Comparison of Best Management Practice Adoption Between Virginia\u27s Chesapeake Bay Basin and Southern Rivers Watersheds

Producers in two regions of Virginia (Chesapeake Bay basin and Southern Rivers region) were surveyed to compare farming practices and agricultural best management practice (BMP) adoption. Objectives were to assess farming operations and determine the extent of cost-share and non-cost-share BMP implementation and gain insight into the impact of selected socioeconomic factors on the BMP adoption. Although farming characteristics and producer attitudes toward pollution and water quality were similar, BMP implementation differed between the two regions. Differences in BMP implementation may be due to a more focused, longer-term NPS pollution control educational effort in the Bay basin

Impact of medical scribes on dermatology trainee and attending experience

Background: Medical scribe integration into academic dermatology practices results in decreased attending documentation time, improved physician efficiency, and positive patient satisfaction. However, scribes' impact on dermatology education has not been explored. Methods: We conducted a cross-sectional survey at the Brigham and Women's Hospital Dermatology Department and its associated residency program assessing trainee and attending perceptions of scribe impact on documentation time, teaching time, and quality of teaching. Results: Thirty-nine surveys (67% of eligible population) were analyzed. The majority of faculty and trainees perceived that scribes decreased documentation time (92% attendings, 88% trainees), increased attendings' direct teaching time (57% attendings, 76% trainees), increased attending availability to answer questions (57% attendings, 68% trainees), and improved overall education (57% attendings, 80% trainees). Trainees generally perceived educational benefits of scribes more strongly than attendings. Trainees and attendings had discordant views regarding number of patients that the trainee sees (29% attendings, 72% trainees, P<0.05) and the amount of supervision provided for procedures (43% attendings, 56% trainees). Conclusions: The positive impact of scribes on dermatology education is consistent with results in other disciplines. Although hospitals typically invest in scribes to increase physician efficiency, this study suggests that scribes can also improve the educational experience

Synthesis and Single-Electron Oxidation of Bulky Bis(m-terphenyl)chalcogenides: The Quest for Kinetically Stabilized Radical Cations

Sterically encumbered bis(m-terphenyl)chalcogenides, (2,6-Mes2C6H3)2E (E=S, Se, Te) were obtained by the reaction of the chalcogen tetrafluorides, EF4, with three equivalents of m-terphenyl lithium, 2,6-Mes2C6H3Li. The single-electron oxidation of (2,6-Mes2C6H3)2Te using XeF2/K[B(C6F5)4] afforded the radical cation [(2,6-Mes2C6H3)2Te][B(C6F5)4] that was isolated and fully characterized. The electrochemical oxidation of the lighter homologs (2,6-Mes2C6H3)2E (E=S, Se) was irreversible and impaired by rapid decomposition

Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis : an international, multidisciplinary Delphi-based consensus

Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.Peer reviewe

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice

Botanical drugs and preparations in the traditional medicine of West Azerbaijan (Iran)

We present the results of an investigation of the traditional ethnobotany and ethnomedicine of West Azerbaijan (Iran). Tn this region medicinal plants are often the only easily accessible health care alternative for most of the population in rural areas and in fact folk herbal medicine is the most used remedy to cure common diseases. In this paper we present the most frequently used native species and the most common preparations made from them, in order to preserve the plant popular knowledge, which has traditionally been only an oral one. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

On a three-dimensional volume tracking model of droplet impact

A three-dimensional model has been developed, of droplet impact onto asymmetric surface geometries. The model is based on RIPPLE, and com-bines a xed-grid control volume discretization of the ow equations with a volume tracking algorithm to track the droplet free surface. Surface tension is modelled as a volume force acting on uid near the free surface. Contact angles are applied as a boundary condition at the contact line. The results of two scenarios are presented, of the oblique impact of a 2 mm water droplet at 1 m/s ontoa45 o incline, and of a similar impact of a droplet onto a sharp edge. Photographs are presented of such impacts, against which the numer-ical results are compared. The contact angle boundary condition is applied in one of two ways. For the impact onto an incline, the temporal variation of contact angles at the leading and trailing edges of the droplet was mea-sured from photographs. This data is applied as a boundary condition to the simulation, and an interpolation scheme proposed to evaluate contact angles between the leading and trailing edges. A simpler model is then proposed, for contact angle as a function of contact line velocity, and applied to both ge-ometries. The model requires values of only two contact angles, at a rapidly advancing and a rapidly receding contact line. Simulation results compare well with photographic data. 1 I