Making a Choice

It is our responsibility as educators to see that our students receive training to meet the present-day challenges facing our clients. The graduate programs in social work are especially suited for training and implementing Screening Brief Intervention and Referral to Treatment (SBIRT) as these programs prepare advanced practitioners to provide care to those with the greatest need and often the least access to mental health and addiction treatment. Schools of Social Work have a strong history of placing advanced clinical MSW interns that focus on diverse populations in behavioral health clinics, primary care clinics, hospitals, substance abuse clinics, schools, residential facilities, family preservation and reunification, child services as well as an essential presence in the VA system. Making a choice to include SBIRT training in our curricula is a viable strategy for enhancing the skills our students will need in practice with strong potential to increase the number of providers while significantly increasing access to behavioral interventions for clients and patients

Effect of interleukin-6 receptor blockade on surrogates of vascular risk in rheumatoid arthritis: MEASURE, a randomised, placebo-controlled study

Objectives The interleukin-6 receptor (IL-6R) blocker tocilizumab (TCZ) reduces inflammatory disease activity in rheumatoid arthritis (RA) but elevates lipid concentrations in some patients. We aimed to characterise the impact of IL-6R inhibition on established and novel risk factors in active RA. Methods Randomised, multicentre, two-part, phase III trial (24-week double-blind, 80-week open-label), MEASURE, evaluated lipid and lipoprotein levels, high-density lipoprotein (HDL) particle composition, markers of coagulation, thrombosis and vascular function by pulse wave velocity (PWV) in 132 patients with RA who received TCZ or placebo. Results Median total-cholesterol, low-density lipoprotein-cholesterol (LDL-C) and triglyceride levels increased in TCZ versus placebo recipients by week 12 (12.6% vs 1.7%, 28.1% vs 2.2%, 10.6% vs −1.9%, respectively; all p&#60;0.01). There were no significant differences in mean small LDL, mean oxidised LDL or total HDL-C concentrations. However, HDL-associated serum amyloid A content decreased in TCZ recipients. TCZ also induced reductions (&#60;30%) in secretory phospholipase A2-IIA, lipoprotein(a), fibrinogen and D-dimers and elevation of paraoxonase (all p&#60;0.0001 vs placebo). The ApoB/ApoA1 ratio remained stable over time in both groups. PWV decreases were greater with placebo than TCZ at 12 weeks (adjusted mean difference 0.79 m/s (95% CI 0.22 to 1.35; p=0.0067)). Conclusions These data provide the first detailed evidence for the modulation of lipoprotein particles and other surrogates of vascular risk with IL-6R inhibition. When compared with placebo, TCZ induced elevations in LDL-C but altered HDL particles towards an anti-inflammatory composition and favourably modified most, but not all, measured vascular risk surrogates. The net effect of such changes for cardiovascular risk requires determination.</p

Faculty development and engagement in curriculum change

Curriculum review and revision is a faculty responsibility, but can be challenging. Online modules were developed to prepare faculty for upcoming curriculum change. Based on adult, active learning principles, the modules explored AACN Essentials and other professional guidelines. The expected outcomes were to increase faculty engagement in curriculum change

Effects of forest management on fish habitat and macroinvertebrates in northeast Oregon streams

This study describes streams in the Blue Mountains and Wallowa Mountains of Northeastern Oregon in order to characterize the interactions between the terrestrial and aquatic ecosystems and to determine how logging affects those relationships. Five stream reach pairs, each consisting of an undisturbed reach and a similar reach flowing through an area where the riparian zone had been logged, along with six additional undisturbed reaches were studied. The riparian stand, large woody debris, stream channel morphology and the benthic macroinvertebrate community were measured at each reach. Large woody debris volume ranged from 91.1 to 284.0 m³/ha and was greater in the logged reaches than undisturbed reaches. Stream channel morphology, as indicated by the pool-riffle ratio, in the logged reaches was not significantly different than undisturbed reaches and percent pool area was less than 30 percent in all reaches. Macroinvertebrate density ranged from 146.6 to 963.2 individuals/sample and was greater in the logged reach of each stream pair. Community diversity, as expressed by the Shannon-Wiener Diversity Index, at logged reaches was not significantly different from that at undisturbed reaches. Although some differences were found between logged stream reaches and undisturbed reaches, there was no indication that overall fish habitat was greatly diminished or improved as a result of logging

Effects of Training on Social Work, Nursing and Medical Trainees' Knowledge, Attitudes and Beliefs Related to Screening and Brief Intervention for Alcohol Use

Indiana University's Schools of Social Work, Nursing and Medicine formed a consortium to advance education for Screening Brief Intervention and Referral to Treatment (SBIRT). Trainees participated in SBIRT training and completed data collection before, immediately after, and 30 days after a face-to-face training. The study explored participants' perceptions about the training and the likelihood of implementing SBI in practice, including attitudes and beliefs that may be predictive of SBIRT utilization in clinical practice. Results show the training targeting SBI and MI behaviors may improve participants' self-reported competence with SBI. This improvement was consistent and strong in all programs. The study results also provided a preliminary indication that the training affected participants' perception of time utilization and compensation for performing SBI

A Pilot Intervention to Increase Parent-Child Communication About Alcohol Avoidance

Enhancing parent-child communication regarding alcohol use through educational print correspondence is a potentially cost-effective tool in health promotion. The purpose of this pilot study was to examine whether a series of postcards addressing specific alcohol risk and protective factors, sent to the parents/guardians of preadolescents in two different school settings, influenced parent-child communication regarding alcohol use. Subjects for this study included parents of participating 6th grade students attending one neighborhood (N=262) and one magnet (bused) (N=388) inner-city school. Participating students were randomly assigned to the intervention or control group. Baseline data were collected from students, enabling the intervention to be tailored to students\u27 individual needs. Parents of students assigned to the intervention were mailed up to 10 prevention postcards over five weeks. Parents completed a 10-item telephone survey eight weeks after implementation of the prevention postcards. The overall parent response rate was 74% (N=478). Results of this pilot intervention found that postcards increased parent-child communication regarding alcohol use, but that these efects difered by school setting and race. Although significant efects were found for the intervention group, further analysis revealed that efects were found only for White parents at the magnet school. Discussion of these differences and implications for research and educational programming are provided

Estimation of tulathromycin depletion in plasma and milk after subcutaneous injection in lactating goats using a nonlinear mixed-effects pharmacokinetic modeling approach

Citation: Lin, Z. M., Cuneo, M., Rowe, J. D., Li, M. J., Tell, L. A., Allison, S., . . . Gehring, R. (2016). Estimation of tulathromycin depletion in plasma and milk after subcutaneous injection in lactating goats using a nonlinear mixed-effects pharmacokinetic modeling approach. Bmc Veterinary Research, 12, 10. https://doi.org/10.1186/s12917-016-0884-4Background: Extra-label use of tulathromycin in lactating goats is common and may cause violative residues in milk. The objective of this study was to develop a nonlinear mixed-effects pharmacokinetic (NLME-PK) model to estimate tulathromycin depletion in plasma and milk of lactating goats. Eight lactating goats received two subcutaneous injections of 2.5 mg/kg tulathromycin 7 days apart; blood and milk samples were analyzed for concentrations of tulathromycin and the common fragment of tulathromycin (i.e., the marker residue CP-60,300), respectively, using liquid chromatography mass spectrometry. Based on these new data and related literature data, a NLME-PK compartmental model with first-order absorption and elimination was used to model plasma concentrations and cumulative excreted amount in milk. Monte Carlo simulations with 100 replicates were performed to predict the time when the upper limit of the 95% confidence interval of milk concentrations was below the tolerance. Results: All animals were healthy throughout the study with normal appetite and milk production levels, and with mild-moderate injection-site reactions that diminished by the end of the study. The measured data showed that milk concentrations of the marker residue of tulathromycin were below the limit of detection (LOD = 1.8 ng/ml) 39 days after the second injection. A 2-compartment model with milk as an excretory compartment best described tulathromycin plasma and CP-60,300 milk pharmacokinetic data. The model-predicted data correlated with the measured data very well. The NLME-PK model estimated that tulathromycin plasma concentrations were below LOD (1.2 ng/ml) 43 days after a single injection, and 62 days after the second injection with a 95% confidence. These estimated times are much longer than the current meat withdrawal time recommendation of 18 days for tulathromycin in non-lactating cattle. Conclusions: The results suggest that twice subcutaneous injections of 2.5 mg/kg tulathromycin are a clinically safe extra-label alternative approach for treating pulmonary infections in lactating goats, but a prolonged withdrawal time of at least 39 days after the second injection should be considered to prevent violative residues in milk and any dairy goat being used for meat should have an extended meat withdrawal time

Low-Level Waste Disposal Alternatives Analysis Report

This report identifies and compares on-site and off-site disposal options for the disposal of contract-handled and remote-handled low-level waste generated by the Idaho National Laboratory and its tenants. Potential disposal options are screened for viability by waste type resulting in a short list of options for further consideration. The most crediable option are selected after systematic consideration of cost, schedule constraints, and risk. In order to holistically address the approach for low-level waste disposal, options are compiled into comprehensive disposal schemes, that is, alternative scenarios. Each alternative scenario addresses the disposal path for all low-level waste types over the period of interest. The alternative scenarios are compared and ranked using cost, risk and complexity to arrive at the recommended approach. Schedule alignment with disposal needs is addressed to ensure that all waste types are managed appropriately. The recommended alternative scenario for the disposal of low-level waste based on this analysis is to build a disposal facility at the Idaho National Laboratory Site

Interrater Reliability of Functional Lumen Imaging Probe Panometry and High-Resolution Manometry for the Assessment of Esophageal Motility Disorders.

INTRODUCTION: High-resolution manometry (HRM) and functional lumen imaging probe (FLIP) are primary and/or complementary diagnostic tools for the evaluation of esophageal motility. We aimed to assess the interrater agreement and accuracy of HRM and FLIP interpretations. METHODS: Esophageal motility specialists from multiple institutions completed the interpretation of 40 consecutive HRM and 40 FLIP studies. Interrater agreement was assessed using intraclass correlation coefficient (ICC) for continuous variables and Fleiss κ statistics for nominal variables. Accuracies of rater interpretation were assessed using the consensus of 3 experienced raters as the reference standard. RESULTS: Fifteen raters completed the HRM and FLIP studies. An excellent interrater agreement was seen in supine median integral relaxation pressure (ICC 0.96, 95% confidence interval 0.95-0.98), and a good agreement was seen with the assessment of esophagogastric junction (EGJ) outflow, peristalsis, and assignment of a Chicago Classification version 4.0 diagnosis using HRM (κ = 0.71, 0.75, and 0.70, respectively). An excellent interrater agreement for EGJ distensibility index and maximum diameter (0.91 [0.90-0.94], 0.92 [0.89-0.95]) was seen, and a moderate-to-good agreement was seen in the assignment of EGJ opening classification, contractile response pattern, and motility classification (κ = 0.68, 0.56, and 0.59, respectively) on FLIP. Rater accuracy for Chicago Classification version 4.0 diagnosis on HRM was 82% (95% confidence interval 78%-84%) and for motility diagnosis on FLIP Panometry was 78% (95% confidence interval 72%-81%). DISCUSSION: Our study demonstrates high levels of interrater agreement and accuracy in the interpretation of HRM and FLIP metrics and moderate-to-high levels for motility classification in FLIP, supporting the use of these approaches for primary or complementary evaluation of esophageal motility disorders