Pharmaceutical care in an inpatient pediatric intensive care unit: an international multicentric study

Introduction Pediatric intensive care patient represent a population athigh risk for drug-related problems. Our objective is to describe drugrelated problems and intervention of four decentralized pharmacists inpediatric and cardiac intensive care unit.Materials & Methods Multicentric, descriptive and prospectivestudy over a six-month period (August 1st 2009-January 31st 2010).Drug-related problems and clinical interventions were compiled infour pediatric centers using a tool developed by the Socie´te´ Franc¸aisede Pharmacie Clinique. Data concerning patients, drugs, intervention,documentation, approval (if needed), and estimated impact werecompiled. The four pharmacists participating were from Belgium (B),France (F), Quebec (Q) and Switzerland (S).Results A total of 996 interventions were collected: 129 (13%) in B,238 (24%) in F, 278 (28%) in Q and 351 (35%) in S. These interventionstargeted 269 patients (median 22 month-old, 52% male): 69(26%) in B, 88 (33%) in F, 56 (21%) in Q and in S. These data werecollected during 28 non consecutive days in the clinical unit in B, 59days in F, 42 days in Q and 63 days in S. The main drug-relatedproblems were inappropriate administration technique (293, 29%),untreated indication (254, 25%) and supra therapeutic dosage (106,11%). The pharmacist's interventions concerned mainly administrationmode optimization (223, 22%), dose adjustment (200, 20%) andtherapeutic monitoring (164, 16%). The three major drug classesleading to interventions were anti-infectives for systemic use (233,23%) and alimentary tract and metabolism drugs (218, 22%). Interventionsconcerned mainly residents and all clinical staff (209, 21%).Among the 879 (88%) interventions requiring a physician's approval,731 (83%) were accepted. Interventions were considered as having amoderate (51%) or major (17%) clinical impact. Among the interventionsprovided, 10% were considered to have an economicalpositive impact. Differences and similarities between countries willbe presented at the poster session.Discussion & Conclusion Decentralized pharmacist at patient bedsideis a pre-requisite for pharmaceutical care. There are limitedstudies comparing the activity of clinical pharmacists betweencountries. This descriptive study illustrates the ability of clinicalpharmacist to identify and solve drug-related problems in pediatricintensive care unit in four different francophone countries.

Copper, zinc and manganese in soils of two watersheds in Santa Catarina with intensive use of pig slurry

Systematic pig slurry application to crop soils may lead to the accumulation of heavy metals in regions with intensive pig raising. The aim of this study was to evaluate the accumulation of Cu, Zn and Mn in soils under systematic pig slurry application. For this purpose, soil samples were collected from two of the most representative watersheds of Santa Catarina where the predominant activity is pig raising. In each watershed, 12 properties were chosen to evaluate the different systems of pig husbandry (complete cycle (CC), farrowing (FaU) and finishing units (FiU)). Based on information of the producers, soil samples were collected in areas with and without systematic manure application. To determine the total Cu, Zn and Mn content in soils and manure, a methodology proposed by the Environmental Protection Agency of the United States (USEPA), method nº 3050B, was used. For the available heavy metal content, Cu and Zn was extracted with HCl 0.1 mol L-1 and Mn with KCl 1 mol L-1. Data were subjected to multivariate analysis, using the canonical discriminant analysis to identify the metals that best differentiate the soils studied within each swine housing system. Successive pig slurry applications cause an increase in Cu, Zn and Mn availability in the soil and this indicates the need for monitoring of the metal concentrations over time. The critical values of Cu in the soil can be reached and exceeded more rapidly than Zn. The results showed that the soil type may be one of the attribute underlying the determination of public policies in pig raising and waste management because soils such as Inceptisols were shown to be more prone to possible contamination since they may more rapidly reach total critical Cu levels.

Tunisian population data on 10 Y-chromosomal loci.

Alleles and haplotypes frequencies for 10 Y-chromosome STR loci (DYS19, DYS385 I/II, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393, DYS438 and DYS439), included in the Y-Plex6 and Y-Plex5 kits were determined for a Tunisian population sample of 100 male individuals.

Concentrate feeding and milk yield based on field data of milk recorded herds

Selostus: Väkirehuruokinnan vaikutus maidontuotantoon karjantarkkailutiloilta kerätyssä kenttäaineistossa

Le diabète de type 2 est-il uniquement une affaire d'hyperglycémie? Entre science, humanisme et economie [Type 2 diabetes, is it just a case of hyperglycemia? Confusion between the interests of science, humanity and the economy]

The recommendations for the treatment of type 2 diabetic patients are often centered on the glycemia. These clinical trials based on this approach show only a beneficial effects on the prevention of microangiopathy. The coronary artery disease which is the main cause of mortality among these patients, is not reduced. These data should be interpreted with a systemic prospect. The diabetes vascular complications have multifactorial causes and these clinical trials are motivated for the promotion of hypoglycemic agents. Fortunately, the STENO study offers another glance on the treatment of the diabetes, associating multirisk approach and patients' accompaniment. It obliges to have a critical glance on the research often moved by economic issues and gives to the center a humanistic approach based on the therapeutic relation.

Forensic science and the paradigm of quality

Due to various contexts and processes, forensic science communities may have different approaches, largely influenced by their criminal justice systems. However, forensic science practices share some common characteristics. One is the assurance of a high (scientific) quality within processes and practices. For most crime laboratory directors and forensic science associations, this issue is conditioned by the triangle of quality, which represents the current paradigm of quality assurance in the field. It consists of the implementation of standardization, certification, accreditation, and an evaluation process. It constitutes a clear and sound way to exchange data between laboratories and enables databasing due to standardized methods ensuring reliable and valid results; but it is also a means of defining minimum requirements for practitioners' skills for specific forensic science activities. The control of each of these aspects offers non-forensic science partners the assurance that the entire process has been mastered and is trustworthy. Most of the standards focus on the analysis stage and do not consider pre- and post-laboratory stages, namely, the work achieved at the investigation scene and the evaluation and interpretation of the results, intended for intelligence beneficiaries or for court. Such localized consideration prevents forensic practitioners from identifying where the problems really lie with regard to criminal justice systems. According to a performance-management approach, scientific quality should not be restricted to standardized procedures and controls in forensic science practice. Ensuring high quality also strongly depends on the way a forensic science culture is assimilated (into specific education training and workplaces) and in the way practitioners understand forensic science as a whole.

Three-dimensional interpolation of soil data: fertility and pedomorphological features in southern Brazil

The graphical representation of spatial soil properties in a digital environment is complex because it requires a conversion of data collected in a discrete form onto a continuous surface. The objective of this study was to apply three-dimension techniques of interpolation and visualization on soil texture and fertility properties and establish relationships with pedogenetic factors and processes in a slope area. The GRASS Geographic Information System was used to generate three-dimensional models and ParaView software to visualize soil volumes. Samples of the A, AB, BA, and B horizons were collected in a regular 122-point grid in an area of 13 ha, in Pinhais, PR, in southern Brazil. Geoprocessing and graphic computing techniques were effective in identifying and delimiting soil volumes of distinct ranges of fertility properties confined within the soil matrix. Both three-dimensional interpolation and the visualization tool facilitated interpretation in a continuous space (volumes) of the cause-effect relationships between soil texture and fertility properties and pedological factors and processes, such as higher clay contents following the drainage lines of the area. The flattest part with more weathered soils (Oxisols) had the highest pH values and lower Al3+ concentrations. These techniques of data interpolation and visualization have great potential for use in diverse areas of soil science, such as identification of soil volumes occurring side-by-side but that exhibit different physical, chemical, and mineralogical conditions for plant root growth, and monitoring of plumes of organic and inorganic pollutants in soils and sediments, among other applications. The methodological details for interpolation and a three-dimensional view of soil data are presented here.

Estimation of field capacity from ring infiltrometer-drainage data

Field capacity (FC) is a parameter widely used in applied soil science. However, its in situ method of determination may be difficult to apply, generally because of the need of large supplies of water at the test sites. Ottoni Filho et al. (2014) proposed a standardized procedure for field determination of FC and showed that such in situ FC can be estimated by a linear pedotransfer function (PTF) based on volumetric soil water content at the matric potential of -6 kPa [θ(6)] for the same soils used in the present study. The objective of this study was to use soil moisture data below a double ring infiltrometer measured 48 h after the end of the infiltration test in order to develop PTFs for standard in situ FC. We found that such ring FC data were an average of 0.03 m³ m- 3 greater than standard FC values. The linear PTF that was developed for the ring FC data based only on θ(6) was nearly as accurate as the equivalent PTF reported by Ottoni Filho et al. (2014), which was developed for the standard FC data. The root mean squared residues of FC determined from both PTFs were about 0.02 m³ m- 3. The proposed method has the advantage of estimating the soil in situ FC using the water applied in the infiltration test.

Evaluation Gives STAR High Marks, Data Download, Iowa Department of Corrections, February 2010

The Division of Criminal and Juvenile Justice Planning (CJJP) recently released an evaluation of the intensive substance abuse treatment program at the Iowa Correctional Institution for Women (ICIW) – STAR (Sisters Together Achieving Recovery). STAR is a licensed inpatient program utilizing a genderbased therapeutic community model (TC).

Prevalence and factors of intensive care unit conflicts: the conflicus study.

RATIONALE: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. OBJECTIVES: To record the prevalence, characteristics, and risk factors for conflicts in ICUs. METHODS: One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries). MEASUREMENTS AND MAIN RESULTS: Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings. CONCLUSIONS: Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.

Advanced geostatistical and machine-learning models for spatial data analysis of radioactively contaminated regions

Radioactive soil-contamination mapping and risk assessment is a vital issue for decision makers. Traditional approaches for mapping the spatial concentration of radionuclides employ various regression-based models, which usually provide a single-value prediction realization accompanied (in some cases) by estimation error. Such approaches do not provide the capability for rigorous uncertainty quantification or probabilistic mapping. Machine learning is a recent and fast-developing approach based on learning patterns and information from data. Artificial neural networks for prediction mapping have been especially powerful in combination with spatial statistics. A data-driven approach provides the opportunity to integrate additional relevant information about spatial phenomena into a prediction model for more accurate spatial estimates and associated uncertainty. Machine-learning algorithms can also be used for a wider spectrum of problems than before: classification, probability density estimation, and so forth. Stochastic simulations are used to model spatial variability and uncertainty. Unlike regression models, they provide multiple realizations of a particular spatial pattern that allow uncertainty and risk quantification. This paper reviews the most recent methods of spatial data analysis, prediction, and risk mapping, based on machine learning and stochastic simulations in comparison with more traditional regression models. The radioactive fallout from the Chernobyl Nuclear Power Plant accident is used to illustrate the application of the models for prediction and classification problems. This fallout is a unique case study that provides the challenging task of analyzing huge amounts of data ('hard' direct measurements, as well as supplementary information and expert estimates) and solving particular decision-oriented problems.

Evaluating effects of spectral training data distribution on continuous field mapping performance

Continuous field mapping has to address two conflicting remote sensing requirements when collecting training data. On one hand, continuous field mapping trains fractional land cover and thus favours mixed training pixels. On the other hand, the spectral signature has to be preferably distinct and thus favours pure training pixels. The aim of this study was to evaluate the sensitivity of training data distribution along fractional and spectral gradients on the resulting mapping performance. We derived four continuous fields (tree, shrubherb, bare, water) from aerial photographs as response variables and processed corresponding spectral signatures from multitemporal Landsat 5 TM data as explanatory variables. Subsequent controlled experiments along fractional cover gradients were then based on generalised linear models. Resulting fractional and spectral distribution differed between single continuous fields, but could be satisfactorily trained and mapped. Pixels with fractional or without respective cover were much more critical than pure full cover pixels. Error distribution of continuous field models was non-uniform with respect to horizontal and vertical spatial distribution of target fields. We conclude that a sampling for continuous field training data should be based on extent and densities in the fractional and spectral, rather than the real spatial space. Consequently, adequate training plots are most probably not systematically distributed in the real spatial space, but cover the gradient and covariate structure of the fractional and spectral space well. (C) 2009 International Society for Photogrammetry and Remote Sensing, Inc. (ISPRS). Published by Elsevier B.V. All rights reserved.

La pertinence en science forensique. Une (en)quête épistémologique et empirique

A criminal investigation requires to search and to interpret vestiges of a criminal act that happened in a past time. The forensic investigator arises in this context as a critical reader of the investigation scene, in search of physical traces that should enable her to tell a story of the offence/crime which allegedly occurred. The challenge of any investigator is to detect and recognise relevant physical traces in order to provide forensic clues for investigation and intelligence purposes. Inspired by this obser- vation, the current research focuses on the following questions : What is a relevant physical trace? And, how does the forensic investigator know she is facing one ? The interest of such questions is to provide a definition of a dimension often used in forensic science but never studied in its implications and operations. This doctoral research investigates scientific paths that are not often explored in forensic science, by using semiotic and sociological tools combined with statistical data analysis. The results are shown following a semiotic path, strongly influenced by Peir- ce's studies, and a second track, called empirical, where investigations data were analysed and forensic investigators interviewed about their work practices in the field. By the semiotic track, a macroscopic view is given of a signification process running from the discove- red physical trace at the scene to what is evaluated as being relevant for the investigator. The physical trace is perceived in the form of several signs, whose meaning is culturally codified. The reasoning should consist of three main steps : 1- What kind of source does the discovered physical trace refer to ? 2- What cause/activity is at the origin of this source in the specific context of the case ? 3- What story can be told from these observations ? The stage 3 requires to reason in creating hypotheses that should explain the presence of the discovered trace coming from an activity ; the specific activity that is related to the investigated case. To validate this assumption, it would depend on their ability to respond to a rule of relevancy. The last step is the symbolisation of the relevancy. The rule would consist of two points : the recognition of the factual/circumstantial relevancy (Is the link between the trace and the case recognised with the formulated hypothesis ? ) and appropriate relevancy (What investment is required to collect and analyse the discovered trace considering the expected outcome at the investigation/intelligence level?). This process of meaning is based on observations and a conjectural reasoning subject to many influences. In this study, relevancy in forensic science is presented as a conventional dimension that is symbolised and conditioned by the context, the forensic investigator's practice and her workplace environment (culture of the place). In short, the current research states relevancy results of the interactions between parameters from situational, structural (or organisational) and individual orders. The detection, collection and analysis of relevant physical traces at scenes depends on the knowledge and culture mastered by the forensic investigator. In the study of the relation relevant trace-forensic investigator, this research introduces the KEE model as a conceptual map that illustrates three major areas of forensic knowledge and culture acquisition, involved in the research and evaluation of the relevant physical trace. Through the analysis of the investigation data and interviews, the relationship between those three parameters and the relevancy was highlighted. K, for knowing, embodies a rela- tionship to the immediate knowledge allowing to give an overview of the reality at a specific moment ; an important point since relevancy is signified in a context. E, for education, is considered through its relationship with relevancy via a culture that tends to become institutionalised ; it represents the theoretical knowledge. As for the parameter E, for experience, it exists in its relation to relevancy in the adjustments of the strategies of intervention (i.e a practical knowledge) of each practitioner having modulated her work in the light of success and setbacks case after case. The two E parameters constitute the library resources for the semiotic recognition process and the K parameter ensures the contextualisation required to set up the reasoning and to formulate explanatory hypotheses for the discovered physical traces, questioned in their relevancy. This research demonstrates that the relevancy is not absolute. It is temporal and contextual; it is a conventional and relative dimension that must be discussed. This is where the whole issue of the meaning of what is relevant to each stakeholder of the investigation process rests. By proposing a step by step approach to the meaning process from the physical trace to the forensic clue, this study aims to provide a more advanced understanding of the reasoning and its operation, in order to streng- then forensic investigators' training. This doctoral research presents a set of tools critical to both pedagogical and practical aspects for crime scene management while identifying key-influences with individual, structural and situational dimensions. - Une enquête criminelle consiste à rechercher et à faire parler les vestiges d'un acte incriminé passé. L'investigateur forensique se pose dans ce cadre comme un lecteur critique des lieux à la recherche de traces devant lui permettre de former son récit, soit l'histoire du délit/crime censé s'être produit. Le challenge de tout investigateur est de pouvoir détecter et reconnaître les traces dites pertinentes pour fournir des indices forensiques à buts d'enquête et de renseignement. Inspirée par un tel constat, la présente recherche pose au coeur de ses réflexions les questions suivantes : Qu'est-ce qu'une trace pertinente ? Et, comment fait le forensicien pour déterminer qu'il y fait face ? L'intérêt de tels questionnements se comprend dans la volonté de définir une dimension souvent utili- sée en science forensique, mais encore jamais étudiée dans ses implications et fonctionnements. Cette recherche se lance dans des voies d'étude encore peu explorées en usant d'outils sémiotiques et des pratiques d'enquêtes sociologiques combinés à des traitements statistiques de données. Les résultats sont représentés en suivant une piste sémiotique fortement influencée par les écrits de Peirce et une seconde piste dite empirique où des données d'interventions ont été analysées et des investigateurs forensiques interviewés sur leurs pratiques de travail sur le terrain. Par la piste sémiotique, une vision macroscopique du processus de signification de la trace en élément pertinent est représentée. La trace est perçue sous la forme de plusieurs signes dont la signification est codifiée culturellement. Le raisonnement se formaliserait en trois principales étapes : 1- Quel type de source évoque la trace détectée? 2- Quelle cause/activité est à l'origine de cette source dans le contexte précis du cas ? 3- Quelle histoire peut être racontée à partir de ces observations ? Cette dernière étape consiste à raisonner en créant des hypothèses devant expliquer la présence de la trace détectée suite à une activité posée comme étant en lien avec le cas investigué. Pour valider ces hypothèses, cela dépendrait de leur capacité à répondre à une règle, celle de la pertinence. Cette dernière étape consiste en la symbolisation de la pertinence. La règle se composerait de deux points : la reconnaissance de la pertinence factuelle (le lien entre la trace et le cas est-il reconnu dans l'hypothèse fournie?) et la pertinence appropriée (quel est l'investissement à fournir dans la collecte et l'exploitation de la trace pour le bénéfice attendu au niveau de l'investigation/renseignement?). Tout ce processus de signification se base sur des observations et un raisonnement conjectural soumis à de nombreuses influences. Dans cette étude, la pertinence en science forensique se formalise sous les traits d'une dimension conventionnelle, symbolisée, conditionnée par le contexte, la pratique de l'investigateur forensique et la culture du milieu ; en somme cette recherche avance que la pertinence est le fruit d'une interaction entre des paramètres d'ordre situationnel, structurel (ou organisationnel) et individuel. Garantir la détection, la collecte et l'exploitation des traces pertinentes sur les lieux dépend de la connaissance et d'une culture maîtrisées par le forensicien. Dans l'étude du rapport trace pertinente-investigateur forensique, la présente recherche pose le modèle SFE comme une carte conceptuelle illustrant trois grands axes d'acquisition de la connaissance et de la culture forensiques intervenant dans la recherche et l'évaluation de la trace pertinente. Par l'analyse des données d'in- terventions et des entretiens, le rapport entre ces trois paramètres et la pertinence a été mis en évidence. S, pour savoir, incarne un rapport à la connaissance immédiate pour se faire une représentation d'une réalité à un instant donné, un point important pour une pertinence qui se comprend dans un contexte. F, pour formation, se conçoit dans son rapport à la pertinence via cette culture qui tend à s'institutionnaliser (soit une connaissance théorique). Quant au paramètre E, pour expérience, il se comprend dans son rapport à la pertinence dans cet ajustement des stratégies d'intervention (soit une connaissance pratique) de chaque praticien ayant modulé leur travail au regard des succès et échecs enregistrés cas après cas. F et E formeraient la bibliothèque de ressources permettant le processus de reconnaissance sémiotique et S assurerait la contextualisation nécessaire pour poser le raisonnement et formuler les hypothèses explicatives pour les traces détectées et questionnées dans leur pertinence. Ce travail démontre que la pertinence n'est pas absolue. Elle est temporelle et contextuelle, c'est une dimension conventionnelle relative et interprétée qui se doit d'être discutée. C'est là que repose toute la problématique de la signification de ce qui est pertinent pour chaque participant du processus d'investigation. En proposant une lecture par étapes du processus de signification depuis la trace à l'indice, l'étude vise à offrir une compréhension plus poussée du raisonnement et de son fonctionnement pour renforcer la formation des intervenants forensiques. Cette recherche présente ainsi un ensemble d'outils critiques à portée tant pédagogiques que pratiques pour la gestion des lieux tout en identifiant des influences-clé jouées par des dimensions individuelles, structurelles et situationnelles.

EuroPhenome: a repository for high-throughput mouse phenotyping data.

The broad aim of biomedical science in the postgenomic era is to link genomic and phenotype information to allow deeper understanding of the processes leading from genomic changes to altered phenotype and disease. The EuroPhenome project (http://www.EuroPhenome.org) is a comprehensive resource for raw and annotated high-throughput phenotyping data arising from projects such as EUMODIC. EUMODIC is gathering data from the EMPReSSslim pipeline (http://www.empress.har.mrc.ac.uk/) which is performed on inbred mouse strains and knock-out lines arising from the EUCOMM project. The EuroPhenome interface allows the user to access the data via the phenotype or genotype. It also allows the user to access the data in a variety of ways, including graphical display, statistical analysis and access to the raw data via web services. The raw phenotyping data captured in EuroPhenome is annotated by an annotation pipeline which automatically identifies statistically different mutants from the appropriate baseline and assigns ontology terms for that specific test. Mutant phenotypes can be quickly identified using two EuroPhenome tools: PhenoMap, a graphical representation of statistically relevant phenotypes, and mining for a mutant using ontology terms. To assist with data definition and cross-database comparisons, phenotype data is annotated using combinations of terms from biological ontologies.

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome.

BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.