Risk and pharmacoeconomic analyses of the injectable medication process in the paediatric and neonatal intensive care units

Objective To analyse safety risks in injectable medications. To assess the potential impact and pharmacoeconomic aspects of safety tools. Design The injectable drug process was prospectively assessed using a failure modes, effects and criticality analysis. Criticality indexes were estimated based on their likelihood of occurrence, detection probability and potential severity. The impact of 10 safety tools on the criticality index was calculated and extrapolated to all drugs injected daily. Yearly costs for a reduction in criticality by 1 point (=1 quali) per day were estimated. Setting Paediatric and neonatal intensive care units in a University Hospital. Participants Two paediatric nurses, a neonatologist, three hospital pharmacists. Interventions Qualitative and quantitative risk assessment. Main Outcome Measures Failure modes, criticality indexes, cost-efficacy ratios. Results Thirty-one failure modes identified, with the mean of their entire criticality indexes totalling 4540. The most critical failure mode was microbial contamination. The following gains were predicted: 1292 quali (46 500 per day by extrapolation) from ready-to-use syringes, 1201 (72 060) by employing a clinical pharmacist, 996 (59 780) from double check by nurses and 984 (59 040) with computerized physician order entry. The best cost-efficacy ratios were obtained for a clinical pharmacist (1 quali = 0.54 euros), double check (1 quali = 0.71 euros) and ready-to-use syringes (1 quali = 0.72 euros). Computerized physician order entry showed the worst cost-efficacy ratio due to a very high investment costs (1 quali = 22.47 euros). Conclusion Based on our risk and pharmacoeconomic analyses, clinical pharmacy and ready-to-use syringes appear as the most promising safety tool

La fauna de serpientes de la provincia de Córdoba, Argentina: I. Lista y distribución

We have reeorded 24 species occurring in the province's territory (29" to 35" S; 61" to 65" W), including one (Tomodon ocellatus) not mentioned previously. The list and distribution maps are based on 3 966 specimens sent to the Serpentarium of the Centre for Applied Zoology at Córdoba between 1973 and 1981.We have reeorded 24 species occurring in the province's territory (29" to 35" S; 61" to 65" W), including one (Tomodon ocellatus) not mentioned previously. The list and distribution maps are based on 3 966 specimens sent to the Serpentarium of the Centre for Applied Zoology at Córdoba between 1973 and 1981

Prevalence of Asymptomatic SARS-CoV-2 Infection in the General Population of the Veneto Region: Results of a Screening Campaign with Third-Generation Rapid Antigen Tests in the Pre-Vaccine Era

The aim of our study was to ascertain the prevalence of SARS-CoV-2 infection in the general population during a period of moderate risk, just before Italy started to implement its vaccination campaign. A third-generation antigenic nasal swab sample was collected by a healthcare provider, and all individuals testing positive subsequently had a nasopharyngeal swab for molecular testing; the result was used to calculate the positive predictive value. The population consisted of 4467 asymptomatic adults with a mean age of 46.8 +/- 16.00 years. The 62.2% tested for the first time, while 37.8% had previously undergone a mean 2.2 tests for SARS-CoV-2. With 77 of our overall sample reporting they had previously tested positive for COVID-19 and 14 found positive on our screening test, the overall estimated prevalence of the infection was 0.31%. Nine of the 14 cases were confirmed on molecular testing with a PPV of 64.3%. The mean age of the individuals testing positive was 38.1 +/- 17.4. Based on the timing of symptom onset, six of the above cases were classified as false negatives, and the adjusted estimated prevalence was 0.34%. Describing levels of infection in a general population seems to be very difficult to achieve, and the universal screening proved hugely expensive particularly in a low-prevalence situation. Anyway, it is only thanks to mass screening efforts that epidemiological data have been collected. This would support the idea that routine screening may have an impact on mitigating the spread of the virus in higher-risk environments, where people come into contact more frequently, as in the workplace

Kinetics of Bamberger rearrangement of N-phenylhydroxylamine in a reusable homogeneous system: CH3CN-H2O-CF3COOH

4-Aminophenol is an important raw material for several products in the field of dyes, photographs and pharmaceutics. For instance, paracetamol (N-acetyl-4-aminophenol) a widely employed analgesic and antipyretic [1]. Bases of the present research have been the recent results in the Beckmann rearrangement of the cyclohexanone oxime to caprolactam in CH3CN-CF3COOH solvent catalytic system [2]. The system CH3CN-CF3COOH in that reaction is fully reusable because of the acidity of the CF3COOH does not allow formation of the caprolactam salt and does not need neutralization [2]. Here we study the reactivity of the CH3CN-H2O-CF3COOH system in the Bamberger rearrangement of N-phenylhydroxylamine to 4-aminophenol the former being the key intermediate in the selective hydrogenation of nitrobenzene to 4-aminophenol. The reaction is carried out in a thermostatted reactor and the kinetics has been followed by HPLC and UV-Vis measurements. Both H2O and CF3COOH are in large excess and in any case an apparent first order has been observed, then a first order kobs have been reported. The influence of the operative variable has been studied and in particular the influence of CF3COOH and H2O concentration on reaction rate is shown in Figure 1. The increase of CF3COOH correspond to an increase of the reaction rate, on the contrary H2O inhibits the kinetics. These results suggest that H2O competes in one stage of the rearrangement thus reducing the overall rate, for instance, H2O may influence protonation equilibria

Risk and pharmacoeconomic analyses of the injectable medication process in the paediatric and neonatal intensive care units

OBJECTIVE: To analyse safety risks in injectable medications. To assess the potential impact and pharmacoeconomic aspects of safety tools. DESIGN: The injectable drug process was prospectively assessed using a failure modes, effects and criticality analysis. Criticality indexes were estimated based on their likelihood of occurrence, detection probability and potential severity. The impact of 10 safety tools on the criticality index was calculated and extrapolated to all drugs injected daily. Yearly costs for a reduction in criticality by 1 point (=1 quali) per day were estimated. SETTING: Paediatric and neonatal intensive care units in a University Hospital. PARTICIPANTS: Two paediatric nurses, a neonatologist, three hospital pharmacists. INTERVENTIONS: Qualitative and quantitative risk assessment. MAIN OUTCOME MEASURES: Failure modes, criticality indexes, cost-efficacy ratios. RESULTS: Thirty-one failure modes identified, with the mean of their entire criticality indexes totalling 4540. The most critical failure mode was microbial contamination. The following gains were predicted: 1292 quali (46 500 per day by extrapolation) from ready-to-use syringes, 1201 (72 060) by employing a clinical pharmacist, 996 (59 780) from double check by nurses and 984 (59 040) with computerized physician order entry. The best cost-efficacy ratios were obtained for a clinical pharmacist (1 quali = 0.54 euros), double check (1 quali = 0.71 euros) and ready-to-use syringes (1 quali = 0.72 euros). Computerized physician order entry showed the worst cost-efficacy ratio due to a very high investment costs (1 quali = 22.47 euros). CONCLUSION: Based on our risk and pharmacoeconomic analyses, clinical pharmacy and ready-to-use syringes appear as the most promising safety tools

White matter fiber density abnormalities in cognitively normal adults at risk for late-onset Alzheimer's disease

Tau accumulation affecting white matter tracts is an early neuropathological feature of late-onset Alzheimer's disease (LOAD). There is a need to ascertain methods for the detection of early LOAD features to help with disease prevention efforts. The microstructure of these tracts and anatomical brain connectivity can be assessed by analyzing diffusion MRI (dMRI) data. Considering that family history increases the risk of developing LOAD, we explored the microstructure of white matter through dMRI in 23 cognitively normal adults who are offspring of patients with Late-Onset Alzheimer's Disease (O-LOAD) and 22 control subjects (CS) without family history of AD. We also evaluated the relation of white matter microstructure metrics with cortical thickness, volumetry, in vivo amyloid deposition (with the help of PiB positron emission tomography -PiB-PET) and regional brain metabolism (as FDG-PET) measures. Finally we studied the association between cognitive performance and white matter microstructure metrics. O-LOAD exhibited lower fiber density and fractional anisotropy in the posterior portion of the corpus callosum and right fornix when compared to CS. Among O-LOAD, reduced fiber density was associated with lower amyloid deposition in the right hippocampus, and greater cortical thickness in the left precuneus, while higher mean diffusivity was related with greater cortical thickness of the right superior temporal gyrus. Additionally, compromised white matter microstructure was associated with poorer semantic fluency. In conclusion, white matter microstructure metrics may reveal early differences in O-LOAD by virtue of parental history of the disorder, when compared to CS without a family history of LOAD. We demonstrate that these differences are associated with lower fiber density in the posterior portion of the corpus callosum and the right fornix.Fil: Sanchez, Stella Maris. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Duarte Abritta, Barbara Micaela. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Abulafia, Carolina Andrea. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas; ArgentinaFil: de Pino, Gabriela. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Bocaccio, Hernan. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Castro, Mariana Nair. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Fisiología, Biología Molecular y Celular; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Sevlever, Gustavo. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Fonzo, Greg A.. University of Texas at Austin; Estados UnidosFil: Nemeroff, Charles B.. University of Texas at Austin; Estados UnidosFil: Gustafson, Deborah. State University of New York; Estados Unidos. University of Skövde; SueciaFil: Guinjoan, Salvador Martín. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Fisiología, Biología Molecular y Celular; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas. Laboratorio de Neurofisiología; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Villarreal, Mirta Fabiana. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentin

Concorso di progettazione per la riqualificazione di Piazza Volta - Via Grassi - Via Garibaldi - Como (CO)

open7openOsvaldo Pogliani (capogruppo), Davide Di Fonzo, Luciano Crespi, Davide Crippa, Roberto de Paolis, Barbara Di Prete, Francesco TosiOsvaldo Pogliani (capogruppo), ; Davide Di Fonzo, ; Crespi, Luciano; Crippa, Davide; DE PAOLIS, Roberto; DI PRETE, Barbara; Tosi, Francesc

Multi-source statistics:Basic situations and methods

Many National Statistical Institutes (NSIs), especially in Europe, are moving from single‐source statistics to multi‐source statistics. By combining data sources, NSIs can produce more detailed and more timely statistics and respond more quickly to events in society. By combining survey data with already available administrative data and Big Data, NSIs can save data collection and processing costs and reduce the burden on respondents. However, multi‐source statistics come with new problems that need to be overcome before the resulting output quality is sufficiently high and before those statistics can be produced efficiently. What complicates the production of multi‐source statistics is that they come in many different varieties as data sets can be combined in many different ways. Given the rapidly increasing importance of producing multi‐source statistics in Official Statistics, there has been considerable research activity in this area over the last few years, and some frameworks have been developed for multi‐source statistics. Useful as these frameworks are, they generally do not give guidelines to which method could be applied in a certain situation arising in practice. In this paper, we aim to fill that gap, structure the world of multi‐source statistics and its problems and provide some guidance to suitable methods for these problems

Clinical correlates of "pure" essential tremor: the TITAN study

BackgroundTo date, there are no large studies delineating the clinical correlates of "pure" essential tremor (ET) according to its new definition.MethodsFrom the ITAlian tremor Network (TITAN) database, we extracted data from patients with a diagnosis of "pure" ET and excluded those with other tremor classifications, including ET-plus, focal, and task-specific tremor, which were formerly considered parts of the ET spectrum.ResultsOut of 653 subjects recruited in the TITAN study by January 2022, the data of 208 (31.8%) "pure" ET patients (86M/122F) were analyzed. The distribution of age at onset was found to be bimodal. The proportion of familial cases by the age-at-onset class of 20 years showed significant differences, with sporadic cases representing the large majority of the class with an age at onset above 60 years. Patients with a positive family history of tremor had a younger onset and were more likely to have leg involvement than sporadic patients despite a similar disease duration. Early-onset and late-onset cases were different in terms of tremor distribution at onset and tremor severity, likely as a function of longer disease duration, yet without differences in terms of quality of life, which suggests a relatively benign progression. Treatment patterns and outcomes revealed that up to 40% of the sample was unsatisfied with the current pharmacological options.DiscussionThe findings reported in the study provide new insights, especially with regard to a possible inversed sex distribution, and to the genetic backgrounds of "pure" ET, given that familial cases were evenly distributed across age-at-onset classes of 20 years. Deep clinical profiling of "pure" ET, for instance, according to age at onset, might increase the clinical value of this syndrome in identifying pathogenetic hypotheses and therapeutic strategies