The impact of a post-take ward round pharmacist on the risk score and enactment of medication-related recommendations

There is a scarcity of published research describing the impact of a pharmacist on the post-take ward round (PTWR) in addition to ward-based pharmacy services. The aim of this paper was to evaluate the impact of clinical pharmacists' participation on the PTWR on the risk assessment scores of medication-related recommendations with and without a pharmacist. This includes medication-related recommendations occurring on the PTWR and those recommendations made by the ward-based pharmacist on the inpatient ward. A pre-post intervention study was undertaken that compared the impact of adding a pharmacist to the PTWR compared with ward-based pharmacist services alone. A panel reviewed the risk of not acting on medication recommendations that was made on the PTWR and those recorded by the ward-based pharmacist. The relationship between the risk scores and the number and proportion of recommendations that led to action were compared between study groups. There were more medication-related recommendations on the PTWR in the intervention group when a pharmacist was present. Proportionately fewer were in the 'very high and extreme' risk category. Although there was no difference in the number of ward pharmacist recommendations between groups, there was a significantly higher proportion of ward pharmacist recommendations in the "very high and extreme" category in those patients who had been seen on a PTWR attended by a pharmacist than when a pharmacist was not present. There were a greater proportion of "low and medium" risk actionable medication recommendations actioned on the PTWR in the intervention group; and no difference in the risk scores in ward pharmacist recommendations actioned between groups. Overall, the proportion of recommendations that were actioned was higher for those made on the PTWR compared with the ward. The addition of a pharmacist to the PTWR resulted in an increase in low, medium, and high risk recommendations on the PTWR, more very high and extreme risk recommendations made by the ward-based pharmacist, plus an increased number of recommendations being actioned during the patients' admission

The biogeochemical influence of nitrate, dissolved oxygen, and dissolved organic carbon on stream nitrate uptake

Streams are potential hotspots for retention and removal of NO3−, and understanding the mechanisms that enhance NO3− reactivity in stream systems is critical for predicting and preventing eutrophication. Both dissolved organic C (DOC) and dissolved O2 (DO) influence NO3− removal processes. Assessing the individual impacts of NO3−, DO, and DOC concentrations on stream NO3− removal is difficult because these factors covary and are coupled through the C and N cycles. We used an experimental approach to quantify the influences of NO3−, DOC, and DO on NO3− transport in headwater streams of the Ipswich and Parker River watersheds (Massachusetts, USA) with contrasting levels of DOC and DO. In a 1st set of experiments, we added NO3− to address how uptake kinetics differed between a low-DO/high-DOC stream (Cedar Swamp Creek) and a high-DO/low-DOC stream (Cart Creek). In a 2nd set of experiments, we manipulated, for the first time at the reach scale, both DO and DOC in a factorial experiment. DO was added to the low-DO stream by injecting O2 and was removed from the high-DO stream by adding sodium sulfite. DOC was added both alone and in combination with the DO manipulations. NO3− concentration was an important control of NO3− uptake velocity in our study streams, consistent with previous findings. The results of the DOC and DO manipulations suggested that DO determines whether a stream has net NO3− uptake or production and that the presence of DOC magnifies the DO response processes. Addition of DOC by itself did not lead to increased NO3− uptake. In addition, we observed organic matter priming effects, wherein the addition of labile organic matter resulted in accelerated metabolism of naturally occurring DOC in the water column. Priming effects have not been reported previously in stream systems. Results from our experiments suggest that NO3− uptake in streams might arise from complex interactions among DOC, DO, and NO3−, and ultimately, from the influence of DO on dominant stream processes

Building Sustainable Research Engagements: Lessons Learned From Research With Schools

Engaged scholarship, translational science, integrated research, and interventionist research, all involve bringing research into a practical context. These usually require working with communities and institutions, and often involve community based participatory research. The article offers practical guidance for engaged research. The authors have experience in doing medical research with schools. There are very few guiding principles or literature to assist the school-based researcher, especially outside of educational research. Practical guidance for all community investigators is in short supply. The dual purpose of this article is to provide a comprehensive framework for conducting school based research and to offer broad-based guidance, and a set of heuristics, for engaged researchers

Separation of river network–scale nitrogen removal among the main channel and two transient storage compartments

Transient storage (TS) zones are important areas of dissolved inorganic nitrogen (DIN) processing in rivers. We assessed sensitivities regarding the relative impact that the main channel (MC), surface TS (STS), and hyporheic TS (HTS) have on network denitrification using a model applied to the Ipswich River in Massachusetts, United States. STS and HTS connectivity and size were parameterized using the results of in situ solute tracer studies in first‐ through fifth‐order reaches. DIN removal was simulated in all compartments for every river grid cell using reactivity derived from Lotic Intersite Nitrogen Experiment (LINX2) studies, hydraulic characteristics, and simulated discharge. Model results suggest that although MC‐to‐STS connectivity is greater than MC‐to‐HTS connectivity at the reach scale, at basin scales, there is a high probability of water entering the HTS at some point along its flow path through the river network. Assuming our best empirical estimates of hydraulic parameters and reactivity, the MC, HTS, and STS removed approximately 38%, 21%, and 14% of total DIN inputs during a typical base flow period, respectively. There is considerable uncertainty in many of the parameters, particularly the estimates of reaction rates in the different compartments. Using sensitivity analyses, we found that the size of TS is more important for DIN removal processes than its connectivity with the MC when reactivity is low to moderate, whereas TS connectivity is more important when reaction rates are rapid. Our work suggests a network perspective is needed to understand how connectivity, residence times, and reactivity interact to influence DIN processing in hierarchical river systems

A Geoarcheological Survey of the Proposed Plainview Hike and Bike Trail, Hale County, Texas

In March of 2005, the Texas Department of Transportation issued work authorization #575-01-SA005 to the Center for Archaeological Research (CAR) at the University of Texas at San Antonio to conduct a survey of areas affected by proposed improvements to the Plainview hike and bike trail in southern Plainview, Hale County, Texas. The survey was conduced under Texas Antiquities Permit #3707 between March 31 and April 7, 2005. Steve Tomka and Raymond Mauldin served as Principal Investigators. Trail construction included 2.0 miles of additional construction and 1.3 miles of improvements to existing trails. The Right-of-Way is 50 feet and extends from one to three feet below ground surface. Archeological services included a pedestrian survey, excavation of fifty-five auger tests placed no more than 100 m apart, and twenty-one Gradall trenches. Two of these trenches exposed the stratigraphy of Running Water Draw near the Plainview Site, 41HA1. Bulk samples were collected for OSL dating, diatoms analysis, and lithologic analysis for further examination of the age and stratigraphic context of the Plainview Site, which is a State Archeological Landmark, a National Landmark, and a National Register of Historic Places property. Site 41HA12 was re-examined with 10 mechanical auger tests and 1 trench, which found only recent alluvial and cultural deposition. No additional archeological sites were recorded. This report includes descriptions of the fieldwork, results of the special analyses performed on bulk sediment samples collected, and a discussion of the geomorphology of Running Water Draw with specific focus on the results from trenches excavated near the Plainview Site. The single artifact and all documents and photographs generated from this project are curated at the Center for Archaeological Research at The University of Texas at San Antonio

Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012.

BACKGROUND: Risks of adverse birth outcomes in England and Wales are relatively low but vary across ethnic groups. We aimed to explore the role of mother's country of birth on birth outcomes across ethnic groups using a large population-based linked data set. METHODS: We used a cohort of 4.6 million singleton live births in England and Wales to estimate relative risks of neonatal mortality, infant mortality and preterm birth, and differences in birth weight, comparing infants of UK-born mothers to infants whose mothers were born in their countries or regions of ethnic origin, or elsewhere. RESULTS: The crude neonatal and infant death risks were 2.1 and 3.2 per 1000, respectively, the crude preterm birth risk was 5.6% and the crude mean birth weight was 3.36 kg. Pooling across all ethnic groups, infants of mothers born in their countries or regions of ethnic origin had lower adjusted risks of death and preterm birth, and higher gestational age-adjusted mean birth weights than those of UK-born mothers. White British infants of non-UK-born mothers had slightly lower gestational age-adjusted mean birth weights than White British infants of UK-born mothers (mean difference -3 g, 95% CI -5 g to -0.3 g). Pakistani infants of Pakistan-born mothers had lower adjusted risks of neonatal death (adjusted risk ratio (aRR) 0.84, 95% CI 0.72 to 0.98), infant death (aRR 0.84, 95% CI 0.75 to 0.94) and preterm birth (aRR 0.85, 95% CI 0.82 to 0.88) than Pakistani infants of UK-born Pakistani mothers. Indian infants of India-born mothers had lower adjusted preterm birth risk (aRR 0.91, 95% CI 0.87 to 0.96) than Indian infants of UK-born Indian mothers. There was no evidence of a difference by mother's country of birth in risk of birth outcomes among Black infants, except Black Caribbean infants of mothers born in neither the UK nor their region of origin, who had higher neonatal death risks (aRR 1.71, 95% CI 1.06 to 2.76). CONCLUSION: This study highlights evidence of better birth outcomes among UK-born infants of non-UK-born minority ethnic group mothers, and could inform the design of future interventions to reduce the risks of adverse birth outcomes through improved targeting of at-risk groups