A case report of terbinafine-induced acute generalized exanthematous pustulosis in a striking photodistributed pattern.

Acute generalized exanthematous pustulosis is a rare severe cutaneous adverse reaction that classically presents in intertriginous or flexural areas and subsequently spreads diffusely across the trunk and extremities. To date, few cases of acute generalized exanthematous pustulosis arising in a photodistributed pattern are documented. Herein, we describe the second known case of photodistributed generalized exanthematous pustulosis arising in association with oral terbinafine use, providing a summary of the previously documented cases along with exploration of the potential pathophysiological mechanisms for this cutaneous reaction.

Identifying factors influencing sustainability of innovations in cancer survivorship care: a qualitative study.

OBJECTIVES: Moving innovations into healthcare organisations to increase positive health outcomes remains a significant challenge. Even when knowledge and tools are adopted, they often fail to become integrated into the long-term routines of organisations. The objective of this study was to identify factors and processes influencing the sustainability of innovations in cancer survivorship care. DESIGN: Qualitative study using semistructured, in-depth interviews, informed by grounded theory. Data were collected and analysed concurrently using constant comparative analysis. SETTING: 25 cancer survivorship innovations based in six Canadian provinces. PARTICIPANTS: Twenty-seven implementation leaders and relevant staff from across Canada involved in the implementation of innovations in cancer survivorship. RESULTS: The findings were categorised according to determinants, processes and implementation outcomes, and whether a factor was necessary to sustainability, or important but not necessary. Seven determinants, six processes and three implementation outcomes were perceived to influence sustainability. The necessary determinants were (1) management support; (2) organisational and system-level priorities; and (3) key people and expertise. Necessary processes were (4) innovation adaptation; (5) stakeholder engagement; and (6) ongoing education and training. The only necessary implementation outcome was (7) widespread staff and organisational buy-in for the innovation. CONCLUSIONS: Factors influencing the sustainability of cancer survivorship innovations exist across multiple levels of the health system and are often interdependent. Study findings may be used by implementation teams to plan for sustainability from the beginning of innovation adoption initiatives.

Defining sustainability in practice: views from implementing real-world innovations in health care.

BACKGROUND: One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability. METHODS: We conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (n = 27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes. RESULTS: Participants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits. CONCLUSIONS: Participants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.

Environmental predictors of ice seal presence in the Bering Sea.

Ice seals overwintering in the Bering Sea are challenged with foraging, finding mates, and maintaining breathing holes in a dark and ice covered environment. Due to the difficulty of studying these species in their natural environment, very little is known about how the seals navigate under ice. Here we identify specific environmental parameters, including components of the ambient background sound, that are predictive of ice seal presence in the Bering Sea. Multi-year mooring deployments provided synoptic time series of acoustic and oceanographic parameters from which environmental parameters predictive of species presence were identified through a series of mixed models. Ice cover and 10 kHz sound level were significant predictors of seal presence, with 40 kHz sound and prey presence (combined with ice cover) as potential predictors as well. Ice seal presence showed a strong positive correlation with ice cover and a negative association with 10 kHz environmental sound. On average, there was a 20-30 dB difference between sound levels during solid ice conditions compared to open water or melting conditions, providing a salient acoustic gradient between open water and solid ice conditions by which ice seals could orient. By constantly assessing the acoustic environment associated with the seasonal ice movement in the Bering Sea, it is possible that ice seals could utilize aspects of the soundscape to gauge their safe distance to open water or the ice edge by orienting in the direction of higher sound levels indicative of open water, especially in the frequency range above 1 kHz. In rapidly changing Arctic and sub-Arctic environments, the seasonal ice conditions and soundscapes are likely to change which may impact the ability of animals using ice presence and cues to successfully function during the winter breeding season.