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The concept of saturation is commonly mentioned in pharmacy research, but there has been recent debate among the applied qualitative research community that challenges the appropriateness of this construct for many qualitative research efforts. This begins by describing the origins of saturation as a grounded theory construct and discusses how saturation is currently being used. Three challenges are discussed related to the use of saturation in pharmacy related to the epistemological, methodological, and practical use of saturation by pharmacy researchers and how they relate to the goals and reporting quality of pharmacy practice research The commentary describes how the concept of information power and established guidance on analysis quality can better justify sample size inform decisions about when to cease further data collection, hopefully increasing the transparency of reporting and supporting rigorous and coherent analyses. [ABSTRACT FROM AUTHOR]

The patient-reported outcomes measurement information system (PROMIS) was developed by investigators funded by the National Institutes of Health as a standardized means of directly assessing the patients' perspectives across domains. PROMIS domains include physical function, pain, fatigue, emotional distress, and social health. Various studies have reported increased utilization of PROMIS in research articles in specific specialties; however, the extent to which PROMIS has been employed in the field of plastic and reconstructive surgery remains unclear. The goal of the present study was to characterize the prevalence and trends of PROMIS within plastic and reconstructive surgery articles. Literature search was conducted across multiple databases for PROMIS studies within plastic surgery literature. We identified 136 articles and the following data were extracted: author name, journal, impact factor, country of origin, year of publication, publication type, subspecialty, study size, and PROMIS measures used. In this study, 136 studies met the inclusion criteria. There was an overall increasing trend in the number of PROMIS studies published. The most common subspecialties that used PROMIS measures were general reconstruction (n = 24), hand (n = 9), and burn (n = 5). The most used PROMIS measures were the pain interference (n = 26), pain intensity (n = 15), and depression (n = 13). A total of 24 journals included PROMIS studies with a mean impact factor of 3.73 (SD = 3.2). The most common country of origin was the United States (n = 42). The data demonstrated an increasing use of PROMIS within plastic surgery across a wide variety of subspecialities and study designs. The characterization of these trends allows researchers and clinicians alike to gain a greater understanding of this powerful tool in measuring patient care. [Display omitted] [ABSTRACT FROM AUTHOR]

• Incorporating early bedside cycling into inpatient cardiac rehabilitation programs after heart valve surgery could lead to more recovery of walking functional capacity, ADL autonomy, and pulmonary function. • Adding early bedside cycling to routine inpatient cardiac rehabilitation following heart valve surgery could lead to shorter ICU and total hospital stays. • The better physical function and shorter hospital stays that could result from adopting early bedside cycling following heart valve surgery can have several practical implications. To assess whether adding bedside cycling to inpatient cardiac rehabilitation (CR) early after heart valve surgery could lead to better physical function and shorter length of hospital stays. This is a single-centered, randomized, controlled, parallel-group intervention study. This study was conducted at the National Heart Institute from December 2022 to June 2023. Thirty-one patients following heart valve surgery completed this study after being randomized into 2 groups: an intervention group (n 1 =16) and an active control group (n 2 =15). Eligibility criteria were heart valve surgery with median sternotomy, clinical stability, and age from 20 to 40 years. The intervention group received early bedside cycling for the lower limbs, using a mini bike, in addition to an inpatient CR program, and the control group received the inpatient CR program alone. The primary outcome was the physical functional capacity assessed by the 6-minute walk distance (6MWD). The secondary outcomes were the Barthel Index (BI), the forced vital capacity (FVC), the length of intensive care unit (ICU) stay, the total length of hospital stay, and the physical component summary (PCS) of the 12-item Short Form (SF-12) Health Survey. Compared with the control group, the intervention group showed significantly greater 6MWD (P <.001), BI score (P <.001), and FVC (P =.006) at hospital discharge, and shorter ICU stay (P =.002) and total hospital stay (P =.015). At 1-month follow-up, the intervention group showed a non-significantly higher PCS mean score than the control group (P =.057). Adding early bedside cycling to a usual inpatient CR program after heart valve surgery could induce significantly greater short-term physical functional capacity as assessed by the 6MWD, better activities of daily living as evaluated by the BI, higher pulmonary function as measured by the FVC, and shorter lengths of ICU and total hospital stays than the usual inpatient CR program alone. [ABSTRACT FROM AUTHOR]

Various studies regarding retractions of publications have determined the rate of retraction has increased in recent years. Although this trend may apply to any field, there is a paucity of literature exploring the publication of erroneous studies within plastic and reconstructive surgery. The present study aims to identify trends in frequency and reasons for retraction of plastic and reconstructive surgery studies, with analysis of subspecialty and journals. A database search was conducted for retracted papers within plastic and reconstructive surgery. The initial search yielded 2347 results, which were analyzed by two independent reviewers. 77 studies were jointly identified for data collection. The most common reasons for retractions were duplication (n = 20, 25.9 %), request of author (n = 15, 19.5 %), plagiarism (n = 9, 11.6 %), error (n = 9, 11.6 %), fraud (n = 2, 2.6 %), and conflict of interest (n = 1, 1.3 %). 15 were basic science studies (19.4 %), 58 were clinical science studies (75.3 %), and 4 were not categorized (5.2 %). Subspecialties of retracted papers were maxillofacial (n = 29, 37.7 %), reconstructive (n = 17, 22.0 %), wound healing (n = 8, 10.4 %), burn (n = 6, 7.8 %), esthetics (n = 5, 6.5 %), breast (n = 3, 3.9 %), and trauma (n = 1, 1.3 %). Mean impact factor was 2.9 and average time from publication to retraction was 32 months. Analysis of retracted plastic surgery studies revealed a recent rise in frequency of retractions, spanning a wide spectrum of journals and subspecialties. [Display omitted] [ABSTRACT FROM AUTHOR]

Obesity is considered a modifiable risk factor prior to total knee arthroplasty (TKA); however, little data support this hypothesis. Our purpose was to evaluate patients who have a body mass index (BMI) >40 presenting for TKA to determine the incidence of: (1) patients who achieved successful weight loss through nutritional modification or bariatric surgery and (2) patients who underwent TKA over the study period without the presence of a formal optimization program. This was a retrospective, single-center analysis. Inclusion criteria included: Kellgren and Lawrence grade 3 or 4 knee osteoarthritis, BMI >40 at presentation, and minimum 1-year follow-up (mean 45 months) (N = 624 patients). Demographics, weight loss interventions, pursuit of TKA, maximum BMI change, and Patient-Reported Outcomes Measurement Information System scores were collected. Multivariable logistic and linear regressions evaluated associations of underlying demographic and treatment characteristics with outcomes. There were 11% of patients who ended up pursuing TKA over the study period. Bariatric surgery was 3.7 times more likely to decrease BMI by minimum 10 compared to nonsurgical intervention (95% confidence interval [CI] [1.7, 8.1]; P =.001). Bariatric surgery resulted in mean BMI change of −3.3 (range, 0 to 22) compared to nonsurgical interventions (−2.6 [range, 0 to 12]) and no intervention (0.4 [range, 0 to 15]; P <.0001). Bariatric surgery patients were 3.1 times more likely to undergo TKA (95% CI [1.3, 7.1]; P =.008), and nonsurgical interventions were 2.4 times more likely to undergo TKA (95% CI [1.3, 4.5]; P =.006) compared to no intervention. Non-White patients across all interventions were less likely to experience loss >5 BMI compared to White patients (95% CI [0.2, 0.9]; P =.018). Most patients were unable to reduce BMI more than 5 to 10 over a mean 4-year period without a formal weight optimization program. Utilization of bariatric surgery was most successful compared to nonsurgical interventions, although ultimate pursuit of TKA remained low in all cohorts. [ABSTRACT FROM AUTHOR]

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The prostatic utricle (PU) consists of the caudal remnant of the Müllerian duct and the urogenital sinus. The term "vagina masculina" is used if other Müllerian structures are associated with the PU. This work aims to investigate the incidence, management, and follow up of enlarged PUs and Müllerian remnants in males with posterior hypospadias. This study presents a retrospective review of cases presented with posterior hypospadias over a 5-year period. Prior to hypospadias repair, retrograde urethrograms were used to investigate enlarged PU. Subsequently, they were classified according to the Ikoma score and further assessed by karyotyping and cystoscope. Surgical excision was indicated in cases with symptomatic utricles or vagina masculina. Thirty patients were included in the study in the period between 2015 and 2020 (Table). All cases were asymptomatic initially. Twelve patients were diagnosed with enlarged PU; three of them had vagina masculina. One case with perineal hypospadias had a separate perineal opening for PU. Following hypospadias repair, three of the eight cases treated conservatively turned symptomatic. The incidence of enlarged PU and Müllerian remnants varied among different studies. However, it increased as the severity of hypospadias increased. Preoperative urethrogram was helpful in the diagnosis and classification of PU, but it had its limitations. Cystoscope was more advantageous in diagnosing vagina masculina. Although most cases were asymptomatic, some turned symptomatic after hypospadias repair. Some cases with perineal hypospadias had PU with a separate perineal opening. The incidence of enlarged PUs or Müllerian remnants was 40%. Although cases were asymptomatic before hypospadias surgery, some cases turned into symptomatic after hypospadias repair. In some cases, the PU or Müllerian remnants had a separate perineal opening. They can be classified as a particular form of Ikoma grade III necessitating surgical intervention. Summary table Patients with enlarged prostatic utricle or Müllerian remnants. Summary table No Type of Hypospadias Ikoma Score 1 Penoscrotal II (V) 2 Penoscrotal I 3 Penoscrotal I 4 Perineal II 5 Penoscrotal I 6 Scrotal II (V) 7 Scrotal III (V) 8 Penoscrotal II 9 Penoscrotal I 10 Perineal III (Particular Form) 11 Penoscrotal II 12 Perineal II (V): Vagina masculina. [ABSTRACT FROM AUTHOR]

The purpose of our study was to compare the performance of 2D (FFDM) against 3D (FFDM plus DBT) examinations in the post-treatment surveillance of asymptomatic breast cancer survivors. A list of women with a history of breast cancer who underwent screening mammography (2D or 3D) from 5/2017 to 5/2020 was retrieved. A total of 20,210 examinations were identified and performance metrics were compared. There were no statistically significant difference in cancer detection rate (CDR) (p = 0.38), recall rate (RR) (p = 0.087), or positive predictive value (PPV) (p = 0.74) between 2D vs. 3D examinations. Stratification by breast tissue identified no statistically significant difference in CDR (p = 0.581 and p = 0.428), RR (p = 0.230 and p = 0.205), or PPV (p = 0.908 and p = 0.721) between fatty/scattered and heterogeneous/extremely dense breast tissue when comparing 2D vs 3D examinations. Stratification by age did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 2D vs. 3D examinations in the 60–69 years group (p = 0.021). Stratification by race did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 3D vs. 2D examinations in white women (p = 0.036). Stratification by laterality (bilateral vs. unilateral post mastectomy) did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased in 2D vs. 3D examinations in unilateral studies (p = 0.009). For asymptomatic women with a history of breast cancer, there is no evidence that the addition of DBT to FFDM improves CDR, RR, or PPV. More studies are needed concerning screening methodologies supplementing FFDM in the screening regimens of breast cancer survivors. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy disproportionally impacts racial/ethnic minority populations. Regarded as trusted, accessible, and knowledgeable, pharmacists are strategically positioned to address this threat using effective communication strategies such as motivational interviewing (MI). Little data exists on programs that prepare student-pharmacists to use MI to combat vaccine hesitancy in underrepresented populations. Student pharmacists elected to participate in co-curricular training on addressing COVID-19 vaccine hesitancy in racial/ethnic minority populations. The training included a web-based module on using MI to address COVID-19 vaccine hesitancy and a live group objective structured clinical examination (OSCE) with standardized patient encounters that included prevalent COVID-19 vaccine concerns. Faculty assessed the group's ability to employ core elements of MI to correct vaccine misinformation. After the OSCE, students received feedback from the standardized actors and evaluators. Change in student confidence was assessed. After the training, students volunteered at eight different community events to utilize MI to address vaccine hesitancy in underrepresented patient populations. A total of 17 students completed the training. Four out of the six groups received a passing score on the OSCE. Students performed satisfactory in the major domains of MI but struggled to answer knowledge-based questions regarding COVID-19 vaccines. As a result of the training, a significant increase in student confidence was seen. All participating students rated the training as either "excellent" or "good." A novel, co-curricular educational initiative was an effective tool to prepare student-pharmacists to utilize MI to combat vaccine hesitancy in underrepresented racial/ethnic minority populations. [ABSTRACT FROM AUTHOR]

Amidst the growth and development of different civilizations, art and architecture progressed simultaneously, shaping one another. At many times they advanced analogously. This research presents different aspects of art that are employed in churches and investigates whether there is an analogy between these aspects in church architecture as well or not. Cases from different church denominations are presented from both Egypt and Mediterranean countries in Western Europe, thus discussing the dialect between art and architecture. The domain of the church was selected for this dialect, as art is employed affluently in many worship houses in general and churches specifically, deeming the task viable and comprehensible. [ABSTRACT FROM AUTHOR]

Background: Even though patient engagement in the pharmacy encounter is low, few studies focus on activating patients. A Question Prompt List (QPL) has been used successfully in other parts of healthcare to encourage patients to raise their questions and concerns. For a QPL to be useful in a pharmacy setting, it first must be considered valuable and be accepted by pharmacists.Objective: To investigate the experience of community pharmacists using a QPL in counseling patients about prescribed medications.Methods: An explorative, qualitative study was conducted in 2020. A QPL, for use in pharmacy counseling, was developed based on previous literature. Semi-structured interviews were held with pharmacists. A thematic analysis approach was conducted, and the analytical framework Technology Acceptance Model (TAM) was used.Results: Data were collected in 7 Swedish community pharmacies in interviews with 29 purposefully selected pharmacists. Three themes were identified: Perceived usefulness: the impact of the QPL on patient activation in the encounter, Perceived ease of use of the QPL in pharmacies, and Increasing the perceived usefulness and ease of use of the QPL. The pharmacists perceived patients as more active in the meeting when using the QPL. The list focused the conversation on medications, which the pharmacists appreciated from a professional point of view. They described the QPL as a useful tool that could easily be integrated into the dispensing process and required little training; however, challenges described were, for example, time constraints and stress.Conclusions: Pharmacists reported that using a QPL improved patient participation in the encounter. Encouraging counseling on medications was seen as beneficial from a professional point of view. In the early adoption phase, the QPL was easy to implement and did not increase the pharmacists' workload. A QPL appears to be a promising tool for pharmacists to improve the quality of the consultation experience. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Increased levels of stromal tumor-infiltrating lymphocytes (sTILs) have recently been considered a favorable independent prognostic and predictive biomarker in triple-negative breast cancer (TNBC). The purpose of this study was to determine the relationship between BI-RADS (Breast Imaging Reporting and Data System) ultrasound lexicon descriptors and sTILs in TNBC.Materials and Methods: Patients with stage I-III TNBC were evaluated within a single-institution neoadjuvant clinical trial. Two fellowship-trained breast radiologists used the BI-RADS ultrasound lexicon to assess pretreatment tumor shape, margin, echo pattern, orientation, posterior features, and vascularity. sTILs were defined as low <20 or high ≥20 on the pretreatment biopsy. Fisher's exact tests were used to assess the association between lexicon descriptors and sTIL levels.Results: The 284 patients (mean age 52 years, range 24-79 years) were comprised of 68% (193/284) with low-sTIL tumors and 32% (91/284) with high-sTIL tumors. TNBC tumors with high sTILs were more likely to have the following features: (1) oval/round shape than irregular shape (p = 0.003), (2) circumscribed or microlobulated margins than spiculated, indistinct, or angular margins (p = 0.0005); (3) complex cystic and solid pattern than heterogeneous pattern (p = 0.006); and (4) posterior enhancement than shadowing (p = 0.002). There was no significant association between sTILs and descriptors for orientation and vascularity (p = 0.06 and p = 0.49, respectively).Conclusion: BI-RADS ultrasound descriptors of the pretreatment appearance of a TNBC tumor can be useful in discriminating between tumors with low and high sTIL levels. Therefore, there is a potential use of ultrasound tumor characteristics to complement sTILs when used as stratification factors in treatment algorithms for TNBC. [ABSTRACT FROM AUTHOR]

Background: Heart failure patients need GPs to adhere to treatment guidelines to improve health outcomes.Objective: To examine the extent to which pharmacotherapy of heart failure patients referred for a Home Medicines Review (HMR) adheres to heart failure management guidelines.Methods: This retrospective study examined HMR reports of patients with heart failure, who were referred for a HMR due to polypharmacy. Analysis established current pharmacotherapy patients were taking and whether it aligned with heart failure guidelines. Further analysis established the types of recommendations made to the referring GPs, in order to optimise heart failure pharmacotherapy.Results: There were 258 patients referred for HMRs between 2015 and 2018; 30 patients had a diagnosis of heart failure and therefore included in the analysis. Out of these, 13 patients were not on an ACEI and 23 were not on an AR2B; seven patients were neither on ACEI nor AR2B. The pharmacist recommended commencing ACEI in 4 patients and an AR2B in 2 patients. Nine patients were not on any B-blocker, and 4 patients were recommended to commence a B-blocker. Most patients were on suboptimal doses of their heart failure medicines, for which dose up-titrations were recommended. There was a recommendation to assess 6 patients for symptoms indicative of heart failure exacerbation, e.g. SOB.Conclusion: Heart failure pharmacotherapy in patients referred for HMRs was not optimised. Pharmacists play a crucial role in optimising the treatment of heart failure, and in prompting GPs to align pharmacotherapy with treatment guidelines. [ABSTRACT FROM AUTHOR]

Pharmacy schools must have a framework to ensure students have the necessary knowledge, skills, attitudes, and behaviors to be successful during advanced pharmacy practice experiences (APPEs). Ten summative assessments, called APPE-readiness assessments (ARAs), were developed based on eight competencies encompassing skills, behaviors, and attitudes that must be demonstrated prior to APPEs. All eight competencies were assessed in the course Case Studies in Pharmacotherapy IV, which is offered in the final semester of the didactic curriculum immediately prior to APPEs. A 15-question pre- and post-survey was conducted to assess student confidence in performing each APPE-readiness competency. Cohort data was evaluated by the curriculum and assessment committee to assess curriculum effectiveness and areas for improvement. Upon completion of the course, the average first-attempt pass rate across all ARAs was 92.4%. All students who failed on the first attempt passed on the second attempt, thereby demonstrating APPE-readiness. Out of 62 students, 45 and 44 completed the pre- and post-survey, respectively. Prior to the ARAs, the overall average of students who felt (strongly) confident about their ability to perform each competency was 82.2 ± 2.1%. This increased to 92.6 ± 1.6% after the ARAs. The development of an APPE-readiness assessment plan focusing on skills, attitudes, and behaviors provides insight into student and cohort performance and allows for continuous quality assurance of the pre-APPE curriculum. [ABSTRACT FROM AUTHOR]

Upon graduation and licensing, pharmacists work very closely with pharmacy technicians. Despite this, opportunities for learning together as students are limited. We developed and implemented a pilot intraprofessional event for pharmacy and pharmacy technician students. The purpose of this study was to evaluate the perceived value and learner confidence through analysis of participant feedback. Pharmacy students from the University of Waterloo School of Pharmacy and pharmacy technician students from Lambton College participated in an intraprofessional event that included a three-station practice objective structured clinical exam (OSCE) and a case discussion regarding a methadone dispensing error, followed by a facilitated debrief. Upon completion of the event, students were invited to complete an online feedback questionnaire. Twenty-one pharmacy students and 22 pharmacy technician students participated in the event. Twenty-one students completed the questionnaire, for a response rate of 49%. The majority of respondents agreed or strongly agreed that the event enhanced learning and confidence in working together to provide interprofessional care. Students seemed to find the OSCE to be particularly valuable. Feedback suggestions for improvement indicated a desire for more activities and time allocated to the event. We designed and implemented a pilot intraprofessional event that was well-received by pharmacy students and pharmacy technician students. This supports the development of future similar events. [ABSTRACT FROM AUTHOR]

In the discipline of architectural history and theory, it is of crucial importance to analyze buildings and building styles that came from the past, thus attempting to interpret the meanings projected by the architecture of these heritage buildings. Doing so enables one to stand on solid grounds of understanding the cultural identity of a nation. Only by then, future architects would be able to create new architecture, yet still an offspring of their heritage, thus emphasizing the identity of the realm. Religion forms an integral part of one's cultural identity. Throughout history, religious architecture has always been rich in its symbolic aspects. This paper attempts to revisit symbolism in Coptic Orthodox Architectural design, and categorizes it in accordance to the nature of the different symbols, thus enhancing the understanding of this heritage to prepare researchers and practitioners for analysis of symbols in ancient church buildings. It is worth mentioning that this categorization can be adapted to be utilized in the analysis of symbols in religious worship houses from other denominations and other architectural buildings of different functions as well. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care.Objectives: This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship.Methods: Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other.Results: We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care.Conclusion: The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration. [ABSTRACT FROM AUTHOR]

• Antimicrobial stewardship programs are becoming increasingly common. • Clinical practice guidelines are available for antimicrobial stewardship programs. • These guidelines provide valuable information for program recommendations. • Barriers to implementing recommendations need more exploration. Antimicrobial stewardship programs (ASPs) are dedicated to improving antimicrobial use. Although clinical practice guidelines (CPGs) are available for the development of ASPs, it is unclear what the quality of these guidelines are. We therefore systematically reviewed published CPGs for the development of acute care hospital-based ASPs. Primary literature, CPG and health technology assessment databases, and infectious diseases society websites were searched. Abstract and full-text review of the search results for inclusion were performed independently by 2 assessors. Overall quality of included CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. We identified 1,064 unique publications; 18 warranted full-text review. Five publications were included in the final review. The National Institute for Care and Excellence from the United Kingdom, the Dutch Working Party on Antibiotic Policy, and the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America from the United States all had high quality guidelines on the Appraisal of Guidelines for Research and Evaluation II scale. We identified 5 CPGs for creating a hospital-based ASP. Prior authorization and/or restriction policies that appeared in all 5 guidelines should be considered essential for the development of an effective hospital-based ASP. High quality CPGs are available for implementation of ASPs in acute care hospitals. [ABSTRACT FROM AUTHOR]

Abstract Within the quest of better understanding of architecture, interpretation of signs and symbols play an important role. An article was presented earlier to analyze an ancient Coptic Orthodox church, within the course of an ongoing PhD, studying the visual message of this architecture (Guirguis et al., 2016). Now, a contemporary case study is being examined, to investigate whether the modern architecture of the same building type carries a message as its counter in the antiquity, and what the meanings projected might be. The study uncovers meanings imbued by the building showing that this contemporary architecture is an offspring of the Coptic heritage and that it delivers a message to the congregation. [ABSTRACT FROM AUTHOR]

Background: The patient care process (PCP) was adopted to move community pharmacy practice from the traditional dispensing role to a more professional level of patient care. However, research has not yet empirically characterized how pharmacists conduct the PCP in community pharmacies.Objectives: This study characterizes how pharmacists employ the PCP when evaluating medication appropriateness in a simulated community pharmacy setting.Methods: A mixed methods analysis was employed to analyze simulated patient-pharmacist interactions (i.e., consultations), and concurrent think-aloud (checking sessions). Transcripts were quantitatively coded for elements of the PCP. A generic qualitative approach was used to explore how pharmacists provided care.Results: Almost all pharmacists checked for medication indication, safety, and manageability at the end of the process when releasing the medication to the patient. Still, most pharmacists gathered insufficient information to fully evaluate medication appropriateness. Six overarching themes described consultations and checking sessions: missed opportunities, the absence of personalized assessments, reliance on routines, nonspecific questions, communication style, and response to patient cues. The quantitative and qualitative findings together created a picture of incomplete assessments which were driven by technical routines and medication-focused communication.Conclusion: Overall, the majority of pharmacists completed most of the patient-care process. Even so, pharmacists did not complete a full assessment of medication appropriateness. Patient care tasks were driven by routines and occurred at the end of the process, whereas the initial patient assessment and prescription check were mainly devoted to technical activities. Pharmacists had opportunities to enhance patient-centered communication by engaging patients in dialogue and recognizing patient emotional cue. [ABSTRACT FROM AUTHOR]

Background: A collaborative patient-pharmacist interaction is fundamental to greater patient satisfaction with pharmacy care and improved medication adherence. Effective pharmacist-patient communication occurs when both pharmacist and patient are able to successfully attend to not only the typical tasks and goals of the interaction but also basic face needs that underlie all social interaction; autonomy, competence or esteem, and fellowship. Addressing face needs occurs through conventional and strategic communication strategies that respond to the emerging needs throughout an interaction. Pharmacist-patient interactions are not just about transfer of information and medications. Both parties assess the situation, the others' intentions within the context of their own goals and this influences how they choose to act throughout the interaction. Face-work Theory provides a framework to understand these interaction processes in pharmacist-patient communication.Objectives: The aim of this study was to determine face needs, threats and the strategic communication strategies used to address these within community pharmacist-patient interactions.Methods: This exploratory descriptive study drew upon principles of ethology to first describe naturally occurring behaviour and then to interpret this behaviour within the context of Face-work theory. Twenty-five audio-recorded community pharmacist-patient interactions were collected and analyzed. The average length of these interactions was 3:67 min with a range of 0.39 s-9:35 min.Results: Multiple face needs for both pharmacist and patient were evident in most interactions. Autonomy, competence and fellowship face needs were negotiated in the following contexts: participative relationships, concordant role expectations, sensitive topics, and negotiating expertise and knowledge. Competence face needs for both parties were the most dominant need found in negotiating role expectations. The most common communication strategies used to support face were solidarity based strategies while indirect and depersonalized questions were commonly employed to mitigate face threat.Implications and Significance: Face-work Theory is a novel approach to understand processes and outcomes of patient-pharmacist interactions in community pharmacies. Linking speech acts with face needs and threats may help to elucidate how pharmacist-patient interactions achieve both task oriented and interpersonal goals. [ABSTRACT FROM AUTHOR]

Objectives: To describe pharmacists' self-reported refill monitoring activities and test for demographic and work setting differences that contribute to variation.Methods: This study used a cross-sectional survey design. A 4-contact survey was mailed to 599 community pharmacists randomly selected from a list provided by the state board of pharmacy. Surveys were mailed in June and July 2013. Descriptive statistics and analysis of variance were used to characterize these data.Results: Of the 599 surveys mailed, 269 complete responses were received for a 44.9% response rate. Pharmacists reported reviewing the patient's medication profile for 40% of refills. Of the 29% of refills handed off, pharmacists asked 70% of patients if they had any questions and 23% a specific question about drug therapy. Pharmacists at mass merchandisers and those in smaller towns were least likely to examine the profile, whereas pharmacists working at independent stores, owners, and pharmacists with a BS Pharm degree were most likely to hand off refills to patients. Demographic and work-setting characteristics factors were not associated with the rate of asking specific questions about the patient's drug therapy, although pharmacists with a BS Pharm, at an independent store, or working in the smallest towns were least likely to ask "Any questions?" when handing off the prescription.Conclusion: Pharmacists reported reviewing patient profiles, handing off prescriptions, and asking medication-specific questions to fewer than one-half of patients picking up refills. Pharmacists were more likely to inquire if patients had any questions than to ask specific questions, and other researchers have reported that the former phrasing may inadvertently serve to reduce patient engagement. [ABSTRACT FROM AUTHOR]

Background: In Alberta (Canadian province), the Chat Check Chart (CCC) model was developed to help pharmacists understand how patient care standards fit into routine practice. The CCC model outlines a process that covers the following: 1) Chart-asking three prime questions to gather information; 2) Check-perform pharmacotherapy workup by assessing prescription's indication, efficacy, safety and manageability; and 3) Chart-document findings of the pharmacotherapy workup.Objectives: To characterize how pharmacist collect patient information and apply the pharmacotherapy workup when evaluating routine prescriptions in community pharmacy settings.Methods: An observational study with a mixed methods analysis was employed. Participants were surveyed and audio-recorded talking with patients, as well as thinking aloud while evaluating medication therapy. Quantitative analysis was conducted to describe the proportion of time allotted to clinical or technical duties when using the 3 prime questions and pharmacotherapy workup in routine practice. A generic qualitative approach was conducted to describe how the pharmacists evaluated prescriptions and counseled patients.Results: Nine pharmacists from five different pharmacy stores participated in this study. Fifteen recordings of consults and 14 think-alouds were eligible for analysis. Pharmacists allotted 16% of their think-aloud on clinical related issues for new and chronic medications, and the remainder on technical dispensing activities. All pharmacists checked if the medication was safe, but fewer than half checked if the prescription was indicated, effective, or useable (i.e., adherence). Pharmacists covered more content areas when checking the appropriateness for new prescriptions in comparison to chronic refills. Four overarching themes arose from the qualitative analysis: missed opportunities, absence of personalized assessments, reliance on routine pharmacist activities, and non-specific questions.Conclusions: Pharmacists gathered insufficient clinical information to assess their patients' medication therapy, as they overly relied on the patients' profiles, asked patients non-specific questions, and missed patient cues. Routine activities appeared to shape practice including a bias against refill prescriptions and a focus on technical dispensing activities. [ABSTRACT FROM AUTHOR]

Study Objective: To conduct a study to assess the incidence of pulmonary complications associated with robotic-assisted surgeries in women with various gynecologic conditions.Design: Retrospective study.Setting: Tertiary care center.Patients: There were 296 patients included in this study. Patient characteristics and comorbidities were noted. Surgical characteristics and respiratory parameters were recorded for all patients. Intraoperative complications and postoperative complications were noted for up to 30 days after surgery. Patients were followed for a median of 231 days in an effort to detect any long-term complications. The primary outcome was postoperative pulmonary complications, and the secondary outcome measure was all complications.Interventions: None.Measurements and Main Results: The study was composed of 296 patients. Only 5 patients (2%) experienced a pulmonary complication. Overall, 38 patients (13%) experienced complications, including both major and minor complications. Average airway pressure and maximum airway pressure were both associated with a significantly higher risk of pulmonary complications (p = .02 and p = .008, respectively). Age, body mass index, tidal volume, respiratory rate, estimated blood loss, and length of procedure were all found to not be statistically significant in patients who experienced a pulmonary complication versus patients who did not experience one.Conclusion: Robotic gynecologic surgery is safe and tolerated well by most patients. This study supports that there is a low rate of pulmonary complications in those who undergo robotic-assisted surgery for gynecologic indications, as well as a low overall complication rate. [ABSTRACT FROM AUTHOR]

Background: Pharmacogenetic (PGx) testing is an evidence-based approach to finding effective medication therapies. While community pharmacists are ideally situated to provide PGx testing, the extent of its implementation is limited within community pharmacies.Objective: This study aimed to explore trends in the international peer-reviewed primary literature on community pharmacists' implementation of PGx and map the main findings on the Theoretical Domains Framework (TDF).Methods: A literature search and 2-step screening were conducted per PRISMA Extension for Scoping Reviews. Inclusion criteria were English language, community pharmacy setting, full papers, and empirical research. Data were collated in a data extraction form. The main findings were deductively mapped on the TDF with a content analysis approach.Results: Of 1176 identified documents screened, 39 were included in this scoping review. Four groups of research were identified: pre-implementation surveys, interviews, and focus groups (56%, n=22), PGx implementation: single cohort to assess feasibility (38%, n=15), PGx implementation: controlled study to assess feasibility (n=1, 2.5%), and efficacy of PGx (2.5%, n=1). Most studies throughout the 4 groups sought pharmacists' perceptions (46%, n=18) and used the quantitative paradigm (77%, n=30). TDF mapping documented positive beliefs about the benefits of PGx testing as a part of the pharmacists' role. Barriers to PGx use included pharmacists' awareness of knowledge gaps, low confidence in interpreting and communicating PGx results, concerns about cost, privacy, and integration into pharmacy workflow.Conclusion: Research addressing PGx implementation within the community pharmacy evolved from assessing individuals' perceptions of PGx to determining the feasibility of PGx testing in pharmacies and evaluating the impact of PGx testing on patient outcomes in depression. Mapping the main findings on the TDF facilitates the development of multidimensional interventions, potentially targeting patients, pharmacists, and health policy. [ABSTRACT FROM AUTHOR]

Sponges are important constituents of coral reef ecosystems, including those around the Arabian Peninsula. Despite their importance, our knowledge on demosponge diversity in this area is insufficient to recognize, for example, faunal changes caused by anthropogenic disturbances. We here report the first assessment of demosponge molecular biodiversity from Arabia, with focus on the Saudi Arabian Red Sea, based on mitochondrial and nuclear ribosomal molecular markers gathered in the framework of the Sponge Barcoding Project. We use a rapid molecular screening approach on Arabian demosponge collections and analyze results in comparison against published material in terms of biodiversity. We use a variable region of 28S rDNA, applied for the first time in the assessment of demosponge molecular diversity. Our data constitutes a solid foundation for a future more comprehensive understanding of sponge biodiversity of the Red Sea and adjacent waters. [ABSTRACT FROM AUTHOR]

Background: Interactive communication approaches may help to shift pharmacy practice toward more patient-centered care. One example of such an approach is the 3 prime questions (3PQs). Patients' preferences for pharmacists' interactive communication styles were not identified in the literature.Objective: The purpose of this paper was to explore standardized patient (SP) preferences, satisfaction, and perceptions of pharmacists' communication style and changes in pharmacist to standardized patient talk-time ratio.Design: Mixed methods, before and after evaluation.Setting: SPs were hired from the University of Alberta's Standardized Patient Program, Canada.Participants: Twelve SPs and 10 pharmacists.Intervention: SPs were video recorded interacting with the same pharmacists before and after pharmacist training on the 3PQs. SPs participated in an open-ended interview using stimulated recall on videos of their pharmacist encounters.Main Outcome Measures: Explore SP preferences, satisfaction, and perceptions of pharmacists' communication style, in addition to changes in pharmacist to standardized patient talk-time ratio before and after the interventionResults: Generally SPs were satisfied with pharmacists' interactive communication style post training. Qualitative themes varied with SPs' preference for an interactive approach (58%, i.e., Conversation with Equals, Double Check, and Manageable Information) or traditional approach (33%, i.e., Expected Information, Shouldn't the Pharmacist Know, and Feels Uncomfortable) and improvements in item scores varied by type of prescription. Pharmacists' use of the 3PQs increased patient talk time for scenarios with new chronic and acute medication, though pharmacists still dominated the conversation.Conclusion: Just over half of SPs preferred an interactive communication style, although a third of SPs preferred a communication style that focused on information provision. Patients had more time to talk in some interactive encounters. Pharmacists may need to be aware of patient expectations when using the 3PQs. [ABSTRACT FROM AUTHOR]

Objective: To identify which activities produced a significant improvement in blood pressure control in patients with type 2 diabetes when pharmacists were added to primary care teams. Methods: This prespecified, secondary analysis evaluated medication management data from a randomized controlled trial. The primary outcome was a change in treatment, defined as addition, dosage increase, or switching of an antihypertensive medication during the 1-year study period. The secondary outcome was a change in antihypertensive medication adherence using the medication possession ratio (MPR). Results: The 200 evaluable trial patients had a mean age of 59 (SD, 11) years, 44% were men, and mean blood pressure was 130 (SD, 16)/74 (SD, 10) mmHg at baseline. Treatment changes occurred in 45 (42%) of 107 patients in the intervention group and 24 (26%) of 93 patients in the control group (RR, 1.63; 95% Cl, 1.08-2.46). Addition of a new medication was the most common type of change, occurring in 34 (32%) patients in the intervention group and 17 (18%) patients in the control group (P = 0.029). Adherence to antihypertensive medication was high at baseline (MPR, 93%). Although medication adherence improved in the intervention group (MPR, 97%) and declined in the control group (MPR, 91%), the difference between groups was not significant (P = 0.21). Conclusion: The observed improvement in blood pressure control when pharmacists were added to primary care teams was likely achieved through antihypertensive treatment changes and not through improvements in antihypertensive medication adherence. [ABSTRACT FROM AUTHOR]

Objective: To discuss common causes of medication errors occurring upon transitions of care and review key interventions that should be implemented to ensure effective communication and accurate completion of medication reconciliation. Data sources: MEDLINE (1946 to November 2014) using MeSH terms medication errors, medication reconciliation, and nursing homes in addition to conventional text words, including transitions of care and medication safety; Agency for Healthcare Research and Quality Patient Safety Network using search terms transitions of care, medication errors, and medication reconciliation; and relevant websites of national organizations pertaining to transitions of care and medication reconciliation. Study selection: Limited to English-language journals with no limitation set on the year of publication for clinical trials, meta-analyses, and reviews. Data extraction: At the authors’ discretion, preference was given to references focusing on pharmacists’ role in transitions of care and medication reconciliation. Results: Most medication errors stem from a lack of effective communication between health care providers during transitions of care. Part of successful communication and correct patient hand-off is completing accurate medication reconciliation. A patient case highlights a life-threatening medication error that occurred during a transition of care due to ineffective communication between a pharmacist and nurse while transferring medication information. Conclusion: To provide patients with accurate medication information, pharmacists should perform medication reconciliation upon transitions of care using The Joint Commission’s five-step process. Pharmacists can conduct numerous interventions to prevent medication errors during transitions of care and ensure patient safety. Pharmacists are integral to evaluating the appropriateness of medication use, ensuring information is updated in the health record, and verbally communicating accurate information to other health professionals. [ABSTRACT FROM AUTHOR]

Objective To evaluate student perceptions of the benefit of integration of cumulative, case-based quizzes. Additionally, this study discusses whether the integration of cumulative, case-based quizzes enhances student retention and aids in the development of improved critical thinking skills. Methods Current second- and third-year pharmacy student were administered six to seven cumulative, case-based quizzes, as an integrated component of both the Cardiovascular and Special Topics Pharmacotherapy courses. Current pharmacy students completed online pre- and post-course surveys that included questions assessing the student’s perceived benefit of the quizzes and demographic information. Final exam grades and final course grades of students who completed the two pharmacotherapy courses this year were compared to final exam and final course grades of students who completed the courses the prior year. Performances on higher-level Bloom’s taxonomy questions on the final exams were also compared to those of students from the prior year in order to evaluate whether critical thinking skills improved. Results A total of 97 students completed the pre- and post-course surveys. There was a statistically significant difference in student perception regarding the potential benefits of case-based quizzes in the two pharmacotherapy courses ( p < 0.001). Student responses exhibited an improved perception regarding the impact of case implementation at the conclusion of the semester. Conclusion Students in both pharmacotherapy courses perceived cumulative case-based quizzes as beneficial. Students believed cumulative case-based quizzes aided in their learning and retention of the course material and will improve their clinical skills as future pharmacists. [ABSTRACT FROM AUTHOR]

Unexpected positive intraoperative cultures (UPIC) in presumed aseptic revision arthroplasty can be difficult to interpret. The purpose of this retrospective study was to compare the incidence of subsequent periprosthetic joint infection (PJI) in patients who received antibiotic therapy according to an institutional protocol with those who did not and whether they meet Musculoskeletal Infection Society (MSIS) criteria for PJI. In patients who were treated with antibiotic according to institutional criteria, the incidence of PJI after revision was higher in those who did not meet MSIS criteria (22%) than in those that met MSIS criteria (14%; P > 0.71). UPIC in aseptic revision arthroplasty are not uncommon. PJI cannot be excluded in patients that do not meet MSIS definition. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objective of this study was to evaluate student pharmacist experience and academic performance in the first offering of a drug information and literature evaluation course utilizing a blended learning approach. Methods: An anonymous online survey, course grades, and evaluations were compared with the traditional offering (composed of live lectures and occasional recitations). Results: The blended learning strategy doubled the time spent in recitation; 96% of students reported them as “helpful.” Students preferred viewing lectures online and viewed most lectures on time. Students reported that online lectures in this course provided an equal educational value compared with “live” lectures. Compared to the traditional course, there was no difference in examination scores or course evaluations. Course grades and student perception of achieving course objectives were improved with the blended learning course. Implications: The blended learning strategy allowed for an increase in active learning sessions, higher course grades, and improvement in components of the course evaluations. [Copyright &y& Elsevier]

Abstract: Background: Pharmacists worldwide require improved patient-centered communication skills as they transition from a dispensing role to enhanced involvement in patient care. Researchers have studied pharmacist communication through audio and video recordings of patient–pharmacist encounters. A meta-narrative review of research using these recordings will offer insight into the extent of biomedical vs. patient-centered communication in patient–pharmacist exchanges. Objectives: This review aimed to characterize research on patient–pharmacists interactions using audio or video recordings and explore the 1) focus of research questions, 2) study design, 3) data analysis methods, 4) main findings and 5) presence of patient-centered vs. biomedical models of interaction. Methods: Drawing on the principles of meta-narrative systematic review, a literature search was performed to identify studies published in English. No publication date limits were implemented. Key search terms included: “audio recording”, “video recording”, “communication”, “patient counseling”, “patient interaction”, “discourse analysis”, “conversation analysis”, “narrative analysis”, and “content analysis”. The search was conducted in five databases: Medline, Embase, International Pharmaceutical Abstracts (IPA), Web of Science, and Academic Search Complete. Results: Forty-one articles met the inclusion criteria and represent 32 unique collections of patient–pharmacist recordings. The 23 quantitative studies focused on “what” was in the interaction, whereas the 5 qualitative studies characterized specialized pharmacy practice and 13 studies used conversational analysis to describe “how” patients and pharmacists interact. The majority of research described the content of recorded interactions in community pharmacies. Twenty-three studies presented evidence of a biomedical model, whereas 8 studies characterized a patient-centered focus. Conclusions: A developing body of research used recordings to describe the content of patient–pharmacist communication and explore the quality of the interactions, validation of coding tools, impact of an intervention, and patient–pharmacist power asymmetry. Study findings, particularly the identification of biomedical vs. patient-centered communication, were guided by the quantitative, qualitative, or conversational analysis research paradigm. [Copyright &y& Elsevier]

Abstract: This paper presents and discusses flow patterns around solid models constructed to represent sand (or snow) formations and dunes with and without upstream fencing. These flow patterns were obtained experimentally (by visualization) as well as computationally. The objective here is to give recommendations regarding protection against dangers posed by drift and/or movement of dunes on nearby roads and structures. The effects of mounting upwind fences on the flow pattern and the location of reattachment relative to dune base (shelter zone length) were examined. The effect of fencing was graphically plotted with fence position and height for given dune form. Computation and experiment showed acceptable agreement. Moreover, results indicate that some dune/fence combinations may cause shifting of the dune upwind (instead of downwind in the absence of fence). This effect means that, with such combinations, a dune would eventually disappear. The distance between the model downwind base line and the location of reattachment (length of shelter zone) was plotted against the distance of fence from upwind base line of model to determine the best possible dune/fence combination. Solid fencing (constructed from masonry bricks or stones) to shelter isolated sand humps and dunes is effective in alleviating dangers on nearby structures (dune shifting upwind and to less sand drift and saltation downwind). Also, the results indicated that, it is recommended to start by dune fencing and give enough time for the project zone to widen and be effectively protected before starting the construction. [Copyright &y& Elsevier]

Objectives: To describe how an electronic health record (EHR) was integrated into community pharmacists' patterns of patient care and to explore factors that are related to the use of medication and laboratory value information from the EHR. Design: Descriptive, exploratory, nonexperimental study. Setting: Edmonton, Canada, between November 2008 and March 2009. Participants: 16 pharmacists, 3 pharmacy technicians, and 2 pharmacy interns from primary care networks, long-term care settings, community independent and chain pharmacies, and grocery store pharmacies. Intervention: Qualitative interviews. Main outcome measure: Pharmacists' self-reported use of EHR. Results: Pharmacists in a patient-centered care practice (involving medication therapy management activities) were more likely to adopt the EHR for medication history and laboratory values, whereas pharmacists whose practice was focused on medication dispensing primarily used the EHR for patient demographic and dispensing records. Six general factors influenced the use of EHR: patients, pharmacists, pharmacy, other health professionals (i.e., physicians), EHR, and environment. Access to the medical record versus EHR and timeliness were barriers specific to pharmacists in a patient-centered practice. Factors that affected EHR use for pharmacists with primarily a dispensing practice were role understanding, dispensing versus lab records, valid reasons for using EHR, and fear of legal and disciplinary issues. Conclusion: Many community pharmacists embraced the EHR as a part of practice change, particularly those in patient-centered care practices. Practice type (patient-centered care or dispensing) greatly influenced pharmacists' use of EHR, specifically laboratory values. Because these qualitative findings are exploratory in nature, they may not be generalized beyond the participating pharmacies. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pharmacy students in the community setting are ideally situated to help patients monitor chronic diseases; however, their beliefs toward monitoring patients'' health are not known. Objectives: Study objectives are to identify relevant survey constructs and survey measures about monitoring beliefs, establish their psychometric properties, and describe students'' beliefs about monitoring. Methods: Four constructs that assess pharmacy students'' monitoring beliefs were identified through literature review and pilot research: self-efficacy, outcome expectancies, role beliefs, and mattering. Measures of each construct were adapted or developed. The psychometric properties of each scale were evaluated in fourth year pharmacy students. A confirmatory factor analysis (CFA) was used to provide evidence for the factor structure of the scales and validity. Internal consistency reliability was assessed with Cronbach''s alpha. Finally, students'' responses were described. Results: The response rate was 94% (119 of 127 students). A CFA revealed that a 5-factor model with the elimination of 2 questions was a better fitting model than the originally proposed 4-factor model. Reliability was good for scales except the negative outcome expectancies. Overall, students had positive attitudes toward their monitoring role and were “rather sure” they could routinely monitor. Conclusions: Evidence was provided for the psychometric properties of new measures of monitoring specific self-efficacy, outcome expectancies, and monitoring role orientation, as well as a new measure of general mattering for pharmacy. These instruments have the potential to help pharmacy practice researchers assess pharmacy students'' and ultimately pharmacists'' beliefs about monitoring. [Copyright &y& Elsevier]

Abstract: Angiopoietin-like protein 4 (ANGPTL4) represents an adipokine with metabolic effects within adipose tissue, such as inhibition of lipoprotein lipase activity and stimulation of lipolysis. These effects were convincingly demonstrated in mice. Therefore, we asked whether genetic variation within the ANGPTL4 gene contributes to prediabetic phenotypes, such as dyslipidemia, insulin resistance, or β-cell dysfunction, in white subjects at an increased risk for type 2 diabetes mellitus. We genotyped 629 subjects with and without a family history of diabetes for the 4 single nucleotide polymorphisms (SNPs) rs4076317, rs2278236, rs1044250, and rs11672433 and performed correlational analyses with metabolic traits. For metabolic characterization, all subjects underwent an oral glucose tolerance test; a subset was additionally characterized by hyperinsulinemic-euglycemic clamp. The 4 SNPs rs4076317, rs2278236, rs1044250, and rs11672433 cover 100% of common genetic variation (minor allele frequency ≥0.05) within the ANGPTL4 gene (r 2 ≥ 0.8). None of these SNPs revealed significant correlation with anthropometric data (sex, age, body mass index, body fat, and waist-hip ratio) or with family history of diabetes. Furthermore, no reliable correlations were found with fasting triglycerides, fasting nonesterified fatty acids, and area under the curve of nonesterified fatty acids during oral glucose tolerance test or with parameters of insulin sensitivity and insulin secretion. Finally, haplotype analysis revealed the existence of 8 common diplotypes. None of these, however, was significantly correlated with insulin sensitivity, insulin secretion, or plasma lipid measures. We conclude that common genetic variation within the ANGPTL4 gene may not play a major role in the development of prediabetic phenotypes in our white population. [Copyright &y& Elsevier]

Objectives: To determine the proportion of patients with diabetes mellitus who knew their personal and target glycosylated hemoglobin (AIC), blood pressure, and low density lipoprotein cholesterol (LDL-C) (ABC) levels and the proportion of patients whose recalled ABC levels were below targets set by the American Diabetes Association (ADA).Design: Cross-sectional survey.Setting: 35 community and clinic pharmacies in May 2003 through May 2004.Participants: 132 student pharmacists in Ambulatory Pharmaceutical Care Clerkship who recruited a convenience sample of 816 evaluable patients with diabetes.Intervention: Student-administered questionnaires.Main Outcome Measures: Patients' self-reported and target ABC values and comparison of these with recommended ADA guidelines.Results: The greatest number of patients were able to recall their personal blood pressure level (68%), followed by A1C (53%) and LDL-C (23%). Of those who knew their levels, one-half or fewer were within ADA targets for one or more ABCs. Only 1% of patients who were able to provide ABC levels were below all three ADA target values. Patients were most likely to provide an A1C target (43%), followed by blood pressure (35%) and LDL-C (21%).Conclusions: While almost three-quarters of the patients identified in community pharmacies knew their blood pressure levels, one-half or fewer knew their A1C or LDL-C levels. Fewer than 50% of patients reported even one ABC target number. Pharmacists should take advantage of this educational opportunity by working with patients with diabetes to increase their knowledge of these ABCs. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is a need to describe how role theory has been used by researchers to describe various phenomena in pharmacy so as to identify gaps in knowledge and future research priorities. Objective: The primary purpose of this article is to review how role theory has been used in the community pharmacy literature. Secondary objectives are to (1) examine the use of role theory over the evolution of the profession of pharmacy, (2) determine what role theory perspectives have been used, (3) explore the implications of role theory for patient-pharmacist interactions, and (4) explore implications for future pharmacy research using role theory. Methods: A literature search of Web of Knowledge and International Pharmaceutical Abstracts was conducted. Articles were included if they examined some aspect of role theory in community pharmacy and were categorized based on their role theory perspective and “era” of pharmacy in which they were published. Results: Thirty research articles were identified spanning from 1956 to 2004 with the majority (19 studies) using mail surveys. Articles used functionalist (9 studies), organizational (7), functional and organization (4), cognitive (10), and symbolic interactionist (1) perspectives to role theory. The number of articles using role theory has been increasing over time. The functional and symbolic interactionist perspectives provide rich descriptions of the multiple pharmacy roles and allow for a clearer understanding of the barriers affecting actors'' experience. Using an organization perspective, role stressors such as role conflict, ambiguity, and overload were found to impact pharmacists'' worklife. Cognitive role theory research has clearly shown that pharmacists'' and patients'' expectations for the encounter shape interaction. Conclusions: The use of role theory informs both researchers and practitioners about the practice of pharmacy and patient interactions. Still, there is much work to be done in role theory and pharmacy research. Experimental designs, longitudinal studies, and qualitative research methodologies may warrant greater use and attention. Role change should be identified as a priority, and research is needed to elucidate what interventions change patients'' and pharmacists'' expectations of the patient-pharmacist interaction. [Copyright &y& Elsevier]

This paper introduces state dependent utility into the standard Mehra and Prescott [J. Monet. Econ. 15 (1985) 145] economy by allowing the representative agent''s coefficient of relative risk aversion to vary with the underlying economy''s growth rate. Existence of equilibrium is proved and its asymptotic properties analyzed. This generalization leads to level dependent marginal rates of substitution, a property that sharply distinguishes this model from the standard construct. For very low coefficients of relative risk aversion, the equilibrium risk free and risky security returns are demonstrated to have volatilities and an associated equity premium that substantially exceed what is found in the data. This provides a contrasting perspective on the classic “equity premium puzzle.” [Copyright &y& Elsevier]