Frail older people with multi-morbidities in primary care: a new integrated care clinical pharmacy service

Background: Older people confined to their own homes due to frailty, multiple long-term conditions and/or complex needs, are known to be at risk of medicines-related problems. Whilst a health and social care team approach to supporting these patients is advocated, there is limited evidence regarding how pharmacists can best contribute. Objective: To describe a new specialist pharmacy service (called the integrated care clinical pharmacist) in terms of how it works, what it achieves and its policy implications. Setting: Patients’ own homes in Lambeth, London, UK. Method: Community matrons identified patients who were experiencing medicines-related problems. These were referred to the integrated care clinical pharmacist who undertook a full medication review and recorded activities, which were independently analysed anonymously. Main Outcome Measure: Medicines-related problems and the associated interventions. Result: 143 patients were referred to the service over a 15-month period. A total of 376 medicines-related problems were identified: 28 (7%) supply issues, 107 (29%) compliance issues, 241 (64%) clinical issues. A diverse range of interventions were instigated by the pharmacist, requiring the coordination of community pharmacists, primary and secondary health and social care professionals. Conclusion: This project demonstrated that including an integrated care clinical pharmacy service as part of the health and social care team that visits frail, older people in their own homes has benefits. The service operated as part of a wider inter-professional community team. The service also supported current health policy priorities in medicines optimization by identifying and addressing a wide range of medicines-related problems for this vulnerable patient group

Measurement of inclusive J/ψ suppression in Au+Au collisions at sNN=200 GeV through the dimuon channel at STAR

J/ψ suppression has long been considered a sensitive signature of the formation of the Quark-Gluon Plasma (QGP) in relativistic heavy-ion collisions. In this letter, we present the first measurement of inclusive J/ψ production at mid-rapidity through the dimuon decay channel in Au+Au collisions at sNN=200 GeV with the STAR experiment. These measurements became possible after the installation of the Muon Telescope Detector was completed in 2014. The J/ψ yields are measured in a wide transverse momentum (pT) range of 0.15 GeV/c to 12 GeV/c from central to peripheral collisions. They extend the kinematic reach of previous measurements at RHIC with improved precision. In the 0-10% most central collisions, the J/ψ yield is suppressed by a factor of approximately 3 for pT>5 GeV/c relative to that in p+p collisions scaled by the number of binary nucleon-nucleon collisions. The J/ψ nuclear modification factor displays little dependence on pT in all centrality bins. Model calculations can qualitatively describe the data, providing further evidence for the color-screening effect experienced by J/ψ mesons in the QGP

Charge-dependent pair correlations relative to a third particle in p + Au and d + Au collisions at RHIC

Quark interactions with topological gluon configurations can induce chirality imbalance and local parity violation in quantum chromodynamics. This can lead to electric charge separation along the strong magnetic field in relativistic heavy-ion collisions – the chiral magnetic effect (CME). We report measurements by the STAR collaboration of a CME-sensitive observable in p+Au and d+Au collisions at 200 GeV, where the CME is not expected, using charge-dependent pair correlations relative to a third particle. We observe strong charge-dependent correlations similar to those measured in heavy-ion collisions. This bears important implications for the interpretation of the heavy-ion data

Observation of charge asymmetry dependence of pion elliptic flow and the possible chiral magnetic wave in heavy-ion collisions

We present measurements of $\pi^-$ and $\pi^+$ elliptic flow, $v_2$, at midrapidity in Au+Au collisions at $\sqrt{s_{_{\rm NN}}} =$ 200, 62.4, 39, 27, 19.6, 11.5 and 7.7 GeV, as a function of event-by-event charge asymmetry, $A_{ch}$, based on data from the STAR experiment at RHIC. We find that $\pi^-$ ($\pi^+$) elliptic flow linearly increases (decreases) with charge asymmetry for most centrality bins at $\sqrt{s_{_{\rm NN}}} = \text{27 GeV}$ and higher. At $\sqrt{s_{_{\rm NN}}} = \text{200 GeV}$, the slope of the difference of $v_2$ between $\pi^-$ and $\pi^+$ as a function of $A_{ch}$ exhibits a centrality dependence, which is qualitatively similar to calculations that incorporate a chiral magnetic wave effect. Similar centrality dependence is also observed at lower energies.Comment: 6 pages, 4 figure

Centrality and transverse momentum dependence of elliptic flow of multi-strange hadrons and ϕ\phi meson in Au+Au collisions at sNN\sqrt{s_{NN}} = 200 GeV

We present high precision measurements of elliptic flow near midrapidity ($|y|<1.0$) for multi-strange hadrons and $\phi$ meson as a function of centrality and transverse momentum in Au+Au collisions at center of mass energy $\sqrt{s_{NN}}=$ 200 GeV. We observe that the transverse momentum dependence of $\phi$ and $\Omega$ $v_{2}$ is similar to that of $\pi$ and $p$, respectively, which may indicate that the heavier strange quark flows as strongly as the lighter up and down quarks. This observation constitutes a clear piece of evidence for the development of partonic collectivity in heavy-ion collisions at the top RHIC energy. Number of constituent quark scaling is found to hold within statistical uncertainty for both 0-30$\%$ and 30-80$\%$ collision centrality. There is an indication of the breakdown of previously observed mass ordering between $\phi$ and proton $v_{2}$ at low transverse momentum in the 0-30$\%$ centrality range, possibly indicating late hadronic interactions affecting the proton $v_{2}$.Comment: 7 pages and 4 figures, Accepted for publication in Physical Review Letter

Observation of Transverse Spin-Dependent Azimuthal Correlations of Charged Pion Pairs in p↑+pp^\uparrow+p at s=200\sqrt{s}=200 GeV

We report the observation of transverse polarization-dependent azimuthal correlations in charged pion pair production with the STAR experiment in $p^\uparrow+p$ collisions at RHIC. These correlations directly probe quark transversity distributions. We measure signals in excess of five standard deviations at high transverse momenta, at high pseudorapidities eta>0.5, and for pair masses around the mass of the rho-meson. This is the first direct transversity measurement in p+p collisions. Comparing the results to data from lepton-nucleon scattering will test the universality of these spin-dependent quantities.Comment: 11 pages, 5 figures, 15 tables. Submitted to PR

Energy dependence of acceptance-corrected dielectron excess mass spectrum at mid-rapidity in Au+Au collisions at sNN=19.6\sqrt{s_{NN}} = 19.6 and 200 GeV

The acceptance-corrected dielectron excess mass spectra, where the known hadronic sources have been subtracted from the inclusive dielectron mass spectra, are reported for the first time at mid-rapidity $|y_{ee}|<1$ in minimum-bias Au+Au collisions at $\sqrt{s_{NN}}$ = 19.6 and 200 GeV. The excess mass spectra are consistently described by a model calculation with a broadened $\rho$ spectral function for $M_{ee}<1.1$ GeV/$c^{2}$. The integrated dielectron excess yield at $\sqrt{s_{NN}}$ = 19.6 GeV for $0.4<M_{ee}<0.75$ GeV/$c^2$, normalized to the charged particle multiplicity at mid-rapidity, has a value similar to that in In+In collisions at $\sqrt{s_{NN}}$ = 17.3 GeV. For $\sqrt{s_{NN}}$ = 200 GeV, the normalized excess yield in central collisions is higher than that at $\sqrt{s_{NN}}$ = 17.3 GeV and increases from peripheral to central collisions. These measurements indicate that the lifetime of the hot, dense medium created in central Au+Au collisions at $\sqrt{s_{NN}}$ = 200 GeV is longer than those in peripheral collisions and at lower energies.Comment: 9 pages, 6 figure

Azimuthal anisotropy in U+U and Au+Au collisions at RHIC

Collisions between prolate uranium nuclei are used to study how particle production and azimuthal anisotropies depend on initial geometry in heavy-ion collisions. We report the two- and four-particle cumulants, $v_2\{2\}$ and $v_2\{4\}$, for charged hadrons from U+U collisions at $\sqrt{s_{\rm NN}}$ = 193 GeV and Au+Au collisions at $\sqrt{s_{\rm NN}}$ = 200 GeV. Nearly fully overlapping collisions are selected based on the amount of energy deposited by spectators in the STAR Zero Degree Calorimeters (ZDCs). Within this sample, the observed dependence of $v_2\{2\}$ on multiplicity demonstrates that ZDC information combined with multiplicity can preferentially select different overlap configurations in U+U collisions. An initial-state model with gluon saturation describes the slope of $v_2\{2\}$ as a function of multiplicity in central collisions better than one based on Glauber with a two-component multiplicity model.Comment: Final paper version accepted for publication in Phys. Rev. Lett. New version includes comparisons to a constituent quark glauber mode

Long-range pseudorapidity dihadron correlations in dd+Au collisions at sNN=200\sqrt{s_{\rm NN}}=200 GeV

Dihadron angular correlations in $d$+Au collisions at $\sqrt{s_{\rm NN}}=200$ GeV are reported as a function of the measured zero-degree calorimeter neutral energy and the forward charged hadron multiplicity in the Au-beam direction. A finite correlated yield is observed at large relative pseudorapidity ($\Delta\eta$) on the near side (i.e. relative azimuth $\Delta\phi\sim0$). This correlated yield as a function of $\Delta\eta$ appears to scale with the dominant, primarily jet-related, away-side ($\Delta\phi\sim\pi$) yield. The Fourier coefficients of the $\Delta\phi$ correlation, $V_{n}=\langle\cos n\Delta\phi\rangle$, have a strong $\Delta\eta$ dependence. In addition, it is found that $V_{1}$ is approximately inversely proportional to the mid-rapidity event multiplicity, while $V_{2}$ is independent of it with similar magnitude in the forward ($d$-going) and backward (Au-going) directions.Comment: 8 pages, 4 figure