Developing consensus on hospital prescribing indicators of potential harms amenable to decision support

Aim: To develop a list of prescribing indicators specific for the hospital setting that would facilitate the prospective collection of high severity and/or high frequency prescribing errors, which are also amenable to electronic clinical decision support (CDS). Method: A three-stage consensus technique (electronic Delphi) was carried out with 20 expert pharmacists and physicians across England. Participants were asked to score prescribing errors using a 5-point Likert scale for their likelihood of occurrence and the severity of the most likely outcome. These were combined to produce risk scores, from which median scores were calculated for each indicator across the participants in the study. The degree of consensus between the participants was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or more was achieved. Results: A total of 80 prescribing errors were identified by consensus as being high or extreme risk. The most common drug classes named within the indicators were antibiotics (n=13), antidepressants (n=8), nonsteroidal anti-inflammatory drugs (n=6), and opioid analgesics (n=6).The most frequent error type identified as high or extreme risk were those classified as clinical contraindications (n=29/80). Conclusion: 80 high risk prescribing errors in the hospital setting have been identified by an expert panel. These indicators can serve as the basis for a standardised, validated tool for the collection of data in both paperbased and electronic prescribing processes, as well as to assess the impact of electronic decision support implementation or development.

Structural and Biochemical Characterization of Peroxiredoxin Q beta from Xylella fastidiosa CATALYTIC MECHANISM AND HIGH REACTIVITY

The phytopathogenic bacterium Xylella fastidiosa is the etiological agent of various plant diseases. To survive under oxidative stress imposed by the host, microorganisms express antioxidant proteins, including cysteine-based peroxidases named peroxiredoxins. This work is a comprehensive analysis of the catalysis performed by PrxQ from X. fastidiosa (XfPrxQ) that belongs to a peroxiredoxin class still poorly characterized and previously considered as moderately reactive toward hydroperoxides. Contrary to these assumptions, our competitive kinetics studies have shown that the second-order rate constants of the peroxidase reactions of XfPrxQ with hydrogen peroxide and peroxynitrite are in the order of 107 and 106 M(-1) s(-1), respectively, which are as fast as the most efficient peroxidases. The XfPrxQ disulfides were only slightly reducible by dithiothreitol; therefore, the identification of a thioredoxin system as the probable biological reductant of XfPrxQ was a relevant finding. We also showed by site-specific mutagenesis and mass spectrometry that an intramolecular disulfide bond between Cys-47 and Cys-83 is generated during the catalytic cycle. Furthermore, we elucidated the crystal structure of XfPrxQ C47S in which Ser-47 and Cys-83 lie similar to 12.3 angstrom apart. Therefore, significant conformational changes are required for disulfide bond formation. In fact, circular dichroism data indicated that there was a significant redox-dependent unfolding of alpha-helices, which is probably triggered by the peroxidatic cysteine oxidation. Finally, we proposed a model that takes data from this work as well data as from the literature into account.

Bj-PRO-5a, a natural angiotensin-converting enzyme inhibitor, promotes vasodilatation mediated by both bradykinin B(2) and M1 muscarinic acetylcholine receptors

Bradykinin-potentiating peptides (BPPs) or proline-rich oligopeptides (PROs) isolated from the venom glands of Bothrops jararaca (Bj) were the first natural inhibitors of the angiotensin-converting enzyme (ACE) described. Bj-PRO-5a (< EKWAP), a member of this structurally related peptide family, was essential for the development of captopril, the first site-directed ACE inhibitor used for the treatment of human hypertension. Nowadays, more Bj-PROs have been identified with higher ACE inhibition potency compared to Bj-PRO-5a. However, despite its modest inhibitory effect of ACE inhibition, Bj-PRO-5a reveals strong bradykinin-potentiating activity, suggesting the participation of other mechanisms for this peptide. In the present study, we have shown that Bj-PRO-5a induced nitric oxide (NO) production depended on muscarinic acetylcholine receptor M1 subtype (mAchR-M1) and bradykinin B(2) receptor activation, as measured by a chemiluminescence assay using a NO analyzer. Intravital microscopy based on transillumination of mice cremaster muscle also showed that both bradykinin B(2) receptor and mAchR-M1 contributed to the vasodilatation induced by Bj-PRO-5a. Moreover, Bj-PRO-5a-mediated vasodilatation was completely blocked in the presence of a NO synthase inhibitor. The importance of this work lies in the definition of novel targets for Bj-PRO-5a in addition to ACE, the structural model for captopril development. (C) 2011 Elsevier Inc. All rights reserved.

Identification of an α-peptide in Haliotis rubra with homology to the Lymnaea α-CDCP spawning peptide

It is now understood that a combination of molluscan reproductive peptides are commonly cleaved from a large preprohormone and influence different aspects of spawning behavior. One type of reproductive peptide, known in Lymnaea stagnalis as [alpha]-CDCP, and in Aplysia californica as [alpha]-BCP, acts in egg laying via temperature-dependent autoinhibition or autoexcitation of neuronal cells. In our study, the expression of [alpha]-CDCP-like peptide in the blacklip abalone, Haliotis rubra, was identified by Western blots and immunocytochemistry, using an antiserum developed against [alpha]-CDCP. Western blots of total protein isolated from the central nervous system, cerebral and pleuropedal ganglia, as well as gonad and heptopancreas tissues of sexually mature adults, identified a protein of approximately 100 kDa as well as a range of smaller reactive peptides. This finding suggests that a reproductive [alpha]-peptide is probably synthesized from a single larger precursor protein. The larger peptides were also identified in Western blots of several abalone tissues, lmmunocytochemistry using the same antiserum showed the presence of immunoreactive axons in all the tissues studied, indicating synthesis or transport of products. The function of the abalone [alpha]-CDCP-like peptide is yet to be determined.

Estresse financeiro e recuperação no ambiente corporativo : estudos de casos no setor de telecomunicações do Brasil após privatização

O objetivo deste trabalho foi explorar o tema de estresse financeiro e recuperação no ambiente corporativo através de uma revisão bibliográfica e estudos de casos, fazendo um paralelo entre os conceitos e conclusões levantadas por autores que estudaram o tema e casos reais vivenciados por empresas do setor de telecomunicações no Brasil. Muitos autores apontaram os fatores externos (cenário macroeconômico, mudanças na estrutura da indústria, falta de liquidez no mercado financeiro, etc.) e os fatores internos (erro dos administradores) dentre as principais causas que levam uma empresa a apurar estresse financeiro, enfatizando que, os fatores internos são determinantes na maioria dos fracassos corporativos. Os autores também mencionaram importantes estratégias de sucesso a serem implementadas dentro de um processo de recuperação, destacando as estratégias voltadas para o aumento de eficiência (redução de custos e despesas, venda de ativos, etc.) e estratégias voltadas para o empreendorismo (re-posicionamento de mercado, entrada em novos produtos). O trabalho desenvolveu estudos de casos de empresas do setor de telecomunicações do Brasil no período após a privatização, que vivenciaram estresse financeiro e implementaram um processo de recuperação. Dentro deste critério, os casos de estresse financeiro da Embratel e da BCP foram os objetos de análise e contribuíram para interessantes conclusões sobre as causas que levaram as empresas de telecomunicações a enfrentarem estresse financeiro, as estratégias de recuperação implementadas, os aprendizados dos casos analisados e como os conceitos e conclusões descritos na revisão bibliográfica se aplicaram nos casos.

Distribuições hiperbólicas generalizadas: aplicações ao mercado português

O objectivo desta tese é discutir o uso das distribuições hiperbólicas generalizadas como modelo para os retornos logarítmicos de 4 activos do mercado de capitais Português. Os activos em análise são o índice Português PSI 20 e as 3 maiores empresas pertencentes ao PSI 20: PT, EDP e BCP. Os dados são constituidos pelos valores de fecho diário durante mais de 8 anos. Utilizando o software R procederemos à estimação dos parâmetros das distribuições para ajustamento aos dados empíricos. Para medir o grau de ajustamento das distribuições aos dados empíricos usamos os gráficos QQ-plots e 4 distâncias: Kolmogorov-Smirnov, Kuiper, Anderson-Darling e Fajardo-Farias-Ornelas. Os resultados obtidos permitem concluir que o melhor ajustamento é feito pela hiperbólica generalizada e em seguida a distribuição normal inversa gaussiana. Todas as distribuições desta família ajustam-se muito melhor que a distribuição normal. Por último temos uma aplicação ao cálculo do preço de derivados financeiros, nomeadamente a fórmula de uma opção de compra Europeia no modelo discutido.

Ambiente computacional paradesenvolvimento de aplicações de controladores lógicos programáveis baseado em linguagens SFC e ST

This work proposes an environment for programming programmable logic controllers applied to oil wells with BCP type method of artificially lifting. The environment will have an editor based in the diagram of sequential functions for programming of PLCs. This language was chosen due to the fact of being high-level and accepted by the international standard IEC 61131-3. The use of these control programs in real PLC will be possible with the use of an intermediate level of language based on XML specification PLCopen T6 XML. For the testing and validation of the control programs, an area should be available for viewing variables obtained through communication with a real PLC. Thus, the main contribution of this work is to develop a computational environment that allows: modeling, testing and validating the controls represented in SFC and applied in oil wells with BCP type method of artificially lifting

Adesão, proliferação e genotoxicidade celular de celulose bacteriana modificada por plasma

Bacterial cellulose (BC) has a wide range of potential applications, namely as temporary substitute skin in the treatment of skin wounds, such as burns, ulcers and grafts. Surface properties determine the functional response of cells, an important factor for the successful development of biomaterials. This work evaluates the influence of bacterial cellulose surface treatment by plasma (BCP) on the cellular behavior and its genotoxicity potential. The modified surface was produced by plasma discharge in N2 and O2 atmosphere, and the roughness produced by ion bombardment characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Cell adhesion, viability and proliferation on BCP were analysed using crystal violet staining and the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium (MTT) method. Genotoxicity was evaluated using the comet and cytokinesis block micronucleus assay. The results show that the plasma treatment changed surface roughness, producing an ideal cell attachment, evidenced by more elongated cell morphology and improved proliferation. The excellent biocompatibility of BCP was confirmed by genotoxicity tests, which showed no significant DNA damage. The BCP has therefore great potential as a new artificial implant

Estudo de estratégias de otimização para poços de petróleo com elevação por bombeio de cavidades progressivas

The progressing cavity pump artificial lift system, PCP, is a main lift system used in oil production industry. As this artificial lift application grows the knowledge of it s dynamics behavior, the application of automatic control and the developing of equipment selection design specialist systems are more useful. This work presents tools for dynamic analysis, control technics and a specialist system for selecting lift equipments for this artificial lift technology. The PCP artificial lift system consists of a progressing cavity pump installed downhole in the production tubing edge. The pump consists of two parts, a stator and a rotor, and is set in motion by the rotation of the rotor transmitted through a rod string installed in the tubing. The surface equipment generates and transmits the rotation to the rod string. First, is presented the developing of a complete mathematical dynamic model of PCP system. This model is simplified for use in several conditions, including steady state for sizing PCP equipments, like pump, rod string and drive head. This model is used to implement a computer simulator able to help in system analysis and to operates as a well with a controller and allows testing and developing of control algorithms. The next developing applies control technics to PCP system to optimize pumping velocity to achieve productivity and durability of downhole components. The mathematical model is linearized to apply conventional control technics including observability and controllability of the system and develop design rules for PI controller. Stability conditions are stated for operation point of the system. A fuzzy rule-based control system are developed from a PI controller using a inference machine based on Mandami operators. The fuzzy logic is applied to develop a specialist system that selects PCP equipments too. The developed technics to simulate and the linearized model was used in an actual well where a control system is installed. This control system consists of a pump intake pressure sensor, an industrial controller and a variable speed drive. The PI control was applied and fuzzy controller was applied to optimize simulated and actual well operation and the results was compared. The simulated and actual open loop response was compared to validate simulation. A case study was accomplished to validate equipment selection specialist system

Desenvolvimento de um simulador de bombeio por cavidades progressivas

The method of artificial lift of progressing cavity pump is very efficient in the production of oils with high viscosity and oils that carry a great amount of sand. This characteristic converted this lift method into the second most useful one in oil fields production. As it grows the number of its applications it also increases the necessity to dominate its work in a way to define it the best operational set point. To contribute to the knowledge of the operational method of artificial lift of progressing cavity pump, this work intends to develop a computational simulator for oil wells equipped with an artificial lift system. The computational simulator of the system will be able to represent its dynamic behavior when submitted to the various operational conditions. The system was divided into five subsystems: induction motor, multiphase flows into production tubing, rod string, progressing cavity pump and annular tubing-casing. The modeling and simulation of each subsystem permitted to evaluate the dynamic characteristics that defined the criteria connections. With the connections of the subsystems it was possible to obtain the dynamic characteristics of the most important arrays belonging to the system, such as: pressure discharge, pressure intake, pumping rate, rod string rotation and torque applied to polish string. The shown results added to a friendly graphical interface converted the PCP simulator in a great potential tool with a didactic characteristic in serving the technical capability for the system operators and also permitting the production engineering to achieve a more detail analysis of the dynamic operational oil wells equipped with the progressing cavity pump

Simulação computacional do escoamento em bombas de cavidades progressivas

The use of Progressing Cavity Pumps (PCPs) in artificial lift applications in low deep wells is becoming more common in the oil industry, mainly, due to its ability to pump heavy oils, produce oil with large concentrations of sand, besides present high efficiency when compared to other artificial lift methods. Although this system has been widely used as an oil lift method, few investigations about its hydrodynamic behavior are presented, either experimental or numeric. Therefore, in order to increase the knowledge about the BCP operational behavior, this work presents a novel computational model for the 3-D transient flow in progressing cavity pumps, which includes the relative motion between rotor and stator, using an element based finite volume method. The model developed is able to accurately predict the volumetric efficiency and viscous looses as well as to provide detailed information of pressure and velocity fields inside the pump. In order to predict PCP performance for low viscosity fluids, advanced turbulence models were used to treat, accurately, the turbulent effects on the flow, which allowed for obtaining results consistent with experimental values encountered in literature. In addition to the 3D computational model, a simplified model was developed, based on mass balance within cavities and on simplification on the momentum equations for fully developed flow along the seal region between cavities. This simplified model, based on previous approaches encountered in literature, has the ability to predict flow rate for a given differential pressure, presenting exactness and low CPU requirements, becoming an engineering tool for quick calculations and providing adequate results, almost real-time time. The results presented in this work consider a rigid stator PCP and the models developed were validated against experimental results from open literature. The results for the 3-D model showed to be sensitive to the mesh size, such that a numerical mesh refinement study is also presented. Regarding to the simplified model, some improvements were introduced in the calculation of the friction factor, allowing the application fo the model for low viscosity fluids, which was unsuccessful in models using similar approaches, presented in previous works

Simulação computacional da interação fluido-estrutura em bombas de cavidades progressivas

The pumping through progressing cavities system has been more and more employed in the petroleum industry. This occurs because of its capacity of elevation of highly viscous oils or fluids with great concentration of sand or other solid particles. A Progressing Cavity Pump (PCP) consists, basically, of a rotor - a metallic device similar to an eccentric screw, and a stator - a steel tube internally covered by a double helix, which may be rigid or deformable/elastomeric. In general, it is submitted to a combination of well pressure with the pressure generated by the pumping process itself. In elastomeric PCPs, this combined effort compresses the stator and generates, or enlarges, the clearance existing between the rotor and the stator, thus reducing the closing effect between their cavities. Such opening of the sealing region produces what is known as fluid slip or slippage, reducing the efficiency of the PCP pumping system. Therefore, this research aims to develop a transient three-dimensional computational model that, based on single-lobe PCP kinematics, is able to simulate the fluid-structure interaction that occurs in the interior of metallic and elastomeric PCPs. The main goal is to evaluate the dynamic characteristics of PCP s efficiency based on detailed and instantaneous information of velocity, pressure and deformation fields in their interior. To reach these goals (development and use of the model), it was also necessary the development of a methodology for generation of dynamic, mobile and deformable, computational meshes representing fluid and structural regions of a PCP. This additional intermediary step has been characterized as the biggest challenge for the elaboration and running of the computational model due to the complex kinematic and critical geometry of this type of pump (different helix angles between rotor and stator as well as large length scale aspect ratios). The processes of dynamic generation of meshes and of simultaneous evaluation of the deformations suffered by the elastomer are fulfilled through subroutines written in Fortan 90 language that dynamically interact with the CFX/ANSYS fluid dynamic software. Since a structural elastic linear model is employed to evaluate elastomer deformations, it is not necessary to use any CAE package for structural analysis. However, an initial proposal for dynamic simulation using hyperelastic models through ANSYS software is also presented in this research. Validation of the results produced with the present methodology (mesh generation, flow simulation in metallic PCPs and simulation of fluid-structure interaction in elastomeric PCPs) is obtained through comparison with experimental results reported by the literature. It is expected that the development and application of such a computational model may provide better details of the dynamics of the flow within metallic and elastomeric PCPs, so that better control systems may be implemented in the artificial elevation area by PCP

Simulação do escoamento multifásico no interior de bombas de cavidades progressivas metálicas

The progressing cavity pumping (PCP) is one of the most applied oil lift methods nowadays in oil extraction due to its ability to pump heavy and high gas fraction flows. The computational modeling of PCPs appears as a tool to help experiments with the pump and therefore, obtain precisely the pump operational variables, contributing to pump s project and field operation otimization in the respectively situation. A computational model for multiphase flow inside a metallic stator PCP which consider the relative motion between rotor and stator was developed in the present work. In such model, the gas-liquid bubbly flow pattern was considered, which is a very common situation in practice. The Eulerian-Eulerian approach, considering the homogeneous and inhomogeneous models, was employed and gas was treated taking into account an ideal gas state. The effects of the different gas volume fractions in pump volumetric eficiency, pressure distribution, power, slippage flow rate and volumetric flow rate were analyzed. The results shown that the developed model is capable of reproducing pump dynamic behaviour under the multiphase flow conditions early performed in experimental works

The reactivity of oytho-methoxy-substituted catechol radicals with sulfhydryl groups: Contribution for the comprehension of the mechanism of inhibition of NADPH oxidase by apocynin

Redox processes are involved in the mechanism of action of NADPH oxidase inhibitors such as diphenyleneiodonium and apocynin. Here, we studied the structure-activity relationship for apocynin and analogous ortho-methoxy-substituted catechols as inhibitors of the NADPH oxidase in neutrophils and their reactivity with peroxidase. Aiming to alter the reduction potential, the ortho-methoxy-catechol moiety was kept constant and the substituents at para position related to the hydroxyl group were varied. Two series of compounds were employed: methoxy-catechols bearing electron-withdrawing groups (MC-W) such as apocynin, vanillin, 4-nitroguaiacol, 4-cyanoguaiacol, and methoxy-catechol bearing electron-donating groups (MC-D) such as 4-methylguaiacol and 4-ethylguaiacol. We found that MC-D were weaker inhibitors compared to MD-W. Furthermore, the radicals generated by oxidation of MC-W via MPO/H(2)O(2), but not for MC-D, were able to oxidize glutathione (GSH) as verified by the formation of thiyl radicals, depletion of GSH, and recycling of the ortho-methoxy-catechols during their oxidations. The capacity of oxidizing sulfhydryl (SH) groups was also verified when ovalbumin was incubated with MC-W, but not for MC-D. Since the effect of apocynin has been correlated with inactivation of the cytosolic fractions of the NADPH oxidase complex and its oxidation during the inhibitory process develops a special role in this process, we suggest that the close relationship between the reactivity of the radicals of MC-W compounds with thiol groups and their efficacy as NADPH oxidase inhibitor could be the chemical pathway behind the mechanism of action of apocynin and should be taken into account in the design of new and specific NADPH oxidase inhibitors. (c) 2007 Elsevier B.V. All rights reserved.