Development of a quality use of medicines coding system to rate clinical pharmacists' medication review recommendations

Objective: To develop a 'quality use of medicines' coding system for the assessment of pharmacists' medication reviews and to apply it to an appropriate cohort. Method: A 'quality use of medicines' coding system was developed based on findings in the literature. These codes were then applied to 216 (111 intervention, 105 control) veterans' medication profiles by an independent clinical pharmacist who was supported by a clinical pharmacologist with the aim to assess the appropriateness of pharmacy interventions. The profiles were provided for veterans participating in a randomised, controlled trial in private hospitals evaluating the effect of medication review and discharge counselling. The reliability of the coding was tested by two independent clinical pharmacists in a random sample of 23 veterans from the study population. Main outcome measure: Interrater reliability was assessed by applying Cohen's kappa score on aggregated codes. Results: The coding system based on the literature consisted of 19 codes. The results from the three clinical pharmacists suggested that the original coding system had two major problems: (a) a lack of discrimination for certain recommendations e. g. adverse drug reactions, toxicity and mortality may be seen as variations in degree of a single effect and (b) certain codes e. g. essential therapy were in low prevalence. The interrater reliability for an aggregation of all codes into positive, negative and clinically non-significant codes ranged from 0.49-0.58 (good to fair). The interrater reliability increased to 0.72-0.79 (excellent) when all negative codes were excluded. Analysis of the sample of 216 profiles showed that the most prevalent recommendations from the clinical pharmacists were a positive impact in reducing adverse responses (31.9%), an improvement in good clinical pharmacy practice (25.5%) and a positive impact in reducing drug toxicity (11.1%). Most medications were assigned the clinically non-significant code (96.6%). In fact, the interventions led to a statistically significant difference in pharmacist recommendations in the categories; adverse response, toxicity and good clinical pharmacy practice measured by the quality use of medicine coding system. Conclusion: It was possible to use the quality use of medicine coding system to rate the quality and potential health impact of pharmacists' medication reviews, and the system did pick up differences between intervention and control patients. The interrater reliability for the summarised coding system was fair, but a larger sample of medication regimens is needed to assess the non-summarised quality use of medicines coding system.

An approach to verifying and debugging simulation models governed by ordinary differential equations: Part 2. Residuals analysis and a case study

In Part 1 of this paper a methodology for back-to-back testing of simulation software was described. Residuals with error-dependent geometric properties were generated. A set of potential coding errors was enumerated, along with a corresponding set of feature matrices, which describe the geometric properties imposed on the residuals by each of the errors. In this part of the paper, an algorithm is developed to isolate the coding errors present by analysing the residuals. A set of errors is isolated when the subspace spanned by their combined feature matrices corresponds to that of the residuals. Individual feature matrices are compared to the residuals and classified as 'definite', 'possible' or 'impossible'. The status of 'possible' errors is resolved using a dynamic subset testing algorithm. To demonstrate and validate the testing methodology presented in Part 1 and the isolation algorithm presented in Part 2, a case study is presented using a model for biological wastewater treatment. Both single and simultaneous errors that are deliberately introduced into the simulation code are correctly detected and isolated. Copyright (C) 2003 John Wiley Sons, Ltd.

Therapeutic potential of venom peptides

Venomous animals have evolved a vast array of peptide toxins for prey capture and defence. These peptides are directed against a wide variety of pharmacological targets, making them an invaluable source of ligands for studying the properties of these targets in different experimental paradigms. A number of these peptides have been used in vivo for proof-of-concept studies, with several having undergone preclinical or clinical development for the treatment of pain, diabetes, multiple sclerosis and cardiovascular diseases. Here we survey the pharmacology of venom peptides and assess their therapeutic prospects.

Assessing forest fire as a potential PCDD/F source in Queensland, Australia

Forest fires are suggested as a potential and significant source of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs), even though no studies to date provide sufficient evidence to confirm forest fires as a source of PCDD/Fs. Recent investigations in Gueensland, Australia have identified a widespread contamination of PCDDs (in particular OND) in soils and sediments in the coastal region from an unknown source of PCDD/Fs. Queensland is predominately rural; it has few known anthropogenic sources of PCDD/Fs, whereas forest fires are a frequent occurrence. This study was conducted to assess forest fires as a potential source of the unknown PCDD/F contamination in Queensland. A combustion experiment was designed to assess the overall mass of PCDD/Fs before and after a simulated forest fire. The results from this study did not identify an increase in Sigma-PCDD/Fs or OCDD after the combustion process. However, specific non-2,3,7,8 substituted lower chlorinated PCDD/Fs were elevated after the combustion process, suggesting formation from a precursor. The results from this study indicate that forest fires are unlikely to be the source of the unknown PCDD contamination in Gueensland, rather they are a key mechanism for the redistribution of PCDD/Fs from existing sources and precursors.

Subsoil nitrogen mineralisation and its potential to contribute to NH4 accumulation in a Vertosol

High concentrations of NH4+ (up to 270 kg N/ha) have been observed in a Vertosol below 1 m depth in south-east Queensland. This study examined the possibility that mineralisation associated with the removal of native vegetation (Acacia harpophylla) for cropping was responsible for the production of NH4+. Particularly, the potential contribution of decomposing root material and/or dissolved organic nitrogen (DON) leached into the subsoil after clearing was investigated. The amount of N that was contained within native vegetation root material was determined from an area of native vegetation adjacent to the cleared site containing elevated NH4+ concentrations. In addition, the amount of NH4+ that could be mineralised in the native vegetation soil was determined by monitoring NH4+ concentrations over 360 days in intact cores, and by conducting waterlogged incubations. To determine the rate at which a source of DON leached into the subsoil would mineralise, soil was amended with glutamic acid at a rate of 250 mg N/kg and placed under waterlogged incubation. The possibility that the acidic pH of the subsoil, or the lack of a significant subsoil microbial population, was inhibiting mineralisation was also examined by increasing soil pH from 4.4 to 7.0, and inoculating the subsoil with surface soil microorganisms during waterlogged incubations. Low concentrations of N, approximately 90 kg N/ha between 1.2 and 3 m, were found in the native vegetation root material. In addition, no net N mineralisation was observed in either the extended incubation of intact cores or in the control samples of the waterlogged incubations. Net N mineralisation was also not detected when the subsoil was amended with a source of organic N. Results indicate that this lack of mineralisation is largely due to pH inhibition of the microbial population. It is concluded that the mineralisation of either in situ organic material, or DON transported to the subsoil during leaching events, is unlikely to have significantly contributed to the subsoil NH4 accumulation at the study site.

Potential for early involvement of CYP isoforms in aspects of human cadmium toxicity

This paper investigates the possible link between non-workplace cadmium (Cd) exposure, cytochrome P450 expression and hypertension. We present results of our investigation into the relationships between liver and kidney Cd burdens and the abundance of the CYP isoform 4A11. Our data show associations between non-workplace Cd exposure and changes in the abundance of hepatic and renal cortical CYP4A11. In liver the levels of immunochemically detectable CYP4A11 were positively correlated with tissue Cd content while in contrast CYP4A11 abundance was inversely correlated with kidney Cd burden. These differences are most likely related to the different Cd burden of the tissues. These observations suggest the potential for involvement of Cd as a mediator of CYP4A11 expression in kidney cortex and indicate that elevations in kidney Cd content may be involved in hypertension via alteration of the expression of this particular isoform. Potential mechanisms by which Cd may alter CYP4A11 expression are discussed briefly. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Low-temperature single-crystal Raman and neutron-diffraction study of the hydrogenous ammonium copper(II) tutton salt and the deuterated analogue in the metastable state

Low-temperature (15 K) single-crystal neutron-diffraction structures and Raman spectra of the salts (NX4)(2)[CU(OX2)(6)](SO4)(2), where X = H or D, are reported. This study is concerned with the origin of the structural phase change that is known to occur upon deuteration. Data for the deuterated salt were measured in the metastable state, achieved by application of 500 bar of hydrostatic pressure at similar to303 K followed by cooling to 281 K and the subsequent release of pressure. This allows for the direct comparison between the hydrogenous and deuterated salts, in the same modification, at ambient pressure and low temperature. The Raman spectra provide no intimation of any significant change in the intermolecular bonding. Furthermore, structural differences are few, the largest being for the long Cu-O bond, which is 2.2834(5) and 2.2802(4) Angstrom for the hydrogenous and the deuterated salts, respectively. Calorimetric data for the deuterated salt are also presented, providing an estimate of 0.17(2) kJ/mol for the enthalpy difference between the two structural forms at 295.8(5) K. The structural data suggest that substitution of hydrogen for deuterium gives rise to changes in the hydrogen-bonding interactions that result in a slightly reduced force field about the copper(II) center. The small structural differences suggest different relative stabilities for the hydrogenous and deuterated salts, which may be sufficient to stabilize the hydrogenous salt in the anomalous structural form.

Functionalized macrocyclic compounds: potential sensors of small molecules and ions

The potential applications of macrocycles in chemistry and at its interfaces with biology and physics continue to emerge, one of which is as receptors for small molecules and ions. This review illustrates these applications with examples from the last ten years employing complexation as the binding mechanism; some of the systems presented have already found real-world sensor applications. In any case, the challenges remain to design more selective and sensitive receptors for guests.

Electrochemistry of P450cin: new insights into P450 electron transfer

Electrochemistry of bacterial cytochrome P450cin (CYP176A) reveals that, unusually, substrate binding does not affect the heme redox potential, although a marked pH dependence is consistent with a coupled single electron/single proton transfer reaction in the range 6 < pH < 10.

The basal ganglia and semantic engagement: Potential insights from semantic priming in individuals with subcortical vascular lesions, Parkinson's disease, and cortical lesions

The impact of basal ganglia dysfunction on semantic processing was investigated by comparing the performance of individuals with nonthalamic subcortical (NS) vascular lesions, Parkinson's disease (PD), cortical lesions, and matched controls on a semantic priming task. Unequibiased lexical ambiguity primes were used in auditory prime-target pairs comprising 4 critical conditions; dominant related (e.g., bank-money), subordinate related (e.g., bank-river), dominant unrelated (e.g.,foot-money) and subordinate unrelated (e.g., bat-river). Participants made speeded lexical decisions (word/nonword) on targets using a go-no-go response. When a short prime-target interstimulus interval (ISI) of 200 ins was employed, all groups demonstrated priming for dominant and subordinate conditions, indicating nonselective meaning facilitation and intact automatic lexical processing. Differences emerged at the long ISI (1250 ms), where control and cortical lesion participants evidenced selective facilitation of the dominant meaning, whereas NS and PD groups demonstrated a protracted period of nonselective meaning facilitation. This finding suggests a circumscribed deficit in the selective attentional engagement of the semantic network on the basis of meaning frequency, possibly implicating a disturbance of frontal-subcortical systems influencing inhibitory semantic mechanisms.

Prospecção de toxicidade de fungicidas por análises macroscópicas, microscópicas e moleculares em Allium cepa

Apesar dos benefícios econômicos dos agrotóxicos para a agricultura, os efeitos negativos à saúde humana e ao meio ambiente são questionados. Dentre os agroquímicos que são usados na agricultura, destacam-se os fungicidas, que são utilizados em grande quantidade nas lavouras para controle de doenças. Com intuito de verificar os danos ocasionados por esses compostos, diversos métodos de avaliação têm sido utilizados na análise de toxicidade e mutagenicidade dos agrotóxicos. As análises macroscópicas (germinação e crescimento radicular) e microscópicas (índice mitótico, aberrações cromossômicas e nucleares) são importantes na determinação da toxicidade de compostos lançados ao meio ambiente, porque permite averiguar danos na germinação, no desenvolvimento da plântula e no ciclo celular. No entanto, para melhor compreensão dos mecanismos moleculares da mutação e de seus efeitos sobre a população exposta à contaminação ambiental, os marcadores moleculares oferecem perspectivas, por medir o efeito direto da exposição sobre o DNA. O objetivo do trabalho foi avaliar o potencial tóxico dos fungicidas por análises macroscópicas, microscópicas e moleculares em Allium cepa. Os resultados indicam redução nos parâmetros de germinação, crescimento radicular e índice mitótico nas maiores concentrações para os princípios ativos difenoconazol, tebuconazol, procimidona e iprodiona, quando comparados ao controle negativo, mostrando que os princípios apresentaram efeito genotóxico, citotóxico, fitotóxico para as raízes de Allium cepa pela alta frequência de aberrações cromossômicas, nucleares e redução do índice mitótico. Os resultados moleculares indicaram mudança no perfil de amplificação dos primers SSR (Sequência Simples Repetitiva) e o ISSR (Inter Sequência Simples Repetitiva), após a exposição do Allium cepa aos princípios ativos, incluindo alterações na perda, ganho e mudança na intensidade de banda. A perda e o ganho de bandas aconteceram à medida que aumentou a concentração dos princípios ativos. O método de agrupamento e as distâncias e dissimilaridades mostraram relação de dose-dependência, pois conseguiu separar as maiores concentrações do controle negativo para os princípios ativos no ISSR e SSR, com exceção dos princípios procimidona e iprodiona no SSR. Esses dados indicam que possui relação entre as análises utilizadas, sendo indicadores confiáveis para detectar alterações por substâncias químicas. Os marcadores moleculares ISSR e SSR são ferramentas eficientes em avaliar alterações ocasionadas no DNA por fungicidas podendo ser utilizada em estudos de toxicidade.

Qualidade da água da lagoa Juara (Serra/ES) : avaliações físicas, químicas e respostas fisiológicas e citogenéticas em plantas

A gestão dos recursos hídricos necessita da integração entre os critérios físicos e químicos, e os aspectos bióticos, os quais possibilitam identificar os efeitos combinados de substâncias e avaliar suas influências. Os sistemas testes Allium cepa e Tradescantia pallida, são utilizados para o estudo da poluição aquática a partir de aspectos citogenéticos. Além destes biomarcadores, os teores de clorofila também são utilizados em estudos de estresse devido ao reflexo a múltiplos fatores. Assim, o objetivo deste trabalho foi avaliar a qualidade da água da lagoa Juara (Município de Serra/ES) pela análise integrada de aspectos físicos, químicos e ecotoxicológicos a partir de estudos citogenéticos em A. cepa e T. pallida, e fotossintéticos nesta última espécie. Foram definidas três estações amostrais ao longo da lagoa e a partir de amostras de água foram analisados parâmetros tais como condutividade, oxigênio dissolvido, concentração de nutrientes e metais. A determinação dos metais ocorreu por análises de espectrometria de massa. O teste do A. cepa foi realizado a partir sementes germinadas em amostras de água da lagoa. Com plantas de T. pallida, foi realizado o ensaio da mitose em ponta de raiz de T. pallida e dosado os teores de pigmentos cloroplastídicos em folhas totalmente expandidas. Para tanto, foi realizado ensaio utilizando-se a água da lagoa como solvente para solução de Hoagland onde estacas previamente enraizadas de T. pallida foram expostas durante 24 horas e 40 dias para as avaliações citogenéticas e fotossintéticas, respectivamente. Foi realizado novo teste do A. cepa nas águas da lagoa após os 40 dias de ensaio para aferir a manutenção das propriedades químicas das amostras. A avaliação citogenética nas duas espécies envolveu a análise dos índice mitótico (IM), índice de aberrações cromossômicas (AC) e frequência de micronúcleos (MN). Para a análise estatística foi utilizada a análise de variância seguida pelo teste de Tukey (p < 0.05) para a comparação dos tratamentos durante a mesma campanha, e teste de Bonferroni (p < 0,05) para a comparação entre as campanhas. Os resultados físicos e químicos mensurados demonstram que a lagoa Juara apresenta indícios de eutroficação artificial. Duas estações amostrais, em pelo menos uma campanha amostral, apresentaram potenciais citotóxico, genotóxico e mutagênico. Todavia, esses potenciais não demonstram relação com os teores de Fe e Mn quantificados, levando a crer que tais pontos apresentam outros potenciais poluentes. Os danos citogenéticos observados apresentaram efeitos maximizados durante a segunda campanha, demostrando o efeito do período de chuva na intensificação da poluição nesse ambiente. O estudo do metabolismo fotossintético em T. pallida, demonstrou os teores de pigmentos cloroplastídicos relacionados ao elevado aporte de nutrientes presentes nas estações J2 e J3. Sendo o excesso destes, o provável responsável pelo teor inferior de pigmentos em J3. Observa-se que os ensaios com A. cepa e T. pallida responderam de maneira fidedigna ao risco potencial do ambiente, complementando as análises físicas e químicas usualmente utilizadas na avaliação da qualidade da água de ambientes lacustres.

O efeito da carga normal no comportamento tribológico de uma superliga de cobalto no ensaio pino-disco

O coeficiente de atrito e o desgaste nas superligas de cobalto são fortemente influenciados pela transformação de fase de CFC para HC que ocorre devido ao trabalho mecânico, conforme já reportado pela literatura. Após essa transformação, os valores de μ costumam se situar na faixa de 0,15 a 0,20. Este trabalho apresenta o comportamento do atrito e do desgaste em um ensaio de deslizamento sem lubrificação utilizando uma configuração pino-disco, sendo o pino feito de aço inoxidável supermartensítico e o disco de uma superliga de cobalto fundida, num tribômetro PLINT TE67. Os ensaios foram conduzidos em temperatura ambiente, com uma velocidade e variando-se a carga normal de deslizamento entre 5 e 500 N. O coeficiente de atrito e o potencial elétrico de contato foram monitorados durante os ensaios. Utilizou-se a MEV e a perfilometria 3D para caracterizar o volume e o mecanismo de desgaste. Para as cargas de 350, 400 e 450 N, após atingir condições de regime estacionário, um valor de coeficiente de atrito não usual (μ<0,01) e uma baixa taxa de desgaste foram encontradas. A análise da difração de raios-X revelou a presença de transformação de fases.

Turkey's Accession to the European Union in terms of impact on the EU's security and defense policies: potential and drawbacks

This study explores the impact of Turkey's likely entry in the European Union (EU) in terms of the EU's foreign, security and defense policies. It reviews Turkish capabilities, namely its military capabilities, which could provide the EU with valuable defense assets. There are differences related to Turkey's relations with the EU, which have increasingly spilled over into the NATO, hindering the development of cooperation over crisis management operations. The article then delves in the implications of Turkey's strategic geographical location to EU policies. It reviews how far the EU and Turkey may have convergent interests in some of the neighboring regions, especially in the Middle East.