The role of community pharmacists in supporting self-management in patients with psoriasis.

Background: The majority of patients with psoriasis have mild to moderate disease which can be managed in primary care with topical therapies. The supportive role of pharmacists for patients with long-term dermatological conditions is largely unknown. Objective: To assess the impact of an educational intervention delivered by community pharmacists to improve self-management for people with psoriasis. Method: The study involved a pre- and post-intervention design. Seven community pharmacies were selected based on their location (urban, rural etc.) and the pharmacists recruited via local comprehensive research networks. Patients with mild to moderate psoriasis were recruited either opportunistically or via a letter of invite by pharmacists who undertook a face-to-face consultation with one follow-up visit after 6 weeks. The primary outcome was the change in person-centred dermatology self-care index (PEDESI) score and secondary outcomes were the self-assessed psoriasis and severity index (SAPASI), measuring disease severity and the dermatology quality of life index (DLQI). Key findings: A total of 47 patients were recruited. At 6 weeks, 42/47 (89.3%) patients completed the follow-up consultation. There was a significant increase in mean PEDESI scores (25.15 versus 17.78, P < 0.001) at 6 weeks compared to baseline. Similarly, SAPASI (11.60 versus 7.74, P < 0.001) and DLQI (7.21 versus 4.14, P < 0.001) scores improved significantly. Conclusion: Pharmacist-assisted support for patients with psoriasis improved knowledge, reduced disease severity and the impact on quality of life. These results suggest that community pharmacists might have an important role to play in facilitating self-management for patients with psoriasis

An exploratory study of the views of community pharmacy staff on the management of patients with undiagnosed skin problems.

Objective: The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients presenting with symptomatic skin problems. Methods: The study involved semi-structured telephone interviews with 10 pharmacists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management. Advice from the local ethics committee was that approval was not required for the study. We analysed the interviews using the framework approach. Key finding: Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non-serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharmacists reporting insufficient time to deal effectively with patients. MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier. Conclusion: Our findings suggest that the role of pharmacists and MCAs is complementary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy-supported self-care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology

Student Performance in a Pharmacotherapy Oncology Module Before and After Flipping the Classroom

Objective. To determine if a flipped classroom improved student examination performance in a pharmacotherapy oncology module. Design. Third-year pharmacy students in 2012 experienced the oncology module as interactive lectures with optional case studies as supplemental homework. In 2013, students experienced the same content in a primarily flipped classroom. Students were instructed to watch vodcasts (video podcasts) before in-class case studies but were not held accountable (ie, quizzed) for preclass preparation. Examination questions were identical in both cohorts. Performance on examination questions was compared between the two cohorts using analysis of covariance (ANCOVA), with prior academic performance variables (grade point average [GPA]) as covariates. Assessment. The students who experienced the flipped classroom approach performed poorer on examination questions than the cohort who experienced interactive lecture, with previous GPA used as a covariate. Conclusion. A flipped classroom does not necessarily improve student performance. Further research is needed to determine optimal classroom flipping techniques

The Models of Authority Project: Extending the DigiPal Framework for Script and Decoration

The DigiPal project for palaeography has featured in previous DH conferences. It includes a generalised framework for the description and analysis of handwriting, initially applied to Old English of the eleventh century but subsequently extended to Latin, Hebrew, and decoration; it incorporates a novel model for describing handwriting; and a recent addition allows the embedding of linked palaeographical images into prose description. The purpose of this poster is to present new developments which form part of two further major grants, one of which is the Models of Authority project. Specifically, the focus here is on the incorporation of textual content into the model for handwriting

Self-Rupturing Hermetic Valve

For commercial, military, and aerospace applications, low-cost, small, reliable, and lightweight gas and liquid hermetically sealed valves with post initiation on/off capability are highly desirable for pressurized systems. Applications include remote fire suppression, single-use system-pressurization systems, spacecraft propellant systems, and in situ instruments. Current pyrotechnic- activated rupture disk hermetic valves were designed for physically larger systems and are heavy and integrate poorly with portable equipment, aircraft, and small spacecraft and instrument systems. Additionally, current pyrotechnically activated systems impart high g-force shock loads to surrounding components and structures, which increase the risk of damage and can require additional mitigation. The disclosed mechanism addresses the need for producing a hermetically sealed micro-isolation valve for low and high pressure for commercial, aerospace, and spacecraft applications. High-precision electrical discharge machining (EDM) parts allow for the machining of mated parts with gaps less than a thousandth of an inch. These high-precision parts are used to support against pressure and extrusion, a thin hermetically welded diaphragm. This diaphragm ruptures from a pressure differential when the support is removed and/or when the plunger is forced against the diaphragm. With the addition of conventional seals to the plunger and a two-way actuator, a derivative of this design would allow nonhermetic use as an on/off or metering valve after the initial rupturing of the hermetic sealing disk. In addition, in a single-use hermetically sealed isolation valve, the valve can be activated without the use of potential leak-inducing valve body penetrations. One implementation of this technology is a high-pressure, high-flow-rate rupture valve that is self-rupturing, which is advantageous for high-pressure applications such as gas isolation valves. Once initiated, this technology is self-energizing and requires low force compared to current pyrotechnic-based burst disk hermetic valves. This is a novel design for producing a single-use, self-rupturing, hermetically sealed valve for isolation of pressurized gas and/or liquids. This design can also be applied for single-use disposable valves for chemical instruments. A welded foil diaphragm is fully supported by two mated surfaces that are machined to micron accuracies using EDM. To open the valve, one of the surfaces is moved relative to the other to (a) remove the support creating an unsupported diaphragm that ruptures due to over pressure, and/or (b) produce tension in the diaphragm and rupture it

AUMI-Futurism: the Elsewhere and "Elsewhen" of (Un)Rolling the Boulder and Turning the Page

This article discusses two performances that used the movement-to-music technology known as the "Adaptive Use Musical Instrument" or AUMI to allow differently-abled participants to collaborate with one another: (Un)Rolling the Boulder: Improvising New Communities, a multimedia, mixed-ability improvisation that was staged at the University of Kansas in October 2013 and Turning the Page, an interdisciplinary musical theatre piece premiered in Ottawa, Canada in April 2014. We theorize these performances as examples of "AUMI-Futurism”, combining insights gleaned from two different sources: the Afrofuturist philosophy of composer, improviser, and bandleader Sun Ra, and the work of disability studies scholar Alison Kafer. This essay examines the collaborative, improvisatory processes that surrounded (Un)Rolling the Boulder and Turning the Page, focusing in particular on the role that the AUMI software played in imagining and performing new communities

Enhancing Peak Network Traffic Prediction via Time-Series Decomposition

For network administration and maintenance, it is critical to anticipate when networks will receive peak volumes of traffic so that adequate resources can be allocated to service requests made to servers. In the event that sufficient resources are not allocated to servers, they can become prone to failure and security breaches. On the contrary, we would waste a lot of resources if we always allocate the maximum amount of resources. Therefore, anticipating peak volumes in network traffic becomes an important problem. However, popular forecasting models such as Autoregressive Integrated Moving Average (ARIMA) forecast time-series data generally, thus lack in predicting peak volumes in these time-series. More than often, a time-series is a combination of different features, which may include but are not limited to 1) Trend, the general movement of the traffic volume, 2) Seasonality, the patterns repeated over some time periods (e.g. daily and monthly), and 3) Noise, the random changes in the data. Considering that the fluctuation of seasonality can be harmful for trend and peak prediction, we propose to extract seasonalities to facilitate the peak volume predictions in the time domain. The experiments on both synthetic and real network traffic data demonstrate the effectiveness of the proposed method

NPRL: Nightly Profile Representation Learning for Early Sepsis Onset Prediction in ICU Trauma Patients

Sepsis is a syndrome that develops in response to the presence of infection. It is characterized by severe organ dysfunction and is one of the leading causes of mortality in Intensive Care Units (ICUs) worldwide. These complications can be reduced through early application of antibiotics, hence the ability to anticipate the onset of sepsis early is crucial to the survival and well-being of patients. Current machine learning algorithms deployed inside medical infrastructures have demonstrated poor performance and are insufficient for anticipating sepsis onset early. In recent years, deep learning methodologies have been proposed to predict sepsis, but some fail to capture the time of onset (e.g., classifying patients' entire visits as developing sepsis or not) and others are unrealistic to be deployed into medical facilities (e.g., creating training instances using a fixed time to onset where the time of onset needs to be known apriori). Therefore, in this paper, we first propose a novel but realistic prediction framework that predicts each morning whether sepsis onset will occur within the next 24 hours with the help of most recent data collected at night, when patient-provider ratios are higher due to cross-coverage resulting in limited observation to each patient. However, as we increase the prediction rate into daily, the number of negative instances will increase while that of positive ones remain the same. Thereafter, we have a severe class imbalance problem, making a machine learning model hard to capture rare sepsis cases. To address this problem, we propose to do nightly profile representation learning (NPRL) for each patient. We prove that NPRL can theoretically alleviate the rare event problem. Our empirical study using data from a level-1 trauma center further demonstrates the effectiveness of our proposal

Miniature Piezoelectric Shaker for Distribution of Unconsolidated Samples to Instrument Cells

The planned Mars Science Laboratory mission requires inlet funnels for channeling unconsolidated powdered samples from the sampling and sieving mechanisms into instrument test cells, which are required to reduce cross-contamination of the samples and to minimize residue left in the funnels after each sample transport. To these ends, a solid-state shaking mechanism has been created that requires low power and is lightweight, but is sturdy enough to survive launch vibration. The funnel mechanism is driven by asymmetrically mounted, piezoelectric flexure actuators that are out of the load path so that they do not support the funnel mass. Each actuator is a titanium, flextensional piezoelectric device driven by a piezoelectric stack. The stack has Invar endcaps with a half-spherical recess. The Invar is used to counteract the change in stress as the actuators are cooled to Mars ambient temperatures. A ball screw is threaded through the actuator frame into the recess to apply pre-stress, and to trap the piezoelectric stack and endcaps in flexure. During the vibration cycle of the flextensional actuator frame, the compression in the piezoelectric stack may decrease to the point that it is unstressed; however, because the ball joint cannot pull, tension in the piezoelectric stack cannot be produced. The actuators are offset at 120 . In this flight design, redundancy is required, so three actuators are used though only one is needed to assist in the movement. The funnel is supported at three contact points offset to the hexapod support contacts. The actuator surface that does not contact the ring is free to expand. Two other configurations can be used to mechanically tune the vibration. The free end can be designed to drive a fixed mass, or can be used to drive a free mass to excite impacts (see figure). Tests on this funnel mechanism show a high density of resonance modes between 1 and 20 kHz. A subset of these between 9 and 12 kHz was used to drive the CheMin actuators at 7 V peak to peak. These actuators could be driven by a single resonance, or swept through a frequency range to decrease the possibility that a portion of the funnel surface was not coincident with a nodal line (line of no displacement). The frequency of actuation can be electrically controlled and monitored and can also be mechanically tuned by the addition of tuning mass on the free end of the actuator. The devices are solid-state and can be designed with no macroscopically moving parts. This design has been tested in a vacuum at both Mars and Earth ambient temperatures ranging from 30 to 25