Do endovascular filters prevent PE as effectively as anticoagulants in patients with DVT?

Although inferior vena cava filters (IVCFs) reduced the incidence of PE in a randomized controlled trial (RCT), patients treated with IVCFs and anticoagulation with unfractionated heparin or low-molecular- weight heparin had a greater risk of developing recurrent DVT than patients treated with anticoagulation alone (SOR: B, 1 RCT)

Standardizing STI Screening in Child Sexual Abuse Cases at the CARES Institute

Children who are sexually abused have a higher risk of contracting STIs and/or becoming pregnant. CDC STI testing guidelines should be adhered to in order to provide the safest outcomes for patients. Physician compliance with testing guidelines plays a significant role in ensuring patient safety, which highlights the importance of ensuring high physician compliance. Identifying ways physicians can improve compliance can enhance patient care. In order to determine compliance rates of the CARES Institute physicians, data was extracted from 275 patient charts from 2017 and 100 patients charts from 2021, before and after a continuing medical education (CME) training was provided to CARES physicians. Statistical analyses were performed on these sets of data to determine compliance rates. A second CME training including conclusions from these analyses was provided to CARES physicians in 2023. Data collection and analysis from new 2023 patient statuses is currently in progress. Results from analysis of the 2017 and 2021 data showed an increase in compliance rates from 2017 to 2021. This highlights the potential benefit of physician education to increasing physician adherence to STI testing protocol. Further physician education is still necessary to reach higher rates of compliance. Future studies can focus on identifying commonly non-documented risk factors for STIs and determining ways to improve documentation

Psychometric evaluation of disordered eating measures in bariatric surgery candidates

Introduction: Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown. Methods: Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed. Materials: The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor EatingQuestionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131). Results: CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43–0.82; revised scales α = 0.67–0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures. Conclusions: Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid

Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis

This review investigates the relationship between weight and risk of medical instability (specifically bradycardia, hypotension, hypothermia, and hypophosphatemia) in adolescents with typical and atypical anorexia nervosa. Atypical anorexia nervosa, listed as an example under the DSM-5 category of Other Specified Feeding and Eating Disorders (OSFED), describes patients who are not clinically underweight but otherwise meet criteria for anorexia nervosa. There is a lack of empirical evidence exploring medical complications in adolescents presenting with atypical anorexia nervosa. The small number of studies that do exist in this area indicate that medical instability exists across a range of weights, with weight loss being associated with increased medical risk, independent of underweight. The aim of this review was to collate and analyse results from available studies and identify indicators of medical risk in these two groups of adolescents with restrictive eating disorders. Studies were identified by systematic electronic search of medical databases, including PubMed and EMBASE. All studies investigated the relationship between weight and medical instability and included adolescents diagnosed with anorexia nervosa or atypical anorexia nervosa. One randomised controlled trial, five cohort studies and three chart reviews were included, with a total sample size of 2331 participants. Between 29 and 42% of participants presented with medical instability requiring hospitalisation, in the absence of underweight. Underweight adolescents were significantly more likely to have lower blood pressures (p < 0.0001) and bradycardia was significantly associated with greater weight loss (p < 0.05). There were no statistically significant associations found between degree of underweight and heart rate, temperature, or rate of weight loss (p = 0.31, p = 0.46 and p = 0.16, respectively). Adolescents that were less than 70% median body mass index were significantly more likely to have hypophosphatemia (p < 0.05). The findings of this review support the hypothesis that medical instability can occur across a range of weights in adolescent eating disorders, with rapid weight loss being an important indicator of increasing medical risk. Results were limited by the small number of existing studies that contained data for statistical analysis. Rapid weight loss should be considered as an important indicator of medical instability in adolescents presenting with both typical and atypical anorexia nervosa

Incentivizing a carbon-free economy: a method to identify free-riders

Top-down approaches to reducing global carbon dioxide emissions have so far met with limited success, even though most countries accept the urgency of mitigating climate change and have entered into various agreements that should help reduce emissions. This article does not dismiss the importance of such "top-down" agreements for developing rational strategies to achieve declining total emissions, but it suggests a complementary approach to encourage immediate "bottom-up" progress on climate goals that do not need to wait for global cooperation. This paper develops a framework to identify free-riding behavior among countries that use three readily measured parameters of the country’s economy: carbon intensity, rate of change of the carbon intensity, and per capita GDP. It then goes on to propose a simple formula to calculate trade sanctions against a free-riding country that could be used in bilateral actions to incentivize carbon emissions reductions. The paper argues that the value of the goods, the difference in carbon intensity between the importer and exporter, and the cost of carbon removal can be used to calculate the unfair trade advantage of a free-riding country. The dynamics of the proposed framework are tested through three case studies, highlighting current free-rider behavior - based on historic emissions for the period 1991-2012; an lternate, hypothetical scenario whereby a subset of countries follow aggressive carbon emission reductions; and a 450 ppm stabilization scenario

Shifting Selves: Queer Muslim Asylum Seekers in the Netherlands

This dissertation explores the potential of the queer Muslim asylum seeker to confront the Dutch national imaginary. An archetype of homonationalism, the Netherlands faces rising tides of Islamophobia, waters which queer Muslims must learn to navigate. An asylum seeker’s success in the system depends on their “credibility”, hinging on the consistency of their self-representation which is constantly being reconstructed. These constant reconstructions, what Ewing (1990) refers to as “shifting selves”, are not conscious or noticed by the individual; yet, in the context of asylum claim-making, reconstitutions of the self may rise to the surface, asylum seekers then engaging in conscious strategizing. I analyze these contexts ethnographically through informal interviews and participant observation, at the height of the so-called “Refugee Crisis” of the mid-2010s in Europe. I find that as the figure of the queer Muslim asylum seeker confronts the Dutch national imaginary, it both confirms it—representing national commitments to human rights, to tolerance, and to protection of sexual minorities—and challenges it—embodying impossible identities, and evincing a failure of the nation to live up to its ideals: What is “tolerance” when it is weaponized against minority groups? What kind of queerness is being protected if deviation from a cultural norm is disqualifying? Whose human rights are being protected by a system that demands the subject of those rights conform to formulations inconsistent with lived experience

Impurity And Interdiffusion In The Magnesium-aluminum System

Magnesium alloys offer a base of lightweight engineering materials for electronic, military and transportation applications where weight reduction is crucial for higher efficiency. Understanding fundamental diffusion behavior in Mg alloys elicits better materials properties through the optimization of processing techniques and heat treatments, whose material responses are affected by diffusion. The main objective of this study is to provide a clear, comprehensive description of the diffusion behavior in the technically important magnesium-aluminum binary metallic system. In this study, diffusion in the Mg-Al system was observed through solid diffusion couples and thin film specimens in the temperature range of 673-523K. The formation and growth of the intermetallic phases, β-Mg2Al3 and γ-Mg17Al12, and the absence of the ε- Mg23Al30 phase was observed. The β-Mg2Al3 phase grew thicker, had higher parabolic growth constants and lower activation energy for growth. Concentration-dependent interdiffusion coefficients were determined using the Boltzmann-Matano method. Interdiffusion in the β-Mg2Al3 phase was the highest, followed by the γ-Mg17Al12 phase, the Al solid solution and the Mg solid solution. Intrinsic diffusion coefficients at the marker plane composition of 38 at.% Mg in the β-Mg2Al3 were determined from Heumann’s method for Mg and Al, for which Al was higher. Extrapolations of the impurity diffusion coefficients in both terminal solid solutions were made and compared to available literature data. The thermodynamic factor, tracer diffusivity and atomic iv mobility of Mg and Al at the marker plane concentration were estimated using Mg activities in the β-Mg2Al3 available from literature. The impurity diffusion of Al and self-diffusion of the stable isotope, 25Mg, in polycrystalline Mg was measured from thin film specimens via depth profiling using secondary ion mass spectrometry. The Al impurity diffusion observed is compared to the extrapolations from the parallel interdiffusion study. The self-diffusion measurements are compared to reported literature values and were observed to be significantly higher. Several reasons for the observed difference in the magnitude of diffusivities are discussed

Standardized parenteral nutrition for the transition phase in preterm infants: a bag that fits

The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase

Creating a Pharmacy Internship: A Toolbox for Success

&nbsp; Objective: To describe available compensated student internships and provide guidance for new program development. Methods:&nbsp; A search was conducted using PubMed, MEDLINE, and Google with the following search terms: pharmacy, intern, internship, and student.&nbsp; All English language publications were considered for inclusion.&nbsp; Articles describing IPPE or APPE student utilization were excluded. Key findings: Pharmacy student internship programs are common in practice, though there are few with published outcome data.&nbsp; Most often, interns serve as pharmacist extenders and participate in activities that center around extension of pharmacy services within the institution.&nbsp; Development of new programs should include partnering with nearby pharmacy programs and state boards of pharmacy to develop a well matched curriculum and allow for interns to practice at the top of their license.&nbsp; Lastly, outcomes should be measured and disseminated for the benefit of the academy.&nbsp; Additional considerations for developing a student internship program and guidance are provided. Conclusions: Although in existence for decades, minimal published reports showcase institutional outcomes associated with student internships.&nbsp; No data is available to show the downstream effect an internship can have on direct patient care activities. &nbsp; Article Type:&nbsp; Not

Pharmacy Internships: We Can Do Better

The pharmacist’s role in patient care is expanding, and the profession must prepare its graduates for direct patient care. Internships can help facilitate this training outside of the formal pharmacy curriculum. Intern roles can expand beyond distributive tasks to compliment the full range of pharmacist activities, providing value to the student and institution. Crucially, outcomes measured must not only be traditional measures of student and pharmacist output, but also the growth and success of the student within the program. Creative metrics (e.g. resilience or leadership development) should be considered when assessing programmatic outcomes. Programs already engaged in internship programs should assess their respective programs and report findings. Article Type:&nbsp; Commentar