Satisfaction survey for a medication management program : satisfaction guaranteed?

BACKGROUND Providing clinical pharmacy services to patients in their homes after discharge from hospital has been reported to reduce health care costs and improve outcomes. The Medication Management Program of the Fraser Health Authority involves pharmacists making home visits to provide clinical pharmacy services to elderly patients who have recently been discharged from hospital and others considered to be at high risk for adverse drug events. Although clinical and economic outcomes of this program have been evaluated, humanistic outcomes such as satisfaction have not been assessed. Moreover, very little evaluation of patient satisfaction with home pharmacy services has been reported in the literature. OBJECTIVE To evaluate patient satisfaction with the Medication Management Program. METHODS A telephone survey instrument, consisting of 7 Likert-scale items and 2 open-ended questions, was developed and administered to patients who received a home pharmacist visit between September 1 and November 23, 2011. In addition to the survey responses, demographic and clinical data for both respondents and nonrespondents were collected. RESULTS Of the 175 patients invited to participate in the survey, 103 (58.9%) agreed to participate. The majority of respondents agreed or strongly agreed with all of the survey items, indicating satisfaction with the program. For example, 97 (94%) agreed or strongly agreed that they would recommend the pharmacist home visit program continue to be available, and all 103 (100%) agreed or strongly agreed that they were satisfied with the pharmacist home visit. Respondents provided some suggestions for program improvement. CONCLUSIONS The survey findings demonstrate that patients were satisfied with the home clinical pharmacy services offered through the Fraser Health Medication Management Program.

Comparing methods for modelling spreading cell fronts

Spreading cell fronts play an essential role in many physiological processes. Classically, models of this process are based on the Fisher-Kolmogorov equation; however, such continuum representations are not always suitable as they do not explicitly represent behaviour at the level of individual cells. Additionally, many models examine only the large time asymptotic behaviour, where a travelling wave front with a constant speed has been established. Many experiments, such as a scratch assay, never display this asymptotic behaviour, and in these cases the transient behaviour must be taken into account. We examine the transient and asymptotic behaviour of moving cell fronts using techniques that go beyond the continuum approximation via a volume-excluding birth-migration process on a regular one-dimensional lattice. We approximate the averaged discrete results using three methods: (i) mean-field, (ii) pair-wise, and (iii) one-hole approximations. We discuss the performace of these methods, in comparison to the averaged discrete results, for a range of parameter space, examining both the transient and asymptotic behaviours. The one-hole approximation, based on techniques from statistical physics, is not capable of predicting transient behaviour but provides excellent agreement with the asymptotic behaviour of the averaged discrete results, provided that cells are proliferating fast enough relative to their rate of migration. The mean-field and pair-wise approximations give indistinguishable asymptotic results, which agree with the averaged discrete results when cells are migrating much more rapidly than they are proliferating. The pair-wise approximation performs better in the transient region than does the mean-field, despite having the same asymptotic behaviour. Our results show that each approximation only works in specific situations, thus we must be careful to use a suitable approximation for a given system, otherwise inaccurate predictions could be made.

Global analysis of serum microRNAs as potential biomarkers for lung adenocarcinoma

Early diagnosis and the ability to predict the most relevant treatment option for individuals is essential to improve clinical outcomes for non-small cell lung cancer (NSCLC) patients. Adenocarcinoma (ADC), a subtype of NSCLC, is the single biggest cancer killer and therefore an urgent need to identify minimally invasive biomarkers to enable early diagnosis. Recent studies, by ourselves and others, indicate that circulating miRNA s have potential as biomarkers. Here we applied global profiling approaches in serum from patients with ADC of the lung to explore if miRNA s have potential as diagnostic biomarkers. This study involved RNA isolation from 80 sera specimens including those from ADC patients (equal numbers of stages 1, 2, 3, and 4) and age- and gender-matched controls (n = 40 each). Six hundred and sixty-seven miRNA s were co-analyzed in these specimens using TaqMan low density arrays and qPCR validation using individual miRNA s. Overall, approximately 390 and 370 miRNA s were detected in ADC and control sera, respectively. A group of 6 miRNA s, miR-30c-1* (AU C = 0.74; P < 0.002), miR-616(AU C = 0.71; P = 0.001), miR-146b-3p (AU C = 0.82; P < 0.0001), miR-566 (AU C = 0.80; P < 0.0001), miR-550 (AU C = 0.72; P = 0.0006), and miR-939 (AU C = 0.82; P < 0.0001) was found to be present at substantially higher levels in ADC compared with control sera. Conversely, miR-339-5p and miR-656 were detected at substantially lower levels in ADC sera (co-analysis resulting in AU C = 0.6; P = 0.02). Differences in miRNA profile identified support circulating miRNA s having potential as diagnostic biomarkers for ADC. More extensive studies of ADC and control serum specimens are warranted to independently validate the potential clinical relevance of these miRNA s as minimally invasive biomarkers for ADC.

Exploring retinal markers of diabetic neuropathy

Purpose To investigate the application of retinal nerve fibre layer (RNFL) thickness as a marker for severity of diabetic peripheral neuropathy (DPN) in people with Type 2 diabetes. Methods This was a cross-sectional study whereby 61 participants (mean age 61 [41-75 years], mean duration of diabetes 14 [1-40 years], 70% male) with Type 2 diabetes and DPN underwent optical coherence tomography (OCT) scans. Global and 4 quadrant (TSNI) RNFL thicknesses were measured at 3.45mm around the optic nerve head of one eye. Neuropathy disability score (NDS) was used to assess the severity of DPN on a 0 to 10 scale. Participants were divided into three age-matched groups representing mild (NDS=3-5), moderate (NDS=6-8) and severe (NDS=9-10) neuropathy. Two regression models were fitted for statistical analysis: 1) NDS scores as co-variate for global and quadrant RNFL thicknesses, 2) NDS groups as a factor for global RNFL thickness only. Results Mean (SD) RNFL thickness (µm) was 103(9) for mild neuropathy (n=34), 101(10) for moderate neuropathy (n=16) and 95(13) in the group with severe neuropathy (n=11). Global RNFL thickness and NDS scores were statistically significantly related (b=-1.20, p=0.048). When neuropathy was assessed across groups, a trend of thinner mean RNFL thickness was observed with increasing severity of neuropathy; however, this result was not statistically significant (F=2.86, p=0.065). TSNI quadrant analysis showed that mean RNFL thickness reduction in the inferior quadrant was 2.55 µm per 1 unit increase in NDS score (p=0.005). However, the regression coefficients were not statistically significant for RNFL thickness in the superior (b=-1.0, p=0.271), temporal (b=-0.90, p=0.238) and nasal (b=-0.99, p=0.205) quadrants. Conclusions RNFL thickness was reduced with increasing severity of DPN and the effect was most evident in the inferior quadrant. Measuring RNFL thickness using OCT may prove to be a useful, non-invasive technique for identifying severity of DPN and may also provide additional insight into common mechanisms for peripheral neuropathy and RNFL damage.

An overview of the role of goethite surfaces in the environment

Goethite, one of the most thermodynamically stable iron oxides, has been extensively researched especially the structure (including surface structure), the adsorption capacity to anions, organic/organic acid (especially for the soil organic carbon) and cations in the natural environment and its potential application in environmental protection. For example, the adsorption of heavy metals by goethite can decrease the concentration of heavy metals in aqueous solution and immobilize; the adsorption to soil organic carbon can decrease the release of carbon and fix carbon. In this present overview, the possible physicochemical properties of the goethite surface contributing to the strong affinity of goethite to nutrients and contaminants in natural environment are reported. Moreover, these chemicals adsorbed by goethite were also summarized and the suggested adsorption mechanism for these adsorbates was elucidated, which will help us understand the role of goethite in natural environment and provide some information about goethite as an absorbent. In addition, the feasibility of goethite used as catalyst carrier and the precursor of NZVI was proposed for removal of environmental pollution.

Unintended consequences : satellite policy and Indigenous television

This article examines two instances of media policy involving satellite transmission and Indigenous television: the introduction of the Viewer Access Satellite Television (VAST) platform in 2010 and the introduction of AUSSAT in the mid-1980s. The government’s failure to provide community and Indigenous broadcasters with an access regime at the time of AUSSAT resulted in Australia’s first and only Indigenous commercial television licensee, Imparja. Over a quarter of a century later, Imparja now forms part of the joint-venture company that runs VAST, a key component of Australia’s digital switchover planning. During the passage of the legislative amendments required to establish VAST, the issue of access resurfaced – this time in relation to Australia’s national and community Indigenous television channels. The article recounts the events leading up to the 2010 Bill, and examines the intended and unintended consequences of satellite policy in relation to Indigenous media, including equalisation and transparency of government funding programs.

Features-pooling blind jpeg image steganalysis

In this research, we introduce a new blind steganalysis in detecting grayscale JPEG images. Features-pooling method is employed to extract the steganalytic features and the classification is done by using neural network. Three different steganographic models are tested and classification results are compared to the five state-of-the-art blind steganalysis.

Stepwise engineering of a Pichia pastoris D-amino acid oxidase whole cell catalyst

Trigonopsis variabilis D-amino acid oxidase (TvDAO) is a well characterized enzyme used for cephalosporin C conversion on industrial scale. However, the demands on the enzyme with respect to activity, operational stability and costs also vary with the field of application. Processes that use the soluble enzyme suffer from fast inactivation of TvDAO while immobilized oxidase preparations raise issues related to expensive carriers and catalyst efficiency. Therefore, oxidase preparations that are more robust and active than those currently available would enable a much broader range of economically viable applications of this enzyme in fine chemical syntheses. A multi-step engineering approach was chosen here to develop a robust and highly active Pichia pastoris TvDAO whole-cell biocatalyst. As compared to the native T. variabilis host, a more than seven-fold enhancement of the intracellular level of oxidase activity was achieved in P. pastoris through expression optimization by codon redesign as well as efficient subcellular targeting of the enzyme to peroxisomes. Multi copy integration further doubled expression and the specific activity of the whole cell catalyst. From a multicopy production strain, about 1.3 x 103 U/g wet cell weight (wcw) were derived by standard induction conditions feeding pure methanol. A fed-batch cultivation protocol using a mixture of methanol and glycerol in the induction phase attenuated the apparent toxicity of the recombinant oxidase to yield final biomass concentrations in the bioreactor of >or= 200 g/L compared to only 117 g/L using the standard methanol feed. Permeabilization of P. pastoris using 10% isopropanol yielded a whole-cell enzyme preparation that showed 49% of the total available intracellular oxidase activity and was notably stabilized (by three times compared to a widely used TvDAO expressing Escherichia coli strain) under conditions of D-methionine conversion using vigorous aeration. Stepwise optimization using a multi-level engineering approach has delivered a new P. pastoris whole cell TvDAO biocatalyst showing substantially enhanced specific activity and stability under operational conditions as compared to previously reported preparations of the enzyme. The production of the oxidase through fed-batch bioreactor culture and subsequent cell permeabilization is high-yielding and efficient. Therefore this P. pastoris catalyst has been evaluated for industrial purposes.

Generation of two isomers of C5H from the corresponding anions. A theoretically motivated mass spectrometric study

Molecular orbital calculations have predicted the stability of a range of connectivities for the radical C5H potential surface. The most energetically favorable of these include the linear C4CH geometry and two ring-chain structures HC2C3 and C2C3H The corresponding anions are also shown to be theoretically stable, and furthermore, a fourth isomer, C2CHC2, is predicted to be the most stable anion connectivity. These results have motivated experimental efforts. Methodologies for the generation of the non-ring-containing isomeric anions C4CH and C2CHC2 have been developed utilizing negative ion mass spectrometry. The absolute connectivities of the anions have been established using deuterium labeling, charge reversal, and neutralization reionization techniques. The success of the latter experiment confirms theoretical predictions of stability of the corresponding neutral species. This is the first reported observation of the neutral C2CHC2 species that calculations predict to be substantially less stable than the C4CH connectivity but still bound relative to isomerization processes.

Nonlinear container ship model for the study of parametric roll resonance

Parametric roll is a critical phenomenon for ships, whose onset may cause roll oscillations up to +-40 degrees, leading to very dangerous situations and possibly capsizing. Container ships have been shown to be particularly prone to parametric roll resonance when they are sailing in moderate to heavy head seas. A Matlab/Simulink parametric roll benchmark model for a large container ship has been implemented and validated against a wide set of experimental data. The model is a part of a Matlab/Simulink Toolbox (MSS, 2007). The benchmark implements a 3rd-order nonlinear model where the dynamics of roll is strongly coupled with the heave and pitch dynamics. The implemented model has shown good accuracy in predicting the container ship motions, both in the vertical plane and in the transversal one. Parametric roll has been reproduced for all the data sets in which it happened, and the model provides realistic results which are in good agreement with the model tank experiments.

Walled gardens

The most significant recent development in scholarly publishing is the open-access movement, which seeks to provide free online access to scholarly literature. Though this movement is well developed in scientific and medical disciplines, American law reviews are almost completely unaware of the possibilities of open-access publishing models. This Essay explains how open-access publishing works, why it is important, and makes the case for its widespread adoption by law reviews. It also reports on a survey of law review publication policies conducted in 2004. This survey shows, inter alia, that few law reviews have embraced the opportunities of open-access publishing, and many of the top law reviews are acting as stalking horses for the commercial interests of legal database providers. The open-access model promises greater access to legal scholarship, wider readership for law reviews, and reputational befits for law reviews and the law schools that house them. This Essay demonstrates how open access comports with the institutional aims of law schools and law reviews, and is better suited to the unique environment of legal publishing than the model that law reviews currently pursue. Moreover, the institutional structure of law reviews means that it is possible that the entire corpus of law reviews could easily move to an open-access model, making law the first discipline with a realistic prospect of complete commitment to free, open access to all scholarly output.

Simultaneous expression of the bacterial Dictyoglomus thermophilum xynB gene under three different Trichoderma reesei promoters

Multiple copies of expression cassettes driven by the Trichoderma reesei xylanase 2 (xyn2) and cellobiohydrolase 2 (cbh2) promoters were introduced into the recombinant T. reesei EC-21 generated to express a thermostable Dictyoglomus thermophilum xylanase (XynB) under the egl2 promoter for further improvement of the enzyme yield. The transformants were screened based on increased XynB activity only. Multiple promoter transformant MPP-4 expressing the xynB gene under all the three promoters was found to be the highest producer of XynB, giving a 65% increase in yield compared to the parental single-promoter recombinant EC-21. The multiple-promoter transformant strains harboured six to nine copies of the xynB gene. Amongst the three promoters, egl2 seemed to have the strongest effect on XynB expression. The shotgun approach we used proved to be effective for rapid enhancement of protein expression using three promoters active at the near-neutral pH of the cultivation medium.

Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain

This study determined differences between computer workers with varying levels of neck pain in terms of work stressors, employee strain, electromyography (EMG) amplitude and heart rate response to various tasks. Participants included 85 workers (33, no pain; 38, mild pain; 14, moderate pain) and 22 non-working controls. Work stressors evaluated were job demands, decision authority, and social support. Heart rate was recorded during three tasks: copy-typing, typing with superimposed stress and a colour word task. Measures included electromyography signals from the sternocleidomastoid (SCM), anterior scalene (AS), cervical extensor (CE) and upper trapezius (UT) muscles bilaterally. Results showed no difference between groups in work stressors or employee strain measures. Workers with and without pain had higher measured levels of EMG amplitude in SCM, AS and CE muscles during the tasks than controls (all P < 0.02). In workers with neck pain, the UT had difficulty in switching off on completion of tasks compared with controls and workers without pain. There was an increase in heart rate, perceived tension and pain and decrease in accuracy for all groups during the stressful tasks with symptomatic workers producing more typing errors than controls and workers without pain. These findings suggest an altered muscle recruitment pattern in the neck flexor and extensor muscles. Whether this is a consequence or source of the musculoskeletal disorder cannot be determined from this study. It is possible that workers currently without symptoms may be at risk of developing a musculoskeletal disorder.

Generation of two isomers of C5H from the corresponding anions. A theoretically motivated mass spectrometric study

Molecular orbital calculations have predicted the stability of a range of connectivities for the radical C5H potential surface. The most energetically favorable of these include the linear C4CH geometry and two ring-chain structures HC2C3 and C2C3H The corresponding anions are also shown to be theoretically stable, and furthermore, a fourth isomer, C2CHC2, is predicted to be the most stable anion connectivity. These results have motivated experimental efforts. Methodologies for the generation of the non-ring-containing isomeric anions C4CH and C2CHC2 have been developed utilizing negative ion mass spectrometry. The absolute connectivities of the anions have been established using deuterium labeling, charge reversal, and neutralization reionization techniques. The success of the latter experiment confirms theoretical predictions of stability of the corresponding neutral species. This is the first reported observation of the neutral C2CHC2 species that calculations predict to be substantially less stable than the C4CH connectivity but still bound relative to isomerization processes.

Mediators of physical activity behavior change among women with young children

Background Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior. Design Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations. Main Outcome Measures Adequate physical activity (PA), self-efficacy (SE) and partner support (PS). Results: Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05–2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17–2.94) and PS (OR=2.29, CI=1.46–3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76–2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change. Conclusions The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.