The impact of a pilot continuing professional development module on hospital pharmacists’ preparedness to provide contemporary advice on the clinical use of vancomycin

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: Revised international clinical guidelines for the antibiotic vancomycin have changed the advice pharmacists need to provide to medical and nursing colleagues. OBJECTIVES: (1) To determine the self-reported confidence of hospital pharmacists to provide contemporary advice on vancomycin and (2) to evaluate hospital pharmacists' knowledge to provide contemporary advice on vancomycin following a pilot continuing professional development (CPD) module. METHODS: The study was a prospective two-phase design in an Australian teaching hospital. Phase one: a survey of pharmacist self-reported confidence to eight questions on providing contemporary advice on vancomycin. Responses were recorded using a Likert scales. Phase two: The provision of a pilot online CPD module on vancomycin containing knowledge-based assessment based on a clinical vignette. Likert scales recorded self-reported confidence were reported as median and interquartile range (IQR). Knowledge assessment was reported using descriptive statistics. The main outcome measure were the self-reported confidence, and knowledge of pharmacists regarding provision of contemporary advice on clinical vancomycin use. RESULTS: Response rates for surveys; confidence n = 35 (72.9 %) and knowledge n = 31 (58.5 %). Phase one: confidence was highest regarding vancomycin dosing and monitoring with 71.4-81.6 % of respondents agreeing or strongly agreeing that they were confident in these domains. Respondents agreeing or strongly agreeing were least confident regarding intravenous administration and infusion related reactions, 57.1 and 45.7 % respectively. Respondents who provided advice on vancomycin >10 times in the prior 12 months reported significantly higher confidence in; therapeutic range 1 (IQR 1-2) versus 2 (IQR 1-3) p = 0.02; amending dosage based on therapeutic drug monitoring results 2 (IQR 1-3) versus 3 (IQR 2-3) p = 75 % of pharmacists. CONCLUSION: Pharmacists' self-reported confidence to managing vancomycin was variable but generally high. Knowledge scores were consistently high after pharmacists completed a pilot CPD module on vancomycin. These data provides impetus for a randomised controlled study across multiple sites to determine the extent to which pharmacist knowledge on vancomycin can be attributed to completion of an online CPD

The Relationship between Knee Valgus and Clinical Measures in Professional Basketball: A CART Analysis

Background/Purpose: Lower extremity injuries occur at an amplified rate in professional basketball. Evidence suggests that knee frontal plane valgus may be associated with risk of injury. The Landing Error Scoring System includes the assessment of maximum knee valgus during a countermovement jump. The investigation of interactions among linear and non-linear factors may help the understanding of the interdependence of various measures and poor performance on the knee valgus displacement (KVD) component of the LESS in professional basketball players. The purpose of this study was to investigate predictors of knee valgus displacement on the LESS. We hypothesize that a positive finding on the knee valgus displacement component of the LESS will be predicted by select clinical measures. Methods: 47 professional basketball players participated. Measurements were completed as part of preseason mobility screening prior to the 2015-16 and 2016-17 NBA seasons. Classification and Regression Tree Analysis (CART) were used to investigate linear and non-linear interactions among predictors and their influence on KVD in players who performed the LESS test. Results: Of the 47 players included in this study, 16 players did not test positive for KVD on the LESS test and 31 did. Pruning resulted in 4 splits (r2=0.507) demonstrating that KVD was predicted by total hip rotation range of motion, dominant leg hip external rotation, and standing arch height index measure. Predictive modeling, classified 18 of the 31 players with KVD and 8 of the 16 players who tested negative for KVD. The area under the ROC curve was .9183, suggesting that classification of players using this model was not random. Conclusion: KVD and performance on the LESS has been linked with injury. CART analysis captured linear and non-linear interactions between clinical measures suggesting that lower extremity biomechanical factors may be associated with predicting KVD during performance on the LESS. Clinical Relevance: KVD and the LESS test has been shown to be predictive of injury. Identifying which clinical measures may be linked with poor performance on this test may aide clinicians in determining appropriate interventions that may be associated with improved scores and minimize risk of injury.https://ecommons.udayton.edu/dpt_symposium/1000/thumbnail.jp

Aeronautic Instruments. Section V : Power Plant Instruments

Part 1 gives a general discussion of the uses, principles, construction, and operation of airplane tachometers. Detailed description of all available instruments, both foreign and domestic, are given. Part 2 describes methods of tests and effect of various conditions encountered in airplane flight such as change of temperature, vibration, tilting, and reduced air pressure. Part 3 describes the principal types of distance reading thermometers for aircraft engines, including an explanation of the physical principles involved in the functioning of the instruments and proper filling of the bulbs. Performance requirements and testing methods are given and a discussion of the source of error and results of tests. Part 4 gives methods of tests and calibration, also requirements of gauges of this type for the pressure measurement of the air pressure in gasoline tanks and the engine oil pressure on airplanes. Part 5 describes two types of gasoline gauges, the float type and the pressure type. Methods of testing and calibrating gasoline depth gauges are given. The Schroeder, R. A. E., and the Mark II flowmeters are described

The NASA-UC Eta-Earth Program: III. A Super-Earth orbiting HD 97658 and a Neptune-mass planet orbiting Gl 785

We report the discovery of planets orbiting two bright, nearby early K dwarf stars, HD 97658 and Gl 785. These planets were detected by Keplerian modelling of radial velocities measured with Keck-HIRES for the NASA-UC Eta-Earth Survey. HD 97658 b is a close-in super-Earth with minimum mass Msini = 8.2 +/- 1.2 M_Earth, orbital period P = 9.494 +/- 0.005 d, and an orbit that is consistent with circular. Gl 785 b is a Neptune-mass planet with Msini = 21.6 +/- 2.0 M_Earth, P = 74.39 +/- 0.12 d, and orbital eccentricity 0.30 +/- 0.09. Photometric observations with the T12 0.8 m automatic photometric telescope at Fairborn Observatory show that HD 97658 is photometrically constant at the radial velocity period to 0.09 mmag, supporting the existence of the planet.Comment: Submitted to ApJ, 7 pages, 6 figures, 5 table

Self-esteem, self-efficacy and optimism as psychological resources among family caregivers of people with dementia: findings from the IDEAL study

YesBeing a family caregiver, and in particular giving care to someone with dementia, impacts upon mental and physical health, and potentially reduces the ability of caregivers to ‘live well’. This paper examines whether three key psychological resources, self-efficacy, optimism and self-esteem, are associated with better outcomes for caregivers of people with dementia. Design and Participants Caregivers of 1283 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of selfefficacy, optimism and self-esteem, and ‘living well’ (quality of life, life satisfaction and well-being). Multivariate linear regression was used to examine the association between psychological resources and ‘living well’. Results Self-efficacy, optimism and self-esteem were all independently associated with better capability to ‘live well’ for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day). Conclusions Low self-efficacy, optimism and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers

Evaluation of bone marrow lesion volume as a knee osteoarthritis biomarker - longitudinal relationships with pain and structural changes: data from the Osteoarthritis Initiative

Abstract Introduction Bone marrow lesion (BML) size may be an important imaging biomarker for osteoarthritis-related clinical trials and reducing BML size may be an important therapeutic goal. However, data on the interrelationships between BML size, pain, and structural progression are inconsistent and rarely examined in the same cohort. Therefore, we evaluated the cross-sectional and longitudinal associations of BML volume with knee pain and joint space narrowing (JSN). Methods A BML volume assessment was performed on magnetic resonance images of the knee collected at the 24- and 48-month Osteoarthritis Initiative visits from a convenience sample of 404 participants in the progression cohort. During the same visits, knee pain was assessed with WOMAC pain scores and knee radiographs were acquired and scored for JSN. BML volume was summed to generate a total knee volume and an index tibiofemoral compartment volume (compartment with greater baseline JSN). Primary analyses included multiple linear regressions (outcome = pain, predictor = total knee BML volume) and logistic regressions (outcome = JSN, predictor = index tibiofemoral compartment BML volume). Results This sample was 49% female with a mean age of 63 (9.2 standard deviation (SD)) years, and 71% had radiographic osteoarthritis in the study knee. Larger baseline BMLs were associated with greater baseline knee pain (P = 0.01), the presence of JSN at baseline (odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.23 to 1.83), and JSN progression (OR = 1.27, 95%CI = 1.11 to 1.46). Changes in total knee BML volume had a positive association with changes in knee pain severity (P = 0.004) and this association may be driven by knees that were progressing from no or small baseline BMLs to larger BMLs. In contrast, we found no linear positive relationship between BML volume change and JSN progression. Instead, regression of medial tibiofemoral BML volume was associated with JSN progression compared to knees with no or minimal changes in BML volume (OR = 3.36, 95%CI = 1.55 to 7.28). However, follow-up analyses indicated that the association between JSN progression and BML volume change may primarily be influenced by baseline BML volume. Conclusion Large baseline BMLs are associated with greater baseline knee pain, the presence of JSN at baseline, and disease progression. Additionally, BML regression is associated with decreased knee pain but not a reduced risk of concurrent JSN progression

Evidence of the Generation of Isosaccharinic Acids and Their Subsequent Degradation by Local Microbial Consortia within Hyper-Alkaline Contaminated Soils, with Relevance to Intermediate Level Radioactive Waste Disposal

The contamination of surface environments with hydroxide rich wastes leads to the formation of high pH (>11.0) soil profiles. One such site is a legacy lime works at Harpur Hill, Derbyshire where soil profile indicated in-situ pH values up to pH 12. Soil and porewater profiles around the site indicated clear evidence of the presence of the α and β stereoisomers of isosaccharinic acid (ISA) resulting from the anoxic, alkaline degradation of cellulosic material. ISAs are of particular interest with regards to the disposal of cellulosic materials contained within the intermediate level waste (ILW) inventory of the United Kingdom, where they may influence radionuclide mobility via complexation events occurring within a geological disposal facility (GDF) concept. The mixing of uncontaminated soils with the alkaline leachate of the site resulted in ISA generation, where the rate of generation in-situ is likely to be dependent upon the prevailing temperature of the soil. Microbial consortia present in the uncontaminated soil were capable of surviving conditions imposed by the alkaline leachate and demonstrated the ability to utilise ISAs as a carbon source. Leachate-contaminated soil was sub-cultured in a cellulose degradation product driven microcosm operating at pH 11, the consortia present were capable of the degradation of ISAs and the generation of methane from the resultant H2/CO2 produced from fermentation processes. Following microbial community analysis, fermentation processes appear to be predominated by Clostridia from the genus Alkaliphilus sp, with methanogenesis being attributed to Methanobacterium and Methanomassiliicoccus sp. The study is the first to identify the generation of ISA within an anthropogenic environment and advocates the notion that microbial activity within an ILW-GDF is likely to influence the impact of ISAs upon radionuclide migration

Practice-based evidence for children and adolescents: Advancing the research agenda in schools.

The American Psychological Association Task Force on Evidence- Based Practice for Children and Adolescents (2008) recommended a systems approach to enhancing care in order to improve outcomes for children and adolescents with mental health needs and redress persistent systemic problems with the structure of services. Recommendations for enhancing an ecological approach to the adoption and implementation of evidence-based practices are offered through increased attention to practice-based research frameworks for adoption and dissemination. Five criteria are discussed for providing acceptable evidence, including (a) systematic evidence searching and adoption of evidence-based prevention and intervention practices, (b) implementation and adherence to intervention integrity, (c) invoking standards for drawing inferences from interventions, (d) using quality assessments to measure outcomes, and (e) adopting formal data analysis procedures to assess intervention outcomes. Each criterion is illustrated with an example. Future research and policy agendas are outlined.Psycholog