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Fatigue while driving is one of the risk factors of road crashes. It's still poorly considered in interventions because of insufficient literature. In addition, the literature on this issue doesn't focus on two-wheelers, the most frequent users in the Benin context. The study examined the prevalence of fatigue while driving among two-wheeled vehicle drivers and the related factors. It's a secondary baseline data analysis from a cohort of road crash victims recruited from five hospitals in Benin. Data were collected from July 2019 to January 2020. Patients who identified themselves as drivers during the accident were included. data on individual characteristics, including fatigue status in the moments preceding the collision, and other risk factors and environmental settings, were extracted. We used multivariate logistic regression. Among the respondents, 12.20% (95% CI=10.20‑14.53) reported fatigue in the moments preceding the collision. The odds of fatigue while driving were significantly higher in male drivers (aOR=3.60; 95% CI=1.08‑11.98), during professional trips (aOR=2.09; 95% CI=1.30‑3.37), in non‑helmet wearers (aOR=1.85; 95% CI=1.09‑3.13), in users of stimulants (aOR=3.13; 95% CI=1.50‑6.54), in those with a history of chronic diseases (aOR=1.95; 95% CI=1.16‑3.27), at dusk (aOR=4.22; 95% CI=2.22‑8.02), at night (aOR=6.90; 95% CI=3.95‑12.05), and on Inter‑State National Roads (aOR=2.01;95% CI=1.18‑3.43). Fatigue is a risk factor for road crashes in Benin, associated with other risk factors that highlight particularly vulnerable profiles and groups. Integrating prevention policies based on these cumulative risk factors will result in efficiency improvements.

Pharmacists are providing clinical services in nontraditional practice settings including the patient-centered medical home (PCMH). PCMHs strive to improve patient outcomes in a number of ways, including through innovative use of health information technology (HIT) and by encouraging patients to take an active role in their health care. This paper describes a pharmacist-directed smoking cessation program at a PCMH that utilizes HIT to engage patients in the smoking cessation process and lessons learned from implementation of the program to guide other pharmacists considering implementing a similar program. Secure messaging through the patient portal of the electronic medical record (EMR) can be an effective way to deliver a smoking cessation program for appropriately selected patients and aligns with PCMH standards as the program uses HIT to engage patients in self-management. Type: Original Research

Purpose: The National Committee for Quality Assurance (NCQA) has standards for recognizing Patient-Centered Medical Homes (PCMH) including one for medication management. Study objectives were to identify if and how providers within a PCMH recognized under the 2008 guidelines were documenting components of medication management to meet NCQA's 2011 requirements including: 1) providing information about new prescriptions to >80% of patients; 2) assessing understanding of medications for >50% of patients; and 3) assessing response and barriers to medication adherence for >50% of patients. Methods: Physician and pharmacist-led patient visits from a family medicine office, from February 1 to August 1, 2012 were assessed. Patients over 18 years old taking at least one medication were included. A retrospective chart review was performed to assess documented components of medication management. Descriptive statistics were used to analyze data. Results: A systematic sampling of 450 physician-led and 195 pharmacist-led patient visits, demonstrated providers did not meet documentation goals for providing patients information on new prescriptions (65% pharmacist, 24% physician, 36% of total provider notes) or for assessment of patients' understanding of medications (9% pharmacist 12% physician, 11% of total provider notes). Individually each type of provider did not meet the goal of assessing patient response and barriers to adherence to medication, but with combined intervention by the pharmacists and the physicians, the site was able to surpass NCQA's percentage goal (57% and 58%). Conclusions: No components of medication management are well documented. Using the electronic medical record, pharmacists may be able to develop documentation tools and assist sites to meet NCQA's goals for medication management. Type: Original Research

Objective: To describe examples of effective teaching strategies utilized within a required nonprescription therapeutics course, in order to accommodate learning characteristics of Millennials. Case Study: Instructors identified unique characteristics of Millennial generation students through literature review and focused educational workshops. These characteristics include the desire for active learning where didactic lectures make a connection to life, the incorporation of technology, and assignments that focus on team work. Course modifications were then made based on these characteristics including redesign of large group course lectures with incorporation of patient cases, inclusion of a variety of online components including the opportunity to provide course feedback, and active learning small group projects within workshop sections. Evaluation:Student evaluation of the course and instructors significantly improved after introducing changes to the course compared to previous years. Each component of the student evaluation resulted in a statistically significant change in mean score. Verbal and written evaluations indicated a very positive learning experience for students. Grade mean (3.3 vs. 3.8, p Conclusions: By identifying characteristics of Millennial generation student learners, traditional teaching methods can be modified in order to enhance retention of material and optimize their learning process. Course changes improved the learning experience for students and instructors. Instructors' willingness to evaluate generational differences and adapt teaching enhances the learning experiences in the classroom for both students and instructors. Type: Case Study

Purpose: As community pharmacies are implementing increasingly more clinical services they are faced with a new challenge of marketing these services. This article discusses The Ohio State University College of Pharmacy Clinical Partners Program's (Clinical Partners) experiences in marketing clinical services to patients, barriers encountered through these experiences, and presents suggestions for future marketing of services. Experience: Clinical Partners developed two targeted marketing projects and evaluated impact on patient enrollment in services. In January 2008, the pharmacy ran a series of radio advertisements, newspaper print advertisements, and face to face marketing in the community with the focus of each being patient care services. During this project five individuals expressed interest in Clinical Partners' services. Four indicated that they heard about Clinical Partners through the radio ad and one through the pharmacy website, though none chose to enroll in services. In 2009 Clinical Partners focused on marketing MTM in the form of a comprehensive medication review to current patients already enrolled in its anticoagulation management service. Following a three month period, 6 patients (8%) of the 71 patients receiving the marketing intervention chose to enroll in MTM. Four additional patients have enrolled in MTM since conclusion of the project. Discussion: These projects and a review of available literature revealed barriers that pharmacies encounter when marketing clinical services to patients in an outpatient setting including patients' unawareness of the role a pharmacist can play outside dispensing medications, patients' belief they do not need clinical services, and patients' unwillingness to pay a pharmacist out of pocket for services. Future Implications: To overcome these identified challenges, community pharmacies should consider integration of marketing techniques such as tailoring marketing to a target population, forming and utilizing relationships with patients, and looking to past marketing successes in developing marketing plans. Pharmacists should also be adventurous in exploring new ways to promote pharmacy clinical services to find creative solutions to barriers encountered. As community pharmacies continue to grow the realm of clinical services offered to patients, it is important also to develop and implement marketing strategies to support the services and expansion of the profession so that these services can be embraced by patients and the health care community. Type: Idea paper

Objective: To describe examples of effective teaching strategies utilized within a required nonprescription therapeutics course, in order to accommodate learning characteristics of Millennials.Case Study: Instructors identified unique characteristics of Millennial generation students through literature review and focused educational workshops. These characteristics include the desire for active learning where didactic lectures make a connection to life, the incorporation of technology, and assignments that focus on team work. Course modifications were then made based on these characteristics including redesign of large group course lectures with incorporation of patient cases, inclusion of a variety of online components including the opportunity to provide course feedback, and active learning small group projects within workshop sections.Evaluation: Student evaluation of the course and instructors significantly improved after introducing changes to the course compared to previous years. Each component of the student evaluation resulted in a statistically significant change in mean score. Verbal and written evaluations indicated a very positive learning experience for students. Grade mean (3.3 vs. 3.8, p

Purpose: As community pharmacies are implementing increasingly more clinical services they are faced with a new challenge of marketing these services. This article discusses The Ohio State University College of Pharmacy Clinical Partners Program’s (Clinical Partners) experiences in marketing clinical services to patients, barriers encountered through these experiences, and presents suggestions for future marketing of services.Experience: Clinical Partners developed two targeted marketing projects and evaluated impact on patient enrollment in services. In January 2008, the pharmacy ran a series of radio advertisements, newspaper print advertisements, and face to face marketing in the community with the focus of each being patient care services. During this project five individuals expressed interest in Clinical Partners’ services. Four indicated that they heard about Clinical Partners through the radio ad and one through the pharmacy website, though none chose to enroll in services. In 2009 Clinical Partners focused on marketing MTM in the form of a comprehensive medication review to current patients already enrolled in its anticoagulation management service. Following a three month period, 6 patients (8%) of the 71 patients receiving the marketing intervention chose to enroll in MTM. Four additional patients have enrolled in MTM since conclusion of the project.Discussion: These projects and a review of available literature revealed barriers that pharmacies encounter when marketing clinical services to patients in an outpatient setting including patients’ unawareness of the role a pharmacist can play outside dispensing medications, patients’ belief they do not need clinical services, and patients’ unwillingness to pay a pharmacist out of pocket for services.Future Implications: To overcome these identified challenges, community pharmacies should consider integration of marketing techniques such as tailoring marketing to a target population, forming and utilizing relationships with patients, and looking to past marketing successes in developing marketing plans. Pharmacists should also be adventurous in exploring new ways to promote pharmacy clinical services to find creative solutions to barriers encountered. As community pharmacies continue to grow the realm of clinical services offered to patients, it is important also to develop and implement marketing strategies to support the services and expansion of the profession so that these services can be embraced by patients and the health care community.

Currently, the Cloud Computing (CC) and Internet of Things (IoT) have emerged as advanced technologies that enable new levels of connection and data processing. As the IoT ecosystem grows, it becomes more important to ensure the security and integrity of IoT devices and the data they create in cloud. The identification and prevention of intrusions in both cloud and IoT cloud systems has become a major challenge. In this research work, a new intrusion detection framework based on Extra Tree Regression Classifier and Grid Search Optimized Long ShortTerm Memory (ETR-GSO-LSTM) is used to identify and classify intrusions in IoT and Cloud environments. The input data is first gathered via the CIC-IDS-2018 and KDD-Dataset, which include a lot of information about network traffic and possible security issues. The data preprocessing tasks such as label encoding and data augmentation was performed to perform more amount of labelled data for analysis. Another crucial phase in the intrusion detection process is feature selection, and the ETR Classifier has shown to be a significant tool in determining the most relevant characteristics from the dataset. These chosen features assist in reducing dimensionality and improving the accuracy of the intrusion detection model. Finally, GSO-LSTM appears as a potential strategy for classification, which employs the capacity of LSTM networks to examine sequential data and find abnormalities in real time. The proposed ETR-GSO-LSTM achieves detection or classification accuracy of 99.95% and 99.9% on the CIC-IDS 2018 and NSL-KDD datasets, respectively. From the result analysis, it clearly shows that the proposed ETR-GSO-LSTM obtains better performance in all the metrices when compared to Enhanced Long-Short Term Memory with Recurrent Neural Network (ELSTM-RNN) and Unsupervised Technique Ensemble based IDS (UTENIDS). [ABSTRACT FROM AUTHOR]

Purpose: Medication history is the method many organizations use to adhere to The Joint Commission's (TJC) National Patient Safety Goal (NPSG) to communicate accurate patient medication information. Literature is sparse comparing the number of medication histories completed in-person versus virtually. Methods: This is a single system, multi-site, retrospective observational study. Patients included were admitted through the Emergency Department during October 2022. The primary aim of this study compared the percent capture rates of medication history between 2 hybrid sites to an in-person site within a health-system. Our secondary objective compared the differences in the 'medication history acuity score' (MHAS), defined as the total number of edits, additions, and deletions made during a medication history. Results : The medication history capture rate at the in-person site was 74% and at the hybrid sites were 91% and 80%. There were no differences in total medications on each medication history between in-person and hybrid (11 [5-16] vs 11 [6-16]; P =.252). There were no differences in changes made on medication histories between in-person and hybrid (4 [1-7] vs 3 [1-7]; P =.595). Conclusions: Our study demonstrates that medication history capture rates and MHAS are comparable in both in-person and hybrid environments. This similarity suggests the feasibility of implementing hybrid models for medication history services in diverse healthcare settings, potentially enhancing the capacity of health systems to meet TJC NPSG. These findings indicate that hybrid models could be an effective strategy for healthcare systems to optimize their medication history services, especially in settings with varied patient volumes and site specialties. [ABSTRACT FROM AUTHOR]

In Internet of Things (IoT) and cloud systems, Intrusion Detection (ID) is very vital for protecting the security infrastructures. ID techniques are extensively used to detect and track malicious threats in cloud and IoT systems. In the IoT based ID, the conventional techniques work based on the manual traffic feature values that increase the complexity of the networks and achieve a limited detection rate on the larger IoT databases. For addressing the above-stated issues and achieving high classification results, an effective deep learning based ID-System (IDS) is implemented in this article. Initially, the IoT data is acquired from the NSW-NB15 and NSL-KDD databases, and then, the standard scaling normalization technique, known as Min-Max normalization, is applied to select the dominant attributes and to eliminate outliers from the acquired databases. Additionally, the optimal features are selected from the rescaled normalized data by implementing the Bat optimization algorithm. The selection of optimal features decreases the computational complexity and training time of the IDS. The chosen optimal features are passed into the DenseNet model for carrying out intrusion attack detection. Particularly, in the binary-class classification, the Bat-based DenseNet model obtained 98.89% and 98.40% of accuracy on the UNSW-NB15 and NSL-KDD databases, correspondingly. The obtained simulation results prove the higher effectiveness of the current study when it is related to the state-of-the-art classifiers. [ABSTRACT FROM AUTHOR]

The article describes economic insecurity that occurs in a time of uncertainty and affects human development and social well-being. The authors defined indicators to analyze, identified and justified the vector of state policy, and studied the socio-economic issues of territorial development as a source of risks. The dataunder analysis were obtained from public sources, systematized, and subjected to economic analysis using the methods of absolute, relative, and mean values, as well as graphical and logical methods. The period under study covered 2018–2022, which made it possible to assess the impact of the uncertainty caused by the COVID 19 pandemic on the Russian federal districts by analyzing indicators of economic security. The research revealed economic and social risks, as well as the state policy in leveling them across the country. The pandemic triggered economic uncertainty, which destabilized the social well-being and development opportunities of the population in the regions. The current state policy provides long-term transformations and allows the population to adapt to changes.