Remodeling the Medication Collection Process With Prescription in Locker Box (PILBOX): Prospective Cross-sectional Study.

BACKGROUND: Traditionally, patients wishing to obtain their prescription medications have had to physically go to pharmacy counters and collect their medications via face-to-face interactions with pharmacy staff. Prescription in Locker Box (PILBOX) is a new innovation allowing patients and their caregivers to collect medication asynchronously, 24/7 at their convenience, from medication lockers instead of from pharmacy staff. OBJECTIVE: This study aimed to determine the willingness of patients and caregivers to use this new innovation and factors that affect their willingness. METHODS: This prospective cross-sectional study was conducted over 2 months at 2 public primary health care centers in Singapore. Patients or caregivers aged 21 years and older who came to pharmacies to collect medications were administered a 3-part questionnaire face-to-face by trained study team members after they gave their consent to participate in the study. RESULTS: A total of 222 participants completed the study. About 40% (89/222, 40.1%) of participants were willing to use PILBOX to collect their medications. Among participants who were keen to use the PILBOX service, slightly more than half (47/89, 53%) were willing to pay for the PILBOX service. Participants felt that ease of use (3.5 [SD 1.2]) of PILBOX was the most important factor affecting their willingness to use the medication pickup service. This was followed by waiting time (3.4 [SD 1.3]), cost of using the medication pickup service (3.0 [SD 1.4]), and 24/7 accessibility (2.6 [SD 1.4]). This study also found that age (P=.01), language literacy (P<.001), education level (P<.001), working status (P=.01), and personal monthly income (P=.01) were factors affecting the willingness of patients or caregivers to use PILBOX. CONCLUSIONS: Patients and caregivers are keen to use PILBOX to collect their medications for its convenience and the opportunity to save time if it is easy to use and not costly.

Methane yield phenotypes linked to differential gene expression in the sheep rumen microbiome.

Ruminant livestock represent the single largest anthropogenic source of the potent greenhouse gas methane, which is generated by methanogenic archaea residing in ruminant digestive tracts. While differences between individual animals of the same breed in the amount of methane produced have been observed, the basis for this variation remains to be elucidated. To explore the mechanistic basis of this methane production, we measured methane yields from 22 sheep, which revealed that methane yields are a reproducible, quantitative trait. Deep metagenomic and metatranscriptomic sequencing demonstrated a similar abundance of methanogens and methanogenesis pathway genes in high and low methane emitters. However, transcription of methanogenesis pathway genes was substantially increased in sheep with high methane yields. These results identify a discrete set of rumen methanogens whose methanogenesis pathway transcription profiles correlate with methane yields and provide new targets for CH4 mitigation at the levels of microbiota composition and transcriptional regulation.

Transcranial Pulse Stimulation with Ultrasound in Alzheimer's Disease-A New Navigated Focal Brain Therapy.

Ultrasound-based brain stimulation techniques may become a powerful new technique to modulate the human brain in a focal and targeted manner. However, for clinical brain stimulation no certified systems exist and the current techniques have to be further developed. Here, a clinical sonication technique is introduced, based on single ultrashort ultrasound pulses (transcranial pulse stimulation, TPS) which markedly differs from existing focused ultrasound techniques. In addition, a first clinical study using ultrasound brain stimulation and first observations of long term effects are presented. Comprehensive feasibility, safety, and efficacy data are provided. They consist of simulation data, laboratory measurements with rat and human skulls and brains, in vivo modulations of somatosensory evoked potentials (SEP) in healthy subjects (sham controlled) and clinical pilot data in 35 patients with Alzheimer's disease acquired in a multicenter setting (including neuropsychological scores and functional magnetic resonance imaging (fMRI)). Preclinical results show large safety margins and dose dependent neuromodulation. Patient investigations reveal high treatment tolerability and no major side effects. Neuropsychological scores improve significantly after TPS treatment and improvement lasts up to three months and correlates with an upregulation of the memory network (fMRI data). The results encourage broad neuroscientific application and translation of the method to clinical therapy and randomized sham-controlled clinical studies.

Language related differences of the sustained response evoked by natural speech sounds.

In tonal languages, such as Mandarin Chinese, the pitch contour of vowels discriminates lexical meaning, which is not the case in non-tonal languages such as German. Recent data provide evidence that pitch processing is influenced by language experience. However, there are still many open questions concerning the representation of such phonological and language-related differences at the level of the auditory cortex (AC). Using magnetoencephalography (MEG), we recorded transient and sustained auditory evoked fields (AEF) in native Chinese and German speakers to investigate language related phonological and semantic aspects in the processing of acoustic stimuli. AEF were elicited by spoken meaningful and meaningless syllables, by vowels, and by a French horn tone. Speech sounds were recorded from a native speaker and showed frequency-modulations according to the pitch-contours of Mandarin. The sustained field (SF) evoked by natural speech signals was significantly larger for Chinese than for German listeners. In contrast, the SF elicited by a horn tone was not significantly different between groups. Furthermore, the SF of Chinese subjects was larger when evoked by meaningful syllables compared to meaningless ones, but there was no significant difference regarding whether vowels were part of the Chinese phonological system or not. Moreover, the N100m gave subtle but clear evidence that for Chinese listeners other factors than purely physical properties play a role in processing meaningful signals. These findings show that the N100 and the SF generated in Heschl's gyrus are influenced by language experience, which suggests that AC activity related to specific pitch contours of vowels is influenced in a top-down fashion by higher, language related areas. Such interactions are in line with anatomical findings and neuroimaging data, as well as with the dual-stream model of language of Hickok and Poeppel that highlights the close and reciprocal interaction between superior temporal gyrus and sulcus.