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Purpose: The purpose of this tutorial is to introduce the interview as a complementary component to the holistic process for graduate admissions. To do so, procedural details of two master's degree programs in speech-language pathology are provided that successfully execute two different but effective interview methods for speech-language pathology admissions. Graduate applicant interview processes are used in order to assess the whole applicant at Pacific University's School of Communication Sciences & Disorders and the Woolfolk School of Communication Sciences and Disorders at Our Lady of the Lake University. Other health profession fields have established evidence that demonstrates the utility of graduate admissions interviews for holistic review. This evidence can be used by communication sciences and disorders programs to expand our awareness and knowledge, engage with the limitations, and problem solve solutions to implement and improve interview processes. Conclusions: Reviewing applicants beyond test scores, grades, and other traditional components is critical in order to select students who are the best match for any program. A holistic approach to admissions could involve the inclusion of interviews to collect information on the personal qualities of applicants and provide one way to measure noncognitive attributes. Interviews allow for assessment of communication skills, suitability for the program, and applicant strengths not evident in traditional measures. Whatever the chosen method, interviews may be a valuable tool in graduate admissions that can be used in conjunction with traditional test scores and grade point average to predict academic and clinic performance and encourage equitable and inclusive ways of learning about applicants.

Episodic specificity inductions, involving brief training in recollecting episodic details, have been shown to improve subsequent performance on tasks involving remembering the past, imagining the future and problem solving. The current study examined if specificity inductions targeting self-referential past or future episodic thinking would have dissociable effects on generating past and future episodic detail and problem solving. Sixty-three participants were randomised to either a past self-referential or future self-referential episodic induction. All participants also completed a control task. Participants randomised to the self-referential future thinking induction generated more episodic details on past and future narrative tasks compared to a control task, whereas participants randomised to a self-referential past thinking induction showed similar performance to the control task. When examining within-group performance of participants randomised to the past or future induction, we found some evidence of dissociable effects of inductions on narrative generation tasks, but not on problem solving outcomes. Our findings suggest that self-referential inductions may be useful for increasing episodic specificity, but that the temporal distance and direction of the induction matters. We discuss our results in the context of the potential clinical utility of this approach for populations vulnerable to autobiographical memory disruption.

Spatial memory impairments are observed in people with Huntington's disease (HD), however, the domain of spatial memory has received little focus when characterizing the cognitive phenotype of HD. Spatial memory is traditionally thought to be a hippocampal-dependent function, while the neuropathology of HD centers on the striatum. Alongside spatial memory deficits in HD, recent neurocognitive theories suggest that a larger brain network is involved, including the striatum. We examined the relationship between hippocampal and striatal volumes and spatial memory in 36 HD gene expansion carriers, including premanifest (n = 24) and early manifest HD (n = 12), and 32 matched healthy controls. We assessed spatial memory with Paired Associates Learning, Rey-Osterrieth Complex Figure Test, and the Virtual House task, which assesses three components of spatial memory: navigation, object location, and plan drawing. Caudate nucleus, putamen, and hippocampal volumes were manually segmented on T1-weighted MR images. As expected, caudate nucleus and putamen volumes were significantly smaller in the HD group compared to controls, with manifest HD having more severe atrophy than the premanifest HD group. Hippocampal volumes did not differ significantly between HD and control groups. Nonetheless, on average, the HD group performed significantly worse than controls across all spatial memory tasks. The spatial memory components of object location and recall of figural and topographical drawings were associated with striatal and hippocampal volumes in the HD cohort. We provide a case to include spatial memory impairments in the cognitive phenotype of HD, and extend the neurocognitive picture of HD beyond its primary pathology within the striatum.

In many jurisdictions, governments award fiscal privileges to the nonprofit organisations they have granted ‘charitable’ or ‘public-benefit’ status. 1 To be eligible for this status, the organisati...

Hippocampal-dependent spatial memory impairments are seen in Huntington's disease animal models. Similar impairments were recently reported in Huntington's disease participants on analogous spatial memory tasks (e.g., virtual Morris Water Maze), however, these tasks do not translate well to the range of functions involved in day-to-day spatial cognition. In this study we examined ‘real-life’ hippocampal-dependent spatial memory in Huntington's disease participants. We studied premanifest Huntington's disease (N = 24), early manifest Huntington's disease (N = 14), and matched healthy controls (N = 33) with a virtual environment, which demanded spatial memory function on three levels: navigation, object location, and plan drawing. To examine the case for hippocampal-dependent spatial memory more closely, we compared the performance of our Huntington's disease participants to that of a group of temporal lobe epilepsy patients (N = 30) who were previously tested on the virtual environment. Spatial memory performance was also compared to two common neuropsychological tests of spatial cognition, the Paired Associates Learning from the Cambridge Neuropsychological Automated Test Battery, and the Rey–Osterrieth Complex Figure Test. People with early manifest Huntington's disease were impaired across all spatial memory tasks. Premanifest Huntington's disease participants were most notably impaired on the object location measure of the virtual environment, which is heavily dependent on hippocampal function, but showed no such impairments on the Paired Associates Learning or the Rey–Osterrieth Complex Figure Test. Object location memory and navigation performance did not differ between people with Huntington's disease and temporal lobe epilepsy. Aligned with studies in Huntington's disease animal models, ‘real-life’ spatial memory is impaired in people with Huntington's disease prior to clinical diagnosis. This alignment has important implications for testing treatments for Huntington's disease. From the standpoint of neurodegeneration, the dependence of our spatial memory measures on hippocampal function extends the focus of cognitive assessment research in Huntington's disease beyond its primary pathology within the striato-frontal circuit.

Autobiographical memory is widely posited to serve self, social and directive functions. Recent evidence suggests marked autobiographical memory impairments in Huntington's disease (HD), however, no study to date has determined how the perceived functions of autobiographical reminiscence may be altered in HD. The current study aimed to assess the self-reported frequency and function of autobiographical reminiscence in HD. We assessed autobiographical reminiscence in late premanifest (

Purpose Pharmacists are accountable for medication-related services provided to patients. As payment models transition from reimbursement for volume to reimbursement for value, pharmacy departments must demonstrate improvements in patient care outcomes and quality measure performance. The transition begins with an awareness of quality measures for which pharmacists and pharmacy personnel can demonstrate accountability across the continuum of care. The objective of the Pharmacy Accountability Measures (PAM) Work Group is to identify measures for which pharmacy departments can and should assume accountability. Summary The National Quality Forum (NQF) Quality Positioning System (QPS) was queried for NQF-endorsed medication-related measures. Included measures were curated into a data set of 6 therapeutic categories: antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship. Subject matter expert (SME) panels assigned to each area analyzed each measure according to a predetermined ranking system developed by the PAM Work Group. Measures remaining after SME review were disseminated during a public comment period for review and ballot. Over 1,000 measures are captured in the NQF QPS; 656 of the measures were found to be endorsed and medication use related or impacted by medication management services. A single reviewer categorized 140 measures into therapeutic categories for SME review; the remaining measures were unrelated to those clinical domains. The SME groups identified 28 measures for inclusion. Conclusion An understanding of the endorsed quality measures available for public reporting programs provides an opportunity for pharmacists to demonstrate accountability for performance, thus improving quality and safety and demonstrating value of care provided.

Autobiographical memory dysfunction is a pervasive feature of neurodegenerative disorders, but less is known about the integrity of autobiographical memory in Huntington's disease (HD). Deficits in anterograde verbal episodic memory on traditional neuropsychological tests have been detected in HD, however, whether personally-relevant autobiographical retrieval is also affected is unknown. We examined autobiographical memory performance in 26 participants genetically confirmed to have HD who were in the peri-manifest stage of the disease (including 12 in the late premanifest stage and 14 who were early diagnosed), and 24 matched controls using the Autobiographical Interview (AI), a semi-structured interview assessing retrieval of autobiographical details from discrete epochs across the lifetime. Relative to controls, people with HD exhibited global episodic autobiographical memory impairments, regardless of recency or remoteness of the memory being retrieved. While specific cues bolstered the retrieval of episodic (internal) details in HD participants, their performance remained significantly below that of controls. Moreover, following probing, people with HD retrieved more extraneous (external) details not directly related to the autobiographical event they originally retrieved, including semantic details, repetitions, and metacognitive statements. Our results reveal marked autobiographical memory dysfunction in HD, not directly attributable to strategic retrieval deficits, and suggest that autobiographical memory impairment may represent an overlooked feature of the cognitive phenotype of HD.

III-Sb barrier detectors suitable for the mid-wave infrared were grown on GaSb by molecular beam epitaxy. Using both bulk-InAsSb and an InAsSb–InAs strained layer superlattice, operation close to room temperature was demonstrated with cutoff wavelengths of 4.82 and 5.79 μm, respectively, with zero-bias operation possible for the bulk-InAsSb detector. X-ray diffraction, temperature dependent dark current, and spectral quantum efficiency were measured, and an analysis based on calculated specific detectivity was carried out. 1/f noise effects are considered. Results indicate that these optimized devices may be suitable as alternatives to InSb, or even HgCdTe, for many applications, especially where available power is limited.

A majority of ovarian tumors eventually recur in a drug-resistant form leaving patients few treatment options. The goal of this study was to explore the phenotypic and molecular characteristics of a cisplatin-resistant ovarian cancer cell line (OVCAR8R) as compared to its cisplatin-sensitive syngeneic counterpart (OVCAR8) and to explore the effectiveness of a novel therapeutic, Withaferin A (WA). In addition to unique morphological characteristics and increased expression of vimentin, the small heat shock proteins (Hsps) αB-Crystallin and Hsp27 are constitutively expressed in OVCAR8R cells while OVCAR8 cells do not express these Hsps, supporting that Hsp overexpression may confer resistance to chemotherapy and promote a more aggressive tumor type. WA treatment causes apoptosis in a dose-dependent manner in OVCAR8 cells, while the OVCAR8R cells remain viable at comparable doses of WA. αB-Crystallin was upregulated in a dose dependent manner in the WA-treated OVCAR8R cells. To determine the significance of αB-crystallin expression in conferring a more aggressive phenotype, αB-crystallin was silenced by CRISPR-Cas9 in OVCAR8R cells. Strikingly, the morphology of the OVCAR8R-αB-crystallin-knockout clones revert to the morphology of the cisplatin-sensitive OVCAR8 cell line. Molecular characterization reveals concurrent downregulation of Hsp27, and decreased expression of vimentin supporting that loss of αB-Crystallin is coincident with a less aggressive molecular phenotype. Upon challenge with WA, vimentin is downregulated in the αB-crystallin-null clones and in the cisplatin-sensitive OVCAR8 cells, but not in the OVCAR8R cells. Transient transfection of wildtype αB-Crystallin, but not a chaperone-defective mutant, alters the morphology of the OVCAR8 cells where the αB-Crystallin-knockout clones closely resemble the cisplatin-resistant OVCAR8R cells. Further, transient overexpression of wildtype αB-crystallin, but not a chaperone-defective-mutant, protects cells from WA-induced apoptosis as compared to GFP-transfected cells. Migration assays reveal that OVCAR8R cells have increased migration capability as compared to their cisplatin-sensitive counterparts and silencing of αB-Crystallin decreases migration of cisplatin-resistant cells. This research supports the potential effectiveness of WA as a therapy for ovarian cancer cells that acquire resistance to platinum-based therapies and underscores that αB-crystallin confers a more aggressive cellular phenotype and therefore, may be a promising molecular target for a better clinical outcome. Citation Format: Merideth K. Krevosky, Melissa M. Carmichael. The small heat shock protein αB-crystallin protects versus withaferin A-induced apoptosis and confers a more metastatic phenotype in cisplatin-resistant ovarian cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 865.

Episodic specificity inductions, involving brief training in recollecting episodic details, have been shown to improve subsequent performance on tasks involving remembering the past, imagining the future and problem solving. The current study examined if specificity inductions targeting self-referential past or future episodic thinking would have dissociable effects on generating past and future episodic detail and problem solving. Sixty-three participants were randomised to either a past self-referential or future self-referential episodic induction. All participants also completed a control task. Participants randomised to the self-referential future thinking induction generated more episodic details on past and future narrative tasks compared to a control task, whereas participants randomised to a self-referential past thinking induction showed similar performance to the control task. When examining within-group performance of participants randomised to the past or future induction, we found some evidence of dissociable effects of inductions on narrative generation tasks, but not on problem solving outcomes. Our findings suggest that self-referential inductions may be useful for increasing episodic specificity, but that the temporal distance and direction of the induction matters. We discuss our results in the context of the potential clinical utility of this approach for populations vulnerable to autobiographical memory disruption.

Objective Academic detailing (AD) is a promising intervention to address the growing morbidity and mortality associated with opioids. While AD has been shown to be effective in improving provider prescribing practices across a range of conditions, it is unclear how best to implement AD. The present study was designed to identify key lessons for implementation based on a model AD program in the Veterans Health Administration (VA). Design Qualitative process evaluation using semistructured interviews. Setting Seven VA health care systems in the Sierra Pacific region. Subjects Current and former academic detailers (N = 10) and VA providers with varying exposure to AD (high, low, or no; N = 20). Methods Semistructured interviews were audio-recorded and transcribed. We used a team-based, mixed inductive and deductive approach guided by the Consolidated Framework for Implementation Research. Results Key lessons identified by academic detailers and providers coalesced around key themes: 1) one-on-one sessions customized to the provider's patient population are most useful; 2) leadership plays a critical role in supporting providers' participation in AD programs; 3) tracking academic detailer and provider performance is important for improving performance for both groups; 4) academic detailers play a key role in motivating provider behavior change and thus training in Motivational Interviewing is highly valuable; and 5) academic detailers noted that networking is important for sharing implementation strategies and resources. Conclusions Identifying and incorporating these key lessons into the implementation of complex interventions like AD are critical to facilitating uptake of evidence-based interventions addressing the opioid epidemic.

Chronic opioid therapy-clinical reminder (COT-CR) is a decision support tool to prompt providers to carefully assess patients prescribed chronic opioids. This tool was developed to address inappropriate opioid prescribing.To determine COT-CR's impact on reducing morphine equivalent monthly dose (MEMD) and risk index for overdose or serious prescription opioid-induced respiratory depression (RIOSORD) values in veterans receiving chronic opioids.This retrospective cohort review matched patients with a complete COT-CR to patients with an incomplete COT-CR using propensity scores. In the primary aim, an interrupted time series design evaluated for changes in MEMD 12 months before and 6 months after the index date. The index date was the first pain or primary care provider visit post COT-CR installation. In the secondary aims, a retrospective cohort design was used to evaluate the changes in RIOSORD index score and risk class 6 months after the index date.After matching, 3801 patients were included in the complete and incomplete COT-CR groups, respectively. Greater average reduction in MEMD (-11.6 MEMD; 95% CI = -0.97 to -22.25 MEMD; P = 0.032) and RIOSORD index score (-0.53 RIOSORD index score; 95% CI = -1.00, -0.05 RIOSORD index score; P = 0.030) was observed in patients with a complete COT-CR compared to patients with an incomplete COT-CR. Differences in RIOSORD risk class were insignificant.Completing the COT-CR was associated with reduced MEMD and RIOSORD values. This suggests that active monitoring can change prescribing patterns, thereby, reducing the overall risk of opioid overdose in at-risk veterans.

Purposes The objective of this study was to determine the percentage of veterans with active hepatitis C virus (HCV) infection who were deemed to be candidates for treatment and to identify factors associated with treatment ineligibility. Methods This was a multisite, retrospective cohort analysis of veterans with HCV infection within the Veteran Integrated Service Network 21. Patients evaluated between August and November 2015 who were viremic and not receiving HCV treatment were included in the analysis. Reasons for treatment exclusion were determined by an experienced clinician and recorded into a regional population management dashboard. Descriptive statistics were used to describe the population. The t test for normally distributed data, the Mann-Whitney rank sum test for data that failed normality testing, or the χ 2 test were used to examine differences between the treatment eligible and ineligible cohorts. Generalized linear mixed-effects models were conducted to estimate patient outcomes relevant to various disease states and characteristics while controlling for interfacility variability. Findings The cohort included 1,003 veterans within 5 medical centers; 988 (98.5%) were male, and 625 (62%) had a fibrosis 4 score >3.25, indicating the presence of ALD. According to clinician classification, 478 (48%) were considered HCV treatment candidates, whereas 525 (52%) were determined to be treatment ineligible. The most common reasons documented by clinicians for treatment ineligibility included unstable or uncontrolled comorbidities (n = 118 [22.4%]), excessive alcohol use (n = 116 [22.1%]), and treatment refusal by the patient (n = 69 [13%]). On the basis of statistical modeling and reporting odds ratios (ORs) and 95% CIs, diagnoses of active alcohol use disorder (OR = 0.68; 95% CI, 0.47–0.98; P = 0.038), hepatocellular carcinoma (OR = 0.24; 95% CI, 0.13–0.47; P P = 0.049) were statistically associated with treatment ineligibility, whereas posttraumatic stress disorder (OR = 1.48; 95% CI, 1.01–2.18; P = 0.046) was associated with treatment eligibility. There were no statistically significant differences found for other psychiatric diagnoses or an encounter for homelessness. Implications Results of this study indicate that a high percentage of patients may not be considered treatment eligible at initial clinical review. Within this veteran population, the presence of uncontrolled comorbidities and excessive alcohol use were the most commonly reported reasons for treatment ineligibility. On the basis of this analysis, processes could be established to address modifiable barriers to treatment, thus expanding the number of individuals receiving potentially curative therapy for HCV infection.

Background Youth depression is highly prevalent and is related to impairments in academic, social and behavioural functioning. Evidence-based treatments are available, but many young people do not respond or sufficiently recover with first-line options, and a significant proportion experience relapse. Consequently, there is clear scope to enhance intervention in this critical period of early-onset depression. Memory specificity training (MeST) is a low-intensity intervention for depression that targets reduced specificity when recalling memories of the past, a common cognitive vulnerability in depression. This randomised controlled trial will assess the efficacy of adding a computerised version of MeST (c-MeST) to usual care for youth depression. Methods/design Young people aged 15–25 years with a major depressive episode (MDE) will be recruited and randomised to have immediate access to the seven session online c-MeST program in addition to usual care, or to usual care and wait-list for c-MeST. The primary outcomes will be diagnostic status of an MDE and self-reported depressive symptoms assessed at baseline, 1-, 3- and 6-month intervals. Autobiographical memory specificity and other variables thought to contribute to the maintenance of reduced memory specificity and depression will be assessed as mediators of change. Discussion Online provision of c-MeST provides a simple, low-intensity option for targeting a cognitive vulnerability that predicts the persistence of depressive symptoms. If found to be efficacious as an adjunct to usual care for depressed youth, it could be suitable for broader roll-out, as c-MeST is highly accessible and implementation requires only minimal resources due to the online and automated nature of intervention. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619000234112p. Registered on the 18 February 2019. All items from the WHO Trial Registration Data Set can be found within the protocol. Protocol version 1.0

Warnings about memory errors can reduce their incidence, although past work has largely focused on associative memory errors. The current study sought to explore whether warnings could be tailored to specifically reduce false recall of categorical information in both younger and older populations. Before encoding word pairs designed to induce categorical false memories, half of the younger and older participants were warned to avoid committing these types of memory errors. Older adults who received a warning committed fewer categorical memory errors, as well as other types of semantic memory errors, than those who did not receive a warning. In contrast, young adults' memory errors did not differ for the warning versus no-warning groups. Our findings provide evidence for the effectiveness of warnings at reducing categorical memory errors in older adults, perhaps by supporting source monitoring, reduction in reliance on gist traces, or through effective metacognitive strategies.

Purpose The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. Summary Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans. Within a group of specialty task forces, physicians, nurses, and pharmacists assist in the design and development of evidence-based tools to leverage timely electronic health information into metrics, benchmarks, and targets to assist with goal achievement. Examples of programs designed to improve care in 3 areas were selected for further description and review of outcomes. Population health improvement using Healthcare Effectiveness Data and Information Set and hepatitis C metrics were used to describe populations that may have an indication for evidence-based care but are not receiving it. Deprescribing efforts are described, as are medication safety monitoring efforts to prevent potential adverse events known to be associated with therapy. Conclusion Quality, safety, and value outcomes are the measures of success for population health programs in VISN 21. Data-rich project dashboards and reports are developed by pharmacist data analysts and implemented and used by teams of clinicians who provide continuous feedback and support to improve population health. The use of task forces, metrics, benchmarks, targets, and teams is instrumental in the successful application of these tools.

The study examined potential factors and attitudes associated with providing fraudulent academic claims. A total of 319 students completed an online survey which involved reading a vignette about an incomplete assignment. Participants reported whether they would contact their instructor to gain an extension, expressed their confidence in the believability of reasons for not completing an assignment, and answered questions about their attitudes toward academic excuse making. The results indicated that academic consequences of failing to turn in an assignment and communication medium did not affect the rate at which participants reported claims. Participants most commonly reported family emergency as a reason, and expressed higher confidence that the instructor would believe this reason if they or a classmate reported it. Furthermore, a survey about attitudes toward academic excuse making suggested that the belief that academic excuse making is not really a form of deception was associated with a greater likelihood of reporting a fraudulent claim, and that those who preferred email communication tended to endorse survey items that conveyed the ease of reporting academic excuses via email.

I feel supremely honored to be standing before you tonight. I consider this a lifetime achievement award. This recognition, voted on by such a prestigious group of professional leaders who have gone before me, is truly an honor counted among the highest I have ever been awarded. In fact, I believe

National healthcare policy is affecting the way health systems provide care by mandating accountability through standardized performance measures and incentives for improvement. Health systems are responding by adopting management systems—in many cases, systems from other industries—to measure

The purpose of the following paper is to demonstrate that the "limits of physics" are in a very important way determined by the conceptual framework and language of discourse that we use to describe physical reality. In this paper we examine three areas where the structure of discourse has been particularly difficult. In this regard we examine three problems, the problem of time (which is discussed in two sections of the paper), the problem of non-locality in quantum mechanics and some related general difficulties of interpretation specific to the Copenhagen school, and the concept of maximality as it is employed with respect to cosmic inflation in general relativity and quantum cosmology., 8 pages

Competence is distinct from performance. An increased level of competence does not necessarily lead to improved performance, yet both are often cited as important reasons for professional certification.[1][1] It is the responsibility of the medical and pharmacy professions to ensure the ongoing

In order to maximize social welfare, governments should subsidize at different rates the private contributions made to different categories of charitable or publicly beneficial civic activity. This prescription stands in contrast to the standard practice of subsidizing such contributions uniformly and suggests the need to evaluate not only that practice but also the diverse initiatives of several governments to subsidize at higher rates certain contributions made to certain categories. The case for differential subsidies is made here with reference to a model in which the government chooses the subsidies and amounts of direct funding, as well as a personal transfer and linear taxes on earnings and consumption. The categories differ in terms of the individuals contributing, the individuals receiving the charitable goods and services, and the effectiveness of direct funding relative to contributions. A linear expenditure system illustrates the restrictive conditions necessary for uniform contribution subsidies being optimal.

The current work examined the self‐presentation–self‐regulation relationship utilizing a design in which participants disclosed self‐information during an actual interpersonal interaction. By comparison, prior work relied on assessing participants’ intention to disclose. Our findings showed that making self‐presentation disclosures during an interaction depleted participants’ self‐regulatory resources as a function of attachment style and intimacy level of disclosures. We discuss how using an interpersonal paradigm clarifies a self‐presentation rather than decision‐making interpretation of earlier work's results, how deciding what to disclose (i.e., intent) and actually making disclosures can be considered distinctly different acts, and how reversing the variable relationship (i.e., opposite to prior work) has theoretical importance because it examines the inverse question that is implied, but not tested or demonstrated in earlier work.

In deciding the means, levels, and targets of taxation and spending across third-sector organizations, governments seeking to increase social welfare should use fiscal concepts and indicators that can detect and grade the welfare consequences of their decisions. On these terms, charity, as its meaning has originated and evolved in common law, is a deficient fiscal concept: it is neither teleological nor gradational, and therefore can offer no guidance on how to design and differentiate the fiscal treatment of third-sector organizations in ways that could increase social welfare. In general, the national governments of Australia, Canada, England and Wales, India, and Singapore treat uniformly the third-sector organizations whose purposes comply with the legal meaning of charity. In order to reform and differentiate that treatment with the prospect of increasing social welfare thereby, governments should start by dispensing with charity as a fiscal concept.

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

This article introduces the practice and theory of subsidizing at different rates the private financial contributions made to different categories of charitable or publicly beneficial civic activities. It describes and compares the practices by which eight governments apply differential subsidies, and then summarizes guidelines for their design that can be inferred from optimal tax and expenditure theory. It does this in the hope that differential subsidies will receive greater attention in the public policy literatures that deal with financing the third-sector.

Pharmacy is striving to evolve from a technical profession in which pharmacists prepare and dispense medications to one in which they take responsibility for the development and execution of each patient's pharmacotherapeutic plan. This is being guided by pharmacy leaders and professional organizations, but they are not able to make the changes necessary to achieve their vision alone. In order to effectively implement change, pharmacists need to own their vision of pharmacy practice. The authors spoke to a number of established leaders in the pharmacy profession about what the individual pharmacist could do to change the culture and environment at the local level. The leaders' advice proved remarkably consistent and could be summarized into three categories: vision, socialization (relationships and networks), and self-development. Excerpts from three of these interviews were compiled into one report to be used as a guide to help pharmacists implement changes needed to achieve the vision of pharmacy practice.

The offshore Indus Basin is a rift and passive margin basin offshore Pakistan and northwest India. Rifting associated with break up of the India/Madagascar/Seychelles plates began during the Late Cretaceous and was accompanied by a major period of volcanism associated with the Deccan volcanic event. A major volcanic centre was located along the south of the basin adjacent to the Saurashtra Arch transform fault and resulted in the deposition of up to 7 km of extrusive basalts interbedded with Late Cretaceous–Paleocene marine sediments. The basalts show stacked prograding reflection patterns on seismic data. A chain of northeast–southwest-trending volcanic seamounts in the central part of the deep-water basin formed topographic highs for the development of shallow-water carbonates during the Eocene post-rift phase. The passive margin stratigraphy includes up to 9 km of Oligocene–Recent age clastic sediments from the Indus River system. The proximal part of the Indus Fan contains spectacular large-scale channel-levees in the Miocene and Plio-Pleistocene intervals. Fourteen major channel-levee systems have been identified in the Plio-Pleistocene and represent potential reservoir targets. Trap types include extensional rollover anticlines at the shelf edge, drape structures over the Eocene carbonate highs, stratigraphic traps along the Murray Ridge and folds associated with strike-slip faults along the Murray Ridge. A key challenge for future exploration is to determine whether source rocks are present in sufficient quality for commercial discoveries.

Summary Endovascular aneurysm repair (EVAR) has become an established alternative to open repair (OR). We present a consecutive series of 486 elective patients with large infra-renal aortic abdominal aneurysm, comparing OR with EVAR. Prospective data collected during an 8-year period from January 1997 to October 2005 was reviewed. Statistical analysis performed using SPSS data editor with χ2 tests and Mann–Whitney U-tests. There were 486 patients with 329 OR (293 males, 36 females) with median age of 72 years with median diameter 6.3 cm and 157 EVAR (148 males, 9 females) with median age 75 years with median diameter 6.1 cm. Mortality was 13 (4%) for OR and 5 (3.2%) for EVAR (three of whom were in the UK EVAR 2 trial). Blood loss was significantly less for EVAR 500 ml vs. 1500 ml for OR. Sixty-five (19.8%) patients with OR had significantly more peri-operative complications compared with 14 (8.9%) with EVAR. The length of stay in hospital was significantly less for EVAR. This non-randomised study shows that although EVAR does not have a statistically significantly lower mortality, it does have statistically significantly lower complication rates compared with OR. EVAR can be achieved with good primary success, but long-term follow-up is essential to assess durability.

A recent article by Helling and Johnson,[1][1] published as part of the proceedings of the 2014 ASHP Ambulatory Care Summit, provides a chronology of many historical successes in ambulatory care pharmacy practice since the 1960s. As we approach the 75th anniversary of ASHP and celebrate the 50th

Background: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known. Objectives: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization’s Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA. Methods: We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA’s Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool. Results: Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1% of fracture patients as high risk (33.0% and 34.6% for hip and any major fracture, respectively); eFRAX classified 17.4% correctly (17.4% for hip and 0.2% for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35% more likely to fracture (95% CI = 23%-47%; P < 0.01) compared with 17% for eFRAX (95% CI = 5%-32%; P < 0.01). Conclusions: VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.

Use of recommended IV aminophylline dosage regimens in 48 older, acutely ill, hospitalized patients with chronic obstructive pulmonary disease (COPD) resulted in excessive plasma theophylline concentrations in 29 percent of these patients. A mean dose of 0.89 mg/kg/hr produced a plasma concentration which ranged from 7 to 52 mcg/ml with a mean of 21.9 mcg/ml. Plasma theophylline concentration was determined spectrophotometrically from plasma samples drawn at least 12 hours after a loading dose and initiation of a constant infusion. Severity of toxicity strongly correlated with the plasma theophylline concentration in 18 patients. Nausea and/or vomiting preceded life-threatening drug-induced arrhythmias and seizures less than half the time. Tachycardia was found to be the most consistent symptom associated with toxicity. These patients had lower plasma clearances than otherwise healthy younger adult asthmatics and healthy volunteers. Toxicity and identifiable risk factors for excessive plasma levels strongly correlated with reduced plasma clearance. Dosage modifications based upon plasma clearances from COPD patients without concurrent functional abnormalities and those with liver dysfunction and cardiac decompensation ranged from 0.7 to 0.12 mg/kg/hr. This study clearly demonstrates the poor correlation between dose and plasma concentration and the strong relationship between toxicity and plasma concentration. These results as well as those previously reported mandate that the relatively simple, rapid and inexpensive theophylline plasma measurement be used in all patients receiving IV aminophylline for longer than 24 hours in order to prevent toxicity.