Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice.

OBJECTIVES: To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT). SETTING: Community pharmacies in Spain. PARTICIPANTS: 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over. INTERVENTION: The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT. RESULTS: 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed. CONCLUSIONS: The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete. TRIAL REGISTRATION NUMBER: CGFTRA-2017-01

Expression of the major and pro-oncogenic H3K9 lysine methyltransferase SETDB1 in non-small cell lung cancer

SETDB1 is a key histone lysine methyltransferase involved in gene silencing. The SETDB1 gene is amplified in human lung cancer, where the protein plays a driver role. Here, we investigated the clinical significance of SETDB1 expression in the two major forms of human non-small cell lung carcinoma (NSCLC), i.e., adenocarcinoma (ADC) and squamous cell carcinoma (SCC), by combining a meta-analysis of transcriptomic datasets and a systematic review of the literature. A total of 1140 NSCLC patients and 952 controls were included in the association analyses. Our data revealed higher levels of SETDB1 mRNA in ADC (standardized mean difference, SMD: 0.88; 95% confidence interval, CI: 0.73–1.02; p less than 0.001) and SCC (SMD: 0.40; 95% CI: 0.13–0.66; p = 0.003) compared to non-cancerous tissues. For clinicopathological analyses, 2533 ADC and 903 SCC patients were included. Interestingly, SETDB1 mRNA level was increased in NSCLC patients who were current smokers compared to non-smokers (SMD: 0.26; 95% CI: 0.08–0.44; p = 0.004), and when comparing former smokers and non-smokers (p = 0.009). Furthermore, the area under the curve (AUC) given by the summary receiver operator characteristic curve (sROC) was 0.774 (Q = 0.713). Together, our findings suggest a strong foundation for further research to evaluate SETDB1 as a diagnostic biomarker and/or its potential use as a therapeutic target in NSCLC. © 2019 by the authors. Licensee MDPI, Basel, Switzerland

Chest imaging features of patients afflicted with Influenza A (H1N1) in a Malaysian tertiary referral centre

This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis

The Near-Sun Streamer Belt Solar Wind: Turbulence and Solar Wind Acceleration

The fourth orbit of Parker Solar Probe (PSP) reached heliocentric distances down to 27.9 Rs, allowing solar wind turbulence and acceleration mechanisms to be studied in situ closer to the Sun than previously possible. The turbulence properties were found to be significantly different in the inbound and outbound portions of PSP's fourth solar encounter, likely due to the proximity to the heliospheric current sheet (HCS) in the outbound period. Near the HCS, in the streamer belt wind, the turbulence was found to have lower amplitudes, higher magnetic compressibility, a steeper magnetic field spectrum (with spectral index close to -5/3 rather than -3/2), a lower Alfv\'enicity, and a "1/f" break at much lower frequencies. These are also features of slow wind at 1 au, suggesting the near-Sun streamer belt wind to be the prototypical slow solar wind. The transition in properties occurs at a predicted angular distance of ~4{\deg} from the HCS, suggesting ~8{\deg} as the full-width of the streamer belt wind at these distances. While the majority of the Alfv\'enic turbulence energy fluxes measured by PSP are consistent with those required for reflection-driven turbulence models of solar wind acceleration, the fluxes in the streamer belt are significantly lower than the model predictions, suggesting that additional mechanisms are necessary to explain the acceleration of the streamer belt solar wind

Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial

BackgroundNon-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD).MethodsA 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data.ResultsNinety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, pConclusionsA community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice.Trial registration numberACTRN12618000410257

Amphiphilic core-cross-linked micelles functionalized with bis(4-methoxyphenyl)phenylphosphine as catalytic nanoreactors for biphasic hydroformylation

Core-cross-linked micelles (CCM) functionalized at the core with covalently linked bis(p-methoxyphenyl) phenylphosphine (BMOPPP) ligands have been synthesized by a three-step one-pot radical polymerization in emulsion, using the polymerization-induced self-assembly (PISA) strategy and reversible addition-fragmentation chain transfer (RAFT) as the controlling method. The CCM are obtained by chain extending in water poly(methacrylic acid-co-poly(ethylene oxide) methyl ether methacrylate) (P(MAA-co-PEOMA), degree of polymerization of 30, MAA/PEOMA units molar ratio of 50:50) synthesized in a first step by RAFT with a 95:5 M mixture of styrene and 4-[bis(p-methoxyphenyl)phosphino]styrene (BMOPPS) units. The resulting micelles exhibiting a core composed of P(S-co-BMOPPS) segments with a degree of polymerization of 300 are then crosslinked in a third step with a mixture of di(ethylene glycol) dimethacrylate (DEGDMA) and styrene. The resulting BMOPPP@CCM exhibit a narrow size distribution (PDI = 0.16) with an average diameter of 81 nm in water and swell in THF or by addition of toluene to the latex. The addition of [Rh(acac) (CO)2] to the toluene-swollen latex results in metal coordination to the phosphine ligands. 31P{1H} NMR spectroscopy shows that the Rh centers undergo rapid intraparticle phosphine ligand exchange. Application of these nanoreactors to the aqueous biphasic hydroformylation of 1-octene shows excellent activity and moderate catalyst leaching

Mechanical Design Analysis of MQXFB, the 7.2-m-Long Low-β Quadrupole for the High-Luminosity LHC Upgrade

As part of the High-Luminosity Large Hadron Collider (LHC) Project, a set of Nb Snquadrupoles are being developed, aiming to enhance the performance of the inner triplets. The new magnets, identified as MQXFA and MQXFB, will share the same cross section with two different lengths, 4.2 and 7.2 m, respectively. During the magnet development, three short models were tested, along with a number of mechanical models, demonstrating the capability of the magnet cross section to achieve the specified performances. The same performances are now required for the full-length magnets. To ensure this, the authors studied the impact of the magnet length on the capability of the structure to provide an adequate support to the coils. Finite element and simplified analytical models were used to evaluate the impact of the magnet length on the stresses in the magnet ends and coil elongation during powering. The models were calibrated using the results from the short model tests, and used to provide an indication on the required prestress and its foreseen impact on the magnet performance.

Nestedness across biological scales

This is the final published version. Available from Public Library of Science via the DOI in this record.All data sets are available for download in the repository https:// bitbucket.org/maucantor/unodf_analyses/src.Biological networks pervade nature. They describe systems throughout all levels of biological organization, from molecules regulating metabolism to species interactions that shape ecosystem dynamics. The network thinking revealed recurrent organizational patterns in complex biological systems, such as the formation of semi-independent groups of connected elements (modularity) and non-random distributions of interactions among elements. Other structural patterns, such as nestedness, have been primarily assessed in ecological networks formed by two non-overlapping sets of elements; information on its occurrence on other levels of organization is lacking. Nestedness occurs when interactions of less connected elements form proper subsets of the interactions of more connected elements. Only recently these properties began to be appreciated in one-mode networks (where all elements can interact) which describe a much wider variety of biological phenomena. Here, we compute nestedness in a diverse collection of one-mode networked systems from six different levels of biological organization depicting gene and protein interactions, complex phenotypes, animal societies, metapopulations, food webs and vertebrate metacommunities. Our findings suggest that nestedness emerge independently of interaction type or biological scale and reveal that disparate systems can share nested organization features characterized by inclusive subsets of interacting elements with decreasing connectedness. We primarily explore the implications of a nested structure for each of these studied systems, then theorize on how nested networks are assembled. We hypothesize that nestedness emerges across scales due to processes that, although system-dependent, may share a general compromise between two features: specificity (the number of interactions the elements of the system can have) and affinity (how these elements can be connected to each other). Our findings suggesting occurrence of nestedness throughout biological scales can stimulate the debate on how pervasive nestedness may be in nature, while the theoretical emergent principles can aid further research on commonalities of biological networks.Conselho Nacional de Desenvolvimento Científico e TecnológicoSão Paulo Research FoundationKillam TrustsThe Brazilian Federal Agency for Support and Evaluation of Graduate Education within the Ministry of Education of BrazilFundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarin

Porcine endogenous retroviruses PERV A and A/C recombinant are insensitive to a range of divergent mammalian TRIM5 proteins including human TRIM5

The potential risk of cross-species transmission of porcine endogenous retroviruses (PERV) to humans has slowed the development of xenotransplantation, using pigs as organ donors. Here, we show that PERVs are insensitive to restriction by divergent TRIM5{alpha} molecules despite the fact that they strongly restrict a variety of divergent lentiviruses. We also show that the human PERV A/C recombinant clone 14/220 reverse transcribes with increased efficiency in human cells, leading to significantly higher infectivity. We conclude that xenotransplantation studies should consider the danger of highly infectious TRIM5{alpha}-insensitive human-tropic PERV recombinants