Community Pharmacists' Contribution to Medication Reviews for Older Adults : A Systematic Review

ObjectivesTo identify medication review interventions for older adults that involve community pharmacists and evidence of outcomes of these interventions. DesignSystematic review. MeasurementsCinahl, MEDLINE (Ovid), Scopus, International Pharmaceutical Abstracts, and Cochrane Library were searched for articles published between January 2000 and February 2016. Articles involving community pharmacists in medication reviews for outpatients aged 65 and older were included. Evidence of economic, clinical, and humanistic outcomes of interventions was summarized. ResultsSixteen articles were found that described 12 medication review interventions, of which 6 were compliance and concordance reviews, 4 were clinical medication reviews, and 2 were prescription reviews according to a previously developed typology. Community pharmacists' contributions to reviewing medications varied from sending the dispensing history to other healthcare providers to comprehensive involvement in medication management. The most commonly assessed outcomes of the interventions were medication changes leading to reduction in actual or potential drug-related problems (n=12) and improved adherence (n=5). ConclusionRegardless of community pharmacists' contributions to interventions, medication review interventions seem to reduce drug-related problems and increase medication adherence. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacists' contributions to reviewing medications and improving the health of older adults.Peer reviewe

Essee teknillisen mekaniikan tutkimuksen eettisistä kysymyksistä ja haasteista

Tiivistelmä Artikkeli on koostettu kolmesta kurssin 920002J, Tieteellinen tutkimus ja etiikka, kevään 19.03.–10.04.2018 esseestä, jotka käsittelevät tutkimuksen eettisiä kysymyksiä ja haasteita. Teknillisen mekaniikan alalla tieteen etiikasta keskustellaan aivan liian vähän, ja tämän artikkelin tarkoituksena on toimia keskustelun avaajana toivottavasti samalla tuoden myös uusia näkökulmia aiheeseen. Osa näistä eettisistä asioista on Suomessa syntyneelle, eläneelle ja suomalaisen arvomaailman omaavalle henkilölle itsestäänselvyyksiä

Benchmarking of two flexible multibody dynamic simulation software in engine simulations

Summary In this paper, two different commercial multibody dynamic (MBD) simulation software cases are studied. Due to the restrictions determined in the conditions of contract, the names of the software are not revealed, instead being called Software S and Software E. The central purpose of this research was to investigate the abilities of Software S in the simulation of a large engine, as a part of the strength analysis process. The abilities were studied by comparing the program with another, here called Software E, which is designed primarily for engine simulations. The capabilities of Software E have been proven after years of usage at Wärtsilä, resulting in its essential role in the strength analysis process today. The aim was to find the shortcomings and restrictions of Software S but also advantages it could bring to the strength analysis process for Wärtsilä. Similar simulation models were also built using both programs during this research. A 16-cylinder V-engine was selected as the subject because of its size in order to obtain further information about the behavior of the program when working with extensive model files. The components of the engine were flexible and were reduced FE models, also called super elements. The forces and contact situations that occur inside the engine were modeled using elements provided by the MBD programs. Different levels of detail of the modeling elements were used to obtain information about the flexibility of the program. The results obtained from time integrations were compared to ensure the similarity of both modeling elements used. Also, this paper reports the calculation times. In addition, a small-scale study was performed for Software S to clarify the effect of the modes used in time integrations towards results accuracy and calculation times. Simulation models were built successfully in both programs, and the results obtained correlated with each other on an adequate level. Significant differences appeared in the features and usability of the programs in general. The GUI of Software S is advanced and user-friendly, whereas Software E is not focused on these features. On the other hand, the modeling element library of Software E covers all of the required features related to large engine simulations, some of which Software S is lacking. This work can be used in assistance when considering buying new software for a company as well as when investigating new development areas that could be improved with new software

Stable and unstable friction in fretting contacts

Abstract Designing contacts susceptible to fretting is a challenging task due to uncertainties related to friction. For example, coefficient of friction has shown to vary as a function of load cycles and so-called non-Coulomb friction can exist during individual load cycles. Concepts of stable and unstable friction are presented in this manuscript. Based on experiments, no fretting is to be expected if the utilization of friction is kept below unstable friction threshold. If contact is subjected to tangential load above this threshold, reciprocating slippage, fretting, is to be expected even if the contact was initially in stick. Experimental evidence for existence of such threshold is presented in form of friction data, slip data and fretting scars

FEM-based wear simulation for fretting contacts

Abstract This article presents a robust Finite-Element-Method-based wear simulation method, particularly suitable for fretting contacts. This method utilizes the contact subroutine in a commercial finite element solver Abaqus. It is based on a user-defined contact formulation for both normal and tangential directions. For the normal contact direction, a nodal gap field is calculated by using a simple Archard's wear equation to describe the depth of material removal due to wear. The wear field is included in the contact pressure calculation to allow simulation of wear and contact stress evolution during the loading cycles. The main advantage of this approach is that all contact variables are accessible inside the routine, which allows full coupling between normal and tangential contact variables. Also, there is no need for mesh modifications during the solution. This makes the implementation flexible, robust and particularly suitable for fretting cases where friction and tangential contact stiffness play an essential role. The method is applied to the bolted joint type fretting test case. The methodology is also fully applicable to complex real component simulations

Finite element method modeling of crankshaft axial impact measurements

Abstract It has been recently discovered that there is a periodical axial impact phenomenon in a running engine crankshaft. Bending of the shaft causes significant extension of the crankshaft and impact to the engine block through the axial thrust bearing. The aim of this work is to study impact-induced energy fluctuations in a complex-shaped Wärtsilä sixteen vee 32 engine crankshaft by using an explicit finite element method (FEM) during the first 25 ms after impact. Using the FEM allows us to study real components used in industry, and analyze their dynamics in the transient phase. In conclusion, we found interesting results that can be used as guidelines for a full-scale crankshaft measurement instrumentation plan. The full-scale measurements will be performed later in the Wärtsilä Oy facility at Vaasa, Finland. The main finding is that a substantive amount of energy is trapped in the head region and the first two crank pins of the crankshaft, which can affect crankshaft durability regarding high-cycle fatigue

Micromechanical modeling of short crack nucleation and growth in high cycle fatigue of martensitic microstructures

Abstract High cycle fatigue (HCF) is a frequently limiting failure mechanism of machine elements and modern high strength steels. Present day design rules rely on semi-empirical methods, guidelines and utilization of macroscopic analysis means in origin, such as fracture mechanics. The resulting challenge is that short crack regime, critical for HCF in terms of lifetime of components and products, is somewhat poorly handled. This is an outcome of the fact that the present means and methodologies do not explicitly account for effects arising from material microstructure, an oversight micromechanics aims to rectify. Micromechanical modeling operating on fatigue at the scale of material microstructure necessitates the introduction of suitable means to describe the mechanisms of cyclic plastic deformation and microstructural morphologies, considered critical for HCF especially at the early stages of micro-crack nucleation and damage evolution towards and within the short crack regime. In current work, a crystal plasticity based approach with combined hardening is utilized to capture the respective deformation response utilizing full field modeling. The modeling is carried out for both simplified prior austenite grain like microstructures as well as complex imaging based martensitic quenched and tempered steel microstructural models. A fully coupled damage modeling scheme is introduced to track damage nucleation and evolution at the scale of the studied microstructures. Crack closure is included within the approach to track behavior of microstructure scale defects under, e.g., fully reversed loading, more realistically. Model calibration is addressed and application cases involving damage and crack growth both under monotonic and cyclic loading are presented. The results demonstrate how the coupling of damage to crystal plasticity modeling can be utilized to identify and track the evolution of microstructure scale damage mechanisms in complex martensitic microstructures. Interactions between strain localization and damage accumulation are presented as well as transition from micro-cracking to short crack growth. The results show that the proposed approach can interpret the intricate dependencies and relations between complex microstructures, their (cyclic) deformation mechanisms and evolution of damage, the outcomes regarding crack formation and behavior are found to be in line with similar experimental studies. The proposed framework for modeling damage in polycrystalline microstructures is quite general in its capabilities. By solely introducing a suitable crystal plasticity based deformation model and a damage model describing nucleation and softening can plastic slip and damage interactions be studied in complex microstructures, and in principle, on any system where similar constitutive models are utilizable. The exploitation of the resulting micromechanical modeling and simulation capabilities lies both in simulation driven design of fatigue resistant components and high strength steels

Running-in in fretting, transition from near-stable friction regime to gross sliding

Abstract It has been shown that quenched and tempered steel in gross-sliding fretting conditions, with tens of microns of slip amplitude, leads to fretting induced cracking and high and non-Coulomb friction. At low tangential load levels, there was only insignificant cracking. However, the running condition tends to change from stick to gross-sliding with a slip amplitude of a few micrometres. In this study, novel two-phase fretting experiments were done where quenched and tempered steel contact is run first at low loads that are initially in stick (running-in phase), followed by a gross-sliding phase with a slip amplitude of 35 μm. The results show that gross-sliding phase friction was reduced and the fretting induced cracks were shorter when the running-in phase was done at high enough load level and lasted more than 10⁶ load cycles. At the highest running-in load levels, the resulting crack lengths were approximately halved in comparison to experiments without running-in, and it was possible to achieve nearly ideal Coulomb friction in the gross-sliding phase when the running-in duration was 10.2 × 10⁶ load cycles. It is concluded that it is possible to control fretting-induced friction and cracking by carefully controlled running-in

Avoiding the high friction peak in fretting contact

Abstract Fretting fatigue and wear may exist if two parts have small amplitude relative rubbing between the contacting surfaces. A peak in the coefficient of friction typically occurs during the first thousands of loading cycles in dry fretting contact with quenched and tempered steel. This peak is related to adhesive friction and wear causing non-Coulomb friction and high local contact stresses possibly leading to cracking. The focus of the study is the effect of different experimental methods on the frictional behavior of the fretting contact between the steel surfaces. The use of pre-corroded specimens and contact lubrication delayed and reduced the initial peak. However, a pre-added third body layer removed the peak completely

Micromechanical modeling of the role of Inclusions in high cycle fatigue damage Initiation and short crack growth

Abstract Multiscale microstructural and micromechanical modeling has arisen as a candidate to improve upon the classical methodologies for evaluation of fatigue crack initiation and propagation, both concerning improving our understanding of the fundamental material deformation and damage processes as well as in establishing more accurate design rules for engineering purposes. By exploiting methodologies of multiscale materials modeling, the vision is that engineering material properties can be directly computed based on microstructural scale analysis of single crystal plasticity and damage evolution. The models can then be further used to simulate the various dependencies affiliated with fatigue damage arising from material microstructure, such as the effects of stress triaxiality, compressive loading, and overall complex stress states. The overall goal of these efforts is the general decrease in empiricism, inaccuracy and affiliated uncertainty in the fatigue modeling and design chain. Current work utilizes novel crystal plasticity coupled damage model to evaluate the inclusion of steel microstructure interactions with the objective of better understanding and quantifying the role inclusions play concerning nucleation and growth of microstructure scale fatigue cracks. The approach is microstructural, i.e., material characteristics such as microstructural morphologies, individual phases, and inclusions are included explicitly in the numerical finite element models, and the subsequent behavior concerns single crystal deformation and initiation of fatigue. The analysis uses a micromechanical model where crystal plasticity and damage directly couple. A case study is carried out for primarily martensitic quenched and tempered steel for machine construction. The results suggest potential ways of exploiting multiscale materials modeling in the design of fatigue resistant microstructures, optimization of material solutions and improved fatigue design of products and components