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Rebecca J Bartlett Ellis,1 Deanna Hertz,2 Patrick Callahan,3 Todd M Ruppar4 1Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA; 2Ipsos Ltd., South Lake Tahoe, CA, USA; 3Becton, Dickinson and Company, San Diego, CA, USA; 4Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USACorrespondence: Rebecca J Bartlett EllisDepartment of Science of Nursing Care, Indiana University School of Nursing, 600 Barnhill Drive, E423, Indianapolis, IN 46202, USATel +1 317 274 0047Email rjbartle@iu.eduPurpose: Medication nonadherence is a significant and multidimensional problem contributing to an increased risk of morbidity and mortality. Inconveniences in pharmacy and home contexts may increase nonadherence. This research examined inconveniences in pharmacy and home contexts associated with self-reported nonadherence, controlling for demographic and medication-taking covariates.Methods: Data from 4682 individuals who reported self-managing medications in an online marketing survey between October and December 2017 were analyzed in this secondary analysis. Nonadherence was dichotomized using a single question about likelihood to take medications as prescribed (adherence=always; nonadherence=most of the time, some of the time, never). Multivariable logistic regression with backwards elimination was used to examine the pharmacy (use of home delivery, number prescriptions picked up and visits to pharmacy) and home context (method used to organize/manage medications, satisfaction, and bother with management) variables and the demographic (age, sex, race/ethnicity, education, income, insurance) and medication (number of oral medications, medication changes and frequency of taking) covariates associated with nonadherence.Results: Overall, 25.8% of the responses indicated nonadherence. Nonadherence was more likely for individuals making fewer separate pharmacy trips (OR 0.98; 95% CI 0.97– 0.99); picking up fewer prescriptions (OR 0.96; 95% CI 0.93– 0.99); never, rarely or sometimes using mail order compared with always (OR 1.71; 95% CI 1.30– 2.26); not satisfied with managing medications (OR 2.13; 95% CI 1.42– 3.19); and using pill pouches and being bothered by them (OR 8.28; 95% CI 1.83– 37.31). Using pill pouches or a pillbox and not being bothered by them significantly decreased nonadherence likelihood. Younger and female respondents and those reporting medication changes in the last year were also more likely to report nonadherence.Conclusion: Though reasons for nonadherence are multidimensional, this study suggests that inconveniences in both the pharmacy and home context are important. Improving adherence requires addressing issues of inconvenience across the care continuum.Keywords: medication adherence, medication compliance, community pharmaceutic services, outpatient, drug packaging, behavior and behavior mechanisms, MeSH

Using 0.8 x 10(6) D+ D- pairs collected with the CLEO-c detector at the psi(3770) resonance, we have searched for flavor-changing neutral current and lepton-number-violating decays of D+ mesons to final states with dielectrons. We find no indication of either, obtaining 90% confidence level upper limits of B(D+ --> pi+ e+ e-) < 7.4 x 10(-6), B(D+ --> pi- e+ d+) < 3.6 x 10(-6), B(D+ --> K+ e+ e-) < 6.2 x 10(-6), and B(D+ --> K- e+ e+) < 4.5 x 10(-6).

Vivek Y Reddy,1 Yue Zhong,2 Alysha M McGovern,2 Stacey L Amorosi,2 Meghan B Gavaghan,3 Deanna S Hertz,3 Kaywei Low,3 Scott Freeman,3 David R Holmes Jr4 1Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA; 3Ipsos Healthcare, New York, NY, USA; 4Mayo Clinic, Rochester, MN, USACorrespondence: Vivek Y Reddy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1030, New York, NY, 10029, USA, Tel +1 212 241-7114, Fax +1 646 537-9691, Email vivek.reddy@mountsinai.orgBackground: As healthcare costs are increasingly being shifted from payers to patients, it is important to understand the economic consequences of therapeutic strategies to both payers and patients.Objective: To determine the relative costs to Medicare and Medicare beneficiaries (patients) of warfarin, non-vitamin K oral anticoagulants (NOACs), and left atrial appendage closure (LAAC) for stroke risk reduction in nonvalvular atrial fibrillation.Methods: An economic model was developed to assess costs at 5 and 10 years. For warfarin and NOACs, inputs were derived from published meta-analyses; for LAAC with the Watchman device, inputs were derived from pooled 5-year PROTECT AF and PREVAIL trial results. The model captured therapy costs vs clinical event costs, including procedural complications and follow-up clinical outcomes. Costs were based on 2023 Medicare reimbursement and copayment rates.Results: At 10 years, overall LAAC costs (&dollar;48,337) were lower than those of NOACs (&dollar;81,198) and warfarin (&dollar;52,359). Overall LAAC costs were lower than those of NOACs by year 5 and warfarin by year 9. At 5 years, patient LAAC costs were lowest at &dollar;4,764, compared to &dollar;7,146 and &dollar;6,453 for NOACs and warfarin, respectively. LAAC patient costs were lower than those of NOACs by year 3 and warfarin by year 4. Clinical events comprised 96% of overall warfarin costs vs 48% for LAAC and 40% for NOACs.Conclusion: LAAC yielded the lowest overall and patient costs. Warfarin costs were largely driven by clinical events, which may represent an unplanned financial burden for patients. These considerations should be incorporated into shared decision-making discussions about stroke prophylaxis strategies.Keywords: economic analysis, medicare, patient, warfarin, NOACs, watchman

Keneuoe Cecilia Nthontho,1,2 Andrew Khulekani Ndlovu,1 Kirthana Sharma,3 Ishmael Kasvosve,1 Daniel Louis Hertz,4 Giacomo Maria Paganotti2,5,6 1School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana; 2Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; 3Rutgers Global Health Institute, New Brunswick, NJ, USA; 4Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 5Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 6Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, BotswanaCorrespondence: Giacomo Maria Paganotti, Botswana-University of Pennsylvania Partnership, PO Box 45498, Riverwalk Gaborone, Botswana, Tel +267 3555375, Email paganottig@bup.org.bwAbstract: Breast cancer is the most frequent cause of cancer death in low- and middle-income countries, in particular among sub-Saharan African women, where response to available anticancer treatment therapy is often limited by the recurrent breast tumours and metastasis, ultimately resulting in decreased overall survival rate. This can also be attributed to African genomes that contain more variation than those from other parts of the world. The purpose of this review is to summarize published evidence on pharmacogenetic and pharmacokinetic aspects related to specific available treatments and the known genetic variabilities associated with metabolism and/or transport of breast cancer drugs, and treatment outcomes when possible. The emphasis is on the African genetic variation and focuses on the genes with the highest strength of evidence, with a close look on CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5, CYP19A1, UGT1A4, UGT2B7, UGT2B15, SLC22A16, SLC38A7, FcγR, DPYD, ABCB1, and SULT1A1, which are the genes known to play major roles in the metabolism and/or elimination of the respective anti-breast cancer drugs given to the patients. The genetic variability of their metabolism could be associated with different metabolic phenotypes that may cause reduced patients’ adherence because of toxicity or sub-therapeutic doses. Finally, this knowledge enhances possible personalized treatment approaches, with the possibility of improving survival outcomes in patients with breast cancer.Keywords: breast cancer, genetic variability, inter-ethnic differences, pharmacogenetics, sub-Saharan Africa, toxicity