Quality of care for NSAID users: development of an assessment tool

Objective. Assessments of NSAID use based on authoritative guidelines typically overlook patients’ views and nuances of \ud medical history. Our objective was to develop an assessment tool that incorporates these aspects, and technical items, for quality of care assessments in NSAID users. \ud \ud Methods. Patients newly referred to a university hospital were interviewed by a nurse using an agreed template. A multidisciplinary group of rheumatologists, nurse specialists, primary care physicians and a pharmacist reviewed current guidance and systematic reviews on NSAID use, and a series of interview transcripts. The group agreed, by informal consensus, important determinants of effective and safe NSAID use. Technical aspects of medical care and items that reflected interpersonal care were included in an index for assessing quality of care for individual patients. Interview transcripts of 100 patients were scored by panel members and reliability of scores was tested by calculating weighted percentage agreement and the kappa statistic. \ud \ud Results. Our final index had five domains: medical risk factors; steps taken to reduce risk; knowledge of adverse effects; NSAID dose; and cost efficiency. Each item was scored 0, 1 or 2. Scores were summed, giving a maximum of 10 (low scores indicating low quality). Intra-rater agreement was >90%; kappa was 0.47–0.87 for individual domains and 0.59 for overall score. Inter-rater agreement for overall score was 95%; kappa was 0.25–0.78 for domains and 0.48 for overall score. Patients with especially low scores were identified using the mode of scores for five assessors; obvious clinical concerns were identified, supporting index face validity. \ud \ud Conclusions. A simple index to evaluate quality of care for NSAID users based on a patient interview is described. This may be used by one or more assessors to examine care standards and highlight deficiencies in relation to NSAID use in practice

Urban sediment transport through an established vegetated swale:Long term treatment efficiencies and deposition

Vegetated swales are an accepted and commonly implemented sustainable urban drainage system in the built urban environment. Laboratory and field research has defined the effectiveness of a vegetated swale in sediment detention during a single rainfall-runoff event. Event mean concentrations of suspended and bed load sediment have been calculated using current best analytical practice, providing single runoff event specific sediment conveyance volumes through the swale. However, mass and volume of sediment build up within a swale over time is not yet well defined. This paper presents an effective field sediment tracing methodology and analysis that determines the quantity of sediment deposited within a swale during initial and successive runoff events. The use of the first order decay rate constant, k, as an effective pollutant treatment parameter is considered in detail. Through monitoring tagged sediment deposition within the swale, the quantity of sediment that is re-suspended, conveyed, re-deposited or transported out of the swale as a result of multiple runoff events is illustrated. Sediment is found to continue moving through the vegetated swale after initial deposition, with ongoing discharge resulting from resuspension and conveyance during subsequent runoff events. The majority of sediment initially deposited within a swale is not detained long term or throughout its design life of the swale

Advanced extravehicular activity systems requirements definition study. Phase 2: Extravehicular activity at a lunar base

The focus is on Extravehicular Activity (EVA) systems requirements definition for an advanced space mission: remote-from-main base EVA on the Moon. The lunar environment, biomedical considerations, appropriate hardware design criteria, hardware and interface requirements, and key technical issues for advanced lunar EVA were examined. Six remote EVA scenarios (three nominal operations and three contingency situations) were developed in considerable detail

The short-term influence of cumulative, sequential rainfall-runoff flows on sediment retention and transport in selected SuDS devices

It is necessary to understand Sustainable urban Drainage Systems (SuDS) sediment retention efficiencies to fully comprehend SuDS pollution removal properties and urban sediment movement from source-to sink. This research presents the detention and transport of a single tagged sediment release through four SuDS devices over 12 months, with the aim of quasi-quantifying these selected SuDS devices sediment detention efficiencies. Field monitoring and mass balance analysis of deposited sediment shows that tagged sediment from the single sediment release moves through the monitored SuDS, with deposition declining over the 12-month monitoring period. Initial retention is high (>80% during the first week of monitoring) but falls below 80% after multiple consecutive rainfall-runoff events (events ≤50% ARI). The field monitoring illustrates retention to generally remain above 50%, suggesting that SuDS are highly efficient at retaining urban sediment pollution but that deposition of a single sediment release may resuspend due to cumulative rainfall-runoff events

The Challenge Of Negation In Searches And Queries

Negation poses certain challenges for queries and searches. This paper deals with exclusionary queries implemented using the ISO database language SQL and a dialog-based interface and with retrieval searches involving negation. This research arose because instructors in database courses noticed a large proportion of students making mistakes on certain queries. The paper explores underlying comprehension issues and makes practical recommendations on identifying potential sources of error and avoiding incorrect or misleading results. Proposed actions include changes in general education and database training and encouraging implementation of the new SQL:1999 standard

Dosing Characteristics of Recombinant Human Luteinizing Hormone or Human Menopausal Gonadotrophin-Derived LH Activity in Patients Undergoing Ovarian Stimulation: A German Fertility Database Study

Objectives: The aim of the study was to evaluate dosing of recombinant human luteinizing hormone (r-hLH) or human menopausal gonadotrophin (hMG)-derived medications with LH activity in ovarian stimulation (OS) cycles for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Design: A non-interventional study was performed to analyse data from the German RecDate database (January 2007-December 2011). Participants/Materials, Setting, Methods: Starting/total r-hLH/hMG dose, OS duration/cycle number, r-hLH/hMG initiation day (first day of administration), and population/cycle characteristics were assessed in women (& GE;18 years) undergoing OS for IVF/ICSI using r-hLH or hMG-derived medications (excluding corifollitropin alfa, clomiphene citrate, letrozole, mini/micro-dose human chorionic gonadotrophin, and urofollitropin alone). Data were summarized descriptively. Results: 67,858 identified cycles utilized medications containing r-hLH (10,749), hMG (56,432), or both (677). Mean (standard deviation) OS duration with r-hLH and hMG was 10.1 (4.43) and 9.8 (6.16) days, respectively. Median (25th-75th percentile) r-hLH starting dose (75.0 [75.0-150.0] IU) was consistent across patients regardless of age, infertility diagnosis, or gonadotrophin-releasing hormone (GnRH) protocol. Median (25th-75th percentile) hMG-derived LH activity starting dose was 225.0 (150.0-300.0) IU, regardless of GnRH protocol, but was lower in women aged <35 years and those with ovulation disorders/polycystic ovary syndrome. Median (25th-75th percentile) total dose for r-hLH (750.0 [337.5-1,125.0] IU) and hMG-derived LH activity (1,575.0 [750.0-2,625.0] IU) varied according to patients' age, infertility diagnosis, cycle number, and r-hLH/hMG initiation day. GnRH antagonist use resulted in a numerically higher median total hMG-derived LH activity dose than GnRH agonist use. Limitations: The data used in this study were taken from electronic medical records relating to a specific timeframe (2007-2011) and therefore may not accurately reflect current clinical practice; however, it is likely that the differences between the two compounds would be maintained. Additionally, secondary data sources may suffer from uniformity and quality issues. Conclusions: The standard of care for OS cycles is described with respect to IVF/ICSI treatment including an LH component in Germany during the specified timeframe

The Multifunctional Protein BAG3: A Novel Therapeutic Target in Cardiovascular Disease

The B-cell lymphoma 2–associated anthanogene (BAG3) protein is expressed most prominently in the heart, the skeletal muscle, and in many forms of cancer. In the heart, it serves as a co-chaperone with heat shock proteins in facilitating autophagy; binds to B-cell lymphoma 2, resulting in inhibition of apoptosis; attaches actin to the Z disk, providing structural support for the sarcomere; and links the α-adrenergic receptor with the L-type Ca2+ channel. When BAG3 is overexpressed in cancer cells, it facilitates prosurvival pathways that lead to insensitivity to chemotherapy, metastasis, cell migration, and invasiveness. In contrast, in the heart, mutations in BAG3 have been associated with a variety of phenotypes, including both hypertrophic/restrictive and dilated cardiomyopathy. In murine skeletal muscle and vasculature, a mutation in BAG3 leads to critical limb ischemia after femoral artery ligation. An understanding of the biology of BAG3 is relevant because it may provide a therapeutic target in patients with both cardiac and skeletal muscle disease

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Decreased levels of BAG3 in a family with a rare variant and in idiopathic dilated cardiomyopathy.

The most common cause of dilated cardiomyopathy and heart failure (HF) is ischemic heart disease; however, in a third of all patients the cause remains undefined and patients are diagnosed as having idiopathic dilated cardiomyopathy (IDC). Recent studies suggest that many patients with IDC have a family history of HF and rare genetic variants in over 35 genes have been shown to be causative of disease. We employed whole-exome sequencing to identify the causative variant in a large family with autosomal dominant transmission of dilated cardiomyopathy. Sequencing and subsequent informatics revealed a novel 10-nucleotide deletion in the BCL2-associated athanogene 3 (BAG3) gene (Ch10:del 121436332_12143641: del. 1266_1275 [NM 004281]) that segregated with all affected individuals. The deletion predicted a shift in the reading frame with the resultant deletion of 135 amino acids from the C-terminal end of the protein. Consistent with genetic variants in genes encoding other sarcomeric proteins there was a considerable amount of genetic heterogeneity in the affected family members. Interestingly, we also found that the levels of BAG3 protein were significantly reduced in the hearts from unrelated patients with end-stage HF undergoing cardiac transplantation when compared with non-failing controls. Diminished levels of BAG3 protein may be associated with both familial and non-familial forms of dilated cardiomyopathy

Negative mode MS/MS to read digital information encoded in sequence-defined oligo(urethane)s: A mechanistic study

International audienceMS/MS sequencing is an unrivaled technique to decipher binary information chemically encoded in the backbone of sequence-controlled synthetic polymers constructed with two co-monomers of different mass, arbitrarily designated as the 0- and 1-bit of the ASCII alphabet. Efficiency of this "reading" step relies however on the simplicity of MS/MS patterns, which depends on both polymer chemistry and chain length. In this context, polyurethanes (PUs) were very promising candidates as dissociation of small deprotonated oligomers (n \\textless 8) yielded a single fragment series. The carbamate bond cleavage reaction was hence studied in details to tentatively anticipate the CID behavior of longer chains prior to optimizing their synthesis. In spite of the simplicity of MS/MS spectra, three different mechanisms were evidenced; however, they were not expected to induce MS/MS complexity when activating longer chains, as verified for sequence-controlled PUs containing up to two bytes of information (i.e., 16 co-monomers). In contrast, the ionization step appeared to be an issue: deprotonation yield of the end-group in negative ion mode electrospray was observed to strongly decrease as PU chain length increases. This sensitivity issue was addressed by introducing a second acidic end-group to allow doubly deprotonated oligomers with no impact on their CID behavior. (C) 2017 Elsevier B.V. All rights reserved