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"Murphy, Kevin D."
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Women architects at work : making American modernism
\"The first comprehensive history of the role of women architects within the history of American modernism\"-- Provided by publisher.
BOOK
Measurement properties of EQ-5D-3L and EQ-5D-5L in recording self-reported health status in older patients with substantial multimorbidity and polypharmacy
Background
The EQ-5D-3L and EQ-5D-5L are two generic health-related quality of life measures, which may be used in clinical and health economic research. They measure impairment in 5 aspects of health: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The aim of this study was to assess the performance of the EQ-5D-3L and EQ-5D-5L in measuring the self-reported health status of older patients with substantial multimorbidity and associated polypharmacy.
Methods
Between 2017 and 2019, we administered EQ-5D-3L and EQ-5D-5L to a subset of patients participating in the OPERAM trial at 6 months and 12 months after enrolment. The OPERAM trial is a two-arm multinational cluster randomised controlled trial of structured medication review assisted by a software-based decision support system versus usual pharmaceutical care, for older people (aged ≥ 70 years) with multimorbidity and polypharmacy. In the psychometric analyses, we only included participants who completed the measures in full at 6 and 12 months. We assessed whether responses to the measures were consistent by assessing the proportion of EQ-5D-5L responses, which were 2 or more levels away from that person’s EQ-5D-3L response. We also compared the measures in terms of informativity, and discriminant validity and responsiveness relative to the Barthel Index, which measures independence in activities of daily living.
Results
224 patients (mean age of 77 years; 56% male) were included in the psychometric analyses. Ceiling effects reported with the EQ-5D-5L (22%) were lower than with the EQ-5D-3L (29%). For the mobility item, the EQ-5D-5L demonstrated better informativity (Shannon’s evenness index score of 0.86) than the EQ-5D-3L (Shannon’s evenness index score of 0.69). Both the 3L and 5L versions of EQ-5D demonstrated good performance in terms of discriminant validity, i.e. (out of all items of the EQ-5D-3L and EQ-5D-5L, the pain/discomfort and anxiety/depression items had the weakest correlation with the Barthel Index. Both the 3L and 5L versions of EQ-5D demonstrated good responsiveness to changes in the Barthel Index.
Conclusion
Both EQ-5D-3L and EQ-5D-5L demonstrated validity and responsiveness when administered to older adults with substantial multimorbidity and polypharmacy who were able to complete the measures.
Journal Article
Impact of a short-term pharmacy study abroad Program: student outcomes and program evaluation
Objective
This study examined the impact of a short-term study abroad program, focusing on program evaluation, attendee satisfaction, and acquired knowledge and skills. A questionnaire survey was conducted covering various aspects including demographics, program evaluation, and feedback.
Results
Results indicated higher female participation due to gender imbalances in pharmacy students in Egypt, with senior students recognizing the value of international experience. Attendee satisfaction was high, with positive feedback on accommodation, tours, and workshop materials. Field visits and workshops provided valuable experiential learning, with attendees suggesting extending the program’s duration. The program equipped attendees with knowledge and skills relevant to pharmaceutical products and services, leading to improved competences and perceptions. The study concludes that such study abroad experiences profoundly impact personal growth and recommends integrating them into educational curricula for valuable experiences.
Journal Article
Mississippi roll
Now on its final voyage, the historical steamboat Natchez is known for her super-powered guest entertainers. But after the suspicious death of a crew member, retired NY police detective Leo Storgman decides to make this incident his personal case. His findings only lead to a growing number of questions. Is there some truth behind the ghostly sightings of the steamboat's first captain Wilbur Leathers? What secret does the current captain seem to be hiding? And could the Natchez be ferrying mysterious - and possibly dangerous - cargo onboard?
Book
Intervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): a structured medication review with support of a computerised decision support system
Background
Several approaches to medication optimisation by identifying drug-related problems in older people have been described. Although some interventions have shown reductions in drug-related problems (DRPs), evidence supporting the effectiveness of medication reviews on clinical and economic outcomes is lacking. Application of the STOPP/START (version 2) explicit screening tool for inappropriate prescribing has decreased inappropriate prescribing and significantly reduced adverse drug reactions (ADRs) and associated healthcare costs in older patients with multi-morbidity and polypharmacy. Therefore, application of STOPP/START criteria during a medication review is likely to be beneficial.
Incorporation of explicit screening tools into clinical decision support systems (CDSS) has gained traction as a means to improve both quality and efficiency in the rather time-consuming medication review process. Although CDSS can generate more potential inappropriate medication recommendations, some of these have been shown to be less clinically relevant, resulting in alert fatigue. Moreover, explicit tools such as STOPP/START do not cover all relevant DRPs on an individual patient level. The OPERAM study aims to assess the impact of a structured drug review on the quality of pharmacotherapy in older people with multi-morbidity and polypharmacy. The aim of this paper is to describe the structured, multi-component intervention of the OPERAM trial and compare it with the approach in the comparator arm.
Method
This paper describes a multi-component intervention, integrating interventions that have demonstrated effectiveness in defining DRPs. The intervention involves a structured history-taking of medication (SHiM), a medication review according to the systemic tool to reduce inappropriate prescribing (STRIP) method, assisted by a clinical decision support system (STRIP Assistant, STRIPA) with integrated STOPP/START criteria (version 2), followed by shared decision-making with both patient and attending physician. The developed method integrates patient input, patient data, involvement from other healthcare professionals and CDSS-assistance into one structured intervention.
Discussion
The clinical and economical effectiveness of this experimental intervention will be evaluated in a cohort of hospitalised, older patients with multi-morbidity and polypharmacy in the multicentre, randomized controlled OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly), which will be completed in the last quarter of 2019.
Trial registration
Universal Trial Number:
U1111-1181-9400
Clinicaltrials.gov:
NCT02986425
, Registered 08 December 2016.
FOPH (Swiss national portal):
SNCTP000002183
. Netherlands Trial Register:
NTR6012
(07-10-2016).
Journal Article
Modeling and Estimation of Structural Damage
Modelling and Estimation of Damage in Structures is a comprehensiveguide to solving the type of modelling and estimation problems associated with the physics of structural damage.
* Provides a model-based approach to damage identification
* Presents an in-depth treatment of probability theory and random processes
* Covers both theory and algorithms for implementing maximum likelihood and Bayesian estimation approaches
* Includes experimental examples of all detection and identification approaches
* Provides a clear means by which acquired data can be used to make decisions regarding maintenance and usage of a structure
eBook
Prepartum fatty acid supplementation in sheep. II. Supplementation of eicosapentaenoic acid and docosahexaenoic acid during late gestation alters the fatty acid profile of plasma, colostrum, milk and adipose tissue, and increases lipogenic gene expression of adipose tissue
The objectives of this study were as follows: 1) to establish whether feeding a source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to ewes during late gestation changes the fatty acid profile of colostrum, milk, ewe adipose tissue, and plasma and subsequently lamb plasma and red blood cells (RBC), and 2) to investigate the effects of EPA and DHA on mRNA expression in ewe adipose tissue. Eighty-four gestating ewes (28 pens, three per pen) were blocked by lambing day and assigned to a diet with an addition of fat at 0.39% of the DM during the last 50 d of gestation using Ca salts of a palm fatty acid distillate (PFAD) high in palmitic and oleic acids or EPA + DHA. Blood samples were taken from ewes on days 20, 1 (parturition), and 30 and from lambs on days 1 and 30 for plasma fatty acid analysis. Fatty analysis of lamb RBC was performed on day 1. Colostrum samples were taken at lambing and milk samples on day 30 for fatty acid analysis. Subcutaneous adipose tissue biopsies were taken from one ewe per pen on day 20 for fatty acid analysis and gene expression analysis of 27 genes. Treatment × day interactions (P < 0.10) were observed for several isomers of C18:1, with concentrations that were greater in plasma of EPA + DHA ewes on day 20, but were not different on day 1 or 30. Plasma concentrations of EPA tended to be greater (P = 0.07), whereas DHA was greater (P < 0.001) in EPA + DHA ewes compared with PFAD ewes. There was no difference in EPA or DHA in adipose tissue with EPA + DHA vs. PFAD supplementation (P > 0.10). Concentrations of fatty acids with 6 to 10 carbons were significantly increased (P < 0.05) in colostrum and milk of EPA + DHA ewes. There was a treatment × day interaction with EPA + DHA ewes yielding greater EPA (P = 0.03) and DHA (P = 0.04) concentrations than PFAD in colostrum, but not in milk. Treatment × day interactions (P < 0.05) were observed for several C18:1 isomers with concentrations that were greater in EPA + DHA ewe colostrum, but were not different between treatments in milk. In lamb plasma and RBC, EPA and DHA were not different between treatments (P > 0.10). The expression of fatty acid synthase and leptin was significantly increased (P < 0.05), whereas the expression of diacylglycerol acyltransferase 2 tended to be increased (P = 0.08) by supplementation of EPA + DHA vs. PFAD. These results suggest that supplementation with EPA and DHA to ewes during late gestation alters the fatty acid profile of plasma, colostrum, and milk and may increase lipogenesis.
Journal Article
Jumping Instabilities in the Post-Buckling of a Beam on a Partial Nonlinear Foundation
Mode jumping is an instability phenomenon in the post-buckling region, which causes a sudden change in the equilibrium configuration and is thus harmful to structure. The configuration of a partial elastic foundation can directly induce mode coupling from the buckling stage and through the whole post-buckling region. The mode coupling effect due to the configuration of partial foundation on mode jumping is investigated and demonstrated to be an important factor of determining mode jumping. By properly choosing the partial elastic foundation configuration, mode jumping can be avoided.
Journal Article
Tensionless contact of a finite beam: Concentrated load inside and outside the contact zone
For a finite beam with a nonzero gap distance, an asymmetric concentrated load can be either inside or outside of the contact zone. A new governing equation is given for the case of a concentrated load outside the contact zone. By numerically solving the left-side and right-side contact lengths of the beam, a criterion is established to determine whether the concentrated load is inside or outside the contact zone. A more general approach on the tensionless contact of a beam is thus presented.
Journal Article