Examining the Use of Rapid Polymerase Chain Reaction Assay in Optimizing Antimicrobial Usage in Respiratory Viral Infections

Abstract Category: Research Purpose: Historically, respiratory pathogen testing has included the use of cultures and antigen-testing. Introduction of rapid polymerase chain reaction (PCR) assay has resulted in fast, effective identification of viral pathogens. However, studies show conflicting findings in the usefulness of PCR technology in the management of respiratory infections. The objective of this study is to examine the use of viral PCR assays in the management of respiratory viral infections in a community hospital. The study will describe viral PCR use in identifying viral pathogens, evaluating appropriate treatment, and de-escalating of antimicrobial therapy when indicated. Methods: Patients will be identified from daily molecular result reports provided to the pharmacy. Admitted patients 18 years of age or older who received viral respiratory PCR testing between July 1, 2017 and March 31, 2018 will be randomly selected for study inclusion. Patients who do not meet the inclusion criteria or have a documented respiratory infection treatment within two weeks prior to the time of admission will be excluded. Data collected will include viral PCR results, diagnostic labs, time of PCR result, time of initial antimicrobial treatment, and time of therapy modification. Findings: Preliminary data demonstrates that 26.7% (16/60) of the patients who had PCR assay testing were determined to be positive for a respiratory viral infection. The most commonly reported virus in this group was rhinovirus/enterovirus (10/16, 62.5%). Additionally, data also reveals that in addition to the rapid PCR assays, approximately 1 in every 3 patients received an influenza A and B antigen test (18/60, 30%) and 61.7% (37/60) had a procalcitonin level. Furthermore, all of the patients who tested positive for a respiratory viral infection were managed appropriately taking into account any co-infection. The antimicrobial de-escalation time when antimicrobial therapy was not indicated was approximately 4 hours. Discussion: Research in progress Implications for Practice: This study will demonstrate the role of rapid polymerase chain reaction assays as a diagnostic tool for respiratory viral infections and their role in antimicrobial therapy management. The results of the study will highlight the importance of reducing unnecessary diagnostic testing in the setting of respiratory viral infections. Additionally, this study will evaluate the appropriateness of initial antimicrobial treatment as well as the time to therapy optimization upon PCR results

Development of well-defined Group 4 β-diketonate complexes and Application in Polyurethane Elastomers Catalysis

Polymeric fibres, films, coatings and moulded products are ubiquitous in modern society, and are used in applications as diverse as packaging materials, clothing, medical devices, etc. Mechanistic and kinetic considerations are useful in the development of efficient catalysts for controlled selective polymerisations, which is essential for the production of polymeric materials possessing properties tailored to suit their application. Mercury-based compounds are used as catalysts in many applications of the synthesis of polyurethanes such as the production of polyurethane elastomers. Due to the environmental impact of mercury, there is a need to replace such catalysts with complexes based on benign metals. Group 4 metals are an attractive option, both in terms of reactivity and their benign environmental nature. A series of novel complexes have been synthesised, fully characterised, and their activity and selectivity investigated in a model reaction. The molecular structures of a number of potential catalysts have been determined by single crystal X-ray diffraction experiments. These potential catalysts have been screened in the model reaction utilising in situ reaction monitoring in order to acquire kinetic data. A method to study catalyst selectivity has also been developed. The results of these kinetic and selectivity studies are presented in this thesis and compared to the industrial phenylmercury neodecanoate catalyst system. A selection of well-defined complexes which have been synthesised as part of this body of work have also been evaluated in the preparation of polyurethane elastomers. Physical characterisation techniques such as Differential Scanning Calorimetry (DSC), Dynamic Mechanical Analysis (DMA) and Scanning Electron Microscopy (SEM) have been used for this purpose.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Objetivos 2020 y Educación Infantil

En este trabajo de final de grado se mostrará un análisis sobre la Educación Infantil partiendo desde los objetivos 2020 que ha propuesto la Unión Europea, tratándolos y centrándonos en concreto en el referido a la educación infantil. Posteriormente se aclarará cual es el significado del término Educación Infantil, teniendo en cuenta un amplio conjunto de definiciones que nos ayudaran a entenderlo, pasando por las metodologías más relevantes de este tipo de educación así como la situación actual de debate en la que se encuentra debido a la aparición de metodologías más modernas. También veremos cómo influye a nivel social, teniendo en cuenta el tema de la estratificación social y concluyendo con cómo es esta en España y la evolución que ha tenido a lo largo de la historia.In the following text an analysis on Chilhood Education, based on the objetives 2020 proposed by the European Union, will be presented, clarifying them and focusing specially in the one that concerns this topic (Chilhood Educacion). Subsequently the meaning of the term Childhood Education will be properly explained, keeping in mind a wide range of definitions that will help us understand it, going through the most relevant methodologies in this field and also the current debate around this topic due to the appearance of more modern methodologies. We will also see its influence on a social level, taking into account the well-known subject of social stratification and finishing by stating how it is in Spain and the evolution that it has suffered through history

Projection of Potential Reimbursement of a Post-Hospital Discharge Pharmacist Operated Medication Management Service

Abstract Category: Practice Innovation / Performance Improvement (PI) Purpose: It is well established in the literature that pharmacists providing medication therapy management services (MTM) post-hospital discharge can improve medication adherence and safety, as well as decrease Emergency Department visits and readmissions. Although the evidence supports these programs, the number of patients receiving such services is very limited, mainly due to cost. The purpose of this study is to determine if enough revenue can be generated to sustain a post-discharge pharmacist driven medication therapy management program. Methods: A prospective review of patients discharged from medical/surgical units for an 11 months period is being conducted. Two hundred fifty patients will be randomly selected. Demographics and financial information will be recorded. Patients with insurance that provides MTM services, with 8 or more prescription medications, and 3 or more chronic conditions will be considered qualifying patients. Cost of operating the program will be based on the average pharmacist salary and benefits. A fee of $75 for conducting a Complete Medication Review (CMR) will be used to calculate reimbursement. Findings: Using a randomization formula, 55 patients have been selected to determine if they would qualify for MTM services. Eleven patients (20$65.00 per hour to operate the program and an average reimbursement fee of $75.00 per (CMR), the number needed to cover the daily cost of operating the program on a full-time basis was calculated to be 7 patients CMR’s per day. Discussion: The findings of this study suggest that the reimbursement produced can help offset the cost of operating the service on an hour per hour basis. It was estimated that a minimum of seven patient CMR’s must be performed per day to cover the cost of operating the MTM program with a dedicated full-time pharmacist. The study data suggests an average of six patients per day may be eligible but this does not include willingness of patients to participate or if they are receiving MTM services elsewhere. Modifications to decrease the cost of operating the program include: decreasing the number of hours per day used for this program, decreasing the number of days the services are rendered, and incorporating pharmacy students and residents under the supervision of a pharmacist to provide the service. Implications for Practice: The implementation of a medication therapy management program at West Kendall Baptist Hospital, can help resolve medication related problems post discharge, improve patient’s adherence to treatment, potentially decrease readmissions and generate sufficient pharmacy revenue to support the program on a part-time basis

Use of sera cell free DNA (cfDNA) and exovesicle-DNA for the molecular diagnosis of chronic Chagas disease

This research was funded by the ERANet program, Research in prevention of congenital Chagas disease: parasitological, placental and immunological markers (ERANet17/HLH-0142 (Cochaco). Instituto Carlos III, Ministerio de Sanidad, Gobierno de Espana. Fundacion Ramon Areces "Interactoma de las exovesiculas de T. cruzi y de los inmunocomplejos que forman con las celulas del hospedador: implicaciones en la patologia de la enfermedad de Chagas (2019)". PreChag y el titulo Exovesiculas circulantes como marcadoras de diagnostico, PREcoz de la Enfermedad de CHAGas del XXI Concurso Nacional para la adjudicacion de Ayudas a la Investigacion en Ciencias de la Vida y de la Materia (2022). Ministerio de Ciencia y Tecnologia of the government of Spain funded the project PGC2018-099424-B-I00 and The financial support given by the proyect A-BIO-350-UGR18 I+D+i Proyect "Programa Operativo FEDER de Andalucia JJAA" 2014-2020.Chagas disease, a neglected tropical disease, is now considered a worldwide health concern as a result of migratory movements from Central and South America to other regions that were considered free of the disease, and where the epidemiological risk is limited to transplacental transmission or blood or organ donations from infected persons. Parasite detection in chronically ill patients is restricted to serological tests that only determine infection by previous infection and not the presence of the parasite, especially in patients undergoing treatment evaluation or in newborns. We have evaluated the use of nucleic acids from both circulating exovesicles and cell-free DNA (cfDNA) from 50 samples twice randomly selected from a total of 448 serum samples from immunologically diagnosed patients in whom the presence of the parasite was confirmed by nested PCR on amplicons resulting from amplification with kinetoplastid DNA-specific primers 121F-122R. Six samples were randomly selected to quantify the limit of detection by qPCR in serum exovesicles. When the nucleic acids thus purified were assayed as a template and amplified with kinetoplastid DNA and nuclear satellite DNA primers, a 100% positivity rate was obtained for all positive samples assayed with kDNA-specific primers and 96% when SAT primers were used. However, isolation of cfDNA for Trypanosoma cruzi and amplification with SAT also showed 100% positivity. The results demonstrate that serum exovesicles contain DNA of mitochondrial and nuclear origin, which can be considered a mixed population of exovesicles of parasitic origin. The results obtained with serum samples prove that both cfDNA and Exovesicle DNA can be used to confirm parasitaemia in chronically ill patients or in samples where it is necessary to demonstrate the active presence of the parasite. The results confirm for the first time the existence of exovesicles of mitochondrial origin of the parasite in the serum of those affected by Chagas disease.ERANet17/HLH-0142Instituto Carlos III, Ministerio de Sanidad, Gobierno de EspañaFundación Ramón ArecesSpanish Government PGC2018-099424-B-I00I+D+i Proyect "Programa Operativo FEDER de Andalucia JJAA" A-BIO-350-UGR1