Adverse drug events in an intensive care unit of a university hospital

Purpose Adverse drug events (ADEs) are harmful and occur with alarming frequency in critically ill patients. Complex pharmacotherapy with multiple medications increases the probability of a drug interaction (DI) and ADEs in patients in intensive care units (ICUs). The objective of the study is to determine the frequency of ADEs among patients in the ICU of a university hospital and the drugs implicated. Also, factors associated with ADEs are investigated. Methods This cross-sectional study investigated 299 medical records of patients hospitalized for 5 or more days in an ICU. ADEs were identified through intensive monitoring adopted in hospital pharmacovigilance and also ADE triggers. Adverse drug reactions (ADR) causality was classified using the Naranjo algorithm. Data were analyzed through descriptive analysis, and through univariate and multiple logistic regression. Results The most frequent ADEs were ADRs type A, of possible causality and moderate severity. The most frequent ADR was drug-induced acute kidney injury. Patients with ADEs related to DIs corresponded to 7% of the sample. The multiple logistic regression showed that length of hospitalization (OR = 1.06) and administration of cardiovascular drugs (OR = 2.2) were associated with the occurrence of ADEs. Conclusion Adverse drug reactions of clinical significance were the most frequent ADEs in the ICU studied, which reduces patient safety. The number of ADEs related to drug interactions was small, suggesting that clinical manifestations of drug interactions that harm patients are not frequent in ICUs.

Antimicrobial drug administration errors identified in Brazilian multicentric study

Medication administration errors (MAE) are the most frequent kind of medication errors. Errors with antimicrobial drugs (AD) are relevant because they may interfere inpatient safety and in the development of microbial resistance. The aim of this study is to analyze the AD errors detected in a Brazilian multicentric study of MAE. It was a devcriptive and explorotory study carried out in clinical units in five Brazilian teaching hospitals. The hospitals were investigated during 30 days. MAE were detected by observation technique. MAE were classified in categories: wrong route(WR), wrong patient(WP), wrong dose(WD) wrong time (WT) and unordered drug (UD). AD with MA E were classified by Anatomical-Therapeutical-Chemical Classification System. AD with narrow therapeutic index (NTI) wet-e identified A descriptive statistical analysis was performed using SPSS version 11.5 software. A total of 1500 errors were observed, 277 (18.5%) of them were error with AD. The hopes of AD error were: WT87.7%, QD 6.9%, WR 1.5%, UD 3.2% and WP 0.7%. The number of AD found was 36. The mostly ATC class were fluoroquinolones 13.9%, combinations of penicillin 13.9%, macrolides 8.3% and third-generation cephalosporines 5.6%. The parenteral drug dosage form was associated with 55.6% of AD. 16.7% of AD were NTI. 47.4% of WD and 21.8% WT were with NTI drugs. This study shows that these errors should be considered potential areas for improvement in the medication process and patient safety plus there is requirement to develop rational drug use of AD.

Hardened properties of self-compacting concrete - A statistical approach

This work presents a statistical study on the variability of the mechanical properties of hardened self-compacting concrete, including the compressive strength, splitting tensile strength and modulus of elasticity. The comparison of the experimental results with those derived from several codes and recommendations allows evaluating if the hardened behaviour of self-compacting concrete can be appropriately predicted by the existing formulations. The variables analyzed include the maximum size aggregate, paste and gravel content. Results from the analyzed self-compacting concretes presented variability measures in the same range than the expected for conventional vibrated concrete, with all the results within a confidence level of 95%. From several formulations for conventional concrete considered in this study, it was observed that a safe estimation of the modulus of elasticity can be obtained from the value of compressive strength; with lower strength self-compacting concretes presenting higher safety margins. However, most codes overestimate the material tensile strength. (C) 2010 Elsevier Ltd. All rights reserved.

Proposal of a High-Level Language for Writing Self Modifying Programs

This paper proposes a simple high-level programming language, endowed with resources that help encoding self-modifying programs. With this purpose, a conventional imperative language syntax (not explicitly stated in this paper) is incremented with special commands and statements forming an adaptive layer specially designed with focus on the dynamical changes to be applied to the code at run-time. The resulting language allows programmers to easily specify dynamic changes to their own program`s code. Such a language succeeds to allow programmers to effortless describe the dynamic logic of their adaptive applications. In this paper, we describe the most important aspects of the design and implementation of such a language. A small example is finally presented for illustration purposes.

Suspension of apatite particles in a self-aerated Denver laboratory flotation cell

Effective solids suspension is a necessary precondition for particle collection, and solids suspension is largely dependent on the hydrodynamics of the flotation cell. This study attempted to correlate the status of the suspension of apatite particles of different sizes in a Denver laboratory flotation cell versus the impeller rotational speed (N) adopted to operate the machine. The latter variable (N) influences the impeller capacity to lift the particles from the bottom of the tank and also to disperse them throughout the volume of the vessel. Such an impeller capacity can be characterized by the critical impeller speed for the accomplishment of solids off-bottom suspension (N(z)) and also by the velocity of the radial water flow discharged by the impeller (U) divided by the particle terminal settling velocity (U(s)). This way, the status of the suspension of apatite particles inside the flotation cell can be characterized by one of three categories: ""segregation"" (N/N(2) < 0.60 and U(s)/U > 0.08); ""suspension"" (0.60 <= N/N(2) < 1 and 0.06 < U(s)/U < 0.10); and ""dragging"" (N/N(2) >= 1 and U(s)/U <= 0.03). The range of impeller rotational speed (N), which was able to suspend the finest particles (D(p) = 90,mu m), was unable to suspend the coarsest particles (D(P) = 254 mu m). Conversely, the high value of N (N > 1,300 rpm), which is adequate to suspend the coarsest particles, may promote the entrainment of the finest particles to the froth layer.

High Carbon Ferro-chromium Production by Self-reducing Process: Effects of Fe-Si and Fluxing Agent Additions

The technology of self-reducing pellets for ferro-alloys production is becoming an emerging process due to the lower electric energy consumption and the improvement of metal recovery in comparison with the traditional process. This paper presents the effects of reduction temperature, addition of ferro-silicon and addition of slag forming agents for the production of high carbon ferro-chromium by utilization of self-reducing pellets. These pellets were composed of Brazilian chromium ore (chromite) concentrate, petroleum coke, Portland cement, ferro-silicon and slag forming components (silica and hydrated lime). The pellets were processed at 1 773 K, 1 823 K and 1 873 K using an induction furnace. The products obtained, containing slag and metallic phases, were analyzed by scanning electron microscopy and chemical analyses (XEDS). A large effect on the reduction time was observed by increasing the temperature from 1 773 K to 1 823 K for pellets without Fe-Si addition: around 4 times faster at 1 823 K than at 1 773 K for reaction fraction close to one. However, when the temperature was further increased from 1 823 K to 1 873 K the kinetics improved by double. At 1 773 K, the addition of 2% of ferro-silicon in the pellet resulted in an increasing reaction rate of around 6 times, in comparison with agglomerate without it. The addition of fluxing agents (silica and lime), which form initial slag before the reduction is completed, impaired the full reduction. These pellets became less porous after the reduction process.

High Carbon Ferro-Chromium by Self-Reducing Process

This paper discusses the effects of temperature, addition of ferro-silicon and fluxing agents for the production of high carbon ferro-chromium by self-reducing process. The use of self-reducing agglomerates for ferro-alloys production is becoming an emerging processing technology due to lowering the electric energy consumption and improving the metal recovery in comparison with traditional ones. The self-reducing pellets were composed by chromite, petroleum coke, cement and small (0.1% - 2%) addition of ferro-silicon. The slag composition was adjusted by addition of fluxing agents. The reduction of pellets was carried out at 1773K (1500 degrees C), 1823K (1550 degrees C) and 1873K (1600 degrees C) by using induction furnace. The products obtained, containing slag and metallic phases, were analyzed by scanning electron microscopy and chemical analyses (XEDS). By increasing temperature from 1773K to 1823K large effect on the reduction time was observed. It decreased from 30 minutes to 10 minutes, for reaching around 0.98 reduction fraction. No significant effect on reduction time was observed when the reduction temperature was increased from 1823K to 1873K. At 1773K, the addition of 2% of ferro-silicon in the pellet resulted in an increasing reaction rate of around 6 times, in comparison with agglomerate without this addition. The addition of fluxing agents (silica and hydrated lime) has effect on reduction time (inverse relationship) and the pellets become less porous after reduction.

Electrophoretic deposition of ZrO(2)-Y(2)O(3): a bi-component study concerning self-assemblies

There are many industrial advantages of using mechanical multi-oxides mixtures to obtain ceramic parts by electrophoretic deposition (EPD). This is mainly because one could avoid complex chemical synthesis routes to achieve a desirable composition. However, EPD of these suspensions is not an easy task as well since many different surfaces are present, leading to unexpected suspension behavior. The particles surface potentials and interactions can, however, be predicted by an extension of the DLVO theory. Using this theory, one can control the suspension properties and particles distribution. The objective of this work was to apply the colloidal chemistry theories to promote the formation of a heterocoagulation between ZrO(2) and Y(2)O(3) particles in ethanol suspension to achieve a suitable condition for EPD. After identifying a condition where those particles had opposite surface charges and adequate relative sizes, heterocoagulation was observed at operational pH 7.5, generating an organized agglomerate with ZrO(2) particles surrounding Y(2)O(3), with a net zeta potential of -16.6 mV. Since the agglomerates were stable, EPD could be carried out and homogeneous deposits were obtained. The deposited bodies were sintered at 1600 A degrees C for 4 h and partially stabilized ZrO(2) could be obtained without traces of Y(2)O(3) second phases.

Thermodynamic self-consistency issues related to the Cluster Variation Method: The case of the BCC Cr-Fe (Chromium-Iron) system

The Cluster Variation Method (CVM), introduced over 50 years ago by Prof. Dr. Ryoichi Kikuchi, is applied to the thermodynamic modeling of the BCC Cr-Fe system in the irregular tetrahedron approximation, using experimental thermochemical data as initial input for accessing the model parameters. The results are checked against independent data on the low-temperature miscibility gap, using increasingly accurate thermodynamic models, first by the inclusion of the magnetic degrees of freedom of iron and then also by the inclusion of the magnetic degrees of freedom of chromium. It is shown that a reasonably accurate description of the phase diagram at the iron-rich side (i.e. the miscibility gap borders and the Curie line) is obtained, but only at expense of the agreement with the above mentioned thermochemical data. Reasons for these inconsistencies are discussed, especially with regard to the need of introducing vibrational degrees of freedom in the CVM model. (C) 2008 Elsevier Ltd. All rights reserved.

Probing Individual Quantum Dots: Noise in Self-Assembled Systems

In this work we explore the noise characteristics in lithographically-defined two terminal devices containing self-assembled InAs/InP quantum dots. The experimental ensemble of InAs dots show random telegraph noise (RTN) with tuneable relative amplitude-up to 150%-in well defined temperature and source-drain applied voltage ranges. Our numerical simulation indicates that the RTN signature correlates with a very low number of quantum dots acting as effective charge storage centres in the structure for a given applied voltage. The modulation in relative amplitude variation can thus be associated to the altered electrostatic potential profile around such centres and enhanced carrier scattering provided by a charged dot.

Self-organized criticality and the predictability of human behavior

The behavior of normal individuals and psychiatric patients vary in a similar way following power laws. The presence of identical patterns of behavioral variation occurring in individuals with different levels of activity is suggestive of self-similarity phenomena. Based on these findings, we propose that the human behavior in social context can constitute a system exhibiting self-organized criticality (SOC). The introduction of SOC concept in psychological theories can help to approach the question of behavior predictability by taking into consideration their intrinsic stochastic character. Also, the ceteris paribus generalizations characteristic of psychological laws can be seen as a consequence of individual level description of a more complex collective phenomena. Although limited, this study suggests that, if an adequate level of description is adopted, the complexity of human behavior can be more easily approached and their individual and social components can be more realistically modeled. (C) 2009 Elsevier Ltd. All rights reserved.

Generation of self-similar Gaussian time series by means of the DWT and DWPT variance maps

Due to the several kinds of services that use the Internet and data networks infra-structures, the present networks are characterized by the diversity of types of traffic that have statistical properties as complex temporal correlation and non-gaussian distribution. The networks complex temporal correlation may be characterized by the Short Range Dependence (SRD) and the Long Range Dependence - (LRD). Models as the fGN (Fractional Gaussian Noise) may capture the LRD but not the SRD. This work presents two methods for traffic generation that synthesize approximate realizations of the self-similar fGN with SRD random process. The first one employs the IDWT (Inverse Discrete Wavelet Transform) and the second the IDWPT (Inverse Discrete Wavelet Packet Transform). It has been developed the variance map concept that allows to associate the LRD and SRD behaviors directly to the wavelet transform coefficients. The developed methods are extremely flexible and allow the generation of Gaussian time series with complex statistical behaviors.

Electrochemical and spectroscopic characterization of screen-printed gold-based electrodes modified with self-assembled monolayers and Tc85 protein

This work investigates the formation of self-assembled monolayers (SAMs) of cystamine and cystamine-glutaraldehyde on a screen-printed electrode, and the immobilization of the Tc85 protein (from Trypanosoma cruzi) on these monolayers. The methods used included infrared techniques, cyclic voltammetry, and electrochemical impedance spectroscopy. The electrochemical studies were performed at pH 6.9 in 0.1 mol L(-1) phosphate buffer solution containing Fe(CN)(6)(-3/-4) redox species. The surface coverage (0) of the electrode was 0.10 (cystamine), 0.35 (cystamine-glutaraldehyde) and 0.84 (Tc85). Interpretation of electrochemical impedance spectroscopy results was based on a charge-transfer reaction involving Fe(CN)(6)(-3/-4) species at high frequencies, followed by a diffusion through the monolayers at lower frequencies. Estimates of the electrode surface coverage, active site radius, and distance between two adjacent sites assumed that charge transfer occurred at the active sites, and that there was a planar diffusion of redox species to these sites. (C) 2009 Elsevier B.V. All rights reserved.

SELF-SIMILARITY AND LAMPERTI CONVERGENCE FOR FAMILIES OF STOCHASTIC PROCESSES

We define a new type of self-similarity for one-parameter families of stochastic processes, which applies to certain important families of processes that are not self-similar in the conventional sense. This includes Hougaard Levy processes such as the Poisson processes, Brownian motions with drift and the inverse Gaussian processes, and some new fractional Hougaard motions defined as moving averages of Hougaard Levy process. Such families have many properties in common with ordinary self-similar processes, including the form of their covariance functions, and the fact that they appear as limits in a Lamperti-type limit theorem for families of stochastic processes.

Cyclophosphamide levels in sites of preparation and administration of antineoplastic drugs

The extensive use of antineoplastic agents in chemotherapy may be at risk to health care workers involved in the preparation and administration of these drugs. In this study cyclophosphamide, a drug classified as a human carcinogen, was quantified by adapting a previous analytical method using gas chromatography coupled to mass spectrometry (GC-MS) after solid phase extraction with diatomaceous earth. The drug was measured by analysis in surfaces (wipe samples) and gloves, collected from four different hospitals, before and after the practice of cleaning procedures, and the use of a closed-system device for the preparation and administration. Validation results were satisfactory and cyclophosphamide levels ranging from below the quantification limit to 141000 ng. Our findings demonstrated that surfaces and materials contamination was found in all hospitals during the traditional open technique for preparation and administration of cyclophosphamide and a significant reduction in contamination when a closed-system device was used. However, some values were considered unexpected, especially those obtained from samples collected after the cleaning surfaces.