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Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes. [ABSTRACT FROM AUTHOR]

Do American troops help or hinder economic growth in other countries? We consider a newly constructed dataset of the deployment of U.S. troops over the years 1950–2000 and discover a positive relationship between deployed troops and host country economic growth, which is robust to multiple control variables. Each tenfold increase in U.S. troops is associated with a one–third percentage point increase in average host country annual growth. We explore three possible causal explanations: a Keynesian aggregate demand boost; the diffusion of institutions; and security. Extensive econometric testing, including the use of panel data, confirms the core relationship. [ABSTRACT FROM PUBLISHER]

The authors discusses the efforts of the American Society of Health-System Pharmacists (ASHP) to survey residency programs about strategies used to reduce resident burnout and encourage the development of programs promoting well-being and resilience. Topics mentioned include efforts of residency program directors (RPDs) to maintain compliance with ASHP standards, lack of data to point RPDs toward best practices to address burnout, and the role of ASHP in supporting stakeholders in residencies.

Describes how the Mesa (Arizona) Public School Districts explored the possibilities offered by career education. Commitment of a total school district to career education concepts; Reasons why guidance practitioners were not making significant input into the evolving career education structure; Reduction of the manageable size for which guidance would accept responsibility.

Background: Before the publication of the M40-A standard by the United States National Committee for Clinical Laboratory Standards (NCCIS), no quality control data for swab transport systems (STSs) had been available. Aims: To compare three commercially available STSs against the published standard to ascertain bacterial survival after a set holding time. Method: Charcoal and non-charcoal containing swabs were inoculated with standard volumes and numbers of a range of bacteria commonly isolated from clinical material. Bacterial counts were taken at time zero, six, 24, and 48 hours, with the results being compared against the NCCLS standard. Results: The standard clearly differentiated between the three STSs tested, with one product being superior to the other two products in providing better survival. Conclusion: The standard now provides manufacturers and users of STSs with meaningful data to provide, purchase, and compare an STS for routine clinical use. [ABSTRACT FROM AUTHOR]

Background: Since the approval of the oral factor Xa inhibitors, there have been concerns regarding the ability to neutralize their anticoagulant effects after intracranial hemorrhage (ICH). Multiple guidelines suggest using prothrombin complex concentrates (PCCs) in these patients on the basis of research that includes a limited number of patients with ICH. Given this, we aimed to evaluate the safety and efficacy of PCCs for factor Xa inhibitor-related ICH in a large, multicenter cohort of patients.Methods: This was a multicenter, retrospective, observational cohort study of patients with apixaban- or rivaroxaban-related ICH who received PCCs between January 1, 2015, and March 1, 2019. The study had 2 primary analysis groups: safety and hemostatic efficacy. The safety analysis evaluated all patients meeting inclusion criteria for the occurrence of a thrombotic event, which were censored at hospital discharge or 30 days after PCC administration. Patients with intracerebral, subarachnoid, or subdural hemorrhages who had at least 1 follow-up image within 24 hours of PCC administration were assessed for hemostatic efficacy. The primary efficacy outcome was the percentage of patients with excellent or good hemostasis on the basis of the modified Sarode criteria. Secondary outcomes included an evaluation of in-hospital mortality, length of stay, infusion-related reactions, and thrombotic event occurrence during multiple predefined periods.Results: A total of 663 patients were included and assessed for safety outcomes. Of these, 433 patients met criteria for hemostatic efficacy evaluation. We observed excellent or good hemostasis in 354 patients (81.8% [95% CI, 77.9-85.2]). Twenty-five (3.8%) patients had a total of 26 thrombotic events, of which 22 occurred in the first 14 days after PCC administration. One patient had documentation of an infusion-related reaction. For the full cohort of patients, in-hospital mortality was 19.0%, and the median intensive care unit and hospital lengths of stay were 2.0 and 6.0 days, respectively.Conclusions: Administration of PCCs after apixaban- and rivaroxaban-related ICH provided a high rate of excellent or good hemostasis (81.8%) coupled with a 3.8% thrombosis rate. Randomized, controlled trials evaluating the clinical efficacy of PCCs in patients with factor Xa inhibitor-related ICH are needed. [ABSTRACT FROM AUTHOR]

Premium wine production is limited to regions climatically conducive to growing grapes with balanced composition and varietal typicity. Three central climatic conditions are required: (i) adequate heat accumulation; (ii) low risk of severe frost damage; and (iii) the absence of extreme heat. Although wine production is possible in an extensive climatic range, the highest-quality wines require a delicate balance among these three conditions. Although historical and projected average temperature changes are known to influence global wine quality, the potential future response of wine-producing regions to spatially heterogeneous changes in extreme events is largely unknown. Here, by using a high-resolution regional climate model forced by the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios A2 greenhouse gas emission scenario, we estimate that potential premium winegrape production area in the conterminous United States could decline by up to 81% by the late 21st century. While increases in heat accumulation will shift wine production to warmer climate varieties and/or lower-quality wines, and frost constraints will be reduced, increases in the frequency of extreme hot days (>35°C) in the growing season are projected to eliminate winegrape production in many areas of the United States. Furthermore, grape and wine production will likely be restricted to a narrow West Coast region and the Northwest and Northeast, areas currently facing challenges related to excess moisture. Our results not only imply large changes for the premium wine industry, but also highlight the importance of incorporating fine-scale processes and extreme events in climate-change impact studies. [ABSTRACT FROM AUTHOR]

Presents articles on the topic of nuclear physics in a special 1984 physics news supplement. Natural radioactivity and the possibility for alpha particles to cluster in a decay mode; Description of nuclear wobble and the excitation energy of the wobble mode; Collective flow in nucleus-nucleus collisions at the Bevalac accelerator in Berkeley, California; Cooperative pion production and study by the GSI Laboratory in Darmstadt, West Germany and a Stony Brook-Oak Ridge collaboration; Experiments with slow or confined neutrons at the Institute Laue-Langevin in Grenoble, France.

Winter wheat plants were sampled during the spring and autumn to identify fungi associated with root rot in Alabama. Samples were taken from 61 fields in the major wheat-producing areas of the state; 179 fungi were isolated, identified, and tested for pathogenicity. Of the fungi identified, 46 (26%) were Gaeumannomyces graminis var. tritici, 37 (21%) were Cochliobolus sativus, and 55 (31%) were Fusarium species of which 37 (21%) were Fusarium oxysporum. Other fungi identified that were pathogenic on wheat were Rhizoctonia solani, Sclerotium rolfsii, and Pythium spp. G. g. var. tritici was the main pathogen associated with diseased root and lower stem tissue of wheat in Albama. [ABSTRACT FROM AUTHOR]

Objectives: Hyperchloremia has been associated with increased morbidity and mortality in critically ill patients. While previous research has demonstrated an association between hypertonic saline and hyperchloremia, limited data exist in neurocritical care patients. The objective of this study is to determine the impact of moderate hyperchloremia (chloride ≥ 115 mmol/L) on clinical outcomes in intracerebral hemorrhage patients treated with continuous IV infusion 3% hypertonic saline.Design: Multicenter, retrospective, propensity-matched cohort study.Setting: Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and comprehensive stroke center designation.Patients: Intracerebral hemorrhage patients discharged between September 2011 and September 2015 were evaluated and matched 1:1 based on propensity scoring.Interventions: Continuous IV infusion 3% hypertonic saline.Measurements and Main Results: A total of 219 patients were included in the unmatched cohort (143 moderate hyperchloremia and 76 nonhyperchloremia) and 100 patients in the propensity-matched cohort. In-hospital mortality was significantly higher in those who developed moderate hyperchloremia in a propensity-matched cohort (34% vs 14%; p = 0.02). Moderate hyperchloremia independently predicted in-hospital mortality in multivariable logistic regression analysis (odds ratio, 4.4 [95% CI, 1.4-13.5]; p = 0.01).Conclusions: We observed higher rates of in-hospital mortality in patients who developed moderate hyperchloremia during treatment with continuous IV infusion 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality. These results suggest that chloride values should be monitored closely during hypertonic saline treatment as moderate elevations may impact outcomes in intracerebral hemorrhage patients. [ABSTRACT FROM AUTHOR]

What is known and objective Non-adherence to controller asthma medications is an important public health problem. It is estimated to occur in 30-70% of individuals and is a significant risk factor for asthma morbidity and mortality. The aim of this study was to determine the level of adherence, as indicated by refill rates, to controller asthma medications in a community pharmacy setting. Methods Secondary analyses of a community pharmacy dispensing database in 15 locations throughout Utah. Results and discussion The dispensing records of 2193 patients who received controller medications for asthma in a 12-month period, and had a minimum of 6-month potential coverage (180 days) from the date of their first receipt of a controller medication in that period, were examined. Using standard metrics to gauge adherence, the proportion of days covered ( PDC) and the medication possession ratio ( MPR), the average coverage for controller asthma medications across a 6-month period (180 days) was poor, averaging less than 50% of days' availability. Standard cut-offs (≥80% medication availability) indicated that only 14-16% of patients had 'satisfactory' adherence over their 6-month follow-on period. Females and older patients had significantly greater satisfactory adherence. Medication adherence was significantly greater with inhaled corticosteroid ( ICS)-long-acting β2-agonist ( LABA) combinations than with ICS alone. What is new and conclusion This study confirms the considerable scope of the asthma therapy non-adherence problem. Therefore, it is imperative to conduct survey-based research linked directly to pharmacy-based dispensing data to derive patient behavioural, attitudinal and environmental factors that may contribute to the issue, and then pilot and evaluate interventions for change. [ABSTRACT FROM AUTHOR]

The article describes the results of the 2003 Behavioral Risk Factor Surveillance System survey on arthritis-attributable work limitation (AAWL), released in the U.S. It found that the prevalence of AAWL among all working-age adults ranged from 3.4% in Hawaii to 15.0% in Kentucky. It notes that physical impairments might underlie AAWL by interfering with the ability of a person to perform work-related tasks and therefore constitute substantial disability.

Reports on cases of human rabies in California, Georgia, Minnesota, New York, and Wisconsin in 2000. Death of all of the patients as a result of the disease; Number of rabies cases which have been associated with bites from bats; Suggestion that medical advice should be sought for any type of animal bite.

Examines lint rot of cotton bolls caused by Nigrospora oryzae in the coastal region of Alabama during 2000 and 2001. Gray lock sign and symptom in the plant; Analysis of plant tissue; Relationship between disease incidence and weather parameters.