Assessing Patient Adherence and Satisfaction: Clinical Services Beyond the Pharmacy Counter

Medication adherence is a bigger problem than many of us are willing to admit. If patients do not take their medications as prescribed, they will not get the full therapeutic benefits and will put themselves at risk if serious harm. An estimated 125,000 deaths occur in the United States annually due to non-adherence. The objective of this study is to establish a pharmacy intervention model that best provides patient satisfaction and improved medication adherence through the use of home visits and follow-up calls by pharmacists and pharmacy interns at Clark’s Pharmacy. In order to do this, patients receiving home visits from pharmacists or pharmacy interns will receive phone calls 90 days after every visit. These will be patients that have recently been discharged from skilled nursing facilities and other health care centers. In the calls, survey questions will be asked in order to measure their adherence and satisfaction with the pharmacy. Satisfaction will be measured in addition to adherence because studies show that there is a positive correlation between it and adherence. The questions will be formulated in consultation with a pharmacist who has used a similar survey over the phone before. We will need to use convenience sampling, since only patients of Clark’s Pharmacy already being visited at home will qualify to participate. This will be a cross-sectional study. Once data has been collected, SPSS will be used to run descriptive statistics, as well as a Chi-squared test. Data collection will take place from the spring of 2015 until the fall of 2016

Patients’ Perceptions of Pharmacist Intervention Through Pre-Screened Medication Therapy Management Service

Background: The continued challenge of time commitment in a community pharmacy setting is reported by pharmacists as the single largest setback in providing quality patient care. Additionally, when efforts are made by pharmacists to intervene on a patient’s therapy through medication therapy management (MTM), patient “no shows” further challenge an already busy community pharmacy world. Many studies show the value of a pharmacist-patient relationship. However, continued barriers prevent the value of this relationship to take full effect. While numerous methods of comprehensive medication review take place, the issue of establishing a model that best suits the needs of community pharmacy patients still exists. Statement of the Problem: To assess patients’ perceptions of pharmacist intervention through a pre-screened medication therapy management service at prescription pick-up. Description of Methodology: This study utilized a nonprobability convenience sampling of MTM participants at a local community pharmacy pickup for research. A questionnaire was designed to assess patients’ perceptions prior to and after the pharmacist intervention. All adult patients willing to participate in MTM services were included. After the MTM intervention, participants were encouraged to complete the questionnaire at home and mail it back to the pharmacy. The questionnaires were then collected from the pharmacy for review and data was analyzed with SPSS software. Results: Reported increased patient satisfaction and knowledge by survey following the MTM intervention. Unfortunately, the results were insignificant and the study did not achieve ideal power. Conclusions: The descriptive statistical results enumerated in this study do not reveal any applicable trends relating to the use of MTM services at-large. Despite these findings, however, all patients who commented on the intervention provided positive feedback. Further research is encouraged to appropriately assess the value of pharmacist-delivered MTM at prescription pick-up

Forming Realistic Late-Type Spirals in a LCDM Universe: The Eris Simulation

Simulations of the formation of late-type spiral galaxies in a cold dark matter LCDM universe have traditionally failed to yield realistic candidates. Here we report a new cosmological N-body/SPH simulation of extreme dynamic range in which a close analog of a Milky Way disk galaxy arises naturally. Termed Eris, the simulation follows the assembly of a galaxy halo of mass Mvir=7.9x10^11 Msun with a total of N=18.6 million particles (gas + dark matter + stars) within the final virial radius, and a force resolution of 120 pc. It includes radiative cooling, heating from a cosmic UV field and supernova explosions, a star formation recipe based on a high gas density threshold (nSF=5 atoms cm^-3 rather than the canonical nSF=0.1 atoms cm^-3), and neglects AGN feedback. At the present epoch, the simulated galaxy has an extended rotationally-supported disk with a radial scale length Rd=2.5 kpc, a gently falling rotation curve with circular velocity at 2.2 disk scale lenghts of V2.2=214 km/s, a bulge-to-disk ratio B/D=0.35, and a baryonic mass fraction that is 30% below the cosmic value. The disk is thin, is forming stars in the region of the Sigma_SFR - Sigma_HI plane occupied by spiral galaxies, and falls on the photometric Tully-Fisher and the stellar mass-halo virial mass relations. Hot (T>3x10^5 K), X-ray luminous halo gas makes only 26% of the universal baryon fraction and follows a flattened density profile proportional to r^-1.13 out to r=100 kpc. Eris appears then to be the first cosmological hydrodynamic simulation in which the galaxy structural properties, the mass budget in the various components, and the scaling relations between mass and luminosity are all consistent with a host of observational constraints. (Abridged)Comment: 12 pages, 7 figures, accepted for publication on the Astrophysical Journa

The Zurich Environmental Study (ZENS) of galaxies in groups along the cosmic web. V. properties and frequency of merging satellites and centrals in different environments

We use the Zurich ENvironmental Study (ZENS) database to investigate the environmental dependence of the merger fraction $\Gamma$ and merging galaxy properties in a sample of ~1300 group galaxies with $M>10^{9.2}M_\odot$ and 0.05<z<0.0585. In all galaxy mass bins investigated in our study, we find that $\Gamma$ decreases by a factor of ~2-3 in groups with halo masses $M_{HALO}>10^{13.5} M_\odot$ relative to less massive systems, indicating a suppression of merger activity in large potential wells. In the fiducial case of relaxed groups only, we measure a variation $\Delta\Gamma/\Delta \log (M_{HALO}) \sim - 0.07$ dex$^{-1}$, which is almost independent of galaxy mass and merger stage. At galaxy masses $>10^{10.2} M_\odot$, most mergers are dry accretions of quenched satellites onto quenched centrals, leading to a strong increase of $\Gamma$ with decreasing group-centric distance at these mass scales.Both satellite and central galaxies in these high mass mergers do not differ in color and structural properties from a control sample of nonmerging galaxies of equal mass and rank. At galaxy masses $<10^{10.2} M_\odot$, where we mostly probe satellite-satellite pairs and mergers between star-forming systems, close pairs (projected distance $<10-20$ kpc) show instead $\sim2\times$ enhanced (specific) star formation rates and $\sim1.5\times$ larger sizes than similar mass, nonmerging satellites. The increase in both size and SFR leads to similar surface star-formation densities in the merging and control-sample satellite populations.Comment: Published in ApJ, 797, 12

Dwarf galaxy formation with H2-regulated star formation

We describe cosmological galaxy formation simulations with the adaptive mesh refinement code Enzo that incorporate a star formation prescription regulated by the local abundance of molecular hydrogen. We show that this H2-regulated prescription leads to a suppression of star formation in low mass halos (M_h < ~10^10 M_sun) at z>4, alleviating some of the dwarf galaxy problems faced by theoretical galaxy formation models. H2 regulation modifies the efficiency of star formation of cold gas directly, rather than indirectly reducing the cold gas content with "supernova feedback". We determine the local H2 abundance in our most refined grid cells (76 proper parsec in size at z=4) by applying the model of Krumholz, McKee, & Tumlinson, which is based on idealized 1D radiative transfer calculations of H2 formation-dissociation balance in ~100 pc atomic--molecular complexes. Our H2-regulated simulations are able to reproduce the empirical (albeit lower z) Kennicutt-Schmidt relation, including the low Sigma_gas cutoff due to the transition from atomic to molecular phase and the metallicity dependence thereof, without the use of an explicit density threshold in our star formation prescription. We compare the evolution of the luminosity function, stellar mass density, and star formation rate density from our simulations to recent observational determinations of the same at z=4-8 and find reasonable agreement between the two.Comment: replaced with version published in Ap

Characterizing mass, momentum, energy and metal outflow rates of multi-phase galactic winds in the FIRE-2 cosmological simulations

We characterize mass, momentum, energy and metal outflow rates of multi-phase galactic winds in a suite of FIRE-2 cosmological "zoom-in" simulations from the Feedback in Realistic Environments (FIRE) project. We analyze simulations of low-mass dwarfs, intermediate-mass dwarfs, Milky Way-mass halos, and high-redshift massive halos. Consistent with previous work, we find that dwarfs eject about 100 times more gas from their interstellar medium (ISM) than they form in stars, while this mass "loading factor" drops below one in massive galaxies. Most of the mass is carried by the hot phase ($>10^5$ K) in massive halos and the warm phase ($10^3-10^5$ K) in dwarfs; cold outflows ($<10^3$ K) are negligible except in high-redshift dwarfs. Energy, momentum and metal loading factors from the ISM are of order unity in dwarfs and significantly lower in more massive halos. Hot outflows have $2-5\times$ higher specific energy than needed to escape from the gravitational potential of dwarf halos; indeed, in dwarfs, the mass, momentum, and metal outflow rates increase with radius whereas energy is roughly conserved, indicating swept up halo gas. Burst-averaged mass loading factors tend to be larger during more powerful star formation episodes and when the inner halo is not virialized, but we see effectively no trend with the dense ISM gas fraction. We discuss how our results can guide future controlled numerical experiments that aim to elucidate the key parameters governing galactic winds and the resulting associated preventative feedback.Comment: Accepted to MNRAS with minor revisions, main body is 25 pages with 14 figure

The coevolution of the velocity and mass functions of galaxies and dark haloes

We employ a bias-corrected abundance matching technique to investigate the coevolution of the LCDM dark halo mass function (HMF), the observationally derived velocity dispersion and stellar mass functions (VDF, SMF) of galaxies between z=1 and 0. We use for the first time the evolution of the VDF constrained through strong lensing statistics by Chae (2010) for galaxy-halo abundance matching studies. As a local benchmark we use a couple of z ~ 0 VDFs (a Monte-Carlo realised VDF based on SDSS DR5 and a directly measured VDF based on SDSS DR6). We then focus on connecting the VDF evolution to the HMF evolution predicted by N-body simulations and the SMF evolution constrained by galaxy surveys. On the VDF-HMF connection, we find that the local dark halo virial mass-central stellar velocity dispersion (Mvir-sigma) relation is in good agreement with the individual properties of well-studied low-redshift dark haloes, and the VDF evolution closely parallels the HMF evolution meaning little evolution in the Mvir-sigma relation. On the VDF-SMF connection, it is also likely that the stellar mass-stellar velocity dispersion (Mstar-sigma) relation evolves little taking the abundance matching results together with other independent observational results and hydrodynamic simulation results. Our results support the simple picture that as the halo grows hierarchically, the stellar mass and the central stellar velocity dispersion grow in parallel. We discuss possible implications of this parallel coevolution for galaxy formation and evolution under the LCDM paradigm.Comment: 15 pages, 12 figures, MNRAS, revised extensively after referee comment

Pattern recognition receptors as potential therapeutic targets in inflammatory rheumatic disease

The pattern recognition receptors of the innate immune system are part of the first line of defence against pathogens. However, they also have the ability to respond to danger signals that are frequently elevated during tissue damage and at sites of inflammation. Inadvertent activation of pattern recognition receptors has been proposed to contribute to the pathogenesis of many conditions including inflammatory rheumatic diseases. Prolonged inflammation most often results in pain and damage to tissues. In particular, the Toll-like receptors and nucleotide-binding oligomerisation domain-like receptors that form inflammasomes have been postulated as key contributors to the inflammation observed in rheumatoid arthritis, osteoarthritis, gout and systemic lupus erythematosus. As such, there is increasing interest in targeting these receptors for therapeutic treatment in the clinic. Here the role of pattern recognition receptors in the pathogenesis of these diseases is discussed, with an update on the development of interventions to modulate the activity of these potential therapeutic targets