An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: The role of written and spoken communication

We tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing

Success in Managing Waste With No Identified Path to Disposal at the INEEL

The Idaho National Engineering and Environmental Laboratory (INEEL) is aggressively managing waste with no identified path to disposal (WNPD), which was previously termed special case waste (SCW). As a result of several years of this aggressive management, the INEEL has reduced its WNPD volume from approximately 38,000 m3 in 1993 to approximately 6.33 m3 in 1999. This paper discusses how the INEEL reduced its WNPD volume. It specifically discusses the beryllium reflector waste produced from the Advanced Test Reactor (ATR) as an example of the INEEL's success in managing its WNPD. The INEEL's success in reducing its WNPD volume is the result of establishing long-range strategic objectives and consistently allocating an annual budget to implement specific work tasks that are consistent with these objectives. In addition, specific short- and long-range work tasks were developed and documented in work control documents. The work tasks are evaluated annually for consistency with the strategic objectives. Since the INEEL has successfully reduced its WNPD volume, it is now focusing on disposing of the remaining volume and preventing future generation of WNPD. As a result of this focused effort, a life-cycle disposal plan was developed for the Advanced Test Reactor (ATR) beryllium waste. This plan covers beryllium reflectors currently stored in the ATR canal and beryllium reflectors generated through 2050. This plan includes a pollution prevention (P2) opportunity, which applies to the DOE complex reactor beryllium reflector waste stream. The P2 opportunity also contributes to planning for the international nuclear industry to extend the life and reduce the radionuclide activation of nonfuel material in existing and newly developed test reactor nuclear power systems. In Fiscal Year 2000, the INEEL is focusing on further reducing its WNPD volume. To completely dispose of the INEEL WNPD, it will need a national plan for disposing of some WNPD categories. Therefore, the INEEL WNPD Program is participating in the DOE complex integrated planning process for legacy and future generated WNPD waste

Practical applications of multi-agent systems in electric power systems

The transformation of energy networks from passive to active systems requires the embedding of intelligence within the network. One suitable approach to integrating distributed intelligent systems is multi-agent systems technology, where components of functionality run as autonomous agents capable of interaction through messaging. This provides loose coupling between components that can benefit the complex systems envisioned for the smart grid. This paper reviews the key milestones of demonstrated agent systems in the power industry and considers which aspects of agent design must still be addressed for widespread application of agent technology to occur

Phenolic metabolites of anthocyanins following a dietary intervention study in post-menopausal women

Scope Numerous studies feeding anthocyanin-rich foods report limited bioavailability of the parent anthocyanins. The present study explores the identity and concentration of the phenolic metabolites of anthocyanins in humans. Methods and results Anthocyanin metabolites were quantified in samples collected from a previously conducted 12-wk elderberry intervention study in healthy post-menopausal women. Individual 1-, 2- and 3-h post-bolus urine samples and pooled plasma samples following acute (single bolus) and chronic (12-wk supplementation) anthocyanin consumption (500 mg/day) were analysed using HPLC-ESI-MS/MS. Twenty-eight anthocyanin metabolites were identified in urine and 21 in plasma (including sulfates of vanillic, protocatechuic and benzoic acid). Phenolic metabolites reached peak concentrations of 1237 nM in plasma, while anthocyanin conjugates only reached concentrations of 34 nM. Similarly, in urine, phenolic metabolites were detected at concentrations of 33 185 ± 2549 nM/mM creatinine, while anthocyanin conjugates reached concentrations of 548 ± 219 nM/mM creatinine. There was no evidence that chronic exposure had any impact on either the profile or quantity of metabolites recovered relative to acute exposure. Conclusion An extensive range of phenolic metabolites of anthocyanin was identified following elderberry consumption in humans, including 11 novel metabolites, which were identified at much higher concentrations than their parent compounds

Screening mammography uptake within Australia and Scotland in rural and urban populations

Objective. To test the hypothesis that rural populations had lower uptake of screening mammography thanurban populations in the Scottish and Australian setting.Method. Scottish data are based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invitedto attend for screening during the 2008 to 2010 round (N = 27,416). Australian data were drawn from the 2010survey of the 1946–51 cohort of the Australian Longitudinal Study on Women's Health (N = 9890 women).Results. Contrary to our hypothesis, results indicated that women living in rural areas were not less likely toattend for screening mammography compared to women living in urban areas in both Scotland (OR for rural =1.17, 95% CI = 1.06–1.29) and Australia (OR for rural = 1.15, 95% CI = 1.01–1.31).Conclusions. The absence of rural–urban differences in attendance at screening mammography demonstratesthat rurality is not necessarily an insurmountable barrier to screening mammograph

Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation

BackgroundPhysical activity (PA) programmes effective under ‘research’ conditions may not be effective under ‘real-world’ conditions. A potential solution is to refer patients to existing PA community-based PA services.MethodsA process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-deliveredPA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD.ResultsIn Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends.ConclusionsThe current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity

Domain-based perceptions of risk:a case study of lay and technical community attitudes towards managed aquifer recharge

Despite growing water scarcity, communities in many parts of the developed world often reject technically and economically sound options for water augmentation. This paper reports findings from a study investigating risk perceptions associated with a proposed Managed Aquifer Recharge scheme in Australia. Q-Methodology was used to compare decision-making frameworks of lay community and „technical expert‟ participants. Technical expert participants were also asked to approximate the decision-making framework of a „typical‟ community member. The emerging contrasts between lay community frameworks and those approximated by technical experts suggest that there are prevailing yet errant assumptions about lay community attitudes towards new technologies. The findings challenge the characterisation of the lay community and technical experts as being in entrenched opposition with one another

Smoking cessation during pregnancy: the influence of partners, family and friends on quitters and non-quitters

This research compared pregnant quitters’ and non-quitters’ accounts of how partners, family and friends influenced their smoking cessation attempts. Qualitative secondary data analysis was carried out on a purposive sample of motivational interview transcripts undertaken by research midwives with pregnant women as part of SmokeChange, a smoking cessation intervention. Interviews with all quitters in the intervention group (n = 12) were analysed comparatively with interviews from a matched sample of non-quitters (n = 12).The discourses of both revealed similarity in how their partners, family and friends influenced their cessation efforts: salient others were simultaneously perceived by both groups of women as providing drivers and barriers to quit attempts; close associates who smoked were often perceived to be as supportive as those who did not. However, women who quit smoking during pregnancy talked more about receiving active praise/encouragement than those who did not. While close associates play an important role in women’s attempts to stop smoking during pregnancy, the support they provide varies; further research is needed to develop a better understanding of how key relationships help or hinder cessation during pregnancy

Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation

Background:Physical activity (PA) programmes effective under ‘research’ conditions may not be effective under ‘real-world’ conditions. A potential solution is to refer patients to existing PA community-based PA services.Methods:A process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD.Results:In Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends.Conclusions:The current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity

The Impact of Membrane Lipid Composition on Macrophage Activation in the Immune Defense against Rhodococcus equi and Pseudomonas aeruginosa

Nutritional fatty acids are known to have an impact on membrane lipid composition of body cells, including cells of the immune system, thus providing a link between dietary fatty acid uptake, inflammation and immunity. In this study we reveal the significance of macrophage membrane lipid composition on gene expression and cytokine synthesis thereby highlighting signal transduction processes, macrophage activation as well as macrophage defense mechanisms. Using RAW264.7 macrophages as a model system, we identified polyunsaturated fatty acids (PUFA) of both the n-3 and the n-6 family to down-regulate the synthesis of: (i) the pro-inflammatory cytokines IL-1β, IL-6 and TNF-α; (ii) the co-stimulatory molecule CD86; as well as (iii) the antimicrobial polypeptide lysozyme. The action of the fatty acids partially depended on the activation status of the macrophages. It is particularly important to note that the anti-inflammatory action of the PUFA could also be seen in case of infection of RAW264.7 with viable microorganisms of the genera R. equi and P. aeruginosa. In summary, our data provide strong evidence that PUFA from both the n-3 and the n-6 family down-regulate inflammation processes in context of chronic infections caused by persistent pathogens