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Purpose The accuracy of cost savings and reimbursement predictions for medications added to an academic medical center formulary was assessed. Methods Formulary changes over a 5-year period were reviewed by the investigators. Medications were included if the medication was added to formulary and the monograph included cost savings or reimbursement data that indicated a positive net margin. The primary endpoints were percent predicted cost savings and net margin per medication based on medication cost only. Secondary endpoints included the percent of medications with at least 100% predicted cost savings or net margin and evaluation of median percent predicted savings or net margin individually. Results The pharmacy and therapeutics committee reviewed 558 formulary agenda items, 184 of which were selected for further analysis. In total, 19 medications were identified as having a predicted monetary advantage. The endpoints of percent predicted cost savings and net margin yielded a median of 76.5% (range 72.9-188.71%) (n = 3) and 148.2% (IQR 108.9-543.3%) (n = 16), respectively. For 13 (68%) of 19 medications, the percent predicted cost savings or net margin was at least 100%. Conclusion Economic predictions utilized for formulary management at an academic medical center generated net positive monetary value for medications where predicted cost savings or reimbursement factored into the decision to add a medication to the formulary.

Background and objectives The Cochrane Central Register of Controlled Trials (CENTRAL) is compiled from a number of sources, including PubMed and Embase. Since 2017, we have increased the number of sources feeding into CENTRAL and improved the efficiency of our processes through the use of application programming interfaces, machine learning, and crowdsourcing.Our objectives were twofold: (1) Assess the effectiveness of Cochrane's centralized search and screening processes to correctly identify references to published reports which are eligible for inclusion in Cochrane systematic reviews of randomized controlled trials (RCTs). (2) Identify opportunities to improve the performance of Cochrane's centralized search and screening processes to identify references to eligible trials. Methods We identified all references to RCTs (either published journal articles or trial registration records) with a publication or registration date between 1st January 2017 and 31st December 2018 that had been included in a Cochrane intervention review. We then viewed an audit trail for each included reference to determine if it had been identified by our centralized search process and subsequently added to CENTRAL. Results We identified 650 references to included studies with a publication year of 2017 or 2018. Of those, 634 (97.5%) had been captured by Cochrane's Centralised Search Service. Sixteen references had been missed by the Cochrane's Centralised Search Service: six had PubMed-not-MEDLINE status, four were missed by the centralized Embase search, three had been misclassified by Cochrane Crowd, one was from a journal not indexed in MEDLINE or Embase, one had only been added to Embase in 2019, and one reference had been rejected by the automated RCT machine learning classifier. Of the sixteen missed references, eight were the main or only publication to the trial in the review in which it had been included. Conclusion This analysis has shown that Cochrane's centralized search and screening processes are highly sensitive. It has also helped us to understand better why some references to eligible RCTs have been missed. The CSS is playing a critical role in helping to populate CENTRAL and is moving us toward making CENTRAL a comprehensive repository of RCTs.

This study assessed the efficacy of an interactive Moodle lesson teaching the subject of references commonly used to answer drug information (DI) questions on pharmacy student performance and retention. Students were randomized to receive education via either the lesson or a recorded lecture. Students completed a baseline knowledge assessment, an assignment following instruction, the same baseline assessment at the end of the semester to assess retention, and a survey on their experience with the assigned education technique. The differences of median grades on assessments and survey results between groups were compared via Mann-Whitney U tests. Student performance on the baseline assessment was comparable between groups (n = 40 per group; 47.22% vs. 48.61%). Retention of knowledge was less in students in the lesson group (63.89%) than in the lecture group (75%). Students taught by lecture performed better (90.63%) than those taught by lesson (87.5%) on the post-instruction assignment. Survey results from participants (n = 32/80) showed more students in the lecture group (n = 16) agreed time associated with educational technique was reasonable (69% vs. 31%), technique was valuable to learning (75% vs. 44%), and experience was satisfying (56% vs. 31%). These results show student retention of knowledge was not improved with use of a Moodle lesson in comparison with a recorded lecture. Student performance was better immediately following education when taught by lecture and more lecture-taught students agreed the educational technique was time-appropriate, valuable, and satisfying.

Objective Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution's clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. Design Retrospective electronic medical records review. Methods The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011, and August 31, 2014, with ICD-9 codes for MRSA and pneumonia. Included patients were at least 18 years of age and had vancomycin or linezolid initiated at least 2 days after admission and continued for at least 2 consecutive days. The primary end points were extent of antibiotic use before and after order form change and length of stay (LOS) and hospital charges in the two treatment groups. A secondary aim was to detect any gross discrepancies in patient outcomes such as treatment duration, mechanical ventilation duration, all-cause mortality rate, nephrotoxicity, and 30-day readmission between the two treatment groups. Measurements and Main Results Outcomes in 227 patients were assessed. Linezolid use increased 16.2% subsequent to the change in the order form. Although not statistically significant, the median hospital admission charge was $6200 lower in patients treated with linezolid compared with those treated with vancomycin ($25,900 vs $32,100). Hospital LOS was significantly associated with Charlson Comorbidity Index score (p

Long-term daylight deprivation such as during the Antarctic winter has been shown to lead to delayed sleep timing and sleep fragmentation. We aimed at testing whether retinal sensitivity, sleep and circadian rest-activity will change during long-term daylight deprivation on two Antarctic bases (Concordia and Halley VI) in a total of 25 healthy crew members (mean age: 34 ± 11y; 7f). The pupil responses to different light stimuli were used to assess retinal sensitivity changes. Rest-activity cycles were continuously monitored by activity watches. Overall, our data showed increased pupil responses under scotopic (mainly rod-dependent), photopic (mainly L-/M-cone dependent) as well as bright-blue light (mainly melanopsin-dependent) conditions during the time without direct sunlight. Circadian rhythm analysis revealed a significant decay of intra-daily stability, indicating more fragmented rest-activity rhythms during the dark period. Sleep and wake times (as assessed from rest-activity recordings) were significantly delayed after the first month without sunlight (p

Made available in DSpace on 2018-11-26T15:27:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-09-01 Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) Water samples were collected quarterly for 1 year from the newly created Osamu Utsumi uranium mine pit lake, Brazil, which is affected by acid mine drainage (AMD). The water presented mean pH values of 3.8, high mean electrical conductivity values (2391 A mu S/cm), manganese (74 mg/L), sulfate (1413 mg/L) and uranium (3 mg/L). The density of rotifera was significantly higher than that of cladoceran. Rotifera Keratella americana, K. cochlearis and the Cladocera Bosminopsis deitersi, Bosmina sp., are being reported for the first time in samples from a uranium pit lake with AMD. Of the species registered, the order Bdelloidea was the most important in terms of density (17,500-77,778 ind/m(3)), since it occurred throughout the whole sampling period. The combined effect of moderately acidic pH and other potential stress factors, such as high concentrations of stable and radioactive contaminants, probably influenced the zooplankton species composition in the pit lake. Brazilian Nucl Energy Commiss, Pocos de Caldas Lab, Radioecol Lab, BR-37701970 Pocos De Caldas, MG, Brazil Alfenas Fed Univ, Dept Biol, Limnol Lab, BR-37130000 Alfenas, MG, Brazil Univ Estadual Paulista, Dept Environm Engn, BR-12247004 Sao Jose Dos Campos, SP, Brazil Brazilian Nucl Energy Commiss, Pocos de Caldas Lab, Chem Anal Lab, BR-37701970 Pocos De Caldas, MG, Brazil Univ Estadual Paulista, Dept Environm Engn, BR-12247004 Sao Jose Dos Campos, SP, Brazil FAPEMIG: APQ-7807-5.04/07

Mass spectrometry is a potentially attractive means of monitoring the survival and efficacy of bioaugmentation agents, such as the dioxin-mineralizing bacterium Sphingomonas wittichii strain RW1. The biotransformation activity of RW1 phenotypes is determined primarily by the presence and concentration of the dioxin dioxygenase, an enzyme initiating the degradation of both dibenzo- p -dioxin and dibenzofuran (DF). We explored the possibility of identifying and characterizing putative cultures of RW1 by peptide mass fingerprinting (PMF) targeting this characteristic phenotypic biomarker. The proteome from cells of RW1—grown on various media in the presence and absence of DF—was partially purified, tryptically digested, and analyzed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Mascot online database queries allowed statistically significant identification of RW1 in disrupted, digested cells ( P < 0.01 to 0.05) and in digested whole-cell extracts ( P < 0.00001 to 0.05) containing hundreds of proteins, as determined by two-dimensional gel electrophoresis. Up to 14 peptide ions of the alpha subunit of the dioxin dioxygenase (43% protein coverage) were detected in individual samples. A minimum of 10 7 DF-grown cells was required to identify dioxin degradation-enabled phenotypes. The technique hinges on the detection of multiple characteristic peptides of a biomarker that can reveal at once the identity and phenotypic properties of the microbial host expressing the protein. The results demonstrate the power of PMF of minimally processed microbial cultures as a sensitive and specific technique for the positive identification and phenotypic characterization of certain microorganisms used in biotechnology and bioremediation.

The objective of the study was to conduct a retrospective audit of patients who presented with priapism in Western Australia during the years 1985-2000. We searched the records of the teaching hospitals in metropolitan Perth and those of the Keogh Institute for Medical Research for the diagnostic code for priapism. A total of 82 episodes of priapism in 63 patients occurred over this 16 year period. In all, 62 episodes occurred after intracavernosal injections (ICI) and 20 were due to other causes. Treatment of priapism included simple aspiration of blood, intracavernosal injection of alpha-adrenergic agents and surgical shunt procedures. Priapism occurring outside the setting of ICI was more likely to require surgery; seven of 20 episodes. After ICI therapy, eight of 62 episodes required shunts. The use of prostaglandin E1 as the drug of choice in ICI therapy in 1989 led to a fall in the incidence of ICI-induced priapism. Priapism is a major side effect of ICI therapy and an uncommon, although important, side effect of other conditions. The incidence of priapism has fallen with the introduction of prostaglandin E1 monotherapy as the favoured drug for ICI therapy of erectile failure.

A time-of-flight (TOF) mass spectrometry gating technique is applied to a study of methanol clusters subjected to ionizations via intense femtosecond laser pulses. The resulting high charged species (C2+, C3+/O4+) acquire large amounts of kinetic energy resulting from Coulomb repulsion of multicharged atomic ions that reside in close proximity to one another. Protons which are of two kinds, methyl and hydroxyl, also acquire large amounts of kinetic energy. When compared with protons generated from the Coulomb explosion of water clusters ((H2O)n, n≤20), protons from methanol clusters ((CH3OH)n, n≤10) acquire less overall average kinetic energy, which is in agreement with earlier findings that suggest greater clustering yields higher energy. Interestingly, despite the lower average kinetic energy released, the methanol protons peak at a higher value of energy than those generated in the water cluster system, an effect attributed to the presence of both methyl and hydroxyl groups.

Pyridine clusters are subjected to intense femtosecond laser pulses at fluences around 10 15 W cm −2 at 620 nm, which results in multiple ionization and concomitant Coulomb explosion. A combined covariance map is considered which can be viewed as the overlay of two maps that describe the statistical interaction of the resulting time-of-flight spectra of the pyridine clusters which lead to species having large values of kinetic energy. The combined map is constructed from ones involving both positive covariance values and anti-covariance values obtained in the same experimental study. Significantly, the individual points representing positive and anti-covariance effects arising from the ionization of the clusters via femtosecond laser pulses are found to be mutually exclusive of each other as exemplified in this pyridine study. Our extension of covariance mapping, which was originally formulated by Frasinski et al. for simple molecular interactions, and is further developed in the present study, elucidates the presence of competitive reactions within cluster systems by comparison of the two maps.

A new method is presented for determining the mass of products resulting from metastable decay in a reflectron time-of-flight mass-spectrometer. The validity of the calculation was confirmed through comparison to experimental values obtained while studying a water cluster and a methanol cluster system.

Automatic therapeutic substitution (ATS) is a mechanism that, upon patient hospitalization, prompts the pharmacist to exchange an equivalent formulary drug for a nonformulary medication, typically without prescriber contact. In facilities utilizing ATS, there is the possibility that physicians and patients may be unaware of the substitution, potentially leading to drug-drug interactions, therapeutic duplication, and/or increased patient expense following discharge should the original regimen not be resumed. The purpose of this study was to determine the frequency with which hospitalized patients subjected to an ATS protocol were not returned to outpatient drug therapy.A retrospective chart review of adult patients admitted to an academic medical center between January 1 and June 30, 2011, was conducted. Patients were included if they were admitted on angiotensin-converting enzyme (ACE) inhibitors, antidepressants, nonsedating antihistamines, histamine (H2) receptor antagonists, or proton pump inhibitors (PPIs), and were then prescribed a different agent via ATS. Admission and discharge medication reconciliation documents, dictated discharge summaries, and patient education documentation reports were reviewed for drug therapies and doses, as well as medication counseling evidence. The primary endpoint was the percentage of patients not returned to original outpatient therapy following ATS. Secondary endpoints included prescribing events in patients not returned to original therapy, the rate and source of drug therapy counseling at discharge, and the number of patients discharged on a potentially cost-prohibitive drug, defined as any drug available only as a branded product during the study period.A total of 317 interventions were identified through review of pharmacy records. Of these, 47 patients (15%) were not returned to original outpatient therapy. Within this subsection, 15 patients (32%) were discharged on the substituted drug, eight patients (17%) resumed initial therapy but received a dosage adjustment from previous outpatient therapy, and three patients (6%) were discharged on a drug that was neither the substituted product nor the previous outpatient therapy. The remaining 21 patients had therapy discontinued (n = 12/47, 26%) or lacked documentation of discharge therapy (9/47, 19%). Nursing staff provided medication counseling to 288 of the 317 patients (91%). Overall, 51 patients (16%) were identified as receiving a cost-prohibitive drug.Patients subject to ATS of commonly substituted drug classes were returned to their original outpatient drug therapy more than 85% of the time following inpatient hospitalizations, with similar rates of medication counseling at discharge. The prescribing of cost-prohibitive drugs has been identified as a potential area for pharmacist intervention at discharge.

Ultrafast pump−probe spectroscopic studies on the hydrated 7-azaindole monomer are presented. The experiments provide evidence that excited-state proton transfer in the gas-phase hydrated 7-azaindole monomer may be possible, as predicted by theory, and can occur by means of a water proton bridge. As explained in the text, full tautomerization may not be occurring, but rather the transfer of a proton from the 7-azaindole monomer to the solvating water molecules. A calculated geometry for the structure of 7-azaindole clustered with four waters is presented and used to explain the rate increase observed in this species compared to the 7-azaindole monomer clustered with two and three waters.

Presented here are femtosecond pump-probe studies on the water-solvated 7-azaindole dimer, a model DNA base pair. In particular, studies are presented that further elucidate the nature of the reactive and nonreactive dimers and also provide new insights establishing that the excited state double-proton transfer in the dimer occurs in a stepwise rather than a concerted manner. A major question addressed is whether the incorporation of a water molecule with the dimer results in the formation of species that are unable to undergo excited state double-proton transfer, as suggested by a recent study reported in the literature [Nakajima, A., Hirano, M., Hasumi, R., Kaya, K., Watanabe, H., Carter, C. C., Williamson, J. M. & Miller, T. (1997) J. Phys. Chem. 101, 392–398]. In contrast to this earlier work, our present findings reveal that both reactive and nonreactive dimers can coexist in the molecular beam under the same experimental conditions and definitively show that the clustering of water does not induce the formation of the nonreactive dimer. Rather, when present with a species already determined to be a nonreactive dimer, the addition of water can actually facilitate the occurrence of the proton transfer reaction. Furthermore, on attaining a critical hydration number, the data for the nonreactive dimer suggest a solvation-induced conformational structure change leading to proton transfer on the photoexcited half of the 7-azaindole dimer.

To study the effects of retinoic acid on the skin in vivo, we have subverted the activity of endogenous receptors by targeting expression of a dominant negative mutant of retinoic acid receptor alpha (RAR alpha) to the epidermis of transgenic mice. At birth, mice expressing the mutant RAR alpha transgene exhibited a marked phenotype of a red, shiny skin that was somewhat sticky to touch. Severely affected neonates died within 24 hr. Histological changes in the epidermis were subtle with the phenotypic stratum corneum appearing slightly thinner and more loosely packed than in controls. Electron microscopic studies revealed that lipid multilamellar structures were not present between cells in the stratum corneum of phenotypic mice. When assayed for transepidermal water loss, phenotypic skin lost water at a rate three times faster than controls, suggesting that neonatal lethality resulted from loss of epidermal barrier function. The absence of a functional lipid barrier in transgenic mice first became evident at E17 when lipids were extruded initially into the intercellular space. We have identified a potential pathway linking inhibition of retinoid signaling with disruption of the lipid barrier that involves peroxisome proliferator-activated receptors. This study documents the role of the retinoid signaling pathway in formation and maintenance of a functional epidermis and provides the first evidence that this is mediated in part by modulation of lipid metabolism.

The paper presents a complex model of heat and mass transfer in a multi-layer protective clothing exposed to a flash fire and interacting with the human skin. The clothing was made of porous fabric layers separated by air gaps. The fabrics contained bound water in the fibres and moist air in the pores. The moist air was also present in the gaps between fabric layers or internal fabric layer and the skin. Three skin sublayers were considered. The model accounted for coupled heat transfer by conduction, thermal radiation and associated with diffusion of water vapour in the clothing layers and air gaps. Heat exchange due to phase transition of the bound water were also included in the model. Complex thermal and mass transfer conditions at internal or external boundaries between fabric layers and air gaps as well as air gap and skin were assumed. Special attention was paid to modelling of thermal radiation which was coming from the fire, penetrated through protective clothing and absorbed by the skin. For the first time non-grey properties as well as optical phenomena at internal or external boundaries between fabric layers and air gaps as well as air gap and skin were accounted for. A series of numerical simulations were carried out and the risk of heat injures was estimated.

The 'service of research on neutronics and criticality' of Valduc CEA research center, proposes several experimental facilities for neutron and gamma irradiation: two metallic reactors, a solution reactor, two accelerators.

Hydrostatic extrusion is a technique based on severe plastic deformation. Characteristic features of this process are very large deformation, high strains, strain rates and considerable thermal effect. Temperature is one of the most important factors which controls the structure and mechanical properties of material during this process. Due to very high extrusion pressure (of the order of magnitude 1 GPa) and high speed of extruded material only the ‘contactless’ methods of the product temperature measurement during the process are possible. Results of measurements with use of ThermaCAM SC 2000 at recording frequency 50 Hz are presented in the paper for hydrostatic extrusion of aluminium wires with OD between 2-3 mm.

The main goal of the study is to test the applicability of Infrared Thermography for verification of Thermal Boundary Conditions at external non-isothermal walls bounding the flow domain. Experimental and numerical studies have been made for transient and steady natural convection in a differentially heated cube filled with water. The analysis is carried out for pure convection of water in the vicinity of the freezing region (cold wall temperature Tc= 0 o C), and for convection of water

Australian Natural History Series: Great Whales. John Bannister. 2008. CSIRO Publishing, Collingwood, Victoria, Australia. 142 pp. $27.45. ISBN: 978-0-64309-373-7 (softcover). Australian Natural History Series: Platypus. Fourth Edition. Tom Grant, illustrated by Dominic Fanning. 2008. CSIRO Publishing, Collingwood, Victoria, Australia. 159 pp. $27.45. ISBN: 978-0-64309-370-6 (softcover).

Heat transfer characteristics, including the convective flow driven by melting of subcooled phase change material (PCM) in the horizontal annulus gap, were experimentally studied The inner cylinder was heated with a constant surface heat flux and the outer cylinder had a constant temperature. The history of the temperature field was measured with an infrared scanning system. It is shown in this paper that contribution of natural convection in the melt region becomes significant as the Stefan number increases. In recent years numerous experimental and numerical studies or analytical solutions, have been performed to explain the prinCipal mechanism of energy transfer occurring during the melting or solidification. In many of these practical cases natural convection effects, in the melted region, dominate over diffusion. Also an experimental and numerical investigation has been conducted at the Institute of Heat Engineering to study the characteristics of natural convection for the melting of n-octadecan inside a horizontal annulus gap [1-4]. Understanding and predicting the melt behavior of phase change material (PCM) is of special importance in designing cost-effective heat receivers of latent thermal energy storage (L TES). The temperature field and the solid-liquid interface boundary can be conventionally studied with the help of thermocouples. Another technique used in measurements of such kind is the application of thermochromic liquid crystals (TLC) suspended as small tracer particles. The Particle Image Thermometry (Pin is based on temperature-dependent reflectivity of TLC at visible light wavelengths [5]. Another sensor to study the solid-liquid interface is optical fiber [6]. This paper reports experimental results on the melting in a horizontal annulus gap using infrared (IR) thermography. This method has several advantages over measurements performed with usage of thermocouples, especially in experiments on natural convective melting/solidification heat transfer. Some advantages of IR thermography are: it is a non-intrusive measurement of temperature in the whole test cell (not only in the chosen points), it leads to simultaneous measurements of temperature and progress of the liquid-solid interface, it avoids disturbance of the heat flow caused by the presence of the numerous thermocouples.

A free volume approach has been used to describe the effect of apparent solute molecular size on solute membrane diffusion coefficient in poly(2-hydroxyethyl methacrylate) (pHEMA) and pHEMA crosslinked with 1 mole % ethyleneglycol dimethacrylate (EGDMA). Analysis of experimental results indicates, that for hydrophilic nonelectrolytes and inorganic chloride salts in the molecular weight range 20—500, the membrane diffusion coefficient decreases exponentially with increasing molecular size. p]Solute partition coefficients have been calculated for pHEMA and pHEMA crosslinked with 1 mole % EGDMA using a three-state model for gel water. Comparison of these calculations with experimental partition coefficients indicates that hydrophilic nonelectrolytes and inorganic chloride salts partition primarily into bulk water regions. From this result it may be implied that solute permeation occurs in gel bulk water.

The dynamical systems herein are Morse-Smale diffeomorphisms and flows on C ∞ {C^\infty } compact manifolds. We show the asymptotic rate of approach of orbits to the sinks of the systems to be bounded by an expression of the form K exp ⁡ ( − D N ) K\;\exp ( - DN) , where D D may be any number smaller than C = min p { 1 / m log Jac D P f m | W u ( P ) } C = {\min _p}\{ 1/m\;\log \;\operatorname {Jac}\;{D_P}\,{f^m}|{W^u}(P)\} . Here the minimum is taken over all nonsink P P in the nonwandering set of f f , and m m is the period of P P . We extend our theorems to the entire manifold, so that there is no restriction on the location of the initial points of trajectories.

Hydrogels of varying water content were prepared to investigate the relationship between water content and diffusion coefficient. Poly(methoxyethyl methacrylate) (pMEMA), poly(methoxyethoxyethyl methacrylate) (pMEEMA) and copolymers of MEMA and MEEMA with poly(2-hydroxyethyl methacrylate) (pHEMA) were formulated to give hydrogels with water contents ranging from approximately 3% to 63%. The results of the diffusion experiments were examined in light of a free volume model of diffusive transport. Excellent theoretical-experimental correlation was obtained for the hydrogels and temperatures used in this study. This model was used also to correct for the effects of temperature on gel swelling. Arrhenius activation energies obtained using this correction approach the activation energy for tritiated water in pure water as gel hydration increases.