Effect of a Smart Pill Bottle and Pharmacist Intervention on Medication Adherence in Patients with Multiple Myeloma New to Lenalidomide Therapy.

BACKGROUND: U.S. specialty drug spend is expected to reach $400 billion by 2020, with significant growth in oncology. New oral oncology approvals have allowed for more convenient outpatient administration compared with physician-administered chemotherapies; however, patients may encounter challenges with adherence when taking medications at home. Emerging medication adherence technology (MAT) attempts to provide at-home adherence support, and while one such technology, smart pill bottles (SPB), claims to improve medication adherence, few studies have formally assessed their effects. OBJECTIVES: To assess the effect of an SPB with pharmacist intervention on medication adherence in adult patients with multiple myeloma (MM) new to lenalidomide therapy (≤ 5 cycle dispenses). Secondary objectives were to evaluate treatment cycles completed, evaluate the significance of real-time pharmacist engagement (intervention group only), determine the incremental cost-effectiveness ratio (ICER), and evaluate patient satisfaction and likelihood to use an SPB. METHODS: This prospective, random assignment, single-site, and single-blinded study recruited 40 adult patients diagnosed with MM new to lenalidomide at a specialty pharmacy. Recruitment was completed January-February 2016, and the length of study was 6 months. Participants were randomized 1:1 between the intervention and control groups. The intervention group received lenalidomide in activated SPBs with light, chimes, text message reminders, and pharmacist follow-up if weekly SPB adherence rates dropped below 80%. The control group received lenalidomide in identical SPBs with all alerts deactivated. SBPs contained cellular capabilities, enabling around-the-clock data transmission and captured data upon bottle-uncapping events. Patient adherence was calculated by dividing the number of bottle-uncapping events by the total number of doses supplied for each dosing cycle. Lenalidomide cycles completed and pharmacist outreach to the same patient were counted to determine pharmacist intervention. The ICER was calculated to determine SPB cost-effectiveness, and a Likert scale survey was given to the intervention group to evaluate patient satisfaction with the full-service SPB. RESULTS: Sixteen participants in each arm completed the study; 4 patients in each arm were lost to follow-up. Median adherence was improved for the intervention group compared with the control group (median = 100% vs. 87.4%; P = 0.001). The ICER per patient percentage adherence increase was found to be $96.03. Sixty percent of patients in the intervention group who responded to the post-satisfaction survey rated the full SPB service very positively. CONCLUSIONS: In this study, SPB interventions were associated with increased medication adherence and patient satisfaction. This pilot also provides empirical data on the cost-effectiveness of adherence technology used in a specialty pharmacy oncology setting. DISCLOSURES: This study was supported by Avella Specialty Pharmacy and AdhereTech. All authors are employees of Avella; Eric Sredzinski was an option holder of Avella; and none of the Avella authors had a financial interest in AdhereTech. AdhereTech provided the SPBs and data services for the duration of this study. The authors report no other potential conflicts of interest. Interim study data were presented at the 2016 Southwestern States Residency Conference (SSRC) on June 20, 2016, in Phoenix, AZ.

Functional Data Analysis of high-frequency load curves reveals drivers of residential electricity consumption.

Smart energy meters generate real time, high frequency data which can foster demand management and response of consumers and firms, with potential private and social benefits. However, proper statistical techniques are needed to make sense of this large amount of data and translate them into usable recommendations. Here, we apply Functional Data Analysis (FDA), a novel branch of Statistics that analyses functions-to identify drivers of residential electricity load curves. We evaluate a real time feedback intervention which involved about 1000 Italian households for a period of three years. Results of the FDA modelling reveal, for the first time, daytime-indexed patterns of residential electricity consumption which depend on the ownership of specific clusters of electrical appliances and an overall reduction of consumption after the introduction of real time feedback, unrelated to appliance ownership characteristics.

BtM, a Low-cost Open-source Datalogger to Estimate the Water Content of Nonvascular Cryptogams.

Communities of nonvascular cryptogams, such as mosses or lichens, are an important part of the Earth's biodiversity, contributing to the regulation of the carbon and nitrogen cycles in many ecosystems. Being poikilohydric organisms, they do not actively control their internal water content and need a humid environment to activate their metabolism. Therefore, studying water relationships of nonvascular cryptogams is crucial to understand both their diversity patterns and their functions in the ecosystems. We present the BtM datalogger, a low-cost open-source platform for the study of the water content of nonvascular cryptogams. The datalogger is designed to measure ambient temperature, humidity, and conductance from up to eight samples simultaneously. We provide a design for a printed circuit board (PCB), a detailed protocol to assemble the components, and the required source code. All this makes the assembly of the BtM datalogger accessible to any research group, even to those without previous specialized knowledge. Therefore, the design presented here has the potential to help popularize the use of this type of device among ecologists and field biologists.

Why is the market for hybrid electric vehicles (HEVs) moving slowly?

Hybrid electric vehicles (HEVs) could be a good short term option to help achieve global targets regarding road transport greenhouse gas emissions. Several common and country-specific public policies based on price or tax rebates are established in order to encourage the adoption of HEVs. The present research empirically assesses market preferences for HEVs in Spain, looking at the role of subsidies. An interactive internet-based survey was conducted in a representative sample (N = 1,200) of Spanish drivers. Drivers are willing to pay an extra amount of €1,645 for a HEV model compared to a conventional vehicle, premium which is well below the price markup for these cars. Therefore, current levels of economic subsidies applied in isolation to promote these types of vehicles may have a quite limited effect in extending their use. Overall, it is found that drivers have clear misconceptions about HEVs, which affect their purchasing choices and perceptions. Therefore, a policy mix of various incentives (including informational campaigns) may be required in order to stimulate the demand for HEVs.

Intsy: a low-cost, open-source, wireless multi-channel bioamplifier system.

OBJECTIVE: Multi-channel electrical recordings of physiologically generated signals are common to a wide range of biomedical fields. The aim of this work was to develop, validate, and demonstrate the practical utility of a high-quality, low-cost 32/64-channel bioamplifier system with real-time wireless data streaming capability. APPROACH: The new 'Intsy' system integrates three main off-the-shelf hardware components: (1) Intan RHD2132 bioamplifier; (2) Teensy 3.2 microcontroller; and (3) RN-42 Bluetooth 2.1 module with a custom LabView interface for real-time data streaming and visualization. Practical utility was validated by measuring serosal gastric slow waves and surface EMG on the forearm with various contraction force levels. Quantitative comparisons were made to a gold-standard commercial system (Biosemi ActiveTwo). MAIN RESULTS: Intsy signal quality was quantitatively comparable to that of the ActiveTwo. Recorded slow wave signals had high SNR (24 ± 2.7 dB) and wavefront propagation was accurately mapped. EMG spike bursts were characterized by high SNR (⩾10 dB) and activation timing was readily identified. Stable data streaming rates achieved were 3.5 kS s-1 for wireless and 64 kS s-1 for USB-wired transmission. SIGNIFICANCE: Intsy has the highest channel count of any existing open-source, wireless-enabled module. The flexibility, portability and low cost ($1300 for the 32-channel version, or $2500 for 64 channels) of this new hardware module reduce the entry barrier for a range of electrophysiological experiments, as are typical in the gastrointestinal (EGG), cardiac (ECG), neural (EEG), and neuromuscular (EMG) domains.

Forecasting electric vehicles sales with univariate and multivariate time series models: The case of China.

The market demand for electric vehicles (EVs) has increased in recent years. Suitable models are necessary to understand and forecast EV sales. This study presents a singular spectrum analysis (SSA) as a univariate time-series model and vector autoregressive model (VAR) as a multivariate model. Empirical results suggest that SSA satisfactorily indicates the evolving trend and provides reasonable results. The VAR model, which comprised exogenous parameters related to the market on a monthly basis, can significantly improve the prediction accuracy. The EV sales in China, which are categorized into battery and plug-in EVs, are predicted in both short term (up to December 2017) and long term (up to 2020), as statistical proofs of the growth of the Chinese EV industry.

Low cost venom extractor based on Arduino(®) board for electrical venom extraction from arthropods and other small animals.

Extracting venom from small species is usually challenging. We describe here an affordable and versatile electrical venom extractor based on the Arduino(®) Mega 2560 Board, which is designed to extract venom from arthropods and other small animals. The device includes fine tuning of stimulation time and voltage. It was used to collect venom without apparent deleterious effects, and characterized for the first time the venom of Zoropsis spinimana, a common spider in French Mediterranean regions.

Measuring treatment costs of typical waste electrical and electronic equipment: A pre-research for Chinese policy making.

Waste Electrical and Electronic Equipment (WEEE) volume is increasing, worldwide. In 2011, the Chinese government issued new regulations on WEEE recycling and disposal, establishing a WEEE treatment subsidy funded by a levy on producers of electrical and electronic equipment. In order to evaluate WEEE recycling treatment costs and revenue possibilities under the new regulations, and to propose suggestions for cost-effective WEEE management, a comprehensive revenue-expenditure model (REM), were established for this study, including 7 types of costs, 4 types of fees, and one type of revenue. Since TV sets dominated the volume of WEEE treated from 2013 to 2014, with a contribution rate of 87.3%, TV sets were taken as a representative case. Results showed that the treatment cost varied from 46.4RMB/unit to 82.5RMB/unit, with a treatment quantity of 130,000 units to 1,200,000 units per year in China. Collection cost accounted for the largest portion (about 70.0%), while taxes and fees (about 11.0 %) and labor cost (about 7.0 %) contributed less. The average costs for disposal, sales, and taxes had no influence on treatment quantity (TQ). TQ might have an adverse effect on average labor and management costs; while average collection and purchase fees, and financing costs, would vary with purchase price, and the average sales fees and taxes would vary with the sales of dismantled materials and other recycled products. Recycling enterprises could reduce their costs by setting up online and offline collection platforms, cooperating with individual collectors, creating door-to-door collection channels, improving production efficiency and reducing administrative expenditures. The government could provide economic incentives-such as subsidies, low-cost loans, tax cuts and credits-and could also raise public awareness of waste management and environmental protection, in order to capture some of the WEEE currently discarded into the general waste stream. Foreign companies with advanced WEEE utilization technology could invest or participate in this area, producing profits for themselves while helping to develop and implement environmentally friendly and energy-saving technologies applicable to the Chinese market.

Disparities in wheelchair procurement by payer among people with spinal cord injury.

OBJECTIVE: To identify insurance provider-related disparities in the receipt of lightweight, customizable manual wheelchairs or power wheelchairs with programmable controls among community-dwelling people with spinal cord injury (SCI). SETTING: Six Spinal Cord Injury Model System centers. DESIGN: A multicenter cross-sectional study. PARTICIPANTS: A total of 359 individuals at least 16 years of age or older and 1 year after SCI who use a manual or power wheelchair as their primary means of mobility. The subjects were stratified by payer, and payers were grouped according to reimbursement characteristics as follows: Medicaid/Department of Vocational Rehabilitation (DVR), private/prepaid, Medicare, Worker's Compensation (WC)/Veterans Affairs (VA), and self pay. METHODS: Demographic, wheelchair, and payer data were collected by medical record review and face-to-face interview. RESULTS: There were 125 participants in the Medicaid/DVR group, 120 in the private/prepaid group, 55 in the Medicare group, 30 in the WC/VA group, and 29 in the self-pay group. For manual wheelchair users, the likelihood of having a lightweight, customizable wheelchair was 97.5% for private/prepaid, 96.3% for Medicaid/DVR, 94.1% for WC/VA, 87.5% for Medicare, and 82.6% for self pay. For power wheelchair users, those with WC/VA (100%) were most likely to receive a customizable power wheelchair with programmable controls, followed by private/prepaid (95.1%), Medicaid/DVR (86.0 %), Medicare (83.9%), and self pay (50.0%). CONCLUSIONS: The only payer group for which all beneficiaries received wheelchairs that met standard of care were power wheelchairs provided by WC/VA. Fewer than 90% of people whose manual wheelchair was paid for by Medicare and self pay, and whose power wheelchair was paid for by Medicaid/DVR, Medicare, and self pay did not meet standard of care. Although these findings need to be correlated with long-term risks, such as overuse injuries, breakdowns, and participation, this study demonstrates that disparities in wheelchair procurement by insurance provider persist.

Processo de implantação dos sistemas de logística reversa de equipamentos eletroeletrônicos previstos na Política Nacional de Resíduos Sólidos: uma visão dos gestores / Reverse Logistics of Electrical and Electronic Equipment of the National Solid Waste Policy Deployment Process perceptions of managers

A viabilização da coleta e destinação correta dos resíduos pós-consumo é prevista pela Política Nacional de Resíduos Sólidos (PNRS) - Lei n°12.305 de 2010-importante marco regulatório para a gestão ambiental no Brasil. Dentre diversos aspectos enunciados, destacam-se o princípio da responsabilidade compartilhada pelo ciclo de vida dos produtos e o instrumento logística reversa. O art. 33 desta lei considera prioritária a implantação de sistemas de logística reversa (SLR) para seis classes de resíduos, dentre eles os resíduos de equipamentos eletroeletrônicos (REEE). Objetivos: analisar e caracterizar o discurso de gestores do comércio, da indústria, do poder público e das cooperativas, relacionados com o setor de eletroeletrônicos sobre a implantação de SLR. Métodos: Foram realizadas entrevistas semiestruturadas com nove gestores envolvidos no processo de implantação de SLR de eletroeletrônicos. Os dados foram transcritos, categorizados e posteriormente analisados pelo software Classification Hiérarchique Classificatoire et Cohésitive - CHIC®. O modelo dos múltiplos fluxos foi utilizado para auxiliar no entendimento do processo de formação da PNRS. Resultados: foram obtidas sete árvores hierárquicas de similaridade e quatro grupos com diferentes forças de implicação. Conclusão: Os pontos relevantes identificados mostram que: 1) o Acordo Setorial foi o instrumento escolhido para implantação de SLR de REEE, mas existem entraves entre os setores privado e público...

The feasibility of collection and proper disposal of post-consumer waste is provided by the National Solid Waste Policy (PNRS) - Law n° 12.305 2010-important regulatory framework for environmental management in Brazil. Among several aspects listed, highlight the principle of shared responsibility for the lifecycle of products and reverse logistics tool. The art. 33 of this law considers a priority the implementation of reverse logistics systems (SLR) for six classes of waste, including waste electrical and electronic equipment (WEEE). Objectives: To analyze and characterize the speech of managers of trade, industry, public authorities and cooperatives, related to consumer electronics over the implementation of SLR. Methods: Semi-structured interviews were conducted with nine managers involved in the implementation of electronic SLR process. Data were transcribed, categorized and analyzed using the software Classification Hierarchique Classificatoire et Cohésitive - CHIC®. The model of "multiple streams" was used to assist in understanding the process of formation of PNRS. Results: seven hierarchical trees of similarity and four groups with different forces of implication were obtained. Conclusion: The relevant points identified show that: 1) the 'Sectoral Agreement' was the instrument chosen for the implementation of the WEEEs SLR, but there are barriers between the private and public sectors, generating delays in signing the agreement...

The role of major donors in health aid to the Democratic People's Republic of Korea.

We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea / 예방의학회지

We investigated the major trends in health aid financing in the Democratic People's Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK's Ministry of Unification. We identified the ROK, United Nations Children's Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK's precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.

Construction, in vitro and in vivo evaluation of an in-house conductance meter for measurement of skin hydration.

Different probes are used in dermato-cosmetic research to measure the electrical properties of the skin. The principle governing the choice of the geometry and material of the measuring probe is not well defined in the literature and some device's measuring principles are not accessible for the scientific community. The purpose of this work was to develop a simple inexpensive conductance meter for the objective in vivo evaluation of skin hydration. The conductance meter probe was designed using the basic equation governing wave propagation along Transverse Electromagnetic transmission lines. It consisted of two concentric copper circular electrodes printed on FR4 dielectric material. The performance of the probe was validated by evaluating its measurement depth, its ability to monitor in vitro water sorption-desorption and in vivo skin hydration effect in comparison to that of the Corneometer CM 825. The measurement depth of the probe, 15 µm, was comparable to that of CM 825. The in vitro readings of the probe correlated strongly with the amount of water adsorbed on filter paper. Skin hydration after application of a moisturizer was monitored effectively by the new probe with good correlation to the results of CM 825. In conclusion, a simple probe for evaluating skin hydration was made from off-the-shelf materials and its performance was validated in comparison to a commercially available probe.

CheapStat: an open-source, "do-it-yourself" potentiostat for analytical and educational applications.

Although potentiostats are the foundation of modern electrochemical research, they have seen relatively little application in resource poor settings, such as undergraduate laboratory courses and the developing world. One reason for the low penetration of potentiostats is their cost, as even the least expensive commercially available laboratory potentiostats sell for more than one thousand dollars. An inexpensive electrochemical workstation could thus prove useful in educational labs, and increase access to electrochemistry-based analytical techniques for food, drug and environmental monitoring. With these motivations in mind, we describe here the CheapStat, an inexpensive (<$80), open-source (software and hardware), hand-held potentiostat that can be constructed by anyone who is proficient at assembling circuits. This device supports a number of potential waveforms necessary to perform cyclic, square wave, linear sweep and anodic stripping voltammetry. As we demonstrate, it is suitable for a wide range of applications ranging from food- and drug-quality testing to environmental monitoring, rapid DNA detection, and educational exercises. The device's schematics, parts lists, circuit board layout files, sample experiments, and detailed assembly instructions are available in the supporting information and are released under an open hardware license.

Institutional disposition and management of end-of-life electronics.

Institutions both public and private face a challenge to develop policies to manage purchase, use, and disposal of electronics. Environmental considerations play an increasing role in addition to traditional factors of cost, performance and security. Characterizing current disposition practices for end-of-life electronics is a key step in developing policies that prevent negative environmental and health impacts while maximizing potential for positive social and economic benefits though reuse. To provide a baseline, we develop the first characterization of quantity, value, disposition, and flows of end-of-life electronics at a major U.S. educational institution. Results of the empirical study indicate that most end-of-first-life electronics were resold through public auction to individuals and small companies who refurbish working equipment for resale or sell unusable products for reclamation of scrap metal. Desktop and laptop computers sold for refurbishing and resale averaged U.S. $20-100 per unit, with computers sold directly to individuals for reuse reaching $250-350 per unit. This detailed assessment was coupled with a benchmarking survey of end-of-life electronics management practices at other U.S. universities. Survey results indicate that while auctions are still commonplace, an increasing number of institutions are responding to environmental concerns by creating partnerships with local recycling and resale entities and mandating domestic recycling. We use the analyses of current disposition practices as input to discuss institutional strategies for managing electronics. One key issue is the tension between benefits of used equipment sales, in terms of income for the institution and increased reuse for society, and the environmental risks because of unknown downstream practices.

Note: A robust low-cost high-sensitivity subangstrom bidirectional displacement sensor.

The design of a simple, robust, low-cost, and bidirectional displacement sensor with subangstrom resolution is described. A small gold plate is attached to the object, whose displacement is to be measured, and a small gold tip is brought into contact with the plate, establishing a reference current between the two. Movements of the gold plate away from the tip lead to a change in the tip-plate current; the reference current is then re-established by moving the tip using a simple magnetic actuator. The resolution of the sensor has been calibrated using an interferometer and was shown to be as high as 0.3 Å per system count. Potential applications of the sensor are numerous, including microbar air pressure measurement, motion and infrasound detection, thermal sensing, and gravitational field and relativistic gravity wave measurement.

Review of recycling performance indicators: a study on collection rate in Taiwan.

The Taiwan Environmental Protection Administration (Taiwan EPA) launched a national Extended Producer Responsibility (EPR) system after integrating eight private recycling organizations in 1998. After that, the environmental performance of the EPR system brought a lot of attention to policy makers. Many studies show positive environmental effects of the EPR system in Taiwan. However, there are controversial questions remained, such as whether the performance indicators used are the right choice to estimate the environmental effects of the recycling policy? Can those estimated results really reflect the performance of the system? This paper would therefore like to more accurately evaluate the performance indicators of the EPR system based on data observed over the past decade in Taiwan. In the process of evaluating the performance indicators, we have found that the collection rates for durable goods are often ignored in countries that pursue a zero waste policy. This may affect the actual recycling outcome and resource direction targeted by producers. However, in order for the collection rate to be adopted as a policy indicator, how to estimate the amounts of retired or waste products during a period is critical. In this paper, we estimate the collection rate for electrical and electronic waste by using the survival analysis and ownership data analysis approaches. We also provide a comparison of both approaches and put forward suggestions for directions in the future in solid waste management.