Approval of new drugs by the U. S. food and drug administration: Problems with the process and access to unapproved drugs

Today, the vast majority of drugs available for patient use have gone through a rigorous system of human clinical trials supervised by the Food and Drug Administration (FDA), to ensure the drugs are safe and efficacious. There are now citizen advocacy groups that seek use of drugs not yet approved by the FDA, to be administered to terminally ill patients who have exhausted all other available means of therapy. The FDA has programs for terminal patients, under the supervision of their physicians, to use unapproved drugs; however, the advocacy groups seek access to drugs in much earlier phases than is now allowed, raising serious safety concerns for patients. Use of drugs outside of the clinical trials system undermines the integrity of the FDA’s drug development process by slowing enrollment, which in turn slows approval and timely access of safe and efficacious drugs to all of society

Quantitative determination of the local adsorption structure of carbonate on Ag(110)

The local geometry of carbonate (CO3) on Ag(1 1 0), formed by the reaction of CO2 with preadsorbed oxygen, has been investigated using C Is scanned-energy mode photoelectron diffraction. The carbonate species is essentially planar and adsorbs almost parallel to the surface in an off-atop site relative to an outermost layer Ag atom, at a C-Ag layer spacing of 2.64 +/- 0.09 Angstrom, with a well-defined azimuthal orientation. This geometry is best understood in terms of the added-row model proposed by Guo and Madix in which additional Ag atoms lie adjacent to the carbonate, such that bonding can occur through at least one of the oxygen atoms. The distance between this oxygen and its nearest neighbour Ag adatom is 1.90 +/- 0.42 Angstrom. The C-O distances are in the range 1.26-1.30 Angstrom. While the symmetry of the carbonate in the optimum structure is reduced, the D-3h symmetry of the isolated species lies within the limits of Precision. (C) 2002 Elsevier Science B.V. All rights reserved

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia