Pharmacy intervention at an intensive care rehabilitation clinic

Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal Infirmary. Within this programme a medication review by the critical care pharmacist provided an opportunity to identify and resolve any pharmaceutical care issues and also an opportunity to educate patients and their caregivers about changes to their medication. Methods: During the medication review we identified ongoing pharmaceutical care issues which were communicated to the patient’s primary care physician (GP) by letter or a telephone call. The patients were also encouraged to discuss any issues raised with their GP. The significance of the interventions was classified from those not likely to be of clinical benefit to the patient, to those which prevented serious therapeutic failure. Results: Data was collected from 47 of the 48 patients who attended the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67%). The pharmacist made 69 recommendations; including 20 relating to drugs which had been withheld and not restarted, dose adjustments were suggested on 13 occasions and new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission was clarified on 12 occasions. Lastly adverse drug effects were reported on 4 occasions and the incorrect drug was prescribed on 2 occasions. Of the interventions made 58% were considered to be of moderate to high impact. Conclusions: The pharmacist identified pharmaceutical care issues with 18.6% of the prescribed medications. Just over half of the patients reported that they were not made aware of any alterations to their prescribed medication on discharge. Therefore a pharmacy intervention is an essential part of an intensive care rehabilitation programme to address any medication related problems, provide education and to ensure patients gain optimal benefit from their medication

VLA Observations of the Infrared Dark Cloud G19.30+0.07

We present Very Large Array observations of ammonia (NH3) (1,1), (2,2), and CCS (2_1-1_0) emission toward the Infrared Dark Cloud (IRDC) G19.30+0.07 at ~22GHz. The NH3 emission closely follows the 8 micron extinction. The NH3 (1,1) and (2,2) lines provide diagnostics of the temperature and density structure within the IRDC, with typical rotation temperatures of ~10 to 20K and NH3 column densities of ~10^15 cm^-2. The estimated total mass of G19.30+0.07 is ~1130 Msun. The cloud comprises four compact NH3 clumps of mass ~30 to 160 Msun. Two coincide with 24 micron emission, indicating heating by protostars, and show evidence of outflow in the NH3 emission. We report a water maser associated with a third clump; the fourth clump is apparently starless. A non-detection of 8.4GHz emission suggests that the IRDC contains no bright HII regions, and places a limit on the spectral type of an embedded ZAMS star to early-B or later. From the NH3 emission we find G19.30+0.07 is composed of three distinct velocity components, or "subclouds." One velocity component contains the two 24 micron sources and the starless clump, another contains the clump with the water maser, while the third velocity component is diffuse, with no significant high-density peaks. The spatial distribution of NH3 and CCS emission from G19.30+0.07 is highly anti-correlated, with the NH3 predominantly in the high-density clumps, and the CCS tracing lower-density envelopes around those clumps. This spatial distribution is consistent with theories of evolution for chemically young low-mass cores, in which CCS has not yet been processed to other species and/or depleted in high-density regions.Comment: 29 pages, 9 figures, accepted for publication by ApJ. Please contact the authors for higher resolution versions of the figure

Analysing long-term interactions between demand response and different electricity markets using a stochastic market equilibrium model. ESRI WP585, February 2018

Power systems based on renewable energy sources (RES) are characterised by increasingly distributed, volatile and uncertain supply leading to growing requirements for flexibility. In this paper, we explore the role of demand response (DR) as a source of flexibility that is considered to become increasingly important in future. The majority of research in this context has focussed on the operation of power systems in energy only markets, mostly using deterministic optimisation models. In contrast, we explore the impact of DR on generator investments and profits from different markets, on costs for different consumers from different markets, and on CO2 emissions under consideration of the uncertainties associated with the RES generation. We also analyse the effect of the presence of a feed-in premium (FIP) for RES generation on these impacts. We therefore develop a novel stochastic mixed complementarity model in this paper that considers both operational and investment decisions, that considers interactions between an energy market, a capacity market and a feed-in premium and that takes into account the stochasticity of electricity generation by RES. We use a Benders decomposition algorithm to reduce the computational expenses of the model and apply the model to a case study based on the future Irish power system. We find that DR particularly increases renewable generator profits. While DR may reduce consumer costs from the energy market, these savings may be (over)compensated by increasing costs from the capacity market and the feed-in premium. This result highlights the importance of considering such interactions between different markets

Measurements of magnetic circuit characteristics for comprehension of intrinsic magnetic properties of materials from surface inspection

A transfer function is presented for calculating magnetic field and flux density inside a test material as a result of surface measurement. By considering flux leakage, we introduce a parameter η, called the leakage coefficient, which can be experimentally determined. It is introduced into the equations to make the transfer function more practical. The distribution of field inside a test material is then discussed in accordance with a surfacemagnetic charge model

Magnetomechanical effect in nickel and cobalt

The change in magnetization as a result of applied uniaxial stress has been measured in nickel and cobalt. Both tensile and compressive stresses were applied up to 125 MPa. Magnetostriction and anhysteretic magnetization as a function of stress were also measured. The change in magnetization with stress depended on the applied stress and the displacement between the prevailing magnetization and anhysteretic. At the loop tips, nickel showed a +6 mT (compression) and −6 mT (tension) magnetization change while cobalt displayed a +15 mT (compression) and −15 mT (tension) magnetization change. At remanence,nickel decreased in magnetization by 45 mT under either sign of stress, while cobalt decreased by 20 mT also under either sign of stress. Magnetomechanical changes in magnetization near the loop tips were mostly reversible, while at remanence the magnetomechanical change was predominately irreversible. Cobalt generally displayed larger changes in magnetization with stress than nickel at locations close to the loop tips, while the converse was true at locations near remanence. The results confirm the hypothesis that the magnetomechanical effect(dM/dσ) depends on the displacement between the anhysteretic and prevailing magnetization

Does tiny-scale atomic structure exist in the interstellar medium ?

We report on preliminary results from the recent multi-epoch neutral hydrogen absorption measurements toward three pulsars, B0823+26, B1133+16 and B2016+28, using the Arecibo telescope. We do not find significant variations in optical depth profiles over periods of 0.3 and 9--10 yr, or on spatial scales of 10--20 and 70--85 AU. The large number of non detections of the tiny scale atomic structure suggests that the AU-sized structure is not ubiquitous in the interstellar medium and could be quite a rare phenomenon.Comment: Accepted by ApJ Letters, 5 pages, 2 figure

Cavitation-induced ignition of cryogenic hydrogen-oxygen fluids

The Challenger disaster and purposeful experiments with liquid hydrogen (H2) and oxygen (Ox) tanks demonstrated that cryogenic H2/Ox fluids always self-ignite in the process of their mixing. Here we propose a cavitation-induced self-ignition mechanism that may be realized under these conditions. In one possible scenario, self-ignition is caused by the strong shock waves generated by the collapse of pure Ox vapor bubble near the surface of the Ox liquid that may initiate detonation of the gaseous H2/Ox mixture adjacent to the gas-liquid interface. This effect is further enhanced by H2/Ox combustion inside the collapsing bubble in the presence of admixed H2 gas

Heart enhancers with deeply conserved regulatory activity are established early in zebrafish development.

During the phylotypic period, embryos from different genera show similar gene expression patterns, implying common regulatory mechanisms. Here we set out to identify enhancers involved in the initial events of cardiogenesis, which occurs during the phylotypic period. We isolate early cardiac progenitor cells from zebrafish embryos and characterize 3838 open chromatin regions specific to this cell population. Of these regions, 162 overlap with conserved non-coding elements (CNEs) that also map to open chromatin regions in human. Most of the zebrafish conserved open chromatin elements tested drive gene expression in the developing heart. Despite modest sequence identity, human orthologous open chromatin regions recapitulate the spatial temporal expression patterns of the zebrafish sequence, potentially providing a basis for phylotypic gene expression patterns. Genome-wide, we discover 5598 zebrafish-human conserved open chromatin regions, suggesting that a diverse repertoire of ancient enhancers is established prior to organogenesis and the phylotypic period