Evaluating Reference Consultations in the Academic Library

In 2015, McGill University Library undertook a project to investigate, propose, and pilot test a method for evaluating the quality and outcomes of reference consultations. The goal of the project was to gather evidence to demonstrate the importance of reference consultations as part of librarians’ core contributions to the university. The evaluation tool was developed based on input from librarians, users, and a review of the literature. The evaluation was sent out to 98 users during the pilot test period. There were 53 responses to the evaluation tool for a response rate of 54%. Though preliminary, the results of the pilot test can be helpful in determining the usefulness of evaluating reference consultations, and the outcomes of engaging in assessment of this core library service. The results from this project suggest that implementing a tool to evaluate consultations can be used to inform services and to demonstrate the value of the library for research, teaching, and learning

Disrupting the “Norm” with Collaborative Strategic Reading

Using a case study of a seventh-grade language arts classroom, the authors describe an evidence-based approach to reading comprehension instruction, collaborative strategic reading, which supports all learners by changing the nature of learning and participation

Axonal growth arrests after an increased accumulation of Schwann cells expressing senescence markers and stromal cells in acellular nerve allografts

Acellular nerve allografts (ANAs) and other nerve constructs do not reliably facilitate axonal regeneration across long defects (>3 cm). Causes for this deficiency are poorly understood. In this study, we determined what cells are present within ANAs before axonal growth arrest in nerve constructs and if these cells express markers of cellular stress and senescence. Using the Thy1-GFP rat and serial imaging, we identified the time and location of axonal growth arrest in long (6 cm) ANAs. Axonal growth halted within long ANAs by 4 weeks, while axons successfully regenerated across short (3 cm) ANAs. Cellular populations and markers of senescence were determined using immunohistochemistry, histology, and senescence-associated β-galactosidase staining. Both short and long ANAs were robustly repopulated with Schwann cells (SCs) and stromal cells by 2 weeks. Schwann cells (S100β(+)) represented the majority of cells repopulating both ANAs. Overall, both ANAs demonstrated similar cellular populations with the exception of increased stromal cells (fibronectin(+)/S100β(−)/CD68(−) cells) in long ANAs. Characterization of ANAs for markers of cellular senescence revealed that long ANAs accumulated much greater levels of senescence markers and a greater percentage of Schwann cells expressing the senescence marker p16 compared to short ANAs. To establish the impact of the long ANA environment on axonal regeneration, short ANAs (2 cm) that would normally support axonal regeneration were generated from long ANAs near the time of axonal growth arrest (“stressed” ANAs). These stressed ANAs contained mainly S100β(+)/p16(+) cells and markedly reduced axonal regeneration. In additional experiments, removal of the distal portion (4 cm) of long ANAs near the time of axonal growth arrest and replacement with long isografts (4 cm) rescued axonal regeneration across the defect. Neuronal culture derived from nerve following axonal growth arrest in long ANAs revealed no deficits in axonal extension. Overall, this evidence demonstrates that long ANAs are repopulated with increased p16(+) Schwann cells and stromal cells compared to short ANAs, suggesting a role for these cells in poor axonal regeneration across nerve constructs

Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

<p>Abstract</p> <p>Background</p> <p>The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.</p> <p>Methods</p> <p>Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.</p> <p>Results</p> <p>Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.</p> <p>Conclusions</p> <p>Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.</p

Intra-individual effects of food upon the pharmacokinetics of rifampicin and isoniazid

Background: Poor response to TB therapy might be attributable to subtherapeutic levels in drug-compliant patients. Pharmacokinetic parameters can be affected by comorbidities or the interaction of drugs with food. Objectives: This study aimed to determine the effect of food intake upon pharmacokinetics of rifampicin and isoniazid in a Peruvian population with TB. Methods: Rifampicin and isoniazid levels were analysed at 2, 4 and 6 h after drug intake in both fasting and non-fasting states using LC-MS methods. Results: Sixty patients participated in the study. The median rifampicin Cmax and AUC0–6 were higher during fasting than non-fasting: 7.02 versus 6.59 mg/L (P = 0.054) and 28.64 versus 24.31 mg·h/L (P = 0.002). There was a statistically significant delay overall of non-fasting Tmax compared with the fasting state Tmax (P = 0.005). In the multivariate analysis, besides the effect of fasting, Cmax for females was 20% higher than for males (P = 0.03). Concerning isoniazid, there were significant differences in the Cmax during non-fasting (median = 3.51 mg/L) compared with fasting (4.54 mg/L). The isoniazid dose received had an effect upon the isoniazid levels (1.26, P = 0.038). In the multivariate analysis, isoniazid exposure during fasting was found to be 14% higher than during non-fasting (CI = 1.02–1.28, P < 0.001). Neither radiological extent of the disease nor consumption of food with drug intake nor pharmacokinetics of rifampicin or isoniazid was associated with a poorer treatment outcome. Conclusions: Rifampicin in particular and isoniazid pharmacokinetics were significantly affected by the intake of the drug with food between and within individuals

Examining Older Adults\u27 Perceptions of Usability and Acceptability of Remote Monitoring Systems to Manage Chronic Heart Failure

Objective: This study was conducted to evaluate the feasibility, usability, and acceptability of using remote monitoring systems (RMS) in monitoring health status (e.g., vital signs, symptom distress) in older adults (≥ 55) with chronic heart failure (HF). Method: Twenty-one patients (52.4% women, mean age 73.1 ± 9.3) were trained to measure and transmit health data with an RMS. Data transmissions were tracked for 12 weeks. Results: All participants initiated use of RMS within 1 week; 71%, 14%, and 14% of patients transmitted daily health data 100%, ≥ 75%, and \u3c 75% of the time, respectively, for 12 weeks. Overall usability and acceptability of the RMS were 4.08 ± 0.634 and 4.10 ± 0.563, respectively (when scored on a range of 1-5, where 1 = strongly disagree and 5 = strongly agree). Discussion: Findings show that an RMS-based intervention can be successfully implemented in a group of older patients with chronic HF

Aircraft Conceptual Design Using Vehicle Sketch Pad

Vehicle Sketch Pad (VSP) is a parametric geometry modeling tool that is intended for use in the conceptual design of aircraft. The intent of this software is to rapidly model aircraft configurations without expending the expertise and time that is typically required for modeling with traditional Computer Aided Design (CAD) packages. VSP accomplishes this by using parametrically defined components, such as a wing that is defined by span, area, sweep, taper ratio, thickness to cord, and so on. During this phase of frequent design builds, changes to the model can be rapidly visualized along with the internal volumetric layout. Using this geometry-based approach, parameters such as wetted areas and cord lengths can be easily extracted for rapid external performance analyses, such as a parasite drag buildup. At the completion of the conceptual design phase, VSP can export its geometry to higher fidelity tools. This geometry tool was developed by NASA and is freely available to U.S. companies and universities. It has become integral to conceptual design in the Aeronautics Systems Analysis Branch (ASAB) here at NASA Langley Research Center and is currently being used at over 100 universities, aerospace companies, and other government agencies. This paper focuses on the use of VSP in recent NASA conceptual design studies to facilitate geometry-centered design methodology. Such a process is shown to promote greater levels of creativity, more rapid assessment of critical design issues, and improved ability to quickly interact with higher order analyses. A number of VSP vehicle model examples are compared to CAD-based conceptual design, from a designer perspective; comparisons are also made of the time and expertise required to build the geometry representations as well

Older adults and mobile technology: Factors that enhance and inhibit utilization in the context of behavioral health

While numbers and proportions of older adults with behavioral health issues are expected to substantially increase, there is also a widening gap in available services for older adults. Mobile health interventions (mhealth) are a way to address existing barriers to treatment, provide frontline assessment and increase access to services for older adults. Due to perpetuated stereotypes, many assume that older adults do not utilize mobile technology nor will they accept a mHealth intervention. The purpose of this paper is to synthesize contemporary literature from information technology and healthcare regarding: (1) current mobile technology utilization by older adults, particularly in regards to health; (2) factors affecting older adult motivation to engage with mobile technology; and (3) older adult preferences for interacting with mobile technology. Findings reveal that significant proportions of older adults: already utilize mobile technology; are willing to engage in existing mobile interventions for health reasons; and have positive attitudes overall towards mobile technology. Finally, recommendations for optimizing mobile interventions to better suit older adults with behavioral health problems are reviewed

Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings

ObjectiveSmall series of thoracotomy for mitral valve repair have demonstrated clinical benefit. This multi-institutional administrative database analysis compares outcomes of thoracotomy and sternotomy approaches for mitral repair.MethodsThe Premier database was queried from 2007 to 2011 for mitral repair hospitalizations. Premier contains billing, cost, and coding data from more than 600 US hospitals, totaling 25 million discharges. Thoracotomy and sternotomy approaches were identified through expert rules; robotics were excluded. Propensity matching on baseline characteristics was performed. Regression analysis of surgical approach on outcomes and costs was modeled.ResultsExpert rule analysis positively identified thoracotomy in 847 and sternotomy in 566. Propensity matching created 2 groups of 367. Mortalities were similar (thoracotomy 1.1% vs sternotomy 1.9%). Sepsis and other infections were significantly lower with thoracotomy (1.1% vs 4.4%). After adjustment for hospital differences, thoracotomy carried a 17.2% lower hospitalization cost (−$8289) with a 2-day stay reduction. Readmission rates were significantly lower with thoracotomy (26.2% vs 35.7% at 30 days and 31.6% vs 44.1% at 90 days). Thoracotomy was more common in southern and northeastern hospitals (63% vs 37% and 64% vs 36%, respectively), teaching hospitals (64% vs 36%) and larger hospitals (>600 beds, 78% vs 22%).ConclusionsRelative to sternotomy, thoracotomy for mitral repairs provides similar mortality, less morbidity, fewer infections, shorter stay, and significant cost savings during primary admission. The markedly lower readmission rates for thoracotomy will translate into additional institutional cost savings when a penalty on hospitals begins under the Affordable Care Act's Hospital Readmissions Reduction Program