A Rural-Urban Comparison Of Preferences Expressed by Elders for Long-Term Care Arrangements

This paper examines the long-term care (LTC) arrangements selected by rural older people, identifies the characteristics associated with their selections, and compares patterns of selection and related factors with those of elderly urban residents. The research is based upon 1,240 cases selected from a larger statewide area probability sample of noninstitutionalized persons at least 60 years old. Results, based upon tabular and logistic regression analysis, suggest that older rural residents are more likely than their urban counterparts to select LTC arrangements that involve both formal and informal forms of care as well as arrangements that are more likely to facilitate remaining at their current residences. Furthermore, there appear to be rural-urban differences in the major factors that explain selection of specific LTC arrangements. Implications for future research and for long-term care policy are discussed

The Swallowing Characteristics of Thickeners, Jellies and Yoghurt Observed Using an In Vitro Model

© The Author(s) 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Drinks and foods may be thickened to improve swallowing safety for dysphagia patients, but the resultant consistencies are not always palatable. Characterising alternative appetising foods is an important task. The study aims to characterise the in vitro swallowing behaviour of specifically formulated thickened dysphagia fluids containing xanthan gum and/or starch with standard jellies and yoghurt using a validated mechanical model, the “Cambridge Throat”. Observing from the side, the model throat can follow an experimental oral transit time (in vitro-OTT) and a bolus length (BL) at the juncture of the pharynx and larynx, to assess the velocity and cohesion of bolus flow. Our results showed that higher thickener concentration produced longer in vitro-OTT and shorter BL. At high concentration (spoon-thick), fluids thickened with starch-based thickener showed significantly longer in vitro-OTT than when xanthan gum-based thickener was used (84.5 s ± 34.5 s and 5.5 s ± 1.6 s, respectively, p < 0.05). In contrast, at low concentration (nectar-like), fluids containing xanthan gum-based thickener demonstrated shorter BL than those of starch-based thickener (6.4 mm ± 0.5 mm and 8.2 mm ± 0.8 mm, respectively, p < 0.05). The jellies and yoghurt had comparable in vitro-OTT and BL to thickeners at high concentrations (honey-like and spoon-thick), indicating similar swallowing characteristics. The in vitro results showed correlation with published in vivo data though the limitations of applying the in vitro swallowing test for dysphagia studies were noted. These findings contribute useful information for designing new thickening agents and selecting alternative and palatable safe-to-swallow foods.Peer reviewe

The use of polymer blends to improve stability and performance of electrospun solid dispersions: The role of miscibility and phase separation

© 2021 Elsevier B.V. All rights reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1016/j.ijpharm.2021.120637Solid dispersion-based nanofiber formulations of poorly soluble drugs prepared by electrospinning (ES) with a water-soluble polymer, can offer significant improvements in drug dissolution for oral drug administration. However, when hygroscopic polymers, such as polyvinylpyrrolidone (PVP) are used, environmental moisture sorption can lead to poor physical stability on storage. This study investigated the use of polymer blends to modify PVP-based ES formulations of a model poorly soluble drug, fenofibrate (FF), to improve its physical stability without compromising dissolution enhancement. FF-PVP ES dispersions demonstrated clear dissolution enhancement, but poor storage stability against high humidity. Polymer blends of PVP with Eudragit E, Soluplus and hypromellose acetate succinate (HPMCAS), were selected because of the low intrinsic moisture sorption of these polymers. The drug-polymer and polymer-polymer miscibility study revealed that FF was more miscible with Eudragit E and Soluplus than with PVP and HPMCAS, and that PVP was more miscible with HPMCAS than Eudragit E and Soluplus. This led to different configurations of phase separation in the placebo and drug-loaded fibres. The in vitro drug release data confirmed that the use of PVP-Eudragit E retained the dissolution enhancement of the PVP formulation, whereas PVP-Soluplus reduced the drug release rate in comparison to FF-PVP formulations. The moisture sorption results confirmed that moisture uptake by the polymer blends was reduced, but formulation deformation occurred to phase-separated blend formulations. The data revealed the importance of miscibility and phase separation in understanding the physical stability of the ES fibre mats. The findings provide insight into the design of formulations that can provide dissolution enhancement balanced with improved storage stabilityPeer reviewedFinal Accepted Versio

Searches for a Nursing Home: Personal and Situational Factors

Telephone and follow-up in-depth interviews were used to gather information from 25 sponsors (primary contact people or responsible parties) of nursing home residents to learn more about the nursing home search and selection process. Quantitative analyses revealed that sponsors who engaged in anticipatory action prior to the need for nursing home placement had lower personal competence scores than those sponsors who did not anticipate the need for nursing home care. As might be expected, sponsors who were involved in time-pressured searches had the highest stress scores. In-depth analyses of the qualitative data illuminated the diverse ways in which the situational factors (time-pressured versus non-time-pressured searches and antici patory versus nonanticipatory behavior) affected the personal factors (perceived competence and stress) to create idiosyncratic experiences for the sponsors. The findings show the value of offering professional assistance to individuals who are at the stage of seeking information about nursing homes.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Poly(N-isopropyl acrylamide) – poly(ethylene glycol) – poly(N-isopropyl acrylamide) as a thermoreversible gelator for topical administration

This article is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported licence: https://creativecommons.org/licenses/by-nc/3.0/.Poly(N-isopropyl acrylamide) – block– poly(ethylene glycol) – block– poly(N-isopropyl acrylamide) is known to exhibit a thermally-induced solution-to-gel transition in water, which may be exploited for biomedical applications. This “thermoreversible gelator” has great potential for application in topical drug delivery to the surfaces of the body such as the skin, eye, and vagina, but this has not yet been evaluated. This study evaluates PNIPAM98-PEG122-PNIPAM98 as a thermoreversible gelator for vaginal drug delivery, for the first time evaluating the effect of polymer concentration on gelation, studying rheological parameters relevant to topicals, measuring dissolution rates, stability and the phenomemon of mucoadhesion. Two drugs relevant to vaginal administration, progesterone and tenofovir disoproxil fumarate are investigated for use in the thermoreversible gelators, studying both hydrophobic and hydrophilic drug solubilisation and release. Throughout the study, comparison is made with poloxamer 407, the most commonly studied thermoreversible gelator. PNIPAM98-PEG122-PNIPAM98 exhibits several advantages for topical drug delivery, having low viscosity at room temperature to allow easy application, then exhibiting a gelation just below body temperature to form a viscous gel which is resistant to dissolution and relatively mucoadhesive. Drug release is highly dependent on temperature, with elevation to body temperature resulting in a dramatic retardation of progesterone release, which may be used in future medicines to provide sustained delivery of hydrophobic xenobiotics.Peer reviewedFinal Accepted Versio

Polymers exhibiting lower critical solution temperatures as a route to thermoreversible gelators for healthcare

Funding Information: M.T.C. acknowledges support from the EPSRC (EP/T00813X/1). The University of Hertfordshire are thanked for funding the research project of P.H. Publisher Copyright: © 2020 The Authors. Advanced Functional Materials published by Wiley-VCH GmbHThe ability to trigger changes to material properties with external stimuli, so-called “smart” behavior, has enabled novel technologies for a wide range of healthcare applications. Response to small changes in temperature is particularly attractive, where material transformations may be triggered by contact with the human body. Thermoreversible gelators are materials where warming triggers reversible phase change from low viscosity polymer solution to a gel state. These systems can be generated by the exploitation of macromolecules with lower critical solution temperatures included in their architectures. The resultant materials are attractive for topical and mucosal drug delivery, as well as for injectables. In addition, the materials are attractive for tissue engineering and 3D printing. The fundamental science underpinning these systems is described, along with progress in each class of material and their applications. Significant opportunities exist in the fundamental understanding of how polymer chemistry and nanoscience describe the performance of these systems and guide the rational design of novel systems. Furthermore, barriers to translating technologies must be addressed, for example, rigorous toxicological evaluation is rarely conducted. As such, applications remain tied to narrow fields, and advancements will be made where the existing knowledge in these areas may be applied to novel problems of science.Peer reviewe

The effect of dilution of fusidic acid cream and betamethasone dipropionate cream in complex extemporaneous mixes on formulation performance

© 2022 The Authors. Published by Elsevier B.V. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/The Aron regimen is an unconventional therapy which entails frequent applications of an extemporaneously prepared three component system (a topical antibiotic, a corticosteroid and an emollient), with the intention of decolonising the skin of S. aureus whilst treating atopic dermatitis. The impact of heavily diluting these topical medicinal products, to differing extents, on formulation performance is not well understood thus was investigated in this study. Following a single application of a range of compounded Aron mixes (fusidic acid and betamethasone dipropionate diluted to varying extents in an emollient base), significant reductions in the expected drug flux across silicone membrane, ex vivo percutaneous absorption and skin retention of both drugs relative to the marketed products were observed. This was attributed to a number of complex formulation effects making such changes difficult to predict in a clinical setting. Further investigations are required to evaluate the impact of frequent applications of the Aron mix to widespread areas on clinical efficacy, antimicrobial resistance and long term side effects.Peer reviewe

Easy to Swallow “Instant” Jelly Formulations for Sustained Release Gliclazide Delivery

© 2020 The Authors. Published by Elsevier Inc. on behalf of the American Pharmacists Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).It is a challenge to safely administer sustained release medicines to patients with dysphagia. Sustained release tablets must not be crushed and multiparticulates with large particle sizes cause gritiness reducing patient acceptability. The aim of this study was to develop “instant” jellies as delivery vehicles incorporating sustained release microparticles for patients with dysphagia. Dry powder mixtures containing gelling agents such as sodium alginate and calcium ions were hydrated in 20 mL of water and formed a jelly texture within 10 min. The “instant” jellies demonstrated comparable properites to commercial “read-to-eat” jellies in appearance, rheological/textural properties and in vitro swallowing performance in an artificial throat model. Gliclazide sustained release microparticles were produced by fluidized bed coating using Eudragit® NM 30 D and achieved 99% production yield and final coated particle size (D50) of 198 4.3 µm. Sustained gliclazide release was achieved over 15 h and the incorporation of the particles into the jellies significantly decreased the drug release rate. This novel drug delivery system offers a patient-centric solution to the long-standing challenge of administering sustained release medicines to patients with dysphagia and can potentially be used for paediatric patients.Peer reviewe

Rationalising polymer selection for supersaturated film forming systems produced by an aerosol spray for the transdermal delivery of methylphenidate

Film forming systems offer a number of advantages for topical and transdermal drug delivery, in particular enabling production of a supersaturated state which can greatly improve drug absorption and bioavailability. However the suitability of individual film forming polymers to stabilise the supersaturated state and optimise delivery of drugs is not well understood. This study reports the use of differential scanning calorimetry (DSC) to measure the solubility of methylphenidate both as the free base and as the hydrochloride salt in two polymethacrylate copolymers, Eudragit RS (EuRS) and Eudragit E (EuE) and relates this to the ability of films formed using these polymers to deliver methylphenidate across a model membrane. EuRS provided greater methylphenidate delivery when the drug was formulated as the free base in comparison EuE because the lower solubility of the drug in EuRS provided a higher degree of drug saturation in the polymeric film. In contrast EuE provided greater delivery of methylphenidate hydrochloride as EuRS could not prevent its crystallisation from a supersaturated state. Methylphenidate flux across the membrane could be directly related to degree of saturation of the drug in the film formulation as estimated by the drug solubility in the individual polymers demonstrating the importance of drug solubility in the polymer included in film forming systems for topical/transdermal drug delivery. In addition DSC has been demonstrated to be a useful tool for determining the solubility of drugs in polymers used in film forming systems and the approaches outlined here are likely to be useful for predicting the suitability of polymers for particular drugs in film forming transdermal drug delivery systems

Acute effect of repeated sprints on inter-limb asymmetries during unilateral jumping

The aim of the present study was to investigate the effects of multiple repeated sprints on unilateral jump performance and inter-limb asymmetries. Eighteen recreationally active males performed three single leg countermovement jumps (SLCMJ) as baseline data. The repeated sprint protocol was 6 x 40 m with 20 seconds of passive rest between each sprint. This protocol was conducted four times, each set separated by four minutes of rest. Within that rest period, subjects performed one SLCMJ on each limb after two minutes of rest. A one-way ANOVA showed significant reductions (p < 0.05; ES = -0.52 to -0.99) in jump height on both limbs after each set relative to baseline. Inter-limb asymmetries increased at each time point and ranged from 7.62-14.67%, with significant increases in asymmetry seen after sets three (p = 0.046) and four (p = 0.002). Significant increases in sprint time were shown between sprints one and six in each set (p ≤ 0.01). A fatigue index (%) was also calculated and showed an exponential increase from 5.74% (set one) to 13.50% (set four), with significant differences between all sets (p < 0.001) with the exception of sets three and four. Results from this study show that a 6 x 40 m repeated sprint protocol is a sufficient dose for implementing acute fatigue in recreationally active subjects. This was manifested by reductions in jump height at all time points and jump height asymmetries after the third and fourth sets. These findings indicate that jump height from unilateral jump testing may be a useful metric to use during the monitoring process in recreationally trained athletes