Effect of a care transition intervention by pharmacists: an RCT

Abstract Background Pharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits. Methods Design. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering. Results Study groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group. Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups. Trial registration Clinicaltrials.gov registration: NCT00513903 , August 7, 2007.http://deepblue.lib.umich.edu/bitstream/2027.42/109686/1/12913_2014_Article_3640.pd

The opposites task: Using general rules to test cognitive flexibility in preschoolers

A brief narrative description of the journal article, document, or resource. Executive functions play an important role in cognitive development, and during the preschool years especially, children's performance is limited in tasks that demand flexibility in their behavior. We asked whether preschoolers would exhibit limitations when they are required to apply a general rule in the context of novel stimuli on every trial (the "opposites" task). Two types of inhibitory processing were measured: response interference (resistance to interference from a competing response) and proactive interference (resistance to interference from a previously relevant rule). Group data show 3-year-olds have difficulty inhibiting prepotent tendencies under these conditions, whereas 5-year-olds' accuracy is near ceiling in the task. (Contains 4 footnotes and 1 table.

Development and validation of a multivariable model for prediction of malignant transformation and recurrence of oral epithelial dysplasia

Background: Oral epithelial dysplasia (OED) is the precursor to oral squamous cell carcinoma which is amongst the top ten cancers worldwide. Prognostic significance of conventional histological features in OED is not well established. Many additional histological abnormalities are seen in OED, but are insufficiently investigated, and have not been correlated to clinical outcomes. Methods: A digital quantitative analysis of epithelial cellularity, nuclear geometry, cytoplasm staining intensity and epithelial architecture/thickness is conducted on 75 OED whole-slide images (252 regions of interest) with feature-specific comparisons between grades and against non-dysplastic/control cases. Multivariable models were developed to evaluate prediction of OED recurrence and malignant transformation. The best performing models were externally validated on unseen cases pooled from four different centres (n = 121), of which 32% progressed to cancer, with an average transformation time of 45 months. Results: Grade-based differences were seen for cytoplasmic eosin, nuclear eccentricity, and circularity in basal epithelial cells of OED (p &lt; 0.05). Nucleus circularity was associated with OED recurrence (p = 0.018) and epithelial perimeter associated with malignant transformation (p = 0.03). The developed model demonstrated superior predictive potential for malignant transformation (AUROC 0.77) and OED recurrence (AUROC 0.74) as compared with conventional WHO grading (AUROC 0.68 and 0.71, respectively). External validation supported the prognostic strength of this model. Conclusions: This study supports a novel prognostic model which outperforms existing grading systems. Further studies are warranted to evaluate its significance for OED prognostication.</p

Sensitivity of northwest Australian tropical cyclone activity to ITCZ migration since 500 CE

Tropical cyclones (TCs) regularly form in association with the intertropical convergence zone (ITCZ), and thus, its positioning has implications for global TC activity. While the poleward extent of the ITCZ has varied markedly over past centuries, the sensitivity with which TCs responded remains poorly understood from the proxy record, particularly in the Southern Hemisphere. Here, we present a high-resolution, composite stalagmite record of ITCZ migrations over tropical Australia for the past 1500 years. When integrated with a TC reconstruction from the Australian subtropics, this time series, along with downscaled climate model simulations, provides an unprecedented examination of the dependence of subtropical TC activity on meridional shifts in the ITCZ. TCs tracked the ITCZ at multidecadal to centennial scales, with a more southward position enhancing TC-derived rainfall in the subtropics. TCs may play an increasingly important role in Western Australia’s moisture budgets as subtropical aridity increases due to anthropogenic warming

Search for Gravitational-wave Inspiral Signals Associated with Short Gamma-ray Bursts During LIGO's Fifth and Virgo's First Science Run

Progenitor scenarios for short gamma-ray bursts (short GRBs) include coalescenses of two neutron stars or a neutron star and black hole, which would necessarily be accompanied by the emission of strong gravitational waves. We present a search for these known gravitational-wave signatures in temporal and directional coincidence with 22 GRBs that had sufficient gravitational-wave data available in multiple instruments during LIGO's fifth science run, S5, and Virgo's first science run, VSR1. We find no statistically significant gravitational-wave candidates within a [ – 5, + 1) s window around the trigger time of any GRB. Using the Wilcoxon-Mann-Whitney U-test, we find no evidence for an excess of weak gravitational-wave signals in our sample of GRBs. We exclude neutron star-black hole progenitors to a median 90% confidence exclusion distance of 6.7 Mpc

First search for gravitational waves from the youngest known neutron star

We present a search for periodic gravitational waves from the neutron star in the supernova remnant Cassiopeia A. The search coherently analyzes data in a 12 day interval taken from the fifth science run of the Laser Interferometer Gravitational-Wave Observatory. It searches gravitational-wave frequencies from 100 to 300 Hz and covers a wide range of first and second frequency derivatives appropriate for the age of the remnant and for different spin-down mechanisms. No gravitational-wave signal was detected. Within the range of search frequencies, we set 95% confidence upper limits of (0.7–1.2) × 10^(−24) on the intrinsic gravitational-wave strain, (0.4–4) × 10^(−4) on the equatorial ellipticity of the neutron star, and 0.005–0.14 on the amplitude of r-mode oscillations of the neutron star. These direct upper limits beat indirect limits derived from energy conservation and enter the range of theoretical predictions involving crystalline exotic matter or runaway r-modes. This paper is also the first gravitational-wave search to present upper limits on the r-mode amplitude