SATISFACTION WITH CLINICAL PHARMACY SERVICES PROVIDED TO SPECIAL CARE HOMES IN SASKATCHEWAN

Residents in long-term care facilities use a high number of medications and are at greater risk for adverse drug events compared to elderly persons not living in a long-term care facility. Pharmacists as part of a multidisciplinary team can help optimize drug therapy and prevent adverse drug events. The Saskatchewan College of Pharmacists (SCP) has developed Standards of Practice for pharmacists providing pharmacy services to all residents of long-term care facilities. The purpose of this study was to compare the current provision of, and expectation for clinical pharmacy services provided to special care homes in Saskatchewan. This study also compared different service expectations between those who receive pharmacy services (Directors of Care) and those who provide pharmacy services (pharmacists) to possibly identify a barrier to providing clinical services to special care homes. Other perceived barriers for pharmacists providing clinical services to special care homes were also documented. The study was a cross-sectional design using a questionnaire. Questions were based on SCP's Standards of Practice for Pharmacists Providing Services to Long-Term Care Residents. A sample of 149 Directors of Care from 152 special care homes in Saskatchewan and 125 pharmacists were surveyed. SPSS 11.0 for Windows was used to perform the analysis. This study identified significant quality of service gaps for all clinical services studied. The service gaps were more negative for care homes without a designated "in- house" pharmacist compared to care homes with a pharmacist. Director of Care actual expectations for pharmacy services were higher than pharmacists perceived them to be, indicating a potential barrier. The most frequently reported barrier to providing clinical pharmacy services by pharmacists was time with 94.9% indicating "sometimes" or "always" a barrier. The Standards of Practice are the expected level of pharmacy care for residents living in long-term care facilities. The data suggest there was a quality of service gap between the expected level of care and the level of care provided. Pharmacists, their professional associations, the College of Pharmacy and Nutrition, Directors of Care and the Regional Health Authorities will need to work together to eliminate the barriers for pharmacists providing clinical services to long-term care facilities

Donating and self-interest: The influence of (im)moral behavior and norms

Život i rad u suvremenom društvu ne prate samo nova otkrića, dostignuća i napredak u gotovo svim područjima ljudske djelatnosti nego i mnogobrojne posljedice, i to ne samo pozitivne već i negativne. Dakako, sve se te promjene odražavaju i na životu i radu ljudi, posebno na njihovu zdravlju, pa nije ni čudno što upravo očuvanje i unapređenje tjelesnog i mentalnog zdravlja postaje za suvremenog čovjeka imperativ vremena u kojem živi. Sve te karakteristike života u suvremenom društvu imaju posebnu težinu kada su u pitanju najmlađi i mladi, dakle djeca i učenici. Nedovoljno kretanje djece i mladih te boravak u zatvorenim prostorima negativno su utjecali na antropološki status i na zdravstveno stanje pojedinca općenito, a brojna istraživanja nedvojbeno upućuju na zaključak čak da je primjereno tjelesno vježbanje vrlo učinkovito i gotovo nezamjenjivo sredstvo u borbi za zaštitu i unapređivanje zdravlja, posebno s gledišta rada i življenja u suvremenom životu. Cilj ovog diplomskog rada bio je otkriti koliko su učenici uključeni u izvannastavne sportske i izvanškolske sportske aktivnosti, bave li se sportom u slobodno vrijeme i u kojoj mjeri te otkriti stavove učenika prema kineziološkim aktivnostima i bavljenju sportom u životu. Za potrebe ovog istraživanja uključen je uzorak od 61 učenika od prvog do četvrtog razreda u jednoj osnovnoj školi ruralne sredine. Metodom anketnog upitnika ispitane su sportske aktivnosti (izvannastavne sportske i izvanškolske sportske aktivnosti), učestalost treninga (tjedno), aktivnost provođenja slobodnog vremena te stavovi o sportu. Rezultati istraživanja pokazali su da je njih 50 uključeno u izvannastavne ili izvanškolske sportske aktivnosti, što iznosi 82%. Razlike u bavljenju kineziološkim aktivnostima između spola nisu značajne, dok između razreda ima razlika. Učenici se više bave izvanškolskim sportskim aktivnostima, najčešće dva puta tjedno. Svijest učenika o važnosti bavljenja sportom je naglašena budući da se 44% učenika i učenica u slobodno vrijeme bavi sportom, a 57% učenika i učenica vrlo često se želi baviti sportom. Glavni razlog zbog kojeg se ne bave sportom je taj što se bave drugim aktivnostima.The life and work in a modern society do not follow only new discoveries, achievements and progress in almost all areas of human activity, but also a number of consequences, not only positive but also negative. Of course, all these changes reflect on the life and work of people, especially to their health, so it is not surprising that just the preservation and improvement of physical and mental health of modern man becomes imperative of the time in which he lives. All these characteristics of life in a modern society have a special weight when it comes to the youngest and young, so children and students. Insufficient movement of children and young people and stay indoors had a negative impact on the anthropological status and the health status of the individual in general, and numerous studies have undoubtedly point to the conclusion that even the appropriate physical exercise is very effective and almost indispensable tool in the fight for the protection and promotion of health, particularly from the standpoint of the work and life in the modern life.The aim of this thesis was to find out how many students are involved in extracurricular sports and out of school sports activities, do they do sports in their free time and to what extent, and discover the attitudes of students towards kinesiology activities andrecreation in their lives. The purposes of this study included a sample of 61 students from the first to the fourth grade in elementary school in a rural area. Method of the questionnaire tested sports activities (extracurricular sports and out of school sports activities), training frequency (weekly), leisure activities and attitudes about the sport. The results showed that 50 of them are involved in extracurricular or out of school sports activities, which is 82%. Differences in dealing with kinesiology activities between the sexes are not big, while there are differences between classes. Students are more engaged in out of school sports activities, usually twice a week. Student awareness of the importance of sports is highlighted as the 44% of students in their free time do sports, and 57% of boys and girls want to play sports very often. The main reason for not being engaged in sports is that they are engaged in other activities

CoLT5: Faster Long-Range Transformers with Conditional Computation

Many natural language processing tasks benefit from long inputs, but processing long documents with Transformers is expensive -- not only due to quadratic attention complexity but also from applying feedforward and projection layers to every token. However, not all tokens are equally important, especially for longer documents. We propose CoLT5, a long-input Transformer model that builds on this intuition by employing conditional computation, devoting more resources to important tokens in both feedforward and attention layers. We show that CoLT5 achieves stronger performance than LongT5 with much faster training and inference, achieving SOTA on the long-input SCROLLS benchmark. Moreover, CoLT5 can effectively and tractably make use of extremely long inputs, showing strong gains up to 64k input length.Comment: Added CoDA reference and minor edits to clarify routin

Systematic Review and Meta-Analysis of Preterm Birth and Later Systolic Blood Pressure

Lower birth weight because of fetal growth restriction is associated with higher blood pressure later in life, but the extent to which preterm birth ( <37 completed weeks' gestation) or very low birth weight ( <1500 g) predicts higher blood pressure is less clear. We performed a systematic review of 27 observational studies that compared the resting or ambulatory systolic blood pressure or diagnosis of hypertension among children, adolescents, and adults born preterm or very low birth weight with those born at term. We performed a meta-analysis with the subset of 10 studies that reported the resting systolic blood pressure difference in millimeters of mercury with 95% CIs or SEs. We assessed methodologic quality with a modified Newcastle-Ottawa Scale. The 10 studies were composed of 1342 preterm or very low birth weight and 1738 term participants from 8 countries. The mean gestational age at birth of the preterm participants was 30.2 weeks (range: 28.8-34.1 weeks), birth weight was 1280 g (range: 1098-1958 g), and age at systolic blood pressure measurement was 17.8 years (range: 6.3-22.4 years). Former preterm or very low birth weight infants had higher systolic blood pressure than term infants (pooled estimate: 2.5 mm Hg [95% CI: 1.7-3.3 mm Hg]). For the 5 highest quality studies, the systolic blood pressure difference was slightly greater, at 3.8 mm Hg (95% CI: 2.6-5.0 mm Hg). We conclude that infants who are born preterm or very low birth weight have modestly higher systolic blood pressure later in life and may be at increased risk for developing hypertension and its sequela

Modelling Primordial Gas in Numerical Cosmology

We have reviewed the chemistry and cooling behaviour of low-density (n<10^4 cm^-3) primordial gas and devised a cooling model wich involves 19 collisional and 9 radiative processes and is applicable for temperatures in the range (1 K < T < 10^8 K). We derived new fits of rate coefficients for the photo-attachment of neutral hydrogen, the formation of molecular hydrogen via H-, charge exchange between H2 and H+, electron detachment of H- by neutral hydrogen, dissociative recombination of H2 with slow electrons, photodissociation of H2+, and photodissociation of H2. Further it was found that the molecular hydrogen produced through the gas-phase processes, H2+ + H -> H2 + H+, and H- + H -> H2 + e-, is likely to be converted into its para configuration on a faster time scale than the formation time scale. We have tested the model extensively and shown it to agree well with former studies. We further studied the chemical kinetics in great detail and devised a minimal model which is substantially simpler than the full reaction network but predicts correct abundances. This minimal model shows convincingly that 12 collisional processes are sufficient to model the H, He, H+, H-, He+, He++, and H2 abundances in low density primordial gas for applications with no radiation fields.Comment: 26 pages of text, 4 tables, and 6 eps figures. The paper is also available at http://zeus.ncsa.uiuc.edu:8080/~abel/PGas/bib.html Submitted to New Astronomy. Note that some of the hyperlinks given in the paper are still under constructio

Heterosubtypic Neutralizing Monoclonal Antibodies Cross-Protective against H5N1 and H1N1 Recovered from Human IgM+ Memory B Cells

Background: The hemagglutinin (HA) glycoprotein is the principal target of protective humoral immune responses to influenza virus infections but such antibody responses only provide efficient protection against a narrow spectrum of HA antigenic variants within a given virus subtype. Avian influenza viruses such as H5N1 are currently panzootic and pose a pandemic threat. These viruses are antigenically diverse and protective strategies need to cross protect against diverse viral clades. Furthermore, there are 16 different HA subtypes and no certainty the next pandemic will be caused by an H5 subtype, thus it is important to develop prophylactic and therapeutic interventions that provide heterosubtypic protection. Methods and Findings: Here we describe a panel of 13 monoclonal antibodies (mAbs) recovered from combinatorial display libraries that were constructed from human IgM+ memory B cells of recent (seasonal) influenza vaccinees. The mAbs have broad heterosubtypic neutralizing activity against antigenically diverse H1, H2, H5, H6, H8 and H9 influenza subtypes. Restriction to variable heavy chain gene IGHV1-69 in the high affinity mAb panel was associated with binding to a conserved hydrophobic pocket in the stem domain of HA. The most potent antibody (CR6261) was protective in mice when given before and after lethal H5N1 or H1N1 challenge. Conclusions: The human monoclonal CR6261 described in this study could be developed for use as a broad spectrum agent for prophylaxis or treatment of human or avian influenza infections without prior strain characterization. Moreover, the CR6261 epitope could be applied in targeted vaccine strategies or in the design of novel antivirals. Finally our approach of screening the IgM+ memory repertoire could be applied to identify conserved and functionally relevant targets on other rapidly evolving pathogens

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Abdominal aortic aneurysm is associated with a variant in low-density lipoprotein receptor-related protein 1

Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significant heritability. We carried out a genome-wide association discovery study of 1866 patients with AAA and 5435 controls and replication of promising signals (lead SNP with a p value &lt; 1 × 10-5) in 2871 additional cases and 32,687 controls and performed further follow-up in 1491 AAA and 11,060 controls. In the discovery study, nine loci demonstrated association with AAA (p &lt; 1 × 10-5). In the replication sample, the lead SNP at one of these loci, rs1466535, located within intron 1 of low-density-lipoprotein receptor-related protein 1 (LRP1) demonstrated significant association (p = 0.0042). We confirmed the association of rs1466535 and AAA in our follow-up study (p = 0.035). In a combined analysis (6228 AAA and 49182 controls), rs1466535 had a consistent effect size and direction in all sample sets (combined p = 4.52 × 10-10, odds ratio 1.15 [1.10-1.21]). No associations were seen for either rs1466535 or the 12q13.3 locus in independent association studies of coronary artery disease, blood pressure, diabetes, or hyperlipidaemia, suggesting that this locus is specific to AAA. Gene-expression studies demonstrated a trend toward increased LRP1 expression for the rs1466535 CC genotype in arterial tissues; there was a significant (p = 0.029) 1.19-fold (1.04-1.36) increase in LRP1 expression in CC homozygotes compared to TT homozygotes in aortic adventitia. Functional studies demonstrated that rs1466535 might alter a SREBP-1 binding site and influence enhancer activity at the locus. In conclusion, this study has identified a biologically plausible genetic variant associated specifically with AAA, and we suggest that this variant has a possible functional role in LRP1 expression