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The Kellogg Biological Station Long-term Agroecosystem Research site (KBS LTAR) joined the national LTAR network in 2015 to represent a northeast portion of the North Central Region, extending across 76,000 km 2 of southern Michigan and northern Indiana. Regional cropping systems are dominated by corn (Zea mays)-soybean (Glycine max) rotations managed with conventional tillage, industry-average rates of fertilizer and pesticide inputs uniformly applied, few cover crops, and little animal integration. In 2020, KBS LTAR initiated the Aspirational Cropping System Experiment as part of the LTAR Common Experiment, a co-production model wherein stakeholders and researchers collaborate to advance transformative change in agriculture. The Aspirational (ASP) cropping system treatment, designed by a team of agronomists, farmers, scientists, and other stakeholders, is a five-crop rotation of corn, soybean, winter wheat (Triticum aestivum), winter canola (Brassicus napus), and a diverse forage mix. All phases are managed with continuous no-till, variable rate fertilizer inputs, and integrated pest management to provide benefits related to economic returns, water quality, greenhouse gas mitigation, soil health, biodiversity, and social well-being. Cover crops follow corn and winter wheat, with fall-planted crops in the rotation providing winter cover in other years. The experiment is replicated with all rotation phases at both the plot and field scales and with perennial prairie strips in consistently low-producing areas of ASP fields. The prevailing practice (or Business as usual [BAU]) treatment mirrors regional prevailing practices as revealed by farmer surveys. Stakeholders and researchers evaluate the success of the ASP and BAU systems annually and implement management changes on a 5-year cycle., (© 2024 The Author(s). Journal of Environmental Quality published by Wiley Periodicals LLC on behalf of American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

Purpose: Accurately describing pharmacy productivity in the ambulatory oncology infusion setting is important to ensure appropriate labor utilization. The purpose of this study was to develop a productivity model utilizing weighted medication complexity and prospective schedule data to determine if predicted productivity corresponds to actual productivity across 6 ambulatory oncology infusion sites., Methods: This study was a 2-part analysis. Part 1 was to modify the historic productivity model from dispense code weighting to individual medication complexity weighting. Medication-specific relative value units were determined by analyzing 12 months of historic timestamp data from the electronic health record and gravimetric technology software. The productivity model containing updated relative value units was compared to the historic model to determine if the difference in total calculated full-time equivalents (FTEs) was within 2.0 FTEs. Part 2 applied prospective infusion schedule data to the updated model to determine if predicted productivity corresponded to actual productivity (within 2.0 FTEs) for pharmacy infusion services., Results: The mean difference in total calculated FTEs for infusion during the study period was 2.46 (standard deviation = 1.87) and was within the range of 2.0 FTEs (P = 0.54), indicating that the updated model was not statistically different from the historic model. The mean difference in total calculated FTEs between the predictive and actual productivity model for infusion was 18.28 (standard deviation = 1.00) and was out of the range of 2.0 FTEs (P < 0.001), indicating that predicted productivity was statistically different from the actual productivity., Conclusion: Medication complexity weighting can be used to provide a comprehensive assessment of workload and productivity across pharmacy infusion services. The methodology used to assess predictive productivity should be explored further., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Soft skills include communication skills and personality traits that are important when choosing a dentist, but other factors within the dental office also seem to be important for patients. The aim of this study is to evaluate factors that are important to people in a dentist as well as characteristics of the ideal dentist and to evaluate possible age-, gender-, and residence of living specific differences. A telephone survey with participants aged 35 years or older (ag—age group: ag 1: 35−50 years, ag 2: 70−84 years, ag 3: >85 years) in three German cities was conducted. Data were analyzed with respect to gender and age. Most of the participants (n = 298, 64.2%), regardless of their own gender, age, or place of residence did not care about the gender of the dentist. In general, the price of the treatment does not play a role in choosing the ideal dentist. Women differ significantly from men in their choice of dentist (ANOVA p < 0.001 (preference of non-smoker), ANOVA p < 0.001 (preference, that the dentist does not smell of smoke, importance of appearance (ANOVA p < 0.001) and psycho-social skills, etc.). As age increases, professional experience and psycho-social competencies are rated as important. With the increase in age, the mean value of the desired years of professional experience increases without significant differences between age groups. The importance of advanced training (ANOVA p < 0.001; Bonferoni correction: significant difference between ag 1 and ag 2 p < 0.001, and ag 1 and ag 3 p < 0.001) decreases with age. Especially for participants aged 70 to 84 years, a relationship of trust is important. Between the places of residence, statistical differences for almost all surveyed items were found (e.g., importance that the dentist speaks the patients’ native language ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig, Berlin and Mainz, and Leipzig and Mainz (each p < 0.001), dentist has a specialization ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig and Berlin and Mainz (each p < 0.001), etc.). Dentists should be trained to develop psycho-social skills to meet the special demands of the increasing older population.

Purpose: Because of high costs associated with oral oncology drugs, patients are often unable to afford their medications. Developing and implementing an oral oncology drug repository program can provide cost savings and waste reduction opportunities to oncology patients and health care systems., Methods: Strategies to implement an oral oncology drug repository program include the following: (1) define patient eligibility requirements for the collected drug, (2) ensure patients have long-term availability to preferred treatment, (3) identify optimal oral oncology drugs to use, (4) provide safe drug collection with protocol, (5) calculate the amount of resources needed to provide services, (6) obtain adequate space to operate safely and efficiently, (7) establish safe disposal of the drug deemed inappropriate for use, and (8) spread awareness to prospective patient participants., Results: To date, The Ohio State University Wexner Medical Center oral oncology drug repository program has received 11 drug collections and has redispensed drugs several times. With additional resources, the plan is to expand the repository program's scope to include other drugs and reach more patients., Conclusion: Developing and implementing an oral oncology drug repository program for patients was logistically feasible due to strategic planning with many early successes. As national attention continues to be placed on reducing oral oncology drug costs, additional research is needed regarding strategies to best incorporate pharmacy services into innovative patient care opportunities.

Objective: To identify motivators and barriers to pharmacy student completion of instructor evaluations, and to develop potential strategies to improve the evaluation process., Methods: Completed at four Ohio Colleges of Pharmacy, Phase I consisted of a student/faculty survey and Phase II consisted of joint student/faculty focus groups to discuss Phase I data and to problem solve., Results: In Phase I, the top three student-identified and faculty-perceived motivators to completion of evaluations were to (1) make the course better, (2) earn bonus points, and (3) improve the instructor's teaching. The top three student-identified barriers to completion of evaluations were having to (1) evaluate multiple instructors, (2) complete several evaluations around the same time, and (3) complete lengthy evaluations. Phase II focus groups identified a number of potential ways to enhance the motivators and reduce barriers, including but not limited to making sure faculty convey to students that the feedback they provide is useful and to provide examples of how student feedback has been used to improve their teaching/the course., Conclusions: Students and faculty identified motivators and barriers to completing instructor evaluations and were willing to work together to improve the process., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To conduct a simulated medication regimen with second-year pharmacy students to determine their anticipated versus actual difficulty in adhering to it., Methods: Second-year pharmacy students were given 6 fictitious medications (jellybeans) and a drug regimen to adhere to for 6 days. Pre- and post-intervention surveys were conducted to compare participants anticipated vs. actual difficulty with adherence and changes in empathy toward patients., Results: The 69 (96%) students who participated in the study missed on average 16% of all simulated medication doses and noted that adhering to the complex medication regimen was more difficult than they had anticipated. Eighty-nine percent of students agreed or strongly agreed the project was valuable in developing empathy towards patients taking complex medication regimens., Conclusions: Pharmacy students participating in a simulated medication regimen missed a notable number of doses and reported a greater level of empathy for patients taking complex medication regiments. Finding meaningful ways to integrate adherence into the curriculum is essential.

Objectives: Specific organisms can be added to foods to target an effect (probiotics) or non-digestible carbohydrates can be used to foster the development of a favorable flora in the intestinal tract (prebiotics). The significance of pro- and prebiotics have been studied extensively, providing many current and theoretical treatment options. The objective of this paper is to provide a brief overview of commercial products available for the practicing clinician., Methods: The literature was evaluated for the most commonly used and studied pre- and probiotics available. In addition, information regarding each of the products was obtained from the manufacturer., Results: We found that all products are not formulated the same and the content of live organisms can differ. Currently available products are relatively safe but caution should be used for any patients that may have allergies to inactive ingredients in the product or are immunocompromised., Conclusions: Many probiotics and prebiotics are commercially available to aid in promoting healthy bowel flora to resist disease. This reference can be a helpful tool for the pharmacist when answering questions or making recommendations to a patient.

Episodes of post-tonsillectomy hemorrhage are unpredictable and potentially life-threatening. Primary post-tonsillectomy hemorrhage (< 24 hr postoperatively) is generally considered to be more common and more serious than secondary hemorrhage (> 24 hr). Therefore, recent studies have focused on the control of primary hemorrhage in order to determine the appropriate length of postoperative observation. The issue of follow-up is becoming more important in light of the increasing popularity of outpatient tonsillectomy. We undertook a prospective study to evaluate the incidence of post-tonsillectomy hemorrhage over the short and long term (3 mo). We studied 602 patients, aged 23 months to 89 years (mean: 20.6 yr), who had undergone inpatient tonsillectomy in 1999 and who had been hospitalized for at least 5 days. Our goal was to ascertain the number of episodes of postoperative hemorrhage that required surgical treatment under general anesthesia. We were able to contact 601 of these patients (or their parents) by telephone 3 months postoperatively to inquire about any instances of delayed secondary bleeding. In all, 16 patients (2.7%) had experienced post-tonsillectomy bleeding that required surgically achieved hemostasis under general anesthesia. Of this group, 11 patients (68.8%) had experienced primary hemorrhage and were treated immediately, and five (31.3%) experienced secondary hemorrhage. One patient in the latter group experienced excessive bleeding 38 days postoperatively, which we believe is the latest episode of secondary bleeding reported to date. Based on the findings of this study, we believe that a postoperative follow-up period of 10 days is sufficient to identify all but the most rare cases of post-tonsillectomy hemorrhage.

The haemodynamic and antianginous efficacy of percutaneous nitroglycerin was evaluated in 24 patients with coronary heart disease. Groups of 8 patients each received one, two or four patches (nitroglycerin liberation 5 mg per patch within 24 hours). Prior to application and after 1 and 2 hours cardiac frequency, arterial and pulmonary arterial pressures and exercise tolerance were assessed. Cardiac frequency and arterial pressure showed no relevant changes after application of patches. The mean pulmonary arterial pressure decreased after application of one or two plasters by 18.5 and 22.2% at rest and by 12.7 and 21.1%, respectively, during exercise. The working capacity showed a trend towards improvement only. With four nitroglycerin patches the mean pulmonary arterial pressure at rest was lower by 26.2% and during exercise by 39.1%. The working capacity rose significantly by 48.7%. Comparison of these effects with oral single dosage of 20 mg 5-isosorbide mononitrate (ISMN) showed that two simultaneously administered plasters did not achieve efficacy of 20 mg 5-ISMN, four plasters, however, were more effective.