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Urban overheating affects the energy, health, power, survivability and environmental quality of cities. We calculated the magnitude of overheating in Sydney, Australia, at close to 9 °C, which causes a cooling penalty of up to 16% and an increase in the indoor overheating levels of up to 56%. We developed and evaluated eight heat mitigation scenarios based on the use of reflective surfaces, additional greenery, an increase in the evapotranspiration rate and several combinations of these factors. We estimated that mitigation can decrease the peak ambient temperature by up to 2.9 °C, reduce the maximum annual cooling consumption by up to 1.5 TWh, decrease the CO2 emissions by as much as 1.21 MT CO2, reduce indoor overheating by up to 80%, decrease the heat-related morbidity by 1.07–1.49, and decrease the heat-related mortality anomaly by as much as 1.39 per 100,000 citizens. We estimated the associated water penalty range to be between 80 and 100 Gl/year or between 13 and 16.7% of the water consumption in Sydney. © 2020

The Patagonian Andes represent a unique natural laboratory to study surface deformation in relation to deep slab dynamics. In the sector comprised between latitudes 41°30’ and 43°S, new apatite (U-Th)/He ages indicate a markedly different unroofing pattern between the ‘broken foreland’ area (characterized by Late Cretaceous to Paleogene exhumation) and the adjacent Andean sector to the west, which is dominated by Miocene-Pliocene exhumation. These unroofing stages can be confidently ascribed to inversion tectonics involving reverse fault-related uplift and concomitant erosion. Late Cretaceous-Paleogene shortening and exhumation are well known to have affected also the thrust belt sector of the study area during a prolonged stage of flat-slab subduction. Therefore, the different ages of near-surface unroofing documented in this study suggest coupling of the deformation between the thrust belt and its foreland during periods of flat-slab subduction (e.g. during Late Cretaceous-Paleogene times), and dominant uncoupling during periods of steep-slab subduction and rollback, even when these are associated with high convergence rates (i.e. > 4 cm/year), as those documented in Miocene times for the Patagonian Andes.

A new high resolution shallow marine seismic survey provides further insights on the fault source of the October 29th, 1900 earthquake, which affected a large region of North–central Venezuela, both offshore islands and mainland. This Mw 7.6 to 7.7 seismic event has been indistinctly ascribed to either the La Tortuga or San Sebastian fault, which has installed a live debate among different authors. These two faults allegedly run roughly east–west offshore, along the Coastal range. The San Sebastian fault (SSF) bounds this range to the north, being responsible for its linearity and the steep slope of its northern flank, whereas the La Tortuga fault (LTF) would do about the same, but some 20–30 km farther north, based on acoustic surveys carried out in the late 70's and early 80's. We herein bring strong evidence to support that the SSF is the source fault of this major offshore earthquake, mainly based on the freshness of its submarine scarp and recent fault throw, preserved at the Chuspa bay (close to Cabo Codera, eastern end of the Coastal range in central Venezuela), as depicted by one of the profiles. In addition, it is shown that most of the previous extent ascribed to LTF is not so. The LTF, besides exhibiting mainly normal slip, is much shorter than originally proposed. This precludes that LTF may have the seismic potential for an earthquake as big as the 1900 event. Finally, available reflection seismic data reveal the existence of a major fault system bounding the La Guaira shelf on the north, which exhibits tectonic inversion of pre existing extensional faults, shortening and strong syn-tectonic deformation during the Plio-Quaternary deposition. Sedimentation in the Bonaire basin during the Plio-Quaternary time is strongly controlled by this system activity.

The chemopreventive effects of isothiocyanate moringin isolated from Moringa oleifera seeds 1)Vivarelli F. 2)Paolini M. 3)Michl C. 4)Rascle A. 5)Weigl J. 6)De nicola G. 7)Iori R. 8)Cirillo S. 9)Canistro D. University of Bologna Over the past years, there has been a growing interest in the natural constituents of vegetables as a potential means of cancer control. Isothiocyanates (ITCs) are considered as ideal chemopreventive agents, due to their abundance in easily accessible brassica vegetables, their ability to target multiple pathways involved in cancer aetiology coupled with a favourable toxicological profile. Recently it was reported that sulphoraphane (SFN) inhibits STAT5-mediated transcription. STAT5 (Signal Transducer and Activator of transcription 5) belongs to a family of transcription factors (STAT1-6) mainly present in an inactive form in the cytoplasm of numerous cell types and which are activated by phosphorylation in response to specific cytokines hormones and growth factors. STAT5 plays a key role in the control of cell proliferation and survival, via the regulation of genes such as c-Myc, Pim-1, Bcl-x, Osm or Cis and it also contributes to immune cell differentiation and function. Its activity is normally tightly controlled, and is hence frequently found deregulated in cancer where it is often constitutively activated. For these reasons STAT inhibitors are considered as potential candidates for cancer prevention or therapy. Beside SFN, more recently the isothiocyanate moringin (GMG-ITC), isolated from the Moringa oleifera, has caught the interest of scientific community for its anti-inflammatory activity through the inhibition of the NF-κ B pathway and it showed interesting anti cancer effects against mouse multiple myeloma and human astrocytoma cell line. However, till now, very little is known about the activity of GMG-ITC on cell signaling pathways. The present study was conceived to explore the potential inhibitory effect of GMG-ITC on crucial pathways commonly up-regulated in cancer, such as JAK/STAT and NF-κB comparing results with those obtained with SFN. Results showed how SFN and GMG-ITC were able to suppress IL-3- induced expression of STAT5 target genes in mouse pro-B cells, however, GMG-ITC reported a stronger inhibitory activity compared to SFN. Both GMG-ITC and SFN did not inhibit STAT5 phosphorylation, suggesting a downstream inhibitory event. Expression of interferon (IFNα)- stimulated STAT1/STAT2 target genes (G1P3, ISG15, STAT1, IRF9) in HeLa cells were downregulated by GMG-ITC and SFN without altering STAT1 and STAT2 phosphorylation. Also in this case GMG-ITC exhibited a more marked activity then those observed with SFN. Notable, basal expression of c-Myc remained unaffected upon treatment with up to 10 μM SFN or GMG-ITC, indicating that both ITCs inhibit STAT5-induced but not basal c-Myc. GMG-ITC and SFN had a limited effect on IFNα-induced STAT1 and STAT2 activity, indicating that both ITCs differentially target JAK/STAT signaling pathways. Furthermore, we showed that GMG-ITC in the micromolar range is a more potent inhibitor of TNF-induced NF-κB activity than SFN. TNF-induced expression of IL-8 and IL-6 was inhibited by both SFN and GMG-ITC, but this last appeared to be more effective. Interestingly, SFN and GMG-ITC inhibit NF-κ B signaling with a greater potency than that mediated by the well-known NF-κB inhibitor curcumin. As a whole, our data indicate how GMGITC could be considered as a potent inhibitor of STAT5, NF-κ B as well as STAT1/STAT2 signaling pathways, often overcoming the effects obtained with SFN. Given the implication of these pathways in the carcinogenesis, inflammatory diseases and immune disorders, GMG-ITC could represent a newsworthy and attractive chemopreventive agent.

The lack of tobacco combustion, the most attractive feature of electronic cigarettes (e-cigs), has quickly made these new devices become the most sought-after alternative to the traditional cigarettes, contributing also to its widespread safety perception. Contrary to the general belief that the electronic nicotine-delivery systems avoid the release of harmful chemicals, the high temperature reached by e-cig solutions can actually generate dozens of toxic compounds, some of which are listed as known human carcinogens. Male Sprague Dawley rats, at 8 weeks of age, were housed under a 12h-light/12h-dark cycle, 22°C, 60% humidity, and fed ad libitum. After 5 days’ adaptation, the rats were randomly split into two groups of 10 animals each (non-exposed (control group) and exposed). Animals were whole-body exposed to 11 cycles/day, in order to consume 1 mL/day of e-liquid containing 18 mg/mL of nicotine. At the end of each cycle, the animals were transferred to a clean chamber to begin the next one. Animals were treated 5 days/week for 4 consecutive weeks. Rats were fasted 16 h prior to sacrifice. Animals were anesthetized by administering Zoletil 100 (100 mg/kg b.w.) and then sacrificed by decapitation according to the approved Ministerial procedures. The rats’ brains were isolated and their lipid matter was subjected to the analysis of total fatty acids, sterols and oxysterols composition. The e-cig aerosol exposure decreased the total lipid content in rat brain. A slight increase of saturated fatty acids and n-6 long-chain polyunsaturated fatty acids (LC-PUFA) was detected, while n-3 LC-PUFA dropped. A reduction of total cholesterol content and its oxidation products was also observed; in fact, the levels of 7alfa-hydroxycholesterol, alfa/beta-epoxycholesterol isomers and triol were lower compared to those found in the control group. The present research study revealed how e-cigs aerosol could disrupt the lipid and cholesterol homeostasis in rat brain, which could contribute to the new occurrence of some neurodegenerative diseases. A deeper investigation is needed to assess the harmful health impact of e-cigs, particularly after long-term exposure.

The NRC report Science and Decisions: Advancing Risk Assessment made several recommendations to improve chemical risk assessment, with a focus on in-depth chronic dose–response assessments conducted by the U.S. Environmental Protection Agency. The recommendations addressed two broad elements: improving technical analysis and utility for decision making. To advance the discussions in the NRC report, in three multi-stakeholder workshops organized by the Alliance for Risk Assessment, available and evolving risk assessment methodologies were considered through the development and application of case studies. A key product was a framework ( http://www.allianceforrisk.org/Workshop/Framework/ProblemFormulation.html ) to guide risk assessors and managers to various dose–response assessment methods relevant to a range of decision contexts ranging from priority setting to full assessment, as illustrated by case studies. It is designed to facilitate selection of appropriate methodology for a variety of problem formulations and includes a variety of methods with supporting case studies, for areas flagged specifically by the NRC committee for consideration – e.g., susceptible sub-populations, population variability and background. The framewok contributes to organization and communication about methodologies for incorporating increasingly biologically informed and chemical specific knowledge into dose–response analysis, which is considered critical in evolving fit-for-purpose assessment to address relevant problem formulations.

The variability of stable isotope ratios (δ(2) H, δ(13) C, δ(15) N, δ(18) O and δ(34) S) along the production chain of pasta (durum wheat, flour and pasta) produced by using both conventional and organic farming systems in four Italian regions in 2 years was investigated. The aim was to evaluate if and how the farming system and geographical origin affect stable isotope ratios determined along the production chain. Irrespective of the processing technology, 65% of the samples were correctly classified according to the farming system and 98% were correctly classified regarding the geographical region. When considering both farming system and geographical region simultaneously, 80% of the samples were correctly classified. The measured isotope parameters were thus primarily affected by the geographical origin. In conclusion, it is expected that the use of these parameters will allow the development of analytical control procedures that can be used to check the geographical origin of Italian organic and conventional pasta and its raw materials. Copyright © 2016 John WileySons, Ltd.

Background The management of vestibular schwannoma is still a quite controversial issue and can include wait and see policy, surgery and radiotherapy, mainly with stereotactic technique. The purpose of this study is to review the results of recent clinical series treated by radiotherapy. Materials and methods Literature search was performed by Pubmed and Scopus by using the words "vestibular schwannoma, acoustic neuroma, radiotherapy, radiosurgery". Results Management options of VS include wait and see, surgery and radiotherapy. In case of small lesions, literature data report local control rates higher than 90% after radiosurgery (SRS) similar those of surgical techniques. Recent literature reviews show favourable functional outcome by using SRS. Several literature data support the use of fractionated stereotactic radiotherapy (FSRT) in case of large inoperable lesions. Conclusion Radiotherapy plays a relevant role in the treatment of VS. In small-size lesions, SRS can guarantee similar local control and potentially better function outcome compared to surgery. In case of large and irregularly shaped lesions, FSRT can be the used when surgery is not feasible.

Aggressive cancer treatment is a challenge in elderly patients. The present study aims to assess tolerance in terms of acute toxicity and compliance of concurrent chemo-radiotherapy (cCRT) in a series of patients aged ≥70 years.Clinical records of patients aged ≥70 years who underwent cCRT between January 2005 and December 2013 were reviewed. Concurrent CRT had curative intent in 134 patients (97.8 %) and palliative intent in 3 patients (2.2 %). Chemotherapy (CT) drugs and schedule were selected according to tumor histology. Radiotherapy median dose was 45.0 Gy (range 11-70 Gy) for curative purposes and 54 Gy (range 40-56 Gy) for palliative purposes. Incidence of acute toxicity and compliance to cCRT were analyzed and correlated with age, Karnofsky Performance Status (KPS), and Charlson Comorbidity Index (CCI).Overall, 137 patients, 82 males (60 %) and 55 females (40 %), median age 74 years (range 70-90 years) were analyzed. Concurrent CRT schedule was completed by 132 patients (96.4 %). Thirty-one of these patients (23.5 %) temporarily interrupted treatment. Hematological toxicity with grade ≥1 was observed in 25 patients (18.2 %), gastrointestinal toxicity in 55 (40.1 %), and genitourinary in 13 (9.5 %). Mucositis with grade ≥1 was recorded in 19 patients (13.9 %). No statistical significant correlation between KPS, CCI, and toxicity was found. A correlation trend between mucositis and patient age (p = 0.05) was observed.Concurrent CRT for elderly was feasible and quite well tolerated. Great attention in prescribing CT dose should be paid to limit acute toxicity.

Ameliorative potential of Raphanus sativus cv. Sango sprout juice in obese rats maintained with high fat diet or switched to regular diet F. Vivarelli1, D. Canistro1, A. Sapone1, G.R. De Nicola2, C. Babot Marquillas1, R. Iori2, F. Gentilini3, M. Paolini1 1Dept. of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy 2Industrial Crop Research Centre, Agricultural Research Council, (CRA-CIN), Via di Corticella, 133, 40128, Bologna, Italy 3Dept. of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy Obesity is a worldwide epidemic characterized not only by excessive fat deposition but also by systemic low grade of inflammation and high oxidative stress. Despite much progress has been achieved in recent years, current pharmacological approaches for long-term therapy offer modest benefits for most patients. The present study evaluated the ameliorative effect of Raphanus sativus Sango sprout juice (SSJ), a Brassica extraordinarily rich in anthocyanins (AC) and isothiocyanates (ITCs), in a non-genetic model of obesity (high fat diet-HFD induced). Rats were fed with HFD or regular diet (RD); after 10-weeks, the HFD animals were assigned to four experimental units and the interventional period was 28 days long: 1) HFD-RD, the diet switched from HFD to RD and received the vehicle only; 2) HFD+SSJ and 3) HFD-RD+SSJ, treated with 75 mg/kg b.w. of SSJ; 4) HFD and 5) RD vehicle only, controls. Our model of obesity showed hyperlipidaemia as well as a marked increase of body and liver weight. The transition from HFD to RD, as expected, led to a significant loss of excess weight (-9.83 g; p

Effetti del germoglio di Raphanus Sativus CV Sango in un modello animale di obesità F. Vivarelli1, D. Canistro1, A. Sapone1, C. Babot Marquillas1, G.R. De Nicola2, R. Iori2, I.C. Antonazzo1, F. Gentilini3 e M. Paolini1. 1 Unità di Tossicologia Molecolare, Dipartimento di Farmacia e Biotecnologie, Alma Mater Studiorum, Università di Bologna, 40127 Bologna, Italia. 2 Consiglio per la Ricerca e la Sperimentazione in Agricoltura, Centro di Ricerca per le Colture Industriali (CRA-CIN), 40128 Bologna, Italia. 3 Dipartimento di Scienze Mediche Veterinarie, Alma Mater Studiorum, Università di Bologna, 40064 Ozzano dell’Emilia, Bologna, Italia. L’Organizzazione Mondiale della Sanità (OMS) ha riconosciuto l’obesità come un’epidemia globale, che costituisce uno dei principali problemi concernenti la salute pubblica, essendo un importante fattore di rischio per varie malattie croniche, come il diabete mellito di tipo 2, malattie cardiovascolari, patologie endocrine e tumori. Evidenze scientifiche sostengono l’ipotesi che alcuni alimenti o derivati abbiano effetti benefici sulla salute e, ad oggi, la corretta nutrizione è considerata un valido strumento di prevenzione per numerose patologiche. E’ noto, come l’obesità influenzi lo status ossidativo, determinando un’anomala produzione di specie reattive dell’ossigeno (ROS), condizione che frequentemente viene esacerbata da una deplezione delle comuni difese antiossidanti a livello cellulare. Diversi vegetali appartenenti alla famiglia delle Brassicaceae, contenenti elevate concentrazioni di glucosinolati (GLs) e isotiocianati (ITCs), hanno attirato l’interesse della comunità scientifica per le loro proprietà ipolipemizzanti e antiossidanti, come evidenziato dal crescente numero di studi preclinici ed epidemiologici. Scopo di questo lavoro è stato quello di indagare gli effetti del succo di germoglio di Raphanus Sativus Sango (SSJ), una Brassicacea straordinariamente ricca in antocianine (AC) e GLs, in un modello animale non genetico di obesità. La patologia è stata indotta sottoponendo ratti del ceppo Sprague Dawley a una dieta iperlipidica (HFD) per 10 settimane consecutive; al gruppo di controllo è stata assegnata una dieta standard (RD). Tre differenti dosaggi (15, 75 o 150 mg/kg p.c.) di SSJ sono stati somministrati per os per 28 giorni consecutivi; durante la fase di intervento, ai relativi gruppi di controllo (HFD e RD) è stato somministrato un volume equivalente del veicolo (acqua). I risultati mostrano una significativa riduzione del peso corporeo nei gruppi trattati con il dosaggio più basso (body weight gain = -0.29 g, p

Aim A literature review was performed to analyse the role of stereotactic radiotherapy given in a single shot or in a fractionated fashion for recurrent skull base tumours in order to ascertain if it can be a real salvage approach. Background The management of recurrent skull base tumours can have a curative or palliative intent and mainly includes surgery and RT. Materials and methods One-thousand-ninety-one articles were found in the search databases and the most relevant of them were analysed and briefly described. Results Data on recurrences of meningioma, pituitary adenoma, craniopharyngioma, chordoma and chondrosarcoma, vestibular schwannoma, glomus jugulare tumours, olfactory neuroblastoma and recurrences from head and neck tumours invading the base of skull are reported highlighting the most relevant results in terms of local control, survival, side effects and complications. Conclusions In conclusion, it emerges that SRS and FSRT are effective and safe radiation modalities of realize real salvage treatment for recurrent skull base tumours.

Effect of Vitamin E supplementation on xenobiotic-metabolizing and antioxidant enzymes in rat. F. Vivarelli1 D. Canistro1, A. Sapone1, S. Filippi2, I.C. Antonazzo1, C. Babot Marquillas1 M. Paolini1 1 Molecular Toxicology Unit, Department of Pharmacy and Biotechnology, Alma-Mater Studiorum, University of Bologna, 40127 Bologna, Italy. 2 Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of NEUROFARBA and Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy. Since its discovery and isolation Vitamin E (VE) has been considered a “safe” agent. VE has a number of biological functions being the antioxidant one, as peroxyl radical scavenger, the best known. The relationship between VE and cancer risk has been investigated in epidemiological studies and clinical trials with conflicting results. Recently, Selenium and Vitamin E Cancer Prevention Trial (SELECT) unexpectedly showed an increased risk of all primary cancers among healthy man supplemented with VE. As the literature reports that VE induce the P450 in human hepatoma cell line (HepG2), and being also known that such induction is always linked to an increased free radical and metabolite generation (cocarcinogenesis), we hypothesized that a generalized CYP upregulation migth have a role in the SELECT outcomes. Sprague Dawley male rats were intraperitoneally daily treated (for 7 or 14 consecutive days) with VE (α-tocopherol) at 100 or 200 mg/kg b.w. doses. The putative effects of VE on hepatic and renal microsomal CYP-linked monooxygenases as well as on antioxidant and post-oxidative enzymes were investigated. The almost neutral effect exerted by VE on hepatic phase I and II xenobiotic metabolizing enzymes, and the appreciable increase of catalase (up to 73% after 7 day treatment at lowest dose, p

The effect of yeast and chromium yeast on gilthead seabream (Sparus auratus L) performance, carcass indices and body composition was studied. Whether supplementation affected liver microsomal mixed function oxidases using either multibioprobes (testosterone) or highly specific substrates to cytochrome P450 (CYP) isoforms was also investigated. Seabream juveniles (35‐37 g initial weight) were allocated into 12 800 L tanks of 50 fish each for 87 days and fed pelleted experimental diets, i.e. control, yeast supplemented (1.6%) and chromium yeast supplemented at both low (800 p.p.b.) and high chromium level (53 810 p.p.b.). At the end of the experiment, growth, feed conversion ratio, thermal-unit growth coefficient, carcass yield, hepatosomatic index, and carcass and fillet proximate compositions were similar among treatments and only condition factor was statistically different. Organic chromium at both doses affected CYP-catalysed drug reactions slightly, as shown by the modest effect on the regio- and stereoselective hydroxylations of testosterone, as well as the metabolism of the selected probes. Overall, we found that chromium yeast did not change performance substantially, nor carcass indices, carcass and fillet chemical compositions, or hepatic xenobiotic metabolizing enzymes of gilthead seabream.

The authors investigated the potential of a 32-channel (32ch) receiving head coil for functional magnetic resonance imaging (fMRI) compared to a standard eight-channel (8ch) coil using a motor task. Brain activation was analyzed in 14 healthy right-handed subjects performing finger tapping with the right index finger (block design) during two experimental sessions, one with the 8ch and one with the 32ch coil (applied in a pseudorandomized order). Additionally, a phantom study was performed to compare signal-to-noise ratios (SNRs) of both coils. During both fMRI sessions, analysis of motor conditions resulted in an activation of the left “hand knob” (precentral gyrus). Application of the 32ch coil obtained additional activation clusters in the right cerebellum, left superior frontal gyrus (SMA), left supramarginal gyrus, and left postcentral gyrus. The phantom study revealed a significantly higher SNR for the 32ch coil compared to the 8ch coil in superficial cortical areas located near the surface of the brain. The 32ch technology has a potential impact on fMRI studies, especially in paradigms that result in activation of cortical areas located near the surface of the brain.

To explore whether sagittal abdominal diameter as a marker of abdominal obesity is a risk factor for death and morbidity in patients in the intensive care unit and a better outcome determinant for obese patients than body mass index.Prospective, observational study from April 2008 to January 2009.Two general intensive care units, both in Toulouse University Hospitals, France.All adult patients admitted in the two intensive care units except those routinely discharged within 48 hrs or those having conditions with possible effect on anthropometric indices.Measurement of the sagittal abdominal diameter at admission allowed us to divide the studied population into abdominally obese, underweight, and control groups.The primary outcome measure was mortality in the intensive care unit until day 60 after admission. Secondary outcomes were morbidity and length of stay in the intensive care unit. Among 503 patients admitted, 403 were included. At admission, age, diabetes, dyslipidemia, hypertension, Simplified Acute Physiology Score II, and McCabe scores were higher in the abdominally obese group (n = 109) than in the control group (n = 277). The rate of death was higher in the abdominally obese group compared to control (44% vs. 25.3%; p.01). After adjustment for age, simplified acute physiology score, II and McCabe score, a multivariate analysis showed an increased risk of death in the abdominally obese group (adjusted odds ratio, 2.12; 95% confidence interval, 1.25-3.60). A body mass index30 kg/m2 was not an independent risk factor for death. During the stay in the intensive care unit, incidence of acute renal failure and abdominal compartment syndrome were higher in the abdominally obese group.A high sagittal abdominal diameter, and not a high body mass index, is an independent risk factor of death in critically ill patients.

Obesity, associated with morbidity and mortality, is a complex disorder, characterised by an increase in fat mass (FM). Most authors agree in considering essential an integrated treatment made up of nutritional intervention, physical reconditioning programme and cognitive-behavioural psychotherapy. However, the feasibility is problematic and data in literature confirming the validity of this approach are poor. AIM: To verify the efficacy of a multidimensional approach (Nutritional Psycho-Physical Reconditioning — NPPR) in obesity treatment. METHODS: All patients admitted from June 2002 to June 2004 (464 subjects) ranged from 18 to 65 years old, with a body mass index (BMI)

The 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy delineate new expectations for experiential education within curricula and include guidance on the development and conduct of Pharmacy Practice Experiences. The American College of Clinical Pharmacy (ACCP) Educational Affairs Subcommittee C developed a position statement to further delineate the views of ACCP on factors necessary to meet contemporary standards for doctoral education in pharmacy and to provide guidance to our membership on how to implement the new standards. This White Paper provides explanation and supporting documentation for positions on quantitative and qualitative aspects of experiential education, as well as requirements for practice sites, preceptor roles, qualification, credentialing, and development and assessment of student performance.

To determine the direct medical costs of treating lower respiratory tract infections (LRTIs) in a managed care organization (MCO).Retrospective analysis of a regional MCO identifying adults diagnosed with acute exacerbation of chronic bronchitis (AECB) or community- acquired pneumonia (CAP).A claims database examination of International Classification of Diseases, Ninth Revision, Clinical Modification codes was conducted to identify adults receiving initial outpatient care for an LRTI during 2005-2006. Medical record review then was conducted to verify clinical diagnosis of AECB or CAP. Clinical and demographic data were collected. Outpatient office and clinic visits, hospitalization, and radiology, pathology, and pharmacy records were used to determine treatment costs. Treatment failure was determined by use of a second antibiotic course, follow-up emergency room presentation, or hospitalization for LRTI within 28 days of the index visit. The primary outcome was per-case treatment cost from the payer perspective.Clinical diagnosis was confirmed for 65 unique coded visits (60 patients; 39 with AECB, 22 with CAP; 1 in both cohorts). Initial visit, initial diagnostic testing, and subsequent hospitalization accounted for the majority (63%) of payer costs. Antibiotics were responsible for 15% of payer costs. Higher initial antibiotic expenditure in the AECB cohort yielded a cost-benefit ratio of 3:1. Mean per-case costs for success and failure were $277$372 for AECB, and $493$3019 for CAP, respectively.Initial visit and hospitalization costs contribute the majority of payer expenditure while antibiotic expenditure incurs a nominal burden. Higher expenditure on initial antibiotic therapy in the AECB population appears to be beneficial.