Mission Possible: Improving the Lives of All Older Adults in Marin

In 2012, Marin County's Division of Aging and Adult Services conducted a needs assessment that provided a detailed account of the demographics, economic security, health, housing, status of caregiving, and quality of life for the county's older adult population. This report also revealed that people's own assessment of their health was less positive among Hispanic/Latino and African American older adults compared to their white counterparts. The survey findings were supplemented by conducting community forums among specific groups (i.e., AfricanAmerican, Latino/Hispanic, family caregivers, low-income persons, and residents in rural areas) to gain insight into service needs and service barriers.These findings reinforce the results of a 2008 assessment in which nearly half of the Marin service agencies surveyed identified inadequacy in the cultural competence of their services. Ninety-one percent indicated that the lack of services for low-income older adults was a moderate to widespread problem. These challenges were also echoed in focus groups conducted with Spanish-speaking and lesbian, gay, bisexual, and transgender (LGBT) older adults.While prior efforts have improved understanding of the needs of Marin's older adults, there remains a gap in knowledge of the availability and status of culturally competent services among Marin's service providers. This effort sought to address this gap and identify organizational strategies that would improve the ability of agencies to provide high quality services to a diverse population of older adults in Marin County

Enzyme-Based Nitric Oxide Releasing Thin Films and Scaffolds

Nitric oxide synthase enzyme (NOS) embedded in thin films and scaffolds, when exposed to a solution of its substrate arginine, a source of reducing equivalents, and other required ingredients of the NOS reaction, can release fluxes of nitric oxide (NO). The latter is a molecule known to counteract platelet aggregation, and thus can prevent the thrombosis cascade on the surfaces of implantable medical devices. Therefore NO antithrombogenic regimens such as active coatings and embedded scaffolds have the potential to increase the lifespan of implantable biomaterials. Layer-by-layer electrostatic adsorption allows for assembly of multi-component protein/polyelectrolytes nanostructured films. Electrospun fiber matrices may embed proteins in aqueous pockets that allow the formation of functional scaffolds. Such functional coatings and polymer scaffolds have potential applications as antithrombotic surfaces. In this project, inducible nitric oxide synthase is proposed as a functional component in active thin films and electrospun scaffolds for nitric oxide release under physiologic conditions. Atomic force microscopic (AFM) imaging confirms the presence of enzyme in adsorbed thin films. Fourier transform infrared (FTIR) spectroscopic analysis was used to characterize structure-function relationships of NOS-containing thin films. Voltammetry was used to characterize the active catalyst concentration on adsorbed surfaces and activity of NOS-containing thin films. Further, analysis of cyclic voltammetric data enabled the study of Michaelis-Menten kinetics of NOS-containing thin films. Other spectrophotometric and spectrofluorometric assays were used to monitor nitric oxide release for the NOS-based thin films and scaffolds. Three polymers were characterized for their ability to embed iNOSoxy and show enzyme activity in electrospun scaffolds. For the LbL method, during protein adsorption, an adjusted pH of 8.6 or the use of a branched matrix immobilizes more enzyme units in thin layers compared to pH 7.0 or a l

Chemometric – assisted UV spectrophotometric method for determination of antihyperlipidemic agents in pharmaceutical formulation

This presented work is based on application of two multivariate calibration methods for simultaneous UV-VIS spectrophotometric determination of active substances in combined pharmaceutical formulation composed of Atorvastatin calcium (ATV) and Ezetimibe (EZT). The methods used were Principal Component Regression (PCR) and Partial Least Square (PLS). The Spectra of ATV and EZT were recorded at concentrations within their linear range 5.0-30.0 μg/ml for both drugs. 28 set of mixtures were used for calibration and 08 set of mixtures were used for validation in the wavelength range of 230 to 260 nm with the wavelength intervals λ= 0.5 nm in methanol. The methods were validated as per International Conference on HarmonizationQ2 (R1) (ICH) guidelines. These methods were successfully applied for determination of drugs in pharmaceutical formulation (tablet) with no interference of the excipient as indicated by the recovery study results. The proposed methods are simple, rapid and can be easily used as an alternative analysis tool in the quality control as well as in process control of drugs and formulation

DEVELOPMENT AND OPTIMIZATION OF RIZATRIPTAN BENZOATE ETHOSOMES

Objective: The objective of this study was to assess the development of ethosomal drug delivery system for site-specific topical delivery of rizatriptan benzoate (RBZ) for sustained action.Methods: In the present study ethosomes were prepared using the cold method. The formulation was optimized using 33 full factorial designs. The lipid concentration (X1), ethanol concentration (X2) and stirring speed (X3) were selected as independent factors and the vesicle size (Y1) and % entrapment efficiency (Y2) were selected as dependent variables.Results: The equation of multiple regression revealed that there was no significant interaction among factors. The lipid concentration had a positive effect on vesicle size while ethanol concentration and stirring speed had a negative effect. For entrapment efficiency, all factors showed a positive effect while lipid concentrative found to be the main influencing factor. The formulation F4E459 (4% SPC, 45% v/v ethanol 900 RPM), which was characterized by optimum vesicle size (5.5 µm) and high entrapment efficiency (93.32%), was considered to be an optimal formulation. The scanning electron microscopy (SEM) results showed that RBZ ethosome have a smooth surface. The polydispersity index (PI) and zeta potential of the optimized formulation were found to be 0.493±0.021and–21.3 mV respectively. In vitro permeation through rat abdominal skin from the ethosomal gel followed Higuchi diffusion model over a period of 8 h.Conclusion: The results obtained in this research work clearly indicated a promising potential of ethosomal carrier system of RBZ for migraine treatment with a topical approach for sustained action

A New Algorithm for Shared Simultaneous Learning of Alzheimer's Disease Progression

Alzheimer’s Disease (AD), a progressive neurodegenerative disease, is the most common form of dementia in older adults. It is preceded by stages of subtle cognitive decline called as Mild Cognitive Impairment (MCI), which is further stratified into Early (EMCI) and Late (LMCI) stages. Several imaging biomarkers are being investigated for early and accurate diagnosis as well as prognosis, and traditional approaches have generally focused on training multiple independent binary classifiers for distinguishing between Normal Controls (NC), EMCI, LMCI and AD subjects. However, these multiple one vs one classifiers could hold complementary information and sharing this information during the training may improve predictive performance. We introduce a new framework to perform Shared Simultaneous Learning (SSL) of sparse logistic regression classifiers for NC vs EMCI, EMCI vs LMCI, and LMCI vs AD classification. We achieve this by adding a new term to the logistic loss function to enforce the weight vectors to be similar to each other. We introduce a constraint to minimize the squared Euclidean distance between the three weight vectors. A smooth approximation for the absolute value function is used and the model is optimized using gradient descent with line search. For each classifier, at the current gradient descent step, weights from the other two classifiers are shared. We evaluated this algorithm on Structural Brain Connectome Networks generated from diffusion MRI of 202 subjects from the multicenter Alzheimer’s Disease Neuroimaging Initiative 2 (ADNI2) dataset. The normalized adjacency matrices were vectorized and passed as input for training along with the corresponding class labels. SSL outperformed independently trained multiple linear binary classifiers and achieved an average AUC of 0.53 for NC vs EMCI, 0.68 for EMCI vs LMCI, and 0.73 for LMCI vs AD classification. We also analyzed the brain connectivity patterns associated with highest odds ratio and show that abnormal inter-hemispheric connectivity patterns are indicative of EMCI vs LMCI whereas the right hemisphere of the brain is involved in the later stages

Anticipated difficult airway management in a case of hemifacial microsomia

Airway management in paediatric patients with facial abnormalities is challenging for an experienced anaesthesiologist. Both mask ventilation and intubation can be difficult or impossible, especially with associated congenital facial anomalies. Hemifacial microsomia (HFM) is linked with mandibular hypoplasia and temporomandibular joint anomalies. These abnormalities may cause problems for direct laryngoscopy and endotracheal intubation.  A case report of a two-year-old child having HFM with a history of failed intubation in the past is presented here. We did manoeuvres for proper fitting of mask and to prevent air leak during mask ventilation. As there was a history of failed intubation, we kept difficult intubation kit including fiberoptic bronchoscopy, video laryngoscopy and ultrasound ready

FORMULATION AND EVALUATION OF RACECADOTRIL MUCOADHESIVE MICROSPHERES

Objective: To develop and evaluate the mucoadhesive microsphere using combinations of natural polymers chitosan and xanthan gum for sustained release. Methods: In the present work mucoadhesive microspheres were prepared by using natural polymers like chitosan and xanthan gum by using the emulsion chemical cross-linking method. Chemical cross-linking was done by using glutaraldehyde. The 22 factorial design was employed to show the effect of cross-linking agent and processing factor-like stirring and speed. Prepared microspheres were evaluated for their particle size, surface morphology, drug entrapment efficiency, in vitro drug release, swelling index, and mucoadhesive strength. Results: The size of microspheres of factorial batches were in the range of 26-46 µm. The swelling index was showed in the range of 1.51-1.66 percentage. The equation of multiple regression revealed that there was significant interaction among factors. The glutaraldehyde concentration had a positive effect on % entrapment efficiency, % cumulative drug release and % mucoadhesion. Stirring speed showed a negative impact on % entrapment efficiency, % cumulative drug release and % mucoadhesion. The interactive effect of glutaraldehyde concentration and the stirring speed was found to be positive for % entrapment efficiency and % cumulative drug release. In vitro drug release study of optimized formulation F2 show 96 % of drug release with 6 h indicating sustained release behavior with diffusion mechanism. The SEM image of the optimized batch was spherical with a porous surface. Conclusion: The results obtained in this research work indicated that a promising potential of chitosan and xanthan gum combination for the preparation of the mucoadhesive microsphere of Racecadotril