A first update on mapping the human genetic architecture of COVID-19

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Inventory of Drug Samples in a Health Care Institution

ABSTRACT Background: Few data exist on the presence of drug samples in health care facilities. Although the use of drug samples has potential benefits, this practice is also controversial, as it can contribute to non-optimal drug use. The objective of this study was to evaluate the inventory of drug samples in a health care institution and to determine compliance with existing policies and procedures.Methods: This descriptive observational study was conducted in a university hospital centre from October 18 to November 1, 2007. A standardized data collection form was used for a physical inventory, which was intended to identify all drug samples available in the institution. The following information was recorded: number of locations where drug samples were found, primary patient care activity performed at each location, number of storage areas in the location, type of storage, presence of a lock, location of the key (if a lock was present), medical specialty, number of physicians and nurses likely to use the samples, reasons given for handing out samples, presence of a designated person to manage the samples, physical inventory (i.e., various details for each distribution unit), and declaration of samples to the pharmacy department. The inventory was conducted by 2 research assistants during day shifts.Results: A total of 84 locations were included in the inventory, and drug samples were found in 21 locations (with a total of 31 storage areas). All of the locations were intended for ambulatory patients (outpatient clinics and day centres). No drug samples were found in inpatient care units. The drug samples, which came from 62 different pharmaceutical companies, represented a total of 159 generic entities and 266 different brands. Of the distribution units for drug samples that were identified during this inventory, 59% were not on the hospital’s local formulary. Furthermore, only 3.5% of the distribution units had been declared to the pharmacy department, in accordance with established policy. The sample distribution units, including expired units, totalled 78 955 doses, with a total value of Can$48 783 (based on unit prices in effect in October 2007).Conclusion: This study presents an inventory of drug samples in an urban health care institution and reports compliance with the institution’s policies and procedures regarding drug samples. Samples were found only in outpatient clinics and represented 2.4 times the hospital’s floor stock of medications. Most of the samples inventoried were not listed on the hospital’s formulary. It appears that the use of drug samples is underestimated in hospital settings. Further studies are needed to evaluate the importance of drug samples and the risks associated with their use.RÉSUMÉContexte : On ne dispose que peu de données sur la présence d’échantillons de médicaments dans les établissements de santé. Bien que l’utilisation des échantillons de médicaments ait des bienfaits potentiels, le recours à ces échantillons est également controversé, car il pourrait contribuer à l’utilisation non optimale des médicaments.Objectif : Évaluer les stocks d’échantillons de médicaments dans un établissement de santé et déterminer la conformité avec les politiques et procédures de l’établissement.Méthodes : Une étude d’observation descriptive a été menée dans un centre hospitalier universitaire entre le 18 octobre et le 1er novembre 2007. Un formulaire standardisé de collecte de données a été utilisé pour procéder à l’inventaire matériel de tous les échantillons de médicaments sur place. Les renseignements suivants ont été enregistrés : le nombre d’emplacements où les échantillons se trouvaient, l’activité primaire de soins aux patients réalisée à chaque emplacement, le nombre de points d’entreposage à l’emplacement, le type d’entreposage, la présence d’un dispositif de verrouillage, l’emplacement de la clé (si verrouillage), la spécialité médicale, le nombre de médecins et d’infirmières et infirmiers susceptibles d’utiliser les échantillons, les raisons motivant l’utilisation des échantillons, la présence d’une personne désignée à la gestion des échantillons, les stocks physiques (c.-à-d. divers détails pour chaque unité de conditionnement), et la déclaration des échantillons au service de pharmacie. L’inventaire a été réalisé par deux assistants de recherche durant les quarts de jour.Résultats : Au total, 84 emplacements ont fait l’objet de l’inventaire et on a trouvé des échantillons de médicaments dans 21 de ces emplacements (avec un total de 31 points d’entreposage). Tous les emplacements étaient destinés aux patients ambulatoires (consultations externes et centres de jour). Aucun échantillon de médicament n’a été retrouvé dans les unités de soins aux patients hospitalisés. Les échantillons de médicaments, qui provenaient de 62 sociétés pharmaceutiques différentes, représentaient en tout 159 entités génériques et 266 marques de commerce différentes. Des unités de conditionnement pour les échantillons de médicaments dénombrées durant l’inventaire, 59$ (calculée sur le prix unitaire en vigueur en octobre 2007).Conclusion : Cette étude présente les stocks des échantillons de médicaments dans un établissement de soins de santé urbain et fait état de la conformité avec les politiques et procédures de l’établissement relativement aux échantillons de médicaments. Les échantillons n’ont été retrouvés que dans les cliniques externes et représentaient 2,4 fois les stocks de médicaments au commun de l’hôpital. La plupart des échantillons répertoriés n’étaient pas sur la liste de médicaments de l’hôpital. Il semble que l’utilisation des échantillons de médicaments en milieu hospitalier soit sous-estimée. D’autres études sont nécessaires pour évaluer l’importance de l’utilisation des échantillons de médicaments et les risques associés à leur utilisation

Analyse proactive du risque associé à la distribution et à l’utilisation des échantillons de médicaments

Résumé Objectif : Il s’agit d’une étude par simulation menée au Centre hospitalier universitaire Sainte-Justine, un établissement de soins de 500 lits. Elle est basée sur un modèle d’analyse des modes de défaillance, de leurs effets et de leur criticité décrit par Williams et collaborateurs. Source de données : À partir d’une revue de la documentation scientifi que et d’une étude de terrain, un panel d’experts composé de pharmaciens et de médecins a développé un diagramme d’Ishikawa portant sur les six étapes du processus de distribution et d’utilisation des échantillons de médicaments. Trente (30) modes de défaillance potentiels ont été identifi és et liés à l’une des six étapes du processus. Mise en contexte : Cette étude illustre la valeur d’une analyse des risques prospective et devrait encourager les gestionnaires et les cliniciens à une plus grande utilisation de ces techniques dans le futur. La simplicité de la méthode contribue à l’utilisation facile de l’analyse des risques rapportés et à l’identifi cation des actions à entreprendre. Conclusion : Cette étude décrit une évaluation critique des risques relatifs aux échantillons de médicaments au moyen de la méthode d’analyse des modes de défaillance, de leurs effets et de leur criticité et évalue l’impact de nouvelles mesures sur les risques établis par rapport à la situation actuelle. On peut réduire théoriquement de près de 25 % l’indice de criticité par une intervention administrative. Abstract Objective: This is a simulation study done at the Centre hospitalier universitaire Sainte-Justine, a 500-bed hospital. It is based on a method of failure mode, effects, and criticality analysis, as described by Williams and collaborators. Source of data: Based on a review of the scientific literature and an on-site study, an expert panel of pharmacists and physicians developed an Ishikawa diagram for the six steps of the distribution process and use of drug samples. Thirty potential failure modes were identifi ed and related to one of the six steps of the process. Context: This study demonstrates the value of prospective risk analysis and should encourage managers and clinicians to take advantage of these techniques in the future. The simplicity of this method facilitates the analysis of reported risks and identification of actions to take. Conclusion: This study describes a critical evaluation of the risks related to drug samples using the method of failure mode, effects and criticality analysis, and evaluates the impact of new measures on risks related to the current situation. An administrative intervention can theoretically reduce the criticality index by approximately 25%. Key words: drug samples; failure mode; effects and criticality analysis model; FMECA

Long-term tree inventory data from mountain forest plots in France

International audienceWe present repeated tree measurement data from 63 permanent plots in mountain forests in France. Plot elevations range from 800 (lower limit of the montane belt) to 1942 m a.s.l (subalpine belt). Forests mainly consist of pure or mixed stands dominated by European beech (Fagus sylvatica), Silver fir (Abies alba) and Norway spruce (Picea abies), in association with various broadleaved species at low elevation and with Arolla pine (Pinus cembra) at high elevation. The plot network includes 23 plots in stands that have not been managed for the last 40 years (at least) and 40 plots in plots managed according to an uneven-aged system with single-tree or small-group selection cutting. Plot sizes range from 0.2 ha to 1.9 ha. Plots were installed from 1994 to 2004 and re-measured 2 to 5 times during the 1994-2015 period. During the first census (installation), living trees more than 7.5 cm in dbh were identified, their diameter at breast height (dbh) was measured and their social status (strata) noted. Trees were spatially located, either with x, y and z coordinates (40 plots) or within subplots 0.25 ha square (23 plots). In addition, in a subset of plots (58 plots), tree heights and tree crown dimensions were measured on a subset of trees and dead standing trees and stumps were included in the census. Remeasurements after installation include live tree diameters (including recruited trees), tree status (living, damaged, dead, stump), and for a subset of trees, height. At the time of establishment of the plots, plot densities ranges from 181 to 1328 stemsha(-1) and plot basal areas ranges from 13.6 to 81.3 m(2) ha(-1)

The R&D PERFROI project on Thermal mechanical and thermal hydraulics behaviors of a fuel rod assembly during a Loss Of Coolant Accident

International audienceThe safety principle in case of a LOCA is to preserve the short and long term coolability of the core. The associated safety requirements are to ensure the resistance of the fuel rods upon quench and post-quench loads and to maintain a coolable geometry in the core. An R&D program has been launched by IRSN with the support of EDF, to perform both experimental and modeling activities in the frame of the LOCA transient, on technical issues such as: - flow blockage within a fuel rods bundle and its potential impact on coolability, - fuel fragment relocation in the ballooned areas: its potential impact on cladding PCT (Peak Cladding Temperature) and on the maximum oxidation rate, - potential loss of cladding integrity upon quench and post-quench loads. The PERFROI project (2014-2019) focusing on the first above issue, is structured in two axes: 1. axis 1: thermal mechanical behavior of deformation and rupture of cladding taking into account the contact between fuel rods; specific research at LaMCoS laboratory focus on the hydrogen behavior in cladding alloys and its impact on the mechanical behavior of the rod; and, 2. axis 2: thermal hydraulics study of a partially blocked region of the core (ballooned area taking into account the fuel relocation with local over power), during cooling phase by water injection; More detailed activities foreseen in collaboration with LEMTA laboratory will focus on the characterization of two phase flows with heat transfer in deformed structures