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The 2023 Educational Affairs Committee reviewed relevant position statements and publications to update the 2014 ACCP position statement on the educational outcomes (EOs) necessary for pharmacy students to enter postgraduate year 1 (PGY1) residency training. The committee initially aligned entry‐level graduate outcomes with current PGY1 residency competencies achieved after postgraduate training. The committee then used these alignments to identify consistencies, insufficiencies, and gaps in preparation. This process revealed that the EOs and entrustable professional activities from curricular outcomes and entrustable professional activities and the North American Pharmacist Licensure Examination blueprint could serve as a partial list of outcomes necessary to enter postgraduate training; however, some of the outcomes necessary to enter residency were not consistently addressed. To improve residency readiness, the committee recommends that both academic programs and the individual learner evaluate and seek opportunities to address any curricular gaps in alignment. The findings also underscore the need for a single set of well‐defined and mutually agreed‐on educational competencies that evolve over time and embrace the knowledge, skills, and attitudes that demonstrate residency readiness. [ABSTRACT FROM AUTHOR]

Precision medicine has the potential to have a significant impact on both drug development and patient care. It is crucial to not only provide prompt effective antiseizure treatment for critically ill patients after seizures start but also have a proactive mindset and concentrate on epileptogenesis and the underlying cause of the seizures or seizure disorders. Critical illness presents different treatment issues compared with the ambulatory population, which makes it challenging to choose the best antiseizure medications and to administer them at the right time and at the right dose. Since there is a paucity of information available on antiseizure medication dosing in critically ill patients, therapeutic drug monitoring is a useful tool for defining each patient's personal therapeutic range and assisting clinicians in decision‐making. Use of pharmacogenomic information relating to pharmacokinetics, hepatic metabolism, and seizure etiology may improve safety and efficacy by individualizing therapy. Studies evaluating the clinical implementation of pharmacogenomic information at the point‐of‐care and identification of biomarkers are also needed. These studies may make it possible to avoid adverse drug reactions, maximize drug efficacy, reduce drug–drug interactions, and optimize medications for each individual patient. This review will discuss the available literature and provide future insights on precision medicine use with antiseizure therapy in critically ill adult patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare a portable ultrasound (US) device and a traditional US for performing transcranial ultrasonography (CCT) in patients with Parkinson's disease (PD). Methods: This is a cross‐sectional, observational, and analytical study. The study recruited a total of 129 individuals from two public hospitals in the city of Rio de Janeiro in a prospective and non‐randomized manner between September 2019 and July 2021 as follows: group A with 31 patients with PD, group B with 65 patients with PD, and group C with 64 healthy individuals. Group A was used to collect data to establish the agreement analysis of the TCS measurements between the two devices. Groups B and C provided data for constructing the receiver operating characteristic curve for the handheld US. The subjects underwent the assessment of the transtemporal bone window (TW) quality, the mesencephalon area, the size of the third ventricle, and the substantia nigra (SN) hyperechogenicity area. Results: There was a good agreement between the methods regarding the quality of the TW–Kappa concordance coefficient of 100% for the right TW and 83% for the left, the midbrain area—intraclass correlation coefficient (ICC) of 69%, the SN area ICC = 90% for the right SN and 93% for the left and the size of the third ventricle ICC = 96%. The cutoff point for the SN echogenic area in the handheld US was 0.20 cm2. Conclusions: The handheld US is a viable imaging method for performing TCS because it shows good agreement with the measurements performed with traditional equipment, and the measurement of SN echogenic area for PD diagnosis presents good sensitivity and specificity. [ABSTRACT FROM AUTHOR]

There is a paucity of literature regarding the optimal selection of combination antiseizure medications (ASMs) for drug‐resistant epilepsy (DRE). The aim of this scoping review is to evaluate current evidence related to "rational polytherapy" among adults with DRE. Using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐SCr) guidelines, PubMed, ProQuest, CINAHL, and Cochrane databases were searched using DRE‐ and polytherapy‐related keywords. The exclusion criteria applied included: non‐English; non‐human studies; non‐research studies; participants less than 18 years; status epilepticus; ASM monotherapy; and certain ASMs. In Covidence, two researchers independently reviewed articles for inclusion at each phase, with a third resolving conflicts. Data were extracted, with quality appraisal using the Mixed Methods Appraisal Tool (MMAT). Of the 6477 studies imported for screening, 33 studies were included. Clinical, humanistic, and economic outcomes were reported by 26, 12, and one study, respectively. Common efficacy‐related clinical outcomes included ≥50% reduction in seizure frequency (n = 14), seizure freedom (n = 14), and percent reduction in seizure frequency (n = 8). Common humanistic outcomes included quality of life (n = 4), medication adherence (n = 2), sleep‐related outcomes (n = 2), and physician and patient global assessments (n = 2). The economic study reported quality‐adjusted life years. The median MMAT score was 80 (range: 60–100). Two studies referenced the standard definition of DRE, whereas five studies did not specifically define DRE. Gaps in the literature include limited generalizability, minimal reports in pregnancy, and lack of optimal ASM combinations, among others. Strengths of the evidence include addressing a variety of outcomes. Inconsistent definitions of DRE, small sample sizes, and heterogeneity among studies limit the ability to draw meaningful conclusions. Optimal combinations of ASMs for rational polytherapy for DRE is unclear. [ABSTRACT FROM AUTHOR]

Problem: NK cells are important for healthy pregnancy and aberrant phenotypes or effector functions have been associated with RPL. We compared expression of a broad panel of NK cell receptors, including immune checkpoint receptors, and investigated their clinical association with RPL as this might improve patient stratification and prediction of RPL. Method of study: Peripheral blood mononuclear cells were isolated from 52 women with RPL and from 2 women with an uncomplicated pregnancy for flowcytometric analysis and plasma was used to determine anti‐CMV IgG antibodies. Results: Between RPL and controls, we observed no difference in frequencies of T‐, NKT or NK cells, in CD56dimCD16+ or CD56brightCD16‐ NK cell subsets or in the expression of KIRs, NKG2A, NKG2C, NKG2D, NKp30, NKp44, NKp46 or DNAM1. NK cells from women with RPL had a higher expression of LILRB1 and TACTILE and this was associated with the number of losses. The immune checkpoint receptors PD1, TIM3 and LAG3 were not expressed on peripheral blood NK cells. In RPL patients, there was a large variation in NKG2C expression and higher levels could be explained by CMV seropositivity. Conclusion: Our study identified LILRB1 and TACTILE as NK cell receptors associated with RPL. Moreover, we provide first support for the potential role of CMV in RPL via its impact on the NK cell compartment. Thereby our study could guide future studies to confirm the clinical association of LILRB1, TACTILE and NKG2C with RPL in a larger cohort and to explore their functional relevance in reproductive success. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic is a socially shared health issue that has had profound impacts on all aspects of community life and requires collaborative coping responses. Drawn from the extended theoretical model of communal coping, we examined (a) factors that promote community members' communal coping and (b) the influence of communal coping on perceived stress and positive adaptation in the context of COVID‐19. An empirical test based on the survey of participants (N = 257) living in the state of New York showed that strong community identity, but not the length of residency in the same community and integrated connectedness to communication resources of the community, was positively associated with communal coping orientation. Having a higher communal coping orientation was not related to perceived stress, but it was positively related to engagement in COVID‐19 preventive behaviors. The implications of these findings for understanding communal coping at the community level and future directions are discussed. [ABSTRACT FROM AUTHOR]

Background: Subclinical depressive symptoms are highly prevalent among adolescents and are associated with negative consequences, which may pose an economic burden for society. We conducted a prevalence‐based cost‐of‐illness study using a societal perspective to investigate the cost‐of‐illness of subclinical depressive symptoms among adolescents. Methods: Using a bottom‐up approach, cost questionnaires were assessed to measure costs from 237 Dutch families with an adolescent aged 11–18 with subclinical depressive symptoms (of which 34 met the criteria of a depressive disorder). The study is registered in the Dutch Trial Register (Trial NL5584/NTR6176; www.trialregister.nl/trial/5584). Results: Our calculations show that adolescents with subclinical depressive symptoms cost the Dutch society more than €42 million annually, expressed in costs related to depressive symptoms. Secondary analyses were performed to test the reliability and stability of the costs. When costs related to psychological problems were considered, the annual costs amounted to €67 million. The total societal costs related to physical problems amounted to approximately €126 million. All costs combined (depressive, psychological, behavioural and physical problems and other reasons) amounted to a €243 million. Total costs were highest for physical‐related problems of the adolescent (52% of the total costs), followed by psychological (28%), depressive (17%) and behavioural problems (1%). Using an international prevalence rate, societal costs related to depressive symptoms resulted in €54 million a year. Conclusions: Cost‐effective prevention programmes seem warranted given the high societal costs and risk of future costs as subclinical depressive symptoms could be a precursor of clinical depression later in life. [ABSTRACT FROM AUTHOR]

Pharmacy has long struggled to embrace a unified professional identity despite many leaders calling for such. With societal and scientific evolutions, the functions of the pharmacist have changed over time, often assuming multiple identity discourses. Pharmacy has also been seen as a very heterogeneous profession with product‐ and patient‐focused practitioners, contributing to the lack of a unifying identity. This commentary argues that to advocate for and promote our profession we must confront the brutal facts and realize the true state of pharmacy practice. The fact is that all areas of pharmacy practice, both product‐ and patient‐focused, have always shared a central theme which is and has been the pharmacist's professional identity: the prevention, identification, and management of medication therapy problems and their root causes as the medication specialist. Fully embracing this professional identity will help the profession assume a clear and unique role on the healthcare team in optimizing patient care and allow for meaningful practice‐based research, grounded in theory, which will improve the education of currently practicing and future pharmacists. A firm professional identity will also allow for a seamless continuation between pharmacist education and practice across a lifetime, strengthening the pharmacy profession as a whole. [ABSTRACT FROM AUTHOR]

Augmented renal clearance (ARC), a phenomenon of enhanced elimination of renal solutes, has been described in adult critically ill patients, but little is known about the phenomenon in children. The aim of this scoping review was to gather and summarize all evidence on ARC in pediatric patients to examine its breadth and depth including prevalence, risk factors, and pharmacokinetic alterations and identify any gaps for further areas of inquiry. PubMed, Embase, and Web of Science were searched for titles, abstracts, or keywords that focused on ARC. Non‐English studies, reviews, and nonhuman studies were excluded. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐ScR) guidelines. Data were extracted on article type, study details, patient population, ARC definition and prevalence, methods of renal function assessment, and study results. A total of 215 citations were found with 25 citations meeting the criteria for inclusion in pediatrics (2102 total patients); the majority of studies (84%) focused on pharmacokinetics (PK) of antimicrobial agents. The median/mean age range was 1.25–12 years. There were a total of 10 different definitions of ARC. The prevalence of ARC ranged from 7.8% to 78%. The most common method for documenting creatinine clearance (CrCl) was the modified Schwartz equation (64%). Only 20% of studies reported risk factors for ARC including low serum creatinine, increasing age, febrile neutropenia, male, septic shock, and treatment with antibiotics. Glycopeptide antimicrobials were the most evaluated class (42.9%) among the 21 antimicrobial drug studies. All studies reported increased drug clearance and/or poor probability of achieving target concentrations of the agents studied. ARC showed variable prevalence in pediatric patients likely due to the lack of a standard definition and many studies not considering age‐related changes in CrCl with pediatric intensive care unit (PICU) patients. ARC was shown to impact PK of antibiotics commonly administered to pediatric patients, which may necessitate changes in standard dosing regimens. [ABSTRACT FROM AUTHOR]

An intraoperative power failure (IOPF) is a complete or partial absence of the electrical power supply with or without the availability of a backup generator system during an operative or other invasive procedure. An IOPF can be stressful for the OR team and puts surgical patients at risk for adverse outcomes. To prepare providers for an IOPF, a CRNA piloted a project to create an evidence‐based, facility‐specific cognitive aid (CA) to guide decision making and enhance patient management and outcomes during an IOPF. The project team tested the battery‐power capabilities of essential anesthesia equipment, including anesthesia gas machines, IV pumps, and vital sign monitors, and included the results in the CA. A needs assessment survey was sent to the anesthesia professionals at the facility to promote clinician buy‐in and solicit feedback for creating the CA. [ABSTRACT FROM AUTHOR]

In pharmacy education, we are experiencing the "new normal" after an "inflection point" along with a host of other overused phrases. Yet, without doubt, there is pressing need to reconsider what was once standard operating procedure. When an inflection point is viewed as opportunity, it sparks a strategic boom. Indeed, the confluence of threats and opportunities caused—or revealed—by the COVID‐19 pandemic is setting the stage for an acceleration of change in professional education. In this paper, we investigate the motivations and approaches to accelerate needed change in pharmacy education. Though prompted by the demand for rapid restructuring in response to the COVID‐19 pandemic, these ideas transcend any one driver. We argue that now is the time to disrupt current practices through innovation leading to new educational models and present sample solutions. We consider academic, social, technological, economic, and political (ASTEP) forces driving the imperative to educational change. [ABSTRACT FROM AUTHOR]

Introduction: Growth mindset is a motivation theory proposed by Carol Dweck that posits our beliefs about intelligence, and the ability to change mindsets can have impacts on how we approach challenges, respond to criticism challenges and orient our goals. This study characterised articles on growth mindset theory in health professions education to: summarise the aspects of growth mindset being researched, describe the discussed benefits of growth mindset theory and outline strategies discussed that may promote a growth mindset. Methods: A systematic review of the literature yielded 4927 articles—articles were reviewed and excluded if they were outside of health professions education and did not discuss Dweck's growth mindset theory. The final review yielded 14 research articles and 13 commentaries, which were characterised and analysed using content analysis. Results: The included articles were published in 2016 and beyond; the articles represented a diverse context, participant type and approach. Most research studies measured participant mindsets and evaluated the correlation with other variables (eg grit, well‐being, anxiety). Articles often highlighted benefits and strategies to promote a growth mindset at the learner, educator and organisation level. The most common learner benefits were to help them be more receptive to feedback as well as increased resiliency and perseverance, educator benefits focused on supporting collaborative relationships and safe learning environments. The most prevalent strategies discussed were teaching learners about growth mindset theory, shifting faculty feedback to emphasise effort and to prioritise feedback across the organisation. Conclusion: The growth mindset framework has been shown in other fields to help others manage educational challenges and enhance learning environments. Researchers are encouraged to explore how interventions such as teaching about and prioritising a growth mindset can support learners, health care professionals, educators and organisations. Curious how growth mindset has been researched in health professions education? In this review, the authors mapped research in our field, shining light on the benefits of (and strategies to promote) a growth mindset. [ABSTRACT FROM AUTHOR]

While there continues to be a sense of unpredictability with the current COVID-19 pandemic as well as any other future pandemics, one thing will be certain - teachers will be better equipped to carry on training the next generation of healthcare learners. During a time of incredible uncertainty, the COVID-19 pandemic had catalysed the adoption of telehealth and virtual learning. The programme enabled learners to engage in a structured programme to simultaneously acquire health communication and coaching skills while addressing social and technological barriers to patient care. [Extracted from the article]

Abstract: Surgical team members use fire risk assessment tools to determine the risk of a surgical fire occurring and facilitate communication to reduce risk. The purposes of this quality improvement project were to improve knowledge and awareness of surgical fire risk and increase practitioners’ use of a fire risk assessment tool during the surgical safety communication process. We recruited a purposive sample of participants that included all surgical team members of a metropolitan ambulatory surgical center. We based the educational intervention on published evidence and findings of a preintervention knowledge, attitude, and practice (KAP) survey. We assessed knowledge, current practice, and practice intent using a 10‐item pretest and posttest, and used a follow‐up posttest to assess knowledge retention and practice change. The findings suggest that a brief educational intervention regarding fire risk assessment contributes to improving staff member knowledge and use of prevention strategies. [ABSTRACT FROM AUTHOR]

Using the Chinese writing system, which is unique with respect to the composition of each character in terms of its graphic shape, as an example, this chapter addresses the neurobiological underpinnings of reading and writing and how these brain circuits are used in different languages. [ABSTRACT FROM AUTHOR]

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. [ABSTRACT FROM AUTHOR]

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most widely utilized class of cholesterol-lowering agents, carrying multiple indications for both primary and secondary cardiovascular risk reduction. Concern was raised by previously published post hoc analyses and observational studies that noted an increased risk of hemorrhagic stroke in patients receiving a statin. Subsequent studies have demonstrated conflicting results regarding the role of statin therapy on hemorrhagic stroke risk and patient outcomes. New evidence suggests that statins taken prior to or continued during admission for intracerebral hemorrhage (ICH) may be associated with positive outcomes. Evidence also suggests deleterious outcomes resulting from the abrupt discontinuation of statins upon hospital admission for multiple disease states including ICH. Conflicting data also exist for the use of statins following aneurysmal subarachnoid hemorrhage (aSAH). Recent evidence suggests statins started during admission for aSAH confer no additional benefit in reducing delayed ischemic neurologic deficits despite initial positive results. Larger scale evaluation of the role of statin therapy following hemorrhagic stroke is warranted. The available literature is reviewed to provide guidance for therapeutic decision making. [ABSTRACT FROM AUTHOR]

Objective The site of action for antiepileptic drugs ( AEDs) is within the brain; however, cerebrospinal fluid ( CSF) concentration is highly variable. Lacosamide ( LCM) is approved by the U.S. Food and Drug Administration ( FDA) for treatment of partial-onset seizures in adults, and has linear pharmacokinetics in serum. Penetration across the blood-brain barrier ( BBB) is unknown. This study aims to provide additional insights into the pharmacokinetics of LCM. Methods Thirty adults undergoing craniotomy for treatment of intractable epilepsy or brain tumor were recruited and were either taking LCM long term (group 1, n = 15), or were LCM naive, receiving LCM as prophylaxis for surgery (group 2, n = 15). All patients received one intravenous ( IV) dose (15 min infusion) immediately prior to craniotomy. CSF and arterial blood were collected simultaneously following craniotomy. LCM concentrations were measured in serum and CSF. Results LCM concentration differences between groups 1 and 2 for both CSF and serum were statistically significant (p ≤ 0.0005), but there was no statistically significant difference in CSF/serum ratios (group 1 = 0.726 ± 0.231; group 2 = 0.556 ±0.241; p = 0.0585). LCM concentration in serum correlated positively with CSF concentration in group 1 (Pearson r = 0.8527, p < 0.0001). The time interval between the end of dose delivery and sample collection correlated positively with the CSF/serum ratio for the drug-naive group (Pearson r = 0.6525; p = 0.0084). Treatment with other AEDs did not affect LCM distribution between serum and CSF. Significance Although chronic dosing resulted in higher LCM concentrations in serum and CSF compared to drug-naive patients, the CSF/serum ratio was not affected by LCM pretreatment. These data suggest that LCM serum concentration may reliably predict CSF concentration. [ABSTRACT FROM AUTHOR]

Study Objectives To identify demographic and clinical risk factors associated with gastrointestinal ( GI) bleeding among a large cohort of patients with atrial fibrillation ( AF) who initiated dabigatran therapy for stroke prevention, and to describe patterns of subsequent anticoagulant use after occurrence of the GI bleeding event. Design Retrospective cohort study. Data Sources Large, nationwide United States commercial insurance database. Patients A total of 21,033 patients with nonvalvular AF who initiated dabigatran between October 19, 2010, and December 31, 2012. Measurements and Main Results We used multivariate Cox regression analysis to estimate the effect of baseline demographic and clinical characteristics on the probability of a GI bleeding event. Patterns of anticoagulation use after GI bleeding were also examined descriptively. Of the 21,033 patients receiving dabigatran, 446 (2.1%) experienced a GI bleed during follow-up. GI bleeding rates differed across many baseline characteristics. Male sex was associated with a lower risk (adjusted hazard ratio [ aHR] 0.78, 95% confidence interval [ CI] 0.64-0.95) of GI bleeding. Compared with patients younger than 55 years, those aged 55-64, 65-74, and 75 years or older yielded aHRs of 1.54 (95% CI 0.89-2.68), 2.72 (95% CI 1.59-4.65), and 4.52 (95% CI 2.68-7.64), respectively. Renal impairment ( aHR 1.67, 95% CI 1.24-2.25), heart failure ( aHR 1.25, 95% CI 1.01-1.56), alcohol abuse ( aHR 2.57, 95% CI 1.52-4.35), previous Helicobacter pylori infection ( aHR 4.75, 95% CI 1.93-11.68), antiplatelet therapy ( aHR 1.49, 95% CI 1.19-1.88), and digoxin use ( aHR 1.49, 95% CI 1.19-1.88) were also associated with an increased GI bleeding risk. Of the 446 patients who experienced a GI bleed, 193 (43.3%) restarted an anticoagulant, with most (65.8%) filling prescriptions for dabigatran; the mean time was 50.4 days until restarting any subsequent anticoagulant. Conclusion The risk of GI bleeding in patients receiving dabigatran is highly associated with increased age and cardiovascular, renal, and other comorbidities, even after adjusting for other factors. Fewer than 50% of patients restarted an anticoagulant after experiencing a GI bleed. Clinicians should continue to monitor for these risk factors or consider whether alternative therapies may be appropriate. [ABSTRACT FROM AUTHOR]

This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean ( M) age =10.28, standard deviation (SD) =1.35], 176 non-referred anxious children recruited in primary schools ( M age =9.94, SD =1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Leadership programs in public health have been declining in numbers since 2012. The decline in training programs could be due to the lack of outcome-based results and the lack of a manageable set of standardized skills needed for public health leadership. A comprehensive study was completed in two phases to determine if the current model of public health leadership institutes is effective at generating outcome-based results. The following paper will focus on the first phase of the study. The first phase included a qualitative analysis to determine the domains, definitions, and skills needed to lead. An analysis of the skills, domains, definitions, and traits included in five established and commonly used leadership models/theories in public health leadership development (Transformational, Servant, Appreciative, Collaborative, and Emotional Intelligence leadership) plus the National Public Health Leadership Development Network ( NLN) Leadership for Community Health, Safety & Resilience Competency Framework was completed. Of the 161 different skills, definitions, traits, and/or competencies from the five leadership models and the NLN competency framework, 123 were determined to be related to one of six domains needed for leadership and were defined into 21 skills. The findings could lead to more uniformity in public health leadership development and evaluation. [ABSTRACT FROM AUTHOR]

Seizures are a well-described complication of acute brain injury and neurosurgery. Antiepileptic drugs ( AEDs) are frequently utilized for seizure prophylaxis in neurocritical care patients. In this review, the Neurocritical Care Society Pharmacy Section describes the evidence associated with the use of AEDs for seizure prophylaxis in patients with intracerebral tumors, traumatic brain injury, aneurysmal subarachnoid hemorrhage, craniotomy, ischemic stroke, and intracerebral hemorrhage. Clear evidence indicates that the short-term use of AEDs for seizure prophylaxis in patients with traumatic brain injury and aneurysmal subarachnoid hemorrhage may be beneficial; however, evidence to support the use of AEDs in other disease states is less clear. [ABSTRACT FROM AUTHOR]

Children's prior attitudes toward school may be an important entry factor to consider in their initial adjustment to kindergarten. This short-term longitudinal study examined children's affective orientations and other school-related perceptions and approaches to learning in late preschool and then 1 to 2 months after entry into kindergarten. Child, parent, and teacher reports were obtained, and classroom practices were observed. Findings showed that children who anticipated liking school demonstrated more positive approaches and adjustment in kindergarten than did less enthusiastic children. Children's approaches to learning in the classroom, reported by teachers and parents, were similar across the transition from preschool to kindergarten, despite notable differences in practices. Recommendations for practice include attending to children's affective orientations, involving multiple informants in school readiness assessments, and fostering communication among teachers in school transition activities. [ABSTRACT FROM AUTHOR]

Introduction: Several studies from resource-limited settings have demonstrated that clinical and immunologic criteria are poor predictors of virologic failure, confirming the need for viral load monitoring or at least an algorithm to target viral load testing. We used data from an electronic patient management system to develop an algorithm to identify patients at risk of viral failure using a combination of accessible and inexpensive markers.Methods: We analyzed data from HIV-positive adults initiated on antiretroviral therapy (ART) in Johannesburg, South Africa, between April 2004 and February 2010. Viral failure was defined as ≥2 consecutive HIV-RNA viral loads >400 copies/ml following suppression ≤400 copies/ml. We used Cox-proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Weights for each predictor associated with virologic failure were created as the sum of the natural logarithm of the adjusted HR and dichotomized with the optimal cut-off at the point with the highest sensitivity and specificity (i.e. ≤4 vs. >4). We assessed the diagnostic accuracy of predictor scores cut-offs, with and without CD4 criteria (CD4 <100 cells/mm3; CD4 < baseline; >30% drop in CD4), by calculating the proportion with the outcome and the observed sensitivity, specificity, positive and negative predictive value of the predictor score compared to the gold standard of virologic failure.Results: We matched 919 patients with virologic failure (1:3) to 2756 patients without. Our predictor score included variables at ART initiation (i.e. gender, age, CD4 count <100 cells/mm3, WHO stage III/IV and albumin) and laboratory and clinical follow-up data (drop in haemoglobin, mean cell volume (MCV) <100 fl, CD4 count <200 cells/mm3, new or recurrent WHO stage III/IV condition, diagnosis of new condition or symptom and regimen change). Overall, 51.4% had a score 51.4% had a score ≥4 and 48.6% had a score <4. A predictor score including CD4 criteria performed better than a score without CD4 criteria and better than WHO clinico-immunological criteria or WHO clinical staging to predict virologic failure (sensitivity 57.1% vs. 40.9%, 25.2% and 20.9%, respectively).Conclusions:Predictor scores or risk categories, with CD4 criteria, could be used to identify patients at risk of virologic failure in resource-limited settings so that these patients may be targeted for focused interventions to improve HIV treatment outcomes. [ABSTRACT FROM AUTHOR]

This article evaluates theoretical claims linking relational uncertainty to experiences of stress during interactions with a partner. Two observational studies were conducted to evaluate the association between relational uncertainty and salivary cortisol in the context of hurtful and supportive interactions. In Study 1, participants ( N = 89) engaged in a conversation about core traits or values with a partner, who was trained to be hurtful. In Study 2, participants ( N = 89) received supportive messages after completing a series of stressful tasks and receiving negative performance feedback. As predicted, partner uncertainty was associated with greater cortisol reactivity to the hurtful interaction in Study 1. Contrary to expectations, Study 1 results also indicated that self uncertainty was associated with less cortisol reactivity, when self, partner, and relationship uncertainty were tested in the same model. Study 2 revealed that relational uncertainty dampened cortisol reactions to performing poorly on tasks while the partner observed. As predicted, Study 2 also found that partner uncertainty was associated with less cortisol recovery after the supportive interaction, but neither self nor relationship uncertainty was associated with rate of cortisol change during the recovery period. [ABSTRACT FROM AUTHOR]

Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan Hyponatremia is associated with significant morbidity and mortality in a wide variety of patients with underlying disease states. Hospital-associated hyponatremia is a common occurrence, and all forms of hyponatremia are independently associated with heightened resource consumption during hospitalization as well as after discharge to both short- term and long-term care facilities. The chronic morbidities of hyponatremia, even when not severe, can have a significant impact on health care costs. Resolving hyponatremia during hospitalization decreases the risk of mortality conferred by the disorder. Patients at risk for hyponatremia may not receive adequate investigation into cause of hyponatremia; thus, increased awareness may result in better identification of patients at risk, and more aggressive monitoring in both the inpatient and outpatient settings may lead to appropriate intervention. In the management of hyponatremia, clinical pharmacists have a key role in identifying the source of the hyponatremia, carefully monitoring serum sodium concentration and symptoms of hyponatremia, and intervening with appropriate therapy including avoidance of interventions that may exacerbate hyponatremia. [ABSTRACT FROM AUTHOR]

Transient ischemic attacks (TIAs) have been redefined recently. The new tissue-based definition of TIA abandons the 24-hour restriction on symptom duration previously used to differentiate TIA from acute ischemic stroke and requires neuroimaging studies to identify the cause of the ischemia and to determine the presence and extent of brain injury. This new definition brings to light the need for urgent diagnostic testing and timely initiation of treatment, as well as secondary prevention measures to reduce the increased risk of stroke, cardiovascular complications, and death in the days and weeks after a TIA. Pharmacists play a key role in identifying patients at risk for a first or recurrent TIA or stroke, educating high-risk patients on the signs and symptoms of TIA or stroke and the need for urgent evaluation and treatment, overcoming barriers to timely diagnosis and treatment, and ensuring that appropriate primary or secondary prevention strategies are in place. Furthermore, studies have shown that pharmacist-led interventions can lead to significant improvements in modifiable risk factors, such as blood pressure and cholesterol levels, as well as drug adherence, and may reduce the occurrence of strokes. These interventions may also help maintain patients' health-related quality of life and improve patients' satisfaction with care. [ABSTRACT FROM AUTHOR]

The authors examined the attitudes and reasons of 119 American psychologists, counselors, and clinical social workers who had never sought personal therapy. Nontherapy seekers, compared to therapy seekers, expressed less-positive attitudes toward its value as a prerequisite for clinical work and for ongoing professional development. Women, men, and members of all three professions were equally likely to have sought therapy, but cognitive–behavioral therapists and academics were significantly less likely to do so. Top reasons for not undergoing personal therapy entailed dealing with stress in other ways, receiving sufficient support from friends and family, believing coping strategies were effective, and resolving the problem before therapy was needed. The likelihood of seeking personal treatment in the future as well as reasons for doing so are discussed. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64:1–9, 2008. [ABSTRACT FROM AUTHOR]

The antiproliferative activity of three benzopyrans isolated from the chloroform extract of the aerial parts of Hypericum polyanthemum was analysed in order to determine their effect on the growth and cell cycle in the U-373 MG glioblastoma cell line. Compound 1 was less cytotoxic than compounds 2 and 3. A synergistic effect was noticed when the three benzopyrans were used simultaneously. The cytotoxicity noted could be related to an arrest in G2/M phase, leading to apoptosis in the U-373 MG glioblastoma cell line. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Tacrolimus trough concentration is being currently used for dose individualization. • Limited sampling strategies (LSS) have been developed and validated for renal transplant patients. • Earlier literature has suggested that measurement of tacrolimus AUC is more reliable than trough with respect to both rejection and nephrotoxicity. WHAT THIS STUDY ADDS • Four thousand renal transplants take place annually in India, with many patients prescribed tacrolimus in combination with mycophenolate and steroid. • In this study a LSS with two points, i.e. trough and 1.5 h postdose was developed and validated to estimate AUC0–12. • The added benefit of only a single additional sample with completion of blood collection in 1.5 h and minimum additional cost makes this a viable LSS algorithm in renal transplant patients. • In patients having tacrolimus trough concentrations outside the recommended range (<3 and >10 ng ml−1 in the treatment protocol in our institution) or having side-effects in spite of trough concentrations in the desired range, we can estimate AUC using this LSS for a better prediction of exposure. AIMS To develop and validate limited sampling strategy (LSS) equations to estimate area under the curve (AUC0–12) in renal transplant patients. METHODS Twenty-nine renal transplant patients (3–6 months post transplant) who were at steady state with respect to tacrolimus kinetics were included in this study. The blood samples starting with the predose (trough) and collected at fixed time points for 12 h were analysed by microparticle enzyme immunoassay. Linear regression analysis estimated the correlations of tacrolimus concentrations at different sampling time points with the total measured AUC0–12. By applying multiple stepwise linear regression analysis, LSS equations with acceptable correlation coefficients ( R2), bias and precision were identified. The predictive performance of these models was validated by the jackknife technique. RESULTS Three models were identified, all with R2 ≥ 0.907. Two point models included one with trough (C0) and 1.5 h postdose (C1.5), another with trough and 4 h postdose. Increasing the number of sampling time points to more than two increased R2 marginally (0.951 to 0.990). After jackknife validation, the two sampling time point (trough and 1.5 h postdose) model accurately predicted AUC0–12. Regression coefficient R2 = 0.951, intraclass correlation = 0.976, bias [95% confidence interval (CI)] 0.53% (−2.63, 3.69) and precision (95% CI) 6.35% (4.36, 8.35). CONCLUSION The two-point LSS equation [AUC0–12 = 19.16 + (6.75.C0) + (3.33.C1.5)] can be used as a predictable and accurate measure of AUC0–12 in stable renal transplant patients prescribed prednisolone and mycophenolate. [ABSTRACT FROM AUTHOR]

Increased intracranial pressure after neurologic injury is a clinical challenge that often requires administration of osmotic agents. The most common osmotic agent used for treatment has been mannitol; however, interest has been renewed in using hypertonic saline after neurologic injury, since it is not associated with hypovolemia. The types of procedures or injury for which hypertonic saline has been used are vast, from elective craniotomy for tumor resection to stroke and traumatic brain injury. Unfortunately, there is a paucity of well-controlled clinical trials that provide evidence for the best concentration, administration approach, and length of therapy with hypertonic saline. The bulk of the data exists for traumatic brain injury, although most of these data are from observational and retrospective analyses, which do not allow for an evaluation of the impact of hypertonic saline on clinical outcomes. Nonetheless, both animal and clinical data suggest that patients with traumatic brain injury and those with stroke may benefit from hypertonic saline therapy. Since hypertonic saline has a high risk of injury with inappropriate administration and is considered a "high-alert" drug, safety issues surrounding its dispensing and administration must be considered. Randomized outcome trials comparing mannitol with hypertonic saline in various subpopulations of neurologic injury would add valuable information to the literature and provide a basis for establishment of best clinical practices. [ABSTRACT FROM AUTHOR]

Study Objective. To evaluate the short-term (12 wks) safety and tolerability of a once-daily, fixed-dose abacavir-lamivudine combination versus twice-daily dosing of the separate components, both with background antiretroviral therapy. Design. Phase IIIB, randomized, open-label, parallel-group, multicenter study. Setting. One hundred forty-six human immunodeficiency virus (HIV) clinics. Patients. Six hundred eighty antiretroviral therapy-naive patients with HIV type 1 RNA greater than 1000 copies/ml at baseline. Intervention. Patients were randomly assigned in a 2:1 manner to receive either abacavir 600 mg-lamivudine 300 mg once/day or abacavir 300 mg twice/day and lamivudine 150 mg twice/day. Subjects were stratified based on choice of third or fourth antiretroviral drug (nucleoside reverse transcriptase inhibitor [NRTI], NNRTI, or protease inhibitor), assigned before randomization. Measurements and Main Results. The primary end point was occurrence of grades 2-4 adverse events and serious adverse events; abacavir hypersensitivity reactions were considered serious adverse events. Baseline characteristics were similar between the once-daily (455 patients) and twice-daily (225 patients) groups. The rates of all grades 2-4 adverse events were similar: once-daily 33% (150 patients), twice-daily 31% (69). A slightly larger proportion of patients in the twice-daily group experienced drug-related grades 2-4 adverse events: once-daily 10% (47), twice-daily 16% (36). Rates of all serious adverse events (once-daily 11% [49], twice-daily 10% [22]) and drug-related serious adverse events (once-daily 5% [21], twice-daily 8% [17]) were similar. The rate of suspected abacavir hypersensitivity reaction was 5.3% (once-daily 4.4% [20], twice-daily 7.1% [16]), with a higher rate for the NNRTI stratum of the twice-daily group (8.6% [10]) than in any other stratum (once-daily, NNRTI 4.3% [10]; twice-daily, protease inhibitor 5.6% [6]; once-daily, protease inhibitor 4.6% [10]). Conclusion. In the short-term, the rates of adverse events in the once-daily and twice-daily groups appeared to be similar. The rate of suspected abacavir hypersensitivity reaction in the once-daily group was lower than the rate in the twice-daily group. [ABSTRACT FROM AUTHOR]

Cerebral vasospasm remains one of the leading causes of mortality in patients who experience a subarachnoid hemorrhage but survive the initial 24 hours. Vasospasm generally occurs 3-4 days after the initial subarachnoid hemorrhage and peaks at 5-7 days. The pathophysiology of vasospasm is poorly understood, which directly contributes to the inconsistency of management and creates a formidable challenge in clinical practice. Traditionally, hemodilution, bypervolemia, and induced hypertension (so-called triple H therapy); calcium channel blockers; and endovascular therapy have been used as either prophylactic therapy or treatment. However, management of vasospasm varies among physicians and institutions mainly because of a lack of large clinical trials and inconsistent results. Practice has been based primarily on case reports and the preference of each practitioner. Several experimental therapies have been explored; however, large, prospective, randomized controlled trials are needed to elucidate the role of these therapies. [ABSTRACT FROM AUTHOR]

Antagonists can play a role in sexual system evolution if tolerance or resistance is sex-dependent. Our understanding of this role will be enhanced by consideration of the effects of antagonists on other plant-animal interactions. This study determined whether the sex morphs of a gynodioecious Fragaria virginiana differ in their susceptibility and response to damage by spittlebugs and whether damage altered pollinator attraction traits or interactions with other antagonists. Tolerance, but not resistance, to spittlebugs differed between the sexes. Generally, spittlebugs were more damaging to hermaphrodites than females, a finding in accord with the hypothesis that the pollen-beating morph is less tolerant of source-damage than the pollen-sterile morph when damage is incurred during flowering. In both sex morphs, spittlebugs reduced inflorescence height, increased petal size, but did not affect the number of open flowers per day, suggesting that the net effect of damage may be to increase pollinator attraction. Spittlebug infestation modified interactions with other antagonists in a sex-dependent manner: spittlebugs reduced attack by bud-clipping weevils in hermaphrodites but increased infection by leaf fungi in females. The complex interactions between plant sex, antagonists, and pollinator attraction documented here emphasize the importance of considering sex-differential multi-species interactions in plant sexual evolution. [ABSTRACT FROM AUTHOR]

Most flowering plants rely on animal pollinators to transfer male gametes between individuals, and thus a significant problem for gender dimorphic plants is that pollinators often avoid female flowers. Here we show for the first time that one important reason pollinators shun female flowers is because they do not smell like males. We compared emission rates and floral scent composition in a gynodioecious wild strawberry (Fragaria virginiana) where females receive half as many visits by generalist pollinators as conspecific hermaphrodites. We used floral extracts to determine the source of sexually dimorphic odor and pollinator responses. Specifically, we used extracts of whole flowers and specific floral parts in choice tests to determine that pollinators preferred the scent of hermaphrodite flowers over those of females and that this discrimination was due primarily to the scent of hermaphrodite anthers. These data conclusively show that scent can be a major driver of pollinator behavior in gender dimorphic plants. Our results also indicate that scent is an important modulator of pollinator behavior even in a small flowered, weakly scented species visited by generalist pollinators, and not just peculiar to intensely scented, deceptive, or specialized pollination systems. [ABSTRACT FROM AUTHOR]

Class I phosphoinositide 3-kinases (PI3K) are known to play a significant role in neutrophil chemotaxis. However, the relative contributions of different PI3K isoforms, and how these impact on lung inflammation, have not been addressed. In vitro studies using wild-type and PI3Kγ knockout neutrophils demonstrated the major role of the γ isoform in chemotactic but not chemokinetic events. This was confirmed by a model of direct chemokine instillation into the airways in vivo. Within all studies, a low yet significant degree of neutrophil movement in the absence of PI3Kγ could be observed. No role for the δ isoform was demonstrated both in vitro and in vivo using PI3Kδ kinase-dead knock-in mice. Moreover, further studies using the broad-spectrum PI3K inhibitors wortmannin or LY294002 showed no other class I PI3K isoforms to be involved in these chemotactic processes. Here, we identify a contributory PI3K-independent mechanism of neutrophil movement, yet demonstrate PI3Kγ as the pivotal mediator through which the majority of neutrophils migrate into the lung in response to chemokines. These data resolve the complexities of chemokine-induced neutrophilia and PI3K signaling and define the γ isoform as a promising target for new therapeutics to treat airway inflammatory diseases. [ABSTRACT FROM AUTHOR]

ABSTRACT: Sleep affects the health and well-being of children and plays a key role in preventing disease and injury, stability of mood, and ability to learn. Unfortunately, children often do not get adequate sleep on a regular basis. This study surveyed 199 fifth-grade students regarding their sleep habits using the Sleep Self-Report (SSR) instrument (child's form), the Morningness/Eveningness (M/E) Scale, and additional demographic questions. Students' teachers also were asked to evaluate their students' behavior using the Teacher's Daytime Sleepiness Questionnaire (TDSQ). Results indicated many students experienced problems with sleep-related behavior. However, correlating the TDSQ scale with the SSR Daytime Sleepiness Subscale produced a weak correlation coefficient, indicating teachers may not be able to accurately identify students with sleep problems. Overall findings indicated these students displayed sleep behavior similar to other US children. However, research involving children's sleep behavior is limited, and more research is needed. Parents should monitor their children's sleep times, and teachers need to be aware how sleep deprivation can affect children's mood, reaction time, and concentration. Health education curricula need to include sleep-related instruction at all grade levels to address this concern. (J Sch Health. 2005;75(2):50-56). [ABSTRACT FROM AUTHOR]

We explore the effects of gender dimorphism on resistance (damage avoidance) and tolerance (growth and fitness compensation) to a flower bud clipping weevil in a gynodioecious wild strawberry. Using both natural populations and a common garden, we document pervasive hermaphrodite-biased damage and identify several floral traits associated with resistance. Lower flower number, lower pollen production per flower, and earlier flowering date were associated with higher resistance. Because the sex morphs do not differ in flower number or flowering time, the presence of pollen is the main factor determining sex-differential resistance. We confirmed that simulated clippins was a good surrogate for weevil clipping, and we used simulated clipping to assess sex-morph- and sex-function-specific tolerance. We found that females were less tolerant than hermaphrodites in terms of seed and fruit production, but the sex morphs were similarly unable to compensate fully in flower production. Hermaphrodites showed some ability to compensate in pollen per flower, but this was not large enough to offset flower losses, leading to net undercompensation for pollen per plant. We evaluated potential mechanisms for tolerance and found that the number of reserve buds was the most consistent predictor of tolerance. Finally, we found that herbivory shifted sex expression of hermaphrodites toward greater femaleness via both plastic changes in allocation and direct effects of loss of male-functioning flowers. Our work indicates that the effects of herbivory on sexual system evolution can include sexual phenotype-biased herbivore damage and sex-dependent tolerance, as well as herbivory-induced changes in hermaphrodite sex allocation. In addition, this study suggests that pollen production is subject to selection via herbivores that opposes selection mediated by pollinators. [ABSTRACT FROM AUTHOR]

Study Objective. To assess central nervous system (CNS) penetration of cefepime in adults with external ventricular drains and to compare the achieved cerebrospinal fluid (CSF) concentrations with the usual minimum inhibitory concentrations (MICs) of common pathogens. Design. Open-label, prospective study. Setting. University-affiliated medical center. Patients. Seven patients with external ventricular drains and normal renal function (documented creatinine clearance 60 ml/min) who received cefepime 2 g intravenously every 12 hours for treatment of nosocomial pneumonia. Intervention. Serial serum and CSF samples were obtained concurrently after the fourth dose during one dosing interval, Measurements and Main Results. The concentration-time profiles in serum and CSF were comodeled by using a two-compartment model with zero-order infusion to the central compartment. The CSF concentration-time profiles of the individual patients were compared with published MIC[sub90] of common pathogens isolated in nosocomial meningitis. Our model reasonably characterized the disposition of cefepime in serum and CSF. Penetration into the CNS was 4-34% based on area under the curve and was 5-58% based on minimum concentration. Conclusion. Penetration of cefepime into the CNS was variable among the patients (4-34%) but appeared similar to that reported for other cephalosporins given to treat meningitis. The concentrations attained by most patients in this study were above the MIC[sub90] of many common nosocomial organisms. [ABSTRACT FROM AUTHOR]

Presents a study on the safety, effectiveness and efficiency of ketamine, ketamine and xylazine and Telazol to immobilize wild-caught fishers or Martes pennanti. Importance of chemical immobilization; Methodology; Trends in body temperature among the animals.

The article presents information related to dispute resolution in the workplace. It is noted that employees are protected against arbitrary authority and unjust punitive action with the presence of effective means of dispute resolution in the workplace. It is mentioned that an attempt by a participant in the workforce to resolve a problem in the employment relationship is dispute resolution in the workplace.