bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restoring in‐stream habitat in urban catchments: Modify flow or the channel?
Authors: Anim Desmond O. , Fletcher Tim D. , Vietz Geoff J. , Pasternack Gregory B. , Burns Matthew J. 
Published: October 2018

AbstractUrban streams have almost universally altered physical habitat conditions due to excess stormwater run‐off. This includes changes to in‐channel hydraulics and channel morphology. Restoration of in‐channel habitat has two main levers: address the hydrology or channel morphology. Both variables impact in‐stream habitat, but understanding the relative role of hydrologic and morphologic change remains a challenge. This study uses two‐dimensional hydraulic modelling to examine the relative roles of flow and channel morphology in setting hydraulic conditions. We investigated four test scenarios involving the combinations of urban versus natural hydrology and urban versus natural channel morphology. The analysis investigated three ecologically relevant hydraulics characteristics: bed mobilization, retentive habitat, and floodplain inundation, using Shields stress, shallow slow‐water habitat (SSWH) area, and floodplain inundation area hydraulic metrics, respectively. The results indicate substantial differences in hydraulic conditions between the two reaches. The urban reach showed increased bed mobility potential and SSWH availability plummeted as flow increased, whereas the natural channel showed a relatively stable bed with substantially more SSWH at most flows. Floodplain inundation frequency was low in the urban channel with decreased duration. Scenarios examined suggest that hydraulic conditions are highly sensitive to channel morphology relative to flow regime. This suggests that once channel form has been degraded, mitigating urbanization impacts on flow regime cannot maintain “natural” channel hydraulics. Management approaches therefore must protect channel morphology from change. Where the channel has already been fundamentally altered, opportunities for channel morphology rehabilitation need to be considered.
Early urine electrolyte patterns in patients with acute heart failure
Authors: Collins Sean P. , Jenkins Cathy A. , Baughman Adrienne , Miller Karen F. , Storrow Alan B. , Han Jin H. , Brown Nancy J. , Liu Dandan , Luther James M. , McNaughton Candace D. , Self Wesley H. , Peng Dungeng , Testani Jeffrey M. , Lindenfeld JoAnn 
Published: October 2018

AbstractAimsWe conducted a prospective study of emergency department (ED) patients with acute heart failure (AHF) to determine if worsening HF (WHF) could be predicted based on urinary electrolytes during the first 1–2 h of ED care. Loop diuretics are standard therapy for AHF patients. A subset of patients hospitalized for AHF will develop a blunted natriuretic response to loop diuretics, termed diuretic resistance, which often leads to WHF. Early detection of diuretic resistance could facilitate escalation of therapy and prevention of WHF.Methods and resultsPatients were eligible if they had an ED AHF diagnosis, had not yet received intravenous diuretics, had a systolic blood pressure > 90 mmHg, and were not on dialysis. Urine electrolytes and urine output were collected at 1, 2, 4, and 6 h after diuretic administration. Worsening HF was defined as clinically persistent or WHF requiring escalation of diuretics or administration of intravenous vasoactives after the ED stay. Of the 61 patients who qualified in this pilot study, there were 10 (16.3%) patients who fulfilled our definition of WHF. At 1 h after diuretic administration, patients who developed WHF were more likely to have low urinary sodium (9.5 vs. 43.0 mmol; P < 0.001) and decreased urine sodium concentration (48 vs. 80 mmol/L; P = 0.004) than patients without WHF. All patients with WHF had a total urine sodium of <35.4 mmol at 1 h (100% sensitivity and 60% specificity).ConclusionsOne hour after diuretic administration, a urine sodium excretion of <35.4 mmol was highly suggestive of the development of WHF. These relationships require further testing to determine if early intervention with alternative agents can prevent WHF.
Sinuosity evolution along an incising channel: New insights from the Jordan River response to the Dead Sea level fall
Authors: Dente Elad , Lensky Nadav G. , Morin Efrat , Dunne Thomas , Enzel Yehouda 
Published: October 2018

AbstractThe geomorphic evolution of the Jordan River in recent decades indicates that interaction between incision and high‐magnitude floods controls sinuosity changes under increasing mouth gradients during base‐level fall. The evolution of the river was analyzed based on digital elevation models, remotely sensed imagery, hydrometric data, and a hydraulic model. The response varies along the river. Near the river mouth, where incision rate is high and a deep channel forms, overbank flooding is less likely. There, large floods exert high shear stress within the confined channel, increasing sinuosity. Upstream, near the migrating knickzone channel gradients also increase, incision is more moderate and floods continue to overtop the banks, favoring meander chute cutoffs. The resulting channel has a downstream well‐confined meandering segment and an upstream low‐sinuosity segment. These new insights regarding spatial differences along an incising channel can improve interpretations of the evolution of ancient planforms and floodplains that responded to base‐level decline. © 2018 John Wiley & Sons, Ltd.
Early (90‐day) mortality after radical radiotherapy for head and neck squamous cell carcinoma: A population‐based analysis
Authors: Hamilton Sarah Nicole , Tran Eric , Berthelet Eric , Wu Jonn , Olson Robert 
Published: October 2018

AbstractBackgroundA retrospective, population‐based analysis of 90‐day mortality in patients with squamous cell carcinoma of the head and neck treated with radiotherapy was performed to determine the early mortality rate and associated risk factors.MethodsData were abstracted for all consecutive patients with cancer of the head and neck treated from 1998 to 2014 at the BC Cancer Agency with curative intent radiotherapy (n = 5658). Logistic regression analysis was used to determine factors associated with early mortality.ResultsThe median age at diagnosis was 63 years. The mortality rate at 90 days after starting radiotherapy (RT) was 3.6% (n = 203/5658). The cause of death was attributed to head and neck cancer for 81% of patients. Multivariate analysis demonstrated that increasing age, oral cavity subsite, and advanced T and N classification were associated with an increased risk of early mortality (p < .05).ConclusionsThe risk of early mortality was 3.6%. Elderly patients with advanced T and N classification had the highest risk of early mortality.
The dynamics of national ICT ecosystems
Authors: Nguyen Simon Pettersen , Mahundi Masoud Hussein 
Published: October 2018

AbstractThe ICT ecosystem is a new and emerging concept which suggests that ICTs should not be viewed as technical systems in insolation, but rather as a part of a wider network that takes into account non‐technical dynamics, being socio‐economic, political, spatial, and such. Nguyen, Nielsen, and Sæbø (2017) have conceptualized thenational ICT ecosystemwhich adequately describes the socio‐technical components surrounding an ICT embedded within a country. However, their conceptualization is merely a static description of the ecosystems' components without sufficient description of their dynamics. Based on a case study of a health management information system and its surrounding ecosystem in Tanzania, we contribute by identifying three dynamics of national ICT ecosystems: (1) evolution occurring in small and incremental steps; (2) co‐adaption in the ecosystem following integrations between ICTs; and (3) ICTs being integrated due to perceived network effects.
Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial
Authors: Dehmer Steven P. , Maciosek Michael V. , Trower Nicole K. , Asche Stephen E. , Bergdall Anna R. , Nyboer Rachel A. , O'Connor Patrick J. , Pawloski Pamala A. , Sperl‐Hillen JoAnn M. , Green Beverly B. , Margolis Karen L. 
Published: October 2018

BackgroundPharmacist‐managed (team‐based) care for hypertension with home blood pressure monitoring support interventions has been widely studied and shown to be effective in improving rates of hypertension control and lowering blood pressure; however, few studies have evaluated the economic considerations related to bringing these programs into usual practice.ObjectiveTo analyze the economic outcomes of the Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (Hyperlink) study, a cluster randomized controlled trial which used home blood pressure telemonitoring and pharmacist case management to achieve better blood pressure control in patients with uncontrolled hypertension was conducted.MethodsA prospective analysis compared differences in medical costs and encounters in the Hyperlink telemonitoring intervention and usual care groups in the 12 months pre‐ and postenrollment using medical and pharmacy insurance claims from a health care sector perspective. Generalized estimating equation models were used to estimate differences between the groups over time. These results, combined with previously published prospective study results on intervention costs and blood pressure outcomes, were used to estimate cost‐effectiveness measures for blood pressure control and reduction.FindingsTotal medical costs in the intervention group were lower compared with the usual care group by an average of $281 per person, but this difference was not statistically significant. Clinic‐based office visit, radiology, pharmacy and hospital costs were also nonsignificantly lower in the intervention group. Statistically significant differences were found in lipid‐related laboratory costs (higher) and in hypertension‐related (higher) and lipid‐related (lower) pharmacy costs. Patterns in medical costs were similar for medical encounters. On average, the intervention cost $7337 per person achieving hypertension control and $139 or $265 per mm Hg reduction in systolic or diastolic blood pressure, respectively.ConclusionsHome blood pressure monitoring and pharmacist case management to improve hypertension care can be implemented without increasing, and potentially reducing, overall medical care costs.
Longitudinal trends in base antiretroviral therapy utilization for human immunodeficiency virus from 2000 to 2016
Authors: Magagnoli Joseph , Sutton S. Scott , Hardin James W. , Edun Babatunde 
Published: October 2018

ObjectiveThe aim of this retrospective, observational study was to describe utilization trends in the base antiretroviral therapy (ART) for management of human immunodeficiency virus in United States Veterans for the time period of 1998 to 2016.MethodsThe Veterans Affairs Informatics and Computing Infrastructure was accessed to obtain ART utilization trends among US Veterans using a national cohort of unique persons within the Department of Veterans Affairs between January 1998 and September 2016. Spaghetti plots of summary statistics were created to visualize the trends in ART across time. For each month, the percentage that each regimen or individual drug constitutes for each ART during that particular month was calculated.ResultsA total of 38 347 patients and 3 714 472 patient‐months were eligible for the study. ART base drug utilization patterns have undergone numerous changes over the past 18 years and the utilization patterns consistently coincided with treatment guideline updates. Among the specific ART regimens, the boosted protease inhibitor (PI) regimen had a total of 17 372 patients and 1 126 708 patient‐months; the integrease strand transfer inhibitors (ISTIs) regimen had 6666 patients and 197 265 patient‐months; the non‐nucleoside reverse transcriptase inhibitors regimen had 17 449 patients and 1 001 606 patient‐months; the PI regimen had 11 367 patients and 571 589 patient‐months; and the single tablet regimen had a total of 18 034 patients and 817 304 patient‐months.ConclusionPatients were initially managed in 1998 with multiple tablet regimens consisting of a base PI. Many changes to base ART utilization subsequently occurred over the next 18 years. Examples of changes include the advent of boosted therapy, once‐daily dosing, single tablet regimens, and ISTIs.
Creation of Experiential Education Honors to replace Dean's List in recognizing students for exemplary experiential achievement
Authors: Briceland Laurie L. , Rosa Sandra W. , Jablanski Cindy , Lubowski Teresa J. 
Published: October 2018

ObjectiveTo develop and implement an Experiential Education (EE) Honors policy designed to recognize excellence throughout introductory/advanced pharmacy practice experience (IPPE/APPE) sequences, as a replacement of Dean's List recognition of academic achievement during the Final Professional (P4) year. The created policy recognizes excellence in ≤10% of students during the APPE sequence predicated on preceptor APPE evaluation of communications, professionalism, and therapeutics knowledge inherent within the APPEs. The awardee selection criterion incorporates preceptor feedback/grades, faculty rubric‐graded work‐products, national poster presentation during P4, and previous IPPE distinctions. Disqualifications include academic integrity infractions, ≤B+ grades, and “Needs Improvement” student learning outcome/competency ratings.MethodsGrade point averages (GPAs) of EE Honors awardees were compared with an equal number of graduating students in the same cohort who earned the highest GPAs to test the hypothesis that EE Honors awardees would be a different subset of graduates than those solely with high GPAs.ResultsEE Honors have been implemented for 5 years. Over the 5‐year collective, students who received EE Honors earned an average GPA of 3.41, which was lower than top GPA earners (an average GPA of 3.82 for a similar size cohort), demonstrating that the EE Honors awardees were a different subset of students than solely the top GPA earners.ConclusionsThe EE Honors Policy has replaced Dean's List to recognize exemplary performance in 10% of students during the EE sequences. Not surprisingly, due to the comprehensive nature of APPE evaluation which includes professionalism and communications skills, EE award winners were not necessarily the students with the highest GPAs, revealing a different subset of the student population who rises to the top when recognizing exemplary experiential performance.
Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients
Authors: Taber David J. , Gebregziabher Mulugeta , Posadas Aurora , Schaffner Caitlin , Egede Leonard E. , Baliga Prabhakar K. 
Published: October 2018

BackgroundHealth disparities in African‐American (AA) kidney transplant recipients compared with non‐AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity.ObjectiveTo assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients.MethodsProspective, pharmacist‐led, technology‐aided, 6‐month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one‐year posttransplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent‐to‐treat analyses, with differences assessed between AA and non‐AA recipients.ResultsThe participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs end of study 68%, P = 0.054) and hemoglobin A1c (HgbA1c) <7% (baseline 33% vs end of study 47%, P = 0.061). African‐Americans demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, P = 0.026), which was not evident in non‐AAs (−0.13 mmHg per month, P = 0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, P = 0.003), which was similar within AAs (−0.11% per month, P = 0.004) and non‐AAs (−0.14% per month, P = 0.029). There were no changes in low‐density lipoproteins, triglycerides, or high‐density lipoproteins over the course of the study. Medication errors were significantly reduced and self‐reported medication adherence significantly improved over the course of the study.ConclusionThese results demonstrate the potential efficacy of a pharmacist‐led, technology‐aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients (ClinicalTrials.gov NCT02763943).
Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patients
Authors: Heavner Mojdeh S. , Nguyen Nam K. , Knauert Melissa P. , Verceles Avelino , Pisani Margaret A. , Seung Hyunuk , Gonzales Jeffrey P. 
Published: October 2018

ObjectivesSleep deprivation is associated with significant patient morbidity in the intensive care unit (ICU) and must be addressed through a systematic, interdisciplinary approach. The objectives of this study were to describe pharmacists' perceptions and practices regarding sleep in the ICU. We also assessed the prevalence and characteristics of systematic processes to promote sleep in ICU patients.MethodsWe administered an international, cross‐sectional survey to 1723 pharmacists via a member distribution list through the American College of Clinical Pharmacy Critical Care Practice and Research Network. The survey included questions about pharmacists' demographics, practice sites, and individual and site‐specific perceptions of sleep promotion practices.ResultsTwo hundred fifty‐five (15%) pharmacists initiated the survey and 195 were completed and included for analysis. Respondents most commonly had less than 5 years of experience in ICU practice, completed a Critical Care Pharmacy Residency, and worked in a Medical or Surgical ICU. All participants responded that the assessment of sleep quality is important in the ICU. Most respondents reported that they recommend both non‐pharmacological (81%) and pharmacological (93%) interventions to optimize sleep in their ICU patients. Pharmacists reported most commonly recommending to adjust non‐sleep‐related medications to avoid nighttime administration (41.4%) and initiating melatonin receptor agonists (33.7%). A low number of respondents (9%) reported the presence of a sleep protocol in their ICU. Within this subset, 59% reported that less than half of their ICU patients actually receive the protocol and 41% indicated low protocol compliance.ConclusionsCritical care pharmacists value sleep, and most recommend interventions to optimize sleep in their patients. However, sleep protocols in ICUs are uncommon, and overall protocol use and compliance are perceived to be low. Pharmacists can improve protocol use and compliance and potentially impact sleep, delirium incidence, or other ICU patient outcomes. This impact should be evaluated in future studies.
Psychosocial determinants of physician acceptance toward an antimicrobial stewardship program and its computerized decision support system in an acute care tertiary hospital
Authors: Chua Alvin Q. , Tang Sarah S. L. , Lee L. W. , Yii Daphne Y. C. , Kong S. T. , Lee Winnie , Chlebicki Maciej P. , Kwa Andrea L. H. , Lie Desiree A. 
Published: October 2018

ObjectivesAntimicrobial stewardship programs (ASPs) often employ multipronged strategies, including Computerized Decision Support Systems (CDSSs), to promote appropriate prescribing. Physicians are key determinants of program effectiveness, yet little is known about their attitudes towards these interventions. We aimed to explore hospital physicians' perceptions of and attitudes toward ASPs and CDSSs using a focus group discussion (FGD) approach.MethodsWe recruited physicians from one large tertiary teaching hospital where an ASP and CDSS were available, by purposive sampling and snowballing. Study participants were junior physicians (house officers and medical officers), and senior physicians (consultants who supervise the junior physicians and lead the clinical teams). FGDs for junior and senior physicians were conducted separately using the same question guide. FGDs were audio‐recorded and transcripts independently and systematically coded with subsequent adjudication. Major themes on facilitators and barriers to acceptance of ASPs were extracted. FGDs and coding occurred concurrently. Data analysis and interpretation were consistent with a grounded theory approach.ResultsTwenty‐nine junior and eight senior physicians participated in six and two FGDs, respectively. Theme saturation was achieved. Two themes reflected facilitators for ASP acceptance: (1) helpfulness of ASP strategies; and (2) ASP team members' proactive contact, both of which guided physician antibiotic prescribing. Four themes identified barriers: (1) the primary team's clinical judgment is of utmost importance; (2) the consultant makes the final decision; (3) lack of awareness of ASP strategies/CDSS; and (4) perceived complexity of the CDSS.ConclusionCommunication, education, and medical hierarchy influence ASP acceptance by physicians. Future research is needed to identify best approaches to enhance collaboration between physicians and their ASP teams to enhance ASP/CDSS acceptance.
Evaluation of a comprehensive, integrated, medical service‐based pharmacy practice model
Authors: Vest Tyler A. , Carrasquillo Michelle A. , Morbitzer Kathryn A. , Cruz Jennifer L. , Eckel Stephen F. 
Published: October 2018

PurposePrior to 2008, the pharmacy practice model utilized by the University of North Carolina (UNC) Medical Center was a traditional central pharmacist and clinical specialist model. The department of pharmacy implemented a unique and innovative pharmacy practice model in 2008 organized around medical services. Through this medical service‐based model, all patients are now covered by a pharmacist. The objectives of this study were to evaluate the sustainability of the improvements associated with the medical service‐based pharmacy practice model at UNC Medical Center, which included pharmacist turnover, employee satisfaction and workforce engagement, resident and student involvement in patient care, and inpatient drug costs.MethodsThis retrospective analysis focused on data spanning fiscal year (FY) 2004 to 2016. Internal data reporting sources were analyzed to evaluate the outcomes of this practice model.ResultsIn FY 2016, 67% of work groups were tier 1 (highest satisfaction tier) and 4% were tier 3 (lowest satisfaction tier) and inpatient pharmacist turnover rate was only 7% compared with a 17% hospital turnover rate. Prior to 2008, the average difference between actual and expected drug expenditures was $2.8 million per year, and post‐implementation, the average difference improved to $3.3 million per year. In FY 2017, the department had 35 residents, representing a 169% increase in number of residency positions available compared with FY 2008. In FY 2016, 134 months of early immersion experiences were offered, 29 months of Introductory Pharmacy Practice Experiences (IPPEs), and 417 months of Advanced Pharmacy Practice Experiences (APPEs), which represents a 263% increase in IPPE months and a 369% increase in APPE months from FY 2008.ConclusionThis practice model, along with other factors, has had a continued sustained positive impact on employee engagement, inpatient drug costs, and patient care in our health system. In addition, this practice model is organized around pharmacist responsibilities that support continued growth of pharmacy learners.