Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing

Background Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent drug related problems (DRPs). Objectives The primary objective was to make an inventory of the DRPs and resident pharmacist on-ward interventions (PIs) identified in a geriatric acute care unit using CPOE system. The secondary objective was to evaluate the physicians\u27 acceptance of the proposed interventions. Setting A 26-bed geriatric ward of a 1,300-bed teaching hospital. Method A 6-month descriptive study with prescription analysis and recommendations to physicians by a resident pharmacist during five half days a week. Main outcome measures Patients\u27 characteristics, number of prescribed drugs per patient, nature and frequency of DRPs and PIs, physicians\u27 acceptance and drugs questioned. Results Resident pharmacist reviewed 311 patients and identified 241 DRPs. One hundred and fifty-two patients (49 %) had at least one DRP (mean +/- A SD age 87 +/- A 6 years, mean +/- A SD number of prescribed drugs 10.7 +/- A 3.4). Most frequent DRPs were: untreated indication (n = 58, 24.1 %), dose too high (n = 46, 19.1 %), improper administration (n = 31, 12.9 %) and drug interactions (n = 23, 9.5 %). The rate of physicians\u27 acceptance was 90.0 % (7.5 % refusals, 2.5 % not assessable). DRPs related to CPOE system misuse (n = 35, 14.5 %) appeared as a worrying phenomenon (e.g., errors in selecting dosage or unit, or duplication of therapy). Conclusion A resident pharmacist detected various DRPs. Most PIs were accepted. DRPs related to the misuse of the CPOE system appeared potentially dangerous and need particular attention by healthcare professionals. The description of the DRPs is an essential step for implementation of targeted clinical pharmacy services in order to optimize pharmacists\u27 job time

Modeling Inhomogeneous DNA Replication Kinetics

In eukaryotic organisms, DNA replication is initiated at a series of chromosomal locations called origins, where replication forks are assembled proceeding bidirectionally to replicate the genome. The distribution and firing rate of these origins, in conjunction with the velocity at which forks progress, dictate the program of the replication process. Previous attempts at modeling DNA replication in eukaryotes have focused on cases where the firing rate and the velocity of replication forks are homogeneous, or uniform, across the genome. However, it is now known that there are large variations in origin activity along the genome and variations in fork velocities can also take place. Here, we generalize previous approaches to modeling replication, to allow for arbitrary spatial variation of initiation rates and fork velocities. We derive rate equations for left- and right-moving forks and for replication probability over time that can be solved numerically to obtain the mean-field replication program. This method accurately reproduces the results of DNA replication simulation. We also successfully adapted our approach to the inverse problem of fitting measurements of DNA replication performed on single DNA molecules. Since such measurements are performed on specified portion of the genome, the examined DNA molecules may be replicated by forks that originate either within the studied molecule or outside of it. This problem was solved by using an effective flux of incoming replication forks at the model boundaries to represent the origin activity outside the studied region. Using this approach, we show that reliable inferences can be made about the replication of specific portions of the genome even if the amount of data that can be obtained from single-molecule experiments is generally limited

Mathematical Modelling of DNA Replication Reveals a Trade-off between Coherence of Origin Activation and Robustness against Rereplication

Eukaryotic genomes are duplicated from multiple replication origins exactly once per cell cycle. In Saccharomyces cerevisiae, a complex molecular network has been identified that governs the assembly of the replication machinery. Here we develop a mathematical model that links the dynamics of this network to its performance in terms of rate and coherence of origin activation events, number of activated origins, the resulting distribution of replicon sizes and robustness against DNA rereplication. To parameterize the model, we use measured protein expression data and systematically generate kinetic parameter sets by optimizing the coherence of origin firing. While randomly parameterized networks yield unrealistically slow kinetics of replication initiation, networks with optimized parameters account for the experimentally observed distribution of origin firing times. Efficient inhibition of DNA rereplication emerges as a constraint that limits the rate at which replication can be initiated. In addition to the separation between origin licensing and firing, a time delay between the activation of S phase cyclin-dependent kinase (S-Cdk) and the initiation of DNA replication is required for preventing rereplication. Our analysis suggests that distributive multisite phosphorylation of the S-Cdk targets Sld2 and Sld3 can generate both a robust time delay and contribute to switch-like, coherent activation of replication origins. The proposed catalytic function of the complex formed by Dpb11, Sld3 and Sld2 strongly enhances coherence and robustness of origin firing. The model rationalizes how experimentally observed inefficient replication from fewer origins is caused by premature activation of S-Cdk, while premature activity of the S-Cdk targets Sld2 and Sld3 results in DNA rereplication. Thus the model demonstrates how kinetic deregulation of the molecular network governing DNA replication may result in genomic instability

Domain structure in biphenyl incommensurate phase II observed by electron paramagnetic resonance

The domain structure in incommensurate phase II of single biphenyl crystal has been observed by investigations of the optically excited states of the Electronic Paramagnetic Resonance (E.P.R.) deuterated naphthalene molecular probes which substitute biphenyl molecules. Our results confirm that this phase is a 1q bi-domain one. The analysis of the spectra obtained in X band (9.5 GHz) experiments, in relation with the spin Hamiltonian parameter properties permits us to show that the E.P.R. probe rotates around a direction perpendicular to its long axis while the biphenyl molecule undergoes a twist movement around this axis. They also account for a regime which is like a “ multi-soliton " regime while the modulation is a plane wave one in the pure single crystal. The two molecules of the high temperature cell do not exactly experience the saure displacement field in the incommensurate phase and consequently the two domains can be distinguished. The spin Hamiltonian parameters which characterize the E.P.R. probes have been determined in the incommensurate phase II of biphenyl.La structure en domaines de la phase II du biphényle est mise en évidence par les investigations dans les états photo-excités des molécules de naphtalène deutéré, utilisées comme sondes de Résonance Paramagnétique Electronique, se substituant de manière diluée dans le mono-cristal de biphényle. Ceci confirme que cette phase est 1q bi-domaine. L'analyse des spectres obtenus dans des expériences en bande X (9.5 GHz) en relation avec les propriétés de l'hamiltonien de spin permet de montrer que la sonde moléculaire tourne autour d'une direction perpendiculaire à son grand axe alors que la molécule de biphényle subit un mouvement de twist autour de cet axe. Les résultats montrent que ces sondes rendent compte d'un régime qui est comme un régime “ multi-solitons " alors que la modulation est plane dans le cristal pur. Les deux molécules sondes de la cellule élémentaire haute température ne subissent pas les mêmes champs de déplacements dans la phase incommensurable et en conséquence les deux domaines peuvent être distingués. Les paramètres de l'hamiltonien de spin qui caractérisent les sondes R.P.E. ont été déterminés dans la phase II du biphényle

Influence of an External Shear Stress on the Domain Structure in Incommensurate Phase II of Biphenyl

The incommensurate phase II of biphenyl is a bi-domain one. The naphthalene paramagnetic molecular probes used in this experiment permit the differentiation of these two domains: each Electron Paramagnetic Resonance line of the high temperature phase of biphenyl gives rise to two incommensurate lines in the phase II. But by applying a relevant shear stress, one favours one domain; this behaviour is observed on the E.P.R. spectra which exhibit only one incommensurate line. These results complete the ones obtained about the domain structure of phase II of biphenyl.La phase incommensurable II du biphényle est composée de deux domaines. La sonde paramagnétique moléculaire de naphtalène utilisée dans cette expérience de résonance paramagnétique électronique permet de différentier les deux domaines. Ainsi chaque raie R.P.E. du naphtalène de la phase haute température du biphényle donne en phase II deux raies incommensurables. Mais en appliquant une contrainte de cisaillement judicieusement choisie on favorise un domaine; ceci se voit sur le spectre R.P.E. qui ne présente alors qu'une seule raie incommensurable correspondant au domaine privilégié. Ces résultats complètent ceux obtenus précédemment sur la structure en domaines de la phase II du biphényle

Ngse au Point d'une technique d'obtention de couches minces texturées de MoSe2_2

A new process to obtain textured MoSe$_2$ thin films is described MoTe$_2$ thin films obtained by D.C. diode sputtering are annealed at 840 K during 24 h under Te and Se vapors. During the annealing MoSe$_2$ crystallites growths with their c axis perpendicular to the plane of the substrate. The evolution of the properties of the layers is investigated by X-Ray photoelectron spectroscopy (Y.PS), X-ray diffraction and scanning electron microscopy, the atomic ratio Se/Te is taken as parameter.Une technologie d'obtention de couches minces texturées de MoSe$_2$ a été mise au point. Ces couches sont obtenues à partir de couches de MoTe$_2$ déposées par pulvérisation diode continue, puis traitées thermiquement (recuit 24 h à 840 K) en présence de vapeur de Te et de Se, L'évolution des propriétés des couches, en fonction du rapport atomique Se/Te présent lors du recuit, est étudiée par spectroscopie de photoélectrons (XPS), diffraction de rayons X et microscopie à balayage

Influence of the stoichiometry deviation on the electrical properties of MoTe2-x

Transport coefficient measurements (electrical conductivity, Hall effect, thermoelectric power) have been performed on single crystals of MoTe 2-x (x = 0.01 and 0.015) in a wide range of temperatures. The samples were prepared by a based Te flux method and the deviation from stoichiometry was obtained by a thermal treatment. Experimental results are interpreted on the basis of a compensated p-type semiconductor model. The lacunar origin of the two impurity levels is clearly shown. For a weak departure from stoichiometry, the carriers are scattered in two ways : ionized impurities and thermal lattice modes. For a larger departure, the donor and acceptor levels broaden in two narrow energy bands. At low temperatures, the conduction mechanisms are mainly governed by a thermal hopping of small polarons in these bands. At higher temperatures, the contribution of the extended states must be taken into account. It is shown that the presence of Te-lacunar-sites leads to a greater polarization of the material and a much higher interaction between the valence and the acceptor energy bands. The model adopted here is in agreement with the band structure of the group VI transition metal dichalcogenides which have a trigonal prism coordination.Les mesures des coefficients de transport (conductivité électrique, effet Hall, pouvoir thermoélectrique) ont été effectuées sur des monocristaux de MoTe2-x (x = 0,01 et 0,015) dans une gamme étendue de température. Les échantillons ont été préparés par une méthode à base de flux de tellure et l'écart à la stoechiométrie a été obtenu par un traitement thermique. Les écarts expérimentaux sont interprétés sur la base d'un modèle de semiconducteur de type p compensé. L'origine lacunaire des deux niveaux d'impuretés est clairement mise en évidence. Pour un écart faible à la stœchiométrie, les porteurs de charge sont diffusés de deux façons différentes: impuretés ionisées et modes de réseau thermiques. Pour un plus grand écart, les niveaux donneurs et accepteurs s'élargissent en deux bandes étroites d'énergie. A basse température, les mécanismes de conduction sont principalement gouvernés par des sauts activés thermiquement de petits polarons dans ces bandes. A plus haute température, la contribution des états étendus doit être prise en compte. Il est également montré que la présence de sites lacunaires de tellure conduit à une plus grande polarisation du matériau et à une interaction beaucoup plus importante entre la bande de valence et la bande d'acceptcurs. Le modèle adopté ici est de manière générale en accord avec la structure de bande des dichalcogénures des métaux de transition du groupe VI à coordination trigonale prismatique