Improving Utilization of Clinical Pharmacy Services in a Health Professional Shortage Area

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses. Objectives: Develop and implement a pre-visit pharmacy services screening tool, and educate staff about the value of CPS. Methods: Quality improvement, pre-post comparison at a single-site primary care office in a state-designated health professional shortage area. Participants are adult patients referred to pharmacy services and staff. Data was collected for six weeks after implementation and compared to the same six-week period in 2022. Results: Referrals increased from n = 7 to n = 23 after the intervention. A 2-sample Fisher’s exact test determined there was insufficient evidence to support a relationship between pre- and post-implementation rates of referrals categorized by purpose (p = 0.215). Conclusions: Use of a pre-visit checklist and pharmacy services screening tool increased referrals compared to standard practice. Implications: Further studies are needed to evaluate the impact on patient and organizational outcomes from the increase in patient referrals to CPS. Keywords: interprofessional collaboration; clinical pharmacist; primary care; collaborative practice agreement; quality improvemen

The Euro Crisis in the Mirror of the EMS: How Tying Odysseus to the Mast Avoided the Sirens but Led Him to Charybdi

Why was recovery from the euro area crisis delayed for a decade? The explanation lies in the absence of credible and timely policies to backstop financial intermediaries and sovereign debt markets. In this paper we add light and color to this analysis, contrasting recent experience with the 1992-3 crisis in the European Monetary System, when national central banks and treasuries more successfully provided this backstop. In the more recent episode, the incomplete development of the euro area constrained the ability of the ECB and other European institutions to do likewis

The Euro Crisis in the Mirror of the EMS: How Tying Odysseus to the Mast Avoided the Sirens but Led Him to Charybdis

Why was recovery from the euro area crisis delayed for a decade? The explanation lies in the absence of credible and timely policies to backstop financial intermediaries and sovereign debt markets. In this paper we add light and color to this analysis, contrasting recent experience with the 1992-3 crisis in the European Monetary System, when national central banks and treasuries more successfully provided this backstop. In the more recent episode, the incomplete development of the euro area constrained the ability of the ECB and other European institutions to do likewise.Keynes Fund at Cambridge University. The Making of the Euro-Area Crisis: Lessons from Theory and History (JHLP)

Facilitating an Art Hive: The Courage to Belong

FACILITATING AN ART HIVE: THE COURAGE TO BELONG HAILEY TALLMAN This research paper explores the psychological concept of belonging and why it is an essential human need. Art Hives, an emerging form of nonclinical art therapy delivery, is defined and explained, as is their central principle of inclusion. Through the methodology of autoethnography, the researcher examines her own experiences of belonging as a facilitator in a particular art hive, and explores how the needs of belonging, autonomy, competency and generosity can be met in this space. The complexities of belonging are examined, including three antecedents to belonging, and the belonging paradox. The researcher supports her findings with motivational research and The Circle of Courage, which deem “belonging” to be an essential need along with autonomy, competence and generosity. Shame Resilience Theory is linked to how shame keeps people from feeling they belong. The researcher discusses ways that building the courage to be vulnerable and authentic can help facilitators and participants overcome shame. Finally, the researcher concludes that in order to sustain a welcoming Art Hive, facilitators need to nurture their own autonomy, competence, generosity and inclusion in order to experience their own sense of belonging, as well as foster these experiences in Art Hive participants. Keywords: Art Hive, belonging, autonomy, competence, generosity, inclusion, shame, The Circle of Courage, facilitation, authenticity, vulnerability

Hierarchical multiscale materials modeling: Calibration, uncertainty quantification, and decision support

Computational material models help establish structure-property relationships by simulating properties, and are most effective when physically-based. The length and time scales of each simulation are constrained both by model type and computing power. Significant uncertainty can arise when models attempt to bridge across length and time scales, especially when using different model constructs. Hierarchical multiscale modeling (HMM) links models at different scales by informing parameters and form of higher scale models based on lower scale simulations, which can reduce uncertainty. The combination of diverse information sources in HMMs requires rigorous approaches to evaluate uncertainty propagation. In the pursuit of improved methods for empirical testing and development of model hierarchies, four approaches in which information is coordinated amongst multiple models are presented. (1) In a reconciled top-down and bottom-up approach, a likelihood-based model calibration method is proposed, and bcc Fe crystal plasticity (CP) is used to demonstrate the compatibility of information pathways. (2) A statistical volume element (SVE) ensemble-based homogenization scheme of two models of cartridge brass polycrystal plasticity is used to inform a Bammann-Chiesa-Johnson macroplasticity model with a local variation in parameters. The effects of SVE size and model form on the performance of the homogenization in bridging microstructure variability to macroscale uncertainty are explored. (3) A multiscale model development framework is outlined for the reduced order modeling of mesoscale variability in cartridge brass. The variability in SVE simulations is included with the results of a series of spherical microindentation experiments in a multiscale data collection. An initial study of the modeling involved in connecting the two length scales is performed. (4) In a CP-finite element method (FEM) based Materials Knowledge System model of -Ti, the influence of texture is considered. Texture is parameterized using generalized spherical harmonics. The CP-FEM model is used with polycrystalline SVE-ensembles to calibrate the MKS model across different textures, sampled according to an uncertainty reduction criterion. Results of the work suggest that data collection is an especially critical step in the formulation and deployment of hierarchical multiscale models. The use of bottom-up information in calibrating a multiscale model is shown to be susceptible to bias. A multiscale approach to coarse-grained simulations of polycrystals at the mesoscale is proposed. An approach to automating the data collection for a reduced-order model of microstructure sensitive response is shown to be competitive with manual data selection, prior to full optimization of the automated approach.Ph.D

A study of bacteria in bovine semen and their effect upon livability of spermatozoa

Digitized 2007 AES.Includes bibliographical references (pages 11-12)

Conducting Polymers and Corrosion III. A Scanning Vibrating Electrode Study of Poly(3-octyl pyrrole) on Steel and Aluminum

Electroactive conducting polymers (ECPs) continue to be of considerable interest as components of corrosion-resistant coating systems. ECPs, in addition to being conductive, are redox active materials, typically with potentials that are positive of iron and aluminum. Thus, as with chromate, interesting and potentially beneficial interactions of ECPs with active metal alloys such as steel and aluminum are anticipated. In this work, the scanning vibrating electrode technique (SVET), also known as the current density probe, was used to probe such interactions between a poly(3-octyl pyrrole) coating (POP) and cold-rolled steel and aluminum (Al 2024-T3) substrates. The POP coatings were scribed to simulate a defect through the coating to the metal substrate surface. The SVET was used to map the current flowing in and around the defect while the sample was immersed in either 3% NaCl (steel) or in dilute Harrison solution (aluminum), an aqueous solution consisting of 0.35% (NH4)2SO4, 0.05% NaCl. Although there were significant differences in the behavior of the POP-coated steel and POP-coated aluminum substrates, both exhibited a significant delay before the onset of any observable current compared to uncoated or epoxy-coated samples. Current density maps for the steel clearly indicate that the reduction reaction occurred on the conducting polymer surface, with oxidation confined to the defect. Current density maps for the aluminum alloy never displayed significant oxidation at the defect. Rather, reduction (after a significant delay) occurred at the defect as well as across the polymer surface, with concomitant localized undercoating oxidation of the aluminum substrate

Evaluating causes of error in landmark-based data collection using scanners

In this study, we assess the precision, accuracy, and repeatability of craniodental landmarks (Types I, II, and III, plus curves of semilandmarks) on a single macaque cranium digitally reconstructed with three different surface scanners and a microCT scanner. Nine researchers with varying degrees of osteological and geometric morphometric knowledge landmarked ten iterations of each scan (40 total) to test the effects of scan quality, researcher experience, and landmark type on levels of intra- and interobserver error. Two researchers additionally landmarked ten specimens from seven different macaque species using the same landmark protocol to test the effects of the previously listed variables relative to species-level morphological differences (i.e., observer variance versus real biological variance). Error rates within and among researchers by scan type were calculated to determine whether or not data collected by different individuals or on different digitally rendered crania are consistent enough to be used in a single dataset. Results indicate that scan type does not impact rate of intra- or interobserver error. Interobserver error is far greater than intraobserver error among all individuals, and is similar in variance to that found among different macaque species. Additionally, experience with osteology and morphometrics both positively contribute to precision in multiple landmarking sessions, even where less experienced researchers have been trained in point acquisition. Individual training increases precision (although not necessarily accuracy), and is highly recommended in any situation where multiple researchers will be collecting data for a single project