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Pharmaceutical care for non-communicable diseases (NCD) in Indonesia needs improvement especially in provinces like Kalimantan Selatan (Kalsel) with increasing NCD prevalence. This research explored possible improvements for Kalsel pharmacists NCD Continuing Professional Development (CPD) programmes.The study aims to identify Kalsel pharmacists' engagement with, experiences of, and expectations for NCD-focused CPD activities, and CPD stakeholders' views on these expectations.This sequential mixed-methods study used a quantitative survey to map Kalsel pharmacists' CPD engagement and preferences. The survey findings, and Kalsel pharmacists' knowledge and skills in NCD management, were further explored in four geographically-diverse focus group discussions (FGDs). Triangulated findings from the survey and FGDs were presented to pharmacist CPD stakeholders in a modified Nominal Group Technique (NGT) discussion, resulting in a prioritised list of CPD activities and allocation of local leadership for each activity.The survey response rate was 51% (249/490) with fair representation of the geographic spread. CPD sessions were seen as a social event to network with colleagues (34%) and improve knowledge (31%). Major hindrances for participation were work commitments (25%) and travel needs (22%). Most participants (64%), especially the more senior, preferred explicitly interactive CPD formats (adjusted odds ratio 0.94 for each additional year from graduation; 95% confidence interval 0.89-0.99; p = 0.036). The FGDs identified challenges in managing NCD, strengths and gaps in NCD knowledge, and preferences for NCD CPD. The modified NGT produced 12 actions which five major stakeholders agreed to lead.An explicitly interactive NCD CPD programme based on a community of practice model and supported by blended learning is likely to be most effective for pharmacists in the Kalimantan Selatan province of Indonesia. A co-designed multi-stakeholder systems-based approach to CPD programme, as used in this study, is likely to increase the engagement and success of the programme.

Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education.Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020.Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p 0.042) and age and towards treatment of CP; ρ = -0.556, p 0.007) at T2.Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.

National Institute for Occupational Safety and Health (NIOSH) researchers continue to study worker exposure to respirable crystalline silica (RCS) and develop interventions to reduce these exposures. Occupational overexposures to RCS continue to cause illness and deaths in many industries and RCS has been identified as a serious exposure risk associated with hydraulic- fracturing operations during oil and gas extraction. In 2016 the Occupational Safety and Health Administration (OSHA) reduced the permissible exposure limit (PEL) to 0.05 milligrams of silica per cubic meter of air, averaged over an 8-hour day. This mandate requires hydraulic-fracturing operations to implement dust controls and safer work methods to protect workers from silica exposures above this PEL by June 23, 2021. At hydraulic-fracturing sites utilizing sand movers, pneumatic transfer of fracking sand is the primary source of aerosolized RCS. Currently, there are limited commercially available engineering controls for the collection of dust emitted from thief hatches on sand movers. The goal of this research is to develop a robust, cost-effective, weather resistant, portable, self-cleaning dust collection system that can be retrofitted onto sand mover thief hatches. A prototype was designed, built, and tested, and it was determined that the system could handle flows in the range of 600 to 1300 cfm with loading/cleaning cycle times of 40 and 5 minutes respectively and demonstrated operating efficiencies of 97-99%. Further development of this NIOSH prototype is being done in collaboration with an industry partner with the goal of developing a commercially viable, cost-effective solution to reduce RCS at hydraulic-fracturing sites around the world.

We sought to design a micro-curriculum to structure supervised clinical placements for junior medical students within a variety of community-based settings of differing clinical disciplines. Given the gaps in the literature, this paper reflects on the opportunities and challenges of our design, implementation, and evaluation strategies in constructing an integrated task-based micro-curriculum for interprofessional community-based learning in year 2 of a four-year graduate entry program. The design was informed by a systems thinking framework and guided by contemporary curricular theories on self-directed and interprofessional learning. Extensive consultations with stakeholders were undertaken. Alignment with relevant national level documents and curricular frameworks was ensured. The systems thinking approach provided first, an experience of applying thinking tools for a deeper understanding of how various parts of this micro-curriculum and subsystems should be integrated. Second, applying the toolkit uncovered tension points on which leverage could optimise future enhancements. Eighteen types of health professions were recruited including 105 general practitioners and 253 healthcare practitioners from a range of disciplines. Systems thinking allows for the identification of various interacting elements within the curriculum to be considered as part of an integrated whole. Insights from this model could inform the design of similar innovative curricula.

The Domain Name System (DNS) is a fundamental backbone service of the Internet. In practice, this infrastructure often shows flaws, which indicate that measuring the DNS is important to understand potential (security) issues. Several works deal with the DNS and present such problems, mitigations, and attack vectors. A so far overlooked issue is the fact that DNS servers might answer with information about internal network information (e.g., hostnames) to external queries. This behavior results in a capability to perform an active network reconnaissance without the need for individual vulnerabilities or exploits. Analyzing how public DNS services might involuntarily disclose sensitive information ties in with the trust we have on Internet services.

To describe psychotropic polypharmacy in Australia between 2006 and 2015.We used pharmaceutical claims from a national 10% sample of people with complete dispensing histories to estimate the annual prevalence of the combined use (overlap of60 days exposure) of ≥2 psychotropics overall and within the same class or subclass (class and subclass polypharmacy). We also estimated the proportion of polypharmacy episodes involving one, two, three and four or more unique prescribers.The prevalence of class polypharmacy between 2006 and 2015 in people dispensed specific psychotropic classes was 5.9-7.3% for antipsychotics, 2.1-3.7% for antidepressants and 4.3-2.9% for benzodiazepines. The prevalence of antipsychotic polypharmacy was higher than expected given the prevalence of antipsychotic exposure and combinations of sedating agents were notably common. Overall, 26.7% of polypharmacy episodes involved multiple prescribers but having multiple prescribers occurred more frequently for class and subclass polypharmacy and people with four or more concomitant psychotropics.Psychotropic polypharmacy is common, despite limited evidence of risks and benefits. Increases in polypharmacy with multiple prescribers may be due to poor communication with patients and between health care professionals.

Although relations between marital status and health have been substantiated, the results of relatively few studies suggest how or why marriage is associated with health. To understand how marriage and health are associated, this study was designed to examine the role of health beliefs. Two thousand two hundred and six (2,206) adults who participated in the New Jersey Family Health Survey provided information about their marital status, proactive health beliefs, and proactive health behaviors. Results indicated that being married (vs. single) was positively associated with men's proactive health beliefs, whereas marriage did not appear to influence women's proactive health beliefs positively. Significant relations between participants' reports of proactive health beliefs and proactive health behaviors were found. Findings are discussed in terms of the importance of understanding the complex nature of associations between social relationships and health.

The biography of the Heidelberg Professor of Psychiatry Carl Schneider (1891-1946) represents a combination of a quest for psychiatric reform, pronounced interest in brain research, and commitment to the first systematic extermination of a minority during the Nazi era, the murder of psychiatric patients. Guided by a biological concept that included the individual and his environment and thus interpreting the interactive and social sphere from a purely biological viewpoint, Schneider considered cure and extermination as two sides of the same coin. Psychiatric patients should receive intensive "biological" therapy, but if they were incurable and could not be integrated into society, they lost their reason for existence also in the biological sense. This can be illustrated by Schneider's research department in Heidelberg (1943/1944) where 52 children and adolescents were subjected to an extensive diagnostic program. Twenty of these children were murdered in the name of research at the Eichberg psychiatric asylum.

The individual or nongroup health insurance market has played a prominent role in recent policy discussions seeking ways to improve the efficiency and equity with which health insurance is obtained in the United States (Pauly and Percy 2000; McClellan and Baicker 2002; Pauly and Nichols 2002). In particular, the nongroup market has been viewed by some as an alternative to the existing system of employment-based health insurance, one that would provide increased health plan choice to enrollees, portability of coverage, and enhanced competition among health insurers. Additionally, the nongroup market has been the focus of proposals to expand health insurance coverage to the uninsured population through the use of tax credits as in the Fair Care for the Uninsured Act of 2003 and the Health Coverage Tax Credits Program of the Trade Act of 2002. Finally, beginning in the early 1990s, about half the states implemented nongroup insurance regulatory reforms intended to improve access to coverage in the individual health insurance market through a variety of enrollment and rate reform provisions. At the same time, the nongroup health insurance market presents a number of inherent challenges (Pauly and Nichols 2002). Because the decision to enroll in nongroup coverage is made by individuals, this market tends to have high administrative costs and is vulnerable to adverse risk selection. Except where proscribed by regulation, insurer business practices in this market leave many who arguably need coverage the most, such as those with chronic conditions, with access only to coverage that is extremely costly, has high cost sharing and limited benefits, and excludes preexisting conditions, or with no coverage at all. Business cycles that favorably affect the premiums and enrollment in employer-sponsored coverage compound instability in the nongroup market as individuals face shifting opportunities to obtain generally more affordable group coverage (Chollet 2004; Monheit et al. 2004). In times of economic expansion, tight labor markets may lead more employers to offer employer-sponsored health insurance to comparatively young workers, drawing them out of the nongroup market and leaving that market with a comparatively higher cost-enrolled population. Finally, as a “bridge” or “residual” health insurance for those with interruptions in coverage from other sources and a long-term source of coverage for few, the nongroup market is small, enrolling less than 7 percent of the nonelderly population (Fronstin 2004). Given this broad interest in nongroup insurance and its relatively small and unstable enrollment, there is a need for precise data on enrollment to evaluate the performance of this market and its response to various policy initiatives. To date, most studies of nongroup enrollment rely on household surveys, most commonly the federal government's Current Population Survey (CPS). However, recent analyses of the CPS disclose some unsettling findings. For instance, despite its substantial out-of-pocket cost, 27 percent of enrollees with individually purchased insurance reported incomes less than $20,000 in 2003 (Fronstin 2004). Moreover, work by LoSasso and Buchmueller (2004) evaluating the impact of the State Children's Health Insurance Program (SCHIP) suggested that parents of low-income children enrolled in SCHIP tend to misreport such coverage as private nongroup insurance. The authors conclude that such measurement error leads to an overstatement of SCHIP crowd-out of private insurance and an understatement of SCHIP enrollment. Consistent with this observation is the well-documented undercount of Medicaid enrollment in household surveys compared with administrative totals. While research to date has not pointed to misreporting of nongroup coverage by public program enrollees, a few studies have examined possible sources of the Medicaid undercount in depth (Call et al. 2002; SHADAC 2004). These factors raise the question of how well household respondents report nongroup coverage and point to the critical implication of such measurement error for not only the evaluation of individual market performance but also for studies of public coverage expansions. In this paper, we address this measurement issue through the application of unique data on enrollees in nongroup coverage in the New Jersey Individual Health Coverage Program (IHCP) and compare our findings with enrollment estimates from several household surveys. One motivation for our study has been our observation of a wide disparity between estimates from household surveys and enrollment statistics compiled by state insurance regulators. The magnitude of this difference cannot be explained by previously documented methodological differences in the survey reference period between our data and that of the CPS. In general, we find that household survey estimates overstate nongroup health coverage enrollment 3.5 to fourfold compared with administrative statistics reported to state regulators, and we find that the characteristics of nongroup enrollees from household surveys differ significantly from a survey of a sample of enrollees obtained directly from nongroup carriers. The latter provides evidence consistent with the hypothesis that public coverage is frequently misreported as nongroup insurance. Our findings suggest that applying conventional household survey methods to analyses of the nongroup insurance market will lead to flawed conclusions about market performance, and that survey methods should be modified to assure unbiased estimates of nongroup coverage.

Silymarin, the active extract from milk thistle, has been extensively used in patients with liver disease of different etiology. Although silymarin is a complex of 7 flavonolignans and polyphenols, silibinin is usually regarded as the most active component. In vitro and in vivo studies indicate that silymarin and silibinin protect the liver from oxidative stress and sustained inflammatory processes, mainly driven by Reactive Oxygen Species (ROS) and secondary cytokines. Oxidative stress and inflammation are also involved in cellular damage of many other tissues and their role in the development and toxic reactions in patients receiving cancer therapies is established. The protective effects of silymarin and silibinin, demonstrated in various tissues, suggest a clinical application in cancer patients as an adjunct to established therapies, to prevent or reduce their toxicity. Here we discuss the possible mechanism of the protective action of silymarin and silibinin, focusing on cancer therapies as agents causing cellular damage.