Comprehensive Medication Management: Implications for the Patient and Pharmacist

Since 1979, state pharmacy practice laws have begun to allow pharmacists to provide advanced levels of care in collaboration with prescribers. These might be termed medication therapy management, collaborative practice, comprehensive medication management and other variations. Invariably, pharmacists working closely with prescribers and patients in care of chronic disease have achieved dramatic results including improvement in surrogate markers, decreased rates of secondary large organ disease, decreased mortality, decreased hospitalizations, and as a result decreased spending.1-28 This paper will discuss the profound impact of advanced practice models on patient care and the health care system, the current status of New York’s collaborative drug therapy management law, the comprehensive medication management proposal in Governor Cuomo’s fiscal year 2018 Budget bill, and its potential impact on morbidity and mortality when applied to chronic disease

On-stack replacement, distilled

On-stack replacement (OSR) is essential technology for adaptive optimization, allowing changes to code actively executing in a managed runtime. The engineering aspects of OSR are well-known among VM architects, with several implementations available to date. However, OSR is yet to be explored as a general means to transfer execution between related program versions, which can pave the road to unprecedented applications that stretch beyond VMs. We aim at filling this gap with a constructive and provably correct OSR framework, allowing a class of general-purpose transformation functions to yield a special-purpose replacement. We describe and evaluate an implementation of our technique in LLVM. As a novel application of OSR, we present a feasibility study on debugging of optimized code, showing how our techniques can be used to fix variables holding incorrect values at breakpoints due to optimizations

Multi-site Integrated Optical Addressing of Trapped Ions

One of the most effective ways to advance the performance of quantum computers and quantum sensors is to increase the number of qubits or quantum resources used by the system. A major technical challenge that must be solved to realize this goal for trapped-ion systems is scaling the delivery of optical signals to many individual ions. In this paper we demonstrate an approach employing waveguides and multi-mode interferometer splitters to optically address multiple $^{171}\textrm{Yb}^+$ ions in a surface trap by delivering all wavelengths required for full qubit control. Measurements of hyperfine spectroscopy and Rabi flopping were performed on the E2 clock transition, using integrated waveguides for delivering the light needed for Doppler cooling, state preparation, coherent operations, and detection. We describe the use of splitters to address multiple ions using a single optical input per wavelength and use them to demonstrate simultaneous Rabi flopping on two different transitions occurring at distinct trap sites. This work represents an important step towards the realization of scalable integrated photonics for atomic clocks and trapped-ion quantum information systems.Comment: 7 pages, 4 figures (+2 supplementary figures

We Are History: The Outlines of a Quasi-Substantive Philosophy of History

In times of a felt need to justify the value of the humanities, the need to revisit and re-establish the public relevance of the discipline of history cannot come as a surprise. On the following pages I will argue that this need is unappeasable by scholarly proposals. The much desired revitalization of historical writing lies instead in reconciling ourselves with the dual meaning of the word history, in exploring the necessary interconnection between history understood as the course of events and as historical writing. Despite the general tendency of the last decades to forbid philosophizing about history in the former sense (at least in departments of history and philosophy), I think that to a certain extent we already do so without succumbing to substantive thought. We already have the sprouts of a speculative although only quasi-substantive philosophy of history that nevertheless takes seriously the postwar criticism of the substantive enterprise. In this essay I will first try to outline this quasi-substantive philosophy of history that attests to the historical sensibility of our times; and second, I will try to outline its consequences regarding history as historical writing. Finally, in place of a conclusion I will suggest that historical writing is not as much a contribution to public agendas as it is the very arena in which public life is at stake

Viral load is strongly associated with length of stay in adults hospitalised with viral acute respiratory illness

Background: respiratory viruses are detectable in a large proportion of adults hospitalised with acute respiratory illness. For influenza and other viruses there is evidence that viral load and persistence are associated with certain clinical outcomes but it is not known if there is an association between viral load and hospital length of stay. Methods: 306 adults hospitalised with viral acute respiratory illness were studied. Associations between viral load and length of stay were examined. Multiple linear regression analysis was performed to control for age, comorbidity, influenza vaccine status, duration of illness prior to hospitalisation, bacterial co-infection, clinical group and virus subtype.Results: high viral load was associated with a longer duration of hospitalisation for all patients (p &lt;0.0001). This remained significant across all virus types and clinical groups and when adjusted for age, comorbidity, duration of illness prior to hospitalisation, bacterial co-infection and other factors. Conclusions: high viral loads are associated with prolonged hospital length of stay in adults with viral acute respiratory illness. This further supports existing evidence demonstrating that viral acute respiratory illness is a viral load driven process and suggests that viral load could be used in clinical practise to predict prolonged hospitalisation and prioritise antivirals. International Standard Randomised Controlled Trial Number (ISRCTN): 21521552<br/

The environmental deposition of influenza virus from patients infected with influenza A(H1N1)pdm09: implications for infection prevention and control

In a multi-center, prospective, observational study over two influenza seasons, we sought to quantify and correlate the amount of virus recovered from the nares of infected subjects with that recovered from their immediate environment in community and hospital settings. We recorded the symptoms of adults and children with A(H1N1)pdm09 infection, took nasal swabs, and sampled touched surfaces and room air. Forty-two infected subjects were followed up. The mean duration of virus shedding was 6.2 days by PCR (Polymerase Chain Reaction) and 4.2 days by culture. Surface swabs were collected from 39 settings; 16 (41%) subject locations were contaminated with virus. Overall, 33 of the 671 (4.9%) surface swabs were PCR positive for influenza, of which two (0.3%) yielded viable virus. On illness Day 3, subjects yielding positive surface samples had significantly higher nasal viral loads (geometric mean ratio 25.7; 95% CI 1.75, 376.0, p=0.021) and a positive correlation (r=0.47, p=0.006) was observed between subject nasal viral loads and viral loads recovered from the surfaces around them. Room air was sampled in the vicinity of 12 subjects, and PCR positive samples were obtained for five (42%) samples. Influenza virus shed by infected subjects did not detectably contaminate the vast majority of surfaces sampled. We question the relative importance of the indirect contact transmission of influenza via surfaces, though our data support the existence of super-spreaders via this route. The air sampling results add to the accumulating evidence that supports the potential for droplet nuclei (aerosol) transmission of influenza

The Evolution of Compact Binary Star Systems

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars -- compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.Comment: 105 pages, 18 figure

Measuring the dynamic mechanical response of hydrated mouse bone by nanoindentation

This study demonstrates a novel approach to characterizing hydrated bone's viscoelastic behavior at lamellar length scales using dynamic indentation techniques. We studied the submicron-level viscoelastic response of bone tissue from two different inbred mouse strains, A/J and B6, with known differences in whole bone and tissue-level mechanical properties. Our results show that bone having a higher collagen content or a lower mineral-to-matrix ratio demonstrates a trend towards a larger viscoelastic response. When normalized for anatomical location relative to biological growth patterns in the antero-medial (AM) cortex, bone tissue from B6 femora, known to have a lower mineral-to-matrix ratio, is shown to exhibit a significantly higher viscoelastic response compared to A/J tissue. Newer bone regions with a higher collagen content (closer to the endosteal edge of the AM cortex) showed a trend towards a larger viscoelastic response. Our study demonstrates the feasibility of this technique for analyzing local composition-property relationships in bone. Further, this technique of viscoelastic nanoindentation mapping of the bone surface at these submicron length scales is shown to be highly advantageous in studying subsurface features, such as porosity, of wet hydrated biological specimens, which are difficult to identify using other methods