Teaching prescribing: just what the doctor ordered? A thematic analysis of the views of newly qualified doctors

Undergraduate medical education has been criticised for failing to adequately prepare doctors for the task of prescribing. Pharmacists have been shown to improve medication use in hospitals. This study aims to elicit the views of intern doctors on the challenges of prescribing, and to suggest changes in education to enhance prescribing practice and potential role of the pharmacist. Semi-structured, qualitative interviews were conducted with intern doctors in their first year post qualification in an Irish hospital. Data collection was conducted until no new themes emerged and thematic analysis was performed. Thirteen interviews took place. Interns described training in practical prescribing as limited and felt the curriculum failed to convey the reality of actual prescribing. Pharmacists were perceived to be a useful, but underutilised, information source in the prescribing process. They requested an earlier introduction, and repeated exposure, to prescribing, and suggested the involvement of peers and pharmacists in this teaching. Intern doctors reported difficulties in applying knowledge gained in medical school to clinical practice. New strategies are needed to enhance the clinical relevance of the medical curriculum by rethinking the learning outcomes regarding prescribing practice and the involvement of pharmacists in prescribing education

Competition of fusion and quasi-fission in the reactions leading to production of the superheavy elements

The mechanism of fusion hindrance, an effect observed in the reactions of cold, warm and hot fusion leading to production of the superheavy elements, is investigated. A systematics of transfermium production cross sections is used to determine fusion probabilities. Mechanism of fusion hindrance is described as a competition of fusion and quasi-fission. Available evaporation residue cross sections in the superheavy region are reproduced satisfactorily. Analysis of the measured capture cross sections is performed and a sudden disappearance of the capture cross sections is observed at low fusion probabilities. A dependence of the fusion hindrance on the asymmetry of the projectile-target system is investigated using the available data. The most promising pathways for further experiments are suggested.Comment: 8 pages, 7 figures, talk presented at 7th International School-Seminar on Heavy-Ion Physics, May 27 - June 1, 2002, Dubna, Russi

Emerging resistance among bacterial pathogens in the intensive care unit – a European and North American Surveillance study (2000–2002)

Background Globally ICUs are encountering emergence and spread of antibiotic-resistant pathogens and for some pathogens there are few therapeutic options available. Methods Antibiotic in vitro susceptibility data of predominant ICU pathogens during 2000–2 were analyzed using data from The Surveillance Network (TSN) Databases in Europe (France, Germany and Italy), Canada, and the United States (US). Results Oxacillin resistance rates among Staphylococcus aureus isolates ranged from 19.7% to 59.4%. Penicillin resistance rates among Streptococcus pneumoniae varied from 2.0% in Germany to as high as 20.2% in the US; however, ceftriaxone resistance rates were comparably lower, ranging from 0% in Germany to 3.4% in Italy. Vancomycin resistance rates among Enterococcus faecalis were ≤ 4.5%; however, among Enterococcus faecium vancomycin resistance rates were more frequent ranging from 0.8% in France to 76.3% in the United States. Putative rates of extended-spectrum β-lactamase (ESBL) production among Enterobacteriaceae were low, \u3c6% among Escherichia coli in the five countries studied. Ceftriaxone resistance rates were generally lower than or similar to piperacillin-tazobactam for most of the Enterobacteriaceae species examined. Fluoroquinolone resistance rates were generally higher for E. coli (6.5% – 13.9%), Proteus mirabilis (0–34.7%), and Morganella morganii (1.6–20.7%) than other Enterobacteriaceae spp (1.5–21.3%). P. aeruginosa demonstrated marked variation in β-lactam resistance rates among countries. Imipenem was the most active compound tested against Acinetobacter spp., based on resistance rates. Conclusion There was a wide distribution in resistance patterns among the five countries. Compared with other countries, Italy showed the highest resistance rates to all the organisms with the exception of Enterococcus spp., which were highest in the US. This data highlights the differences in resistance encountered in intensive care units in Europe and North America and the need to determine current local resistance patterns by which to guide empiric antimicrobial therapy for intensive care infections

A data mining approach to the SAR values over large MR image repositories

Purpose: In magnetic resonance imaging, the radiofrequency energy absorption arises as one of the main safety concerns, being mainly related with increased body temperature. Monitoring radiofrequency absorption is achieved by the estimation of specific absorption rate (SAR), whose implementation lies on equipment manufacturers, which in turn are not totally enlightening about its calculus. This work presents an exploratory approach of whole-body SAR values stored in DICOM metadata aiming to find correlation with body weight, body mass index (BMI), gender and pulse sequences for abdominal/pelvic (17.812 series) and head (29.907 series) studies. Methods and Materials: All studies were acquired in a 3 Tesla scanner with high-performance gradients. Data were extracted using Dicoogle, a DICOM metadata mining tool. Several DICOM tags were analysed (e.g. patient weight, height, gender, sequence name). For each study type, specifically weighted pulse sequences were related with weight, BMI and gender through boxplot diagrams, statistical and effect size analysis. Results: SAR limits were never exceeded. Generally, SAR values tended to decrease with increasing body weight and BMI values for abdominal/pelvic studies. On the other hand, head studies showed different trends regarding distinct pulse sequences. SAR values tend to be higher in male individuals (p<0,05). As expected, turbo spin echo sequences present the highest SAR values. The values found for echo gradient spoiled sequence (FLASH) were also high. Conclusion: It is confirmed that SAR estimates are related with the analysed variables. An individual examination of pulse sequences is recommended to observe trends regarding weight, BMI or gender.publishe

Search for the Production of Element 112 in the 48Ca + 238U Reaction

We have searched for the production of element 112 in the reaction of 231 MeV 48Ca with 238U. We have not observed any events with a "one event" upper limit cross section of 1.6 pb for EVR-fission events and 1.8 pb for EVR-alpha events.Comment: 6 pages, 3 figures, submitted to Phys. Rev.

Clinically Actionable Insights into Initial and Matched Recurrent Glioblastomas to Inform Novel Treatment Approaches

© 2019 H. P. Ellis et al. Glioblastoma is the most common primary adult brain tumour, and despite optimal treatment, the median survival is 12-15 months. Patients with matched recurrent glioblastomas were investigated to try to find actionable mutations. Tumours were profiled using a validated DNA-based gene panel. Copy number variations (CNVs) and single nucleotide variants (SNVs) were examined, and potentially pathogenic variants and clinically actionable mutations were identified. The results revealed that glioblastomas were IDH-wildtype (IDHWT; n = 38) and IDH-mutant (IDHMUT; n = 3). SNVs in TSC2, MSH6, TP53, CREBBP, and IDH1 were variants of unknown significance (VUS) that were predicted to be pathogenic in both subtypes. IDHWT tumours had SNVs that impacted RTK/Ras/PI(3)K, p53, WNT, SHH, NOTCH, Rb, and G-protein pathways. Many tumours had BRCA1/2 (18%) variants, including confirmed somatic mutations in haemangioblastoma. IDHWT recurrent tumours had fewer pathways impacted (RTK/Ras/PI(3)K, p53, WNT, and G-protein) and CNV gains (BRCA2, GNAS, and EGFR) and losses (TERT and SMARCA4). IDHMUT tumours had SNVs that impacted RTK/Ras/PI(3)K, p53, and WNT pathways. VUS in KLK1 was possibly pathogenic in IDHMUT. Recurrent tumours also had fewer pathways (p53, WNT, and G-protein) impacted by genetic alterations. Public datasets (TCGA and GDC) confirmed the clinical significance of findings in both subtypes. Overall in this cohort, potentially actionable variation was most often identified in EGFR, PTEN, BRCA1/2, and ATM. This study underlines the need for detailed molecular profiling to identify individual GBM patients who may be eligible for novel treatment approaches. This information is also crucial for patient recruitment to clinical trials

Quasifission at extreme sub-barrier energies

With the quantum diffusion approach the behavior of the capture cross-section is investigated in the reactions $^{92,94}$Mo + $^{92,94}$Mo, $^{100}$Ru + $^{100}$Ru, $^{104}$Pd + $^{104}$Pd, and $^{78}$Kr + $^{112}$Sn at deep sub-barrier energies which are lower than the ground state energies of the compound nuclei. Because the capture cross section is the sum of the complete fusion and quasifission cross sections, and the complete fusion cross section is zero at these sub-barrier energies, one can study experimentally the unique quasifission process in these reactions after the capture.Comment: 3 pages, 3 figure

The Glauber model and the heavy ion reaction cross section

We reexamine the Glauber model and calculate the total reaction cross section as a function of energy in the low and intermediate energy range, where many of the corrections in the model, are effective. The most significant effect in this energy range is by the modification of the trajectory due to the Coulomb field. The modification in the trajectory due to nuclear field is also taken into account in a self consistent way. The energy ranges in which particular corrections are effective, are quantified and it is found that when the center of mass energy of the system becomes 30 times the Coulomb barrier, none of the trajectory modification to the Glauber model is really required. The reaction cross sections for light and heavy systems, right from near coulomb barrier to intermediate energies have been calculated. The exact nuclear densities and free nucleon-nucleon (NN) cross sections have been used in the calculations. The center of mass correction which is important for light systems, has also been taken into account. There is an excellent agreement between the calculations with the modified Glauber model and the experimental data. This suggests that the heavy ion reactions in this energy range can be explained by the Glauber model in terms of free NN cross sections without incorporating any medium modification.Comment: RevTeX, 21 pages including 9 Postscript figures, submitted to Phys. Rev.

Про сутність і структуру процесів взаємодії суб’єктів інноваційної діяльності

Сутність взаємодії суб’єктів інноваційної діяльності у статті визначається з урахуванням трансформації творчого зерна у суспільне надбання, що пов’язане з узгодженням економічних інтересів на всіх рівнях НІС; наводиться секторальна структура НІС за функціональним критерієм та критерієм, що враховує інноваційну активність економічних суб’єктів.In the article essence of co-operation of actors of innovative activity is determined taking into account transformation of creative corn in public property which is related to the concordance of economic interests at all levels of NIS; a sector structure of NIS is pointed after a functional criterion and criterion which takes into account innovative activity of economic actors