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Abstract The use of supplementary cementitious materials (SMCs) is one of the three essential factors for the sustainability of the cement industry. To reduce CO2 emissions, several studies have introduced new methods for the utilization of industrial wastes such as the addition into cementitious materials. The objectives of this study were to chemically and physically characterize refractory ceramic industry waste and determine its viability as an SMC. The pozzolanic characteristics or SMC characteristics of the refractory waste were investigated using standard tests. The results revealed that the refractory waste was mainly composed of Al2O3 and SiO2. The mineralogical analysis revealed that the mullite was the major phase of the waste, followed by small amounts of cristobalite and quartz phases. The results of the modified Chapelle test and pozzolanic activity index with lime after 7 days indicated that the waste did not meet the minimum pozzolanicity required by the standard. However, the waste improved the mechanical resistance of the cement specimens containing the waste after 28 days compared with the reference sample, indicating the promising potential of the material for this application. This result indicated that the refractory waste shows a filler type effect, and thus, can be employed as an SCM.

Undergraduates' use of academic libraries is associated with academic achievement, but library research resources are underutilized, and little is known about what factors contribute to students' use of these resources. A random sample of undergraduate students from a historically women's college in the United States (N = 207; 59.2% white; 87.7% female or transfemale, 5.9% gender queer, 5.9% gender non-conforming, and 0.5% other gender) reported on their information literacy self-efficacy, attitudes toward research in undergraduate courses, and behavioral intentions to engage with library resources and services using an anonymous online questionnaire. Controlling for past library research and class year, results indicated that self-efficacy and positive research disposition were associated with greater library research intentions ([beta]s = 0.246, ps = 0.005), with positive disposition related to intentions most strongly among students of underrepresented racial and ethnic identities (b = 0.4817, p <0.0001). Surprisingly, greater research anxiety was associated with greater library research intentions ([beta] = 0.345, p =0.005), and no significant relation emerged for perceived usefulness (p =0.05). Self-efficacy is an important factor in library research intentions, and attitudes should be assessed multidimensionally as they relate to library research intentions in different ways. Future research should apply these findings to library instruction and research methods course design to enhance student self-efficacy, encourage library use, and promote success in undergraduate learning.

Acute pancreatitis can result in fat necrosis, typically occurring in the peripancreatic region within weeks to months, and it generally appears as a low attenuation collection, with minimal heterogeneity. There are no specific imaging features that can diagnose retroperitoneal fat necrosis which may imitate other entities including certain malignancies, which may lead to invasive studies for diagnosis. Herein, we present a case of extensive retroperitoneal fat necrosis beyond the peripancreatic region that developed 10 days after an episode of acute pancreatitis.

Abstract Two important and large non-point sources of nitrogen in residential areas that adversely affect water quality are stormwater runoff and effluent from on-site treatment systems. These sources are challenging to control due to their variable flow rates and nitrogen concentrations. Denitrifying bioreactors that employ a lignocellulosic wood chip medium contained within a saturated (anoxic) zone are relatively new technology that can be implemented at the local level to manage residential non-point nitrogen sources. In these systems, wood chips serve as a microbial biofilm support and provide a constant source of organic substrate required for denitrification. Denitrifying wood chip bioreactors for stormwater management include biofilters and bioretention systems modified to include an internal water storage zone; for on-site wastewater, they include upflow packed bed reactors, permeable reactive barriers, and submerged wetlands. Laboratory studies have shown that these bioreactors can achieve nitrate removal efficiencies as high as 80–100% but could provide more fundamental insight into system design and performance. For example, the type and size of the wood chips, hydraulic loading rate, and dormant period between water applications affects the hydrolysis rate of the lignocellulosic substrate, which in turn affects the amount and bioavailability of dissolved organic carbon for denitrification. Additional field studies can provide a better understanding of the effect of varying environmental conditions such as ambient temperature, precipitation rates, household water use rates, and idle periods on nitrogen removal performance. Long-term studies are also essential for understanding operations and maintenance requirements and validating mathematical models that integrate the complex physical, chemical, and biological processes occurring in these systems. Better modeling tools could assist in optimizing denitrifying wood chip bioreactors to meet nutrient reduction goals in urban and suburban watersheds.

ABSTRACT: Control of Conyza spp. prior to soybean sowing has faced difficulties because of the resistance cases in Brazil, hence new herbicides as halauxifen-methyl + diclosulam are important to manage this specie. The objective of this research was to evaluate the effectiveness of the herbicide halauxifen-methyl + diclosulam applied at pre-planting of soybean. The experiments were set up in three locations in Paraná State, Brazil, in the 2015/2016 season. The herbicide halauxifen-methyl + diclosulam was associated with glyphosate and compared to other commercial herbicide to Conyza spp. control. The application occurred 15 days before soybean sowing, in plants of Conyza spp. with an average height of 20-35 cm in the three areas. None of the treatments promoted Conyza spp. control above 90%, when soybean was at the V1 stage; however, the findings showed that halauxifen-methyl + diclosulam promoted better control in comparison to the other treatments. The control reached >90% at V3 soybean development stage, in which treatments containing glyphosate + halauxifen-methyl + diclosulam were more effective than the other treatments. In addition, treatments with glyphosate + halauxifen-methyl + diclosulam decreased dry matter content of Conyza spp. between 87 and 93%, depending on the location, when compared to the control. The burndown treatment to Conyza spp. with glyphosate + halauxifen-methyl + diclosulam did not decrease soybean yield, and it was always higher than the untreated check.

Introduction: Due to usability, feasibility, and acceptability concerns, observational treatment fidelity measures are often challenging to deploy in schools. Teacher self-report fidelity measures with specific design features might address some of these barriers. This case study outlines a community-engaged, iterative process to adapt the observational Treatment Integrity for Elementary Settings (TIES-O) to a teacher self-report version designed to assess the use of practices to support children's social-emotional competencies in elementary classrooms. Method: Cognitive walkthrough interviews were conducted with teachers to improve the usability of the teacher self-report measure, called the Treatment Integrity for Elementary Schools-Teacher Report (TIES-T). Qualitative content analysis was used to extract themes from the interviews and inform changes to the measure. Results: Increasing clarity and interactive elements in the measure training were the dominant themes, but suggestions for the measure format and jargon were also suggested. Conclusion: The suggested changes resulted in a brief measure, training, and feedback system designed to support the teacher's use of practices to support children's social-emotional competencies in elementary classrooms. Future research with the TIES-T will examine the score reliability and validity of the measure.

Abstract Background African Americans and those of lower socioeconomic status (SES) are at disproportionate risk for hypertension- and cardiovascular-disease-related mortality relative to their counterparts. Progress in reducing these disparities is slowed by the facts that these disparities are difficult to mitigate in older adults and early origins of these disparities are poorly understood. The Social Status Adversity and Health in Daily Life Moments Study aims to precisely understand the proximal cognitive-emotional mechanisms by which unique social exposures disproportionately impacting these populations influence blood pressure (BP) parameters early in the lifespan and determine which individuals are more at risk. Methods The study uses ecological momentary assessment (EMA) and ambulatory blood pressure (ABP) monitoring to assess race- and SES-based factors as they manifest in daily life moments alongside simultaneously manifesting cognitive-emotional states and ABP. A sample of 270 healthy African Americans between the ages of 18 and 30 is being recruited to complete two periods of 2-day, 2-night hourly ABP monitoring alongside hourly EMA assessments of socioeconomic strain, unfair treatment, and neighborhood strain during the waking hours. ABP data will be used to calculate ecologically valid measures of BP reactivity, variability, and nocturnal dipping. Other measures include actigraphy equipment worn during the monitoring period and comprehensive assessment of behavioral and psychosocial risk and resilience factors. Multilevel and multiple linear regression analyses will examine which momentary social adversity exposures and cognitive-emotional reactions to these exposures are associated with worse BP parameters and for whom. Discussion This is the first time that this research question is approached in this manner. The Social Status Adversity and Health in Daily Life Moments Study will identify the cognitive-emotional mechanisms by which the most impactful race- and SES-based exposures influence multiple BP parameters in African American emerging adults. Further, it will identify those most at risk for the health impacts of these exposures. Achievement of these aims will shape the field’s ability to develop novel interventions targeting reduction of these exposures and modification of reactions to these exposures as well as attend to those subpopulations most needing intervention within the African American emerging adult population.

Background: Increasing student numbers and logistical challenges in pharmacy education limit patient counselling and clinical placement opportunities. Computer-based simulation (CBS) offers scalable, interactive learning but faces integration barriers.Objective: To explore global perceptions of CBS implementation in pharmacy education among educators and students. Methods: An online cross-sectional survey was developed based on literature review and expert feedback. The survey was distributed globally through academic pharmacy organisations, social media, and the authors’ networks. It included 20 questions targeting pharmacy educators and students.Results: Responses from 152 educators across 38 countries and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO) were analysed using descriptive and inferential statistics. The majority of educators (90.1%, n = 137) and students (84.2%, n = 330) expressed comfort with using CBS and implementing it in their curriculum. Despite this, CBS was perceived as underutilised by 53.5% (n = 81) of educators and 63.7% (n = 250) of students. Students valued CBS for enhancing communication and problem-solving skills, while educators highlighted its relevance to community pharmacy practice. Both groups supported CBS use in assessments. All educators (100%) identified workload reduction as a key priority, hoped CBS could assist in this area. Educators also reported barriers such as financial constraints (56.6%, n = 86) and insufficient technical support (53.3%, n = 81). On the other hand, students were less optimistic about institutional support, with only a few (7.4%, n = 29) believed institutional leaders would actively support CBS adoption. Regional differences emerged, with SEARO (Southeast Asia) and AFRO (Africa) showing the lowest CBS usage rates. Educators in SEARO, AFRO, and EMRO (Eastern Mediterranean) raised concerns about technical support, while those in SEARO, AFRO, and WPRO (Western Pacific, including Australia, New Zealand, and Singapore) expressed financial concerns. Educators in AFRO and WPRO, however, reported being 100% comfortable with using CBS.Conclusion: Both students and educators recognised the potential of CBS in pharmacy education, with strong support for its integration. Addressing barriers such as educator workload, financial constraints, and technical support is crucial for broader adoption. Improved resource allocation and targeted training for educators are essential to effectively incorporate CBS into the pharmacy curriculum.

BackgroundAt the University of Tasmania (UTAS), pharmacy education traditionally relies on placements to provide students with hands-on experience. However, these placements have become increasingly limited due to logistical challenges and growing student numbers. Computer-based simulation (CBS) has the potential to offer a scalable, effective alternative to enhance learning and critical thinking. However, integrating CBS in pharmacy education faces several barriers that must be addressed for successful implementation.ObjectiveTo gain insight into pharmacy educators’ and students’ views regarding the barriers, and potential solutions, to integrating CBS in pharmacy practice education.MethodsThis mixed-methods case study involved semi-structured interviews with pharmacy educators and quantitative surveys with pharmacy students. The data underwent thematic coding for interview transcripts and statistical analysis for survey responses. The findings were integrated by examining convergence, complementarity, and discrepancy, revealing insights into how pharmacy students and educators perceive implementation barriers and improvement strategies for CBS.ResultsTen interviews were conducted, and 75 survey responses were collected, with a 62.5% response rate. Key barriers to CBS integration included educators’ heavy workload, scepticism about CBS’s educational value, and general integration challenges. Students, however, showed high acceptance of CBS, with 70.7% agreeing that CBS could assess their knowledge, 69.3% emphasising its role in developing problem-solving skills, and 80% viewing CBS as a complement to classroom study. Proposed solutions for enhancing CBS uptake included additional institutional support by appointing dedicated simulation technicians, leveraging champions to advocate for CBS, and aligning CBS with educational objectives.ConclusionA significant gap between students’ readiness and educators’ hesitancy to use CBS in pharmacy education was identified. While students are eager to adopt new technologies, educators expressed reservations, primarily due to workload concerns and uncertainties about the efficacy of CBS. The feedback from educators suggests that institutions may see improved uptake by employing dedicated support personnel and initiating targeted training programs. Future research should focus on exploring barriers and facilitators, using larger and more diverse samples, and gaining deeper insights into decision-makers’ perspectives to enhance the integration and efficacy of CBS in pharmacy education.

Neste trabalho, apresenta-se o estudo experimental em escala laboratorial e industrial da incorporação de resíduo do tratamento de Drenagem Ácida de Mina (DAM) na formulação de massa de cerâmica vermelha, com substituição parcial das argilas. Foram realizados algumas análises e ensaios nas amostras dos blocos cerâmicos: análise dilatométrica a verde, absorção de água, resistência à compressão, eflorescência de sais solúveis e emissões atmosféricas (MP e SOx). Os resultados das análises nos corpos de prova ensaiados indicam aumento de resistência a compressão. Os ensaios de eflorescência de sais solúveis indicam maior intensidade de cristalização de sais solúveis na superfície dos corpos de prova e blocos cerâmicos à medida que se aumenta o percentual de resíduo. As análises realizadas nos blocos cerâmicos ensaiados em escala industrial, recomendam uma proporção de até 2,5% de resíduo na massa cerâmica.An experimental laboratory and industry scale study of the incorporation of residue from Acid Drainage Mine (ADM) in the ceramics mass, with partial substitution of clays, is presented. Some analyses and assays of the ceramic blocks were been carried out: dilatometry, water absorption, compressive strength, efflorescence and emissions (MP and SOx). The results show an increase of compressive strength. The efflorescence assays indicate greater intensity of crystallization of soluble salts in the surface of the ceramic blocks for increasing residue content. The analyses in the ceramic blocks in industrial scale recommend a ratio of up to 2.5% of waste in bulk ceramics.

Abstract Background Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in a cohort of breast cancer patients with bone-dominant metastases to determine response criteria. The thresholds for 95% specificity of change versus no-change were then applied to a second cohort of breast cancer patients with bone-dominant metastases. Methods For this study, nine patients with 38 bone lesions were imaged with 18F-FDG in the same calibrated scanner twice within 14 days. Tumor uptake was quantified by the most commonly used PET parameter, the maximum tumor voxel normalized by dose and body weight (SUVmax) and also by the mean of a 1-cc maximal uptake volume normalized by dose and lean-body-mass (SULpeak). The asymmetric repeatability coefficients with confidence intervals for SUVmax and SULpeak were used to determine the limits of 18F-FDG uptake variability. A second cohort of 28 breast cancer patients with bone-dominant metastases that had 146 metastatic bone lesions was imaged with 18F-FDG before and after standard-of-care therapy for response assessment. Results The mean relative difference of SUVmax and SULpeak in 38 bone tumors of the first cohort were 4.3% and 6.7%. The upper and lower asymmetric limits of the repeatability coefficient were 19.4% and − 16.3% for SUVmax, and 21.2% and − 17.5% for SULpeak. 18F-FDG repeatability coefficient confidence intervals resulted in the following patient stratification using SULpeak for the second patient cohort: 11-progressive disease, 5-stable disease, 7-partial response, and 1-complete response with three inevaluable patients. The asymmetric repeatability coefficients response criteria for SULpeak changed the status of 3 patients compared to the standard Positron Emission Tomography Response Criteria in Solid Tumors of ± 30% SULpeak. Conclusion In evaluating bone tumor response for breast cancer patients with bone-dominant metastases using 18F-FDG SUVmax, the repeatability coefficients from test-retest studies show that reductions of more than 17% and increases of more than 20% are unlikely to be due to measurement variability. Serial 18F-FDG imaging in clinical trials investigating bone lesions in these patients, such as the ECOG-ACRIN EA1183 trial, benefit from confidence limits that allow interpretation of response.

Abstract Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.

Introduction At least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm (‘adverse events’). When a patient is seriously harmed, an investigation or review is undertaken to reduce the risk of further incidents occurring. Despite 20 years of investigations into adverse events in healthcare, few evaluations provide evidence of their quality and effectiveness in reducing preventable harm.This study aims to develop consistent, informed and robust best practice guidance, at state and national levels, that will improve the response, learning and health system improvements arising from adverse events.Methods and analysis The setting will be healthcare organisations in Australian public health systems in the states of New South Wales, Queensland, Victoria and the Australian Capital Territory. We will apply a multistage mixed-methods research design with evaluation and in-situ feasibility testing. This will include literature reviews (stage 1), an assessment of the quality of 300 adverse event investigation reports from participating hospitals (stage 2), and a policy/procedure document review from participating hospitals (stage 3) as well as focus groups and interviews on perspectives and experiences of investigations with healthcare staff and consumers (stage 4). After triangulating results from stages 1–4, we will then codesign tools and guidance for the conduct of investigations with staff and consumers (stage 5) and conduct feasibility testing on the guidance (stage 6). Participants will include healthcare safety systems policymakers and staff (n=120–255) who commission, undertake or review investigations and consumers (n=20–32) who have been impacted by adverse events.Ethics and dissemination Ethics approval has been granted by the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH02007 and 2023/ETH02341).The research findings will be incorporated into best practice guidance, published in international and national journals and disseminated through conferences.

Introduction: In the dynamic landscape of healthcare, pharmacists play a critical role in ensuring the well-being of communities, and having solid professional organisations to support pharmacists is essential in crucial activities, including continuing education, advocacy and establishing service standards. Eight pharmacy organisations play vital roles in representing pharmacists in various sectors and collectively contribute to developing, regulating, and promoting the pharmacy profession in Australia. However, a notable lack of female representation in these organisations' leadership roles has led to an increased focus on gender balance and equity. Objective: To determine if the gender distribution in pharmacy leadership aligns with the pharmacy workforce in Australia (64% women) and how it has changed in the five years since our last study on the issue. Setting: Australia. Method: Eight key Australian pharmacy organisations were identified. The website for each organisation was accessed, and data were recorded for their 2023 boards/committees/councils based on annual reports. Data recorded include name, number of males, number of females, and the gender of the president/chair of each board/committee/council. Results: Data were obtained for 340 separate professional committee members from the eight organisations (including state/territory branches) in 2023. Gender balance in pharmacy organisations has increased significantly since 2018, with women's representation in leadership positions now at 58% (47% 2018). Conclusion: Gender equity within Australian pharmacy professional organisations has significantly progressed.

Abstract Purpose To investigate combined MRI and 18F-FDG PET for assessing breast tumor metabolism/perfusion mismatch and predicting pathological response and recurrence-free survival (RFS) in women treated for breast cancer. Methods Patients undergoing neoadjuvant chemotherapy (NAC) for locally-advanced breast cancer were imaged at three timepoints (pre, mid, and post-NAC), prior to surgery. Imaging included diffusion-weighted and dynamic contrast-enhanced (DCE-) MRI and quantitative 18F-FDG PET. Tumor imaging measures included apparent diffusion coefficient, peak percent enhancement (PE), peak signal enhancement ratio (SER), functional tumor volume, and washout volume on MRI and standardized uptake value (SUVmax), glucose delivery (K1) and FDG metabolic rate (MRFDG) on PET, with percentage changes from baseline calculated at mid- and post-NAC. Associations of imaging measures with pathological response (residual cancer burden [RCB] 0/I vs. II/III) and RFS were evaluated. Results Thirty-five patients with stage II/III invasive breast cancer were enrolled in the prospective study (median age: 43, range: 31–66 years, RCB 0/I: N = 11/35, 31%). Baseline imaging metrics were not significantly associated with pathologic response or RFS (p > 0.05). Greater mid-treatment decreases in peak PE, along with greater post-treatment decreases in several DCE-MRI and 18F-FDG PET measures were associated with RCB 0/I after NAC (p

Measurement in the social sciences involves assigning values to particular empirical cases and plays a vital role in the research process, but it can be tricky to teach. Unless an undergraduate social sciences research methods course includes the collection of original data, many of the issues of measurement can seem abstract and arcane to students. To help illustrate how a social science researcher goes from a conceptualization to assigning values to cases, I developed a lecture that centers on the question "which artists are one-hit wonders?" I used the rules developed by Chris Molanphy to help students see how we can develop applicable methods for any possible case and make a measure that is both reliable and valid. The example also helps illustrate the difference between categorical and numerical variables by comparing the categorization of artists as one-hit wonders and the relative numerical value of the chart position of the artist's most successful song.

Since the outset of the COVID-19 pandemic, the global healthcare community has faced the challenge of understanding and addressing the ongoing and multi-faceted SARS-CoV-2 infection outcomes. As millions of individuals worldwide continue to navigate the complexities of post-hospitalization recovery, reinfection rates, and the increasing prevalence of Long-COVID symptoms, comprehensive COVID-19 rehabilitation strategies are greatly needed. Previous studies have highlighted the potential synergy between exercise and nutrition, suggesting that their integration into patient rehabilitation programs may yield improved clinical outcomes for survivors of COVID-19. Our group aimed to consolidate existing knowledge following the implementation of patient, intervention, comparison, and outcome (PICO) search strategies on the distinct and combined impacts of exercise and nutrition interventions in facilitating the recovery of COVID-19 patients following hospitalization, with a specific focus on their implications for both public health and clinical practice. The incorporation of targeted nutritional strategies alongside exercise-based programs may expedite patient recovery, ultimately promoting independence in performing activities of daily living (ADLs). Nonetheless, an imperative for expanded scientific inquiry remains, particularly in the realm of combined interventions. This mini-review underscores the compelling prospects offered by an amalgamated approach, advocating for the seamless integration of exercise and nutrition as integral components of post-hospitalization COVID-19 rehabilitation. The pursuit of a comprehensive understanding of the synergistic effects and effectiveness of exercise and nutrition stands as a crucial objective in advancing patient care and refining recovery strategies in the wake of this enduring global health crisis.

Introduction: Partnered pharmacist medication charting (PPMC), a process redesign hypothesised to improve medication safety and interdisciplinary collaboration, was trialed in a tertiary hospital’s emergency department (ED).Objective: To evaluate the health-related impact and economic benefit of PPMC.Methods: A pragmatic, controlled study compared PPMC to usual care in the ED. PPMC included a pharmacist-documented best-possible medication history (BPMH), followed by a clinical conversation between a pharmacist and a medical officer to jointly develop a treatment plan and chart medications. Usual care included medical officer-led traditional medication charting in the ED, without a pharmacist-obtained BPMH or clinical conversation. Outcome measures, assessed after propensity score matching, were length of hospital or ED stay, relative stay index (RSI), in-hospital mortality, 30-day hospital readmissions or ED revisits, and cost.Results: A total of 309 matched pairs were analysed. The median RSI was reduced by 15.4% with PPMC (p = 0.029). There were no significant differences between the groups in the median length of ED stay (8 vs. 10 h, p = 0.52), in-hospital mortality (1.3% vs. 1.3%, p > 0.99), 30-day readmission rates (21% vs. 17%; p = 0.35) and 30-day ED revisit rates (21% vs. 19%; p = 0.68). The hospital spent approximately $138.4 for the cost of PPMC care per patient to avert at least one medication error bearing high/extreme risk. PPMC saved approximately $1269 on the average cost of each admission.Conclusion: Implementing the ED-based PPMC model was associated with a significantly reduced RSI and admission costs, but did not affect clinical outcomes, noting that there was an additional focus on medication reconciliation in the usual care group relative to current practice at our study site.

Background: Major depressive disorder (MDD) is frequently chronic and relapsing. The use of maintenance or continuation transcranial magnetic stimulation (TMS) has received clinical and some research support. Objective: To conduct a case series study to report the outcomes of once-weekly (OW) or once-fortnightly (OF) continuation TMS in a real-life setting. Methods: We offered OW or OF TMS sessions to patients with MDD in remission or partial remission/relapse. Results: Ten patients received OW TMS and four received OF TMS, for 8 to 46 weeks. No patients in either group who were in remission or partial remission at baseline experienced a relapse. Improvements in HAMD6 and CGI-S scores were statistically significant or of borderline significance for the total sample and the OW group. Conclusions: This naturalistic, open-label observational study indicates that OW TMS is effective as maintenance therapy in MDD, while also offering some support for OF TMS maintenance in preventing relapse.

In order to enhance interdisciplinary collaboration and promote better medication management, a partnered pharmacist medication charting (PPMC) model was piloted in the emergency department (ED) of an Australian referral hospital. The primary objective of this study was to evaluate the impact of PPMC on the timeliness of time-critical medicines (TCMs), completeness of medication orders, and assessment of venous thromboembolism (VTE) risk. This concurrent controlled retrospective pragmatic trial involved individuals aged 18 years and older presenting to the ED from 1 June 2020 to 17 May 2021. The study compared the PPMC approach (PPMC group) with traditional medical officer-led medication charting approaches in the ED, either an early best-possible medication history (BPMH) group or the usual care group. In the PPMC group, a BPMH was documented promptly soon after arrival in the ED, subsequent to which a collaborative discussion, co-planning, and co-charting of medications were undertaken by both a PPMC-credentialled pharmacist and a medical officer. In the early BPMH group, the BPMH was initially obtained in the ED before proceeding with the traditional approach of medication charting. Conversely, in the usual care group, the BPMH was obtained in the inpatient ward subsequent to the traditional approach of medication charting. Three outcome measures were assessed –the duration from ED presentation to the TCM’s first dose administration (e.g., anti-Parkinson’s drugs, hypoglycaemics and anti-coagulants), the completeness of medication orders, and the conduct of VTE risk assessments. The analysis included 321 TCMs, with 107 per group, and 1048 patients, with 230, 230, and 588 in the PPMC, early BPMH, and usual care groups, respectively. In the PPMC group, the median time from ED presentation to the TCM’s first dose administration was 8.8 h (interquartile range: 6.3 to 16.3), compared to 17.5 h (interquartile range: 7.8 to 22.9) in the early BPMH group and 15.1 h (interquartile range: 8.2 to 21.1) in the usual care group (p < 0.001). Additionally, PPMC was associated with a higher proportion of patients having complete medication orders and receiving VTE risk assessments in the ED (both p < 0.001). The implementation of the PPMC model not only expedited the administration of TCMs but also improved the completeness of medication orders and the conduct of VTE risk assessments in the ED.

Structured health system-based programs, such as cardiac rehabilitation, may reduce the risk of recurrent stroke. This study aimed to co-design and evaluate a structured program of rehabilitation, developed based on insights from focus groups involving stroke survivors and health professionals. Conducted in Tasmania, Australia in 2019, the 7-week program comprised one hour of group exercise and one hour of education each week. Functional capacity (6 min walk test), fatigue, symptoms of depression (Patient Health Questionnaire), and lifestyle were assessed pre- and post-program, with a historical control group for comparison. Propensity score matching determined the average treatment effect (ATE) of the program. Key themes from the co-design focus groups included the need for coordinated care, improved psychosocial management, and including carers and peers in programs. Of the 23 people approached, 10 participants (70% men, mean age 67.4 ± 8.6 years) completed the program without adverse events. ATE analysis revealed improvements in functional capacity (139 m, 95% CI 44, 234) and fatigue (−5 units, 95% CI −9, −1), with a small improvement in symptoms of depression (−0.8 units, 95% CI −1.8, 0.2) compared to controls. The co-designed program demonstrated feasibility, acceptability, and positive outcomes, suggesting its potential to support stroke survivors.

Abstract Mechanical properties of additively manufactured structures fabricated using material extrusion additive manufacturing are predicted through combining thermal modeling with entanglement theory and molecular dynamics approaches. A one-dimensional model of heat transfer in a single road width wall is created and validated against both thermography and mechanical testing results. Various model modifications are investigated to determine which heat transfer considerations are important to predicting properties. This approach was able to predict tear energies on reasonable scales with minimal information about the polymer. Such an approach is likely to be applicable to a wide range of amorphous and low crystallinity thermoplastics.

We present 1.8 yr of near-daily Swift monitoring of the bright, strongly variable Type 1 active galactic nucleus (AGN) Fairall 9. Totaling 575 successful visits, this is the largest such campaign reported to date. Variations within the UV/optical are well correlated, with longer wavelengths lagging shorter wavelengths in the direction predicted by thin-disk/lamppost models. The correlations are improved by “detrending,” subtracting a second-order polynomial fit to the UV/optical light curves to remove long-term trends that are not of interest to this study. Extensive testing indicates detrending with higher-order polynomials removes too much intrinsic variability signal on reverberation timescales. These data provide the clearest detection to date of interband lags within the UV, indicating that neither emission from a large disk nor diffuse continuum emission from the broad-line region (BLR) can independently explain the full observed lag spectrum. The observed X-ray flux variations are poorly correlated with those in the UV/optical. Further, subdivision of the data into four ∼160 days light curves shows that the UV/optical lag spectrum is highly stable throughout the four periods, but the X-ray to UV lags are unstable, significantly changing magnitude and even direction from one period to the next. This indicates the X-ray to UV relationship is more complex than predicted by the simple reprocessing model often adopted for AGN. A “bowl” model (lamppost irradiation and blackbody reprocessing on a disk with a steep rim) fit suggests the disk thickens at a distance (∼10 lt-day) and temperature (∼8000 K) consistent with the inner edge of the BLR.

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are an urgent global health threat. Inferring the dynamics of local CRE dissemination is currently limited by our inability to confidently trace the spread of resistance determinants to unrelated bacterial hosts. Whole-genome sequence comparison is useful for identifying CRE clonal transmission and outbreaks, but high-frequency horizontal gene transfer (HGT) of carbapenem resistance genes and subsequent genome rearrangement complicate tracing the local persistence and mobilization of these genes across organisms. Methods To overcome this limitation, we developed a new approach to identify recent HGT of large, near-identical plasmid segments across species boundaries, which also allowed us to overcome technical challenges with genome assembly. We applied this to complete and near-complete genome assemblies to examine the local spread of CRE in a systematic, prospective collection of all CRE, as well as time- and species-matched carbapenem-susceptible Enterobacterales, isolated from patients from four US hospitals over nearly 5 years. Results Our CRE collection comprised a diverse range of species, lineages, and carbapenem resistance mechanisms, many of which were encoded on a variety of promiscuous plasmid types. We found and quantified rearrangement, persistence, and repeated transfer of plasmid segments, including those harboring carbapenemases, between organisms over multiple years. Some plasmid segments were found to be strongly associated with specific locales, thus representing geographic signatures that make it possible to trace recent and localized HGT events. Functional analysis of these signatures revealed genes commonly found in plasmids of nosocomial pathogens, such as functions required for plasmid retention and spread, as well survival against a variety of antibiotic and antiseptics common to the hospital environment. Conclusions Collectively, the framework we developed provides a clearer, high-resolution picture of the epidemiology of antibiotic resistance importation, spread, and persistence in patients and healthcare networks.

Abstract Despite the great abundance of pyrite in nature and its role as one of the main sources of SO2 emissions in industrial processes, there is little definitive information about the kinetics and mechanisms of pyrite oxidation and decomposition reactions. This work aimed to determine the viability of applying the Friedman method for kinetic parameter determination to the oxidation and decomposition reactions of pyrite from the coal mining industry in order to obtain pyrite-based magnetic materials. Such method is based on the use of experimental weight loss data obtained using thermogravimetric analysis (TG) for the determination of the reaction activation energies. Thus, the activation energy, the pre-exponential factor and the reaction order were obtained using TG curves with different heating rates (2.5, 5.0, 7.5 and 10.0 K.min-1). For inert atmosphere, the calculated activation energies of approximately 280 kJ.mol-1 agree with the literature values. The reaction in oxidant atmosphere showed two predominant weight loss regions, suggesting the existence of two different reactions. The 482 kJ.mol-1 value obtained for the activation energy of the second weight loss that occurred at approximately 770 K was similar to the results reported by other authors. For the observed weight loss at approximately 650 K, similar values were not found in the literature to compare to the results of the Friedman method. The theoretical activation energy was therefore determined with empirical equations. A theoretical value of approximately 1000 kJ.mol-1 was obtained for the decomposition of pyrrhotite. The values found for the other kinetic parameters showed inconsistencies.