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A large-scale palaeomagnetic study (125 specimens from 88 sampling localities) has been carried out on the Whin Sill complex and its associated dykes in northern England. The dominant carrier of remanent magnetization of the doleritic rocks is relatively pure magnetite of pseudo-single domain size, and the characteristic remanent magnetizations are typically well defined and unidirectional. Regionally consistent palaeomagnetic directions are obtained from three geographically distinct parts of the Whin Sill complex, here named as the Holy Island Sill (Declination/Inclination (D/I) = 189.5/-2.8, [[alpha].sub.95] 6.3), the Alnwick Sill (D/I = 194.6/-25.6, [[alpha].sub.95] = 8.1) and the Hadrian's Wall-Permines Sill (D/I = 189.2/3.3, [[alpha].sub.95] = 3.5). Although the Holy Island Sill and the Hadrian's Wall--Pennines Sill are of similar age (c. 296 Ma) and indistinguishable on palaeomagnetic grounds, the difference in palaeomagnetic directions between them and the Alnwick Sill demonstrates the multi-component nature of the complex; magma-flow indicators suggest that the Holy Island Sill and the Hadrian's Wall--Pennines Sill may also represent separate intrusion events. Dykes local to the three sills have remanence directions corresponding to their respective sills and can tentatively be identified as their feeder dykes. Virtual geomagnetic poles for the three palaeomagnetic sites are: Holy Island Sill and Holy Island Dyke, 346.8E, 35.4S; Alnwick Sill, High Green Dyke and St. Oswald's Chapel Dyke. 337.1E, 47.1S; Hadrian's Wall-Pennines Sill and Hett Dyke, 347.1E, 32.9S. Keywords: sills, dykes, palaeomagnetism, emplacement, dolerite.

Background: Attention to open innovation is more important for future research. The impact of the globalization era in health care means that nursing staff are required to be competitive and more professional with the use of increasingly developing technology. Innovation performance is an important determinant of organizational success. Objective: The substantial for this study is analysing key factors which effect the relationship between competence, motivation to innovate the performance of nursing with organizational commitment as mediating. Method: This research adopted cross-sectional research. The total respondents in this study was 60 nurses at Jasmine Room RSST Klaten with a census. This study used a hypothesis for applying path analysis, validity reliability for questioner, Statistic-test, and also coefficient determination with correlation. Results: Path 1 show that competence (Co) and motivation (Mt) have positive significance on organizational commitment (Z). Path 2 shows that competence (Co), motivation (Mt), and organizational commitment (Z) have positive significance. Highlighting the findings, nurse behaviour in innovation is based on competence. The support of hospital organizational commitment has an impact on strengthening nurses' ability in innovation behaviour. Improving the behaviour of nursing personnel in innovating will realize public health needs, and the need for understanding in healthy behaviour. In nursing staff, both those at a young or old age who will retire, competence becomes a factor that cannot be ruled out by funds to innovate. For the motivation, it does not have much meaning for nursing personnel who are old and about to retire. Conclusion: The spotlight on findings shows the behaviour of nurses in innovation is based on competence. The support of hospital organizational commitment has the impact of strengthening the ability of nurses in innovation behaviour. Increasing the behaviour of nursing personnel in innovating will realize public health needs, and the need for understanding healthy behaviour. Keywords: Innovation performance, multicultural competence, motivation, organizational commitment.

IntroductionSince 2015, Colombia has faced a significant humanitarian challenge, receiving 2.9 million displaced Venezuelans. This study examines organizational cooperation in the humanitarian response to this migration crisis, aiming to understand the coordination dynamics among key organizations and actors.MethodsOur research combined interviews and web scraping to gather data on key actors and their relationships in the humanitarian response. We employed Social Network Analysis (SNA) to examine these relationships and the collaborative strategies among entities, focusing on how they address the migration challenges.ResultsThe results indicate that cooperation occurred through mediated channels, where established NGOs collaborated via coordination mechanisms established by international non-governmental organizations (INGOs), often involving diaspora volunteer-based organizations and through ad-hoc coordination. We also identified that organizations specializing in specific activities often exhibited limited coordination with others operating in the same sector. Lastly, the results suggest that coordination mechanisms played a crucial role in driving activities and facilitating the diversification of responses, partly through allocating financial resources.DiscussionThis study contributes to the humanitarian aid and migration literature, focusing on Colombia's migration response. It employs a mixed-methods approach, including Social Network Analysis (SNA), to explore the dynamics within humanitarian networks. It highlights the role of the Venezuelan diaspora NGOs, challenging the conventional view of migrants solely as aid recipients. The research uncovers the complex roles of intermediaries and coordination mechanisms, offering new insights into constructing effective humanitarian network structures. It advocates for a collaborative and inclusive approach to managing migration situations.

Susu merupakan nutrisi yang disukai mikroba untuk tumbuh.Padakeadaan normal jumlah mikroflora adalah 103CFU/mL susu. Pada sapiyang terjangkit radang (masitis) dapat dijumpai bakteri jenis Corybacterium, Staphylococcus sp, Streptococcus sp, dan Enterobacteriaceae yang jumlahnya dapat mencapai 105 CFU/mL susu. Tujuan penelitian ini adalah untuk mengetahui jumlah total bakteri pada susu sapi segar di peternakan daerah Kalijambe, Sragen. Metode pada penelitian ini menggunakan uji mikrobiologi dengan tigauji, yaitu breed, MBRT dan rezasurin. Sampel susu sapi segar yang digunakan pada penelitian ini ada 4 jenis yaitu susu sapi segar A, susu sapi segar B, susu sapi segar C dan susu sapi segar D, di mana di masing-masing jenis susu tersebut terdapat pengulangan sebanyak satu kali (secara duplo). Berdasarkan ketiga uji yang telah dilaksankan dapat disimpulkan bahwa sampel susu A1, A2, B1, dan B2 layak konsumsi dan sampel susu C1, C2, D1 dan D2 tidak layak konsumsi dikarenakan jumlah cemaran bakteri melebihi batas minimum SNI 3141.1- 2011(1x106CFU/ml). Hasil uji “t” menunjukkan bahwa jumlah total mikroba susu segar pada 4 sampel (A, B, C, D) berbeda nyata (P < 0,05), sehingga dapat disimpulkan bahwa kualitas susu segar di peternakan Kalijambe, Sragen adalah termasuk bagus untuk susu A dan B (sesuai SNI 2011), sedangkan untuk susu C dan D kurang bagus (tidak sesuai dengan SNI 2011).

Konsumsi garam sangat diperlukan oleh manusia untuk bertahan hidup karena tubuh manusia bergantung pada natrium untuk kontraksi otot, transmisi saraf dan sistem kontrol guna menyeimbangkan cairan tubuh, bersama dengan elektrolit lain seperti kalium. Terlalu banyak makan garam dapat berdampak buruk bagi kesehatan seperti hipertensi dan proteinuria. Hipertensi merupakan gangguan pada system peredaran darah, yang cukup banyak mengganggu kesehatan masyarakat. Salah satu komplikasi hipertensi adalah gagal ginjal, proteinuria merupakan salah satu manifestasi klinisnya. Tujuan umum penelitian ini adalah mengetahui hubungan mengkonsumsi garam berlebihan dikaitkan dengan kejadian hipertensi yang berlanjut ke proteinuria di Puskesmas Jaten II Karanganyar, sedangkan tujuan khususnya adalah untuk mengetahui gambaran umum karakteristik responden dan untuk mengetahui data khusus karakteristik responden. Jenis penelitian ini adalah kualitatif dengan desain penelitian deskriptif observasional. Populasi dalam penelitian ini adalah seluruh pasien hipertensi di Puskesmas Jaten II Karanganyar yang berjumlah 34 orang. Sampel dalam penelitian ini adalah seluruh anggota populasi. Teknik pengambilan sampel yang digunakan dalam penelitian ini adalah purposive sampling. Kesimpulan penelitian ini adalah mengkonsumsi garam akan mengakibatkan keseimbangan natrium dan kalium tidak seimbang, sehingga menyulitkan ginjal bekerja dengan baik dengan munculnya proteinuria. Kemudian yang terjadi adalah retensi cairan diikuti dengan naiknya tekanan darah. Kata Kunci : garam, protein, hipertensi, puskesmas

Objective: To determine signalment, injury type, trauma severity score, and outcome of canine trauma patients undergoing surgical (emergency room [ER] or operating room [OR]) and nonsurgical treatment in addition to time to surgery, specialty services involved, and cost in the OR surgery population., Design: Retrospective evaluation of medical record and hospital trauma registry data on canine trauma cases., Setting: University teaching hospital., Animals: One thousand six hundred and thirty dogs presenting for traumatic injury between May 2017 and July 2020., Interventions: None., Measurements and Main Results: Demographics and outcome were compared for canine trauma patients undergoing OR surgery (12.8%, 208/1630), ER surgery (39.1%, 637/1630), or no surgical intervention (48.2%, 785/1630). Among the 2 surgical groups, 98.9% (836/845) survived to discharge compared with 92.2% (724/785) of the nonsurgical group (P < 0.0001). The OR surgical group had significantly higher median Animal Trauma Triage scores (2 vs 1, P < 0.0001) and median days in hospital (2 vs < 1, P < 0.0001) compared with the other groups. For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (45.2%, 94/208) and general surgery (26.9%, 56/208). Neurology and general surgery cases required the longest median length of stay in hospital, and ophthalmology and dentistry cases required the shortest. The median cost of visit was highest in neurology ($10,032) and lowest in ophthalmology ($2305) and dentistry ($2404)., Conclusions: Surgical intervention in canine trauma patients appears to be associated with higher survival rates, and among the surgery groups, mortality was highest in the ER and general surgery groups. OR surgical intervention, in particular general surgery and neurology, was associated with increased length of hospitalization, increased cost, and higher Animal Trauma Triage scores., (© Veterinary Emergency and Critical Care Society 2024.)

Objective: To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population., Design: Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases., Setting: University teaching hospital., Animals: Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020., Interventions: None., Measurements and Main Results: Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups., Conclusions: Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products., (© 2023 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Aims: There is limited research using real-world data to evaluate protective cardiovascular effects of glucagon-like peptide-1 (GLP-1) agonists among adults with type 2 diabetes (T2D) early in treatment., Materials and Methods: We conducted a retrospective, active comparator cohort study using 2011-2015 administrative claims data to compare cardiovascular disease (CVD) event rates following initiation of exenatide extended-release (E-ER), exenatide immediate-release (E-IR) or liraglutide in T2D adults who previously received no other antidiabetic medication (ADM) except metformin. The primary outcome was time to first major adverse CVD event (ischaemic heart disease, stroke, congestive heart failure or peripheral arterial disease) after starting GLP-1. Cox proportional hazards regression was used to model the association between index GLP-1 and CVD events, adjusting for baseline patient, prescriber and plan characteristics. Primary analyses included all patients with ≥2 prescription fills for the index GLP-1, regardless of subsequent refill adherence or initiation of other ADM after index date., Results: Compared with liraglutide, neither E-ER nor E-IR was associated with risk of composite major CVD events (hazard ratios [HRs] for E-ER and E-IR: 1.33 [95% C.I. 0.73-2.39] and 1.30 [0.81-2.09]). No associations were observed between event rates for individual CVD components. The HR for an ischaemic event with E-IR relative to liraglutide was 1.85 (95% C.I. 0.97-3.53). Adjusting for time-varying exposure to other ADM and CVD medications after index date produced similar results., Conclusions: Initiating either immediate or extended-release exenatide rather than liraglutide was not associated with significant differences in CVD risk in this observational real-world study., (© 2023 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.)

This study aimed to identify the strongest barriers and motivators associated with each step toward buprenorphine prescribing (1. obtaining a waiver, 2. beginning to prescribe, and 3. prescribing to more people) among a sample of Missouri-based medical professionals (N = 130). Item weights (number of endorsements times mean rank of the item's importance) were calculated based on their responses. Across groups, lack of access to psychosocial support services, need for higher levels of care, and clinical complexity were strong barriers. Among non-prescribers (n = 57, 46.3%), administrative burden, potential of becoming an addiction clinic, and concern about misuse and diversion were most heavily weighted. Among prescribers (n = 66, 53.7%), patients' inability to afford medications was a barrier across phases. Prominent motivators among all groups were the effectiveness of buprenorphine, improvement in other health outcomes, and a personal interest in treating addiction. Only prescribers reported the presence of institutional support and mentors as significant motivators., (© 2021. National Council for Mental Wellbeing.)

Introduction: Patients with opioid use disorder may have difficulty transitioning from full-agonist opioids to sublingual buprenorphine due to the risk of precipitated opioid withdrawal. Novel strategies have been developed to facilitate this transition, including the use of micro-dosing with transdermal buprenorphine. We began using a transdermal buprenorphine transition strategy at our hospital in 2019., Methods: We performed a retrospective observational cohort study of patients treated with transdermal buprenorphine to facilitate transition from full-agonist opioids (prescribed or recreational) while hospitalized between January 2019 and December 2020. Patients were excluded if transdermal buprenorphine was given for pain, if they did not receive at least one dose of sublingual buprenorphine while hospitalized, or if their clinical course precluded analysis of their tolerance of the transition protocol. Data on the doses and timing of medications, symptoms during transition, and hospital outcomes were abstracted from the electronic medical record., Results: We identified 41 cases that satisfied inclusion and exclusion criteria. Thirty-five cases involved a transition from medically indicated opioids; of these, 8 cases involved a transition from methadone. Six cases involved a transition from illicit opioids used prior to hospital presentation. For patient transitioning from medically indicated opioids, the median milligram morphine equivalent (MME) on the day prior to transdermal buprenorphine application was 63.8 (range 0-900, IQR 153.8) and the median MME on the day of transdermal buprenorphine application was 34.5 (range 0-600, IQR 65.3). The median initial dose of sublingual buprenorphine administered was 8 mg (range 2-8mg, IQR 6mg), the median total first-day dose was 16mg (range 2-24mg, IQR 16mg), and the median total daily dose on the last day of follow-up was 16mg (range 2-24mg, IQR 16mg). In 38 cases, patients completed the transition to sublingual buprenorphine and were still taking buprenorphine at the time they left the hospital. The transition protocol was fairly well-tolerated, with 59% of cases tolerating it well and 32% tolerating it fairly., Discussion: Our findings suggest that the use of transdermal buprenorphine to facilitate transition to sublingual buprenorphine is generally well-tolerated, and may be helpful in hospitalized patients. We identified several areas for improvement in future practice by reviewing the clinical courses of patients who tolerated transition poorly. Limitations of the study include its retrospective chart review design, the lack of a standardized transition protocol during the study period, and the lack of standardized data in the medical record regarding patients' tolerance of the transition protocol. Future research should include prospective studies using a standardized protocol and structured, pre-planned assessments of opioid withdrawal during the transition period., Conclusion: The use of transdermal buprenorphine to facilitate induction of sublingual buprenorphine therapy in hospitalized patients with OUD was generally well-tolerated in this single-center retrospective observational study. Further prospective research is needed to demonstrate efficacy and optimize treatment protocols.

Introduction: Despite widespread recognition of the opioid crisis, opioid overdose remains a common reason for Emergency Department (ED) utilization. Treatment for these patients after stabilization often involves the provision of information for outpatient treatment options. Ideally, an ED visit for overdose would present an opportunity to start treatment for opioid use disorder (OUD) immediately. Although widely recognized as effective, opioid agonist therapy with methadone and buprenorphine commonly referred to as "medication-assisted therapy" but more correctly as "medication for addiction treatment" (MAT), can be difficult to access even for motivated individuals due to shortages of prescribers and treatment programs. Moreover, opioid agonist therapy may not be appropriate for all patients, as many patients who present after overdose are not opioid dependent. More treatment options are required to successfully match patients with diverse needs to an optimal treatment plan in order to avoid relapse. Naltrexone, a long-acting opioid antagonist, available orally and as a monthly extended-release intramuscular injection, may represent another treatment option. Methods: We conducted a literature search of MEDLINE and PubMed. We aimed to capture references related to naltrexone and is use as MAT for OUD, as well as manuscripts that discussed naltrexone in comparison toother agents used for MAT, opioid detoxification, and naltrexone metabolism. Our initial search logic returned a total of 618 articles. Following individual evaluation for relevance, we selected 65 for in-depthreview. Manuscripts meeting criteria were examined for citations meriting further review, leading to the addition of 30 manuscripts Conclusions: Here, we review the pharmacology of naltrexone as it relates to OUD, its history of use, and highlight recent studies and new approaches for use of the drug as MAT including its potential initiation after ED visit for opioid overdose.

Previous studies suggest beta-adrenergic receptor (β-AR) antagonists (β-blockers) decrease breast cancer progression, tumor metastasis, and patient mortality; however the mechanism for this is unknown. Immunohistochemical analysis of normal and malignant breast tissue revealed overexpression of β1-AR and β3-AR in breast cancer. A retrospective cross-sectional study of 404 breast cancer patients was performed to determine the effect of β-blocker usage on tumor proliferation. Our analysis revealed that non-selective β-blockers, but not selective β-blockers, reduced tumor proliferation by 66% (p < 0.0001) in early stage breast cancer compared to non-users. We tested the efficacy of propranolol on an early stage breast cancer patient, and quantified the tumor proliferative index before and after treatment, revealing a propranolol-mediated 23% reduction (p = 0.02) in Ki67 positive tumor cells over a three-week period. The anti-proliferative effects of β-blockers were measured in a panel of breast cancer lines, demonstrating that mammary epithelial cells were resistant to propranolol, and that most breast cancer cell lines displayed dose dependent viability decreases following treatment. Selective β-blockers alone or in combination were not as effective as propranolol at reducing breast cancer cell proliferation. Molecular analysis revealed that propranolol treatment of the SK-BR-3 breast cancer line, which showed high sensitivity to beta blockade, led to a reduction in Ki67 protein expression, decreased phosphorylation of the mitogenic signaling regulators p44/42 MAPK, p38 MAPK, JNK, and CREB, increased phosphorylation of the cell survival/apoptosis regulators AKT, p53, and GSK3β. In conclusion, use of non-selective β-blockers in patients with early stage breast cancer may lead to decreased tumor proliferation.

Health care leaders and policymakers are turning to the patient-centered medical home (PCMH) model to contain costs, improve the quality of care, and create a more positive primary care work environment. We describe how Group Health, an integrated delivery system, developed and implemented a PCMH intervention that included standardized structural and practice level changes. This intervention was spread to a diverse set of 26 primary care practices in 14 months using Lean Management principles. Group Health's experience provides valuable insights that can be used to improve the design and implementation of future PCMH models.

Objective: This prospective study examined whether psychological variables related to the transdiagnostic theory of eating disorders measured at admission predicted length of time to reach 85 per cent of ideal body weight (IBW) among underweight adolescents hospitalized for an eating disorder., Method: Thirty-three girls (aged 12-17) weighing below 85 per cent of IBW, admitted to an inpatient and/or partial hospitalization eating disorder programme completed self-report measures at admission. Cox regression tested whether scores on admission measures predicted time to reach 85 per cent of IBW., Results: After controlling for IBW at admission, higher self-esteem and lower perfectionism predicted shorter time to reach 85 per cent of IBW, with emotion regulation as a marginally significant predictor., Conclusion: Self-esteem and perfectionism may be predictors of responsiveness to weight-gain efforts during hospitalization. Further studies are necessary to determine whether these variables might be appropriate targets for intervention to promote weight gain in underweight girls with eating disorders.

Background: This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission., Methods: Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness., Results: Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial., Conclusion: Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.

Introduction: Errors in medication reconciliation constitute a large area of potential injury to patients. Medication reconciliation is rarely incorporated into medical school curriculums so students learn primarily from observing clinical care., Aim: To design and implement an interactive learning exercise to teach second year medical students about medication reconciliation, Setting: Northwestern University Feinberg School of Medicine, Chicago, IL PROGRAM DESCRIPTION: The Medication Reconciliation Simulation teaches medical students how to elicit information from active real-world sources to reconcile a medication history., Program Evaluation: At the conclusion of the session, students completed a Likert scale survey rating the level of improvement in their knowledge and comfort in obtaining medication histories. Students rated their knowledge level as having increased by 27% and their comfort level as having increased by 20%. A full 91% of the 158 students felt that it should be performed again for the following medical student class., Discussion: The Medication Reconciliation Simulation is the first to specifically target medication reconciliation as a curriculum topic for medical students. Students praised the entertaining simulation and felt it provided a very meaningful experience on the patient safety topic. This simulation is generalizable to other institutions interested in teaching medication reconciliation and improving medication safety.

Background: Electronic health records (EHRs) may be used to assess quality of care., Objective: To evaluate the accuracy of automated review of EHR data to measure quality of care for outpatients with heart failure., Design: Observational study of quality of care for heart failure comparing automated review of EHR data with automated review followed by manual review of electronic notes for patients with apparent quality deficits (hybrid review)., Setting: An academic general internal medicine clinic with several years' experience using a commercial EHR., Patients: 517 adults with a qualifying International Classification of Diseases, Ninth Revision, diagnosis of heart failure in their EHR data and 2 or more clinic visits over the past 18 months., Measurements: Left ventricular ejection fraction (LVEF), prescription of a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) for patients with left ventricular systolic dysfunction (LVEF <0.40) and prescription of warfarin for patients with comorbid atrial fibrillation., Results: Performance based on automated review of EHR data was similar to that based on hybrid review for assessing LVEF measurement (94.6% vs. 97.3%), prescription of beta-blockers (90.9% vs. 92.8%), and prescription of ACE inhibitors or ARBs (93.9% vs. 98.7%). However, performance based on automated review was lower than that based on hybrid review for prescription of warfarin for atrial fibrillation (70.4% vs. 93.6%), primarily because automated review did not detect documentation of accepted reasons for not prescribing warfarin., Limitations: The findings may not be applicable to other practices and other EHRs. The authors used EHR data to identify eligible patients, so the study may have excluded some patients with heart failure. Patient charts were manually reviewed only if a provider appeared to fail a quality measure on automated review and did not determine the sensitivity and specificity of automated review according to standard definitions., Conclusions: Automated review of EHR data to measure the quality of care of outpatients with heart failure missed many exclusion criteria for medications documented only in providers' notes. As a result, it sometimes underestimated performance on medication-based quality measures.

Objective: To compare compliance, psychiatric disorders, and family support in children with insulin-dependent diabetes mellitus (IDDM) hospitalized with diabetic ketoacidosis (DKA) and clinic controls., Method: Twenty-five youths hospitalized with DKA and 25 matched outpatient subjects with IDDM with no history of DKA during the preceding year were assessed cross-sectionally, using the Diagnostic Interview Schedule for Children, measures of general and diabetes-specific family functioning, and measures of self-esteem and social competence. Levels of glycosylated hemoglobin and information about compliance with the treatment regimen were obtained., Results: A significantly higher number of psychiatric disorders was observed in the hospitalized children, with 88% meeting criteria for at least one disorder (versus 28% of controls). Self-esteem and social competence were lower in the hospitalized group, and their families scored lower on problem-solving and diabetes-specific "warmth-caring.", Conclusions: Children with recurrent DKA may be at greater risk of associated psychopathology than diabetic controls with no such history. DKA children's reports of noncompliance may be more sensitive than their parents' reports, and their families may lack warm, caring parent-child relationships.

This study evaluated the relationship between Marlatt and Gordon's (1985) Abstinence Violation Effect (AVE) and fasting outcomes of patients enrolled in a Very Low Calorie Diet (VLCD) and behavior education program. Within the first 11 weeks of the VLCD, 41 of 76 patients reported a fasting lapse and rated this lapse on an attribution scale. Patients reporting greater characterological attributions for their first lapse (i.e., a higher AVE) lost a smaller percentage of their excess weight during active fasting than patients reporting more situational attributions r(39) = -.36, p less than .025. First lapse AVE ratings did not distinguish between program dropout versus completer status, but high AVE dropouts did spend fewer weeks in the VLCD program than low AVE dropouts, r(12) = -.54, p less than .05. Although a faster's initial level of obesity accounted for the largest portion of weight loss outcome variance, the AVE accounted for a significant additional portion of outcome.