Impact of community pharmacist intervention on concurrent benzodiazepine and opioid prescribing patterns

Objectives (1) To evaluate the number of opioid/benzodiazepine (BZD) prescription changes resulting from pharmacist communication to prescriber(s); (2) to determine the number of patients on concurrent opioid/BZD therapy from single versus multiple prescribers; (3) to compare the number of opioid/BZD prescription changes resulting from communication when a single versus multiple prescribers was involved in a patient’s care; and (4) to compare the number of opioid/BZD prescription changes resulting from communication via fax versus the Kansas Health Information Network (KHIN) direct messaging feature. Methods Prospective study conducted at 13 community pharmacies, including patients 18 years of age or older simultaneously filling opioid and BZD prescriptions within 90 days before October 2017. Prescribers received faxed or KHIN communication proposing evidence-based prescription changes to opioid/BZD agents. Prescription changes were evaluated weekly for 3 months after the initial intervention. Descriptive statistics assessed demographics and the number and types of prescription changes. Spearman rho correlations compared prescription changes and number of prescriptions to number of prescribers; a priori alpha was set at 0.05. Results A total of 137 prescribers and 121 patients were included. Ninety-nine prescribers were contacted via fax and 38 via KHIN. After 4 weeks, 34 recommendations were received: 20 responses (59%) indicated rejection of recommendations, 5 (15%) approved BZD taper/discontinuation, 3 (9%) deferred changes until a patient visit, 2 (6%) approved opioid taper/discontinuation, 2 (6%) prescribed naloxone, and 2 (6%) withdrew from the patient’s care. Three months after communication, 35 prescription changes were noted: 22 (63%) opioid/BZD agent tapers/discontinuation, 14 (26%) opioid/BZD dose increases, and 2 (6%) naloxone prescriptions. There was positive correlation between the number of tapered/discontinued agents and the number of prescribers involved in a patient’s care (P = 0.046). Conclusion A faxed pharmacist intervention may help to reduce opioid/BZD coprescribing, especially when multiple providers are involved in a patient’s care

Comparison of engagement and emotional responses of older and younger adults interacting with 3D cultural heritage artefacts on personal devices

The availability of advanced software and less expensive hardware allows museums to preserve and share artefacts digitally. As a result, museums are frequently making their collections accessible online as interactive, 3D models. This could lead to the unique situation of viewing the digital artefact before the physical artefact. Experiencing artefacts digitally outside of the museum on personal devices may affect the user's ability to emotionally connect to the artefacts. This study examines how two target populations of young adults (18–21 years) and the elderly (65 years and older) responded to seeing cultural heritage artefacts in three different modalities: augmented reality on a tablet, 3D models on a laptop, and then physical artefacts. Specifically, the time spent, enjoyment, and emotional responses were analysed. Results revealed that regardless of age, the digital modalities were enjoyable and encouraged emotional responses. Seeing the physical artefacts after the digital ones did not lessen their enjoyment or emotions felt. These findings aim to provide an insight into the effectiveness of 3D artefacts viewed on personal devices and artefacts shown outside of the museum for encouraging emotional responses from older and younger people

Improving permafrost physics in the coupled Canadian Land Surface Scheme (v.3.6.2) and Canadian Terrestrial Ecosystem Model (v.2.1) (CLASS-CTEM)

The Canadian Land Surface Scheme and Canadian Terrestrial Ecosystem Model (CLASS-CTEM) together form the land surface component of the Canadian Earth System Model (CanESM). Here, we investigate the impact of changes to CLASS-CTEM that are designed to improve the simulation of permafrost physics. Overall, 18 tests were performed, including changing the model configuration (number and depth of ground layers, different soil permeable depth datasets, adding a surface moss layer), and investigating alternative parameterizations of soil hydrology, soil thermal conductivity, and snow properties. To evaluate these changes, CLASS-CTEM outputs were compared to 1570 active layer thickness (ALT) measurements from 97 observation sites that are part of the Global Terrestrial Network fo

In Solidarity

This edition of Next Page is a departure from our usual question and answer format with a featured campus reader. Instead, we asked speakers who participated in the College’s recent Student Solidarity Rally (March 1, 2017) to recommend readings that might further our understanding of the topics on which they spoke

Intravenous erythropoietin in patients with ST-segment elevation myocardial infarction - REVEAL: A randomized controlled trial

Context: Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. Objective: To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting, and Patients: A prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single dose (60 000 U of epoetin alfa) efficacy phase; the Reduction of Infarct Expansion and Ventricular Remodeling With Erythropoietin After Large Myocardial Infarction (REVEAL) trial was conducted at 28 US sites between October 2006 and February 2010, and included 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. Intervention: Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. Main Outcome Measure: Infarct size, expressed as percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging performed 2 to 6 days after study medication administration (first CMR) and again 12±2 weeks later (second CMR). Results: In the efficacy cohort, the infarct size did not differ between groups on either the first CMR scan (n=136; 15.8% LV mass [95% confidence interval {CI}, 13.3-18.2% LV mass] for the epoetin alfa group vs 15.0% LV mass [95% CI, 12.6-17.3% LV mass] for the placebo group; P=.67) or on the second CMR scan (n=124; 10.6% LV mass [95% CI, 8.4-12.8% LV mass] vs 10.4% LV mass [95% CI, 8.5-12.3% LV mass], respectively; P=.89). In a prespecified analysis of patients aged 70 years or older (n=21), the mean infarct size within the first week (first CMR) was larger in the epoetin alfa group (19.9% LV mass; 95% CI, 14.0-25.7% LV mass) than in the placebo group (11.7% LV mass; 95% CI, 7.2-16.1% LV mass) (P=.03). In the safety cohort, of the 125 patients who received epoetin alfa, the composite outcome of death, MI, stroke, or stent thrombosis occurred in 5 (4.0%; 95% CI, 1.31%-9.09%) but in none of the 97 who received placebo (P=.04). Conclusions: In patients with STEMI who had successful reperfusion with primary or rescue PCI, a single intravenous bolus of epoetin alfa within 4 hours of PCI did not reduce infarct size and was associated with higher rates of adverse cardiovascular events. Subgroup analyses raised concerns about an increase in infarct size among older patients. Trial Registration: clinicaltrials.gov Identifier: NCT00378352. ©2011 American Medical Association. All rights reserved

Modularity of plant metabolic gene clusters: a trio of linked genes that are collectively required for acylation of triterpenes in oat

Operon-like gene clusters are an emerging phenomenon in the field of plant natural products. The genes encoding some of the best-characterized plant secondary metabolite biosynthetic pathways are scattered across plant genomes. However, an increasing number of gene clusters encoding the synthesis of diverse natural products have recently been reported in plant genomes. These clusters have arisen through the neo-functionalization and relocation of existing genes within the genome, and not by horizontal gene transfer from microbes. The reasons for clustering are not yet clear, although this form of gene organization is likely to facilitate co-inheritance and co-regulation. Oats (Avena spp) synthesize antimicrobial triterpenoids (avenacins) that provide protection against disease. The synthesis of these compounds is encoded by a gene cluster. Here we show that a module of three adjacent genes within the wider biosynthetic gene cluster is required for avenacin acylation. Through the characterization of these genes and their encoded proteins we present a model of the subcellular organization of triterpenoid biosynthesis

Cleaning verification by air/water impingement

This paper will discuss how the Kennedy Space Center intends to perform precision cleaning verification by Air/Water Impingement in lieu of chlorofluorocarbon-113 gravimetric nonvolatile residue analysis (NVR). Test results will be given that demonstrate the effectiveness of the Air/Water system. A brief discussion of the Total Carbon method via the use of a high temperature combustion analyzer will also be given. The necessary equipment for impingement will be shown along with other possible applications of this technology

A Sweeping Jet Application on a High Reynolds Number Semispan Supercritical Wing Configuration

The FAST-MAC circulation control model was modified to test an array of unsteady sweeping-jet actuators at realistic flight Reynolds numbers in the National Transonic Facility at the NASA Langley Research Center. Two types of sweeping jet actuators were fabricated using rapid prototype techniques, and directed over a 15% chord simple-hinged flap. The model was configured for low-speed high-lift testing with flap deflections of 30 and 60, and a transonic cruise configuration with a 0 flap deflection. For the 30 flap high-lift configuration, the sweeping jets achieved comparable lift performance in the separation control regime, while reducing the mass flow by 54% as compared to steady blowing. However, the sweeping jets were not effective for the 60 flap. For the transonic cruise configuration, the sweeping jets reduced the drag by 3.3% at an off design condition. The drag reduction for the design lift coefficient for the sweeping jets provided only half the drag reduction shown for the steady blowing case (6.5%), but accomplished this with a 74% reduction in mass flow

A Sweeping Jet Application on a High Reynolds Number Semispan Supercritical Wing Configuration

The FAST-MAC circulation control model was modified to test an array of unsteady sweeping-jet actuators at realistic flight Reynolds numbers in the National Transonic Facility at the NASA Langley Research Center. Two types of sweeping jet actuators were fabricated using rapid prototype techniques, and directed over a 15% chord simple-hinged flap. The model was configured for low-speed high-lift testing with flap deflections of 30 deg and 60 deg, and a transonic cruise configuration having a 0 deg flap deflection. For the 30 deg flap high-lift configuration, the sweeping jets achieved comparable lift performance in the separation control regime, while reducing the mass flow by 54% as compared to steady blowing. The sweeping jets however were not effective for the 60 deg flap. For the transonic cruise configuration, the sweeping jets reduced the drag by 3.3% at an off-design condition. The drag reduction for the design lift coefficient for the sweeping jets offer is only half the drag reduction shown for the steady blowing case (6.5%), but accomplished this with a 74% reduction in mass flow

An overview of ADSL Homed Nepenthes Honeypots In Western Australia

This paper outlines initial analysis from research in progress into ADSL homed Nepenthes honeypots. One of the Nepenthes honeypots prime objective in this research was the collection of malware for analysis and dissection. A further objective is the analysis of risks that are circulating within ISP networks in Western Australian. What differentiates Nepenthes from many traditional honeypot designs it that is has been engineered from a distributed network philosophy. The program allows distribution of results across a network of sensors and subsequent aggregation of malware statistics readily within a large network environment