2,347 research outputs found
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
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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
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