Clinical interventions proposed by a pharmacist in the intensive care unit.

Patients admitted to the Intensive Care Unit (ICU) are at increased risk of adverse drug events due to underlying comorbidities, organ dysfunction and pharmacokinetic alterations in addition to being prescribed almost twice as many medications as patients in general hospital wards. The role of the pharmacist in this setting has developed considerably and includes working as a part of the multi-disciplinary team providing several clinical services. Locally, clinical pharmacy services were limited in ICU. Thus, the aim of this study was to assess the interventions of a pharmacist in ICU by quantifying and categorising drug-related problems (DRPs) identified by, and determining the frequency and type of clinical interventions suggested by a pharmacist introduced in ICU. The study was carried out over eight weeks in ICU of an acute general hospital in Malta, during which the pharmacist reviewed medication charts of patients admitted to ICU over the study period and identified DRPs. DRPs and suggested pharmaceutical interventions (PIs) were discussed with ICU clinicians or nurses depending on type of PI, and the outcome was recorded. All data was recorded in a previously validated, adapted, and piloted data collection tool. Data was classified into type of DRP and PI, therapeutic class, and outcome relating to acceptance and implementation of PIs. During the study period, medication charts of 124 ICU patients were reviewed. The pharmacist identified 161 DRPs in 54 patients and suggested a PI for each DRP. The most frequently identified DRP categories were 'administration related' (29%), 'supratherapeutic dosage' (20%) and 'drug monitoring' (18%). The most common categories of suggested PIs were 'dose adjustment' (34%) and 'administration optimisation' (29%). Antimicrobials (46%) and medications acting on the central nervous system (17%) were the therapeutic classes most frequently involved in DRPs. The ICU clinical team accepted and implemented 95% of PIs suggested by the pharmacist. This research demonstrated the value of introduction of a pharmacist within ICU. The high rate of accepted PIs concerning a wide range of DRPs demonstrate that advanced collaboration between a pharmacist and the ICU team is possible. The proposed clinical interventions by the pharmacist reflect the contribution of the pharmacist to the reduction of DRPs in critically ill patients, thus, optimising treatment for these patients

Chemical determinants of occupational hypersensitivity pneumonitis

Background: Workplace inhalational exposures to low molecular weight (LMW) chemicals cause hypersensitivity pneumonitis (HP) as well as the more common manifestation of respiratory hypersensitivity, occupational asthma (OA). Aims: To explore whether chemical causation of HP is associated with different structural and physico-chemical determinants from OA. Methods: Chemical causes of human cases of HP and OA were identified from searches of peer-reviewed literature up to the end of 2011. Each chemical was categorised according to whether or not it had been the attributed cause of at least one case of HP. The predicted asthma hazard was determined for each chemical using a previously developed quantitative structure-activity relationship (QSAR) model. The chemicals in both sets were independently and ‘blindly’ analysed by an expert in mechanistic chemistry for a qualitative prediction of protein cross-linking potential and determination of lipophilicity (log Kow). Results: Ten HP causing chemicals were identified and had a higher median QSAR predicted asthma hazard than the control group of 101 OA causing chemicals (p < 0.005). Nine of ten HP causing chemicals were predicted to be protein cross-linkers compared to 24/92 controls (p<0.0001). The distributions of log Kow indicated higher values for the HP list (median 3.47) compared to controls (median 0.81) (p < 0.05). Conclusion: These findings suggest that chemicals capable of causing HP tend to have higher predicted asthma hazard, are more lipophilic and are more likely to be protein cross-linkers than those causing OA. Key words: hypersensitivity pneumonitis, occupational chemicals, occupational respiratory disease, toxic inhalatio

Investigation of systemic inflammatory response in first trimester pregnancy failure

Background: The contribution of local and systemic inflammation to the pathophysiology of sporadic first trimester miscarriages remains unclear. The objective of this study was to investigate the inflammatory response in the circulation of women presenting with first trimester miscarriage. Methods: Levels of tumour necrosis factor alpha (TNFa), TNF receptors 1 and 2, interferon gamma (IFNg), interleukin (IL)-6 and IL-10 were assayed using cytometric bead arrays in plasma samples from 29 euploid and 21 aneuploid missed miscarriages, 35 normal pregnant controls and 31 non-pregnant women (NPW). Whole blood flow cytometry was carried out with samples from 17 euploid and 16 aneuploid miscarriages, 18 pregnant controls and 13 NPW. Results: The plasma of women with euploid miscarriage contained significantly higher circulating levels of TNFa (P , 0.005), IFNg (P , 0.005), IL-6 (P , 0.005) and IL-10 (P , 0.01) than that of pregnant controls, irrespective of gestational age. Significantly (P , 0.05) higher TNF-R1 levels at 6–9 weeks, and significantly higher TNFa/IL-6 (P , 0.001) and significantly lower TNFa/IL-10 (P , 0.001) and IFNg/IL-10 (P , 0.001) ratios at 10–14 weeks, were also found in euploid miscarriage cases compared with pregnant controls. TNFa/IL-10 ratio in plasma was significantly (P , 0.05) lower in miscarriages with an abnormal karyotype than those with normal karyotype. Normal pregnant women had a significantly higher plasma level of IFNg (P , 0.01) and IFNg/IL-10 ratio (P , 0.005), a significantly (P , 0.005) lower TNF-R1 level, and a significant (P , 0.05) increase in stimulated TNFa in monocytes, compared with NPW. Conclusions: Our data confirm that there is an inflammatory reaction in normal pregnancy compared with the non-pregnant state, which may be disrupted during miscarriage.peer-reviewe

An MPEG-7 scheme for semantic content modelling and filtering of digital video

Abstract Part 5 of the MPEG-7 standard specifies Multimedia Description Schemes (MDS); that is, the format multimedia content models should conform to in order to ensure interoperability across multiple platforms and applications. However, the standard does not specify how the content or the associated model may be filtered. This paper proposes an MPEG-7 scheme which can be deployed for digital video content modelling and filtering. The proposed scheme, COSMOS-7, produces rich and multi-faceted semantic content models and supports a content-based filtering approach that only analyses content relating directly to the preferred content requirements of the user. We present details of the scheme, front-end systems used for content modelling and filtering and experiences with a number of users

Optimized methods to measure acetoacetate, 3-hydroxybutyrate, glycerol, alanine, pyruvate, lactate and glucose in human blood using a centrifugal analyser with a fluorimetric attachment

Optimized methods are described for the analysis of glucose, lactate, pyruvate, alanine, glycerol, D-3-hydroxybutyrate and acetoacetate in perchloric acid extracts of human blood using the Cobas Bio centrifugal analyser. Glucose and lactate are measured using the photometric mode and other metabolites using the fluorimetric mode. The intra-assay coefficients of variation ranged from 0.7 to 4.1%, except with very low levels of pyruvate and acetoacetate where the coefficients of variation were 7.1 and 12% respectively. All seven metabolites can be measured in a perchloric acid extract of 20 μl of blood. The methods have been optimized with regard to variation in the perchloric acid content of the samples. These variations arise from the method of sample preparation used to minimize changes occurring in metabolite concentration after venepuncture

Quality of life is associated with chronic inflammation in schizophrenia: a cross-sectional study

International audienceInflammation may play a crucial role in the pathogenesis of schizophrenia. However, the association between chronic inflammation and health outcomes in schizophrenia remains unclear, particularly for patient-reported outcomes. The aim of this study was to investigate the relationship between quality of life (QoL) and chronic inflammation assessed using C -Reactive Protein (CRP) in patients with schizophrenia. Two hundred and fifty six patients with schizophrenia were enrolled in this study. After adjusting for key socio-demographic and clinical confounding factors, patients with high levels of CRP (>3.0 mg/l) had a lower QoL than patients with normal CRP levels (OR = 0.97, 95% CI = 0.94-0.99). An investigation of the dimensions of QoL revealed that psychological well-being, physical well-being and sentimental life were the most salient features of QoL associated with CRP. Significant associations were found between lower educational level (OR = 4.15, 95% CI = 1.55-11.07), higher body mass index (OR = 1.16, 95% CI = 1.06-1.28), higher Fagerstrom score (OR = 1.22, 95% CI = 1.01-1.47) and high levels of CRP. After replications with longitudinal approaches, the association between QoL and chronic inflammation may offer interesting interventional prospects to act both on inflammation and QoL in patients with schizophrenia

Integrated geophysical-petrological modeling of lithosphere-asthenosphere boundary in central Tibet using electromagnetic and seismic data

We undertake a petrologically driven approach to jointly model magnetotelluric (MT) and seismic surface wave dispersion (SW) data from central Tibet, constrained by topographic height. The approach derives realistic temperature and pressure distributions within the upper mantle and characterizes mineral assemblages of given bulk chemical compositions as well as water content. This allows us to define a bulk geophysical model of the upper mantle based on laboratory and xenolith data for the most relevant mantle mineral assemblages and to derive corresponding predicted geophysical observables. One-dimensional deep resistivity models were derived for two groups of MT stations. One group, located in the Lhasa Terrane, shows the existence of an electrically conductive upper mantle layer and shallower conductive upper mantle layer for the other group, located in the Qiangtang Terrane. The subsequent one-dimensional integrated petrological-geophysical modeling suggests a lithosphere-asthenosphere boundary (LAB) at a depth of 80¿120 km with a dry lithosphere for the Qiangtang Terrane. In contrast, for the Lhasa Terrane the LAB is located at about 180 km but the presence of a small amount of water in the lithospheric mantle (<0.02 wt%) is required to fit the longest period MT responses. Our results suggest two different lithospheric configurations beneath the southern and central Tibetan Plateau. The model for the Lhasa Terrane implies underthrusting of a moderately wet Indian plate. The model for the Qiangtang Terrane shows relatively thick and conductive crust and implies thin and dry Tibetan lithosphere.Peer Reviewe

Dataset of coded handwriting features for use in statistical modelling

© 2017 The Authors The data presented here is related to the article titled, “Using handwriting to infer a writer's country of origin for forensic intelligence purposes” (Agius et al., 2017) [1]. This article reports original writer, spatial and construction characteristic data for thirty-seven English Australian1 writers and thirty-seven Vietnamese writers. All of these characteristics were coded and recorded in Microsoft Excel 2013 (version 15.31). The construction characteristics coded were only extracted from seven characters, which were: ‘g’ ‘h’ ‘th’ ‘M’ ‘0’ ‘7’ and ‘9’. The coded format of the writer, spatial and construction characteristics is made available in this Data in Brief in order to allow others to perform statistical analyses and modelling to investigate whether there is a relationship between the handwriting features and the nationality of the writer, and whether the two nationalities can be differentiated. Furthermore, to employ mathematical techniques that are capable of characterising the extracted features from each participant