Investigating Film Properties of Polymers Used in Anhydrous Sunscreen Formulations Using Scanning Electron Microscopy (SEM): Polymer/Polymer Interactions and Their Relation to Vapor Transmission.

A mechanistic understanding of the role of polymers in waterproofing anhydrous sunscreen formulations has been hypothesized in the past, but has never been clearly established. In this article, we demonstrate the utility of field emission scanning electron microscopy (SEM) to generate images of sunscreen films in the presence and absence of several polymers. VA/butyl maleate/isobornyl acrylate copolymer was studied alone and in combination with hydroxypropyl cellulose and acrylates/dimethicone copolymer. Anhydrous sunscreen formulations were sprayed onto stratum corneum substrates and left to dry. SEM micrographs of treated stratum corneum sections were then collected at various magnifications. Vapor transmission data were collected using an evaporimeter to understand the permeability of these films in the presence and absence of film formers. Examination of the SEM images reveals that after spraying the product onto a layer of corneocytes, the sunscreen filters formed a hydrophobic barrier over the skin, whereas added polymers formed films over the sunscreen layer. The shape of the film formed by various polymers and its porosity were influenced by chemistry and concentration. When more than one polymer was incorporated in the sunscreen formulation, the interactions between the polymers influenced the formation of the film. Cumulative evaporimeter data indicated that the sunscreen phase had the highest reduction in cumulative evaporation rate (39.3%/h) followed by the addition of a film former to the spray, which reached an additional reduction of 17.9%/h in the best case. This method was also used to examine the film properties of a commercial sun protection factor 30 sunscreen product containing VA/butyl maleate/isobornyl acrylate copolymer. SEM micrographs of the commercial product applied to skin showed the same fingerprint as prototype formulations containing VA/butyl maleate/isobornyl acrylate copolymer. Overall, this method can be used by sun care scientists in the development and optimization of anhydrous sunscreen sprays.

Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site.

BACKGROUND: Hormone receptor and HER-2/neu discordance between the primary lesion and first metastasis has been reported. This study was performed to determine further biomarker discordance rates between the first and subsequent metastatic breast cancer lesions. METHODS: We performed a retrospective review of paired biomarkers from primary breast cancers compared to first reported and subsequent metastases from 103 patients with breast cancer. The estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu status were reported at all three time points. In addition, hormone, cytotoxic, and targeted treatments were recorded for primary and metastatic disease, and survival was determined. RESULTS: Between the primary and first metastases, discordance rates for ER, PR, and HER-2/neu were 15.8%, 33.7%, and 14.3%, respectively. There was discordance between the first and second metastases for the ER receptor in 18.8%, PR receptor in 19.8%, and HER-2/neu in 10.7%. Overall, there was discordance between the primary tumor and either the first or second metastases for ER in 27.7%, PR receptor in 40.7%, and HER-2/neu in 19.6% of cases. Discordance of either ER or PR affected survival, with worse survival experienced by those patients with all three hormone receptors remaining negative, and intermediate survival reported for those with discordant tumors (ER χ2=14.27, p=0.0008; PR χ2=11.31, p=0.0035). There was no difference in survival for patients whose HER-2/neu tumors were discordant. CONCLUSION: This study demonstrated that continued metastatic disease evolution may be associated with different tumor biology and that studies of metastatic lesions appear warranted, especially if targeted therapy is an option.

Aiming to complete the matrix: Eye-movement analysis of processing strategies in children's relational thinking.

The present study examines 5- to 8-year-old children's relation reasoning in solving matrix completion tasks. This study incorporates a componential analysis, an eye-tracking method, and a microgenetic approach, which together allow an investigation of the cognitive processing strategies involved in the development and learning of children's relational thinking. Developmental differences in problem-solving performance were largely due to deficiencies in engaging the processing strategies that are hypothesized to facilitate problem-solving performance. Feedback designed to highlight the relations between objects within the matrix improved 5- and 6-year-olds' problem-solving performance, as well as their use of appropriate processing strategies. Furthermore, children who engaged the processing strategies early on in the task were more likely to solve subsequent problems in later phases. These findings suggest that encoding relations, integrating rules, completing the model, and generalizing strategies across tasks are critical processing components that underlie relational thinking. (PsycINFO Database Record

Learning Motivational Interviewing: A Pathway to Caring and Mindful Patient Encounters.

We designed our project to explore the experience of learning motivational interviewing (MI). The project impetus came from a desire to improve our skill in communicating with patients. We created a curriculum led by an MI specialist that provided didactic sessions, discussions and individual feedback. In evaluating our audio-taped MI encounters, we approached beginner proficiency. Also, we recognized the need for formal MI education and practice to fully develop the interventionist skills needed for clinical work and our next research project about preparing patients for transition to adult health care. Lastly, we realized that MI strategies reflect aspects of caring theory and mindfulness, important components of patient-centered care.

Implementing motivational interviewing in a pediatric hospital.

Motivational Interviewing is a collaborative style of communication designed to strengthen a person's own motivation and commitment to change. We report on our ongoing efforts to implement motivational interviewing to address health behavior change among several patient populations in our pediatric hospital, including sexual risk reduction among adolescents, increased self-care for patients with spina bifida, increased adherence for adolescents with Type 1 diabetes, and facilitation with transition from pediatric to adult care among gastroenterology patients.

Population pharmacokinetics of oral baclofen in pediatric patients with cerebral palsy.

OBJECTIVE: To characterize the population pharmacokinetics (PK) of oral baclofen and assess impact of patient-specific covariates in children with cerebral palsy (CP) in order to support its clinical use. SUBJECTS DESIGN: Children (2-17 years of age) with CP received a dose of titrated oral baclofen from 2.5 mg 3 times a day to a maximum tolerated dose of up to 20 mg 4 times a day. PK sampling followed titration of 10-12 weeks. Serial R- and S-baclofen plasma concentrations were measured for up to 16 hours in 49 subjects. Population PK modeling was performed using NONMEM 7.1 (ICON PLC; Ellicott City, Maryland). RESULTS: R- and S-baclofen showed identical concentration-time profiles. Both baclofen enantiomers exhibited linear and dose/kg-proportional PK, and no sex differences were observed. Average baclofen terminal half-life was 4.5 hours. A 2-compartment PK model with linear elimination and transit absorption steps adequately described concentration-time profiles of both baclofen enantiomers. The mean population estimate of apparent clearance/F was 0.273 L/h/kg with 33.4% inter-individual variability (IIV), and the apparent volume of distribution (Vss/F) was 1.16 L/kg with 43.9% IIV. Delayed absorption was expressed by a mean transit time of 0.389 hours with 83.7% IIV. Body weight, a possible genetic factor, and age were determinants of apparent clearance in these children. CONCLUSION: The PK of oral baclofen exhibited dose-proportionality and were adequately described by a 2-compartment model. Our population PK findings suggest that baclofen dosage can be based on body weight (2 mg/kg per day) and the current baclofen dose escalation strategy is appropriate in the treatment of children with CP older than 2 years of age.

Moving from A to Z: successful implementation of a statin switch program by a large physician group.

OBJECTIVE: To describe the implementation and impact of a centralized statin switch program at a large academic medical center. METHODS: Patients on atorvastatin were identified from electronic medical records and pharmacy claims data. Relevant information was sent to physicians for approval of the proposed switches. Approved patients were then contacted via phone and offered the opportunity to switch to simvastatin; those who switched received a new prescription for simvastatin. To assess the independent impact of the active switch process, conversion rates within a single insurance plan were compared for patients who participated in this program versus those who were contacted only by mail. RESULTS: Physicians approved 3207 of the 3677 patients identified for this program. A total of 1710 approved patients accepted the switch, 704 declined, and 170 became ineligible. Information packets were mailed to 623 patients who could not be contacted. Within the single insurance plan, the generic dispensing rate for statins among the 1867 patients included in our program was significantly higher than that for the 2472 patients in the mail-only group (59.2% vs 35.8%, P <.001). Over 8 months, the direct cost of the program was $131,000 with projected annual cost savings of up to $1.14 million to payers and up to $250 for each patient who switched. CONCLUSION: A proactive and voluntary statin switch program to promote the use of a lower cost generic alternative can be successfully implemented in a fee-for-service health system setting with benefits to patients, providers, and payers.

Using a modified electronic health record to develop nursing process skills.

In our study, we described the experiences and behaviors of beginning nursing students learning the nursing process using a modified electronic health record. Eight students led by an experienced nursing instructor from a midwestern university comprised the criterion purposive sample. Data were obtained from observations of the group, interviews with students and the teacher, and evaluation of care plans that were generated using the technology. Two foundational themes were identified through qualitative content analysis: Techno-Savvy Students and Teacher, Simulated Technology, and Data-Rich Case Studies--a valuable hybrid "SEED" for learning. Seeing, Hearing, and Doing--a catalyst for application and spontaneous interaction. The concluding theme emerged: Honing the Data Gatherer and Data User Roles with a Modified Electronic Health Record--an authentic, learner-centered experience. Further study is needed to measure learning outcomes with similar technology-based, learner-centered activities.

An interdisciplinary workshop to improve palliative care: advanced heart failure--clinical guidelines and healing words.

OBJECTIVE: Effective communication is recognized as an essential process to providing quality care, including palliative and end-of-life care. Discussion of prognosis and support needs of patients with heart failure is particularly challenging given the nature of the condition and care across several settings. The objective was to design, implement, and evaluate an interdisciplinary workshop aimed at improving attitudes and skills related to communication with patients and family, health team communication and documentation, and assessment of physical and emotional symptoms. METHODS: A pretest, delayed posttest evaluation design was used to evaluate two 4-h workshops offered to nurses, social workers, and other nonphysician clinicians. RESULTS: Although baseline reports of skills were high for the participants, significant improvement was noted for objectives emphasized in the workshop. SIGNIFICANCE OF RESULTS: This project demonstrated the feasibility of designing, marketing a brief workshop, and positively impacting communication and documentation skills.

Toward a systems- and control-oriented agent framework.

This paper develops a systems- and control-oriented intelligent agent framework called the hybrid intelligent control agent (HICA), as well as its composition into specific kinds of multiagent systems. HICA is essentially developed around a hybrid control system core so that knowledge-based planning and coordination can be integrated with verified hybrid control primitives to achieve the coordinated control of multiple multimode dynamical systems. The scheme is applied to the control of teams of unmanned air and ground vehicles engaged in a pursuit-evasion war game. Results are demonstrated in simulation.

Beyond the rhythm and routine: adjusting to life in assisted living.

In Western countries, demographic trends indicate an increase in the aging population well into the next century. Because of declining health, many older adults will benefit from residence in assisted living (AL). The purpose of this qualitative study was to explore the experience and contextual influences in everyday decision-making of four older adults in AL using a case study method. Several themes emerged as significant in older adult satisfaction with everyday decision-making (i.e., trigger event, level of physical functioning, inside and outside support systems, past patterns of decision-making). Strategies for assessing and strengthening these contextually relevant factors are discussed.

Analysis of sharp-end, frontline human error: beyond throwing out "bad apples".

Sharp-end, frontline human error occurs close to the delivery of patient care. The purpose of this article is to examine the mechanism of human error and cognition, and to explore the antecedents, attributes, and consequences of frontline human error. Fallible decision-making and actions leading to patient injury are explicated in a case study. The discussion includes strategies for preventing patient injury by refining system flaws.