Comprehensive medication reviews by ward-based pharmacists in Swedish hospitals: what does the patient have to say?

Rationale, aims, and objectives: Inappropriate medication prescribing and use amongst older patients is a major patient safety and health care problem. To promote appropriate medication prescribing and use, comprehensive medication reviews (CMRs) by ward-based pharmacists, including follow-up telephone calls after hospital discharge, have been conducted in older patients in the context of a randomized controlled trial (RCT). One of the key actors in a CMR is the patient. To support the understanding of the effects of CMRs on patients' health outcomes and improve clinical practice, knowledge about the patient perspective is needed. We therefore aimed to explore older patients' experiences with, and views on, hospital-initiated CMRs and follow-up telephone calls by ward-based clinical pharmacists within an RCT. Methods: We conducted in-depth semi-structured interviews with 15 patients (66-94 years) and carers from four hospitals in Sweden. Discussion topics included communication, information, decision-making, and effects on the patient. Interviews took place after discharge, were audio-recorded, transcribed verbatim, and thematically analysed using a framework approach. Results: In general, patients' experiences and views were positive. Seven key themes were identified: (a) feeling of being taken care of and heterogenous health effects; (b) the pharmacist is competent; (c) despite the unclear role of pharmacists, their involvement is appreciated; (d) patients rely on health care professionals for decision-making; (e) importance of being informed, but receiving and retaining information is problematic; (f) time, location, and other factors influencing the effectiveness of CMRs; and (g) generic substitution is a problem. Conclusions: Older patients generally have positive experiences with and views on CMRs and follow-up telephone calls. However, some factors, like the unclear role of the ward-based pharmacist and problems with receiving and retaining information, may negatively impact the effectiveness of these interventions. Future initiatives on hospital-initiated CMRs by clinical pharmacists should address these negative factors and utilize the positive views

Food-web structure in relation to environmental gradients and predator-prey ratios in tank-bromeliad ecosystems

Little is known of how linkage patterns between species change along environmental gradients. The small, spatially discrete food webs inhabiting tank-bromeliads provide an excellent opportunity to analyse patterns of community diversity and food-web topology (connectance, linkage density, nestedness) in relation to key environmental variables (habitat size, detrital resource, incident radiation) and predators: prey ratios. We sampled 365 bromeliads in a wide range of understorey environments in French Guiana and used gut contents of invertebrates to draw the corresponding 365 connectance webs. At the bromeliad scale, habitat size (water volume) determined the number of species that constitute food-web nodes, the proportion of predators, and food-web topology. The number of species as well as the proportion of predators within bromeliads declined from open to forested habitats, where the volume of water collected by bromeliads was generally lower because of rainfall interception by the canopy. A core group of microorganisms and generalist detritivores remained relatively constant across environments. This suggests that (i) a highly-connected core ensures food-web stability and key ecosystem functions across environments, and (ii) larger deviations in food-web structures can be expected following disturbance if detritivores share traits that determine responses to environmental changes. While linkage density and nestedness were lower in bromeliads in the forest than in open areas, experiments are needed to confirm a trend for lower food-web stability in the understorey of primary forests

Controls on gut phosphatisation : the trilobites from the Weeks Formation Lagerstätte (Cambrian; Utah)

Despite being internal organs, digestive structures are frequently preserved in Cambrian Lagerstätten. However, the reasons for their fossilisation and their biological implications remain to be thoroughly explored. This is particularly true with arthropods--typically the most diverse fossilised organisms in Cambrian ecosystems--where digestive structures represent an as-yet underexploited alternative to appendage morphology for inferences on their biology. Here we describe the phosphatised digestive structures of three trilobite species from the Cambrian Weeks Formation Lagerstätte (Utah). Their exquisite, three-dimensional preservation reveals unique details on trilobite internal anatomy, such as the position of the mouth and the absence of a differentiated crop. In addition, the presence of paired pygidial organs of an unknown function is reported for the first time. This exceptional material enables exploration of the relationships between gut phosphatisation and the biology of organisms. Indeed, soft-tissue preservation is unusual in these fossils as it is restricted to the digestive structures, which indicates that the gut played a central role in its own phosphatisation. We hypothesize that the gut provided a microenvironment where special conditions could develop and harboured a source of phosphorus. The fact that gut phosphatization has almost exclusively been observed in arthropods could be explained by their uncommon ability to store ions (including phosphorous) in their digestive tissues. However, in some specimens from the Weeks Formation, the phosphatisation extends to the entire digestive system, suggesting that trilobites might have had some biological particularities not observed in modern arthropods. We speculate that one of them might have been an increased capacity for ion storage in the gut tissues, related to the moulting of their heavily-mineralised carapace

Allelic replacement of the streptococcal cysteine protease SpeB in a Δsrv mutant background restores biofilm formation

<p>Abstract</p> <p>Background</p> <p>Group A <it>Streptococcus </it>(GAS) is a Gram-positive human pathogen that is capable of causing a wide spectrum of human disease. Thus, the organism has evolved to colonize a number of physiologically distinct host sites. One such mechanism to aid colonization is the formation of a biofilm. We have recently shown that inactivation of the streptococcal regulator of virulence (Srv), results in a mutant strain exhibiting a significant reduction in biofilm formation. Unlike the parental strain (MGAS5005), the streptococcal cysteine protease (SpeB) is constitutively produced by the <it>srv </it>mutant (MGAS5005Δ<it>srv</it>) suggesting Srv contributes to the control of SpeB production. Given that SpeB is a potent protease, we hypothesized that the biofilm deficient phenotype of the <it>srv </it>mutant was due to the constitutive production of SpeB. In support of this hypothesis, we have previously demonstrated that treating cultures with E64, a commercially available chemical inhibitor of cysteine proteases, restored the ability of MGAS5005Δ<it>srv </it>to form biofilms. Still, it was unclear if the loss of biofilm formation by MGAS5005Δ<it>srv </it>was due only to the constitutive production of SpeB or to other changes inherent in the <it>srv </it>mutant strain. To address this question, we constructed a Δ<it>srv</it>Δ<it>speB </it>double mutant through allelic replacement (MGAS5005Δ<it>srv</it>Δ<it>speB</it>) and tested its ability to form biofilms <it>in vitro</it>.</p> <p>Findings</p> <p>Allelic replacement of <it>speB </it>in the <it>srv </it>mutant background restored the ability of this strain to form biofilms under static and continuous flow conditions. Furthermore, addition of purified SpeB to actively growing wild-type cultures significantly inhibited biofilm formation.</p> <p>Conclusions</p> <p>The constitutive production of SpeB by the <it>srv </it>mutant strain is responsible for the significant reduction of biofilm formation previously observed. The double mutant supports a model by which Srv contributes to biofilm formation and/or dispersal through regulation of <it>speB</it>/SpeB.</p

A Better-response Strategy for Self-interested Planning Agents

[EN] When self-interested agents plan individually, interactions that prevent them from executing their actions as planned may arise. In these coordination problems, game-theoretic planning can be used to enhance the agents¿ strategic behavior considering the interactions as part of the agents¿ utility. In this work, we define a general-sum game in which interactions such as conflicts and congestions are reflected in the agents¿ utility. We propose a better-response planning strategy that guarantees convergence to an equilibrium joint plan by imposing a tax to agents involved in conflicts. We apply our approach to a real-world problem in which agents are Electric Autonomous Vehicles (EAVs). The EAVs intend to find a joint plan that ensures their individual goals are achievable in a transportation scenario where congestion and conflicting situations may arise. Although the task is computationally hard, as we theoretically prove, the experimental results show that our approach outperforms similar approaches in both performance and solution quality.This work is supported by the GLASS project TIN2014-55637-C2-2-R of the Spanish MINECO and the Prometeo project II/2013/019 funded by the Valencian Government.Jordán, J.; Torreño Lerma, A.; De Weerdt, M.; Onaindia De La Rivaherrera, E. (2018). A Better-response Strategy for Self-interested Planning Agents. Applied Intelligence. 48(4):1020-1040. https://doi.org/10.1007/s10489-017-1046-5S10201040484Aghighi M, Bäckström C (2016) A multi-parameter complexity analysis of cost-optimal and net-benefit planning. In: Proceedings of the Twenty-Sixth International Conference on International Conference on Automated Planning and Scheduling. AAAI Press, London, pp 2–10Bercher P, Mattmüller R (2008) A planning graph heuristic for forward-chaining adversarial planning. In: ECAI, vol 8, pp 921–922Brafman RI, Domshlak C, Engel Y, Tennenholtz M (2009) Planning games. In: IJCAI 2009, Proceedings of the 21st international joint conference on artificial intelligence, pp 73–78Bylander T (1994) The computational complexity of propositional strips planning. Artif Intell 69(1):165–204Chen X, Deng X (2006) Settling the complexity of two-player nash equilibrium. In: 47th annual IEEE symposium on foundations of computer science, 2006. FOCS’06. IEEE, pp 261–272Chien S, Sinclair A (2011) Convergence to approximate nash equilibria in congestion games. Games and Economic Behavior 71(2):315–327de Cote EM, Chapman A, Sykulski AM, Jennings N (2010) Automated planning in repeated adversarial games. In: 26th conference on uncertainty in artificial intelligence (UAI 2010), pp 376–383Dunne PE, Kraus S, Manisterski E, Wooldridge M (2010) Solving coalitional resource games. Artif Intell 174(1):20–50Fabrikant A, Papadimitriou C, Talwar K (2004) The complexity of pure nash equilibria. In: Proceedings of the thirty-sixth annual ACM symposium on theory of computing, STOC ’04, pp 604–612Friedman JW, Mezzetti C (2001) Learning in games by random sampling. J Econ Theory 98(1):55–84Ghallab M, Nau D, Traverso P (2004) Automated planning: theory & practice. ElsevierGoemans M, Mirrokni V, Vetta A (2005) Sink equilibria and convergence. In: Proceedings of the 46th annual IEEE symposium on foundations of computer science, FOCS ’05, pp 142–154Hadad M, Kraus S, Hartman IBA, Rosenfeld A (2013) Group planning with time constraints. Ann Math Artif Intell 69(3):243–291Hart S, Mansour Y (2010) How long to equilibrium? the communication complexity of uncoupled equilibrium procedures. Games and Economic Behavior 69(1):107–126Helmert M (2003) Complexity results for standard benchmark domains in planning. Artif Intell 143(2):219–262Helmert M (2006) The fast downward planning system. J Artif Intell Res 26(1):191–246Jennings N, Faratin P, Lomuscio A, Parsons S, Wooldrige M, Sierra C (2001) Automated negotiation: prospects, methods and challenges. Group Decis Negot 10(2):199–215Johnson DS, Papadimtriou CH, Yannakakis M (1988) How easy is local search? J Comput Syst Sci 37 (1):79–100Jonsson A, Rovatsos M (2011) Scaling up multiagent planning: a best-response approach. In: Proceedings of the 21st international conference on automated planning and scheduling, ICAPSJordán J, Onaindía E (2015) Game-theoretic approach for non-cooperative planning. In: 29th AAAI conference on artificial intelligence (AAAI-15), pp 1357–1363McDermott D, Ghallab M, Howe A, Knoblock C, Ram A, Veloso M, Weld D, Wilkins D (1998) PDDL: the planning domain definition language. Yale Center for Computational Vision and Control, New HavenMilchtaich I (1996) Congestion games with player-specific payoff functions. 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Comparison of the virulence of exopolysaccharide-producing Prevotella intermedia to exopolysaccharide non-producing periodontopathic organisms

<p>Abstract</p> <p>Background</p> <p>Evidence in the literature suggests that exopolysaccharides (EPS) produced by bacterial cells are essential for the expression of virulence in these organisms. Secreted EPSs form the framework in which microbial biofilms are built.</p> <p>Methods</p> <p>This study evaluates the role of EPS in <it>Prevotella intermedia </it>for the expression of virulence. This evaluation was accomplished by comparing EPS-producing <it>P. intermedia </it>strains 17 and OD1-16 with non-producing <it>P. intermedia </it>ATCC 25611 and <it>Porphyromonas gingivalis </it>strains ATCC 33277, 381 and W83 for their ability to induce abscess formation in mice and evade phagocytosis.</p> <p>Results</p> <p>EPS-producing <it>P. intermedia </it>strains 17 and OD1-16 induced highly noticeable abscess lesions in mice at 10⁷colony-forming units (CFU). In comparison, <it>P. intermedia </it>ATCC 25611 and <it>P. gingivalis </it>ATCC 33277, 381 and W83, which all lacked the ability to produce viscous materials, required 100-fold more bacteria (10⁹CFU) in order to induce detectable abscess lesions in mice. Regarding antiphagocytic activity, <it>P. intermedia </it>strains 17 and OD1-16 were rarely internalized by human polymorphonuclear leukocytes, but other strains were readily engulfed and detected in the phagosomes of these phagocytes.</p> <p>Conclusions</p> <p>These results demonstrate that the production of EPS by <it>P. intermedia </it>strains 17 and OD1-16 could contribute to the pathogenicity of this organism by conferring their ability to evade the host's innate defence response.</p

“One-Size-Fits-All”? Optimizing Treatment Duration for Bacterial Infections

Historically, antibiotic treatment guidelines have aimed to maximize treatment efficacy and minimize toxicity, but have not considered the evolution of antibiotic resistance. Optimizing the duration and dosing of treatment to minimize the duration of symptomatic infection and selection pressure for resistance simultaneously has the potential to extend the useful therapeutic life of these valuable life-saving drugs without compromising the interests of individual patients

Ranking species in mutualistic networks

Understanding the architectural subtleties of ecological networks, believed to confer them enhanced stability and robustness, is a subject of outmost relevance. Mutualistic interactions have been profusely studied and their corresponding bipartite networks, such as plant-pollinator networks, have been reported to exhibit a characteristic “nested” structure. Assessing the importance of any given species in mutualistic networks is a key task when evaluating extinction risks and possible cascade effects. Inspired in a recently introduced algorithm –similar in spirit to Google's PageRank but with a built-in non-linearity– here we propose a method which –by exploiting their nested architecture– allows us to derive a sound ranking of species importance in mutualistic networks. This method clearly outperforms other existing ranking schemes and can become very useful for ecosystem management and biodiversity preservation, where decisions on what aspects of ecosystems to explicitly protect need to be made

Tidal and groundwater fluxes to a shallow, microtidal estuary : constraining inputs through field observations and hydrodynamic modeling

This paper is not subject to U.S. copyright. The definitive version was published in Estuaries and Coasts 35 (2012): 1285-1298, doi:10.1007/s12237-012-9515-x.Increased nutrient loading to estuaries has led to eutrophication, degraded water quality, and ecological transformations. Quantifying nutrient loads in systems with significant groundwater input can be difficult due to the challenge of measuring groundwater fluxes. We quantified tidal and freshwater fluxes over an 8-week period at the entrance of West Falmouth Harbor, Massachusetts, a eutrophic, groundwater-fed estuary. Fluxes were estimated from velocity and salinity measurements and a total exchange flow (TEF) methodology. Intermittent cross-sectional measurements of velocity and salinity were used to convert point measurements to cross-sectionally averaged values over the entire deployment (index relationships). The estimated mean freshwater flux (0.19 m3/s) for the 8-week period was mainly due to groundwater input (0.21 m3/s) with contributions from precipitation to the estuary surface (0.026 m3/s) and removal by evaporation (0.048 m3/s). Spring–neap variations in freshwater export that appeared in shorter-term averages were mostly artifacts of the index relationships. Hydrodynamic modeling with steady groundwater input demonstrated that while the TEF methodology resolves the freshwater flux signal, calibration of the index– salinity relationships during spring tide conditions only was responsible for most of the spring–neap signal. The mean freshwater flux over the entire period estimated from the combination of the index-velocity, index–salinity, and TEF calculations were consistent with the model, suggesting that this methodology is a reliable way of estimating freshwater fluxes in the estuary over timescales greater than the spring– neap cycle. Combining this type of field campaign with hydrodynamic modeling provides guidance for estimating both magnitude of groundwater input and estuarine storage of freshwater and sets the stage for robust estimation of the nutrient load in groundwater.Funding was provided by the USGS Coastal and Marine Geology Program and by National Science Foundation Award #0420575 from the Biocomplexity/Coupled Biogeochemical Cycles Program