Methods to reduce prescribing errors in elderly patients with multimorbidity

The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in older multimorbid people. The European Union-funded SENATOR and OPERAM clinical trials commencing in 2016 will examine the impact of customized software engines in reducing medication-related morbidity, avoidable excess cost, and rehospitalization in older multimorbid people

How many voices did you hear? Natural variability disrupts identity perception from unfamiliar voices

Our voices sound different depending on the context (laughing vs. talking to a child vs. giving a speech), making within‐person variability an inherent feature of human voices. When perceiving speaker identities, listeners therefore need to not only ‘tell people apart’ (perceiving exemplars from two different speakers as separate identities) but also ‘tell people together’ (perceiving different exemplars from the same speaker as a single identity). In the current study, we investigated how such natural within‐person variability affects voice identity perception. Using voices from a popular TV show, listeners, who were either familiar or unfamiliar with this show, sorted naturally varying voice clips from two speakers into clusters to represent perceived identities. Across three independent participant samples, unfamiliar listeners perceived more identities than familiar listeners and frequently mistook exemplars from the same speaker to be different identities. These findings point towards a selective failure in ‘telling people together’. Our study highlights within‐person variability as a key feature of voices that has striking effects on (unfamiliar) voice identity perception. Our findings not only open up a new line of enquiry in the field of voice perception but also call for a re‐evaluation of theoretical models to account for natural variability during identity perception

Cohesion and joint speech: right hemisphere contributions to synchronized vocal production

Synchronized behavior (chanting, singing, praying, dancing) is found in all human cultures and is central to religious, military, and political activities, which require people to act collaboratively and cohesively; however, we know little about the neural underpinnings of many kinds of synchronous behavior (e.g., vocal behavior) or its role in establishing and maintaining group cohesion. In the present study, we measured neural activity using fMRI while participants spoke simultaneously with another person. We manipulated whether the couple spoke the same sentence (allowing synchrony) or different sentences (preventing synchrony), and also whether the voice the participant heard was "live" (allowing rich reciprocal interaction) or prerecorded (with no such mutual influence). Synchronous speech was associated with increased activity in posterior and anterior auditory fields. When, and only when, participants spoke with a partner who was both synchronous and "live," we observed a lack of the suppression of auditory cortex, which is commonly seen as a neural correlate of speech production. Instead, auditory cortex responded as though it were processing another talker's speech. Our results suggest that detecting synchrony leads to a change in the perceptual consequences of one's own actions: they are processed as though they were other-, rather than self-produced. This may contribute to our understanding of synchronized behavior as a group-bonding tool. SIGNIFICANCE STATEMENT Synchronized human behavior, such as chanting, dancing, and singing, are cultural universals with functional significance: these activities increase group cohesion and cause participants to like each other and behave more prosocially toward each other. Here we use fMRI brain imaging to investigate the neural basis of one common form of cohesive synchronized behavior: joint speaking (e.g., the synchronous speech seen in chants, prayers, pledges). Results showed that joint speech recruits additional right hemisphere regions outside the classic speech production network. Additionally, we found that a neural marker of self-produced speech, suppression of sensory cortices, did not occur during joint synchronized speech, suggesting that joint synchronized behavior may alter self-other distinctions in sensory processing

Learning Two-input Linear and Nonlinear Analog Functions with a Simple Chemical System

The current biochemical information processing systems behave in a predetermined manner because all features are defined during the design phase. To make such unconventional computing systems reusable and programmable for biomedical applications, adaptation, learning, and self-modification baaed on external stimuli would be highly desirable. However, so far, it haa been too challenging to implement these in real or simulated chemistries. In this paper we extend the chemical perceptron, a model previously proposed by the authors, to function as an analog instead of a binary system. The new analog asymmetric signal perceptron learns through feedback and supports MichaelisMenten kinetics. The results show that our perceptron is able to learn linear and nonlinear (quadratic) functions of two inputs. To the best of our knowledge, it is the first simulated chemical system capable of doing so. The small number of species and reactions allows for a mapping to an actual wet implementation using DNA-strand displacement or deoxyribozymes. Our results are an important step toward actual biochemical systems that can learn and adapt

Self-assembled photosystem-I biophotovoltaics on nanostructured TiO2 and ZnO

The abundant pigment-protein membrane complex photosystem-I (PS-I) is at the heart of the Earth’s energy cycle. It is the central molecule in the “Z-scheme” of photosynthesis, converting sunlight into the chemical energy of life. Commandeering this intricately organized photosynthetic nanocircuitry and re-wiring it to produce electricity carries the promise of inexpensive and environmentally friendly solar power. We here report that dry PS-I stabilized by surfactant peptides functioned as both the light-harvester and charge separator in solar cells self-assembled on nanostructured semiconductors. Contrary to previous attempts at biophotovoltaics requiring elaborate surface chemistries, thin film deposition, and illumination concentrated into narrow wavelength ranges the devices described here are straightforward and inexpensive to fabricate and perform well under standard sunlight yielding open circuit photovoltage of 0.5 V, fill factor of 71%, electrical power density of 81 µW/cm2 and photocurrent density of 362 µA/cm2, over four orders of magnitude higher than any photosystem-based biophotovoltaic to date

Programmable Assembly of DNA-Functionalized Liposomes by DNA

This document is the Accepted Manuscript version of a Published Work that appeared in final form in ACS Nano, copyright © American Chemical Society after peer review and technical editing by publisher. To access the final edited and published work see http://dx.doi.org/10.1021/nn1030093Bionanotechnology involves the use of biomolecules to control both the structure and property of nanomaterials. One of the most studied examples is DNA-directed assembly of inorganic nanoparticles such as gold nanoparticles (AuNPs). However, systematic studies on DNA-linked soft nanoparticles, such as liposomes, are still lacking. We herein report the programmable assembly and systematic characterization of DNA-linked liposomes as a function of liposome size, charge, fluidity, composition, DNA spacer, linker DNA sequence, and salt concentration for direct comparison to DNA-directed assembly of AuNPs. Similar to the assemblies of AuNPs, sharp melting transitions were observed for liposomes where the first derivative of the melting curve full width at half-maximum (fwhm) is equal to or less than 1 °C for all of the tested liposomes, allowing sequence specific DNA detection. We found that parameters such as liposome size, charge, and fluidity have little effect on the DNA melting temperature. Cryo-TEM studies showed that programmable assemblies can be obtained and that the majority of the liposomes maintained a spherical shape in the assembled state. While liposome and AuNP systems are similar in many aspects, there are also important differences that can be explained by their respective physical properties.University of Waterloo || Natural Sciences and Engineering Research Council |

Tunable Growth Factor Delivery from Injectable Hydrogels for Tissue Engineering

Current sustained delivery strategies of protein therapeutics are limited by the fragility of the protein, resulting in minimal quantities of bioactive protein delivered. In order to achieve prolonged release of bioactive protein, an affinity-based approach was designed which exploits the specific binding of the Src homology 3 (SH3) domain with short proline-rich peptides. Specifically, methyl cellulose was modified with SH3-binding peptides (MC-peptide) with either a weak affinity or strong affinity for SH3. The release profile of SH3-rhFGF2 fusion protein from hyaluronan MC-SH3 peptide (HAMC-peptide) hydrogels was investigated and compared to unmodified controls. SH3-rhFGF2 release from HAMC-peptide was extended to 10 days using peptides with different binding affinities compared to the 48 h release from unmodified HAMC. This system is capable of delivering additional proteins with tunable rates of release, while maintaining bioactivity, and thus is broadly applicable