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Librarian professional identity can be understood as a developmental process occurring over time and is indicative of a renegotiation of identity through experiences. This process transpires with o...

Purpose\ud UK primary care provides a rich data source for research. The impact of proposed data collection restrictions is unknown. This study aimed to assess the impact of restricting the scope of electronic health record (EHR) data collection on the ability to conduct research. The study estimated the consequences of restricted data collection on published Clinical Practice Research Datalink studies from high impact journals or referenced in clinical guidelines.\ud \ud Methods\ud A structured form was used to systematically analyse the extent to which individual studies would have been possible using a database with data collection restrictions in place: (1) retrospective collection of specified diseases only; (2) retrospective collection restricted to a 6‐ or 12‐year period; (3) prospective and retrospective collection restricted to non‐sensitive data. Outcomes were categorised as unfeasible (not reproducible without major bias); compromised (feasible with design modification); or unaffected.\ud \ud Results\ud Overall, 91% studies were compromised with all restrictions in place; 56% studies were unfeasible even with design modification. With restrictions on diseases alone, 74% studies were compromised; 51% were unfeasible. Restricting collection to 6/12 years had a major impact, with 67 and 22% of studies compromised, respectively. Restricting collection of sensitive data had a lesser but marked impact with 10% studies compromised.\ud \ud Conclusion\ud EHR data collection restrictions can profoundly reduce the capacity for public health research that underpins evidence‐based medicine and clinical guidance. National initiatives seeking to collect EHRs should consider the implications of restricting data collection on the ability to address vital public health questions.

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.191075][2]][2] A 37-year-old man with HIV infection (CD4+ cell count 706 cells/μL, viral load undetectable) presented with a 3-month history of cough, pharyngitis, low-grade fevers and dark black hemoptysis. A rash had also developed

© The Author(s) 2020. New library and information science professionals, without previous experience in information organizations, are often left adrift, unsure how to apply theory or best practice to a new work environment. To bridge this gap, mentoring and coaching opportunities are often employed (or mandated) to provide new practitioners with required skills, knowledge, or networking. There are opportunities to harness implicit and explicit learning through experiences and interactions through mentoring and coaching. Definitions of mentoring and coaching in the profession are often used interchangeably when discussing the growth and development of an individual. This leads to the following questions: How do librarians define both mentoring and coaching? How do mentoring and coaching relate to professional development? To address the research question, 47 semi-structured interviews were conducted with librarians in Canada, New Zealand, and the United States between 2015 and 2016. Participants were asked about their mentoring and coaching experiences. During the interviews, participants were asked questions about their experiences as a mentor or mentee. In addition, participants were asked to define both “mentoring” and “coaching.” The authors used an inductive approach to data analysis, and interviews were coded by category.

Introduction In England there has been a substantial increase in the use of immediate implant-based reconstruction, accounting for over half of all immediate reconstructions (IR). Less than one third of patients in England undergo autologous reconstruction IR. Our aim was to examine IR trends in Scotland. Methods Data was extracted from the Scottish Morbidity Record held at the Information Services Division of the NHS National Services Scotland. All patients discharged from Scottish hospitals between 2011 and 2016 who had a diagnosis of breast cancer including DCIS and underwent mastectomy were identified. Patients undergoing IR were identified by coding at the time of mastectomy to identify who had IR and what method was used. Results Between 2011 and 2016, 7358 patients underwent a mastectomy for breast cancer. 1845 patients (25%) had an IR. The percentage of patients undergoing IR increased from 22% in 2011 to 26% in 2016. The dominant annual procedure type was autologous reconstruction (free flap and pedicled flaps), accounting for 58% in 2011 and 54% in 2016. Pedicled flaps alone decreased from 40% in 2011 to 28% in 2016 and free flaps increased from 18% in 2011 to 26% in 2016. Implant based reconstruction rates were broadly consistent, 37% in both 2011 and 2016. Pedicled flaps with implant reconstruction decreased from 13% in 2011 to 5% in 2016. Conclusions Autologous reconstruction (with increasing trend for free flaps procedures) remains a constant preferred technique for IR in Scotland, accounting for over half of IR performed.

Background Prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) infections remain challenging. In-depth surveillance integrating patient and isolate data can provide evidence to better inform infection control and public health practice. Methods We analyzed MRSA cases diagnosed in 2010 (n = 212) and 2016 (n = 214) by hospitals in Ontario, Canada. Case-level clinical and demographic data were integrated with isolate characteristics, including antimicrobial resistance (AMR), classic genotyping, and whole-genome sequencing results. Results Community-associated MRSA (epidemiologically defined) increased significantly from 23.6% in 2010 to 43.0% in 2016 (P 2-fold increase in fusidic acid resistance (9.0% to 22.5%, P Conclusions Community-associated MRSA is increasing among hospitalized individuals in Ontario. Clonal shifting from CC5 to CC8 has impacted AMR. We identified a relatively high genetic diversity and limited genomic clustering within these dominant CCs.

This study investigated the effect of low-volume self-regulated high-intensity interval training (SR-HIIT) on cardiorespiratory fitness (CRF), exercise enjoyment, and intentions to repeat. Ten untrained, physically active adults (five males and five females, age: 20.3 ± 0.5 years) undertook a 2-week control period followed by 2-weeks SR-HIIT (6 x 10 min cycle ergometer sessions). Sessions involved alternate bouts at a rating of perceived exertion of 17 (work) and 11 (recovery), with bout durations self-regulated by the participant. Maximal aerobic capacity showed a small increase from post-control (3.14 ± 1.03 L.min-1 34 ) to post-training (3.45 ± 1.14 L.min-1; Xdiff 0.31, 95%CI 0.06 L.min-1, d = 0.28, 95%CL 0.11, 0.45). First ventilatory threshold showed a large increase from post-control (65.6 ± 2.1% V̇ O2max) to post-training (68.0 ± 2.4% V̇ O2max; Xdiff 2.4, 95%CI 1.2%, d = 0.96, 95%CL 0.27, 1.62). Post-exercise enjoyment showed small (Xdiff 3.5, 95%CI 8.1 AU, d = 0.31) and medium (Xdiff 6.9, 95%CI 6.7 AU, d = 0.68) increases from SR-HIIT session 1-3 and 3-6, respectively. There were trivial to medium increases in intention to repeat SR-HIIT once per week (d = 0.06 to 0.63) and three times per week (d = 0.28 to 0.60). Low-volume SR-HIIT elicits meaningful improvements in CRF, is enjoyable, and facilitates good intentions to repeat, and may be an additional option for implementing HIIT to improve general population health and fitness.

The aim of oncoplastic breast conservation (OBC) is to maintain quality of life with an acceptable breast appearance without compromising on oncological effectiveness. For many patients OBC offers an alternative to mastectomy. Despite the widespread adoption of OBC, there is limited high-quality evidence to support the oncological safety of this approach. Randomised trials are unlikely to happen given the complex ethical issues involved in patient choice for surgery. In this chapter, which includes a literature review of the best current available evidence, the key issues regarding oncological safety in OBC are discussed including preoperative planning; tumour resection margins and re-excision rates; local recurrence and patient outcome; and postoperative complications, adjuvant therapy delivery and postoperative surveillance. OBC is an integral part of breast surgery. Preoperative planning within a multidisciplinary setting considering tumour burden, tumour biology and patient selection for OBC technique is required to optimise patient outcomes. OBC allows extensive resections, and subsequently the incidence of positive margins is likely reduced but not ablated. Long-term local and distant recurrence highlights the importance of comparing ‘like with like’ and based on the current evidence OBC is a safe oncological approach even for patients with larger tumours. OBC involves more complex often, lengthy procedures and complications are expected; however, in most cases this does not result in delays to adjuvant therapy. Postoperative surveillance does not appear to be affected, although higher rates of biopsy may be expected.

This paper explores issues relating to the impact of digital technologies on indigenous cultural sustainability. Adoption of digital technologies is represented as a double-edged sword for indigenous communities seeking to maintain and revitalize their cultures; while the affordances of digital technology can disseminate cultural information knowledge quickly, easily and globally, digitalization also raises questions about ownership, control and consultation. These issues are discussed in relation to two case studies from Aotearoa New Zealand from which key points for future research are identified.

Problem Technology can transform health care; future physicians need to keep pace to ensure optimal patient care. Because future doctors are poorly prepared in computer literacy, the authors designed a computer programming certificate course. This Innovation Report describes the course and findings from a qualitative study to understand the ways it prepares medical students to use computing science and technology in medicine. Approach The 14-month Computing for Medicine certificate course (C4M, offered beginning in February 2016), University of Toronto, is comprised of hands-on workshops to introduce programming accompanied by homework exercises, seminars by computer science experts on the application of programming to medicine, and coding projects. Using purposive and maximal variation sampling, 17 students who completed the course were interviewed from April–May 2017. Thematic analysis was performed using an iterative constant comparison approach. Outcomes Participants praised the C4M as an opportunity to achieve computer literacy—including language, syntax, and fundamental computational ideas (and their application to medicine)—and acquire or strengthen algorithmic and logical thinking skills for approaching problems. They highlighted that the course illustrated linkages between computer science and medicine. Participants acknowledged a sometimes-existent chasm between producers and users of technology in medicine, recommending two-way communication between the disciplines when developing technology for use in medicine. Next Steps We recommend that medical schools consider computer literacy an essential skill to foster future collaborative computing partnerships for improved technology use by physicians and optimal patient care. We encourage further evaluation of future iterations of the C4M and similar courses.

As a discipline, library and information studies (LIS) is often considered to lack visibility and a clear identity within academia. Poor understanding of the nature of our field/discipline and our relatively small size has led to LIS programmes being partnered with a range of other subjects, located within diverse faculty structures. We suggest that this can impact on the development of both LIS curricula and research as LIS academics are brought into interdisciplinary relationships with school and faculty colleagues. The study reported here analysed the location of a sample of LIS programmes from New Zealand, Australia, the United States of America, Canada, the United Kingdom, South Africa and Singapore. Compared with previous studies, we found a higher number of ‘stand-alone’ schools as well as some national differences. We reflect on our experiences in a Business School, partnered with the information systems discipline, noting some key differences in boundary setting, field configuration, the ...

Marketing is necessary for all organisations working with a changing client or user base. In order to gauge current marketing practices in libraries, a survey and focus groups were conducted with 36 workshop participants primarily from libraries in Australia. The participants were from a wide range of library backgrounds and it was evident that the focus groups identified a wide range of practices. Participants discussed current marketing activities, highlighting some of the unique ways that libraries are marketing services and collections. Not all libraries have the support and budget necessary to develop a marketing campaign, but librarians can adopt best practices and identify strategies that increase awareness. Libraries may accomplish this by using social media, developing outcomes based marketing plans and being prepared with elevator speeches or stories to explain the library's role within the community. These tactics are deemed necessary as libraries are competing with the Internet to fill the information needs of community members. They are also competing with business, social and educational activities, trying to draw individuals to programmes and services offered. After discussing the current marketing activities participants identified, this paper makes recommendations from the literature about ways of making marketing more efficient in the future. Refereed/Peer-reviewed

Adopting new teaching practices, like the ‘flipped classroom’, disrupts organizational routines within the university. This paper examines flipped classroom implementation from the perspective of four stakeholder groups students, instructors, administrators, and managers), using an organizational routines lens. Disrupting established routines created risk, decreases coordination and shared understanding, and increases time and cognitive load for stakeholders. We conclude that seemingly minor innovations in teaching delivery can have major and disruptive implications for the wider institution.

Professional identity in Library and Information Sciences (LIS) in the United States and Canada is often defined by education, particularly the Masters in Library and Information Science(s) or its equivalent (MLIS). However, education is not the only attribute expected of an information professional. Anteby et al. (2016) developed three lenses for examining professions: Becoming, Doing and Relating. Each of these lenses provides a different view of how professional status is achieved and maintained and reflects the evolution of professional identification over the past century. Given the lack of any recognized definition within LIS, applying the lenses to “information professions” in general provides a framework to discuss professional identity. In order to understand how the LIS community defines information professional an exploratory survey was developed for information professions in the United States and Canada that included an open-ended question about professional identity. The survey was taken by more than 700 information professionals 2014–2015, and includes responses from MLIS students, information professionals with and without an MLIS (or an equivalent degree), LIS educators, retired professionals, and professionals with an MLIS working outside the field, but still active within the community. The responses uncovered a wide range of definitions, which reflected the concepts of lenses of professional status as presented by Anteby et al. However, not all of the definitions were easily assigned to a single lens. The findings do identify other important questions to consider. Why is there such a range of how we define LIS professional? What does this mean about how we interact with society in our professional roles? What impact might this have on how we are viewed by the larger society?

Background This study aims to assess the quantity and quality of available literature on surgical treatment outcomes of spinal stenosis in adult and paediatric achondroplasia patients through a systematic review of literature and to investigate the suitability of conducting a meta-analysis on outcomes of surgical treatment. Methods Online databases were searched according to PRISMA guidelines. No restrictions regarding study design, sample size, previous treatment, or publication date were implemented. The following terms: “Spinal stenosis”, “Spinal Decompression”, “Spinal fusion”, each term separately combined with the term “Achondroplasia” were used. Quality of the included studies were assessed used the Modified Coleman method. Results Five adult and four paediatric single-sample non-comparative studies were identified for inclusion (176 adult and 102 paediatric patients). Meta-analyses assessed the proportion of patients achieving full resolution of symptoms to be 0.51 (95% CI 0.00 to 1.00); the proportion of patients achieving full or partial resolution of symptoms to be 0.90 (95% CI 0.84 to 0.97); the proportion of procedures requiring re-operation to be 0.42 (95% CI 0.34 to 0.50; and the proportion of procedures involving dural tears to be 0.20 (95% CI 0.02 to 0.39). Statistical heterogeneity was very high for full resolution of symptoms and requirement for dural repair; and very low for other outcomes. Conclusions The available literature on this population and condition is sparse, highly heterogenous, and is generally of low quality limiting the value of meta-analysis. Overall, outcomes of surgical decompression of symptomatic spinal stenosis in achondroplasia patients show consistent degree of resolution of symptoms. Duration of symptoms prior to surgical treatment appears to play an important role in the overall outcome of treatment. Therefore, a delay in diagnosis and treatment can potentially be detrimental in achieving a better outcome.

The aims and motivation for training and continuing professional development (CPD) for librarians are many and varied, depending on the organizational context and the needs of participants. How to evidence the transfer of learning from CPD activities to the workplace has long troubled academics in the management field but has not been a topic of focus in the librarianship discipline. The results of a study testing a new approach to the assessment of CPD outcomes for individual librarians, their workplaces, and their patrons are presented. Adapting Guskey's (2000) framework for assessing teacher CPD, two questionnaires were designed to assess the short-term and long-term outcomes of CPD. The analysis indicates that the approach was effective in identifying how participation in CPD inspires change first in individual professional practice and then organizational learning, resulting in service innovations for the benefit of the whole community. The process is conceptualized through Vygotsky Space.

Innovations in suturing devices have facilitated sacrospinous ligament fixation (SSF) for the correction of vaginal vault prolapse. It is uncertain if outcomes using suturing devices differ from those using a traditional suturing technique. We hypothesize that no difference exists in the efficacy and safety 1 year after SSF for vault prolapse performed with suturing devices or using a traditional technique. The objective was to compare SSF using a suturing device with traditional SSF for the treatment of vault prolapse, regarding symptoms of prolapse recurrence, patient satisfaction, incidence of re-operation, and complications 1 year postoperatively. We carried out a retrospective cohort study using register-based national data from 2006 to 2013. The Swedish Quality Register of Gynecological Surgery includes assessments pre-operatively, at hospital admittance, surgery, discharge, and questionnaires at 8 weeks and 1 year after surgery. Demographic variables and surgical methods were included in multivariate logistic regression analyses. In the suturing device group (SDG, n = 353), 71.5% were asymptomatic of recurrence after 1 year compared with 78.7% in the traditional SSF group (TSG, n = 195); risk difference − 7.3% (95%CI −15.2%; 0.7%). Adjusted odds ratio (aOR) for being asymptomatic 1 year postoperatively was 0.56 (95%CI 0.31; 1.02, p = 0.057). Patient satisfaction was similar in SDG and TSG (78.1% vs 78.4%). Reoperation occurred in 7.4% in the SDG compared with 3.6% in the TSG, risk difference 3.8% (95%CI 0.0%; 7.5%), aOR 3.55 (95%CI 1.10; 11.44, p = 0.03). Patient satisfaction was similar 1 year after SSF, despite symptoms of recurrence being more likely and reoperation more common after using a suturing device compared with a traditional technique. The methods did not differ with regard to surgical complications.

We examined five major projects conducted by library associations and related organizations between 2011 and 2016 that focused on the future of libraries and/or librarianship. We employed a sensemaking perspective as the foundation for our research. Through a sensemaking perspective, meaning is intersubjectively co-created. Threats to identity have created triggers for organizations to reexamine the roles of libraries in their communities. This reexamination of the roles of libraries within the community creates or develops a shared context which impacts both professional identity and advocacy efforts. While it is not clear the exact shape and scope of this crisis in the library profession, it is ‘real’ in that it has been meaningfully named, interpreted and enacted. The issue has been discussed coherently and cohesively in the international library community. It is clear that there is concern, internationally, for the future of librarianship.

Background Ritonavir boosted protease inhibitors have been associated with GI intolerance. A post hoc analysis was conducted to assess the GI profile of D/C/F/TAF in treatment naïve patients. Methods The phase 3 AMBER trial (ClinicalTrials.gov: NCT02431247) enrolled treatment naïve patients randomized 1:1 to receive once daily D/C/F/TAF 800/150/200/10 mg or D/C + F/tenofovir disoproxil fumarate (TDF). This post hoc analysis evaluated the incidence, prevalence and duration of GI adverse events of interest (AEOIs) through Wk 96. Related GI AEOIs were defined as diarrhea, nausea, abdominal pain and flatulence (by preferred term using MedDRAv21) deemed very likely, probable, or possibly related to study drug by the investigator. Incidence and prevalence were examined at weekly intervals during the first month of treatment and monthly thereafter. Duration of an AE was calculated for patients whose AEs had start and stop dates. Results In AMBER (N = 725), 362 patients were randomized to D/C/F/TAF and 363 to D/C + F/TDF (Table). Through Wk 48, 14% of D/C/F/TAF patients had a study drug–related GI AEOI vs 19% of D/C + F/TDF patients; of these, all were grade 1/2 and none were serious. Incidence and prevalence of D/C/F/TAF-related GI AEOIs remained low through 96 wks (Figure 1 & 2). Incidence of D/C/F/TAF-related diarrhea and nausea were each 5% in Wk 1 and ≤1% after Wk 2; prevalence of each decreased to < 5% at Wk 2. There was 1 case of D/C/F/TAF-related abdominal discomfort at Wk 1 and none thereafter. Incidence of D/C/F/TAF-related flatulence was < 1% from Wk 1 through Wk 96. Only 2 (1%) patients discontinued before Wk 96 due to a D/C/F/TAF-related GI AEOI (both diarrhea). Through Wk 96, < 3% of patients required treatment with concomitant medication for a D/C/F/TAF-related GI AEOI. Among patients with a D/C/F/TAF-related GI AEOI, the median duration was 16.5 days. Conclusion In AMBER, incidences and prevalences of D/C/F/TAF-related GI AEOIs were low and tended to present early in the study. Combined with rapid decreases in prevalence, these finding suggest that GI AEOIs were transient. Overall, the GI profile of D/C/F/TAF was favorable, and to a greater extent than D/C + F/TDF, suggesting improved tolerance vs an older formulation. Table. Baseline Demographic and Clinical Characteristics Figure 1. Incidence of study drug–related GI AEOIs over time among patients randomized to D/C/F/TAF (n = 362). Figure 2. Prevalence of study drug–related GI AEOIs over time among patients randomized to D/C/F/TAF (n = 362). Disclosures Keith Dunn, PharmD, J&J (Employee, Shareholder) Yangxin Huang, PhD, MS, J&J (Employee) Bryan Baugh, MD, J&J (Employee, Shareholder) Nika Bejou, PharmD, BCIDP, AAHIVP, J&J (Employee, Shareholder) Donghan Luo, PhD, J&J (Employee, Shareholder) Jennifer Campbell, PhD, J&J (Employee, Shareholder) David Anderson, MD, J&J (Employee, Shareholder)

Background: Bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) are important causes of morbidity and mortality in hospitalized patients. Long-term national MRSA BSI surveillance establishes rates for internal and external comparison and provide insight into epidemiologic, molecular, and resistance trends. Here, we present and discuss National MRSA BSI incidence rates and trends over time in Canadian acute-care hospitals from 2008 to 2018. Methods: The Canadian Nosocomial Infection Surveillance Programme (CNISP) is a collaborative effort of the Association of Medical Microbiology and Infectious Disease Canada and the Public Health Agency of Canada. Since 1995, the CNISP has conducted hospital-based sentinel surveillance of MRSA BSIs. Data were collected using standardized definitions and forms from hospitals that participate in the CNISP (48 hospitals in 2008 to 62 hospitals in 2018). For each MRSA BSI identified, the medical record was reviewed for clinical and demographic information and when possible, 1 blood-culture isolate per patient was submitted to a central laboratory for further molecular characterization and susceptibility testing. Results: From 2008 to 2013, MRSA BSI rates per 10,000 patient days were relatively stable (0.60–0.56). Since 2014, MRSA BSI rates have gradually increased from 0.66 to 1.05 in 2018. Although healthcare-associated (HA) MRSA BSI has shown a minimal increase (0.40 in 2014 to 0.51 in 2018), community-acquired (CA) MRSA BSI has increased by 150%, from 0.20 in 2014 to 0.50 in 2018 (Fig. 1). Laboratory characterization revealed that the proportion of isolates identified as CMRSA 2 (USA 100) decreased each year, from 39% in 2015 to 28% in 2018, while CMRSA 10 (USA 300) has increased from 41% to 47%. Susceptibility testing shows a decrease in clindamycin resistance from 82% in 2013 to 41% in 2018. Conclusions: Over the last decade, ongoing prospective MRSA BSI surveillance has shown relatively stable HA-MRSA rates, while CA-MRSA BSI rates have risen substantially. The proportion of isolates most commonly associated with HA-MRSA BSI (CMRSA2/USA 100) are decreasing and, given that resistance trends are tied to the prevalence of specific epidemic types, a large decrease in clindamycin resistance has been observed. MRSA BSI surveillance has shown a changing pattern in the epidemiology and laboratory characterization of MRSA BSI. The addition of hospitals in later years that may have had higher rates of CA-MRSA BSI could be a confounding factor. Continued comprehensive national surveillance will provide valuable information to address the challenges of infection prevention and control of MRSA BSI in hospitals.Funding: NoneDisclosures: None

An understanding of genetics and genomics is increasingly important for all clinicians. Next-generation genomic sequencing technologies enable sequencing of the entire human genome in short timescales, and are increasingly being implemented in health care systems. Clinicians across all medical specialties will increasingly use results generated from genomic testing to inform their clinical practice and provide the best quality of care for patients. These innovations are already transforming the diagnostic pathways for rare genetic diseases, including skeletal dysplasias, with an inevitable impact on the traditional roles of diagnosticians. This article covers the fundamentals of human genetics, mechanisms of genetic variation and the technologies used to investigate the genetic basis of disease, with a specific focus on skeletal dysplasias and the potential impact of genomics on paediatric radiology.

Background Although lung volume reduction surgery (LVRS) improves survival in appropriately selected patients with COPD, few procedures are performed. The National Institute for Health and Care Excellence has recommended a more systematic approach to identifying potential candidates. We investigated LVRS referrals from a UK primary care population and aimed to establish an accurate estimate of eligible patients and determine a strategy for identifying potential candidates systematically. Methods Clinical Practice Research Datalink GOLD (a primary care database) and the linked Hospital Episode Statistics inpatient and Diagnostic Imaging Dataset were used. Patients with COPD who had undergone LVRS, patients who met basic eligibility criteria for further screening for LVRS, and patients meeting a more stringent eligibility criteria were identified from April 2012 to September 2015. Thoracic CT scan, pulmonary rehabilitation status, referral to respiratory outpatient clinics, and acute exacerbation of COPD requiring hospitalization were compared between actual LVRS recipients and potentially eligible patients. Results Among the 73,697 patients with COPD included, 36 (0.05%) received LVRS, 5,984 (8.1%) met basic eligibility criteria, and 159 (0.2%) met more stringent eligibility criteria. LVRS recipients were younger (mean age ± SD, 64 ± 9.2 years) than the stringently eligible patients (mean age ± SD, 69 ± 8.9 years; P = .01). Few patients meeting stringent eligibility criteria (6.9%) had a CT scan of the thorax in the preceding 3 years or had been referred for assessment in secondary care. Conclusions A substantial unmet need exists among patients with COPD who could potentially benefit from a lung volume reduction procedure but who are not being investigated or referred to consider this possibility.

Identity is the core of who we are as individuals. It shapes how we present ourselves, our expectations of how we interact with others and their treatment of us, and forms the basis of what we believe are our capabilities and potential. Identity is not limited to individuals, but also includes groups, such as clubs, organizations, and professions. In fact, identification within a profession is an essential rite of passage, which often follows the completion of an educational degree or an intensive training program, both of which have a strong influence on the construction and shape of the individual’s professional identity. While in MLIS programs, like many undergraduate programs, students develop a sense of community, which is reinforced through internships, work experiences and membership in professional organizations. The context of a community is key to the development of professional. Interdisciplinary fields, such as library and information science, use these communities to share information across disciplines and develop academic norms. LIS educators help to develop this identity through course work and interactions with students. As a result, LIS educators need to understand their role and how their teaching contributes to the profession holistically rather than focus on individual positions or roles.

Uganda adopted the integrase inhibitor dolutegravir (DTG) as part its preferred first-line HIV treatment regimen in 2018. Prior to the national rollout, the Uganda Ministry of Health and Clinton Health Access Initiative (CHAI) launched a pilot study in July 2017 aimed at better understanding patients’ and prescribers’ experience and acceptability of DTG. Patients were enrolled in the study if they were newly initiating treatment or switched from an NNRTI regimen due to intolerance. Patients were followed up for 6 months after initiation onto DTG and acceptability and experiences were assessed through questionnaires at one-month and six-month follow-up visits. In addition to acceptability side effects of patients on DTG regimens were assessed. Analysis was conducted using MS Excel and SAS 9.4 and confidence intervals were adjusted for facility level clustering. A total of 365 patients from 6 study sites were enrolled in the study, of whom 50% were treatment-experienced and 50% treatment naïve. 325 patients completed the 6 months of follow-up. Survey results showed a high level of acceptability (more than 90%) of DTG-containing regimens for both categories of patients during the from one-month and six-months interviews. The rate of self-reported side effects amongst patients was 33% overall and higher for experienced (37%) than naïve (29%) patients at 6 months. Although frequencies declined between month-1 and month-6, the changes were not statistically significant. Almost all patients (94%) were virally suppressed at 6 months. Overall, the study findings showed a very high level of acceptability of Dolutegravir-based regimens across both experienced and naïve patients. The overall viral suppression rate in this cohort was 94% at six months of taking DTG-based regimen.

Background: Lung volume reduction surgery (LVRS) improves survival in appropriately selected COPD patients. There are ~15,000 eligible patients in the UK, but only ~100 operations occur each year[1]. We investigated LVRS referrals from a UK primary care population and aimed to identify potential candidates systematically. Methods: We conducted a cohort study from 1/4/12- 30/9/15 using Clinical Practice Research Datalink (CPRD) (a primary care database), linked to Hospital Episode Statistics (HES) inpatient and HES Diagnostic Imaging Dataset (DID). We compared COPD patients who had LVRS to patients potentially eligible who had not received LVRS; using a definition of eligibility of MRC dyspnoea score of 4/5 and FEV1 Results: We included 73,697 COPD patients. 36 (0.05%) had received LVRS during the study period. 3,555 (4.8%) patients were potentially eligible for LVRS based on our criteria. The LVRS population were younger (mean age:64 years, SD:9.2) compared to the potentially eligible patients (mean age:73 years, SD:9.2) (p Conclusions: For the first time in a UK primary care setting, we have quantified the disparity between COPD patients who have had LVRS, and those who are potentially eligible but not referred. This highlights the need for referral for CT scans, which are essential to improve access to this highly effective procedure. 1. McNulty W. BMJ Open Resp Res 2014;1:e000023.

In a public health crisis, experts (such as epidemiologists, public health officers, physicians and virologists) support key decision makers with advice in a highly dynamic, pressured, and time-sensitive context. Experts must process information (to provide advice) as quickly as possible, yet this must be balanced with ensuring the information is credible, reliable, and relevant. When an unexpected event occurs, it may lead to a gap between what is experienced and what was expected; sensemaking is a meaning creation process which is engaged to fill the gap. This research explores how experts engage in sensemaking during a public health crisis.

Overgrowth syndromes comprise a group of heterogeneous disorders characterised by excessive growth parameters, often in association with intellectual disability. To identify new causes of human overgrowth, we have been undertaking trio-based exome sequencing studies in overgrowth patients and their unaffected parents. Prioritisation of functionally relevant genes with multiple unique de novo mutations revealed four mutations in protein phosphatase 2A (PP2A) regulatory subunit B family genes protein phosphatase 2, regulatory Subunit B', beta (PPP2R5B); protein phosphatase 2, regulatory Subunit B', gamma (PPP2R5C); and protein phosphatase 2, regulatory Subunit B', delta (PPP2R5D). This observation in 3 related genes in 111 individuals with a similar phenotype is greatly in excess of the expected number, as determined from gene-specific de novo mutation rates (P = 1.43 × 10(-10)). Analysis of exome-sequencing data from a follow-up series of overgrowth probands identified a further pathogenic mutation, bringing the total number of affected individuals to 5. Heterozygotes shared similar phenotypic features including increased height, increased head circumference and intellectual disability. The mutations clustered within a region of nine amino acid residues in the aligned protein sequences (P = 1.6 × 10(-5)). We mapped the mutations onto the crystal structure of the PP2A holoenzyme complex to predict their molecular and functional consequences. These studies suggest that the mutations may affect substrate binding, thus perturbing the ability of PP2A to dephosphorylate particular protein substrates. PP2A is a major negative regulator of v-akt murine thymoma viral oncogene homolog 1 (AKT). Thus, our data further expand the list of genes encoding components of the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/AKT signalling cascade that are disrupted in human overgrowth conditions.

To prospectively compare radiologically created pigtail gastrostomy (PG), in which the tube is inserted directly through the abdominal wall, versus peroral image-guided gastrostomy (POG), in which the tube is inserted through the mouth. Pain profiles (primary outcome measure), fluoroscopy times, total room times, technical success, complications, and quality of life (QOL) were measured.Sixty patients were prospectively randomized to receive 14-F PG or 20-F POG tubes. All patients received prophylactically created gastrostomies before radiation therapy for head and neck squamous-cell carcinoma. Patients receiving palliative treatment were excluded, as were those with established pharyngeal obstruction. Pain was measured by numeric rating scale (NRS) scores for 6 weeks after the procedure and by intraprocedural fentanyl and midazolam doses and postprocedural 24-h morphine doses. Fluoroscopy times, total room times, technical success, complications up to 6 months, and gastrostomy-related QOL (using the Functional Assessment of Cancer Therapy-Enteral Feeding questionnaire) were determined.Fifty-six patients underwent the randomized procedure. The POG group required significantly higher intraprocedural midazolam and fentanyl doses (mean, 1.2 mg and 67 μg, respectively, for PG vs 1.9 mg and 105 μg for POG; P.001) and had significantly longer fluoroscopy times (mean, 1.3 min for PG vs 4.8 min for POG; P.0001). NRS scores, morphine doses, total room times, technical success, complication rates, and QOL did not differ significantly between groups. The one major complication, a misplaced PG in the peritoneal cavity, followed a technical failure of POG creation.Despite the differences in insertion technique and tube caliber, the measured outcomes of POG and PG are comparable.

Purpose The objective of the study was to assess the efficacy of ovarian artery embolization (OAE) treatment for symptomatic uterine leiomyomas. Methods A retrospective review of 17 patients who underwent OAE in conjunction with uterine artery embolization in a 6-year period (2006-2012) was performed. Ten patients had previous failed embolization, while 7 had not received any embolization therapy before. Percent uterine volume change, percent dominant fibroid volume change, and percent dominant fibroid infarction were assessed with magnetic resonance (MR) imaging. Resolution of menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency were evaluated clinically. Change in menopausal state was also an outcome of interest. Results Mean MR imaging follow-up was performed 3 months post-OAE. MR images showed complete infarction in the majority of cases (64.7%; n = 11), with infarction rates of 90%-100% in 3 cases, 1 case with 30%-50% infarction, and 2 cases with 0%-10% infarction. Average uterine size reduction on MR was 32.3% (95% confidence interval [CI]: 22.5%-42.2%; P < .001). The average size reduction for the dominant fibroid was 42.4% (95% CI: 27.7%-57.0%; P = .01). The mean time to final follow-up visit was 11 months. At this point complete symptom resolution (menorrhagia, dysmenorrhea and bulk-related) was achieved in 82.4% (n = 14) of cases. At the final follow-up 11.8% (n = 2) of cases reported menopause. Conclusions We observed OAE to be an effective and safe adjunct to uterine artery embolization when hypertrophic ovarian artery(ies) require intervention. However, incomplete fibroid infarction of 23% remains a concern with a potential for long-term treatment failure. In addition, long-term effect on ovarian function is uncertain.

With growing enrolment and ongoing research into best practices for team work, many instructors are rethinking how to form, evaluate, and manage teams. In this BoF, instructors will discuss the strategies they have employed, the effectiveness of those approaches, and the tools that support administering teams. Discussion topics may include self- and peer-evaluation, grading strategies, software support, and conflict resolution.

A sound knowledge of basic genetic concepts and definitions needs to be at the fingertips of every practicing orthopaedic surgeon and not least for final professional examinations. A review of the general principles of genetics and inheritance is presented, along with illustrations of some common, and less common, relevant orthopaedic conditions.

Background: Grapefruit juice impacts the metabolism of a number of drugs via inhibition of a variety of metabolic enzymes. This study evaluated the impact of grapefruit juice on the antiplatelet activity of a loading dose and 7 days of maintenance therapy with clopidogrel. Methods: Healthy volunteers participated in two separate treatment protocols. The first protocol included a single 300 mg loading dose of clopidogrel and the second protocol included maintenance therapy with clopidogrel 75 mg given for 7 consecutive days. In both protocols, subjects were randomized to take clopidogrel with grapefruit juice or with tap water. At 6 h after the loading dose and at 6 h after the last maintenance dose of clopidogrel, a P2Y 12 reaction unit (PRU) value using the VerifyNow ® P2Y12 assay was determined. A PRU value > 235 was defined as high on-treatment platelet reactivity (defined as clopidogrel hyporesponse). Results: Fourteen subjects completed the loading dose protocol while 17 subjects completed the maintenance dose protocol. Following administration of the loading dose, the mean PRUs with grapefruit juice and tap water were 235.2 (95% confidence interval (CI): 210.4-260.0) and 177.4 (95% CI: 141.6-213.2), respectively (P = 0.001). Following administration of the loading dose, the numbers of subjects with a PRU > 235 with grapefruit juice and tap water were 9 (64%) and 3 (21%), respectively (P = 0.05). In the maintenance dose protocol, the mean PRUs with grapefruit juice and tap water were 212.4 (95% CI: 175.8-249.0) and 186.1 (95% CI: 149.6-222.7), respectively (P = 0.059). In the maintenance dose protocol, the proportions of patients with a PRU > 235 with grapefruit juice and tap water were 9 (53%) and 4 (23%), respectively (P = 0.16). Discussion: Compared to tap water, grapefruit juice significantly increased the mean PRU in patients following a 300 mg loading dose of clopidogrel. The increase in mean PRU after 7 days of a 75 mg/day maintenance dose of clopidogrel was also increased by grapefruit juice, but the magnitude of the increase was not statistically significant. The proportion of subjects with high on-treatment platelet reactivity with clopidogrel after ingestion with grapefruit juice was not significant during either the loading or maintenance dose. The results of our study are insufficient to reach a valid conclusion concerning an interaction between clopidogrel and grapefruit juice. Cardiol Res. 2014;5(1):1-7 doi: http://dx.doi.org/ 10.14740 / cr307w

A baby girl was born overnight at 27 weeks’ gestation following spontaneous labour, weighing 940 g. She was the second child of healthy non-consanguineous parents. The fetal medicine team were involved. The 20-week ultrasound findings were: At birth, the baby had no respiratory effort, but responded well to bag mask inflation breaths. Clinical examination revealed (see figure 1): Figure 1 Photograph of the infant in her incubator, demonstrating bilateral talipes, clenched hands and clinodactyly, smooth philtrum and microstomia with fixed jaw. Her oxygen requirement increased to 100%, despite high-flow nasal …

OBJECTIVE: The objectives of this study were to determine (1) the association between body mass index (BMI) and acute injury and (2) the association between BMI and bone fracture in children. METHODS: Children 5 to 17 years old were recruited in the emergency department at the British Columbia Children's Hospital. Cases included children treated for an injury, and control subjects were children without an injury in the past 12 months. Participants were administered a questionnaire to derive average activity level and demographic data. Weight and height measurements were taken to calculate BMI. Bivariate and multivariate logistic regressions were used to estimate the odds of injury occurrence by BMI category and the impact of covariates. RESULTS: Logistical regression, after adjusting for age, sex, activity level, and income level, did not reveal an increased association between BMI and acute injury in overweight odds ratio (OR) = 0.90 (0.48-1.70) and obese OR = 1.18 (0.60-2.33) children. Secondary outcome analyses failed to show an increased association between BMI and fracture in overweight OR = 0.44 (0.12, 1.66) and obese OR = 1.02 (0.31, 3.32) children. CONCLUSIONS: This study did not find increasing BMI to be associated with increased acute injury or bone fracture in children. Language: en

BackgroundAsthma episodes and deaths are known to be seasonal. A number of reports have shown peaks in asthma episodes in school-aged children associated with the return to school following the summer vacation. A fall in prescription collection in the month of August has been observed, and was associated with an increase in the number of unscheduled contacts after the return to school in September.ObjectiveThe primary objective of the study was to assess whether or not a NHS-delivered public health intervention reduces the September peak in unscheduled medical contacts.DesignCluster randomised trial, with the unit of randomisation being 142 NHS general practices, and trial-based economic evaluation.SettingPrimary care.InterventionA letter sent (n = 70 practices) in July from their general practitioner (GP) to parents/carers of school-aged children with asthma to remind them of the importance of taking their medication, and to ensure that they have sufficient medication prior to the start of the new school year in September. The control group received usual care.Main outcome measuresThe primary outcome measure was the proportion of children aged 5–16 years who had an unscheduled medical contact in September 2013. Supporting end points included the proportion of children who collected prescriptions in August 2013 and unscheduled contacts through the following 12 months. Economic end points were quality-adjusted life-years (QALYs) gained and costs from an NHS and Personal Social Services perspective.ResultsThere is no evidence of effect in terms of unscheduled contacts in September. Among children aged 5–16 years, the odds ratio (OR) was 1.09 [95% confidence interval (CI) 0.96 to 1.25] against the intervention. The intervention did increase the proportion of children collecting a prescription in August (OR 1.43, 95% CI 1.24 to 1.64) as well as scheduled contacts in the same month (OR 1.13, 95% CI 0.84 to 1.52). For the wider time intervals (September–December 2013 and September–August 2014), there is weak evidence of the intervention reducing unscheduled contacts. The intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children collecting prescriptions in August as well as having scheduled contacts in the same month. These unscheduled contacts in September could be a result of the intervention, as GPs may have wanted to see patients before issuing a prescription. The economic analysis estimated a high probability that the intervention was cost-saving, for baseline-adjusted costs, across both base-case and sensitivity analyses. There was no increase in QALYs.LimitationThe use of routine data led to uncertainty in the coding of medical contacts. The uncertainty was mitigated by advice from a GP adjudication panel.ConclusionsThe intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children both collecting prescriptions and having scheduled contacts in August. After September there is weak evidence in favour of the intervention. The intervention had a favourable impact on costs but did not demonstrate any impact on QALYs. The results of the trial indicate that further work is required on assessing and understanding adherence, both in terms of using routine data to make quantitative assessments, and through additional qualitative interviews with key stakeholders such as practice nurses, GPs and a wider group of children with asthma.Trial registrationCurrent Controlled Trials ISRCTN03000938.Funding detailsThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 93. See the HTA programme website for further project information.

BACKGROUND: There is currently limited evidence regarding the extent Real World Evidence (RWE) has directly impacted the health and social care systems. The aim of this review is to identify national guidelines or guidances published in England from 2000 onwards which have referenced studies using the governmental primary care data provider the Clinical Practice Research Datalink (CPRD). METHODS: The methodology recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Four databases were searched and documents of interest were identified through a search algorithm containing keywords relevant to CPRD. A search diary was maintained with the inclusion/exclusion decisions which were performed by two independent reviewers. RESULTS: Twenty-five guidance documents were included in the final review (following screening and assessment for eligibility), referencing 43 different CPRD/GPRD studies, all published since 2007. The documents covered 12 disease areas, with the majority (N =7) relevant to diseases of the Central Nervous system (CNS). The 43 studies provided evidence of disease epidemiology, incidence/prevalence, pharmacoepidemiology, pharmacovigilance and health utilisation. CONCLUSIONS: A slow uptake of RWE in clinical and therapeutic guidelines (as provided by UK governmental structures) was noticed. However, there seems to be an increasing trend in the use of healthcare system data to inform clinical practice, especially as the real world validity of clinical trials is being questioned. In order to accommodate this increasing demand and meet the paradigm shift expected, organisations need to work together to enable or improve data access, undertake translational and relevant research and establish sources of reliable evidence.

Enrollment in post-secondary online courses has been increasing, but several studies have found that the drop rates in online courses are higher than in face-to-face. In our previous study comparing an online section of CS1 with a face-to-face flipped section, we also found the drop rate higher in the online section. Given that we plan to continue offering online options for our students, we aim to identify factors associated with success in online CS1. In this paper, we examine factors that are under students' own control such as how fully they participate in ungraded but important learning activities, and other factors that we may be able to manipulate and improve, such as students' skills for self-regulated learning, and their sense of community in the course. We found important differences between the online and flipped sections regarding what behaviours and attributes were associated with success. While completion of unmarked practice exercises was a factor for both sections, test anxiety and self-efficacy were factors only for the online section, and intrinsic goal orientation was a factor only for the flipped section.

"Be careful what you wish for, you just might get it." - Proverb In 2005, computing education was experiencing a crisis. Enrollments had "fallen to such an extent that some academic computing programs were facing significant reductions in staffing levels or even elimination". The community responded, with panels to investigate and highlight ways to infuse "passion, beauty, joy and awe" into the introductory experiences, the CS10K project to bring computing to 10,000 teachers and 100,000 students, and better messaging of career opportunities, to name a few of the initiatives to bring students back into our seats.Well, by golly, it worked! It certainly didn't hurt our cause that Wall Street almost collapsed, young whiz kids were becoming TECH billionaires, an inspiring video and an interactive website led millions of people to code for an hour every December, or smart devices put computing into the hands of young people, and social media became the killer app. Whatever it was, CS became hot again. And we mean HOT. There are now several institutions around the world that have well over a thousand students taking CS1 in the Fall of 2015. There's just so much lemonade one can make before the seams start to burst, and the wheels come off the bus, as many shared at SIGCSE 2015 at the Birds of the Feather session.The goal of this panel is to bring together educators who were charged with delivering face-to-face CS1 on the grandest scale the field has ever seen. How did they cope? Does it become all people management with an army of Teaching Assistants? What were the differences and common themes in their survival plans? What is working? What mistakes were made? How are they supporting differential learning for the students who don't have the same experience as others? How is diversity being affected? Finally, what advice would they have for others interested in venturing into the tsunami, and broaden participation at a massive scale?

Objectives The study investigated the opinions of Appalachian College of Pharmacy (ACP) pharmacy students toward active learning (AL) in the didactic curriculum. Methods Data were collected from ACP students using a self-administered questionnaire. Students rated their opinions on a five-point bipolar scale (1 = strongly disagree, and 5 = strongly agree). Results One hundred eighty students (88%) completed the survey. About 23% of class time was devoted to AL. The mean quality score for AL was 5.80 ± 2.44 (scale: 1 = poor quality, 10 = highest quality). Students perceived AL favorably: AL was worthwhile/important (mean = 3.44 ± 1.04), not a waste of time (mean = 3.32 ± 1.18), and helped them to prepare for exams (mean = 3.42 ± 1.10). However, students thought that AL did not help them to become self-directed learners (mean = 2.90 ± 1.05). Conclusions ACP students have favorable opinions concerning AL in general. There is significant room to improve the amount of AL as well as the quality of AL at ACP for the betterment of student learning outcomes.

Approximately 100,000 patients begin hemodialysis each year in the United States. Although an arteriovenous fistula or graft is the preferred method for long-term vascular access during hemodialysis, as these types of vascular access are the most reliable, approximately 30% of patients require the use of catheters to continue hemodialysis. Tunneled, cuffed hemodialysis catheters are discouraged for permanent vascular access because of their high rates of infection, morbidity and mortality, and thrombotic and technical complications. These catheters have a short functional life span and require medical intervention, often thrombolytic therapy, to treat the catheter malfunction. No thrombolytic agent is specifically indicated for the management of occluded hemodialysis catheters. Thus, we performed a systematic review to critically evaluate all available studies that examined the efficacy, safety, and cost of thrombolytic therapy for the management of dysfunctional hemodialysis catheters. Studies were included if they reported efficacy in a specific proportion of affected dysfunctional hemodialysis catheters; reported the proportion of patients experiencing an adverse outcome (especially bleeding); and described the type of catheter used, dose of thrombolytic agent, administration protocol, dwell time, definition of treatment success, time to follow-up for study end points, and sample size. Eighteen studies met the inclusion criteria. The mean ± SD success rate in clearing dysfunctional hemodialysis catheters was greatest with reteplase at 88 ± 4%, followed by alteplase at 81 ± 37% and tenecteplase at 41 ± 5%. Adverse effects associated with the use of these thrombolytic agents administered at low doses were extremely rare. No serious adverse bleeding events attributed to thrombolytic therapy were reported in any of the trials. Aliquotted reteplase from vials for intravenous use was the least costly thrombolytic agent. Thus, at centers that use high volumes of thrombolytics for dysfunctional hemodialysis catheters, reteplase is the thrombolytic agent of choice.

Obesity is a global epidemic and has become a critical issue in Gulf countries such as Kuwait. The objective of this study is to assess the factors that are associated with overweight and obesity among Kuwaiti adult men. Weights and heights of a random sample of 464 men and their companions were collected to obtain body mass index (BMI). The overall levels of overweight and obesity were 48.5% and 19.8%, respectively. Logistic regression analysis of significantly associated factors revealed that factors contributing to risk of overweight and obesity included increasing age, having an obese mother or brother(s) and/or other obese relatives, having a lower grade point average, not being physically active, and being in poor health. Having a higher income and feeling tired were risk factors for obesity only. Family history is an important predictor of overweight and obesity in Kuwaiti men; however, this study identified several modifiable factors. It is recommended that factors that contribute to the development of overweight and obesity in Kuwait be targeted with behavioral change and/or health education interventions.

Recombinant thrombolytic peptides are mainly represented by recombinant forms of tissue plasminogen activator (t-PA), a proteolytic enzyme that catalyzes the conversion of plasminogen into active plasmin, which then functions to dissolve clots. The three clinically relevant recombinant thrombolytic peptides are alteplase (t-PA), reteplase (r-PA), and tenecteplase (TNK). r-PA and TNK have been structurally modified from native t-PA to increase their half-life and fibrin specificity. Thrombolytics play an important role in several diseases, including ST-segment elevation myocardial infarction (STEMI), deep vein thrombosis (DVT) and pulmonary embolism (PE), ischemic stroke, and peripheral arterial disease. Thrombolytic therapy has evolved into an alternative treatment for STEMI, reserved predominantly for patients who do not have access to timely percutaneous coronary intervention. In patients with DVT/PE or arterial related critical limb ischemia, the use of thrombolytic therapy is limited to specific patient populations. Thrombolytic therapy is the treatment of choice for ischemic stroke in patients who presentor=3 hours following the onset of symptoms. Moreover, thrombolytic therapy is used to restore function to stenotized central venous access devices as well as occluded hemodialysis access grafts.

We determined the in vitro antimicrobial susceptibilities of 7,942 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients hospitalized in 48 Canadian hospitals from 1995 to 2008. Regional variations in susceptibilities were identified. The dissemination of community-associated strains in Canada appears to have contributed to increased susceptibility of MRSA to several non-β-lactam antimicrobial agents in the past decade. Reduced susceptibility to glycopeptides was not identified.

This article summarizes a 2000 study of school garden programs and their variation and the impact of such variation on 427 third-grade students' sense of responsibility and attitudes toward science...

Construction and maintenance of the transport infrastructure presents many hazards to workers. In the United Kingdom (UK), safety issues are recognized by government agencies (e.g., Health and Safety Commission, Highways Agency), academia, and industry alike. Increasing skill shortages and an aging working population present problems on collating, organizing, and redistributing safety knowledge before existing workers retire or change jobs. Any influx of international workers also brings problems of language, effective communication, and training into the mix. The knowledge and experience of these workers needs to be tapped and used in the measurement of risks and their subsequent management. In response to these issues, the artificial intelligence methodology, case-based reasoning, has been incorporated into an information technology tool to improve hazard identification and management during a worker's daily tasks of identifying hazards and determining appropriate mitigations. The tool prompts users to classify a given work task and then, using a stored library of cases, suggests possible mitigation strategies. The user can accept or reject suggested mitigations. Results are fed back into the system, which becomes more refined for the next work task and next user. The tool is being developed in collaboration with Carillion Transport, a large UK infrastructure development and management contractor. It is in the development stages, but the ultimate aim will be deployment of the tool to those working in the field of construction and maintenance in infrastructure. A working example of the tool is given, followed by a presentation of its strengths and opportunity for improvement.