Developing a Method for Reporting Patient Harm Due to Antimicrobial Shortages

INTRODUCTION: The number of drug shortages in the United States has increased in recent years. While some literature exists on factors that contribute to antimicrobial shortages, the need remains to accurately gage the level of patient harm incurred as a result of realized antimicrobial shortages. Furthermore, current methods of reporting adverse drug events are known to under-report instances of patient harm. We sought to develop an ongoing and accurate method of reporting patient harm due to antimicrobial shortages, which was convenient, anonymous, and allowed clinicians to estimate the causality due to a shortage. METHODS: We distributed a public SurveyMonkey(®) (SurveyMonkey, Palo Alto, CA, USA) link to gather information regarding institution (for de-duplicating purposes), patient age, sex, antimicrobial product on shortage, type of infection requiring treatment or prophylaxis, adverse event, and patient outcome. RESULTS: To date complete data were reported on four patients being treated for infections that included Stenotrophomonas maltophilia bacteremia, Pneumocystis jirovecii pneumonia, neonatal sepsis of unknown etiology, and cytomegalovirus colitis. Antimicrobials that were unavailable to patients included sulfamethoxazole–trimethoprim, gentamicin, and foscarnet. Two adverse events (a delay in treatment and an inability to treat with other antimicrobials due to resistance) were attributed with probable causality due to a shortage, while the remaining adverse events (death and an inability to tolerate high oral doses) were attributed to have unlikely and possible causalities due to a shortage, respectively. CONCLUSION: These methods encourage reports of antimicrobial shortage harms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40121-014-0040-z) contains supplementary material, which is available to authorized users

New Developments in Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy, or HBOT, is a form of treatment based on the inhalation of 100% pure oxygen while subjected to closed chamber or room at pressures greater than sea level (1 atmosphere, ATA) (Howell et al., 2018; Kocaman, 2020). HBOT is administered through either a mono-place chamber or a multi-place chamber. Mono-place chambers are pressurized with oxygen and are equipped to handle a single person at a time. Multi-place chambers, on the other hand, can accommodate up to 20 people at a time, including medical personnel and intubated patients. These chambers are pressurized with air, and pure oxygen is administered via facemask, hood tent, or endotracheal tube (Gill & Bell, 2004; Howell et al., 2018). Oxygen is primarily used by the body in the formation of ATP, the molecule responsible for fueling cellular processes. When body tissues are injured or damaged, the energetic demand increases, and consequently more oxygen is needed (Kahle & Cooper, 2020). HBOT increases the body’s arterial and tissue oxygen tension, augmenting the amount of oxygen that the blood plasma can carry. This can create a number of beneficial biochemical, cellular, and physiologic effects (Tibbles & Edelsberg, 1996)

Group descent algorithms for nonconvex penalized linear and logistic regression models with grouped predictors

Penalized regression is an attractive framework for variable selection problems. Often, variables possess a grouping structure, and the relevant selection problem is that of selecting groups, not individual variables. The group lasso has been proposed as a way of extending the ideas of the lasso to the problem of group selection. Nonconvex penalties such as SCAD and MCP have been proposed and shown to have several advantages over the lasso; these penalties may also be extended to the group selection problem, giving rise to group SCAD and group MCP methods. Here, we describe algorithms for fitting these models stably and efficiently. In addition, we present simulation results and real data examples comparing and contrasting the statistical properties of these methods

Centrality dependence of charged-particle pseudorapidity distributions from d+Au collisions at sqrt(s_{NN})=200 GeV

Charged-particle pseudorapidity densities are presented for the d+Au reaction at sqrt{s_{NN}}=200 GeV with -4.2 <= eta <= 4.2$. The results, from the BRAHMS experiment at RHIC, are shown for minimum-bias events and 0-30%, 30-60%, and 60-80% centrality classes. Models incorporating both soft physics and hard, perturbative QCD-based scattering physics agree well with the experimental results. The data do not support predictions based on strong-coupling, semi-classical QCD. In the deuteron-fragmentation region the central 200 GeV data show behavior similar to full-overlap d+Au results at sqrt{s_{NN}}=19.4 GeV.Comment: 4 pages, 3figures; expanded discussion of uncertainties; added 60-80% centrality range; added additional discussion on centrality selection bia

Nuclear Stopping in Au+Au Collisions at sqrt(sNN) = 200 GeV

Transverse momentum spectra and rapidity densities, dN/dy, of protons, anti-protons, and net--protons (p-pbar) from central (0-5%) Au+Au collisions at sqrt(sNN) = 200 GeV were measured with the BRAHMS experiment within the rapidity range 0 < y < 3. The proton and anti-proton dN/dy decrease from mid-rapidity to y=3. The net-proton yield is roughly constant for y<1 at dN/dy~7, and increases to dN/dy~12 at y~3. The data show that collisions at this energy exhibit a high degree of transparency and that the linear scaling of rapidity loss with rapidity observed at lower energies is broken. The energy loss per participant nucleon is estimated to be 73 +- 6 GeV.Comment: 5 pages, 4 figure

Evolution of the nuclear modification factors with rapidity and centrality in d+Au collisions at $\sqrt{s_{NN}} = 200 GeV

We report on a study of the transverse momentum dependence of nuclear modification factors $R_{dAu}$ for charged hadrons produced in deuteron + gold collisions at $\sqrt{s_{NN}}= 200$GeV, as a function of collision centrality and of the pseudorapidity ($\eta = 0,1,2.2,3.2$) of the produced hadrons. We find significant and systematic decrease of $R_{dAu}$ with increasing rapidity. The midrapidity enhancement and the forward rapidity suppression are more pronounced in central collisions relative to peripheral collisions. These results are relevant to the study of the possible onset of gluon saturation at RHIC energies.Comment: Four pages, four figures. Published in PRL. Figures 1 and 2 have been updated, and several changes made to the tex

Quark Gluon Plasma an Color Glass Condensate at RHIC? The perspective from the BRAHMS experiment

We review the main results obtained by the BRAHMS collaboration on the properties of hot and dense hadronic and partonic matter produced in ultrarelativistic heavy ion collisions at RHIC. A particular focus of this paper is to discuss to what extent the results collected so far by BRAHMS, and by the other three experiments at RHIC, can be taken as evidence for the formation of a state of deconfined partonic matter, the so called quark-gluon-plasma (QGP). We also discuss evidence for a possible precursor state to the QGP, i.e. the proposed Color Glass Condensate.Comment: 32 pages, 18 figure

Scanning the phases of QCD with BRAHMS

BRAHMS has the ability to study relativistic heavy ion collisions from the final freeze-out of hadrons all the way back to the initial wave-function of the gold nuclei. This is accomplished by studying hadrons with a very wide range of momenta and angles. In doing so we can scan various phases of QCD, from a hadron gas, to a quark gluon plasma and perhaps to a color glass condensate.Comment: 8 pages, 6 figures, proceedings of plenary talk at Quark Matter 2004 conferenc

Wholesale value uncovered: implementing effective marketing strategy and tactics to enhance customer perception

Master of AgribusinessDepartment of Agricultural EconomicsAllen FeatherstoneThe Company is comprised of retail and w holesale agri-input outlets, toll/contract manufacturing and various departments that aid in three tiers of the supply chain. The Company Department 2’s principal goal is to earn a profit and that is achieved by helping their retail customers succeed across Division M. Therefore, a comprehensible strategy for selecting, positioning and promoting wholesale products and services is fundamental in uncovering actual value. The Company has grown to be one of the nation’s foremost agricultural distributors across the United States. Various geographies across the United States, excluding the region, have moved to a three-tier supply chain by merging retail and wholesale outlets. Currently, value demanded from end-users and retail outlets has been supplied from the wholesale level that has sustained the four-tier supply chain a cross the region of the United States. Even though the Company is vertically integrated, their knowled ge and core offerings originate from the retail segment of the supply chain. Retail firms that provide differentiated products and services with the most value to the end-user are those that fit the Company Department 2’s market. In addition, targeted retail fir ms emphasize a full-service business model by supplying produ cts and services across multip le categories. Company Department 2 provides value internally and externally. The three core areas from Company Department 2 are proprietary products, precision products and services, and other retail services valu able to retail customers. Positioning of these core areas differs based on the depth of the current relationship. A flanking strategy is proposed for prospective customers by bundling prestige goods and distribution innovations specifically in the focused proprietary line of products. A guerilla strategy is proposed for existing customers by highlighting product proliferation and improved services across all three of the core areas. Both strategies emphasize advertising and promotion, but more intensive campaigns are proposed with prospective customers. These positioning strategies and tactics are accomplished through accurate implementation at the field level. By risking a claim for what Company Department 2 stands for, communicating how value is created for a customer and communicating the reliability of these offerings, Company Department 2 will develop a unique identity in the marketplace