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The adjustment to the financial crisis was particularly brutal for Eurozone countries targeted by private bondholders. Financial assistance through the newly created Eurozone governance system was conditional on the implementation of austerity measures and the introduction of structural reforms in industrial relations (decentralization of collective bargaining and liberalization of employment protection). Our analysis focuses on the formation process and the structural features of Eurozone supranational institutions. Building from the insights of actor-centred institutionalism, we illustrate the importance of coalitions among some, but not all, important actors based on the overlapping of their non-monolithic preferences in the process of institutional innovation. The structural features of Eurozone institutions curtailed member states’ ability to effectively resist the imposition of internal devaluation policies. A contested outcome, these institutional features were secured by a specific coalition of important actors – most notably, the German government and the European Central Bank – based on their overlapping interests around internal devaluation policies.

Medical school and residency programs encourage increased research, and thousands of abstracts are submitted to conferences annually. This study sought to determine the rate of publication of oral presentations from the 2017 Academic Surgical Congress (ASC) and assess factors that influence the likelihood of publication.Abstracts selected for oral, plenary, and QuickShot presentations at the 2017 ASC were evaluated for publication status. Publication status, including date of publication and journal title, the academic rank of first and senior authors, and the type of study were collected. Senior author funding status, as well as source and amount of funding, were cataloged. These variables were noted at 16 mo and then later at 34 mo after the conference.Of the 360 oral and plenary presentations, 41.4% (n = 149) and 70.5% were published at 16 and then 34 mo, respectively. At 16 mo, Basic science, Clinical outcomes, and Education had publication rates of 31.7%, 51.1%, and 57.7%. At 34 mo, they were 76.1%, 69.1%, and 60.06%. QuickShot presentations had a publication rate of 17%, 69%, and 14% for Basic Science, Clinical Outcomes, and Education, respectively. At 16 mo, abstracts with senior authors with an academic rank of Assistant Professor, Associate Professor, and Professor had publication rates of 43.3% (22), 49.4% (39), and 41.8% (37), respectively (P = 0.697). At 34 mo, publication rates for senior authors was 21.8% (53), 32.9% (80), and 45.2% (110) for Assistant Professor, Associate Professor, and Professor, respectively (P= 0.01). Quick shot presentations had publication rates of 14%, 26%, and 49% for Assistant Professor, Associate Professor, and Professor, respectively. 191 (53.2%) senior authors had funding, of which 125 (66.8%) were from the National Institute of Health. 61% of abstracts with a funded senior author went on to be published, whereas 38.9% of abstracts with an unfunded senior author were published. The presence of funding continued to have a positive association with publication (P 0.01 versus P 0.01) at 16 and 34 mo postconference. In QuickShot presentations, 88% of abstracts with a funded senior author went on to be published. Of Quick shot presentations without funding, 100% were published.There was an increase in publication rate from 16 to 34 mo after the 2017 ASC conference for oral presentations. At longer follow-up, the academic rank of the senior author and the funded abstracts were associated with abstracts achieving publication, whereas the academic rank of the first author, presentation type, and funding source was not. Funding was significantly associated with the Presentation Type at the conference and the Journal Impact Factor of the manuscript, whereas abstract type was not. QuickShot presentations did not fare as well regarding publication status; at approximately 3 y, the publication rate was 43%.

With the goal of improving student success, the chancellor of the California State University (CSU) system issued an executive order that required all CSU campuses to eliminate remedial math course...

While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation.

BackgroundRegenerating islet-derived protein 3α (REG3α) is an antimicrobial peptide secreted by intestinal Paneth cells. Circulating REG3α has been identified as a gut damage marker in inflammatory bowel diseases. People living with human immunodeficiency virus (PWH) on antiretroviral therapy (ART) present with an abnormal intestinal landscape leading to microbial translocation, persistent inflammation, and development of non-AIDS comorbidities. Herein, we assessed REG3α as a marker of gut damage in PWH.MethodsPlasma from 169 adult PWH, including 30 elite controllers (ECs), and 30 human immunodeficiency virus (HIV)–uninfected controls were assessed. REG3α plasma levels were compared with HIV disease progression, epithelial gut damage, microbial translocation, and immune activation markers.ResultsCross-sectionally, REG3α levels were elevated in untreated and ART-treated PWH compared with controls. ECs also had elevated REG3α levels compared to controls. Longitudinally, REG3α levels increased in PWH without ART and decreased in those who initiated ART. REG3α levels were inversely associated with CD4 T-cell count and CD4:CD8 ratio, while positively correlated with HIV viral load in untreated participants, and with fungal product translocation and inflammatory markers in all PWH.ConclusionsPlasma REG3α levels were elevated in PWH, including ECs. The gut inflammatory marker REG3α may be used to evaluate therapeutic interventions and predict non-AIDS comorbidity risks in PWH.

In cool temperate regions, large emissions of nitrous oxide (N2O), an important greenhouse and ozone-depleting gas, have been observed during freeze–thaw (FT) cycles. However, it is unclear how freezing and thawing rates, freezing intensity, and freezing duration influence N2O emissions. We used a laboratory incubation to measure N2O emissions from two soils (sandy loam, silty clay) undergoing a single FT cycle of various freezing and thawing rates [rapid (0.5 °C h−1) vs. slow (0.017 °C h−1)], freezing intensity (−1 vs. −3 °C), and freezing duration (24 vs. 48 freezing degree-days). In general, soil carbon dioxide fluxes during freezing were highest when soils were frozen slowly at −1 °C, whereas fluxes after thawing were highest from the soils frozen and thawed rapidly at −3 °C. Soil N2O emissions during both the freezing and thawing periods were greatest in the soils exposed to rapid freezing to −3 °C, intermediate under rapid freezing to −1 °C and slow freezing to −3 °C, and smallest under slow freezing to −1 °C and the control treatment (constant +1 °C). The similar N2O emissions between the unfrozen control and the slowly frozen −1 °C treatment was unexpected as previous field studies with similar freezing rates and temperatures still experienced high N2O emissions during thaw. This suggests that the physical disruptions caused by freezing and thawing of the surface soil are not the primary driver of FT-induced N2O emissions under field conditions.

Residents often utilize internet resources to evaluate and search for fellowship programs within their desired field. The presence of these resources and the information available through them has the potential to influence applicant decisions. The objective of this study was to analyze the online MIS fellowship information relevant to resident applicants provided by the Fellowship Council Directory (FCD) and institutionally based program webpages. The programs evaluated were chosen based on their inclusion in the FCD, the accrediting body for MIS fellowships. The FCD provides each program a template through which program directors detail information for applicants. This information is publicly accessible through the directory, with each program having a specific page. These webpages were assessed for the presence or absence of 21 previously established individual content criteria. In addition, the presence or absence of a functional link to an institutionally based, program-specific webpage was determined. These program-specific, institutional webpages were then independently accessed via Google® search and separately assessed for the presence or absence of the same 21 previously established content criteria. In total, the FCD listed 144 programs. Each program had a dedicated page within the directory itself with 104 (72%) having functional links listed. Ninety-six (66.6%) of the FCD links were identified as being specific webpages to the fellowship program, verified through a Google® search. Less than half of the programs fulfilled over 50% of identified criteria through the FCD templated directory, with one-third of programs listed failing to provide any program-specific information via a webpage outside the FCD. Information available online for MIS fellowship programs is lacking, with many institutionally supported webpages absent altogether outside of the FCD. Templated formats seem to assist in this deficiency, but should be used cautiously as they also can potentially omit relevant information.

KEY POINTS In 2018, at least 4460 Canadians died from an opioid overdose, of which 94% were determined to be unintentional (accidental) overdoses. This represents a 9% increase in overdose deaths from 2017 and a 48% increase from 2016.[1][1] The recent emergence of street fentanyl, carfentanil and

OBJECTIVE Recent research on open-label placebos, or placebos administered without deception or concealment, suggests that they can be effective in a variety of conditions. The current research sought to unpack the mechanisms underlying the treatment efficacy of open-label placebos. METHOD A health care provider induced an allergic reaction in 148 participants via a histamine skin prick test. Participants were then exposed to 1 of 4 conditions additively leveraging various mechanisms of open-label placebo treatments: a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos. RESULTS There were no main effects of condition on allergic responses. However, participant beliefs about placebos moderated the effect of open-label placebo treatment condition on physiological allergic reactions: the condition including all 4 components of open-label placebos (a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos) significantly reduced physiological allergic reaction among participants with a strong belief in placebos compared with participants in the control group. CONCLUSION Participants' beliefs about placebos interact with information from the provider to reduce physiological allergic reactions in response to an open-label placebo treatment. This study underscores the importance of measuring and understanding how participants' beliefs influence outcomes of treatment, and furthers our understanding of when and how open-label placebo treatments work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE The main purpose of our study was to subjectively assess the quality of a paediatric intensive care unit (PICU) database according to the Directory of Clinical Databases (DoCDat) criteria. DESIGN AND SETTING A survey was conducted between April 1 and June 15, 2018, among the Sainte Justine PICU research group. POPULATION Every member of this group whose research activity required the use of the database and/or who was involved in the development/validation of the database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All 10 research team members (one Information Technology specialist, one junior medical student, and eight clinician researchers) who used the high-resolution database fulfilled the survey (100% response rate). The median quality level of the Sainte Justine PICU database across all the 10 criteria was 3 (2-4), rated on a 1 (worst) to 4 (best) numeric scale. When compared with previously assessed databases through the DoCDat criteria, we found that the Sainte Justine PICU database performance was similar. CONCLUSIONS The PICU high-resolution database appeared of good quality when subjectively assessed by the DoCDat criteria. Further validation procedures are mandatory. We suggest that data quality assessment and validation procedures should be reported when creating a new database.

In cold agricultural regions, animal manure and synthetic fertilizers may be applied in the fall for convenience. However, the fate of applied nitrogen (N) is unclear and may differ depending on N source and interannual and regional variations in winter conditions. A multi-region study using 15N-labelled reactive N (NH4-15N) applied in the fall with pig slurry, dairy cattle slurry, and ammonium sulfate was carried out under a range of climatic conditions. Nitrification and immobilization of applied NH4-N occurred throughout the winter period at all sites. Transformation and losses were slower and less at the sites where significant soil freezing occurred than at the site where soil rarely froze, highlighting the repressive effect of frost. Nevertheless, losses were similar among sites with significant freezing despite marked differences in duration and extent of freezing. This suggests that soil microbes were adapted to prevailing winter conditions at each site and able to use and transform fall-applied N throughout the winter period. Overall, 47%–94% of fall-applied NH4-N was lost from the top 30 cm of soil before seeding in the next spring. Losses were generally greater with synthetic fertilizer than manures, likely because fresh carbon added with manures stimulated immobilization of NH4-N. This multi-region assessment indicates that reactive N applied in the fall has high vulnerability to loss in cold and frozen soils, and strategies for improving N retention over the winter are required even in areas where prolonged freezing occurs.

Potentially inappropriate medications (PIMs) have been associated with a greater risk of adverse drug events and hospitalizations. To reduce PIMs use, a family health team (FHT) implemented a knowledge translation (KT) strategy that included a pharmacist-physician intervention model based on alerts from a computerized alert system (CAS). Our pragmatic, single-site, pilot study was conducted in an FHT clinic in Quebec, Canada. We included community-dwelling older adults (≥ 65 years), with at least 1 alert for selected PIMs and a medical appointment during the study period. PIMs were selected from the Beers and STOPP criteria. The primary outcome was PIMs cessation, decreased dose, or replacement. The secondary outcome was the clinical relevance of the alerts as assessed by the pharmacists. During the 134 days of the study, the CAS screened 369 individuals leading to the identification of 65 (18%) patients with at least 1 new alert. For those 65 patients, the mean age was 77 years, men accounted for 29% of the group and 55% were prescribed 10 or more drugs. One or more clinically relevant alerts were generated for 27 of 65 included patients for an overall clinical relevance of the alerts of 42%. Of the 27 patients with at least 1 relevant alert, 17 (63%) had at least 1 medication change as suggested by the pharmacist. An interdisciplinary pharmacist-physician intervention model, based on alerts generated by a CAS, reduced the use of PIMs in community-dwelling older adults followed by an FHT.

BackgroundThe principles for maintenance intravenous fluid prescription in children were developed in the 1950s. These guidelines based on the use of hypotonic solutions have been challenged regularly for they seem to be associated with an increased risk of hospital-acquired hyponatremia.Case presentationWe report the case of a 4-week-old Caucasian child admitted for acute bronchiolitis who received hypotonic maintenance fluids and developed severe hyponatremia (94 mmol/L) with hyponatremic encephalopathy.ConclusionThis clinical situation can serve as a reminder of the latest recommendations from the American Academy of Pediatrics regarding the use of intravenous fluids that promote the use of isotonic fluids in children.

Background High-dose vitamin C is increasingly used for sepsis and more recently for coronavirus disease 2019 (COVID-19) infections. Proponents argue that the low cost and near perfect safety profile of vitamin C support its early adoption. Yet, adverse events might be underreported and underappreciated. Case presentation We report a 73-year-old non-diabetic white man with end-stage renal disease on peritoneal dialysis admitted to the intensive care unit with septic shock that was suspected to be due to peritonitis. The patient was enrolled in LOVIT (Lessening Organ Dysfunction with VITamin C; ClinicalTrials.gov identifier: NCT03680274), a randomized placebo-controlled trial of high-dose intravenous vitamin C. He developed factitious hyperglycemia, as measured with a point-of-care glucometer, that persisted for 6 days after discontinuation of the study drug, confirmed to be vitamin C after unblinding. He also had short-lived iatrogenic coma because of hypoglycemia secondary to insulin administration. These events triggered a protocol amendment. Conclusions Although factitious hyperglycemia has been reported before using certain glucometers in patients treated with high-dose vitamin C, the persistence of this phenomenon for 6 days after the discontinuation of the therapy is a distinguishing feature. This case highlights the importance of monitoring glucose with a core laboratory assay for up to a week in specific populations, such as patients on peritoneal dialysis.

Background Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT’s work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT’s work when conducting assessments in which home representations are essential to fit a person’s needs. Methods A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results A total of 24 stakeholders contributed significantly to MapIt technology’s co-design over a span of 4 years. Fueled by the objective to enhance MapIt’s acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders’ perception was favorable regarding MapIt’s acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person’s occupational engagement.

Tuberculous meningitis (TBM) is now uncommon in high-income countries. It is the most severe form of extrapulmonary tuberculosis with high rates of mortality and morbidity if diagnosis and treatment are delayed. An 8-month-old girl with TBM who was treated with high-dose intravenous anti-tuberculous drugs (ATD) is reported. Therapeutic drug monitoring (TDM) of isoniazid and rifampicin was undertaken by measuring serial drug concentrations in serum and cerebrospinal fluid (CSF). There was rapid eradication of

Background and importance Proton pump inhibitors (PPIs) are regularly prescribed in the paediatric intensive care unit (PICU) for prevention of stress ulcer and upper gastrointestinal bleed (UGIB). There is no clinical consensus regarding PPI use in the PICU. The reported incidence of UGIB in the PICU is low (0.4–5%). Having ≥2 risk factors has been associated with a higher risk of clinically relevant UGIB in the PICU (severity score at admission PRISM >10, coagulopathy, mechanical ventilation). Despite identification of these risk factors, studies fail to show that stress ulcer prophylaxis significantly decreases UGIB in the PICU. Moreover, recent studies in mostly adult patients have associated PPIs in the acute setting to a higher risk of nosocomial infections and hyponatraemia. Aim and objectives To describe PPI prescription patterns in the PICU and explore potentially associated clinical complications such as nosocomial infections and hyponatraemia. Material and methods A single centre, retrospective, cohort study was conducted on PICU patient charts from 1 January 2017 to 31 December 2018. Results 768 patients were included of whom 234 received a PPI (30.6%). PPI exposed patients were younger (p Conclusion and relevance Our study showed an overuse of PPIs in our PICU, with poorly documented indications. PPIs were statistically and independently associated with an increased risk of nosocomial infections in our population. Prospective randomised trials are needed to evaluate the risk–benefit ratio of PPIs in the PICU. Our results suggest the need for a more rational use of PPIs in the PICU and highlight the lack of clinical guidelines and safety data regarding stress ulcer prophylaxis in critically ill children References and/or acknowledgements Conflict of interest No conflict of interest

Background Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. Methods We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. Results We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. Interpretation Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who are readmitted within 30 days from prior hospitalization for heart failure. Hospitals risk losing millions of dollars due to poor performance. A reduction in CHF readmission rates not only improves healthcare system expenditures, but also patients’ mortality, morbidity, and quality of life. Purpose The purpose of this DNP project is to determine the 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. Specific aims include comparing computed annual re-admission rates with national average, determine the number of multiple 30-day re-admissions, provide descriptive data for demographic variables, and correlate age and heart failure classification with the number of multiple re-admissions. Methods A retrospective chart review was used to collect hospital admission and study data. The setting occurred in an urban hospital in Memphis, TN. The study was reviewed by the UTHSC Internal Review Board and deemed exempt. The electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. Data was cleaned such that each patient admitted had only one heart failure ICD-10 code. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients re-admitted withing 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. Results A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were re-admitted on multiple occasions sequentially, ranging from 2-8 re-admissions. The median age was 60 and 60% male. Due to the skewed distribution (most re-admitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple re-admissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553).

Background In Burkina Faso, maternity is a risk. Global Affairs Canada funded the initiative PASME-2 with World University Service of Canada, Laval University and Farm Radio International to improve maternal outcomes. A preventative program was co-developed in phases. Phase 3 received funding from Social Sciences and Humanities Research Council in partnership with the Centre for International Cooperation in Health and Development (CCISD) and TIESS, a liaison and transfer expert in Québec, to support local teams towards sustainable practice changes. This research aimed at documenting the partnership experience, digital literacy, perceived direct and indirect outcomes. Methods A participative co-design approach, allowed the engagement of several stakeholders in the process. Two active phases where 16 health professionals engaged actively in the VCoP, according to the final agreed-upon Constitutional Chart, are presented. The phases pilot-tested two different technology tools. Results 16 interviews post-phase 1 and 16 interviews post-phase 2 were conducted. Implementation issues as perceived by users are discussed and include: feasibility, challenges, needs, animation, relevance to care, communication and sharing, use and perspectives. Perceived outcomes focus on professional preventative practice changes, skills, family outcomes, challenges to practice integration, knowledge and practice exchanges. Conclusions The phases of experimentation demonstrate that strategies can be put in place to counter the digital literacy challenges and to engage users in new ways of communicating, sharing on the platform about health practices and taking valuable time to do it. Overcoming technology constraints is essential especially in lower resource settings. The most practical life experiences and cases lead to more engagement and innovations. Support from management and upper directorate is significant. Key messages Partnership from several stakeholders is key to implementing a VCoP. Experimenting and sharing solutions is influenced by the capacitating environment that the VCoP can provide with recognition from administration and as a professional development activity.

Compost application to agricultural fields can increase soil organic matter content and soil productivity. This study compared diverse compost products with a non-amended control in small plot and on-farm trials for effects on tuber yield and plant nutrient availability under rain-fed potato production in New Brunswick, Canada. In the small plot trial, mature compost products resulted in a small increase in plant N availability, whereas immature products resulted in net N immobilization. Composts high in K increased plant K availability. However, these effects on nutrient availability did not result in a significant effect on tuber yield. In on-farm trials, compost did not significantly increase yield averaged across 19 site-years of trials. This suggests that any short-term nutrient benefit from application of these wood waste and manure based composts is unlikely to influence crop yield, although there may be the potential to reduce nutrient application rates, particularly for K.

The purpose of the study was to evaluate the influence of establishing a protocol for the use of combined sodium benzoate and sodium phenylacetate (SBSP) (Ammonul®) to treat acute hyperammonemia. This was a retrospective, single-center study in a 24-bed medical and surgical pediatric intensive care unit (PICU) in a tertiary care teaching maternal-child hospital in Canada. Inclusion criteria were age 18 years, PICU admission between 1 January 2000 and 30 June 2016, and SBSP treatment. An SBSP delivery protocol was implemented in our hospital on 30 August 2008 in order to improve management of acute hyperammonemia. Patients were assigned to one of the two groups, without or with protocol, depending on date of admission. SBSP was ordered 34 times during the study period, and 23 orders were considered for analysis (14 with and 9 without protocol). Patient characteristics were similar between groups. The median time from diagnosis to prescription was significantly shorter in the protocol group [40 min (21-82) vs 100 min (70-150), p = 0.03)] but the median time from diagnosis to administration of the treatment was equivalent [144 min (90-220) vs 195 (143-274), (p = 0.2)]. Other clinical outcomes did not differ. This study is the first to compare two SBSP delivery strategies in the treatment of acute hyperammonemia in this PICU setting. Implementation of a delivery protocol shortened the time from diagnosis of hyperammonemia to prescription of SBSP and helped us identify other parameters that can be improved to optimize treatment delivery.

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.180209][2]][2] KEY POINTS Opioid use disorder is one of the most challenging forms of addiction facing the Canadian health care system, and a major contributor to the marked rises in opioid-related morbidity and death that Canada has been

Micronutrient malnutrition, also known as the hidden hunger, affects over two billion people worldwide. Potato is the third most consumed food crop in the world and is therefore a fundamental element of food security for millions of people. Increasing the amount of micronutrients in potatoes could help alleviate worldwide micronutrient malnutrition. Folate (or vitamin B9) is an essential micronutrient in the human diet. Deficiencies in folate lead to serious, sometimes lethal, diseases. Unfortunately, folate intake remains suboptimal in both developing and developed regions of the world. This paper uses folate to illustrate various approaches that could be implemented to increase micronutrient content in potato. It provides a brief overview of recent analyses of folate content in diverse potato germplasm, of changes in folate content during tuber development, and of the effect of postharvest low-temperature storage of potato on folate content, and how an optimization of these different factors could lead to significant increases in folate intake from potato.

In response to Rhode Island’s overdose epidemic, we developed a collaborative, statewide online “dashboard” to provide the public with timely overdose surveillance data. The Web site— www.PreventOverdoseRI.org (PORI)—offers user-friendly data visualizations, plain language education, and interactive resource maps. Development of the site has improved overdose data sharing and transparency in Rhode Island. Preliminary results suggest a successful site launch. Future research will evaluate the effectiveness of PORI in terms of informing strategic initiatives to reduce overdoses in affected communities.

This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby’s medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby’s care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is family-integrated care, where parents are intimately involved in a baby’s care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.

Objectives Heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococci (hVICoNS) are emerging pathogens causing central-line-associated bloodstream infections (CLABSIs) in neonatal intensive care unit (NICU) patients. Given the burden of disease associated with CLABSI and the current lack of therapeutic guidelines, we aimed to compare the effectiveness of linezolid versus vancomycin used as the definitive antibiotic therapy for hVICoNS CLABSI. Methods We performed a retrospective cohort study of infants with hVICoNS CLABSI from a single NICU between 2009 and 2014, treated with either linezolid or vancomycin as definitive antibiotic therapy. CLABSI duration, early and late recurrence and in-hospital mortality were compared using propensity score-adjusted proportional hazards and logistic regression models. Results Of 89 infants with hVICoNS CLABSI, 33 (37.1%) treated with linezolid were compared with 56 (62.9%) treated with vancomycin. The median duration of CLABSI was 5 (range 1-12) versus 4 days (range 0-14) ( P = 0.11), early recurrences were 3.0% versus 7.1% ( P = 0.42), late recurrences 0% versus 14.3% ( P = 0.02) and mortality 27.3% versus 28.6% ( P = 0.90), when treated with linezolid versus vancomycin, respectively. When adjusting using a continuous propensity score, linezolid had an HR of 0.78 (95% CI 0.48-1.27) for CLABSI duration, an OR of 0.23 (95% CI 0.02-2.56) for early recurrence and an OR of 0.9 (95% CI 0.3-2.67) for mortality, relative to vancomycin. Conclusions There was no statistically significant difference between linezolid and vancomycin when used as definitive treatment for hVICoNS CLABSI in NICU patients, in terms of CLABSI duration, recurrence or all-cause mortality.

Chronic immune activation and systemic inflammation during HIV infection despite effective antiretroviral therapy (ART) is associate with non-AIDS co-morbidities in people living with HIV (PLWH). Previous studies have shown that plasma levels of extracellular vesicles (EVs) may be used as immune activation or inflammatory biomarkers of HIV disease progression. Several studies have focused on microRNA and mitochondrial DNA (mtDNA) levels reached concomitantly in immune cells and EVs. We hypothesized that large and small EVs could contain different amounts of microRNA and mtDNA and that could reflect immune activation associated with elevated CD8 T cell count or low CD4/CD8 ratio in PLWH receiving ART. Plasma EVs obtained from PLWH and uninfected control were sized using dynamic light scattering and quantified using flow cytometry. Expression of mature miR-92, miR-155, miR-223 and mtDNA was measured by qRT-PCR. Positive correlation have been observed between CD8+ T cell count and large EV abundance, AChE activity in small EVs and negative correlation with miR-155 levels in small EVs. CD4/CD8 ratio was positively correlated with large EVs abundance and negatively with AChE activity in small EVs and PMN-associated copies of miR-92. MicroRNA-155 level in small EVs were positively correlated with monocyte counts. MiR-155 and mtDNA contents of large EVs were increased more than miR-92 and miR-223 contents in small EVs. A positive correlation was observed between large EVs mtDNA content and CD4 T cell count. These findings suggest that profiling the microRNA and mtDNA contents of EV might provide new functional biomarkers of immune activation and inflammation. Funding Statement: This study was funded through Canadian Institutes of Health Research (CIHR) grants MOP 188726; MOP-267056 (HIV/AIDS initiative) to C.G., MOP-03230 to J.P.R. and to C.T. for the cohort establishment and CIHR Foundation Grant FDN-143218 to M.A. for the studentship awarded to W.W.B., as well as by the Fonds de recherche du Quebec – Sante (FRQ-S) AIDS and infectious diseases network. C.T. is an FRQ-S scholar and holder of the Pfizer/Universite de Montreal chair on HIV translational Research. J-P.R. holds the Louis Lowenstein chair in Hematology & Oncology at McGill University. M-A.J. holds a CIHR Canada Research Chair tier 2 in Immuno-Virology. The infrastructure of the Centre de recherche du CHU de Quebec – Universite Laval is supportes by the FRQ-S. Declaration of Interests: The authors declare that no competing interests exist. Ethics Approval Statement: This study received approval from the ethics review boards of Centre de recherche du CHU de Quebec, Quebec, Canada and the McGill University Health Centre, Montreal, Quebec, Canada. All subjects were anonymous volunteers and provided written informed consent to participate in the study.

Background A first preliminary study conducted in 2017 among the mothers of a postpartum unit showed that 82% of medication administrations were not traced in the electronic medical chart. In this unit, for women postvaginal delivery only, midwives ensure patient management and prescribe basic pain medication, which are self-managed by the mother. These results reveal the insufficient traceability of self-managed medication in the postpartum unit. Purpose To evaluate the professional practices of midwives before and after implementation of medication safety procedures by pharmacists. Material and methods The first round of the audit took place in January 2018. The postpartum unit is divided into four 12-bed sectors and there are 18 midwives working 12 hour shifts. The main criteria evaluated was bedside pillboxes agreement with prescription and computerised traceability of self-administrations. All mothers systematically have the postvaginal delivery analgesia protocol prescribed and their individual chronic treatment if applicable. A mandatory computer commentary was added on the prescription software to be filled in by midwives every 12 hours at pillbox change to allow for twice-daily traceability of self-administered medication. At the same time, a medication safety action plan, including midwives’ awareness to medication errors, was implemented. Following the implementation of safety procedures, a second audit round was held in September 2018. Results The first audit round involved 16 patients and revealed that 69% of pillboxes were in agreement with prescription. Prescription was computerised for 25% of non-protocol medications. Regarding medication administration, 25% of non-protocol administrations were traced, whereas 12.5% of protocol analgesics were. No medication administration was traced in real-time. The second audit including 11 patients, revealed that 100% of pillboxes were in agreement with the prescription. The prescription was computerised for 100% of non-protocol prescriptions. Ninety per cent of non-protocol medication administrations were electronically traced in real-time as were 75% of the per protocol analgesic administrations. Conclusion These pharmacist-led medication safety actions made it possible to ensure safe self-management of postpartum treatments by mothers. Pharmacists’ involvement also helped meet the requirements of the French National Health Authority for the traceability of medication administration and medication self-management. References and/or acknowledgements No conflict of interest.

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who are readmitted within 30 days from prior hospitalization for heart failure. Hospitals risk losing millions of dollars due to poor performance. A reduction in CHF readmission rates not only improves healthcare system expenditures, but also patients' mortality, morbidity, and quality of life. Objectives The purpose of this DNP project is to determine 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. Specific aims include comparing computed annual readmission rates with national average, determine the number of multiple 30-day readmissions, provide descriptive data for demographic variables, and correlate age and heart failure classification with the number of multiple readmissions. Methods A retrospective chart review was conducted to collect hospital admission and study data. The setting occurred in an urban hospital in Memphis, TN. The study was reviewed by the University of Tennessee Internal Review Board and deemed exempt. The electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. Data was cleaned such that each patient admitted had only one heart failure ICD-10 code. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients readmitted within 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. Results A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were readmitted sequentially, on multiple occasions, ranging from two to eight readmissions. The median age was 60 and 60% were male. Due to the skewed distribution (most readmitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple readmissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553).

Background Rhode Island has the tenth highest rate of accidental drug overdose deaths in the United States. In response to this crisis, Anchor Recovery Center, a community-based peer recovery program, developed programs deploying certified Peer Recovery Specialists to emergency departments (AnchorED) and communities with high rates of accidental opioid overdoses (AnchorMORE). Objectives The purpose of this paper is to describe AnchorED and AnchorMORE's activities and implementation process. Methods AnchorED data were analyzed from a standard enrollment questionnaire that includes participant contact information, demographics, and a needs assessment. The AnchorED program outcomes include number of clients enrolled, number of naloxone training sessions, and number of referrals to recovery and treatment services. Overdose deaths and naloxone distribution through AnchorMORE were mapped using Tableau software. Results From July 2016–June 2017, AnchorED had 1329 contacts with patients visiting an emergency department for reported substance misuse cases or suspected overdose. Among the contacts, 88.7% received naloxone training and 86.8% agreed to continued outreach with a Peer Recovery Specialist after their ED discharge. Of those receiving peer recovery services from the Anchor Recovery Community Center, 44.7% (n = 1055/2362) were referred from an AnchorED contact. From July 2016–June 2017, AnchorMORE distributed 854 naloxone kits in high-risk communities and provided 1311 service referrals. Conclusion These findings indicate the potential impact peer recovery programs may have on engaging high-risk populations in treatment, overdose prevention, and other harm reduction activities. Additional research is needed to evaluate the reach of implementation and services uptake.

This paper focuses on the use of unmanned aircraft system (UAS) for multispectral remote sensing in post disaster situation awareness and damage assessment applications. The KHawk UAS was developed as a test bed for multispectral aerial video acquisition. Efficient UAS flight planning, data acquisition, and post flight orthomosaic generation workflows are created to ensure the robustness of the overall remote sensing system. The generated 2D orthomaps and the accuracy analysis are presented for validation purposes. A robust normalized difference vegetation index (NDVI) calibration procedure using ground reflectance targets and a pixel-level linear regression algorithm is proposed. The developed KHawk UAS and the proposed procedure is validated in a post tornado (EF2) damage assessment mission.

Background The emergence of coagulase-negative staphylococci with reduced vancomycin susceptibility in some neonatal intensive care units has resulted in an increase of linezolid use. Linezolid pharmacokinetics (PK) and safety in premature infants still need to be better established. Methods This was a retrospective PK study. All infants who received intravenous linezolid and had linezolid plasma concentrations per standard of care were included. Linezolid concentrations were measured by high performance liquid chromatography. A population PK model was developed using nonlinear mixed effects modeling. Optimal dosing was determined based on achievement of the surrogate pharmacodynamics target for efficacy: a ratio of the area under the concentration-time curve to minimum inhibitory concentration >80. We assessed the occurrence of thrombocytopenia and lactic acidosis in relation with drug exposure. Results A total of 78 plasma concentrations were collected from 26 infants, with a median postnatal age (PNA) of 24 days (8-88) and weight of 1423 g (810-3256). A 1-compartment model described linezolid data well. The final model included PNA and weight on clearance and weight on volume of distribution. Considering an MIC90 of 1 mg/L, all infants reached an area under the concentration-time curve/minimum inhibitory concentration > 80. Although thrombocytopenia and hyperlactatemia occurred frequently, they were not sustained and were not considered related to linezolid. Conclusion and was well tolerated in critically ill premature infants. PNA was the main determinant of clearance.

International audience; Background A significant number of clinical pharmacy services have shown to improve in-hospital medication safety and patient outcome. Prescription review and pharmacist interventions are a fundamental part of hospital clinical pharmacy activities. In a context of restricted financial resources, proving the economic and clinical impact of this activity seems necessary. Objective The aim of this study was to assess the clinical impact on patient outcomes and economic benefit of prescription review by pharmacists. Setting 1624-bed tertiary French university teaching hospital. Method Prospective single center study evaluating prescriptions for which a pharmacist intervention was issued over a 6-month period. The clinical impact of every pharmacist intervention was evaluated by a multidisciplinary experts committee. Economic benefit was evaluated from the public health care system spending standpoint. Main outcome measures Number of avoided hospitalization days and associated public health care system cost-avoidance. Results Prescription review and interventions by pharmacists prevented 73 intensive care unit hospitalization days, 74 continuous monitoring unit hospitalization days and 66 days of conventional hospitalization. €252,294.00 in public health expenditure were thus prevented. For every Euro invested in the prescription review activity, €5.09 of public health spending were potentially saved. Conclusion Our study shows that prescription review and clinical pharmacists' interventions had an impact on clinical outcomes which translated into prevented hospitalization days. Prescription optimization through pharmacist interventions allows significant health care cost savings which makes this service highly efficient

Embedded in the literature on financialization and institutional approaches, this study is an examination of the causal factors of employee downsizing in two institutionally dissimilar settings, France and the UK, using the fuzzy sets variant of Qualitative Comparative Analysis. The findings show that the roughly equivalent use of large-scale lay-offs in the two countries is coupled with strikingly different causal factors. Our argument suggests the importance of complex causation whereby employee downsizing reflects the growing influence of financial considerations in the governance of companies, but its diffusion across countries is shaped by different configurations of institutional arrangements.

Our hypothesis was that recycled crumb rubber can significantly decrease air particulate matter when applied on the top of existing arena sand, and the objective of our study was to test this hypothesis. Treatments were as follows: A (control—existing sand floor), B (recycled rubber 1.5″), and C (recycled rubber 3″). Air quality was measured using three DC1100 monitors (Dylos Corporation; Riverside, CA). Data collections occurred during advanced riding classes twice per week for 3 weeks using randomly assigned horses and riders. Data were analyzed as a three-way analysis of variance with fixed effects using a Tukey post hoc test with SAS (version 9.4; SAS Institute Inc) and significance established at P