Study protocol: The Adherence and Intensification of Medications (AIM) study - a cluster randomized controlled effectiveness study

Abstract Background Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. Methods In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP) measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL), medication adherence determined from pharmacy refill data, and medication intensification rates. Discussion Integration of the three intervention elements - proactive identification, adherence counseling and medication intensification - is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. Trial Registration The ClinicalTrials.gov registration number is NCT00495794.http://deepblue.lib.umich.edu/bitstream/2027.42/78258/1/1745-6215-11-95.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78258/2/1745-6215-11-95.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78258/3/1745-6215-11-95-S1.DOCPeer Reviewe

Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/3/jgs16697-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/2/jgs16697_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/1/jgs16697.pd

A Brief Overview of Ophthalmic Ultrasound Imaging

Ultrasound is one of the oldest imaging modalities. Sound waves are emitted into the body, and the returning echoes can be interpreted. It has become widely used because it can easily be done at bedside with a relatively small apparatus and does not expose the patient to any ionizing radiation. While this technique has seen widespread acceptance in other fields such as cardiology or obstetrics and gynecology, the general use in ophthalmology has been somewhat limited. However, recent advancements in ultrasonic arrays can be a powerful tool in the evaluation of ophthalmic pathology. Such systems can quickly generate very high detail images and 3D reconstructions without the need for extensive manual scanning. The application of this technology includes evaluation of traumatic eye injuries; assessing presence and location of an intraocular foreign body; evaluation of intraocular tumors, including small tumors that have not yet caused visual distortion; evaluation of retinal detachment; and evaluation of vascular disease. The goal of this article is to briefly review the history and development of ultrasound and to provide an overview of the most current systems and applications of ultrasound use in ophthalmologic clinical evaluation

Complete Genome Sequence of Pasteurella multocida Sequence Type 394, Isolated from a Case of Bovine Respiratory Disease in Australia

Here, we present the completely closed genome sequence of Pasteurella multocida 17BRD-035, a bovine respiratory disease (BRD) pathogen from Queensland, Australia, with genes that confer resistance to β-lactams, tilmicosin, and tetracycline. It consists of a single 2,624,884-bp chromosome and an average GC content of 40.23% and belongs to the newly described Rural Industries Research and Development Corporation (RIRDC) sequence type 394

Rapid phase adjustment of melatonin and core body temperature rhythms following a 6-h advance of the light/dark cycle in the horse

<p>Abstract</p> <p>Background</p> <p>Rapid displacement across multiple time zones results in a conflict between the new cycle of light and dark and the previously entrained program of the internal circadian clock, a phenomenon known as jet lag. In humans, jet lag is often characterized by malaise, appetite loss, fatigue, disturbed sleep and performance deficit, the consequences of which are of particular concern to athletes hoping to perform optimally at an international destination. As a species renowned for its capacity for athletic performance, the consequences of jet lag are also relevant for the horse. However, the duration and severity of jet lag related circadian disruption is presently unknown in this species. We investigated the rates of re-entrainment of serum melatonin and core body temperature (BT) rhythms following an abrupt 6-h phase advance of the LD cycle in the horse.</p> <p>Methods</p> <p>Six healthy, 2 yr old mares entrained to a 12 h light/12 h dark (LD 12:12) natural photoperiod were housed in a light-proofed barn under a lighting schedule that mimicked the external LD cycle. Following baseline sampling on Day 0, an advance shift of the LD cycle was accomplished by ending the subsequent dark period 6 h early. Blood sampling for serum melatonin analysis and BT readings were taken at 3-h intervals for 24 h on alternate days for 11 days. Disturbances to the subsequent melatonin and BT 24-h rhythms were assessed using repeated measures ANOVA and analysis of Cosine curve fitting parameters.</p> <p>Results</p> <p>We demonstrate that the equine melatonin rhythm re-entrains rapidly to a 6-h phase advance of an LD12:12 photocycle. The phase shift in melatonin was fully complete on the first day of the new schedule and rhythm phase and waveform were stable thereafter. In comparison, the advance in the BT rhythm was achieved by the third day, however BT rhythm waveform, especially its mesor, was altered for many days following the LD shift.</p> <p>Conclusion</p> <p>Aside from the temperature rhythm disruption, rapid resynchronization of the melatonin rhythm suggests that the central circadian pacemaker of the horse may possess a particularly robust entrainment response. The consequences for athletic performance remain unknown.</p

Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139955/1/hesr12788-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139955/2/hesr12788_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139955/3/hesr12788.pd

Efficacy of amodiaquine in the treatment of uncomplicated falciparum malaria in young children of rural north-western Burkina Faso

BACKGROUND: Combination therapy has become a new paradigm in malaria treatment. Amodiaquine is a common partner drug in different malaria combination therapies used or investigated in sub-Saharan Africa, but data on its efficacy as a single drug are scarce. METHODS: The objective of the study was to determine the efficacy of amodiaquine against falciparum malaria in neighbouring rural and urban areas of north-western Burkina Faso. The study was designed as an uncontrolled trial in children aged 6–59 months with uncomplicated falciparum malaria in the Nouna Health District. RESULTS: During the rainy season 2005, 117 children were enrolled, 62 from the rural and 55 from the urban study area. The crude adequate clinical and parasitological response (ACPR) rate was 103/117 (88%) by day 14 but decreased to 28/117 (24%) by day 28. After PCR correction for reinfections, ACPR rates were 108/117 (92%) and 71/117 (61%) by day 14 and day 28, respectively. There were no significant differences in efficacy between urban and rural areas. The Plasmodium falciparum crt K76T mutation not predict AQ failure, but was selected in parasites re-appearing following treatment. No serious adverse events occurred and only 16 other adverse events were recorded. CONCLUSION: Compared to chloroquine, amodiaquine is more effective against uncomplicated falciparum malaria in Burkina Faso. However, a considerable degree of amodiaquine resistance already exists and it is currently unclear how this resistance will develop when amodiaquine in combination with other drugs is used on a large scale. TRIAL REGISTRATION: Current Controlled Trials ISRCTN73824458

Cancer patient and provider responses to companion scales assessing experiences with LGBTQI-affirming healthcare

BackgroundSexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample.MethodsNational convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional analysis, lower scores on items indicated greater knowledge, more affirming attitudes or behaviors, and greater confidence in clinical preparedness to care for SGM patients. Pearson chi-square tests compared dichotomous variables and independent samples t-tests compared continuous variables. Other results were reported using descriptive frequencies.ResultsBoth patient and provider samples were predominantly female sex assigned at birth, cisgender, and heterosexual. Providers were more likely than patients to report affirming cues in clinic, as well as the ability for patients to easily document their name in use and pronouns. Providers were more likely to report asking about patient values and preferences of care versus patients’ recollection of being asked. Patients were more likely to report understanding why they were asked about both sex assigned at birth and gender identity compared to providers’ perceptions that patients would understand being asked about both. Patients were also more likely to report comfort with providers asking about sex assigned at birth and gender identity compared to providers’ perceptions of patient comfort. SGM providers had greater knowledge of SGM patient social determinants of health and cancer risks; felt more prepared to care for gay patients; were more likely to endorse the importance of knowing patient sexual orientation and gender identity; and were more likely to indicate a responsibility to learn about SGM patient needs and champion positive system changes for SGM patients compared to heterosexual/cisgender peers. Overall, providers wished for more SGM-specific training.ConclusionDifferences between patient and provider reports of affirming environments as well as differences between SGM and heterosexual/cisgender provider care support the need for expanded professional training specific to SGM cancer care

Exploring smartphone keyboard interactions for Experience Sampling Method driven probe generation

Keyboard interaction patterns on a smartphone is the input for many intelligent emotion-aware applications, such as adaptive interface, optimized keyboard layout, automatic emoji recommendation in IM applications. The simplest approach, called the Experience Sampling Method (ESM), is to systematically gather self-reported emotion labels from users, which act as the ground truth labels, and build a supervised prediction model for emotion inference. However, as manual self-reporting is fatigue-inducing and attention-demanding, the self-report requests are to be scheduled at favorable moments to ensure high fidelity response. We, in this paper, perform fine-grain keyboard interaction analysis to determine suitable probing moments. Keyboard interaction patterns, both cadence, and latency between strokes, nicely translate to frequency and time domain analysis of the patterns. In this paper, we perform a 3-week in-the-wild study (N = 22) to log keyboard interaction patterns and self-report details indicating (in)opportune probing moments. Analysis of the dataset reveals that time-domain features (e.g., session length, session duration) and frequency-domain features (e.g., number of peak amplitudes, value of peak amplitude) vary significantly between opportune and inopportune probing moments. Driven by these analyses, we develop a generalized (all-user) Random Forest based model, which can identify the opportune probing moments with an average F-score of 93%. We also carry out the explainability analysis of the model using SHAP (SHapley Additive exPlanations), which reveals that the session length and peak amplitude have strongest influence to determine the probing moments

Haematological evaluation of Wistar rats exposed to chronic doses of cadmium, mercury and combined cadmium and mercury

Cadmium and mercury present in the environment, cause blood disorders. This study was conducted to evaluate the influence of cadmium, mercury and their combination on hematological parameters of Wistar rats. For this purpose, two different doses of each metal and their combination were administered orally for 28 days to six groups of five rats each. Two groups (A and B) were respectively exposed to CdCl2 (0.25 and 2.5 mg/kg), two other groups (C and D) respectively received HgCl2 (0.12 and 1.2 mg/kg) and the last two groups (E and F) were respectively treated with the combination of these two metals: (0.25 mg/kg Cd + 0.12 mg/kg Hg) and (2.5 mg/kg Cd + 1.2 mg/kg Hg). The control group (G) received the same volume of distilled water. At the end of exposure, bodies of rats were weighed and the whole blood was collected by retro-orbital sinus method for analysis of hematological parameters. The results of this study show a significant decrease (p&lt;0.05) in white blood cells (WBC) in the lot treated with the combination (0.25 mg/kg Cd + 012 mg/kg Hg) and also indicate a significant decrease (p&lt;0.05) in WBC, red blood cells (RBC), hemoglobin concentration (HGB) and the mean corpuscular hemoglobin concentration (MCHC) with high levels of mercury (2.5 mg/kg) and the combination (2.5 mg/kg Cd + 1.2 mg/kg Hg). An increase in the number of platelet count (PLT) in all intoxicated lots was observed.Keywords: Cadmium, mercury, hematology, blood parameters, ratsAfrican Journal of BiotechnologyVol. 12(23), pp. 3731-373