Prescription Drugs in Nursing Homes: Managing Costs and Quality in a Complex Environment

This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives

Methods of Measuring Lock-In Strength and their Application to the Case of Flow over a Cavity Locking into a Single Side Branch Resonator

Lock-in is a non-linear interaction between a flow induced noise source and a resonator when their respective frequencies are near each other. Lock-in has been reported under many different labels and for many different applications. There is a need however for a consistent community wide method to measure the strength of lock-in so that data from different tests and different source/resonator combinations can be compared. This paper discusses three methods for measuring lock-in strength. The first, Resonant Response Method, (RRM) subtracts (in the decibel scale) the linear modal response of the resonator to broadband (BB) flow noise from the resonant response when lock-in occurs. The second, Quality Factor Method (QFM) tracks the change in quality factor of the resonant response. The third defines the strength in terms of the difference between peak response and the local BB levels. The RRM is applied to a fundamental test in water of a weak source from grazing flow over a cavity locking into acoustic resonant modes of a single side branch resonator. The major velocity effects are captured in the resonant response to BB flow and not in lock-in strength. However, Strouhal stage number and modal damping is shown to have a significant impact on strength. For two modes, strength versus flow rate using the RRM is compared to strengths obtained using the QFM; on a decibel scale the results are shown to be within experimental uncertainty. However, the QFM is noticeably more difficult to apply. The author recommends the use of the Resonant Response Method as the most tractable measure of lock-in strength

Tunable Fiber‐Cavity Enhanced Photon Emission from Defect Centers in hBN

Realization of quantum photonic devices requires coupling single quantum emitters to the mode of optical resonators. In this work, a hybrid system consisting of defect centers in few-layer hexagonal boron nitride (hBN) grown by chemical vapor deposition and a fiber-based Fabry–Pérot cavity is presented. The sub 10-nm thickness of hBN and its smooth surface enable efficient integration into the cavity mode. This hybrid platform is operated over a broad spectral range larger than 30 nm and its tuneability is used to explore different coupling regimes. Consequently, very large cavity-assisted signal enhancement up to 50-fold and strongly narrowed linewidths are achieved, which is owing to cavity funneling, a record for hBN-cavity systems. Additionally, an excitation and readout scheme is implemented for resonant excitation that allows to establish cavity-assisted photoluminescence excitation (PLE) spectroscopy. This work marks an important milestone for the deployment of 2D materials coupled to fiber-based cavities in practical quantum technologies

Lifting the Anterior Midcheek and Nasolabial Fold:Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

BACKGROUND: A limitation of current facelift techniques is the early postoperative reappearance of anterior midcheek laxity associated with recurrence of the nasolabial fold (NLF).OBJECTIVES: This study was undertaken to examine the regional anatomy of the anterior midcheek and NLF with a focus on explaining the early recurrence phenomenon and to explore the possibility of alternative surgical methods that prolong NLF correction.METHODS: Fifty cadaver heads were studied (16 embalmed, 34 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT. Mechanical testing of the melo fat pad (MFP) and skin was performed to gain insight on which structure is responsible for transmission of the lifting tension in a composite facelift procedure.RESULTS: Anatomical dissections, sheet plastination and micro-CT demonstrated the three-dimensional architecture and borders of the MFP. Histology of a lifted midcheek demonstrated that a composite MFP lift causes a change in connective tissue organization from a hanging-down pattern into a pulled upward pattern suggesting traction on the skin. Mechanical testing confirmed that, in a composite lift, despite the sutures being placed directly into the deep aspect of the MFP, the lifting tension distal to the suture is transmitted through the skin and not through the MFP.CONCLUSIONS: As a composite midcheek lift is usually performed, it is the skin and not the MFP itself, that bears the load of the non-dissected tissues distal to the lifting suture. For this reason, early recurrence of the NLF occurs following skin relaxation in the postoperative period. Accordingly, specific surgical procedures for remodeling the MFP should be explored, possibly in combination with volume restoration of the fat and bone, for more lasting improvement of the NLF.</p

Low dose CT vs plain abdominal radiography for the investigation of the acute abdomen

Background: To compare low-dose abdominal computed tomography (LDCT) with plain abdominal radiography (AR) in the primary investigation of acute abdominal pain to determine if there is a difference in diagnostic yield, the number of additional investigations required and hospital length of stay (LOS). Methods: This randomized controlled trial was approved by the institutional review board, and informed consent was obtained. Patients presenting to the emergency department with an acute abdomen and who would normally be investigated with AR were randomized to either AR or LDCT. The estimated radiation dose of the LDCT protocol was 2–3 mSv compared to 1.1 mSv for AR. Pearson\u27s chi-square and the independent samples t-test were used for the statistical analysis. Results: A total of 142 patients were eligible, and after exclusions and omitting those with incomplete data, 55 patients remained for analysis in the AR arm and 53 in the LDCT arm. A diagnosis could be obtained in 12 (21.8%) patients investigated with AR compared to 34 (64.2%) for LDCT (P \u3c 0.001). Twenty-eight (50.9%) patients in the AR group required further imaging during their admission compared to 14 (26.4%) in the LDCT group (P= 0.009). There was no difference in the median hospital LOS (3.84 days for AR versus 4.24 days for LDCT, P= 0.83). Conclusion: LDCT demonstrates a superior diagnostic yield over AR and reduces the number of subsequent imaging tests for a minimal cost in radiation exposure. However, there is no difference in the overall hospital LOS between the two imaging strategies

COVID-19 among adults living with HIV:correlates of mortality among public sector healthcare users in Western Cape, South Africa

Abstract Introduction While a large proportion of people with HIV (PWH) have experienced SARS‐CoV‐2 infections, there is uncertainty about the role of HIV disease severity on COVID‐19 outcomes, especially in lower‐income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. Methods We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS‐CoV‐2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID‐19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first‐diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID‐19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized

Ferumoxytol for the treatment of iron deficiency and iron-deficiency anemia of pregnancy.

Introduction: A litany of recent evidence supports the morbidity of intra-natal iron-deficiency anemia and its prodrome, iron deficiency. Oral iron administered during second and third trimesters does not get to the developing fetus if the mother is iron deficient. This is especially concerning as the rapidly developing fetal brain is in particular need of iron sufficiency. Intra-natal iron deficiency is associated with autism, schizophrenia and abnormal brain structure. The obstetrical literature reports an unacceptably high incidence of gastrointestinal adverse events with oral iron. The time iron honored standard in the United States for intravenous iron replenishment in gravidas is iron sucrose. While safe and effective, four to seven visits are required to accomplish what newer formulations can achieve with one. Methods: Ferumoxytol is a superparamagnetic iron oxide linked to polyglucose sorbitol carboxymethylether-binding elemental iron tightly allowing administration of complete replacement doses in 15-30 min. Herein, we report the results of 131 consecutive, non-selected, iron-deficient second- and third-trimester pregnant women who received either 510 mg of intravenous (IV) ferumoxytol twice or 1020 mg once. Results: Hemoglobin and iron parameter increments were highly statistically significant. No adverse events were reported. We report how a single infusion is safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. Conclusion: Ferumoxytol represents an efficacious and safe method of administration of IV iron which improves convenience for patients and practitioners, and is cost saving due to fewer visits. Plain language summary: One or two infusions of intravenous iron for iron deficiency or iron-deficiency anemia of pregnancy simplifies careThis study was conducted to highlight the inconvenience of multiple doses of IV iron and how administering the same dose in one or two infusions simplifies care. We report how a single infusion is as safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. This study supports a growing body of evidence, to date, unreported, with ferumoxytol in pregnancy, reporting improved convenience and decreased costs with higher doses of IV iron in one or two visits

The Lantern Vol. 28, No. 2, Spring 1961

• A New Bedlam • A Priori • Germ Warfare • Verse for a Sympathy Card • On Lamartine\u27s Crucifix • On Art • Hope • Hymn to the Morning • An Educator Speaks • Come Out • Insemination • A Day\u27s Hope • Laura • Walking Together • 20 September 1960 • 15 October 1960 • The Governor\u27s Dog • One of the Gang • Poem • Knowledge is Freedom • To Conservative Child • Seventeen American Skating Careers at the Zenithhttps://digitalcommons.ursinus.edu/lantern/1080/thumbnail.jp