Dynamics of Generalized Assisted Inflation

We study the dynamics of multiple scalar fields and a barotropic fluid in an FLRW-universe. The scalar potential is a sum of exponentials. All critical points are constructed and these include scaling and de Sitter solutions. A stability analysis of the critical points is performed for generalized assisted inflation, which is an extension of assisted inflation where the fields mutually interact. Effects in generalized assisted inflation which differ from assisted inflation are emphasized. One such a difference is that an (inflationary) attractor can exist if some of the exponential terms in the potential are negative.Comment: 27 page

Prevalence and follow-up of potentially inappropriate medication and potentially omitted medication in older patients with cancer - The PIM POM study

Objectives: To determine the prevalence of Potentially Inappropriate Medication (PIMs) and Potentially Omitted Medication (POMs) in older patients with cancer. Materials and Methods: In this prospective observational study (hospital) pharmacists conducted comprehensive medication reviews in older patients with cancer (aged >= 65 years) receiving parenteral chemotherapy and/or immunotherapy at the Deventer Hospital. PIMs and POMs were identified using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP), the Screening Tool to Alert doctors to the Right Treatment (START), and pharmacists' expert opinion. Recommendations regarding PIMs and POMs were communicated to the patient's oncologist/haematologist and follow-up was measured. Associations between covariates and the prevalence of PIMs and POMs were statistically analysed. Results: For the 150 patients included, 180 PIMs and 86 POMs were identified with a prevalence of 78%. Using pharmacists' expert opinion in addition to only STOPP/START criteria contributed to 49% of the PIMs and 23% of the POMs. A follow-up action was required in 73% of the 266 PIMs and POMs. Number of medicines and Charlson Comorbidity Index score were both associated with having at least one PIM and/or POM (p = .031 and p = .016, respectively). Conclusion: The prevalence of PIMs and POMs and subsequent follow-up in older patients with cancer is high. A pharmacist-led comprehensive medication review is a good instrument to identify these PIMs and POMs and to optimize patients' treatment. A complete approach, including pharmacists' expert opinion, is recommended to identify all PIMs and POMs in clinical practice. (C) 2020 The Authors. Published by Elsevier Ltd

The performance of COBRA, a decision rule to predict the need for intensive care interventions in intentional drug overdose

BACKGROUND: COBRA was developed as a decision rule to predict which patients visiting the emergency department (ED) following intentional drug overdose will not require intensive care unit (ICU) interventions. COBRA uses parameters from five vital systems (cardiac conduction, oxygenation, blood pressure, respiration, and awareness) that are readily available in the ED. COBRA recommends against ICU admission when all these parameters are normal. OBJECTIVE: The primary aim of this study was to determine the negative predictive value (NPV) of COBRA in predicting ICU interventions. Secondary outcomes were the sensitivity, specificity and positive predictive value (PPV), and the observation time required for a reliable prediction. DESIGN: Observational cohort study. SETTINGS AND PARTICIPANTS: Patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function were included, and data necessary to complete the decision rule was collected. The attending physician in the ED made the actual admission decision, on the basis of clinical judgement. COBRA was measured 0, 3 and 6 h after arrival at the ED. OUTCOME MEASURES: Need for ICU interventions (treatment of convulsion; defibrillation; mechanical or noninvasive ventilation; intravenous administration of vasopressive agents, antiarrhythmics, atropine, calcium, magnesium or sedation; continuous hemofiltration or administration of antagonist/antidote and fluid resuscitation). MAIN RESULTS: Of 230 new cases (144 unique patients), 59 were immediately referred to the psychiatric services and/or sent home by the attending physician, 27 went to a regular ward, and 144 were admitted to the ICU. Of these 144 cases, 40 required one or more ICU interventions. By the time the first parameters were collected, the NPV of COBRA was 95.6%. After 3 h of observation, NPV was 100%, while sensitivity, specificity and PPV were 100, 61.1 and 35.1%, respectively. None of these values improved by prolonging the observation time to 6 h. CONCLUSION: In patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function, the COBRA decision rule showed good performances in predicting the need for intensive care interventions, with a NPV of 100% after 3 h of observation

Matrix metalloproteinase 13 modulates intestinal epithelial barrier integrity in inflammatory diseases by activating TNF

Several pathological processes, such as sepsis and inflammatory bowel disease (IBD), are associated with impairment of intestinal epithelial barrier. Here, we investigated the role of matrix metalloproteinase MMP13 in these diseases. We observed that MMP13(-/-) mice display a strong protection in LPS- and caecal ligation and puncture-induced sepsis. We could attribute this protection to reduced LPS-induced goblet cell depletion, endoplasmic reticulum stress, permeability and tight junction destabilization in the gut of MMP13(-/-) mice compared to MMP13(+/+) mice. Both in vitro and in vivo, we found that MMP13 is able to cleave pro-TNF into bioactive TNF. By LC-MS/MS, we identified three MMP13 cleavage sites, which proves that MMP13 is an alternative TNF sheddase next to the TNF converting enzyme TACE. Similarly, we found that the same mechanism was responsible for the observed protection of the MMP13(-/-) mice in a mouse model of DSS-induced colitis. We identified MMP13 as an important mediator in sepsis and IBD via the shedding of TNF. Hence, we propose MMP13 as a novel drug target for diseases in which damage to the gut is essential

Combatting infectious diseases: nanotechnology as a platform for rational vaccine design

Drug Delivery Technolog

Brane solutions and integrability: a status report

We review the status of the integrability and solvability of the geodesics equations of motion on symmetric coset spaces that appear as sigma models of supergravity theories when reduced over respectively the timelike and spacelike direction. Such geodesic curves describe respectively timelike and spacelike brane solutions. We emphasize the applications to black holes.Comment: 4 pages, Proceedings of ERE 2010, Granada, 6-10 september 201

Brane solutions and integrability: a status report

We review the status of the integrability and solvability of the geodesics equations of motion on symmetric coset spaces that appear as sigma models of supergravity theories when reduced over respectively the timelike and spacelike direction. Such geodesic curves describe respectively timelike and spacelike brane solutions. We emphasize the applications to black holes.Comment: 4 pages, Proceedings of ERE 2010, Granada, 6-10 september 201

Scaling solutions and geodesics in moduli space

In this paper we consider cosmological scaling solutions in general relativity coupled to scalar fields with a non-trivial moduli space metric. We discover that the scaling property of the cosmology is synonymous with the scalar fields tracing out a particular class of geodesics in moduli space - those which are constructed as integral curves of the gradient of the log of the potential. Given a generic scalar potential we explicitly construct a moduli metric that allows scaling solutions, and we show the converse - how one can construct a potential that allows scaling once the moduli metric is known.Comment: 10 pages, 3 figure