Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial.

BACKGROUND: Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES: ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS: The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL: The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS: A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).

Unmet Dental Needs Among Mid-to-Older Deaf and Hard of Hearing Women in the U.S.

Introduction: Despite the significant number of deaf and hard of hearing (DHH) people living in the U.S., oral health research on DHH people who use American Sign Language (ASL) is virtually nonexistent. This study aims to investigate dental needs among mid-to-older DHH women and identify social determinants of health that may place them at higher risk for unmet dental health needs as the primary outcome. Methods: This cross-sectional study uses data drawn from Communication Health domain in the PROMIS-DHH Profile and oral health data from the National Health and Nutrition Examination Survey. Both measures were administered in ASL and English between November 2019 and March 2020. Univariate and bivariate analysis included only complete data, and multivariable logistic regression analyses were conducted on multiply imputed data. Results: Out of 197 DHH women (41 to 71+ years old) who answered the dental visit question, 48 had unmet dental needs and 149 had met dental needs. Adjusting for sociodemographic variables, disparity in dental needs was observed across education [OR (95% CI): 0.45(0.15, 1.370)] and communication health [0.95 (0.90, 1.01)]. Discussion: Our study is the first to describe DHH mid-to-older women's access to oral health care. DHH women who do not have a college degree may be impacted. Further research is needed to elucidate the particular risk factors, including cultural, to which DHH individuals from marginalized racial groups are susceptible to unmet oral health needs. Conclusions: Evidence shows that DHH ASL users who have less years of education or are single experience barriers in accessing dental care.

Artificial intelligence in in vitro fertilization: a computer decision support system for day-to-day management of ovarian stimulation during in vitro fertilization.

OBJECTIVE: To describe a computer algorithm designed for in vitro fertilization (IVF) management and to assess the algorithm's accuracy in the day-to-day decision making during ovarian stimulation for IVF when compared to evidence-based decisions by the clinical team. DESIGN: Descriptive and comparative study of new technology. SETTING: Private fertility practice. INTERVENTION(S): None. PATIENT(S): Data were derived from monitoring during ovarian stimulation from IVF cycles. The database consisted of 2,603 cycles (1,853 autologous and 750 donor cycles) incorporating 7,376 visits for training. An additional 556 unique cycles were used for challenge and to calculate accuracy. There were 59,706 data points. Input variables included estradiol concentrations in picograms per milliliter; ultrasound measurements of follicle diameters in two dimensions in millimeters; cycle day during stimulation and dose of recombinant follicle-stimulating hormone during ovarian stimulation for IVF. MAIN OUTCOME MEASURE(S): Accuracy of the algorithm to predict four critical clinical decisions during ovarian stimulation for IVF: [1] stop stimulation or continue stimulation. If the decision was to stop, then the next automated decision was to [2] trigger or cancel. If the decision was to return, then the next key decisions were [3] number of days to follow-up and [4] whether any dosage adjustment was needed. RESULT(S): Algorithm accuracies for these four decisions are as follows: continue or stop treatment: 0.92; trigger and schedule oocyte retrieval or cancel cycle: 0.96; dose of medication adjustment: 0.82; and number of days to follow-up: 0.87. These accuracies are for first iteration of the algorithm. CONCLUSION(S): We describe a first iteration of a predictive analytic algorithm that is highly accurate and in agreement with evidence-based decisions by expert teams during ovarian stimulation during IVF. These tools offer a potential platform to optimize clinical decision making during IVF.

Correction to: Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners.

The article Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners, written by Kevin Callahan, was originally published electronically on the publisher's internet portal (currently SpringerLink) on August 29, 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on August, 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners.

This study investigated interpersonal skills associated with the concept of behavioral artistry (BA), a repertoire of practitioner behaviors including care, attentiveness, and creativity, among others, associated with the effective delivery of applied behavior analysis (ABA) treatment. Survey results indicated parents of children with autism preferred BA descriptors for ABA therapists over non-BA descriptors. A separate survey of 212 university students on a standardized personality assessment revealed students majoring and/or working in the field of ABA had lower levels of BA than those in other human services professions. Practitioners with higher BA scores were observed and rated more positively in their delivery of ABA for children with autism. Implications for training/supervising effective ABA practitioners within a BA model are discussed.

Evaluation of long-term conservation agriculture and crop intensification in rice-wheat rotation of Indo-Gangetic Plains of South Asia: Carbon dynamics and productivity.

In the context of deteriorating soil health, stagnation of yield in rice-wheat cropping system (RWCS) across Indo- Gangetic plains (IGP) and environmental pollution, a long term field experiment was conducted during 2009-2016 taking four crop scenarios with conservation agriculture (CA), crop intensification and diversified cropping as intervening technology aiming to evaluate the sustainability of the systems. Scenario 1 (S1) represented conventional farmers' practice of growing rice and wheat with summer fallow. In scenario 2 (S2) and scenario 3 (S3), legume crop was taken along with rice and wheat with partial CA and full CA, respectively. Conventional RWCS was replaced with rice-potato + maize- cowpea cropping system with partial CA in scenario 4 (S4). The S3 scenario registered highest total organic carbon (TOC) stock of 47.71 Mg C ha-1 and resulted in significant increase of 14.57% over S1 (Farmer's practice) in 0-30 cm soil depth after 7 years of field trial. The S4 scenario having intensified cropping systems recorded lowest TOC of 39.33 Mg C ha-1 and resulted in significant depletion of 17.56% in C stock with respect to S3 in 0-30 cm soil depth. The TOC enrichment was higher in S2, S3 and S4 scenario in the surface soil (0-10 cm) compared to S1. At lower depth (20-30 cm), the TOC enrichment was significantly higher in S2 (12.82 Mg C ha-1) and S3 (13.10 Mg C ha-1 soil) over S1 scenario. The S2 and S3 scenario recorded highest increased allocation of TOC (3.55 and 6.13 Mg C ha-1) to passive pool over S1. The S2 (15.72 t ha-1), S3 (16.08 t ha-1) and S4 (16.39 t ha-1) scenarios recorded significantly higher system rice equivalent yield over S1 (10.30 t ha-1). Among the scenarios, S3 scenario had greater amount of total soil organic carbon, passive pool of carbon and higher system rice equivalent yield, thus, is considered the best cropping management practice to maintain soil health and food security in the middle IGP.

Mixtures of tense and relaxed state polymerized human hemoglobin regulate oxygen affinity and tissue construct oxygenation.

Pure tense (T) and relaxed (R) quaternary state polymerized human hemoglobins (PolyhHbs) were synthesized and their biophysical properties characterized, along with mixtures of T- and R-state PolyhHbs. It was observed that the oxygen affinity of PolyhHb mixtures varied linearly with T-state mole fraction. Computational analysis of PolyhHb facilitated oxygenation of a single fiber in a hepatic hollow fiber (HF) bioreactor was performed to evaluate the oxygenation potential of T- and R-state PolyhHb mixtures. PolyhHb mixtures with T-state mole fractions greater than 50% resulted in hypoxic and hyperoxic zones occupying less than 5% of the total extra capillary space (ECS). Under these conditions, the ratio of the pericentral volume to the perivenous volume in the ECS doubled as the T-state mole fraction increased from 50 to 100%. These results show the effect of varying the T/R-state PolyhHb mole fraction on oxygenation of tissue-engineered constructs and their potential to oxygenate tissues.

Fusion failure of dense-cored proacrosomal vesicles in an inducible mouse model of male infertility.

The acrosome is a specialized secretory vesicle located in the head of spermatozoa and has an essential role during fertilization. This organelle and the sperm nucleus have aberrant morphologies in forms of male infertility in humans (teratozoospermia), often associated with poor motility (asthenoteratozoospermia). To further our understanding of the aetiology of these conditions, we have performed a pathological investigation of a model of asthenoteratozoospermia that can be induced in mice by N-butyldeoxynojirimycin (NB-DNJ). We have found that, in mice treated with NB-DNJ, instead of an acrosome forming over the round spermatid nucleus, multivesicular bodies (MVB) accumulate in the vicinity of this nucleus. Electron microscopy has revealed that proacrosomic vesicles or granules (PAG) secreted during the Golgi phase of spermiogenesis do not fuse together to form an acrosomic vesicle, but rather attach transiently to the spermatid nucleus. Immunocytochemistry has shown that acrosomal membrane proteins and cytosolic acrosome-associated proteins are redirected to MVB in affected testes, whereas glycoproteins originating in the dense core of the PAG are degraded. Thus, the major effect of NB-DNJ is to inhibit membrane fusion of Golgi-derived secretory vesicles destined for acrosome formation, raising the possibility that these vesicles are critically affected in forms of (astheno)teratozoospermia.

Effect of changes in syringe driver height on flow: a small quantitative study.

OBJECTIVE: To quantify flow irregularities in drug delivery caused by vertical displacement of syringe pumps. METHODS: A bench experiment was performed to quantify the effect of height on pumps used in our intensive care and theatre settings. A standard syringe pump and line set loaded with a dye solution was run through a graduated length of tubing, and the effect of changing pump height quantified by measuring progress down the tubing over time. RESULTS: A 30 cm elevation produced significant drug delivery boluses - up to seven times the programmed rate at 2mL/h. Delivery rate increased in inverse proportion to the programmed rate, as did the time taken to return to the programmed rate. Lowering the pump 30 cm resulted in no-flow times of up to 180 seconds at a flow rate of 2mL/h - again inversely proportional to programmed rate. CONCLUSIONS: Vertical displacement of a common syringe pump by 30 cm produced significant bolus and cessation phenomena. These findings confirm the observations of previous authors and also demonstrate significant flow irregularities with smaller vertical displacements than previously tested. Further testing with other brands of pumps is required before a solution to this clinically important problem may be approached.

Saliva and bloodspot cortisol: novel sampling methods to assess hydrocortisone replacement therapy in hypoadrenal patients.

BACKGROUND: In patients with hypoadrenalism, it is often difficult to assess the optimal dose of glucocorticoid replacement. Serial serum cortisol measurements for a cortisol day curve are sometimes used, but this has low acceptability for patients. In this study, we evaluate the reliability of saliva and capillary bloodspot cortisol as alternative methods in assessing cortisol profiles in hypoadrenal patients on hydrocortisone replacement. METHODS: We first examined the correlations between serum cortisol, saliva and bloodspot cortisol in in-hospital patients not on glucocorticoid therapy. We then studied 18 hypoadrenal patients on hydrocortisone therapy and measured their serum, saliva and bloodspot cortisol concurrently at seven different time points in a single day. RESULTS: For in-hospital patients, a significant correlation exists between saliva and serum cortisol (R = 0.7121, P < 0.0001), but there is a stronger correlation between bloodspot and serum cortisol (R = 0.9494, P < 0.0001). The correlations were weaker in hypoadrenal patients on hydrocortisone (saliva and serum cortisol: R = 0.6262, P < 0.001; bloodspot and serum cortisol: R = 0.7871, P < 0.001). When we evaluated each measurement with respect to an arbitrary target range, there was a greater degree of agreement between serum and capillary bloodspot cortisol (85% agreement) than between serum and saliva cortisol (65% agreement) (P < 0.001). CONCLUSION: Bloodspot samplings provide a simple and convenient way for ambulant hypoadrenal patients on hydrocortisone replacement therapy to assess cortisol levels at multiple times in a single day. This may be useful in determining the optimal glucocorticoid dose for hypoadrenal patients.