zanthoxylum zanthoxyloides and Punica granatum were identified as the most potent with EC50 values of 74, 97 and 164 μg/mL, respectively. Our results encourage further investigation of their use as complementary treatment options for ascariasis, alongside MDA.

Objective: The use of transesophageal echocardiography (TEE) by certified registered nurse anesthetists (CRNAs) during noncardiac surgery is relatively uncommon despite its unique potential to diagnose causes of hemodynamic instability. To address this problem, educational endeavors designed to provide practical TEE skills to CRNAs are needed. The aim of the current study was to evaluate the feasibility, acceptability, efficacy, and utility of a 2-day focused TEE workshop in nurse anesthesia education that employed a protocol involving a limited number of views and used goal-directed, qualitative assessments of critical physiologic parameters., Methods: This was a prospective, observational study involving 14 second-year nurse anesthesia students. The cohort was evaluated following completion of this workshop by simulator-based testing involving hypothetical clinical scenarios, and this test data was analyzed according to the percent successful acquisition and interpretation of TEE views to determine immediate objective teaching efficacy. The acceptability, perceived efficacy, and perceived utility of the workshop were assessed by online survey, and survey responses were qualitative and quantitative in nature., Results: Participants acquired appropriate TEE views associated with clinical scenarios 99% of the time and correctly interpreted the pathology in those views 93% of the time. Participants uniformly perceived significant educational value in this workshop and intend to incorporate TEE in their future clinical practice., Conclusions: A 2-day workshop to teach focused TEE to nurse anesthesia trainees directed by a streamlined protocol is feasible, acceptable, and perceived as useful by participants, and provides practical experience and entry-level competency in this point-of-care ultrasound modality., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The Pediatric Anesthesia COVID-19 Collaborative (PEACOC) is a research network to advance the care of children during the pandemic. Here we calculate the prevalence of coronavirus disease 2019 (COVID-19) among children undergoing anesthesia, look at prevalence in the population data from the Centers for Disease Control and Prevention (CDC), and assess independent risk factors for infection., Methods: This was a multicenter, retrospective, observational study. Children aged 28 days to 18 years scheduled for anesthesia services at 12 centers requiring universal COVID-19 testing from March 29, 2020 to June 30, 2020 were included. COVID-19 positivity rates among those tested were plotted and trends were assessed using the Cochran Armitage test of trend. Independent risk factors were explored using multivariable logistic regression., Results: Data were collected and analyzed on 33,320 anesthesia encounters including 265 children with COVID-19. Over the study period, the rates of infections in the pediatric anesthesia population did not demonstrate a significant trend. In the general population, there was a significant downward trend in infection rates ( P < .001). In exploratory analysis, multivariable risk factors for a COVID-19 positive test were Black/African American race, Hispanic ethnicity, American Society of Anesthesiologists (ASA) physical status III or above, overweight and obese body mass index (BMI), orthopedic cases, abdominal cases, emergency cases, absence of injury and trauma, and West region (all P < .05)., Conclusions: Rates of COVID-19 in pediatric anesthesia patients were consistently lower than in the general population. Independent risk factors of a positive test for children were identified. This is the first time universal testing for a single infectious disease was undertaken on a wide scale. As such, the association of infection with surgical case type or emergency case status is unprecedented., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 International Anesthesia Research Society.)

Unique challenges face pediatric surgeons at community-based nonteaching hospitals. Communication and collaboration among and between healthcare providers, hospital administrators, and quaternary referral programs is crucial for the success of these smaller hospitals as they care for children., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Commonly, false peyote refers to Lophophora diffusa . However, several other unrelated cacti go by this colloquial name. They either resemble "true" peyote, Lophophora williamsii , or are found in similar habitats. To date, over 40 different alkaloids have been isolated from the Lophophora genus. Of these, only the pharmacological actions of mescaline ( 1 ) have been extensively investigated. The major alkaloid in L. diffusa is pellotine ( 2 ), a tetrahydroisoquinoline (THIQ), which was briefly marketed as a sleeping aid around the beginning of the 20th century, following reports of its hypnotic properties in humans. Pharmacological experiments with the Lophophora THIQs were performed at the turn of the 20th century, whereas the chemical synthesis was not realized until several decades later. The biosynthetic pathways of the main Lophophora alkaloids were reported at the end of the 1960s. In this review, the relationship of the different "false peyotes" to L. williamsii , in regard to their alkaloid content, the bio- and chemical synthesis of the most relevant alkaloids, and their corresponding pharmacology will be outlined and discussed.

Ethnopharmacological Relevance: Studies show that ethnic minorities continue to use their cultural traditional medicines also after migration to the West. Research in this field is necessary, given that little is known about traditional medicines' impact on health-related problems. This study sheds light on the issue through a qualitative study among ethnic Pakistanis residing in Denmark., Aim of the Study: The study addresses perception, knowledge and attitudes regarding the use of medicinal plants among Pakistanis living in Copenhagen. We furthermore document and identify the medicinal plants used in households., Materials and Methods: Data were collected through in-depth, semi-structured interviews with sixteen ethnic Pakistanis aged 30-80 years. Interviews were transcribed verbatim and analysed through Emerson's two-phased analysis method. Medicinal plant products in the interviewees' households were collected, photographed, identified and deposited at Museum of Natural Medicine at University of Copenhagen., Results: A total number of 121 Pakistani traditional medicines were identified, and found to represent both medicinal plants and foods. The average number of quoted Pakistani Traditional Medicines was 18 (N=16). Interviewees independently reported the same traditions for preparation and consumption of Pakistani traditional medicines. Factors that play a role in choosing to use Pakistani traditional medicines are frequent visits to Pakistan, belief in the healing power of totkas (homemade medicinal preparation), religious knowledge and the occurrence of recent illness within the family. Further, the upkeep of traditional use depends on the availability of Pakistani traditional medicines., Conclusion: The study enhanced understanding of ethnic Pakistanis' perception and continued use of traditional medicines within the household after migration to the West. In the context of Western biomedicine, little is known of the potential toxicity and side-effects of many of the Pakistani traditional medicines found to be used in households in Copenhagen., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

The present study was carried out to investigate the wound healing potentials of 17 medicinal plants historically used in Ghana for wound healing. Warm and cold water extracts were prepared from the 17 dried plant species and tested in vitro in the scratch assay with NIH 3T3 fibroblasts from mice. The wound healing scratch assay was used to evaluate the effect of the plants on cell proliferation and/or migration in vitro, as a test for potential wound healing properties. After 21 hours of incubation increased proliferation and/or migration of fibroblasts in the scratch assay was obtained for 5 out of the 17 plant species. HPLC separation of the most active plant extract, which was a warm water extract of Philenoptera cyanescens , revealed the wound healing activity to be attributed to rutin and a triglycoside of quercetin. The present study suggests that Allophylus spicatus , Philenoptera cyanescens , Melanthera scandens , Ocimum gratissimum , and Jasminum dichotomum have wound healing activity in vitro., Competing Interests: The authors declare that they have no competing interests.

Background: The mountainous Wakhan and Pamir in northeastern Afghanistan is one of the most isolated yet inhabited places in Asia. It is home to the agropastoralist Wakhi and the last Afghan semi-nomadic Kyrgyz. We present a study of plant names and uses, along with comparisons of plant name etymology, origins of plant resources, intra- and intercultural exchanges and relations, and the relative availability of the known and used plants., Methods: The fieldwork was conducted as an expedition in the summer of 2010, and visited settlements and pastures in Upper Wakhan and Big and Little Pamir. Semi-structured group interviews, talks and observations gave initial data on names, uses and the relative availability of used plants, and provided foundation for individual interviews using an interview-herbarium containing vouchers of the 72 most frequently used plants or plant groups., Results: Wakhi and Kyrgyz plant names are recorded in western transcription, the new Wakhi alphabet, phonetically and in Cyrillic. The present study documents a large body of endemic, indigenous plant knowledge; on crops, fuel, fodder, cosmetics, dyes, vegetables, veterinary medicine, traditional medicines and other plant uses which sustain life in Wakhan and Pamir. Overall, the Wakhi use considerably more plants than the Kyrgyz, and their materia medica and use thereof is more complex. Although the Wakhi and Kyrgyz are close neighbours, there are few indications of direct knowledge transfer between them. Most shared plant uses are strictly necessary for survival in the mountains. While there are few differences between genders and cultural subgroups within the two cultures, the Wakhi and Kyrgyz exhibit great differences both in their total number of use-plants and the distance from which they obtain them. The agropastoralist Wakhi appear to have their basic needs for wild natural resources covered within half a days travel, while the relatively plant-derived environment of the high Pamir appears to have necessitated the nomadic Kyrgyz to adapt by developing uses and obtaining plants that are comparatively remote., Conclusion: The comparative differences in plant uses between the agropastoralist Wakhi and nomadic Kyrgyz appear to be accentuated by an environment at the extreme of what is humanly possible.

Ethnopharmacological Relevance: The plants tested in this study were examples of plants historically used to treat or alleviate several types of stomach disorders manifested by e.g. stomachache, diarrhoea or dysentery. These plants have been consumed typically as a decoction, sometimes mixed with other flavourings. The aim of this study was to evaluate the anti-Blastocystis activity of 24 plant parts from 21 medicinal plants from Ghana., Materials and Methods: The medicinal plants were collected in the Greater Accra region of Ghana. Every plant part was tested in three different extracts; an ethanolic, a warm, and a cold water extract, at a final concentration of 1 mg/mL for the initial screening, and in a range from 0.0156 to 1mg/mL for determination of inhibitory concentrations. The obligate anaerobic parasitic gut protist Blastocystis (subtype 4) was used as a 48 h old subcultivated isolate in the final concentration of 10(6) cells/mL. Plant extracts inoculated with Blastocystis were incubated at 37 °C for 24 h and 48 h. Both MIC minimum inhibitory concentration (MIC90) assays and minimal lethal concentration (MLC) assays were performed after 24 h and 48 h. The half maximal inhibitory concentration (IC50) was derived after 24 h and 48 h. Antimicrobial activity was tested against two Gram-positive and two Gram-negative bacteria for all 24 plant parts at a final concentration of 1mg/mL., Results: Screening of the 24 different plant parts showed significant anti-Blastocystis activity of six of the ethanolic extracts: Mallotus oppositifolius, IC50, 24 h 27.8 µg/mL; Vemonia colorata, IC50, 24 h 117.9 µg/mL; Zanthoxylum zanthoxyloides, cortex IC50, 24 h 255.6 µg/mL; Clausena anisata, IC50, 24 h 314.0 µg/mL; Z. zanthoxyloides, radix IC50, 24 h 335.7 µg/mL and Eythrina senegalensis, IC50, 24 h 527.6 µg/mL. The reference anti-protozoal agent metronidazole (MTZ) had an IC50, 24 h of 7.6 µg/mL. Only C. anisata showed antimicrobial activity at a concentration of 800 µg/mL., Conclusion: Six ethanolic plant extracts showed significant anti-parasitic activity against Blastocystis. M. oppositifolius showed nearly as good activity as the reference anti-protozoal drug MTZ. Historically, the active plants found in this study have been used against dysentery, diarrhoea or other stomach disorders. Nowadays they are not used specifically for dysentery, but they are being used as medicinal plants against various stomach disorders., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Ethnopharmacological Relevance: The present study was carried out to investigate the traditional use, pharmacology and active compounds of four plants commonly used as excipients in herbal medicine in Ghana., Materials and Methods: A comprehensive literature search was conducted to gain knowledge about the traditional use, pharmacology and active compounds of the four plant excipients. The broth dilution antibacterial assay and the DPPH radical scavenging antioxidant assay were used to evaluate the antibacterial and antioxidant activity of the plants, respectively. Ethanol, warm water and cold water extracts were prepared from the dried seeds/fruits of Aframomum melegueta, Piper guineense, Xylopia aethiopica and Monodora myristica, and tested in the assays., Results: A. melegueta and P. guineense seemed to act as pharmacoenhancers, since they have been shown to inhibit specific CYP-enzymes. A. melegueta could act as an antioxidant to preserve herbal preparations. None of the plant excipients had antibacterial activity against the bacteria tested in this study. Compounds with an aromatic or pungent smell had been identified in all the plant excipients. An explanation for the use of the plants as excipients could rely on their taste properties., Conclusion: The present study suggests that there may be more than one simple explanation for the use of these four plants as excipients. Plausible explanations have been proven to be: (1) a way to increase the effect of the medicine, (2) a way to make the medicine more palatable or (3) a way to preserve the activity of the medicinal preparation over time., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Ethnopharmacological Relevance: Laportea aestuans (L.) Chew (Urticaceae) was historically ingested together with chalk by pregnant women in Ghana when suffering from heartburn. The aim of this study was to evaluate the antacid activity of the aerial parts of L. aestuans., Materials and Methods: Aerial parts of L. aestuans were collected in the Accra region of Ghana. The antacid activity was measured according to Fordtran׳s titration model. 90 mL tap water and test material in a 500 mL beaker were warmed to 37°C on a magnetic stirrer and was continuously stirred at approximately 30 rpm in order to mimic the movements of the stomach. A titration was carried out with an artificial gastric acid to the end point of pH 3. The acid secretion rate was approximately 3 mL and pH was monitored with a pH meter. Concentrations of 666 and 1332 mg dried plant material were tested, both with and without addition of calcium carbonate (CaCO3)., Results: Both CaCO3 and L. aestuans had a significant better ability than water to neutralise an artificial stomach acid. 666 mg plant material together with CaCO3 compared to CaCO3 alone showed approximately the same neutralisation time. When mixing 1332 mg plant material with CaCO3 the neutralisation time was significantly higher than for CaCO3 alone and exhibited an antacid profile that was able to maintain the neutralising activity one pH-unit higher for an extended period of time., Conclusion: The results indicate that L. aestuans showed an antacid activity when combined with CaCO3. With further investigations of the active compound, mechanism of action and possible toxicity, the plant could form the basis of a novel antacid., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Plants used to treat inflammatory ailments, pain, fever and infections in the Pamir Mountains in northeastern Afghanistan, were tested for antibacterial and COX-1 inhibitory activity. Water and ethanol extracts of 20 species were tested for antibacterial activity against two gram positive and two gram negative bacteria. The ethanol extract of Arnebia guttata inhibited Staphylococcus aureus with a MIC of 6 µg/mL. Water and ethanol extracts of Ephedra intermedia and the ethanol extracts of Lagochilus cabulicus and Peganum harmala inhibited Staphylococcus aureus at 0.5 mg/mL, and the P. harmala extract further inhibited the growth of Bacillus subtilis and E. coli, also with MICs of 0.5 mg/mL. Ethanol extracts of Artemisia persica (IC50: 0.5 µg/mL), Dragocephalum paulsenii (IC50: 0.5 µg/mL), Ephedra intermedia (IC50: 3.8 µg/mL), Hyoscyamus pusillus, Nepeta parmiriensis (IC50: 0.7 µg/mL) and Rumex patientia subsp. pamiricus (IC50: 3.5 µg/mL) exhibited COX-1 inhibitory activity. The observed in vitro activities support the use of some of the plant species in the traditional medicine systems of the Pamir Mountains.

Ethnopharmacological Relevance: The roots of Rubia tibetica are chewed as an antidote to anaphylaxis caused by bites of the tick Ornithodoros lahorensis by the Wakhi people in Afghanistan., Aims of the Study: To test whether Rubia tibetica possess anti-histamine effect., Materials and Methods: Water and ethanol extracts of roots of Rubia tibetica were tested for anti-histamine effect on the H1-receptor in the guinea pig ileum assay. Fixed concentrations of plant extract with increasing concentrations of histamine were examined. Mepyramine was used as control., Results and Conclusion: The ethanol extract of Rubia tibetica showed dose-dependent anti-histamine effect, whereas the water extract had little activity. The chewing of Rubia tibetica roots may alleviate the fatal swelling of the tongue during anaphylaxis.

Purpose: To investigate the ability of proton ((1)H) magnetic resonance imaging (MRI) to distinguish between pulmonary inflammation and fibrosis., Materials and Methods: Three groups of Sprague-Dawley rats (n = 5) were instilled intratracheally with bleomycin (2.5 U/kg or 3.5 U/kg) in saline or with saline only. Rats were imaged at 2.0 Tesla using a multi-slice Carr-Purcell-Meilboom-Gill (CPMG) sequence with 6 ms echo spacing. Signal intensity (S(0)) and T(2) were calculated on a pixel-by-pixel basis using images collected before dosing and 1, 2, 4, and 7 weeks after. At each time point, data from dosed animals were compared with controls, and bivariate statistical analysis was used to classify image pixels containing abnormal tissue. At week 7, pulmonary function tests were performed, then all rats were killed, left lungs were formalin fixed and tri-chrome stained for histological analysis of collagen content, and right lungs were used to measure water and hydroxyproline (collagen) content., Results: The product S(0)xT(2) significantly correlated with water and collagen content in the high-dose group (P = 0.004 and P = 0.03, respectively). However, S(0) and T(2) of abnormal tissue were correlated for all time points (r = 0.93, P < 0.001), and could not distinguish inflammation from fibrosis., Conclusion: MRI can be used to confidently localize pulmonary inflammation and fibrosis, but it lacks specificity., (Copyright 2010 Wiley-Liss, Inc.)

2-Butoxyethanol (BE) is the most widely used glycol ether solvent. BEs major metabolite, butoxyacetic acid (BAA), causes hemolysis with significant species differences in sensitivity. Several PBPK models have been developed over the past two decades to describe the disposition of BE and BAA in male rats and humans to refine health risk assessments. More recent efforts by Lee et al. [Lee, K.M., Dill, J.A., Chou, B.J., Roycroft, J.H., 1998. Physiologically based pharmacokinetic model for chronic inhalation of 2-butoxyethanol. Toxicol. Appl. Pharmacol. 153, 211-226] to describe the kinetics of BE and BAA in the National Toxicology Program (NTP) chronic inhalation studies required the use of several assumptions to extrapolate model parameters from earlier PBPK models developed for young male rats to include female F344 and both sexes of B6C3F1 mice and the effects of aging. To replace these assumptions, studies were conducted to determine the impact of age, gender and species on the metabolism of BE, and the tissue partitioning, renal acid transport and plasma protein binding of BAA. In the current study, the Lee et al. PBPK model was updated and expanded to include the further metabolism of BAA and the salivary excretion of BE and BAA which may contribute to the forestomach irritation observed in mice in the NTP study. The revised model predicted that peak blood concentrations of BAA achieved following 6 h inhalation exposures are greatest in young adult female rats at concentrations up to 300 ppm. This is not the case predicted for old (> or =18 months) animals, where peak blood concentrations of BAA in male and female mice were similar to or greater than female rats. The revised model serves as a quantitative tool for integrating an extensive pharmacokinetic and mechanistic database into a format that can readily be used to compare internal dosimetry across dose, route of exposure and species.