A Method of Precise Auto-Calibration in a Micro-Electro-Mechanical System Accelerometer.

A novel design of a MEMS (Micro-Electromechanical System) capacitive accelerometer fabricated by surface micromachining, with a structure enabling precise auto-calibration during operation, is presented. Precise auto-calibration was introduced to ensure more accurate acceleration measurements compared to standard designs. The standard mechanical structure of the accelerometer (seismic mass integrated with elastic suspension and movable plates coupled with fixed plates forming a system of differential sensing capacitors) was equipped with three movable detection electrodes coupled with three fixed electrodes, thus creating three atypical tunneling displacement transducers detecting three specific positions of seismic mass with high precision, enabling the auto-calibration of the accelerometer while it was being operated. Auto-calibration is carried out by recording the accelerometer indication while the seismic mass occupies a specific position, which corresponds to a known value of acting acceleration determined in a pre-calibration process. The diagram and the design of the mechanical structure of the accelerometer, the block diagram of the electronic circuits, and the mathematical relationships used for auto-calibration are presented. The results of the simulation studies related to mechanical and electric phenomena are discussed.

Evaluating Opioid Dispensing Rates among Pediatrics and Young Adults based on CURES Data Reporting in California from 2015-2019.

BACKGROUND: Receipt of opioid prescriptions in pediatric and young adult patients may be a risk factor for future opioid misuse. Data from prescription drug monitoring programs provide insight on outpatient opioid use. In our study, we analyzed the opioid dispensing rates for pediatrics and young adults in California. METHODS: A secondary analysis was performed from 2015-2019 using Controlled Utilization Review and Evaluation System data. This database provides dispensing data of controlled substances in California. Patients younger than 25 years who were prescribed opiates were analyzed by county. We further divided them into two groups (children: ≤14 years; adolescents and young adult: 15-24 years). Descriptive statistics and heat maps were used to illustrate the trends in opioid usage among different age groups. RESULTS: The overall percentages for the number of opioids being dispensed to patients aged <25 years have decreased over the past four years. In 2015, 6 out of 58 counties in California were considered "high-rate" with >2.9% of opioids dispensed to patients younger than 25 years old; in 2019, this number reduced to zero. Patients 25 and older received a higher proportion of opioids compared to younger populations; in 2019, 35.91% of opioids were dispensed to patients 45-64, and 8.92% to patients younger than 25. CONCLUSION: Pediatric opioid prescriptions have declined over the recent years. However, a high degree of variability of prescription rates between demographic counties was noted. More studies are warranted in order to understand this discrepancy in opioid prescribing among pediatric and young adult patients.

Racial and ethnic disparities in opioid use for adolescents at US emergency departments.

BACKGROUND: Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. METHODS: This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11-21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method. RESULTS: There was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6-15.9%), and 17.4% (95% CI, 16.5-18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601-0.906, aOR = 0.739, 95% CI 0.578-0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500-0.672, aOR = 0.807, 95% CI 0.685-0.951, respectively) compared to non-Hispanic Whites. CONCLUSIONS: Differences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed.

Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting.

This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.

Evaluating risk factors for acute graft versus host disease in pediatric hematopoietic stem cell transplant patients receiving tacrolimus.

To identify the clinical and pharmacological risk factors associated with tacrolimus pharmacodynamics for acute graft-versus-host disease (aGVHD) in pediatric patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) from a matched related donor. A retrospective cohort single center chart review study was conducted with pediatric patients who received tacrolimus prophylaxis after allogeneic HSCT between January 1, 2017, and December 31, 2019. Potential risk factors were tested separately between aGVHD and non-aGVHD cohorts and were further analyzed in a logistic regression model with backward elimination and a partial least squares discriminant analysis. Thirty-three patient cases were included in our study and 52% (17/33) developed aGVHD while on tacrolimus prophylaxis. When tested independently, donor age and sibling versus parent donor/recipient relation were shown to be statistically significant between aGVHD and non-aGVHD patients (p < 0.005). Pharmacological factors associated with tacrolimus treatment failed to demonstrate a significant impact on patient's risk of aGVHD. Using a best fit logistic regression model that tested all the variables together, donor age was the only significant variable predicting patient's risk of aGVHD (p < 0.01). Donor relationship and donor age were unable to be evaluated separately and are therefore confounding variables. Among pediatric patients receiving allogeneic HSCT, aGVHD risk is significantly decreased by either sibling donor and/or younger donors. Although no conclusions were drawn on the effect of tacrolimus therapy (p = 0.08), results warrant additional research with a larger sample size to evaluate the accuracy of monitoring tacrolimus serum trough levels.

Parental Psychosocial Factors Moderate Opioid Administration Following Children's Surgery.

BACKGROUND: This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain. METHODS: Participants in this longitudinal analysis were children ages 2-12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset. RESULTS: Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child's pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant. CONCLUSIONS: These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.

Evaluating the 0-10 Point Pain Scale on Adolescent Opioid Use in US Emergency Departments.

OBJECTIVE: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. METHODS: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11-21 from 2008-2017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). RESULTS: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 visits nationwide. Overall, patients with a score of 10 were 1.35 times more likely to receive an opioid than patients scoring a 9, 41.7% (CI95 39.7-43.8%) and 31.0% (CI95 28.8-33.3%), respectively. Opioid use was significantly different between traditional pain score cutoffs of mild (1-3) and moderate pain (4-6), where scores of 4 were 1.76 times more likely to receive an opioid than scores of 3, 15.5% (CI95 13.7-17.3%) and 8.8% (CI95 7.1-10.6%), respectively. Scores of 7 were 1.33 times more likely to receive opioids than scores of 6, 24.7% (CI95 23.0-26.3%) and 18.5% (CI95 16.9-20.0%), respectively. Fractures had the highest likelihood of receiving an opioid, as 49.2% of adolescents with a fracture received an opioid (CI95 46.4-51.9%). Within this subgroup, only adolescents reporting a fracture pain score of 10 had significantly higher opioid use than adjacent pain scores, where fracture patients scoring a 10 were 1.4 times more likely to use opioids than those scoring 9, 82.2% (CI95 76.1-88.4%) and 59.8% (CI95 49.0-70.5%), respectively. CONCLUSIONS: While some guidelines in the adult population have revised cut-offs and groupings of the traditional tiers on a 0-10 point pain scale, the adolescent population may also require further examination to potentially warrant a similar adjustment.

Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting.

BACKGROUND: This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. METHODS: Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. RESULTS: There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. CONCLUSION: Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.

Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption.

OBJECTIVE: Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain. METHODS: Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy surgery and their parents. Longitudinal multilevel modeling examined changes in both parent-reported pain and hydrocodone/APAP consumption (mg/kg) on days 1 to 7 after surgery. RESULTS: Parent reports of postoperative pain were higher in Hispanic/Latinx patients compared to their Non-Hispanic White counterparts (ß = -0.15; 95% CI: -0.28, -0.01). There was also a significant interaction of ethnicity and pain on opioid consumption (ß = 0.07; 95% CI: 0.01, 0.13). The relationship between parent perceived pain and opioid use was stronger for Non-Hispanic White children, suggesting that this group was more likely to consume opioids to help manage clinically significant postsurgical pain. CONCLUSIONS: Hispanic/Latinx children might be at risk for undertreatment of surgical pain. Findings highlight the importance of assessing parent background and cultural beliefs as predictors of at home pain management and the potential effectiveness of tailored interventions that educate parents about monitoring and treating child postoperative pain.

National gender differences in the prescribing of opioid medications from 2006 to 2015.

OBJECTIVE: To identify gender differences in opioid prescribing from ambulatory care settings and identify factors associated with prescribing of opioids for men and women. DESIGN AND PARTICIPANTS: Retrospective analysis of data from The National Ambulatory Medical Care Survey from January 1, 2006 to December 31, 2015. Eligible patients were at least 18 years old on the date of the physician office visit. Data were collected on patient demographics and clinical factors. Data were analyzed using bivariate and multivariate logistic regression models to explore differences in opioid prescribing among men and women. Due to the large sample size, the significance level was set to p < 0.001. MAIN OUTCOME MEASURE: Opioid prescribing during an office visit. RESULTS: A total of 322 957 ambulatory care visits for adults were included in the analysis representing 7.8 billion weighted visits nationally. In 771 601 088 (9.8 percent) visits, an opioid was prescribed. Women received an opioid prescription at 9.4 percent of visits compared to 10.4 percent of visits for men. Gender differences for factors including age, region, payment method, and pain diagnosis were observed (p < 0.001). Women had a higher number of visits with an opioid (449 277 925 vs 322 323 163), but men had higher odds of being prescribed an opioid (OR: 1.214; CI: 1.214-1.214). CONCLUSION: Men are more likely to be prescribed an opioid as compared to women, but women are being prescribed more opioids overall. Gender differences should be further explored to develop gender-specific interventions to reduce opioid prescribing.

The impact of the pharmacist on continuity of care during transitions of care: A systematic review.

OBJECTIVES: To evaluate programs that provide pharmacy-led continuity of care services and to assess their effectiveness in improving patient outcomes. DATA SOURCES: Three databases were used to conduct the article search and assess relevant articles: PubMed (Medline), Cinahl, and Web of Science. STUDY SELECTION: Articles that included prospective measurement with defined clinical outcomes of the impact of including a pharmacist in discharge planning and continuity of care after a hospitalization were included in the review. Articles were limited to those available in English, conducted within the United States, and including humans. DATA EXTRACTION: Relevant articles from the full database collections through April 2017. RESULTS: Readmission rates were the most common primary outcome evaluated. Other primary outcomes included medication adherence, medication error identification and reduction, and patient satisfaction. Although the data has shown that pharmacists play a crucial role by promoting medication adherence and providing effective medication reconciliation, this systematic review did not result in identifying any one pharmacist intervention to be the most effective in improving continuity of care. CONCLUSION: There is both a need and an opportunity for research that supports best practices in providing continuity of care during transitions of care.

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities.

The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first-line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.

Exploring the relationship of digital information sources and medication adherence.

We present a retrospective analysis of data collected in the United States from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Role in order to model the relationship between health information sources and medication adherence and perception. Our results indicate that while the digital age has presented prescription users with many non-traditional alternatives for health information, the use of digital content has a significant negative correlation with pharmaceutical adherence and attitudes toward medication. These findings along with previous research suggest that in order to fully realize the potential benefits of the digital age in regards to patient health, positive patient-provider discussions regarding information found online, efforts to improve general health literacy and improvements in the quality and accuracy of the information found are key. Given that higher reliance on digital content is correlated with younger age, the analysis suggests that proactive measures should be taken to educate younger prescription users about the merits and pitfalls of information seeking techniques as they pertain to health literacy.

Evaluating Factors Impacting Medication Adherence Among Rural, Urban, and Suburban Populations.

PURPOSE: To evaluate differences in prescription medication adherence rates, as well as influencing factors, in rural and urban adults. METHODS: This is a retrospective analysis of the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Role. A total of 26,173 participants completed the survey and provided usable data. Participants using between 1 and 30 prescription medications and living more than 0 miles and up to 200 miles from their nearest pharmacy were selected for the study, resulting in a total of 15,933 participants. Data from the 2010 US Census and Rural Health Research Center were used to determine the population density of each participant's ZIP code. Participant adherence to reported chronic medications was measured based on the 8-item Morisky Medication Adherence Scale (MMAS-8). FINDINGS: Overall adherence rates did not differ significantly between rural and urban adults with average adherence based on MMAS-8 scores of 5.58 and 5.64, respectively (P = .253). Age, income, education, male sex, and white race/ethnicity were associated with higher adherence rates. While the overall adherence rates between urban and rural adults were not significantly different, the factors that influenced adherence varied between age-specific population density groupings. CONCLUSION: These analyses suggest that there is no significant difference in adherence between rural and urban populations; however, the factors contributing to medication adherence may vary based on age and population density. Future adherence intervention methods should be designed with consideration for these individualized factors.

Trends in Opioid Use in Pediatric Patients in US Emergency Departments From 2006 to 2015.

Importance: The use of opioids to treat pain in pediatric patients has been viewed as necessary; however, this practice has raised concerns regarding opioid abuse and the effects of opioid use. To effectively adjust policy regarding opioids in the pediatric population, prescribing patterns must be better understood. Objective: To evaluate opioid prescribing patterns in US pediatric patients and factors associated with opioid prescribing. Design, Setting, and Participants: This cross-sectional study used publicly available data from the National Hospital Ambulatory Medical Care Survey from January 1, 2006, to December 31, 2015. Analysis included the use of bivariate and multivariate models to evaluate factors associated with opioid prescribing. Practitioners from emergency departments throughout the United States were surveyed, and data were collected using a representative sample of visits to hospital emergency departments. The study analyzed all emergency department visits included in the National Hospital Ambulatory Medical Care Survey for patients younger than 18 years. All statistical analysis was completed in June of 2018 and updated upon receiving reviewer feedback in October of 2018. Exposures: Information regarding participants' medications was collected at time of visit. Participants who reported taking 1 or more opioids were identified. Main Outcomes and Measures: Evaluation of opioid prescribing patterns across demographic factors and pain diagnoses. Results: A total of 69 152 visits with patients younger than 18 years (32 727 female) were included, which were extrapolated by the National Hospital Ambulatory Medical Care Survey to represent 293 528 632 visits nationwide, with opioid use representing 21 276 831 (7.25%) of the extrapolated visits. Factors including geographic region, race, age, and payment method were associated with statistically significant differences in opioid prescribing. The Northeast reported an opioid prescribing rate of 4.69% (95% CI, 3.69%-5.70%) vs 8.84% (95% CI, 6.82%-10.86%) in the West (P = .004). White individuals were prescribed an opioid at 8.11% (95% CI, 7.23%-8.99%) of visits vs 5.31% (95% CI, 4.31%-6.32%) for nonwhite individuals (P < .001). Those aged 13 to 17 years were significantly more likely to receive opioid prescriptions (16.20%; 95% CI, 14.29%-18.12%) than those aged 3 to 12 years (6.59%; 95% CI, 5.75%-7.43%) or 0 to 2 years (1.70%; 95% CI, 1.42%-1.98%). Patients using Medicaid for payment were less likely to receive an opioid than those using private insurance (5.47%; 95% CI, 4.79%-6.15% vs 9.73%; 95% CI, 8.56%-10.90%). There was no significant difference in opioid prescription across sexes. Opioid prescribing rates decreased when comparing 2006 to 2010 with 2011 to 2015 (8.23% [95% CI, 6.75%-9.70%] vs 6.30% [95% CI, 5.44%-7.17%]; P < .001); however, opioid prescribing rates remained unchanged in specific pain diagnoses, including pelvic and back pain. Conclusions and Relevance: This research demonstrated an overall reduction in opioid use among pediatric patients from 2011 to 2015 compared with the previous 5 years; however, there appear to be variations in factors associated with opioid prescribing. The association of location, race, payment method, and pain diagnoses with rates of prescribing of opioids suggests areas of potential quality improvement and further research.

Evaluating Patient Preferences for Different Incentive Programs to Optimize Pharmacist-Provided Patient Care Program Enrollment.

BACKGROUND: Employers have increased efforts to engage employees in health and wellness programs. Providing employees with incentives to participate in these programs has been shown to improve overall enrollment and engagement. One program that has had challenges with enrollment and engagement is medication therapy management (MTM). OBJECTIVES: To (a) determine how individuals evaluate different financial incentives to improve participation in an MTM program and (b) measure the effect of participant characteristics on incentive preference. METHODS: This study was composed of a paper-based survey administered to participants after focus group sessions. Participants included MTM-eligible beneficiaries from 2 employer groups and included MTM-naive and MTM-experienced participants. Incentive preference was measured based on 3 bipolar scales that compared 3 incentives: $100 gift certificates, $8 copay reduction for 6 months, and $100 added to paycheck. RESULTS: A total of 72 participants completed the survey: 34 participants were MTM experienced, and 38 were MTM naive. Overall participant preference reporting resulted in inconsistencies. Copay reduction was preferred to a gift certificate (55.6% vs. 37.5%); money in paycheck was preferred over copay reduction (48.6% vs. 40.3%); and gift certificates were preferred over money in paycheck (56.9% vs. 22.2%). However, subgroup analysis resulted in a more consistent preference reporting, with MTM-experienced participants consistently preferring copay reduction over gift certificates (67.6% vs. 23.5%) and money in paycheck (55.9% vs. 29.4%). MTM-naive participants preferred a gift certificate over copay reduction (51.4% vs. 44.7%) and cash in paycheck (68.4% vs. 23.7%). CONCLUSIONS: The results of this study suggest that gift certificates were preferred by MTM-naive participants, which supports the use of gift certificates as an incentive for MTM-naive patients to enroll in an MTM program. Conversely, the use of a copay reduction program was preferred by MTM-experienced participants, suggesting that it may be ideal for participants already enrolled in an MTM program. The results suggest the potential value of using multiple forms of incentives to attract MTM-naive and experienced beneficiaries. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to disclose. All authors contributed to study concept and design. Cernohous and Vaidyanathan collected the data, and Tomaszewski took the lead in data interpretation, along with Cernohous. The manuscript was written and revised primarily by Tomaszewski, along with Cernohous and Vaidyanathan.

Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8).

BACKGROUND: Preconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. METHODS: This cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. RESULTS: Of the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P < 0.001) and perceived knowledge (p < 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence. CONCLUSION: Less than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs.

Consumers' characteristics associated with the use of mail pharmacy services in the United States: Findings from the 2015 National Consumer Survey on the Medication Experience.

OBJECTIVES: The purpose of this study was to describe current users of mail pharmacy services and to evaluate factors associated with the use of mail pharmacy services. DESIGN: Cross-sectional online survey-based study. SETTING AND PARTICIPANTS: The data were obtained from the 2015 National Consumer Survey on the Medication Experience, which included 26,173 adults from throughout the United States. OUTCOME MEASURES: Mail pharmacy utilization was based on participant self-report. Demographic variables included age, education, race, gender, insurance status, distance to nearest pharmacy, number of disease states, and income. Chi-square and t test analyses were conducted to assess the factors associated with mail pharmacy use. Multivariable logistic regressions were used to compute the odds ratios (ORs) and 95% confidence intervals for the predictors of mail pharmacy usage. RESULTS: Overall, 17% of respondents reported the use of mail pharmacy services. Based on chi-square analysis, use of mail pharmacy services was significantly associated with age, education, race, and region. In addition, distance to nearest pharmacy and the report of the presence of certain disease states were significantly associated with mail pharmacy use (P <0.001). Based on the results of logistic regression analysis, there was a significant association of mail pharmacy use by age, having chronic diseases, level of education, distance to nearest pharmacy, and other included variables (P <0.05). CONCLUSION: Mail pharmacy service users accounted for 17% of the respondents of this study. Advancing age, presence of chronic diseases, increasing level of education, and increasing distance to the nearest pharmacy were positively associated with the use of mail pharmacies. Further research is needed to better understand patient-specific reasons for choosing mail pharmacies or community pharmacies.

Biosimilar Naming Conventions: Pharmacist Perceptions and Impact on Confidence in Dispensing Biologics.

BACKGROUND: The approval of the first biosimilar in the United States has placed increased pressure on the FDA to provide guidance on the naming convention that will be assigned to current and future biosimilars. The release of the FDA draft guidance on nonproprietary naming of biosimilars in August 2015 established a naming convention for all biologic products, including biosimilars. However, the draft guidance is nonbinding while the FDA continues to receive input from stakeholders, and it does not address the naming convention that will be used for products designated as interchangeable biologics. OBJECTIVES: To (a) determine pharmacist perceptions of biosimilar naming conventions and their impact on confidence to dispense biosimilars and (b) measure the burden that is created by laws and regulations requiring pharmacists to complete postdispense notifications. METHODS: A cross-sectional survey of 781 members of the Academy of Managed Care Pharmacy and the Hematology/Oncology Pharmacy Association was conducted using an online survey software program. RESULTS: Participants reported preferring a biosimilar naming convention that uses a nonproprietary base with a designated suffix (48.1%), compared with the use of a nonproprietary base alone (26.3%), nonproprietary base plus a prefix (14.2%), or a unique brand name (11.4%). However, when participants were asked to report their confidence levels when dispensing a biosimilar in place of the reference biologic, more participants reported high levels of confidence when the products shared the same nonproprietary name (62.9%). A majority of participants (64.9%) reported perceptions of increased burden when required to provide a postdispense notification to prescribers when dispensing biosimilars. CONCLUSIONS: According to the survey used in this study, pharmacists prefer the use of a naming convention for biosimilars that includes a nonproprietary proper name with a designated suffix; however, levels of confidence in substituting a biosimilar for the reference biologic are highest when products share the same nonproprietary name. In addition, the results of this study suggest that the naming convention and postdispense notification requirements may affect the willingness of some pharmacists to dispense interchangeable biologics. This effect will be minimized if interchangeable biologics share the same nonproprietary name as the reference biologics. DISCLOSURES: Funding for this study was provided by the Academy of Managed Care Pharmacy. The author reports no conflicts of interest. Tomaszewski was responsible for all aspects of project and manuscript development.

Carrier density distribution in silicon nanowires investigated by scanning thermal microscopy and Kelvin probe force microscopy.

The use of scanning thermal microscopy (SThM) and Kelvin probe force microscopy (KPFM) to investigate silicon nanowires (SiNWs) is presented. SThM allows imaging of temperature distribution at the nanoscale, while KPFM images the potential distribution with AFM-related ultra-high spatial resolution. Both techniques are therefore suitable for imaging the resistance distribution. We show results of experimental examination of dual channel n-type SiNWs with channel width of 100 nm, while the channel was open and current was flowing through the SiNW. To investigate the carrier distribution in the SiNWs we performed SThM and KPFM scans. The SThM results showed non-symmetrical temperature distribution along the SiNWs with temperature maximum shifted towards the contact of higher potential. These results corresponded to those expressed by the distribution of potential gradient along the SiNWs, obtained using the KPFM method. Consequently, non-uniform distribution of resistance was shown, being a result of non-uniform carrier density distribution in the structure and showing the pinch-off effect. Last but not least, the results were also compared with results of finite-element method modeling.