Prescription Drug Monitoring Programs: Evolution and Evidence

This Issue Brief reviews the current status and characteristics of PDMPs, their use, and evidence of their effectiveness. It summarizes best practices for PDMPs and the needs for further research and evaluation

Achieving Effective Antidepressant Pharmacotherapy in Primary Care: The Role of Depression Care Management in Treating Late-Life Depression

To estimate the effect of an evidence-based depression care management (DCM) intervention on the initiation and appropriate use of antidepressant in primary care patients with late-life depression. DESIGN : Secondary analysis of data from a randomized trial. SETTING : Community, primary care. PARTICIPANTS : Randomly selected individuals aged 60 and older with routine appointments at 20 primary care clinics randomized to provide a systematic DCM intervention or care as usual. METHODS : Rates of antidepressant use and dose adequacy of patients in the two study arms were compared at each patient assessment (baseline, 4, 8, and 12 months). For patients without any antidepressant treatment at baseline, a longitudinal analysis was conducted using multilevel logistic models to compare the rate of antidepressant treatment initiation, dose adequacy when initiation was first recorded, and continued therapy for at least 4 months after initiation between study arms. All analyses were conducted for the entire sample and then repeated for the subsample with major or clinically significant minor depression at baseline. RESULTS : Rates of antidepressant use and dose adequacy increased over the first year in patients assigned to the DCM intervention, whereas the same rates held constant in usual care patients. In longitudinal analyses, the DCM intervention had a significant effect on initiation of antidepressant treatment (adjusted odds ratio (OR)=5.63, P <.001) and continuation of antidepressant medication for at least 4 months (OR=6.57, P =.04) for patients who were depressed at baseline. CONCLUSIONS : Evidence-based DCM models are highly effective at improving antidepressant treatment in older primary care patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66406/1/j.1532-5415.2009.02226.x.pd

The α1‐adrenergic receptor is involved in hepcidin upregulation induced by adrenaline and norepinephrine via the STAT3 pathway

Elevated body iron stores are associated with hypertension progression, while hypertension is associated with elevated plasma catecholamine levels in patients. However, there is a gap in our understanding of the connection between catecholamines and iron regulation. Hepcidin is a key iron‐regulatory hormone, which maintains body iron balance. In the present study, we investigated the effects of adrenaline (AD) and norepinephrine (NE) on hepatic hepcidin regulation. Mice were treated with AD, NE, phenylephrine (PE, α1‐adrenergic receptor agonist), prazosin (PZ, α1‐adrenergic receptor antagonist), and/or propranolol (Pro, β‐adrenergic receptor antagonist). The levels of hepcidin, as well as signal transducer and activator of transcription 3 (STAT3), ferroportin 1 (FPN1), and ferritin‐light (Ft‐L) protein in the liver or spleen, were assessed. Six hours after AD, NE, or PE treatment, hepatic hepcidin mRNA levels increased. Pretreatment with PZ, but not Pro, abolished the effects of AD or NE on STAT3 phosphorylation and hepatic hepcidin expression. When mice were treated with AD or NE continuously for 7 days, an increase in hepatic hepcidin mRNA levels and serum hepcidin concentration was also observed. Meanwhile, the expected downstream effects of elevated hepcidin, namely decreased FPN1 expression and increased Ft‐L protein and non‐heme iron concentrations in the spleen, were observed after the continuous AD or NE treatments. Taken together, we found that AD or NE increase hepatic hepcidin expression via the α1‐adrenergic receptor and STAT3 pathways in mice. The elevated hepatic hepcidin decreased FPN1 levels in the spleen, likely causing the increased iron accumulation in the spleen

Risk factors for overweight and obesity, and changes in body mass index of Chinese adults in Shanghai

<p>Abstract</p> <p>Background</p> <p>Over the past two decades, the prevalence of overweight or obesity has increased in China. The aims of this study were to firstly assess the baseline prevelences and the risk factors for overweight and obesity, and secondly to detect the changes of body mass index (BMI) over a follow-up period in Chinese adults in Shanghai.</p> <p>Methods</p> <p>The data set of a population-based longitudinal study was analyzed. Anthropometric and biochemical data were collected for 5364 subjects (aged 25–95 years) during a period of 1998–2001. Among those individuals, 3032 subjects were interviewed and reexamined at the second survey from 2003 to 2004. Then the standardized prevalences for overweight and obesity were calculated using baseline data; the possible contributing factors of overweight and obesity were detected using binary logistic regression analysis; and the changes of BMI were evaluated after an average of 3.6-year follow-up period.</p> <p>Results</p> <p>(1) According to the WHO standard and the Chinese standard, the sex- and age-standardized prevalences were 27.5% and 32.4% for overweight, and 3.7% and 9.1% for obesity, respectively. (2) The risks of overweight and obesity differed among different age groups. Family history of obesity increased the risk of overweight and obesity by about 1.2-fold for both genders. Current male smokers had a lower risk of overweight and obesity (OR = 0.76, <it>p </it>< 0.05) than nonsmokers. In contrast, current male drinkers had a higher risk of overweight and obesity (OR = 1.42, <it>p </it>< 0.05) than nondrinkers. Compared with low-educated women, medium- and high- educated women were at lower risk of overweight and obesity, and the corresponding ORs (95% CIs) were 0.64 (0.52–0.79) and 0.50(0.36–0.68), respectively. (3) The annual changes of BMI means ranged from an increase of 0.1 kg/m²to a decrease of 0.2 kg/m²(by genders and age groups). Meanwhile, the BMI increase was statistically significant in the 35–44 years age group, and the BMI decrease was significant above 65 years for both genders.</p> <p>Conclusion</p> <p>This study showed high prevalence of overweight and obesity in Shanghai metropolis populations. The risk factors of overweight and obesity were multifactorial and gender specific. After 3.6 years, BMI means changed slightly, BMI increased mainly in middle-aged individuals and decreased in old individuals.</p

The diagnostic analysis of the planet bearing faults using the torsional vibration signal

© 2019 Elsevier Ltd This paper aims to investigate the effectiveness of using the torsional vibration signal as a diagnostic tool for planet bearing fault detection. The inner race of the planet bearing is connected to the planet carrier and its outer race is connected to the planet gear bore hole. When moving, the planet bearing not only spins around the planet gear axis, but also revolves about the sun gear axis. This rotating mechanism poses a challenge for the condition monitoring of the planet bearing because of the variant vibration transfer paths. The transducer mounted on the carrier arm measuring the torsional vibration is theoretically free from this modulation effect and it is used in this research to extract the diagnostic information from the torsional vibration. A 34 degrees of freedom planetary gear lumped-parameter model with detailed planet bearing model was developed to obtain the dynamic response. The planet bearing was modelled by 5 degrees of freedom, with 2 degrees of freedom from the outer race, 2 degrees of freedom from the inner race and one degree of freedom from the sprung-mass. The variations of the sun-planet and ring-planet mesh stiffnesses were evaluated by the finite element method and the variation of the planet bearing stiffness was evaluated by the Hertzian contact theory. The localized faults on the planet bearing inner race, outer race and the rolling element were created mathematically and then these faults were incorporated into the planetary gear model to obtain the faulted vibration signal. The linear prediction method and the minimum entropy deconvolution method were used to enhance the planet bearing signal and then the amplitude demodulation results were analysed. It was found that the carrier arm instantaneous angular speed was an effective alternative approach for planet gear condition monitoring

Puzzles and Riddles

In this MA thesis, I will investigate and discuss my graduation project and how it has been researched during the process. This writing runs parallel to my art practice and is connected the theory of “Three orders” of Lacan” to the concept of “The Realm with Me”, which was redefined by Chinese artist critic Guowei Wang and originally illustrated as the “sublime” by Immanuel Kant. I have aimed to find my own way to consider the aesthetic concepts and open the surface of my body to navigate the fragmentation in my dreams of remembering and transform them into the narrative texts and patterns to rewrite them into a larger context. Additionally, I will explore such concepts as childhood, family and identity in my works. I have divided my work into five chapters. Chapter 1 focuses on the aesthetic concept of the sublime which brings out the idea of “The Realm with Me”. In it, I will look at my works through the theoretical foundations of aesthetics and a brief exposition of psychoanalytic theory. The works of Freud and Lacan provide a theoretical framework to understand the identification of art and sublime. I will then distinguish three different orders of Lacan’s theory to be helpful in terms of my expression. Chapter 2 focuses on the background of Chinese urbanization, defined as a process during which laborers move from agriculture to manufacturing and from countryside to urban areas. It will look at my works based on extensive research and fieldwork of the greenhouse in my hometown of Huzhou, China. Chapter 3 focuses on my personal experience. The impact of family, society and environment is significant in understanding trauma conditions and relationships. I will start by narrating a personal in-between experience that led me to question how I deal with childhood trauma and the traumatic fragments in my dreams, which is the beginning of my research process and explore how it will be transformed into images. Dreams also serve as an essential element and material in my art practice. Chapter 4 will conclude what has already been written about. During the above process, a contextual, philosophical and informational ground will be provided by this writing, which is concerned as a connecting element, both as a description of my artistic process and as an integrated part of my work. 2 Chapter 5 mainly concerns my art practice on the basis of my personal experience and other artists' works, which has led me in my pursuit to discover artistic creation from anxiety, trauma and fear in the collective memory from my dreams. I will look at contemporary artists who are also interested in the idea of childhood trauma and how it appears in their work. In addition, I will describe my video installations and sculptures and connect my art practice with activity of play, a form of surrealism. The puzzle game will be provided as a method to understand how those theories are related to my art practice and bring the research into the field of art-making. The final chapter is a reflection for my MA degree solo show at Hulduland, in which I intended to approach the research in this thesis into practice. Through the process of creating the artwork and contemplating its outcome, I would like to make a conclusion for my MA degree practice that could lead me to potential further development