Stressors in the pharmacy: An observational of interruptions in pharmacy

Errors in the healthcare field are a significant problem. Interruptions leading to distractions can cause errors as these interruptions can distract the pharmacy workers from their tasks. Hence it is important to study interruptions, their types, how they are caused, where they come from, when they occur, how long they last, and how pharmacists and technicians feel about them. The objectives of this observational study were to: 1) classify interruptions based on the type of interruption and cause, time, location, and duration, 2) identify differences in interruption types, duration and frequency across days of the week or time of day, and the analysis of these stressors can aid in improving the processes and increasing safety within the pharmacy. Poster originally presented at the MU Spring 2011 Undergraduate Research and Creative Achievements Forum

Extracorporeal Shock Wave Therapy (ESWT) as a treatment for recurrent Neurogenic Heterotopic Ossification (NHO)

“This is an Accepted Manuscript of an article published by Taylor & Francis in Brain Injury on 5 Feb 2013, available online: http://www.tandfonline.com/10.3109/02699052.2012.729293." © 2013 Informa UK Ltd.Primary objective: To describe the effects of extracorporeal shock wave therapy (ESWT) on neurogenic heterotopic ossification (NHO). Research design: A single case study was considered the most appropriate methodology in this situation. Methods and procedures: The subject was a 43 year old female 10 years post-traumatic brain injury with recurring NHO around the hip joint. Baseline assessments of pain using a 10-point VAS, range of motion of the hip using a goniometer and walking ability (number of steps over a standard distance) were conducted. Four applications of ESWT using a Minispec™ Extracorporeal Shock Wave Lithotripsy machine (Medispec Int. USA) administered over 6 weeks to the anterolateral aspect of the right hip. Follow-up assessments were conducted weekly over the period of intervention and then monthly for 5 months. Main outcomes and results: Immediately following treatment, pain was reduced to 0 on the VAS scale; hip range of motion increased and the number of steps over a standard distance reduced, indicating increased step length. At 5-month follow-up, without further ESWT intervention, these results were maintained. Conclusion: This case study suggests that ESWT may be a non-invasive, low risk intervention for the management of NHO

Deaf-1 regulates epithelial cell proliferation and side-branching in the mammary gland

BACKGROUND: The transcription factor DEAF-1 has been identified as a high affinity binding partner of the LIM-only protein LMO4 that plays important roles in mammary gland development and breast cancer. Here we investigated the influence of DEAF-1 on human and mouse mammary epithelial cells both in vitro and in vivo and identified a potential target gene. RESULTS: Overexpression of DEAF-1 in human breast epithelial MCF10A cells enhanced cell proliferation in the mammary acini that develop in 3D cultures. To investigate the effects of Deaf-1 on mammary gland development and oncogenesis, we generated MMTV-Deaf-1 transgenic mice. Increased ductal side-branching was observed in young virgin mammary glands, accompanied by augmented cell proliferation. In addition, the ratio of the progesterone receptor isoforms PRA and PRB, previously implicated in regulating ductal side-branching, was altered. Affymetrix gene profiling studies revealed Rac3 as a potential target gene and quantitative RT-PCR analysis confirmed that Rac3 was upregulated by Deaf-1 in immortalized mouse mammary epithelial cells. Furthermore, MMTV-Deaf-1 transgenic mammary glands were found to have elevated levels of Rac3 mRNA, suggesting that it is a bona fide target. CONCLUSION: We have demonstrated that overexpression of Deaf-1 enhances the proliferation of human breast epithelial cells in vitro and mouse epithelial cells in vivo. Transgenic mammary glands overexpressing Deaf-1 exhibited a modest side-branching phenotype, accompanied by an increase in the number of BrdU-positive cells and a decrease in the proportion of PRA-expressing cells. Although proliferation was enhanced in Deaf-1 transgenic mice, overexpression of this gene was not sufficient to induce the formation of mammary tumors. In addition, our studies identified Rac3, encoding a small Rho-like GTPase, as a potential target of Deaf-1 in mouse mammary epithelial cells

The Iowa Homemaker vol.9, no.2

What the Graduate May Do by Mary Elva Sather, page 1 Art in Flower Arrangement by Ruth Dean, page 2 Here Comes the Bride by Dorothy Anderson, page 3 Grading Market Eggs by Jean Guthrie, page 3 Art and Artists, page 4 4-H Club by Mrs. Edith Barker, page 6 Home Economics Association by Marcia E. Turner, page 8 Mrs. Scott Takes a Vacation by Isabel Leith, page 10 Editorial, page 11 Alumnae News by Vera Caulum, page 1

The Iowa Homemaker vol.7, no.9

New Spring Millinery by Gladys Parker, page 1 What Can We Expect of the Young Child? by Marguerite Herr, page 2 New German Architecture by Lotte Matschoss, page 4 After Graduation – What? by Mrs. Mary Elva Crockett, page 5 4-H Club by Mrs. Edith Barker, page 6 State Association Page by Marcia E. Turner, page 8 Home Economics Research at Iowa State by Melba Nisewanger, page 10 Editorial, page 11 Who’s There and Where by Vera Caulum, page 12 Life in East India by Frances Thomas, page 14 Home Economics Vod-Vil, page 1

Influences on the diet quality of pre-school children:importance of maternal psychological characteristics

OBJECTIVE: To test the hypothesis that maternal psychological profiles relate to children's quality of diet. DESIGN: Cross-sectional study. Mothers provided information on their health-related psychological factors and aspects of their child's mealtime environment. Children's diet quality was assessed using an FFQ from which weekly intakes of foods and a diet Z-score were calculated. A high score described children with a better quality diet. Cluster analysis was performed to assess grouping of mothers based on psychological factors. Mealtime characteristics, describing how often children ate while sitting at a table or in front of the television, their frequency of takeaway food consumption, maternal covert control and food security, and children's quality of diet were examined, according to mothers' cluster membership. SUBJECTS: Mother-child pairs (n 324) in the Southampton Initiative for Health. Children were aged 2-5 years. SETTING: Hampshire, UK. RESULTS: Two main clusters were identified. Mothers in cluster 1 had significantly higher scores for all psychological factors than mothers in cluster 2 (all P < 0.001). Clusters were termed 'more resilient' and 'less resilient', respectively. Children of mothers in the less resilient cluster ate meals sitting at a table less often (P = 0.03) and watched more television (P = 0.01). These children had significantly poorer-quality diets (β = -0.61, 95% CI -0.82, -0.40, P ≤ 0.001). This association was attenuated, but remained significant after controlling for confounding factors that included maternal education and home/mealtime characteristics (P = 0.006). CONCLUSIONS: The study suggests that mothers should be offered psychological support as part of interventions to improve children's quality of diet

Medium Truck Duty Cycle Data from Real-World Driving Environments: Final Report

Since the early part of the 20th century, the US trucking industry has provided a safe and economical means of moving commodities across the country. At present, nearly 80% of US domestic freight movement involves the use of trucks. The US Department of Energy (DOE) is spearheading a number of research efforts to improve heavy vehicle fuel efficiencies. This includes research in engine technologies (including hybrid and fuel cell technologies), lightweight materials, advanced fuels, and parasitic loss reductions. In addition, DOE is developing advanced tools and models to support heavy vehicle research and is leading the 21st Century Truck Partnership and the SuperTruck development effort. Both of these efforts have the common goal of decreasing the fuel consumption of heavy vehicles. In the case of SuperTruck, a goal of improving the overall freight efficiency of a combination tractor-trailer has been established. This Medium Truck Duty Cycle (MTDC) project is a critical element in DOE s vision for improved heavy vehicle energy efficiency; it is unique in that there is no other existing national database of characteristic duty cycles for medium trucks based on collecting data from Class 6 and 7 vehicles. It involves the collection of real-world data on medium trucks for various situational characteristics (e.g., rural/urban, freeway/arterial, congested/free-flowing, good/bad weather) and looks at the unique nature of medium trucks drive cycles (stop-and-go delivery, power takeoff, idle time, short-radius trips). This research provides a rich source of data that can contribute to the development of new tools for FE and modeling, provide DOE a sound basis upon which to make technology investment decisions, and provide a national archive of real-world-based medium-truck operational data to support energy efficiency research. The MTDC project involved a two-part field operational test (FOT). For the Part-1 FOT, three vehicles each from two vocations (urban transit and dry-box delivery) were instrumented for the collection of one year of operational data. The Part-2 FOT involved the towing and recovery and utility vocations for a second year of data collection. The vehicles that participated in the MTDC project did so through gratis partnerships in return for early access to the results of this study. Partnerships such as these are critical to FOTs in which real-world data is being collected. In Part 1 of the project, Oak Ridge National Laboratory (ORNL) established partnerships with the H.T. Hackney Company (HTH), one of the largest wholesale distributors in the country, distributing products to 21 states; and with Knoxville Area Transit (KAT), the city of Knoxville s transit system, which operates across Knoxville and parts of Knox County. These partnerships and agreements provided ORNL access to three Class-7 day-cab tractors that regularly haul 28 ft pup trailers (HTH) and three Class-7 buses for the collection of duty cycle data. In addition, ORNL collaborated with the Federal Motor Carrier Safety Administration (FMCSA) to determine if there were possible synergies between this duty cycle data collection effort and FMCSA s need to learn more about the operation and duty cycles of medium trucks. FMCSA s primary interest was in collecting safety data relative to the driver, carrier, and vehicle. In Part 2 of the project, ORNL partnered with the Knoxville Utilities Board, which made available three Class-8 trucks. Fountain City Wrecker Service was also a Part 2 partner, providing three Class-6 rollback trucks. In order to collect the duty cycle and safety-related data, ORNL developed a data acquisition system (DAS) that was placed on each test vehicle. Each signal recorded in this FOT was collected by means of one of the instruments incorporated into each DAS. Other signals were obtained directly from the vehicle s J1939 and J1708 data buses. A VBOX II Lite collected information available from a global positioning system (GPS), including speed, acceleration, and spatial location information at a rate of 5 Hz for the Part 1 FOT. For the Part 2 FOT, this information was obtained from DAS-based GPS instrumentation. The Air-Weigh LoadMaxx, a self-weighing system that determines the vehicle s gross weight by means of pressure transducers, was used to collect vehicle payload information for the combination, urban transit, and towing and recovery vehicles. A cellular modem, the Raven X EVDO V4221, facilitated the communication between the eDAQ-lite (the data collection engine of the system) and the user. The modem functioned as a wireless gateway, allowing data retrievals and system checks to be performed remotely. Also, in partnership with FMCSA, two additional safety sensors were installed on the combination vehicles: the MGM e-Stroke brake monitoring system and the Tire SafeGuard tire pressure monitoring system. All of these sensors posted data to the J1939 data bus, enabling the signals to be read withou..

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members