FLUKA Simulations of Pion Decay Gamma-radiation from Energetic Flare Ions

Gamma-ray continuum at > 10 MeV photon energy yields information on > 0.2 - 0.3 GeV/nucleon ions at the Sun. We use the general-purpose Monte Carlo code FLUKA (FLUktuierende KAskade) to model the transport of ions injected into thick and thin target sources, the nuclear processes that give rise to pions and other secondaries and the escape of the resulting photons from the atmosphere. We give examples of photon spectra calculated with a range of different assumptions about the primary ion velocity distribution and the source region. We show that FLUKA gives results for pion decay photon emissivity in agreement with previous treatments. Through the directionality of secondary products, as well as Compton scattering and pair production of photons prior to escaping the Sun, the predicted spectrum depends significantly on the viewing angle. Details of the photon spectrum in the 100 MeV range may constrain the angular distribution of primary ions and the depths at which they interact. We display a set of thick-target spectra produced making various assumptions about the incident ion energy and angular distribution and the viewing angle. If ions are very strongly beamed downward, or ion energies do not extend much above 1 GeV/nucleon, the photon spectrum is highly insensitive to details of the ion distribution. Under the simplest assumptions, flares observed near disc centre should not display significant radiation above 1 GeV photon energy. We give an example application to Fermi Large Area Telescope data from the flare of 12 June 2010.Comment: 25 pages, 13 figures, to be published in Solar Physic

Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: Impact of a pharmacist in a multidisciplinary HF clinic

Background: Drug-related negative outcomes (DNOs) are health problems that patients experience due to drug use or nonuse. Heart failure (HF) patients are at high risk of experiencing DNOs owing to polypharmacy, comorbidities, and age. Methods and Results: Ninety-seven consecutive HF patients were enrolled and followed for 6 months. A pharmacist, integrated within a multidisciplinary HF team, reviewed the medication of each patient to detect, resolve, and/or prevent possible DNOs, risks of developing a DNO (rDNOs) and the drug-related problems (DRPs) that are associated with them. We detected 147 DNOs/rDNOs with a mean of 1.5 ± 1.4 per patient. Among DNOs, 45% were due to a lack of a pharmacologic treatment (need for a drug) and 24% were treatments with an insufficient drug dose (quantitative ineffectiveness). Among rDNOs, 33% were due to use of an unsafe drug (nonquantitative lack of safety) and 30% to quantitative ineffectiveness. Ninety-four percent of DNOs/rDNOs were preventable, and, importantly, 5.5% were classified as clinically serious. During follow-up, pharmacist interventions solved or prevented the health problem in 83% of cases. The most frequently identified DRPs were "insufficiently treated health problem" (31%), "inadequate dose, regimen, or duration of a drug" (22%), "probability of adverse effects" (16%), and "nonadherence" (14%). A significant relationship between the number of DNOs/rDNOs and the number of drugs was found (P < .013). Conclusions: Chronic HF outpatients have a high incidence of preventable DNOs. The inclusion of a pharmacist in multidisciplinary HF teams should be considered, because it is clinically beneficial for patients and it increases HF specialists' awareness of DNOs, especially those beyond HF. © 2011 Elsevier Inc. All rights reserved

The circulating transcriptome as a source of biomarkers for melanoma

The circulating transcriptome is a valuable source of cancer biomarkers, which, with the exception of microRNAs (miRNAs), remains relatively unexplored. To elucidate which RNAs are present in plasma from melanoma patients and which could be used to distinguish cancer patients from healthy individuals, we used next generation sequencing (NGS), and validation was carried out by qPCR and/or ddPCR. We identified 442 different microRNAs in samples, eleven of which were differentially expressed (p < 0.05). Levels of miR-134-5p and miR-320a-3p were significantly down-regulated (p < 0.001) in melanoma samples (n = 96) compared to healthy controls (n = 28). Differentially expressed protein-encoding mRNA 5'-fragments were enriched for the angiopoietin, p21-activated kinase (PAK), and EIF2 pathways. Levels of ATM1, AMFR, SOS1, and CD109 gene fragments were up-regulated (p < 0.001) in melanoma samples (n = 144) compared to healthy controls (n = 41) (AUC = 0.825). Over 40% of mapped reads were YRNAs, a class of non-coding RNAs that to date has been little explored. Expression levels of RNY3P1, RNY4P1, and RNY4P25 were significantly higher in patients with stage 0 disease than either healthy controls or more advanced stage disease (p < 0.001). In conclusion, we have identified a number of novel RNA biomarkers, which, most importantly, we validated in multi-center retrospective and prospective cohorts, suggesting potential diagnostic use of these RNA species

The circulating transcriptome as a source of biomarkers for melanoma

The circulating transcriptome is a valuable source of cancer biomarkers, which, with the exception of microRNAs (miRNAs), remains relatively unexplored. To elucidate which RNAs are present in plasma from melanoma patients and which could be used to distinguish cancer patients from healthy individuals, we used next generation sequencing (NGS), and validation was carried out by qPCR and/or ddPCR. We identified 442 different microRNAs in samples, eleven of which were differentially expressed (p < 0.05). Levels of miR-134-5p and miR-320a-3p were significantly down-regulated (p < 0.001) in melanoma samples (n = 96) compared to healthy controls (n = 28). Differentially expressed protein-encoding mRNA 5'-fragments were enriched for the angiopoietin, p21-activated kinase (PAK), and EIF2 pathways. Levels of ATM1, AMFR, SOS1, and CD109 gene fragments were up-regulated (p < 0.001) in melanoma samples (n = 144) compared to healthy controls (n = 41) (AUC = 0.825). Over 40% of mapped reads were YRNAs, a class of non-coding RNAs that to date has been little explored. Expression levels of RNY3P1, RNY4P1, and RNY4P25 were significantly higher in patients with stage 0 disease than either healthy controls or more advanced stage disease (p < 0.001). In conclusion, we have identified a number of novel RNA biomarkers, which, most importantly, we validated in multi-center retrospective and prospective cohorts, suggesting potential diagnostic use of these RNA species

New metrics to assess type 2 diabetes after bariatric surgery: the "time-within-remission range"

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the "time-within-remission range" as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, "time-within-remission range" and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m2) underwent primary bariatric procedures. "Time-within-remission range" were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the "time-within-remission range". The association of bariatric techniques with "time-within-remission range", using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The "time-within-remission range" unveils a superiority of gastric bypass compared to sleeve gastrectomy

Brazilian scientific production on pharmaceutical care from 1990 to 2009

Brazilian scientific production on pharmaceutical care was identified based on articles indexed on the Medline, Embase, Lilacs, Web of Science and International Pharmaceutical Abstracts databases. Sixty-three articles published in both national and international journals were retrieved. With regard to authors, 72.3% were from the Southeast and South Regions, and 60.8% were affiliated to public universities. In relation to the type of studies, 85.7% were descriptive, and the most frequently researched fields were community pharmacies, hospitals and primary health care units. Articles were original in 65.1% of cases, updates in 20.6%, and reviews in 7.9%. An increase in publications commenced in 2006. In 31.7% of cases, authors had adopted a bibliographical study design, 28.6% qualitative study, 23.8% intervention, and 15.9% observational study design. The most researched subjects were elderly with chronic diseases. The importance of stimulating the conducting of experimental and qualitative studies, as well as amplifying authorship affiliated with the service area, foreign authors and with research in a wide variety of practice settings were highlighted. Despite the limited quantity of articles, an increase in their number as well as in their scope and quality is expected, so as to create further knowledge that contributes to the recognition of pharmacists' actions by patient healthcare teams.<br>Identificam-se características da produção científica brasileira sobre atenção farmacêutica, a partir de artigos indexados nas bases Medline, Embase, Lilacs, Web of Science e International Pharmaceutical Abstracts. Foram localizados 63 artigos em revistas nacionais e internacionais. Em relação aos autores, 72,3% pertenciam as Regiões Sudeste e Sul e 60,8% estavam vinculados a universidades públicas. Quanto ao tipo de pesquisa, 85,7% foram descritivas, sendo campos mais pesquisados: farmácias comunitárias, hospitais e unidades básicas de saúde. Os artigos foram considerados originais (65,1%), atualizações (20,6%) e revisões (7,9%). O aumento das publicações se deu a partir de 2006. Em 31,7% dos casos os autores optaram por estudo bibliográfico, 28,6% qualitativo, 23,8% de intervenção e 15,9% observacional. Os principais sujeitos pesquisados foram idosos com enfermidades crônicas. Aponta-se a importância de estimular a realização de estudos experimentais e qualitativos, ampliar a autoria vinculada à área de serviços, o vínculo com autores estrangeiros e a pesquisa em todos os ambientes de prática. Apesar da quantidade limitada de artigos espera-se aumento de seu número, abrangência e qualidade de forma a gerar conhecimento que contribua para o reconhecimento das ações do farmacêutico na equipe de atenção ao paciente

“Manejar la Situacion”: Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru

Previous analyses of Partner Notification (PN) have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections (STI) among men who have sex with men (MSM) and men who have sex with men and women (MSMW) in Lima, Peru. Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to “manejar la situacion” [manage the situation] by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of “managing the situation” as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America