Are Pharmacists Responsible for Physicians\u27 Prescription Errors? McKee v. American Home Products, 113 Wash. 2d 701, 782 P.2d 1045 (1989)

In McKee v. American Home Products, the Washington Supreme Court held that pharmacists\u27 duties do not include contacting physicians who make judgment errors when prescribing medication. When physicians make obvious errors, however, juries decide whether pharmacists should contact physicians. This Note examines McKee and proposes that either juries should determine pharmacists\u27 duties in all cases or, alternatively, the legislature should require pharmacists to contact physicians whenever prescriptions as issued could harm patients

The efficacy of dietary intervention on gastrointestinal involvement in systemic sclerosis:A systematic literature review

BACKGROUND: Gastrointestinal involvement in systemic sclerosis is common and a major cause of disease-related morbidity. Patients increasingly enquire about dietary modifications that may help with gastrointestinal symptoms. Many clinical practice reviews and treatment guidelines make specific reference to dietary modifications in the management of gastrointestinal involvement in systemic sclerosis. We report the findings of a systematic literature review designed to evaluate the evidence to support dietary modification in the management of gastrointestinal symptoms of systemic sclerosis.METHODS: A systematic literature review protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International prospective register of systematic reviews (CRD42018103549). Standardised searches of EMBASE and MEDLINE were undertaken to identify studies reporting the outcome of dietary modification in the management of gastrointestinal symptoms of systemic sclerosis. Wide heterogeneity in study design, interventions and study outcomes necessitated a qualitative data synthesis.RESULTS: Our standardised searches identified 1032 articles, of which 3 were deemed eligible for full data extraction. These studies were small (mean 19 subjects per study), single centre, short-term (mean 6 week duration) open-label non-randomised studies examining the role of probiotics, low-fermentable oligo-saccharides, disaccharides, monosaccharides, and polyol (low-FODMAP) diet and highly individualised medical nutrition therapy counselling, respectively. Improvements in patient-reported outcome assessment of gastrointestinal symptoms were reported after intervention with probiotic therapy and low-FODMAP diet but not following tailored dietary and nutritional counselling. The Risk of Bias Assessment Tool for Nonrandomized Studies identified high risk-of-bias for confounding variables and blinding of assessors in each of the three studies evaluated.CONCLUSIONS: The evidence-base to support dietary modification for gastrointestinal involvement in systemic sclerosis is currently limited and clinical practice guidelines should take a measured approach to such recommendations. The emergence of large patient registries could facilitate the capture of vital practice-based evidence regarding the efficacy of dietary modification in the management of gastrointestinal involvement in systemic sclerosis to inform future clinical practice guidelines.</p

FRESHWATER POND USE BY WHOOPING CRANES DURING A WET WINTER IN COASTAL TEXAS

Wintering whooping cranes (Grus americana) in the Aransas-Wood Buffalo Population have a restricted range along coastal Texas, and they rely on coastal salt marshes and tidal ponds for feeding and roosting habitat as well as upland freshwater ponds for dietary drinking water during drought periods. These upland ponds were used extensively by wintering whooping cranes during a multi-year drought (2011-2014), and use terminated when frequent localized rainfall events occurred across the wintering range. Despite optimum bay salinities that occurred during this study (February-March 2016) in a 6-week winter period, whooping cranes continued to use at least 1 of the 3 upland ponds when tidal pond salinities were \u3e23 ppt, suggesting that need for dietary water is influenced by tidal pond salinities rather than bay salinities

Nineteenth-century Ship-based Catches of Gray Whales, Eschrichtius robustus, in the Eastern North Pacific

The 19th century commercial ship-based fishery for gray whales, Eschrichtius robustus, in the eastern North Pacific began in 1846 and continued until the mid 1870’s in southern areas and the 1880’s in the north. Henderson identified three periods in the southern part of the fishery: Initial, 1846–1854; Bonanza, 1855–1865; and Declining, 1866–1874. The largest catches were made by “lagoon whaling” in or immediately outside the whale population’s main wintering areas in Mexico—Magdalena Bay, Scammon’s Lagoon, and San Ignacio Lagoon. Large catches were also made by “coastal” or “alongshore” whaling where the whalers attacked animals as they migrated along the coast. Gray whales were also hunted to a limited extent on their feeding grounds in the Bering and Chukchi Seas in summer. Using all available sources, we identified 657 visits by whaling vessels to the Mexican whaling grounds during the gray whale breeding and calving seasons between 1846 and 1874. We then estimated the total number of such visits in which the whalers engaged in gray whaling. We also read logbooks from a sample of known visits to estimate catch per visit and the rate at which struck animals were lost. This resulted in an overall estimate of 5,269 gray whales (SE = 223.4) landed by the ship-based fleet (including both American and foreign vessels) in the Mexican whaling grounds from 1846 to 1874. Our “best” estimate of the number of gray whales removed from the eastern North Pacific (i.e. catch plus hunting loss) lies somewhere between 6,124 and 8,021, depending on assumptions about survival of struck-but-lost whales. Our estimates can be compared to those by Henderson (1984), who estimated that 5,542–5,507 gray whales were secured and processed by ship-based whalers between 1846 and 1874; Scammon (1874), who believed the total kill over the same period (of eastern gray whales by all whalers in all areas) did not exceed 10,800; and Best (1987), who estimated the total landed catch of gray whales (eastern and western) by American ship-based whalers at 2,665 or 3,013 (method-dependent) from 1850 to 1879. Our new estimates are not high enough to resolve apparent inconsistencies between the catch history and estimates of historical abundance based on genetic variability. We suggest several lines of further research that may help resolve these inconsistencies

In Situ ATR-SEIRAS of Carbon Dioxide Reduction at a Plasmonic Silver Cathode.

Illumination of a voltage-biased plasmonic Ag cathode during CO2 reduction results in a suppression of the H2 evolution reaction while enhancing CO2 reduction. This effect has been shown to be photonic rather than thermal, but the exact plasmonic mechanism is unknown. Here, we conduct an in situ ATR-SEIRAS (attenuated total reflectance-surface-enhanced infrared absorption spectroscopy) study of a sputtered thin film Ag cathode on a Ge ATR crystal in CO2-saturated 0.1 M KHCO3 over a range of potentials under both dark and illuminated (365 nm, 125 mW cm-2) conditions to elucidate the nature of this plasmonic enhancement. We find that the onset potential of CO2 reduction to adsorbed CO on the Ag surface is -0.25 VRHE and is identical in the light and the dark. As the production of gaseous CO is detected in the light near this onset potential but is not observed in the dark until -0.5 VRHE, we conclude that the light must be assisting the desorption of CO from the surface. Furthermore, the HCO3- wavenumber and peak area increase immediately upon illumination, precluding a thermal effect. We propose that the enhanced local electric field that results from the localized surface plasmon resonance (LSPR) is strengthening the HCO3- bond, further increasing the local pH. This would account for the decrease in H2 formation and increase the CO2 reduction products in the light

Fiduciary Law and the Preservation of Trust in Business Relationships

This chapter explores the role of mandatory fiduciary obligations in preserving trust between business parties. Because contracts are inevitably incomplete, after investment there is always a risk of opportunism. While the parties could try to draft a more detailed agreement prohibiting various forms of opportunism, the very act of haggling over such protections may signal distrust, eliciting costly reactions (defensive measures/hedging/lack of intrinsic motivation) in the counterparty. In the absence of fiduciary protections, a vulnerable party may decide to forgo important protections against opportunism, not because such protections are suboptimal or hard to specify ex ante but because bargaining for them would signal distrust. By contrast, state-imposed fiduciary obligations remove the invocation of distrust by either party to the agreement. We further observe that while fiduciary protections can help prevent distrust among a small number of contracting parties, fiduciary protections may prove inadequate in some settings, especially in addressing horizontal conflicts between beneficiaries. The chapter concludes by observing that the limits of contract and fiduciary law leave a residual zone of vulnerability in which trust and other mechanisms of risk reduction play a significant role

Fiduciary Law and the Preservation of Trust in Business Relationships

This chapter explores the role of mandatory fiduciary obligations in preserving trust between business parties. Because contracts are inevitably incomplete, after investment there is always a risk of opportunism. While the parties could try to draft a more detailed agreement prohibiting various forms of opportunism, the very act of haggling over such protections may signal distrust, eliciting costly reactions (defensive measures/hedging/lack of intrinsic motivation) in the counterparty. In the absence of fiduciary protections, a vulnerable party may decide to forgo important protections against opportunism, not because such protections are suboptimal or hard to specify ex ante but because bargaining for them would signal distrust. By contrast, state-imposed fiduciary obligations remove the invocation of distrust by either party to the agreement. We further observe that while fiduciary protections can help prevent distrust among a small number of contracting parties, fiduciary protections may prove inadequate in some settings, especially in addressing horizontal conflicts between beneficiaries. The chapter concludes by observing that the limits of contract and fiduciary law leave a residual zone of vulnerability in which trust and other mechanisms of risk reduction play a significant role

Factors influencing Raynaud condition score diary outcomes in systemic sclerosis

Objective. Raynaud phenomenon (RP) in systemic sclerosis (SSc) could be influenced by clinical phenotype, environmental factors (e.g., season), and personal factors (e.g., coping strategies and ill-health perceptions). We studied the relative influence of a range of putative factors affecting patient-reported assessment of SSc-RP severity. Methods. SSc patients were enrolled at UK and US sites. Participants completed the 2-week Raynaud Condition Score (RCS) diary alongside collection of patient demographics, clinical phenotype, the Coping Strategies Questionnaire, Pain Catastrophizing Scale, Scleroderma Health Assessment Questionnaire (SHAQ), and both patient/physician visual analog scale (VAS) assessments for RP, digital ulcer disease, and global disease. Environmental temperature data were obtained at each site. A second RCS diary was completed 6 months after enrollment. Results. We enrolled 107 patients (baseline questionnaires returned by 94). There were significant associations between RCS diary variables and both catastrophizing and coping strategies. There were significant associations between RCS diary outcomes and both environmental temperature and season of enrollment. Age, disease duration, sex, disease subtype, smoking, and vasodilator use were not associated with RCS diary outcomes. The best-fitting multivariate model identified the patient RP VAS, SHAQ pain VAS, and SHAQ gastrointestinal VAS subscales as the strongest independent predictors of the RCS. Conclusion. Patient-reported assessment of SSc-RP severity is associated with a number of factors including pain, catastrophizing, and coping strategies. The effects of seasonal variation in environmental temperature on SSc-RP burden has implications for clinical trial design. Treatments targeting SSc-RP pain and the development of behavioral interventions enhancing coping strategies may reduce the burden of SSc-RP.</p

Factors influencing Raynaud condition score diary outcomes in systemic sclerosis

Objective. Raynaud phenomenon (RP) in systemic sclerosis (SSc) could be influenced by clinical phenotype, environmental factors (e.g., season), and personal factors (e.g., coping strategies and ill-health perceptions). We studied the relative influence of a range of putative factors affecting patient-reported assessment of SSc-RP severity. Methods. SSc patients were enrolled at UK and US sites. Participants completed the 2-week Raynaud Condition Score (RCS) diary alongside collection of patient demographics, clinical phenotype, the Coping Strategies Questionnaire, Pain Catastrophizing Scale, Scleroderma Health Assessment Questionnaire (SHAQ), and both patient/physician visual analog scale (VAS) assessments for RP, digital ulcer disease, and global disease. Environmental temperature data were obtained at each site. A second RCS diary was completed 6 months after enrollment. Results. We enrolled 107 patients (baseline questionnaires returned by 94). There were significant associations between RCS diary variables and both catastrophizing and coping strategies. There were significant associations between RCS diary outcomes and both environmental temperature and season of enrollment. Age, disease duration, sex, disease subtype, smoking, and vasodilator use were not associated with RCS diary outcomes. The best-fitting multivariate model identified the patient RP VAS, SHAQ pain VAS, and SHAQ gastrointestinal VAS subscales as the strongest independent predictors of the RCS. Conclusion. Patient-reported assessment of SSc-RP severity is associated with a number of factors including pain, catastrophizing, and coping strategies. The effects of seasonal variation in environmental temperature on SSc-RP burden has implications for clinical trial design. Treatments targeting SSc-RP pain and the development of behavioral interventions enhancing coping strategies may reduce the burden of SSc-RP.</p