Implementation of an Outpatient, Pharmacist-Directed Clinic for Chronic Obstructive Pulmonary Disease

Objective: To describe development and challenges of implementing a pharmacist-led chronic obstructive pulmonary disease (COPD) clinic in the primary care setting. Methods: Starting in October 2014, patients scoring 10-30 on the COPD Assessment Test (CAT) were assigned to the intervention or control group. Intervention patients met with a pharmacist, who provided medication and lifestyle counseling and therapy recommendations to the patients’ primary provider per protocol. Control patients were encouraged to make an appointment with their primary provider for standard care. Two months following the initial CAT administration, the survey was administered again to both study groups by phone. The primary outcome was a comparison of change in CAT scores from baseline between the groups. Secondary outcomes included an analysis of medications, smoking status, vaccination status, hospital stays, visit attendance, and self-evaluation of disease progression. Results: Of the 163 patients contacted, 29 were enrolled. Ninety-one percent of the patients screened with the CAT were eligible based on the CAT requirement with an average baseline CAT score of 18.75. The primary outcome, change in follow up CAT scores, were similar for intervention patients (n=18) versus control patients (n=11), +0.8 versus +0.7 respectively. Four of the intervention patients attended their clinic visit resulting in a 22% show rate. Conclusion: Although our study was underpowered to detect between group differences, the elevated baseline CAT scores support the need for therapy optimization in patients with COPD. Pharmacists are well qualified to meet this need by providing medication counseling, smoking cessation, and therapy management. Additional randomized controlled studies are needed to support improved outcomes for patients with COPD when pharmacists are part of the clinical patient care team

Upper-Crustal Magma Evolution at Intermediate Arc Systems : Uranium-Series Zircon Chronochemistry of the Unzen Volcanic Complex, Southwestern Japan

Crystal-rich (40-50 vol.%) intermediate lava has been the primary eruptive product of several recent hazardous eruptions: Mt. Pinatubo, Philippines (1991), Soufriere Hills, Montserrat (1995-present), and Unzen, Japan (1990-1995). Despite this association with such devastating eruptions, the formation, timing, and evacuation of such magma is not well understood: do such eruptions tap a long-lived, multi-cycle crystal mush, or, is it generated in a single magmatic cycle prior to eruption? This thesis explores this question through research at the Unzen Volcanic Complex (UVC), southwestern Japan, where a 500 ka history of crystal-rich dacitic dome eruptions has built the Unzen Volcanic Complex. Previous studies (e.g. Nakamura, 1995) have demonstrated the role of mafic recharge in rejuvenating crystal mush zone a few months prior to the most recent eruptions, but - until now - its formation and evolution have not been investigated using detailed geochronology. Now, this gap has been addressed through U/Th zircon geochronology and zircon chemistry studies (zircon chronochemistry) on several eruptions, spanning in age from the most recent (Heisei-Shinzan; 1990-1995) to lavas of the Older Unzen period (≥200 ka). Zircon geochronology has revealed the protracted history and evolution of the crystal mush zone at the Unzen Volcanic Complex. Individual zircon surface-interior age pairs, together with zircon age spectra, suggest that portions of this crystal mush have been present in the crust since at least the late Older Unzen period (≥200 ka). Significant zircon growth appears to occur throughout the eruptive hiatus (200-100 ka), suggesting that magmatic activity continued uninterrupted through this period. Zircon chemistry shows that UVC crystals are typical of unaltered, igneous zircon, and - overall - zircon crystals show a restricted range in trace element chemistry in all eruption samples. Ti-in-zircon temperatures show that zircon crystalizes from a low temperature (≤790˚C) magma, in agreement with previous temperatures estimates for UVC upper-crustal magma (e.g. Venezky and Rutherford 1999). Subtle variations in trace element chemistry are observed in titanium and hafnium content through time: titanium contents show a moderate negative correlation with time, while hafnium shows a moderate positive correlation. This suggests that the crystal mush zone has evolved towards a more mature, heterogeneous system. Additionally, Older Unzen eruption samples show restricted chemistry, suggesting that crystallization occurred in a more homogenous, less evolved and possibly warmer crystal mush, compared to zircon of Younger Unzen (100 ka - present) that record variable storage conditions skewed towards a more evolved, poorly-mixed crystal mush. Complex age populations, particularly from samples of the Younger Unzen period, suggest that localized regions within the crystal mush may have different thermal histories. These results lead to the conclusion that eruptions at Unzen are tapping a mature and long-lived, multi-cycle mush of significant longevity

Faking revisited : exerting strategic control over performance on the implicit relational assessment procedure

Across four studies, we demonstrate that effects obtained from the Implicit Relational Assessment Procedure, like those obtained from other indirect procedures, are not impervious to strategic manipulation. In experiment 1, we found that merely informing participants to "fake" their performance without providing a concrete strategy to do so did not eliminate, reverse, or in any way alter the obtained outcomes. However, when those same instructions orientated attention toward the core parameters of the task, participants spontaneously derived a strategy that allowed them to eliminate their effects (experiment 2). When the participants were provided with a viable response strategy, they successfully reversed the direction of their overall Implicit Relational Assessment Procedure effect (experiment 3). By refining the nature of those instructions, we managed to target and alter individual trial-type effects in isolation with some success (experiment 4)

Library Monthly - May 2017

In this issue: A Salute to Our Graduating Seniors Library Survey Results Musicians and Injuries Evaluating Websites New Librarian Alert! Late Night Circulation Assistant Marisha Kellyhttps://spiral.lynn.edu/libpubs/1010/thumbnail.jp

Economic analysis of early intervention for autistic children: findings from four case studies in England, Ireland, Italy and Spain

Background: Many autistic children experience difficulties in their communication and language skills development, with consequences for ’social development into adulthood, often resulting in challenges over the life-course and high economic impacts for individuals, families and society. The PACT (Preschool-Autism-Communication-Trial) intervention is effective in terms of improved social communication and some secondary outcomes. A previously published within-trial economic analysis found that results at 13 months did not support its cost-effectiveness. We modelled cost-effectiveness over 6 years and across four European countries. Methods: Using simulation modelling, we built on economic analyses in the original trial, exploring longer-term cost-effectiveness at 6 years (in England). We adapted our model to undertake an economic analysis of PACT in Ireland, Italy and Spain. Data on resource use were taken from the original trial and a more recent Irish observational study. Results: PACT is cost-saving over time from a societal perspective, even though we confirmed that, at 13 months post-delivery, PACT is more expensive than usual treatment (across all countries) when given to preschool autistic children. After 6 years, we found that PACT has lower costs than usual treatment in terms of unpaid care provided by parents (in all countries). Also, if we consider only out-of-pocket expenses from an Irish study, PACT costs less than usual treatment. Discussion: PACT may be recommended as a cost-saving early intervention for families with an autistic child

Assessing the Total Effect of Time-Varying Predictors in Prevention Research

Observational data are often used to address prevention questions such as, “If alcohol initiation could be delayed, would that in turn cause a delay in marijuana initiation?” This question is concerned with the total causal effect of the timing of alcohol initiation on the timing of marijuana initiation. Unfortunately, when observational data are used to address a question such as the above, alternative explanations for the observed relationship between the predictor, here timing of alcohol initiation, and the response abound. These alternative explanations are due to the presence of confounders. Adjusting for confounders when using observational data is a particularly challenging problem when the predictor and confounders are time-varying. When time-varying confounders are present, the standard method of adjusting for confounders may fail to reduce bias and indeed can increase bias. In this paper, an intuitive and accessible graphical approach is used to illustrate how the standard method of controlling for confounders may result in biased total causal effect estimates. The graphical approach also provides an intuitive justification for an alternate method proposed by James Robins [Robins, J. M. (1998). 1997 Proceedings of the American Statistical Association, section on Bayesian statistical science (pp. 1–10). Retrieved from http://www.biostat.harvard.edu/robins/research.html; Robins, J. M., Hernán, M., & Brumback, B. (2000). Epidemiology, 11 (5), 550–560]. The above two methods are illustrated by addressing the motivating question. Implications for prevention researchers who wish to estimate total causal effects using longitudinal observational data are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45504/1/11121_2005_Article_23.pd

Opportunities for Pharmacists and Student Pharmacists to Provide Clinical Preventive Services

Pharmacists and student pharmacists can play an important role in providing clinical preventive services as specified by the United States Preventive Services Task Force (USPSTF). The USPSTF guidelines provide evidence-based recommendations about clinical preventive services for the general population. The purpose of this paper is to provide information to pharmacists and student pharmacists developing and implementing preventive health care services. Examples of successful pharmacy-based programs are also provided. Pharmacists and student pharmacists can provide preventive health care interventions by conducting screenings, providing education, and making referrals. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Idea Pape

Autism with co-occurring epilepsy care pathway in Europe

Background: Autism and epilepsy often occur together. Epilepsy and other associated conditions have a substantial impact on the well-being of autistic people and their families, reduce quality of life and increase premature mortality. Despite this, there is a lack of studies investigating the care pathway of autistic children with co-occurring epilepsy in Europe. Methods: We analyzed the care pathway for autistic children with associated epilepsy in Italy, Spain and the UK from the perspective of caregivers (using a survey aimed at caregivers of autistic children 0-18 years old), the autistic community and professionals, in order to identify major barriers preventing caregivers and autistic children from receiving timely screening and treatment of possible co-occurring epilepsy. Results: Across all three countries, analysis of the current care pathway showed a lack of systematic screening of epilepsy in all autistic children, delayed treatment of epilepsy in autistic children after diagnosis, lack of treatment of co-occurring epilepsy and incorrect use of antiepileptic drugs. A major challenge is the lack of evidence-based harmonized guidelines for autism with co-occurring epilepsy in these countries. Conclusions: Our findings show both heterogeneity and major gaps in the care pathway for autism with associated epilepsy and the great efforts that caregivers must make for timely screening, diagnosis and adequate management of epilepsy in autistic children. We call for policy harmonization in Europe in order to improve the experiences and quality of life of autistic people and their families

Comparing genetic diversity in three threatened oaks

Genetic diversity is a critical resource for species’ survival during times of environmental change. Conserving and sustainably managing genetic diversity requires understanding the distribution and amount of genetic diversity (in situ and ex situ) across multiple species. This paper focuses on three emblematic and IUCN Red List threatened oaks (Quercus, Fagaceae), a highly speciose tree genus that contains numerous rare species and poses challenges for ex situ conservation. We compare the genetic diversity of three rare oak species-Quercus georgiana, Q. oglethorpensis, and Q. boyntonii-to common oaks; investigate the correlation of range size, population size, and the abiotic environment with genetic diversity within and among populations in situ; and test how well genetic diversity preserved in botanic gardens correlates with geographic range size. Our main findings are: (1) these three rare species generally have lower genetic diversity than more abundant oaks; (2) in some cases, small population size and geographic range correlate with genetic diversity and differentiation; and (3) genetic diversity currently protected in botanic gardens is inadequately predicted by geographic range size and number of samples preserved, suggesting non-random sampling of populations for conservation collections. Our results highlight that most populations of these three rare oaks have managed to avoid severe genetic erosion, but their small size will likely necessitate genetic management going forward

Skunk River Review Fall 2001, vol 13

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