Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June ...30, 2013) to identify relevant articles in people aged > 65 years.
We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy.
International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.
The widespread technological introduction of graphene beyond electronics rests on our ability to assemble this two-dimensional building block into three-dimensional structures for practical devices. ...To achieve this goal we need fabrication approaches that are able to provide an accurate control of chemistry and architecture from nano to macroscopic levels. Here, we describe a versatile technique to build ultralight (density ≥1 mg cm(-3)) cellular networks based on the use of soft templates and the controlled segregation of chemically modified graphene to liquid interfaces. These novel structures can be tuned for excellent conductivity; versatile mechanical response (elastic-brittle to elastomeric, reversible deformation, high energy absorption) and organic absorption capabilities (above 600 g per gram of material). The approach can be used to uncover the basic principles that will guide the design of practical devices that by combining unique mechanical and functional performance will generate new technological opportunities.
Automatic off-line classification and recognition of bird vocalizations has been a subject of interest to ornithologists and pattern detection researchers for many years. Several new applications, ...including bird vocalization classification for aircraft bird strike avoidance, will require real time classification in the presence of noise and other disturbances. The vocalizations of many common bird species can be represented using a sum-of-sinusoids model. An experiment using computer software to perform peak tracking of spectral analysis data demonstrates the usefulness of the sum-of-sinusoids model for rapid automatic recognition of isolated bird syllables. The technique derives a set of spectral features by time-variant analysis of the recorded bird vocalizations, then performs a calculation of the degree to which the derived parameters match a set of stored templates that were determined from a set of reference bird vocalizations. The results of this relatively simple technique are favorable for both clean and noisy recordings.
Neurofibromatosis type 1 (NF1), a genetic disease that affects 1 in 3,000, is caused by loss of a large evolutionary conserved protein that serves as a GTPase Activating Protein (GAP) for Ras. Among ...Drosophila melanogaster Nf1 (dNf1) null mutant phenotypes, learning/memory deficits and reduced overall growth resemble human NF1 symptoms. These and other dNf1 defects are relatively insensitive to manipulations that reduce Ras signaling strength but are suppressed by increasing signaling through the 3'-5' cyclic adenosine monophosphate (cAMP) dependent Protein Kinase A (PKA) pathway, or phenocopied by inhibiting this pathway. However, whether dNf1 affects cAMP/PKA signaling directly or indirectly remains controversial. To shed light on this issue we screened 486 1(st) and 2(nd) chromosome deficiencies that uncover >80% of annotated genes for dominant modifiers of the dNf1 pupal size defect, identifying responsible genes in crosses with mutant alleles or by tissue-specific RNA interference (RNAi) knockdown. Validating the screen, identified suppressors include the previously implicated dAlk tyrosine kinase, its activating ligand jelly belly (jeb), two other genes involved in Ras/ERK signal transduction and several involved in cAMP/PKA signaling. Novel modifiers that implicate synaptic defects in the dNf1 growth deficiency include the intersectin-related synaptic scaffold protein Dap160 and the cholecystokinin receptor-related CCKLR-17D1 drosulfakinin receptor. Providing mechanistic clues, we show that dAlk, jeb and CCKLR-17D1 are among mutants that also suppress a recently identified dNf1 neuromuscular junction (NMJ) overgrowth phenotype and that manipulations that increase cAMP/PKA signaling in adipokinetic hormone (AKH)-producing cells at the base of the neuroendocrine ring gland restore the dNf1 growth deficiency. Finally, supporting our previous contention that ALK might be a therapeutic target in NF1, we report that human ALK is expressed in cells that give rise to NF1 tumors and that NF1 regulated ALK/RAS/ERK signaling appears conserved in man.
StrataGraft® (allogeneic cultured keratinocytes and dermal fibroblasts in murine collagen–dsat) is an FDA-approved viable bioengineered allogeneic cellularized construct for adult patients with deep ...partial-thickness burns requiring surgery. We characterized the structural and functional properties of StrataGraft to improve product understanding by evaluating extracellular matrix (ECM) molecule distribution and secreted protein factor expression in vitro.
ECM protein expression was determined using indirect immunofluorescence on construct cross sections using commercial antibodies against collagen III, IV, VI, laminin-332, and decorin. Human collagen I expression was verified by enzyme-linked immunosorbent assay (ELISA) for collagen I C-terminal propeptide. Soluble protein factor secretion was quantified by multiplex biomarker assays and singleplex ELISA in conditioned media from meshed constructs.
StrataGraft cellular components produced collagen I, collagen III, collagen VI, and decorin in patterns indicating an organized ECM. Distributions of collagen IV and laminin-332 indicated formation of basement membranes and dermal-epidermal junctions. Soluble protein factors were observed in the pg/cm2/h range from 1 h to the experiment end at 168 h.
The organization of the ECM proteins was like human skin and the viable cellular components provided sustained secretion of soluble wound healing factors, making StrataGraft an attractive option for treating severe burns.
•The cellular components of StrataGraft create a structure similar to human skin.•StrataGraft secretes proteins linked to each stage of acute wound healing.•StrataGraft keeps its structural and functional properties after cryopreservation.•StrataGraft may be a good option to treat severe burns while sparing donor sites.
The Appointment-Based Model (ABM) is a care model that helps community pharmacists streamline their medication dispensing workflow while simultaneously integrating patient care into the medication ...preparation process through medication synchronization. Implementation of the ABM has varied across community pharmacies. Further studies that identify tailored implementation approaches are needed to support broad adoption of the ABM in practice.
(1) To determine facilitators and barriers to ongoing adoption and implementation of the ABM at a small chain of rural independent pharmacies where adoption has stalled and (2) to identify implementation strategies to support further adoption of the ABM at these pharmacies METHODS: This project was an exploratory, mid-implementation study. Semistructured interviews were conducted with pharmacy staff who participated in the ongoing implementation and use of the ABM at the pharmacies. Interviews elicited stakeholder-centered perspectives on (1) experiences with the ABM to date, (2) processes and roles for the ABM, and (3) opinions on how implementation of the ABM could be improved at the pharmacies. Rapid qualitative assessment methodology was used for analysis to identify facilitators and barriers and to select implementation strategies.
Thirty-one pharmacy personnel were interviewed: pharmacists (n = 10), pharmacy technicians (n = 7), and fill clerks (n = 14). The research team identified 6 facilitators and 4 barriers to the implementation of the ABM at the pharmacies. Five implementation strategies were selected based on the facilitators and barriers: (1) capture and share local knowledge across pharmacy sites, (2) conduct educational outreach visits, (3) conduct ongoing training, (4) prepare patients to be active participants in the ABM, and (5) organize clinician implementation team meetings.
Development of a stakeholder-driven implementation approach may support further implementation and adoption of the ABM in practice.
A novel digital two-stage linearization filter is proposed for direct-detection (DD) systems and assessed experimentally for the first time. The performance improvement is quantified by experiments ...with a 7 × 25 Gb/s wavelength division multiplexing DD single sideband 16-QAM Nyquist-shaped subcarrier modulation system with a net optical information spectral density of 2.3 (b/s)/Hz. The results indicate that this technique can effectively compensate the nonlinearity caused by square-law detection, while, at the same time reducing the DSP complexity, avoiding the need to perform the multiple iterations which are required in previously proposed beating interference cancellation methods.
A novel bulk acoustic wave (BAW) microgravimetric sensor based on gallium orthophosphate is demonstrated that it is capable of operation at high temperature (up to 900 °C). The sensor is applied to ...the detection of carbon deposition onto electrodeposited nickel from dry methane at 600 °C and used as an analogue for studying the coking of solid oxide fuel cell (SOFC) anodes. The degradation of electrochemical performance due to deposition of carbon onto symmetrical SOFCs with nickel/gadolinium doped ceria electrodes is measured using electrochemical impedance spectroscopy (EIS). Direct correlation is observed between the frequency shift of the sensor and the change in resistance to charge transfer of the SOFC anode. An induction period (∼2 h) following exposure to methane is observed where no significant carbon deposition occurs.
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► A novel sensor is demonstrated to measure carbon deposition on heterogeneous catalyst surfaces. ► Link between carbon deposition, electrochemical performance and mass change observed. ► Induction period prior to carbon deposition on SOFC anode identified. ► Carbon deposition on electrode surface confirmed with Raman spectroscopy.
Raman spectroscopic maps were used to study the local properties of graphene films as grown on corrugated copper foils, by chemical vapour deposition, and after transfer onto SiO2(300nm)/Si ...substrates. Analysis of the Raman peaks show the films exhibit a striped periodic pattern of single- and bi-layer graphene. By performing simultaneous AFM–Raman line maps of the as grown film on Cu we find that the layer growth shows a strong correlation to substrate topography. As a result, compressively strained non-AB stacked bi-layer graphene forms preferentially along the ridges, whilst single-layer graphene grows inside the trenches, of the Cu foil topography. These experimental results suggest that surface mobility is not the dominating factor determining control of layer number in such growth regimes.
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