Comprehensive medication reviews by ward-based pharmacists in Swedish hospitals: what does the patient have to say?

Rationale, aims, and objectives: Inappropriate medication prescribing and use amongst older patients is a major patient safety and health care problem. To promote appropriate medication prescribing and use, comprehensive medication reviews (CMRs) by ward-based pharmacists, including follow-up telephone calls after hospital discharge, have been conducted in older patients in the context of a randomized controlled trial (RCT). One of the key actors in a CMR is the patient. To support the understanding of the effects of CMRs on patients' health outcomes and improve clinical practice, knowledge about the patient perspective is needed. We therefore aimed to explore older patients' experiences with, and views on, hospital-initiated CMRs and follow-up telephone calls by ward-based clinical pharmacists within an RCT. Methods: We conducted in-depth semi-structured interviews with 15 patients (66-94 years) and carers from four hospitals in Sweden. Discussion topics included communication, information, decision-making, and effects on the patient. Interviews took place after discharge, were audio-recorded, transcribed verbatim, and thematically analysed using a framework approach. Results: In general, patients' experiences and views were positive. Seven key themes were identified: (a) feeling of being taken care of and heterogenous health effects; (b) the pharmacist is competent; (c) despite the unclear role of pharmacists, their involvement is appreciated; (d) patients rely on health care professionals for decision-making; (e) importance of being informed, but receiving and retaining information is problematic; (f) time, location, and other factors influencing the effectiveness of CMRs; and (g) generic substitution is a problem. Conclusions: Older patients generally have positive experiences with and views on CMRs and follow-up telephone calls. However, some factors, like the unclear role of the ward-based pharmacist and problems with receiving and retaining information, may negatively impact the effectiveness of these interventions. Future initiatives on hospital-initiated CMRs by clinical pharmacists should address these negative factors and utilize the positive views

The Subleading Term of the Strong Coupling Expansion of the Heavy-Quark Potential in a N=4\mathcal N=4 Super Yang-Mills Plasma

Applying the AdS/CFT correspondence, the expansion of the heavy-quark potential of the ${\cal N}$ supersymmetric Yang-Mills theory at large $N_c$ is carried out to the sub-leading term in the large 't Hooft coupling at nonzero temperatures. The strong coupling corresponds to the semi-classical expansion of the string-sigma model, the gravity dual of the Wilson loop operator, with the sub-leading term expressed in terms of functional determinants of fluctuations. The contributions of these determinants are evaluated numerically.Comment: 17 pages in JHEP3, typos fixed, updated version to be published in JHE

Axion-like-particle search with high-intensity lasers

We study ALP-photon-conversion within strong inhomogeneous electromagnetic fields as provided by contemporary high-intensity laser systems. We observe that probe photons traversing the focal spot of a superposition of Gaussian beams of a single high-intensity laser at fundamental and frequency-doubled mode can experience a frequency shift due to their intermittent propagation as axion-like-particles. This process is strongly peaked for resonant masses on the order of the involved laser frequencies. Purely laser-based experiments in optical setups are sensitive to ALPs in the $\mathrm{eV}$ mass range and can thus complement ALP searches at dipole magnets.Comment: 25 pages, 2 figure

Quark-antiquark potential in AdS at one loop

We derive an exact analytical expression for the one-loop partition function of a string in AdS_5xS^5 background with world-surface ending on two anti-parallel lines. All quantum fluctuations are shown to be governed by integrable, single-gap Lame' operators. The first strong coupling correction to the quark-antiquark potential, as defined in N=4 SYM, is derived as the sum of known mathematical constants and a one-dimensional integral representation. Its full numerical value can be given with arbitrary precision and confirms a previous result.Comment: 16 pages. Typos corrected, minor change

Use of generic medicines in Latvia : Awareness, opinions and experiences of the population

Funding Information: Funding was provided by EEA Financial Mechanism and Latvian state (award number 2012.EEZ/DAP/MIC/183). The project is financially supported by Iceland, Liechtenstein and Norway. Publisher Copyright: © 2019 The Author(s).Background: To stimulate use of generic medicines a combination of supply and demand side mechanisms are employed in the Latvian reimbursement system. It is reported that patients have high out-of-pocket pharmaceutical spending and that they overpay by not choosing generic medicines. Patient preferences may be an important obstacle in implementing generic policy. Objective of this study was to assess awareness, opinions and experience of the Latvian population regarding use of generic medicines. Methods: Survey of representative sample of the population of Latvia (n = 1005) aged 18-74 was conducted in March 2015. The survey was distributed in Latvian and Russian languages using Computer Assisted Web Interviews. Associations between experience with generic medicines, preference for medicines, and sociodemographic variables were tested with Pearson Chi-square statistics. Associations between the previous experience and information given by different sources versus choice between medicines were tested with Spearman's correlation test. Results: 72.3% of the population were informed about generic medicines. Men (66.9%) and respondents with primary or secondary education (58.3%; 69.3%) were less informed compared to total (72.3%). From those who recalled using generic medicines (n = 441), 94.4% evaluated their experience as positive or neutral. Despite this, only 21% of the population would opt for generic medicines. The strongest preference for brand-name medicines was in the age group > 55 (40.5%). Opinion of a physician was the most important factor when choosing between generic and brand-name medicines (88.7%). The more positive the information provided by general practitioners, physician specialists, pharmacists, family members, friends and internet is perceived, the more likely respondents are to choose generic medicines (p < 0.001). Conclusion: This study demonstrates that people in Latvia are aware of generic medicines but only a minority of the population would choose them when presented with a choice. It is therefore important that health care professionals provide objective and unbiased information about generic medicines to their patients. Interventions should aim to reach groups that are less informed and to improve providers' understanding and communication with patients about generics.publishersversionPeer reviewe

The IoT and Unpacking the Heffalump’s Trunk

In this paper we highlight design challenges that the Internet of Things (IoT) poses in relation to two of the guiding design paradigms of our time; Privacy by Design (PbD) and Human Centered Design (HCD). The terms IoT, PbD, and HCD are both suitcase terms, meaning that they have a variety of meanings packed within them. Depending on how the practices behind the terms are applied, notwithstanding their well-considered foundations, intentions, and theory, we explore how PbD and HCD can, if not considered carefully, become Heffalump traps and hence act in opposition to the very challenges they seek to address. In response to this assertion we introduce Object Oriented Ontology (OOO) and experiment with its theoretical framing order to articulate possible strategies for mitigating these challenges when designing for the Internet of Things

Awareness and acceptability of human papillomavirus vaccine: an application of the instrumental variables bivariate probit model

<p>Abstract</p> <p>Background</p> <p>Although lower uptake rates of the human papillomavirus (HPV) vaccine among socioeconomically disadvantaged populations have been documented, less is known about the relationships between awareness and acceptability, and other factors affecting HPV vaccine uptake.</p> <p>The current study aimed to estimate the potential effectiveness of increased HPV vaccine awareness on the acceptability of HPV vaccination in a nationally representative sample of women, using a methodology that controlled for potential non-random selection.</p> <p>Methods</p> <p>This study used a population-based sample from the 2007 Health Information National Trends Survey, a cross-sectional study of the US population aged 18 years or older, and focused on the subsample of 742 women who have any female children under the age of 18 years in the household. An instrumental variables bivariate probit model was used to jointly estimate HPV vaccine awareness and acceptability.</p> <p>Results</p> <p>The proportion of HPV vaccine acceptability among the previously aware and non-aware groups was 58% and 47%, respectively. Results from the instrumental variables bivariate probit model showed that the estimated marginal effect of awareness on acceptability was 46 percentage points, an effect that was even greater than observed.</p> <p>Conclusions</p> <p>Among populations who are not currently aware of the HPV vaccine, the potential impact of raising awareness on acceptability of HPV vaccination is substantial. This finding provides additional support to strengthening public health programs that increase awareness and policy efforts that address barriers to HPV vaccination.</p

Pulse pressure and age at menopause

BACKGROUND: The objective of this study was to study the association of early age at menopause with pulse pressure (PP), a marker of arterial stiffness, and PP change. METHODS: The effect of natural menopause was studied in 2484 women from the Atherosclerosis Risk in Communities (ARIC) Study who had not used hormone replacement therapy and who had not had a hysterectomy. The cross-sectional association of age with PP was evaluated in the entire cohort. The cross-sectional association of recalled age at menopause was evaluated in the 1688 women who were postmenopausal at baseline. PP change over 6 years was assessed in relation to menopausal age separately in women who were postmenopausal at baseline and in those whose menopause occurred during the 6-year interval. RESULTS: Chronological age was strongly and positively associated with PP in cross-sectional analyses, but not independently associated with PP change. While menopausal age was not associated cross-sectionally with PP, early age at menopause (age<45) was significantly and independently associated with a slightly larger increase in PP (8.4, 95% CI 7.0–9.8) than later menopause (6.5, 95% CI 5.8;7.2). However, among normotensive women the difference was not statistically significant (p = 0.07, 6.1 vs 4.7). CONCLUSIONS: Early age at menopause may be related to a greater increase in arterial stiffness, but the effect appears to be small and further evidence is needed