Reducing Costs of Managing Medication Inventory in Automated Dispensing System in Hospital Units

Hospital pharmacies utilize automated dispensing systems (ADS) to store and dispense medication in hospital wards. We propose an algorithm to minimize the inventory management costs incurred in holding and refilling the medications stored in an ADS. The algorithm is a linear integer programming formulation to compute how to configure an ADS, and how to allocate medications into capacity-constrained containers. Using a numerical example with real hospital data we demonstrate significant percentage savings relative to the status quo

Recombinant Human Proteoglycan 4 Regulates Phagocytic Activation of Monocytes and Reduces IL-1β Secretion by Urate Crystal Stimulated Gout PBMCs

Objectives To compare phagocytic activities of monocytes in peripheral blood mononuclear cells (PBMCs) from acute gout patients and normal subjects, examine monosodium urate monohydrate (MSU) crystal-induced IL-1β secretion ± recombinant human proteoglycan 4 (rhPRG4) or interleukin-1 receptor antagonist (IL-1RA), and study the anti-inflammatory mechanism of rhPRG4 in MSU stimulated monocytes. Methods Acute gout PBMCs were collected from patients in the Emergency Department and normal PBMCs were obtained from a commercial source. Monocytes in PBMCs were identified by flow cytometry. PBMCs were primed with Pam3CSK4 (1μg/mL) for 24h and phagocytic activation of monocytes was determined using fluorescently labeled latex beads. MSU (200μg/mL) stimulated IL-1β secretion was determined by ELISA. Reactive oxygen species (ROS) generation in monocytes was determined fluorometrically. PBMCs were incubated with IL-1RA (250ng/mL) or rhPRG4 (200μg/mL) and bead phagocytosis by monocytes was determined. THP-1 monocytes were treated with MSU crystals ± rhPRG4 and cellular levels of NLRP3 protein, pro-IL-1β, secreted IL-1β, and activities of caspase-1 and protein phosphatase-2A (PP2A) were quantified. The peritoneal influx of inflammatory and anti-inflammatory monocytes and neutrophils in Prg4 deficient mice was studied and the impact of rhPRG4 on immune cell trafficking was assessed. Results Enhanced phagocytic activation of gout monocytes under basal conditions (p\u3c0.001) was associated with ROS generation and MSU stimulated IL-1β secretion (p\u3c0.05). rhPRG4 reduced bead phagocytosis by normal and gout monocytes compared to IL-1RA and both treatments were efficacious in reducing IL-1β secretion (p\u3c0.05). rhPRG4 reduced pro-IL-1β content, caspase-1 activity, conversion of pro-IL-1β to mature IL-1β and restored PP2A activity in monocytes (p\u3c0.05). PP2A inhibition reversed rhPRG4’s effects on pro-IL-1β and mature IL-1β in MSU stimulated monocytes. Neutrophils accumulated in peritoneal cavities of Prg4 deficient mice (p\u3c0.01) and rhPRG4 treatment reduced neutrophil accumulation and enhanced anti-inflammatory monocyte influx (p\u3c0.05). Conclusions MSU phagocytosis was higher in gout monocytes resulting in higher ROS and IL-1β secretion. rhPRG4 reduced monocyte phagocytic activation to a greater extent than IL-1RA and reduced IL-1β secretion. The anti-inflammatory activity of rhPRG4 in monocytes is partially mediated by PP2A, and in vivo, PRG4 plays a role in regulating the trafficking of immune cells into the site of a gout flare

A Six-Planet System Around the Star HD 34445

We present a new precision radial velocity dataset that reveals a multi-planet system orbiting the G0V star HD 34445. Our 18-year span consists of 333 precision radial velocity observations, 56 of which were previously published, and 277 which are new data from Keck Observatory, Magellan at Las Campanas Observatory, and the Automated Planet Finder at Lick Observatory. These data indicate the presence of six planet candidates in Keplerian motion about the host star with periods of 1057, 215, 118, 49, 677, and 5700 days, and minimum masses of 0.63, 0.17, 0.1, 0.05, 0.12 and 0.38 Jupiter masses respectively. The HD 34445 planetary system, with its high degree of multiplicity, its long orbital periods, and its induced stellar radial velocity half-amplitudes in the range $2 \,{\rm m\, s^{-1}} \lesssim K \lesssim 5\,{\rm m\, s^{-1}}$ is fundamentally unlike either our own solar system (in which only Jupiter and Saturn induce significant reflex velocities for the Sun), or the Kepler multiple-transiting systems (which tend to have much more compact orbital configurations)Comment: 10 pages, 11 figure

CD11d integrin blockade reduces the systemic inflammatory response syndrome after traumatic brain injury in rats

Traumatic CNS injury triggers a systemic inflammatory response syndrome (SIRS), in which circulating inflammatory cells invade body organs causing local inflammation and tissue damage. We have shown that the SIRS caused by spinal cord injury is greatly reduced by acute intravenous treatment with an antibody against the CD11d subunit of the CD11d/CD18 integrin expressed by neutrophils and monocyte/macrophages, a treatment that reduces their efflux from the circulation. Traumatic brain injury (TBI) is a frequently occurring injury after motor vehicle accidents, sporting and military injuries, and falls. Our studies have shown that the anti-CD11d treatment diminishes brain inflammation and oxidative injury after moderate or mild TBI, improving neurological outcomes. Accordingly, we examined the impact of this treatment on the SIRS triggered by TBI. The anti-CD11d treatment was given at 2. h after a single moderate (2.5-3.0. atm) or 2 and 24. h after each of three consecutive mild (1.0-1.5. atm) fluid percussion TBIs. Sham-injured, saline-treated rats served as controls. At 24. h, 72. h, and 4 or 8. weeks after the single TBI and after the third of three TBIs, lungs of rats were examined histochemically, immunocytochemically and biochemically for downstream effects of SIRS including inflammation, tissue damage and expression of oxidative enzymes. Lung sections revealed that both the single moderate and repeated mild TBI caused alveolar disruption, thickening of inter-alveolar tissue, hemorrhage into the parenchyma and increased density of intra-and peri-alveolar macrophages. The anti-CD11d treatment decreased the intrapulmonary influx of neutrophils and the density of activated macrophages and the activity of myeloperoxidase after these TBIs. Moreover, Western blotting studies showed that the treatment decreased lung protein levels of oxidative enzymes gp91phox, inducible nitric oxide synthase and cyclooxygenase-2, as well as the apoptotic pathway enzyme caspase-3 and levels of 4-hydroxynonenal-bound proteins (an indicator of lipid peroxidation). Decreased expression of the cytoprotective transcription factor Nrf2 reflected decreased lung oxidative stress. Anti-CD11d treatment also diminished the lung concentration of free radicals and tissue aldehydes.In conclusion, the substantial lung component of the SIRS after single or repeated TBIs is significantly decreased by a simple, minimally invasive and short-lasting anti-inflammatory treatment

SPARK Linking Ready Kids to Ready Schools: A Report on Policy Insights from the Governors' Forum Series

Each year too many children start kindergarten unprepared to learn. Many will never catch up. The reasons for this are complex, but this much is clear: The multiple systems – from family to schools to government – that should be supporting young children too often are failing to do so. The W.K. Kellogg Foundation seeks to change that, and to permanently improve systems that affect children's learning.As policymakers look for ways to improve student outcomes by creating "seamless" systems of education starting at preschool, communities have been getting it done. SPARK (Supporting Partnerships to Assure Ready Kids) — a fiveyear initiative funded by the Kellogg Foundation — has contributed a unique, community-based perspective to the national conversation on what it takes to effectively link learning systems. In particular, SPARK examines what it takes at the beginning of the education pipeline to link early learning to the early grades. The goal is to make sure that children are ready for school and that schools are ready for them — a formula critical for a lifetime of successful learning.SPARK efforts are deeply anchored in the community and are designed to assure that children are successful both before and after they enter school. The strategy of working with schools, early care and education providers, families and community partners has yielded a set of proven ways to align local systems of education — approaches that have been tested in diverse rural and urban communities in Florida, Georgia, Hawaii, Mississippi, New Mexico, North Carolina, Ohio and Washington, D.C. What SPARK community-based sites have done to create connections across local systems of learning stands to influence larger school reform issues and state policy discussions about what is needed to create a more holistic learning experience for children — one that results in academic success at grade three and beyond

Loss-of-Function Variants in TBC1D32 Underlie Syndromic Hypopituitarism

Context: Congenital pituitary hormone deficiencies with syndromic phenotypes and/or familial occurrence suggest genetic hypopituitarism; however, in many such patients the underlying molecular basis of the disease remains unknown. Objective: To describe patients with syndromic hypopituitarism due to biallelic loss-of-function variants in TBC1D32, a gene implicated in Sonic Hedgehog (Shh) signaling. Setting: Referral center. Patients: A Finnish family of 2 siblings with panhypopituitarism, absent anterior pituitary, and mild craniofacial dysmorphism, and a Pakistani family with a proband with growth hormone deficiency, anterior pituitary hypoplasia, and developmental delay. Interventions: The patients were investigated by whole genome sequencing. Expression profiling of TBC1D32 in human fetal brain was performed through in situ hybridization. Stable and dynamic protein-protein interaction partners of TBC1D32 were investigated in HEK cells followed by mass spectrometry analyses. Main Outcome Measures: Genetic and phenotypic features of patients with biallelic loss-offunction mutations in TBC1D32. Results: The Finnish patients harboured compound heterozygous loss-of-function variants (c.1165_1166dup p.(Gln390Phefs*32) and c.2151del p.(Lys717Asnfs*29)) in TBC1D32; the Pakistani proband carried a known pathogenic homozygous TBC1D32 splice-site variant c.1372 + 1G > A p.(Arg411_Gly458del), as did a fetus with a cleft lip and partial intestinal malrotation from a terminated pregnancy within the same pedigree. TBC1D32 was expressed in the developing hypothalamus, Rathke's pouch, and areas of the hindbrain. TBC1D32 interacted with proteins implicated in cilium assembly, Shh signaling, and brain development. Conclusions: Biallelic TBC1D32 variants underlie syndromic hypopituitarism, and the underlying mechanism may be via disrupted Shh signaling.Peer reviewe

The Two Variables in The Triple System HR 6469=V819 Her: One Eclipsing, One Spotted

A complete BV light curve, from 14 nights of good data obtained with the Vanderbilt University-Tennessee State University (VU-TSU) automatic telescope, are presented and solved with the Wilson-Devinney program. Third light is evaluated, with the companion star brighter by 0.58m in V and 0.11m in B. The eclipses are partial. Inferred color indices yield F2 V and F8 V for the eclipsing pair and G8 IV-III for the distant companion star. After removing the variability due to eclipses, we study the residual variability of the G8 IV-III star over the ten years 1982 to 1992. Each yearly light curve is fit with a two-spot model. Three relatively long-lived spots are identified, with rotation periods of 85.9d, 85.9d, and 86.1d. The weak and intermittent variability is understood because the G8 IV-III star has a Rossby number at the threshold for the onset of heavy spottedness

Using the past to constrain the future: how the palaeorecord can improve estimates of global warming

Climate sensitivity is defined as the change in global mean equilibrium temperature after a doubling of atmospheric CO2 concentration and provides a simple measure of global warming. An early estimate of climate sensitivity, 1.5-4.5{\deg}C, has changed little subsequently, including the latest assessment by the Intergovernmental Panel on Climate Change. The persistence of such large uncertainties in this simple measure casts doubt on our understanding of the mechanisms of climate change and our ability to predict the response of the climate system to future perturbations. This has motivated continued attempts to constrain the range with climate data, alone or in conjunction with models. The majority of studies use data from the instrumental period (post-1850) but recent work has made use of information about the large climate changes experienced in the geological past. In this review, we first outline approaches that estimate climate sensitivity using instrumental climate observations and then summarise attempts to use the record of climate change on geological timescales. We examine the limitations of these studies and suggest ways in which the power of the palaeoclimate record could be better used to reduce uncertainties in our predictions of climate sensitivity.Comment: The final, definitive version of this paper has been published in Progress in Physical Geography, 31(5), 2007 by SAGE Publications Ltd, All rights reserved. \c{opyright} 2007 Edwards, Crucifix and Harriso