Bridging the Location Gap: Physician Perspectives of Physician-Pharmacist Collaboration in Patient Care (BRIDGE Phase II)

Background: To optimize patient outcomes, the patient-centred medical home model emphasizes comprehensive team-based care. Pharmacists are qualified to enhance appropriate medication use and help improve patient outcomes through provision of medication therapy management (MTM) services. To optimally provide MTM, pharmacists must effectively collaborate with physicians. This study explored factors that influence pharmacist-physician collaboration. Methods and Findings: A convenience sample of five physicians participated in semi-structured interviews and the resulting data were analyzed using qualitative methods. Transcripts of the interviews were independently coded for themes by two researchers. Five themes emerged: trustworthiness, role specification, relationship initiation, effects on practice, and professional awareness/expectations. Conclusions: Overall interviewees spoke positively about pharmacists; however, when discussing collaboration, they spoke almost exclusively about pharmacists within their clinic. Since most pharmacists practice outside of clinics, bridging the location gap is imperative for collaboration. In addition, physicians lacked an overall understanding of pharmacists’ training and clinical capacity. This may inhibit pharmacists from participating to their full professional capability within integrated healthcare teams. One approach to resolve this lack of physician understanding of pharmacists’ role and value may be to co-educate health professional students. Further research is needed to explore ways to improve interprofessional collaborative care

Costs and Consequences of Wake Effects Arising from Uncoordinated Wind Energy Development

Optimal wind farm locations require a strong and reliable wind resource and access to transmission lines. As onshore and offshore wind energy grows, preferred locations become saturated with numerous wind farms. An upwind wind farm generates ‘wake effects’ (decreases in downwind wind speeds) that undermine a downwind wind farm’s power generation and revenues. Here we use a diverse set of analysis tools from the atmospheric science, economic and legal communities to assess costs and consequences of these wake effects, focusing on a West Texas case study. We show that although wake effects vary with atmospheric conditions, they are discernible in monthly power production. In stably stratified atmospheric conditions, wakes can extend 50+ km downwind, resulting in economic losses of several million dollars over six years for our case study. However, our investigation of the legal literature shows no legal guidance for protecting existing wind farms from such significant impacts

ARMY SPECIAL FORCES IN THE ALASKAN ARCTIC

Army Special Operations Forces (ARSOF) are poorly manned, trained, organized, and equipped to conduct sustained operations in the Arctic. ARSOF currently conducts “Arctic Tourism”: misaligned and episodic training combined with personnel policies that dilute Arctic expertise and limit institutional knowledge and unit capability. This is compounded by the strained relationship between the U.S. government and Alaska Native communities, denying the U.S. military Arctic expertise and presenting a gap for malign influence. To address this issue, we examined the question: How can the United States Army Special Operations Command influence policy, improve strategy, and optimize readiness in the Alaskan Arctic in support of the 2022 NDS and NSS, 2019 DOD Arctic Strategy, and the 2022 Army Arctic Strategy? Through Arctic training events, conferences, and case studies, we determined ARSOF currently does not have a dedicated formation to provide Arctic capability or capacity. Historical U.S. and current Canadian indigenous units provide models for an Alaskan homeland defense and domain awareness force, but current cultural and political conditions prohibit implementation. Our main recommendation is that an Alaska-based National Guard Special Forces unit provides the best means to establish ARSOF Arctic capability, mend relationships with Alaska Natives for a potential indigenous homeland defense organization, and build future capacity to project power in Arctic regions abroad.Distribution Statement A. Approved for public release: Distribution is unlimited.Major, United States ArmyMajor, United States ArmyMajor, United States Arm

Characterisation of Hybrid Pixel Detectors with capacitive charge division

In order to fully exploit the physics potential of the future high energy e+ e- linear collider, a Vertex Tracker providing high resolution track reconstruction is required. Hybrid pixel sensors are an attractive technology due to their fast read-out capabilities and radiation hardness. A novel pixel detector layout with interleaved cells between the readout nodes has been developed to improve the single point resolution. The results of the characterisation of the first processed prototypes are reported.Comment: 5 pages, 2 figures, presented at LCWS2000, Linear Collider Workshop, October 24-28 2000, Fermi National Accelerator Laboratory, Batavia, Illinois, U.S.A. Proceedings to be published by the American Institute of Physic

Ariel - Volume 12(13) Number 2

Editor Gary Fishbein Production & Business Manager Rich Davis Layout Editor Lynn Solomon Assistant Layout Editors Bessann Dawson Tonie Kline Becky A. Zuurbier Photography Editor Ben Alma

Overcoming Impostor Syndrome

ALA Core\u27s AvramCamp is designed to be a safe and inclusive day-long workshop for people of marginalized genders, including women, non-binary folks, and trans men, to come together and discuss challenges these groups commonly face while working in the library technology field. Each AvramCamp begins with a workshop to talk about Impostor Syndrome: what it is, how to recognize it, and strategies to overcome those feelings of being a fake or a fraud. Participants are encouraged to engage with the facilitators, creating a lively and honest discussion around an often private and sensitive topic

The involvement of Kidney DNA methylation in blood pressure regulation

Background and aims: Increasing evidence suggests that epigenetic modifications such as DNA methylation (5mC) is important to the development of essential hypertension, and that changes in DNA methylation of blood cells is associated to blood pressure (BP). So far there has been no studies of epigenetic changes in the kidney - an important effector organ in BP regulation. The aim of this study was to compare the global and gene specific methylation status in the kidney between normal and hypertensive subjects. Methods and results: We used 96 human renal tissue samples from the TRANScriptome of RenaL HumAN TissueE (TRANSLATE) Study to measure DNA methylation. TRANSLATE consists of carefully characterised collections of “apparently healthy” specimens of human kidneys. DNA was extracted from peripheral blood leukocytes and kidney tissue using the DNeasy blood and tissue Qiagen kit. Global methylation was measured by ELISA assay to determine the percentage of 5mC and loci specific methylation status was determined using Infinium HumanMethylation 450K array (Illumina®, Australia). A significant negative relationship was found in the renal samples between 5mC% and systolic (SBP) and diastolic (DBP) blood pressure readings (SBP r=-0.25, P=<0.05), DBP r=-0.32, P=<0.01). This correlation was also evident when BP is adjusted for hypertensive medication effects (adjusted SBP P=<0.05, adjusted DBP P=<0.01). There was no significant relationship in DNA extracted from peripheral blood leukocytes between 5mC% and BP reading. We found 275 loci differentially methylated between hypertensive and normotensive individuals. Conclusions: DNA methylation is an important molecular mechanism for BP and hypertension in humans Maciej D Tomaszewski3, Fadi J Charchar4

Iterative annotation to ease neural network training: Specialized machine learning in medical image analysis

Neural networks promise to bring robust, quantitative analysis to medical fields, but adoption is limited by the technicalities of training these networks. To address this translation gap between medical researchers and neural networks in the field of pathology, we have created an intuitive interface which utilizes the commonly used whole slide image (WSI) viewer, Aperio ImageScope (Leica Biosystems Imaging, Inc.), for the annotation and display of neural network predictions on WSIs. Leveraging this, we propose the use of a human-in-the-loop strategy to reduce the burden of WSI annotation. We track network performance improvements as a function of iteration and quantify the use of this pipeline for the segmentation of renal histologic findings on WSIs. More specifically, we present network performance when applied to segmentation of renal micro compartments, and demonstrate multi-class segmentation in human and mouse renal tissue slides. Finally, to show the adaptability of this technique to other medical imaging fields, we demonstrate its ability to iteratively segment human prostate glands from radiology imaging data.Comment: 15 pages, 7 figures, 2 supplemental figures (on the last page