Cross-sectional studies in prescribing research

A cross-sectional study aims to describe the overall picture of a phenomenon, a situational problem, an attitude or an issue, by asking a cross-section of a given population at one specified moment in time. This paper describes the key features of the cross-sectional survey method. It begins by highlighting the main principles of the method, then discusses stages in the research process, drawing on two surveys of primary care pharmacists to illustrate some salient points about planning, sampling frames, definition and conceptual issues, research instrument design and response rates. Four constraints in prescribing studies were noted. First the newness of the subject meant a low basis of existing knowledge to design a questionnaire. Second, there was no public existing database for the sampling frame, so a pragmatic sampling exercise was used. Third, the definition of a Primary Care Pharmacist (PCP) [in full] and respondents recognition of that name and identification with the new role limited the response. Fourth, a growing problem for all surveys, but particularly with pharmacists and general practitioners (GP) [in full] is the growing danger of survey fatigue, which has a negative impact on response levels.

Primary care pharmacists: a profile

A survey was carried out in 1998 in 43 English health authorities of primary care pharmacists (employed to provide prescribing advice to GPs at medical practice level). 119 responses were received (66%). Most combined working as a PCP with another occupation, usually community pharmacy (57%), hospital pharmacy (13%) or as an academic (7%). 53% of respondents worked 8 hours or less per week as a PCP. Only 18 respondents were employed full-time as a PCP. The most common activities were drug information (91%), PACT analysis (90%), drug cost containment (90%) and review of individual patient medication (88%). (7 refs.)

The design of novel antifolates against pneumocystis carinii

The pneumonia caused by Pneumocystis carinii is ultimately responsible for the death of many acquired immunodeficiency syndrome (AIDS) patients. Large doses of trimethoprim and pyrimethamine in combination with a sulphonamide and/or pentamidine suppress the infection but produce serious side-effects and seldom prevent recurrence after treatment withdrawal. However, the partial success of the aforementioned antifolates, and also trimetrexate used alone, does suggest dihydrofolate reductase (DHFR) as a target for the development of antipneumocystis agents. From the DHFR inhibitory activities of 3'-substituted pyrimethamine analogues it was suggested that the 3'-(3'',3''-dimethyltriazen-1''-yl) substituent may be responsible for the greater activity for the P.carinii over the mammalian enzyme. Crystallographic and molecular modeling studies revealed considerable geometrical and electronic differences between the triazene and the chemically related formamidine functions that may account for the differences in DHFR inhibitory profiles. Structural and electronic parameters calculated for a series of 3'-(3'',3''-disubstitutedtriazen-1''-yl) pyrimethamine analogues did not correlate with the DHFR inhibitory activities. However, the in vitro screening against P.carinii DHFR revealed that the 3''-hydroxyethyl-3''-benzyl analogue was the most active and selective. Models of the active sites of human and P.carinii DHFRs were constructed using DHFR sequence and structural homology data which had identified key residues involved in substrate and cofactor binding. Low energy conformations of the 3'',3''-dimethyl and 3''-hydroxyethyl-3''-benzyle analogues, determined from nuclear magnetic resonance studies and theoretical calculations, were docked by superimposing the diaminopyrimidine fragment onto a previously docked pyrimethamine analogue. Enzyme kinetic data supported the 3''-hydroxyethyl-3''-benzyl moiety being located in the NADPH binding groove. The 3''-benzyl substituent was able to locate to within 3 AA of a valine residue in the active site of P.carinii DHFR thereby producing a hydrophobic contact. The equivalent residue in human DHFR is threonine, more hydrophilic and less likely to be involved in such a contact. This difference may account for the greater inhibitory activity this analogue has for P.carinii DHFR and provide a basis for future drug design. From an in vivo model of PCP in immunosuppressed rats it was established that the 3"-hydroxyethyl-3"-benzyl analogue was able to reduce the.P.carinii burden more effectively with increasing doses, without causmg any visible signs of toxicity. However, equivalent doses were not as effective as pentamidine, a current treatment of choice for Pneumocystis carinii pneumonia.

Phase-conjugated pilots for fibre nonlinearity compensation in CO-OFDM transmission

We experimentally demonstrate a novel fibre nonlinearity compensation technique for CO-OFDM based on phase-conjugated pilots (PCPs), showing that, by varying the PCP overhead a performance improvement up to 4 dB can be achieved allowing highly flexible adaptation to link characteristics.

Phase-conjugated pilots for fibre nonlinearity compensation in CO-OFDM transmission

In this paper, we demonstrate a novel fiber nonlinearity compensation technique for coherent optical orthogonal frequency-division multiplexing (CO-OFDM) systems based on the transmission of phase-conjugated pilots (PCPs). In this scheme, a portion of OFDM subcarriers (up to 50%) is transmitted with its phase conjugates, which is used at the receiver to estimate the nonlinear distortions in the respective subcarriers and other subcarriers, which are not accompanied by PCPs. Simulation and experimental results show that by varying the PCP overhead, a performance improvement up to 4 dB can be achieved. In addition, the proposed technique can be effectively applied in both single polarization and polarization-division multiplexed systems, in both single channel and wavelength-division multiplexing systems, thus, offering highest flexibility in implementations.

Techniques for noise and nonlinear impairments compensation in CO-OFDM transmission

In this paper, we discuss recent advances in digital signal processing techniques for compensation of the laser phase noise and fiber nonlinearity impairments in coherent optical orthogonal frequency division multiplexing (CO-OFDM) transmission. For laser phase noise compensation, we focus on quasi-pilot-aided (QPA) and decision-directed-free blind (DDF-blind) phase noise compensation techniques. For fiber nonlinearity compensation, we discuss in details the principle and performance of the phase-conjugated pilots (PCP) scheme.

The construction and optimization of an ion mobility spectrometer for the analysis of explosives and drugs

Today, over 15,000 Ion Mobility Spectrometry (IMS) analyzers are employed at worldwide security checkpoints to detect explosives and illicit drugs. Current portal IMS instruments and other electronic nose technologies detect explosives and drugs by analyzing samples containing the headspace air and loose particles residing on a surface. Canines can outperform these systems at sampling and detecting the low vapor pressure explosives and drugs, such as RDX, PETN, cocaine, and MDMA, because these biological detectors target the volatile signature compounds available in the headspace rather than the non-volatile parent compounds of explosives and drugs.^ In this dissertation research volatile signature compounds available in the headspace over explosive and drug samples were detected using SPME as a headspace sampling tool coupled to an IMS analyzer. A Genetic Algorithm (GA) technique was developed to optimize the operating conditions of a commercial IMS (GE Itemizer 2), leading to the successful detection of plastic explosives (Detasheet, Semtex H, and C-4) and illicit drugs (cocaine, MDMA, and marijuana). Short sampling times (between 10 sec to 5 min) were adequate to extract and preconcentrate sufficient analytes (> 20 ng) representing the volatile signatures in the headspace of a 15 mL glass vial or a quart-sized can containing ≤ 1 g of the bulk explosive or drug.^ Furthermore, a research grade IMS with flexibility for changing operating conditions and physical configurations was designed and fabricated to accommodate future research into different analytes or physical configurations. The design and construction of the FIU-IMS were facilitated by computer modeling and simulation of ion’s behavior within an IMS. The simulation method developed uses SIMION/SDS and was evaluated with experimental data collected using a commercial IMS (PCP Phemto Chem 110). The FIU-IMS instrument has comparable performance to the GE Itemizer 2 (average resolving power of 14, resolution of 3 between two drugs and two explosives, and LODs range from 0.7 to 9 ng). ^ The results from this dissertation further advance the concept of targeting volatile components to presumptively detect the presence of concealed bulk explosives and drugs by SPME-IMS, and the new FIU-IMS provides a flexible platform for future IMS research projects.^

Comparative transcriptome analyses of Pseudomonas aeruginosa

One of the hallmarks of bacterial survival is their ability to adapt rapidly to changing environmental conditions. Niche adaptation is a response to the signals received that are relayed, often to regulators that modulate gene expression. In the post-genomic era, DNA microarrays are used to study the dynamics of gene expression on a global scale. Numerous studies have used Pseudomonas aeruginosa--a Gram-negative environmental and opportunistic human pathogenic bacterium--as the model organism in whole-genome transcriptome analysis. This paper reviews the transcriptome studies that have led to immense advances in our understanding of the biology of this intractable human pathogen. Comparative analysis of 23 P. aeruginosa transcriptome studies has led to the identification of a unique set of genes that are signal specific and a core set that is differentially regulated. The 303 genes in the core set are involved in bacterial homeostasis, making them attractive therapeutic targets.

The Construction and Optimization on an Ion Mobility Spectrometer for the Analysis of Explosives and Drugs

Today, over 15,000 Ion Mobility Spectrometry (IMS) analyzers are employed at worldwide security checkpoints to detect explosives and illicit drugs. Current portal IMS instruments and other electronic nose technologies detect explosives and drugs by analyzing samples containing the headspace air and loose particles residing on a surface. Canines can outperform these systems at sampling and detecting the low vapor pressure explosives and drugs, such as RDX, PETN, cocaine, and MDMA, because these biological detectors target the volatile signature compounds available in the headspace rather than the non-volatile parent compounds of explosives and drugs. In this dissertation research volatile signature compounds available in the headspace over explosive and drug samples were detected using SPME as a headspace sampling tool coupled to an IMS analyzer. A Genetic Algorithm (GA) technique was developed to optimize the operating conditions of a commercial IMS (GE Itemizer 2), leading to the successful detection of plastic explosives (Detasheet, Semtex H, and C-4) and illicit drugs (cocaine, MDMA, and marijuana). Short sampling times (between 10 sec to 5 min) were adequate to extract and preconcentrate sufficient analytes (> 20 ng) representing the volatile signatures in the headspace of a 15 mL glass vial or a quart-sized can containing ≤ 1 g of the bulk explosive or drug. Furthermore, a research grade IMS with flexibility for changing operating conditions and physical configurations was designed and fabricated to accommodate future research into different analytes or physical configurations. The design and construction of the FIU-IMS were facilitated by computer modeling and simulation of ion’s behavior within an IMS. The simulation method developed uses SIMION/SDS and was evaluated with experimental data collected using a commercial IMS (PCP Phemto Chem 110). The FIU-IMS instrument has comparable performance to the GE Itemizer 2 (average resolving power of 14, resolution of 3 between two drugs and two explosives, and LODs range from 0.7 to 9 ng). The results from this dissertation further advance the concept of targeting volatile components to presumptively detect the presence of concealed bulk explosives and drugs by SPME-IMS, and the new FIU-IMS provides a flexible platform for future IMS research projects.

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

Indicador de vulnerabilidade agropecuária a extremos climáticos para o nordeste do Brasil

The effects of climate change on human societies have become the focus of many researchers for their research. Understanding weather patterns (circulation of the atmosphere, precipitation, temperature) is essences for predicting extreme weather, but analyze how these extreme events act in our society and look for ways to reduce the impact caused by these events is the great challenge. Using a concept very in the humanities and social sciences to understand these impacts and the adaptation of the society's vulnerability. The objective of this work is to develop and apply a methodology for evaluating fining scale and quantify the vulnerability of the Brazilian Northeast to climatic extremes, developing a methodology that combines aspects of vulnerability to drought, as well as socioeconomic and climatic indicators used to assess exposure, ability to adaptation and the sensitivity of geographical microregions of the region. The assessment of the susceptibility or degree of exposure to risk is the regional using the SPI (Standardized Precipitation Index) by the degree of magnitude dried (MD), the rate of precipitation such as PCD (Precipitation Concentration Degree) and PCP (Precipitation Period Concentration) helped characterize and regional climatology, these indices showed satisfactory results in the pilot study of Rio Grande do Norte to assess the degree of exposure to drought. Regarding sensitivity agricultural / livestock multivariate statistical technique to factor analysis showed acceptable results for the proposed model using data for the period 1990-1999 (P1). The application of the analysis of vulnerability considering the adaptive capacity, as the adaptive disability have almost similar results with much of the region's vulnerability to extreme south of Bahia state as a part of the semiarid region has a degree of vulnerability among moderate and mean

Características dos programas de residência médica em cardiologia do estado do Rio Grande do Norte

The present study had as goal to evaluate Rio Grande do Norte state’s medical residency programs (MRP) in Cardiology. It’s a descriptive study, including a documental analysis of the program’s accreditation processes (PAP) of cardiology’s medical residency in Rio Grande do Norte state in 2014 and the analysis of the resident’s perception about his professional education as a specialist in Cardiology. Beside the documental analysis of the PAPs, it was applied a semi-structured questionnaire with closed questions Likert style and open questions to all the current and former residents of the MRPs analyzed. Two MRPs in Cardiology were identified in Rio Grande do Norte state, one hosted in a public institution and the other in a private institution. The documental analysis showed a greater amount of preceptors with a good level of ownership on the public institution in comparison with the private one, as well as a bigger number of publications, participation in congresses and in book’s publications. The private institution presents a better Urgency’s infrastructure, with emergency room and cardiologic ICU. It IS clear that the residents are aware of how a good residency must work, as well as the strengths and fragilities of their own residences. Most of Onofre Lopes Universitary Hospital’s residents point out as a strength the organization, participation and quality of the preceptors, practice activities and scientific debates, great amount of patients and the visits and debates with the preceptors on the sickrooms. As the greatest fragilities, they emphasize the lack of a urgency service of their own and a specialized ICU. In Coração Hospital of Natal (HCor), it is listed as weak points the theoretic scheduling and the few ambulatory practices. As positive aspects, they report the preceptors, the agility on the execution of exams, a good number of serious patients and procedures. In both residences, it is seen a certain difficulty in accepting the important and mandatory items imposed by the rules of the Medical Residences’ National Committee, such as: biostatistics, bioethics, medical ethic, epidemiology and research methodology. Besides that, the residents recognize that both hospitals have a good infrastructure and technological support, especially in imaging methods. The evaluation of PRMCs identifies the strengths of each program and the aspects to be improved in both programs. It also allowed the observation of difficulties in accepting some regulations contained in the CNRM resolution by the resident, such as participation in activities such as biostatistics, epidemiology and research methodology as well as the improvement needs of specific technical training, such as in emergency care. Thus, our results make possible to develop strategies for continued improvement of PRMC in RN state. In addition, it enabled the preparation of the resident’s manual in cardiology, containing even a breakdown of resident evaluation system, which could serve as a model for other residency programs.

Planejando com lean construction: diretrizes para implementação da construção enxuta em obras

Nowadays lives up in an era of tight credit caused by the global financial crisis, as occurred in the past, it is the responsibility of various sectors and segments of society find ways to reinvent itself. In this context, Lean Construction presents itself as a strong alternative production management for companies in the construction segment. Arising out of lean thinking that originated in Japan in the postwar period and has spread around the world in times of extreme scarcity with the oil crisis. In practice the Lean Construction is a philosophy that seeks to improve the process of production management, maximizing the value of the flow from the customer's perspective through the elimination of losses. And thrives in environments and cultures that consider the scarcity of resources like something natural, applying both the macroeconomic crisis as in times of prosperity. The Planning and Production Control - PCP presents itself as a fundamental building block for companies to protect themselves in the face of economic fluctuations, seeking for their survival and success in the competitive market. Motivated by the lack of discussion of the topic in the local academy, and for the identification of 93.33% of construction companies that do not make use of methodological tools for PCP in the state, this dissertation aims to study and propose the implementation of lean construction in methodology of planning projects implemented on construction sites. This characterized the management system, of the production of a construction company, pointing out the main causes of ineffectiveness related to consequent low performance of one of his ventures. In sequence, the PCP was implemented with the use of tools to serve the principles of lean construction. This being monitored through indicators that provided managers managerial view of process of actions control and production of protective mechanisms. All implementation guidelines and application of this management model, were exposed in a simplified way, practical and efficient, in order to break the resistance of new practices and old paradigms in the industry.

Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.

BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. METHODS: PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. CONCLUSION: Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.

Reduced calcification decreases photoprotective capability in the Coccolithophorid Emiliania huxleyi

Intracellular calcification of coccolithophores generates CO2 and consumes additional energy for acquisition of calcium and bicarbonate ions; therefore, it may correlate with photoprotective processes by influencing the energetics. To address this hypothesis, a calcifying Emiliania huxleyi strain (CS-369) was grown semi-continuously at reduced (0.1 mM, LCa) and ambient Ca2+ concentrations (10 mM, HCa) for 150 d (>200 generations). The HCa-grown cells had higher photosynthetic and calcification rates and higher contents of Chl a and carotenoids compared with the naked (bearing no coccoliths) LCa-grown cells. When exposed to stressfull levels of photosynthetically active radiation (PAR), LCa-grown cells displayed lower photochemical yield and less efficient non-photochemical quenching (NPQ). When the LCa- or HCa-grown cells were inversely shifted to their counterpart medium, LCa to HCa transfer increased photosynthetic carbon fixation (P), calcification rate (C), the C/P ratio, NPQ and pigment contents, whereas those shifted from HCa to LCa exhibited the opposite effects. Increased NPQ, carotenoids and quantum yield were clearly linked with increased or sustained calcification in E. huxleyi. The calcification must have played a role in dissipating excessive energy or as an additional drainage of electrons absorbed by the photosynthetic antennae. This phenomenon was further supported by testing two non-calcifying strains, which showed insignificant changes in photosynthetic carbon fixation and NPQ when transferred to LCa conditions