Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study

Background: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published randomised controlled trials on pharmacotherapy reviews showed no or little effect on morbidity and mortality. Therefore we designed the PHARM (Preventing Hospital Admissions by Reviewing Medication)-study with the objective to study the effect of the total pharmaceutical care process on medication related hospital admissions and on adverse drug events, survival and quality of life. Methods/Design: The PHARM-study is designed as a cluster randomised, controlled, multi-centre study in an integrated primary care setting. Patients with a high risk of a medication related hospital admission are included in the study with randomisation at GP (general practitioner) level. We aim to include 14200 patients, 7100 in each arm, from at least 142 pharmacy practices. The intervention consists of a patient-centred, structured, pharmaceutical care process. This process consists of several steps, is continuous and occurrs over multiple encounters of patients and clinicians. The steps of this pharmaceutical care process are a pharmaceutical anamnesis, a review of the patient's pharmacotherapy, the formulation and execution of a pharmaceutical care plan combined with the monitoring and follow up evaluation of the care plan and pharmacotherapy. The patient's own pharmacist and GP carry out the intervention. The control group receives usual care. The primary outcome of the study is the frequency of hospital admissions related to medication within the study period of 12 months of each patient. The secondary outcomes are survival, quality of life, adverse drug events and severe adverse drug events. The outcomes will be analysed by using mixed-effects Cox models. Discussion: The PHARM-study is one of the largest controlled trials to study the effectiveness of the total pharmaceutical care process. The study should therefore provide evidence as to whether such a pharmaceutical care process should be implemented in the primary care setting

Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review

Contains fulltext : 69123.pdf (publisher's version ) (Open Access)BACKGROUND: Neck pain is a significant health problem in modern society. There is evidence to suggest that neck muscle strength is reduced in patients with neck pain. This article provides a critical analysis of the research literature on the clinimetric properties of tests to measure neck muscle strength or endurance in patients with non-specific neck pain, which can be used in daily practice. METHODS: A computerised literature search was performed in the Medline, CINAHL and Embase databases from 1980 to January 2007. Two reviewers independently assessed the clinimetric properties of identified measurement methods, using a checklist of generally accepted criteria for reproducibility (inter- and intra-observer reliability and agreement), construct validity, responsiveness and feasibility. RESULTS: The search identified a total of 16 studies. The instruments or tests included were: muscle endurance tests for short neck flexors, craniocervical flexion test with an inflatable pressure biofeedback unit, manual muscle testing of neck musculature, dynamometry and functional lifting tests (the cervical progressive iso-inertial lifting evaluation (PILE) test and the timed weighted overhead test). All the articles included report information on the reproducibility of the tests. Acceptable intra- and inter-observer reliability was demonstrated for t enduranctest for short neck flexors and the cervical PILE test. Construct validity and responsiveness have hardly been documented for tests on muscle functioning. CONCLUSION: The endurance test of the short neck flexors and the cervical PILE test can be regarded as appropriate instruments for measuring different aspects of neck muscle function in patients with non-specific neck pain. Common methodological flaws in the studies were their small sample size and an inappropriate description of the study design

Discrete and fuzzy dynamical genetic programming in the XCSF learning classifier system

A number of representation schemes have been presented for use within learning classifier systems, ranging from binary encodings to neural networks. This paper presents results from an investigation into using discrete and fuzzy dynamical system representations within the XCSF learning classifier system. In particular, asynchronous random Boolean networks are used to represent the traditional condition-action production system rules in the discrete case and asynchronous fuzzy logic networks in the continuous-valued case. It is shown possible to use self-adaptive, open-ended evolution to design an ensemble of such dynamical systems within XCSF to solve a number of well-known test problems

Dual Loop Line-Focusing Solar Power Plants with Supercritical Brayton Power cycles

Most of the deployed commercial line-focusing solar power plants with Parabolic Troughs (PTC) or Linear Fresnel (LF) solar collectors and Rankine power cycles use a Single Loop Solar Field (SF), Configuration 1 illustrated in Fig. 2, with synthetic oil as Heat Transfer Fluid (HTF) [1, 2]. However, thermal oils maximum operating temperature should be below ~400ºC for assuring no oil degradation, hence limiting the power cycle gross efficiency up to ~38%. For overcoming this limitation Molten Salts (MS) as HTF in linear solar collectors (PTC and LF) were recently experimented in pilot facilities [3, 4]. Direct MS main drawbacks are the equipments and components material corrosion and the salts freezing temperature, requiring heat tracing to avoid any sald solidification, hence increasing the Solar Field (SF) capital investment cost and parasitic energy looses. Concentrated Solar Power plants (CSP) with Dual Loop SF are being studied since 2012 [5] for gaining the synergies between thermal oils and MS properties. In the Dual Loop SF the HTF in the primary loop is thermal oil (Dowtherm A) [6] for heating the Balance Of Plant (BOP) working fluid from ~300ºC up to ~400ºC, and a secondary loop with Solar Salt (60% NaNO3, 40% KNO3) as HTF, for boosting the working fluid temperature from ~400ºC up to 550ºC [7, 8, 9]. The CSP Dual Loop state of the art technology includes Rankine power cycles, the main innovation of this paper is the integration between Dual Loop SF and the supercritical Carbon Dioxide (s-CO2) Brayton power cycles [10], see Configurations 2 and 3 illustrated in Fig. 3a, Fig 3b. A secondary innovation studied in this paper is the integration between thermal oil HTF (Dowtherm A) in linear solar collectors, a widely validated and mature technology, with the s-CO2 Brayton power cycles. This technical solution is very cost competitive with carbon steel receiver pipes, low SF operating pressure, and no requiring any heat tracing. Two main conclusions are deducted from this researching study. Firstly we demonstrated the higher gross plant efficiency ~44.4%, with 550ºC Turbine Inlet Temperature (TIT), provided by the Dual Loop with the Simple recuperated s-CO2 Brayton cycle with reheating, in comparison with 41.8% obtained from the Dual Loop SF and subcritical water Rankine power cycle. And finally the second conclusion obtained is the selection of the most cost competitive plant configuration with a Single loop SF with Dowtherma A and a s-CO2 Brayton power cycle due to the receiver material low cost and no heat tracing for the thermal oil

Nitrogen forms affect root structure and water uptake in the hybrid poplar

The study analyses the effects of two different forms of nitrogen fertilisation (nitrate and ammonium) on root structure and water uptake of two hybrid poplar (Populus maximowiczii x P. balsamifera) clones in a field experiment. Water uptake was studied using sap flow gauges on individual proximal roots and coarse root structure was examined by excavating 18 whole-root systems. Finer roots were scanned and analyzed for architecture. Nitrogen forms did not affect coarse-root system development, but had a significant effect on fine-root development. Nitrate-treated trees presented higher fine:coarse root ratios and higher specific root lengths than control or ammonium treated trees. These allocation differences affected the water uptake capacity of the plants as reflected by the higher sapflow rate in the nitrate treatment. The diameter of proximal roots at the tree base predicted well the total root biomass and length. The diameter of smaller lateral roots also predicted the lateral root mass, length, surface area and the number of tips. The effect of nitrogen fertilisation on the fine root structure translated into an effect on the functioning of the fine roots forming a link between form (architecture) and function (water uptake)

Netherlands

The Netherlands traditionally had ample early retirement possibilities. Several reforms introduced from the late 1990s onward contributed to the successful reversal of this early exit trend. As a result, in 2018, employees o