Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016

BACKGROUND: While naloxone, the overdose reversal medication, has been available for decades, factors associated with its availability through pharmacies remain unclear. Studies suggest that policy and pharmacist beliefs may impact availability. Indiana passed a standing order law for naloxone in 2015 to increase access to naloxone. OBJECTIVE: To identify factors associated with community pharmacy naloxone stocking and dispensing following the enactment of a statewide naloxone standing order. METHODS: A 2016 cross-sectional census of Indiana community pharmacists was conducted following a naloxone standing order. Community, pharmacy, and pharmacist characteristics, and pharmacist attitudes about naloxone dispensing, access, and perceptions of the standing order were measured. Modified Poisson and binary logistic regression models attempted to predict naloxone stocking and dispensing, respectively. RESULTS: Over half (58.1%) of pharmacies stocked naloxone, yet 23.6% of pharmacists dispensed it. Most (72.5%) pharmacists believed the standing order would increase naloxone stocking, and 66.5% believed it would increase dispensing. Chain pharmacies were 3.2 times as likely to stock naloxone. Naloxone stocking was 1.6 times as likely in pharmacies with more than one full-time pharmacist. Pharmacies where pharmacists received naloxone continuing education in the past two years were 1.3 times as likely to stock naloxone. The attempted dispensing model yielded no improvement over the constant-only model. CONCLUSIONS: Pharmacies with larger capacity took advantage of the naloxone standing order. Predictors of pharmacist naloxone dispensing should continue to be explored to maximize naloxone access

Shot noise in superconducting junctions with weak link formed by Anderson impurity

A theory is developed to study shot noise in superconducting (SAS) and hybrid (SAN) junctions with singly occupied Anderson impurity (A) as a weak link. The zero-frequency DC component of the shot noise spectral density is calculated at zero temperature as a function of the bias at different Coulomb repulsion strengths U, and show a remarkable structure resulting from combination of electron-electron interaction and Andreev reflections.Comment: 4 two column pages including 4 .eps figure

The potential impact of Ocean Thermal Energy Conversion (OTEC) on fisheries

The commercial development of ocean thermal energy conversion (OTEC) operations will involve some environmental perturbations for which there is no precedent experience. The pumping of very large volumes of warm surface water and cold deep water and its subsequent discharge will result in the impingement, entrainment, and redistribution of biota. Additional stresses to biota will be caused by biocide usage and temperature depressions. However, the artificial upwelling of nutrients associated with the pumping of cold deep water, and the artificial reef created by an OTEC plant may have positive effects on the local environment. Although more detailed information is needed to assess the net effect of an OTEC operation on fisheries, certain assumptions and calculations are made supporting the conclusion that the potential risk to fisheries is not significant enough to deter the early development of IDEe. It will be necessary to monitor a commercial-scale plant in order to remove many of the remaining uncertainties. (PDF file contains 39 pages.

Multiple Andreev Reflection and Giant Excess Noise in Diffusive Superconductor/Normal-Metal/Superconductor Junctions

We have studied superconductor/normal metal/superconductor (SNS) junctions consisting of short Au or Cu wires between Nb or Al banks. The Nb based junctions display inherent electron heating effects induced by the high thermal resistance of the NS boundaries. The Al based junctions show in addition subharmonic gap structures in the differential conductance dI/dV and a pronounced peak in the excess noise at very low voltages V. We suggest that the noise peak is caused by fluctuations of the supercurrent at the onset of Josephson coupling between the superconducting banks. At intermediate temperatures where the supercurrent is suppressed a noise contribution ~1/V remains, which may be interpreted as shot noise originating from large multiple charges.Comment: 7 pages, 7 figures, extended versio

Full Current Statistics in Diffusive Normal-Superconductor Structures

We study the current statistics in normal diffusive conductors in contact with a superconductor. Using an extension of the Keldysh Green's function method we are able to find the full distribution of charge transfers for all temperatures and voltages. For the non-Gaussian regime, we show that the equilibrium current fluctuations are enhanced by the presence of the superconductor. We predict an enhancement of the nonequilibrium current noise for temperatures below and voltages of the order of the Thouless energy E_Th=D/L^2. Our calculation fully accounts for the proximity effect in the normal metal and agrees with experimental data. We demonstrate that the calculation of the full current statistics is in fact simpler than a concrete calculation of the noise.Comment: 4 pages, 2 figures (included

Subgap anomaly and above-energy-gap structure in chains of diffusive SNS junctions

We present the results of low-temperature transport measurements on chains of superconductor--normal-constriction--superconductor (SNS) junctions fabricated on the basis of superconducting PtSi film. A comparative study of the properties of the chains, consisting of 3 and 20 SNS junctions in series, and single SNS junctions reveals essential distinctions in the behavior of the current-voltage characteristics of the systems: (i) the gradual decrease of the effective suppression voltage for the excess conductivity observed at zero bias as the quantity of the SNS junctions increases, (ii) a rich fine structure on the dependences dV/dI-V at dc bias voltages higher than the superconducting gap and corresponding to some multiples of 2\Delta/e. A model to explain this above-energy-gap structure based on energy relaxation of electron via Cooper-pair-breaking in superconducting island connecting normal metal electrods is proposed.Comment: RevTex, 5 pages, 4 figure

Reduction in Recurrent Cardiovascular Events with Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes from the TRITON-TIMI 38 Trial

Aims: In the TRITON-TIMI 38 trial, greater platelet inhibition with prasugrel reduced the first occurrence of the primary endpoint (cardiovascular death, MI, or stroke) compared with clopidogrel in patients with an acute coronary syndrome (ACS) undergoing planned percutaneous coronary intervention. We hypothesized that prasugrel would reduce not only first events but also recurrent primary endpoint events and therefore total events compared with clopidogrel. Methods and results: Poisson regression analysis was performed to compare the number of occurrences of the primary endpoint between prasugrel and clopidogrel in TRITON-TIMI 38. Landmark analytic methods were used to evaluate the risk of a recurrent primary endpoint event following an initial non-fatal endpoint event. Among patients with an initial non-fatal event, second events were significantly reduced with prasugrel compared to clopidogrel (10.8 vs. 15.4%, HR 0.65, 95% CI 0.46–0.92; P = 0.016), as was CV death following the non-fatal event (3.7 vs. 7.1%, HR 0.46, 95% CI 0.25–0.82; P = 0.008). Overall there was a reduction of 195 total primary efficacy events with prasugrel vs. clopidogrel (rate ratio 0.79, 95% CI 0.71–0.87; P < 0.001). Recurrent bleeding events occurred infrequently (TIMI major non-CABG bleeds: four with prasugrel and two with clopidogrel). Study drug discontinuation was frequent following the initial major bleeding event (42% of patients discontinued study drug). Conclusion: While standard statistical analytic techniques for clinical trials censor patients who experience a component of the primary composite endpoint, total cardiovascular events remain important to both patients and clinicians. Prasugrel, a more potent anti-platelet agent, reduced both first and subsequent cardiovascular events compared with clopidogrel in patients with ACS

Two-dimensional array of diffusive SNS junctions with high-transparent interfaces

We report the first comparative study of the properties of two-dimensional arrays and single superconducting film - normal wire - superconducting film (SNS) junctions. The NS interfaces of our SNS junctions are really high transparent, for superconducting and normal metal parts are made from the same material (superconducting polycrystalline PtSi film). We have found that the two-dimensional arrays reveal some novel features: (i) the significant narrowing of the zero bias anomaly (ZBA) in comparison with single SNS junctions, (ii) the appearance of subharmonic energy gap structure (SGS), with up to n=16 (eV=\pm 2\Delta/n), with some numbers being lost, (iii) the transition from 2D logarithmic weak localization behavior to metallic one. Our experiments show that coherent phenomena governed by the Andreev reflection are not only maintained over the macroscopic scale but manifest novel pronounced effects as well. The behavior of the ZBA and SGS in 2D array of SNS junctions strongly suggests that the development of a novel theoretical approach is needed which would self-consistently take into account the distribution of the currents, the potentials, and the superconducting order parameter.Comment: RevTex, 5 pages, 5 figure

Reference standardization and triglyceride interference of a new homogeneous HDL-cholesterol assay compared with a former chemical precipitation assay

A homogeneous HDL-c assay (HDL-H), which uses polyethylene glycol-modified enzymes and sulfated alpha-cyclodextrin, was assessed for precision, accuracy, and cholesterol and triglyceride interference. In addition, its analytical performance was compared with that of a phosphotungstic acid (PTA)/MgCl2 precipitation method (HDL-P). Within-run CVs were < or = 1.87%; total CVs were < or = 3.08%. Accuracy was evaluated in fresh normotriglyceridemic sera using the Designated Comparison Method (HDL-H = 1.037 Designated Comparison Method + 4 mg/L; n = 63) and in moderately hypertriglyceridemic sera by using the Reference Method (HDL-H = 1.068 Reference Method - 17 mg/L; n = 41). Mean biases were 4.5% and 2.2%, respectively. In hypertriglyceridemic sera (n = 85), HDL-H concentrations were increasingly positively biased with increasing triglyceride concentrations. The method comparison between HDL-H and HDL-P yielded the following equation: HDL-H = 1.037 HDL-P + 15 mg/L; n = 478. We conclude that HDL-H amply meets the 1998 NCEP recommendations for total error; its precision is superior compared with that of HDL-P, and its average bias remains below +/-5% as long as triglyceride concentrations are < or = 10 g/L and in case of moderate hypercholesterolemia