Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Background: The diagnosis of symptomatic cancer-associated thrombosis often causes distress and alarm for patients, especially for those unaware of the risk, or the signs and symptoms to look out for. There are few data about cancer patients’ experiences of incidentally diagnosed pulmonary embolism (IPE), where lack of warning (recognised signs, symptoms) may cause delayed diagnosis and aggravate distress. Objectives: To explore cancer patients’ experience of the diagnosis of and living with incidental pulmonary embolism treated with anticoagulation. Methods: A qualitative study using modified grounded theory approach. Semi-structured interviews were conducted as part of a mixed- methods prospective observational survey study of consenting patients with IPE. Data were subjected to thematic analysis. The qualitative findings are presented. Findings: Eleven participants were interviewed (mean age 68.3 years, range 38–82 years; various forms of cancer and stages). Three major themes and one cross-cutting theme were generated. Theme (1): IPE is experienced in the context of cancer and concomitant comorbidities. Issues are understood in the shadow of–and often overshadowed by—current serious illness. Theme (2): Being diagnosed with IPE. Misattribution to cancer or other comorbidities caused delay in help-seeking and diagnosis. Theme (3): Coping with anticoagulation. Participants’ incorporated anticoagulation treatment and its effects into their daily routine with acceptance and stoicism. Finally, the cross-cutting theme relates to a lack of information and uncertainty, contributing to distress throughout the experience. Conclusion: The diagnosis of IPE was upsetting and unexpected. Expert and timely information was valued by those with IPE. Education called for about the increased risk of cancer-associated thrombosis and the signs and symptoms to be aware of

Detecting Geyser Activity with Infrasound

We monitored geyser activity in the Lower Geyser Basin (LGB) of Yellowstone National Park with dual four-element microphone arrays separated by ~ 600 m. The arrays were independently used to identify incident coherent plane wave energy, then conjoint cross beam back-azimuths from the two arrays were used to precisely locate signal sources. During a week in August 2011 we located repeating infrasound events, peaked in energy between 1 and 10 Hz, originating from at least five independent geothermal features, including the episodically erupting Great Fountain, Fountain and Kaleidoscope Geysers, as well as periodic infrasound from nearby Botryoidal and persistent sound from Firehole Spring. Although activity from nearby cone-type geysers was not detected in the infrasound band up through 50 Hz, the major fountain-type geysers (i.e., with columns greater than 10 m) could be detected at several kilometers, and two minor geysers (i.e., a few meters in eruption height) could be tracked at distances up to a few hundred meters. Detection of geyser activity was especially comprehensive at night when ambient noise was low. We conclude that infrasound monitoring of fountain-type geysers permits convenient tracking of geyser activity, episodicity, signal duration, energy content, and spectral content. These parameters enable objective statistical quantification of geyser behavior and changes over time that may be due to external forcing. Infrasonic study of geyser activity in an individual basin has great monitoring utility and can be reasonably accomplished with two or more distributed sensor arrays

Clinical consequences of asbestos-related diffuse pleural thickening: A review

Asbestos-related diffuse pleural thickening (DPT), or extensive fibrosis of the visceral pleura secondary to asbestos exposure, is increasingly common due to the large number of workers previously exposed to asbestos. It may coexist with asbestos related pleural plaques but has a distinctly different pathology. The pathogenesis of this condition as distinct from pleural plaques is gradually becoming understood. Generation of reactive oxygen and nitrogen species, profibrotic cytokines and growth factors in response to asbestos is likely to play a role in the formation of a fibrinous intrapleural matrix. Benign asbestos related pleural effusions commonly antedate the development of diffuse pleural thickening. Environmental as well as occupational exposure to asbestos may also result in pleural fibrosis, particularly in geographic areas with naturally occurring asbestiform soil minerals. Pleural disorders may also occur after household exposure. High resolution computed tomography (CT) is more sensitive and specific than chest radiography for the diagnosis of diffuse pleural thickening, and several classification systems for asbestos-related disorders have been devised. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (PET) scanning may be useful in distinguishing between DPT and malignant mesothelioma. DPT may be associated with symptoms such as dyspnoea and chest pain. It causes a restrictive defect on lung function and may rarely result in respiratory failure and death. Treatment is primarily supportive

Prescribing errors and other problems reported by community pharmacists

INTRODUCTION: Prevention of medication errors is a priority for health services worldwide. Pharmacists routinely screen prescriptions for potential problems, including prescribing errors. This study describes prescribing problems reported by community pharmacists and discusses them from an error prevention perspective. METHOD: For one month, nine community pharmacists documented prescribing problems, interventions made, and the proximal causes of the problems. The results were presented to local GPs and pharmacists at a meeting and feedback was invited. RESULTS: For 32 403 items dispensed, pharmacists reported 196 prescribing problems (0.6%). The reporting rates ranged from 0.2%–1.9% between pharmacists and were inversely correlated to dispensing volume. Prescriptions containing incomplete or incorrect information accounted for two-thirds of the problems. Lack of information on the prescriptions and transcribing/typing errors were the most frequently cited proximal causes. A few pitfalls of computerized prescribing were observed. CONCLUSION: Although rates of prescribing problems reported were relatively low, community pharmacists and patients remain important safeguards. This study identified potential causes of prescribing errors, and illustrated areas which could be improved in the design of computerized prescribing systems, and the communication and sharing of information between GPs and pharmacists

A Stromgren view of the multiple populations in globular clusters

We discuss a variety of photometric indices assembled from the uvby Stromgren system. Our aim is to examine the pros and cons of the various indices to find the most suitable one(s) to study the properties of multiple populations in globular clusters (GCs) discovered by spectroscopy. We explore in particular the capabilities of indices like m_1 and c_y at different metallicities. We define a new index delta_4=(u-v)-(b-y) to separate first and second stellar generations in GCs of any metal abundance, since it keeps the sensitivity to multiple stellar populations over all the metallicity range and at the same time minimizes the sensitivity to photometric errors. We detecte clear differences in the red giant branches of the GCs examined, like skewness or bi/multi-modality in color distribution. We connect the photometric information with the spectroscopic results on O, Na abundances we obtained in our survey of GCs. Finally, we compute the effects of different chemical composition on the Stromgren filters and indices using synthetic spectra.Comment: Accepted for publication on Astronomy and Astrophysics. Figures 1,3,5 degraded in resolutio

Accuracy and Reliability of Dosing Equations to Individualize Theophylline Treatment of Apnea of Prematurity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90103/1/j.1875-9114.1995.tb04360.x.pd

Prospective Evaluation of Two Dosing Equations for Theophylline in Premature Infants

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90141/1/j.1875-9114.1996.tb02995.x.pd

Design of Organic Ternary Blends and Small-Molecule Bulk Heterojunctions: Photophysical Considerations

We explored relationships between photophysical processes and solar cell characteristics in solution-processable bulk heterojunctions (BHJs), in particular: (1) polymer donor:fullerene acceptor:small-molecule (SM) nonfullerene acceptor, (2) polymer donor:SM donor:SM nonfullerene acceptor, and (3) SM donor:SM nonfullerene or fullerene acceptor. Addition of a nonfullerene SM acceptor to “efficient” polymer:fullerene BHJs led to a reduction in power conversion efficiency (PCE), mostly due to decreased charge photogeneration efficiency and increased disorder. By contrast, addition of an SM donor to “inefficient” polymer:SM nonfullerene acceptor BHJs led to a factor of two to three improvement in the PCE, due to improved charge photogeneration efficiency and transport. In most blends, exciplex formation was observed and correlated with a reduced short-circuit current (Jsc) without negatively impacting the open-circuit voltage (Voc). A factor of ∼5 higher PCE was observed in SM donor:fullerene acceptor BHJs as compared to SMBHJs with the same SM donor but nonfullerene acceptor, due to enhanced charge carrier photogeneration in the blend with fullerene. Our study revealed that the HOMO and LUMO energies of molecules comprising a blend are not reliable parameters for predicting Voc of the blend, and an understanding of the photophysics is necessary for interpreting solar cell characteristics and improving the molecular design of BHJs

Alteration in endothelial permeability occurs in response to the activation of PAR2 by factor Xa but not directly by the TF-factor VIIa complex

Alterations in the endothelial permeability occur in response to the activation of coagulation mechanisms in order to control clot formation. The activation of the protease activated receptors (PAR) can induce signals that regulate such cellular responses. PAR2 is a target for the coagulation factor Xa (fXa) and tissue factor-factor VIIa (TF-fVIIa) complex. By measuring the permeability of dextran blue across endothelial monolayer, we examined the mechanisms linking coagulation and endothelial permeability. Activation of PAR2 using the agonist peptide (PAR2-AP) resulted in increased permeability across the monolayer and was comparable to that obtained with VEGF at 60 min. Incubation of cells with activated factor Xa (fXa) resulted in an initial decrease in permeability by 30 min, but then significantly increased at 60 min. These responses required fXa activity, and were abrogated by incubation of the cells with a PAR2-blocking antibody (SAM11). Activation of PAR2 alone, or inhibition of PAR1, abrogated the initial reduction in permeability. Additionally, inclusion of Rivaroxaban (0.6 µg/ml) significantly inhibited the response to fXa. Finally, incubation of the endothelial monolayers up to 2 h with TF-containing microvesicles derived from MDA-MB-231 cells, in the presence or absence of fVIIa, did not influence the permeability across the monolayers. In conclusion, fXa but not TF-fVIIa is a noteworthy mediator of endothelial permeability. The rapid initial decrease in permeability requires PAR2 and PAR1 which may act to constrain bleeding. The longer-term response is mediated by PAR2 with increased permeability, presumably to enhance clot formation at the site of damage

Enhanced Charge Photogeneration Promoted by Crystallinity in Small-Molecule Donor-Acceptor Bulk Heterojunctions

We examined sub-nanosecond time-scale charge carrier dynamics in crystalline films of a functionalized anthradithiophene (ADT) donor (D) with three different acceptor (A) molecules. A four-fold enhancement in ultrafast charge carrier separation efficiency was observed in D/A blends with a fullerene acceptor added at 7–10 wt. % concentrations, whereas a gradual decrease in peak photocurrent amplitude with acceptor concentration was observed with functionalized pentacene and indenofluorene acceptors. The results were directly correlated with the ADT-tri(ethylsilyl)ethynyl-F donor crystallinity. In the best-performing blends, the presence of crystalline acceptor domains was also established