Feasibility of Therapeutic Drug Monitoring (TDM) for Imatinib: Preliminary considerations on the dosage adjustment approach for CML patients enrolled in the Imatinib Concentration Monitoring (I-COME) study

Background: As imatinib pharmacokinetics are highly variable, plasma levels differ largely between patients under the same dosage. Retrospective studies in chronic myeloid leukemia (CML) patients showed significant correlations between low levels and suboptimal response, and between high levels and poor tolerability. Monitoring of plasma levels is thus increasingly advised, targeting trough concentrations of 1000 μg/L and above. Objectives: Our study was launched to assess the clinical usefulness of systematic imatinib TDM in CML patients. The present preliminary evaluation questions the appropriateness of dosage adjustment following plasma level measurement to reach the recommended trough level, while allowing an interval of 4-24 h after last drug intake for blood sampling. Methods: Initial blood samples from the first 9 patients in the intervention arm were obtained 4-25 h after last dose. Trough levels in 7 patients were predicted to be significantly away from the target (6 <750 μg/L, and 1 >1500 μg/L with poor tolerance), based on a Bayesian approach using a population pharmacokinetic model. Individual dosage adjustments were taken up in 5 patients, who had a control measurement 1-4 weeks after dosage change. Predicted trough levels were confronted to anterior model-based extrapolations. Results: Before dosage adjustment, observed concentrations extrapolated at trough ranged from 359 to 1832 μg/L (median 710; mean 804, CV 53%) in the 9 patients. After dosage adjustment they were expected to target between 720 and 1090 μg/L (median 878; mean 872, CV 13%). Observed levels of the 5 recheck measurements extrapolated at trough actually ranged from 710 to 1069 μg/L (median 1015; mean 950, CV 16%) and had absolute differences of 21 to 241 μg/L to the model-based predictions (median 175; mean 157, CV 52%). Differences between observed and predicted trough levels were larger when intervals between last drug intake and sampling were very short (~4 h). Conclusion: These preliminary results suggest that TDM of imatinib using a Bayesian interpretation is able to bring trough levels closer to 1000 μg/L (with CV decreasing from 53% to 16%). While this may simplify blood collection in daily practice, as samples do not have to be drawn exactly at trough, the largest possible interval to last drug intake yet remains preferable. This encourages the evaluation of the clinical benefit of a routine TDM intervention in CML patients, which the randomized Swiss I-COME study aims to.

Talouden hallinta ja talousneuvonta ylivelkaantumisen estämisessä

Tutkielman tavoitteena oli saada näkemys kunnallisten talous- ja velkaneuvontatoimistojen antaman talousneuvonnan toimivuudesta ylivelkaantumisen estämisessä sekä mahdollisista kehitystarpeista. Tutkielmassa käsitellään talousneuvonnan perustana oleva lainsäädäntö, tasapainoisen talouden perusteita sekä velkaantumisen syitä. Varsinainen tutkimus tehtiin internetin kautta toteutetulla kunnallisille talous- ja velkaneuvojille suunnatulla kyselyllä. Kyselyllä selvitettiin muun muassa, kuinka paljon talousneuvontaa annetaan, minkälaista tuo annettu neuvonta on ja annetaanko neuvontaa yrittäjille. Lisäksi haluttiin saada selville talous- ja velkaneuvojien käyttämä talousneuvontaprosessi. Tutkimustuloksista ilmenee, että vaikka talous- ja velkaneuvonnasta annettu laki painottaa talousneuvontaa, talous- ja velkaneuvojien tyypilliset työtehtävät liittyvät yksityishenkilön velkajärjestelyyn. Varsinaista talousneuvontaa annetaan kohtuullisen vähän. Suurin osa talous- ja velkaneuvojista oli sitä mieltä, että talousneuvonnalla voidaan kokonaan tai osittain estää ylivelkaantuminen. Yli puolet talous- ja velkaneuvojista ei antaisi talousneuvontaa yrittäjille, mutta pääsyy kieltäytymiselle oli kuitenkin resurssipula. Talousneuvonnan antamisen tueksi tulisi saada koulutusta, materiaalia sekä konkreettisia välineitä, kuten atk-ohjelmia. Velkaantuminen on pysyvä osa markkinataloutta ja yhteiskunnan tulee kantaa siitä vastuu. Tärkeintä olisi kuitenkin saada ihmiset motivoitumaan oman taloudellisen tilanteen hoitamiseen.

Validation study of the Spanish Version of the Work-Family Conflict Questionnaire (CCTF)

In this study, a brief Work-Family Conflict (WFC) Questionnaire in the Spanish language is proposed that takes into account the two directions commonly reported in the literature: work interference with family (WIF), and family interference with work (FIW). The results obtained through exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) with two independent samples, carried out for women and men, showed acceptable validity and reliability. A copy of the instrument in Spanish language is provided, together with the Amos 4 syntax to perform the factor invariance analysis for women and men. The suggested Work-Family Conflict Questionnaire (in Spanish, abbreviated as CCTF) may be useful in studies performed in the work setting, considering the special relevance of the concept in this line of research.

The role of tributary relative timing and sequencing in controlling large floods

Hydrograph convolution is a product of tributary inputs from across the watershed. The time-space distribution of precipitation, the biophysical processes that control the conversion of precipitation to runoff and channel flow conveyance processes, are heterogeneous and different areas respond to rainfall in different ways. We take a subwatershed approach to this and account for tributary flow magnitude, relative timing, and sequencing. We hypothesize that as the scale of the watershed increases so we may start to see systematic differences in subwatershed hydrological response. We test this hypothesis for a large flood (T >100 years) in a large watershed in northern England. We undertake a sensitivity analysis of the effects of changing subwatershed hydrological response using a hydraulic model. Delaying upstream tributary peak flow timing to make them asynchronous from downstream subwatersheds reduced flood magnitude. However, significant hydrograph adjustment in any one subwatershed was needed for meaningful reductions in stage downstream, although smaller adjustments in multiple tributaries resulted in comparable impacts. For larger hydrograph adjustments, the effect of changing the timing of two tributaries together was lower than the effect of changing each one separately. For smaller adjustments synergy between two subwatersheds meant the effect of changing them together could be greater than the sum of the parts. Thus, this work shows that while the effects of modifying biophysical catchment properties diminishes with scale due to dilution effects, their impact on relative timing of tributaries may, if applied in the right locations, be an important element of flood management.

How to identify and recruit nurses to a survey 14 and 24 years after graduation in a context of scarce data : lessons learnt from the 2012 nurses at work pilot study on nurses' career paths

Nursing workforce data are scarce in Switzerland, with no active national registry of nurses. The worldwide nursing shortage is also affecting Switzerland, so that evidence-based results of the nurses at work project on career paths and retention are needed as part of the health care system stewardship; nurses at work is a retrospective cohort study of nurses who graduated in Swiss nursing schools in the last 30 years. Results of the pilot study are presented here (process and feasibility). The objectives are (1) to determine the size and structure of the potential target population by approaching two test-cohorts of nursing graduates (1988 and 1998); (2) to test methods of identifying and reaching them 14 and 24 years after graduation; (3) to compute participation rates, and identify recruitment and participation biases.

Ethnic sensitive substance abuse work : services for non-Finnish speaking clients in substance abuse treatment units in Finland today

The purpose of this study was to examine the current situation in substance abuse treatment units in Finland in taking non-Finnish speaking clients into consideration. The initiative for this research came from the Development of Alcohol and Drugs Intervention group at Stakes (National Research and Development Centre for Welfare and Health). Their aim was to gather information about the functioning and relevance of the quality assessment forms based on the quality recommendations for substance abuse work, filled in by substance abuse treatment units. The ethnic issue was chosen as the main approach in the study. The aim of this research was to answer the following questions: what is the readiness and competence in substance abuse treatment units in Finland to receive and encounter non-Finnish speaking clients, how is the quality of these services assessed and/or developed in the units, and what has been the role and functioning of the quality recommendations and quality assessment forms in working with non-Finnish speaking clients. The research methods used in the study were both quantitative and qualitative. The information concerning language services provided in the units was gathered from the quality assessment forms and basic information forms found in the database maintained by Stakes. The total amount of units found in the database was 267. In addition to that, semi-structured theme-interviews were carried out in four substance abuse treatment units in order to get a more deep understanding of how the services function in practice. The few number of non-Finnish speaking clients in the units may explain to a certain degree the results of the research. The results however showed that there is still space for improving the services. In the light of quality recommendations, the degree of language options provided in substance abuse treatment units in Finland today is low. Also the quantity of interpreter services provided in the units is scarce. There could also be unified guidelines specially tailored for substance abuse treatment units on how to work with ethnic minorities, as the knowledge is currently adopted from several different instances. The quality recommendations as well as quality assessment forms were valued and applied in the units appropriately and were also perceived to have an effect on the functioning, and quality, in the units.

Opening The Fortress : the work of public gaze on the Swiss asylum reality

The Fortress (La Forteresse) is a 2008 documentary film by Fernand Melgar that reports the Swiss asylum reality from a distant but committed point of view. The documentary describes the life of asylum seekers awaiting in a federal centre the decision to grant them-or not-refugee status. It subtly raises the issue of the role that "textual realities", grasped from the spectator's point of view, play in the production of public discourses. Most of all, it subtly poses the question of the (Swiss) spectator as an actor of the asylum policy, in the context of a semi-direct democracy. After evoking the notion of sensible experience for linking spectatorship to politics, we look at how the documentary invites its model spectator to accept the film's moral premises. Furthermore, focusing on the Swiss public sphere, we deliver an account of the reception by empirical spectators, notably by a group of leftist activists that tend to subvert Melgar's intentions. This two-fold analysis leads us to exhibit that, in a context of discursive struggles, The Fortress generates an original space of deliberation and experience, which appeals to the public to exercise their political agency on asylum policy without being constricted by an antagonist framework.

The Challenges Of Implementing High Performance Work Practices In The Nonprofit Sector

The last economic crisis raised huge challenges for nonprofit organizations. It is now critical for nonprofit organizations to show not only their social legitimacy but also their efficiency and competency to claim for grants (Kearns, Bell, Deem, & McShane, 2012). High Performance Work Practices (HPWP) are a way to foster performance and thus to answer challenges nonprofit organizations are currently facing. However, such practices have until then only been considered for the corporate world. The entire philosophy behind nonprofit organizations contrasts radically from the for-profit sector. Human resources management in particular may differ as well. The aim of this article is precisely to analyze the challenges of implementing HPWP in nonprofit organizations. In order to explore those challenges, we study the HR practices of a nonprofit organization based in UK that struggles against poverty. Discussion of results highlights good practices that should be applied along the nonprofit sector.

Rasvaisten jätevesien puhdistus

Rasvaisten jätevesien puhdistus on sitä tuottaville yrityksille kallista ja hankalaa. Nykyisten päästövaatimusten saavuttaminen on perinteisillä jätevedenkäsittelymenetelmillä vaikeaa tai lähes mahdotonta, riippuen käsiteltävän jäteveden ominaisuuksista. Rasvaisen jäteveden käsittelyssä on käytetty mm. laskeutusta, flotaatiota, hydrosykloneja, pisaroitusta, suodatusta sekä biologista käsittelyä. Lisäksi happohydrolyysiä voidaan soveltaa edellä mainittujen menetelmien esikäsittelynä. Useita näitä erotusmenetelmiä voidaan myös tehostaa kemikaalien lisäyksellä. Työn kirjallisuusosassa on käsitelty rasvaisten jätevesien ja emulsioiden kalvosuodatusta ja kalvojen käyttöä pisaroituselementtinä. Tavanomaisessa kalvosuodatuksessa tarkoituksena on erottaa kalvoa läpäisemätön rasvajae ja permeoituva vesijae toisistaan, kun taas pisaroittamisen tarkoituksena on saada dispergoituneen faasin pisarakoko kasvamaan joko kalvon pinnalla tai sen huokosissa. Pisarakoon kasvaessa emulsion stabiilisuus heikkenee ja faasit voidaan helpommin erottaa toisistaan. Työn kokeellisessa osassa tavoitteena oli tutkia kalvosuodatuksen ja erilaisten kalvojen toimivuutta esteröintilaitoksen rasvaisten jätevesien käsittelyssä. Tutkimuksessa käytettiin MW- (GE Osmonics), C30F- (Nadir Filtration), Teflon Typar- (Tetratex) sekä JX-kalvoa (Osmonics Desal). Haastetta työhön syntyi tutkittujen jätevesien ominaisuuksien suuresta vaihtelusta sitä tuottavan laitoksen panostyylisestä toiminnasta johtuen. Lisäksi tutkittiin, onko syöttöliuoksen pH-säädöllä ja laskeutuksella ennen suodatusta merkittävää etua itse kalvosuodatusprosessiin. Kalvotekniikkaa voidaan tämän tutkimuksen perusteella soveltaa myös esteröintilaitoksen rasvaisten jätevesien suodatukseen, ja erityistä etua saadaan jäteveden pH-säädöllä (pH 3) ja laskeutuksella ennen varsinaista suodatusta. Tällaiseen käsittelyyn soveltuu tutkituista kalvoista parhaiten hydrofiilinen regeneroidusta selluloosasta valmistettu C30F-kalvo, jonka etuna on vähäinen foulaantuminen muihin tutkittuihin kalvoihin verrattuna.

Label-free detection of tobramycin in serum by transmission-localized surface plasmon resonance.

In order to improve the efficacy and safety of treatments, drug dosage needs to be adjusted to the actual needs of each patient in a truly personalized medicine approach. Key for widespread dosage adjustment is the availability of point-of-care devices able to measure plasma drug concentration in a simple, automated, and cost-effective fashion. In the present work, we introduce and test a portable, palm-sized transmission-localized surface plasmon resonance (T-LSPR) setup, comprised of off-the-shelf components and coupled with DNA-based aptamers specific to the antibiotic tobramycin (467 Da). The core of the T-LSPR setup are aptamer-functionalized gold nanoislands (NIs) deposited on a glass slide covered with fluorine-doped tin oxide (FTO), which acts as a biosensor. The gold NIs exhibit localized plasmon resonance in the visible range matching the sensitivity of the complementary metal oxide semiconductor (CMOS) image sensor employed as a light detector. The combination of gold NIs on the FTO substrate, causing NIs size and pattern irregularity, might reduce the overall sensitivity but confers extremely high stability in high-ionic solutions, allowing it to withstand numerous regeneration cycles without sensing losses. With this rather simple T-LSPR setup, we show real-time label-free detection of tobramycin in buffer, measuring concentrations down to 0.5 μM. We determined an affinity constant of the aptamer-tobramycin pair consistent with the value obtained using a commercial propagating-wave based SPR. Moreover, our label-free system can detect tobramycin in filtered undiluted blood serum, measuring concentrations down to 10 μM with a theoretical detection limit of 3.4 μM. While the association signal of tobramycin onto the aptamer is masked by the serum injection, the quantification of the captured tobramycin is possible during the dissociation phase and leads to a linear calibration curve for the concentrations over the tested range (10-80 μM). The plasmon shift following surface binding is calculated in terms of both plasmon peak location and hue, with the latter allowing faster data elaboration and real-time display of the results. The presented T-LSPR system shows for the first time label-free direct detection and quantification of a small molecule in the complex matrix of filtered undiluted blood serum. Its uncomplicated construction and compact size, together with the remarkable performances, represent a leap forward toward effective point-of-care devices for therapeutic drug concentration monitoring.