Inclusion of salt form on prescription medication labeling as a source of patient confusion: a pilot study

Background: It has been estimated that 10,000 patient injuries occur in the US annually due to confusion involving drug names. An unexplored source of patient misunderstandings may be medication salt forms. Objective: The objective of this study was to assess patient knowledge and comprehension regarding the salt forms of medications as a potential source of medication errors. Methods: A 12 item questionnaire which assessed patient knowledge of medication names on prescription labels was administered to a convenience sample of patients presenting to a family practice clinic. Descriptive statistics were calculated and multivariate analyses were performed. Results: There were 308 responses. Overall, 41% of patients agreed they find their medication names confusing. Participants correctly answered to salt form questions between 12.1% and 56.9% of the time. Taking more prescription medications and higher education level were positively associated with providing more correct answers to 3 medication salt form knowledge questions, while age was negatively associated. Conclusions: Patient misconceptions about medication salt forms are common. These findings support recommendations to standardize the inclusion or exclusion of salt forms. Increasing patient education is another possible approach to reducing confusion.

Is there a relation between environmental exposure to teratogenic substances during pregnancy and congenital anomalies in the newborn? A pilot study in Portugal

Background: Maternal occupation as a proxy of environmental exposure has been consistently associated with specific congenital anomalies (CA) in the foetus and newborn. On the other hand, geographical location of the mother such as place of residence and place of work have not been used as proxy for environmental exposures during pregnancy. We designed a pilot study aiming to investigate the association between maternal place of residence and workplace during pregnancy and CA in Portugal. Methods: Cases and controls are identified in the maternity unit. Cases are all live births with at least one CA delivered in the Barreiro hospital located in a heavy industrial area near Lisboa. Controls are the two normal births following each case. Residents outside the study area, stillbirths and women who decline to participate or are incapable of giving consent are excluded. A health professional interviews the mothers using a questionnaire adapted from the registry form of the Portuguese national registry of CA and includes information on places during pregnancy (residence, workplace, leisure), and demographic characterization as place of birth, infant sex, weight, description of CA, age of mother, ethnicity, maternal birth place. Maternal health and obstetric history, education, smoking, alcohol, drugs and medication use is also collected as potential confounders. Results: The pilot study started in January 2016 and at the moment two cases and four controls have been recruited without refusals. The study will continue to be implemented and it is proposed to start in other hospital units during 2016.

A pilot study on the productivity and behavior of the gestating sow housed in a flex stall

Animal welfare is a controversial topic in modern animal agriculture, partly because it generates interest from both the scientific community and the general public. The housing of gestating sows, particularly individual housing, is one of the most critical concerns in farm animal welfare. We hypothesize that the physical size of the standard gestation stall may limit movement and evoke demands and challenges on the sow to affect the physiological and psychological well-being of the individually housed sow. Thus, improvements in the design of the individual gestation stall system that allow more freedom to move, such as increasing stall width or designing a stall that could accommodate the changing size of the pregnant sow, may improve sow welfare. The objective of this pilot study was to evaluate the effects of a width adjustable stall (FLEX) on productivity and behavior of dry sows. The experiment consisted of 3 replications (block 1, n=4 sows; block 2, n=4 sows; block 3, n=8 sows), and multi-parious sows were allotted to either a FLEX stall or standard gestation stall for 1 gestation period. Sow mid-girth (top of the back to bottom of the udder) was measured 5-6 times throughout gestation to determine the best time points for FLEX stall width expansions. FLEX stall width was adjusted according to mid-girth measurements, and expanded to achieve an additional 2 cm of space between the bottom of the sow’s udder and floor of the stall so that sows could lie in full lateral recumbency without touching the sides of the stall. Productivity data recorded included: sow body weight (BW) and BW gain, number of piglets born and born alive, proportions of piglets stillborn, mummified, lost between birth and weaning, and weaned, and litter and mean piglet birth BW, weaning BW, and average BW gain from birth-to-weaning. Lesions were recorded on d 21 and d 111 of gestation. Sub-pilot behavior data were observed and registered for replicate 1 sows using continuous video-records for the l2 hour lights on period (period 1, 0600-1000; period 2, 1000-1400; period 3, 1400-1800) prior FLEX stall adjustment and 12 hour lights on period post adjustment on d 21, 22, 23, 43, 44, 45, 93, 94, 95. A randomized complete block design with a 2 × 2 factorial arrangement for treatments was used to analyze sow productivity and performance traits. Data were analyzed using the Mixed Models procedure of SAS. A preliminary analysis of data means and numerical trends was used to analyze sow behavior measurements. Sows housed in a FLEX stall had more (P < 0.05) total born and a tendency for more piglets born alive (P = 0.06) than sows housed in a standard stall. Sow body weight also tended to be higher (P = 0.06) for sows housed in a FLEX stall compared to sows housed in a standard stall. There were numerical trends for mean durations of sit, lay, lay (OUT), and eat behaviors to be greater for sows housed in a FLEX stall compared with sows housed in a standard stall. The mean duration of lay (IN) behavior tended to be numerically less for sows housed in a FLEX stall compared with sows housed in a standard stall. There were numerical trends for the mean durations of stand and drink behaviors to be greater for sows housed in a standard stall compared with sows housed in a FLEX stall. The mean frequencies of postural changes and mean durations of oral-nasal-facial and sham-chew behaviors were numerically similar between types of gestation stall. Mean durations and numerical trends indicate that time of day influenced all of the behaviors assessed in this study. The results of this pilot study indicate that the adjustable FLEX stall may affect sow productivity and behavior differently than the standard gestation stall, and thus potentially improve sow well-being. Future research should continue to compare the new FLEX stall design to current housing systems in use and examine physiological traits and immune status in addition to behavioral and productivity traits to assess the effects that this housing system has on the overall welfare of the gestating sow.

Endoluminal calprotectin measurement in assessment of pouchitis and a new index of disease activity: a pilot study

Pouchitis is the most common complication following proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis (UC). To provide a standardized definition of pouchitis clinical, endoscopic and histological markers were grouped and weighted in the pouch disease activity index (PDAI). However, the delay in the assessment of the final score due to the time requested for histological analysis remains the main obstacle to the index implementation in clinical practice so that the use of modified-PDAI (mPDAI) with exclusion of histologic subscore has been proposed. We tested the ability of calprotectin measurement in the pouch endoluminal content to mimic the histologic score as defined in the PDAI, the index that we adopted as gold standard for pouchitis diagnosis. Calprotectin was measured by ELISA in the pouch endoluminal content collected during endoscopy in 40 consecutive patients with J-pouch. In each patient PDAI and mPDAI were calculated and 15% of patients were erroneously classified by mPDAI. ROC analysis of calprotectin values vs. acute histological subscore ≥ 3 identified different calprotectin cut-off values with corresponding sensitivity and specificity allowing the definition and scoring of different range of calprotectin subscores. We incorporated the calprotectin score in the mPDAI obtaining a new score that shows the same specificity as PDAI for diagnosis of pouchitis and higher sensitivity when compared with mPDAI. The use of the proposed new score, once validated in a larger series of patients, might be useful in the early management of patients with symptoms of pouchitis.

The development and field test of a Mealtime Interaction Clinical Observation Tool: a pilot study and clinical research portfolio

Objective: The purpose of this study was to develop and test psychometric properties of a Mealtime Interaction Clinical Observation Tool (MICOT) that could be used to facilitate assessment and behavioural intervention in childhood feeding difficulties. Methods: Thematic analysis of four focus groups with feeding and behaviour experts identified the content and structure of the MICOT. Following refinement, inter-rater reliability was tested between three healthcare professionals. Results: Six themes were identified for the MICOT, which utilises a traffic-light system to identify areas of strength and areas for intervention. Despite poor inter-rater reliability, for which a number of reasons are postulated, some correlation between psychologists’ ratings was evident. Healthcare professionals liked the tool and reported that it could have good clinical utility. Conclusion: The study provides a promising first version of a clinical observation tool that facilitates assessment and behavioural intervention in childhood feeding difficulties.

Signs and Symptoms of Dry Eye in Keratoconus Patients: A Pilot Study

Purpose: To compare signs and symptoms of dry eye in keratoconus (KC) patients versus healthy subjects. Methods: A total of 15 KC patients (KC group, n = 15 eyes) and 16 healthy subjects (control group, 16 eyes) were enrolled in this study. The Schirmer I test with no anesthetic, tear break-up time (TBUT), corneal staining characteristics, and ocular surface disease index (OSDI) scores were evaluated for both groups. Impression cytology, combined with/scanning laser confocal microscopy (LCM), was performed to evaluate goblet cell density, mucin cloud height (MCH), and goblet cell layer thickness (CLT). Finally, tear concentrations of di-adenosine tetraphosphate (Ap4A) were assessed. Results were statistically analyzed using Shapiro–Wilk and non-parametric Wilcoxon rank sum tests. Statistical significance was set at p < 0.05. Results: KC patients had lower tear volumes and greater corneal staining than did healthy subjects (p < 0.05). OSDI scores were 44.96 ± 8.65 and 17.78 ± 6.50 for the KC and control groups, respectively (p < 0.05). We found no statistically significant differences in TBUT between groups. Impression cytology revealed lower goblet cell densities in KC group patients versus control group subjects (84.88 ± 32.98 and 128.88 ± 50.60 cells/mm,2 respectively, p < 0.05). There was a statistically significant reduction in MCH and CLT in KC group patients compared with control group subjects. Ap4A tear concentrations were higher in KC group patients than in control group subjects (2.56 ± 1.10 and 0.15 ± 0.12 µM, respectively, p < 0.05). Conclusions: The parameters evaluated in this study indicate that KC patients suffer greater symptoms of dry eye and greater tear instability, primarily due to the decreased mucin production in their tears, than do healthy patients with no KC.

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi

Aim To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables. Methods We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or bloodborne infection. We performed the haematological tests at the Malawi-Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories. Results Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer’s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer’s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups. Conclusions Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results.

Design and Pilot Study for an Efficient High-Throughput Automated Computer-Vision Guided Intelligent De-Calyxing Machine for Post-Harvest Strawberry Processing

Strawberries harvested for processing as frozen fruits are currently de-calyxed manually in the field. This process requires the removal of the stem cap with green leaves (i.e. the calyx) and incurs many disadvantages when performed by hand. Not only does it necessitate the need to maintain cutting tool sanitation, but it also increases labor time and exposure of the de-capped strawberries before in-plant processing. This leads to labor inefficiency and decreased harvest yield. By moving the calyx removal process from the fields to the processing plants, this new practice would reduce field labor and improve management and logistics, while increasing annual yield. As labor prices continue to increase, the strawberry industry has shown great interest in the development and implementation of an automated calyx removal system. In response, this dissertation describes the design, operation, and performance of a full-scale automatic vision-guided intelligent de-calyxing (AVID) prototype machine. The AVID machine utilizes commercially available equipment to produce a relatively low cost automated de-calyxing system that can be retrofitted into existing food processing facilities. This dissertation is broken up into five sections. The first two sections include a machine overview and a 12-week processing plant pilot study. Results of the pilot study indicate the AVID machine is able to de-calyx grade-1-with-cap conical strawberries at roughly 66 percent output weight yield at a throughput of 10,000 pounds per hour. The remaining three sections describe in detail the three main components of the machine: a strawberry loading and orientation conveyor, a machine vision system for calyx identification, and a synchronized multi-waterjet knife calyx removal system. In short, the loading system utilizes rotational energy to orient conical strawberries. The machine vision system determines cut locations through RGB real-time feature extraction. The high-speed multi-waterjet knife system uses direct drive actuation to locate 30,000 psi cutting streams to precise coordinates for calyx removal. Based on the observations and studies performed within this dissertation, the AVID machine is seen to be a viable option for automated high-throughput strawberry calyx removal. A summary of future tasks and further improvements is discussed at the end.

Contrast sensitivity evaluation with filter contact lenses in patients with retinitis pigmentosa: a pilot study

Purpose: the aim of this pilot study was to test whether retinitis pigmentosa patients would benefit from filter contact lenses as an effective optical aid against glare and photophobia. Methods: fifteen subjects with retinitis pigmentosa were enrolled in this study. All of them were evaluated with filter soft contact lenses (MaxSight), filter glasses (CPF 527) and without filters (control). All patients were assessed for the three aid conditions by means of best corrected visual acuity (BCVA), contrast sensitivity (without glare and with central and peripheral glare)(CSV-1000) and a specific subjective questionnaire about quality of vision. Results: BCVA was slightly better with filters than without filter but the differences were not statistically significant. Contrast sensitivity without glare improved significantly with the contact lenses (p<0.05). The central glare had significant differences for the frequencies of 3 cpd and 18 cpd between the contact lens filter and the control group (p=0.021 and p=0.044, respectively). For the peripheral glare contrast sensitivity improved with contact lens versus control group for highest frequencies, 12 and 18 cpd (p<0.001 and p=0.045, respectively). According to the questionnaire the contact lens filter gave them more visual comfort than the glasses filter under the scenarios of indoors glare, outdoors activities and indoors comfort. Conclusion: the filter contact lenses seem to be a good option to improve the quality of vision of patients with retinitis pigmentosa.

Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.

Medial and lateral hamstrings and quadriceps co-activation affects knee joint kinematics and ACL elongation : a pilot study

Assessment of interstitial lung disease in Sjögren’s syndrome by lung ultrasound: a pilot study of correlation with high-resolution chest tomography

The background of this study is to assess the accuracy of lung ultrasound (LUS) to diagnose interstitial lung disease (ILD) in Sjögren’s syndrome (Sjs), in patients who have any alterations in pulmonary function tests (PFT) or respiratory symptoms. LUS was correlated with chest tomography (hrCT), considering it as the imaging gold standard technique to diagnose ILD. This is a pilot, multicenter, cross-sectional, and consecutive-case study. The inclusion criteria are ≥18 years old, Signs and symptoms: according to ACEG 2002 criteria, respiratory symptoms (dyspnea, cough), or any alterations in PFR. LUS was done following the International Consensus Conference on Lung Ultrasound protocol for interstitial syndrome (B pattern). Of the 50 patients in follow-up, 13 (26%) met the inclusion criteria. All were women with age 63.62 years (range 39–88). 78.6% of the cases had primary Sjs (SLE, RA, n = 2). The intra-rater reliability k is 1, according to Gwet’s Ac1 and GI index (probability to concordance—e(K)—, by Cohen, of 0.52). LUS has a sensitivity of 1 (95% CI 0.398–1.0), specificity of 0.89 (95% CI 0.518–0.997), and a positive probability reason of 9.00 (95% CI 7.1–11.3) to detect ILD. The correlation of Pearson is r = 0.84 (p < 0.001). To check the accuracy of LUS to diagnose ILD, a completely bilateral criterion of yes/no for interstitial pattern was chosen, AUC reaches significance, 0.94 (0.07) (95% CI 0.81–1.0, p = 0.014). LUS reaches an excellent correlation to hrCT in Sjs affected with ILD, and might be a useful technique in daily clinical practice for the assessment of pulmonary disease in the sicca syndrome. © 2016 SIMI

Audience attitudes towards simil sync: a pilot study

This thesis is based on a pilot investigation which explores the attitudes of a sample of Italian viewers towards the simil sync technique which in Italy is used for the dub of non-fictional television contents. The thesis seeks to analyse and define the characteristics of this dubbing modality which is often considered by scholars and professionals in the dubbing industry a hybrid modality of standard synchronised dubbing and voice-over. In order to investigate viewers’ attitudes, I organised 4 focus groups sessions which, due to the impact of Covid-19 pandemic, were carried out online. The online recruitment of participants, which was a difficult task, resulted in a small sample of eighteen participants (and two interviewees). The four online focus groups revealed that participants were aware of the simil sync technique. They recognised that the clips were dubbed in a different modality from standard synchronised dubbing. The characteristic that was mostly mentioned for detecting simil sync was the original soundtrack that was audible below the dub, followed by the identification of the genre of the programme in the clip and the absence of lip sync. Moreover, while simil sync with a barely audible original soundtrack received neutral or positive attitudes, simil sync with a more audible original soundtrack, instead, was tolerated or considered annoying. Simil sync passed unnoticed in the in-depth interviews in which the discussion about dubbing was not focused on the distinction between two dubbing modalities, for instance simil sync versus standard synchronised dubbing, but rather on the distinction between programmes that originated in Italian and those that were translated into Italian from another language and then dubbed.