Animals employ different sexual signal modes (e.g. visual, acoustic, chemical) in different environments and behavioural contexts. If sensory structures are costly, then evolutionary shifts in primary signal mode should be associated with changes in sensor morphology. Further, sex differences are expected if male and female signalling behaviours differ. Fireflies are known for their light displays, but many species communicate exclusively with pheromones, including species that recently lost their light signals. We performed phylogenetically controlled analyses of male eye and antenna size in 46 North American taxa, and found that light signals are associated with larger eyes and shorter antennae. In addition, following a transition from nocturnal light displays to diurnal pheromones, eye size reductions occur more rapidly than antenna size increases. In agreement with the North American taxa, across 101 worldwide firefly taxa in 32 genera, we found light displays are associated with larger eye and smaller antenna sizes in both males and females. For those taxa with both male and female data, we found sex differences in eye size and, for diurnal species, in antenna size.

Introduction Early diagnosis and optimization of heart failure therapies in patients with acute heart failure (AHF), including in the prehospital setting, is crucial to improving outcomes. However, making the diagnosis of AHF in the prehospital setting is difficult. The goal of this study was to evaluate the accuracy of prehospital diagnosis (AHF versus not heart failure [HF]) in patients with acute dyspnea when compared to final hospital diagnosis. Methods We conducted a retrospective study of adult patients transported by emergency medical services (EMS) with a primary or secondary complaint of shortness of breath. Patients were identified through an EMS electronic database (ESO) and matched to their hospital encounter. ESO was reviewed for prehospital diagnosis and management. Hospital electronic medical records were reviewed to determine final hospital diagnosis, management in the emergency department and hospital, disposition, and length of stay. The primary outcome compared prehospital diagnosis to final hospital diagnosis, which served as our criterion standard. Results Of 199 included patients, 50 (25%) had a final diagnosis of AHF. Prehospital paramedic sensitivity and accuracy for AHF were 14% (7/50; confidence interval [CI] 0.06-0.26) and 77% (CI 0.70-0.82), respectively. In the 50 patients with AHF, 14 (28%) received nitroglycerin in the prehospital setting, while 27 (54.0%) patients were inappropriately treated with albuterol. Conclusion Prehospital paramedics had poor sensitivity and moderate accuracy for the diagnosis of AHF. A small percentage of patients ultimately diagnosed with AHF had HF therapy initiated in the prehospital setting. This data highlights the fact that AHF is difficult to diagnose in the prehospital setting and is commonly missed.

Introduction: While gamification of point-of-care ultrasound (POCUS) is well received by learners, little is known about the knowledge gained from material taught during these events. We set out to determine whether a POCUS gamification event improved knowledge of interpretation and clinical integration of POCUS. Methods: This was a prospective observational study of fourth-year medical students who participated in a 2.5-hour POCUS gamification event consisting of eight objective-oriented stations. Each station had one to three learning objectives associated with the content taught. Students completed a pre-assessment; they then participated in the gamification event in groups of three to five per station and subsequently completed a post-assessment. Differences between pre- and postsession responses were matched and analyzed using Wilcoxon signed-rank test and Fisher’s exact test. Results: We analyzed data from 265 students with matched pre- and post-event responses; 217 (82%) students reported no to little prior POCUS experience. Most students were going into internal medicine (16%) and pediatrics (11%). Knowledge assessment scores significantly improved from pre- to post-workshop, 68% vs 78% (P=0.04). Self-reported comfort with image acquisition, interpretation, and clinical integration all significantly improved from pre- to post-gamification event (P<0.001). Conclusion: In this study we found that gamification of POCUS, with clear learning objectives, led to improved student knowledge of POCUS interpretation, clinical integration, and self-reported comfort with POCUS.

Introduction: Lung ultrasound (LUS) scoring of pulmonary edema severity has been proposed as a marker to track treatment response in acute heart failure (AHF), with a hypothetical advantage of detecting changes in congestion more quickly than traditional markers of treatment response. We compared change in LUS congestion score to contemporaneous changes in daily weight, natriuretic peptides, subjective score of worst AHF symptom (WSS), and clinical/exam findings in hospitalized heart failure patients from ED arrival to discharge, to determine which measure showed the most dynamic reduction during decongestive therapy. Methods: This is a preliminary analysis of an ongoing prospective observational cohort study. ED patients were enrolled if they were being treated for presumed AHF diagnosis and if a LUS met diagnostic criteria for pulmonary edema. LUS, BNP, body weight, WSS, and clinical congestion score (CCS) (calculated based on orthopnea, JVD, hepatomegaly, and peripheral edema) were assessed at ED arrival and daily through discharge. Random effects models of percent change were fit for each measure, adjusted for initial value, to estimate magnitude and speed of change during ED and in-hospital decongestion. Results: 78 observations of 21 patients were analyzed. Median age and NYHA score were 66 y/o and 4, respectively. LUS score dropped the most quickly, showed greatest mean change from ED to discharge, and showed the greatest change prior to transition to PO diuretics (initial 24-60 hours). BNP did not fall below ED values until day 3, and did not reach its nadir until day 6. The CCS correlated well with LUS, but showed a smaller magnitude of change from ED to discharge. Weight and WSS showed no significant change. Conclusions: LUS score showed a more rapid and larger change in response to diuretic therapy, suggesting it may be a more dynamic measure of decongestion than conventional measures of treatment efficacy.

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