Improving Screening For Alcohol Use Amongst Women in Primary Care

Purpose: The purposes of this practice inquiry project were to examine the effect of the addition of a standardized screening tool (AUDIT-C) within the ambulatory electronic health record (AEHR) and the effect of an education session with primary care providers on documentation of alcohol screening and counseling within the AEHR. Furthermore, provider confidence with Screening, Brief Intervention, and Referral to Treatment (SBIRT) was compared before and after the educational session. Methods: A quasi-experimental one-group pretest posttest design was utilized via chart review prior to and following the educational intervention for patients seen for an annual wellness exam. Data extracted included any alcohol screening performed as well as any subsequent education in the event of a positive alcohol screen. Provider confidence was assessed via questionnaire utilizing a Likert scale in relation to various SBIRT practices. The questionnaire was administered immediately prior to and 3 months post-intervention. Results: Assessment of alcohol use with a standardized screening tool increased from 44% to 74%, a statistically significant increase. For those who stated that they did consume alcohol, documentation of frequency of alcohol use improved. Statistically significant increases were noted in the assessment of number of drinks consumed per drinking day and the assessment of binge drinking. Among positive alcohol use screenings, documentation of an additional detailed assessment of use as well as documentation of alcohol use counseling improved. Provider confidence overall improved for general screening practices, but provider confidence decreased for practices specific to alcohol dependent or hazardous alcohol consuming patients. Conclusion: Alcohol use screening and provider confidence with general screening practices improved after the addition of the AUDIT-C to the AEHR and the training session. This program could serve as a model for adoption of other primary care clinics. Given that provider confidence decreased overall in relation to counseling and intervention for patients who screen positive for hazardous or dependent alcohol use, additional education is necessary on brief intervention and resources for referral

The Impact of eHR on Professional Competence in HRM: Implications for the Development of HR Professionals

[Excerpt] Information technology has been cited as a critical driver of HR’s transition from a focus on administrative tasks to a focus on serving as a strategic business partner. This strategic role not only adds a valuable dimension to the HR function but also changes the competencies that define the success of HR professionals. Interviews were conducted with HR representatives from 19 firms to examine the linkage between electronic human resources (eHR) and the reshaping of professional competence in HRM. Based on the findings, we draw implications for the development of HR competencies and identify learning strategies that HR professionals can utilize to fulfill their changing roles and responsibilities

Smart Drugs “As Common As Coffee”: Media Hype about Neuroenhancement

Background: The use of prescription drugs to improve cognitive functioning in normal persons -"neuroenhancement" - has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement

Exploring the Impact of Galaxy Interactions over Seven Billion Years with CAS

We explore galaxy assembly over the last seven billion years by characterizing "normal" galaxies along the Hubble sequence, against strongly disturbed merging/interacting galaxies with the widely used CAS system of concentration (C), asymmetry (A), and 'clumpiness' (S) parameters, as well as visual classification. We analyze Hubble Space Telescope (HST) ACS images of ~4000 intermediate and high mass (> 10^9 solar masses) galaxies from the GEMS survey, one of the largest HST surveys conducted to date in two filters. We explore the effectiveness of the CAS criteria [A>S and A>~0.35] in separating normal and strongly disturbed galaxies at different redshifts, and quantify the recovery and contamination rate. We also compare the average star formation rate and the cosmic star formation rate density as a function of redshift between normal and interacting systems identified by CAS.Comment: ASP conference proceedings of 2007 Bash Symposium. Latex with asp2006.sty. 4 pages, 4 figure

Numerical Methods for the Stochastic Landau-Lifshitz Navier-Stokes Equations

The Landau-Lifshitz Navier-Stokes (LLNS) equations incorporate thermal fluctuations into macroscopic hydrodynamics by using stochastic fluxes. This paper examines explicit Eulerian discretizations of the full LLNS equations. Several CFD approaches are considered (including MacCormack's two-step Lax-Wendroff scheme and the Piecewise Parabolic Method) and are found to give good results (about 10% error) for the variances of momentum and energy fluctuations. However, neither of these schemes accurately reproduces the density fluctuations. We introduce a conservative centered scheme with a third-order Runge-Kutta temporal integrator that does accurately produce density fluctuations. A variety of numerical tests, including the random walk of a standing shock wave, are considered and results from the stochastic LLNS PDE solver are compared with theory, when available, and with molecular simulations using a Direct Simulation Monte Carlo (DSMC) algorithm

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Selective hydroxylation of 1,8- and 1,4-cineole using bacterial P450 variants

This study has evaluated the use of the P450 metalloenzymes CYP176A1, CYP101A1 and CYP102A1, together with engineered protein variants of CYP101A1 and CYP102A1, to alter the regioselectivity of 1,8- and 1,4-cineole hydroxylation. CYP176A1 was less selective for 1,4-cineole oxidation when compared to its preferred substrate, 1,8-cineole. The CYP102A1 variants significantly improved the activity over the WT enzyme for oxidation of 1,4- and 1,8-cineole. The CYP102A1 R47L/Y51F/A74G/F87V/L188Q mutant generated predominantly (1S)-6α-hydroxy-1,8-cineole (78% e.e.) from 1,8-cineole. Oxidation of 1,4-cineole by the CYP102A1 R47L/Y51F/F87A/I401P variant generated the 3α product in >90% yield. WT CYP101A1 formed a mixture metabolites with 1,8-cineole and very little product was generated with 1,4-cineole. In contrast the F87W/Y96F/L244A/V247L and F87W/Y96F/L244A variants of CYP101A1 favoured formation of 5α-hydroxy-1,8-cineole (>88%, 1S 86% e.e.) while the F87V/Y96F/L244A variant generated (1S)-6α-hydroxy-1,8-cineole in excess (90% regioselective, >99% e.e.). The CYP101A1 F87W/Y96F/L244A/V247L and F87W/Y96F/L244A mutants improved the oxidation of 1,4-cineole generating an excess of the 3α metabolite (1S > 99% e.e. with the latter). The CYP101A1 F87L/Y96F variant also improved the oxidation of this substrate but shifted the site of oxidation to the isopropyl group, (8-hydroxy-1,4-cineole). When this 8-hydroxy metabolite was generated in significant quantities desaturation of C8C9 to the corresponding alkene was also detected