Reduksjon i potensielt uheldig legemiddelbruk blant sykehjemsbeboere : - et kvalitetsforbedringsprosjekt

Bakgrunn 40 000 nordmenn bor på sykehjem, og dette er en gruppe som får mange medisiner. På grunn av aldersforandringer, interaksjoner og liknende regnes mange av disse medisinene som uheldige for eldre. Vi har ønsket å lage et prosjekt som skal redusere forekomsten av uheldig medikamentforskrivning til eldre på sykehjem. Kunnskapsgrunnlag Vi har gjort et systematisk litteratursøk som dokumenterer at potensielt uheldig forskrivning er et velkjent problem over store deler av verden, noe som gjenspeiles i norske data. Flere forskergrupper har definert hvilke medikamenter som er mest problematiske i aldersgruppen. Av disse har vi valgt å bruke NorGeP-listen. Tiltak, kvalitetsindikator og metode Vårt tiltak er medikamentgjennomgang ved farmasøyt. En farmasøyt skal gå gjennom medikamentkurven til pasienter ved sykehjemmet, og så delta på previsitten med tilsynslege og sykepleier, hvor en skal diskutere om medisinen bør kontinueres eller seponeres. Resultatindikatoren vår er å gjøre en opptelling av antall brudd på NorGeP-listen før og etter, hos et tilfeldig utvalg av pasientene. Prosessindikatoren er en kontinuerlig opptelling av forbruket av visse nevroleptika på sykehjemmet. Organisering/ledelse Vi ser for oss at prosjektet bør drives kommunalt, med en ledergruppe bestående av helsesjef/kommunelege og avdelingssykepleier fra sykehjemmet. Den viktigste ledelsesutfordringen er knyttet til det å motivere tilsynslege og sykepleiere. Vurdering Vi mener at prosjektet vårt er viktig, praktisk gjennomførbart, økonomisk bærekraftig – og det kan gi mange pasienter en bedre livskvalitet

Development and validation of a machine learning-based predictive model to improve the prediction of inguinal status of anal cancer patients: A preliminary report

Introduction: The role of prophylactic inguinal irradiation (PII) in the treatment of anal cancer patients is controversial. We developped an innovative algorithm based on the Machine Learning (ML) allowing the tailoring of the prescription of PII. Results: Once verified on the independent testing set, J48 showed the better performances, with specificity, sensitivity, and accuracy rates in predicting relapsing patients of 86.4%, 50.0% and 83.1% respectively (vs 36.5%, 90.4% and 80.25%, respectively, for LR). Methods: We classified 194 anal cancer patients with Logistic Regression (LR) and other 3 ML techniques based on decision trees (J48, Random Tree and Random Forest), using a large set of clinical and therapeutic variables. We tested obtained ML algorithms on an independent testing set of 65 anal cancer patients. TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) methodology was used for the development, the Quality Assurance and the description of the experimental procedures. Conclusion: In an internationally approved quality assurance framework, ML seems promising in predicting the outcome of patients that would benefit or not of the PII. Once confirmed in larger and/or multi-centric databases, ML could support the physician in tailoring the treatment and in deciding if deliver or not the PII

A geographic information system for characterizing exposure to Agent Orange and other herbicides in Vietnam.

Between 1961 and 1971, U.S. military forces dispersed more than 19 million gallons of phenoxy and other herbicidal agents in the Republic of Vietnam, including more than 12 million gallons of dioxin-contaminated Agent Orange, yet only comparatively limited epidemiologic and environmental research has been carried out on the distribution and health effects of this contamination. As part of a response to a National Academy of Sciences' request for development of exposure methodologies for carrying out epidemiologic research, a conceptual framework for estimating exposure opportunity to herbicides and a geographic information system (GIS) have been developed. The GIS is based on a relational database system that integrates extensive data resources on dispersal of herbicides (e.g., HERBS records of Ranch Hand aircraft flight paths, gallonage, and chemical agent), locations of military units and bases, dynamic movement of combat troops in Vietnam, and locations of civilian population centers. The GIS can provide a variety of proximity counts for exposure to 9,141 herbicide application missions. In addition, the GIS can be used to generate a quantitative exposure opportunity index that accounts for quantity of herbicide sprayed, distance, and environmental decay of a toxic factor such as dioxin, and is flexible enough to permit substitution of other mathematical exposure models by the user. The GIS thus provides a basis for estimation of herbicide exposure for use in large-scale epidemiologic studies. To facilitate widespread use of the GIS, a user-friendly software package was developed to permit researchers to assign exposure opportunity indexes to troops, locations, or individuals

Long-term impact of chronic variable stress in adolescence versus adulthood

Adolescence is a period of active development of stress regulatory neurocircuitry. As a consequence, mechanisms that control the responses to stress are not fully matured during this developmental period, which may result in vulnerability to chronic stress. We hypothesized that adolescent chronic stress would have negative consequences on stress adaptation later in life. Male Wistar rats (PND40) were subjected to chronic variable stress (CVS) for 2 weeks, with 2 daily stressors randomly presented and overnight social stressors twice a week. After five weeks, animals were evaluated during adulthood, using the elevated plus maze (EPM) and the forced swim test (FST). The hypothalamic-pituitary adrenal (HPA) axis response to a 30-min restraint was also assessed. Results are compared to those of adult rats tested 5 weeks following CVS cessation. Our results demonstrate that the long-term effects of CVS are specific to the age of application of the stress regime. We show how behavior and HPA axis response as well as hypothalamic paraventricular nucleus activation can differ with age, resulting in differential behavioral adaptations for animals stressed in adolescence and dysregulation of the HPA axis in the animals stressed in adulthood, These data underscore the importance of the adolescent period in determining resilience of the HPA axis and programming behavioral responses later in life.Fil: Cotella, Evelin Mariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Scarponi Gómez, Antonela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Lemen, Paige. University of Cincinnati; Estados UnidosFil: Chen, Carrie. University of Cincinnati; Estados UnidosFil: Fernández, Guillermo César. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Hansen, Christian. Laboratorio de Análisis Clínicos Especializados; ArgentinaFil: Herman, James. University of Cincinnati; Estados UnidosFil: Paglini, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; Argentin

Plasma ceramide, a real-time predictive marker of pulmonary and hepatic metastases response to stereotactic body radiation therapy combined with irinotecan

AbstractBackground and purposesEarly biomarkers of tumour response are needed to discriminate between responders and non-responders to radiotherapy. We evaluated the ability of ceramide, a bioactive sphingolipid, to predict tumour sensitivity in patients treated by hypofractionated stereotactic body radiation therapy (SBRT) combined with irinotecan chemotherapy.Materials and methodsPlasma levels of total ceramide and of its subspecies were measured before and during treatment in 35 patients with liver and lung oligometastases of colorectal cancer included in a phase II trial. Cer levels were quantified by LC–ESI-MS/MS and compared to tumour volume response evaluated one year later by CT-scan.ResultsPretreatment plasma ceramide levels were not indicative of tumour response. Nevertheless, the levels of total ceramide and of its 4 main subspecies were significantly higher at days 3 and 10 of treatment in objective responders than in non-responders. According to Kaplan–Meier curves, almost complete tumour control was achieved at 1year in patients with increased total ceramide levels whereas 50% of patients with decreased levels experienced an increase in tumour volume.ConclusionsTotal plasma ceramide is a promising biomarker of tumour response to SBRT combined with irinotecan that should enable to segregate patients with high risk of tumour escape

Comparing demographics of signatories to public letters on diversity in the mathematical sciences

In its December 2019 edition, the \textit{Notices of the American Mathematical Society} published an essay critical of the use of diversity statements in academic hiring. The publication of this essay prompted many responses, including three public letters circulated within the mathematical sciences community. Each letter was signed by hundreds of people and was published online, also by the American Mathematical Society. We report on a study of the signatories' demographics, which we infer using a crowdsourcing approach. Letter A highlights diversity and social justice. The pool of signatories contains relatively more individuals inferred to be women and/or members of underrepresented ethnic groups. Moreover, this pool is diverse with respect to the levels of professional security and types of academic institutions represented. Letter B does not comment on diversity, but rather, asks for discussion and debate. This letter was signed by a strong majority of individuals inferred to be white men in professionally secure positions at highly research intensive universities. Letter C speaks out specifically against diversity statements, calling them "a mistake," and claiming that their usage during early stages of faculty hiring "diminishes mathematical achievement." Individuals who signed both Letters B and C, that is, signatories who both privilege debate and oppose diversity statements, are overwhelmingly inferred to be tenured white men at highly research intensive universities. Our empirical results are consistent with theories of power drawn from the social sciences.Comment: 21 pages, 2 tables, 2 figures; minor textual edits made to previous versio

Ethanol, at physiological concentrations, affects ethylene sensing in tomato germinating seeds and seedlings

Ethanol is known to accumulate in various plant organs under various environmental conditions. However, there are very scarce data about ethanol sensing by plants. We observed that ethanol accumulates up to 3.5 mM during tomato seed imbibition, particularly when seeds were stacked. Stacked seeds germinated less than spread out seeds suggesting ethanol inhibits germination. In support of this, exogenous ethanol at physiological concentrations, ranging from 1 to 10 mM, inhibited germination of wild type tomato seeds. However, the germination pattern over the whole ethanol concentration range tested was modified in an ethylene insensitive mutant, never-ripe (nr). The effects of exogenous ethanol were not linked to differences in ethylene production by imbibed seeds. But, we observed that exogenous ethanol at a concentration as low as 0.01 mM down regulated the expression of some ethylene receptors. Moreover, the triple response induced by ethylene in tomato seedlings was partially alleviated by 1 mM ethanol. Similar observations were made on Arabidopsis seeds. These results show there are interactions between ethylene sensing and ethanol in plants

Seizure burden in severe earlyâ life epilepsy: Perspectives from parents

ObjectivesSeizure burden is typically measured by seizure frequency yet it entails more than seizure counts, especially for people with severe epilepsies and their caregivers. We aimed to characterize the multiâ faceted nature of seizure burden in young people and their parents who are living with severe earlyâ life epilepsies.MethodsA oneâ day workshop and a series of teleconferences were held with parents of children with severe, refractory epilepsy of earlyâ life origin and providers for children with epilepsy. The workshop sessions were structured as focus groups and aimed to identify components of seizure burden and their impact from the perspective of parents and providers. Data were gathered, organized, and refined during the workshop using an iterative 4â step process that drew upon grounded theory.ResultsThree primary components of seizure burden were identified: frequency, severity, and unpredictability, which was as important if not more important at times than frequency and severity. Caregivers noted that the impacts of seizures were experienced as acuteâ immediate consequences, longerâ term consequences, and as chronic effects that develop and evolve over time. The severity of the child’s neurological and medical status as well as where in the disease journey a family was represented additional contextual factors that influenced the experience of seizure burden.SignificancePatientâ reported and patientâ centered outcomes are increasingly incorporated into the evaluation of treatment effectiveness. Without understanding how the disease creates burden for the patient (or family), it is difficult to know how to assess the impact of treatment. Our preliminary findings indicate seizure burden is a complex construct and unpredictability can be as important as frequency and severity.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149509/1/epi412319_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149509/2/epi412319.pd