Message from Dean Erdman

Congratulations to the Center and its Director, Dr. Laura Gitlin, on the inaugural issue of CARAH’s newsletter. In our discussions of the development of CARAH, one of the principal goals of the Center is its educational mission as is clear from the other information contained in this publication. Committed as the Center’s research professionals are to improving the health and quality of life of our seniors, it is not enough to conduct research that has the potential to provide significant help and support for patients and their caregivers. Those findings must also be disseminated, must be translated into action, must be available to those most in need of that information, and as widely as possible. The newsletter is one approach the Center is initiating in order to achieve its educational mission. As important as the newsletter is to advancing the goals of CARAH, it is equally valuable in advancing the mission of Jefferson College of Health Professions (JCHP), within which CARAH resides. The future of health care depends very heavily on the contributions of several disciplines to meet the needs of patients, most especially the needs of our senior patients. The College places the highest priority on the development of health professionals who are ready upon graduation to work as a member of a team in the provision of care. CARAH has adopted this interdisciplinary approach in all of its activities, and is collaborating with several departments not only in JCHP (Occupational and Physical Therapy and Nursing) but also with Jefferson Medical College (and its Farber Institute of the Neurosciences and the Depts. of Family Medicine, Psychiatry, and Neurology). The Center thus becomes an ideal site to nurture the growth and development of these interdisciplinary values and experiences. The potential, then, for enhancing and expanding the effectiveness of team care through interdisciplinary educational experiences, for hastening the translation of the findings of the research being conducted in CARAH to the care of elderly patients especially, is a goal that coincides superbly with the mission of the College and University. It is thus my pleasure to welcome the advent of this newsletter as a remarkable opportunity to support the development and expansion of the programs of CARAH that are so clearly connected to and supportive of the Jefferson mission

Field experiments with Gypsum in Iowa

Whether gypsum, or land plaster, which was quite widely used as a fertilizer in Europe 150 years ago and later in the United States, can be profitably used on Iowa soils is the interesting question with which the experiments reported in this bulletin have to do. As yet no final answer can be given, but this much can be said on the basis of this experimental work; Gypsum applied to some Iowa soils gave some beneficial results in oat and red clover yields and very decidedly good results in alfalfa yields. Gypsum supplies a large proportion of sulfur as well as calcium and when any crop such as alfalfa requires these elements applications of gypsum may prove profitable. This is especially true of Iowa soils, many of which arc deficient in sulfur. Further, gypsum is an Iowa product, conveniently at hand and can be produced economically. The experiments suggest definitely that it is worth the while of Iowa farmers to try out this material on a limited scale

NONLINEAR REGRESSION FUNCTIONS FOR FORAGE NUTRIENT DISAPPEARANCE FROM BAGS INCUBATED IN THE RUMEN

Seven nonlinear regression functions are compared for fitting rumen in situ disappearance data. The standard function is based on a simple one-compartment model. In addition, we consider a time lag modification, a two-compartment model, and functions based on underlying probability models for degradation time. The empirical suitability of the seven regression functions are assessed using two in situ experiments involving forages fed to dairy cows. A function based on the loglogistic distribution is shown to have empirical and theoretical advantages

Notes on the Dodder Gall Weeveil, Smicronyx Sculpticollis Casey

Author Institution: New Jersery Department of Agricultur

Development and Implementation of a Pharmacist-managed Outpatient Parenteral Antimicrobial Therapy Program

Purpose The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described. Summary A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, and (5) acquisition of administrative support to approve the program. In this program, the OPAT pharmacist plays an integral role in the management and oversight of OPAT patients, working under a collaborative agreement with infectious diseases physicians. The OPAT pharmacist assists with appropriate patient and regimen selection, confirmation of orders on discharge, assuring that laboratory tests for safety surveillance are performed and evaluated, performing routine monitoring for adverse events and line complications, and assuring the removal of the vascular access device upon the completion of OPAT. Conclusion: The OPAT program provides structured monitoring, patient follow-up, and led to improvements in patient outcome with minimization of treatment and line-related adverse events

Correlation of Adherence to the 2012 Infectious Diseases Society of America Practice Guidelines with Patient Outcomes in the Treatment of Diabetic Foot Infections in an Outpatient Parenteral Antimicrobial Programme

Aim To evaluate adherence to the 2012 Infectious Diseases Society of America practice guidelines for the management of patients with diabetic foot infections and to determine an association between adherence and clinical outcome. Methods A retrospective chart review was performed to evaluate the management and clinical outcomes of patients with diabetic foot infections treated with outpatient parenteral antimicrobial therapy between 1 January 2011 and 30 June 2012 at Wishard Health Services/Eskenazi Health. Adherence to individual Infectious Diseases Society of America diabetic foot infection treatment guideline recommendations was measured, and then assessed in relation to clinical outcome. Results A total of 57 patients (61% male, mean age 54 years) with moderate to severe diabetic foot infection met the inclusion criteria. None of the treatment courses of these patients adhered to all the Infectious Diseases Society of America guideline recommendations. The recommendations most frequently adhered to were consultation of appropriate multidisciplinary teams (n=54, 94.7%) and performance of diagnostic imaging (n=52, 89.5%). The recommendations least frequently adhered to were diabetic foot wound classification scoring on admission (n=0, 0%), appropriate culture acquisition (n=12, 21.2%), surgical intervention when indicated (n=32, 46.2%) and appropriate empiric antibiotic selection (n=34, 59.7%). Of 56 patients, 52 (92.9%) experienced clinical cure at the end of outpatient parenteral antimicrobial therapy compared with 34 of 53 patients (64%) at 6 months after the completion of therapy. Adherence to individual guidelines was not associated with clinical outcome. Patients who experienced treatment failure were more likely to have severe diabetic foot infection or peripheral neuropathy. Conclusions Adherence to the Infectious Diseases Society of America diabetic foot infection guideline recommendations was found to be suboptimal in the present study. The effect of adhering to individual Infectious Diseases Society of America diabetic foot infection recommendations on clinical outcome needs to be investigated

Video feedback intervention for cognitively impaired older drivers: A randomized clinical trial

Introduction: This clinical trial aimed to determine whether in-car video feedback about unsafe driving events (UDE) to cognitively impaired older drivers and family members leads to a reduction in such driving behaviors. Methods: We randomized 51 cognitively impaired older drivers to receive either (1) a weekly progress report with recommendations and access to their videos, or (2) video monitoring alone without feedback over 3 months. Results: UDE frequency/1000 miles was reduced by 12% in feedback (rate ratio [RR] = 0.88, 95% confidence interval [CI] = .58-1.34), while remaining constant with only monitoring (RR = 1.01, 95% CI = .68-1.51). UDE severity/1000 miles was reduced by 37% in feedback (RR = 0.63, 95% CI = .31-1.27), but increased by 40% in monitoring (RR = 1.40, 95% CI = .68-2.90). Cognitive impairment moderated intervention effects ( Discussion: Results suggest the potential to improve driving safety among mild cognitively impaired older drivers using a behavior modification approach aimed at problem behaviors detected in their natural driving environment

Black carbon as an additional indicator of the adverse health effects of airborne particles compared with PM10 and PM2.5.

Current air quality standards for particulate matter (PM) use the PM mass concentration [PM with aerodynamic diameters ≤ 10 μm (PM(10)) or ≤ 2.5 μm (PM(2.5))] as a metric. It has been suggested that particles from combustion sources are more relevant to human health than are particles from other sources, but the impact of policies directed at reducing PM from combustion processes is usually relatively small when effects are estimated for a reduction in the total mass concentration

Are Dietary Bioactives Ready for Recommended Intakes?12

Research has shown that numerous dietary bioactive components that are not considered essential may still be beneficial to health. The dietary reference intake (DRI) process has been applied to nonessential nutrients, such as fiber, yet the majority of bioactive components await a recommended intake. Despite a plethora of new research over the past several years on the health effects of bioactives, it is possible that the field may never reach a point where the current DRI framework is suitable for these food components. If bioactives are to move toward dietary guidance, they will likely require an alternative path to get there