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Purpose: Gemcitabine, a pyrimidine nucleoside, is approved for the treatment of non-small cell lung cancer, pancreatic carcinoma, and breast cancer. Chemotherapy regimens are determined experimentally with static tissue culture systems, animal models, and in Phase I clinical trials. The aim of this study was to assess for gemcitabine-induced cell death following infusion of drug under clinically-relevant conditions of infusion rate and drug exposure in an in vitro bioreactor system.Methods: To estimate an appropriate harvest time for cells from the bioreactor after drug treatment, we estimated the temporal relationship between gemcitabine treatment for 1 h and cell death at a later time point with monolayer growth assays (i.e., static culture). Afterward, 5.3 mg gemcitabine was infused over 0.5 h in the bioreactor, followed by mono-exponential decay, simulating patient concentration-time profiles (n = 4). Controls were run with drug-free media (n = 4). Cells were harvested from the bioreactor at a later time point and assessed for cell death by flow cytometry.Results: According to monolayer growth assay results, cytotoxicity became more apparent with increasing time. The E Max for cells 48 h after treatment was 50% and after 144 h, 93% (P = 0.022; t test), while flow cytometry showed complete DNA degradation by 120 h. Gemcitabine was infused in the bioreactor. The gemcitabine area under the concentration-time curve (AUC) was 56.4 microM h and the maximum concentration was 87.5 +/- 2.65 microM. Flow cytometry results were as follows: the G1 fraction decreased from 65.1 +/- 4.91 to 28.6 +/- 12% (P = 0.005) and subG1 increased from 14.1 +/- 5.28 to 42.6 +/- 9.78% (P = 0.004) relative to control. An increase in apoptotic cells was observed by TUNEL assay.Conclusions: The in vitro bioreactor system will be expanded to test additional cell lines, and will serve as a useful model system for assessing the role of drug pharmacokinetics in delivery of optimized anticancer treatment. [ABSTRACT FROM AUTHOR]

Freshwater crayfish are amongst the largest macroinvertebrates and play a keystone role in the ecosystems they occupy. Understanding the global distribution of these animals is often hindered due to a paucity of distributional data. Additionally, non-native crayfish introductions are becoming more frequent, which can cause severe environmental and economic impacts. Management decisions related to crayfish and their habitats require accurate, up-to-date distribution data and mapping tools. Such data are currently patchily distributed with limited accessibility and are rarely up-to-date. To address these challenges, we developed a versatile e -portal to host distributional data of freshwater crayfish and their pathogens (using Aphanomyces astaci , the causative agent of the crayfish plague, as the most prominent example). Populated with expert data and operating in near real-time, World of Crayfish ™ is a living, publicly available database providing worldwide distributional data sourced by experts in the field. The database offers open access to the data through specialized standard geospatial services (Web Map Service, Web Feature Service) enabling users to view, embed, and download customizable outputs for various applications. The platform is designed to support technical enhancements in the future, with the potential to eventually incorporate various additional features. This tool serves as a step forward towards a modern era of conservation planning and management of freshwater biodiversity., Competing Interests: The authors declare there are no competing interests., (©2024 Ion et al.)

Introduction: Early in COVID-19, continuing professional development (CPD) providers quickly made decisions about program content, design, funding and technology. Although experiences during an earlier pandemic cautioned providers to make disaster plans, CPD was not entirely prepared for this event. We sought to better understand how CPD organisations make decisions about CPD strategy and operations during a crisis., Methods: This is a descriptive qualitative research study of decision making in two organisations: CPD at the University of Toronto (UofT) and the US-based Society for Academic Continuing Medical Education (SACME). In March 2021, using purposive and snowball sampling, we invited faculty and staff who held leadership positions to participate in semi-structured interviews. The interview focused on the individual's role and organisation, their decision-making process and reflections on how their units had changed because of COVID-19. Transcripts were reviewed, coded and analysed using thematic analysis. We used Mazmanian et al.'s Ecological Framework as a further conceptual tool., Results: We conducted eight interviews from UofT and five from SACME. We identified that decision making during the pandemic occurred over four phases of reactions and impact from COVID-19, including shutdown, pivot, transition and the 'new reality'. The decision-making ability of CPD organisations changed throughout the pandemic, ranging from having little or no independent decision-making ability early on to having considerable control over choosing appropriate pathways forward. Decision making was strongly influenced by the creativity, adaptability and flexibility of the CPD community and the need for social connection., Conclusions: This adds to literature on the changes CPD organisations faced due to COVID-19, emphasising CPD organisations' adaptability in making decisions. Applying the Ecological Framework further demonstrates the importance of time to decision-making processes and the relational aspect of CPD. To face future crises, CPD will need to embrace creative, flexible and socially connected solutions. Future scholarship could explore an organisation's ability to rapidly adapt to better prepare for future crises., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Isoperla riverae sp. n. is described from the southeastern USA. The new species is proposed based on details of the adult habitus, male aedeagus, vesicle, female subgenital plate, ovum chorion, and larval habitus. Supporting data includes color images, scanning electron micrographs, genetic analysis of DNA barcodes, and comparative morphology of cognate species. The larva of Isoperla lenati Szczytko & Kondratieff, 2015 is also described supported by color images.

Two new species of stream-dwelling crayfish, Cambarus lapidosus, the Stony Fork Crayfish, and Cambarus burchfielae, the Falls Crayfish, are described from the Yadkin River basin in western North Carolina, USA, using an integrative taxonomic approach consisting of morphological, genetic, and biogeographic data. Both species were previously considered to be members of the widely distributed Cambarus species C complex, which occurs throughout mid-Atlantic Slope river basins; however, they are in fact morphologically and genetically more similar to the Cambarus robustus species complex from interior basins in the south-central Appalachians, indicating Atlantic basin stream capture of an Interior basin faunal group has occurred in this region. Both new species described herein can be differentiated from these two complexes, and each other, by several morphological characteristics. Cambarus lapidosus and C. burchfielae are differentiated from C. species C by the absence of cervical spines and the presence of 1-2 subpalmar tubercles on the chelae in most specimens; both species are less-punctate across the areola than C. aff. robustus. Cambarus burchfielae is further differentiated from C. lapidosus, C. species C, and C. aff. robustus by the presence of a narrower and sparsely punctate areola, a single weak row of tubercles on the mesial margin of the palm, and the absence of tubercles on the dorsal surface of the dactyl. The newly described species are genetically sister taxa and together are most similar by genetic distance to undescribed members of the C. robustus species complex from the nearby (~30 km) Watauga River basin and most phylogenetically similar to C. aff. robustus from the adjacent New River basin; both are interior basin drainages. The newly-described species are endemic to the Blue Ridge Mountains of western North Carolina and have restricted distributions (<100 km2-150 km2) in small (<4th order) tributaries to the Yadkin River. Cambarus lapidosus is known only from the upper Stony Fork watershed and C. burchfielae is known only from the upper reaches of the adjacent Lewis Fork watershed; both species likely qualify for conservation status protections under narrow geographic range criteria.

Objective: The aim of this article is to discuss the etiology, prevalence, impact, and management of disruptive behavior in physicians. These various aspects will be examined at both the individual and system level, to provide appropriate perspective and detail effective approaches to address these behaviors., Method: Clinical experience and review of the authors' and other researchers' findings provide consensus on numerous key aspects of physician disruptive behavior., Results: Physicians demonstrating disruptive behavior are often distressed. The behavior should be understood as arising from biopsychosocial contributors, knowledge gaps, insight, and systems factors. These contributors are inclusive and may interact with each other., Conclusions: A comprehensive approach is required which can include assessment/reassessment tools, individualized programming (therapy, coaching, instruction), deliberate practice, medical follow-up, and system intervention. Complications include the diversity of disruptive behaviors, the many contributory factors therein, disagreement about methodology/measurement, and the role of the system.

Background: Stress has been linked to numerous health outcomes, including internalizing and externalizing behaviors, self-esteem, and physical health. Culture has also been linked to stress and health. This study examined the links between stress and health, and the potential moderating role of Latinx ethnic pride (LEP)., Methods: The sample consisted of 119 Latinx youth from the Midwestern U.S. Mothers and youth completed surveys. Variables included the Multicultural Events Scale for Adolescents (MESA), parent and home stressors/risks (PHSR), LEP, depressive symptoms, aggression, frustration, and self-esteem. Research assistants measured child heights and weights and calculated BMI percentiles., Results: LEP was negatively related to MESA, depressive symptoms, aggression, and frustration, and positively related to self-esteem. MESA and PHSR were associated with depressive symptoms, aggression, frustration, and self-esteem, but not with BMI percentile. In adjusted regression analyses, LEP moderated the effects MESA had on frustration and self-esteem, marginally moderated the link between MESA and depressive symptoms, and was not related to aggression or BMI percentile. LEP did not moderate the relationship between PHSR with any health outcomes., Conclusions: Stressors were generally related to child mental health. LEP may play an important role in protecting against some of the effects of stressful events on mental health outcomes.

The Cataloochee Crayfish, Cambarus ectopistes sp. nov., is a large, stream-dwelling crayfish that occupies a narrow noncontiguous distribution within the Appalachian Mountain region running through the Upper Tennessee River basin, in the French Broad, Pigeon, and Nolichucky watersheds along the Tennessee and North Carolina border. It is split from the southernmost extent of the C. robustus species complex, and is morphologically and genetically most similar to a second undescribed member of the group endemic to the upper Nolichucky River watershed in North Carolina. Cambarus ectopistes sp. nov. can be distinguished from other members of the C. robustus complex and co-distributed congeners by a combination of characters, including body size, coloration, and morphology of the chela and rostrum. The new species is typically found in channel and edge habitats of moderate to large perennial streams with large cobbles and boulders.

Rapid environmental change is reshaping ecosystems and driving species loss globally. Carnivore populations have declined and retracted rapidly and have been the target of numerous translocation projects. Success, however, is complicated when these efforts occur in novel ecosystems. Identifying refuges, locations that are resistant to environmental change, within a translocation framework should improve population recovery and persistence. American martens (Martes americana) are the most frequently translocated carnivore in North America. As elsewhere, martens were extirpated across much of the Great Lakes region by the 1930s and, despite multiple translocations beginning in the 1950s, martens remain of regional conservation concern. Surprisingly, martens were rediscovered in 2014 on the Apostle Islands of Lake Superior after a putative absence of >40 yr. To identify the source of martens to the islands and understand connectivity of the reintroduction network, we collected genetic data on martens from the archipelago and from all regional reintroduction sites. In total, we genotyped 483 individual martens, 43 of which inhabited the Apostle Islands (densities 0.42-1.46 km -2 ). Coalescent analyses supported the contemporary recolonization of the Apostle Islands with progenitors likely originating from Michigan, which were sourced from Ontario. We also identified movements by a first-order relative between the Apostle Islands and the recovery network. We detected some regional gene flow, but in an unexpected direction: individuals moving from the islands to the mainland. Our findings suggest that the Apostle Islands were naturally recolonized by progeny of translocated individuals and now act as a source back to the reintroduction sites on the mainland. We suggest that the Apostle Islands, given its protection from disturbance, complex forest structure, and reduced carnivore competition, will act as a potential refuge for marten along their trailing range boundary and a central node for regional recovery. Our work reveals that translocations, even those occurring along southern range boundaries, can create recovery networks that function like natural metapopulations. Identifying refuges, locations that are resistant to environmental change, within these recovery networks can further improve species recovery, even within novel environments. Future translocation planning should a priori identify potential refuges and sources to improve short-term recovery and long-term persistence., (© 2021 by the Ecological Society of America.)

Purpose: Unprofessional behavior, which can include failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness, can be demonstrated by medical trainees and practicing physicians. In the authors' experience, these types of behaviors are associated with exposure to adverse childhood experiences (ACEs). Given this overlap, the authors studied the percentage of ACEs among trainees and physicians referred for fitness-for-duty evaluations and patterns between the types of ACEs experienced and the reason for referral., Method: A final sample of 123 cases of U.S. trainees and physicians who had been referred to a Midwestern center for assessment and/or remediation of professionalism issues from 2013 to 2018 was created. Included professionalism lapses fell within 3 categories: boundary violation, disruptive behavior, or potential substance use disorder concerns. All participants completed a psychosocial developmental interview, which includes questions about ACE exposure. Overall rate of reported ACEs and types of ACEs reported were explored., Results: Eighty-six (70%) participants reported at least 1 ACE, while 27 (22%) reported 4 or more. Compared with national data, these results show significantly higher occurrence rates of 1 or more ACEs and a lower occurrence rate of 0 ACEs. ACEs that predicted reasons for referral were physical or sexual abuse, feeling unwanted or unloved, witnessing abuse of their mother or stepmother, or caretaker substance use., Conclusions: In this sample, ACE exposure was associated with professionalism issues. Remediating individuals with professionalism issues and exposure to ACEs can be complicated by heightened responses to stressful stimuli, difficulties with collaboration and trust, and decreased self-efficacy. Adoption of a trauma-informed medical education approach may help those that have been impacted by trauma rebuild a sense of control and empowerment. The findings of this study may be useful predictors in identifying those at risk of problematic behavior and recidivism before a sentinel event., (Copyright © 2021 by the Association of American Medical Colleges.)

Management of disease affecting peanut in the southeastern United States has benefited from extensive field research identifying disease-associated risk factors since the 1990s. An assessment of risk factors associated with tomato spotted wilt (TSW), caused by tomato spotted wilt virus and spread exclusively by thrips, is available to growers through Peanut Rx, a tool developed to inform peanut management decisions. Peanut Rx provides an assessment of relative TSW risk as an index. The assessment provides information about the relative degree to which a field characterized by a specified suite of practices is at risk of crop loss caused by TSW. Loss results when infection occurs, and infection rates are determined, in part, by factors outside a grower's control, primarily the abundance of dispersing, viruliferous thrips. In this study, we incorporated meteorological variables useful for predicting thrips dispersal, increasing the robustness of the Peanut Rx framework in relation to variation in the weather. We used data from field experiments and a large grower survey to estimate the relationships between weather and TSW risk mediated by thrips vectors, and developed an addition to Peanut Rx that proved informative and easy to implement. The expected temporal occurrence of major thrips flights, as a function of heat and precipitation, was translated into the existing risk-point system of Peanut Rx. Results from the grower survey further demonstrated the validity of Peanut Rx for guiding growers' decisions to minimize risk of TSW.

Background: The literature on unprofessional behavior is reviewed. It is well accepted that unprofessional behavior, including a lack of civility and respect, can have a negative impact on patient safety and quality of care., Methods: We used a focused review in the context of 20 years of experience of assessing, treating, and remediating unprofessional behavior. The review highlights that unprofessional behavior can stem from a variety of sources, including health, psychological/psychiatric issues, social functioning or support, or a combination of these. The review covers the challenges in the work environment and the relationship between outcome, as experienced by the physician, and the likelihood the physician will repeat or modify his or her behavior., Results: Based on the evidence provided in the review and our clinical and research experience, we offer a new framework for the assessment, treatment, and remediation of physicians with professionalism transgressions: the Environmentally Valid Learning Approach. The approach is related to and expands on Miller's Pyramid by adding bio-psycho-social functioning and professional identity to the Pyramid. It emphasizes the dynamic and environmental characteristics of professional identity., Conclusions: Effective intervention is possible. Consideration of contributory factors, addressing/treating those factors, teaching/remediating skill deficiencies, and determining elements that need to be in place to foster implementation and maintenance of the developing skills are necessary components for successful resolution. The behavior is fully remediated when a self-sustaining alternative to the unprofessional behavior is established and the desired behavior becomes a permanent part of the physician's behavioral repertoire., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The Jewel Mudbug, Lacunicambarus dalyae sp. nov., is a large, colorful primary burrowing crayfish found in Alabama, Florida, Georgia, Mississippi and Tennessee. This species is most similar in appearance to the Paintedhand Mudbug, L. polychromatus, a species found across the Midwestern United States. The ranges of the two species overlap minimally, and they can be distinguished from each other based on several characters, the most notable of which is the much longer central projection of the gonopod in Form I and II males of L. dalyae sp. nov. relative to L. polychromatus. Like its congeners, L. dalyae sp. nov. is commonly found in burrows in the banks and floodplains of streams and is resilient to a moderate amount of anthropogenic habitat degradation, being occasionally collected from burrows in roadside ditches and urban lawns.

This Invited Commentary highlights the prevalence of adverse childhood experiences and the potential effect that such experiences can have in the medical education setting on trainees, colleagues, and faculty. The author draws on 20 years of experience working in organizations devoted to helping physicians with disruptive behavior learn new behavioral skills to enable them to function within the complex medical environment. A case example-an amalgam of individuals who have presented for remediation-is used to illustrate the issues that result from adverse childhood experiences. There is a broad and well-understood literature demonstrating a correlation between early life trauma and medical and mental health issues. Adverse early life experiences can also contribute to attachment-related difficulties including problems with boundaries, trust, and suspiciousness; lack of reciprocity; lack of attunement with others' emotional states; as well as regulation issues, including difficulties labeling and expressing feelings and internal states. Difficulties with self-concept, including a lack of continuous and predictable sense of self, low self-esteem, and shame and guilt, are also associated with exposure to adverse childhood experiences. Given the documented high proportion of health care workers, including physicians, who are trauma survivors, trauma-sensitive education must be a priority, not only in medical school but across the educational continuum.

Leeches (Hirudinida) comprise a charismatic, yet often maligned group of organisms. Despite their ecological, economic, and medical importance, a general consensus on the phylogenetic relationships of major hirudinidan lineages is lacking. This absence of a consistent, robust phylogeny of early-diverging lineages has hindered our understanding of the underlying processes that enabled evolutionary diversification of this clade. Here, we used an anchored hybrid enrichment-based phylogenomic approach, capturing hundreds of loci to investigate phylogenetic relationships among major hirudinidan lineages and their closest living relatives. Our results suggest that a dramatic reinterpretation of early leech evolution is warranted. We recovered Branchiobdellida as sister to a clade that includes all major lineages of hirudinidans, but found Acanthobdella to be nested within Oceanobdelliformes. These results cast doubt on the utility of Acanthobdella as a "missing link" used to explain the origin of blood-feeding in hirudineans. Further, our results support a deep divergence between predominantly marine and freshwater lineages, while not supporting the reciprocal monophyly of jawed and proboscis-bearing leeches. To sum up, our phylogenomic resolution of early-diverging leeches provides a necessary foundation for illuminating the evolution of host-symbiont associations and key adaptations that have allowed leeches to colonize a wide diversity of habitats worldwide., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.)

Major habitat transitions, such as those from marine to freshwater habitats or from aquatic to terrestrial habitats, have occurred infrequently in animal evolution and may represent a barrier to diversification. Identifying genomic events associated with these transitions can help us better understand mechanisms that allow animals to cross these barriers and diversify in new habitats. Study of the Capitella telata and Helobdella robusta genomes allows examination of one such habitat transition (marine to freshwater) in Annelida. Initial examination of these genomes indicated that the freshwater leech H. robusta contains many more copies (12) of the sodium-potassium pump alpha-subunit (Na + /K + -ATPase) gene than does the marine polychaete C. telata (2). The sodium-potassium pump plays a key role in maintenance of cellular ionic balance and osmoregulation, and Na + /K + -ATPase duplications may have helped annelids invade and diversify in freshwater habitats. To assess whether the timing of Na + /K + -ATPase duplications coincided with the marine-to-freshwater transition in Clitellata, we used transcriptomic data from 18 annelid taxa, along with the two genomes, to infer a species phylogeny and identified Na + /K + -ATPase gene transcripts in order to infer the timing of gene duplication events using tree-based methods. The inferred timing of Na + /K + -ATPase duplication events is consistent with the timing of the initial marine-to-freshwater transition early in the history of clitellate annelids, supporting the hypothesis that gene duplications may have played a role in the annelid diversification into freshwater habitats., (© 2019 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2019 European Society For Evolutionary Biology.)

A new species of stream-dwelling crayfish, Cambarus franklini, the South Mountains crayfish, is described from the upper South Fork Catawba River basin in western North Carolina, USA using morphological and genetic data. Cambarus franklini was previously considered a member of the widespread and morphologically variable Cambarus species C complex and is morphologically most similar to an undiagnosed member of the group native to the upper Catawba River basin in NC. Cambarus franklini can be differentiated from this species group by several morphological characteristics including: lacking a well-defined double row of tubercles along the mesial margin of the palm, possessing a more weakly convergent and longer acumen, and conspicuous blue-green and red coloration, particularly throughout the telson and along the distal margins of the rami. This species is phylogenetically most similar to Cambarus johni, Cooper, 2006, another former member of the Cambarus species C group. Cambarus franklini has a limited geographic range (100 km2) and is currently known only from the Henry and Jacob Fork watersheds in the South Mountains region of the Eastern Blue Ridge foothills.

Entocythere cambaria was described by William S. Marshall in 1903 as the first species in what would later become family Entocytheridae. Designated as the type species of Entocythere both by original designation and monotypy, E. cambaria is integral to understanding relationships within the genus. Yet, a type series for E. cambaria was not designated, and specimens used by Marshall to describe the species have since been deemed no longer extant. C.W. Hart Jr. and Dabney Hart assigned a neotype for E. cambaria in 1974, but this specimen was not catalogued into the Invertebrate Zoology Collection at the Smithsonian Institution's National Museum of Natural History, and subsequently disappeared. A specimen, which we believe to be Hart and Hart's intended neotype, was recently discovered, giving us the opportunity to clarify the neotype designation of E. cambaria, and provide a complete description based on modern standards for podocopid ostracods. In addition, based on careful scrutiny of numerous specimens, including the types, we synonymize Entocythere illinoisensis with E. cambaria, and describe in full for the time the adult female of the species.

Cambarus acuminatus was described by Walter Faxon in 1884 from three specimens collected from the Saluda River in northwestern South Carolina, USA. Cambarus acuminatus sensu lato has since been acknowledged to comprise a species complex. This complex, also known as Cambarus sp. C, spans a range across much of the Piedmont Plateau and Coastal Plain from central South Carolina north to Maryland and southeastern Pennsylvania. A primary impediment to a much-needed thorough taxonomic assessment and revision of C. sp. C is the absence of taxonomically useful type material of C. acuminatus coupled with the lack of a detailed description of the species. Here we provide a redescription of C. acuminatus based on modern standards for astacoidean crayfishes in the genus Cambarus and emend the circumscription of the species, thereby laying the groundwork necessary for future taxonomic and phylogenetic work within, and involving, the C. sp. C complex.

Competing Interests: The authors have declared that no competing interests exist.

The obligately parthenogenetic marbled crayfish, Procambarus virginalis, is the first formally described asexual species of the Crustacea Decapoda. It is a triploid descendant of the sexually reproducing slough crayfish, Procambarus fallax. Here we describe the morphology of cultured and wild marbled crayfish of wide size ranges in detail and photodocument all taxonomically relevant characters. Some morphological traits and coloration showed considerable variation within populations despite the monoclonal nature of marbled crayfish. There were also significant differences between wild and laboratory populations with respect to body proportions, coloration and spination. Comparison with Procambarus fallax revealed no qualitative morphological characters that unambiguously identify the marbled crayfish. Analysis of the mitochondrial cytochrome c oxidase subunit I gene (COI) and nuclear microsatellites of marbled crayfish and Procambarus fallax from different sources indicated that the tri-allelic microsatellite PclG-02 is better suitable than COI to identify the marbled crayfish. A respective identification key is provided. The COI and microsatellites of Procambarus fallax from different areas of Florida and southern Georgia suggest that the parents of the first marbled crayfish may have come from northern Union County, northern Florida.

Ostracods of the family Entocytheridae are obligate ectosymbionts of other crustaceans, including crayfishes, isopods, amphipods, and a species of freshwater crab. Entocytheridae, with five subfamilies, 35 genera, and 213 currently accepted species, represents one the most diverse groups of extant freshwater ostracods. Here, we present the results of an extensive literature review, documenting the often complex historical taxonomic activity and resulting classification of Entocytheridae. This overview highlights inconsistencies, errors, and additional sources of confusion that have been inadvertently introduced into the literature, a number of which have remained uncorrected for decades. Also provided is a comprehensive checklist of taxonomic nomenclature and a list of currently accepted names in Entocytheridae.

Pontoscolex corethrurus is the most widespread earthworm species in tropical and sub-tropical zones and one of the most studied in soil science. Although, ecological interactions of P. corethrurus with its environment are well documented, the taxonomic status of the species remains unclear. In this study, we investigated phylogenetic relationships within the genus Pontoscolex, in particular focusing on morphologically indistinguishable (i.e., cryptic) lineages. A total of 792 specimens collected from 25 different countries and islands all over the world were analyzed using two mitochondrial (COI and 16S rDNA) and two nuclear (internal transcribed spacers 2 and 28S rDNA) markers, and a total of 11 morphological characters both internal and external were investigated in all genetically characterized lineages. A large-scale multilocus sequence data matrix was also obtained for Pontoscolex spp. specimens using the Anchored Hybrid Enrichment (AHE) method. Multilocus phylogenetic and phylogenomic analyses, combined with species delimitation methods; including single locus (mPTP, ABGD) and multilocus (BPP) approaches, revealed congruent results. Four cryptic species were supported within the P. corethrurus species complex, and four potentially new species within the genus Pontoscolex. One widespread lineage (L1), within P. corethrurus complex was observed in the current population of Fritz Müller's garden where P. corethrurus was first described in 1856. Cryptic lineages were observed in sympatry at several localities. This, in combination with observed heteroplasmy in COI gene in one population raises an important question of reproductive isolation between these species., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Cambarus polypilosus sp. nov. is a stream-dwelling crayfish endemic to tributaries in the Buffalo and lower Duck River drainage, and a reach of the lower Tennessee River in the Western Highland Rim of West-Central Tennessee, U.S.A. The new species is closely allied to the three members of the former subgenus Glareocola, but can be differentiated from each by a combination of characters, including body size, coloration, spination, setation, and form I male gonopod morphology. Several meristic measurements and ratios also differentiate C. polypilosus sp. nov. from Cambarus friaufi, to which it is morphologically most similar. Cambarus polypilosus sp. nov. appears to be common in cherty gravel and cobble habitats, where it is typically found in interstices at depths of 0.3 m or more below the substrate surface.

Introduction: Assessment of efficacy of continuous professional development is an important part of continuing professional development programing as one of its goals is to increase the performance of the clinicians that serve the community. A frequently used and researched classification system for skill mastery is the Dreyfus and Dreyfus Model of Skill Acquisition. An alternative approach is the core competency framework that informs the assessment of residents and forms the foundation of the American Board of Medical Specialties Program for Maintenance of Certification. There are a number of methods of assessment of each competence. One of the most broadly employed and researched methods is a multisource assessment (360°) methodology., Methods: Three hundred sixty-degree data were collected from 264 raters of physicians holding supervisory roles. Raters included the physicians' leaders, peers, and support/reports. The scale items were taken from an instrument developed for the assessment of interpersonal and communications skills, professionalism, and system-based practice. The Dreyfus scale was purposely built for this application., Results: The Dreyfus scale was reduced to a single dimension, and raters assigned their score on that dimension as the indicator of their assessment of the physician's level of mastery. Results of a multivariate analysis of variance indicated a significant relationship between Dreyfus mastery score and competency items (P < .0001)., Discussion: These findings demonstrate a relationship between a measure of Dreyfus skill acquisition and measures based on the American Board of Medical Specialties/Accreditation Council for Graduate Medical Education six core competency framework. Results have implication for continuing professional development design and assessment.

Objective: To determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available., Methods: A comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians., Results: Two-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians., Conclusions: Reliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.

Targeted sampling efforts by the authors for the signal crayfish, Pacifastacus leniusculus, from its native range in the John Day River Basin, Oregon, U.S.A. yielded entocytherid ostracods with a male copulatory complex so clearly different from other entocytherines that a new genus, Aurumcythere gen. nov. is proposed to receive them. This newly proposed, apparently nonsclerotized, genus with hook and spur-like prominences of the posteroventral end of the peniferum is the first new genus of the subfamily Entocytherinae named since Hobbs & Peters described Aphelocythere (= Waltoncythere) in 1977. Aurumcythere gen. nov. represents only the second genus of entocytherid known from the Pacific Northwest. Lack of sclerotization in Aurumcythere gen. nov. provides new insight into poorly understood mating behaviors of entocytherid ostracods.

Background: Earthworms (Crassiclitellata) are a diverse group of annelids of substantial ecological and economic importance. Earthworms are primarily terrestrial infaunal animals, and as such are probably rather poor natural dispersers. Therefore, the near global distribution of earthworms reflects an old and likely complex evolutionary history. Despite a long-standing interest in Crassiclitellata, relationships among and within major clades remain unresolved., Methods: In this study, we evaluate crassiclitellate phylogenetic relationships using 38 new transcriptomes in combination with publicly available transcriptome data. Our data include representatives of nearly all extant earthworm families and a representative of Moniligastridae, another terrestrial annelid group thought to be closely related to Crassiclitellata. We use a series of differentially filtered data matrices and analyses to examine the effects of data partitioning, missing data, compositional and branch-length heterogeneity, and outgroup inclusion., Results and Discussion: We recover a consistent, strongly supported ingroup topology irrespective of differences in methodology. The topology supports two major earthworm clades, each of which consists of a Northern Hemisphere subclade and a Southern Hemisphere subclade. Divergence time analysis results are concordant with the hypothesis that these north-south splits are the result of the breakup of the supercontinent Pangaea., Conclusions: These results support several recently proposed revisions to the classical understanding of earthworm phylogeny, reveal two major clades that seem to reflect Pangaean distributions, and raise new questions about earthworm evolutionary relationships.

Introduction: Continuous professional development relies on the link between performance and an educational process aimed at improving knowledge and skill. One of the most broadly used frameworks for assessing skills is Miller's Pyramid. This Pyramid has a series of levels of achievement beginning with knowledge (at the base) and ending with routine application in the clinical setting., Methods: The purpose of this study was to determine the degree of convergence of two measurement methods, one based on Miller's framework, the second using the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties (ACGME/ABMS) Core Competency framework. The data were gathered from the faculty of a large, Midwestern regional health care provider and hospital system. Data from 264 respondents were studied. The 360° data were from raters of physicians holding supervisory roles in the organization. The scale items were taken from an instrument that has been validated for both structure and known group prediction., Results: The Miller scale was purposely built for this application. The questions were designed to describe each level of the model. The Miller scale was reduced to a single dimension. This result was then regressed on the items from the 360° item ratings. Results of a multivariate analysis of variance isolated a significant relationship between the Miller's Pyramid score and the competency items (P < 0.001)., Discussion: These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.

Molecular genetic approaches are playing an increasing role in conservation science by identifying biodiversity that may not be evident by morphology-based taxonomy and systematics. So-called cryptic species are particularly prevalent in freshwater environments, where isolation of dispersal-limited species, such as crayfishes, within dendritic river networks often gives rise to high intra- and inter-specific genetic divergence. We apply here a multi-gene molecular approach to investigate relationships among extant species of the crayfish genus Pacifastacus, representing the first comprehensive phylogenetic study of this taxonomic group. Importantly, Pacifastacus includes both the widely invasive signal crayfish Pacifastacus leniusculus, as well as several species of conservation concern like the Shasta crayfish Pacifastacus fortis. Our analysis used 83 individuals sampled across the four extant Pacifastacus species (omitting the extinct Pacifastacus nigrescens), representing the known taxonomic diversity and geographic distributions within this genus as comprehensively as possible. We reconstructed phylogenetic trees from mitochondrial (16S, COI) and nuclear genes (GAPDH), both separately and using a combined or concatenated dataset, and performed several species delimitation analyses (PTP, ABGD, GMYC) on the COI phylogeny to propose Primary Species Hypotheses (PSHs) within the genus. All phylogenies recovered the genus Pacifastacus as monophyletic, within which we identified a range of six to 21 PSHs; more abundant PSHs delimitations from GMYC and ABGD were always nested within PSHs delimited by the more conservative PTP method. Pacifastacus leniusculus included the majority of PSHs and was not monophyletic relative to the other Pacifastacus species considered. Several of these highly distinct P. leniusculus PSHs likely require urgent conservation attention. Our results identify research needs and conservation priorities for Pacifastacus crayfishes in western North America, and may inform better understanding and management of P. leniusculus in regions where it is invasive, such as Europe and Japan.

Objective: Age correlated changes in mental and physical capacity have contributed to increasing concerns about older physicians' clinical competence. This paper explores the relationship between age and health in a clinical population referred for fitness for duty evaluations., Methods: Fifty cases from an evaluation center performing fitness for duty evaluations were randomly selected. Cases were reviewed for referral reason, demographic information, diagnosis, and recommendations., Results: Age ranged from 28-70 (median age of 51, mode of 45).Eighty-eight percent of cases had a diagnosed medical condition with potential cognitive sequellae., Conclusion: While the literature supports performance concerns in aging practitioners, health independent of age, appears to be an important contributing factor. A screening process considering biopsychosocial reserve and professional load while applicable to older clinicians would optimally be implemented for physicians across their careerspan., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

The solvent dependence of the photophysical properties of three naphthylmethylene malononitriles, 1-(1-naphthalenylmethylene)-propanedinitrile (1-MN), 2-(2-naphthalenylmethylene)-propanedinitrile (2-MN), and 2-(3,4-dihydro-1(2H)-phenanthrenylidene)-propanedinitile (r2-MN), was studied in order to determine their potential utility as fluidity probes and to make comparisons to the better studied benzylidene malononitriles. Density functional calculations were used to understand the possible conformational states related to rotation about the vinyl-aromatic bond ("τ"). Absorption and emission frequencies, extinction coefficients, fluorescence quantum yields, and fluorescence lifetimes were measured in 11 representative solvents. Both the computational and experimental results indicate that the S0 → S1 transitions of these molecules have substantial charge-transfer character and produce highly polar excited states. Emission appears to result from relaxed S1 states which do not differ qualitatively from the Franck-Condon states reached by absorption. In 2-MN, time-resolved emission reveals the presence of two ground-state conformers ("a" and "b" differing by ∼180° rotation about τ) coexisting in low-polarity solvents. In contrast, 1-MN appears to exist primarily as a single dominant ground-state conformer. Fluorescence lifetimes vary from ∼1 ps in 1-MN to ∼200 ps in 2-MN(a) at room temperature. With the exception of 2-MN(a), the lifetimes vary systematically with solvent in a manner similar to what is observed in the benzylidene malononitriles. Both solvent polarity and fluidity appear to be important determinants of lifetime. The primary mechanism of fluorescence decay in naphthylmethylene malononitriles is likely to be the same as that of the benzylidene malononitriles-twisting about the double bond in S1, which leads to rapid internal conversion via a conical intersection with S0.

Introduction: The relationship among an individual's sense of self-efficacy, motivation to change, barriers to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and the acquisition of knowledge in a continuing medical education (CME) activity., Methods: The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 6-item scale following on the work of Prochaska and colleagues. The knowledge acquisition was measured in a simple post measure. The participants were enrolled in a CME activity focused on HIV. , Results: The CME activities had a significant effect on knowledge. Preliminary analysis demonstrates a relationship among the self-efficacy measure, the motivation to change measure, and global intent to change. Specifically, as reported earlier, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change that, in turn, is predictive of formation of intent to change practice patterns. Interestingly, there were also relationships among the self-efficacy measure, the motivation to change measure, and knowledge acquisition. Finally, as expected, there was a significant relationship between knowledge and intent to change practice. , Discussion: Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent as well as its effect on knowledge acquisition. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change as well as learning following CME-self-efficacy., (© 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.)

Rationale and Objectives: Higher resolution medical imaging platforms are rapidly emerging, but there is a challenge in applying these tools in a clinically meaningful way. The purpose of the current study was to evaluate a novel three-dimensional (3D) software imaging environment, known as interactive science publishing (ISP), in appraising 3D computed tomography images and to compare this approach with traditional planar (2D) imaging in a series of lung cancer cases., Materials and Methods: Twenty-four physician volunteers at different levels of training across multiple specialties were recruited to evaluate eight lung cancer-related clinical vignettes. The volunteers were asked to compare the performance of traditional 2D versus the ISP 3D imaging in assessing different visualization environments for diagnostic and measurement processes and to further evaluate the ISP tool in terms of general satisfaction, usability, and probable applicability., Results: Volunteers were satisfied with both imaging methods; however, the 3D environment had significantly higher ratings. Measurement performance was comparable using both traditional 2D and 3D image evaluation. Physicians not trained in 2D measurement approaches versus those with such training demonstrated better performance with ISP and preferred working in the ISP environment., Conclusions: Recent postgraduates with only modest self-administered training performed equally well on 3D and 2D cases. This suggests that the 3D environment has no reduction in accuracy over the conventional 2D approach, while providing the advantage of a digital environment for cross-disciplinary interaction for shared problem solving. Exploration of more effective, efficient, self-directed training could potentially result in further improvement in image evaluation proficiency and potentially decrease training costs., (Copyright © 2015. Published by Elsevier Inc.)

Purpose: The major purpose of this study was to examine Spanish and English phonological productions (patterns/deviations) of typically developing bilingual preschool children. Phonological scores were compared in order to determine if significant differences exist between (a) boys and girls, (b) 4- and 5-year-olds, and/or (c) their productions of Spanish and English words., Method: Fifty-six bilingual 4- and 5-year-old children (27 boys and 29 girls) who attended Head Start programs named stimulus items for Spanish and English phonological assessment instruments that were similar in procedures and analyses., Results: Multivariate analyses indicated no significant differences for phonological scores between boys and girls or between the 2 languages. Differences between the 4- and 5-year-olds, however, were significant, with the 5-year-olds performing better than the 4-year-olds. Liquid deviations and omissions of consonants in clusters/sequences were the most frequently occurring phonological deviations., Conclusions: Phonological score differences between typically developing bilingual Spanish-English-speaking preschool boys and girls from similar backgrounds are not likely to be significant. Better phonological scores, however, can be expected for 5-year-olds than for 4-year-olds. Moreover, phonological deviation percentage scores of typically developing bilingual children for comparable Spanish and English assessment instruments are likely to be similar.

Introduction: The relationship between an individual's sense of self-efficacy, motivation to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and intent to implement continuing medical education (CME) activity learnings., Methods: The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 4-item scale following on the work of Johnson, et al. The self-efficacy scale has been confirmed for structure, and together the 2 scales provide indicators of 3 underlying variables-2 self-efficacy constructs and a motivation variable. In addition, a global intent to implement measure was collected., Results: Preliminary analysis demonstrates a significant relationship between a self-efficacy construct, the motivation to change construct, and global intent to change. Specifically, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change, which, in turn, is predictive of formation of an intent to change practice patterns., Discussion: Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent. This is consistent with an earlier report on the relationship among self-efficacy, barriers to change, and stated intent. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change following CME: self-efficacy. A focus on the participants' sense of self-agency may provide a path to practice change., (© 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.)

Background: Gemcitabine is used for the treatment of several solid tumours and exhibits high inter-individual pharmacokinetic variability. In this study, we explore possible predictive covariates on drug and metabolite disposition., Methods: Forty patients were enrolled. Gemcitabine and dFdU concentrations in the plasma and dFdCTP concentrations in peripheral blood mononuclear cell were measured to 72 h post infusion, and pharmacokinetic parameters were estimated by nonlinear mixed-effects modelling. Patient-specific covariates were tested in model development., Results: The pharmacokinetics of gemcitabine was best described by a two-compartment model with body surface area, age and NT5C2 genotype as significant covariates. The pharmacokinetics of dFdU and dFdCTP were adequately described by three-compartment models. Creatinine clearance and cytidine deaminase genotype were significant covariates for dFdU pharmacokinetics. Rate of infusion of <25 mg m(-2) min(-1) and the presence of homozygous major allele for SLC28A3 (CC genotype) were each associated with an almost two-fold increase in the formation clearance of dFdCTP., Conclusion: Prolonged dFdCTP systemic exposures (≥72 h) were commonly observed. Infusion rate <25 mg m(-2) min(-1) and carriers for SLC28A3 variant were each associated with about two-fold higher dFdCTP formation clearance. The impacts of these covariates on treatment-related toxicity in more selected patient populations (that is, first-line treatment, single disease state and so on) are not yet clear.

Background: Cannulation of the radial artery is frequently performed for invasive hemodynamic monitoring. Complications arising from indwelling catheters have been described in small case series; however, their surgical management is not well described. Understanding the presentation and management of such complications is imperative to offer optimal treatment, particularly because the radial artery is increasingly accessed for percutaneous coronary interventions., Methods: We conducted a retrospective review to identify patients who underwent surgical intervention for complications arising from indwelling radial artery catheters from 1997 to 2011., Results: We identified 30 patients who developed complications requiring surgical intervention. These complications were categorized into ischemic and nonischemic, with 15 patients identified in each cohort. All patients presenting with clinical hand or digital ischemia underwent thrombectomy and revascularization. Complications in the nonischemic group included three patients with deep abscesses with concomitant arterial thrombosis, two with deep abscesses alone, and 10 with pseudoaneurysms. Treatment strategy in this group varied with the presenting pathology. Among the entire case series, three patients required reintervention after the initial surgery, all in individuals initially presenting with ischemia who developed recurrent thrombosis of the radial artery. There were no digital or hand amputations in this series. However, the overall in-hospital mortality in these patients was 37%, reflecting the severity of illness in this patient cohort. Three patients who were positive for heparin-induced thrombocytopenia antibody had 100% mortality compared with those who were negative (P = .04, Fisher exact test). In-hospital mortality was higher in patients presenting with initial ischemia than in those with nonischemic complications (53% vs 20%; P = .06). Among 10 patients who presented with pseudoaneurysms, five (50%) were septic at presentation with positive blood cultures, and six (60%) had positive operating room cultures. Staphylococcus aureus was identified as the causative organism in all of these patients., Conclusions: Complications of radial artery cannulation requiring surgical intervention can represent infectious and ischemic sequelae and have the potential to result in major morbidity, including digital or hand amputation and sepsis, or death. Although surgical treatment is successful and often required in these patients to treat severe hand ischemia, hemorrhage, or vascular infection, these complications tend to occur in critically ill hospitalized patients with an extremely high mortality. This must be taken into consideration when planning surgical intervention in this patient cohort. Finally, radial arterial cannulation sites should not be overlooked when searching for occult septic sources in critically ill patients., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

The use of reference models as templates of historical or natural conditions to assess restoration progress is inherently logical; however, difficulties occur in application because of the need to incorporate temporal variation in ecosystems caused by disturbance and succession, as well as seasonal, interannual, or decadal variability. The landscape-scale restoration of the globally threatened and fire-dependent longleaf pine ecosystem in the southeastern United States is an example in which restoration efforts are even more complicated by the limited availability of extant reference sites. This study uses the dynamic reference conceptual framework to assess the direction and rate of recovery with respect to biodiversity restoration goals using a 15-year vegetation data set from an experimental restoration treatment in fire-excluded, hardwood-encroached longleaf pine sandhills. We compared ground-cover vegetation response to midstory hardwood removal through herbicide application, mechanical removal, and fire only. Nonmetric multidimensional scaling ordinations and proportional similarity analyses suggest that, while vegetation changed in all treatments over time, no differences in species composition or hardwood density in the ground cover were attributable to hardwood reduction treatments after 15 years with frequent prescribed fire. Furthermore, the results of this study indicate that considerable variability is associated with reference sites over time. Sites identified in 1994 as attainable restoration targets had become a moving target themselves, changing in magnitude consistent with alterations in restoration plots attributable to treatment effects and shaped by the modest increase in fire frequency imposed since 1998. In a broad restoration context, this study demonstrates a conceptual framework to better understand and integrate the range of spatial and temporal variation associated with the best available reference sites. It also illustrates a practical tool for statistically defining reference sites and for measuring restoration success in continually changing conditions that should be widely applicable to other ecosystems and restoration goals.