Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks.

BACKGROUND: Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. OBJECTIVE: This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. METHODS: A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. RESULTS: This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The "long diameter + short diameter + thickness" index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95% CI 1.03-2.44), female (OR 2.54, 95% CI 1.70-3.78), dysphagia (OR 3.54, 95% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. CONCLUSIONS: This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence.

Changes in Sediment Fatty Acid Composition during Passage through the Gut of Deposit Feeding Holothurians: Holothuria atra (Jaeger, 1883) and Holothuria leucospilota (Brandt, 1835).

Sea cucumbers Holothuria atra and Holothuria leucospilota play an important role in the bioturbation of sediment in coral reef and rocky intertidal ecosystems. This study investigated changes in sediment fatty acid (FA) composition during gut passage in H. atra and H. leucospilota. The FA composition did not differ significantly between species. Comparison of FA composition in ambient sediment (AS), foregut (FG), midgut (MG), hindgut (HG), and faecal pellets (FPs) indicated that marked changes in FA composition occurred during passage through the gut of H. atra and H. leucospilota. Saturated fatty acids (SAFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and branched fatty acids (BrFAs) were significantly higher in FG than in AS, suggesting that both species selectively ingested nutrient rich particles. Significant reduction of SAFAs, MUFAs, PUFAs, and BrFAs occurred in MD and HD, with complete elimination of most PUFAs in FPs. A decrease in PUFAs 20:5ω3, 18:4ω3, 22:5ω3, 22:6ω3, 18:2ω6, 18:3ω3, 18:3ω6, odd-numbered BrFAs, and MUFA 18:1ω7 indicated that algal detritus and bacteria were important part of diet. These results have implications for the fate of specific dietary FAs, especially ω3 and ω6, and the contribution holothurian FPs make to the FA composition of coral reef and rocky intertidal ecosystems.

Possible food sources of macrozoobenthos in the manko mangrove ecosystem, okinawa (Japan): a stable isotope analysis approach.

Identifying potential food sources in mangrove ecosystems is complex because of the multifarious inputs from both land and sea. This study, which was conducted in the Manko mangrove ecosystem of Okinawa, Japan, determined the composition of the stable isotopes δ(13)C and δ(15)N in primary producers and macrozoobenthos to estimate the potential food sources assimilated and to elucidate the target trophic levels of the macrozoobenthos. We measured the two stable isotope signatures of three gastropods (Cerithidea sp., Cassidula mustelina, Peronia verruculata), two crabs (Grapsidae sp., Uca sp.), mangrove tree (Kandelia candel) leaves, and sediment from the mangrove ecosystem. The respective carbon and nitrogen isotope signature results were as follows: -22.4‰ and 8.6‰ for Cerithidea sp., -25.06‰ and 8‰ for C. mustelina, -22.58‰ and 8‰ for P. verruculata, -24.3‰ and 10.6‰ for unidentified Grapsidae, -21.87 ‰ and 11.5 ‰ for Uca sp., -29.81‰ and 11‰ for K. candel, and -24.23‰ and 7.2‰ for the sediment. The stable isotope assimilation signatures of the macrozoobenthos indicated sediment as their food source. Considering the trophic levels, the stable isotope values may also indicate that the five macrozoobenthos species were secondary or higher consumers.

Effects of temperature on gamete longevity and fertilization success in two sea urchin species, Echinometra mathaei and Tripneustes gratilla.

We investigated gamete longevity in two sea urchin species, Echinometra mathaei (Em) and Tripneustes gratilla (Tg), via laboratory experiments. The longevity of dry sperm at different ages (6, 12, 18, 24, and 30 h after collection) was tested at 20 degrees, 25 degrees, and 30 degrees C. Sperm viability was determined by the percent cleavage of eggs after in-vitro fertilization. Dry sperm of Em remained viable longer than dry sperm of Tg at all temperatures. The viability of dilute sperm and eggs was also determined at 20 degrees, 25 degrees, and 30 degrees C over varying durations (for sperm, 5, 45, and 85 min; for eggs, 1, 3, 6, 12, and 24 h). The viability of dilute Em sperm remained relatively constant over time (nearly 100%) at 20 degrees and 25 degrees C, but decreased rapidly at 30 degrees C. The viability of Tg sperm declined gradually over time at 20 degrees C and decreased sharply at 25 degrees and 30 degrees C. Eggs of Em and Tg remained fertilizable for 12 and 6 h, respectively. Most eggs of Em and Tg underwent normal development when exposed for less than 6 h and 3 h, respectively. These results may illuminate the different fertilization strategies of these two sea urchin species.