Patient understanding of pharmacogenomic test results in clinical care.

OBJECTIVE: Previous research has not objectively assessed patients' comprehension of their pharmacogenomic test results. In this study we assessed understanding of patients who had undergone cytochrome P450 2C19 (CYP2C19) pharmacogenomic testing. METHODS: 31 semi-structured interviews with patients who underwent CYP2C19 testing after cardiac catheterization and had been sent a brochure, letter, and wallet card explaining their results. Answers to Likert and binary questions were summarized with descriptive statistics. Qualitative data were analyzed using a grounded theory approach, with particular focus on categorization. RESULTS: No participants knew the name of the gene tested or their metabolizer status. Seven participants (23%) knew whether the testing identified any medications that would have lower effectiveness or increased adverse effects for them at standard doses ("Adequate Understanding"). Four participants (13%) read their results from the letter or wallet card they received but had no independent understanding ("Reliant on Written Materials"). Ten participants remembered receiving the written materials (32%). CONCLUSION: A majority of participants who had undergone CYP2C19 PGx testing did not understand their results at even a minimal level and would be unable to communicate them to future providers. PRACTICE IMPLICATIONS: Further research is necessary to improve patient understanding of PGx testing and their results, potentially through improving patient-provider communication.

Review of Domain Wall Dynamics Engineering in Magnetic Microwires.

The influence of magnetic anisotropy, post-processing conditions, and defects on the domain wall (DW) dynamics of amorphous and nanocrystalline Fe-, Ni-, and Co-rich microwires with spontaneous and annealing-induced magnetic bistability has been thoroughly analyzed, with an emphasis placed on the influence of magnetoelastic, induced and magnetocrystalline anisotropies. Minimizing magnetoelastic anisotropy, either by the selection of a chemical composition with a low magnetostriction coefficient or by heat treatment, is an appropriate route for DW dynamics optimization in magnetic microwires. Stress-annealing allows further improvement of DW velocity and hence is a promising method for optimization of DW dynamics in magnetic microwires. The origin of current-driven DW propagation in annealing-induced magnetic bistability is attributed to magnetostatic interaction of outer domain shell with transverse magnetization orientation and inner axially magnetized core. The beneficial influence of the stress-annealing on DW dynamics has been explained considering that it allows increasing of the volume of outer domain shell with transverse magnetization orientation at the expense of decreasing the radius of inner axially magnetized core. Such transverse magnetic anisotropy can similarly affect the DW dynamics as the applied transverse magnetic field and hence is beneficial for DW dynamics optimization. Stress-annealing allows designing the magnetic anisotropy distribution more favorable for the DW dynamics improvement. Results on DW dynamics in various families of nanocrystalline microwires are provided. The role of saturation magnetization on DW mobility improvement is discussed. The DW shape, its correlation with the magnetic anisotropy constant and the microwire diameter, as well as manipulation of the DW shape by induced magnetic anisotropy are discussed. The engineering of DW propagation through local stress-annealing and DW collision is demonstrated.

Microwire-Based Sensor Array for Measuring Wheel Loads of Vehicles.

In this paper, a magnetic microwire-based sensor array embedded under the pavement is proposed as a weighing system at customs ports of entry. This sensor is made of a cementitious material suitable for embedding within the core of concrete structures prior to curing. The objective of this research is to verify the feasibility of stress monitoring for concrete materials using an array of cement-based stress/strain sensors that have been developed using the magnetic sensing property of an embedded microwire in a cement-based composite. Test results for microwire-based sensors and gauge sensors are compared. The strain sensitivity and their linearity are investigated through experimental testing under compressive loadings. Sensors made of these materials can be designed to satisfy specific needs and reduce costs in the production of sensor aggregates with improved coupling performance, thus avoiding any disturbance to the stress state.

Facilitation of accurate and effective radiation therapy using fentanyl pectin nasal spray (FPNS) to reduce incidental breakthrough pain due to procedure positioning.

PURPOSE: To provide effective and accurate radiotherapy (RT) for advanced cancer patients who experience breakthrough pain (BP) due to positioning manoeuvres, through the use of FPNS. Secondary endpoints were the dose and time required to achieve a 50% numeric rating scale (NRS) reduction and conduction of a pharmacoeconomic analysis. PATIENTS AND METHODS: Twenty-seven advanced cancer patients with moderate-severe BP associated with routine radiotherapy procedures and manoeuvres were selected to receive FPNS. Most patients (20/27) had bone metastases. The patients showed a low Karnovsky performance status (mean 54%; range: 30-80). BP intensity was scored with the NRS before and after the procedures that triggered it. All patients were already receiving opioid baseline treatment at a total dose equivalent to 40-160mg oral morphine. Before the procedure, BP was treated with 100-400µg of FPNS. Data related to tolerance, pain relief, onset of the relief and efficient dose to allow RT to proceed were collected. RESULTS: In 26 patients the BP score was reduced by at least 50% as determined in 15.5min (range 8-35min) after fentanyl pectin intranasal administration, and pain relief started after 7min (range 3-15min); p<0.05 in both cases. The duration of pain reduction facilitated the proceeding of RT. The Mean NRS score before the procedure was 9 (95%CI: 8.6-9.4) and decreased during procedure to 3 (95%CI: 2.5-3.8). The average dose of FPNS for most patients was 100-200µg to achieve pain control, except in three patients who required progressive doses of up to 300-400µg. After receiving 300µg, one patient dropped out of the study due to severe adverse effects (nausea). Seven patients reported minor undesirable effects related to FPNS administration. CONCLUSIONS AND IMPLICATIONS: Certain necessary RT procedures in advanced cancer patients can cause severe BP episodes. A simple, safe, fast acting and strong analgesic is needed. FPNS is a rapidly absorbed opioid analgesic with a pain relief profile that would be particularly well suited for this patient population. By reducing BP, the drug enables the completion of necessary RT procedures without needless patient discomfort. When BP is attenuated, Department productivity is maintained and unnecessary delays are avoided. Further studies and clinical trials are needed to assess therapeutic FPNS dosages with a view to defining efficacy in the correct clinical context.

An embedded stress sensor for concrete SHM based on amorphous ferromagnetic microwires.

A new smart concrete aggregate design as a candidate for applications in structural health monitoring (SHM) of critical elements in civil infrastructure is proposed. The cement-based stress/strain sensor was developed by utilizing the stress/strain sensing properties of a magnetic microwire embedded in cement-based composite (MMCC). This is a contact-less type sensor that measures variations of magnetic properties resulting from stress variations. Sensors made of these materials can be designed to satisfy the specific demand for an economic way to monitor concrete infrastructure health. For this purpose, we embedded a thin magnetic microwire in the core of a cement-based cylinder, which was inserted into the concrete specimen under study as an extra aggregate. The experimental results show that the embedded MMCC sensor is capable of measuring internal compressive stress around the range of 1-30 MPa. Two stress sensing properties of the embedded sensor under uniaxial compression were studied: the peak amplitude and peak position of magnetic switching field. The sensitivity values for the amplitude and position within the measured range were 5 mV/MPa and 2.5 µs/MPa, respectively.