ABSTRACT
Research shows a significant reduction in travel demand during the pandemic. Vaccines are currently distributed, allowing us to go back to pre-COVID-19 life, if that is the case. This study provides insight into changes in activities and travel demand during the pandemic and expected changes after the pandemic. Our paper presents the findings from a Likert scale survey (n = 360) conducted in Norway June-July 2021. We investigate how relocated activities impacted travel behaviour during the pandemic, and prospects of lasting impacts of the pandemic. The results show that the prevalence of home office and digital meetings, the new normal for many people during the pandemic, will continue to some degree after the pandemic. There is an increased willingness to commute by active modes, while no pronounced increase in car commutes is reported. However, car use is expected to increase for leisure trips; a significant correlation with the demand of more domestic outdoor travel. One out of five states that they will use public transport less often in the future. We may expect more online shopping, although home-deliveries for groceries is not as popular as for non-edible goods-not during the pandemic nor after. Earlier disruptive events have shown that people tend to adjust back to normal after a while, even if they have stated otherwise. There are certain mid-pandemic habits that go along with political goals and/or employers' interests, implying these might be prolonged into the future.
ABSTRACT
BACKGROUND: Despite the recent increase in opioid overdoses across Canada, few pharmacy-led initiatives have been implemented to address issues related to opioid prescribing in the hospital setting. OBJECTIVES: The primary objective of this study was to develop a clinical tool, intended for use by hospital pharmacists and informed by best practices from the literature, that would provide a structured approach to enhancing the safety of opioid prescribing. The secondary objective was to collect pharmacists' opinions about the feasibility and utility of this tool. METHODS: A comprehensive literature search and pharmacist focus group analysis provided content for development of a candidate clinical tool. This tool was then piloted by clinical pharmacists working on general medical and surgical units in a single hospital. Pharmacists participating in the pilot were invited to complete an online survey concerning their perceptions of the tool. Descriptive statistics were used to analyze the survey results. RESULTS: The literature search and focus group analysis led to development of a candidate clinical tool that focused on Medication review, Optimization, Reassessment, and Education (MORE). It included key risk factors relating to opioid safety, along with suggested mitigating strategies. The MORE tool was piloted for 3 weeks by 14 clinical pharmacists, 9 of whom responded to the subsequent survey. Five respondents indicated that the clinical tool increased their ability to identify risk factors. Five respondents also noted an increase in their ability to identify possible interventions. Most respondents felt that the tool was useful and that it would be feasible to integrate it into their practice; however, they noted that a more streamlined version could improve ease of use. CONCLUSIONS: The MORE tool was well received by clinical pharmacists. Implementation of the tool into routine practice requires additional changes to improve ease of use. Suggestions for modifying and streamlining the tool will be incorporated into future versions.
CONTEXTE: Malgré l'augmentation récente des surdoses d'opioïdes au Canada, peu d'initiatives menées sous la houlette de pharmacies ont été mises en place sur les enjeux potentiels liés à la prescription d'opiacés en milieu hospitalier. OBJECTIFS: L'objectif principal de cette étude visait à élaborer un outil destiné aux pharmaciens d'hôpitaux, s'inspirant des meilleures pratiques rapportées dans la documentation, qui fournirait une approche structurée pour améliorer la sécurité de la prescription d'opioïdes. L'objectif secondaire consistait à recueillir les opinions des pharmaciens sur la faisabilité et l'utilité d'un tel outil. MÉTHODE: Des recherches bibliographiques étendues ainsi qu'une analyse de groupes de discussion de pharmaciens ont fourni le contenu nécessaire à l'élaboration d'un outil clinique expérimental. Ensuite, cet outil a été testé par des pharmaciens cliniciens travaillant dans des unités médicales générales et chirurgicales au sein d'un seul hôpital. Les pharmaciens participant au projet pilote ont été invités à répondre à une enquête en ligne sur leur perception de l'outil. Des statistiques descriptives ont permis d'analyser les résultats de l'enquête. RÉSULTATS: Les recherches bibliographiques et l'analyse des groupes de discussion ont débouché sur le développement d'un outil clinique nommé MORE [pour Medication review, Optimization, Reassessment, and Education, ou Examen, optimisation, réévaluation et éducation aux médicaments]. Il comprenait des facteurs de risque liés à la sécurité des opioïdes ainsi que des suggestions de stratégies d'atténuation. Quatorze pharmaciens cliniciens, dont neuf ont répondu à l'enquête qui a suivi, ont testé le MORE pendant trois semaines. Cinq répondants ont indiqué que l'outil clinique augmentait leur capacité à déterminer les facteurs de risque. Cinq ont également noté une meilleure capacité à déterminer les interventions possibles. La plupart des répondants ont estimé que l'outil était utile et qu'il serait possible de l'intégrer dans leur pratique; cependant, ils ont aussi noté qu'une version simplifiée pourrait faciliter son utilisation. CONCLUSIONS: Les pharmaciens cliniciens ont bien accueilli l'outil MORE. Sa mise en oeuvre dans la pratique courante exige cependant des changements supplémentaires pour faciliter son utilisation. Les versions à venir tiendront compte des propositions visant à le modifier et à le simplifier.
ABSTRACT
Signaling through the adaptor protein myeloid differentiation factor 88 (MyD88) promotes carcinogenesis in several cancer models. In contrast, MyD88 signaling has a protective role in the development of azoxymethane (AOM)/dextran sodium sulfate (DSS) colitis-associated cancer (CAC). The inability of Myd88(-/-) mice to heal ulcers generated upon injury creates an altered inflammatory environment that induces early alterations in expression of genes encoding proinflammatory factors, as well as pathways regulating cell proliferation, apoptosis, and DNA repair, resulting in a dramatic increase in adenoma formation and progression to infiltrating adenocarcinomas with frequent clonal mutations in the beta-catenin gene. Others have reported that toll-like receptor (Tlr) 4-deficient mice have a similar susceptibility to colitis to Myd88-deficient mice but, unlike the latter, are resistant to CAC. We have observed that mice deficient for Tlr2 or Il1r do not show a differential susceptibility to colitis or CAC. However, upon AOM/DSS treatment Il18(-/-) and Il18r1(-/-) mice were more susceptible to colitis and polyp formation than wild-type mice, suggesting that the phenotype of Myd88(-/-) mice is, in part, a result of their inability to signal through the IL-18 receptor. This study revealed a previously unknown level of complexity surrounding MyD88 activities downstream of different receptors that impact tissue homeostasis and carcinogenesis.
