We have measured total hadronic photoproduction cross sections on carbon, copper, and lead. Tagged-photon energies ranged from 20 to 185 GeV for copper and from 45 to 82 GeV for carbon and lead. The energy and A dependence of shadowing were computed by comparing these results to the hydrogen cross section as measured nearly simultaneously with the same apparatus. We observed somewhat more shadowing than did most experiments at lower photon energies.The photoproduction cross section from complex nuclei should be less than the sum of individual nucleon cross sections because (naively) some nucleons "shadow" others by absorbing out the hadronic part of the photon beam. This effect has been observed in photoproduction by real photons of up to 18 GeV. 1 " 6 Although the results of Ref. 1 disagreed with the vector-meson-dominance (VMD) model used in that paper, it is possible to find models 7 that do give reasonable agreement with the shadowing observed in photoproduction. VMD models do, however, have difficulty accounting for the rapid decrease of shadowing when the photons become slightly spacelike. 8 More data will be useful for suggesting the direction in which models must be elaborated.We have measured the dependence of the total photoproduction cross section on A, the atomic weight of the target nucleus. One reason for doing so was to get a more accurate measurement of shadowing than has been hitherto possible. The cross section is easier to measure at high energies and our apparatus was designed to achieve the very high precision needed for detecting the small energy dependence of the hydrogen cross section. 9 Another reason for doing this measurement was to extend the energy range of shadowing data. Such an extension could, for example, show effects of higher-mass states. The higher the mass of a vector state, the higher the photon energy must be in order that the state contribute to shadowing. In fact, neutron and K L cross sections on nuclei do show an increase in the amount of shadowing with increasing energy,, 10 " 12 This increase can be interpreted as an effect of "inelastic screening" 13 of the forward scattering amplitude, in which an incident hadron diffractively dissociates (into a possibly higher-mass state) at one point within the nucleus and recombines at another. In VMD calculations of shadowing, this would correspond to including off-diagonal terms.The measurement was performed in the Fermilab tagged-photon beam. Tagged photons were produced from copper radiators of 6 and 15 mils (0.0107 and 0.0267 radiation lengths). The beam, detection apparatus, and trigger were the same as used in a measurement of the total photoproduction cross section on hydrogen. 9 However, the hydrogen target was replaced by carbon, copper, and lead targets-each a rectangle larger than the beam and each of approximately 0.1 radiation length in thickness. These targets were mounted in a vacuum box so that each could be rotated into the beam. An empty target slot permitted measurement and subtraction of the rate of hadronic...

Background: Chronic kidney disease (CKD) is a condition presenting with long-term slow progression of structural and/or functional damage to the kidneys. Early detection is key to preventing complications and improving outcomes. Point-of-care estimated glomerular filtration rate (eGFR) screening technology allows for detection of abnormal kidney function in the community pharmacy setting. Objective: To evaluate the effectiveness of a community pharmacist-directed point-of-care screening program and to identify the prevalence of CKD in high-risk patients. Design: Quantitative observational. Setting: Four community pharmacies in British Columbia over a 6-month period. Patients: In all, 642 participants with at least one CKD risk factor were identified and screened. Mean age was 60 years and females accounted for 55% of the study population. Measurements: Serum creatinine was measured from peripheral blood using the HeathTab® screening system (Piccolo® Renal Function Panel with the Piccolo® blood chemistry analyzer). eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Methods: Patients provided a sample of peripheral blood via a self-administered finger-prick and analytical data to assess kidney function was reported including blood urea nitrogen (BUN), serum creatinine, and electrolytes by the HealthTab® screening system. Once results were available, the pharmacist conducted a comprehensive medication review with the patient and recommended certain follow-up actions if appropriate. Results: CKD risk factor included diabetes (30%), hypertension (45%), cardiovascular disease (12%), family history of kidney disease (13%), age over 55 years (68%), and an Aboriginal, Asian, South Asian, or African ethnic background (82%). A total of 11.5% of patients had eGFR values lower than 60 mL/min (abnormal renal function) and 34% had an eGFR between 60 and 89 mL/min (minimally reduced renal function). Overall pharmacists’ actions included blood pressure check (98%), education on CKD and risk factors (89%), medication review (72%), and physician follow-up (38%). Limitations included lack of follow-up beyond the 3-month study period prevented medical confirmation of CKD and limited the ability to quantify the impact of pharmacist interventions on the clinical outcomes of patients with low eGFR. Conclusion: These results illustrate the prevalence of abnormal renal function among undiagnosed, high-risk patients in the community. Pharmacists, as the most accessible healthcare practitioners, are ideally positioned to utilize novel point-of care technologies to improve access to CKD screening, facilitate follow-up, and increase awareness around the importance of early detection.

Hypodermoclysis (subcutaneous fluid administration) is a valuable means of replacing fluids and maintaining hydration for older people and palliative care patients. This literature review looks at three aspects of the therapy--client groups, wound care and types of infusion fluids.

Background: Helicobacter pylori is identified by the World Health Organization as a major risk factor of gastritis, peptic ulcer disease and gastric carcinomas. As point-of-care screening technology becomes more widely available, pharmacists are ideally suited to use this tool to screen patients with H. pylori infection. Purpose: The objective of this study was to evaluate the feasibility of implementing point-of-care screening technology for H. pylori into community pharmacy practice and to assess the number of patients who are positively identified as a result of testing. Methods: Three pharmacies in Toronto, Ontario, offered H. pylori screening as part of their clinical programs. Pharmacists enrolled patients with symptoms of dyspepsia and/or receiving acid suppressant therapy for >6 weeks. Decision to screen was based on the Canadian Helicobacter Study Group Consensus (CHSG). Patients were screened using the Rapid Response H. pylori test. Results: Seventy-one patients were recruited, with a mean age of 46.3 years. Patients were ethnically diverse, with a significant proportion (59.2%) identified as being born outside of North America, including Asia (26.8%), Africa (9.9%), the Middle East (7%), Europe (9.9%) and South and Central America (5.6%). Overall, the detection rate of H. pylori infection was 21%. North Americans had the lowest incidence of an undiagnosed H. pylori infection (6.9%). Europeans (28.6%), Middle Easterners (20%) and Asians (21.1%) had a moderate incidence, followed by the highest prevalence in those of African descent (71.4%). Conclusion: These results highlight the readiness of community pharmacists to adopt H. pylori screening into practice and to leverage this novel technology to positively identify and treat undiagnosed H. pylori infection. Can Pharm J (Ott) 2020;153:xx-xx.