Aquifer heterogeneity controls to quality monitoring network performance for the protection of groundwater production wells.

A groundwater monitoring network surrounding a pumping well (such as a public water supply) allows for early contaminant detection and mitigation where possible contaminant source locations are often unknown. This numerical study investigates how the contaminant detection probability of a hypothetical sentinel-well monitoring network consisting of one to four monitoring wells is affected by aquifer spatial heterogeneity and dispersion characteristics, where the contaminant source location is randomized. This is achieved through a stochastic framework using a Monte Carlo approach. A single production well is considered that results in converging non-uniform flow close to the well. Optimal network arrangements are obtained by maximizing a weighted risk function that considers true and false positive detection rates, sampling frequency, early detection, and contaminant travel time uncertainty. Aquifer dispersivity is found to be the dominant parameter for the quantification of network performance. For the range of parameters considered, a single monitoring well screening the full aquifer thickness is expected to correctly and timely identify at least 12% of all incidents resulting in contaminants reaching the production well. This proportion increases to a global maximum of 96% for a network consisting of four wells and very dispersive transport conditions. Irrespective of network size and sampling frequency, more dispersive transport conditions result in higher detection rates. Increasing aquifer heterogeneity and decreasing aquifer spatial continuity also lead to higher detection rates, though these effects are diminished for networks of 3 or more wells. Statistical anisotropy has no effect on the network performance. Earlier detection, which is critical for remedial action and supply safety, comes with a significant cost in terms of detection rate, and should be carefully considered when a monitoring network is being designed.

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists

OBJECTIVE: To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status. METHODS: Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis. RESULTS: For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors. CONCLUSIONS: North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status

No disponible

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists.

OBJECTIVE: To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status. METHODS: Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis. RESULTS: For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors. CONCLUSIONS: North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.

Parallel Simulation in Subsurface Hydrology: Evaluating the Performance of Modeling Computers.

Monte Carlo uncertainty analysis, model calibration and optimization applications in hydrology, usually involve a very large number of forward transient model solutions, often resulting in computational bottlenecks. Parallel processing can significantly reduce overall simulation time, benefiting from the architecture of modern computers. This work investigates system performance using two realistic flow and transport modeling scenarios, applied to various modeling hardware, to provide information on the expected performance of parallel simulations and inform investment decisions. We investigate how performance, measured in terms of speedup and efficiency, changes with increasing number of parallel processes. We conclude that the maximum performance achieved by parallelization can range from 40% to 100% of the theoretical limit, with the lower increases associated with multi-CPU servers. The number of parallel processes required to maximize performance is application dependent, and in contrast to common practice, often needs to be significantly larger than the total number of system CPU cores. Further testing is required to better understand how the physical problem being simulated affects the optimal number of parallel processes needed. Finally, when laptops are considered for modeling applications, careful consideration should be given not only to the specifications but also to the intended use designated by the manufacturer.

Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists

OBJECTIVE: Entrustable Professional Activities (EPAs) are a list of professional tasks (with associated competency ratings) that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. This manuscript assesses the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota. METHODS: This survey assessed the self-reported EPA activities (inclusive of the PHP domain) of registered pharmacists living and practicing in North Dakota. There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded. RESULTS: Within the PHP domain, pharmacists reported performing "Minimize adverse drug events and medication errors" most frequently (mean=3.4, SD=2.0), followed by "Ensure that patients have been immunized against vaccine-preventable diseases" (mean=2.3, SD 2.3), "Maximize the appropriate use of medications in a population" (mean=2.2, SD 2.3), and "Identify patients at risk for prevalent diseases in a population" (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists. CONCLUSION: Pharmacists in North Dakota reported that EPAs in the PHP domain are practiced regularly. Thus, EPAs in the PHP domain have potential as a means to assess outcomes in pharmacy education and practice

No disponible

Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists.

BACKGROUND: Entrustable Professional Activities (EPAs) are a list of professional tasks that pharmacy educational organizations support, and accreditation organizations encourage, for assessment by colleges and schools of pharmacy. OBJECTIVE: This manuscript evaluates the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota. METHODS: This survey evaluated the self-reported EPA activities of registered pharmacists living and practicing in North Dakota. For EPAs and supporting tasks in the 6 domains (including the PHP domain), respondents were asked to self-report the number of times during the last 30 days that they perform the task, using a 6 point response scale (0, 1, 2, 3, 4, 5 or more times). There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded. RESULTS: Within the PHP domain, pharmacists reported performing "Minimize adverse drug events and medication errors" most frequently (mean=3.4, SD=2.0), followed by "Ensure that patients have been immunized against vaccine-preventable diseases" (mean=2.3, SD 2.3), "Maximize the appropriate use of medications in a population" (mean=2.2, SD 2.3), and "Identify patients at risk for prevalent diseases in a population" (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists. CONCLUSIONS: Pharmacists in North Dakota currently perform some population health promoter activities, but not at a consistent and high level. Most of the health prevention activities were medication-related and oriented towards individual patients (micro-level), rather than at a community (population-based) macro-level.

Study Abroad Course for Pre-pharmacy and Pharmacy Students to Learn About Global Health.

Objective. To design, implement, and assess a study abroad course in Ireland for pre-professional and Doctor of Pharmacy (PharmD) students. Methods. An elective study abroad course was created for pre-professional and PharmD students at North Dakota State University. The course included comparison of the US and Ireland's health care delivery systems and participation in history and cultural experiences in Ireland. Prior to the trip, students and preceptors attended seminars related to the culture of Ireland. The three-week trip to Ireland took place between the spring and summer semesters in 2016. Student assignments while abroad included completion of a self-reflection journal with daily entries describing what the student learned and how the experience impacted them, and completion and presentation of a term paper comparing Ireland's pharmacy system with that in the United States. Pre- and post-travel surveys were conducted to assess students' perceptions of and learning from the experience, and to identify areas for course improvement. Results. Students' evaluations of the course and travel experiences were positive. However, students' perceptions of their cultural awareness were largely unchanged. Conclusion. The course was well received by students. Other PharmD programs may benefit from implementing similar study abroad experiences.

Appraisal of the entrustable professional activities (EPAs) patient care provider domain by North Dakota pharmacists

BACKGROUND: Entrustable Professional Activities (EPAs) are the latest addition to a list of professional competencies that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. OBJECTIVE: The study's objective is to assess the use of Core EPAs in the patient care domain (by practice setting, position, and preceptor status) in contemporary pharmacy practice. METHODS: This survey assessed the EPA activities of pharmacists practicing in North Dakota. The pharmacists were asked "how many times in the past 30 days have you delivered the following services in your practice setting?" Response options were: 0, 1, 2, 3, 4, and 5 or more times. RESULTS: Of 990 potential respondents, 457 pharmacists (46.1%) returned a survey, and 107 (10.8%) answered every survey item in the patient care domain. Respondents reported that the highest rated activity items "Collect information to identify a patient's medication-related problems and health-related needs," and "Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs" were performed an average of 3.9 times per week (SD=1.8), and 3.8 times per week (SD=2.0), respectively. Both of these items, were reported for 70% of the respondents at 5 or more times per week. For these items, the highest reported practice setting was 'other' practice settings (e. g. , long-term care, community health centers) followed by chains, hospitals, and independent pharmacies. By position, clinical pharmacists and preceptors reported the highest activity levels for most EPAs and supportive example tasks. CONCLUSIONS: This study provides empirical evidence suggesting (but not proving) that EPAs have potential as a means to assess outcomes in pharmacy education and practice. Our study sets the stage for future work that further refines and assesses core EPA activities and supportive example tasks to measure the impact of how this process relates to outcomes of care

No disponible

The effects of denitrification parameterization and potential benefits of spatially targeted regulation for the reduction of N-discharges from agriculture.

Diffuse nitrate leaching from agricultural areas is a major environmental problem in many parts of the world. Understanding where in a catchment nitrate is removed is key for designing effective land use management strategies that protect water quality, while minimizing the impact on economic development. In this study we assess the effects of spatially targeted nitrate leaching regulation in a basin with limited knowledge of the complexity of chemical heterogeneity. Three alternative nitrate reactivity spatial parameterizations were incorporated in a catchment-scale flow and transport model and used to evaluate the effectiveness of four possible spatially targeted regulation options. Our findings confirm that denitrification parameterization cannot be numerically determined based on model inversion alone. Detailed field based characterization using physical and geochemical methods should be considered and incorporated in the numerical inversion scheme. We also demonstrate that there are potential benefits of implementing spatially targeted regulation compared to spatially uniform regulation. Focusing regulation in areas where nitrate residence time is short, such as riparian zones or areas with low natural N-reduction, results in greater reduction of N-discharges through groundwater. Significantly improved efficiencies can be expected when delineation of management zones considers the chemical heterogeneity and groundwater flow paths. These improved efficiencies are achieved by adopting management rules that regulate land use in discharge sensitive areas, where leaching changes contribute the most to the catchment nitrate discharges. In our case study, regulation in discharge sensitive zones was twice as efficient compared to other management options.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota.

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Impact of Achieved Tenure and Promotion on Faculty Research Productivity at a School of Pharmacy.

OBJECTIVE: Critics of the promotion and tenure system contend that promotion and tenure may lead to a decline in research productivity ("dead wood phenomena") by those faculty. To assess this perception, we compiled the publications and grants at the time of application for promotion, and again through 2017 for the same faculty following promotion and/or tenure. METHODS: Promotion documents at a school of pharmacy at a public Midwestern university were assessed. Mean publication rates and grant dollars per year per faculty member were compared to the same group of faculty (n=13) pre and post-promotion. RESULTS: At the time of promotion to associate professor, mean numbers of total publications per year per faculty in the pharmacy practice department were 1.1, compared to 1.4 post-promotion. For pharmaceutical sciences department faculty, corresponding means were 5.0 and 4.1, respectively. At the time of promotion to full professor, mean numbers of total publications per year for pharmacy practice faculty were 7.0, compared to 7.2 post-promotion. For pharmaceutical sciences faculty, corresponding means were 3.5 and 4.7, respectively. For grant activity, both associate professors and full professors increased the mean total dollars per year from pre-promotion to post-promotion for both departments. CONCLUSION: Research productivity at this school of pharmacy continues to be either maintained or increased since promotion for the collective group of faculty. This evidence runs counter to the perception that promotion and tenure may lead to decreased scholarly productivity. The study provides a roadmap for other schools/colleges to quantify research productivity and make comparisons to national mean levels reported in the literature.

Appraisal of the entrustable professional activities (EPAs) patient care provider domain by North Dakota pharmacists.

BACKGROUND: Entrustable Professional Activities (EPAs) are the latest addition to a list of professional competencies that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. OBJECTIVE: The study's objective is to assess the use of Core EPAs in the patient care domain (by practice setting, position, and preceptor status) in contemporary pharmacy practice. METHODS: This survey assessed the EPA activities of pharmacists practicing in North Dakota. The pharmacists were asked "how many times in the past 30 days have you delivered the following services in your practice setting?" Response options were: 0, 1, 2, 3, 4, and 5 or more times. RESULTS: Of 990 potential respondents, 457 pharmacists (46.1%) returned a survey, and 107 (10.8%) answered every survey item in the patient care domain. Respondents reported that the highest rated activity items "Collect information to identify a patient's medication-related problems and health-related needs," and "Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs" were performed an average of 3.9 times per week (SD=1.8), and 3.8 times per week (SD=2.0), respectively. Both of these items, were reported for 70% of the respondents at 5 or more times per week. For these items, the highest reported practice setting was 'other' practice settings (e.g., long-term care, community health centers) followed by chains, hospitals, and independent pharmacies. By position, clinical pharmacists and preceptors reported the highest activity levels for most EPAs and supportive example tasks. CONCLUSIONS: This study provides empirical evidence suggesting (but not proving) that EPAs have potential as a means to assess outcomes in pharmacy education and practice. Our study sets the stage for future work that further refines and assesses core EPA activities and supportive example tasks to measure the impact of how this process relates to outcomes of care.

Is Telehealth Right for Your Practice and Your Patients With Asthma?

INTRODUCTION: Telehealth services are becoming increasingly used to provide care to patients living in rural areas. Little is known about the patient satisfaction with the provision of these services. METHODS: A prospective cohort pilot study was developed to evaluate the use of telehealth for the delivery of asthma education services in the rural, medically underserved community of Oakes, North Dakota. A certified asthma educator used real-time, audio-visual telehealth technology to meet with patients the local community pharmacy. Patients met with the educator monthly for the first three months of the study, and once every three months thereafter. Patient satisfaction was measured using a five item survey. RESULTS: Eighteen patients completed the study (90 percent completion rate). Patient satisfaction scores were relatively high, typically between 4 and 5 on a 5-point scale. CONCLUSIONS: Participants in a rural, medically underserved community found the community pharmacy location and the telehealth technology a convenient means to access a specialty provider for asthma education.

Pharmacist contributions to the ten essential services of public health in three National Association of Boards of Pharmacy regions.

BACKGROUND: Pharmacists have contributed to improved population health through the delivery of public health services, but their contributions often go unrecognized within the larger health care system. OBJECTIVES: To determine pharmacist perceptions of their contributions to the 10 essential services of public health and to compare those contributions among pharmacists in Iowa, North Dakota, and Manitoba. METHODS: Licensed pharmacists in Iowa, North Dakota, and Manitoba were sent an online survey of their perceived level of achievement of the 10 essential services of public health. RESULTS: A total of 649 pharmacists completed the survey. The 3 essential services that scored the highest overall were enforce laws and regulations that protect health and ensure safety, inform and educate people about health issues, and participate in ongoing training beyond continuing education requirements. Contributions of pharmacists to the 10 essential services of public health were previously evaluated by frequency of citation in the published literature. There was relative agreement between what was reported in the literature and what was determined by survey. One exception was "enforce laws and regulations that protect health and ensure safety," which was rarely reported in the literature but was reported in the survey to be the most frequently delivered service. CONCLUSION: Pharmacist contributions to improved population health should be reported with the use of the 10 essential services of public health. This will increase recognition of pharmacist contributions and better align the disciplines of pharmacy and public health. In particular, pharmacists should consider ways to increase their level of involvement in the community and in partnership with other health care professionals.

Perceived sustainability of community telepharmacy in North Dakota.

OBJECTIVES: To assess the sustainability of the business model underlying the North Dakota Telepharmacy Project (NDTP). SETTING: Of the 38 community pharmacy organizations (14 central, 24 remote), 27 organizations (11 central and 16 remote sites) in North Dakota provided a useable set of responses (71.1% response rate). A twelfth organization (a community pharmacy) ceased operations over the study's time frame and was not included in the data analysis. PRACTICE DESCRIPTION: Emphasis is placed on NDTP community telepharmacies, because the community telepharmacy business model is more established than hospital telepharmacies. Yet little is known about the long-run financial viability of telepharmacies. PRACTICE INNOVATION: Originally funded by a series of federal grants, the goal of the NDTP was to create the infrastructure necessary to support the development of telepharmacy sites. A 48-item questionnaire assessed the self-reported operational, financial, and community impacts of a community telepharmacy. EVALUATION: The questionnaire was administered from December 2015 to February 2016 to all NDTP community telepharmacy owners-managers. Thus, 1 participant (owner-manager) addressed both central and remote-site locations served by a pharmacy. RESULTS: Most respondents reported that their telepharmacy sites (especially remote sites) generate small positive financial returns for the organization. Respondents also reported that the closure of their remote sites would significantly harm the communities they serve. CONCLUSION: NDTP aims of restoration and retention have been achieved via the investment and shared decision making with pharmacy owners in North Dakota. The telepharmacy model is sustainable, even if it does not generate significant economic profit.

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota

Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services. Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community. Conclusion: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking (AU)

No disponible

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

BACKGROUND: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists' delivery of public health services. OBJECTIVE: To assess Iowa and North Dakota pharmacists' practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. METHODS: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. RESULTS: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community. CONCLUSION: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.

PCMHs, ACOs, and medication management: lessons learned from early research partnerships.

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).  Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs. Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services.