How to Improve the Use of Proton Pump Inhibitors

Introduction: Proton pump inhibitors (PPI) are one of the most prescribed medications in the world with proven efficacy. However, several studies showed that their use often doesn't respect indications, leading to over-consumption, thus exposing patients to drug interactions and adverse events (for example pneumonias). Interruption of PPIs can induce a rebound phenomenon. This generates costs for health systems.Methods: This is a prospective interventional study performed in two hospitals: La Chaux-de-Fonds (CDF, cases) and Neucha^tel (NE, control) during two six-month periods, comparing use of PPIs before and after intervention. We elaborated recommendations (PPI doses and treatment duration) based on recent medical literature that we summarized on A6 cards and gave out to all prescribing doctors in the hospital of CDF and held a 30-minute information session for the departments of surgery, medicine and anesthesiology in March 2010. Doctors were asked to apply our recommendations as often as possible, leaving space for their own assessment. No information was given to the doctors of the control hospital. The number of PPI tablets that the pharmacy sent to each careunit in both hospitals was counted and adjusted to the number of patientdays from April to September 2009 (before intervention) and April to September 2010 (after intervention). The number of other antacids that were used in both hospitals was counted during the same periods. General practitioners (GP) in the region around CDF received an explanation letter to avoid re-introduction, after discharge from the hospital, of PPI treatment stopped during the stay. The number of gastro-duodenal ulcers and upper digestive hemorrhages was counted from April to December 2009 and the same period in 2010 in both hospitals.Results: In 2010, in the hospital of CDF, the use of PPIs per 100 patient-days decreased by 36% in the surgical and medical departments compared to 2009. In the control hospital the use of PPIs per 100 patient-days increased by 10% in the surgical department and decreased by 5% in the medical department during the same periods. The decrease from 2009 to 2010 of PPI utilization in CDF comparing to NE is statistically significant: p<0.0001. Use of other antacids didn't change, ulcers or digestive hemorrhages decreased slightly from 2009 to 2010 in both hospitals. Conclusions: The study showed that with a very low-cost intervention, it is possible to decrease considerably the use of PPIs in a hospital, without taking any risk for gastro-intestinal complications.

Alcohol expectancies and alcohol outcomes: effects of the use of protective behavioral strategies.

OBJECTIVE: Alcohol expectancies (AEs) are positively associated with drinking behaviors, whereas the use of protective behavioural strategies (PBS) is negatively related to alcohol outcomes among young adults. PBS have been shown to weaken relationships between some alcohol risk factors and alcohol outcomes. This study aimed to examine longitudinally the moderating effect of PBS on the relationships between AEs and alcohol outcomes among young adults. METHOD: Participants (N = 188; 61.7% female) were U.S. young adults participating in a larger longitudinal study. Measures of PBS, AEs, alcohol use, and related consequences were used from the baseline and 12-month follow-up assessments. RESULTS: Negative binomial hurdle models found that PBS (total score) significantly moderated the relationship between positive AEs and consequences, such that among high school seniors endorsing higher positive AEs, those using more PBS in high school reported fewer negative consequences 1 year later. PBS (Manner of Drinking) also moderated the relationship between negative AEs and alcohol use, revealing the use of PBS in high school as having a protective function against later drinking among participants with high positive AEs. Last, PBS (Serious Harm Reduction) significantly moderated the associations between positive AEs and alcohol use and between negative AEs and consequences, such that participants with higher AEs and higher PBS use in high school were at greatest risk for drinking and experiencing negative consequences later. CONCLUSIONS: Overall, these findings suggest that PBS use may be protective by weakening relationships between positive AEs and alcohol outcomes. Limitations and future directions are discussed.

THE ROLE OF NANOMATERIALS IN COSMETICS: NATIONAL AND INTERNATIONAL LEGISLATIVE ASPECTS

Nanotechnology is currently one of the fastest growing scientific fields. The products of this science have become part of our everyday lives. However, to date, regulatory agencies have not yet established a single definition for nanomaterials and nanotechnology. Therefore, each country has its own definitions and legislation to control products containing nanomaterials. Being relatively new materials, there are no long-term studies showing their impact on human health and the environment. Consequently, countries control the amount of nanomaterials present in cosmetics, allowing the end consumer to choose which cosmetic to use, by choosing products with or without nanomaterials. Therefore, the primary objective of this study was to identify the most used nanomaterials in cosmetics and verify whether these formulations are in accordance with the laws in force in the United States, the European Union and Brazil, thereby determining if the cosmetics on the market are in line with the existing laws in these three economic powers. This study is unique and will contribute to furthering the discussion on existing laws pertinent to the use of nanotechnology in cosmetics.

Use of gibberellin in floriculture

This review aimed to show the use of gibberellin in floriculture. In this context, it should be noted that the benefit of the activity of the gibberellins has brought major advances in the field of physiology. Its use is one of the most important tools for the development of agriculture. Thus, the study concluded that the use of gibberellins has been increasingly used by producers and is also a vast important subject that may help in increasing the production of flowers if the farms are dedicated to this purpose.

Exploring the use of local binary patterns as focus measure

[EN]In this work local binary patterns based focus measures are presented. Local binary patterns (LBP) have been introduced in computer vision tasks like texture classification or face recognition. In applications where recognition is based on LBP, a computational saving can be achieved with the use of LBP in the focus measures. The behavior of the proposed measures is studied to test if they fulfill the properties of the focus measures and then a comparison with some well know focus measures is carried out in different scenarios.

Use of linezolid in neonatal and pediatric inpatient facilities-results of a retrospective multicenter survey

The purpose of this investigation was to describe the use of linezolid in pediatric inpatient facilities. A retrospective multicenter survey including data from nine participating tertiary care pediatric inpatient facilities in Germany and Austria was undertaken. Data on 126 off-label linezolid treatment courses administered to 108 patients were documented. The survey comprises linezolid treatment in a broad spectrum of clinical indications to children of all age groups; the median age was 6.8 years (interquartile range 0.6-15.5 years; range 0.1-21.2 years; ten patients were older than 18 years of age but were treated in pediatric inpatient units). Of the 126 treatment courses, 27 (21%) were administered to preterm infants, 64 (51%) to pediatric oncology patients, and 5% to patients soon after liver transplantation. In 25%, the infection was related to a medical device. Linezolid iv treatment was started after intensive pre-treatment (up to 11 other antibiotics for a median duration of 14 days) and changed to enteral administration in only 4% of all iv courses. In 39 (53%) of 74 courses administered to children older than 1 week and younger than 12 years of age, the dose was not adjusted to age-related pharmacokinetic parameters. In only 17 courses (13%) was a pediatric infectious disease consultant involved in the clinical decision algorithm. Linezolid seemed to have contributed to a favorable outcome in 70% of all treatment courses in this survey. Although retrospective, this survey generates interesting data on the off-label use of linezolid and highlights several important clinical aspects in which the use of this rescue antibiotic in children might be improved.

Restricted use of glycopeptides in paediatric cancer patients with fever and neutropenia

Until now, studies confirming the safety of glycopeptide restriction in the empirical treatment of prolonged fever and neutropenia included only nine children. In an open-label observational study, the use of teicoplanin in paediatric oncology patients was investigated. A period of unrestricted use (2001-2003) was compared with a second period (2004) following implementation of a restrictive treatment guideline. Empirical first-line treatment consisted of piperacillin/tazobactam; in 2004, fosfomycin was added after 72 h as the second-line combination instead of teicoplanin. In total, 213 episodes (n=163 in 2001-2003; n=50 in 2004) managed with teicoplanin or fosfomycin (only 2004) were eligible. Empirical treatment of fever of unknown origin with teicoplanin was reduced by 97%. In 2004, the mean length of stay was 0.4 days shorter, no infection-related death occurred and no vancomycin-resistant enterococci were detected. Restriction of empirical glycopeptides is safe in paediatric cancer patients after first-line treatment with piperacillin/tazobactam. Fosfomycin appears to offer a feasible and cost-saving alternative in second-line combination therapy.

Impact of anti-inflammatory treatment on the onset of uveitis in juvenile idiopathic arthritis: Longitudinal analysis from a nation-wide paediatric rheumatological database

PURPOSE Based on a nation-wide database, this study analysed the influence of methotrexate (MTX), TNF inhibitors and a combination of the two on uveitis occurrence in JIA patients. METHODS Data from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating paediatric rheumatological sites. Patients with JIA disease duration of less than 12 months at initial documentation and ≥2 years of follow-up were included in this study. The impact of anti-inflammatory treatment on the occurrence of uveitis was evaluated by discrete-time survival analysis. RESULTS A total of 3,512 JIA patients (mean age 8.3±4.8 years, female 65.7%, ANA-positive 53.2%, mean age at arthritis onset 7.8±4.8 years) fulfilled the inclusion criteria. Mean total follow-up time was 3.6±2.4 years. Uveitis developed in a total of 180 patients (5.1%) within one year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). DMARD treatment in the year before uveitis onset significantly reduced the risk for uveitis: MTX (HR 0.63, p=0.022), TNF inhibitors (HR 0.56, p<0.001) and a combination of the two (HR 0.10, p<0.001). Patients treated with MTX within the first year of JIA had an even a lower uveitis risk (HR 0.29, p<0.001). CONCLUSION The use of DMARDs in JIA patients significantly reduced the risk for uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect. This article is protected by copyright. All rights reserved.

SADMFR Guidelines for the Use of Cone-Beam Computed Tomography/Digital Volume Tomography

In 2011, the first consensus conference on guidelines for the use of cone-beam computed tomography (CBCT) was convened by the Swiss Society of Dentomaxillofacial Radiology (SGDMFR). This conference covered topics of oral and maxillofacial surgery, temporomandibular joint dysfunctions and disorders, and orthodontics. In 2014, a second consensus conference was convened on guidelines for the use of CBCT in endodontics, periodontology, reconstructive dentistry and pediatric dentistry. The guidelines are intended for all dentists in order to facilitate the decision as to when the use of CBCT is justified. As a rule, the use of CBCT is considered restrictive, since radiation protection reasons do not allow its routine use. CBCT should therefore be reserved for complex cases where its application can be expected to provide further information that is relevant to the choice of therapy. In periodontology, sufficient information is usually available from clinical examination and periapical radiographs; in endodontics alternative methods can often be used instead of CBCT; and for implant patients undergoing reconstructive dentistry, CT is of interest for the workflow from implant planning to the superstructure. For pediatric dentistry no application of CBCT is seen for caries diagnosis.

Exploring the use of pharmaceutical patient assistance programs as an option to improve access to and affordability of prescription drugs

Background. Pharmaceutical-sponsored patient assistance programs (PAPs) are charity programs that provide free or reduced-priced medications to eligible patients. PAPs have the potential to improve prescription drug accessibility for patients but currently there is limited information about their use and effectiveness. ^ Objectives and methods. This dissertation described the use of PAPs in the U.S. through the conduct of two studies: (1) a systematic review of primary studies of PAPs from commercially-published and “grey” literature sources; and (2) a retrospective, cross-sectional study of cancer patients' use of PAPs at a tertiary care cancer outpatient center. ^ Results. (1) The systematic review identified 33 studies: 15 evaluated the impact of PAP enrollment assistance programs on patient healthcare outcomes; 7 assessed institutional costs of providing enrollment assistance; 7 surveyed stakeholders; 4 examined other aspects. Standardized mean differences calculated for disease indicator outcomes (most of which were single group, pre-posttest designs) showed significant decreases in glycemic and lipid control, and inconsistent results for blood pressure. Grey literature abstracts reported insufficient statistics for calculations. Study heterogeneity made weighted summary estimates inappropriate. Economic analyses indicated positive financial benefits to institutions providing enrollment assistance (cost) compared to the wholesale value of the medications provided (benefit); analyses did not value health outcomes. Mean quality of reporting scores were higher for observational studies in commercially-published articles versus full text, grey literature reports. (2) The cross-sectional study found that PAP outpatients were significantly more likely to be uninsured, indigent, and < 65 years old than non-PAP patients. Nearly all non-PAP and PAP prescriptions were for non-cancer conditions, either for co-morbidities (e.g., hypertension) or the management of treatment side effects (e.g., pain). Oral chemotherapies from PAPs were significantly more likely to be for breast versus other cancers, and be a newer, targeted versus traditional chemotherapy.^ Conclusions. In outpatient settings, PAP enrollment assistance plus additional medication services (e.g., counseling, reminders, and free samples) is associated with improved disease indicators for patients. Healthcare institutions, including cancer centers, can offset financial losses from uncompensated drug costs and recoup costs invested in enrollment assistance programs by procuring free PAP medications. Cancer patients who are indigent and uninsured may be able to access more outpatient medications for their supportive care needs through PAPs, than for cancer treatment options like oral chemotherapies. Because of the selective availability of drugs through PAPs, there may be more options for newer, oral, targeted chemotherapies for the treatment breast cancer versus other for other cancers.^

The role of visualizations in urban forestry. Conclusions from managers’ perspectives

La presente tesis examina el uso potencial y actual de las técnicas de simulación visual aplicadas al campo de la gestión y la planificación del arbolado urbano. El estudio incluye las aplicaciones potenciales de las visualizaciones por ordenador, así como los beneficios que esto acarrearía. También se analizan las posibles barreras que surgirían de la implementación de esta nueva herramienta y se ofrece una lista de recomendaciones para superarlas. La investigación tiene un carácter exploratorio que utiliza una combinación de técnicas de investigación cuantitativas y cualitativas, dónde se emplean cuestionarios y entrevistas personales semi-estructuradas para estudiar y analizar las opiniones y reacciones de los gestores de arbolado urbano de los distritos de la ciudad de Londres (Reino Unido), denominados Tree Officers (LTOs). Para el desarrollo de la tesis se recopilaron y analizaron las respuestas al cuestionario del 41 por ciento de los LTOs pertenecientes al 88 por ciento de los distritos de Londres y se realizaron un total de 17 entrevistas personales. Los resultados del análisis estadístico de las respuestas del cuestionario y los análisis cruzados de las distintas variables se complementaron con las conclusiones obtenidas del análisis temático de los datos cualitativos recopilados durante las entrevistas. Los usos potenciales de las técnicas de simulación visual aplicadas a la gestión y planificación del arbolado urbano sugeridos fueron obtenidos combinado las conclusiones de, primero, la comparación de las cuestiones que los LTOs consideraron que más tiempo y recursos necesitaban y que actualmente no era posible resolverlas satisfactoriamente con las herramientas y los procesos disponibles, con la información acerca de cómo se habían empleado las visualizaciones en situaciones similares en otros campos tales como planificación urbano, el paisajismo o la gestión forestal. Segundo, se analizaron las reacciones y opiniones de los LTOs ante un conjunto de visualizaciones presentadas durante las entrevistas, desarrolladas ad hoc para mostrar un abanico representativo de ejemplos de utilización de las técnicas de simulación visual, que, a su vez se complementaron con los usos adicionales que los propios LTOs sugirieron tras ver las visualizaciones presentadas. Los resultados muestran que el uso actual de simulaciones visuales por parte de los LTOs es muy limitado pero si que reciben un gran número de visualizaciones de otros departamentos y como parte de la documentación presentada en las solicitudes de permisos para edificación o desarrollo urbanístico. Los resultados indican que las visualizaciones que son presentadas a los LTOs no son objetivas ni precisas por lo que se argumenta que esta situación es un factor importante que impide una toma de decisiones adecuada y una correcta transmisión de infracción al público y al resto de partes implicadas. Se sugiere la creación de un código que regule el uso de visualizaciones en el campo de la gestión y planificación del arbolado urbano. ABSTRACT This thesis examined the use of computer visualizations in urban forestry management and planning. Potential roles of visualizations were determined the benefits that its use would provide. Additionally, the possible barriers in the implementation of visualizations in urban forestry management and planning were also studied and recommendations on how to overcome them were provided The research conducted was an exploratory study using survey research methods and personal semi-structured interviews. The perspectives and reactions of London (UK) boroughs’ tree officers (LTOs) were analysed combining quantitative and qualitative research methods. The study surveyed 41 percent of all Tree Officers in London, obtaining responses from 88 percent of the boroughs and performed 17 personal interviews. Statistical analysis of the data and cross-variables analysis provided rich information that was then complemented with the conclusions from thematic analysis of the qualitative data from the interviews. Potential roles of visualizations were determined first by understanding the challenges that LTOs are facing today and comparing them with how visualizations have helped in similar situations in urban forestry and other related fields like landscape architecture, urban planning and forestry; second, the reactions of LTOs to a set of examples of proposed uses of visualizations were also complemented with the additional uses proposed by LTOs after seeing the visualizations. The visualizations were created ad hoc to show a variety of representative examples of the sue of visualization in urban forestry management and planning and were presented during the interviews to LTOS. Results show that the current production of visualizations is very reduced among tree officers but that they are frequent receptors of visualizations coming from other departments and as part of the documentation of planning applications. Findings show that the current visualizations that get to Tree Officers are biased and inaccurate and therefore it is argued the the current use of visualizations is a threat to legitimate informed decision making and public information. The development of a code for the use of visualizations in urban forestry management and planning is suggested.

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study

Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.

A grammar of botany : containing an explanation of the system of Linnæus, and the terms of botany, with botanical exercises, for the use of schools and students ... /

"Termini botanici; a dictionary of botanical terms, for the use of students in botany. A new ed. By James Lee ...": p. [227]-314. The dictionary was first published as an appendix to Lee's Introduction to botany.

The Role of Geometry in Wordsworth's "Science of Feelings"

Thesis (Ph.D.)--University of Washington, 2016-06

The role of context in producing item interactions and false memories

Cued recall with an extralist cue poses a challenge for contemporary memory theory in that there is a need to explain how episodic and semantic information are combined. A parallel activation and intersection approach proposes one such means by assuming that an experimental cue will elicit its preexisting semantic network and a context cue will elicit a list memory. These 2 sources of information are then combined by focusing on information that is common to the 2 sources. Two key predictions of that approach are examined: (a) Combining semantic and episodic information can lead to item interactions and false memories, and (b) these effects are limited to memory tasks that involve an episodic context cue. Five experiments demonstrate such item interactions and false memories in cued recall but not in free association. Links are drawn between the use of context in this setting and in other settings.