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Demir, Namık Kemal. "The Need of Adult Education and Training Administration in Lifelong Learning." Mediterranean Journal of Social & Behavioral Research 4, no. 3 (December 1, 2020): 41–45. http://dx.doi.org/10.30935/mjosbr/9600.
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Mujiati, Mujiati, Tri Joko Raharjo, and Achmad Rifai RC. "The Analysis of Learning Model in Office Administration Training at Semarang Job Training Development Center." Journal of Nonformal Education 5, no. 1 (February 28, 2019): 25–34. http://dx.doi.org/10.15294/jne.v5i1.18339.
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One reason for the high level of secondary and vocational school participation in quality that does not meet the competency standards required by the labor market. The need for new breakthroughs in order to improve the quality of human resources as an effort to prepare students in the world of work. The purpose of this research is to describe and analyze: (1) The learning model that is implemented in the office administration training that refers to the principle of adult training, (2) the readiness of the participants after completing the training. This research uses qualitative approach method. The subject is the section of training, training instructors, FMD team and trainees. Engineering data collection done by observation, interviews, and documentation. Data analysis techniques include the collection of data, data presentation, data reduction and withdrawal of the conclusion. An examination of the validity of the data using triangulation of sources and method. The research results showed that: (1) the model of learning which is implemented in office administration training refers to information processing model, personal model and behavior modification model. Implementation of the three models includes: learning syntax, social systems, reaction principles, support systems, instructional impacts and impact accompaniment. In the implementation of learning model in office administration, the training is based on adult learning principle, (2) participants' readiness is nurtured through job training activities that include 14 competency units, softskills activities, and character building.
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Rees, Gareth, Iain Tweedale, Teresa L. Rees, and Martin Read. "Adult Training Policy and Local Labour Markets: Preliminary Comments on the Training Access Points Initiative." British Journal of Education & Work 2, no. 1 (January 1988): 1–15. http://dx.doi.org/10.1080/0269000880020101.
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Schipperus, Martin, Georgia D. Kaiafa, Louise Taylor, Sally Wetten, James Bennett, Georg Kreuzbauer, Andy Boshier, and Anouchka Seesaghur. "Assessment of Self-Administration of Romiplostim after Receipt of Home Administration Training Materials: A Cross-Sectional Study of Patients with Immune Thrombocytopenic Purpura and Caregivers." Blood 128, no. 22 (December 2, 2016): 4918. http://dx.doi.org/10.1182/blood.v128.22.4918.4918.
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Abstract Background: Romiplostim is a subcutaneously administered thrombopoietin-receptor agonist approved for use in the EU for adult patients with chronic immune thrombocytopenia (ITP) refractory to other treatments. Initially approved for administration by healthcare providers (HCP), romiplostim was further approved by the European Medicines Agency in December 2012 for self-administration by select patients/caregivers. Romiplostim-treated chronic ITP patients with stable platelet count ≥ 50 x 109/L for ≥ 4 weeks without dose adjustment eligible for self-administration should be trained in self-administration procedures, and be supervised again after the first 4 weeks of self-administration while reconstituting and injecting romiplostim. To mitigate medication error risk due to self-administration, an additional risk minimisation activity in the form of a Home Administration Training (HAT) pack was designed to support HCPs in selecting patients and training of patients/caregivers. For subcutaneous self-administration of romiplostim, each patient (or caregiver) is supplied with self-administration kit (250/500 mcg romiplostim vial, plunger rod, prefilled sterile water syringe, disposable syringe with Luer-lok, safety needle, vial adapter) and a HAT pack, including placemat to lay out the administration components, checklist, instructions for use, self-administration diary, and instructional video. Aims: To estimate the proportion of adult patients and caregivers who administered romiplostim correctly after being trained with HAT pack. Methods: This multicentre, non-interventional, cross-sectional study was conducted at 12 study centres across 8 countries (Austria, Belgium, France, Germany, Greece, The Netherlands, Spain, and The United Kingdom) from 07 July 2014 to 20 November 2015. Adult (≥ 18 years of age) chronic ITP patients prescribed romiplostim self-administration or caregivers new to administering romiplostim, who provided informed consent at beginning of HAT pack training, received HAT pack training, and were available at first standard-of-care 4-week visit after training, were consecutively enrolled in the study. HCPs directly observed the patient/caregiver in the act of administering romiplostim at the first standard-of-care 4-week visit after HAT pack training, and completed a standardized data collection form. Variables collected included patient demographics, prescribed and administered injection volume per syringe, appropriate alcohol wipe use at injection site, clinically appropriate handling of syringe to avoid contamination, and clinically appropriate subcutaneous injection technique. The primary endpoint, correct administration of romiplostim, was defined as romiplostim dose accuracy within 10% margin of error between prescribed and administered romiplostim dose, and correct romiplostim reconstitution, and successful romiplostim injection, and no HCP intervention during administration to correct patient/caregiver error. All analyses were descriptive and no formal hypothesis was tested. Results: A total of 40 patients/caregivers were enrolled in the study (Table 1). At the first standard-of-care visit, 4 weeks (range: 2 - 8 weeks) after HAT pack training, 35 patients/caregivers (87.5%) administered romiplostim correctly. Romiplostim dose accuracy was within 10% margin of error for all patients. HCP intervention was required in 5 instances (3 patients, 2 caregivers): 1 patient did not ensure all romiplostim was dissolved, 1 patient and 1 caregiver needed verbal encouragement, 1 patient needed nursing intervention to read the correct dose from the vial due to poor eyesight, and 1 caregiver needed guidance with syringe and vial connection. Further follow-up data was available for 2 of these 5 patients/caregivers; they both administered romiplostim correctly at a subsequent visit. Conclusion: Given that this study was conducted on a convenience instead of random sample of patients, generalizability of the results may be limited. Direct observation can be susceptible to observation bias and to the Hawthorne effect with the patients/caregivers acting differently when observed. Nonetheless, the success of most patients and caregivers in correctly administering romiplostim after HAT pack training suggests that self-administration of romiplostim is a feasible option for suitable romiplostim-treated ITP patients. Disclosures Schipperus: Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Partial sponsorship(50% of costs)ASH 2015. Taylor:Amgen: Consultancy. Wetten:Amgen: Employment, Equity Ownership. Bennett:Amgen: Employment. Kreuzbauer:Amgen: Employment, Equity Ownership. Boshier:Amgen: Employment, Equity Ownership. Seesaghur:Amgen: Employment, Equity Ownership.
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Hamilton, Mary, and Paul Davies. "Literacy and long‐term unemployment: options for adult guidance, support and training." British Journal of Education & Work 6, no. 2 (January 1993): 5–19. http://dx.doi.org/10.1080/0269000930060201.
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Helsby, Gill. "Quality Assurance in Youth and Adult Training: Improving Practice or Refining Systems?" British Journal of Education & Work 9, no. 2 (January 1996): 5–16. http://dx.doi.org/10.1080/0269000960090201.
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Zarrindast, M. R., H. Niasari, S. Ahmadi, and B. Shafaghi. "N-methyl-D-aspartate Receptors are Involved in the Effect of Lithium on Passive Avoidance Memory in Mice." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71083-1.
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In the present study, the effects of intracerebroventricular (i.c.v.) injections of N-methyl-D-aspartate (NMDA) receptor agonist and antagonist on the lithium state-dependent memory have been investigated. For memory assessment, one-trial step-down passive avoidance task was used in adult male NMRI mice. Post-training intraperitoneal (i.p.) administration of lithium (10 mg/kg) impaired the memory of passive avoidance task. Pre-test administration of the same dose of the drug (10 mg/kg) restored impairment of memory by lithium given after training. This is known as state-dependent memory. In addition, pre-test administration of both NMDA receptor agonist (NMDA; 0.01 and 0.1 ng/mouse, i.c.v.) and the non-competitive NMDA receptor antagonist, MK-801 (0.1 and 0.5 mg/mouse, i.c.v) also restored impairment of memory induced by post-training lithium. On the other hand, pre-test co-administration of ineffective dose of NMDA (0.001 ng/mouse, i.c.v.) or MK-801 (0.001 mg/mouse, i.c.v) with lower doses of lithium (1.25, 2.5 and 5 mg/kg, i.p.) increased the restoration of memory by lithium. The results suggest that NMDA receptors are involved, at least partly, in the lithium state-dependent memory of passive avoidance task.
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Scaglione, Karen, and Vanessa Loyd. "A Game Changer: Adult-Geriatric Acute Care Nurse Practitioner Fellowship for the Veterans Health Administration." Journal of Doctoral Nursing Practice 14, no. 1 (January 19, 2021): 3–9. http://dx.doi.org/10.1891/jdnp-d-20-00031.
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BackgroundNurse practitioner (NP) fellowship programs assist the novice NP in transitioning to advanced practice while emphasizing building confidence and competence. The Veteran's Health Administration (VHA) offers an NP primary care fellowship program. The purpose of this project was to develop an acute care transition to practice fellowship program at a Midwestern VHA hospital.ObjectiveTo provide an acute care fellowship to facilitate with transition into advanced practice while increasing confidence and competence in the novice NP.MethodsA prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures included evaluation of skills interpreting electrocardiograms (ECG), chest x-rays (CXR), and self-reported confidence in performing these skills over the initial 6-week period of the 12-month program.ResultsThere were three participants (N = 3, 100%). There was a 33% increase in self-reported confidence of readiness to practice at completion of the pilot. However, ECG scores decreased 66% and CXR interpretation scores decreased 33%.ConclusionThe novice NP may benefit from an NP fellowship program.Implications for NursingDespite training and targeted clinical experiences in ECG and CXR interpretations during an acute care fellowship, competence in these skills decreased while self-reported confidence increased at the end of 6 weeks. Continued education and training throughout the 12-month program is recommended to increase the novice NP's competence in these skills while transitioning to their new role.
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Massaro, E. J., and T. F. Massaro. "Low Level Lead Exposure During Neonatal Development Perturbs Cognitive Function." Journal of the American College of Toxicology 6, no. 4 (July 1987): 441–49. http://dx.doi.org/10.3109/10915818709075689.
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Complex maze learning was investigated in male neonatal and adult rats using a latent learning task. The neonates received (intragastric administration) either lead acetate (50 mg Pb/kg) or equimolar sodium acetate on days 6, 9, 12, and 18 postpartum. The adult subjects were exposed to 100 ppm Pb acetate or equimolar sodium acetate in drinking water for 112 days beginning at weaning (day 21 postpartum). Training for the latent learning task began on day 31 postpartum for the neonates and on day 143 for the young adults. The training sequence included free exploration (under conditions of satiation) of a symmetrical latent learning maze or an open field of the same shape and area by the Pb-treated and control subjects (randomly distributed). Subsequently, all subjects were food deprived and appetitively tested in the latent learning maze. Neonatal lead exposure perturbed latent learning: the Pb-treated subjects showed no evidence of latent learning. However, pretest exploratory activity was similar for Pb-exposed and control neonates. Pb exposure had no effect on exploratory activity under normal (nonappetitive) conditions or latent learning performance of young adult subjects despite the increased body burden of Pb. The results suggest that latent learning may be a particularly sensitive measure of Pb exposure in the neonatal rat model.
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Burgdorf, Julia, Alicia Arbaje, and Jennifer L. Wolff. "Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care." Home Health Care Management & Practice 32, no. 2 (September 17, 2019): 67–75. http://dx.doi.org/10.1177/1084822319876608.
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Family caregivers make important contributions to home health care for older adults, but knowledge of the specific roles they assume is lacking. We analyzed data from 1,758 community-dwelling Medicare beneficiaries aged 65+ receiving Medicare-funded home health care between 2011 and 2016, using linked National Health and Aging Trends Study and Outcomes and Assessment Information Set data. Most (86.7%) beneficiaries receiving home health care had an identified need for family caregiver assistance, and nearly 6 in 10 (57.9%) had identified need for caregiver assistance with five or more tasks. After examining significant associations between older adult characteristics and identified needs for caregiver assistance with specific tasks, we identified three profiles of older adults who demonstrate similar patterns of identified need for family caregiver assistance during home health. These profiles include: (1) older adults with greater functional impairment who more often had identified need for assistance with Instrumental Activities of Daily Living, advocacy, or Activities of Daily Living; (2) older adults with cognitive impairment who more often had identified need for assistance with medication administration or supervision; and (3) older adults with greater clinical severity who more often had identified need for assistance with medical procedures and equipment. Findings support calls to develop training interventions and strengthen the partnership between home health providers and family caregivers. These three profiles present a potential framework for the development of family caregiver training programs.
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Dufort-Rouleau, Camille, Benjamin Martin, Vincent Barré, Véronique Bédard, Émilie Dufort Rouleau, Marie-France Beauchesne, Julie Quenneville, and Mathieu Berteau. "Conformity in Prescription and Administration of Respiratory Distress Protocols in a Tertiary Care Hospital in the Province of Quebec: RELIEVE Study." Journal of Palliative Care 35, no. 1 (March 22, 2019): 21–28. http://dx.doi.org/10.1177/0825859719835555.
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Background: Respiratory distress protocols (RDPs) are protocolized prescriptions comprised of 3 medications (a benzodiazepine, an opioid, and an anticholinergic) administered simultaneously as an emergency treatment for respiratory distress in palliative care patients in the province of Quebec, Canada. However, data on appropriate use that justifies the combination of all 3 components is scarce and based on individual pharmacodynamic properties along with expert consensus. Objectives: Our study aimed to evaluate the conformity and the effectiveness of RDPs prescribed and administered to hospitalized adult patients. Methods: This was a prospective and descriptive study conducted in a single center. Prescription and administration conformity were assessed based on predefined appropriateness criteria. Results: A total of 467 adult patients were prescribed a RDP, 175 administrations were documented, and 78 patients received at least 1 RDP. Prescription conformity was assessed on 1473 separate occasions over the trial period. Overall prescription conformity was found to be 37% (95% confidence interval [CI]: 33.6-40.4), and administration conformity was 37.7% (95% CI: 26.2-50.7). Low administration conformity was primarily explained by incorrect indications for RDP use. Seemingly important determinants of higher conformity were prescriber’s speciality in palliative care, use of preprinted orders, pharmacist involvement, and hospitalization in the palliative care unit. Conclusion: This study highlights important gaps in the use of RDPs in our institution. Health-care provider training appears necessary in order to ensure adequate conformity and allow for further evaluation of RDP effectiveness.
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Noyes, Katia, Alaina Zapf, Rachel Depner, Tessa Flores, Alissa Huston, Hani H. Rashid, Demetria McNeal, Olle Jane Sahler, Louis S. Constine, and Fergal J. Fleming. "Feasibility of fully remote administration of problem-solving skills training (PSST) to adult cancer survivors in community settings." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 1536. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.1536.
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1536 Background: Cancer survivors experience significant stress throughout cancer treatment and especially during transition back to normal life. These stressors are particularly severe for rural or socially disadvantaged patients with limited access to care. Improving their problem-solving skills is known to help patients make reasoned and timely decisions about survivorship care that reduce stress and enhance quality of life, physical and social functioning, and overall cancer prognosis. This pilot implementation study examined barriers to and facilitators of providing Problem-Solving Skills Training (PSST) to adult cancer survivors and their caregivers in community settings. Methods: Patients (n = 50) who completed their definitive cancer treatment and cancer survivorship visit within the previous 6 months were recruited from two regional cancer centers and affiliated community cancer clinics. Patients with NCCN distress level >2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions using the Bright IDEAS system of teaching problem solving. Training was offered by a trained therapist in person at the patient’s preferred location or remotely. Patients were invited but not required to include a supportive other (SO). Patient outcomes were assessed at baseline (T1), the end of the intervention/3 months (T2), and 3 months post intervention/6 months (T3). We examined patient and caregiver preferences for mode of communication and therapy, barriers to PSST participation, and adherence rates. An independent consultant interviewed patients and caregivers about factors that promote or inhibit intervention sustainability and its wider adaptation and usefulness. Results: Average age of the participants was 63 years (45-87) with gender, racial and ethnic distributions representative of the local population (64% women, 88% white). Women were 80% less likely to include a SO than men. Among the third of the patients recruited fully remotely, 50% preferred receiving consent materials via regular mail and 18% preferred electronic communication. Among the two patients lost to follow-up before PSST completion and one patient who withdrew despite reporting significant distress, none had a SO in the study. Seventy-six percent of the PSST patients completed the training (defined as > 6 sessions). After study completion, all patients and caregivers reported high satisfaction with Bright IDEAS and high probability of continuing to use the skills learned. Conclusions: Despite significant distress and numerous reported social challenges, patients and caregivers in the PSST arm demonstrated high adherence, skill retention and overall satisfaction. Future research should be tailored to accommodate the preferred type of communication and recruitment approaches of the targeted population and emphasize the positive role of informal caregivers. Clinical trial information: NCT03567850.
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Jafari-Sabet, Majid, Hamed Mofidi, and Mohammad-Sadegh Attarian-Khosroshahi. "NMDA receptors in the dorsal hippocampal area are involved in tramadol state-dependent memory of passive avoidance learning in mice." Canadian Journal of Physiology and Pharmacology 96, no. 1 (January 2018): 45–50. http://dx.doi.org/10.1139/cjpp-2017-0228.
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The precise neurobiological mechanisms of tramadol abuse underlying the cognitive function are still unknown. The aim of the present study was to examine the possible effects of intra-CA1 injections of N-methyl-d-aspartate (NMDA), a glutamate NMDA receptor (NMDAR) agonist, and d,l-2-amino-5-phosphonopentanoic acid (DL-AP5), a competitive NMDAR antagonist, on tramadol state-dependent memory. A single-trial step-down passive avoidance task was used for the assessment of memory retrieval in adult male NMRI mice. Post-training i.p. administration of an atypical μ-opioid receptor agonist, tramadol (2.5 and 5 mg/kg), dose-dependently induced impairment of memory retention. Pre-test injection of tramadol (2.5 and 5 mg/kg) induced state-dependent retrieval of the memory acquired under post-training administration of tramadol (5 mg/kg) influence. Pre-test intra-CA1 injection of NMDA (10−5 and 10−4 μg/mouse) 5 min before the administration of tramadol (5 mg/kg, i.p.) dose-dependently inhibited tramadol state-dependent memory. Pre-test intra-CA1 injection of DL-AP5 (0.25 and 0.5 μg/mouse) reversed the memory impairment induced by post-training administration of tramadol (5 mg/kg). Pre-test administration of DL-AP5 (0.25 and 0.5 μg/mouse) with an ineffective dose of tramadol (1.25 mg/kg) restored the retrieval and induced tramadol state-dependent memory. It can be concluded that dorsal hippocampal NMDAR mechanisms play an important role in the modulation of tramadol state-dependent memory.
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Ghorbanalizadeh-Khalifeh-Mahaleh, B., S. Taheri, M. Sahengharani, A. Rezayof, A. Haeri-Rohani, and M. R. Zarrindast. "Intra-Dorsal Hippocampal Microinjection of Lithium and Scopolamine Induce a Cross State-Dependent Learning in Mice." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71091-0.
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Background:Lithium a mood stabilizer may exert adverse effects on memory. We have previously shown that lithium induces state-dependent learning. Cholinergic systems of the brain may play an important role in memory function and mood regulation. In the present study, effects of intra-dorsal hippocampal (intra-CA1) injections of lithium and scopolamine on memory and cross state-dependent learning between two drugs were investigated.Methods:For memory assessment, a one-trial step-down inhibitory avoidance task was used in adult male NMRI mice.Results:Intra-CA1 administration of lithium (0.5 and 1 μg/mouse) after training or injection of the drug (0.5μg/mouse) before testing impaired memory when retrieval was tested 24 h later. The memory impairment by post-training lithium was reversed by pre-test administration of the drug (0.5μg/mouse, intra-CA1) suggesting lithium state-dependent learning. On the other hand, intra-CA1 administration of scopolamine (0.5, 1 and 2 μg/mouse) after training or injection of the drug (2μg/mouse) before testing impaired memory when retrieval was tested 24 h later. The impairment of memory by post-training injection of scopolamine (2μg/mouse) was restored by the pre-test injection of the drug (1 and 2 μg/mouse). Furthermore, memory impairment induced by post-training injection of lithium (0.5 μg/mouse) and scopolamine (2 μg/mouse) were reversed by pre-test administration of scopolamine (0.5, 1 and 2 μg/mouse) and lithium (0.5 and 1 μg/mouse) respectively. The impairment by lithium was also reversed by physostigmine.Conclusion:The results suggest that microinjection of both lithium and scopolamine induce state-dependent memory and there may be a cross state-dependency between two drugs.
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de Leon, R. D., H. Tamaki, J. A. Hodgson, R. R. Roy, and V. R. Edgerton. "Hindlimb Locomotor and Postural Training Modulates Glycinergic Inhibition in the Spinal Cord of the Adult Spinal Cat." Journal of Neurophysiology 82, no. 1 (July 1, 1999): 359–69. http://dx.doi.org/10.1152/jn.1999.82.1.359.
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Adult spinal cats were trained initially to perform either bipedal hindlimb locomotion on a treadmill or full-weight-bearing hindlimb standing. After 12 wk of training, stepping ability was tested before and after the administration (intraperitoneal) of the glycinergic receptor antagonist, strychnine. Spinal cats that were trained to stand after spinalization had poor locomotor ability as reported previously, but strychnine administration induced full-weight-bearing stepping in their hindlimbs within 30–45 min. In the cats that were trained to step after spinalization, full-weight-bearing stepping occurred and was unaffected by strychnine. Each cat then was retrained to perform the other task for 12 wk and locomotor ability was retested. The spinal cats that were trained initially to stand recovered the ability to step after they received 12 wk of treadmill training and strychnine was no longer effective in facilitating their locomotion. Locomotor ability declined in the spinal cats that were retrained to stand and strychnine restored the ability to step to the levels that were acquired after the step-training period. Based on analyses of hindlimb muscle electromyographic activity patterns and kinematic characteristics, strychnine improved the consistency of the stepping and enhanced the execution of hindlimb flexion during full-weight-bearing step cycles in the spinal cats when they were trained to stand but not when they were trained to step. The present findings provide evidence that 1) the neural circuits that generate full-weight-bearing hindlimb stepping are present in the spinal cord of chronic spinal cats that can and cannot step; however, the ability of these circuits to interpret sensory input to drive stepping is mediated at least in part by glycinergic inhibition; and 2) these spinal circuits adapt to the specific motor task imposed, and that these adaptations may include modifications in the glycinergic pathways that provide inhibition.
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Crapo, Raymond F. "It's Time to Stop Training … and Start Facilitating." Public Personnel Management 15, no. 4 (December 1986): 443–49. http://dx.doi.org/10.1177/009102608601500412.
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This article holds that most agencies have a pedagogically-based training operation and, as such, one that is not effective. The transition to andragogical methodology requires a major re-education of the training staff, an undertaking few training organizations attempt. It is only through adult learning techniques that the “best and brightest” and key policymakers in organizations will become involved in development programs.
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Joseph, Sundari, Susan Klein, Samantha McCluskey, Penny Woolnough, and Lesley Diack. "Inter-agency adult support and protection practice." Journal of Integrated Care 27, no. 1 (February 11, 2019): 50–63. http://dx.doi.org/10.1108/jica-06-2018-0041.
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Purpose Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care. Design/methodology/approach This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the “state of play” in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n=52), Social Care (n=31) and Health (n=18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange. Findings On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals’ own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection. Research limitations/implications This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views. Practical implications This paper reports on a Scottish study that focused on the coordinated and integrated practices amongst the police, health and social services’ professionals who support and protect adult members of society at risk of harm and has implications for their practice. Social implications Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts. Originality/value Studies on the joint-working practices amongst police and health and social services’ professionals who support and protect adult members of society at risk of harm are uncommon. This study investigated professionals’ perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection.
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Larson, Tracey A., Casey E. O’Neill, Michaela P. Palumbo, and Ryan K. Bachtell. "Effects of adolescent caffeine consumption on cocaine self-administration and reinstatement of cocaine seeking." Journal of Psychopharmacology 33, no. 1 (November 28, 2018): 132–44. http://dx.doi.org/10.1177/0269881118812098.
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Background: Caffeine consumption by children and adolescents has risen dramatically in recent years, yet the lasting effects of caffeine consumption during adolescence remain poorly understood. Aim: These experiments explore the effects of adolescent caffeine consumption on cocaine self-administration and seeking using a rodent model. Methods: Sprague-Dawley rats consumed caffeine for 28 days during the adolescent period. Following the caffeine consumption period, the caffeine solution was replaced with water for the remainder of the experiment. Age-matched control rats received water for the duration of the study. Behavioral testing in a cocaine self-administration procedure occurred during adulthood (postnatal days 62–82) to evaluate how adolescent caffeine exposure influenced the reinforcing properties of cocaine. Cocaine seeking was also tested during extinction training and reinstatement tests following cocaine self-administration. Results: Adolescent caffeine consumption increased the acquisition of cocaine self-administration and increased performance on different schedules of reinforcement. Consumption of caffeine in adult rats did not produce similar enhancements in cocaine self-administration. Adolescent caffeine consumption also produced an upward shift in the U-shaped dose response curve on cocaine self-administration maintained on a within-session dose-response procedure. Adolescent caffeine consumption had no effect on cocaine seeking during extinction training or reinstatement of cocaine seeking by cues or cocaine. Conclusions: These findings suggest that caffeine consumption during adolescence may enhance the reinforcing properties of cocaine, leading to enhanced acquisition that may contribute to increased addiction vulnerability.
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Loomis, Colleen, Anne E. Brodsky, S. Sonia Arteaga, Rona Benhorin, Kathleen Rogers-Senuta, Christine M. Marx, and Patricia McLaughlin. "What Works in Adult Educational and Employment Training? Case Study of a Community-Based Program for Women." Journal of Community Practice 11, no. 2 (March 2003): 27–45. http://dx.doi.org/10.1300/j125v11n02_03.
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Lee, B. Craig. "Infectious Diseases Training in Canada: One Size Does Not Fit All." Canadian Journal of Infectious Diseases 12, no. 2 (2001): 98–100. http://dx.doi.org/10.1155/2001/938156.
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PURPOSE:To evaluate training in infectious diseases, determining which components of the training program best prepare residents for their career choices and where improvements are needed.METHOD:A cross-sectional survey was mailed to all 14 physicians who had graduated from both the Adult and Paediatric Infectious Diseases Training Program at the University of Calgary from 1985 to 1998. Responses about the adequacy of training were measured using a Likert-type scale and a qualitative questionnaire.RESULTS:Of 14 mailed questionnaires, nine responses were received (64%). Two-thirds of respondents were in an academic setting, and seven (78%) graduates obtained postfellowship training. The specialists in academic settings were all engaged in multiple nonclinical activities. The clinical and diagnostic microbiological components of training received the highest scores in terms of adequacy of training.CONCLUSION:Graduates of the University of Calgary training program indicated an overall satisfaction with their training. However, improvements are needed in career counselling, health administration, antibiotic utilization, infection prevention and specialized outpatient clinics. Potential strategies for addressing these issues include didactic lectures, enhanced exposure to clinical outpatient settings and provision of designated faculty mentors.
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Fallano, Katherine, Igor Bussel, Larry Kagemann, Kira L. Lathrop, and Nils A. Loewen. "Training strategies and outcomes of ab interno trabeculectomy with the trabectome." F1000Research 6 (January 23, 2017): 67. http://dx.doi.org/10.12688/f1000research.10236.1.
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Plasma-mediated ab interno trabeculectomy with the trabectome was first approved by the US Food and Drug Administration in 2004 for use in adult and pediatric glaucomas. Since then, increased clinical experience and updated outcome data have led to its expanded use, including a range of glaucomas and angle presentations, previously deemed to be relatively contraindicated. The main benefits are a high degree of safety, ease, and speed compared to traditional filtering surgery and tube shunts. The increasing burden of glaucoma and expanding life expectancy has resulted in demand for well-trained surgeons. In this article, we discuss the results of trabectome surgery in standard and nonstandard indications. We present training strategies of the surgical technique that include a pig eye model, and visualization exercises that can be performed before and at the conclusion of standard cataract surgery in patients who do not have glaucoma. We detail the mechanism of enhancing the conventional outflow pathway and describe methods of visualization and function testing.
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Fallano, Katherine, Igor Bussel, Larry Kagemann, Kira L. Lathrop, and Nils A. Loewen. "Training strategies and outcomes of ab interno trabeculectomy with the trabectome." F1000Research 6 (May 2, 2017): 67. http://dx.doi.org/10.12688/f1000research.10236.2.
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Plasma-mediated ab interno trabeculectomy with the trabectome was first approved by the US Food and Drug Administration in 2004 for use in adult and pediatric glaucomas. Since then, increased clinical experience and updated outcome data have led to its expanded use, including a range of glaucomas and angle presentations, previously deemed to be relatively contraindicated. The main benefits are a high degree of safety, ease, and speed compared to traditional filtering surgery and tube shunts. The increasing burden of glaucoma and expanding life expectancy has resulted in demand for well-trained surgeons. In this article, we discuss the results of trabectome surgery in standard and nonstandard indications. We present training strategies of the surgical technique that include a pig eye model, and visualization exercises that can be performed before and at the conclusion of standard cataract surgery in patients who do not have glaucoma. We detail the mechanism of enhancing the conventional outflow pathway and describe methods of visualization and function testing.
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Pomrenze, Matthew B., Michael V. Baratta, Kristin C. Rasmus, Brian A. Cadle, Shinya Nakamura, Lutz Birnbaumer, and Donald C. Cooper. "Cocaine self-administration in mice with forebrain knock-down of trpc5 ion channels." F1000Research 2 (February 15, 2013): 53. http://dx.doi.org/10.12688/f1000research.2-53.v1.
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Canonical transient receptor potential (TRPC) channels are a family of non-selective cation channels that play a crucial role in modulating neuronal excitability due to their involvement in intracellular Ca2+ regulation and dendritic growth. TRPC5 channels a) are one of the two most prevalent TRPC channels in the adult rodent brain; b) are densely expressed in deep layer pyramidal neurons of the prefrontal cortex (PFC); and c) modulate neuronal persistent activity necessary for working memory and attention. In order to evaluate the causal role of TRPC5 in motivation/reward-related behaviors, conditional forebrain TRPC5 knock-down (trpc5-KD) mice were generated and trained to nose-poke for intravenous cocaine. Here we present a data set containing the first 6 days of saline or cocaine self-administration in wild type (WT) and trpc5-KD mice. In addition, we also present a data set showing the dose-response to cocaine after both groups had achieved similar levels of cocaine self-administration. Compared to WT mice, trpc5-KD mice exhibited an apparent increase in self-administration on the first day of cocaine testing without prior operant training. There were no apparent differences between WT and trpc5-KD mice for saline responding on the first day of training. Both groups showed similar dose-response sensitivity to cocaine after several days of achieving similar levels of cocaine intake.
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Perelman, S., J. C. Munzar, and M. Misch. "P101: Needs assessment study for the inter-professional procedural sedation course: methods of adult procedural sedation (MAPS)." CJEM 18, S1 (May 2016): S112. http://dx.doi.org/10.1017/cem.2016.277.
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Introduction: Procedural sedation and analgesia (PSA) is a common practice for non-anaesthesiologists. While complication rates for PSA are low, many of them are preventable. Professional regulatory body requirements state that practitioners should have adequate knowledge and skills to safely administer PSA. However, no certification process currently exists to develop and maintain these competencies. A standardized PSA training course would help close the gap between the best evidence for safe administration of PSA and its implementation in everyday practice. Therefore, we conducted a needs assessment to guide the development of such a PSA training course. Methods: Using modified Dillman methodology, an electronic survey was sent to a convenience sample of 50 potential learners and two groups of stakeholders: 20 hospital administrators and 35 experts in PSA. Questions assessed practice demographics, experience as well as support and interest in the development and attendance of a PSA training course. Prior to distribution, the questionnaire was peer reviewed and pilot-tested for feasibility and comprehension. Responses were stratified based on clinical role. Results: 35 potential learners completed the needs assessment (70% response rate): 15 emergency physicians, 19 registered nurses and 1 nurse practitioner. 48% have been in practice for over 10 years and over 90% participate in PSA at least weekly. 38% received informal training in PSA while 16% obtained no training at all. 86% strongly supported the development of a PSA certification course and were in favour of an inter-professional format. 13 experts responded to the questionnaire within the departments of anesthesia, emergency medicine (EM) and respiratory therapy (37% response rate). 80% supported the need for a PSA training course. 6 hospital administrators responded to the questionnaire within the departments of anesthesia, EM, gastroenterology and respirology (30% response rate). All agreed that standardization of PSA is an important part of patient safety and 80% stated certification in PSA should be a prerequisite for granting privileges to health care professionals to participate in PSA. 60% believed the course should be developed and supported by hospital funds. Conclusion: There is strong support from potential learners and stakeholders for the development of a formal PSA training course.
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Godamunne, A. U. K., D. M. G. Fernando, and S. U. B. Tennakoon. "(P1-44) Health Emergency and Disaster Management Training for Health Professionals." Prehospital and Disaster Medicine 26, S1 (May 2011): s112—s113. http://dx.doi.org/10.1017/s1049023x11003761.
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BackgroundSri Lanka has learned, with contributions from a 30-year war and a tsunami, that disasters happen when and where least expected. Thus the Health Emergency and Disaster Management Training Centre (HEDMaTC) of the Faculty of Medicine, University of Peradeniya was established to prepare Sri Lankan healthcare workers for all forms of health disasters.DescriptionHEDMaTC conducts training programmes for health professionals, including medical doctors, nurses, emergency technical officers, ambulance drivers and porters. As these are adult training programmes practical methods of training such as drills, workstations, group work and hands on training have been used, in addition to lectures. Emergency care equipment, specific kits and techniques and desktop exercises are used to demonstrate protocols of emergency management and discuss principles of risk management, disaster management concepts, conceptual and technical challenges in measuring disasters and their impact on public health and its effective management. Participants prepare action plans for their individual institution based on the knowledge gained and are discussed in follow up programmes a month later.OutcomeHEDMaTC is the only institution in Sri Lanka that is accredited by the Ministry of Health, Sri Lanka to train their staff in disaster management. HEDMaTC has trained 200 personnel in Public Health Emergency and Disaster Management, 117 in Sexual and Reproductive Health Services in Crises and 1034 in pre-hospital emergency care. The trained personnel were mobilized to the North and East of the country to handle healthcare issues, ranging from administration to ground work, of almost 300,000 displaced civilians in 2009 with a very satisfactory outcome.RecommendationsThe training methods used in these programmes are especially beneficial in adult training and it is to be recommended. We also recommend that HEDMaTC to be developed as a regional training center for South Asia.
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Stetkarova, Ivana, Stuart A. Yablon, Markus Kofler, and Dobrivoje S. Stokic. "Review: Procedure- and Device-Related Complications of Intrathecal Baclofen Administration for Management of Adult Muscle Hypertonia: A Review." Neurorehabilitation and Neural Repair 24, no. 7 (March 16, 2010): 609–19. http://dx.doi.org/10.1177/1545968310363585.
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Background. Intrathecal baclofen (ITB) effectively reduces muscle hypertonia; however, associated complications influence its utility and acceptance. Objective. To systematically review the literature on procedure- and device-related complications associated with ITB infusion therapy for adult muscle hypertonia of spinal or cerebral origin. Methods. The authors searched the PubMed database for full-length articles published in English that reported ITB-associated complications in adults. Of 147 articles retrieved, 32 full-length manuscripts and 10 case reports were reviewed in detail. Results. Overall, 558 complications were reported after 1362 pump implants (0.41 per implant). Methods for characterizing complications varied greatly between studies, as did complication rates, ranging from 0 to 2.24 per implant. Of the 558 complications, 148 (27%) were related to surgical procedures, 39 (7%) to pump problems, and 369 (66%) to catheter malfunctions. The overall complication rate was higher for studies that followed patients for more than 18 months on average (mean 0.56/implant) versus studies with shorter follow-up (0.23/implant, P < .05). Although correlation between the number of implants and the number of complications was significant ( r = .58), the goodness of linear fit was poor because of clusters with varied complication rates. Conclusions. Catheter problems are relatively common and more frequent than pump or surgical procedure complications after ITB pump implantation. Higher complication rates should be expected in centers that follow patients for a longer period of time. Standardized data collection and complication-reporting procedures along with appropriate training should be implemented in centers offering ITB treatment for management of muscle hypertonia.
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Ristoska, Stevica, Biljana Dzipunova, Emilija Stefanovska, Vasilka Rendzova, Vera Radojkova-Nikolovska, and Biljana Evrosimovska. "Orthodontic Treatment of a Periodontally - Affected Adult Patient (Case Report)." Open Access Macedonian Journal of Medical Sciences 7, no. 14 (July 20, 2019): 2343–49. http://dx.doi.org/10.3889/oamjms.2019.629.
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BACKGROUND: The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics.
CASE PRESENTATION: The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention.
CONCLUSION: Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients.
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Moazedi, A. A., Z. Valizadeh, and Gh A. Parham. "The Effects of Pre and Post Training Administration of MK-801 in Dorsal Hippocampus on Learning and Memory in Adult Male Rats." Journal of Biological Sciences 8, no. 2 (February 1, 2008): 416–20. http://dx.doi.org/10.3923/jbs.2008.416.420.
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St-Onge, Maude, Keren Mandelzweig, John C. Marshall, Damon C. Scales, and John Granton. "Critical Care Trainees’ Career Goals and Needs: A Canadian Survey." Canadian Respiratory Journal 21, no. 2 (2014): 93–95. http://dx.doi.org/10.1155/2014/520237.
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BACKGROUND: For training programs to meet the needs of trainees, an understanding of their career goals and expectations is required.OBJECTIVES: Canadian critical care medicine (CCM) trainees were surveyed to understand their career goals in terms of clinical work, research, teaching, administration and management; and to identify their perceptions regarding the support they need to achieve their goals.METHODS: The online survey was sent to all trainees registered in a Canadian adult or pediatric CCM program. It documented the participants’ demographics; their career expectations; the perceived barriers and enablers to achieve their career goals; and their perceptions relating to their chances of developing a career in different areas.RESULTS: A response rate of 85% (66 of 78) was obtained. The majority expected to work in an academic centre. Only approximately one-third (31%) estimated their chances of obtaining a position in CCM as >75%. The majority planned to devote 25% to 75% of their time performing clinical work and <25% in education, research or administration. The trainees perceived that there were limited employment opportunities. Networking and having specialized expertise were mentioned as being facilitators for obtaining employment. They expressed a need for more protected time, resources and mentorship for nonclinical tasks during training.CONCLUSION: CCM trainees perceived having only limited support to help them to achieve their career goals and anticipate difficulties in obtaining successful employment. They identified several gaps that could be addressed by training programs, including more mentoring in the areas of research, education and administration.
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London, Zachary N., Jaffar Khan, Carolyn Cahill, Erica Schuyler, Jana Wold, and Andrew M. Southerland. "2017 Program Director Survey." Neurology 91, no. 15 (September 7, 2018): e1448-e1454. http://dx.doi.org/10.1212/wnl.0000000000006315.
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ObjectiveTo survey adult neurology program directors (PDs) and inform the future development of neurology training programs.MethodsAll US adult neurology PDs were invited to complete the survey. The goals were to determine the demographic makeup of residency programs, characterize curricula, understand PD and program needs, and compare results to those of a similar survey in 2007.ResultsThe response rate was 70.6%. PD demographics for age, faculty track status, and academic rank remain unchanged over the last decade. The proportion of female PDs and assistant PDs has increased significantly. The mean number of residents per training program has also increased significantly. Female PDs are more likely to have a junior academic rank than their male colleagues. Disparities remain between the PDs' time spent on teaching/program administration and salary support. Most PDs support moving fellowship applications later in the training cycle. The majority of PDs find the Clinical Competency Committee process useful in assessing resident competence. A minority of PDs feel that the Accreditation Council for Graduate Medical Education Milestones meet their intended purpose. Half of programs include a curriculum to supplement the clinical experience on child neurology rotations. A third of programs include a supplemental curriculum for psychiatry rotations. The majority of programs offer a general fund for residents to use to support their education.ConclusionDeficiencies exist in compensation for PDs' teaching and administrative time and for academic promotion for female PDs. These results serve as a benchmark for comparison across programs and the basis to advocate for further improvements and support for neurology residency training.
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Curlik, Daniel M., and Tracey J. Shors. "Learning Increases the Survival of Newborn Neurons Provided That Learning Is Difficult to Achieve and Successful." Journal of Cognitive Neuroscience 23, no. 9 (September 2011): 2159–70. http://dx.doi.org/10.1162/jocn.2010.21597.
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Learning increases neurogenesis by increasing the survival of new cells generated in the adult hippocampal formation [Shors, T. J. Saving new brain cells. Scientific American, 300, 46–52, 2009]. However, only some types of learning are effective. Recent studies demonstrate that animals that learn the conditioned response (CR) but require more trials to do so retain more new neurons than animals that quickly acquire the CR or that fail to acquire the CR. In these studies, task parameters were altered to modify the number of trials required to learn a CR. Here, we asked whether pharmacological manipulations that prevent or facilitate learning would decrease or increase, respectively, the number of cells that remain in the hippocampus after training. To answer this question, we first prevented learning with the competitive N-methyl-d-aspartate (NMDA) receptor antagonist (RS)-3-(2-carboxypiperazin-4-yl) propyl-1-phosphonic acid. As a consequence, training did not increase cell survival. Second, we facilitated learning with the cognitive enhancer d-cycloserine, which increases NMDA receptor activity via its actions at the glycine binding site. Administration of d-cycloserine each day before training increased the number of learned responses and the number of cells that survived. All animals that learned the CR retained more of the new cells, but those that learned very quickly retained fewer than those that required more training trials to learn. Together, these results demonstrate that NMDA receptor activation modifies learning and as a consequence alters the number of surviving cells in the adult hippocampus.
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Perry, Cheryl L., MeLisa R. Creamer, Benjamin W. Chaffee, Jennifer B. Unger, Erin L. Sutfin, Grace Kong, Ce Shang, Stephanie L. Clendennen, Suchitra Krishnan-Sarin, and Mary Ann Pentz. "Research on Youth and Young Adult Tobacco Use, 2013–2018, From the Food and Drug Administration–National Institutes of Health Tobacco Centers of Regulatory Science." Nicotine & Tobacco Research 22, no. 7 (April 23, 2019): 1063–76. http://dx.doi.org/10.1093/ntr/ntz059.
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Abstract The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA’s priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10–18 years) and/or young adults (ages 18–34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. Implications The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
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Johnson, Michelle A., and Mattyna L. Stephens. "Race to the Top and the Exclusion of Welfare Recipients From Educational Policy Discourse." Adult Learning 23, no. 4 (October 5, 2012): 188–95. http://dx.doi.org/10.1177/1045159512458261.
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In 2009, President Obama and his administration sought to overhaul the existing educational reform program and launched their initiative titled Race to the Top (RTTT). RTTT, a competitive grant program, comprised six priorities designed to help states reform their current educational systems. Priority five calls for states to evaluate their current adult education programs and explore how they could improve those programs through the collaboration of community and states agencies. States currently support, design, and implement adult education programs under the federal guidelines of the Workforce Investment Act (WIA). Although WIA addresses the needs of a targeted population of adult learners, it does not specifically address the educational needs of welfare recipients. Welfare recipients, who are among those considered to be in dire need of education and training, lack the support of policy to access adult education programs. This article explores the tensions that exist between the espoused purpose of RTTT and WIA, using the state of Texas’ adult education policies as a case example. By using critical discourse analysis, we examine the policies in RTTT and WIA at the state level that defines the nature and scope of adult education. This form of analysis provides an opportunity to critically examine and explore the language of these various policies by focusing on not only what is present in the text but also on what is absent from it as well.
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Hicks, Megan P., Kelly C. Wischerath, Amber L. Lacrosse, and M. Foster Olive. "Increases in Doublecortin Immunoreactivity in the Dentate Gyrus following Extinction of Heroin-Seeking Behavior." Neural Plasticity 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/283829.
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Adult-generated neurons in the dentate gyrus (DG) of the hippocampus play a role in various forms of learning and memory. However, adult born neurons in the DG, while still at an immature stage, exhibit unique electrophysiological properties and are also functionally implicated in learning and memory processes. We investigated the effects of extinction of drug-seeking behavior on the formation of immature neurons in the DG as assessed by quantification of doublecortin (DCX) immunoreactivity. Rats were allowed to self-administer heroin (0.03 mg/kg/infusion) for 12 days and then subjected either to 10 days of extinction training or forced abstinence. We also examined extinction responding patterns following heroin self-administration in glial fibrillary acidic protein thymidine kinase (GFAP-tk) transgenic mice, which have been previously demonstrated to show reduced formation of immature and mature neurons in the DG following treatment with ganciclovir (GCV). We found that extinction training increased DCX immunoreactivity in the dorsal DG as compared with animals undergoing forced abstinence, and that GCV-treated GFAP-tk mice displayed impaired extinction learning as compared to saline-treated mice. Our results suggest that extinction of drug-seeking behavior increases the formation of immature neurons in the DG and that these neurons may play a functional role in extinction learning.
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Naylor, Jason F., Michael D. April, Guyon J. Hill, and Steven G. Schauer. "Pediatric Prehospital Wound Prophylaxis in Iraq and Afghanistan." Military Medicine 185, Supplement_1 (January 2020): 73–76. http://dx.doi.org/10.1093/milmed/usz285.
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Abstract Background Infectious complications of war wounds are a significant source of mortality and morbidity. Tactical Combat Casualty Care (TCCC) guidelines recommend prehospital moxifloxacin, ertapenem, or cefotetan for “all open combat wounds.” We describe the prehospital administration of antibiotics to pediatric trauma patients. Methods We queried the Department of Defense Trauma Registry for all pediatric subjects admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. Results During this time, there were 3,439 pediatric encounters which represented 8.0% of all admissions. Prehospital providers administered a total of 216 antibiotic doses to 210 subjects. Older children received antibiotics more frequently than younger children, were more likely to be male, located in Afghanistan, and injured by explosive with the majority surviving to hospital discharge. Cefazolin and ceftriaxone were the most frequently utilized antibiotics. Conclusions The most frequently administered antibiotics were cephalosporins. TCCC recommended agents for adult prehospital wound prophylaxis were infrequently administered to pediatric casualties. Administration rates of pediatric prehospital wound prophylaxis may be improved with pediatric-specific TCCC guidelines recommending cephalosporins as first-line agents, fielding of a TCCC-oriented Broselow tape, and training prehospital providers on administration of antimicrobials.
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Patton, W. David, and Connie Pratt. "Assessing the Training Needs of High-Potential Managers." Public Personnel Management 31, no. 4 (December 2002): 464–84. http://dx.doi.org/10.1177/009102600203100404.
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Two important issues prompting the creation of comprehensive management development programs in state government are the promotion of technically competent employees to supervisory positions who have not been prepared to manage, and the impending loss of state managers to retirement and the need for succession planning. With these issues in mind, training needs assessment (TNA) is necessary to understand both the needs of the organization for competent managers and of the individuals who are to be prepared to manage in state government. In this case study, we review the advantages and disadvantages of various TNA techniques and select focus groups to conduct the training needs assessment for a comprehensive management development program. Through several focus group sessions, the perspective of practicing managers was solicited for management training needs throughout the state. Alternatives were widely discussed and a synergy of ideas created through the group discussion format. State managers became more informed about the plan for management development and support for the concept was generated among important stakeholders. State managers clearly wanted training that would be immediately applicable to their job duties and wanted the training delivered in a way that is conducive to adult learning. We found that managers are most concerned with effectively performing their roles and responsibilities as managers, and that they must demonstrate leadership and human relations skills in the performance of their responsibilities.
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Pereira, Rosana Aparecida, Fabiana Bolela de Souza, Mayara Carvalho Godinho Rigobello, José Rafael Pereira, Laís Rosa Moreno da Costa, and Fernanda Raphael Escobar Gimenes. "Quality improvement programme reduces errors in oral medication preparation and administration through feeding tubes." BMJ Open Quality 9, no. 1 (February 2020): e000882. http://dx.doi.org/10.1136/bmjoq-2019-000882.
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BackgroundPatients with nasogastric/nasoenteric tube (NGT/NET) are at increased risk of adverse outcomes due to errors occurring during oral medication preparation and administration.AimTo implement a quality improvement programme to reduce the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients.MethodsAn observational study was carried out, comparing outcome measures before and after implementation of the integrated quality programme to improve oral medication preparation and administration through NGT/NET. A collaborative approach based on Plan-Do-Study-Act (PDSA) cycle was used and feedback was given during multidisciplinary meetings.InterventionsGood practice guidance for oral medication preparation and administration through NGT/NET was developed and implemented at the hospital sites; nurses were given formal training to use the good practice guidance; a printed list of oral medications that should never be crushed was provided to all members of the multidisciplinary team, and a printed table containing therapeutic alternatives for drugs that should never be crushed was provided to prescribers at the prescribing room.ResultsImprovement was observed in the following measures: crushing enteric-coated tablets and mixing drugs during medication preparation (from 54.9% in phase I to 26.2% in phase II; p 0.0010) and triturating pharmaceutical form of modified action or dragee (from 32.8 in phase I to 19.7 in phase II; p 0.0010). Worsening was observed though in the following measures: crush compressed to a fine and homogeneous powder (from 7.4%% in phase I to 95% phase II; p 0.0010) and feeding tube obstruction (from 41.8% in phase I to 52.5% phase II; p 0.0950).ConclusionOur results highlight how a collaborative quality improvement approach based on PDSA cycles can meet the challenge of reducing the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients. Some changes may lead to unintended consequences though. Thus, continuous monitoring for these consequences will help caregivers to prevent poor patient outcomes.
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Al’joboori, Yazi D., V. Reggie Edgerton, and Ronaldo M. Ichiyama. "Effects of Rehabilitation on Perineural Nets and Synaptic Plasticity Following Spinal Cord Transection." Brain Sciences 10, no. 11 (November 6, 2020): 824. http://dx.doi.org/10.3390/brainsci10110824.
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Epidural electrical stimulation (ES) of the lumbar spinal cord combined with daily locomotor training has been demonstrated to enhance stepping ability after complete spinal transection in rodents and clinically complete spinal injuries in humans. Although functional gain is observed, plasticity mechanisms associated with such recovery remain mostly unclear. Here, we investigated how ES and locomotor training affected expression of chondroitin sulfate proteoglycans (CSPG), perineuronal nets (PNN), and synaptic plasticity on spinal motoneurons. To test this, adult rats received a complete spinal transection (T9–T10) followed by daily locomotor training performed under ES with administration of quipazine (a serotonin (5-HT) agonist) starting 7 days post-injury (dpi). Excitatory and inhibitory synaptic changes were examined at 7, 21, and 67 dpi in addition to PNN and CSPG expression. The total amount of CSPG expression significantly increased with time after injury, with no effect of training. An interesting finding was that γ-motoneurons did not express PNNs, whereas α-motoneurons demonstrated well-defined PNNs. This remarkable difference is reflected in the greater extent of synaptic changes observed in γ-motoneurons compared to α-motoneurons. A medium negative correlation between CSPG expression and changes in putative synapses around α-motoneurons was found, but no correlation was identified for γ-motoneurons. These results suggest that modulation of γ-motoneuron activity is an important mechanism associated with functional recovery induced by locomotor training under ES after a complete spinal transection.
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Latusz, Joachim, and Marzena Maćkowiak. "Early-life blockade of NMDA receptors induces epigenetic abnormalities in the adult medial prefrontal cortex: possible involvement in memory impairment in trace fear conditioning." Psychopharmacology 237, no. 1 (October 25, 2019): 231–48. http://dx.doi.org/10.1007/s00213-019-05362-5.
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Abstract Rationale Several findings indicate that early-life dysfunction of N-methyl-d-aspartate (NMDA) receptors might cause schizophrenia-like abnormalities in adulthood that might be induced by impairments in epigenetic regulation. Objectives In the present study, we investigated whether postnatal blockade of NMDA receptors (within the first 3 weeks of life) by the competitive antagonist CGP 37849 (CGP) might affect some epigenetic markers in the adult medial prefrontal cortex (mPFC). Methods Histone H3 phosphorylation at serine 10 (H3S10ph), histone H3 acetylation at lysine 9 or 14 (H3K9ac or H3K14ac, respectively), or expression of histone deacetylase (HDAC) 2, HDAC5, myocyte enhancer factor (MEF) 2D and activity-regulated cytoskeleton-associated protein (Arc) were analysed. Moreover, we also evaluated whether the deacetylase inhibitor sodium butyrate (SB; 1.2 mg/kg, ip) could prevent behavioural and neurochemical changes in the mPFC induced by CGP during memory retrieval in the trace fear conditioning paradigm. Results The results showed that CGP administration increased the number of H3S10ph nuclei but did not affect H3K9ac and H3K14ac or HDAC2 protein levels. However, CGP administration altered the HDAC5 mRNA and protein levels and increased the mRNA and protein levels of MEF2D. CGP also increased Arc mRNA, which was correlated with an increase in the amount of Arc DNA bound to MEF2D. SB given 2 h after training prevented impairment of the freezing response and disruption of epigenetic markers (H3S10ph, HDAC5, MEF2D) and Arc expression during memory retrieval induced by CGP administration. Conclusions The early-life blockade of NMDA receptors impairs some epigenetic regulatory processes in the mPFC that are involved in fear memory formation.
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Kitchlew, Rizwana, Miqdad Haider, and Saba Mir. "Awareness about appropriate practice of Sodium Polystyrene Sulfonate administration." Professional Medical Journal 27, no. 01 (January 10, 2020): 52–56. http://dx.doi.org/10.29309/tpmj/2019.27.01.3184.
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In patients of Chronic Kidney Disease (CKD) one of the most frequent and threatening complication is hyperkalemia. Sodium polystyrene sulfonate (SPS) commonly known as Kayexalate is one of the treatment options in management of hyperkalemia. Food and Drug Authority (FDA) has recently issued a warning that SPS is not to be administered at the same time with other oral drugs. Objectives: To assess the prevailing concepts about Sodium Polystyrene Sulfonate administration and its interactions with other drugs among doctors and patients. Study Design: A Descriptive study. Setting: Three Tertiary Care Health Centers of Lahore. Period: 1st January 2018 till 31st July 2018. Material & Methods: The study population includes adult patients who had suffered from hyperkalemia, and the doctors who have been prescribing the drug and gave consent to participate in the survey. The statistical analysis was performed on SPSS version 23. Results: The total number of study participants were 75, where 50 were doctors and 25 were patients receiving Kayexalate treatment. The age range for doctors was between 24 to 55 years with mean age of 31.4 ±7.2 years. Among doctors 37 (74%) prescribe SPS at some interval from other medications, whereas only 4 (8%) prescribe at the interval recommended by FDA (3 hours). Only 19 (38%) said they knew about the latest guidelines of FDA about SPS interaction with other drugs and 38 (76%) had knowledge that SPS hampers absorption of other drugs. Among population comprising of patients receiving kayexalate, the age range was between 27 to 68 years with mean age of 49.2 ±8.5 years. 11 (44%) patients were advised to take this drug at some interval from other drugs. Conclusion: Hyperkalemia is commonly seen in tertiary care setups, especially in CKD patients. Kayexalate being an affordable option for its treatment, there is a need for improvement in training of doctors about its use and its interactions with food and other medications.
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Goncharuk, Nataliia, Oxana Orhiiets, and Leonid Prokopenko. "FORMATION AND DEVELOPMENT OF THE SYSTEM OF PROFESSIONAL TRAINING OF PUBLIC SERVANTS IN UKRAINE: ORGANIZATIONAL, LEGAL, AND ECONOMIC ASPECTS." Baltic Journal of Economic Studies 7, no. 1 (January 22, 2021): 39–46. http://dx.doi.org/10.30525/2256-0742/2021-7-1-39-46.
Full textAbstract:
The subject of the research is the formation and development of the system of professional training of public servants in Ukraine. The relevance of this study is due to the fact that one of the most important tasks of the development of the public service institute in modern conditions is its professionalization, which is carried out primarily through the system of professional training of public servants. Methodology. The paper uses a historical approach, which has made it possible to study the process of formation and development of the system of professional training of public servants in Ukraine. Based on the method of systemic analysis, the current system of professional training of civil servants in Ukraine, its legal framework and strategic priorities for its reform are considered. Results. The purpose of the article is to analyze the process of formation and development of the system of professional training of public servants and ways to increase its efficiency in Ukraine in modern conditions. To achieve this goal, the following research objectives are set: to consider the evolution of the system of professional training of public servants in Ukraine; to analyze the development of the system of professional training of public servants in independent Ukraine; to determine the main directions of its reform in the modern conditions of state formation. The main stages of formation and development of the system of professional training of public servants in Ukraine are justified. The organizational, legal, and economic aspects of formation and development of the system of professional training of public servants in Ukraine, as well as regulatory bases of formation and development of competence of public servants are analyzed. It is established that its financial and resource provision is important for the development of the system of professional training of public servants. Emphasis is placed on the need for continuous professional training of civil servants for their mobility, prompt and effective response to societal challenges in a paradigm of public administration, local government reform and decentralization of power in Ukraine through the development of formal, non-formal and informal education. It is concluded that ensuring the effective operation of public servants directly depends on increasing the level of their competence through professional training. The strategic principles of development of the system of professional training of civil servants are analyzed and the ways of increasing the efficiency of the existing system of professional training of civil servants, heads of local state administrations, their first deputies and deputies, local self-government officials, and deputies of local councils are determined, and the new model of the system of professional education of public servants, which based on European principles and standards for the development of adult education for life, are proposed.
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Lodise Jr., Thomas P., Nicole G. Bonine, J. Michael Ye, Henry J. Folse, and Patrick Gillard. "1166. Development of a Bedside Tool to Predict the Probability of Drug-Resistant Pathogens Among an Adult Population With Gram-Negative Infections." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S351—S352. http://dx.doi.org/10.1093/ofid/ofy210.999.
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Abstract Background Identification of infections caused by antimicrobial-resistant microorganisms is critical to administration of early appropriate antibiotic therapy. We developed a clinical bedside tool to estimate the probability of carbapenem-resistant Enterobacteriaceae (CRE), extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and multidrug-resistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections. Methods A retrospective observational study of the Premier Hospital Database (PHD) was conducted. The study included adult hospitalized patients with complicated urinary tract infection (cUTI), complicated intraabdominal infection (cIAI), bloodstream infections (BSI), or hospital-acquired/ventilator-associated pneumonia (HAP/VAP) with a culture-confirmed Gram-negative infection in PHD from 2011 to 2015. Model development steps are shown in Figure 1. The study population was split into training and test cohorts. Prediction models were developed using logistic regression in the training cohort (Figure 1). For each resistant phenotype (CRE, ESBL, and MDRP), a separate model was developed for community-acquired (index culture ≤3 days of admission) and hospital-acquired (index culture >3 days of admission) infections (six models in total). The predictive performance of the models was assessed in the training and test cohorts. Models were converted to a singular user-friendly interface for use at the bedside. Results The most important predictors of antibiotic-resistant Gram-negative bacterial infection were prior number of antibiotics, infection site, prior infection in the last 3 months, hospital prevalence of each resistant pathogen (CRE, ESBL, and MDRP), and age (Figure 2). The predictive performance was highly acceptable for all six models (Figure 3). Conclusion We developed a clinical prediction tool to estimate the probability of CRE, ESBL, and MDRP among hospitalized adult patients with community- and hospital-acquired Gram-negative infections. Our predictive model has been implemented as a user-friendly bedside tool for use by clinicians to predict the probability of resistant infections in individual patients, to guide early appropriate therapy. Disclosures T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee. N. G. Bonine, Allergan: Employee, Salary. J. M. Ye, Allergan: Employee, Salary. H. J. Folse, Evidera: Employee, Salary. P. Gillard, Allergan: Employee, Salary.
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Voss, Patrice, Maryse Thomas, You Chien Chou, José Miguel Cisneros-Franco, Lydia Ouellet, and Etienne de Villers-Sidani. "Pairing Cholinergic Enhancement with Perceptual Training Promotes Recovery of Age-Related Changes in Rat Primary Auditory Cortex." Neural Plasticity 2016 (2016): 1–18. http://dx.doi.org/10.1155/2016/1801979.
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We used the rat primary auditory cortex (A1) as a model to probe the effects of cholinergic enhancement on perceptual learning and auditory processing mechanisms in both young and old animals. Rats learned to perform a two-tone frequency discrimination task over the course of two weeks, combined with either the administration of a cholinesterase inhibitor or saline. We found that while both age groups learned the task more quickly through cholinergic enhancement, the young did so by improving target detection, whereas the old did so by inhibiting erroneous responses to nontarget stimuli. We also found that cholinergic enhancement led to marked functional and structural changes within A1 in both young and old rats. Importantly, we found that several functional changes observed in the old rats, particularly those relating to the processing and inhibition of nontargets, produced cortical processing features that resembled those of young untrained rats more so than those of older adult rats. Overall, these findings demonstrate that combining auditory training with neuromodulation of the cholinergic system can restore many of the auditory cortical functional deficits observed as a result of normal aging and add to the growing body of evidence demonstrating that many age-related perceptual and neuroplastic changes are reversible.
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De Tullio, Pamela L., Duane M. Kirking, Debra K. Zacardelli, and Paul Kwee. "Evaluation of Long-Term Triazolam Use in an Ambulatory Veterans Administration Medical Center Population." DICP 23, no. 4 (April 1989): 290–93. http://dx.doi.org/10.1177/106002808902300403.
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Triazolam is indicated for the short-term treatment of insomnia. To determine how it was being prescribed and used, we examined triazolam use in patients who had received the drug for greater than six weeks. We reviewed medical charts of 72 adult male patients from an ambulatory Veterans Administration population who had received a 30-day triazolam prescription with at least one refill. Results showed that although prescribed daily doses of triazolam were generally appropriate for the age of the patient being treated, the average length of therapy was 6.2 months. Seventy-five percent of the prescriptions had been written for a one-month supply with five refills. Neither prescriber specialty nor level of training was significantly related to length of therapy. Thirty-nine of the patients (54 percent) were available for a telephone interview to determine how the drug was actually being used and the adverse effects profile. Over 60 percent claimed to be taking the drug every night, 95 percent at the dose prescribed. Sixty-seven percent of the patients taking triazolam nightly reportedly did not sleep as well if they tried a night without the drug. Apart from effects on sleep, dizziness and confusion were the most commonly reported adverse effects. As a result of this study, automatic stop orders on discharge were implemented to limit triazolam therapy to inpatient stays. Physicians must evaluate the need for continued hypnotic therapy so that a longer-acting agent like flurazepam may be used if chronic medication is necessary.
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Thornburg, Courtney, Heidi Lane, Katharine Farrow, Rosalie Brooks, Mina Jahan, and Maria Scopelliti. "Increasing Quality Improvement Capability in a Hemophilia Treatment Center." Blood 128, no. 22 (December 2, 2016): 5908. http://dx.doi.org/10.1182/blood.v128.22.5908.5908.
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Abstract Introduction Persons with hemophilia require complex medical care by a multi-disciplinary team throughout life. There are opportunities for Hemophilia Treatment Centers (HTC) to enhance the care of persons with hemophilia through participation in quality improvement (QI) initiatives. Maintaining comprehensive care and excellent health outcomes are national priorities for Health Resources and Services Administration (HRSA) and the American Thrombosis and Hemostasis Network (ATHN), the National Hemophilia Program Coordinating Center (NHPCC). Rady Children's Hospital San Diego (RCHSD) HTC participated in the NHPCC Dartmouth Improvement Program pilot program with the aim to develop QI capabilities within the HTCs to enhance the care of persons with hemophilia. Methods RCHSD participated in the NHPCC Dartmouth Improvement Program starting in December 2015. A QI team was established including the HTC medical director, nurse case managers, pediatric social worker and the social worker of the collaborating adult HTC. The QI team was coached by an expert TDIMA coach and a "coach in training" from another HTC. The team learned QI methods through in person training, web-based training and weekly team meetings with the coaches. The team assessed HTC data (The 5Ps-purpose, patients, professionals, processes, and patterns) to gain system knowledge and insights to determine a QI theme, global aim, specific aims and associated PDSA cycles. Results The RCHSD HTC QI team established a QI theme to focus on the transfer from pediatric to adult care. The Global Aim of the team is to improve autonomous communication in RCHSD HTC. The process begins with the 12 year old comprehensive clinic visit and ends with a new patient visit at an adult HTC. By working on the process, we expect patients to have the communication skills to be able to arrange medical insurance, call the home care company to order factor and to communicate their health and personal care needs to adult health care providers. We developed four specific aims which are in various stages of testing in PDSA cycles (Table 1). For Aim 1, we found that patients have only basic knowledge of insurance information. For Aim 2, we found that we needed to adjust our clinic process to make sure that patients receive their "after visit summary" that includes the insurance information prior to leaving clinic. Conclusions We developed a QI program within RCHSD HTC focused on improving transfer of care. Once we have completed the specific aim PDSA cycles we will standardize the new and improved procedures. We will continue to develop the program based on internal needs assessment and family input. This training model may be adapted by other HTCs to enhance patient care. Disclosures Thornburg: Mast Pharmaceuticals: Research Funding; Bayer Pharmaceuticals: Research Funding; Shire: Consultancy; Biogen Idec: Other: Data Safety Monitoring Board; Bluebird inc: Other: Data Safety Monitoring Board.
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Sessa, C., M. Zucchetti, T. Cerny, O. Pagani, F. Cavalli, M. De Fusco, J. De Jong, D. Gentili, C. McDaniel, and C. Prins. "Phase I clinical and pharmacokinetic study of oral etoposide phosphate." Journal of Clinical Oncology 13, no. 1 (January 1995): 200–209. http://dx.doi.org/10.1200/jco.1995.13.1.200.
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PURPOSE To determine the bioavailability (F) and the pharmacokinetic profile of both etoposide and its prodrug, etoposide phosphate, after oral and intravenous administration of etoposide phosphate, and to determine the maximum-tolerable dose (MTD) of oral etoposide phosphate administered daily for 5 consecutive days every 3 weeks. In addition, we sought to develop and validate two limited-sampling models (LSMs) to predict the etoposide area under the curve (AUC) 24 hours after administration of oral and intravenous etoposide phosphate. PATIENTS AND METHODS In the F part of the study, patients were assessed for pharmacokinetic studies after one oral and one intravenous administration of the same dose of etoposide phosphate. Etoposide phosphate and etoposide plasma concentrations were assayed by high-performance liquid chromatography (HPLC). To develop LSMs after oral and intravenous administration, patients were randomized between the training and validation data sets. In the phase I part of the study, which followed the F part, the dose of etoposide phosphate was escalated from 50 mg/m2/d for etoposide equivalents for 5 days to 220 mg/m2/d for 5 days. RESULTS Forty adult patients with solid tumors or lymphoma entered the study and 35 were assessable for toxicity. The MTDs were defined as 175 mg/m2 and 220 mg/m2 in previously treated and untreated patients, respectively. Neutropenia was dose-limiting, with high interpatient variability. Within 15 minutes after intravenous administration, etoposide phosphate was no longer detectable in plasma, and it was never detectable after oral administration. Plasma concentrations and pharmacokinetic parameters of etoposide following etoposide phosphate were comparable to those reported for etoposide. The relative F (mean +/- SD) of etoposide after oral etoposide phosphate was 76 +/- 27%, with a range of 37% to 144%. CONCLUSION The clinical and pharmacokinetic results of this study confirm the prodrug hypothesis of etoposide phosphate. Although firm conclusions cannot be drawn, the F of oral etoposide phosphate seems to be comparable to or only slightly better than that of oral etoposide.
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Nasehi, Mohammad, Saman Shahbazzadeh, Mohaddeseh Ebrahimi-Ghiri, and Mohammad-Reza Zarrindast. "Bidirectional influence of amygdala β1-adrenoceptors blockade on cannabinoid signaling in contextual and auditory fear memory." Journal of Psychopharmacology 32, no. 8 (March 27, 2018): 932–42. http://dx.doi.org/10.1177/0269881118760654.
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The basolateral amygdala (BLA) is a major target and modulator of stress and has a critical role in the neural circuitry presenting learned fear behaviors. On the other hand, both the endocannabinoid and noradrenergic systems may be involved in regulating the stress responses, fear, and anxiety. Considering the aforementioned, we have investigated the involvement of the BLA β1-adrenoceptors in conditioned fear responses induced by ACPA, a CB1 receptor (CB1R) agonist. In adult male NMRI mice, freezing responses to context and cue were measured using a Pavlovian fear conditioning apparatus. Pre-training intra-BLA microinjection of xamoterol (0.01 and 0.02 µg/mouse), a partial β1-adrenoceptor agonist, or atenolol (0.5 µg/mouse), a β1-adrenoceptor antagonist, decreased freezing behavior, which suggests an impairment of contextual and auditory fear retrieval. Similar results were found with pre-training intraperitoneal administration of ACPA (0.5 mg/kg). A sub-threshold dose of xamoterol, infused into the BLA, decreased ACPA (0.005 and 0.05 mg/kg) effect on both memories, while atenolol increased ACPA response to the context at the middle dose and decreased ACPA response to the tone at the lower dose. It can be concluded that the blockade of BLA β1-adrenoceptors differentially affects ACPA response on the contextual and auditory conditioned fear memories.
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Kayle, Mariam, Sharron Docherty, Paula Tanabe, Richard Sloane, Gary Maslow, Wei Pan, Jane L. Holl, and Nirmish Shah. "Trajectories of Sickle Cell Disease Severity during Transition to Adult Care." Blood 132, Supplement 1 (November 29, 2018): 318. http://dx.doi.org/10.1182/blood-2018-99-112158.
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Abstract Background Adolescents and young adults (AYAs) with sickle cell disease (SCD) are at increased risk for disease complications and mortality, particularly during transition to adult care. Little is known about the disease course that might be contributing to the increase in morbidity and mortality during transition. This study provides a longitudinal description of the clinical characteristics and disease severity among AYAs with SCD during transition to adult care. Methods We conducted a longitudinal analysis of the electronic health records of 339 AYAs (ages 12-27 years) with SCD (97% black, 56% male, 69% hemoglobin SS) who received care at a comprehensive SCD center in the Southeast US between 1989 and 2015. Measures included sociodemographics, transfer, complications, comorbidities, and severity of SCD (using a modification of the pediatric SCD severity index). We used group-based trajectory modeling to identify subgroups of AYAs with distinct severity trajectories. AYAs who were in care for at least 10 years were included (n=133). We used chi-square and unpaired student t-test to explore subgroup differences among (1) AYAs who died compared to AYAs who were still alive during the study; (2) AYAs who were eligible to transfer (i.e., ≥ 19 years) (n=293) and transferred compared to AYAs who were eligible to transfer and did not transfer; and (3) AYAs with different severity trajectories. Statistical significance was set at p=0.05 and 95% CI. Results Common complications among AYAs (n=339) included vaso-occlusive crises (80%), acute chest syndrome (41%), chronic pain (35%), and cerebral infarcts (22%). Comorbidities included depression (19%) and anxiety (14%). Most AYAs who were eligible to transfer transferred (n=220, 75%) at a mean age of 19 years (SD=1.3). Fourteen AYAs died, 10 (71%) after transfer at a mean of 7.3 years (SD=3.1) from transfer. SCD Severity Trajectories (Figure 1): Group-based trajectory modeling identified both stable and increasing severity trajectory groups: stable-low (n=31, 23%), stable-medium (n= 61, 46%), stable-high (n=6, 5%), low-increasing (n=13, 10%), and medium-increasing (n= 22,17%) severity trajectory groups. Most AYAs (74%) had stable severity over time, whereas 26% had increased severity with increasing age. Subgroup Differences in Care and Mortality: AYAs who died (n=14) spent less time in pediatric care (mean=4.6 years, 95%CI 3.7-5.6), however, had a higher mean number of pediatric annual visits (mean=9.3 visits; 95%CI 6.3-12.3) compared to those who were alive (n=324, mean=6 years in pediatric care, 95%CI 5.7-6.1; mean number of pediatric annual visits=5.4, 95%CI 4.8-6.1). There were no differences in demographics, SCD complications, or morbidity. Subgroup Differences in Transfer to Adult Care (Tables 1 and 2): Compared to AYAs who did not transfer, AYAs who transferred were older and lived closer to the SCD clinic. AYAs who transferred were at higher risk for SCD complications and comorbidities. They were more likely to be receiving hydroxyurea. They had higher mean annual pediatric SCD clinic visits, especially during older adolescence, and were in pediatric care for a longer duration. Subgroup Differences in Disease Severity (Tables 3 and 4). Compared to AYAs in stable severity trajectory groups (Figure 1: Groups 1, 3, and 5), AYAs in unstable disease severity trajectory groups (Figure 1: Groups 2 and 4) were more likely to be married, older, and lived closer to the SCD clinic. AYAs in unstable groups were also at higher risk for SCD complications and comorbidities. They were less likely to be receiving treatments and had less pediatric SCD clinic visits by age 18. However, they were more likely to transfer to adult care, have had more adult SCD visits overall, and remained longer in adult SCD care after transfer. Conclusions Whereas most AYAs with SCD had stable disease severity, nearly a quarter had increasing disease severity, over time. AYAs with increasing severity lived closer to the SCD clinic, were more likely to transfer to adult care, and demonstrated higher and longer use of adult SCD care compared to AYAs with stable disease severity. Genotype was not associated with disease severity trajectory groups, underscoring the importance of clinical care for AYAs, over time. Disclosures Kayle: Department of Health and Human Services, Administration for Community Living, NIDILRR Advanced Rehabilitation Research Training Health and Function Grant #90AR5019 (PI Heinemann): Other: post-doctoral fellowship; Department of Health and Human Services, Administration for Community Living, NIDILRR Advanced Rehabilitation Research Training Health and Function Grant # 90ARHF0003 (PI Heinemann): Other: Postdoctoral fellowship. Tanabe:Duke University: Employment; NIH and AHRQ: Research Funding; Alliant Health: Consultancy. Maslow:The Crohn's and Colitis Foundation and the American Gastroenterological Association, in collaboration with Pfizer, Inc: Research Funding. Holl:Before Brands, Inc: Research Funding; NIH: Research Funding; Branstad Family Foundation: Research Funding; AHRQ: Research Funding. Shah:Novartis: Research Funding, Speakers Bureau.
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Maurmann, Natasha, Gustavo Kellermann Reolon, Sandra Beatriz Rech, Arthur Germano Fett-Neto, and Rafael Roesler. "A Valepotriate Fraction ofValeriana glechomifoliaShows Sedative and Anxiolytic Properties and Impairs Recognition But Not Aversive Memory in Mice." Evidence-Based Complementary and Alternative Medicine 2011 (2011): 1–7. http://dx.doi.org/10.1093/ecam/nep232.
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Plants of the genusValeriana(Valerianaceae) are used in traditional medicine as a mild sedative, antispasmodic and tranquilizer in many countries. This study was undertaken to explore the neurobehavioral effects of systemic administration of a valepotriate extract fraction of known quantitative composition ofValeriana glechomifolia(endemic of southern Brazil) in mice. Adult animals were treated with a single intraperitoneal injection of valepotriate fraction (VF) in the concentrations of 1, 3 or 10 mg kg-1, or with vehicle in the pre-training period before each behavioral test. During the exploration of an open field, mice treated with 10 mg kg-1of VF showed reduced locomotion and exploratory behavior. Although overall habituation sessions for locomotion and exploratory behavior among vehicle control and doses of VF were not affected, comparison between open-field and habituation sessions within each treatment showed that VF administration at 1 and 10 mg kg-1impaired habituation. In the elevated plus-maze test, mice treated with VF (10 mg kg-1) showed a significant increase in the percentage of time spent in the open arms without significant effects in the number of total arm entries. VF at 3 mg kg-1produced an impairment of novel-object recognition memory. In contrast, VF did not affect fear-related memory assessed in an inhibitory avoidance task. The results indicate that VF can have sedative effects and affect behavioral parameters related to recognition memory.
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Maucksch, Christof, Peer M. Aries, Silke Zinke, and Ulf Müller-Ladner. "Patient Satisfaction with the Etanercept Biosimilar SB4 Device, Among Rheumatoid Arthritis and Spondyloarthropathy Patients - A German Observational Study." Open Rheumatology Journal 14, no. 1 (July 21, 2020): 7–14. http://dx.doi.org/10.2174/1874312902014010007.
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Background: The etanercept biosimilar SB4 is a TNF inhibitor authorised for use as a targeted Biological Disease-Modifying Anti-Rheumatic Drug (bDMARD). Various administration devices have been developed for subcutaneous self-injection of bDMARDs. Objective: This study surveyed patient satisfaction with their experience of using the SB4 pre-filled pen device. Methods: This non-interventional, cross-sectional, multi-centre study enrolled adult rheumatoid arthritis and spondyloarthropathy patients who had been treated for at least three months with the SB4 pre-filled pen. Based on a standardized questionnaire, patients rated general satisfaction, handling, user-friendliness, physical characteristics, and training material received. A total of 492 eligible patients completed questionnaires at 43 centres across Germany between August 2017 and June 2018. Data were analysed descriptively. Pre-defined subgroup analyses by previous therapy and by indication were performed. Results: Overall, 87% (95% CI 83% - 90%) of patients reported being ‘satisfied’ or ‘very satisfied’ with the pen. 89% of patients reported that the pen was ‘simple’ or ‘very simple’ to use. Most patients (87%) self-injected. 93% of patients who received training on the use of the pen were ‘satisfied’ or ‘very satisfied’ with the training provided. In this cross-sectional study, 12 patients reported an Adverse Event (AE) and one patient reported a treatment-related AE (nausea). Conclusion: The results demonstrated a high level of general satisfaction among patients using the SB4 pre-filled pen as well as satisfaction with ease of use for patients who were either naïve to bDMARDs or who had switched to SB4 from other bDMARDs.