Current paradigms generally assume that increased plant nitrogen (N) should enhance herbivore performance by relieving protein limitation, increasing herbivorous insect populations. We show, in contrast to this scenario, that host plant N enrichment and high-protein artificial diets decreased the size and viability of Oedaleus asiaticus, a dominant locust of north Asian grasslands. This locust preferred plants with low N content and artificial diets with low protein and high carbohydrate content. Plant N content was lowest and locust abundance highest in heavily livestock-grazed fields where soils were N-depleted, likely due to enhanced erosion. These results suggest that heavy livestock grazing and consequent steppe degradation in the Eurasian grassland promote outbreaks of this locust by reducing plant protein content.

Atmospheric oxygen has varied substantially over the Phanerozoic (the last 500 million years) with periods of both hyperoxia and hypoxia relative to today. Unlike some insect groups, cockroaches have not been reported to exhibit gigantism during the late Paleozoic period of hyperoxia. Studies with modern insects have shown a diversity of developmental responses to oxygen, suggesting that evaluation of historical hypotheses should focus on groups most closely related to those present in the Paleozoic. Here we investigated the impacts of Paleozoic oxygen levels (12-31%) on the development of Blatella germanica cockroaches. Body size decreased strongly in hypoxia, but was only mildly affected by hyperoxia. Development time, growth rate and fecundity were negatively impacted by both hypoxia and hyperoxia. Tracheal volumes were inversely proportional to rearing oxygen, suggesting developmental responses aimed at regulating internal oxygen level. The results of these experiments on a modern species are consistent with the fossil record and suggest that changes in atmospheric oxygen would be challenging for many insects, despite plastic compensatory responses in the tracheal system.

Growth rate, development time, and response to environmental stressors vary tremendously across organisms, suggesting trade-offs that are affected by evolutionary or ecological factors, but such trade-offs are poorly understood. Prior studies using artificially selected lines of Manduca sexta suggest that insects with high growth rates, long development time, and large body size are more sensitive to hypoxic or hyperoxic stresses, such as reactive oxygen species (ROS) production, but the mechanisms and specific life-history associations remain unclear. Here, we manipulated the social environment to differentiate the effects of size, growth rate, and development time on oxygen sensitivity of the giant mealworm, Zophobas morio. Crowding reduced growth rates but yielded larger adults as a result of supernumerary molts and longer development times. The juvenile performance (growth rate, development time, adult mass) of crowd-reared mealworms was less sensitive to variation in atmospheric oxygen than it was for individually reared animals, consistent with the hypothesis that high growth rates are associated with increased sensitivity to ROS. Life span in normoxia was extended by crowd rearing, perhaps due to the larger size and/or increased resources of the larger adults. Life spans of crowd-reared animals were more negatively affected by hypoxia or hyperoxia than life spans of individually reared animals, possibly due to the longer total stress exposure of crowd-reared animals. These data suggest that animals with high growth rates experience a negative trade-off of performance with greater sensitivity to stress during the juvenile phase, while animals with long development times or life spans experience a negative trade-off of greater susceptibility of life span to environmental stress.

e21680 Background: With the shift of cancer care to the outpatient setting, telephone triage is a vital part of today’s oncology practice. UPMC CancerCenter (UPMC) desires to streamline the current telephone triage process across its 31 outpatient clinics. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting, and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication, and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was also prompted to make outbound calls for symptom reassessment. A feedback session with the nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This pilot provided the feedback necessary to develop the latest version of SM which begins roll out across UPMC in November 2016 and includes EMR integration. An update on the software and additional data captured during the pilot will be provided at presentation.

68 Background: Telephone triage is a vital part of today’s oncology practice and is often not standardized and measured to allow for quality improvement. UPMC CancerCenter (UPMC) has 31 outpatient clinics and is in need of a tool to streamline the current telephone triage process. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was prompted to make outbound calls for symptom reassessment. A feedback session with nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. When referencing the decision support materials, nurses felt more confident consulting providers and during independent decision-making. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This prototype fulfilled the defined key components of a tool of this type. SM is currently being refined and incorporated into the Via Portal, Via Oncology’s decision support software. An update on the software and additional data captured during the pilot will be provided at presentation.

137 Background: With the shift of cancer care to the outpatient setting, telephone triage is a vital part of today’s oncology practice. UPMC CancerCenter (UPMC) desires to streamline the current telephone triage process across its 31 outpatient clinics. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting, and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication, and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was also prompted to make outbound calls for symptom reassessment. A feedback session with the nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This pilot provided the feedback necessary to develop the latest version of SM which begins roll out across UPMC in November 2016 and includes EMR integration. An update on the software and additional data captured during the pilot will be provided at presentation.