Boulevard Park shoreline improvements project:environmental impact assessment

The purpose of the Boulevard Park Shoreline Improvements Project is to remove fill, riprap, and sod from the shoreline along Boulevard Park and replace this hardened shoreline with sloping gravel, sand beaches, and rock groins. Ultimately, this alteration of the shoreline will hinder erosion, improve habitat, improve public access to the bay, and decrease the impact of storm surges

Incorporating a clinical pharmacist in an outpatient palliative care team

Title: Incorporating a clinical pharmacist in an outpatient palliative care team Crystal Rim, PharmD; Sharon Leigh, PharmD, BCPS; Linda De Sitter MD, MPH; Mary Grant, ANP; Dana Nguyen, PharmD Palliative care is a growing field in medicine that focuses on delivering care that improves quality of life for patients with serious illnesses. Often, the goals of palliative care differ from traditional goals of medicine. Currently, there is limited data demonstrating the integration of pharmacists in the palliative care setting. The purpose of this quality improvement is to evaluate the clinical pharmacist’s role within an outpatient palliative care team when performing medication reconciliation and review. Medication review includes de-prescribing high-risk medications and optimizing medications in symptom management. Between January and February 2020, the clinical pharmacist interviewed patients referred to the outpatient palliative care service through three different methods: telehealth, pharmacy consult and telephone. The clinical pharmacist provided recommendations to the outpatient palliative care nurse practitioner and primary care provider for medication optimization, symptom management and de-prescribing based on STOPPFrail and Beers Criteria. Data from 19 patients were analyzed. One patient was excluded from analysis due to death. Five patients were interviewed through telehealth. Two patients were directly consulted for pharmacist review by the outpatient palliative care nurse practitioner. Seven patients were interviewed through telephone, of which 4 patients were referred to hospice following palliative care consult. Of 19 patients, 64 total recommendations (29 medication discontinuation, 30 medication optimization, 5 symptom management) were made. Six recommendations were accepted by the provider (3 medication discontinuation, 3 medication optimization). The average time spent on chart review for each patient was 1.5 hours. Pharmacist involvement in outpatient palliative care may be valuable. However, many barriers to providing meaningful interventions were identified in this study. While telehealth provided the convenience to the patient and caregivers, utilization was limited due to lack of standardization of technology. Telephone interviews allowed proper medication reconciliation prior to the palliative care visit, but non-medication related issues may be prioritized after the visit. Finally, pharmacy consult from palliative care nurse practitioners allowed more efficiency, but it did not allow formal pharmacist integration in the outpatient palliative care team. Further studies quantifying the pharmacist role in outpatient palliative care are warranted.https://digitalcommons.psjhealth.org/pharmacy_PGY1mn/1000/thumbnail.jp

Post-Newtonian approximation for isolated systems calculated by matched asymptotic expansions

Two long-standing problems with the post-Newtonian approximation for isolated slowly-moving systems in general relativity are: (i) the appearance at high post-Newtonian orders of divergent Poisson integrals, casting a doubt on the soundness of the post-Newtonian series; (ii) the domain of validity of the approximation which is limited to the near-zone of the source, and prevents one, a priori, from incorporating the condition of no-incoming radiation, to be imposed at past null infinity. In this article, we resolve the problem (i) by iterating the post-Newtonian hierarchy of equations by means of a new (Poisson-type) integral operator that is free of divergencies, and the problem (ii) by matching the post-Newtonian near-zone field to the exterior field of the source, known from previous work as a multipolar-post-Minkowskian expansion satisfying the relevant boundary conditions at infinity. As a result, we obtain an algorithm for iterating the post-Newtonian series up to any order, and we determine the terms, present in the post-Newtonian field, that are associated with the gravitational-radiation reaction onto an isolated slowly-moving matter system.Comment: 61 pages, to appear in Phys. Rev.

Perioperative detection of circulating tumour cells in patients with lung cancer

© 2017 Chudasama et al. Lung cancer is a leading cause of mortality and despite surgical resection a proportion of patients may develop metastatic spread. The detection of circulating tumour cells (CTCs) may allow for improved prediction of metastatic spread and survival. The current study evaluates the efficacy of the ScreenCell® filtration device, to capture, isolate and propagate CTCs in patients with primary lung cancer. Prior to assessment of CTCs, the present study detected cancer cells in a proof-of-principle- experiment using A549 human lung carcinoma cells as a model. Ten patients (five males and five females) with pathologically diagnosed primary non-small cell lung cancer undergoing surgical resection, had their blood tested for CTCs. Samples were taken from a peripheral vessel at the baseline, from the pulmonary vein draining the lobe containing the tumour immediately prior to division, a further central sample was taken following completion of the resection, and a final peripheral sample was taken three days post‑resection. A significant increase in CTCs was observed from baseline levels following lung manipulation. No association was able to be made between increased levels of circulating tumour cells and survival or the development of metastatic deposits. Manipulation of the lung during surgical resection for non-small cell lung carcinoma results in a temporarily increased level of CTCs; however, no clinical impact for this increase was observed. Overall, the study suggests the ScreenCell® device has the potential to be used as a CTC isolation tool, following further work, adaptations and improvements to the technology and validation of results

Reverse migration: Western European Muslim women’s flights to ISIL territory

Since early 2014, the Islamic State of Iraq and the Levant (ISIL) has increasingly recruited Western Muslim men and women to its radical ideology. This thesis examines why Western European Muslim women—specifically from France and Great Britain—are voluntarily migrating to ISIL territory to support Islamic extremism. It evaluates women’s involvement in previous terrorist movements and proposes five potential motivations for migration: grievances toward Western society, ideology, relationships/belonging, identity assertion, and targeted recruitment. Through the analysis of eleven case studies and numerous social media accounts, this thesis demonstrates that European Muslim women choose life in ISIL territory for a variety of reasons. It also illustrates, however, that ISIL’s social media and propaganda campaigns are the strongest forces pushing women toward radicalization and migration. Finally, this paper concludes with recommendations to counter ISIL’s online recruitment success in the West.http://archive.org/details/reversemigration1094547246Captain, United States ArmyApproved for public release; distribution is unlimited