Evaluation of the impact of a therapeutic drug monitoring program in a Swiss University Hospital

Background and objective: Therapeutic Drug Monitoring (TDM) has been introduced early 1970 in our hospital (CHUV). It represents nowadays an important routine activity of the Division of Clinical Pharmacology and Toxicology (PCL), and its impact and utility for clinicians required assessment. This study thus evaluated the impact of TDM recommendations in terms of dosage regimen adaptation. Design: A prospective observational study was conducted over 5 weeks. The primary objective was to evaluate the application of our TDM recommendations and to identify potential factors associated to variations in their implementation. The secondary objective was to identify pre-analytical problems linked to the collection and processing of blood samples. Setting: Four representative clinical units at CHUV. Main outcome measure: Clinical data, drug related data (intake, collection and processing) and all information regarding the implementation of clinical recommendations were collected and analyzed by descriptive statistics. Results: A total of 241 blood measurement requests were collected, among which 105 triggered a recommendation. 37% of the recommendations delivered were applied, 25 % partially applied and 34% not applied. In 4% it was not applicable. The factors determinant for implementation were the clinical unit and the mode of transmission of the recommendation (written vs oral). No clear difference between types of drugs could be detected. Pre-analytical problems were not uncommon, mostly related to completion of request forms and delays in blood sampling (equilibration or steady-state not reached). We have identified 6% of inappropriate and unusable drug level measurements that could cause a substantial cost for the hospital. Conclusion: This survey highlighted a better implementation of TDM recommendations in clinical units where this routine is well integrated and understood by the medical staff. Our results emphasize the importance of communication with the nurse or the physician in charge, either to transmit clinical recommendations or to establish consensual therapeutic targets in specific conditions. Development of strong partnerships between clinical pharmacists or pharmacologists and clinical units would be beneficial to improve the impact of this clinical activity.

Report on a collection of Lutzomyia sand flies (Diptera: Psychodidae) from the middle Solimões (Amazonas, Brazil)

Fifty-two species of Lutzomyia sand flies were identified in contemporaneous samples totalling only 1875 individuals, collected at the same site in tall primary terra-firme rainforest, near the south bank of the Solimões River. The most abundant species belonged to the subgenera Trichophoromyia and Nyssomyia. The subgenera Psathyromyia, Nyssomyia and Psychodopygus represented the greatest number of species. A new, aberrant species of the subgenus Psathyromyia (L. cultellata) and the female of Lu. souzacastroi are described. The Phlebotominae are proposed as a suitable indicator group for biogeographic and diversity studies.

On problems of calculating energy expenditure and substrate utilization from respiratory exchange data.

Indirect calorimetry based on respiratory exchange measurement has been successfully used from the beginning of the century to obtain an estimate of heat production (energy expenditure) in human subjects and animals. The errors inherent to this classical technique can stem from various sources: 1) model of calculation and assumptions, 2) calorimetric factors used, 3) technical factors and 4) human factors. The physiological and biochemical factors influencing the interpretation of calorimetric data include a change in the size of the bicarbonate and urea pools and the accumulation or loss (via breath, urine or sweat) of intermediary metabolites (gluconeogenesis, ketogenesis). More recently, respiratory gas exchange data have been used to estimate substrate utilization rates in various physiological and metabolic situations (fasting, post-prandial state, etc.). It should be recalled that indirect calorimetry provides an index of overall substrate disappearance rates. This is incorrectly assumed to be equivalent to substrate "oxidation" rates. Unfortunately, there is no adequate golden standard to validate whole body substrate "oxidation" rates, and this contrasts to the "validation" of heat production by indirect calorimetry, through use of direct calorimetry under strict thermal equilibrium conditions. Tracer techniques using stable (or radioactive) isotopes, represent an independent way of assessing substrate utilization rates. When carbohydrate metabolism is measured with both techniques, indirect calorimetry generally provides consistent glucose "oxidation" rates as compared to isotopic tracers, but only when certain metabolic processes (such as gluconeogenesis and lipogenesis) are minimal or / and when the respiratory quotients are not at the extreme of the physiological range. However, it is believed that the tracer techniques underestimate true glucose "oxidation" rates due to the failure to account for glycogenolysis in the tissue storing glucose, since this escapes the systemic circulation. A major advantage of isotopic techniques is that they are able to estimate (given certain assumptions) various metabolic processes (such as gluconeogenesis) in a noninvasive way. Furthermore when, in addition to the 3 macronutrients, a fourth substrate is administered (such as ethanol), isotopic quantification of substrate "oxidation" allows one to eliminate the inherent assumptions made by indirect calorimetry. In conclusion, isotopic tracers techniques and indirect calorimetry should be considered as complementary techniques, in particular since the tracer techniques require the measurement of carbon dioxide production obtained by indirect calorimetry. However, it should be kept in mind that the assessment of substrate oxidation by indirect calorimetry may involve large errors in particular over a short period of time. By indirect calorimetry, energy expenditure (heat production) is calculated with substantially less error than substrate oxidation rates.

The type specimens of mosquitoes (Diptera, Culicidae) deposited in the entomological collection of the Instituto Oswaldo Cruz, Rio de Janeiro, Brazil

A list of type specimens of 100 mosquito species deposited in the Entomological collection of the Instituto Oswaldo Cruz is presented. It includes five holotypes belonging to the subfamily Anophelinae; 56 holotypes of Culicinae and two of Toxorhynchitinae. A lectotype is designated for Toxorhynchites fluminensis. The holotypes of six nominal species - Psorophora chiquitana, Psorophora circunflava, Psorophora melanota, Psorophora lanei, Wyeomyia brucei and Uranotaenia noctivaga - previously considered non existent or of unknown location were found in the collection.

Three-year-olds' attachment play narratives and their associations with internalizing problems

Representational strategies of emotion regulation during play are believed to protect children against behaviour problems. Yet, before the age of 4, it appears that children rely more on their attachment figure than on representational strategies to assuage distress. The study was aimed at testing whether 3-year-olds' narrative features during the Attachment Story Completion Task (ASCT) could predict concurrent internalizing problems assessed by the mothers' and fathers' ratings of the child, using the Child Behaviour Checklist Regression analyses including gender, IQ, socio-economic status and ASCT dimensions revealed that representations of supportive caregiving predicted mother-reported internalizing problems (negative association), whereas positive resolution and attachment strategies (security, deactivation, hyperactivation, disorganization) did not. Results were interpreted with reference to Bowlby's hypotheses regarding the aetiology of depression and anxiety disorders. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Statmedia 3 : activitats on-line individualitzades d'estadística i matemàtiques als ensenyaments de Ciències Experimentals i Socials

El projecte Statmedia 3 ha consolidat definitivament la proposta de les assignatures Bioestadística de Biologia, Anàlisi de dades de Ciències Ambientals i d’Estadística Matemàtica de la Diplomatura renovant una part del material creat amb Statmedia 2. S’han inclòs a més Matemàtiques d’Ambientals i Introducció a la Probabilitat del Grau d’Estadística. L’anterior MQD abastava només pràctiques mentre que aquest projecte permet una oferta diversa d’activitats individualitzades. La individualització consisteix en que cada estudiant rep una proposta de cas personalitzada amb dades diferents. Les activitats poden ser programades presencialment o no, però la clau de l’èxit de l’activitat és que l’alumne obtingui reconeixement del seu treball en l’avaluació continuada. La valoració que fan als alumnes de Statmedia és molt bo, i observem que es produeix una millora en els resultats acadèmics. Statmedia 3 ha implicat un important esforç en la vessant informàtica del projecte, la barreja de tecnologies que utilitzem son punteres: Ajax, servlets i applets Java... Hem posat a punt un assistent on-line per dissenyar documents i planificar activitats que facilita la tasca dels professors. La nostre participació en primera línea del procés de convergència a l’EEES ens ha permès anticipar alguns canvis, i s’ha traduït en que el claustre del Departament d’Estadística assumís que Statmedia és una metodologia essencial dels seus plans docents. El projecte continua en un quart projecte MQD consecutiu, on desplegarem la nova tecnologia implementada. L’objectiu principal serà dotar a les assignatures dels 7 graus on participa el departament d’activitats individualitzades en forma de casos pràctics, problemes i proves diverses. La col·lecció de material emmagatzemada en la nostra biblioteca, forjada després de quasi deu anys de treball continuat, juntament amb l’experiència acumulada de com utilitzar Statmedia de la forma més eficient han començat a ser explotades en els nous graus aquest mateix curs 2009-2010.

The Type Specimens of Apoidea (Hymenoptera) Deposited in the Entomological Collection of Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil

A list of 41 Apoidea (Hymenoptera) type specimens deposited in the Entomological Collection of the Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil is presented. The types previously belonged to the Zikán and Schrottky private collections. A total of 11 holotypes and 30 paratypes are listed with their respective data and literature

A parameter-free approach for solving combinatorial optimization problems through biased randomization of efficient heuristics

This paper discusses the use of probabilistic or randomized algorithms for solving combinatorial optimization problems. Our approach employs non-uniform probability distributions to add a biased random behavior to classical heuristics so a large set of alternative good solutions can be quickly obtained in a natural way and without complex conguration processes. This procedure is especially useful in problems where properties such as non-smoothness or non-convexity lead to a highly irregular solution space, for which the traditional optimization methods, both of exact and approximate nature, may fail to reach their full potential. The results obtained are promising enough to suggest that randomizing classical heuristics is a powerful method that can be successfully applied in a variety of cases.

On the stability of the optimal value and the optimal set in optimization problems

The paper develops a stability theory for the optimal value and the optimal set mapping of optimization problems posed in a Banach space. The problems considered in this paper have an arbitrary number of inequality constraints involving lower semicontinuous (not necessarily convex) functions and one closed abstract constraint set. The considered perturbations lead to problems of the same type as the nominal one (with the same space of variables and the same number of constraints), where the abstract constraint set can also be perturbed. The spaces of functions involved in the problems (objective and constraints) are equipped with the metric of the uniform convergence on the bounded sets, meanwhile in the space of closed sets we consider, coherently, the Attouch-Wets topology. The paper examines, in a unified way, the lower and upper semicontinuity of the optimal value function, and the closedness, lower and upper semicontinuity (in the sense of Berge) of the optimal set mapping. This paper can be seen as a second part of the stability theory presented in [17], where we studied the stability of the feasible set mapping (completed here with the analysis of the Lipschitz-like property).

On slicewise monotone parameterized problems and optimal proof systems for TAUT

"Vegeu el resum a l'inici del document del fitxer adjunt"

Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool.

OBJECTIVE: The aim of this pilot study was to describe problems in functioning and associated rehabilitation needs in persons with spinal cord injury after the 2010 earthquake in Haiti by applying a newly developed tool based on the International Classification of Functioning, Disability and Health (ICF). DESIGN: Pilot study. SUBJECTS: Eighteen persons with spinal cord injury (11 women, 7 men) participated in the needs assessment. Eleven patients had complete lesions (American Spinal Injury Association Impairment Scale; AIS A), one patient had tetraplegia. METHODS: Data collection included information from the International Spinal Cord Injury Core Data Set and a newly developed needs assessment tool based on ICF Core Sets. This tool assesses the level of functioning, the corresponding rehabilitation need, and required health professional. Data were summarized using descriptive statistics. RESULTS: In body functions and body structures, patients showed typical problems following spinal cord injury. Nearly all patients showed limitations and restrictions in their activities and participation related to mobility, self-care and aspects of social integration. Several environmental factors presented barriers to these limitations and restrictions. However, the availability of products and social support were identified as facilitators. Rehabilitation needs were identified in nearly all aspects of functioning. To address these needs, a multidisciplinary approach would be needed. CONCLUSION: This ICF-based needs assessment provided useful information for rehabilitation planning in the context of natural disaster. Future studies are required to test and, if necessary, adapt the assessment.

Application of the combined integral method to Stefan problems

In this paper we present a new, accurate form of the heat balance integral method, termed the Combined Integral Method (or CIM). The application of this method to Stefan problems is discussed. For simple test cases the results are compared with exact and asymptotic limits. In particular, it is shown that the CIM is more accurate than the second order, large Stefan number, perturbation solution for a wide range of Stefan numbers. In the initial examples it is shown that the CIM reduces the standard problem, consisting of a PDE defined over a domain specified by an ODE, to the solution of one or two algebraic equations. The latter examples, where the boundary temperature varies with time, reduce to a set of three first order ODEs.

Improving the accuracy of heat balance integral methods applied to thermal problems with time dependent boundary conditions

In this paper the two main drawbacks of the heat balance integral methods are examined. Firstly we investigate the choice of approximating function. For a standard polynomial form it is shown that combining the Heat Balance and Refined Integral methods to determine the power of the highest order term will either lead to the same, or more often, greatly improved accuracy on standard methods. Secondly we examine thermal problems with a time-dependent boundary condition. In doing so we develop a logarithmic approximating function. This new function allows us to model moving peaks in the temperature profile, a feature that previous heat balance methods cannot capture. If the boundary temperature varies so that at some time t & 0 it equals the far-field temperature, then standard methods predict that the temperature is everywhere at this constant value. The new method predicts the correct behaviour. It is also shown that this function provides even more accurate results, when coupled with the new CIM, than the polynomial profile. Analysis primarily focuses on a specified constant boundary temperature and is then extended to constant flux, Newton cooling and time dependent boundary conditions.