Improving over-the-counter medication safety for older adults: A study protocol for a demonstration and dissemination study

BACKGROUND: Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medication. OBJECTIVES: To refine the intervention and implementation strategy through diagnostic and formative evaluation; to evaluate the effectiveness of the intervention for preventing misuse of high-risk OTC medications by older adults; and to evaluate the implementation of the intervention in community pharmacies. METHODS: A system redesign intervention to decrease high-risk OTC medication misuse will be tested to reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult's health status. The study will be conducted in three phases: a participatory design phase, a beta phase, and a test phase. The test phase will be conducted in three mass-merchandise stores. A total of 144 older adults will be recruited. A pre (control)/post (intervention) test will determine the effectiveness of the intervention. The primary outcome will be a comparison of proportion of older adults who misuse OTC medication from baseline to post-intervention. The process of implementation in the community pharmacy setting will be evaluated using the taxonomy proposed by Proctor et al. The participatory design phase has been approved by the institution's IRB (2016-0743). PROJECTED IMPACT: It is anticipated that this project, which focuses on achieving systems-based improvement in an underemphasized area of the medication use process, will reduce ADEs associated with inappropriate OTC medication use in older adults

TEMPORAL AND SPATIAL OCCLUSION OF ADVANCED VISUAL INFORMATION CONSTRAIN EMERGENT COORDINATION OF ONE-HANDED CATCHING BEHAVIOURS

Introduction Dynamic interceptive actions, like catching, are performed under severe spatial and temporal constraints. Here, behavioral processes underpinning one-handed catching was examined using a novel spatial and temporal occlusion design which enabled precise control of pre-release visual information of an actor and a fully coupled action response. Methods An integrated video and ball projection machine was used to create four temporal occlusion and five spatial occlusion conditions of an actor throwing a ball towards participants. Twelve participants’ hand kinematics and gaze behaviors were recorded while attempting to catch a projected ball synchronized with the video footage. Results Temporal occlusion findings revealed that when footage was occluded at earlier time points, catching performance decreased. Movement onset of the catching hand and initiation of visual ball tracking emerged earlier when footage of the thrower was occluded at a later time point in the throwing action. Spatial occlusion did not affect catching success, although movement onset emerged later when increased visual information of the actor was occluded. Later movement onset was countered by greater maximum velocity of the catching hand. The final stages of action (e.g., grasping action of the hand) remained unchanged across both spatial and temporal conditions suggesting the later phases of the action were organised using ball flight information. Discussion Findings revealed how catching behaviors were continuously (re)organized and adapted as information became available in task performance, first by using kinematic information of a thrower's actions, and then by ball flight information. This highlighted the importance of maintaining information-movement coupling during performance of interceptive actions, with these behavioral adaptations having important implications for research that assesses interceptive skills based solely on pre-ball flight information, as in many current video-based simulation paradigms. Contact [email protected]

The Process of Stellar Tidal Disruption by Supermassive Black Holes. The first pericenter passage

Tidal disruption events (TDEs) are among the brightest transients in the optical, ultraviolet, and X-ray sky. These flares are set into motion when a star is torn apart by the tidal field of a massive black hole, triggering a chain of events which is -- so far -- incompletely understood. However, the disruption process has been studied extensively for almost half a century, and unlike the later stages of a TDE, our understanding of the disruption itself is reasonably well converged. In this Chapter, we review both analytical and numerical models for stellar tidal disruption. Starting with relatively simple, order-of-magnitude physics, we review models of increasing sophistication, the semi-analytic ``affine formalism,'' hydrodynamic simulations of the disruption of polytropic stars, and the most recent hydrodynamic results concerning the disruption of realistic stellar models. Our review surveys the immediate aftermath of disruption in both typical and more unusual TDEs, exploring how the fate of the tidal debris changes if one considers non-main sequence stars, deeply penetrating tidal encounters, binary star systems, and sub-parabolic orbits. The stellar tidal disruption process provides the initial conditions needed to model the formation of accretion flows around quiescent massive black holes, and in some cases may also lead to directly observable emission, for example via shock breakout, gravitational waves or runaway nuclear fusion in deeply plunging TDEs.Comment: Review chapter in book: 'The Tidal Disruption of Stars by Massive Black Holes', Space Science Reviews, Springer. Comments welcom

A Pilot Study of Decision Factors Influencing Over-the-Counter Medication Selection and Use by Older Adults

Background and objectives: Despite their availability without prescription, OTC medications pose a risk for significant harm for older adults due to higher likelihood of polypharmacy, drug interactions, and age-related physiological changes. The purpose of this study is to identify the individual decision factors that influence how older adults select and use over-the-counter medications. Methods: A pilot study was conducted with 20 community-dwelling older adults. Older adults met the interviewer at a regional mass merchandise store where they were given both pain and insomnia standardized scenarios. Participants described how they would select and then hypothetically use a given medication to treat the problem described in the scenario. Results: OTC medication selection and reported use were influenced by several person-level decision-making factors including: personal beliefs/knowledge about OTCs, assessment of the ailment, and medical constraints. Conclusion: The findings from this investigation provide direction for interventions to address unsafe OTC medication selection by older adults

Combining microscopic and macroscopic probes to untangle the single-ion anisotropy and exchange energies in an S=1 quantum antiferromagnet

The magnetic ground state of the quasi-one-dimensional spin-1 antiferromagnetic chain is sensitive to the relative sizes of the single-ion anisotropy (D) and the intrachain (J) and interchain (J') exchange interactions. The ratios D/J and J'/J dictate the material's placement in one of three competing phases: a Haldane gapped phase, a quantum paramagnet and an XY-ordered state, with a quantum critical point at their junction. We have identified [Ni(HF)2(pyz)_2]SbF6, where pyz = pyrazine, as a rare candidate in which this behavior can be explored in detail. Combining neutron scattering (elastic and inelastic) in applied magnetic fields of up to 10~tesla and magnetization measurements in fields of up to 60~tesla with numerical modeling of experimental observables, we are able to obtain accurate values of all of the parameters of the Hamiltonian [D = 13.3(1)~K, J = 10.4(3)~K and J' = 1.4(2)~K], despite the polycrystalline nature of the sample. Density-functional theory calculations result in similar couplings (J = 9.2~K, J' = 1.8~K) and predict that the majority of the total spin population resides on the Ni(II) ion, while the remaining spin density is delocalized over both ligand types. The general procedures outlined in this paper permit phase boundaries and quantum-critical points to be explored in anisotropic systems for which single crystals are as yet unavailable

Panoramic SETI: Program Update and High-Energy Astrophysics Applications

Optical SETI (Search for Extraterrestrial Intelligence) instruments that can explore the very fast time domain, especially with large sky coverage, offer an opportunity for new discoveries that can complement multimessenger and time domain astrophysics. The Panoramic SETI experiment (PANOSETI) aims to observe optical transients with nanosecond to second duration over a wide field-of-view ($\thicksim$2,500 sq.deg.) by using two assemblies of tens of telescopes to reject spurious signals by coincidence detection. Three PANOSETI telescopes, connected to a White Rabbit timing network used to synchronize clocks at the nanosecond level, have been deployed at Lick Observatory on two sites separated by a distance of 677 meters to distinguish nearby light sources (such as Cherenkov light from particle showers in the Earth's atmosphere) from astrophysical sources at large distances. In parallel to this deployment, we present results obtained during four nights of simultaneous observations with the four 12-meter VERITAS gamma-ray telescopes and two PANOSETI telescopes at the Fred Lawrence Whipple Observatory. We report PANOSETI's first detection of astrophysical gamma rays, comprising three events with energies in the range between $\thicksim$15 TeV and $\thicksim$50 TeV. These were emitted by the Crab Nebula, and identified as gamma rays using joint VERITAS observations.Comment: 9 pages, 5 figures, SPIE Astronomical Telescopes + Instrumentation conference, 2022, Montr\'eal, Qu\'ebec, Canad

Gene Expression Analysis of Forskolin Treated Basilar Papillae Identifies MicroRNA181a as a Mediator of Proliferation

Auditory hair cells spontaneously regenerate following injury in birds but not mammals. A better understanding of the molecular events underlying hair cell regeneration in birds may allow for identification and eventually manipulation of relevant pathways in mammals to stimulate regeneration and restore hearing in deaf patients.Gene expression was profiled in forskolin treated (i.e., proliferating) and quiescent control auditory epithelia of post-hatch chicks using an Affymetrix whole-genome chicken array after 24 (n = 6), 48 (n = 6), and 72 (n = 12) hours in culture. In the forskolin-treated epithelia there was significant (p<0.05; >two-fold change) upregulation of many genes thought to be relevant to cell cycle control and inner ear development. Gene set enrichment analysis was performed on the data and identified myriad microRNAs that are likely to be upregulated in the regenerating tissue, including microRNA181a (miR181a), which is known to mediate proliferation in other systems. Functional experiments showed that miR181a overexpression is sufficient to stimulate proliferation within the basilar papilla, as assayed by BrdU incorporation. Further, some of the newly produced cells express the early hair cell marker myosin VI, suggesting that miR181a transfection can result in the production of new hair cells.These studies have identified a single microRNA, miR181a, that can cause proliferation in the chicken auditory epithelium with production of new hair cells

Omega-3 polyunsaturated fatty acids favourably modulate cardiometabolic biomarkers in type 2 diabetes: a meta-analysis and meta-regression of randomized controlled trials

BACKGROUND: Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects. METHODS: Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate. RESULTS: A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL [ES: - 0.10, (95% CI - 0.17, - 0.03); p = 0.007], VLDL (ES: - 0.26 (- 0.51, - 0.01); p = 0.044], triglycerides (ES: - 0.39 (- 0.55, - 0.24; p ≤ 0.001] and HbA1c (ES: - 0.27 (- 0.48, - 0.06); p = 0.010]. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α [ES: - 0.59 (- 1.17, - 0.01); p = 0.045] and IL-6 (ES: - 1.67 (- 3.14, - 0.20); p = 0.026]. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05). CONCLUSIONS: n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Colloids as Mobile Substrates for the Implantation and Integration of Differentiated Neurons into the Mammalian Brain

Neuronal degeneration and the deterioration of neuronal communication lie at the origin of many neuronal disorders, and there have been major efforts to develop cell replacement therapies for treating such diseases. One challenge, however, is that differentiated cells are challenging to transplant due to their sensitivity both to being uprooted from their cell culture growth support and to shear forces inherent in the implantation process. Here, we describe an approach to address these problems. We demonstrate that rat hippocampal neurons can be grown on colloidal particles or beads, matured and even transfected in vitro, and subsequently transplanted while adhered to the beads into the young adult rat hippocampus. The transplanted cells have a 76% cell survival rate one week post-surgery. At this time, most transplanted neurons have left their beads and elaborated long processes, similar to the host neurons. Additionally, the transplanted cells distribute uniformly across the host hippocampus. Expression of a fluorescent protein and the light-gated glutamate receptor in the transplanted neurons enabled them to be driven to fire by remote optical control. At 1-2 weeks after transplantation, calcium imaging of host brain slice shows that optical excitation of the transplanted neurons elicits activity in nearby host neurons, indicating the formation of functional transplant-host synaptic connections. After 6 months, the transplanted cell survival and overall cell distribution remained unchanged, suggesting that cells are functionally integrated. This approach, which could be extended to other cell classes such as neural stem cells and other regions of the brain, offers promising prospects for neuronal circuit repair via transplantation of in vitro differentiated, genetically engineered neurons