Survey of Community Pharmacy Customers’ Medication Storage and Disposal Methods

Many people store medications in bathrooms, which provide a moist, humid environment that speeds up the breakdown process of medications. The proper way to store medicines is in a cool, dry place out of the reach of children. Every year medications are also disposed of improperly presenting a risk to both humans and the environment. About one-third of all sold medications are unused. The most common ways patients dispose of medications in the United States are flushing down the toilet or sink, and throwing them away. Because of this pharmaceuticals have been found in groundwater, and drinking water proving hazardous to both humans and ecosystems. In Congress today, both the Drug Free Water Act and the Safe Drug Disposal Act have been proposed to limit the disposal of pharmaceuticals in sewage systems, and provide the means of controlled substance disposal through take-back programs. In February 2007 the White House Office of National Drug Control Policy (ONDCP) established guidelines for the disposal of prescription medications. ONDCP guidelines are: take unused, unneeded or expired medications out of the original container, mix with an undesirable substance (such as coffee grounds), securely seal in impermeable containers, such as sealable bags, and throw into the trash. ONDCP recommends only flushing if the label or patient information specifies to do so. Taking advantage of community pharmaceutical take-back programs is highly encouraged

Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline.

Burn care remains among the most complex of the time-sensitive treatment interventions in medicine today. An enormous quantity of specialized resources are required to support the critical and complex modalities needed to meet the conventional standard of care for each patient with a critical burn injury. Because of these dependencies, a sudden surge of patients with critical burn injuries requiring immediate and prolonged care following a burn mass casualty incident (BMCI) will place immense stress on healthcare system assets, including supplies, space, and an experienced workforce (staff). Therefore, careful planning to maximize the efficient mobilization and rational use of burn care resources is essential to limit morbidity and mortality following a BMCI. The U.S. burn care profession is represented by the American Burn Association (ABA). This paper has been written by clinical experts and led by the ABA to provide further clarity regarding the capacity of the American healthcare system to absorb a surge of burn-injured patients. Furthermore, this paper intends to offer responders and clinicians evidence-based tools to guide their response and care efforts to maximize burn care capabilities based on realistic assumptions when confronted with a BMCI. This effort also aims to align recommendations in part with those of the Committee on Crisis Standards of Care for the Institute of Medicine, National Academies of Sciences. Their publication guided the work in this report, identified here as "conventional, contingency, and crisis standards of care." This paper also includes an update to the burn Triage Tables- Seriously Resource-Strained Situations (v.2)

Decarbonization of the Chemical Industry through Electrification: Barriers and Opportunities

The chemical industry is a major source of economic productivity and employment globally and among the top 3 industrial sources of greenhouse gas (GHG) emissions, along with steel and cement. As global demand for chemical products continues to grow, there is an urgency to develop and deploy sustainable chemical production pathways and re-consider continued investment in current emissionintensive production technologies. This Perspective describes the challenges and opportunities to decarbonize the chemical industry via electrification powered by the low-emission electric power sector, both in the near-term and long-term, and discusses four technological pathways ranging from the more mature direct substitution of heat with electricity and use of hydrogen to technologically less mature, yet potentially more selective approaches based on electrochemistry and plasma. Finally, we highlight the key elements of integrating an electrified industrial process with the power sector to leverage process flexibility to reduce energy costs of chemical production and provide valuable power grid support services. Unlocking such plant-to-grid coordination and the four electrification pathways has significant potential to facilitate rapid and deep decarbonization of the chemical industry sector

Flavin-containing monooxygenase 3 as a potential player in diabetes-associated atherosclerosis

Despite the well-documented association between insulin resistance and cardiovascular disease, the key targets of insulin relevant to the development of cardiovascular disease are not known. Here, using non-biased profiling methods, we identify the enzyme flavin-containing monooxygenase 3 (Fmo3) to be a target of insulin. FMO3 produces trimethylamine N-oxide (TMAO), which has recently been suggested to promote atherosclerosis in mice and humans. We show that FMO3 is suppressed by insulin in vitro, increased in obese/insulin resistant male mice and increased in obese/insulin-resistant humans. Knockdown of FMO3 in insulin-resistant mice suppresses FoxO1, a central node for metabolic control, and entirely prevents the development of hyperglycaemia, hyperlipidemia and atherosclerosis. Taken together, these data indicate that FMO3 is required for FoxO1 expression and the development of metabolic dysfunction

High oleic/stearic fatty-acid desaturation index in cord plasma from infants of mothers with gestational diabetes

ObjectiveEnhanced fatty-acid desaturation by stearoyl-CoA desaturase enzyme-1 (SCD1) is associated with obesity. This study determined desaturation in the cord plasma of newborns of mothers with and without gestational diabetes (GDM).Study designNewborns of mothers with GDM (n=21) and without (control, n=22) were recruited. Cord plasma fatty-acid desaturation indices (palmitoleic/palmitic, oleic/stearic ratios) were compared, and correlated with anthropometrics and biochemical measures. A subset of very low-density lipoprotein (VLDL) desaturation indices were determined to approximate the liver SCD1 activity.ResultThe total oleic/stearic index was higher in GDM, despite adjustment for cord glucose concentrations. Among GDM and controls, the oleic/stearic index correlated with cord glucose concentrations (rs=0.36, P=0.02). Both palmitoleic/palmitic and oleic/stearic indices correlated with waist circumference (r=0.47, P=0.001; r=0.37, P=0.01). The VLDL oleic/stearic index was higher in GDM.ConclusionThe elevated total oleic/stearic index suggests increased lipogenesis in GDM newborns. Factors in addition to glucose supply may influence fetal SCD1 activity