A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities

Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information.

Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK.

Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified.

Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.

Theory building with system dynamics: topic and research contributions

The article discusses various reports published within the issue, including the articles "Closing the Loop: Promoting Synergies with other Theory Building Approaches to Improve System Dynamics Practice," by Birgit Kopainsky and Luis Luna-Reyes, and "On improving dynamic decision-making: Implications from multiple-process cognitive theory," by Bent Bakken.

The massless two-loop two-point function and zeta functions in counterterms of Feynman diagrams

The main part of this thesis describes a method of calculating the massless two-loop two-point function which allows expanding the integral up to an arbitrary order in the dimensional regularization parameter epsilon by rewriting it as a double Mellin-Barnes integral. Closing the contour and collecting the residues then transforms this integral into a form that enables us to utilize S. Weinzierl's computer library nestedsums. We could show that multiple zeta values and rational numbers are sufficient for expanding the massless two-loop two-point function to all orders in epsilon. We then use the Hopf algebra of Feynman diagrams and its antipode, to investigate the appearance of Riemann's zeta function in counterterms of Feynman diagrams in massless Yukawa theory and massless QED. The class of Feynman diagrams we consider consists of graphs built from primitive one-loop diagrams and the non-planar vertex correction, where the vertex corrections only depend on one external momentum. We showed the absence of powers of pi in the counterterms of the non-planar vertex correction and diagrams built by shuffling it with the one-loop vertex correction. We also found the invariance of some coefficients of zeta functions under a change of momentum flow through these vertex corrections.

Mapping of assembled epitopic regions of human chorionic gonadotropin reveals proximity of CTP alpha to the determinant loop beta 93-100

Three overlapping assembled epitopes of beta hCG have been mapped using MAb probes and a single step solid phase radioimmunoassay. These epitopes have been shown to be at receptor binding region comprising of the loop region beta Cys93-Cys100. Importance of disulphide bonds in maintaining integrity of these epitopes is assessed. Two MAbs (INN 58 and INN 22) interact with the beta region as well as the alpha C-terminal peptide, while the other MAb INN 24 interacts with only the beta region. Cross-reactivity pattern with beta hCG and hLH as web as the reported crystal structure of hCG substantiates the epitope identification. The results demonstrate utility of MAbs as probes in investigations on three-dimensional structure of gonadatropins.

Dynamics of loop formation in a semiflexible polymer

The dynamics of loop formation by linear polymer chains has been a topic of several theoretical and experimental studies. Formation of loops and their opening are key processes in many important biological processes. Loop formation in flexible chains has been extensively studied by many groups. However, in the more realistic case of semiflexible polymers, not much results are available. In a recent study [K. P. Santo and K. L. Sebastian, Phys. Rev. E 73, 031923 (2006)], we investigated opening dynamics of semiflexible loops in the short chain limit and presented results for opening rates as a function of the length of the chain. We presented an approximate model for a semiflexible polymer in the rod limit based on a semiclassical expansion of the bending energy of the chain. The model provided an easy way to describe the dynamics. In this paper, using this model, we investigate the reverse process, i.e., the loop formation dynamics of a semiflexible polymer chain by describing the process as a diffusion-controlled reaction. We make use of the ``closure approximation'' of Wilemski and Fixman [G. Wilemski and M. Fixman, J. Chem. Phys. 60, 878 (1974)], in which a sink function is used to represent the reaction. We perform a detailed multidimensional analysis of the problem and calculate closing times for a semiflexible chain. We show that for short chains, the loop formation time tau decreases with the contour length of the polymer. But for longer chains, it increases with length obeying a power law and so it has a minimum at an intermediate length. In terms of dimensionless variables, the closing time is found to be given by tau similar to L-n exp(const/L), where n=4.5-6. The minimum loop formation time occurs at a length L-m of about 2.2-2.4. These are, indeed, the results that are physically expected, but a multidimensional analysis leading to these results does not seem to exist in the literature so far.

Connecting Active-Site Loop Conformations and Catalysis in Triosephosphate Isomerase: Insights from a Rare Variation at Residue96 in the Plasmodial Enzyme

Despite extensive research into triosephosphate isomerases (TIMs), there exists a gap in understanding of the remarkable conjunction between catalytic loop-6 (residues 166-176) movement and the conformational flip of Glu165 (catalytic base) upon substrate binding that primes the active site for efficient catalysis. The overwhelming occurrence of serine at position96 (98% of the 6277 unique TIM sequences), spatially proximal to E165 and the loop-6 residues, raises questions about its role in catalysis. Notably, Plasmodium falciparum TIM has an extremely rare residuephenylalanineat this position whereas, curiously, the mutant F96S was catalytically defective. We have obtained insights into the influence of residue96 on the loop-6 conformational flip and E165 positioning by combining kinetic and structural studies on the PfTIM F96 mutants F96Y, F96A, F96S/S73A, and F96S/L167V with sequence conservation analysis and comparative analysis of the available apo and holo structures of the enzyme from diverse organisms.

Plasmodium falciparum Rosetting Epitopes Converge in the SD3-Loop of PfEMP1-DBL1α

The ability of Plasmodium falciparum parasitized RBC (pRBC) to form rosettes with normal RBC is linked to the virulence of the parasite and RBC polymorphisms that weaken rosetting confer protection against severe malaria. The adhesin PfEMP1 mediates the binding and specific antibodies prevent sequestration in the micro-vasculature, as seen in animal models. Here we demonstrate that epitopes targeted by rosette disrupting antibodies converge in the loop of subdomain 3 (SD3) which connects the h6 and h7 α-helices of PfEMP1-DBL1α. Both monoclonal antibodies and polyclonal IgG, that bound to epitopes in the SD3-loop, stained the surface of pRBC, disrupted rosettes and blocked direct binding of recombinant NTS-DBL1α to RBC. Depletion of polyclonal IgG raised to NTS-DBL1α on a SD3 loop-peptide removed the anti-rosetting activity. Immunizations with recombinant subdomain 1 (SD1), subdomain 2 (SD2) or SD3 all generated antibodies reacting with the pRBC-surface but only the sera of animals immunized with SD3 disrupted rosettes. SD3-sequences were found to segregate phylogenetically into two groups (A/B). Group A included rosetting sequences that were associated with two cysteine-residues present in the SD2-domain while group B included those with three or more cysteines. Our results suggest that the SD3 loop of PfEMP1-DBL1α is an important target of anti-rosetting activity, clarifying the molecular basis of the development of variant-specific rosette disrupting antibodies.

Solid-phase synthesis of an A-B loop mimetic of the C epsilon 3 domain of human IgE: macrocyclization by Sonogashira coupling

The solid-phase synthesis of a cyclic peptide containing the 21-residue epitope found in the A-B loop of the Cepsilon3 domain of human immunoglobulin E has been carried out. The key macrocyclization step to form the 65-membered ring is achieved in similar to15% yield via an "on-resin" Sonogashira coupling reaction which concomitantly installs a diphenylacetylene amino acid conformational constraint within the loop.

Comparing the thermal performance of horizontal slinky-loop and vertical slinky-loop heat exchangers

The heat pump market in the UK has grown rapidly over the last few years. Performance analyses of vertical ground-loop heat exchanger configurations have been widely carried out using both numerical modelling and experiments. However, research findings and design recommendations on horizontal slinky-loop and vertical slinky-loop heat exchangers are far fewer compared with those for vertical ground-loop heat exchanger configurations, especially where the long-term operation of the systems is concerned. The paper presents the results obtained from a numerical simulation for the horizontal slinky-loop and vertical slinky-loop heat exchangers of a ground-source heat pump system. A three-dimensional numerical heat transfer model was developed to study the thermal performance of various heat exchanger configurations. The influence of the loop pitch (loop spacing) and the depth of a vertical slinky-loop installation were investigated and the thermal performance and excavation work required for the horizontal and vertical slinky-loop heat exchangers were compared. The influence of the installation depth for vertical slinky-loop configurations was also investigated. The results of this study show that the influence of the installation depth of the vertical slinky-loop heat exchanger on the thermal performance of the system is small. The maximum difference in the thermal performance between the vertical and horizontal slinky-loop heat exchangers with the same loop diameter and loop pitch is less than 5%.

The Hilbert space of the Chern-Simons theory on a cylinder: a loop quantum gravity approach

As a laboratory for loop quantum gravity, we consider the canonical quantization of the three-dimensional Chern-Simons theory on a noncompact space with the topology of a cylinder. Working within the loop quantization formalism, we define at the quantum level the constraints appearing in the canonical approach and completely solve them, thus constructing a gauge and diffeomorphism invariant physical Hilbert space for the theory. This space turns out to be infinite dimensional, but separable.

Closed loop stability of measure-driven impulsive control systems

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Optimizing the design of preactivated titanium T-loop springs with Loop software

ATMA (Ormco Corp, Glendora, Calif) T-loop spring (TTLS), preactivated with a gable bend distal to the loop, holds promise for producing controlled tipping of the canines and translation of the posterior segment. However, there is currently no consensus as to where the preactivated gable bend or the loop should be placed, what the height of the loop should be, or how the interbracket distance changes the moments produced. Using the Loop software program (dHal, Athens, Greece), we systematically modified a .017 x .025-in TTLS (10 x 6 mm) that was preactivated with a 45 degrees gable bend distal to the loop, and simulated the effects. As the gable bend was moved posteriorly, the moment increased at the posterior bracket more than it decreased at the anterior bracket. As the loop was brought closer to the anterior bracket, the posterior moment decreased at the same rate that it increased anteriorly. As the loop was increased in size, the moments increased both posteriorly and anteriorly. As the interbracket distance increased, the posterior moment decreased, and the anterior moment remained constant. We concluded that the size of the loop should be slightly increased, to 10 x 7 mm, and it should be placed 2 mm from the anterior bracket, with a preactivation bend of 45 degrees, 4 to 5 mm from the posterior bracket (after 4 mm of activation).

Real-time closed-loop electrophysiology: towards new frontiers in in vitro investigations in the neurosciences

Reflected at any level of organization of the central nervous system, most of the processes ranging from ion channels to neuronal networks occur in a closed loop, where the input to the system depends on its output. In contrast, most in vitro preparations and experimental protocols operate autonomously, and do not depend on the output of the studied system. Thanks to the progress in digital signal processing and real-time computing, it is now possible to artificially close the loop and investigate biophysical processes and mechanisms under increased realism. In this contribution, we review some of the most relevant examples of a new trend in in vitro electrophysiology, ranging from the use of dynamic-clamp to multi-electrode distributed feedback stimulation. We are convinced these represents the beginning of new frontiers for the in vitro investigation of the brain, promising to open the still existing borders between theoretical and experimental approaches while taking advantage of cutting edge technologies.

Supersymmetric quantum mechanics on the lattice: I. Loop formulation

Simulations of supersymmetric field theories on the lattice with (spontaneously) broken supersymmetry suffer from a fermion sign problem related to the vanishing of the Witten index. We propose a novel approach which solves this problem in low dimensions by formulating the path integral on the lattice in terms of fermion loops. For N=2 supersymmetric quantum mechanics the loop formulation becomes particularly simple and in this paper – the first in a series of three – we discuss in detail the reformulation of this model in terms of fermionic and bosonic bonds for various lattice discretisations including one which is Q-exact.

Specificities of Caenorhabditis elegans and human hairpin binding proteins for the first nucleotide in the histone mRNA hairpin loop.

The 3' ends of animal replication-dependent histone mRNAs are formed by endonucleolytic cleavage of the primary transcripts downstream of a highly conserved RNA hairpin. The hairpin-binding protein (HBP) binds to this RNA element and is involved in histone RNA 3' processing. A minimal RNA-binding domain (RBD) of approximately 73 amino acids that has no similarity with other known RNA-binding motifs was identified in human HBP [Wang Z-F et al., Genes & Dev, 1996, 10:3028-3040]. The primary sequence identity between human and Caenorhabditis elegans RBDs is 55% compared to 38% for the full-length proteins. We analyzed whether differences between C. elegans and human HBP and hairpins are reflected in the specificity of RNA binding. The C. elegans HBP and its RBD recognize only their cognate RNA hairpins, whereas the human HBP or RBD can bind both the mammalian and the C. elegans hairpins. This selectivity of C. elegans HBP is mostly mediated by the first nucleotide in the loop, which is C in C. elegans and U in all other metazoans. By converting amino acids in the human RBD to the corresponding C. elegans residues at places where the latter deviates from the consensus, we could identify two amino acid segments that contribute to selectivity for the first nucleotide of the hairpin loop.