An Evaluation of Managing and Educating Patients on the Risk of Glucocorticoid-Induced Osteoporosis

AbstractObjectiveTo assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis.MethodsNinety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre–post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet.ResultsThe contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [−6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant.ConclusionsCommunity pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients

Teleology and Realism in Leibniz's Philosophy of Science

This paper argues for an interpretation of Leibniz’s claim that physics requires both mechanical and teleological principles as a view regarding the interpretation of physical theories. Granting that Leibniz’s fundamental ontology remains non-physical, or mentalistic, it argues that teleological principles nevertheless ground a realist commitment about mechanical descriptions of phenomena. The empirical results of the new sciences, according to Leibniz, have genuine truth conditions: there is a fact of the matter about the regularities observed in experience. Taking this stance, however, requires bringing non-empirical reasons to bear upon mechanical causal claims. This paper first evaluates extant interpretations of Leibniz’s thesis that there are two realms in physics as describing parallel, self-sufficient sets of laws. It then examines Leibniz’s use of teleological principles to interpret scientific results in the context of his interventions in debates in seventeenth-century kinematic theory, and in the teaching of Copernicanism. Leibniz’s use of the principle of continuity and the principle of simplicity, for instance, reveal an underlying commitment to the truth-aptness, or approximate truth-aptness, of the new natural sciences. The paper concludes with a brief remark on the relation between metaphysics, theology, and physics in Leibniz

Mutation analysis of HIF prolyl hydroxylases (PHD/EGLN) in individuals with features of phaeochromocytoma and renal cell carcinoma susceptibility

Germline mutations in the von Hippel–Lindau disease (VHL) and succinate dehydrogenase subunit B (SDHB) genes can cause inherited phaeochromocytoma and/or renal cell carcinoma(RCC). Dysregulation of the hypoxia-inducible factor (HIF) transcription factors has been linked to VHL and SDHB-related RCC; both HIF dysregulation and disordered function of a prolyl hydroxylase domain isoform 3 (PHD3/EGLN3)-related pathway of neuronal apoptosis have been linked to the development of phaeochromocytoma. The 2-oxoglutarate-dependent prolyl hydroxylase enzymes PHD1 (EGLN2), PHD2 (EGLN1) and PHD3 (EGLN3) have a key role in regulating the stability of HIF-a subunits (and hence expression of the HIF-a transcription factors). A germline PHD2 mutation has been reported in association with congenital erythrocytosis and recurrent extra-adrenal phaeochromocytoma. We undertook mutation analysis of PHD1, PHD2 and PHD3 in two cohorts of patients with features of inherited phaeochromocytoma (nZ82) and inherited RCC (nZ64) and no evidence of germline mutations in known susceptibility genes. No confirmed pathogenic mutations were detected suggesting that mutations in these genes are not a frequent cause of inherited phaeochromocytoma or RCC

Studies of MCP-PMTs in the miniTimeCube neutrino detector

This report highlights two different types of cross-talk in the photodetectors of the miniTimeCube neutrino experiment. The miniTimeCube detector has 24 $8 \times 8$-anode Photonis MCP-PMTs Planacon XP85012, totalling 1536 individual pixels viewing the 2-liter cube of plastic scintillator

Perspective taking as virtual navigation? Perceptual simulation of what others see reflects their location in space but not their gaze

Other peoples' (imagined) visual perspectives are represented perceptually in a similar way to our own, and can drive bottom-up processes in the same way as own perceptual input (Ward, Ganis, & Bach, 2019). Here we test directly whether visual perspective taking is driven by where another person is looking, or whether these perceptual simulations represent their position in space more generally. Across two experiments, we asked participants to identify whether alphanumeric characters, presented at one of eight possible orientations away from upright, were presented normally, or in their mirror-inverted form (e.g. “R” vs. “Я”). In some scenes, a person would appear sitting to the left or the right of the participant. We manipulated either between-trials (Experiment 1) or between-subjects (Experiment 2), the gaze-direction of the inserted person, such that they either (1) looked towards the to-be-judged item, (2) averted their gaze away from the participant, or (3) gazed out towards the participant (Exp. 2 only). In the absence of another person, we replicated the well-established mental rotation effect, where recognition of items becomes slower the more items are oriented away from upright (e.g. Shepard and Meltzer, 1971). Crucially, in both experiments and in all conditions, this response pattern changed when another person was inserted into the scene. People spontaneously took the perspective of the other person and made faster judgements about the presented items in their presence if the characters were oriented towards upright to them. The gaze direction of this other person did not influence these effects. We propose that visual perspective taking is therefore a general spatial-navigational ability, allowing us to calculate more easily how a scene would (in principle) look from another position in space, and that such calculations reflect the spatial location of another person, but not their gaze

Antineutrino Geophysics with Liquid Scintillator Detectors

Detecting the antineutrinos emitted by the decay of radioactive elements in the mantle and crust could provide a direct measurement of the total abundance of uranium and thorium in the Earth. In calculating the antineutrino flux at specific sites, the local geology of the crust and the background from the world's nuclear power reactors are important considerations. Employing a global crustal map, with type and thickness data, and using recent estimates of the uranium and thorium distribution in the Earth, we calculate the antineutrino event rate for two new neutrino detectors. We show that spectral features allow terrestrial antineutrino events to be identified above reactor antineutrino backgrounds and that the uranium and thorium contributions can be separately determined.Comment: Published paper differs from original submitted preprint because reviewers suggested updated continental crust U/Th abundances. Kamioka geographical location error was in preprint, partially corrected in published version. This version is the same as the published paper, with Kamioka fully corrected. Because of recent interest in this topic, this version is being made available, despite this work being 8 years ol

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing

BACKGROUND: Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. METHODS: The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. RESULTS: Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. CONCLUSIONS: For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits

Leibniz, Acosmism, and Incompossibility

Leibniz claims that God acts in the best possible way, and that this includes creating exactly one world. But worlds are aggregates, and aggregates have a low degree of reality or metaphysical perfection, perhaps none at all. This is Leibniz’s tendency toward acosmism, or the view that there this no such thing as creation-as-a-whole. Many interpreters reconcile Leibniz’s acosmist tendency with the high value of worlds by proposing that God sums the value of each substance created, so that the best world is just the world with the most substances. I call this way of determining the value of a world the Additive Theory of Value (ATV), and argue that it leads to the current and insoluble form of the problem of incompossibility. To avoid the problem, I read “possible worlds” in “God chooses the best of all possible worlds” as referring to God’s ideas of worlds. These ideas, though built up from essences, are themselves unities and so well suited to be the value bearers that Leibniz’s theodicy requires. They have their own value, thanks to their unity, and that unity is not preserved when more essences are added