As-needed Basis Research Articles

Prevalence and predictors of primary nonadherence to medications prescribed in primary care.

Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population. We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care. Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50-0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90-0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit. The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review.

The value of routine involvement of anesthesiologists during endovascular thrombectomy (EVT) for acute ischemic stroke has not been clearly demonstrated. At some institutions, anesthesiologists are involved only as needed, while at other institutions, anesthesiologists are involved from the beginning for every EVT. We retrospectively analyzed the workflow, intraprocedural variables and complications, and outcomes in acute ischemic stroke patients undergoing EVT at a comprehensive stroke center after implementation of routine involvement of an anesthesia team and compared this cohort with patients who received care from sedation-trained nurses working under the supervision of neurointerventionalists with the involvement of anesthesiologists on an as-needed basis. Routine involvement of anesthesiologists was associated with improved workflow performance measures, including decreased median door-to-arterial puncture time (68min; interquartile range (IQR), 15.5-94.5min vs. 81min; IQR, 53-104min; P =0.001), in-room to arterial puncture time (11min; IQR, 8-14min vs. 15min; IQR, 9-21min; P <0.0001), and procedure time (51min; IQR, 40-64min vs. 60min; IQR, 40-88.5min; P =0.007). It was also associated with a nonsignificant trend towards lower rates of desaturation events (8.2% vs. 3.4%; P =0.082) and lower rates of conversion to general anesthesia (1.7% vs. 0%; P =0.160). Ninety-day modified Rankin scores were similar regardless of provider type. Implementation of routine involvement of an anesthesia team during EVT was not associated with improved outcomes but was associated with improved efficiency and greater adherence to guidelines-based physiological parameters, supporting the routine involvement of anesthesiologists during EVT.

A Review of Comprehensive and Ethical Utilization of the Worlds Biomass Resources

In conventional practice, unprocessed biomass resources are transported to biorefineries where they undergo preprocessing to become feedstock before undergoing conversion into various products. The constant supply of biomass to biorefinery cannot be achieved on a just-in-time basis due to the fact that various forms of biomaterials, such as energy crops, logging residue, and agricultural residue, are harvested based on their cycle of development and optimum harvesting timeframe. Biomaterials are typically stored and subsequently transported to biorefineries on an as-needed basis. The current approach has resulted in various challenges concerning logistics, biomass degradation caused by fire and microorganisms, and irregular quality of feedstock as a result of the changing characteristics of the delivered biomass materials. This has been observed through previous encounters. The aforementioned factors have resulted in elevated feedstock expenses, reduced processing capacity, and diminished product output for biorefineries. The present study introduces a novel approach to tackle the challenges associated with conventional methods of biomass feedstock procurement, retention, and preliminary processing, as discussed earlier. This strategy comprises three fundamental elements: firstly, the conservation and preparation of biomass throughout its storage; secondly, the incorporation of all biomass components, even those typically deemed as refuse or impurities; and thirdly, the optimization of the worth of each component. The implementation of this novel methodology involves the establishment of feedstock preprocessing depots in close proximity to the sources of biomass production

Uncertainty-driven modality selection for data-efficient prediction of Alzheimer’s disease

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder. Early prediction of the risk of converting to AD for individuals at pre-dementia stages such as Mild Cognitive Impairment (MCI) is important. This could provide an opportunity for early intervention to slow down disease progression before significant irreversible neurodegeneration occurs. Neuroimaging datasets of different modalities such as MRI and PET have shown great promise. However, different data modalities are associated with varying acquisition costs/levels of accessibility to patients. We propose a machine learning (ML) framework, namely Uncertainty-driven Modality Selection (UMoS), that allows for sequentially adding data modalities for each patient on an as-needed basis, while at the same time achieving high prediction accuracy as if all the modalities were used. UMoS provides a tool to assist clinicians in deciding what data modalities/diagnostic exams each patient needs. We apply UMoS to a real-world dataset from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) based on demographic/clinical data, MRI, and PET. UMoS shows high accuracy for predicting MCI conversion to AD, which has no significant difference from models based on the simultaneous use of all the modalities for each patient. The benefit of UMoS is significant data efficiency accomplished by saving a large percentage of patients from needing to acquire more costly/less accessible data modalities, thus lessening the burden on patients and the healthcare system.

Futibatinib (Lytgobi®)

Futibatinib (Lytgobi®)

Influence of lesion location on lesion reactivation after initial treatment in neovascular age-related macular degeneration.

We aim to evaluate the factors associated with the incidence of lesion reactivation after initial loading injections in patients with neovascular age-related macular degeneration (AMD). This retrospective study included patients diagnosed with treatment-naïve neovascular AMD who received three loading injections of either ranibizumab or aflibercept. After the initial treatment, patients were followed up every 1-2 months during the first year and the follow-up interval was extended to 4 months during the second year. Retreatment was administered on an as-needed basis. The incidence and timing of lesion reactivation at 24 months after diagnosis were identified. In addition, Cox's proportional hazard model was used to evaluate the association of baseline factors with lesion reactivation. Lesion reactivation was defined re-accumulation of subretinal fluid/intraretinal fluid or the development of subretinal/intraretinal hemorrhage. A total of 284 patients (173 men and 111 women) were included in the study. The mean age of the patients was 70.5 ± 8.8 years. During the 24-month follow-up period, lesion reactivation was observed in 216 eyes (76.1%) at a mean of 8.2 ± 4.4 months after diagnosis. The incidence of lesion reactivation was 62.5% in extrafoveal macular neovascularization (MNV), 75.0% in juxtafoveal MNV, and 79.5% in subfoveal MNV. The extrafoveal MNV showed significantly lower incidence of lesion reactivation than subfoveal MNV (P = 0.041, hazard ratio = 0.64). Extrafoveal MNVs showed a lower incidence of lesion reactivation after initial treatment than subfoveal MNVs. This result should be considered when interpreting the results of clinical trials with different eligibility criteria regarding lesion location.

Changes in Production Practices Used for Disease Management in Blueberry Nurseries in Georgia, USA, Over a 15-year Period

Surveys of blueberry [rabbiteye blueberry (Vaccinium virgatum) and southern highbush blueberry (Vaccinium corymbosum interspecific hybrids)] nurseries in the State of Georgia, USA, were conducted in 2007 and 2022 to determine the prevalence of and associations among propagation practices, especially related to disease management. As indicated by the reduction in surveyed nurseries in 2022 (7) compared with 2007 (18), the Georgia blueberry nursery industry has consolidated. However, cultural disease management practices have generally improved in these remaining nurseries. In 2007, in nurseries where cuttings were grown in containers, 77.8% reused containers and 66.7% did not sterilize them before use. The growing medium [pine (Pinus sp.) bark] was reused for subsequent production cycles in 29.4% of nurseries, although such reuse of media tended to be associated with production in beds as opposed to containers (P = 0.08). Nurseries used well water in 88.2% and pond water in 11.8% of cases. Cuttings were grown on benches (vs. the ground) in slightly fewer than half of the nurseries. In contrast, all nurseries surveyed in 2022 grew their cuttings in containers, used well water, and had increased bench use, albeit only slightly. Although all nurseries reused containers, only 28.5% did not sterilize containers before use, and only 14.3% of nurseries reported reusing media. Most nurseries surveyed in 2007 (83.3%) were on a routine, calendar-based fungicide program using a.i. targeted primarily against aboveground diseases (blights and leaf spots) and secondarily against soil-borne water molds (Phytophthora and Pythium species of the Oomycetes class). In contrast, 42.8% of those surveyed in 2022 were on a 2- to 3-week spray schedule, 42.8% used fungicides on an as-needed basis, and 14.4% were on a monthly schedule, indicating that fungicide scheduling varied dramatically among the remaining nurseries.

Exploring key spatial determinants for mobility hub placement based on micromobility ridership

Over the past decade, cities have witnessed a surge in micromobility services that offer flexible mobility options for citizens on an as-needed basis, such as for covering the first/last mile connection of their trips. Although these services have known benefits, including reduced CO2 emissions and less public space required for parking, there is still insufficient understanding of their common dynamics and usage, which can support decision-making in the quest for allocating new mobility infrastructure, like mobility hubs. In this paper, we propose a methodology to identify potential mobility hub locations based on the common associated spatial factors with the ridership of different micromobility services (station-based bike-sharing, dockless moped-style scooter-sharing and scooter-sharing services) in Madrid, Spain. We identify the common associated spatial factors with micromobility usage (e.g. bike stations' density, commercial land use and cycling infrastructure) and train linear models to explore which dependent variables represents better a “common ridership” of multiple micromobility services while fitting better that data. Subsequently, we test our models in a different area to identify potential hotspots for suggested locations. Findings show that considering micromobility ridership altogether using principal component analysis provides better ridership estimations in the test areas. The methodology has the potential to be replicable in other cities and guide decision-making processes for searching potential mobility hub locations.

Practice patterns in revision dacryocystorhinostomy

ABSTRACT Purpose This study aimed to report the practice patterns while performing revision dacryocystorhinostomy (RevDCR) amongst oculoplastic surgeons from several regions across the globe. Methods The survey consisted of 41 specific questions sent via email that contained a link to the Google forms. The questions covered several aspects of the respondents’ practice profiles, evaluation methods, pre-operative choices, surgical techniques, and follow-up preferences while dealing with patients of prior failed DCRs. Questions were answerable either as multiple choice or free text typing. The survey respondents were anonymized. The responses were collected and analyzed, and data were tabulated to understand the preferred practice trends. Results A total of 137 surgeons completed the survey. Most respondents identified themselves as experienced surgeons managing failed DCRs (76.6%, total respondents (n) = 137). The commonly preferred modalities for evaluation of a failed DCR were lacrimal irrigation (91.2%) and nasal endoscopy (66.9%). About 64% (87/137) of the respondents performed a combination of nasal endoscopy, lacrimal irrigation, and probing to localize the area of the failed DCR. A majority of the respondents used anti-metabolites (73.3%, n = 131) and stents (96.4%, 132/137) during the revision surgery. Most surgeons preferred endoscopic approach (44.5%), (61/137) for revising a failed DCR and most preferred general anaesthesia with local infiltration (70.1%, 96/137). Aggressive fibrosis with cicatricial closure was identified as the most frequently encountered cause of failure (84.6%, 115/137). The osteotomy was performed on an as-needed basis by 59.1% (81/137) of the surgeons. Only 10.9% of the respondents used navigation guidance while performing a revision DCR, mainly for post-trauma scenarios. Most of the surgeons completed the revision procedure within 30–60 minutes (77.4%, 106/137). The self-reported outcomes of revision DCRs were good (80–95%, median-90%, n = 137). Conclusion A significantly high percentage of oculoplastic surgeons who responded to this survey from across the globe performed nasal endoscopy in their pre-operative evaluations, preferred endoscopic surgical approach, and used antimetabolites and stents while performing revision DCRs.

The Feasibility of Establishing a Canadian Obstetric Survey System (CanOSS) for Severe Maternal Morbidity: Interim Results [ID: 1377349

INTRODUCTION: Obtaining granular data on events and circumstances leading to severe maternal morbidity (SMM) could complement large epidemiologic studies and enable targeted interventions to improve maternal health. This study aims to assess the feasibility of gathering such data from maternity units across Canada through a Canadian Obstetric Survey System (CanOSS). METHODS: The study is a sequential explanatory mixed-methods study, the first step of which is a nationwide survey of maternity unit leads. Semistructured qualitative interviews are being conducted with unit leads that expressed interest in response to the survey. Responses are reported using proportions and percentages. Interviews are being thematically analyzed. This study was approved by the Hamilton Integrated Research Ethics Board (HiREB) #14002. RESULTS: As of October 18, 2022, we have identified 306 maternity units nationally, and sent 218 surveys, with 59 maternity units across 8 provinces completing. Among these, 34 (83%) report having a system in place for reviewing SMM, conducted on an as-needed basis in 61% of units, and most commonly involving a multidisciplinary panel of experts with representation from nursing (85%), maternity unit leadership (79%), and hospital management (74%). A written report is prepared following 76% of meetings. Findings are shared with health care professionals involved in the event and formulated into recommendations in 79% and 82% of units, respectively. Importantly, 78% of respondents would be willing to contribute anonymized data on SMM within a centralized reporting system. Interviews have taken place with 14 unit leads. Interviewed participants unanimously agree that an obstetric survey system is needed. Concerns raised include privacy, resources, funding, and having a clear definition of SMM. CONCLUSION: This feasibility study will facilitate future planning, clarify barriers to be addressed, and resource implications for gathering data on SMM at a national level, and lay the foundations for a future CanOSS.

Mastocytosis in children

Mastocytosis in children is arare disease characterized by an abnormal accumulation of tissue mast cells. Mastocytosis in children presents with typical skin alterations that are classified as maculopapular cutaneous mastocytosis, diffuse cutaneous mastocytosis, or mastocytoma. Some patients also develop mast cell mediator symptoms, such as pruritus, flush, and anaphylaxis. In many children, the disease is characterized by abenign and usually self-limiting course; systemic mastocytosis with extracutaneous involvement and achronic or progressive course is found only rarely. Therapeutically, H1 antihistamines are primarily used on an as-needed basis or as continuous treatment, depending on the severity. Children, parents and caregivers should be thoroughly educated about the clinical picture and possible trigger factors of mast cell mediator release. For children with extensive skin alterations and severe symptoms, the prescription of an epinephrine auto-injector is recommended for emergency treatment.

Effectiveness and Feasibility of a Self-guided Mobile App Targeting Emotional Well-being in Healthy Adults: 4-Week Randomized Controlled Trial.

Commercial smartphone apps designed to promote emotional well-being are becoming increasingly popular, but few apps have been empirically validated. This study examined the feasibility and effectiveness of a self-guided app designed to reduce daily stress via positive messaging and tailored short inspirational talks (ie, peps). A total of 166 participants (n=112, 67.5% female; mean age 38.48, SD 6.73 years) were recruited through social media advertising and randomized into an intervention (Hey Lemonade app plus twice daily mood monitoring using the Multidimensional Mood Questionnaire [MDMQ]) or active control (twice daily mood monitoring [MDMQ]) group. Primary (coping self-efficacy [CSE]; 3 subscales) and secondary outcomes (vitality, satisfaction with life, perceived stress, positive and negative affect, and hassles and uplifts) were measured at the baseline (week 1) and end point (week 4). The app evaluation questions were assessed at week 2. All interactions and measurements were collected on the internet and through the apps. In total, of 166 participants, 125 (75.3%) completed the trial. There were no differences in dropout rates between the groups (62/81, 76% intervention; 63/85, 74% control). There were significant group-by-time interactions for vitality and hassles but no significant effect for CSE total (P=.05). For the intervention group, the change from baseline to week 4 was significant for vitality (P=.002) and hassles (P=.004), CSE total (P=.008), and CSE Emotional subscale (P=.02). For the control group, any changes over 4 weeks were not significant for any outcome. There was a significant group-by-time interaction for MDMQ calmness (P=.04). By week 4, calmness was significantly higher in the intervention group (P=.046). Of those in the intervention group at week 2 (n=68), 39 (57%) participants recommended the app and 41 (60%) participants wanted to continue using it. Pep talks and customizable voice options were the most popular features. Participants who had access to the smartphone app on an as-needed basis over the 4-week trial showed significant improvements in emotional well-being indicators. More broadly, this suggests that simple accessible solutions may generate meaningful well-being outcomes. Whether these changes are sustained and can be generalized to other population groups is yet to be determined. Australian and New Zealand Clinical Trials Registry (ANZCTR) 12622001005741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384304&isReview=true.

Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations.

To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain. A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed. The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images. Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.

Use of benzodiazepine and Z-drugs and mortality in older adults after myocardial infarction.

The adverse cardiovascular effects of benzodiazepines and Z-drugs (jointly referred as BZDRs) have been of concern. Yet, little is known about the use of BZDRs in relation to mortality risk among older adults with myocardial infarction history (post-MI). This study is a secondary analysis of the Alpha Omega Cohort study, comprising post-MI patients aged 40-60years. Self-reported information on the use of BZDRs, including types and dose, was collected at baseline. Four categories of mortality were examined, namely all-cause mortality, cardiovascular (CVD) mortality, cancer mortality, and non-CVD/non-cancer mortality. Associations between BZDRs use, by types and doses, and mortality were estimated with Cox regression models, adjusted for demographic and classic cardiovascular risk factors. A total of 433 (8.9%) out of 4837 (21.8% females) patients reported BZDRs use at baseline. During a median follow-up of 12.4years, 2287 deaths were documented, of which 825 (36.1%) were due to CVD. BZDRs use was related to a statistically significantly higher risk of all-cause and CVD mortality; adjusted hazard ratios [95% CI] were (1.31 [1.41, 1.52]) and (1.43 [1.14, 1.81]), respectively. These relationships were dose-dependent-patients using BZDRs on an as-needed basis had similar risks compared to the non-uses, whereas patients with a daily use schedule and increasing doses had higher risks (p-value for trend: <0.001). BZDRs use was independently associated with a higher risk of all-cause and cardiovascular mortality in older post-MI patients, and there was evidence for a dose-dependent relationship. NCT00127452 (www. gov).

Bilateral sclerochoroidal calcification in a patient with calcium pyrophosphate deposition disease.

A 60-year-old woman presented with pain and swelling in both of her knees and received a diagnosis of CPPD, based on her clinical characteristics, detection of chondrocalcinosis in multiple joints (including knees and shoulders) (Fig. 1A, B), and a synovial biopsy that was consistent with chondrocalcinosis. The disease was considered to be idiopathic, as she had no other underlying systemic disorders, such as hyperparathyroidism. She was put on colchicine (1.5 mg/day) and (on an as-needed basis) on NSAIDs. The patient was referred to the ophthalmology department because she has longstanding subtle visual complaints. On fundoscopic examination, she had creamy coloured lesions associated with some retinal pigment alterations (Fig. 1C1–C2). An orbital CT scan demonstrated that these lesions were calcified (Fig. 1C3). CPPD is a form of crystal-induced arthritis and it targets the musculoskeletal system. Other system involvements are quite unusual. Eye involvement has only been reported in two cases and has been characterized by sclerochoroidal calcification [1]. Sclerochoroidal calcification may even interfere with the visual function, especially when the deposition is extensive. Moreover, depositions may mimic intraocular tumours, such as a choroidal melanoma [2]. In light of the present case, routine ophthalmic examination should be performed in cases with CPPD, and CPPD should be considered in the differential diagnosis of cases with sclerochoroidal calcification, in addition to the more common causes, such as hyperparathyroidism, parathyroid adenoma, Gitelman syndrome and Bartter syndrome [3]. Informed consent was provided for the publication of this manuscript.

Developing a risk stratification tool for predicting opioid-related respiratory depression after non-cardiac surgery: a retrospective study

ObjectivesAccurately assessing the probability of significant respiratory depression following opioid administration can potentially enhance perioperative risk assessment and pain management. We developed and validated a risk prediction tool to estimate...

Data-Driven Approach Develops Proactive Chemical Treatment Strategies

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper URTeC 3723425, “Delaware Basin Formational Solid Deposit Trends: A Data-Driven Look at Developing Proactive Chemical Treatment Strategies,” by Rachel W. Hudson, SPE, and Kevin J. Spicka, SPE, ChampionX, and Ryan W. Pagel, SPE, Cooper Gray Consulting, et al. The paper has not been peer reviewed. _ This paper highlights a chemical-treatment strategy developed specifically for solids mitigation for a Delaware Basin operator. More than 200 Delaware Basin solid samples from the New Mexico/Texas state line were collected over a 2-year period, spanning seven distinct producing intervals. A statistical approach was taken to determine which formations had the greatest potential for paraffin, carbonate, acid-soluble iron compounds, and sulfate scales. A similar macroscopic approach in other basins may be applied to identify what proactive treatment strategies could be developed based upon the specific challenges of those regions and may similarly improve field performance. Introduction A need exists for optimized cost-effective solids-mitigation and treatment strategies for oil and gas operators across multiple basins. The key is knowing what type of solids have the greatest potential to form before they precipitate and cause issues within a given system. There is a long-standing history of successful chemical and mechanical treatment strategies for solids in the Midland Basin, but less is known about recent unconventional developments in the Delaware Basin, particularly in the Wolfcamp and Bone Springs formations. The Delaware Basin, located within the Permian, is a series of stacked plays. The Avalon sits above the First, Second, and Third Bone Springs, all of which are Leonard-age strata. These formations sit stratigraphically above the Wolfcamp formations. Each producing interval has similar characteristics that directly affect the risk of solid precipitation. During the last decade, the most-common unconventional targets in the Delaware Basin have been the Avalon, Bone Springs, and Wolfcamp formations, which are the focus of the complete paper. Designing cost-effective proactive chemical or mechanical treatment strategies and optimizing those efforts is a challenging dynamic process. Historically, operators take one of two approaches: treat everything while changing chemical type on an as-needed basis or only treating locations where a problem has occurred in the past. Theory and Methods From experiences recorded across the Delaware Basin, it is clear that some formations have more scale or paraffin issues, but this has all been based on individual field experience in localized areas. For example, it is not uncommon to hear that the Second Bone Springs tends to have paraffin issues. If this is true on a larger scale, then widespread untreated solids-deposit data should be able to indicate which solids are the most probable from each formation. If a pattern can be found in the data, then a proactive risk-mitigation and treatment strategy potentially could be defined by formation. If such a data trend exists, it could provide great value and simplify upfront treatment methodology.

Factors affecting the visual outcomes and central macular thickness in diabetic maculopathy after intravitreal bevacizumab.

To assess the outcomes of intravitreal bevacizumab in patients of diabetic maculopathy by anatomical outcomes and best-corrected visual acuity, and to assess the prognostic factors that influence the efficacy of intravitreal bevacizumab. The quasi-experimental study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, from January 2019 to January 2020, and comprised patients with diabetic maculopathy who were administered intravitreal bevacizumab on a monthly basis for three months with further injections administered on an as-needed basis in cases of persistent macular oedema or deterioration of best-corrected visual acuity. The assessment was done pre-injection, and three and six months after the injection. Outcome variables were best-corrected visual acuity and central macular thickness. Data was analysed using SPSS 22. Of the 34 patients, 2(5.9%) were males and 32(94.1%) were females. The overall mean age was 58±10 years. Of the 55 eyes, 27(49.1%) were right and 28(50.9%) were left eyes. After 3 months, the best-corrected visual acuity improved by one line in 20(36.4%) eyes. At 6 months, it improved by one line in 25(45.4%) eyes. After 3 months, the central macular thickness of 48(87.2%) eyes improved anatomically. At 6 months, a further decrease in central macular thickness resulted in 50(90.9%) eyes. The best-corrected visual acuity at 6 months was inversely correlated with central macular thickness and disruption of inner segment/outer segment integrity. Intravitreal bevacizumab injection led to appreciable improvement in best-corrected visual acuity and central macular thickness at 6 months. Disruption of inner segment/outer segment integrity, presence of exudates and cystic changes were noted that lead to poor visual prognosis.

Secure Automatic Identification System (SecAIS): Proof-of-Concept Implementation

The automatic identification system (AIS), despite its importance in worldwide navigation at sea, does not provide any defence mechanisms against deliberate misuse, e.g., by sea pirates, terrorists, business adversaries, or smugglers. Previous work has proposed an international maritime identity-based cryptographic infrastructure (mIBC) as the foundation upon which the offer of advanced security capabilities for the conventional AIS can be built. The proposed secure AIS (SecAIS) does not require any modifications to the existing AIS infrastructure, which can still be used for normal operations. Security-enhanced AIS messages enjoying source authentication, encryption, and legitimate pseudo-anonymization can be handled on an as-needed basis. This paper reports on a proof-of-concept implementation of the SecAIS. Specifically, we report on the implementation of the SecAIS over an mIBC founded on the RFC6507 (ECCSI) and the RFC6508 (SAKKE) standards, and we discuss the results of performance tests with this implementation. The tests indicate that the SecAIS is a feasible solution that does not affect the conventional AIS infrastructure and has an affordable operational cost.

As-Needed Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study.

Psychotropic medications administered on an as-needed basis, often designated as pro re nata (or PRN, hereafter as-needed), can alleviate acute symptoms and facilitate deprescribing, although as-needed use is associated with negative outcomes such as polypharmacy and drug interactions. The aim of this study was to examine the extent to which PRN psychotropic medications are prescribed and administered to assisted living (AL) residents, overall and in relation to resident- and community-level characteristics. Cross-sectional study. All AL residents and select staff in 250 AL communities in 7 states. Data regarding prescribing and administration of 5 types of PRN psychotropic medications in the prior 7days (antipsychotics, mood stabilizers and antiepileptics, antidepressants, anxiolytics/hypnotics, and cognitive enhancers) were abstracted and compared across resident and community characteristics. Prescribing of PRN psychotropics in AL is low (10.3%). Of prescribed PRN medications, 2.5% of residents were administered a PRN and 8% had PRN that was not administered in the previous 7days. Anxiolytics were administered PRN more commonly compared with antipsychotics (2.0% vs 0.2%). Of all PRN psychotropic prescriptions (n= 1039), 70.5% had a written indication describing the reason for administration. Among PRN medications administered (n= 242), the proportion with an indication was lower (62.0%). PRN psychotropic medication prescribing was higher among residents with dementia and a psychiatric diagnosis, and in larger AL communities and those with a higher proportion of dementia care beds. The prescribing and administration of PRN psychotropic medications in AL is relatively rare, although more common among residents with dementia. Emerging psychotropic medication policies should be expanded to address mental health care, anxiolytic/hypnotic use for residents living with dementia, PRN prescribing in chart review, and the use of detailed indications for PRN use, especially when medications are administered by unlicensed care staff.