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Abstract Objective To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Method Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Results Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that “it is effective method to facilitate medication swallowing in residents.” The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). Conclusions This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)‐approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.

The effect of climate change on rockfalls in the German low mountain regions is investigated following two different approaches. The first approach uses a logistic regression model that describes the combined effect of precipitation, freeze–thaw cycles, and fissure water on rockfall probability. The climate change signal for the past 6 decades is analysed by applying the model to meteorological observations. The possible effect of climate change until the end of the century is explored by applying the statistical model to the output of a multi-model ensemble of 23 regional climate scenario simulations. It is found that the number of days per year exhibiting an above-average probability for rockfalls has mostly been decreasing during the last few decades. Statistical significance is, however, present at only a few sites. A robust and statistically significant decrease can be seen in the Representative Concentration Pathway (RCP) climate scenario 8.5 (RCP8.5) simulations for Germany and neighbouring regions, locally falling below −10 % when comparing the last 30 years of the 20th century to the last 30 years of the 21st century. The most important factor determining the projected decrease in rockfall probability is a reduction in the number of freeze–thaw cycles expected under future climate conditions. For the second approach four large-scale meteorological patterns that are associated with enhanced rockfall probability are identified from reanalysis data. The frequency of all four patterns exhibits a seasonal cycle that maximises in the cold half of the year (winter and spring). Trends in the number of days that can be assigned to these patterns are determined both in meteorological reanalysis data and in climate simulations. In the reanalysis no statistically significant trend is found. For the future scenario simulations all climate models show a statistically significant decrease in the number of rockfall-promoting weather situations.

Swallowing oral solid dosage forms is challenging for those who have medication swallowing difficulties, including patients with dysphagia. One option is to mix the drug (whole or crushed) with a thick vehicle (medication lubricant). Previous in vitro studies consistently suggest that thick vehicles could impact the dissolution of solid dosage forms, potentially influencing their therapeutic effectiveness, but do not account for changes that happen during oral processing and swallowing. This study aims to investigate the potential impact of medication lubricants on drug release and examine the effect of oral processing. In vitro dissolution of whole and crushed paracetamol tablets mixed with five commercially available medication lubricants (two IDDSI level 2, two IDDSI level 3, and one IDDSI level 4) were tested with and without oral processing; a medication lubricant with/without paracetamol was placed in the mouth (five healthy volunteers), prepared for swallowing, but then expectorated and assessed for physical characteristics and drug release. Medication lubricants, both alone and mixed with crushed paracetamol tablets, showed a significant decrease in viscosity after oral processing. Without oral processing, IDDSI level 3 and 4 lubricants significantly delayed the dissolution of paracetamol tablets. After oral processing, particularly with crushed tablets, there was a substantial increase in the dissolution rate. These findings suggest that dissolution testing overestimates the impact of medication lubricants on drug dissolution. Therefore, using in vitro dissolution tests to predict the dissolution rate of medications mixed with thick vehicles is discouraged. It is essential to consider ways to incorporate the effects of the oral environment and oral processing on thick vehicles used for oral medication administration.

A rockfall dataset for Germany is analysed with the objective of identifying the meteorological and hydrological (pre-)conditions that change the probability for such events in central Europe. The factors investigated in the analysis are precipitation amount and intensity, freeze–thaw cycles, and subsurface moisture. As there is no suitable observational dataset for all relevant subsurface moisture types (e.g. water in rock pores and cleft water) available, simulated soil moisture and a proxy for pore water are tested as substitutes. The potential triggering factors were analysed both for the day of the event and for the days leading up to it. A logistic regression model was built, which considers individual potential triggering factors and their interactions. It is found that the most important factor influencing rockfall probability in the research area is the precipitation amount at the day of the event, but the water content of the ground on that day and freeze–thaw cycles in the days prior to the event also influence the hazard probability. Comparing simulated soil moisture and the pore-water proxy as predictors for rockfall reveals that the proxy, calculated as accumulated precipitation minus potential evaporation, performs slightly better in the statistical model. Using the statistical model, the effects of meteorological conditions on rockfall probability in German low mountain ranges can be quantified. The model suggests that precipitation is most efficient when the pore-water content of the ground is high. An increase in daily precipitation from its local 50th percentile to its 90th percentile approximately doubles the probability for a rockfall event under median pore-water conditions. When the pore-water proxy is at its 95th percentile, the same increase in precipitation leads to a 4-fold increase in rockfall probability. The occurrence of a freeze–thaw cycle in the preceding days increases the rockfall hazard by about 50 %. The most critical combination can therefore be expected in winter and at the beginning of spring after a freeze–thaw transition, which is followed by a day with high precipitation amounts and takes place in a region preconditioned by a high level of subsurface moisture.

Rapidly evolving floods are rare but powerful drivers of landscape reorganisation that have severe and long-lasting impacts on both the functions of a landscape’s subsystems and the affected society. The July 2021 flood that particularly hit several river catchments of the Eifel region in western Germany and Belgium was a drastic example. While media and scientists highlighted the meteorological and hydrological aspects of this flood, it was not just the rising water levels in the main valleys that posed a hazard, caused damage, and drove environmental reorganisation. Instead, the concurrent coupling of landscape elements and the wood, sediment, and debris carried by the fast-flowing water made this flood so devastating and difficult to predict. Because more intense floods are able to interact with more landscape components, they at times reveal rare non-linear feedbacks, which may be hidden during smaller events due to their high thresholds of initiation. Here, we briefly review the boundary conditions of the 14–15 July 2021 flood and discuss the emerging features that made this event different from previous floods. We identify hillslope processes, aspects of debris mobilisation, the legacy of sustained human land use, and emerging process connections and feedbacks as critical non-hydrological dimensions of the flood. With this landscape scale perspective, we develop requirements for improved future event anticipation, mitigation, and fundamental system understanding.

Instructors and researchers often use research-based assessments to identify the impact of instructional activities. These investigations often focus on issues of diversity, equity, and inclusions by comparing outcomes across social identity groups (e.g., gender, race, and class). Comparisons across groups assume the assessments measure the same factors in the same way across social identity groups. Very few research-based assessments, however, have validation evidence to support this assumption. Measurement invariance testing provides validity evidence that an assessment measures latent factors (e.g., Newtonian thinking or physics identity) equivalently across groups. We examined the measurement invariance of the Eaton and Willoughby five (EW5) factor model on the Force Concept Inventory. We found evidence for measurement invariance across the intersections of gender (men and women) and race or ethnicity (Asian, Black, Hispanic, White, and White Hispanic). These results indicate that performance differences across the five factors can further understanding of equity in physics courses. Without measurement invariance, such work could produce misleading results that undermine efforts to support equity in physics courses.

We present an acute manifestation of mesenteric lymphangioma in a 1-Year-Old Girl. Lymphangiomas (LA) comprise a considerable group of different benign vascular malformations of the lymphatic system and account for about 6% of all benign pediatric tumors. About 5% of LA present intraabdominally as mesenteric LA. Diagnosis of this disease can be initially difficult, but the use of ultrasound allows for a quick diagnosis. Although the tumor is benign, it can lead to an acute abdomen requiring emergency surgery.

Introduction: The decision to deprescribe medications used for both disease prevention and symptom control (dual-purpose medications or DPMs) is often challenging for clinicians. We aim to establish the impact of deprescribing DPMs on patient-related outcomes for older adults near end-of-life (EOL). Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Literature was searched on PubMed, EMBASE, CINAHL, PsycINFO and Google Scholar until December 2019 for studies on deprescribing intervention with a control group (with or without randomisation); targeting ⩾65-year olds, at EOL, with at least one life-limiting illness and at least one potentially inappropriate DPM. We were interested in any patient-related outcomes. Studies with similar outcome assessment criteria were subjected to meta-analysis and narrative synthesis otherwise. The risk of bias was assessed using Cochrane Risk of Bias and ROBINS-I tools for randomised controlled trials (RCTs) and quasi-experimental non-randomised controlled studies, respectively. Results: Five studies covering 689 participants with mean age 81.6–85.7 years, the majority (74.6–100%) with dementia were included. The risk of bias was moderate to low. The deprescribing of DPMs lowered the risk of mortality (risk ratio (RR) = 0.59, 95% confidence interval (CI) = 0.44–0.79) and referral to acute care facilities (RR = 0.40, 95% CI = 0.22–0.73), but did not have a significant impact on the risk of falls, non-vertebral fracture, emergency presentation, unplanned hospital admission, or general practitioner visits. No significant difference was observed in the quality of life, physical and cognitive functions between the intervention and control groups. Conclusion: There is some evidence that deprescribing of DPMs for older adults near the EOL can lower the risk of mortality and referral to acute care facilities, but there are insufficient good-quality studies powered to confirm a benefit in terms of quality of life, physical or cognitive function, health service utilisation and adverse events. Plain Language Summary What is the health impact of withdrawal or dose reduction of medication used for disease prevention and symptom control in older adults near end-of-life? Introduction: Older adults (aged ⩾ 65 years) with advanced diseases such as cancer, dementia, and organ failure tend to have a limited life expectancy. With the progression of these diseases towards the end-of-life, the intensity for day-to-day supportive care becomes increasingly necessary. The use of medications for symptom management is a critical part of such care, but the use of medications for long-term disease prevention can become irrelevant due to the already shortened life expectancy and may become harmful due to alterations in physiology and pharmacology associated with age and frailty. This necessitates the withdrawal or dose reduction of inappropriate medications, the process called deprescribing. The decision to deprescribe medications used for both disease prevention and symptom control (DPMs) in this population is often challenging for clinicians. In this context, whether deprescribing of DPMs can improve patient-related health outcomes is unknown. Methods: Evidence from the literature was reviewed and analysed, and the quality of studies was assessed. Five studies were identified, which had 689 participants with an average age above 80 years and mostly suffering from dementia. Results: The analysis of these studies showed deprescribing of DPMs lowered the risk of death and referral to acute care facilities at 12 months but had no significant impact on falls, non-vertebral fractures, emergency presentations, unplanned hospital admission, general practitioner visits, quality of life, physical and mental functions. Conclusion: In conclusion, there were insufficient numbers of high-quality studies powered to confirm whether deprescribing of DPMs reduces adverse events, health service use, or improves the quality of life or functioning in older adults near the end of life.

Background Making a meaningful decision on deprescribing of potentially inappropriate medications in older adults with life-limiting illnesses (LLIs) and limited life expectancy (LLE) is often challenging. Therefore, we aimed to elicit opinion and gain consensus on a deprescribing tool for use in this population.Methods and analysis A modified-Delphi method will be used to obtain a consensus from a panel of experts in geriatric therapeutics on a deprescribing tool for use in people aged ≥65 years with LLIs and LLE. Through an online survey, in the initial round, the panel will anonymously elicit their opinion on a series of items related to the conceptual model of the deprescribing tool, its practicality and deprescribing of medications, while on the controlled feedback in subsequent rounds till a consensus is reached or the panellists stop revising their answers. In each round, panel members will be using a 5-point Likert scale to rate their agreement with the statement. Consensus will be considered on ≥75% of agreement on the statements.Ethics and dissemination All the participants will receive an invitation and participant information but they need to consent for the participation. Ethics approval has been granted from the University of Queensland Health and Behavioural Sciences, Low and Negligible Risk Ethics Sub-Committee (reference: 2020001069). The results of this project will be disseminated through conferences and a peer-reviewed clinical journal.

Pharmaceuticals and their packaging have a significant negative impact on the environment providing a very strong argument for action on the part of pharmacists and pharmacy technicians to engage with pro-environmental behaviours (PEBs) in their workplaces. The aims of this research were therefore to investigate in hospital pharmacists and pharmacy technicians, 1) factors affecting engagement with workplace PEBs, and 2) determine if legislated carbon reduction targets in the UK influenced workplace PEBs in the UK compared with Australia which does not have legislated carbon reduction targets. The environmentally responsible disposal of pharmaceutical waste was the PEB of interest in this study. A mixed methods research design was utilised and a conceptual model (key variables: environmental attitude, concern, and knowledge, and organisational factors) was developed to identify factors influencing workplace PEBs. Participants were from five hospitals in Queensland, Australia and five NHS hospitals in England, UK. There was no statistically significant difference in environmental attitude or concern between the two groups-most had a mid-environmental attitude score and low levels of environmental concern. Participants lacked knowledge of the issue and the link between the environment and public health. Both Australian and UK participants reported recycling packaging waste was not a priority in the hospital pharmacy workplace (even in hospitals with recycling capability) as hospitals focused on compliance with clinical (contaminated) and confidential waste streams. Environmental attitude, knowledge, and concern therefore appeared to be weak influences on intention to perform workplace PEBs with workplace social norms (compliance due to audits) appearing to be a significant mediator of action. The key difference between the cohorts was that UK pharmacists felt waste was not in the scope of their role, and therefore not their responsibility. This study identified that legislated carbon reduction targets did not influence hospital pharmacy workplace PEBs-neither cohort reported engaging significantly in workplace PEBs. UK Government and NHS sustainability policy did not appear to have disseminated to pharmacy department level of UK public hospitals to any great extent.

Abstract Background High-stakes assessments, such the Graduate Records Examination, have transitioned from paper to computer administration. Low-stakes research-based assessments (RBAs), such as the Force Concept Inventory, have only recently begun this transition to computer administration with online services. These online services can simplify administering, scoring, and interpreting assessments, thereby reducing barriers to instructors’ use of RBAs. By supporting instructors’ objective assessment of the efficacy of their courses, these services can stimulate instructors to transform their courses to improve student outcomes. We investigate the extent to which RBAs administered outside of class with the online Learning About STEM Student Outcomes (LASSO) platform provide equivalent data to tests administered on paper in class, in terms of both student participation and performance. We use an experimental design to investigate the differences between these two assessment conditions with 1310 students in 25 sections of 3 college physics courses spanning 2 semesters. Results Analysis conducted using hierarchical linear models indicates that student performance on low-stakes RBAs is equivalent for online (out-of-class) and paper-and-pencil (in-class) administrations. The models also show differences in participation rates across assessment conditions and student grades, but that instructors can achieve participation rates with online assessments equivalent to paper assessments by offering students credit for participating and by providing multiple reminders to complete the assessment. Conclusions We conclude that online out-of-class administration of RBAs can save class and instructor time while providing participation rates and performance results equivalent to in-class paper-and-pencil tests.

Abstract Background The genetic mechanisms for families who meet the clinical criteria for Lynch syndrome (LS) but do not carry pathogenic variants in the mismatch repair (MMR) genes are still undetermined. We aimed to study the potential contribution of genes other than MMR genes to the biological and clinical characteristics of Norwegian families fulfilling Amsterdam (AMS) criteria or revised Bethesda guidelines. Methods The Hereditary Cancer Biobank of the Norwegian Radium Hospital was interrogated to identify individuals with a high risk of developing colorectal cancer (CRC) for whom no pathogenic variants in MMR genes had been found in routine diagnostic DNA sequencing. Forty-four cancer susceptibility genes were selected and analyzed by using our in-house designed TruSeq amplicon-based assay for targeted sequencing. RNA splicing- and protein-dedicated in silico analyses were performed for all variants of unknown significance (VUS). Variants predicted as likely to affect splicing were experimentally analyzed by resorting to minigene assays. Results We identified a patient who met the revised Bethesda guidelines and carried a likely pathogenic variant in CHEK2 (c.470 T > C, p.I157T). In addition, 25 unique VUS were identified in 18 individuals, of which 2 exonic variants (MAP3K1 c.764A > G and NOTCH3 c.5854G >A) were analyzed in the minigene splicing assay and found not to have an effect on RNA splicing. Conclusions Among high-risk CRC patients that fulfill the AMS criteria or revised Bethesda guidelines, targeted gene sequencing identified likely pathogenic variant and VUS in other genes than the MMR genes (CHEK2, NOTCH3 and MAP3K1). Our study suggests that the analysis of genes currently excluded from routine molecular diagnostic screens may confer cancer susceptibility.

Abstract Background In kindreds carrying path_BRCA1/2 variants, some women in these families will develop cancer despite testing negative for the family’s pathogenic variant. These families may have additional genetic variants, which not only may increase the susceptibility of the families’ path_BRCA1/2, but also be capable of causing cancer in the absence of the path_BRCA1/2 variants. We aimed to identify novel genetic variants in prospectively detected breast cancer (BC) or gynecological cancer cases tested negative for their families’ pathogenic BRCA1/2 variant (path_BRCA1 or path_BRCA2). Methods Women with BC or gynecological cancer who had tested negative for path_BRCA1 or path_BRCA2 variants were included. Forty-four cancer susceptibility genes were screened for genetic variation through a targeted amplicon-based sequencing assay. Protein- and RNA splicing-dedicated in silico analyses were performed for all variants of unknown significance (VUS). Variants predicted as the ones most likely affecting pre-mRNA splicing were experimentally analyzed in a minigene assay. Results We identified 48 women who were tested negative for their family’s path_BRCA1 (n = 13) or path_BRCA2 (n = 35) variants. Pathogenic variants in the ATM, BRCA2, MSH6 and MUTYH genes were found in 10% (5/48) of the cases, of whom 15% (2/13) were from path_BRCA1 and 9% (3/35) from path_BRCA2 families. Out of the 26 unique VUS, 3 (12%) were predicted to affect RNA splicing (APC c.721G > A, MAP3K1 c.764A > G and MSH2 c.815C > T). However, by using a minigene, assay we here show that APC c.721G > A does not cause a splicing defect, similarly to what has been recently reported for the MAP3K1 c.764A > G. The MSH2 c.815C > T was previously described as causing partial exon skipping and it was identified in this work together with the path_BRCA2 c.9382C > T (p.R3128X). Conclusion All women in breast or breast/ovarian cancer kindreds would benefit from being offered genetic testing irrespective of which causative genetic variants have been demonstrated in their relatives.

Background: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment. Objective: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time). Methods: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment. Results: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent:

The effect of climate change on potentially infrastructure-damaging heavy precipitation events in Europe is investigated in an ensemble of regional climate simulations conducted at a horizontal resolution of 12 km. Based on legislation and stakeholder interviews the 10-year return period is used as a threshold for the detection of relevant events. A novel technique for the identification of heavy precipitation events is introduced. It records not only event frequency but also event size, duration and severity (a measure taking duration, size and rain amount into account) as these parameters determine the potential consequences of the event. Over most of Europe the frequency of relevant heavy precipitation events is predicted to increase with increasing greenhouse gas concentrations. The number of daily and multi-day events increases at a lower rate than the number of sub-daily events. The event size is predicted to increase in the future over many European regions, especially for sub-daily events. Moreover, the most severe events were detected in the projection period. The predicted changes in frequency, size and intensity of events may increase the risk for infrastructure damages. The climate change simulations do not show changes in event duration.

INTRODUCTION:Pharmacists are uniquely placed in the community to be of assistance to disaster-affected patients. However, the roles undertaken by pharmacists in disasters are identified based on their own experiences and networks. There is currently no definition or acknowledgment of pharmacists' roles in disasters. OBJECTIVE:To acquire consensus from an expert panel of key opinion leaders within the field of disaster health on pharmacists' roles in disasters throughout the four disaster phases-prevention, preparedness, response, and recovery. METHODS:A Delphi study consisting of three rounds of online surveys was utilised. Twenty-four key opinion leaders were contacted, with 15 completing all three rounds. The 15 expert panellists were presented with 46 roles identified in the literature and asked to rank their opinions on a 5-point Likert scale. This study used an international, all-hazard, and multijurisdictional approach. Consensus was benchmarked at 80% and any role which did not reach consensus was re-queried in the subsequent round. The third round provided the results of the Delphi study and sought commentary on the acceptance or rejection of the roles. RESULTS:Of the 46 roles provided to the expert panel, 43 roles were accepted as roles pharmacists are capable of undertaking in a disaster. There were five roles for the prevention phase, nine for the preparedness phase, 21 for the response phase, and eight for the recovery phase. The experts were asked to prioritise the top five roles for each of the disaster phases. The three roles which did not make consensus were deemed to be specialised roles for disaster pharmacists and not generalisable to the broader pharmacy profession. CONCLUSION:This study identifies pharmacists' roles in disasters which have been accepted by the international disaster health community. The international key opinion leaders recommended that pharmacists could be undertaking 43 roles in a disaster, however, this is dependent on individual jurisdiction considerations. Pharmacy professional associations need to advocate to policymakers for legislative support and to ensure pharmacists are equipped with the training and education required to undertake these roles within specific jurisdictions.

BackgroundThe number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis.MethodsUsing a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative).ResultsOf the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms.ConclusionThis systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.

Educators and researchers often use research-based assessments before and after instruction to measure the efficacy of courses. Limited resources exist for interpreting assessment results, particularly for attitudinal surveys. We present analyses and representations created with data from 192 introductory physics courses that educators and researchers can use to provide a context for interpreting results from the Colorado Learning Attitudes About Science Survey. The provided data came from the online Learning About STEM Student Outcomes platform and from the scientific literature. The representations include scatter plots of pretest and post-test scores and distributions of effect sizes. Educators and researchers can use these representations to show how courses compare to the larger database before and after instruction. Results almost always associated physics courses for nonscience majors with shifts to more expertlike attitudes, whereas this was the case for approximately one-third of introductory physics courses for science majors.

The American Physical Society calls on its members to improve the diversity of physics by supporting an inclusive culture that encourages women and Black, Indigenous, and people of color to become physicists. In the current educational system, it is unlikely for a student to become a physicist if they do not share the same attitudes about what it means to learn and do physics as those held by most professional physicists. Evidence shows college physics courses and degree programs do not support students in developing these attitudes. Rather physics education filters out students who do not enter college physics courses with these attitudes. To better understand the role of attitudes in the lack of diversity in physics, we investigated the intersecting relationships between racism and sexism in inequities in student attitudes about learning and doing physics using a critical quantitative framework. The analyses used hierarchical linear models to examine students’ attitudes as measured by the Colorado Learning Attitudes about Science Survey. The data came from the Learning About STEM Student Outcomes database and included 2170 students in 46 calculus-based mechanics courses and 2503 students in 49 algebra-based mechanics courses taught at 18 institutions. Like prior studies, we found that attitudes either did not change or slightly decreased for most groups. Results identified large differences across intersecting race and gender groups representing educational debts society owes these students. White students, particularly White men in calculus-based courses, tended to have more expertlike attitudes than any other group of students. Instruction that addresses society’s educational debts can help move physics toward an inclusive culture supportive of diverse students and professionals.

The Mediterranean storm track constitutes a well-defined branch of the North Hemisphere storm track and is characterised by small but intense features and frequent cyclogenesis. The goal of this study is to assess the level of consensus among cyclone detection and tracking methods (CDTMs), to identify robust features and to explore sources of disagreement. A set of 14 CDTMs has been applied for computing the climatology of cyclones crossing the Mediterranean region using the ERA-Interim dataset for the period 1979–2008 as common testbed. Results show large differences in actual cyclone numbers identified by different methods, but a good level of consensus on the interpretation of results regarding location, annual cycle and trends of cyclone tracks. Cyclogenesis areas such as the north-western Mediterranean, North Africa, north shore of the Levantine basin, as well as the seasonality of their maxima are robust features on which methods show a substantial agreement. Differences among methods are greatly reduced if cyclone numbers are transformed to a dimensionless index, which, in spite of disagreement on mean values and interannual variances of cyclone numbers, reveals a consensus on variability, sign and significance of trends. Further, excluding ‘weak’ and ‘slow’ cyclones from the computation of cyclone statistics improves the agreement among CDTMs. Results show significant negative trends of cyclone frequency in spring and positive trends in summer, whose contrasting effects compensate each other at annual scale, so that there is no significant long-term trend in total cyclone numbers in the Mediterranean basin in the 1979–2008 period.

Introduction: Community pharmacists are in a suitable position to give advice and provide appropriate services related to sleep disorders to individuals who are unable to easily access sleep clinics. An intervention with proper objective measure can be used by the pharmacist to assist in consultation. Objectives: The study objectives are to evaluate: (1) The effectiveness of a community pharmacy-based intervention in managing sleep disorders and (2) the role of actigraph as an objective measure to monitor and follow-up individuals with sleeping disorders. Methods and Instruments: The intervention care group (ICG) completed questionnaires to assess sleep scale scores (Epworth Sleepiness Scale [ESS] and Insomnia Severity Index [ISI]), wore a wrist actigraph, and completed a sleep diary. Sleep parameters (sleep efficiency in percentage [SE%], total sleep time, sleep onset latency, and number of nocturnal awakenings) from actigraphy sleep report were used for consultation and to validate sleep diary. The usual care group (UCG) completed similar questionnaires but received standard care. Results: Pre- and post-mean scores for sleep scales and sleep parameters were compared between and within groups. A significant difference was observed when comparing pre- and post-mean scores for ISI in the ICG, but not for ESS. For SE%, an increase was found in the number of subjects rated as “good sleepers” at post-assessment in the ICG. Conclusions: ISI scores offer insights into the development of a community pharmacy-based intervention for sleeping disorders, particularly in those with symptoms of insomnia. It also demonstrates that actigraph could provide objective sleep/wake data to assist community pharmacists during the consultation.

Medication lubricants are thick liquids or gels that are designed to aid swallowing of solid oral dosage forms. Tablets and capsules are placed within a spoonful of the product for swallowing. The aim of this study was to describe and compare commercially available medication lubricants in terms of textural suitability for patients with dysphagia. Twelve medication lubricants were characterised according to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. Apparent viscosity, yield stress, thickness consistency, and various texture features were compared. Gloup Forte was the only medication lubricant classified as IDDSI level 4 (pureed/extremely thick) at room (24 °C) temperature. Four other Gloup products were IDDSI level 3 (liquidised/moderately thick) at room temperature but testing at 4 °C or pouring from the container instead of using the pump dispenser resulted in classification as IDDSI level 4. The IDDSI Flow test would have classified MediSpend and Slo Tablets as IDDSI level 3, but their very low yield stress led to these fluids flowing too quickly through the prongs of a fork and so these were classified as

The effect of weather on public transport usage in Berlin is analysed. The number of single and day tickets sold is used as a proxy for the number of occasional public transport users. Analysing more than three years of hourly ticket sale data, it is shown that the most important factor influencing ticket sales is temperature. Temperatures below −5 ^° C lead to an increase in ticket sales by up to 30% on working days, while on hot days (> 28 ^° C) passenger numbers drop by up to 5%. Precipitation increases the number of sales on working days by up to 5%. On weekends, the lowest ticket-sale numbers are associated with wet and either very cold or very hot conditions. Another factor influencing ticket sales is sunshine duration, while wind and snowfall do not seem to play a role for ticket sales in Berlin. It is demonstrated that it is possible to predict ticket sales depending on date, time and weather conditions using a statistical model. On designated public transport routes the effect of weather on passenger numbers can be much stronger than the district average. This is shown for the example of a bus route to a public beach. With each degree of temperature increase, passenger numbers on this line go up by approximately 30%.

Overexpression of the Dual-specificity Tyrosine Phosphorylation-Regulated Kinase 1A (DYRK1A) gene contributes to the retardation, craniofacial anomalies, cognitive impairment, and learning and memory deficits associated with Down Syndrome (DS). DCAF7/HAN11/WDR68 (hereafter WDR68) binds DYRK1A and is required for craniofacial development. Accumulating evidence suggests DYRK1A-WDR68 complexes enable proper growth and patterning of multiple organ systems and suppress inappropriate cell growth/transformation by regulating the balance between proliferation and differentiation in multiple cellular contexts. Here we report, using engineered mouse C2C12 and human HeLa cell lines, that WDR68 is required for normal levels of DYRK1A. However, Wdr68 does not significantly regulate Dyrk1a mRNA expression levels and proteasome inhibition did not restore DYRK1A in cells lacking Wdr68 (Δwdr68 cells). Overexpression of WDR68 increased DYRK1A levels while overexpression of DYRK1A had no effect on WDR68 levels. We further report that WDR68 is similarly required for normal levels of the closely related DYRK1B kinase and that both DYRK1A and DYRK1B are essential for the transition from proliferation to differentiation in C2C12 cells. These findings reveal an additional role of WDR68 in DYRK1A-WDR68 and DYRK1B-WDR68 complexes.

This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada to discuss published and in-progress research on the topic, identify gaps and priorities for future research, and share implementation strategies used in different jurisdictions. Twelve researchers from five countries attended this initial meeting, identified from both personal networks and from authorship lists from published research. Small- and large-group discussions addressed a number of themes, including: clinical, economic and educational outcomes of the service; the perspectives of pharmacists, patients, and other health professionals; operational and policy factors influencing uptake; safety; and the immunizing pharmacist’s role in disaster preparedness. Feedback on our first meeting and outcomes achieved were evaluated on the basis of participant feedback. Key components of the meeting that were considered successful and important lessons learned are summarized, so that other like-minded researchers with a shared pharmacy practice research interest could consider leveraging funding opportunities to establish other international pharmacy practice research networks.

Self-efficacy, the belief in one’s ability to succeed in learning tasks, predicts learning and success in education broadly and physics specifically. While self-efficacy increases for students in most introductory science and mathematics courses, self-efficacy consistently decreases for women in physics courses. This study used the experience sampling method to investigate gender differences in the self-efficacy states high school students experienced in physics, other math and science classes, and other classes. Data for the study came from the Sloan survey of youth and social development and included data from 1332 students at 12 different schools collected between 1993 and 1997. Principle components analysis identified a self-efficacy state measure within the data. Comparisons of self-efficacy states across gender and activity (e.g., physics and science and mathematics courses) using a two-level hierarchical linear model identified a large gender difference in self-efficacy states in physics and only in physics. These results add to the growing evidence that female students’ physics self-efficacy tends to decrease after taking physics courses. Given that self-efficacy predicts career choice and success, decreases in women’s physics self-efficacy may inform why women are much less likely to pursue physics careers than men.

Cyclones moving on a track from the Mediterranean region towards Central Europe can transport humid air masses into the Central European region. Cyclones on this track are of particular interest, as they have historically often caused major river flooding during the summer season. Such systems are also known as Vb cyclones. In this study, an objective identification algorithm is presented, which detects the systems. The algorithm has been applied to the summer half year (April?September) of the ERA40 reanalysis data set. It is able to capture most documented historic hazardous events in the data set. The amount of precipitation affecting the study region is found to increase with the residence time of the cyclone within the region of interest. About 41% of the Vb cyclones are associated with precipitation exceeding the daily mean 95th percentile over Central Europe. In order to detect possible changes in the frequency and severity of Vb cyclones under rising greenhouse gas forcing, the algorithm was applied to an ensemble of 3 simulations with the ECHAM5/OM1 model covering the period from 1971?2100, which were forced with 20th century and A1B scenario greenhouse gas concentrations. For present day forcing, the model overestimates the number of Vb cyclones. The ratio between systems associated with extreme daily precipitation over the area and systems producing less impact in terms of rainfall is, however, close to the number found in observations. For the future scenario period the simulations produce a decrease in the total number of Vb cyclones, due to an eastward shift in the most common northbound cyclone tracks. At the same time, the mean amount of precipitation associated with the Vb cyclones increases by 16%. Due to long term climate variability this increase is not continuously statistical significant. The number of Vb cyclones associated with extreme precipitation remains stable throughout the 21st century.

Birth defects are among the leading causes of infant mortality and contribute substantially to illness and long-term disability. Defects in Bone Morphogenetic Protein (BMP) signaling are associated with cleft lip/palate. Many craniofacial syndromes are caused by defects in signaling pathways that pattern the cranial neural crest cells (CNCCs) along the dorsal-ventral axis. For example, auriculocondylar syndrome is caused by impaired Endothelin-1 (Edn1) signaling, and Alagille syndrome is caused by defects in Jagged-Notch signaling. The BMP, Edn1, and Jag1b pathways intersect because BMP signaling is required for ventral edn1 expression that, in turn, restricts jag1b to dorsal CNCC territory. In zebrafish, the scaffolding protein Wdr68 is required for edn1 expression and subsequent formation of the ventral Meckel's cartilage as well as the dorsal Palatoquadrate. Here we report that wdr68 activity is required between the 17-somites and prim-5 stages, that edn1 functions downstream of wdr68, and that wdr68 activity restricts jag1b, hey1, and grem2 expression from ventral CNCC territory. Expression of dlx1a and dlx2a was also severely reduced in anterior dorsal and ventral 1st arch CNCC territory in wdr68 mutants. We also found that the BMP agonist isoliquiritigenin (ISL) can partially rescue lower jaw formation and edn1 expression in wdr68 mutants. However, we found no significant defects in BMP reporter induction or pSmad1/5 accumulation in wdr68 mutant cells or zebrafish. The Transforming Growth Factor Beta (TGF-β) signaling pathway is also known to be important for craniofacial development and can interfere with BMP signaling. Here we further report that TGF-β interference with BMP signaling was greater in wdr68 mutant cells relative to control cells. To determine whether interference might also act in vivo, we treated wdr68 mutant zebrafish embryos with the TGF-β signaling inhibitor SB431542 and found partial rescue of edn1 expression and craniofacial development. While ISL treatment failed, SB431542 partially rescued dlx2a expression in wdr68 mutants. Together these findings reveal an indirect role for Wdr68 in the BMP-Edn1-Jag1b signaling hierarchy and dorso-anterior expression of dlx1a/2a.

A climatology of cyclones with a focus on their relation to wind storm tracks in the Mediterranean region (MR) is presented. Trends in the frequency of cyclones and wind storms, as well as variations associated with the North Atlantic Oscillation (NAO), the East Atlantic/West Russian (EAWR) and the Scandinavian variability pattern (SCAND) are discussed. The study is based on the ERA40 reanalysis dataset. Wind storm tracks are identified by tracking clusters of adjacent grid boxes characterised by extremely high local wind speeds. The wind track is assigned to a cyclone track independently identified with an objective scheme. Areas with high wind activity – quantified by extreme wind tracks – are typically located south of the Golf of Genoa, south of Cyprus, southeast of Sicily and west of the Iberian Peninsula. About 69% of the wind storms are caused by cyclones located in the Mediterranean region, while the remaining 31% can be attributed to North Atlantic or Northern European cyclones. The North Atlantic Oscillation, the East Atlantic/West Russian pattern and the Scandinavian pattern all influence the amount and spatial distribution of wind inducing cyclones and wind events in the MR. The strongest signals exist for the NAO and the EAWR pattern, which are both associated with an increase in the number of organised strong wind events in the eastern MR during their positive phase. On the other hand, the storm numbers decrease over the western MR for the positive phase of the NAO and over the central MR during the positive phase of the EAWR pattern. The positive phase of the Scandinavian pattern is associated with a decrease in the number of winter wind storms over most of the MR. A third of the trends in the number of wind storms and wind producing cyclones during the winter season of the ERA40 period may be attributed to the variability of the North Atlantic Oscillation.

Measuring student learning is a complicated but necessary task for understanding the effectiveness of instruction and issues of equity in college science, technology, engineering, and mathematics (STEM) courses. Our investigation focused on the implications on claims about student learning that result from choosing between one of two commonly used metrics for analyzing shifts in concept inventories. The metrics are normalized gain (g), which is the most common method used in physics education research and other discipline based education research fields, and Cohen’s d, which is broadly used in education research and many other fields. Data for the analyses came from the Learning About STEM Student Outcomes (LASSO) database and included test scores from 4551 students on physics, chemistry, biology, and math concept inventories from 89 courses at 17 institutions from across the United States. We compared the two metrics across all the concept inventories. The results showed that the two metrics lead to different inferences about student learning and equity due to the finding that g is biased in favor of high pretest populations. We discuss recommendations for the analysis and reporting of findings on student learning data.

We introduce the improved Freie Universität Berlin (FUB) high-resolution radiation scheme FUBRad and compare it to the 4-band standard ECHAM5 SW radiation scheme of Fouquart and Bonnel (FB). Both schemes are validated against the detailed radiative transfer model libRadtran. FUBRad produces realistic heating rate variations during the solar cycle. The SW heating rate response with the FB scheme is about 20 times smaller than with FUBRad and cannot produce the observed temperature signal. A reduction of the spectral resolution to 6 bands for solar irradiance and ozone absorption cross sections leads to a degradation (reduction) of the solar SW heating rate signal by about 20%. The simulated temperature response agrees qualitatively well with observations in the summer upper stratosphere and mesosphere where irradiance variations dominate the signal. Comparison of the total short-wave heating rates under solar minimum conditions shows good agreement between FUBRad, FB and libRadtran up to the middle mesosphere (60–70 km) indicating that both parameterizations are well suited for climate integrations that do not take solar variability into account. The FUBRad scheme has been implemented as a sub-submodel of the Modular Earth Submodel System (MESSy).

As medication experts, pharmacists are key members of the patient’s healthcare team. Pharmacists must maintain their competence to practice to remain responsive to the increasingly complex healthcare sector. This paper seeks to determine how competence training for pharmacists may enhance quality in their professional development. Results of two separately administered surveys (2012 and 2013) were compared to examine the reported continued professional development (CPD) practices of Australian pharmacists. Examination of results from both studies enabled a focus on how the competency standards inform CPD practice.In the survey administered in 2012, 91% (n = 253/278) pharmacists reported that they knew their current registration requirements. However, in the survey administered in 2013, only 43% (n = 46/107) reported utilization of the National Competency Standards Framework for Pharmacists in Australia (NCS) to self-asses their practice as part of their annual re-registration requirements. Fewer, 23% (n = 25/107), used the NCS to plan their CPD. This may be symptomatic of poor familiarity with the NCS, uncertainty around undertaking self-directed learning as part of a structured learning plan and/or misunderstandings around what CPD should include. This is supported by thematic analysis of pharmacists’ social media comments. Initial and ongoing competence training to support meaningful CPD requires urgent attention in Australia. The competence (knowledge, skills and attributes) required to engage in meaningful CPD practice should be introduced and developed prior to entry into practice; other countries may find they are in a similar position.

Purpose. To evaluate the influence of co-administered vehicles on in vitro dissolution in simulated gastric fluid of crushed immediate release tablets as an indicator for potential drug bioavailability compromise. Methods. Release and dissolution of crushed amlodipine, atenolol, carbamazepine and warfarin tablets were tested with six foods and drinks that are frequently used in the clinical setting as mixers for crushed medications (water, orange juice, honey, yoghurt, strawberry jam and water thickened with Easythick powder) in comparison to whole tablets. Five commercial thickening agents (Easythick Advanced, Janbak F, Karicare, Nutilis, Viscaid) at three thickness levels were tested for their effect on the dissolution of crushed atenolol tablets. Results. Atenolol dissolution was unaffected by mixing crushed tablets with thin fluids or food mixers in comparison to whole tablets or crushed tablets in water, but amlodipine was delayed by mixing with jam. Mixing crushed warfarin and carbamazepine tablets with honey, jam or yoghurt caused them to resemble the slow dissolution of whole tablets rather than the faster dissolution of crushed tablets in water or orange juice. Crushing and mixing any of the four medications with thickened water caused a significant delay in dissolution. When tested with atenolol, all types of thickening agents at the greatest thickness significantly restricted dissolution, and products that are primarily based on xanthan gum also delayed dissolution at the intermediate thickness level. Conclusions. Dissolution testing, while simplistic, is a widely used and accepted method for comparing drug release from different formulations as an indicator for in vivo bioavailability. Thickened fluids have the potential to retard drug dissolution when used at the thickest levels. These findings highlight potential clinical implications of the addition of these agents to medications for the purpose of dose delivery and indicate that further investigation of thickened fluids and their potential to influence therapeutic outcomes is warranted. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Wdr68 is a highly conserved scaffolding protein required for craniofacial development and left-right asymmetry. A Ras-Map3k-Wdr68-Dyrk1 signaling relay may mediate these and other diverse signaling events important in development and disease. While the sub-cellular localization of Wdr68 has been shown to be dependent on that of its interaction partners, it is not clear where Wdr68 activity is required during development. Here we show that while a GFP-Wdr68 fusion functionally substituted for craniofacial development in the zebrafish, that a Nuclear Export Signal (NES) fusion protein (GFPNESWdr68) failed to support craniofacial development. As control for NES activity, we show that while GFP-Wdr68 exhibited a pan-cellular distribution in C2C12 cells, the GFPNESWdr68 fusion predominantly localized to the cell cytoplasm, as expected. Interestingly, while GFP-Wdr68 and RFP-Dyrk1a co-localized to the cell nucleus as expected based on the known sub-cellular localization for Dyrk1a, we found that the GFPNESWdr68 fusion redistributed RFP-Dyrk1a to the cell cytoplasm potentially disconnecting the Ras/Dyrk1 signal relay from further downstream targets. Consistent with a nuclear role in gene regulation, we also found that while a transcriptional activation domain fusion, CebpFlagWdr68, functionally substituted for endogenous Wdr68 for craniofacial development, that a transcriptional repression domain fusion, MadFlagWdr68, failed to support craniofacial development. Dyrk1b is required for myogenin (myog) expression in differentiating mouse C2C12 cells and here we report that wdr68 is also important for myog expression in differentiating C2C12 cells. Using a C2C12 cell myog promoter-reporter system, we found that Wdr68 overexpression increased reporter activity while moderate expression levels of MadFlagWdr68 interfered with reporter activity. Taken together, these findings support a nuclear role for Wdr68-containing complexes.

[This paper is part of the Focused Collection on Gender in Physics.] There is growing evidence of persistent gender achievement gaps in university physics instruction, not only for learning physics content, but also for developing productive attitudes and beliefs about learning physics. These gaps occur in both traditional and interactive-engagement (IE) styles of physics instruction. We investigated one gender gap in the area of attitudes and beliefs. This was men’s and women’s physics self-efficacy, which comprises students’ thoughts and feelings about their capabilities to succeed as learners in physics. According to extant research using pre- and post-course surveys, the self-efficacy of both men and women tends to be reduced after taking traditional and IE physics courses. Moreover, self-efficacy is reduced further for women than for men. However, it remains unclear from these studies whether this gender difference is caused by physics instruction. It may be, for instance, that the greater reduction of women’s self-efficacy in physics merely reflects a broader trend in university education that has little to do with physics per se. We investigated this and other alternative causes, using an in-the-moment measurement technique called the Experience Sampling Method (ESM). We used ESM to collect multiple samples of university students’ feelings of self-efficacy during four types of activity for two one-week periods: (i) an introductory IE physics course, (ii) students’ other introductory STEM courses, (iii) their non-STEM courses, and (iv) their activities outside of school. We found that women experienced the IE physics course with lower self-efficacy than men, but for the other three activity types, women’s self-efficacy was not reliably different from men’s. We therefore concluded that the experience of physics instruction in the IE physics course depressed women’s self-efficacy. Using complementary measures showing the IE physics course to be similar to others in which gendered self-efficacy effects have been consistently observed, we further concluded that IE physics instruction in general is likely to be detrimental to women’s self-efficacy. Consequently, there is a clear need to redress this inequity in IE physics, and probably also in traditional instruction.