The goal of this study is to determine barriers and facilitators to the implementation of medication adherence interventions to support cancer patients taking novel, targeted oral anticancer agents ...(OAAs).
We conducted qualitative interviews using a semi-structured guide from the Consolidated Framework for Implementation Research (CFIR). We used purposive sampling to identify clinicians (physicians, pharmacists, nurse practitioners, nurses) and administrators (leadership from medicine, pharmacy, and nursing) who delivered care and/or oversee care delivery for patients with chronic leukemia prescribed an OAA.
A total of 19 individuals participated in an interview (12 clinicians and 7 administrators), with 10 primarily employed by an academic cancer center; 5 employed by the community cancer center; and 4 employed by the integrated health-system specialty pharmacy. Barriers identified included low awareness of adherence interventions, difficulty in adherence measurement, complexity of designing and implementing a structured adherence intervention, and competing priorities. Facilitators identified included support of hospital administrators, value for pharmacists, and willingness to embrace change. Participants also made recommendations moving forward including standardizing workflow, designating champions, iterating implementation strategies, and improving communication between clinicians and with patients.
Individual and system level factors were identified as determinants of implementation effectiveness of medication adherence interventions. A multidisciplinary advisory panel will be assembled to design comprehensive and actionable strategies to refine and implement a structured intervention to improve medication adherence in cancer patients.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
For the first time, a small dual-phase (liquid/gas) xenon time projection chamber was equipped with a top array of silicon photomultipliers for light and charge readout. Here we describe the ...instrument in detail, as well as the data processing and the event position reconstruction algorithms. We obtain a spatial resolution of
∼
1.5
mm
in the horizontal plane. To characterise the detector performance, we show calibration data with internal
83
m
Kr
and
37
Ar
sources, and we detail the production of the latter as well as its introduction into the system. We finally compare the observed light and charge yields down to electronic recoil energies of
2.82
keV
to predictions based on NEST v2.0.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
There must have been plenty of them about, growing up quietly and inoffensively, with nobody taking any particular notice of them…. And so the one in our garden continued its growth ...peacefully, as did thousands like it in neglected spots all over the world…. It was some little time later that the first one picked up its roots and walked.
John Wyndham, The Day of the Triffids
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Alterations to forest canopy structure directly affect the hydrology and biogeochemistry of wooded ecosystems. Epiphytes alter canopy structure, thereby intercepting rainwater, reducing penetration ...of rain to the surface (as throughfall), modifying throughfall chemistry, and changing throughfall responses to storm conditions. These processes are well established for epiphyte presence versus absence; yet, it is unknown how epiphyteâthroughfall interactions change across an epiphyte cover continuum (important information for prediction of ecological changes with epiphyte establishment or decline from disturbance). To fill this gap, we monitored throughfall water and dissolved ions (Naâº, NHââº, Kâº, Mg²âº, Ca²âº, Clâ, NOââ, POâ³â, SOâ²â) beneath a common epiphyte (Tillandsia usneoides L.) across cover percentages (0%â20%, 21%â40%, 41%â60%, 61%â80%, 81%â100%) for 47 storms. Throughfall amount inversely responded to epiphyte cover while increasing salt wash-off and intracellular leaching. Greater epiphyte cover released NHâ⺠and decreased NOââ from throughfall. Storm conditions (high vapor pressure deficit, moderate wind speeds, and low intensity) strengthened throughfall responses as T.usneoides cover increased. Factorial MANOVA results revealed significant trends for throughfall ion enrichment or depletion via wash-off, leaching, and uptake. These data suggest that inclusion of epiphyte alterations to rainwater and solute inputs in ecosystem nutrient budgeting studies should consider the full continuum of epiphyte cover represented at that site.
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BF, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The invasive, non-native herb, giant knotweed (
Polygonum sachalinense), is becoming increasingly common in riparian corridors throughout North America and Europe. Despite its prevalence, there has ...been limited study of its ecological impacts. We investigated the effects of knotweed invasion on the abundance and diversity of forest understory plants, and the quantity and nutrient quality of leaf-litter inputs, in riparian forests in western Washington, USA. Among 39 sampling locations, knotweed stem density ranged from 0 to 8.8
m
−2. Richness and abundance (cover or density) of native herbs, shrubs, and juvenile trees (⩽3
m tall) were negatively correlated with knotweed density. Where knotweed was present (>5.3
stems
m
−2), litter mass of native species was reduced by 70%. Carbon:nitrogen ratio of knotweed litter was 52:1, a value 38–58% higher than that of native woody species (red alder
Alnus rubra and willow
Salix spp.). Resorption of foliar N prior to leaf drop was 76% in knotweed but only 5–33% among native woody species. By displacing native species and reducing nutrient quality of litter inputs, knotweed invasion has the potential to cause long-term changes in the structure and functioning of riparian forests and adjacent aquatic habitats.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Plant species continue to be introduced in North America for various purposes. If the trend continues, it is probable that some will escape cultivation and become invasive in native ecosystems. We ...present a retrospective analysis of several structural, life history, and biogeographical attributes of woody plants introduced in North America to determine which traits characterize species that have and have not invaded. Predictive models derived from discriminant analysis correctly classified 86.2% of the species in cross-validation, whereas those derived from classification and regression trees classified 76% correctly. From these models we created a hierarchical predictive tree that allows the user to divide species into three categories: admit (low risk of invasiveness), deny admission (high risk of invasiveness), or delay admission for further analyses and/or monitor intensively (risk cannot adequately be assessed based on only the included attributes). We recommend that species that are highly invasive elsewhere not be allowed into the U.S. and that a more conservative introduction policy using a hierarchical predictive method be employed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
ASHP Statement on the Roles of Pharmacy Technicians Schultz, Jennifer M; Jeter, Cynthia Kay; Martin, Naomi M ...
American journal of health-system pharmacy,
2016-June-15, 2016-Jun-15, 2016-06-15, 20160615, Volume:
73, Issue:
12
Journal Article
Peer reviewed
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objectives. To prospectively compare the diagnostic ability of unenhanced spiral computed tomography (NCCT) and intravenous urogram (IVU) in the evaluation of adults with acute flank pain.
Methods. ...After giving informed consent, 106 adult patients with acute flank pain suspected of having urolithiasis underwent NCCT followed by IVU. Subsequent follow-up was scheduled within 72 hours in the Urology Clinic. Each NCCT was read by a single radiologist who was unaware of clinical history and IVU results. Each IVU was read by a different radiologist who was unaware of clinical history and NCCT results. Sensitivity, specificity, and positive and negative predictive values were determined for NCCT and IVU.
Results. The diagnosis of ureterolithiasis was defined as unequivocal evidence of urolithiasis on either NCCT or IVP. Seventy-five of 106 patients evaluated were diagnosed with ureterolithiasis. Clinical follow-up was available in 74 (98%) stone patients and in 31 (100%) of 31 non-stone patients. In 72 of the 75 patients diagnosed with ureteral calculi, the NCCT made the diagnosis. IVU made the diagnosis in 65 of the 75 patients. Of the 31 patients without ureterolithiasis, the NCCT was negative in all cases. IVU was negative in 29 of the 31 cases. Unenhanced spiral CT was 96% sensitive and 100% specific (
P <0.001). IVU was 87% sensitive and 94% specific (
P <0.001). Compared with IVU, using the log odds ratio and Fisher’s exact test, NCCT was significantly better able to predict the presence of urolithiasis (
P = 0.015).
Conclusions. NCCT accurately diagnoses ureterolithiasis in patients presenting with acute flank pain. NCCT is significantly better than IVU in determining the presence of urolithiasis.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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