GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Acoustic absorption of hemp-lime construction

Hemp-lime concrete is a sustainable alternative to standard wall construction materials. It boasts excellent hygrothermal properties in part deriving from its porous structure. This paper investigates the acoustic properties of hemp-lime concrete, using binders developed from hydrated lime and pozzolans as well as hydraulic and cementicious binders. To assess the acoustic absorption of hemp-lime walls, as they are commonly finished in practical construction, wall sections are rendered and the resulting impact on absorption is evaluated. Hemp-concretes with lime-pozzolan binders display superior acoustic properties relative to more hydraulic binders. These are diminished when rendered, as the open surface porosity is affected, however hemp-lime construction offers the potential to meet standard and guideline targets for spaces requiring acoustic treatment.

Printmare Against Nature

Nicky Coutts showed a work in the show "Printmare: Against Nature 1", reproducing a miniature storm scene from a Scottish five pound note and an essay titled "Animal Print Suicide" for the accompanying publication "Printmare Against Nature 2". Curated by Finlay Taylor, ‘Against Nature’ was an exhibition exploring conditions of current understandings of geography (or the geo-graphical), natural histories and landscapes. This exhibition concentrated on work that uses print, and the ways in which subtle innovations in this medium are used to investigate some of the complexities that arise when looking at nature in art. An associated publication has been published by Camberwell Press with essays by David Cross and Nicky Coutts, as well as page images by Bob Matthews, Denis Masi, Finlay Taylor, Kate Scrivener and Dick Jewell. Exhibiting artists included Franz Ackermann, Jasone Miranda Bilbao, Sarah Bodman, Ian Brown, Helen Chadwick, Paul Coldwell, Cornford and Cross, Nicky Coutts, Dunhill & O’Brien, Adam Gillam, Oona Grimes, Judith Goddard, Mark Harris, Katsushika Hokusai, Dan Howard-Birt, Susan Johanknecht, James Keith, Serena Korda, Michael Landy, Jo Love, Mike Marshall, Bob Matthews, Julian Opie, Tim O’Riley, Simon Patterson, David Rayson, Rebecca Salter, Kate Scrivener, Jo Stockham, and Herman de Vries.

How valuable is web 2.0 to music criticism? An investigation into the role of web 2.0 and social media in the reception of Benjamin Britten's operas

The internet is deeply integrated with many people's day to day lives, including that of musicians and musicologists. In this thesis, the impact of the internet on classical music criticism in the Web 2.0 age is examined. Using the examples of Britten's operas, Gloriana and Peter Grimes, an overview of their critical reception is examined, using printed reviews found in The Times since their premières, internet based reviews of two specific performances, and the reactions to these performances on Twitter. Theories of media behaviour including de Mul's view of the 'ludic self' are used in order to explain the content found in reviews in conjunction with citizen journalism, of which blogging is an extension. While there are some consistencies between the print reviews and those online, there are stylistic differences, and wider repercussions for the world of criticism in the wake of the democratisation of culture, as critics find their previously regarded authority obsolete to some. Music criticism is no longer the reserve of the musicologists

L1 track finding for a time multiplexed trigger

At the HL-LHC, proton bunches will cross each other every 25. ns, producing an average of 140 pp-collisions per bunch crossing. To operate in such an environment, the CMS experiment will need a L1 hardware trigger able to identify interesting events within a latency of 12.5. μs. The future L1 trigger will make use also of data coming from the silicon tracker to control the trigger rate. The architecture that will be used in future to process tracker data is still under discussion. One interesting proposal makes use of the Time Multiplexed Trigger concept, already implemented in the CMS calorimeter trigger for the Phase I trigger upgrade. The proposed track finding algorithm is based on the Hough Transform method. The algorithm has been tested using simulated pp-collision data. Results show a very good tracking efficiency. The algorithm will be demonstrated in hardware in the coming months using the MP7, which is a μTCA board with a powerful FPGA capable of handling data rates approaching 1. Tb/s.

L'hepcidine : un possible lien entre l'inflammation chronique et le métabolisme du fer dans les maladies rénales chroniques félines

Le rôle de l'inflammation dans le développement et la progression des maladies rénales chroniques (MRC) chez le chat a été peu étudié. L'hepcidine est une protéine de la phase aigue (PPA) de l'inflammation qui contribue au développement des anémies lors de MRC chez l'homme. Les objectifs de cette étude sont de comparer les concentrations en PPAs, en erythropoietine (EPO) ainsi que le statut en fer entre un groupe de chats sains et en MRC. 18 chats sains et 38 chats en MRC ont été recrutés de façon prospective. Les examens réalisés incluaient hématologie, biochimie, analyse d'urine, Serum amyloid A (SAA), haptoglobine (HAP), EPO, hepcidine,fer, TIBC et ferritinne. Nous avons observé une augmentation significative des concentrations en SAA et en hepcidine ainsi qu'une diminution significative du fer et du TIBC dans le groupe MRC (P < .05). Une corrélation positive entre la créatinine et certaines PPAs (SAA and hepcidin; P < .05) était présente. L'augmentation de SAA et hepcidine était significativement associé avec une diminution du TIBC et de l'hématocrite dans le groupe MRC. Les 14 (37%) chats anémiques du groupe MRC avaient une concentration significativement plus basse en fer et en TIBC (P < .05), changements compatibles avec une déficience fonctionelle en fer. Aucun chat n'avait un panel de fer compatible avec une carence en fer absolue. En conclusion, les résultats de cette étude suggèrent que les MRC chez le chat sont des conditions pro-inflammatoires, ayant un impact sur le métabolisme du fer.

L'hepcidine : un possible lien entre l'inflammation chronique et le métabolisme du fer dans les maladies rénales chroniques félines

Le rôle de l'inflammation dans le développement et la progression des maladies rénales chroniques (MRC) chez le chat a été peu étudié. L'hepcidine est une protéine de la phase aigue (PPA) de l'inflammation qui contribue au développement des anémies lors de MRC chez l'homme. Les objectifs de cette étude sont de comparer les concentrations en PPAs, en erythropoietine (EPO) ainsi que le statut en fer entre un groupe de chats sains et en MRC. 18 chats sains et 38 chats en MRC ont été recrutés de façon prospective. Les examens réalisés incluaient hématologie, biochimie, analyse d'urine, Serum amyloid A (SAA), haptoglobine (HAP), EPO, hepcidine,fer, TIBC et ferritinne. Nous avons observé une augmentation significative des concentrations en SAA et en hepcidine ainsi qu'une diminution significative du fer et du TIBC dans le groupe MRC (P < .05). Une corrélation positive entre la créatinine et certaines PPAs (SAA and hepcidin; P < .05) était présente. L'augmentation de SAA et hepcidine était significativement associé avec une diminution du TIBC et de l'hématocrite dans le groupe MRC. Les 14 (37%) chats anémiques du groupe MRC avaient une concentration significativement plus basse en fer et en TIBC (P < .05), changements compatibles avec une déficience fonctionelle en fer. Aucun chat n'avait un panel de fer compatible avec une carence en fer absolue. En conclusion, les résultats de cette étude suggèrent que les MRC chez le chat sont des conditions pro-inflammatoires, ayant un impact sur le métabolisme du fer.

Novel efficient technologies in Europe for axle bearing condition monitoring – the MAXBE project

Axle bearing damage with possible catastrophic failures can cause severe disruptions or even dangerous derailments, potentially causing loss of human life and leading to significant costs for railway infrastructure managers and rolling stock operators. Consequently the axle bearing damage process has safety and economic implications on the exploitation of railways systems. Therefore it has been the object of intense attention by railway authorities as proved by the selection of this topic by the European Commission in calls for research proposals. The MAXBE Project (http://www.maxbeproject.eu/), an EU-funded project, appears in this context and its main goal is to develop and to demonstrate innovative and efficient technologies which can be used for the onboard and wayside condition monitoring of axle bearings. The MAXBE (interoperable monitoring, diagnosis and maintenance strategies for axle bearings) project focuses on detecting axle bearing failure modes at an early stage by combining new and existing monitoring techniques and on characterizing the axle bearing degradation process. The consortium for the MAXBE project comprises 18 partners from 8 member states, representing operators, railway administrations, axle bearing manufactures, key players in the railway community and experts in the field of monitoring, maintenance and rolling stock. The University of Porto is coordinating this research project that kicked-off in November 2012 and it is completed on October 2015. Both on-board and wayside systems are explored in the project since there is a need for defining the requirement for the onboard equipment and the range of working temperatures of the axle bearing for the wayside systems. The developed monitoring systems consider strain gauges, high frequency accelerometers, temperature sensors and acoustic emission. To get a robust technology to support the decision making of the responsible stakeholders synchronized measurements from onboard and wayside monitoring systems are integrated into a platform. Also extensive laboratory tests were performed to correlate the in situ measurements to the status of the axle bearing life. With the MAXBE project concept it will be possible: to contribute to detect at an early stage axle bearing failures; to create conditions for the operational and technical integration of axle bearing monitoring and maintenance in different European railway networks; to contribute to the standardization of the requirements for the axle bearing monitoring, diagnosis and maintenance. Demonstration of the developed condition monitoring systems was performed in Portugal in the Northern Railway Line with freight and passenger traffic with a maximum speed of 220 km/h, in Belgium in a tram line and in the UK. Still within the project, a tool for optimal maintenance scheduling and a smart diagnostic tool were developed. This paper presents a synthesis of the most relevant results attained in the project. The successful of the project and the developed solutions have positive impact on the reliability, availability, maintainability and safety of rolling stock and infrastructure with main focus on the axle bearing health.

Láser Q-Switched en el manejo de ocronosis exógena: revisión sistemática de la literatura

Antecedentes: La ocronosis Exógena (OE) es una enfermedad subdiagnosticada y de difícil manejo (1). El láser Q-Switched (QS) surge como una alternativa para el tratamiento de esta (2). Objetivo: Describir las características de los pacientes, del láser QS y los desenlaces en el tratamiento de OE. Métodos: Se realizó una búsqueda de la literatura en las bases PubMed, Embase, PMC, Scielo, Elselvier, BMJ Case Reports, Journal of Medical Case Reports, Cases Journal e International Medical Case Reports Journal, desde enero del 2000 a marzo del 2016, pacientes con ocronosis exógena, 18 a 70 años, tratados con láser QS. Los artículos fueron evaluados mediante la herramienta de evaluación de validez y valor educativo de reportes de caso descrito por Pierson (3). Resultados: Se encontraron 256 artículos, 63 fueron seleccionados: 28 repetidos y 31 no cumplieron criterios de inclusión. Se escogieron 4 artículos que reportan 12 casos de pacientes con ocronosis exógena diagnosticada mediante estudio histopatológico y tratada con láser QS. Discusión: Hay poca experiencia con el láser QS en OE. En la práctica clínica se usa para tatuajes y patologías pigmentarias dérmicas con resultados satisfactorios. El pigmento dérmico en OE y la corta duración de pulso de láser QS, podrían ser el pilar de tratamiento para OE. Conclusión: El láser QS puede ser útil para el tratamiento en OE, con nivel de evidencia 3 y grado de recomendación D. Se sugiere realizar estudios clínicos con mayor grado de evidencia.

Factores de riesgo preoperatorios asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia

Introducción: la colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio 20% de éstos requieren conversión a técnica abierta. En este estudio se evaluaron los factores de riesgo preoperatorios para conversión en colecistectomía laparoscópica de urgencia. Metodología: se realizó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de variables de interés de los registros de historias clínicas de pacientes operados entre el 2013 y 2016. Se identificaron los motivos de conversión de técnica quirúrgica. Se caracterizó la población de estudio y se estimaron asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron posibles variables de confusión. Resultados: se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5%). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo de Murphy clínico positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano, fueron factores de riesgo para conversión. Se encontró un área bajo la curva ROC= 0,743 (IC95% 0,692–0,794, p= <0,001). Discusión: existen unos factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relacionan con un proceso inflamatorio más severo, por lo que se debe evitar la prolongación del tiempo de espera entre el inicio de los síntomas y la extirpación quirúrgica de la vesícula.