Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study

Background: Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective: The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods: A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results: A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions: Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals

How many manuscripts should I peer review per year?

Peer review provides the foundation for the scholarly publishing system. The conventional peer review system consists of using authors of articles as reviewers for other colleagues' manuscripts in a collaborative-basis system. However, authors complain about a theoretical overwhelming number of invitations to peer review. It seems that authors feel that they are invited to review many more manuscripts than they should when taking into account their participation in the scholarly publishing system. The high number of scientific journals and the existence of predatory journals were reported as potential causes of this excessive number of reviews required. In this editorial, we demonstrate that the number of reviewers required to publish a given number of articles depends exclusively on the journals' rejection rate and the number of reviewers intended per manuscript. Several initiatives to overcome the peer review crises are suggested

Primary healthcare policy and vision for community pharmacy and pharmacists in the united states

© 2020, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved. The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges

DISSOLVED ORGANIC MATTER MOLECULAR FINGERPRINT OF THE WATER MASSES IN THE CAPE VERT FRONTAL ZONE

Oral communicationOcean water masses have been traditionally characterized by the thermohaline and conservative chemical properties (e.g. preformed nutrients) at their respective source regions. However, water masses also can exhibit characteristic levels of other individual compounds or emerging properties associated to compound classes. In this regard, the objective of this contribution is to characterize the dissolved organic matter (DOM) molecular fingerprint of the water masses present in the Cape Vert Frontal Zone (CVFZ). For this purpose, a set of 133 samples was collected from the surface to 4000 m depth in the CVFZ during the FLUXES I cruise (12 July - 11 August 2017) and isolated by solid-phase extraction (SPE), using styrene divinyl benzene polymer cartridges (PPL). The molecular analysis of these SPE-PPL extracts was performed using Fourier Transform Ion Cyclotron Resonance Mass Spectrometry (FT-ICR MS), a method capable of identifying thousands of molecular formulae in DOM. These analyses have been combined with an optimum multiparameter (OMP) water mass analysis to obtain characteristic molecular indices for the eleven water masses present in the CVFZ, stemming from the subtropical and subpolar North and South Atlantic as well as from the Arctic and Antarctic Oceans. In particular, emerging properties such as the molecular diversity (D), mean molecular mass (MW), mean C:N ratio, aromaticity index (AI), double bond equivalent (DBE), and main molecular groups, as well as different compounds (e.g. Lignin) and individual heteroatoms were quantified.ASL

Patterns and drivers of UV absorbing chromophoric dissolved organic matter in the euphotic layer of the open ocean

The global distribution of chromophoric dissolved organic matter (CDOM) in the euphotic layer of the Atlantic, Indian, and Pacific oceans (between 35° N and 40° S) was analyzed by absorption spectroscopy during the Malaspina 2010 circumnavigation. Absorption coefficients at 254 nm (a254) and 325 nm (a325), indices (a254/a365) and spectral slopes (between 275 and 295 nm, S275-295) were calculated from the dissolved fraction of the UV absorption spectra to describe the amount and quality of CDOM. Generalized Additive Models (GAMs) were applied to evaluate the relevance of physical and biogeochemical drivers for the variability of CDOM. Besides the low CDOM values, a first division of our data following the Longhurst’s biogeographic classification showed significant differences in CDOM levels among provinces. The lowest values of a254 and a325 were found in the oligotrophic gyres, particularly in the Indian Ocean, and the highest in the upwelling areas, particularly in the Equatorial Pacific. Opposite distributions were obtained for S275-295 and a254/a365, indicative of higher photobleaching in the gyres. Within each province, whereas a254 was constant through the photic layer, a325 increased significantly with depth as a result of the dominance of photobleaching over biological production in the surface layer and the opposite at depth. The Pacific provinces, including the subtropical gyres, showed, however, significantly higher a325 values, indicative of lower photobleaching/higher biological production. The GAM analysis indicates that a254 and a325 were primarily related to chlorophyll a (Chl a), exhibiting a significant positive linear response. Interestingly, Prochlorococcus and Synechococcus abundances were related to these absorption coefficients. Apparent oxygen utilization also contributed to explain the distributions of these absorption coefficients, being inversely related to a254 and directly related to a325. These results are consistent with the premise that a254 could be a proxy for the concentration of dissolved organic carbon and a325 for the aromatic by-products of biological degradation. The GAM analysis also shows that a254/a365 and S275-295 exhibited inverse relationships with solar radiation, indicating that the biological production of CDOM counteracts photodegradation as solar radiation increases. In summary, whereas photobleaching dictates the vertical distribution of CDOM, Chl a explains the CDOM differences among the photic layer of the tropical and subtropical ocean provinces visited during the circumnavigationMinisterio de Economía y Competitividad | Ref. CDS2008-0007

Metal content determination in biodiesel samples by microwave mineralization and ICP-AES

El trabajo comprende la puesta a punto de un método de digestión, mediante calentamiento de microondas, de muestras de biodiesel obtenidas mediante catálisis homogénea de aceites vegetales, para la determinación de 20 elementos mediante ICP-AES

Dissolved organic matter (DOM) in the open Mediterranean Sea. II: Basin-wide distribution and drivers of fluorescent DOM

Research articleFluorescent dissolved organic matter (FDOM) in the Mediterranean Sea was analysed by excitation–emission matrix (EEM) spectroscopy and parallel factor (PARAFAC) analysis during the cruise HOTMIX 2014. A 4–component model, including 3 humic–like and 1 protein–like compounds, was obtained. To decipher the environmental factors that dictate the distributions of these components, we run generalized additive models (GAMs) in the epipelagic layer and an optimum multiparametric (OMP) water masses analysis in the meso– and bathypelagic layers. In the epipelagic layer, apparent oxygen utilization (AOU) and temperature presented the most significant effects on the variability of the marine humic-like peak M fluorescence, suggesting that its distribution was controlled by the net community respiration of organic matter and photobleaching. On the contrary, the variability of the soil humic-like peak E and the protein–like peak T fluorescence was explained mainly by the prokaryotic heterotrophic abundance, which decreased eastwards. In the meso– and bathypelagic layers, water mass mixing and basin–scale mineralization processes explained >72% and 63% of the humic–like and protein–like fluorescence variability, respectively. When analysing the two basins separately, the OMP model offered a better explanation of the distribution of fluorescence in the eastern Mediterranean Sea, as expected from the reduced biological activity in this ultra–oligotrophic basin. Furthermore, while western Mediterranean deep waters display the usual trend in the global ocean (increase of humic–like fluorescence and decrease of protein–like fluorescence with higher AOU values), the eastern Mediterranean deep waters presented an opposite trend. Different initial fluorescence intensities of the water masses that mix in the eastern basin, with Adriatic and Aegean origins, seem to be behind this contrasting pattern. The analysis of the transect–scale mineralization processes corroborate this hypothesis, suggesting a production of humic–like and a consumption of protein–like fluorescence in parallel with water mass ageing. Remarkably, the transect–scale variability of the chromophoric dissolved organic matter (CDOM) absorbing at the excitation wavelength of the humic–like peak M indicates an unexpected loss with increasing AOU, which suggests that the consumption of the non–fluorescent fraction of CDOM absorbing at that wavelength exceeded the production of the fluorescent fraction observed hereProject HOTMIX (reference CTM2011–30010–C02 01–MAR and 02–MAR), co–financed with FEDER funds (re ference BES–2012–056175) ; the project MODMED from CSIC (PIE, 201730E020) and the project FERMIO (MINECO, CTM2014–57334–JIN), co–financed with FEDER fundsVersión del editor3,26

MicroRNA expression profiling and DNA methylation signature for deregulated microRNA in cutaneous T-cell lymphoma

MicroRNAs usually regulate gene expression negatively, and aberrant expression has been involved in the development of several types of cancers. Microarray profiling of microRNA expression was performed to define a microRNA signature in a series of mycosis fungoides tumor stage (MFt, n=21) and CD30+ primary cutaneous anaplastic large cell lymphoma (CD30+ cALCL, n=11) samples in comparison with inflammatory dermatoses (ID, n=5). Supervised clustering confirmed a distinctive microRNA profile for cutaneous T-cell lymphoma (CTCL) with respect to ID. A 40 microRNA signature was found in MFt including upregulated onco-microRNAs (miR-146a, miR-142-3p/5p, miR-21, miR-181a/b, and miR-155) and downregulated tumor-suppressor microRNAs (miR-200ab/429 cluster, miR-10b, miR-193b, miR-141/200c, and miR-23b/27b). Regarding CD30+ cALCL, 39 differentially expressed microRNAs were identified. Particularly, overexpression of miR-155, miR-21, or miR-142-3p/5p and downregulation of the miR-141/200c clusters were observed. DNA methylation in microRNA gene promoters, as expression regulatory mechanism for deregulated microRNAs, was analyzed using Infinium 450K array and approximately one-third of the differentially expressed microRNAs showed significant DNA methylation differences. Two different microRNA methylation signatures for MFt and CD30+ cALCL were found. Correlation analysis showed an inverse relationship for microRNA promoter methylation and microRNA expression. These results reveal a subgroup-specific epigenetically regulated microRNA signatures for MFt and CD30+ cALCL patients

Urinary transferrin pre-emptively identifies the risk of renal damage posed by subclinical tubular alterations

Nephrotoxicity is an important limitation to the clinical use of many drugs and contrast media. Drug nephrotoxicity occurs in acute, subacute and chronic manifestations ranging from glomerular, tubular, vascular and immunological phenotypes to acute kidney injury. Pre-emptive risk assessment of drug nephrotoxicity poses an urgent need of precision medicine to optimize pharmacological therapies and interventional procedures involving nephrotoxic products in a preventive and personalized manner. Biomarkers of risk have been identified in animal models, and risk scores have been proposed, whose clinical use is abated by their reduced applicability to specific etiological models or clinical circumstances. However, our present data suggest that the urinary level of transferrin may be indicative of risk of renal damage, where risk is induced by subclinical tubular alterations regardless of etiology. In fact, urinary transferrin pre-emptively correlates with the subsequent renal damage in animal models in which risk has been induced by drugs and toxins affecting the renal tubules (i.e. cisplatin, gentamicin and uranyl nitrate); whereas transferrin shows no relation with the risk posed by a drug affecting renal hemodynamics (i.e. cyclosporine A). Our experiments also show that transferrin increases in the urine in the risk state (i.e. prior to the damage) precisely as a consequence of reduced tubular reabsorption. Finally, urinary transferrin pre-emptively identifies subpopulations of oncological and cardiac patients at risk of nephrotoxicity. In perspective, urinary transferrin might be further explored as a wider biomarker of an important mechanism of predisposition to renal damage induced by insults causing subclinical tubular alterations.Research from the authors’ laboratory supporting part of the information incorporated into this article was funded by grants from Instituto de Salud Carlos III (PI14/01776, DT15S/00166, PI15/01055 and PI17/01979, and Retic RD016/0009/0025, REDINREN), Ministerio de Economía y Competitividad (IPT-2012-0779-010000), Junta de Castilla y León (Consejería de Sanidad, BIO/SA20/14, BIO/SA66/15; and Consejería de Educación, SA359U14), and FEDER funds