Description of hospital pharmacy management practice

Health institutions, particularly hospitals, are characterized as complex structures that need managers with a global view of the institution and its relations with the external environment. The hospital pharmacy is a strategic unit, which cooperates with the institutional management and integrates the multiprofessional team in the process related to the acquisition, provision and control of essential inputs for the inpatient care process. The objective in this study is to demonstrate the applicability, in the context of hospital-based health, of a performance measuring system at the pharmacy. Method: A descriptive and longitudinal study was undertaken on the evolution of the key indicator Absence Rate of Standardized Drugs in inpatient care between March 2004 and December 2013. This indicator was employed to monitor the impact of changes the Pharmacy Division has been implementing, as the first step of the pharmaceutical care cycle in the model of the process-based managed approach at a public university hospital. Qualitative data collection methods were used, including observation and documentary analysis, as well as quantitative data collection. Results: After the application of the model, one point of change in the key performance indicator was detected in the tenth month, when the process-based management model was implemented at the pharmacy. Conclusions: The process-based management approach was effective for the hospital pharmacy. The premise adopted is that the administrative changes (interferences), focused on the improvement of the processes and the selection and monitoring of indicators, influence the processes, reducing the variability and improving the qualityAs instituições de saúde, especialmente hospitais, são caracterizadas como estruturas complexas que precisam de administradores com uma visão global da instituição e de suas relações com o ambiente externo. A farmácia hospitalar é uma unidade estratégica, que colabora com a administração institucional e integra a equipe multiprofissional no processo que tange a aquisição, provisão e controle de insumos essenciais para o processo do atendimento do paciente internado. Este estudo tem como objetivo demonstrar a aplicabilidade, no contexto da saúde hospitalar, de um sistema de medição de desempenho da farmácia. Método: Trata-se de um estudo descritivo, longitudinal, sobre a evolução do indicador chave Taxa de Falta de Medicamentos Padronizados na assistência do paciente internado, no período de março de 2004 a dezembro de 2013. Esse indicador foi empregado para monitoramento do impacto de mudanças que a Divisão de Farmácia vem implementando, como primeira etapa do ciclo de assistência farmacêutica dentro do modelo da abordagem de gestão por processos, em um hospital público universitário. Foram usados métodos de coleta de dados qualitativos, incluindo a observação e análise documental, bem como coleta de dados quantitativos. Resultados: Após a aplicação do modelo, um ponto de mudança no indicador chave de desempenho, foi detectado no 10º mês, quando o modelo de gestão baseado em processo foi implementado na farmácia. Conclusões: A abordagem de gestão baseada em processos foi eficaz para a farmácia hospitalar. A premissa adotada é que as mudanças administrativas (interferências), com foco na melhoria dos processos e seleção e acompanhamento de indicadores, têm influencia sobre os processos, reduzindo a variabilidade e melhoria da qualidad

Topological speckles

The time evolution of a topological Su-Schrieffer-Heeger chain is analyzed through the statistics of speckle patterns. The emergence of topological edge states dramatically affects the dynamical fluctuations of the wavefunction. The intensity statistics is found to be described by a family of noncentral chi-squared distributions, with the noncentrality parameter reflecting on the degree of edge-state localization. The response of the speckle contrast with respect to the dimerization of the chain is explored in detail as well as the role of chiral symmetry-breaking disorder, number of edge states, their energy gap, and the locations between which the transport occurs. In addition to providing a venue for speckle customization, our results appeal to the use of speckle patterns for characterization of nontrivial topological properties.Comment: 6 pages, 4 figure

Plant traits controlling growth change in response to a drier climate

This is the final version. Available on open access from Wiley via the DOI in this recordPlant traits are increasingly being used to improve prediction of plant function, including plant demography. However, the capability of plant traits to predict demographic rates remains uncertain, particularly in the context of trees experiencing a changing climate. Here we present data combining 17 plant traits associated with plant structure, metabolism and hydraulic status, with measurements of long-term mean, maximum and relative growth rates for 176 trees from the world’s longest running tropical forest drought experiment. We demonstrate that plant traits can predict mean annual tree growth rates with moderate explanatory power. However, only combinations of traits associated more directly with plant functional processes, rather than more commonly employed traits like wood density or leaf mass per area, yield the power to predict growth. Critically, we observe a shift from growth being controlled by traits related to carbon cycling (assimilation and respiration) in well-watered trees, to traits relating to plant hydraulic stress in drought-stressed trees. We also demonstrate that even with a very comprehensive set of plant traits and growth data on large numbers of tropical trees, considerable uncertainty remains in directly interpreting the mechanisms through which traits influence performance in tropical forests.Conselho Nacional de Desenvolvimento Científico e TecnológicoNatural Environment Research Council (NERC)Australian Research Council (ARC)European Union FP7Fundação de Amparo à Pesquisa do Estado de São Paul

Velocity Dispersion of Excited H2

We present a study of the high rotational bands (J > 2) of H2 toward 4 early type galactic stars: HD 73882, HD 192639, HD 206267, and HD 207538. In each case, the velocity dispersion - characterized by the spectrum fitting parameter b - increases with the level of excitation, a phenomenon that has previously been detected by the Copernicus and IMAPS observatories. In particular, we show with 4 sigma confidence that for HD 192639 it is not possible to fit all J levels with a single b value, and that higher b values are needed for the higher levels. The amplitude of the line broadening, which can be as high as 10 km s^-1, makes explanations such as inhomogeneous spatial distribution unlikely. We investigate a mechanism in which the broadening is due to the molecules that are rotationally excited through the excess energy acquired after their formation on a grain (H2-formation pumping). We show that different dispersions would be a natural consequence of this mechanism. We note however that such process would require a formation rate 10 times higher then what was inferred from other observations. In view of the difficulty to account for the velocity dispersion as thermal broadening (T would be around 10,000 K), we conclude then that we are most certainly observing some highly turbulent warm layer associated with the cold diffuse cloud. Embedded in a magnetic field, it could be responsible for the high quantities of CH+ measured in the cold neutral medium.Comment: accepted in Ap

Drought stress and tree size determine stem CO2 efflux in a tropical forest

CO2 efflux from stems (CO2_stem) accounts for a substantial fraction of tropical forest gross primary productivity, but the climate sensitivity of this flux remains poorly understood. We present a study of tropical forest CO2_stem from 215 trees across wet and dry seasons, at the world's longest running tropical forest drought experiment site. We show a 27% increase in wet season CO2_stem in the droughted forest relative to a control forest. This was driven by increasing CO2_stem in trees 10–40 cm diameter. Furthermore, we show that drought increases the proportion of maintenance to growth respiration in trees > 20 cm diameter, including large increases in maintenance respiration in the largest droughted trees, > 40 cm diameter. However, we found no clear taxonomic influence on CO2_stem and were unable to accurately predict how drought sensitivity altered ecosystem scale CO2_stem, due to substantial uncertainty introduced by contrasting methods previously employed to scale CO2_stem fluxes. Our findings indicate that under future scenarios of elevated drought, increases in CO2_stem may augment carbon losses, weakening or potentially reversing the tropical forest carbon sink. However, due to substantial uncertainties in scaling CO2_stem fluxes, stand‐scale future estimates of changes in stem CO2 emissions remain highly uncertain.This work is a product of a UK NERC independent fellowship grant NE/N014022/1 to L.R., a UK NERC grant NE/J011002/1 to P.M. and M.M., CNPQ grant 457914/2013-0/MCTI/CNPq/FNDCT/LBA/ESECAFLOR to A.C.L.d.C., an ARC grant FT110100457 to P.M. It was previously supported by NERC NER/A/S/2002/00487, NERC GR3/11706, EU FP5-Carbonsink and EU FP7-Amazalert to P.M

Drought stress and tree size determine stem CO2 efflux in tropical forests

This is the author accepted manuscript. The final version is available from Wiley for New Phytologist Trust via the DOI in this record.1. CO2 efflux from stems (CO2_stem) accounts for a substantial fraction of tropical forest gross primary productivity, but the climate sensitivity of this flux remains poorly understood. 2. We present a study of tropical forest CO2_stem from 215 trees across wet and dry seasons, at the world’s longest running tropical forest drought experiment site. 3. We show a 27% increase in wet season CO2_stem in the droughted forest relative to a control forest. This was driven by increasing CO2_stem in trees 10-40 cm diameter. Furthermore, we show that drought increases the proportion of maintenance to growth respiration in trees >20 cm diameter, including large increases in maintenance respiration in the largest droughted trees, >40 cm diameter. However, we found no clear taxonomic influence on CO2_stem and were unable to accurately predict how drought sensitivity altered ecosystem scale CO2_stem, due to substantial uncertainty introduced by contrasting methods previously employed to scale CO2_stem fluxes. 4. Our findings indicate that under future scenarios of elevated drought, increases in CO2_stem may augment carbon losses, weakening or potentially reversing the tropical forest carbon sink. However, due to substantial uncertainties in scaling CO2_stem fluxes, stand-scale future estimates of changes in stem CO2 emissions remain highly uncertain.This work is a product of a UK NERC independent fellowship grant NE/N014022/1 to LR, a UK NERC grant NE/J011002/1 to PM and MM, CNPQ grant 457914/2013-0/MCTI/CNPq/FNDCT/LBA/ESECAFLOR to ACLD, an ARC grant FT110100457 to PM. It was previously supported by NERC NER/A/S/2002/00487, NERC GR3/11706, EU FP5-Carbonsink and EU FP7-Amazalert to PM. LR would also like to acknowledge the support of Dr. Robert Clement, University of Edinburgh and Dr. Timothy Hill, University of Exeter, alongside the contribution of three anonymous reviewers

Deuterium and Oxygen Toward Feige 110: Results from the Far Ultraviolet Spectroscopic Explorer (FUSE) Mission

We present measurements of the column densities of interstellar DI and OI made with the Far Ultraviolet Spectroscopic Explorer (FUSE), and of HI made with the International Ultraviolet Explorer (IUE) toward the sdOB star Feige 110 [(l,b) = (74.09, -59.07); d = 179 +265 -67 pc; z = -154 +57 -227 pc]. Our determination of the DI column density made use of curve of growth fitting and profile fitting analyses, while our OI column density determination used only curve of growth techniques. The HI column density was estimated by fitting the damping wings of the interstellar Ly alpha profile. We find log N(DI) = 15.47 +/- 0.06, log N(OI) = 16.73 +/- 0.10, and log N(HI) = 20.14 +0.13 -0.20 (all errors 2 sigma). This implies D/H = (2.14 +/- 0.82) x 10^-5, D/O = (5.50 +1.64 -1.33) x 10^-2, and O/H = (3.89 +/- 1.67) x 10^-4. Taken with the FUSE results reported in companion papers (Moos et al. 2001) and previous measurements of the local interstellar medium, this suggests the possibility of spatial variability in D/H for sight lines exceeding ~100 pc. This result may constrain models which characterize the mixing time and length scales of material in the local interstellar medium.Comment: 24 pages, 9 figures. Accepted for publication in the Astrophysical Journal Supplement Series. Replacement corrects a typo in original submissio

Data standardization of plant-pollinator interactions

Background: Animal pollination is an important ecosystem function and service, ensuring both the integrity of natural systems and human well-being. Although many knowledge shortfalls remain, some high-quality data sets on biological interactions are now available. The development and adoption of standards for biodiversity data and metadata has promoted great advances in biological data sharing and aggregation, supporting large-scale studies and science-based public policies. However, these standards are currently not suitable to fully support interaction data sharing. Results: Here we present a vocabulary of terms and a data model for sharing plant–pollinator interactions data based on the Darwin Core standard. The vocabulary introduces 48 new terms targeting several aspects of plant–pollinator interactions and can be used to capture information from different approaches and scales. Additionally, we provide solutions for data serialization using RDF, XML, and DwC-Archives and recommendations of existing controlled vocabularies for some of the terms. Our contribution supports open access to standardized data on plant–pollinator interactions. Conclusions: The adoption of the vocabulary would facilitate data sharing to support studies ranging from the spatial and temporal distribution of interactions to the taxonomic, phenological, functional, and phylogenetic aspects of plant–pollinator interactions. We expect to fill data and knowledge gaps, thus further enabling scientific research on the ecology and evolution of plant–pollinator communities, biodiversity conservation, ecosystem services, and the development of public policies. The proposed data model is flexible and can be adapted for sharing other types of interactions data by developing discipline-specific vocabularies of terms.Fil: Salim, José A. Universidade de Sao Paulo; BrasilFil: Saraiva, Antonio M.. Universidade de Sao Paulo; BrasilFil: Zermoglio, Paula Florencia. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Patagonia Norte. Instituto de Investigaciones En Recursos Naturales, Agroecologia y Desarrollo Rural. - Universidad Nacional de Rio Negro. Instituto de Investigaciones En Recursos Naturales, Agroecologia y Desarrollo Rural.; ArgentinaFil: Agostini, Kayna. Universidade Federal do São Carlos; BrasilFil: Wolowski, Marina. Universidade Federal de Alfenas; BrasilFil: Drucker, Debora P.. Empresa Brasileira de Pesquisa Agropecuaria (embrapa);Fil: Soares, Filipi M.. Universidade de Sao Paulo; BrasilFil: Bergamo, Pedro J.. Jardim Botânico do Rio de Janeiro; BrasilFil: Varassin, Isabela G.. Universidade Federal do Paraná; BrasilFil: Freitas, Leandro. Jardim Botânico do Rio de Janeiro; BrasilFil: Maués, Márcia M.. Empresa Brasileira de Pesquisa Agropecuaria (embrapa);Fil: Rech, Andre R.. Universidade Federal dos Vales do Jequitinhonha e Mucuri; BrasilFil: Veiga, Allan K.. Universidade de Sao Paulo; BrasilFil: Acosta, Andre L.. Instituto Tecnológico Vale; BrasilFil: Araujo, Andréa C. Universidade Federal do Mato Grosso do Sul; BrasilFil: Nogueira, Anselmo. Universidad Federal do Abc; BrasilFil: Blochtein, Betina. Pontificia Universidade Católica do Rio Grande do Sul; BrasilFil: Freitas, Breno M.. Universidade Estadual do Ceará; BrasilFil: Albertini, Bruno C.. Universidade de Sao Paulo; BrasilFil: Maia Silva, Camila. Universidade Federal Rural Do Semi Arido; BrasilFil: Nunes, Carlos E. P.. University of Stirling; BrasilFil: Pires, Carmen S. S.. Empresa Brasileira de Pesquisa Agropecuaria (embrapa);Fil: Dos Santos, Charles F.. Pontificia Universidade Católica do Rio Grande do Sul; BrasilFil: Queiroz, Elisa P.. Universidade de Sao Paulo; BrasilFil: Cartolano, Etienne A.. Universidade de Sao Paulo; BrasilFil: de Oliveira, Favízia F. Universidade Federal da Bahia; BrasilFil: Amorim, Felipe W.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Fontúrbel, Francisco E.. Pontificia Universidad Católica de Valparaíso; ChileFil: da Silva, Gleycon V.. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Consolaro, Hélder. Universidade Federal de Catalão; Brasi

MyD88 and STING Signaling Pathways Are Required for IRF3-Mediated IFN-β Induction in Response to Brucella abortus Infection

Type I interferons (IFNs) are cytokines that orchestrate diverse immune responses to viral and bacterial infections. Although typically considered to be most important molecules in response to viruses, type I IFNs are also induced by most, if not all, bacterial pathogens. In this study, we addressed the role of type I IFN signaling during Brucella abortus infection, a facultative intracellular bacterial pathogen that causes abortion in domestic animals and undulant fever in humans. Herein, we have shown that B. abortus induced IFN-β in macrophages and splenocytes. Further, IFN-β induction by Brucella was mediated by IRF3 signaling pathway and activates IFN-stimulated genes via STAT1 phosphorylation. In addition, IFN-β expression induced by Brucella is independent of TLRs and TRIF signaling but MyD88-dependent, a pathway not yet described for Gram-negative bacteria. Furthermore, we have identified Brucella DNA as the major bacterial component to induce IFN-β and our study revealed that this molecule operates through a mechanism dependent on RNA polymerase III to be sensed probably by an unknown receptor via the adaptor molecule STING. Finally, we have demonstrated that IFN-αβR KO mice are more resistant to infection suggesting that type I IFN signaling is detrimental to host control of Brucella. This resistance phenotype is accompanied by increased IFN-γ and NO production by IFN-αβR KO spleen cells and reduced apoptosis

Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and high plasma homocysteine in chronic hepatitis C (CHC) infected patients from the Northeast of Brazil

<p>Abstract</p> <p>Background/Aim</p> <p>Hyperhomocysteinemia due to Methylenetetrahydrofolate Reductase (<it>MTHFR</it>) gene, in particular the C677T (Ala222Val) polymorphism were recently associated to steatosis and fibrosis. We analyzed the frequency of <it>MTHFR </it>gene in a cross-sectional study of patients affected by Chronic Hepatitis C (CHC) from Northeast of Brazil.</p> <p>Method</p> <p>One hundred seven-four untreated patients with CHC were genotyped for the C677T <it>MTHFR</it>. Genomic DNA was extracted from peripheral blood cells and the C677T <it>MTHFR </it>polymorphism was identified by PCR-RFLP. The homocysteine (Hcy) levels were determined by chemiluminescence method. All patients were negative for markers of Wilson's disease, hemochromatosis and autoimmune diseases and have current and past daily alcohol intake less than 100 g/week.</p> <p>Results</p> <p>Among subjects infected with CHC genotype non-1 the frequency of <it>MTHFR </it>genotypes TT was 9.8% <it>versus </it>4.4% genotype 1 (p = 0.01). Nevertheless, association was found between the <it>MTHFR </it>genotype TT × CT/CC polymorphism and the degree of steatosis and fibrosis in both hepatitis C genotype (p < 0.05). A significant difference was found on plasma Hcy levels in patients with steatosis regardless of HCV genotype (p = 0.03).</p> <p>Conclusion</p> <p>Our results indicate that plasma Hcy levels is highly prevalent in subjects with chronic hepatits C with steatosis regardless of HCV genotype and vitamin deficiency. The presence of genotype TT of <it>MTHFR </it>C677T polymorphism was more common in CHC genotype non-1 infected patient regardless of histopathological classification and genotype TT+CT frequencies were significant in the presence of fibrosis grade 1+2 and of steatosis in CHC infected patients from the northeast of Brazil regardless of HCV genotype. The genetic susceptibility of <it>MTHFR </it>C677T polymorphism should be confirmed in a large population.</p