Publications

We present data showing that the urinary metabolic ratio (MR) of metabolite to parent drug can be used to estimate the drug-drug interactions (DDIs) of pain management and substance abuse treatment medications with other coadministered drugs. We quantitatively measure 18 drugs and their phase I metabolites and monitor the effects of 14 interfering drugs on their MRs. The 18 drugs include dextromethorphan, oxycodone, hydrocodone, tramadol, morphine, buprenorphine, fentanyl, clonazepam, alprazolam, quetiapine, carisoprodol, tapentadol, ketamine, methadone, impramine, and amitriptyline. The 14 interfering drugs include fluoxetine, paroxetine, bupropion, citalopram, sertraline, venlafaxine, duloxetine, risperidone, trazodone, aripiprazole, cyclobenzaprine, amphetamine, and tetrahydrocannabinol. Some of these interfering drugs are inhibitors of either the CYP2D6, CYP3A4/5, or CYP2C19 pathways. By using the urinary MR of metabolite/parent drug, we observed patterns of inhibition and enhancement due to DDIs. Using the MR reference intervals of the 18 drug pairs established in an earlier study, and the current DDI system, we can alert providers of unusual metabolism caused by DDIs. This will help providers do better prescribing or review more closely all medications and supplements patients are taking, thus avoiding underdosing or potential medication adverse reactions.

We present data that show that quantitative urine drug concentrations obtained from individuals monitored for drug compliance as part of their participation in chronic opioid or substance abuse treatment can be used to quantify drug metabolism. We quantitatively monitor 18 drugs and their Phase 1 metabolite. These drugs were dextromethorphan, morphine, oxycodone, hydrocodone, quetiapine, tapentadol, tramadol, buprenorphine, clonazepam, fentanyl, imipramine, ketamine, carisoprodol, alprazolam, methadone, and amitriptyline. By using the ratio of metabolite/parent drug (prescribed medication), the expected or reference values for 18 drugs were obtained. Ratio values outside of this reference range could be considered to be caused by genetic metabolizing variants, drug-drug interactions, age, or deception. Alerting providers of the variance in metabolism from the expected norm might reduce overdosing or underdosing patients.

PURPOSE: To assess choroidal vasculature in bilateral age-related macular degeneration (AMD) patients, with neovascular AMD in one eye and dry AMD in the other, using an innovative three-dimensional (3D) algorithm.

METHODS: This retrospective cross-sectional study included 30 patients with asymmetric bilateral AMD. All patients underwent clinical exams and swept-source optical coherence tomography using PlexElite-9000 (Carl Zeiss Meditec, Dublin, CA) scans centered on the fovea. The 3D choroidal vasculature was segmented using our validated deep learning algorithm. These 3D maps were divided into five sectors, with the three largest vessels in each sector selected for mean choroidal vessel diameter and inter-vessel distance (IVD) measurements. Volumetric choroidal thickness (ChT) and choroidal vascularity index (CVI) were calculated. Analysis was performed using a linear mixed model.

RESULTS: This study analyzed 60 eyes from 30 patients, with a mean age of 78.63 ± 8.01 years. Neovascular AMD eyes had significantly higher mean LogMar visual acuity (0.63 ± 0.60 vs. 0.20 ± 0.18, P < 0.001). Neovascular eyes had higher average vessel diameter (253.711 ± 20.777 vs. 232.641 ± 28.249 micrometers, P < 0.001), significant in central, temporal, and superior sectors (P < 0.05). IVD was lower in neovascular AMD (209.563 ± 21.074 vs. 213.867 ± 30.684 µm, P = 0.515). Average ChT was lower in neovascular AMD (193.939 ± 49.627 vs. 198.245 ± 53.786 µm, P = 0.809), significant in the inferior sector (P = 0.011). Additionally, CVI was higher in neovascular AMD (0.365 ± 0.033 vs. 0.353 ± 0.035, P = 0.031), particularly in inferior, superior, and central sectors (P < 0.05).

CONCLUSIONS: Eyes with neovascular AMD demonstrated higher choroidal vessel diameter, ChT, and CVI and decreased IVD compared to dry AMD eyes, possibly related to vessel congestion and inflammation in eyes with active choroidal neovascularization.

Not-In-My-Backyard (NIMBY) facilities, often characterized by their negative externalities, are frequently opposed or resisted by the public. To examine the impact of information interventions on public acceptance of NIMBY facilities, a behavioral investigation experiment consisting of a survey of 100 college students before and after viewing negative videos of either environmentally polluting or psychologically excluding types of NIMBY facilities was conducted to assess the efficacy of these interventions in shaping public perceptions and attitudes. Differences in respondent's attitudes toward the types of NIMBY facilities demonstrated that the information intervention affected perceptions and attitudes toward NIMBY facilities. Changes in response variables for perceived risk, perceived benefits, self-efficacy, positive emotion label, social environment, and public acceptance showed that environmentally polluting NIMBY facilities elicited a more negative response than psychologically excluding NIMBY facilities. Post-intervention, significant differences emerged across all six dimensions, and attitudes toward environmentally polluting NIMBY facilities became more negative than those toward psychologically excluding NIMBY facilities, with a significant increase in the perceived risk and a significant decrease in the perceived benefit. The study demonstrated that information interventions influenced attitudes toward NIMBY facilities, and that this influence differed between the two facility types.

Continuous tracking is the recently developed psychophysical technique for efficiently estimating human visual temporal characteristics. The standard version of the task, referred to as position tracking (PT), asks participants to track the location of a continuously moving target by a motor response (e.g., mouse movement). Some studies have also used a variant method, attribute tracking (AT), which requires participants to track and reproduce a continuously changing attribute (e.g., luminance) of the target instead of position. For both PT and AT, the temporal dynamics of the entire system from vision to action can be estimated from the cross-correlogram (CCG) of the trajectory between the stimulus and response. The similarities and differences in CCG between PT and AT, however, remain elusive but were examined in this study. Experiment 1 compared the two CCGs using luminance-defined circular patches, color-contrast-defined patches, and luminance-defined patches with various spatial frequencies. The results indicate that the PT response was faster and less affected by the stimulus variables than the AT response. Experiment 2 showed that these differences could be reduced by making the visuomotor mapping of PT less direct by reversing the motor response direction and by making the local stimulus change magnitude comparable between PT and AT. The comparison with the traditional reaction time measures (Experiment 3) further showed that the peak latency of CCG from PT aligned better with the simple reaction time, whereas that from AT aligned better with the choice reaction time. These results indicate that CCG is more sluggish for AT than for PT because AT includes the process of identifying the stimulus content (attribute change direction) and mapping it to a motor response arbitrarily specified by the experimenter, and because the effective stimulus change magnitude for AT is often weaker than that for PT. These findings provide a clearer understanding of the meaning of CCGs measured by the two types of continuous tracking tasks.

PURPOSE: To determine the prevalence, factors, temporal trends, and projections of glaucoma over 15 years among multiethnic older Asian adults aged 60 to 100 years.

METHODS: We included 2380 participants (mean [SD] age, 73.6 [8.5] years; 55.2% female) from the baseline phase of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017-2022) study. Comprehensive eye examinations and standardized questionnaires assessed sociodemographic, clinical, and lifestyle factors. Glaucoma and subtypes were defined using International Society of Geographical and Epidemiological Ophthalmology guidelines, with age-standardized prevalence rates based on the 2020 Singapore census. Logistic regression using generalized estimating equations identified risk factors, temporal trends were analyzed using population-based data, and projections utilized United Nations population data.

RESULTS: The census-adjusted glaucoma prevalence was 5.1%, comprising 3.4% primary open-angle glaucoma, 0.7% primary angle-closure glaucoma, and 1% secondary glaucoma. Prevalence was higher among Malays (6.5%) and Indians (6.2%) compared to Chinese (4.9%). Significant factors included older age (odds ratio [OR], 1.07), Malay ethnicity (OR, 2.07), higher intraocular pressure (OR, 1.14), longer axial length (OR, 1.20), cataract surgery (OR, 1.81), and polypharmacy (OR, 2.04). Over two decades, age-adjusted glaucoma prevalence in Singapore remained stable (5%-7%) but increased among Indians (3.65% in 2013 to 6.70% in 2022), likely due to the high rates of systemic diseases. Currently, ∼57,800 Singaporeans aged ≥60 years have glaucoma, projected to rise by 43%, reaching 85,800 by 2040.

CONCLUSIONS: Glaucoma is common among older Singaporeans, with notable sociodemographic and modifiable clinical factors. Rising prevalence among Indians and the projected increase in cases underscore the need for targeted screening and early interventions.

Editor's note: This is the 28th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation-and most can be read without knowledge of the preceding articles. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

Health is determined by the quality of and access to the healthcare system, but more importantly by the characteristics of the social and physical environment in which individuals live. Actions to promote health can be integrated into public policies, especially at the local level. In Switzerland, local authorities do not always have their own competencies in the field of health, but they can act to improve living conditions and promote access to healthcare. In this sense, healthcare professionals have an important role to play in health promotion by initiating, supporting, and participating in collaborations with municipalities, as demonstrated by the creation of health centers. This article provides an overview of the general framework for health promotion at the municipality level and some examples of collaborations.

In 2021, noncommunicable diseases caused 43 million deaths worldwide, with one-third attributable to four major industries: tobacco, alcohol, ultraprocessed foods, and fossil fuels. In this context, can poor health still be explained solely by individual choices? The concept of commercial determinants of health, increasingly discussed in public health, examines the structural causes of these « industrial epidemics » and highlights the influence of economic actors on population health. It urges healthcare professionals, policymakers, and organizations to assess the impact of industrial strategies on consumption behaviors, while advocating for the implementation of appropriate regulations.