Adherence to medicines in the older-aged with chronic conditions : does an intervention concerning adherence by an allied health professional help?

Adherence to medicines is a major determinant of the effectiveness of medicines. However, estimates of non-adherence in the older-aged with chronic conditions vary from 40 to 75%. The problems caused by non-adherence in the older-aged include residential care and hospital admissions, progression of the disease, and increased costs to society. The reasons for non-adherence in the older-aged include items related to the medicine (e.g. cost, number of medicines, adverse effects) and those related to person (e.g. cognition, vision, depression). It is also known that there are many ways adherence can be increased (e.g. use of blister packs, cues). It is assumed that interventions by allied health professions, including a discussion of adherence, will improve adherence to medicines in the older aged but the evidence for this has not been reviewed. There is some evidence that telephone counselling about adherence by a nurse or pharmacist does improve adherence, short- and long-term. However, face-to-face intervention counselling at the pharmacy, or during a home visit by a pharmacist, has shown variable results with some studies showing improved adherence and some not. Education programs during hospital stays have not been shown to improve adherence on discharge, but education programs for subjects with hypertension have been shown to improve adherence. In combination with an education program, both counselling and a medicine review program have been shown to improve adherence short-term in the older-aged. Thus, there are many unanswered questions about the most effective interventions to promote adherence. More studies are needed to determine the most appropriate interventions by allied health professions, and these need to consider the disease state, demographics, and socio-economic status of the older-aged subject, and the intensity and duration of intervention needed.

Spatially offset Raman spectroscopy (SORS) for the analysis and detection of packaged pharmaceuticals and concealed drugs

Spatially offset Raman spectroscopy (SORS) is a powerful new technique for the non-invasive detection and identification of concealed substances and drugs. Here, we demonstrate the SORS technique in several scenarios that are relevant to customs screening, postal screening, drug detection and forensics applications. The examples include analysis of a multi-layered postal package to identify a concealed substance; identification of an antibiotic capsule inside its plastic blister pack; analysis of an envelope containing a powder; and identification of a drug dissolved in a clear solvent, contained in a non-transparent plastic bottle. As well as providing practical examples of SORS, the results highlight several considerations regarding the use of SORS in the field, including the advantages of different analysis geometries and the ability to tailor instrument parameters and optics to suit different types of packages and samples. We also discuss the features and benefits of SORS in relation to existing Raman techniques, including confocal microscopy, wide area illumination and the conventional backscattered Raman spectroscopy. The results will contribute to the recognition of SORS as a promising method for the rapid, chemically-specific analysis and detection of drugs and pharmaceuticals.

Phytophotodermatitis : case reports of children presenting with blistering after preparing lime juice

Letter to the Editor We read with interest the case report entitled ‘‘Contact with fig tree sap: An unusual cause of burn injury’’ by Mandalia et al. [1] and would like to report our similar experience with phytophotodermatitis caused by lime juice. Phototoxic dermatitis is understandably easily confused with a burn, particularly when a patient presents with large blisters of unknown mechanism. At the Royal Children’s Hospital Burns Centre, this injury was treated in the same manner as a burn and is described here...

Transmittance properties of contact lens multipurpose solutions and their effects on a hydrogel lens

Purpose The aim was to assess the compatibility of different multipurpose solutions (MPSs) with one type of silicone hydrogel (SiH) contact lens by, assessing the changes in both ultraviolet (UV) and visible light transmissibility of the hydrogel lens caused by the MPSs. Methods The light transmittance from 200-700 nm were measured for the lotrafilcon B blister pack solution (BPS), six MPSs namely, ReNuMultiPlus Multi-Purpose Solution (Bausch and Lomb Inc., Rochester NY, USA.); Complete RevitaLens Multi-Purpose (Abbott Medical Optics Inc., Quarryvale Co. Dublin, Ireland); All In One Light (Sauflon Pharmaceuticals Ltd., Twickenham, England); SOLO-care AQUA™ (Ciba Vision Corporation Duluth, Georgia, USA.); Biomedics All-in-one solution (CooperVision, Hamble, UK); and HippiaMultiPlus All-in-one solution (Interojo Inc., Kyeonggi-do, Korea), and a lotrafilcon B SiH lens (before and after storage), using a spectrophotometer. Results The UV transmitted through the BPS and the MPS were similar (p >.05, for all), except for the HippiaMultiPlus which was lower (p < 0.001) by 19.8%. Mean transparency values were statistically (p<.001) significantly different between the BPS and the MPSs. All MP solution/SiH lens combinations resulted in relatively high UV transmittance values especially in the UVC spectrum, and significantly increased (p <.001) the visible light transmittance values of the SiH lens. Greater changes in transparency were observed in the ReNu/SiH lens (28.5%) and the Complete RevitaLens/SiH lens (24.9%) combinations. Conclusion The six MPSs showed significant variations in the transmitted UV and visible light. Similar to the BPS, all MPSs were equally transparent, but showed very poor UVA & UVB attenuation, except for the Hippia MultiPlus. The MPS/SiH lens combinations did not significantly affect the lens transparency but it significant increased the lens transmittance of UV radiation, after storage. Further in-vivo studies are needed to validate if this effect is constant.

Influence of Corymbia hybridisation on crown damage by three arthropod herbivores.

Three common pests (eucalypt tortoise beetle Paropsis atomaria, leaf blister sawfly Phylacteophaga froggatti and eriophyid mites) of commercial spotted gum plantations were assessed for their crown damage levels on parent and hybrid Corymbia taxa ( Corymbia torelliana, C. citriodora subsp. variegata and their hybrid) at three common-garden field sites. Damage levels differed significantly between sites for all three herbivore species, and between taxa for eriophyid mites and P. atomaria. However, herbivore response to hybridisation only differed for P. atomaria between sites, even where damage levels did not. Hybrids exhibited three common patterns of susceptibility relative to parent taxa, being most commonly intermediate to their parents for crown damage (additive resistance pattern), or no difference between parents and hybrids, or with one incidence of dominance for susceptibility.

Corymbia leaf oils, latitude, hybrids and herbivory: a test using common-garden field trials

Foliar oils, particularly monoterpenes, can influence the susceptibility of plants to herbivory. In plants, including eucalypts, monoterpenes are often associated with plant defence. A recent analysis revealed an increase in foliar oil content with increasing latitudinal endemism, and we tested this pattern using three eucalypt taxa comprising a latitudinal replacement cline. We also examined the relative concentrations of two monoterpenes (alpha-pinene and 1,8-cineole), for which meta-analyses also showed latitudinal variation, using hybrids of these three taxa with Corymbia torelliana. These, and pure C. torelliana, were then assessed in common-garden field plots for the abundance and distribution of herbivory by four distinct herbivore taxa. Differing feeding strategies among these herbivores allowed us to test hypotheses regarding heritability of susceptibility and relationships to alpha-pinene and 1,8-cineole. We found no support for an increase in foliar oil content with increasing latitude, nor did our analysis support predictions for consistent variation in alpha-pinene and 1,8-cineole contents with latitude. However, herbivore species showed differential responses to different taxa and monoterpene contents. For example, eriophyid mites, the most monophagous of our censused herbivores, avoided the pure species, but fed on hybrid taxa, supporting hypotheses on hybrid susceptibility. The most polyphagous herbivore (leaf blister sawfly Phylacteophaga froggatti) showed no evidence of response to plant secondary metabolites, while the distribution and abundance patterns of Paropsis atomaria showed some relationship to monoterpene yields.

Topical tacrolimus in atopic dermatitis : Effects of long-term treatment on skin and respiratory symptoms

Objective: Patients with atopic dermatitis often have a poor long-term response to conventional topical or systemic treatments. Staphylococcal superinfections, skin atrophy due to corticosteroid use, and asthma and allergic rhinitis are common. Only a few, usually short-term, studies have addressed the effects of different treatments on these problems. Tacrolimus ointment is the first topical compound suitable for long-term treatment. The aim of this thesis was to evaluate the effects of long-term topical tacrolimus treatment on cutaneous staphylococcal colonization, collagen synthesis, and symptoms and signs of asthma and allergic rhinitis. Methods: Patients with moderate-to-severe atopic dermatitis were treated with intermittent 0.1% tacrolimus ointment in prospective, open studies lasting for 6 to 48 months. In Study I, cutaneous staphylococcal colonization was followed for 6 to 12 months. In Study II, skin thickness and collagen synthesis were followed by skin ultrasound and procollagen I and III propeptide concentrations of suction blister fluid samples for 12 to 24 months and compared with a group of corticosteroid-treated atopic dermatitis patients and with a group of healthy subjects. Study III was a cross-sectional study of the occurrence of respiratory symptoms, bronchial hyper-responsiveness, and sputum eosinophilia in atopic dermatitis patients and healthy controls. In Study V, the same parameters as in Study III were assessed in atopic dermatitis patients before and after 12 to 48 months of topical tacrolimus treatment. Study IV was a retrospective follow-up of the effect of tacrolimus 0.03% ointment on severe atopic blepharoconjunctivitis and conjunctival cytology. Results: The clinical response to topical tacrolimus was very good in all studies (p≤0.008). Staphylococcal colonization decreased significantly, and the effect was sustained throughout the study (p=0.01). Skin thickness (p<0.001) and markers of collagen synthesis (p<0.001) increased in the tacrolimus-treated patients significantly, whereas they decreased or remained unchanged in the corticosteroid-treated controls. Symptoms of asthma and allergic rhinitis (p<0.0001), bronchial hyper-responsiveness (p<0.0001), and sputum eosinophilia (p<0.0001) were significantly more common in patients with atopic dermatitis than in healthy controls, especially in subjects with positive skin prick tests or elevated serum immunoglobulin E. During topical tacrolimus treatment the asthma and rhinitis (p=0.005 and p=0.002) symptoms and bronchial hyper-responsiveness (p=0.02) decreased significantly, and serum immunoglobulin E and sputum eosinophils showed a decreasing trend in patients with the best treatment response. Treatment of atopic blepharoconjunctivitis resulted in a marked clinical response and a significant decrease in eosinophils, lymphocytes, and neutrophils in the conjunctival cytology samples. No significant adverse effects or increase in skin infections occurred in any study. Conclusions: The studies included in this thesis, except the study showing an increase in skin collagen synthesis in tacrolimus-treated patients, were uncontrolled, warranting certain reservations. The results suggest, however, that tacrolimus ointment has several beneficial effects in the long-term intermittent treatment of atopic dermatitis. Tacrolimus ointment efficiently suppresses the T cell-induced inflammation of atopic dermatitis. It has a normalizing effect on the function of the skin measured by the decrease in staphylococcal colonization. It does not cause skin atrophy as do corticosteroids but restores the skin collagen synthesis in patients who have used corticosteroids. Tacrolimus ointment has no marked systemic effect, as the absorption of the drug is minimal and decreases along with skin improvement. The effects on the airway: decrease in bronchial hyper-responsiveness and respiratory symptoms, can be speculated to be caused by the decrease in T cell trafficking from the skin to the respiratory tissues as the skin inflammation resolves, as well as inhibition of epicutaneous invasion of various antigens causing systemic sensitization when the skin barrier is disrupted as in atopic dermatitis. Patients with moderate-to-severe atopic dermatitis seem to benefit from efficient long-term treatment with topical tacrolimus.

The mechanical response of tetragonal zirconia polycrystal to conical indentation

Blocks of 3Y-TZP were indented with conical diamond indenters. indentation caused tetragonal to monoclinic phase transformation in a subsurface. Of the cracks generated in the subsurface, radial and lateral cracks can be accounted for by a continuum model of the indented subsurface, built using a combination of the Boussinesq and blister stress fields. Additional ring, median and cone cracks were also observed. It is hypothesized that the latter are motivated by the reduction in blister strength or residual energy brought about by the material damage caused by the phase transformation. This damage reduces the load bearing capacity of the material progressively with increasing normal load.

Estudo do impacto do descarte dos comprimidos de captopril no meio ambiente

O Captopril é um dos medicamentos anti-hipertensivos mais consumidos no Brasil. Constitui-se em um pó cristalino, branco ou levemente amarelado, com leve odor característico de sulfeto, facilmente solúvel em água, etanol, clorofórmio e metanol. Em soluções aquosas, o captopril sofre reação de oxidação, formando em quantidade crescente como produto de degradação o dímero dissulfeto de captopril. Além disso, no período de 24 horas, mais de 95% da dose absorvida é eliminada pela urina, sendo 40 a 50% na forma inalterada, e o restante na forma do dímero dissulfeto de captopril e de outros metabólitos, os quais são encaminhados para o esgoto, podendo assim atingir os corpos dágua. O presente trabalho foi planejado de maneira a estudar o impacto e o comportamento do medicamento e do seu produto de degradação em águas ambientais. Para isso, foi feita a validação do método analítico escolhido, cromatografia líquida de alta eficiência, que foi a ferramenta adequada para garantir a confiabilidade dos dados analíticos do método. Foi monitorada também a estabilidade do fármaco na forma de comprimidos e em solução aquosa, ao longo de 144 dias. Os resultados mostraram que quando os comprimidos de captopril são armazenados em sua embalagem original, nesse caso blister, a uma temperatura controlada igual a 40o C e umidade controlada igual a 75 %, eles permaneceram estáveis. A concentração de captopril apresentou uma média igual a 97,4 %. Por outro lado, quando diluído e armazenado nas mesmas condições de temperatura e umidade citadas anteriormente para a obtenção de uma solução aquosa na concentração igual a 1 mg/mL, a substância captopril chegou a variar de 95,7% a 68,5%. Já o seu produto de degradação, dissulfeto de captopril, atingiu um aumento na concentração de 1,7 para 31,1%, ambos em 144 dias

Thermodynamic model of hydrogen-induced silicon surface layer cleavage

A thermodynamic model of hydrogen-induced silicon surface layer splitting with the help of a bonded silicon wafer is proposed in this article. Wafer splitting is the result of lateral growth of hydrogen blisters in the entire hydrogen-implanted region during annealing. The blister growth rate depends on the effective activation energies of both hydrogen complex dissociation and hydrogen diffusion. The hydrogen blister radius was studied as a function of annealing time, annealing temperature, and implantation dose. The critical radius was obtained according to the Griffith energy condition. The time required for wafer splitting at the cut temperature was calculated in accordance with the growth of hydrogen blisters. (C) 2001 American Institute of Physics.

The effects of the annealing time on helium implantation in Si

The modifications induced in silicon samples by helium implantation before and after isothermal annealing at 673 K have been investigated. The surface morphology has been detected by atomic force microscopy. A hillock structure is observed on the sample surface before and after annealing for 5-10 min. Surface blister formation is observed with an increasing annealing time. The variation of crystal damage with annealing time has been investigated by Rutherford backscattering/channeling. The intensity of the damage peak first increases with annealing time, reaches maximum at an annealing time of 60 min and then decreases. Helium-induced bubbles and residual defects have been observed by transmission electron microscopy, which shows that dislocations are close to the bubbles. (C) 2010 Elsevier B.V. All rights reserved.

Studies on the texture, functionality, rheology and sensory properties of Cheddar and Mozzarella cheeses

The effect of fortification of skim milk powder and sodium caseinate on Cheddar cheeses was investigated. SMP fortification led to decreased moisture, increased yield, higher numbers of NSLAB and reduced proteolysis. The functional and texture properties were also affected by SMP addition and formed a harder, less meltable cheese than the control. NaCn fortification led to increased moisture, increased yield, decreased proteolysis and higher numbers of NSLAB. The functional and textural properties were affected by fortification with NaCn and formed a softer cheese that had similar or less melt than the control. Reducing the lactose:casein ratio of Mozzarella cheese by using ultrafiltration led to higher pH, lower insoluble calcium, lower lactose, galactose and lactic acid levels in the cheese. The texture and functional properties of the cheese was affected by varying the lactose:casein ratio and formed a harder cheese that had similar melt to the control later in ripening. The flavour and bake properties were also affected by decreased lactose:casein ratio; the cheeses had lower acid flavour and blister colour than the control cheese. Varying the ratio of αs1:β-casein in Cheddar cheese affected the texture and functionality of the cheese but did not affect insoluble calcium, proteolysis or pH. Increasing the ratio of αs1:β-casein led to cheese with lower meltability and higher hardness without adverse effects on flavour. Using camel chymosin in Mozzarella cheese instead of calf chymosin resulted in cheese with lower proteolysis, higher softening point, higher hardness and lower blister quantity. The texture and functional properties that determine the shelf life of Mozzarella were maintained for a longer ripening period than when using calf chymosin therefore increasing the window of functionality of Mozzarella. In summary, the results of the trials in this thesis show means of altering the texture, functional, rheology and sensory properties of Mozzarella and Cheddar cheeses.

Estudio de la incidencia de ampollas en el "trekking" y sus factores asociados

Objetivo: Determinar los factores asociados con la presencia de ampollas durante el senderismo. Método: La población de estudio fueron 1155 peregrinos que recibieron asistencia podológica. La información fue obtenida mediante una anamnesis y una exploración podológica. Los factores analizados fueron: edad, sexo, entrenamiento previo, nacionalidad, tipo de calzado, antigüedad del mismo y kilómetros realizados. Resultados: Las ampollas se encontraron en el 71,9 % de los peregrinos y se distribuyeron de manera similar en ambos pies, afectando principalmente el talón (20%) y el quinto dedo (14,6 %). Se encontró asociación con el sexo (p < 0,05). Las deportivas fueron las menos asociadas con ampollas (p = 0,03). No hubo relación significativa con el entrenamiento previo y el uso de calzado nuevo. Conclusiones: La incidencia de ampollas entre los senderistas fue del 80 %, y se asoció con el sexo (mayor en la mujer) y el tipo de calzado.

Interventions for late trabeculectomy bleb leak

BACKGROUND: Late trabeculectomy bleb leaks are a common complication after filtering glaucoma surgery. Although asymptomatic, late bleb leaks may lead to hypotony and are associated with bleb related infections.

OBJECTIVES: To assess the effects of interventions for late trabeculectomy bleb leak.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), MEDLINE (January 1946 to July 2012), EMBASE (January 1980 to July 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 18 July 2012.

SELECTION CRITERIA: We included randomised and quasi-randomised trials in which any treatments for eyes with late bleb leak (interventional and non-interventional) were compared with each other.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors when additional information was needed.

MAIN RESULTS: The review included one multicentre trial based in the USA with 30 eyes of 30 participants. The trial compared two surgical procedures (conjunctival advancement and amniotic membrane transplant) to cover a filtering bleb leak. Conjunctival advancement has been shown to be more effective in sealing filtering bleb leaks.

AUTHORS' CONCLUSIONS: Although a variety of treatments have been proposed for bleb leaks, there is no evidence of their comparative effectiveness.The evidence in this review was provided by a single trial that compared two surgical procedures (conjunctival advancement and amniotic membrane transplant). The trial did show a superiority of conjunctival advancement, which was regarded as standard treatment, to amniotic membrane transplantation. There is a need for more randomised trials to validate the findings of this single trial and provide more information on the different types of interventions, especially non-surgical treatments compared to surgical procedures. We recommend that any intervention should be compared to a standard procedure, which is to date conjunctival advancement.

TRANSHUMANCES, suivi de I ended up being my own trout (jeux de fragments avec Éric Plamondon)

Ce mémoire en recherche-création s’intéresse à la quête identitaire, et / ou au désir de tracer son propre chemin en réinterprétant les événements du passé. Le roman TRANSHUMANCES raconte le pèlerinage d’Alice sur la via Podiensis, qui relie la commune du Puy-en-Velay en France, à Santiago de Compostela en Espagne. Elle marche. Elle marche pour oublier, pour enterrer ses morts, pour avancer, ailleurs. Elle marche et fait de nombreuses rencontres. Par la conversation et la contemplation, elle tente d’apaiser les maux qui la rongent. Elle marche et apprivoise ce chemin mythique, mystique, cette route qui mène le croyant à la rencontre de Dieu et qui pousse l’impie à la rencontre de lui-même. Alice fait la connaissance de John. Ils se racontent des blagues et des secrets, partagent repas et larmes, deviennent frères d’ampoules et rentrent à la maison, changés. L’essai I ended up being my own trout (jeux de fragments avec Éric Plamondon) explore quant à lui à l’écriture fragmentaire, en s’intéressant particulièrement aux effets qu’opèrent les fragments sur la lecture. Éric Plamondon, avec sa trilogie 1984, utilise la forme fragmentaire afin de jouer avec le lecteur : il le fait douter de ses certitudes et le guide vers une vision manipulée de l’Histoire. Le lecteur est alors confronté à la pluralité des interprétations et doit s’imposer comme auteur de sa propre lecture.