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Background The control of the Coronavirus Disease 2019 (COVID-19) pandemic may be dependent on widespread receipt of an effective vaccine. It is important to understand patient health-related behaviors and perceptions to guide public health vaccination strategies. Objectives To examine perceptions of COVID-19 and vaccination beliefs, and identify predictors of intention to receive the COVID-19 vaccine in the US. Methods A cross-sectional, web-based survey guided by the Health Belief Model was conducted using a web-based Qualtrics survey panel of US adults. The main outcome was the intention to receive the COVID-19 vaccine if offered. Additional measures included: demographics, perceptions of COVID-19 severity, risk and susceptibility, views of a potential COVID-19 vaccine, virus and vaccine information sources, vaccine beliefs and behaviors, and seasonal flu vaccine history. Results A total of 1047 complete responses were included. Females had lower odds of intending to receive the COVID-19 vaccine than males (AOR = 0.54, 95% CI: 0.36–0.80). Those with a two-year degree/some college had lower odds of intending to receive the COVID-19 vaccine compared to those with a high school degree/GED (AOR = 0.59, 95% CI: 0.36–0.97). Respondents who perceived the severity of the virus to be higher, perceived a greater COVID-19 vaccine benefit, and perceived greater general vaccine benefits had higher odds of intending to receive a COVID-19 vaccine (AOR = 1.44, 95% CI: 1.09–1.91; AOR = 2.82, 95% CI: 2.24–3.56; AOR = 1.77, 95% CI 1.41–2.21, respectively). Conclusions In this study, intention to receive the COVID-19 vaccine varied across demographics, perceived virus severity, COVID-19 vaccine and general vaccine beliefs. Successful implementation of a COVID-19 immunization strategy by healthcare providers and public health officials will need to incorporate diverse COVID-19 vaccination education strategies tailored to patients' health beliefs.

Background Global effort is key to prevent and control infections effectively. Whereas pharmacists’ involvement in the immunization neighborhood, collaborative effort to meet immunization needs of the public, has reduced burden of vaccine-preventable diseases in Western countries, the impact of pharmacist-involved vaccination advocacy and delivery in Asia Pacific remains unclear. Objective To examine the evidence for impact of pharmacists on immunization advocacy and delivery in Asia Pacific and to assess Singaporean pharmacists’ experience in becoming immunizing pharmacists through the American Pharmacists Association’s Pharmacy-based Immunization certificate training program. Methods A mixed-method study consisted of systematic review and survey was conducted. The systematic review was conducted by searching PubMed and Cumulative Index to Nursing and Allied Health databases from inception to March 2021. Randomized controlled trials and observational studies related to pharmacist-involved immunization advocacy and training conducted in Asia Pacific were included. Eligible studies were appraised for quality using CONsolidated Standards of Reporting Trials (CONSORT) and STrengthening the Reporting of OBservational checklists. In addition, a 20-item Likert-scale survey evaluated the pharmacists’ experience in becoming immunizing pharmacists in Singapore. Frequencies of each response to the survey items were analyzed. Results Six studies were eligible for inclusion; 2 assessing impact of pharmacist as immunizer, 3 reporting outcomes of pharmacist-involved vaccine advocacy, and 1 evaluating the structure of pharmacist immunization training. Although study quality was minimal, all studies echoed positive findings as a result of pharmacist-provided immunization advocacy and delivery. Of the 23 pharmacists completing the survey, 91.3% strongly agreed that quality training was important to become immunizing pharmacists. Conclusion Although limited in number, studies conducted in Asia Pacific reported increased vaccination rates when involving pharmacists. Coupled with the enthusiasm to be trained in immunization advocacy and delivery as elucidated by the Singaporean pharmacists, pharmacists in Asia Pacific should also be advocated for their role in the immunization neighborhood as part of the global effort against vaccine-preventable infectious diseases.

The half‐value layer (HVL) is one of the regulatory required radiation safety parameters that needs to be measured annually. With the advent of solid state detectors and their associated electrometer assembly, the HVL measurement can be conducted with relative ease. In fact, various radiological technique parameters such as tube potential (kV), exposure time in millisecond (msec), air kerma (mGy), and air kerma rate (mGy/sec) can be obtained along with the HVL with just one exposure. The measured (or, calculated) HVL is based on radiation detection systems calibrated for conventional x‐ray systems equipped with tungsten anode and added aluminum filters (molybdenum anode and filter in the case of mammography systems). However, a new generation of radiography and fluoroscopy (R/F) systems, inclusive of interventional angiography equipment, is equipped with varying thicknesses and materials of spectral shaping filters (SSF) to minimize the radiation exposure to the patients while image quality is maintained and optimized. The accuracy of HVL obtained with new generation of R/F systems has not been investigated in depth due to the addition of spectral filters yielding a harder beam quality with a higher HVL than the regulatory required value of 2.9 mm Al HVL at 80 kV. It would be of great interest to determine the accuracy of HVL as measured (or, calculated) by the solid state detector systems (SSDS), especially when accurate radiation dose delivered to the patient is required. In this investigation, the subject is limited to the accuracy of HVL measurement for conventional R/F systems.

Background The Agricultural Improvement Act of 2018 legalized the commercial use of hemp-based products, including cannabidiol (CBD). However, the U.S. Food and Drug Administration (FDA) does not currently regulate the commercial sale of hemp oil–based CBD, and there is no FDA-approved indication for its nonprescription formulations despite the growing demand for, and use of, hemp oil–based CBD. Objectives Characterize the use of hemp oil–based CBD, including brands, formulations, and reasons for use, in a community pharmacy setting and identify the perceived barriers related to the use of hemp oil–based CBD. Methods A pretested 17-question survey was distributed at the point of care at 2 community pharmacy locations and at hemp oil–based CBD education presentations over a 3-month period. The survey consisted of multiple-choice, open-ended, and select-all-that-apply questions, which were analyzed using univariate and bivariate analyses. Results A total of 101 participants completed the survey: 38 were CBD-naive, and 63 were CBD-exposed. Most of the participants were women (79%) and Caucasian (81.6%), with an average age of 59 years (SD 17.26). In the CBD-naive group, the most commonly stated barrier to using hemp oil–based CBD was not enough information about the product. Among the participants who had used or were using at least 1 CBD product, the most commonly used dosage form was sublingual, followed by topical: 46 (46/63 [73%]) and 34 (34/63 [54%]) participants, respectively. Thirty-eight participants used hemp oil–based CBD for pain, 24 participants for sleep, and 17 participants for anxiety. Of these, 62% of the participants informed a health care provider that they were using a hemp oil–based CBD product. Conclusion The participants were using different brands and formulations of hemp oil–based CBD for multiple reasons. The greatest barrier to trying CBD was limited education, which may suggest a need for community education about hemp oil–based CBD products.

Increasing political polarization and growing animus toward political outgroup members may strain marriages in which spouses express political differences. For heterosexual married couples, interre...

The Journal of Chemical Education’s Special Issue on Chemical Safety Education: Methods, Culture, and Green Chemistry is a collection of 38 peer-reviewed papers on the topic of chemical safety educ...

As emerging majority students learn to adjust to academic life, they frequently confront feelings of inadequacy and face changing identities in relation to their home communities. These students of...

Designing and constructing a safe laboratory building is a task that requires a large team. Much of the laboratory safety planning is addressed by the needs expressed by the teaching faculty repres...

United States publicly-funded higher education systems are experiencing increasing pressures. In response, higher education institutions have broadened their appeal to students less likely to attend college as part of their fiscal strategies. This growing student population consists of first-generation students and individuals from marginalized backgrounds who often enter college underprepared, and higher education must retain these emerging-majority students to ensure fiscal stability. When enrollment and retention are viewed from a business model, faculty duties expand into triage care and student emotional support. This qualitative investigation of faculty in a publicly-funded state university explores intrusive teaching practices marked by monitoring and intervening in their students’ emotional and social issues.

ImportanceComputed tomography (CT) radiation doses vary across institutions and are often higher than needed.ObjectiveTo assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT.Design, Setting, and ParticipantsThis randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018.InterventionsImaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention.Main Outcomes and MeasuresPrimary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics.ResultsAcross 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; P P P P P Conclusions and RelevanceFor imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest.Trial RegistrationClinicalTrials.gov Identifier: NCT03000751

Objectives To describe the views of pharmacists and student pharmacists regarding (1) aspects of life and experiences that provide professional and personal satisfaction and fulfillment, (2) causes of stress, and (3) needs related to maintaining satisfaction and fulfillment. Design A generic qualitative research design was used for collecting data from 380 pharmacists and 332 student pharmacists who wrote responses to an online survey hosted by the American Pharmacists Association (APhA) from November 17 to December 2, 2018, using standard data collection procedures applied by that organization. APhA uses its member and affiliate data files as its sampling frame and limits the number of contacts per year for each person in those files. De-identified responses from those who volunteered to write comments were sent to the research team for analysis. A conventional content analysis approach was applied for analysis of the text. Analysts convened to discuss emergent themes and develop operational descriptions. Key segments of text that best represented each theme were identified. Personal presuppositions were disclosed and were useful for developing group consensus for theme identification and description. Rigor was supported through assessment of credibility, confirmability, intercoder checking, transferability, inductive thematic saturation, and authenticity. Setting and participants Participants are in the design since data already collected. Outcome measures Not applicable. Results Findings showed that pharmacists and student pharmacists are able to recognize and pursue achievement, recognition, responsibility, advancement, relationship, esteem, self-actualization, meaning, and accomplishment in both their professional and personal lives. However, external factors such as “workism” and individual factors such as “moral distress” were identified as areas of improvement that are needed for well-being and resilience. Conclusion Pharmacists’ basic human needs are being met, but to improve well-being and resilience for pharmacists in both their professional and personal lives, there is a need for addressing both the external factors and individual factors that they encounter.

Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, whereas others do not, making acceptance testing a subjective and time-consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology and continues with general fluoroscopy and mobile C-arms. Finally, the appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail.

Background The COVID-19 pandemic, restrictions, and social distancing requirements for medical offices reduced scheduling availability and increased virtual televisits by providers. COVID-19 restrictions created a barrier to healthcare access for patients that are being administered long-acting injectable antipsychotics (LAIs) in an already vulnerable population. Objective To describe an LAI medication administration service at a community-based pharmacy during the COVID-19 pandemic, to evaluate patient satisfaction with the administration of LAIs by a pharmacist service in a community-based pharmacy during the COVID-19 pandemic, and to compare the patient's perceptions of receiving LAIs in a community-based pharmacy to another setting previously used for medication administration. Practice Description Independent full-service community-based pharmacy. Practice innovation Implementation of an LAI administration service after an increase in provider referrals of patients to the community-based pharmacy during the COVID-19 pandemic. Evaluation Methods A 4-month prospective convenience sample study conducted to evaluate the LAI medication administration service. The survey containing 32 questions was adapted with permission from a previous survey administered in a large grocery store chain to a similar population. Survey results reported using descriptive statistics. Results Eleven patients completed the survey. Eighty-two percent of patients strongly agreed that they felt comfortable with receiving this service at the community-based pharmacy and were satisfied with the privacy during the service. Seventy-one percent of patients who received this service elsewhere strongly agreed the LAI medication administration service was more convenient than a similar service received elsewhere, yet only 18% of patients strongly agreed that the community-based pharmacy was near their work or home. Conclusion A medication administration service for LAIs was developed in a community-based pharmacy, and patients are satisfied with the service. Further research needs to be completed to evaluate health outcomes and financial implications of this service for the patient and healthcare system.

In this article, we review automatic brightness control (ABC) for fluoroscopy imaging systems. Starting from the simple manual control, the discussion is extended to the kV-primary ABC system, and then to the most recent contrast-to-noise ratio optimized (CNR Optimized) automatic dose rate control system (ADRC). The nature of this review article is trifold. First, it describes the ABC/ADRC and associated circuits governing the operation of the fluoroscopy imaging chain. Second, we show the characteristics of a control logic from a radiation physics point of view. Third, we introduce the most recent activities in the evaluation of CNR-optimized fluoroscopy systems and the phantom design that would be compatible with the design concept of the ADRC. Because of these three subject items in the discussion process, this article is also educational in nature written for medical physicists and radiological technologists who might be less familiar with the design concept of fluoroscopy operation, specifically on the ABC and ADRC. We insert a few related matters associated with fluoroscopy automatic control circuits where they seem applicable and appropriate to enhance the understanding of fluoroscopy operation logic.

The American Pharmacists Association (APhA) Pharmacy-Based Immunization Delivery Certificate Program is commonly used by schools of pharmacy to train student pharmacists in immunizations. This study compared student pharmacists' knowledge retention of immunization content when the live seminar of the APhA Program was delivered as a one-day co-curricular activity or as a five-week required course. The impact of immunization experience on students' knowledge retention was a secondary objective.A 45-question knowledge assessment about immunizations was administered to second and third-year student pharmacists eight months after completing either a five-week course (second-year students) or a one-day seminar (third-year students). Students were also asked about their experience providing patient education, screening, and administering immunizations.Knowledge assessment scores declined by an average of 26.3% from the initial to the eight-month assessment, and declines were similar for second and third-year students. However, students who reported immunizing over 50 patients had significantly higher knowledge retention than those who reported never immunizing.A live immunization training given over one day or five weeks did not impact the retention of immunization knowledge eight months later. However, students who immunized50 patients had greater knowledge retention. These findings indicate the importance of including the application of immunization knowledge in pharmacy curricula to enhance long-term knowledge retention.

Community pharmacies use text message communications for information regarding approaching refills and fill status. Patients can also be notified regarding annual influenza vaccine availability and schedule an appointment for the vaccine.This study aimed to evaluate whether text message communications affected patient presentation and resulted in a percent increase of patients receiving an influenza vaccine compared with previous vaccine season and to determine whether additional vaccines are administered upon presentation.Ambidirectional study retrospectively analyzed the impact, nationally, of a new text message communication on influenza vaccinations at a large community pharmacy chain and prospectively surveyed patients receiving an influenza vaccine at 2 geographically similar pharmacies of the chain in Southwest Virginia. Text message communications regarding vaccine and appointment availability were sent to patients at the age of 18 years and older who opted in to text message communications and received an influenza vaccine with the chain during the 2019-2020 influenza season. Vaccine data from consecutive seasons were compared. Eligible patients in Southwest Virginia were surveyed about how they were informed about availability, previous intent to receive an influenza vaccine, applicability to other vaccines, and effect of the coronavirus disease 2019 pandemic on vaccination. Results were analyzed using bivariate and multivariate analyses.Nationally, influenza vaccines administered increased by 17.45% in patients who permitted text message communication and overall by 13.22% after implementation. Decreases in co-administered pneumococcal vaccines and tetanus, diphtheria, and pertussis vaccines and an increase in co-administered zoster vaccines were observed. A total of 111 patients were surveyed; 4% presented owing to text message communication. A majority were intent on receiving the vaccine before being notified and reported that the pandemic did not affect presentation. Notably, 45.05% of patients were likely to receive routine vaccines if notified by text message.Text message communications are another viable way to increase vaccinations, but further studies should be conducted outside of a pandemic setting.

Background: A large community pharmacy chain implemented a new digital platform to eliminate the need for patients to fill out a traditional vaccine consent form in the pharmacy. The new digital vaccine consent form allowed patients to complete the form online, where it was transmitted directly to the pharmacy’s network. Objectives: To identify the characteristics of patients who used an online digital vaccine consent form to receive vaccinations and to evaluate patient satisfaction and confidence in utilizing the digital vaccine consent form to receive pharmacy services. Methods: This three-month prospective study was conducted in the Mid-Atlantic division of a large community pharmacy chain. A 16-question survey was developed using information from the literature to collect demographic information and patient confidence and satisfaction with the digital vaccine consent form. An email was sent to pharmacy staff containing instructions on the procedure for posting a recruitment flyer, distributing the survey post-vaccination, and how to return completed surveys. Univariate and bi-variate analysis were conducted. Results: Thirty-six participants responded to the survey, majority of participants were female (56%). Two patients used the digital vaccine consent form; both used because it was more convenient and were likely to use the form again. For those who did not use the digital vaccine consent form, 32% feel somewhat unconfident in using digital technologies for pharmacy services. A majority of patients prefer to be notified about new online services by email (39%) or advertisements in the pharmacy (31%). When asked the likelihood of using the digital vaccine consent form in the future, majority stated unlikely (34%) or neutral (25%). Conclusions: Most participants did not utilize the new digital vaccine form. This provides an opportunity to further engage patients on the availability and use of the digital vaccine consent form in order to advance digital technologies for pharmacy services.

Modern fluoroscopes pose a challenge for the clinical physicist for annual testing and continued upkeep. These fluoroscopes are critical to providing care to patients for complex interventions, and continue to evolve in automated image quality adjustments. Few tools in software or hardware currently exist to assist the physicist or technologist in gauging fluoroscope constancy or readiness for procedures. Many modalities such as mammography, computed tomography or even magnetic resonance imaging are much more evolved with respect to testing or quality control. In this work we sought to provide simple reproducible tools and methods for spot evaluating or continued quality testing of interventional fluoroscopes.

On 13 to 14 February 2014 a ~4 h long, VEI 4 eruption occurred at Kelut volcano (Java, Indonesia). Pyroclastic density currents (PDCs) and extensive ash fall led to 7 fatalities and disruption to flights across the Asia-Pacific region. New sedimentological descriptions of the pyroclastic deposits from the 2014 eruption were compared with eyewitness and satellite reports to elucidate temporal variations in eruptive dynamics. The stratigraphy of the deposits is presented in 3 stages, associated with two eruptions that occurred approximately ~15–30 min apart. Stage 1 PDC deposits originate from the smaller onset eruption. The PDC deposits from Stage 2, and tephra fall deposits from Stage 3 originate from the second, plinian eruption. During the onset eruption (Stage 1), low energy PDCs were produced that ran out to 70% by vol.) PDC deposits ran out to 4.7 km from the vent. The deposits reflect an increased output of fresh fragmented magma, and some conduit widening evidenced by dense lithic fragments. Vent instabilities and incorporation of dense material into basal margins of the plume led to the marginal collapse and formation of these PDCs. Stage 3 occurred in the final hour at the peak of the plinian eruption, around 01:00 to 02:00, and produced reversely graded lapilli fall deposits with ≤90 vol% pumice from a 26 km-high plume. This indicates that there was a sustained flux of juvenile magma to the now open vent system, and expansion and fragmentation of the gas-rich magma was at its most efficient. Our study of the eruptive sequence of Kelut provides some constraints on predicted patterns for future explosive activity, critical for further hazard assessment of the volcano. Since 1901 Kelut has erupted on intervals of 1 to 23 years, and the 2014 event characterises a typical “explosive” style of eruption that alternates regularly with effusive dome-formation and collapse events. This pattern depends on the dynamics of magma renewal to the system, and degassing conditions in the shallow magma reservoir and upper conduit. If this pattern holds, and the next eruption occurs within the next two decades, a return of prolonged dome growth could be anticipated.

Objectives To identify perceptions of decision-makers and staff at a local hospital about the pharmacist’s role in transitions of care (TOC) programs. Setting Independent community pharmacy located inside a local community hospital. Practice description Pharmacy personnel offer a bedside delivery service to hospital patients and have professional relationships with administration. Practice innovation Pharmacy personnel intend to expand the bedside delivery service to a comprehensive TOC program. Researchers believed it would be important to gather the perceptions of pharmacist’s role in TOC programs from nonpharmacist clinicians and administration to successfully develop the program. Evaluation This project would identify perceptions to help develop a TOC program. Methods A 22-question survey was developed after consulting with key staff and informed by literature regarding TOC and pharmacists’ roles in patient care services. Collected demographic information included primary department, number of years worked at the institution, and involvement in TOC. After an 8-week survey distribution period, descriptive statistics were performed on the data collected. Results A total of 13 decision-makers and staff responded to the survey with a response rate of 87%. Eleven of 12 respondents (92%) thought that pharmacists should be involved in TOC and can be the communication link between patients and other health care providers to ensure continuity of care. All of the participants thought that pharmacists should provide medication reconciliation and patient and caregiver education through TOC services. The participants were less likely to think that pharmacists should offer follow-up care after discharge. Conclusion Participants agreed that pharmacists should be involved in TOC services but had varied perceptions on the pharmacist’s specific role. Decision-maker and staff perceptions identified in this study will be used to develop the pharmacist’s role in a TOC program at the institution.

To explore how pharmacy interns' training experiences during internship influence understanding and confidence about preparation for providing patient care services in a large community pharmacy chain.A descriptive survey design using a census sample of the 98 pharmacy interns, aged 18 years and older, employed in 52 pharmacies of one community pharmacy chain was conducted. Training experiences influencing understanding and confidence were evaluated with the use of a 38-question survey instrument developed with a focus group of pharmacy interns and distributed via Qualtrics over a period of 12 weeks. Responses were stored in Qualtrics and analyzed with the use of SAS version 9.4.Thirty-four surveys were returned, for a response rate of 35%, with a 20% response rate for all of the questions. Pharmacy interns who completed the American Pharmacist Association "Delivering Medication Therapy Management Services" certificate training program were more likely to agree with statements evaluating understanding (P 0.02) and confidence (P 0.09) in completing a comprehensive medication review and less likely to indicate a need for training (P 0.02). Pharmacy interns have a greater understanding and confidence incorporating immunizations into workflow (both 85%). They also have a greater understanding and confidence in using Advisory Committee on Immunization Practices/Centers for Disease Control and Prevention guidelines for immunization recommendations (90% and 85%, respectively). Pharmacy interns reported that they did not have a strong understanding of and confidence level in providing other patient care services, including medication therapy management services, clinical queue, and point-of-care testing. Survey respondents reported a desire for additional training in these areas.Although pharmacy interns have a greater understanding of how to incorporate immunizations into pharmacy workload and use immunization guidelines, levels of understanding and confidence in providing other patient care services were not as strong. Future development of training for patient care services may help to increase pharmacy intern understanding and confidence.

Current environmental policies, which promote a more sustainable food sector, have boosted efforts to reduce energy demand during processing, and particularly during drying operations. One of the routes towards more sustainable and efficient drying processes is the design and implementation of optimal operational routines for the existing drying equipment. In the food industry, drum-dryers are typically employed for the production of food powders from viscous slurries (e.g. starchy slurries). Food powders are used in a wide range of applications in the food industry, from beverage powders (milk or cocoa), instant soups, spices or flours and flavours. In this framework, we propose a model-based optimisation routine for the operation of a double drum-dryer (product under atmospheric conditions) used in the manufacture of a breakfast cereal porridge. The problem defines optimal steam temperature and optimal rotation speed that minimises the energy demand of the dryer operation for a range of operating conditions that considered different: product formulation, final moisture contents, thickness and initial temperature of the wet slurry. Overall, this work demonstrates the potential of model-based approaches to the design and optimisation of more sustainable and efficient industrial drying technologies in the food sector, which can help in the achievement of short/medium-term energy reduction goals.

This reflective essay follows a faculty working group as they attempt to understand barriers to access to course materials through the scholarship of teaching and learning (SoTL). Through the workgroup’s research and collaboration with students in a problem-based learning course, the workgroup uncovered elements of the hidden curriculum in assumptions regarding course material procurement. The collaboration has served as the foundation for efforts to begin to transform the way that faculty on campus make use of textbooks and course materials in their courses. This transformation should make explicit to faculty that the utilization of course materials for all aspects of the course are often hidden pedagogy and must be made explicit by each instructor.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group Background Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2) Aim To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams. Methods We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback. Results 365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had >3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy. Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive. Conclusions An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.

Ob jectives The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry. Methods Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European. Results The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US. Conclusions DRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe. Key Points • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.

We performed an on-sky MCAO experiment using 4 deformable mirrors (DMs) to analyze the relevance of their sequence to the residual wavefront error. Two DMs were conjugate to 4 and 8 km. The other two DMs were placed in pupil images upstream and downstream of the 4-km and 8-km mirrors. At any time, both high altitude DMs were active but only one pupil DM was active while the other one stayed flat. Firstly, we found that the MCAO control loops using either pupil DM were stable and robust. Dynamic misregistration, which was present for the first pupil DM, was not an immediate problem for the controller. We did not notice an apparent difference when repeatedly switching between the pupil DMs during the operation. A closer analysis of the contrast in the corrected images and AO telemetry indicates an advantage when the pupil correction was applied with the DM that was downstream of the high-altitude DMs. This finding is consistent in several data recorded at different days. The difference, however, is small. A more detailed analysis is probably needed to rule out error sources potentially not considered herein to draw a final conclusion on the optimal sequence of DMs in MCAO and its practical relevance.

CYRA (CrYogenic solar spectrogRAph) is a facility instrument of the 1.6-meter Goode Solar Telescope (GST) at the Big Bear Solar Observatory (BBSO). CYRA focuses on the study of the near-infrared solar spectrum between 1 and 5 microns, a under explored region which is not only a fertile ground for photospheric magnetic diagnostics, but also allows a unique window into the chromosphere lying atop the photosphere. CYRA is the first ever fully cryogenic spectrograph in any solar observatory with its two predecessors, on the McMath-Pierce and Mees Telescopes, being based on warm optics except for the detectors and order sorting filters. CYRA is used to probe magnetic fields in various solar features and the quiet photosphere. CYRA measurements will allow new and better 3D extrapolations of the solar magnetic field and will provide more accurate boundary conditions for solar activity models. Superior spectral resolution of 150,000 and better allows enhanced observations of the chromosphere in the carbon monoxide (CO) spectral bands and will yield a better understanding of energy transport in the solar atmosphere. CYRA is divided into two optical sub-systems: The Fore-Optics Module and the Spectrograph. The Spectrograph is the heart of the instrument and contains the IR detector, grating, slits, filters, and imaging optics all in a cryogenically cooled Dewar (cryostat). The detector a 2048 by 2048 pixel HAWAII 2 array produced by Teledyne Scientific & Imaging, LLC. The interior of the cryostat and the readout electronics are maintained at 90 Kelvin by helium refrigerant based cryo-coolers, while the IR array is cooled to 30 Kelvin. The Fore-Optics Module de-rotates and stabilizes the solar image, provides scanning capabilities, and transfers the GST image to the Spectrograph. CYRA has been installed and is undergoing its commissioning phase., 11 pages, 9 figures, 2 tables. Prepared for SPIE conference proceedings

We present an overview of the National Science Foundation’sDaniel K. Inouye Solar Telescope(DKIST), its instruments, and support facilities. The 4 m aperture DKIST provides the highest-resolution observations of the Sun ever achieved. The large aperture of DKIST combined with state-of-the-art instrumentation provide the sensitivity to measure the vector magnetic field in the chromosphere and in the faint corona, i.e. for the first time with DKIST we will be able to measure and study the most important free-energy source in the outer solar atmosphere – the coronal magnetic field. Over its operational lifetime DKIST will advance our knowledge of fundamental astronomical processes, including highly dynamic solar eruptions that are at the source of space-weather events that impact our technological society. Design and construction of DKIST took over two decades. DKIST implements a fast (f/2), off-axis Gregorian optical design. The maximum available field-of-view is 5 arcmin. A complex thermal-control system was implemented in order to remove at prime focus the majority of the 13 kW collected by the primary mirror and to keep optical surfaces and structures at ambient temperature, thus avoiding self-induced local seeing. A high-order adaptive-optics system with 1600 actuators corrects atmospheric seeing enabling diffraction limited imaging and spectroscopy. Five instruments, four of which are polarimeters, provide powerful diagnostic capability over a broad wavelength range covering the visible, near-infrared, and mid-infrared spectrum. New polarization-calibration strategies were developed to achieve the stringent polarization accuracy requirement of 5×10−4. Instruments can be combined and operated simultaneously in order to obtain a maximum of observational information. Observing time on DKIST is allocated through an open, merit-based proposal process. DKIST will be operated primarily in “service mode” and is expected to on average produce 3 PB of raw data per year. A newly developed data center located at the NSO Headquarters in Boulder will initially serve fully calibrated data to the international users community. Higher-level data products, such as physical parameters obtained from inversions of spectro-polarimetric data will be added as resources allow.

In the United States non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. It occurs in every age group, but predominantly in people with risk factors such as obesity and type 2 diabetes. NAFLD is marked by fat accumulation in the liver leading to liver inflammation, which may lead to scarring and irreversible damage progressing to cirrhosis and liver failure. In animal models, genetic ablation of the protein G0S2 leads to alleviation of liver damage and insulin resistance in high fat diets. The research presented in this paper aims to aid in rational based drug design for the treatment of NAFLD by providing a pathway for a solution state NMR structure of G0S2. Here we describe the expression of G0S2 in an E. coli system from two different constructs, both of which are confirmed to be functionally active based on the ability to inhibit the activity of Adipose Triglyceride Lipase. In one of the constructs, preliminary NMR spectroscopy measurements show dominant alpha-helical characteristics as well as resonance assignments on the N-terminus of G0S2, allowing for further NMR work with this protein. Additionally, the characterization of G0S2 oligomers are outlined for both constructs, suggesting that G0S2 may defensively exist in a multimeric state to protect and potentially stabilize the small 104 amino acid protein within the cell. This information presented on the structure of G0S2 will further guide future development in the therapy for NAFLD.

Background: Adherence, specifically to noninsulin diabetes medications, statins, and renin-angiotensin system antagonists (i.e. angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and aliskiren), is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care. Objectives: (1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patients adherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain. Methods: A six-month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin-angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow-up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six-month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert-scale and multiple choice-based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert-scale questionnaire. At the end of the six-month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni-variate and bi-variate statistics to determine if there was a difference in pharmacy performance scores from the pre-study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence. Results: A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95%) with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey. Conclusions: An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs. Article type: Original Research

Background The Centers for Disease Control and Prevention guidelines recommend naloxone for every high-dose opioid prescription; in 2018, only 1 naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. In Virginia, strategies for creating awareness and availability include the REVIVE! training and the standing protocol for pharmacists to dispense naloxone. Objectives To evaluate if a proactive offer for counseling by pharmacists improves the percent change of patients who receive a prescription for naloxone nasal spray compared with the previous year’s naloxone nasal spray fill history and to determine if the pharmacist’s counseling affects a patient’s confidence with opioid overdose and naloxone use. Methods Prospective 4-month, interventional study in southwest Virginia conducted at 5 geographically similar large community chain pharmacies. A National Drug Code activity report within each store was used to identify patients, aged 18-64 years, filling opioid medication without naloxone. A pharmacist recommended naloxone to patients at the point of care. Patients accepting the recommendation for naloxone received pharmacist counseling from a standardized counseling script and by using a naloxone nasal spray demo kit. All eligible patients were provided a postintervention survey assessing their confidence with naloxone, if naloxone had been recommended before, and if they were picking up naloxone on the basis of the pharmacist’s recommendation. Results were analyzed using univariate and bivariate analyses. Results A total of 121 naloxone prescriptions were dispensed; an increase of 36% compared with the same period during the previous year. In total, 38 patients completed the postintervention survey. After receiving pharmacist counseling, patients indicated being very confident with administering naloxone correctly and for recognizing an opioid overdose, 73.9% and 65.2%, respectively. Of the patients who completed the survey, 60.5% received naloxone and accepted counseling from the pharmacist. Conclusion After pharmacist counseling, naloxone dispensing increased, and patients were confident with both administration and recognition.