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Abstract:Since 2011, an increasing incidence of sexually transmitted infections and risky sexual practices has been reported among young adults in Canada. However, research on sexual risk behaviours of international students in North America is limited, despite an increasing number of students from abroad attending higher education institutions on this continent. This article shares research findings comparing the sexual practices of international and domestic students in five postsecondary institutions in three Canadian provinces (Manitoba, Ontario, Quebec). Two hundred forty-two international students and 1220 domestic students took part in the bilingual online and paper-based survey. Female international students were less likely to be sexually active than international male, domestic male, and domestic female students. International students were significantly less likely to partake in many risky sexual behaviours, such as inconsistent condom use and unplanned sex after consuming alcohol or drugs. However, male international students were more likely to report having multiple sexual partners than male domestic students. These findings are relevant to those who counsel and advise postsecondary students on Canadian campuses and for healthcare practitioners to better understand postsecondary students' sexual practices. Strategies to enhance sexual health and knowledge include targeted promotion of safe sexual practices and sexual education in postsecondary institutions.

This hermeneutic phenomenological study explored the lived experience of the Watson Caring Science Institute Caritas Coach Education Program graduates. Caritas coaches were interviewed to explore: how caring science influenced the development and implementation of the role, how graduates were affected as they lived out this role, and how caritas coaching affected the quality of nursing care. Three themes were identified: finding voice, living life with purpose and meaning, and the need for change in healthcare. Participant experience supported the importance of caritas coaching and its potential to change how nursing is practiced. It also offered an expanded view of nurse coaching.

Background: The majority of patients with head and neck cancer die of locoregional recurrence of disease following surgery and/or radiotherapy. Purpose: Our purpose was to administer induction chemotherapy, perform surgery, and administer concomitant chemoradiotherapy in rapid sequence and to evaluate their impact on locoregional and distant tumor control. Methods: Sixty-four patients with previously untreated, locoregionally advanced head and neck cancer received two cycels of cisplatin, bleomycin, and methotrexate (PBM) (33 patients) or cisplatin, fluorouracil (5-FU), and leucovorin (PFL) (31 patients). PFL was given to patients who were unable to receive bleomycin. Local therapy consisted of surgery and/or concomitant chemoradiotherapy with 5-FU, hydroxyurea, leucovorin, and radiotherapy (FHX-L), all administered every other week. Results: Complete and overall induction response rates were 21% and 79%, respectively, for PBM and 9% and 81%, respectively, for PFL. At completion of local therapy, 81% of the patients were disease-free. With a median follow-up of 35 months, the median survival and time to progression are 22 and 17 months, respectively,for PBM and have not been reached for PFL. Locoregional recurrence of disease is 30% for PBM and 26% for PFL. Distant disease progression is 24% for PBM and only 3% for PFL. Conclusions: The sequencing of induction chemotherapy and concomitant chemoradiotherapy is feasible and results in a high local control rate and in an encouraging survival rate with PFL. The high distant failure (i.e., outside the had and neck area) rate of PBM suggests insufficient systemic activity for that regimen. Implications: Concomitant FHX-L chemoradiotherapy may improve regional control rates of advanced head and neck cancer. Effective systemic therapy may be needed to control systemic micrometastases. PFL, but not PBM, appears to be suitable to accomplish that goal. [J Natl Cancer Inst 84:877-882, 1992]

We record the experiences of staff in a labour, delivery, and obstetric services (LD-OBS) unit in Alberta’s largest quaternary medical centre—the Foothills Medical Centre (FMC)—as they navigated hospital policies during the COVID-19 pandemic. We examine how unit leadership applied these policies to better align with care delivery realities while staying true to the interprofessional nature of the unit.

Prescribers at a 400-bed metropolitan teaching hospital applied for approval to prescribe restricted antimicrobials using Guidance DS®(GDS), an electronic antimicrobial approval system (EAAS). The implementation of Cerner Millennium®(CM), a computerised physician order entry system (CPOE), necessitated a new but cumbersome workflow for prescribers. This prompted an evaluation of the value of a stand-alone EAAS, which has no interface with a CPOE, for antimicrobial stewardship. This study compares the performance of an EAASand CPOE, used alone and in combination, for surveillance of restricted antimicrobials and compliance with antimicrobial restriction policy. General medical and surgical patients prescribed restricted antimicrobials over three defined periods were retrospectively recruited; period one (P1) used GDSplus National Inpatient Medication Chart, period two (P2), GDSplus CM, and period three (P3), CMalone. For each period, 100 medical and 100 surgical restricted antimicrobial orders were collected. Data collection included prescribing date, indication, approvals obtained, and time to approval. Surveillance rate and compliance was compared. The introduction of CMimproved surveillance from 10.5% (P1) to 65% (P2) and 100% (P3) via a CMreporting module (p < 0.0001). Compliance improved from 6% (P1), to 55% (P2) and 76% (P3) (p < 0.0001). Documentation of a clear/complete indication improved from 10% (P1) to 56.5% (P2) and 76.5% (P3) (p < 0.0001). Approvals obtained within 24 h of prescribing improved from 61.9% (P1), to 96.9% (P2), and 100% (P3). Cerner Millennium®, with customisation, optimises surveillance and significantly improves compliance with policy, negating the need for a stand-alone EAAS.

Adenomyoepithelioma (AME) is a biphasic neoplasm of epithelial and myoepithelial cells. It is most commonly found in the breast, although rare cases have been reported from the lung, salivary glands, and skin. There are 5 well-documented cases of cutaneous AME in the literature. We report a new case of cutaneous AME. Our case was commingled with apocrine hidrocystoma. This is the first report of cutaneous AME in a male patient and the first to describe SOX10 immunostaining in cutaneous AME. We review the literature on cutaneous AME and note the greater than chance colocalization with other adnexal tumors. We speculate that AME may represent localized overgrowth of myoepithelial cells within a pre-existent sweat gland tumor. Histopathologists should be aware of the potential of SOX10-positive myoepithelial neoplasms to mimic nodular melanocytic proliferations.

Objective: Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode.Method: Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight-obese patients, and normal weight healthy control subjects.Results: There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group.Conclusions: These data suggest that overweight-obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD.

Our health service is introducing an electronic medication management system (eMMs). Obtaining baseline data on the work patterns of pharmacists will allow assessment of the impact of the eMMs on pharmacists' work patterns. To quantify the time clinical pharmacists spend on various activities over their working day prior to the implementation of an eMMs. During this continuous observational time‐and‐motion study (23 November to 17 December 2009), clinical pharmacists assigned to general medical and surgical wards were shadowed by two independent observers over their entire working days. A customised Access application was used to log times and calculate average times spent on each activity. Other data collected included time from admission to interview and opportunities for medication chart review. 9 pharmacists were observed for 265.3 hours over 30 separate pharmacist observation days. Clinical activities (56% of total time) included professional communication (20%), medication chart review (9.6%), medication history interview (9.5%), clinical review (9.1%), providing information to patients/carers (5.5%), ascertaining discharge drugs required (1.6%), and obtaining drug information (0.5%). Non‐clinical activities (44% of total time) included social activities/breaks (13%), meetings (6.9%), ordering/distribution (6.6%), discharge dispensing (6.3%), walking between wards/pharmacy (5.2%), looking for something (3.1%), and other activities (2.8%). On an average day, each pharmacist reviewed 21 of a possible 38 medication charts (55%), spent 20 minutes on clinical interventions and completed 4.5 medication history interviews. Average time from admission to interview was 67 hours. 18% of pharmacists' time was taken up with discharge/transfer of patients. Most patients 130/141 (93%) at discharge did not require further medication history clarification. This study provides baseline data for comparison of the impact of the eMMs on pharmacist workflow.

Although associations between antipsychotic use and neuropsychological impairment in bipolar I disorder have been observed, there is a lack of studies comparing the effects of specific agents used in this population. We compared performance between patients receiving maintenance treatment with mood stabilizer monotherapy (n=15), adjunctive risperidone (n=15) or quetiapine (n=17), and a group of demographically matched healthy controls (n=28) on tests of executive function (working memory, set shifting, and inhibition) and verbal learning. Despite having a similar clinical profile, patients being treated with risperidone showed significantly impaired working memory, set-shifting, and verbal learning (P<0.05) compared with those either on mood stabilizer monotherapy or adjunctive quetiapine. Although randomized controlled trials are required to confirm the cognitive side effects of medications prescribed for maintenance treatment of bipolar I disorder, preliminary results indicate that addition of risperidone to a mood stabilizer has a negative impact on executive function and verbal learning, an effect not shared with quetiapine.

Serious and life‐threatening adverse drug events are often attributed to intravenous medication administration errors. Although smart infusion pumps are increasingly being adopted by hospitals to prevent such errors, data are lacking on their effectiveness in clinical practice. To measure and characterise intravenous medication administration errors and their clinical significance before and after the implementation of smart infusion pumps. In the pre‐intervention period, an independent observer over 41 working days recorded the prescribing and administration details of infusions administered via the IMED Gemini Volumetric Infusion Pumps. 20 months after the introduction of the smart pumps – Alaris GP Volumetric Pump with Guardrails software – a repeat audit was conducted over 27 working days. Only infusions containing drugs that were to be incorporated into Guardrails (the medication–error–prevention software of the Alaris GP pump) were evaluated. The clinical significance of the identified errors was evaluated by 2 independent assessors (pharmacist and doctor) and rated as ‘low’, ‘moderate’, ‘high’ or ‘extreme’. In the pre‐intervention period, 76 infusions (n = 432, 18%) had one or more errors compared to 25 infusions (n = 266, 9.4%) following the introduction of the smart pumps. Of the 165 infusions administered using Guardrails, only 6 infusions with errors (3.6%) were identified. When drugs were infused with the Alaris GP pumps without Guardrails, the number of errors post‐intervention when compared with errors in the pre‐intervention period were not statistically significant (p = 0.8). When Alaris GP pumps with Guardrails were used there were no errors of ‘extreme’ clinical significance and only 1 error of ‘high’ clinical significance compared to the pre‐intervention period where 1 ‘extreme’ and 30 errors with ‘high’ clinical significance were identified. Alaris GP pumps with Guardrails resulted in significant reductions in the number and clinical significance of intravenous medication administration errors.

Twenty criteria are used to analyze sixteen national action plans that focus on women, peace, and security. United Nations Security Council Resolution 1325, a base for the national plans, highlights the terrible consequences of violent conflict on women and girls as well as the important role of women in all peacebuilding processes. Suggestions are made for those developing or revising plans and include addressing the relevant points from four UN Security Council resolutions (1325, 1820, 1888, and 1889); specifying all processes and timelines; and including civil society participation in all phases of a plan's development; implementation, and assessment.

To describe the implementation of pharmacist‐initiated e‐script transcription service (PETS) in a teaching hospital; to validate the service through process indicators; and to explore the views of stakeholders. Following an initial trial, PETS was implemented in 7 medical and surgical units at Frankston Hospital. Data were collected on activities and discharge prescription errors. Stakeholders' satisfaction was measured using a Likert scale based survey and group interviews. Transcripts of group interviews were analysed by informal word‐based techniques, noting words or synonyms used repeatedly to discover themes. During the implementation phase (8 to 29 February 2008), a daily average of 15 prescriptions (112 items) were prepared by the PETS pharmacist, i.e 30 to 60% of weekday discharge prescriptions. The discharge prescription error/amendment rate was 0.06 per patient. 163 respondents (92%) were satisfied or very satisfied with PETS. As a result of 3 group interviews of 10 doctors, 10 nurses and 10 pharmacists, several areas for enhancement were identified and implemented. PETS has transitioned from trial to mainstream service, facilitating the discharge process and improving continuity of care.

To evaluate a pharmacist‐initiated e‐script transcription service for discharged patients. A sequential prospective study of 2 groups of 40 eligible medical patients recruited from the neurology and respiratory wards. Pre‐implementation of the service, baseline data were collected from 40 consecutive medical patients. After the new service was implemented and allowing for a 2 week run‐in period, data were collected from a further 40 consecutive medical patients. The outcome indicators were the time taken to discharge patients and the number of prescribing errors. The pharmacist‐initiated e‐script transcription service was successfully implemented. The discharge process was faster with the time taken from decision to discharge to actual discharge decreased by 34% (p = 0.02). The time spent by dispensing pharmacists in clarifying and amending discharge prescriptions decreased from 9.5 to 1.5 minutes per patient. The time spent by doctors in preparing discharge prescriptions fell from 15 to 2 minutes per patient. There were also fewer prescribing errors – number of errors decreased from 0.83 to 0.1 per patient (p = 0.0005) and from 0.0962 to 0.0137 per item (p = 0.011). Combining a prescribing role with the medication safety elements of electronic prescribing and medication reconciliation has resulted in significant improvements in the quality, accuracy and timeliness of discharge prescriptions. The centralised discharge transcription service is transferable to a wide variety of health settings. The principles of workforce substitution and process change is important as the health system struggles to meet ever increasing demands.

The article offers information on the National Performing Arts Convention (NPAC) to be held in June 2008 in Denver, Colorado.

Tele HomeCare is a demonstration telemedicine project focused on the delivery of home health care to elderly homebound patients who are receiving care for either congestive heart failure, chronic obstructive pulmonary disease, or chronic wound healing. The telemedicine components of the study involve low-cost, standards-based videoconferencing and Internet access delivered over regular voice-grade telephone service and the patient’s television as well as physiological monitoring. This technology links the patient at home with a home care nurse at the home health agency. This is a randomized clinical trial with control and telemedicine intervention groups. Study design, technology details, and focus group and pilot study results are reported. Outcome measures, including quality of care, access, patient satisfaction, and cost factors, will be reported at the conclusion of the study.

The present study investigated the cognitive style and creative processes of 42 learning disabled and 44 nondisabled students. Subjects were randomly selected and administered the Matching Familiar Figures Test and the Torrance Test of Creative Thinking. A chi-squared analysis suggested a significant difference between the cognitive styles of the two groups of children. Multivariate analysis of variance indicated no significant differences in creativity between learning disabled and nondisabled students, or between reflective and impulsive individuals. Correlational analyses suggested that errors and latencies on the Matching Familiar Figures Test were not significantly related to the creative abilities of either learning disabled or nondisabled children. Theoretical and educational implications of results were discussed.

The article presents the author's views on the benefits of developing closer partnerships and alliances with professional associations for agricultural educators in the U.S. She asserts that closer relationships between agricultural educators and professional associations can provide opportunities for the educators to develop better skills and a broader knowledge base and mentors for students. She also highlights her early experiences as teacher of agriculture.

In the article, the author discusses how can choral groups attract the attention of the current generation of multitasking, socially-minded individuals for them to attend choral concerts. She presents three recommendations on how to capture the interest of the current generation to choral performances, namely, offering more music, presenting performances that are related to the current era, and adopt unique strategies. She cites as example the show titled "Too Much Light," which is among the longest-running shows in Chicago, Illinois.

The article offers information on strategies that can be used for children choral recruitment. These strategies are designed for choral directors and administrators to meet the challenges in keeping choruses thrive. The strategies include establishing connections with schools, developing events and outreach programs, online marketing, and using social networking websites.

To evaluate the impact of an emergency department (ED) pharmacist on prescribing errors 24 hours post‐admission. A prospective controlled sequential study was conducted in the ED of a metropolitan teaching hospital. In the control period, ED patients admitted were followed‐up by ward pharmacists (standard practice). In the active period, they were seen first by the ED pharmacist. Targets of 50 patients were recruited into each study period. All medication charts were reviewed by a senior clinical pharmacist (reviewing pharmacist) at 24 hours post‐admission. Errors were risk‐assessed by a blinded independent physician. The number and type of errors were compared. The profile, type and complexity of patients and number of medications ordered per patient were similar in both periods. There was a 71% relative reduction in errors per patient (p < 0.0001) and a 76% relative reduction in errors per drug order (p < 0.0001) between the control and active periods. The number of errors rated as high‐extreme, moderate or minor, decreased by 64%, 71% and 90% respectively. Overall, the most common types of error were drug omissions (63%); and the most common drugs involved were cardiovascular (31.5%), central nervous system (18%), respiratory (12.6%) and endocrine (10.8%). An ED pharmacist providing timely medication histories resulted in admitted patients significantly more likely to receive an accurate medication chart early in their hospital stay.

The article announces the resignation of Jan Ozias as co-editor of the journal "School Health Alert" as of June 2014.

We conducted a double-blind, randomized crossover study to compare the toxicity and antiemetic efficacy of the 5-hydroxytryptamine3 receptor antagonist batanopride with that of metoclopramide in 21 chemotherapy-naive patients receiving at least 70 mg/m2 cisplatin. The study was terminated when hypotension was observed following the infusion of batanopride at other institutions testing similar drug schedules. Although we observed no hypotension following treatment with batanopride in this trial, we did note asymptomatic prolongation of the corrected QT interval (QTc), PR interval, and QRS complex on the EKG in the batanopride arm. Of 15 evaluable patients, 8 experienced ?2 episodes of emesis within 24 h of the first batanopride infusion, whereas 9/15 subjects experienced ?2 emetic episodes following the administration of metoclopramide. Overall, the evidence suggests that this dosing schedule for batanopride may be too toxic for clinical used.

Huntingtin (Htt) is a protein with a polyglutamine stretch in the N-terminus and expansion of the polyglutamine stretch causes Huntington's disease (HD). Htt is a multiple domain protein whose function has not been well characterized. Previous reports have shown, however, that post-translational modifications of Htt such as phosphorylation and acetylation modulate mutant Htt toxicity, localization, and vesicular trafficking. Lysine acetylation of Htt is of particular importance in HD as this modification regulates disease progression and toxicity. Treatment of mouse models with histone deacetylase inhibitors ameliorates HD-like symptoms and alterations in acetylation of Htt promotes clearance of the protein. Given the importance of acetylation in HD and other diseases, we focused on the systematic identification of lysine acetylation sites in Htt23Q (1–612) in a cell culture model using mass spectrometry. Myc-tagged Htt23Q (1–612) overexpressed in the HEK 293T cell line was immunoprecipitated, separated by SDS-PAGE, digested and subjected to high performance liquid chromatography tandem MS analysis. Five lysine acetylation sites were identified, including three novel sites Lys-178, Lys-236, Lys-345 and two previously described sites Lys-9 and Lys-444. Antibodies specific to three of the Htt acetylation sites were produced and confirmed the acetylation sites in Htt. A multiple reaction monitoring MS assay was developed to compare quantitatively the Lys-178 acetylation level between wild-type Htt23Q and mutant Htt148Q (1–612). This report represents the first comprehensive mapping of lysine acetylation sites in N-terminal region of Htt.

The article presents tips on achieving goals. Focusing on the fixable, observable behavior of an individual instead of on changing his or her attitude is suggested. Knowing oneself is also recommended to avoid creating challenges or confusion or seeking temporary solutions to shortcomings. The importance of setting realistic deadlines for achieving goals is emphasized.

The author offers her views with regard to children's choruses from San Francisco, California who have performed at the inauguration ceremony of U.S. President Barrack Obama in Washington, D.C. in January 2009. The author describes the atmosphere during the ceremony. She quotes Susan McMane, director of the Girls Chorus, saying it is a special privilege to be able to perform choral music at the inauguration. The also narrates how the choruses have prepared for the inaugural peformance.

Discusses the merits of using interactive whiteboards in the classroom. Components of an interactive whiteboard; Sources of interactive whiteboards in the United States; Description of how several schools use their interactive board; Challenges facing schools in introducing interactive whiteboards.

Examines issues related to proposal to implement year-round schooling in the state of New York. Mechanics; Comparison with traditional 10-month school year; Disadvantages; Claims of proponents of year-round schooling.