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Abstract: Psychogeriatric primary care patients are frequently treated with excessive polypharmacy (≥ 10 medications), leading to complications and increased costs. Such cases are rarely included in treatment guidelines and randomized controlled trials. This paper evaluates the impact of clinical pharmacist medication reviews on the quality of pharmacotherapy in primary care psychogeriatric patients with excessive polypharmacy. The retrospective observational multicentric pre-post study included patients (aged 65 or above) treated with at least one psychotropic and ten or more medications. Clinical pharmacists' recommendations were retrieved from medication review forms for the period 2012-2014. The study outcome measures were the number of medications, potentially inappropriate medications in the elderly (PIMs), potential drug-drug interactions which should be avoided (pXDDIs), and adherence to treatment guidelines. The study included 246 patients receiving 3294 medications, of which 14.6% were psychotropics. The clinical pharmacists proposed 374 interventions in psychopharmacotherapy. The general practitioners accepted 45.2% of them (169). Accepting clinical pharmacist recommendations reduced the total number of medications by 7.5% from 13.4 to 12.4 per patient (p < 0.05), the total number of prescribed PIMs by 21.8% from 312 to 244 (p < 0.05), the number of pXDDIs by 54.9% from 71 to 31 (p < 0.05) and also improved treatment guidelines adherence for antidepressants and antipsychotics (p < 0.05). Clinical pharmacist interventions significantly improved the quality of psychopharmacotherapy by reducing the total number of medications, PIMs, and pXDDIs. Accepting clinical pharmacist interventions led to better treatment guidelines adherence.
Keywords: polypharmacy, elderly patients, clinical pharmacist, medications, drug-drug interactions, psychopharmacotherapy
Published in DKUM: 05.07.2024; Views: 91; Downloads: 3
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Abstract: The interplay between awareness diffusion and epidemic spreading has been an active topic of research in recent years. Studies have shown that group interactions are an important consideration in contagion processes, and that thus higher-order interactions should be introduced into epidemic modeling. Research has also shown that individual responses to an unfolding epidemic are often strongly heterogeneous. We therefore present a two-layer network model, where the diffusion of awareness unfolds over 2-simplicial complexes in one layer, and the actual epidemic spreading unfolds over pairwise physical contacts in the other layer. The model takes into account individual differences in the degree of acceptance of information and self-protection measures once the epidemic is perceived. We use the micro Markov chain approach to determine the epidemic threshold of the model, which agrees well with the results obtained by Monte Carlo simulations. We show that the synergistic reinforcement due to 2-simplicial complexes in the virtual layer can restrain epidemic spreading by facilitating awareness diffusion, and moreover, that individual heterogeneity in the physical layer can increase the epidemic threshold and decrease the size of epidemic transmission. However, heterogeneity in the perception can also have the opposite effect because it inhibits the diffusion of awareness. Our results reveal the intricate interplay between awareness diffusion and epidemic spreading, and we hope they can help determine effective control measures.
Keywords: higher-order interactions, awareness diffusion, epidemic spreading, multiplex network, social physics
Published in DKUM: 21.06.2024; Views: 150; Downloads: 7
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Abstract: High molecular weight chitosan (HMWCh), quaternised cellulose nanofibrils (qCNF), and their mixture showed antiviral potential in liquid phase, while this effect decreased when applied to facial masks, as studied in our recent work. To gain more insight into material antiviral activity, spin-coated thin films were prepared from each suspension (HMWCh, qCNF) and their mixture with a 1:1 ratio. To understand their mechanism of action, the interactions between these model films with various polar and nonpolar liquids and bacteriophage phi6 (in liquid phase) as a viral surrogate were studied. Surface free energy (SFE) estimates were used as a tool to evaluate the potential adhesion of different polar liquid phases to these films by contact angle measurements (CA) using the sessile drop method. The Fowkes, Owens–Wendt–Rabel–Kealble (OWRK), Wu, and van Oss–Chaudhury–Good (vOGC) mathematical models were used to estimate surface free energy and its polar and dispersive contributions, as well as the Lewis acid and Lewis base contributions. In addition, the surface tension SFT of liquids was also determined. The adhesion and cohesion forces in wetting processes were also observed. The estimated SFE of spin-coated films varied between mathematical models (26–31 mJ/m2) depending on the polarity of the solvents tested, but the correlation between models clearly indicated a significant dominance of the dispersion components that hinder wettability. The poor wettability was also supported by the fact that the cohesive forces in the liquid phase were stronger than the adhesion to the contact surface. In addition, the dispersive (hydrophobic) component dominated in the phi6 dispersion, and since this was also the case in the spin-coated films, it can be assumed that weak physical van der Waals forces (dispersion forces) and hydrophobic interactions occurred between phi6 and the polysaccharide films, resulting in the virus not being in sufficient contact with the tested material during antiviral testing of the material to be inactivated by the active coatings of the polysaccharides used. Regarding the contact killing mechanism, this is a disadvantage that can be overcome by changing the previous material surface (activation). In this way, HMWCh, qCNF, and their mixture can attach to the material surface with better adhesion, thickness, and different shape and orientation, resulting in a more dominant polar fraction of SFE and thus enabling the interactions within the polar part of phi6 dispersion.
Keywords: films, surface free energy, SFE mathematical models, phi6, wettability, spreading, interactions
Published in DKUM: 21.04.2023; Views: 541; Downloads: 34
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Abstract: If rock beats scissors and scissors beat paper, one might assume that rock beats paper too. But this is not the case for intransitive relationships that make up the famous rock-paper-scissors game. However, the sole presence of paper might prevent rock from beating scissors, simply because paper beats rock. This is the blueprint for the rock-paper-scissors game with protection spillovers, which has recently been introduced as a new paradigm for biodiversity in well-mixed microbial populations. Here we study the game in structured populations, demonstrating that protection spillovers give rise to spatial patterns that are impossible to observe in the classical rock-paper-scissors game.Weshow that the spatiotemporal dynamics of the system is determined by the density of stable vortices, which may ultimately transform to frozen states, to propagating waves, or to target waves with reversed propagation direction, depending further on the degree and type of randomness in the interactions among the species. If vortices are rare, the fixation to waves and complex oscillatory solutions is likelier. Moreover, annealed randomness in interactions favors the emergence of target waves, while quenched randomness favors collective synchronization. Our results demonstrate that protection spillovers may fundamentally change the dynamics of cyclic dominance in structured populations, and they outline the possibility of programming pattern formation in microbial populations.
Keywords: cyclical interactions, pattern formation, vortices, phase transitions, selforganization, biodiversity
Published in DKUM: 03.07.2017; Views: 1201; Downloads: 417
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Abstract: Image scoring sustains cooperation in the repeated two-player prisoner's dilemma through indirect reciprocity, even though defection is the uniquely dominant selfish behaviour in the one-shot game. Many real-world dilemma situations, however, firstly, take place in groups and, secondly, lack the necessary transparency to inform subjects reliably of others' individual past actions. Instead, there is revelation of information regarding groups, which allows for "group scoring" but not for image scoring. Here, we study how sensitive the positive results related to image scoring are to information based on group scoring. We combine analytic results and computer simulations to specify the conditions for the emergence of cooperation. We show that under pure group scoring, that is, under the complete absence of image-scoring information, cooperation is unsustainable. Away from this extreme case, however, the necessary degree of image scoring relative to group scoring depends on the population size and is generally very small. We thus conclude that the positive results based on image scoring apply to a much broader range of informational settings that are relevant in the real world than previously assumed.
Keywords: public goods, group interactions, phase transition, social dilemma, physics of social systems
Published in DKUM: 23.06.2017; Views: 1516; Downloads: 455
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