The development of a Pharmacy Student Work Values Inventory (PSWVI).

The purpose of this study was to develop an instrument that measures pharmacy student work values. The instrument was included in a questionnaire mailed to 1,820 pharmacy students who had just graduated or were in their last year of pharmacy school from 19 schools of pharmacy nationwide. A total of 738 questionnaires were deemed usable for a usable rate of 41.5 percent. After Varimax factor analysis, eleven reliable factors emerged: Quality Patient Care; Supervision and Company Policy; Work Creativity/Variety; Status; Management/Leadership; Economic Return; Work Schedule; Family Responsibilities; Job Security; Co-worker Relationships; and Policies and Procedures. "Job Security," "Family Responsibilities," and "Patient Care" were rated least and negatively important respectively. There were no differences between BS and PharmD degree aspirants on the eleven factors; however, there were some significant differences between sexes. Women rated "Supervision and Company Policy" and "Quality Patient Care" higher than men. Men did not negatively value "Work Schedule" as much as women did, i.e., women preferred to work traditional, weekday hours.     

Distribution of somatic sensory and active-movement neuronal discharge properties in the MI-SI cortical border area in the rat

The rat somatosensory (SI) cortex contains a precise map of the cutaneous periphery, yet its rostromedial edge, which includes part of the fore- and hind paw representation, has been reported to functionally overlap with the electrically excitable primary motor (MI) cortex. Thus, the MI cortex in the rat contains two subregions: (i) rostrally, the "MI-agranular" cortex (i.e., "typical" MI cortex), and (ii) caudally, the "MI-SI-granular" cortex (i.e., the MI-SI overlap). The aim of this study was to assess the degree of overlap in the physiologic properties of single neurons recorded across the MI-SI boundary zone in awake, freely moving rats. Computer techniques were used to characterize both somatosensory receptive fields (cutaneous or "passive joint-manipulation") and discharge correlates of active limb movement in these MI-agranular and MI-SI-granular subregions of the MI. "Active-movement" units were defined as those which discharged strongly in correlation with specific limb movements, but in a manner which could not be predicted by their observable somatosensory properties. Of 92 completely analyzed cells in the MI-SI-granular forepaw region, 86 exhibited specific cutaneous receptive fields on the palmar surface of the forepaw. By contrast with the similarity of these neurons' responses to passive stimulation, they varied markedly in their discharge during active limb movements. For example, many did not respond when their forepaw receptive fields touched the ground during stepping. Furthermore, 31 (of 92) neurons in this region were identified as active-movement, firing in correlation with reaching movements of the forelimb. Seven of these were completely unresponsive to any sensory stimuli, but 24 exhibited an apparent convergence of cutaneous and active-movement properties. Of 86 units recorded in the MI-agranular subregion, 46 responded strongly to passive joint manipulation, but only three responded exclusively to cutaneous stimulation. Twenty-eight (of 86) cells were defined as active-movement, discharging mainly in correlation with forelimb reaching movements. Thus, the active-movement properties of neurons in these two subregions were quite similar, whereas the somatosensory properties were markedly different.     

Breast feeding and smoking hygiene: major influences on cotinine in urine of smokers'' infants.

The determinants of urine cotinine levels were studied in a group of 101 infants aged 3 months, including 79 infants whose mothers were current smokers. At a pre-arranged home visit the infants' mothers completed an interviewer-administered questionnaire, and samples of maternal urine and breast milk and infants' urine were collected. Cotinine and nicotine levels were determined by gas-liquid chromatography. Infant urine cotinine levels ranged from 0 to 140 micrograms/l (0-1120 ng cotinine/mg creatinine). A linear dose response relation between mother's smoking rate and infant urine cotinine level was observed among breast-fed infants (r = 0.79, p less than 0.001). The relation was weaker among infants fed by both breast and bottle (r = 0.56, p = 0.01) and was not apparent among bottle-fed infants (r = 0.15, p = 0.16). In addition to mode of feeding and mother's smoking rate, mother's smoking "hygiene" (assessed by the reported frequency of smoking while feeding and with infant in same room) was independently associated with infant urine cotinine level. Father's smoking pattern and exposure to smoke outside the household did not relate significantly to infant cotinine levels. We conclude that when mothers smoke, breast feeding is the principal determinant of cotinine in infants' urine. It is likely that most of this cotinine comes from cotinine in mothers' breast milk, but further research is needed to establish how much nicotine is ingested by breast-fed infants of mothers who smoke, and to investigate possible health effects.     

Self-management and spina bifida: A systematic review of the literature

BackgroundSelf-management is critical to optimizing the health of individuals with a chronic condition or disability and is, therefore, a central concept in individual and family-centered healthcare delivery. The purpose of this review is to report the state of the science of self-management for individuals with spina bifida (SB) from a lifespan perspective.ObjectiveThis review will summarize the (a) development and use of self-management skills and behaviors across the life span, (b) factors related to self-management behaviors, (c) development of generic or condition-specific measures of self-management used with a spina bifida population, and (d) development and/or outcomes of interventions to improve self-management in SB.MethodsThe search strategy was limited to primary research articles published between 2003 and 2019 and followed PRISMA guidelines. The databases searched included: PubMed, CINAHL, PsycINFO, Web of Science, Cochrane, and Google Scholar. Studies that addressed self-management concepts in individuals throughout the life span and published in English were included.ResultsThe search yielded 108 citations and 56 articles met inclusion/exclusion criteria. A systematic narrative synthesis was reported. The level of evidence identified was primarily Level III articles of good quality. Multiple demographic, environmental, condition and process factors were related to self-management behaviors. SB self-management instruments and intervention development and testing studies were identified.ConclusionsThis review provides a synthesis of the state of the science of self-management including factors related to self-management behaviors, preliminary evidence of instruments for use in SB, factors important to consider in the development and testing of future interventions, and gaps in the literature.     

Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds

Journal of Immigrant and Minority Health - This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse...     

Validation of low-cost models for minimal invasive surgery training of congenital diaphragmatic hernia and esophageal atresia

BackgroundMinimal invasive surgery (MIS) is increasingly used for the correction of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). It is important to master these complex procedures, preferably preclinically, to avoid complications. The aim of this study was to validate recently developed models to train these MIS procedures preclinically.MethodsTwo low cost, reproducible models (one for CDH and one for EA) were validated during several pediatric surgical conferences and training sessions (January 2017–December 2018), used in either the LaparoscopyBoxx or EoSim simulator. Participants used one or both models and completed a questionnaire regarding their opinion on realism (face validity) and didactic value (content validity), rated on a five-point-Likert scale.ResultsOf all 60 participants enrolled, 44 evaluated the EA model. All items were evaluated as significantly better than neutral, with means ranging from 3.7 to 4.1 (p < 0.001). The CDH model was evaluated by 48 participants. All items scored significantly better than neutral (means 3.5–3.9, p < 0.001), with exception of the haptics of the simulated diaphragm (mean 3.3, p = 0.054). Both models were considered a potent training tool (means 3.9).ConclusionThese readily available and low budget models are considered a valid and potent training tool by both experts and target group participants.Type of studyProspective study.Level of evidenceLevel II.     

Overview and update on molecular testing in non-small cell lung carcinoma utilizing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non-small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.     

Osteosarcomatosis

A review of the 690 cases of osteosarcoma in the radiographic file of the Armed Forces Institute of Pathology revealed 29 cases of "osteosarcomatosis" (multiple skeletal sites of osteosarcoma). Fifteen of these patients were 18 years old and under and manifested rapidly appearing, usually symmetric, sclerotic metaphyseal lesions. The remaining 14 patients were more than 18 years old and had fewer, asymmetric sclerotic lesions. In most patients (28 of 29), a radiographically dominant skeletal tumor was seen. Pulmonary metastases occurred in the majority of patients and were detected at the same time as the bone lesions. These 29 patients were studied with regard to demographic data and skeletal distribution and radiographic appearance of their lesions. As a result of the findings, a metastatic origin from a primary dominant osteosarcoma is favored over a multifocal origin as the basis for osteosarcomatosis. Osteosarcomatosis is more commonly encountered in the mature skeleton than has been previously recognized.     

A pharmacoeconomic comparison of antithymocyte globulin and muromonab CD3 induction therapy in renal transplant recipients

Antithymocyte globulin (ATG) and muromonab CD3 (OKT3) are currently the only antilymphocyte preparations that are commercially available for induction immunosuppressive therapy for renal allograft transplantation in the US. ATG, in the usually prescribed doses, is more expensive than muromonab CD3, but muromonab CD3 is associated with more severe adverse effects that may affect clinical outcome and overall cost. We performed a retrospective study of all adult recipients of a first cadaveric renal allograft, who underwent transplantation between January 1991 and December 1994 who received either ATG (n = 92) or muromonab CD3 (n = 91) for induction therapy at our transplant centre. The average age of recipients was older (50 vs 44 yrs; p = 0.001) and extended donors were more commonly used in the ATG group (41 vs 13%; p = 0.0001) compared with the muromonab CD3 group. Nevertheless, at 1 year post-transplant, the incidence of rejection was lower (34 vs 47%) and graft survival was better (93 vs 85%; p = 0.03) in the ATG group. Patients who received ATG were discharged earlier (9.4 vs 13.3 days; p = 0.0001) and had similar serum creatinine levels on the day of discharge (2.4 +/- 1.5 vs 2.1 +/- 1.1 mg/dl; p = 0.25). Overall, the 1-year hospitalisation costs of transplantation and readmissions were similar [$US39,937 +/- 17,014 vs $US42,850 +/- 20,923 (currency year 1994); p = 0.22]. This is the first comparison of ATG and muromonab CD3 in renal transplant recipients to consider clinical as well as economic outcomes. For renal transplant patients in whom induction therapy is used at our centre, the initial expense of ATG can be justified by improved graft survival, fewer rejection episodes, and shorter hospital stays, which are associated with similar overall transplantation costs.