Patients’Knowledge, Attitude and Practices on Disposal Methods of Expired and Unused Medicines: Implication for Creation of Drug Take-Back Program

Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.

Study of the Management and Disposal Practices of Unused or Out-of-Date Medicines by Households in the Municipality of Ouagadougou, Burkina Faso

Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disposed of. In Burkina Faso, there are as yet no guidelines for the disposal of unused medicines in households. The aim of this study was to estimate the extent of household possession of unused or expired medicines, and to describe attitudes and disposal practices. Methods: This was a descriptive cross-sectional study covering households in the Ouagadougou commune conducted from June to August 2021. Two-stage stratified sampling was used: selection of Enumeration Zones (EZs) and selection of households, with each EZ comprising several households. Data collection was based on direct interviews using a structured questionnaire. Data were processed using Epi Info software version 7.2.4.0. Results: In total, 417 household residents were surveyed out of the planned 423 households, corresponding to a completion rate of 98.58% compared with the initial sample. Among the respondents, 79.62% had unused and/or expired medicines in their household. A total of 2562 drug packaging units were counted, for a total weight of 121.90 kg. Nearly 75% were aware that improper disposal was a danger to the environment. Some respondents kept their unused medicines at home until they expired (43.41%), and disposed of them mainly by throwing them in the household garbage (75.58%). The majority (79%) were in favor of the government setting up a take-back program for these medicines. Conclusion: The introduction of a take-back program for unused or out-of-date medicines will ensure safer disposal of medicines, and better protection for households and the environment.

The Impact of Initial Public Offering Lockup Expirations on Liquidity:Evidence from Chinese Stock Market

Previous empirical evidence on the liquidity effect to the lockup expiration is mixed. A sample from Chinese listed firms is adopted and contributes to better understand this effect in emerging markets. The spread and illiquidity significantly increases around lockup expiration in China. Furthermore, the liquidity reaction to firms' disclosure quality is explicitly related. The results confirm that higher disclosure quality is significantly associated with lower abnormal spread and illiquidity impact. The effect of lockup expiration shares on liquidity proxies differs in firm disclosure quality. Identifying the factors affecting liquidity around such events may help regulators develop policies to provide investors with greater confidence in their investments.

A Self-Adaptive Back-off Optimization Scheme Based on Beacons Probability Prediction for Vehicle Ad-Hoc Networks

In order to improve the broadcast reception rates of beacon messages in vehicle ad-hoc networks,a conclusion that the relationship between collision probability and minimum contention window size and the relationship between expiration probability and minimum window size was reached by building a Markov model. According to this conclusion, a back-off algorithm based on adjusting the size of minimum contention window called CEB is proposed, and this algorithm is on the basis of the differential size between the number of expiration beacons and preset threshold. Simulations were done to compare the performance of CEB with that of RBEB and BEB, and the results show that the performance of the new proposed algorithm is better than that of RBEB and BEB.

Respiratory Changes in the Superior Vena Cava Area on Inspiratory and Expiratory Chest CT: Comparison between Patients with COPD and with Bronchial Asthma

Purpose: In patients with obstructive lung diseases, alteration of intrathoracic pressure is closely related to hyperinflation and leads to hemodynamic impairments. Both intrathoracic pressure and hemodynamics are affected by the respiratory phase. In fact, a previous study showed that respiratory phasic variations in the superior vena cava (SVC) area significantly correlated with the extent of emphysema. Chronic obstructive pulmonary disease (COPD) and bronchial asthma manifest different pathophysiological changes in hyperinflation and hemodynamics. The current study was conducted to evaluate differences in respiratory variations in the cross-sectional area of the SVC between patients with COPD and with asthma. Materials and Methods: We measured the SVC area and calculated the ratio of the SVC area on inspiratory and expiratory scans (i/e-SVC ratio) in 66 patients with COPD and 16 patients with asthma. The cor-relations of the i/e-SVC ratios with airflow limitation, pulmonary small vessels less than 5 mm2 (%cross-sectional area [%CSA] < 5), and respiratory changes in lung volume (i/e-LV) obtained by inspiratory and expiratory computed tomography (CT) images were evaluated. Results: There was no significant difference in i/e-SVC ratio between COPD and asthma groups. In COPD patients, the i/e-SVC ratio significantly correlated with the %CSA ﹣0.433, P = 0.003), i/e-LV ratio (ρ = ﹣0.371, P = 0.011), and percent of predicted forced expiratory volume in 1 second (FEV1% predicted) (ρ = ﹣0.474, P = 0.001), whereas in asthma patients, there were no significant correlations between the i/e-SVC ratio and those functional parameters. Conclusion: There would be differences in the relationship between intrathoracic pressure and cardiopulmonary hemodynamics between COPD and asthma patients.

The witching week of herding on bitcoin exchanges

This paper analyses the herding behaviour among exchanges around the expiration of bitcoin futures traded on the Chicago Mercantile Exchange(CME).The database extends from December 2017 to October 2020,taking as a reference the main exchanges that trade bitcoin(Binance,Bitfinex,Bitstamp,Coinbase,itBit,Kraken,and Gemini)and using hourly closing prices and trading volumes in bitcoin and US dollars.Adapting the proposal of Chang,Cheng and Khorana(2000)(CCK)to test conditional herding,we obtain results that indicate that the herding effect is significant during the week before expiration.After expiration,the herding effect lasts for a few hours and disappears.Information overload originating,among other causes,from sophisticated investors’strategies may generate this mimetic behaviour.The results show the relevance of intraday data applied to specific events such as expiration since the unconditional analysis shows,in general,anti-herding behaviour throughout the period of study.

Theory of Fighting the Epidemic with Traditional Chinese Medicine Qigong(气功)Therapy

Qigong(气功)therapy is an active self-paced exercise therapy and it has a long history in traditional Chinese medicine(TCM).As early as the mention of it in the Huang Di Nei Jing(《黄帝内经》Huangdi s Internal Classic),there is a record of using qigong therapy to prevent and treat pestilence.This thesis discusses the idea and methods of qigong therapy in TCM,such as daoyin(导引),expiration and inspiration,and meditation.These methods purpose to have the functions of strengthening and consolidating the primordial qi,improving health conditions,and resisting pestilent qi.Therefore,the core idea of fighting the epidemic with qigong therapy is to enhance the healthy qi,and to prevent the intrusion of pestilent qi into the human body.It embodies the TCM thought of“when there is sufficient healthy qi inside the body,the evil cannot invade the body.”

Expiratory Upper Airway Obstruction Caused by the Soft Palate during Bag-Mask Ventilation

Introduction: Expiratory upper airway obstruction during bag-mask ventilation is not well characterized. Methods: An audit was done to assess expiratory obstruction in 90 adult surgical patients undergoing bag-mask ventilation during the induction of general anaesthesia. Results: Clinicians experienced difficulty delivering gas to the lungs when the head was neutral in 52 of 90 patients (58%;inspiratory obstruction) but this problem was corrected by head tilt and chin lift in all but 2 patients. Clinicians experienced difficulty recovering gas from the lungs when the mouth was held closed under the mask in 30 of the remaining 88 patients (34%;expiratory obstruction). This problem persisted despite head tilt and chin lift in all but one patient but was uniformly corrected by opening the mouth. Inspection of the soft palate revealed that it was lying on the posterior pharyngeal wall in 27 of 30 patients with expiratory obstruction and that the retropalatal space was patent in 55 of 58 patients without expiratory obstruction (χ2, P < 0.001). The clinical predictors of expiratory upper airway obstruction included advanced age, large tongue, and large uvula. Conclusion: Expiratory airway obstruction should be suspected in all cases of difficult mask ventilation that cannot be corrected by head tilt and chin lift. Simply allowing the mouth to open between positive pressure breaths will permit gas to exit the lungs.

Effects of Denture Removal on Expiratory Upper Airway Patency during Mask Ventilation in Complete Denture Wearers under General Anesthesia

Background: Some anesthetized patients present with expiratory airway obstruction (EAO) during mask ventilation (MV). EAO may occur more frequently among edentulous patients for whom a firmer grip of the mask and the mandible is needed to avoid gas leakage. We compared EAO grades before and after denture removal and identified predictors of EAO during MV in edentulous patients. Methods: One hundred and eight denture-wearing edentulous patients were anesthetized, their mouths were wrapped with film, their nasal masks and mandibles were held with two hands, and their lungs were ventilated in a pressure-controlled mode. Their dentures were subsequently removed, mouths were re-wrapped, and nasal MV was reapplied. EAO was graded based on capnography waveforms as follows: Grade I, normal waveform (no obstruction);II, loss of the alveolar plateau of the waveform (partial obstruction);and III, no waveform (total obstruction). EAO grades were compared before and after denture removal. Predictive demographic variables for occurrence of total EAO were identified using a multivariate analysis. Results: The proportions of Grades I, II, and III were 43.5%, 26.9%, and 29.6% when dentures were worn and 35.2%, 15.7%, and 49.1%, respectively, when dentures were removed. A significant difference was observed in EAO grades before and after denture removal (P = 0.000034). Age ≥ 75 years (adjusted odds ratio 3.41;95% confidence interval 1.31 - 8.87;P = 0.012) and body mass index ≥ 25 kg/m2 (adjusted odds ratio 2.61;95% confidence interval 1.07 - 6.40;P = 0.036) were independently associated with an increased incidence of total EAO in patients with their dentures removed. Conclusion: Denture removal impaired expiratory upper airway patency in edentulous patients, particularly in older or obese patients, during MV.

Cough Modulation by Upper Airway Stimuli in Cat—Potential Clinical Application?

The modulation of mechanically induced tracheobronchial cough was tested by applying various stimuli and the elicitation of other airway protective behaviors in pentobarbital anesthetized cats. Capsaicin and histamine were injected in the nose, and mechanical nylon fiber and/or air puff stimulation was applied to the nose and nasopharynx. Reflex responses of cough, sneeze, aspiration reflex and expiration reflex were induced mechanically. Swallow was initiated by the injection of water into oropharynx. Subthreshold mechanical stimulation of nasopharyngeal and nasal mucosa, as well as water stimulation in the oropharynx and larynx, with no motor response, had no effect on rhythmic coughing. Cough responsiveness and excitability increased with capsaicin and air puff stimuli delivered to the nose. Vice versa, the number of cough responses was reduced and cough latency increased when aspiration reflexes (>1) occurred before the cough stimulus or within inter-cough intervals (passive E2 cough phase). The occurrence of swallows increased the cough latency as well. Cough inspiratory and/or expiratory motor drive was enhanced by the occurrence of expiration reflexes, swallows, and sneezes and also by aspiration reflex within the inspiratory phase of cough and by nasal air puff stimuli. Complex central interactions, ordering and sequencing of motor acts from the airways may result in the disruption of cough rhythmic sequence but also in the enhancement of cough. Our data confirm that number of peripheral stimuli and respiratory motor responses significantly alters cough performance. We propose developing and testing stimulation paradigms that modify coughing and could be employed in correcting of inappropriate or excessive coughing.

A Novel Apprehension of the Primary Lung Meridian, Sinew Channel, Divergent Channel, Luo-Connecting Channel Acting as a Single Unit System to Serve Respiration Function Based on Modern Neurophysiology and Kinesiology

The TCM philosophy of a meridian and associated channels pertains to the specific function of one or more organs. We define the Lung Primary Meridian (LUM) together with the Lung Sinew (LUSC), Divergent (LUDC), Luo-connecting (LULCC) Channels as a system of routes plus some parts of the body (such as muscles) to fulfil respiration, as a main function under different situations. There is very limited information about the Lung associated channels in classical literature of TCM. With a clear focus on the function of respiration, we have carried out a detailed analysis of the biomedical consequence of stimulating the LUM, analysed the roles played by LUSC, LUDC, and LULCC. The updated LUM and LUDC include acupoints of other meridians, serving the same purpose of performing satisfactory respiration starting from checking the quality of the inflow through the nose. The LUSC includes the respiratory muscles (plus the associated connective tissues) extending to various parts of the body. The muscles of the limb (as part of the LUSC) embrace the nerves that provide routes for somatosensory reflexes and play the role of locomotion, providing voluntary respiration via the pectoralis muscles. The muscles of LUSC are bounded by stiff connective tissue layers, forming compartments, and are part of the pulley system for various body locomotions. Within a compartment, the interstitial fluid, blood, lymph flows must be potent to protect the associated nerves related to LUM;the healthy state of the LUSC also provides freedom of various types of locomotion. The LULCC exists because the vagus nerve has a part of it passing through the spinal cords all the way down to the sacrum domain, with exiting nerve innervating two-third of the large intestine. The crucial steps of our deductions are supported by experimental evidence based on modern neurophysiology and kinesiology. We discover that all the four channels stated above work as a unit system to allow respiration to be possible under various postures/conditions. The complexity of structures and processes is eased off by providing 29 figures and 13 tables for the relevant muscles and nerves. In addition to respiration, the Lung system in TCM context includes interaction of this system with the sweat gland and neuroendocrine system;such aspects will be left to another study.

Reasons for Reverse Flow of Expired Foods and Discussions on Solutions

In recent years,food safety accidents resulted from reverse flow of expired foods is of frequent occurrence. Therefore,finding out reasons for reverse flow of expired foods and taking effective measures to avoid reverse flow of expired foods are greatly significant to safeguard China's food safety. From analysis on current recovery processing situations and related regulations of expired foods in China,it is found that reverse flow of expired food is mainly resulted from no law to comply with,no regulation to follow in recovery processing of expired foods,enterprises lacking good faith,and imperfect accountability system and supervision system. In view of these factors,it comes up with following recommendations:( 1) Improving legal regulations on processing of expired foods;( 2) Making clear responsibility investigation of supervision and law enforcing departments;( 3) Setting up " Four in One" supervision mode integrating enterprise self-discipline,market supervision,social monitoring,and information platform;( 4) Improving the supervision system for recovery processing of expired foods.

Resistance Measured by Airflow Perturbation Compared with Standard Pulmonary Function Measures

Background: Routine lung function testing requires expensive equipment, or requires maximum expiratory effort. The airflow perturbation device (APD) is a light handheld device, allowing for serial measures of respiratory resistance noninvasively and effortlessly. Methods: In a convenience sample of 398 patients undergoing pulmonary function testing, we compared routine spirometric indices (forced expired volume in 1 second (FEV1), peak expiratory flow (PEF)), and airways resistance (Raw-272 patients), to measures of respiratory resistance measured with the APD including inspiratory (IR), expiratory (ER) and averaged (AR) resistance. Results: Measures of lung function were significantly correlated (p 0.001). On regression analysis, between 7% - 17% of the variance (R2) for FEV1, PEF, and Raw was explained by APD measurements. Approximately 2/3 of the variance in FEV1 was explained by PEF measurements. Conclusions: APD measurements of lung function correlate with conventional measures. Future studies should be directed at exploring the use of the APD device in serial measures of lung function in patients with lung disease.

Assessment of Knowledge, Attitude and Practices towards the Disposal of Unused and Expired Medications among Students of Private Medical Universities in Lusaka, Zambia

Background: The disposal of unused and expired medications has been a concern in many countries in that, the pharmaceutical waste enters the ecosystem and eventually causes a negative impact on human health and environment. Aim: To assess the knowledge, attitude and disposal practices of unused and expired medicines by students in the private medical universities in Lusaka of Zambia. Method: A cross-sectional survey was conducted over a period of 8 weeks among 391 respondents from three private universities in Lusaka. Respondents were polled using semi structured questions that focused on their knowledge, attitudes, and disposal practices for unused and expired drugs. In order to analyze data, the statistical package for social sciences (SPSS) version 20 was utilized. Results: The mean age of the participants was 23 years (SD: ±3). Out of the 391 participants, 320 (81.8%) knew about medicine waste and 391 (100.0%) responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. The drug-take-back system was unknown to a vast percentage of the respondent 371 (94.9%). The majority 274 (70.1%) of respondents had unused medicine stored at home, with antibiotics 215 (56.0%) and analgesia 111 (28.4%) being the most prevalent types of drugs kept in the households. The most commonly used disposal practice for unused 126 (32.2%) and expired medicines 274 (70.1%) was throwing them in household garbage. Only 27 (6.9%) and 30 (7.7%) reported returning unused and expired medicines to the nearest pharmacy respectively. The majority of respondents believed the risk stemmed from the presence of an undesired drug in the home, the potential for harm to children, a lack of proper information on safe disposal practices, and the necessity for a take-back program. Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities.