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Sample records for drug monitor feedback

  1. Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant Staphylococcus aureus infections: a single institution experience

    Directory of Open Access Journals (Sweden)

    Hirano R

    2016-10-01

    Full Text Available Ryuichi Hirano,1 Yuichi Sakamoto,2 Junichi Kitazawa,2 Shoji Yamamoto,1 Naoki Tachibana2 1Department of Pharmacy, 2Laboratory Medicine and Blood Transfusion, Aomori Prefectural Central Hospital, Aomori-shi, Japan Background: Vancomycin (VCM requires dose adjustment based on therapeutic drug monitoring. At Aomori Prefectural Central Hospital, physicians carried out VCM therapeutic drug monitoring based on their experience, because pharmacists did not participate in the dose adjustment. We evaluated the impact of an Antimicrobial Stewardship Program (ASP on attaining target VCM trough concentrations and pharmacokinetics (PK/pharmacodynamics (PD parameters in patients with methicillin-resistant Staphylococcus aureus (MRSA infections. Materials and methods: The ASP was introduced in April 2012. We implemented a prospective audit of prescribed VCM dosages and provided feedback based on measured VCM trough concentrations. In a retrospective pre- and postcomparison study from April 2007 to December 2011 (preimplementation and from April 2012 to December 2014 (postimplementation, 79 patients were treated for MRSA infection with VCM, and trough concentrations were monitored (pre, n=28; post, n=51. In 65 patients (pre, n=15; post, n=50, 24-hour area under the ­concentration–time curve (AUC 0–24 h/minimum inhibitory concentration (MIC ratios were calculated. Results: Pharmacist feedback, which included recommendations for changing dose or using alternative anti-MRSA antibiotics, was highly accepted during postimplementation (88%, 29/33. The number of patients with serum VCM concentrations within the therapeutic range (10–20 μg/mL was significantly higher during postimplementation (84%, 43/51 than during preimplementation (39%, 11/28 (P<0.01. The percentage of patients who attained target PK/PD parameters (AUC 0–24 h/MIC >400 was significantly higher during postimplementation (84%, 42/50 than during preimplementation (53%, 8/15; P=0.013. There were

  2. Therapeutic drug monitoring of atypical antipsychotic drugs

    Directory of Open Access Journals (Sweden)

    Grundmann Milan

    2014-12-01

    Full Text Available Schizophrenia is a severe psychiatric disorder often associated with cognitive impairment and affective, mainly depressive, symptoms. Antipsychotic medication is the primary intervention for stabilization of acute psychotic episodes and prevention of recurrences and relapses in patients with schizophrenia. Typical antipsychotics, the older class of antipsychotic agents, are currently used much less frequently than newer atypical antipsychotics. Therapeutic drug monitoring (TDM of antipsychotic drugs is the specific method of clinical pharmacology, which involves measurement of drug serum concentrations followed by interpretation and good cooperation with the clinician. TDM is a powerful tool that allows tailor-made treatment for the specific needs of individual patients. It can help in monitoring adherence, dose adjustment, minimizing the risk of toxicity and in cost-effectiveness in the treatment of psychiatric disorders. The review provides complex knowledge indispensable to clinical pharmacologists, pharmacists and clinicians for interpretation of TDM results.

  3. Therapeutic drug monitoring in pregnancy.

    Science.gov (United States)

    Matsui, Doreen M

    2012-10-01

    Therapeutic drug monitoring (TDM) is commonly recommended to optimize drug dosing regimens of various medications. It has been proposed to guide therapy in pregnant women, in whom physiological changes may lead to altered pharmacokinetics resulting in difficulty in predicting the appropriate drug dosage. Ideally, TDM may play a role in enhancing the effectiveness of treatment while minimizing toxicity of both the mother and fetus. Monitoring of drug levels may also be helpful in assessing adherence to prescribed therapy in selected cases. Limitations exist as therapeutic ranges have only been defined for a limited number of drugs and are based on data obtained in nonpregnant patients. TDM has been suggested for anticonvulsants, antidepressants, and antiretroviral drugs, based on pharmacokinetic studies that have shown reduced drug concentrations. However, there is only relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Further studies are required to determine whether implementation of TDM during pregnancy improves outcome and is associated with any benefit beyond that achieved by clinical judgment alone. The cost effectiveness of TDM programs during pregnancy also remains to be examined.

  4. Expert monitoring and verbal feedback as sources of performance pressure.

    Science.gov (United States)

    Buchanan, John J; Park, Inchon; Chen, Jing; Mehta, Ranjana K; McCulloch, Austin; Rhee, Joohyun; Wright, David L

    2018-05-01

    The influence of monitoring-pressure and verbal feedback on the performance of the intrinsically stable bimanual coordination patterns of in-phase and anti-phase was examined. The two bimanual patterns were produced under three conditions: 1) no-monitoring, 2) monitoring-pressure (viewed by experts), and 3) monitoring-pressure (viewed by experts) combined with verbal feedback emphasizing poor performance. The bimanual patterns were produced at self-paced movement frequencies. Anti-phase coordination was always less stable than in-phase coordination across all three conditions. When performed under conditions 2 and 3, both bimanual patterns were performed with less variability in relative phase across a wide range of self-paced movement frequencies compared to the no-monitoring condition. Thus, monitoring-pressure resulted in performance stabilization rather than degradation and the presence of verbal feedback had no impact on the influence of monitoring pressure. The current findings are inconsistent with the predictions of explicit monitoring theory; however, the findings are consistent with studies that have revealed increased stability for the system's intrinsic dynamics as a result of attentional focus and intentional control. The results are discussed within the contexts of the dynamic pattern theory of coordination, explicit monitoring theory, and action-focused theories as explanations for choking under pressure. Copyright © 2018. Published by Elsevier B.V.

  5. Enhancing Human Resilience : monitoring, sensing, and feedback

    NARCIS (Netherlands)

    Binsch, O.; Wabeke, T.R.; Koot, G.; Venrooij, W.; Valk, P.J.L.

    2016-01-01

    The development of miniaturized monitoring technology represents the greatest opportunity for advancing Resilience and Mental Health in over a century. All experts of the Resilience- and Mental Health domain are contending with a significant mental health burden, e.g. almost half of all work

  6. Therapeutic drug monitoring of aminoglycosides in neonates

    NARCIS (Netherlands)

    Touw, Daniël J; Westerman, Elsbeth M; Sprij, Arwen J

    2009-01-01

    The efficacy and toxicity of aminoglycosides show a strong direct positive relationship with blood drug concentrations, therefore, therapy with aminoglycosides in adults is usually guided by therapeutic drug monitoring. Dosing regimens in adults have evolved from multiple daily dosing to

  7. A critical assessment of antipsychotic drug monitoring.

    Science.gov (United States)

    Waraska, J; Nagle, J D

    1987-06-01

    Analytic problems associated with monitoring antipsychotic drug levels have largely been resolved. Despite the establishment of target values for some drugs, the clinical utility of such levels remains to be determined.

  8. Beam monitors and transverse feedback system of TRISTAN Main Ring

    International Nuclear Information System (INIS)

    Ieiri, T.; Ishii, H.; Kishiro, J.; Mizumachi, Y.; Mori, K.; Nakajima, K.; Ogata, A.; Shintake, T.; Tejima, M.

    1987-01-01

    The construction of 30 GeV TRISTAN Main Ring (MR) started in 1983 soon after the commissioning of 8 GeV Accumulation Ring (AR). The authors prepared 392 position monitors, 6 synchrotron radiation monitors, 9 screen monitors, 2 DCCT's, 3 scrapers, 12 bunch monitors, transverse feedback systems for two beams and DC separators. Since the required monitoring devices of AR and MR are almost the same, the experiences in AR were very useful in the design of MR monitors. However, machine parameters of two rings are very different and the authors had to review the performance of each item. From the monitor point of view the most important is the difference of revolution frequency; 794.6 kHz for AR and 99.33 kHz for MR. This means that average beam current of MR is 1/8 as small as AR current with the same bunch number and intensity. Therefore, the sensitivity of each monitor must be better in MR. The second difference is that MR should be used as a collider from the beginning. Therefore they must prepare for multi-beam and multi-bunch operation

  9. Therapeutic drug monitoring of antimicrobials

    Science.gov (United States)

    Roberts, Jason A; Norris, Ross; Paterson, David L; Martin, Jennifer H

    2012-01-01

    Optimizing the prescription of antimicrobials is required to improve clinical outcome from infections and to reduce the development of antimicrobial resistance. One such method to improve antimicrobial dosing in individual patients is through application of therapeutic drug monitoring (TDM). The aim of this manuscript is to review the place of TDM in the dosing of antimicrobial agents, specifically the importance of pharmacokinetics (PK) and pharmacodynamics (PD) to define the antimicrobial exposures necessary for maximizing killing or inhibition of bacterial growth. In this context, there are robust data for some antimicrobials, including the ratio of a PK parameter (e.g. peak concentration) to the minimal inhibitory concentration of the bacteria associated with maximal antimicrobial effect. Blood sampling of an individual patient can then further define the relevant PK parameter value in that patient and, if necessary, antimicrobial dosing can be adjusted to enable achievement of the target PK/PD ratio. To date, the clinical outcome benefits of a systematic TDM programme for antimicrobials have only been demonstrated for aminoglycosides, although the decreasing susceptibility of bacteria to available antimicrobials and the increasing costs of pharmaceuticals, as well as emerging data on pharmacokinetic variability, suggest that benefits are likely. PMID:21831196

  10. Cadence Feedback With ECE PEDO to Monitor Physical Activity Intensity

    OpenAIRE

    Ardic, Fusun; G?cer, Esra

    2016-01-01

    Abstract The purpose of this study was to examine the monitoring capabilities of the equipment for clever exercise pedometer (ECE PEDO) that provides audible feedback when the person exceeds the upper and lower limits of the target step numbers per minute and to compare step counts with Yamax SW-200 (YX200) as the criterion pedometer. A total of 30 adult volunteers (15 males and 15 females) were classified as normal weight (n?=?10), overweight (n?=?10), and obese (n?=?10). After the submaxima...

  11. Therapeutic Drug Monitoring in Rheumatic Diseases

    Directory of Open Access Journals (Sweden)

    NG Hoi-Yan Alexandra

    2016-12-01

    Full Text Available The ultimate goal of treating rheumatic disease is to achieve rapid suppression of inflammation, while at the same time minimizing the toxicities from rheumatic drugs. Different patients have different individual pharmacokinetics that can affect the drug level. Moreover, different factors, such as renal function, age or even different underlying diseases, can affect the drug level. Therefore, giving the same dosage of drugs to different patients may result in different drug levels. This article will review the usefulness of therapeutic drug monitoring in maximizing drug efficacy, while reducing the risk of toxicities in Hydroxychloroquine, Mycophenolate Mofetil, Tacrolimus and Tumor Necrosis Factor inhibitors (TNF Inhibitors.

  12. Cadence Feedback With ECE PEDO to Monitor Physical Activity Intensity

    Science.gov (United States)

    Ardic, Fusun; Göcer, Esra

    2016-01-01

    Abstract The purpose of this study was to examine the monitoring capabilities of the equipment for clever exercise pedometer (ECE PEDO) that provides audible feedback when the person exceeds the upper and lower limits of the target step numbers per minute and to compare step counts with Yamax SW-200 (YX200) as the criterion pedometer. A total of 30 adult volunteers (15 males and 15 females) were classified as normal weight (n = 10), overweight (n = 10), and obese (n = 10). After the submaximal exercise test on a treadmill, the moderate intensity for walking was determined by using YX200 pedometer and then the number of steps taken in a minute was measured. Lower and upper limits of steps per minute (cadence) were recorded in ECE PEDO providing audible feedback when the person's walking speed gets out of the limits. Volunteers walked for 30 minutes in the individual step count range by attaching the ECE PEDO and YX200 pedometer on both sides of the waist belt in the same session. Step counts of the volunteers were recorded. Wilcoxon, Spearman correlation, and Bland–Altman analyses were performed to show the relationship and agreement between the results of 2 devices. Subjects took an average of 3511 ± 426 and 3493 ± 399 steps during 30 minutes with ECE PEDO and criterion pedometer, respectively. About 3500 steps taken by ECE PEDO reflected that this pedometer has capability of identifying steps per minute to meet moderate intensity of physical activity. There was a strong correlation between step counts of both devices (P PEDO and YX200 pedometer in the Bland–Altman analysis. Although both devices showed a strong similarity in counting steps, the ECE PEDO provides monitoring of intensity such that a person can walk in a specified time with a desired speed. PMID:26962822

  13. Therapeutic Drug Monitoring of Lithium

    DEFF Research Database (Denmark)

    Mose, Tina; Damkier, Per; Petersen, Magnus

    2015-01-01

    BACKGROUND: Serum lithium is monitored to ensure levels within the narrow therapeutic window. This study examines the interlaboratory variation and inaccuracy of lithium monitoring in Denmark. METHODS: In 16 samples consisting of (1) control materials (n = 4), (2) pooled patient serum (n = 5......), and (3) serum from individual patients (n = 7), lithium was measured in 19 laboratories using 20 different instruments. The lithium concentrations were targeted by a reference laboratory. Ion-selective electrode (n = 5), reflective spectrophotometric (RSM, n = 5), and spectrophotometric (n = 10) methods...... of >12%. Seven of these instruments had a systematic positive or negative bias and more so at lower lithium concentrations. Three poorly calibrated instruments were found in the ion-selective electrode group, 3 in the spectrophotometric group, and 2 in the RSM group. The instruments using reflectance...

  14. 5 CFR 9701.407 - Monitoring performance and providing feedback.

    Science.gov (United States)

    2010-01-01

    ... feedback. 9701.407 Section 9701.407 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN... performance and providing feedback. In applying the requirements of the performance management system and its... organization; and (b) Provide timely periodic feedback to employees on their actual performance with respect to...

  15. Genetic association studies of performance monitoring and learning from feedback: The role of dopamine and serotonin

    NARCIS (Netherlands)

    Ullsperger, M.

    2010-01-01

    Performance monitoring is essential for optimization of action outcomes. Research consistently implicates the posterior medial frontal cortex, particularly the rostral cingulate zone, in monitoring for unfavorable action outcomes, signaling the need for adjustments and learning from feedback.

  16. Drug safety in pregnancy - monitoring congenital anomalies

    NARCIS (Netherlands)

    Morgan, Margery; De Jong-Van Den Berg, Lolkje T. W.; Jordan, Sue

    Aim This paper outlines research into the causes of congenital anomalies, and introduces a pan-European study. The potential roles of nurses and midwives in this area are illustrated by a case report. Background Since the thalidomide disaster, use of drugs in pregnancy has been carefully monitored

  17. Reality Monitoring and Feedback Control of Speech Production Are Related Through Self-Agency.

    Science.gov (United States)

    Subramaniam, Karuna; Kothare, Hardik; Mizuiri, Danielle; Nagarajan, Srikantan S; Houde, John F

    2018-01-01

    Self-agency is the experience of being the agent of one's own thoughts and motor actions. The intact experience of self-agency is necessary for successful interactions with the outside world (i.e., reality monitoring) and for responding to sensory feedback of our motor actions (e.g., speech feedback control). Reality monitoring is the ability to distinguish internally self-generated information from outside reality (externally-derived information). In the present study, we examined the relationship of self-agency between lower-level speech feedback monitoring (i.e., monitoring what we hear ourselves say) and a higher-level cognitive reality monitoring task. In particular, we examined whether speech feedback monitoring and reality monitoring were driven by the capacity to experience self-agency-the ability to make reliable predictions about the outcomes of self-generated actions. During the reality monitoring task, subjects made judgments as to whether information was previously self-generated (self-agency judgments) or externally derived (external-agency judgments). During speech feedback monitoring, we assessed self-agency by altering environmental auditory feedback so that subjects listened to a perturbed version of their own speech. When subjects heard minimal perturbations in their auditory feedback while speaking, they made corrective responses, indicating that they judged the perturbations as errors in their speech output. We found that self-agency judgments in the reality-monitoring task were higher in people who had smaller corrective responses ( p = 0.05) and smaller inter-trial variability ( p = 0.03) during minimal pitch perturbations of their auditory feedback. These results provide support for a unitary process for the experience of self-agency governing low-level speech control and higher level reality monitoring.

  18. Feeding back about eco-feedback: How do consumers use and respond to energy monitors?

    International Nuclear Information System (INIS)

    Buchanan, Kathryn; Russo, Riccardo; Anderson, Ben

    2014-01-01

    To date, a multitude of studies have examined the empirical effect of feedback on energy consumption yet very few have examined how feedback might work and the processes it involves. Moreover, it remains to be seen if the theoretical claims made concerning how feedback works can be substantiated using empirical data. To start to address this knowledge gap, the present research used qualitative data analysis to examine how consumers use and respond to energy monitors. The findings suggest feedback may increase both the physical and conscious visibility of consumption as well as knowledge about consumption. Accordingly, support was evident for the theoretical assertions that feedback transforms energy from invisible to visible, prompts motivated users to learn about their energy habits, and helps address information deficits about energy usage. We conclude by evaluating the feasibility of feedback to substantially reduce consumption and discuss ways in which feedback could be improved to aid its effectiveness in the long term before discussing the implication our findings may have for government policy. - Highlights: • We conduct qualitative analysis using online reviews about energy monitors. • We examine how consumers use and respond to energy monitors. • Energy monitors are used to increase awareness and knowledge of consumption. • Consumers report that the monitors lead them to engage in energy saving behaviours. • Disadvantages of the monitors raise questions about their long-term sustainability

  19. Effects of Information Feedback and Self-Administered Consequences on Self-Monitoring Study Behavior

    Science.gov (United States)

    Richards, C. Steven; And Others

    1976-01-01

    The hypotheses tested among college students (N=87) concerned about study habits were: (a) self-monitoring changes study behavior; (b) information feedback accounts for some of this change; and (c) this change can be enhanced by manipulating the quantity and quality of information feedback and self-administered consequences associated with…

  20. Genotoxic monitoring of nurses handling cytotoxic drugs

    Directory of Open Access Journals (Sweden)

    Anna Tompa

    2016-01-01

    Full Text Available Objective: Several biomarkers may be used to detect harmful exposure and individual susceptibility to cancer. Monitoring of biomarkers related to exposure may have a significant effect on early detection of cell transformation, thereby aiding the primary prevention of various chronic and malignant diseases. Nurses who handle cytotoxic drugs are exposed to carcinogenic agents, which have the potential to interrupt the cell cycle and to induce chromosomal aberrations. The presence of high chromosomal aberrations indicates the need for intervention even when exposure to these carcinogens is low. Methods: Nationally representative samples of 552 nurses were investigated by a follow-up monitoring system. The measured biomarkers were clinical laboratory routine tests, completed with genotoxicological (chromosome aberrations [CAs] and sister chromatid exchanges [SCEs] and immunotoxicological monitoring (ratio of lymphocyte subpopulations and lymphocyte activation markers measured on peripheral blood lymphocytes. Results were compared to the data of 140 healthy, age-matched controls. Results: In nurses exposed to cytostatics, we observed a significantly increased frequency of CAs and SCEs compared with those in the controls. Cytostatic drug exposure also manifested itself in an increased frequency of helper T lymphocytes. Genotoxicological and immunotoxicological changes, as well as negative health effects (i.e., iron deficiency, anemia, and thyroid diseases, increased among cytostatic exposed subjects. Conclusions: These results raised concerns about the protection of nursing staff from chemical carcinogens in the working environment.

  1. Linking ecological science to decision-making: delivering environmental monitoring information as societal feedback.

    Science.gov (United States)

    Vaughan, Hague; Whitelaw, Graham; Craig, Brian; Stewart, Craig

    2003-01-01

    The paper describes the Ecological Monitoring and Assessment Network's (EMAN) operational and program response to certain challenges of environmental monitoring in Canada, in particular, efforts to improve the ability of the network to deliver relevant information to decision makers. In addition to its familiar roles, environmental monitoring should deliver feedback to society on environmental changes associated with development patterns, trends, processes and interventions. In order for such feedback to be effective, it must be relevant, timely, useful and accessible: all characteristics that are defined by the user, not the provider. Demand driven environmental monitoring is explored through EMAN's experiences with Canada's Biosphere Reserves, the NatureWatch Program and the Canadian Community Monitoring Network.

  2. Electrophysiological Correlates of Error Monitoring and Feedback Processing in Second Language Learning.

    Science.gov (United States)

    Bultena, Sybrine; Danielmeier, Claudia; Bekkering, Harold; Lemhöfer, Kristin

    2017-01-01

    Humans monitor their behavior to optimize performance, which presumably relies on stable representations of correct responses. During second language (L2) learning, however, stable representations have yet to be formed while knowledge of the first language (L1) can interfere with learning, which in some cases results in persistent errors. In order to examine how correct L2 representations are stabilized, this study examined performance monitoring in the learning process of second language learners for a feature that conflicts with their first language. Using EEG, we investigated if L2 learners in a feedback-guided word gender assignment task showed signs of error detection in the form of an error-related negativity (ERN) before and after receiving feedback, and how feedback is processed. The results indicated that initially, response-locked negativities for correct (CRN) and incorrect (ERN) responses were of similar size, showing a lack of internal error detection when L2 representations are unstable. As behavioral performance improved following feedback, the ERN became larger than the CRN, pointing to the first signs of successful error detection. Additionally, we observed a second negativity following the ERN/CRN components, the amplitude of which followed a similar pattern as the previous negativities. Feedback-locked data indicated robust FRN and P300 effects in response to negative feedback across different rounds, demonstrating that feedback remained important in order to update memory representations during learning. We thus show that initially, L2 representations may often not be stable enough to warrant successful error monitoring, but can be stabilized through repeated feedback, which means that the brain is able to overcome L1 interference, and can learn to detect errors internally after a short training session. The results contribute a different perspective to the discussion on changes in ERN and FRN components in relation to learning, by extending the

  3. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

    Directory of Open Access Journals (Sweden)

    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  4. Effectiveness of an educational feedback intervention on drug prescribing in dental practice.

    Science.gov (United States)

    Rauniar, G P; Das, B P; Manandhar, T R; Bhattacharya, S K

    2012-01-01

    Irrational use of drugs as well as inappropriate and over drug prescribing leads to unnecessary expenditures and emergence of resistant bacterial strains. Feedback intervention on drug prescribing habits and face to face educational intervention of prescription audit would be effective in rationalizing prescribing practices. To measure the impact of educational feedback intervention on the prescribing behavior of dental surgeons. Prospective audit of twelve hundred outpatients prescriptions in dental OPD at BPKIHS of those dental surgeon who attended the educational intervention session was collected randomly by trained persons on customized data collection sheet before and after educational intervention. A total 1200 prescription were collected, 300 before and 300 after intervention period at the internal of one month, three months and six months. Majority of the prescriptions (39.33%) contained four drugs but after intervention, prescriptions contained mostly one drug, 73% in first month, 78.67% in third month and 65.34% in six month. Mean number of drugs per prescription after intervention were decreased. There was increased number of generic names of drugs after intervention. Amoxicillin, Metronidazole, Chlorhexidine, Povidone iodine gargle, Nimesulide, Ibuprofen, Ibuprofen + paracetamol, and Paracetamol were most commonly prescribed by dental prescribers before and after intervention. Selection of antimicrobial was done on empirical basis which was correct because Amoxicillin concentration reaches effectively in gingival crevicular fluid and Metronidazole covered effectively against anaerobic bacteria were found in orodental infection. The uses of topical anti-infective preparation as irrigants of choice that can kill majority of micro-organisms found is root canal and dental tubules and minimize systemic use of antimicrobials. Nimesulide prescribing needs to be rationalized. Feedback educational intervention of prescription audit is effective to improve their

  5. Swimming Pool Hygiene: Self-Monitoring, Task Clarification, and Performance Feedback Increase Lifeguard Cleaning Behaviors

    Science.gov (United States)

    Rose, Henry M. S.; Ludwig, Timothy D.

    2009-01-01

    The effects of task clarification, self-monitoring, and performance feedback on cleaning behaviors of 9 lifeguards in 3 performance areas (vacuuming, lobby tidying, and pool deck maintenance) were investigated using an ABA reversal design at a county swim complex. A specific task in each performance area was used as a behavioral control. Following…

  6. Audio-Visual Feedback for Self-monitoring Posture in Ballet Training

    DEFF Research Database (Denmark)

    Knudsen, Esben Winther; Hølledig, Malte Lindholm; Bach-Nielsen, Sebastian Siem

    2017-01-01

    An application for ballet training is presented that monitors the posture position (straightness of the spine and rotation of the pelvis) deviation from the ideal position in real-time. The human skeletal data is acquired through a Microsoft Kinect v2. The movement of the student is mirrored......-coded. In an experiment with 9-12 year-old dance students from a ballet school, comparing the audio-visual feedback modality with no feedback leads to an increase in posture accuracy (p

  7. [Therapeutic drug monitoring of three antiepileptic drugs - Back on twenty years of experience].

    Science.gov (United States)

    Serragui, Samira; Zalagh, Fatima; Tanani, Driss Soussi; Ouammi, Lahcen; Moussa, Latifa Ait; Badrane, Narjis; Bencheikh, Rachida Soulaymani

    2016-01-01

    The therapeutic drug monitoring (TDM) of antiepileptic drugs is a tool widely used in the management of epilepsy. In Morocco, this monitoring is carried out by the Centre Anti Poison et Pharmacovigilance (CAPM) since April 1995. This is a retrospective study spanning 20 years. It concerns the therapeutic drug monitoring of Phenobarbital (PB) of carbamazepine (CBZ) and valproic acid (VPA). Therapeutic drug monitoring of the 3 antiepileptic drugs represent 58.85% of all applications received by the CAPM. The dosage of PB was ranked first followed by that of CBZ and finally by the VPA. Weak demand for therapeutic drug monitoring in Morocco could be explained by the low number of neurologists in addition to social factors. With its affordable price by patients, PB is the most prescribed antiepileptic drug in our country, which explains the high demand for its dosage. As for the therapeutic drug monitoring of the antiepileptic drug, they were mainly related to age, the occurrence of adverse effects, the association antiepileptic drugs or in the case of verification of patient compliance. Efforts are required for promoting the interests of therapeutic drug monitoring of antiepileptic drug in the management of epilepsy in Morocco.

  8. Mobile patient feedback through continued monitoring and guideline-based decision support

    OpenAIRE

    Hernando Pérez, María Elena; Martínez Sarriegui, Iñaki; García Sáez, Gema; Quaglini, Silvana; Rigla Cros, Mercedes; Napolitano, Carlo

    2015-01-01

    This paper demonstrates the MobiGuide mobile application that provides patients with guideline-based feedback personalized to their health state, preferences, social context and technological context. Patients? state and compliance are observed through the continued monitorization of physiological and lifestyle parameters: blood glucose, physical activity, ECG, heart rate and blood pressure. The Smartphone application is generic and has a modular structure to allow reusing system components i...

  9. Drug monitoring and individual dose optimization of antimicrobial drugs : oxazolidinones

    NARCIS (Netherlands)

    Cattaneo, Dario; Alffenaar, Jan-Willem; Neely, Michael

    INTRODUCTION: Oxazolidinones are synthetic antibiotics with bacteriostatic activity against Gram-positive pathogens. Linezolid, the first marketed oxazolidinone, has shown also activity against Mycobaterium tuberculosis, including multidrug-resistant and extensively drug-resistant strains. Recently,

  10. Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Binder, Corinna; Schmölzer, Georg M; O'Reilly, Megan; Schwaberger, Bernhard; Urlesberger, Berndt; Pichler, Gerhard

    2014-03-01

    To investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR). In this observational study, 32 participants delivered positive pressure ventilation (PPV) to a modified, leak-free manikin via facemask. Mask leak, tidal volume (VT), positive end expiratory pressure (PEEP) and respiratory rate (RR) were measured with a respiratory function monitor (RFM). Participants had to perform four studies. In the first study, participants performed PPV alone as baseline. Thereafter, three studies were performed in random order. In the PPV+ECC+manometer group, participants had to observe the manometer while the RFM was covered; in the PPV+ECC+RFM group, the RFM was used while the manometer was covered; and in the PPV+ECC+verbal feedback group, the RFM and manometer were covered while a team leader viewed the RFM and provided verbal feedback to the participants. Median (IQR) mask leak of all studies was 15% (5-47%). Comparing the studies, PPV+ECC+RFM and PPV+ECC+verbal feedback had significantly less mask leak than PPV+ECC+manometer. Mean (SD) VT of all studies was 9.5±3.5 mL. Comparing all studies, PPV+ECC+RFM had a significantly higher VT than PPV and PPV+ECC+manometer. As well, PPV+ECC+verbal feedback had a significantly higher VT than PPV. PEEP and RR were within our target, mean (SD) PEEP was 6±2 cmH2O and RR was 36±13/min. During simulated neonatal CPR, ECCs did not influence mask leak, and a RFM and verbal feedback were helpful methods to reduce mask leak and increase VT significantly.

  11. Therapeutic drug monitoring of lopinavir/ritonavir in pregnancy.

    LENUS (Irish Health Repository)

    Lambert, J S

    2011-03-01

    The aim of the study was to determine total and unbound lopinavir (LPV) plasma concentrations in HIV-infected pregnant women receiving lopinavir\\/ritonavir (LPV\\/r tablet) undergoing therapeutic drug monitoring (TDM) during pregnancy and postpartum.

  12. From feedback- to response-based performance monitoring in active and observational learning.

    Science.gov (United States)

    Bellebaum, Christian; Colosio, Marco

    2014-09-01

    Humans can adapt their behavior by learning from the consequences of their own actions or by observing others. Gradual active learning of action-outcome contingencies is accompanied by a shift from feedback- to response-based performance monitoring. This shift is reflected by complementary learning-related changes of two ACC-driven ERP components, the feedback-related negativity (FRN) and the error-related negativity (ERN), which have both been suggested to signal events "worse than expected," that is, a negative prediction error. Although recent research has identified comparable components for observed behavior and outcomes (observational ERN and FRN), it is as yet unknown, whether these components are similarly modulated by prediction errors and thus also reflect behavioral adaptation. In this study, two groups of 15 participants learned action-outcome contingencies either actively or by observation. In active learners, FRN amplitude for negative feedback decreased and ERN amplitude in response to erroneous actions increased with learning, whereas observational ERN and FRN in observational learners did not exhibit learning-related changes. Learning performance, assessed in test trials without feedback, was comparable between groups, as was the ERN following actively performed errors during test trials. In summary, the results show that action-outcome associations can be learned similarly well actively and by observation. The mechanisms involved appear to differ, with the FRN in active learning reflecting the integration of information about own actions and the accompanying outcomes.

  13. Retrospective monitoring of drug utilisation in cardiovascular ...

    African Journals Online (AJOL)

    This retrospective study was carried out to established drug prescribing trends in the management of cardiovascular diseases (CVDs) in the cardiovascular unit of the Department of Medicine, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. 100 folders of patients with various CVDs were randomly ...

  14. The effect of metacognitive monitoring feedback on performance in a computer-based training simulation.

    Science.gov (United States)

    Kim, Jung Hyup

    2018-02-01

    This laboratory experiment was designed to study the effect of metacognitive monitoring feedback on performance in a computer-based training simulation. According to prior research on metacognition, the accurate checking of learning is a critical part of improving the quality of human performance. However, only rarely have researchers studied the learning effects of the accurate checking of retrospective confidence judgments (RCJs) during a computer-based military training simulation. In this study, we provided participants feedback screens after they had completed a warning task and identification task in a radar monitoring simulation. There were two groups in this experiment. One group (group A) viewed the feedback screens with the flight path of all target aircraft and the triangular graphs of both RCJ scores and human performance together. The other group (group B) only watched the feedback screens with the flight path of all target aircraft. There was no significant difference in performance improvement between groups A and B for the warning task (Day 1: group A - 0.347, group B - 0.305; Day 2: group A - 0.488, group B - 0.413). However, the identification task yielded a significant difference in performance improvement between these groups (Day 1: group A - 0.174, group B - 0.1555; Day 2: group A - 0.324, group B - 0.199). The results show that debiasing self-judgment of the identification task produces a positive training effect on learners. The findings of this study will be beneficial for designing an advanced instructional strategy in a simulation-based training environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Adverse Drug Event Monitoring at the Food and Drug Administration: Your Report Can Make a Difference

    OpenAIRE

    Ahmad, Syed Rizwanuddin

    2003-01-01

    The Food and Drug Administration (FDA) is responsible not only for approving drugs but also for monitoring their safety after they reach the market. The complete adverse event profile of a drug is not known at the time of approval because of the small sample size, short duration, and limited generalizability of pre-approval clinical trials. This report describes the FDA's postmarketing surveillance system, to which many clinicians submit reports of adverse drug events encountered while treati...

  16. Urine Creatinine Concentrations in Drug Monitoring Participants and Hospitalized Patients.

    Science.gov (United States)

    Love, Sara A; Seegmiller, Jesse C; Kloss, Julie; Apple, Fred S

    2016-10-01

    Urine drug testing is commonly performed in both clinical and forensic arenas for screening, monitoring and compliance purposes. We sought to determine if urine creatinine concentrations in monitoring program participants were significantly different from hospital in-patients and out-patients undergoing urine drug testing. We retrospectively reviewed urine creatinine submitted in June through December 2015 for all specimens undergoing urine drug testing. The 20,479 creatinine results were categorized as hospitalized patients (H) and monitoring/compliance groups for pain management (P), legal (L) or recovery (R). Median creatinine concentrations (interquartile range, mg/dL) were significantly different (P creatinine concentrations were significantly lower in the R vs. L group (Pcreatinine concentration and may indicate participants' attempts to tamper with their drug test results through dilution means. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Web-Based Cognitive Behavioral Relapse Prevention Program With Tailored Feedback for People With Methamphetamine and Other Drug Use Problems: Development and Usability Study.

    Science.gov (United States)

    Takano, Ayumi; Miyamoto, Yuki; Kawakami, Norito; Matsumoto, Toshihiko

    2016-01-06

    Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches. The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability. We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions. In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention

  18. Feedback from physical activity monitors is not compatible with current recommendations: A recalibration study.

    Science.gov (United States)

    Thompson, Dylan; Batterham, Alan M; Peacock, Oliver J; Western, Max J; Booso, Rahuman

    2016-10-01

    Wearable devices to self-monitor physical activity have become popular with individuals and healthcare practitioners as a route to the prevention of chronic disease. It is not currently possible to reconcile feedback from these devices with activity recommendations because the guidelines refer to the amount of activity required on top of normal lifestyle activities (e.g., 150 minutes of moderate-to-vigorous intensity activity per week over-and-above normal moderate-to-vigorous lifestyle activities). The aim of this study was to recalibrate the feedback from self-monitoring. We pooled data from four studies conducted between 2006 and 2014 in patients and volunteers from the community that included both sophisticated measures of physical activity and 10-year risk for cardiovascular disease and type 2 diabetes (n=305). We determined the amount of moderate-to-vigorous intensity activity that corresponded to FAO/WHO/UNU guidance for a required PAL of 1.75 (Total Energy Expenditure/Basal Metabolic Rate). Our results show that, at the UK median PAL, total moderate-to-vigorous intensity physical activity will be around 735 minutes per week (~11% of waking time). We estimate that a 4% increase in moderate-to-vigorous intensity activity will achieve standardised guidance from FAO/WHO/UNU and will require ~1000 minutes of moderate-to-vigorous intensity activity per week. This study demonstrates that feedback from sophisticated wearable devices is incompatible with current physical activity recommendations. Without adjustment, people will erroneously form the view that they are exceeding recommendations by several fold. A more appropriate target from self-monitoring that accounts for normal moderate-to-vigorous lifestyle activities is ~1000 minutes per week, which represents ~15% of waking time. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  19. A Study on Drug Safety Monitoring Program in India

    Science.gov (United States)

    Ahmad, A.; Patel, Isha; Sanyal, Sudeepa; Balkrishnan, R.; Mohanta, G. P.

    2014-01-01

    Pharmacovigilance is useful in assuring the safety of medicines and protecting the consumers from their harmful effects. A number of single drugs as well as fixed dose combinations have been banned from manufacturing, marketing and distribution in India. An important issue about the availability of banned drugs over the counter in India is that sufficient adverse drug reactions data about these drugs have not been reported. The most common categories of drugs withdrawn in the last decade were nonsteroidal antiinflammatory drugs (28%), antidiabetics (14.28%), antiobesity (14.28%), antihistamines (14.28%), gastroprokinetic drugs (7.14%), breast cancer and infertility drugs (7.14%), irritable bowel syndrome and constipation drugs (7.14%) and antibiotics (7.14%). Drug withdrawals from market were made mainly due to safety issues involving cardiovascular events (57.14%) and liver damage (14.28%). Majority of drugs have been banned since 3-5 years in other countries but are still available for sale in India. The present study compares the drug safety monitoring systems in the developed countries such as the USA and UK and provides implications for developing a system that can ensure the safety and efficacy of drugs in India. Absence of a gold standard for a drug safety surveillance system, variations in culture and clinical practice across countries makes it difficult for India to completely adopt another country's practices. There should be a multidisciplinary approach towards drug safety that should be implemented throughout the entire duration spanning from drug discovery to usage by consumers. PMID:25425751

  20. Medication monitoring and drug testing ethics project.

    Science.gov (United States)

    Payne, Richard; Moe, Jeffrey L; Sevier, Catherine Harvey; Sevier, David; Waitzkin, Michael

    2015-01-01

    In 2012, Duke University initiated a research project, funded by an unrestricted research grant from Millennium Laboratories, a drug testing company. The project focused on assessing the frequency and nature of questionable, unethical, and illegal business practices in the clinical drug testing industry and assessing the potential for establishing a business code of ethics. Laboratory leaders, clinicians, industry attorneys, ethicists, and consultants participated in the survey, were interviewed, and attended two face-to-face meetings to discuss a way forward. The study demonstrated broad acknowledgment of variations in the legal and regulatory environment, resulting in inconsistent enforcement of industry practices. Study participants expressed agreement that overtly illegal practices sometimes exist, particularly when laboratory representatives and clinicians discuss reimbursement, extent of testing, and potential business incentives with medical practitioners. Most respondents reported directly observing probable violations involving marketing materials, contracts, or, in the case of some individuals, directly soliciting people with offers of clinical supplies and other "freebies." While many study respondents were skeptical that voluntary standards alone would eliminate questionable business practices, most viewed ethics codes and credentialing as an important first step that could potentially mitigate uneven enforcement, while improving quality of care and facilitating preferred payment options for credentialed parties. Many were willing to participate in future discussions and industry-wide initiatives to improve the environment.

  1. Biomarkers to monitor drug-induced phospholipidosis

    International Nuclear Information System (INIS)

    Baronas, Elizabeth Tengstrand; Lee, Ju-Whei; Alden, Carl; Hsieh, Frank Y.

    2007-01-01

    Di-docosahexaenoyl (C22:6)-bis(monoacylglycerol) phosphate (BMP) was identified as a promising phospholipidosis (PL) biomarker in rats treated with either amiodarone, gentamicin, or azithromycin. Sprague-Dawley rats received either amiodarone (150 mg/kg), gentamicin (100 mg/kg) or azithromycin (30 mg/kg) once daily for ten consecutive days. Histopathological examination of tissues by transmission electron microscopy (TEM) indicated different degrees of accumulation of phospholipidosis in liver, lung, mesenteric lymph node, and kidney of drug-treated rats but not controls. Liquid chromatography coupled to mass spectrometry (LC/MS) was used to identify levels of endogenous biochemical profiles in rat urine. Urinary levels of di-docosahexaenoyl (C22:6)-bis(monoacylglycerol) phosphate (BMP) correlated with induction of phospholipidosis for amiodarone, gentamicin and azithromycin. Rats treated with gentamicin also had increased urinary levels of several phosphatidylinositol (PI), phosphatidylcholine (PC), and phosphatidylethanolamine (PE) species

  2. International experience feedback on fatigue monitoring systems for nuclear power plants

    International Nuclear Information System (INIS)

    Morilhat, P.

    1997-01-01

    From the very beginning of electro-nuclear programmes the need has become internationally obvious to develop systems aiming at automation and improvement of monitoring of the transients stressing the main mechanical components of nuclear units, by checking the conservativeness of the design no longer from a comparison of causes (temperature and pressure variations) but by directly assessing the results (stresses and linked damage). Prototypes of such systems have appeared since the middle of the 1980's mainly in France, the USA and Germany, and manufacturing them has since continued. Several years of development and on site testing of prototypes of fatigue measuring devices designed by the R and D Direction have enabled contacts with the developers of similar systems to be established and, in some cases, comparisons to be made. The experience accumulated in the use of such systems, both in France and abroad from now on makes a first experience feedback possible. The fatigue measuring device concept is based on a succession of elementary modules which enable the information received from the unit to be processed, first in the form of transient counting (transient meters), then in the form of mechanical diagnosis (fatigue monitoring systems). Among the systems in operation some provide actually only the transient meter part while others link transient meters and fatigue meters (EDF, EPRI and MITSUBISHI systems and some versions of the SIEMENS system). Moreover, numerous systems require, in addition to unit operation instrumentation, specific instrumentation located in monitored areas. The number of devices in operation has not stopped growing since the middle of the 80's to reach 53 systems working in 1996. The biggest developers are EPRI and its consultant Structural Integrity Associates (FatiguePro system), SIEMENS (FAMOS system) and EDF whose gradual implementation of SYSFAC from '96 is going to make its share particularly increase. Technical experience feedback

  3. Self-monitoring and feedback : A new attempt to find the main cause of lexical bias in phonological speech errors

    NARCIS (Netherlands)

    Nooteboom, S.G.; Quené, H.

    2008-01-01

    This paper reports two experiments designed to investigate whether lexical bias in phonological speech errors is caused by immediate feedback of activation, by self-monitoring of inner speech, or by both. The experiments test a number of predictions derived from a model of self-monitoring of inner

  4. Making energy visible: A qualitative field study of how householders interact with feedback from smart energy monitors

    International Nuclear Information System (INIS)

    Hargreaves, Tom; Nye, Michael; Burgess, Jacquelin

    2010-01-01

    This paper explores how UK householders interacted with feedback on their domestic energy consumption in a field trial of real-time displays or smart energy monitors. After examining relevant bodies of literature on the effects of energy feedback on consumption behaviour, and on the complex role of energy and appliances within household moral economies, the paper draws on qualitative evidence from interviews with 15 UK householders trialling smart energy monitors of differing levels of sophistication. It focuses specifically on householder motivations for acquiring the monitors, how the monitors have been used, how feedback has changed consumption behaviour, and the limitations to further behavioural change the householders experienced. The paper concludes by identifying significant implications for future research and policy in this area.

  5. Effect of radioimmunoassay procedures on therapeutic drug monitoring

    International Nuclear Information System (INIS)

    Kampa, I.S.

    1985-01-01

    Methods for the measurement of therapeutic drugs have covered every aspect of analysis from extraction to derivatization. In general, published methods were modified to shorten drug extractions and overall analysis time. The use of different standards, as well as the frequent omission of internal standards, often produced large and clinically unacceptable analytical variations. As a result, physicians would adjust drug dosages according to the physiological response to a standard dose. The introduction of radioimmunoassay techniques for the quantitation of therapeutic drugs have made a significant impact on the clinical chemistry laboratory. The similarities of the various assay methods and the technologists' familiarity with the assay protocols have produced clinically relevant results. Clinical laboratories are now able to frequently analyze a large number of samples with acceptable accuracy and precision. The esoteric test once performed infrequently is today a routine analytical assay often performed STAT. Therapeutic drug monitoring has become a major activity in many clinical laboratories

  6. Therapeutic drug monitoring of atazanavir/ritonavir in pregnancy.

    LENUS (Irish Health Repository)

    Else, L J

    2014-11-01

    Pregnant women experience physiological changes during pregnancy that can have a significant impact on antiretroviral pharmacokinetics. Ensuring optimal plasma concentrations of antiretrovirals is essential for maternal health and to minimize the risk of vertical transmission. Here we describe atazanavir\\/ritonavir (ATV\\/r) plasma concentrations in a cohort of pregnant women undergoing routine therapeutic drug monitoring (TDM).

  7. Drug taper during long-term video-EEG monitoring

    DEFF Research Database (Denmark)

    Guld, A. T.; Sabers, A.; Kjaer, T. W.

    2017-01-01

    Objectives: Anti-epileptic drugs (AED) are often tapered to reduce the time needed to record a sufficient number of seizure during long-term video-EEG monitoring (LTM). Fast AED reduction is considered less safe, but few studies have examined this. Our goal is to examine whether the rate of AED r...

  8. A workshop series using peer-grading to build drug information, writing, critical-thinking, and constructive feedback skills.

    Science.gov (United States)

    Davis, Lindsay E

    2014-12-15

    To utilize a skills-based workshop series to develop pharmacy students' drug information, writing, critical-thinking, and evaluation skills during the final didactic year of training. A workshop series was implemented to focus on written (researched) responses to drug information questions. These workshops used blinded peer-grading to facilitate timely feedback and strengthen assessment skills. Each workshop was aligned to the didactic coursework content to complement and extend learning, while bridging and advancing research, writing, and critical thinking skills. Attainment of knowledge and skills was assessed by rubric-facilitated peer grades, faculty member grading, peer critique, and faculty member-guided discussion of drug information responses. Annual instructor and course evaluations consistently revealed favorable student feedback regarding workshop value. A drug information workshop series using peer-grading as the primary assessment tool was successfully implemented and was well received by pharmacy students.

  9. Advanced process monitoring and feedback control to enhance cell culture process production and robustness.

    Science.gov (United States)

    Zhang, An; Tsang, Valerie Liu; Moore, Brandon; Shen, Vivian; Huang, Yao-Ming; Kshirsagar, Rashmi; Ryll, Thomas

    2015-12-01

    It is a common practice in biotherapeutic manufacturing to define a fixed-volume feed strategy for nutrient feeds, based on historical cell demand. However, once the feed volumes are defined, they are inflexible to batch-to-batch variations in cell growth and physiology and can lead to inconsistent productivity and product quality. In an effort to control critical quality attributes and to apply process analytical technology (PAT), a fully automated cell culture feedback control system has been explored in three different applications. The first study illustrates that frequent monitoring and automatically controlling the complex feed based on a surrogate (glutamate) level improved protein production. More importantly, the resulting feed strategy was translated into a manufacturing-friendly manual feed strategy without impact on product quality. The second study demonstrates the improved process robustness of an automated feed strategy based on online bio-capacitance measurements for cell growth. In the third study, glucose and lactate concentrations were measured online and were used to automatically control the glucose feed, which in turn changed lactate metabolism. These studies suggest that the auto-feedback control system has the potential to significantly increase productivity and improve robustness in manufacturing, with the goal of ensuring process performance and product quality consistency. © 2015 Wiley Periodicals, Inc.

  10. Cadence Feedback With ECE PEDO to Monitor Physical Activity Intensity: A Pilot Study.

    Science.gov (United States)

    Ardic, Fusun; Göcer, Esra

    2016-03-01

    The purpose of this study was to examine the monitoring capabilities of the equipment for clever exercise pedometer (ECE PEDO) that provides audible feedback when the person exceeds the upper and lower limits of the target step numbers per minute and to compare step counts with Yamax SW-200 (YX200) as the criterion pedometer.A total of 30 adult volunteers (15 males and 15 females) were classified as normal weight (n = 10), overweight (n = 10), and obese (n = 10). After the submaximal exercise test on a treadmill, the moderate intensity for walking was determined by using YX200 pedometer and then the number of steps taken in a minute was measured. Lower and upper limits of steps per minute (cadence) were recorded in ECE PEDO providing audible feedback when the person's walking speed gets out of the limits. Volunteers walked for 30 minutes in the individual step count range by attaching the ECE PEDO and YX200 pedometer on both sides of the waist belt in the same session. Step counts of the volunteers were recorded. Wilcoxon, Spearman correlation, and Bland-Altman analyses were performed to show the relationship and agreement between the results of 2 devices.Subjects took an average of 3511 ± 426 and 3493 ± 399 steps during 30 minutes with ECE PEDO and criterion pedometer, respectively. About 3500 steps taken by ECE PEDO reflected that this pedometer has capability of identifying steps per minute to meet moderate intensity of physical activity. There was a strong correlation between step counts of both devices (P PEDO and YX200 pedometer in the Bland-Altman analysis.Although both devices showed a strong similarity in counting steps, the ECE PEDO provides monitoring of intensity such that a person can walk in a specified time with a desired speed.

  11. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring.

    Science.gov (United States)

    Sailer, Anna M; Vergoossen, Laura; Paulis, Leonie; van Zwam, Willem H; Das, Marco; Wildberger, Joachim E; Jeukens, Cécile R L P N

    2017-11-01

    Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm 2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm 2 , p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

  12. Dynamic optical tweezers based assay for monitoring early drug resistance

    International Nuclear Information System (INIS)

    Wu, Xiaojing; Zhu, Siwei; Feng, Jie; Zhang, Yuquan; Min, Changjun; Yuan, X-C

    2013-01-01

    In this letter, a dynamic optical tweezers based assay is proposed and investigated for monitoring early drug resistance with Pemetrexed-resistant non-small cell lung cancer (NSCLC) cell lines. The validity and stability of the method are verified experimentally in terms of the physical parameters of the optical tweezers system. The results demonstrate that the proposed technique is more convenient and faster than traditional techniques when the capability of detecting small variations of the response of cells to a drug is maintained. (letter)

  13. User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

    Science.gov (United States)

    Vermeulen, Joan; Neyens, Jacques CL; Spreeuwenberg, Marieke D; van Rossum, Erik; Sipers, Walther; Habets, Herbert; Hewson, David J; de Witte, Luc P

    2013-01-01

    Purpose To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants The iterative user-centered development process consisted of the following phases: (1) selection of user representatives; (2) analysis of users and their context; (3) identification of user requirements; (4) development of the interface; and (5) evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ); higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in) weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5.2 (standard deviation 0.90) on the modified PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their physical functioning. However, usability was negatively influenced by a few technical errors. Conclusion Involvement of elderly users during the development process resulted in an interface with good usability. However, the technical functioning of the monitoring system needs to be optimized before it can be used to support elderly people in their self-management. PMID

  14. A noise reconfigurable current-reuse resistive feedback amplifier with signal-dependent power consumption for fetal ECG monitoring

    NARCIS (Netherlands)

    Song, Shuang; Rooijakkers, M.J.; Harpe, P.; Rabotti, C.; Mischi, M.; Van Roermund, A.H.M.; Cantatore, E.

    2016-01-01

    This paper presents a noise-reconfigurable resistive feedback amplifier with current-reuse technique for fetal ECG monitoring. The proposed amplifier allows for both tuning of the noise level and changing the power consumption according to the signal properties, minimizing the total power

  15. ß-endorphins as Possible Markers for Therapeutic Drug Monitoring

    Directory of Open Access Journals (Sweden)

    Radivoj Jadrić

    2007-02-01

    Full Text Available This study was performed in order to investigate possible role of brain beta-endorphins as markers of antidepressive drugs therapy monitoring. Experiment was done using amitriptyline and trazodone as antidepressants. For quantification of brain beta-endorphins we used RIA technique. Our results showed significant decrease of brain beta-endorphins concentration in drug-pretreated animals, vs. those in of control group treated with 0,95% NaCl. The lower values were obtained in trazodone pre-treated animals. This study shows that use of psychoactive drugs have influence on brain beta-endorphins concentration. beta-endorphins could be of great importance, used as markers for evaluation of patient treatment.

  16. [Pharmacokinetic alterations in pregnancy and use of therapeutic drug monitoring].

    Science.gov (United States)

    Panchaud, Alice; Weisskopf, Etienne; Winterfeld, Ursula; Baud, David; Guidi, Monia; Eap, Chin B; Csajka, Chantal; Widmer, Nicolas

    2014-01-01

    Following the thalidomide tragedy, pharmacological research in pregnant women focused primarily on drug safety for the unborn child and remains only limited regarding the efficacy and safety of treatment for the mother. Significant physiological changes during pregnancy may yet affect the pharmacokinetics of drugs and thus compromise its efficacy and/or safety. Therapeutic drug monitoring (TDM) would maximize the potential effectiveness of treatments, while minimizing the potential risk of toxicity for the mother and the fetus. At present, because of the lack of concentration-response relationship studies in pregnant women, TDM can rely only on individual assessment (based on an effective concentration before pregnancy) and remains reserved only to unexpected situations such as signs of toxicity or unexplained inefficiency. © 2014 Société Française de Pharmacologie et de Thérapeutique.

  17. Brain Activation in Response to Personalized Behavioral and Physiological Feedback From Self-Monitoring Technology: Pilot Study.

    Science.gov (United States)

    Whelan, Maxine E; Morgan, Paul S; Sherar, Lauren B; Kingsnorth, Andrew P; Magistro, Daniele; Esliger, Dale W

    2017-11-08

    The recent surge in commercially available wearable technology has allowed real-time self-monitoring of behavior (eg, physical activity) and physiology (eg, glucose levels). However, there is limited neuroimaging work (ie, functional magnetic resonance imaging [fMRI]) to identify how people's brains respond to receiving this personalized health feedback and how this impacts subsequent behavior. Identify regions of the brain activated and examine associations between activation and behavior. This was a pilot study to assess physical activity, sedentary time, and glucose levels over 14 days in 33 adults (aged 30 to 60 years). Extracted accelerometry, inclinometry, and interstitial glucose data informed the construction of personalized feedback messages (eg, average number of steps per day). These messages were subsequently presented visually to participants during fMRI. Participant physical activity levels and sedentary time were assessed again for 8 days following exposure to this personalized feedback. Independent tests identified significant activations within the prefrontal cortex in response to glucose feedback compared with behavioral feedback (Pbrain activation when compared with behavior. Participants reduced time spent sedentary at follow-up. Research on deploying behavioral and physiological feedback warrants further investigation. ©Maxine E Whelan, Paul S Morgan, Lauren B Sherar, Andrew P Kingsnorth, Daniele Magistro, Dale W Esliger. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.11.2017.

  18. Therapeutic drug monitoring: how to improve drug dosage and patient safety in tuberculosis treatment

    Directory of Open Access Journals (Sweden)

    Giovanni Sotgiu

    2015-03-01

    Full Text Available In this article we describe the key role of tuberculosis (TB treatment, the challenges (mainly the emergence of drug resistance, and the opportunities represented by the correct approach to drug dosage, based on the existing control and elimination strategies. In this context, the role and contribution of therapeutic drug monitoring (TDM is discussed in detail. Treatment success in multidrug-resistant (MDR TB cases is low (62%, with 7% failing or relapsing and 9% dying and in extensively drug-resistant (XDR TB cases is even lower (40%, with 22% failing or relapsing and 15% dying. The treatment of drug-resistant TB is also more expensive (exceeding €50 000 for MDR-TB and €160 000 for XDR-TB and more toxic if compared to that prescribed for drug-susceptible TB. Appropriate dosing of first- and second-line anti-TB drugs can improve the patient's prognosis and lower treatment costs. TDM is based on the measurement of drug concentrations in blood samples collected at appropriate times and subsequent dose adjustment according to the target concentration. The ‘dried blood spot’ technique offers additional advantages, providing the rationale for discussions regarding a possible future network of selected, quality-controlled reference laboratories for the processing of dried blood spots of difficult-to-treat patients from reference TB clinics around the world.

  19. Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017.

    Science.gov (United States)

    Hiemke, C; Bergemann, N; Clement, H W; Conca, A; Deckert, J; Domschke, K; Eckermann, G; Egberts, K; Gerlach, M; Greiner, C; Gründer, G; Haen, E; Havemann-Reinecke, U; Hefner, G; Helmer, R; Janssen, G; Jaquenoud, E; Laux, G; Messer, T; Mössner, R; Müller, M J; Paulzen, M; Pfuhlmann, B; Riederer, P; Saria, A; Schoppek, B; Schoretsanitis, G; Schwarz, M; Gracia, M Silva; Stegmann, B; Steimer, W; Stingl, J C; Uhr, M; Ulrich, S; Unterecker, S; Waschgler, R; Zernig, G; Zurek, G; Baumann, P

    2018-01-01

    Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs. © Georg Thieme Verlag KG Stuttgart · New York.

  20. How Parents of Teens Store and Monitor Prescription Drugs in the Home

    Science.gov (United States)

    Friese, Bettina; Moore, Roland S.; Grube, Joel W.; Jennings, Vanessa K.

    2013-01-01

    Qualitative interviews were conducted with parents of teens to explore how parents store and monitor prescription drugs in the home. Most parents had prescription drugs in the house, but took few precautions against teens accessing these drugs. Strategies for monitoring included moving the drugs to different locations, remembering how many pills…

  1. Implementation and Impact of an Automated Group Monitoring and Feedback System to Promote Hand Hygiene Among Health Care Personnel

    Science.gov (United States)

    Conway, Laurie J.; Riley, Linda; Saiman, Lisa; Cohen, Bevin; Alper, Paul; Larson, Elaine L.

    2015-01-01

    Article-at-a-Glance Background Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care–associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. Methods An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. Results After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. Conclusions Feedback via an automated system was associated with improved hand hygiene performance in the short term. PMID:25252389

  2. Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel.

    Science.gov (United States)

    Conway, Laurie J; Riley, Linda; Saiman, Lisa; Cohen, Bevin; Alper, Paul; Larson, Elaine L

    2014-09-01

    Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care-associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. Feedback via an automated system was associated with improved hand hygiene performance in the short-term.

  3. Task feedback effects on conflict monitoring and executive control: relationship to subclinical measures of depression.

    Science.gov (United States)

    Holmes, Avram J; Pizzagalli, Diego A

    2007-02-01

    Emerging evidence suggests that depression is associated with executive dysfunction, particularly after committing errors or receiving negative performance feedback. To test this hypothesis, 57 participants performed two executive tasks known to elicit errors (the Simon and Stroop Tasks) during positive or negative performance feedback. Participants with elevated depressive symptoms (Beck Depression Inventory scores >or= 13) were characterized by impaired posterror and postconflict performance adjustments, especially during emotionally negative task-related feedback. Additionally, for both tasks, depressive symptoms were inversely related to postconflict reaction time adjustments following negative, but not positive, feedback. These findings suggest that subclinical depression is associated with impairments in behavioral adjustments after internal (perceived failure) and external feedback about deficient task performance. (c) 2007 APA, all rights reserved.

  4. X-ray beam-position feedback system with easy-to-use beam-position monitor.

    Science.gov (United States)

    Park, Jae Yeon; Kim, Yesul; Lee, Sangsul; Lim, Jun

    2018-05-01

    X-ray beam-position stability is indispensable in cutting-edge experiments using synchrotron radiation. Here, for the first time, a beam-position feedback system is presented that utilizes an easy-to-use X-ray beam-position monitor incorporating a diamond-fluorescence screen. The acceptable range of the monitor is above 500 µm and the feedback system maintains the beam position within 3 µm. In addition to being inexpensive, the system has two key advantages: it works without a scale factor for position calibration, and it has no dependence on X-ray energy, X-ray intensity, beam size or beam shape.

  5. The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review.

    Science.gov (United States)

    van Heuckelum, Milou; van den Ende, Cornelia H M; Houterman, Anne E J; Heemskerk, Charlotte P M; van Dulmen, Sandra; van den Bemt, Bart J F

    2017-01-01

    This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

  6. Adverse drug reactions monitoring of psychotropic drugs: a tertiary care centre study

    Directory of Open Access Journals (Sweden)

    Hemendra Singh

    2017-06-01

    Full Text Available Background: Many new psychotropic drugs/ agents have been developed and found to be effective in the treatment of psychiatric disorders. However, these drugs also exhibit adverse drug reactions (ADRs which may affect compliance in psychiatric patients. Hence the present study was aimed at monitoring and assessing ADRs caused by psychotropic drugs. Methods: A hospital based prospective observational study was carried out in the psychiatry outpatient department of a tertiary care teaching hospital for the duration of six months. Two hundred and two patients were included in the study and ADRs were documented using a predesigned data collection form. The causality assessment was carried out as per the criteria of both the World Health Organization- Uppsala Monitoring Centre (WHO-UMC and Naranjo scale. Severity and predictability assessment of ADRs were also performed. Results: A total of 106 ADRs were observed during the study period with majority of them occurring in 25-35 years of age group (40.56%. Weight gain (18.86% followed by sedation (16.03% and insomnia (11.32% were found to be the commonest ADRs. Risperidone (19.8% and escitalopram (12.3% were the drugs responsible for majority of the ADRs. Causality assessment showed that most of ADRs were possible and probable. 94.33% of ADRs were found to be mild and 89% of them were predictable. Conclusion: A wide range of ADRs affecting central nervous and metabolic systems were reported with psychotropic drugs. The study findings necessitate the need for an active pharmacovigilance programme for the safe and effective use of psychotropics.

  7. User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

    Directory of Open Access Journals (Sweden)

    Vermeulen J

    2013-08-01

    Full Text Available Joan Vermeulen,1 Jacques CL Neyens,1 Marieke D Spreeuwenberg,1 Erik van Rossum,1,2 Walther Sipers,3 Herbert Habets,3 David J Hewson,4 Luc P de Witte1,2 1School for Public Health and Primary Care (CAPHRI, Maastricht University, Maastricht, The Netherlands; 2Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands; 3Expertise Center for Elderly Care, Orbis Medical Center, Sittard, The Netherlands; 4Institute Charles Delaunay, Université de Technologie de Troyes, Troyes, France Purpose: To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants: The iterative user-centered development process consisted of the following phases: (1 selection of user representatives; (2 analysis of users and their context; (3 identification of user requirements; (4 development of the interface; and (5 evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ; higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results: The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5

  8. Use of a consumer market activity monitoring and feedback device improves exercise capacity and activity levels in COPD.

    Science.gov (United States)

    Caulfield, Brian; Kaljo, Indira; Donnelly, Seamas

    2014-01-01

    COPD is associated with a gradual decline in physical activity, which itself contributes to a worsening of the underlying condition. Strategies that improve physical activity levels are critical to halt this cycle. Wearable sensor based activity monitoring and persuasive feedback might offer a potential solution. However it is not clear just how much intervention might be needed in this regard - i.e. whether programmes need to be tailored specifically for the target clinical population or whether more simple activity monitoring and feedback solutions, such as that offered in consumer market devices, might be sufficient. This research was carried out to investigate the impact of 4 weeks of using an off the shelf consumer market activity monitoring and feedback application on measures of physical activity, exercise capacity, and health related quality of life in a population of 10 Stage I and II COPD patients. Results demonstrate a significant and positive effect on exercise capacity (measured using a 6-minute walk test) and activity levels (measured in terms of average number of steps per hour) yet no impact on health related quality of life (St Georges Respiratory Disease Questionnaire).

  9. Students who developed logical reasoning skills reported improved confidence in drug dose calculation: Feedback from remedial maths classes.

    Science.gov (United States)

    Shelton, Chris

    2016-06-01

    The safe administration of drugs is a focus of attention in healthcare. It is regarded as acceptable that a formula card or mnemonic can be used to find the correct dose and fill a prescription even though this removes any requirement for performing the underlying computation. Feedback and discussion in class reveal that confidence in arithmetic skills can be low even when students are able to pass the end of semester drug calculation exam. To see if confidence in the understanding and performance of arithmetic for drug calculations can be increased by emphasising student's innate powers of logical reasoning after reflection. Remedial classes offered for students who have declared a dislike or lack of confidence in arithmetic have been developed from student feedback adopting a reasoning by logical step methodology. Students who gave up two hours of their free learning time were observed to engage seriously with the learning methods, focussing on the innate ability to perform logical reasoning necessary for drug calculation problems. Working in small groups allowed some discussion of the route to the answer and this was followed by class discussion and reflection. The results were recorded as weekly self-assessment scores for confidence in calculation. A self-selecting group who successfully completed the end of semester drug calculation exam reported low to moderate confidence in arithmetic. After four weeks focussing on logical skills a significant increase in self-belief was measured. This continued to rise in students who remained in the classes. Many students hold a negative belief regarding their own mathematical abilities. This restricts the learning of arithmetic skills making alternate routes using mnemonics and memorised steps an attractive alternative. Practising stepwise logical reasoning skills consolidated by personal reflection has been effective in developing student's confidence and awareness of their innate powers of deduction supporting an

  10. Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: a qualitative investigation of reported effects on professional behaviour.

    Science.gov (United States)

    D'Lima, D; Arnold, G; Brett, S J; Bottle, A; Smith, A; Benn, J

    2017-07-01

    Research suggests that providing clinicians with feedback on their performance can result in professional behaviour change and improved clinical outcomes. Departments would benefit from understanding which characteristics of feedback support effective quality monitoring, professional behaviour change and service improvement. This study aimed to report the experience of anaesthetists participating in a long-term initiative to provide comprehensive personalized feedback to consultants on patient-reported quality of recovery indicators in a large London teaching hospital. Semi-structured interviews were conducted with 13 consultant anaesthetists, six surgical nursing leads, the theatre manager and the clinical coordinator for recovery. Transcripts were qualitatively analysed for themes linked to the perceived value of the initiative, its acceptability and its effects upon professional practice. Analysis of qualitative data from participant interviews suggested that effective quality indicators must address areas that are within the control of the anaesthetist. Graphical data presentation, both longitudinal (personal variation over time) and comparative (peer-group distributions), was found to be preferable to summary statistics and provided useful and complementary perspectives for improvement. Developing trust in the reliability and credibility of the data through co-development of data reports with clinical input into areas such as case-mix adjustment was important for engagement. Making feedback specifically relevant to the recipient supported professional learning within a supportive and open collaborative environment. This study investigated the requirements for effective feedback on quality of anaesthetic care for anaesthetists, highlighting the mechanisms by which feedback may translate into improvements in practice at the individual and peer-group level. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia

  11. Adverse drug reaction monitoring of newer oral anti diabetic drugs – a pharmacovigilance perspective

    Directory of Open Access Journals (Sweden)

    Ankita Bhattacharjee

    2016-04-01

    Full Text Available Objective: To monitor and evaluate adverse drug reactions (ADRs of newer oral anti-diabetic drugs in type II diabetics by spontaneous/solicited ADR monitoring.Material and methods: Two hundred and thirty two diabetic patients on newer oral antidiabetic drugs were evaluated prospectively in a cross-sectional study over a period of eighteen months. All patients were followed up for ADRs which were evaluated for incidence, frequency, severity and causality. ADR severity was graded according to University of Virginia Health System Adverse Drug Reaction Reporting program criteria and causality assessment was done using WHO-UMC scale.Results: 190 out of 232 patients (42 patients lost to follow up were evaluated. ADRs were observed in 34 cases (17.9%. Most common ADRs were gastrointestinal (44.2% followed by musculoskeletal (17.6%, metabolic (14.7%, infections (5.9% and others (17.6%. The maximal frequency of ADRs was seen with sitagliptin (6.4% followed by vildagliptin(3.8%, saxagliptin(2.7%, saroglitazar(2.1%, linagliptin(1.6%, canagliflozin(1.6%. 25(73.5%, 8(23.5% and 1(3% ADRs were mild, moderate and severe respectively. 24(70% ADRs were classified as possible, 9(27% probable and 1(3% unlikely on causality assessment. Conclusion: Newer oral antidiabetic drugs like gliptins and SGLT-2 inhibitors have potential to cause ADRs. Gastro-intestinal, musculoskeletal, metabolic were most common ADRs. Active pharmacovigilance should be carried out for risk identification and management. 

  12. Usability testing of a monitoring and feedback tool to stimulate physical activity

    Directory of Open Access Journals (Sweden)

    van der Weegen S

    2014-03-01

    Full Text Available Sanne van der Weegen,1 Renée Verwey,1,2 Huibert J Tange,3 Marieke D Spreeuwenberg,1 Luc P de Witte1,2 1Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, the Netherlands; 2Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands; 3Department of General Practice, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, the Netherlands Introduction: A monitoring and feedback tool to stimulate physical activity, consisting of an activity sensor, smartphone application (app, and website for patients and their practice nurses, has been developed: the 'It's LiFe!' tool. In this study the usability of the tool was evaluated by technology experts and end users (people with chronic obstructive pulmonary disease or type 2 diabetes, with ages from 40–70 years, to improve the user interfaces and content of the tool. Patients and methods: The study had four phases: 1 a heuristic evaluation with six technology experts; 2 a usability test in a laboratory by five patients; 3 a pilot in real life wherein 20 patients used the tool for 3 months; and 4 a final lab test by five patients. In both lab tests (phases 2 and 4 qualitative data were collected through a thinking-aloud procedure and video recordings, and quantitative data through questions about task complexity, text comprehensiveness, and readability. In addition, the post-study system usability questionnaire (PSSUQ was completed for the app and the website. In the pilot test (phase 3, all patients were interviewed three times and the Software Usability Measurement Inventory (SUMI was completed. Results: After each phase, improvements were made, mainly to the layout and text. The main improvement was a refresh button for active data synchronization between activity sensor, app, and server

  13. An audit of therapeutic drug monitoring of anticonvulsants.

    Science.gov (United States)

    Sharpe, P. C.; Morrow, J.; Trimble, E. R.

    1995-01-01

    An audit of therapeutic drug monitoring (TDM) of anticonvulsants was performed to assess both its use and misuse in the management of patients with epilepsy. Over a four week period all samples received for phenytoin, carbamazepine, sodium valproate and phenobarbitone assays were included in the audit. The aims were to establish the source of the specimens, the reasons for the requests and to ascertain what action, if any, would be taken when the result of the assay was provided. A total of 163 separate assays were performed over the four week period (43 phenytoin, 74 carbamazepine, 41 valproate, 5 phenobarbitone). Only 18.7% of all requests originated from the adult neurology department. The vast majority of tests had been ordered by junior medical staff (only 10% by consultants) and approximately 50% were 'routine' with no satisfactory clinical reason for the request offered. There was a tendency to manipulate prescribed doses on the basis of drug levels alone without taking the clinical picture into consideration. These results demonstrate a general ignorance, especially amongst junior medical staff, of the value of TDM of anticonvulsants, and reinforce the need for both an educative and interpretive service to be provided by the Chemical Pathology Department. PMID:8533181

  14. Using Patterns for Multivariate Monitoring and Feedback Control of Linear Accelerator Performance: Proof-of-Concept Research

    International Nuclear Information System (INIS)

    Cordes, Gail Adele; Van Ausdeln, Leo Anthony; Velasquez, Maria Elena

    2002-01-01

    The report discusses preliminary proof-of-concept research for using the Advanced Data Validation and Verification System (ADVVS), a new INEEL software package, to add validation and verification and multivariate feedback control to the operation of non-destructive analysis (NDA) equipment. The software is based on human cognition, the recognition of patterns and changes in patterns in time-related data. The first project applied ADVVS to monitor operations of a selectable energy linear electron accelerator, and showed how the software recognizes in real time any deviations from the optimal tune of the machine. The second project extended the software method to provide model-based multivariate feedback control for the same linear electron accelerator. The projects successfully demonstrated proof-of-concept for the applications and focused attention on the common application of intelligent information processing techniques

  15. A wearable neuro-feedback system with EEG-based mental status monitoring and transcranial electrical stimulation.

    Science.gov (United States)

    Roh, Taehwan; Song, Kiseok; Cho, Hyunwoo; Shin, Dongjoo; Yoo, Hoi-Jun

    2014-12-01

    A wearable neuro-feedback system is proposed with a low-power neuro-feedback SoC (NFS), which supports mental status monitoring with encephalography (EEG) and transcranial electrical stimulation (tES) for neuro-modulation. Self-configured independent component analysis (ICA) is implemented to accelerate source separation at low power. Moreover, an embedded support vector machine (SVM) enables online source classification, configuring the ICA accelerator adaptively depending on the types of the decomposed components. Owing to the hardwired accelerating functions, the NFS dissipates only 4.45 mW to yield 16 independent components. For non-invasive neuro-modulation, tES stimulation up to 2 mA is implemented on the SoC. The NFS is fabricated in 130-nm CMOS technology.

  16. Keeping energy visible? Exploring how householders interact with feedback from smart energy monitors in the longer term

    International Nuclear Information System (INIS)

    Hargreaves, Tom; Nye, Michael; Burgess, Jacquelin

    2013-01-01

    This paper reports on how, over a 12-month period, UK householders interacted with feedback on their domestic electricity consumption in a field trial of real time displays or smart energy monitors. Drawing on the findings of 11 follow-up qualitative interviews with householders involved in a ‘Visible Energy Trial’, the paper suggests that: (i) over time, smart energy monitors gradually become ‘backgrounded’ within normal household routines and practices; (ii) the monitors do increase householders’ knowledge of and confidence about the amount of electricity they consume; (iii) but, beyond a certain level and for a wide variety of reasons, the monitors do not necessarily encourage or motivate householders to reduce their levels of consumption; and (iv) once equipped with new knowledge and expertise about their levels of electricity consumption, household practices may become harder to change as householders realise the limits to their energy saving potential and become frustrated by the absence of wider policy and market support. The paper concludes by reflecting on the policy and research implications of these findings in relation to future transition pathways to a low-carbon economy. - Highlights: ► We interviewed 11 householders who had used a smart energy monitor for 12 months. ► The monitors did help interviewees learn about their energy use. ► Over time, the monitors became ‘backgrounded’ within normal household routines. ► After early behaviour changes, the monitors did not motivate further energy saving. ► The monitors may ‘harden’ energy use patterns in the absence of wider support.

  17. The role of the Australian Adverse Drug Reactions Advisory Committee (ADRAC) in monitoring drug safety

    International Nuclear Information System (INIS)

    Boyd, Ian W.

    2002-01-01

    The Australian adverse drug reaction reporting system is acknowledged as one of the best in the world. Despite its small population of less than 20 million people, Australia's current ADR reporting rate of over 12000 reports per year places it in the top few nations in terms of reports per capita. The ADRAC program has been in operation for over 30 years. Australia was a founding member of the WHO International Drug Monitoring Programme which commenced in 1968 and currently there are about 153000 reports in the ADRAC database. Reports from health professionals have uncovered a number of significant safety problems over the years. Of particular importance are flucloxacillin-induced hepatitis, amoxycillin/clavulanate-induced hepatitis, and the association of cystitis with tiaprofenic acid. The number and quality of the reports has allowed an understanding of the characteristics of the reactions and, using ADRAC reporters as a major source of cases, case-control studies have been completed which have identified risk factors. ADRAC's review of Australian reports has highlighted many important associations that have been disseminated through the Australian Adverse Drug Reactions Bulletin

  18. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department.

    Science.gov (United States)

    Weiner, Scott G; Griggs, Christopher A; Mitchell, Patricia M; Langlois, Breanne K; Friedman, Franklin D; Moore, Rebecca L; Lin, Shuo Cheng; Nelson, Kerrie P; Feldman, James A

    2013-10-01

    We compare emergency provider impression of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assess change in opioid pain reliever prescribing after prescription drug monitoring program review, and examine clinical factors associated with suspected drug-seeking behavior. This was a prospective observational study of emergency providers assessing a convenience sample of patients aged 18 to 64 years who presented to either of 2 academic medical centers with chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to 4 opioid prescriptions by greater than or equal to 4 providers in the 12 months before emergency department evaluation. Emergency providers completed data forms recording their impression of the likelihood of drug-seeking behavior, patient characteristics, and plan for prescribing pre- and post-prescription drug monitoring program review. Descriptive statistics were generated. We calculated agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program definition, and sensitivity, specificity, and positive predictive value of emergency provider impression, using prescription drug monitoring program criteria as the criterion standard. A multivariate logistic regression analysis was conducted to determine clinical factors associated with drug-seeking behavior. Thirty-eight emergency providers with prescription drug monitoring program access participated. There were 544 patient visits entered into the study from June 2011 to January 2013. There was fair agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program (κ=0.30). Emergency providers had sensitivity 63.2% (95% confidence interval [CI] 54.8% to 71.7%), specificity 72.7% (95% CI 68.4% to 77.0%), and positive predictive value 41.2% (95% CI 34.4% to 48

  19. Therapeutic Drug Monitoring of Venlafaxine in an Everyday Clinical Setting

    DEFF Research Database (Denmark)

    Hansen, Morten Rix; Kuhlmann, Ida Berglund; Pottegård, Anton

    2017-01-01

    Venlafaxine is a commonly used antidepressant agent. We aimed to provide detailed information on the associations between venlafaxine dose and concentrations of venlafaxine, by patient age and sex. From a therapeutic drug monitoring (TDM) database located at Odense University Hospital, Denmark, we...... identified all adults for whom the treating physician had requested clinical advice on the TDM result for venlafaxine between 2002 and 2012. We identified 1,077 TDM samples of venlafaxine from 334 males and 743 females (median age 45 years), and the median daily dose was 225 mg. Median plasma concentration...... of venlafaxine and o-desmethyvenlafaxine (ODV) were 306 nmol/L and 861 nmol/L, respectively. The median dose-corrected serum level for venlafaxine was 1.49 nmol/L/mg., while the dose-corrected serum level of men and women were 1.21 nmol/L/mg and 1.60 nmol/L/mg, respectively. The dose-corrected sum of venlafaxine...

  20. Intensive monitoring of new drugs based on first prescription signals from pharmacists : a pilot study

    NARCIS (Netherlands)

    Van Grootheest, AC; Groote, JK; de Jong-van den Berg, LTW

    Background Intensive monitoring can be a valuable tool in the early detection of adverse drug reactions, especially of new drugs. Aim of this pilot study was to investigate the practical possibilities of a system of intensive monitoring, using the pharmacy computer system to detect the first

  1. Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.

    Science.gov (United States)

    Sánchez-Carrillo, Laura Arelí; Rodríguez-López, Juan Manuel; Galarza-Delgado, Dionisio Ángel; Baena-Trejo, Laura; Padilla-Orozco, Magaly; Mendoza-Flores, Lidia; Camacho-Ortiz, Adrián

    2016-08-01

    The importance of hand hygiene in the prevention of health care-associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce. This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance. A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P hand hygiene compliance. Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Limited-Sampling Strategies for Therapeutic Drug Monitoring of Moxifloxacin in Patients With Tuberculosis

    NARCIS (Netherlands)

    Pranger, Arianna D.; Kosterink, Jos G. W.; van Altena, Richard; Aarnoutse, Rob E.; van der Werf, Tjip S.; Uges, Donald R. A.; Alffenaar, Jan-Willem C.

    Background: Moxifloxacin (MFX) is a potent drug for multidrug resistant tuberculosis(TB) treatment and is also useful if first-line agents are not tolerated. Therapeutic drug monitoring may help to prevent treatment failure. Obtaining a full concentration-time curve of MFX for therapeutic drug

  3. Limited-sampling strategies for therapeutic drug monitoring of moxifloxacin in patients with tuberculosis

    NARCIS (Netherlands)

    Pranger, A.D.; Kosterink, J.G.W.; Altena, R. van; Aarnoutse, R.E.; Werf, T.S. van der; Uges, D.R.A.; Alffenaar, J.W.C.

    2011-01-01

    BACKGROUND: Moxifloxacin (MFX) is a potent drug for multidrug resistant tuberculosis(TB) treatment and is also useful if first-line agents are not tolerated. Therapeutic drug monitoring may help to prevent treatment failure. Obtaining a full concentration-time curve of MFX for therapeutic drug

  4. Verantwoording en kosteneffectiviet van therapeutic drug monitoring (1) : Betere behandeling voor minder geld

    NARCIS (Netherlands)

    Touw, D.J.; Neef, C.; Vinks, A.A.

    2003-01-01

    There are a number of effective but highly toxic drugs that exhibit a narrow therapeutic index and marked intersubject pharmacokinetic variability. Optimal therapy with such drugs requires therapeutic drug monitoring (TDM) in order to safely obtain the desired clinical effects. A systematic review

  5. Detecting delay in visual feedback of an action as a monitor of self recognition.

    Science.gov (United States)

    Hoover, Adria E N; Harris, Laurence R

    2012-10-01

    How do we distinguish "self" from "other"? The correlation between willing an action and seeing it occur is an important cue. We exploited the fact that this correlation needs to occur within a restricted temporal window in order to obtain a quantitative assessment of when a body part is identified as "self". We measured the threshold and sensitivity (d') for detecting a delay between movements of the finger (of both the dominant and non-dominant hands) and visual feedback as seen from four visual perspectives (the natural view, and mirror-reversed and/or inverted views). Each trial consisted of one presentation with minimum delay and another with a delay of between 33 and 150 ms. Participants indicated which presentation contained the delayed view. We varied the amount of efference copy available for this task by comparing performances for discrete movements and continuous movements. Discrete movements are associated with a stronger efference copy. Sensitivity to detect asynchrony between visual and proprioceptive information was significantly higher when movements were viewed from a "plausible" self perspective compared with when the view was reversed or inverted. Further, we found differences in performance between dominant and non-dominant hand finger movements across the continuous and single movements. Performance varied with the viewpoint from which the visual feedback was presented and on the efferent component such that optimal performance was obtained when the presentation was in the normal natural orientation and clear efferent information was available. Variations in sensitivity to visual/non-visual temporal incongruence with the viewpoint in which a movement is seen may help determine the arrangement of the underlying visual representation of the body.

  6. High-resolution stable isotope monitoring reveals differential vegetation-soil water feedbacks among plant functional types

    Science.gov (United States)

    Volkmann, T. H. M.; Haberer, K.; Troch, P. A. A.; Gessler, A.; Weiler, M.

    2016-12-01

    Understanding the linked dynamics of rain water recharge to soils and its utilization by plants is critical for predicting the impact of climate and land use changes on the productivity of ecosystems and the hydrologic cycle. While plants require vast quantities of water from the soil to sustain growth and function, they exert important direct and indirect controls on the movement of water through the rooted soil horizons, thereby potentially affecting their own resource availability. However, the specific ecohydrological belowground processes associated with different plant types and their rooting systems have been difficult to quantify with traditional methods. Here, we report on the use of techniques for monitoring stable isotopes in soil and plant water pools that allow us to track water infiltration and root uptake dynamics non-destructively and in high resolution. The techniques were applied in controlled rain pulse experiments with distinct plant types (grass, deciduous trees, grapevine) that we let develop on an initially uniform soil for two years. Our results show that plant species and types differed widely in their plasticity and pattern of root uptake under variable water availability. Thereby, and through notably co-acting indirect effects related to differential root system traits and co-evolution of soil properties, the different plants induced contrasting hydrological dynamics in the soil they had inhabited for only a short period of time. Taken together, our data suggest that the studied soil-vegetation systems evolved a positive infiltration-uptake feedback in which hydrological flow pathways underlying different species diverged in a way that complemented their specific water utilization strategy. Such a feedback could present an indirect competitive mechanism by which plants improve their own water supply and modulate hydrological cycling at the land surface. The ability to directly measure this feedback using in situ isotope methodology

  7. Combining carbon footprinting, monitoring, feedback, and rewards for a broad spectrum reduction of household induced greenhouse gas emissions

    Energy Technology Data Exchange (ETDEWEB)

    Perrels, Adriaan (Government Institute for Economic Research VATT (Finland)); Hongisto, Mikko; Kallio, Arto (VTT Technical Research Centre of Finland (Finland)); Hyvoenen, Kaarina (National Consumer Research Centre KTK (Finland)); Katajajuuri, Juha-Matti (MTT Agrifood Research Finland (Finland)); Nissinen, Ari (Finnish Environment Institute SYKE (Finland))

    2009-07-01

    The study reported in this article (named CLIMATE BONUS) concerns the combined use of verified carbon footprints (possibly visualised through labels), personalised monitoring and feedback services to households regarding the greenhouse gas intensities of their purchases, and a reward system (bonuses) for consumers who manage to reduce the embodied emissions. The study assesses the accuracy and verification requirements and the harmonisation needs for the various information systems and their interfaces. This should culminate in a data strategy, in which a data acquisition, generation and co-ordination strategy and a data quality assurance strategy will be developed. Equally important, the study also assesses, via an own pilot, what the response of households (as consumers) can amount to and how the responsiveness to various incentives can be rated. The paper provides an outline of the intended system, including its rationale. Subsequently, the paper focuses on the consumer pilot and the feedback from the participants. It also provides a brief impression of the expected overall economic effectiveness of the system.

  8. Therapeutic drug monitoring of lopinavir/ritonavir in pregnancy.

    LENUS (Irish Health Repository)

    Lambert, J S

    2012-02-01

    OBJECTIVES: The aim of the study was to determine total and unbound lopinavir (LPV) plasma concentrations in HIV-infected pregnant women receiving lopinavir\\/ritonavir (LPV\\/r tablet) undergoing therapeutic drug monitoring (TDM) during pregnancy and postpartum. METHODS: Women were enrolled in the study who were receiving the LPV\\/r tablet as part of their routine prenatal care. Demographic and clinical data were collected and LPV plasma (total) and ultrafiltrate (unbound) concentrations were determined in the first, second and third trimesters using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS\\/MS). Postpartum sampling was performed where applicable. Antepartum and postpartum trough concentrations (C(trough) ) were compared independently [using analysis of variance (anova)] and on a longitudinal basis (using a paired t-test). RESULTS: Forty-six women were enrolled in the study (38 Black African). Forty women initiated LPV\\/r treatment in pregnancy. Median (range) gestation at initiation was 25 (15-36) weeks and median (range) baseline CD4 count and viral load were 346 (14-836) cells\\/muL and 8724 (<50-267408) HIV-1 RNA copies\\/mL, respectively. Forty women (87%) had LPV concentrations above the accepted minimum effective concentration for wild-type virus (MEC; 1000 ng\\/mL). Geometric mean (95% confidence interval [CI]) total LPV concentrations in the first\\/second [3525 (2823-4227) ng\\/mL; n=16] and third [3346 (2813-3880) ng\\/mL; n=43] trimesters were significantly lower relative to postpartum [5136 (3693-6579) ng\\/mL; n=12] (P=0.006). In a paired analysis (n=12), LPV concentrations were reduced in the third trimester [3657 (2851-4463) ng\\/mL] vs. postpartum (P=0.021). No significant differences were observed in the LPV fraction unbound (fu%). Conclusions The above target concentrations achieved in the majority of women and similarities in the fu% suggest standard dosing of the LPV\\/r tablet is appropriate during pregnancy

  9. Therapeutic drug monitoring in epilepsy clinic: a multi-disciplinary approach

    Directory of Open Access Journals (Sweden)

    Sunee Lertsinudom

    2014-12-01

    Full Text Available Epilepsy is a common public health problem and needs multi-disciplinary treatment. Therapeutic drug monitoring (TDM is one of step of the multi-disciplinary treatment in epilepsy at Epilepsy clinic, Khon Kaen University (Thailand. The TDM service has been established since 2008. Here, we aimed to study the roles of TDM order and epilepsy control. This is a prospective descriptive study in which data collection was done from January 1 to December 31, 2010, the period when pharmacists took part in assessing the appropriateness in measurement and interpretation of TDM in order to provide suggestions for physicians. The 112 patients under study had an average age of 38.21±15.36 years; 254 samples were collected for therapeutic drug monitoring; phenytoin was submitted mostly for drug monitoring at 46.46%; 44.49% of sub-missions for drug level monitoring were made owing to a suspected sub-therapeutic level. Associations were found between reasons of sending samples for drug level monitoring and the measured drug levels, i.e., 66.67% of drug levels found was so low that they were undetectable in sample for patients’ compliance investigation and 38.94% of the drug levels were found to be sub-therapeutic as for the case where submission of samples was done because of suspected sub-therapeutic level, 40% of the cases were found to be in toxicity range in the cases with suspected over-therapeutic levels and monitoring levels, 58.25% were found to be within the therapeutic range. Pharmacists used the interpreted results in patients’ care by recommending physicians to monitor therapeutic drug closely, to adjust the dosage of drugs, and to recommend checking patients’ compliance in their use of drugs at 56.5, 38.9, and 4.3%, respectively. Physicians’ responses were found to be absolute follow, partial follow and not follow at 77.95, 11.03, and 7.48%, respectively. In conclusion, associations were found between reasons of TDM order and measured drug

  10. Best-estimate reactor core monitor using state feedback strategies to resolve uncertainties

    International Nuclear Information System (INIS)

    Martin, R.P.

    1997-01-01

    The development and demonstration of a new algorithm for quantifying uncertainty in best-estimate simulation codes has been investigated. Demonstration is given by way of a prototype reactor core monitor. The architecture of this monitor integrates a distributed parameter estimation technique and the infrastructure required to support this control theory-based algorithm into a production-grade best-estimate simulation code. The Kalman filter with the sequential least-squares parameter estimation algorithm has been extended for application into the computational environment of a best-estimate simulation code, i.e., RELAP5/DOE. In control system terminology this configuration can be thought of as a best-estimate observer

  11. Early Warning Indicators for Population-Based Monitoring of HIV Drug Resistance in 6 African Countries

    NARCIS (Netherlands)

    Sigaloff, Kim C. E.; Hamers, Raph L.; Menke, Jack; Labib, Moheb; Siwale, Margaret; Ive, Prudence; Botes, Mariette E.; Kityo, Cissy; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Geskus, Ronald B.; Stevens, Wendy S.; van Vugt, Michèle; Rinke de Wit, Tobias F.

    2012-01-01

    Human immunodeficiency virus (HIV) RNA testing and HIV drug resistance (HIVDR) testing are not routinely available for therapeutic monitoring of patients receiving antiretroviral therapy (ART) in resource-limited settings. World Health Organization HIVDR early warning indicators (EWIs) assess ART

  12. System monitoring feedback in cinemas and harvesting energy of the air conditioning condenser

    Science.gov (United States)

    Pop, P. P.; Pop-Vadean, A.; Barz, C.; Latinovic, T.; Chiver, O.

    2017-05-01

    Our article monitors the degree of emotional involvement of the audience in the action film in theaters by measuring the concentration of CO2. The software performs data processing obtained dispersion sensors and displays data during the film. The software will also trigger the start of the air conditioning condenser where we can get harvesting energy by installing a piezoelectric device. Useful energy can be recovered from various waste produced in cinema. The time lag between actions and changes in environmental systems determines that decisions made now will affect subsequent generations and the future of our environment.

  13. A Best-Estimate Reactor Core Monitor Using State Feedback Strategies to Reduce Uncertainties

    International Nuclear Information System (INIS)

    Martin, Robert P.; Edwards, Robert M.

    2000-01-01

    The development and demonstration of a new algorithm to reduce modeling and state-estimation uncertainty in best-estimate simulation codes has been investigated. Demonstration is given by way of a prototype reactor core monitor. The architecture of this monitor integrates a control-theory-based, distributed-parameter estimation technique into a production-grade best-estimate simulation code. The Kalman Filter-Sequential Least-Squares (KFSLS) parameter estimation algorithm has been extended for application into the computational environment of the best-estimate simulation code RELAP5-3D. In control system terminology, this configuration can be thought of as a 'best-estimate' observer. The application to a distributed-parameter reactor system involves a unique modal model that approximates physical components, such as the reactor, by describing both states and parameters by an orthogonal expansion. The basic KFSLS parameter estimation is used to dynamically refine a spatially varying (distributed) parameter. The application of the distributed-parameter estimator is expected to complement a traditional nonlinear best-estimate simulation code by providing a mechanism for reducing both code input (modeling) and output (state-estimation) uncertainty in complex, distributed-parameter systems

  14. Monitoring the efficacy of drugs for neglected tropical diseases controlled by preventive chemotherapy.

    Science.gov (United States)

    Albonico, M; Levecke, B; LoVerde, P T; Montresor, A; Prichard, R; Vercruysse, J; Webster, J P

    2015-12-01

    In the last decade, pharmaceutical companies, governments and global health organisations under the leadership of the World Health Organization (WHO) have pledged large-scale donations of anthelmintic drugs, including ivermectin (IVM), praziquantel (PZQ), albendazole (ALB) and mebendazole (MEB). This worldwide scale-up in drug donations calls for strong monitoring systems to detect any changes in anthelmintic drug efficacy. This review reports on the outcome of the WHO Global Working Group on Monitoring of Neglected Tropical Diseases Drug Efficacy, which consists of three subgroups: (i) soil-transmitted helminthiases (ALB and MEB); (ii) onchocerciasis and lymphatic filariasis (IVM); and (iii) schistosomiasis (PZQ). Progress of ongoing work, challenges and research needs for each of the four main drugs used in helminthic preventive chemotherapy (PC) are reported, laying the ground for appropriate implementation of drug efficacy monitoring programmes under the co-ordination and guidelines of the WHO. Best practices for monitoring drug efficacy should be made available and capacity built as an integral part of neglected tropical disease (NTD) programme monitoring. Development of a disease-specific model to predict the impact of PC programmes, to detect outliers and to solicit responses is essential. Research studies on genetic polymorphisms in relation to low-efficacy phenotypes should be carried out to identify markers of putative resistance against all NTD drugs and ultimately to develop diagnostic assays. Development of combination and co-administration of NTD drugs as well as of new drug entities to boost the armamentarium of the few drugs available for NTD control and elimination should be pursued in parallel. Copyright © 2015 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

  15. On the slow diffusion of Point of Care systems in Therapeutic Drug Monitoring

    Directory of Open Access Journals (Sweden)

    Barbara eSanavio

    2015-02-01

    Full Text Available Recent advancements in point-of-care technologies show great transformative promises for personalized preventative and predictive medicine. However, fields like therapeutic drug monitoring, that first allowed for personalized treatment of patient’ disease, still lag behind in the widespread application of point-of-care devices for monitoring of patients. Surprisingly, very few applications in commonly monitored drugs, such as anti-epileptics, are paving the way for a point of care (PoC approach to patient’ therapy monitoring, compared to other fields –like intensive care cardiac markers monitoring, glycemic controls in diabetes, or bench-top hematological parameters analysis at the local drug store. Such delay in the development of portable fast clinically effective drug monitoring devices is in our opinion due more to an inertial drag on the pervasiveness of these new devices into the clinical field than a lack of technical capability. At the same time, some very promising technologies failed in the clinical practice for inadequate understanding of the outcome parameters necessary for a relevant technological breakthrough that has superior clinical performance. We hope, by overviewing both therapeutic drug monitoring practice and its yet unmet needs and latest advancement in micro and nanotechnology applications to PoC clinical devices, to help bridging the two communities, the one exploiting analytical technologies and the one mastering the most advanced techniques, into translating existing and forthcoming technologies in effective devices.

  16. Assessment of pharmacovigilance approaches for monitoring the safety of antimalarial drugs in pregnancy

    NARCIS (Netherlands)

    Dellicour, S.O.M.C.

    2014-01-01

    Post-marketing surveillance of drugs used in pregnancy is challenging, especially in developing countries where resources for pharmacovigilance are rare. There is a need to establish simple but effective systems to monitor safety of drugs given during pregnancy in resource constrained countries.

  17. Why do some therapists not deal with outcome monitoring feedback? A feasibility study on the effect of regulatory focus and person–organization fit on attitude and outcome

    NARCIS (Netherlands)

    de Jong, Kim; de Goede, Marije

    2015-01-01

    Objective: Despite research on its effectiveness, many therapists still have negative attitudes toward using outcome monitoring feedback. The current study aims to investigate how the perceived match between values of an individual and those of the organization (Person–Organization fit; PO fit), and

  18. "Not just eliminating the mosquito but draining the swamp": A critical geopolitics of Turkish Monitoring Center for Drugs and Drug Addiction and Turkey's approach to illicit drugs.

    Science.gov (United States)

    Evered, Kyle T; Evered, Emine Ö

    2016-07-01

    In the 1970s, Turkey ceased to be a significant producer state of illicit drugs, but it continued to serve as a key route for the trade of drugs between East and West. Over the past decade, however, authorities identified two concerns beyond its continued transit state status. These reported problems entail both new modes of production and a rising incidence of drug abuse within the nation-state - particularly among its youth. Amid these developments, new law enforcement institutions emerged and acquired European sponsorship, leading to the establishment of TUBİM (the Turkish Monitoring Center for Drugs and Drug Addiction). Coordinating with and reporting to the European Union agency EMCDDA (the European Monitoring Center for Drugs and Drug Addiction), TUBİM's primary assigned duties entail the collection and analysis of data on drug abuse, trafficking, and prevention, the geographic identification of sites of concern (e.g. consumption, drug-related crimes, and peoples undergoing treatment), and the production of annual national reports. In this article, we examine the geopolitical origins of TUBİM as Turkey's central apparatus for confronting drug problems and its role as a vehicle for policy development, interpretation, and enforcement. In doing so, we emphasize the political and spatial dimensions inherent to the country's institutional and policy-driven approaches to contend with drug-related problems, and we assess how this line of attack reveals particular ambiguities in mission when evaluated from scales at world regional, national, and local levels. In sum, we assess how Turkey's new institutional and legislative landscapes condition the state's engagements with drug use, matters of user's health, and policy implementation at local scales and amid ongoing political developments. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Monitoring of drug intake during pregnancy by questionnaires and LC-MS/MS drug urine screening: evaluation of both monitoring methods.

    Science.gov (United States)

    Hoeke, Henrike; Roeder, Stefan; Bertsche, Thilo; Lehmann, Irina; Borte, Michael; von Bergen, Martin; Wissenbach, Dirk K

    2015-08-01

    Various studies pointed towards a relationship between chronic diseases such as asthma and allergy and environmental risk factors, which are one aspect of the so-called Exposome. These environmental risk factors include also the intake of drugs. One critical step in human development is the prenatal period, in which exposures might have critical impact on the child's health outcome. Thereby, the health effects of drugs taken during gestation are discussed controversially with regard to newborns' disease risk. Due to this, the drug intake of pregnant women in the third trimester was monitored by questionnaire, in addition to biomonitoring using a local birth cohort study, allowing correlations of drug exposure with disease risk. Therefore, 622 urine samples were analyzed by an untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) urine screening and the results were compared to self-administered questionnaires. In total, 48% (n = 296) reported an intake of pharmaceuticals, with analgesics as the most frequent reported drug class in addition to dietary supplements. 182 times compounds were detected by urine screening, with analgesics (42%; n = 66) as the predominantly drug class. A comparison of reported and detected drug intake was performed for three different time spans between completion of the questionnaires and urine sampling. Even if the level of accordance was low in general, similar percentages (~25%, ~19%, and ~ 20%) were found for all groups. This study illustrates that a comprehensive evaluation of drug intake is neither achieved by questionnaires nor by biomonitoring alone. Instead, a combination of both monitoring methods, providing complementary information, should be considered. Copyright © 2014 John Wiley & Sons, Ltd.

  20. WE-DE-209-05: Self-Held Breath Control with Respiratory Monitoring and Feedback Guidance

    International Nuclear Information System (INIS)

    Gifford, K.

    2016-01-01

    Breast radiation therapy is associated with some risk of lung toxicity as well as cardiac toxicity for left-sided cases. Radiation doses to the lung and heart can be reduced by using the deep inspiration breath hold (DIBH) technique, in which the patient is simulated and treated during the deep inspiration phase of the breathing cycle. During DIBH, the heart is usually displaced posteriorly, inferiorly, and to the right, effectively expanding the distance between the heart and the breast/chest wall. As a result, the distance between the medial treatment field border and heart/lung is increased. Also, in a majority of DIBH patients, the air drawn into the thoracic cavity increases the total lung volume. The DIBH was discussed by an AAPM Task Group 10 years ago in the AAPM TG 76 report. However, DIBH is still not the standard of care in many clinics, which may be partially due to challenges associated with its implementation. Therefore, this seccion will focus primarily on how to clinically implement four different DIBH techniques: (1) Active Breathing Control, (2) Spirometric Motion Management, (3) 3D Surface Image-Guided, and (4) Self-held Breath Control with Respiratory Monitoring and Feedback Guidance. Learning Objectives: Describe the physical displacement of the heart and the change in lung volume during DIBH and discuss dosimetric consequences of those changes. Provide an overview of the technical aspects. Describe work flow for patient simulation and treatment. Give an overview of commissioning and routine. Provide practical tips for clinical implementation.

  1. WE-DE-209-05: Self-Held Breath Control with Respiratory Monitoring and Feedback Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, K. [UT MD Anderson Cancer Center (United States)

    2016-06-15

    Breast radiation therapy is associated with some risk of lung toxicity as well as cardiac toxicity for left-sided cases. Radiation doses to the lung and heart can be reduced by using the deep inspiration breath hold (DIBH) technique, in which the patient is simulated and treated during the deep inspiration phase of the breathing cycle. During DIBH, the heart is usually displaced posteriorly, inferiorly, and to the right, effectively expanding the distance between the heart and the breast/chest wall. As a result, the distance between the medial treatment field border and heart/lung is increased. Also, in a majority of DIBH patients, the air drawn into the thoracic cavity increases the total lung volume. The DIBH was discussed by an AAPM Task Group 10 years ago in the AAPM TG 76 report. However, DIBH is still not the standard of care in many clinics, which may be partially due to challenges associated with its implementation. Therefore, this seccion will focus primarily on how to clinically implement four different DIBH techniques: (1) Active Breathing Control, (2) Spirometric Motion Management, (3) 3D Surface Image-Guided, and (4) Self-held Breath Control with Respiratory Monitoring and Feedback Guidance. Learning Objectives: Describe the physical displacement of the heart and the change in lung volume during DIBH and discuss dosimetric consequences of those changes. Provide an overview of the technical aspects. Describe work flow for patient simulation and treatment. Give an overview of commissioning and routine. Provide practical tips for clinical implementation.

  2. Patients' experiences with routine outcome monitoring and clinical feedback systems: A systematic review and synthesis of qualitative empirical literature.

    Science.gov (United States)

    Solstad, Stig Magne; Castonguay, Louis Georges; Moltu, Christian

    2017-05-19

    Routine outcome monitoring (ROM) and clinical feedback (CF) systems have become important tools for psychological therapies, but there are challenges for their successful implementation. To overcome these challenges, a greater understanding is needed about how patients experience the use of ROM/CF. We conducted a systematic literature search of qualitative studies on patient experiences with the use of ROM/CF in mental health services. The findings from 16 studies were synthesized, resulting in four meta-themes: (1) Suspicion towards service providers, (2) Flexibility and support to capture complexity, (3) Empowering patients, and (4) Developing collaborative practice. We discuss the implications of these meta-themes for further development and implementation of ROM/CF into clinical practice, acknowledging the limitations of our review and suggesting avenues for further research. Clinical or methodological significance of this article: This article provides useful and actionable knowledge about the patient perspective on ROM/CF, an important discussion on the current state of research in this area, and useful and concrete suggestions for further avenues of research.

  3. Modelling Formation of a Drug Reservoir in the Stratum Corneum and Its Impact on Drug Monitoring Using Reverse Iontophoresis

    Directory of Open Access Journals (Sweden)

    Yvonne Paulley

    2010-01-01

    Full Text Available Reverse iontophoresis is a relatively new technique for non-invasive drug monitoring in the body. It involves a small electrical current being passed through the skin to facilitate the movement of small charged ions and polar molecules on the skin's surface where the amount of drug can then be measured and hence an accurate estimate of the blood concentration can be made. In vivo studies for several molecules show that initially large amounts of drug are extracted from the body, which are unrelated to the magnitude of the blood concentration; over time the fluxes of extraction decrease to a level proportional to the steady state blood concentration. This suggests that, at first, the drug is being extracted from some source other than the blood; one such candidate for this source is the dead cells which form the stratum corneum. In this paper, we construct two related mathematical models; the first describes the formation of the drug reservoir in the stratum corneum as a consequence of repeated drug intake and natural death of skin cells in the body. The output from this model provides initial conditions for the model of reverse iontophoresis in which charged ions from both the blood and the stratum corneum reservoir compete for the electric current. Model parameters are estimated from data collected for lithium monitoring. Our models will improve interpretation of reverse iontophoretic data by discriminating the subdermal from the skin contribution to the fluxes of extraction. They also suggest that analysis of the skin reservoir might be a valuable tool to investigate patients' exposure to chemicals including therapeutic drugs.

  4. SUZAKU MONITORING OF THE SEYFERT 1 GALAXY NGC 5548: WARM ABSORBER LOCATION AND ITS IMPLICATION FOR COSMIC FEEDBACK

    International Nuclear Information System (INIS)

    Krongold, Y.; Andrade-Velazquez, M.; Binette, L.; Jimenez-Bailon, E.; Elvis, M.; Nicastro, F.; Brickhouse, N. S.; Liu, Y.; Wilkes, B.; Mathur, S.; Reeves, J. N.; Grupe, D.; McHardy, I. M.; Minezaki, T.; Yoshii, Y.

    2010-01-01

    We present a 2 month Suzaku X-ray monitoring of the Seyfert 1 galaxy NGC 5548. The campaign consists of seven observations (with exposure time of ∼30 ks each), separated by ∼1 week. This paper focus on the X-ray Imaging Spectrometer data of NGC 5548. We analyze the response in the opacity of the gas that forms the well-known ionized absorber in this source for ionizing flux variations. Despite variations by a factor of ∼4 in the impinging continuum, the soft X-ray spectra of the source show little spectral variations, suggesting no response from the ionized absorber. A detailed time modeling of the spectra confirms the lack of opacity variations for an absorbing component with high ionization (U X ∼ -0.85), and high outflow velocity (v out ∼ 1040 km s -1 ), as the ionization parameter was found to be consistent with a constant value during the whole campaign. Instead, the models suggest that the ionization parameter of a low ionization (U X ∼ -2.8), low velocity (v out ∼ 590 km s -1 ) absorbing component might be changing linearly with the ionizing flux, as expected for gas in photoionization equilibrium. However, given the lack of spectral variations among observations, we consider the variations in this component as tentative. Using the lack of variations, we set an upper limit of n e 7 cm -3 for the electron density of the gas forming the high ionization, high velocity component. This implies a large distance from the continuum source (R>0.033 pc; R>5000R S ). If the variations in the low ionization, low velocity component are real, they imply n e >9.8 x 10 4 cm -3 and R 1.2 x 10 56 erg) can be enough to disrupt the interstellar medium, possibly quenching or regulating large-scale star formation. However, the total mass and energy ejected by the wind may still be lower than the one required for cosmic feedback, even when extrapolated to quasar luminosities. Such feedback would require that we are observing the wind before it is fully accelerated.

  5. Reproducibility of The Abdominal and Chest Wall Position by Voluntary Breath-Hold Technique Using a Laser-Based Monitoring and Visual Feedback System

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa; Shioyama, Yoshiyuki; Nomoto, Satoru; Ohga, Saiji; Toba, Takashi; Yoshitake, Tadamasa; Anai, Shigeo; Terashima, Hiromi; Honda, Hiroshi

    2007-01-01

    Purpose: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. Methods and Materials: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. Results: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 ± 1.3 mm to 1.5 ± 0.5 mm, 2.5 ± 1.9 mm to 1.1 ± 0.4 mm, and 6.6 ± 2.4 mm to 2.6 ± 1.4 mm in SEBH, SIBH, and DIBH, respectively. Conclusions: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial

  6. Breath-hold monitoring and visual feedback for radiotherapy using a charge-coupled device camera and a head-mounted display. System development and feasibility

    International Nuclear Information System (INIS)

    Yoshitake, Tadamasa; Nakamura, Katsumasa; Shioyama, Yoshiyuki

    2008-01-01

    The aim of this study was to present the technical aspects of the breath-hold technique with respiratory monitoring and visual feedback and to evaluate the feasibility of this system in healthy volunteers. To monitor respiration, the vertical position of the fiducial marker placed on the patient's abdomen was tracked by a machine vision system with a charge-coupled device camera. A monocular head-mounted display was used to provide the patient with visual feedback about the breathing trace. Five healthy male volunteers were enrolled in this study. They held their breath at the end-inspiration and the end-expiration phases. They performed five repetitions of the same type of 15-s breath-holds with and without a head-mounted display, respectively. A standard deviation of five mean positions of the fiducial marker during a 15-s breath-hold in each breath-hold type was used as the reproducibility value of breath-hold. All five volunteers well tolerated the breath-hold maneuver. For the inspiration breath-hold, the standard deviations with and without visual feedback were 1.74 mm and 0.84 mm, respectively (P=0.20). For the expiration breath-hold, the standard deviations with and without visual feedback were 0.63 mm and 0.96 mm, respectively (P=0.025). Our newly developed system might help the patient achieve improved breath-hold reproducibility. (author)

  7. Assessment of tobramycin RIA for drug monitoring and dosage regimen. Comparison with other assay technics

    International Nuclear Information System (INIS)

    Takahashi, S.; Shinozaki, K.; Tsujino, D.; Ohhara, H.; Tanaka, Y.; Arai, S.; Someya, K.; Sasaki, Y.

    1983-01-01

    Because of wide range of inter-individual difference of pharmacokinetic parameter, importance of monitoring blood concentration of aminoglycoside antibiotics in each patient has been recognized. With the purpose to use for monitoring of serum tobramycin (TOB) levels and for adequate dosage regimen RIA of TOB was evaluated in comparison with other assay technics. Gamma Coat TOB RIA kits (Clinical Assay-Travenol Japan) were used for RIA of TOB. The TOB concentrations in the same samples were also measured by two kinds of enzyme immunoassay (EIA) (EMIT EIA and SLFIA EIA), High Performance Liquid Chromatography (HPLC) and bioassay (BA). RIA of TOB is a useful assay method with high sensitivity and reasonably good precision to be used for drug monitoring and adequate dosage regimen. Modification of the method for rapid assay of a small number of samples will increase the clinical usefulness in individualized drug monitoring

  8. Audio Feedback -- Better Feedback?

    Science.gov (United States)

    Voelkel, Susanne; Mello, Luciane V.

    2014-01-01

    National Student Survey (NSS) results show that many students are dissatisfied with the amount and quality of feedback they get for their work. This study reports on two case studies in which we tried to address these issues by introducing audio feedback to one undergraduate (UG) and one postgraduate (PG) class, respectively. In case study one…

  9. The Analytical Chemistry of Drug Monitoring in Athletes

    Science.gov (United States)

    Bowers, Larry D.

    2009-07-01

    The detection and deterrence of the abuse of performance-enhancing drugs in sport are important to maintaining a level playing field among athletes and to decreasing the risk to athletes’ health. The World Anti-Doping Program consists of six documents, three of which play a role in analytical development: The World Anti-Doping Code, The List of Prohibited Substances and Methods, and The International Standard for Laboratories. Among the classes of prohibited substances, three have given rise to the most recent analytical developments in the field: anabolic agents; peptide and protein hormones; and methods to increase oxygen delivery to the tissues, including recombinant erythropoietin. Methods for anabolic agents, including designer steroids, have been enhanced through the use of liquid chromatography/tandem mass spectrometry and gas chromatography/combustion/isotope-ratio mass spectrometry. Protein and peptide identification and quantification have benefited from advances in liquid chromatography/tandem mass spectrometry. Incorporation of techniques such as flow cytometry and isoelectric focusing have supported the detection of blood doping.

  10. The Effect on Teenage Risky Driving of Feedback From a Safety Monitoring System: A Randomized Controlled Trial

    Science.gov (United States)

    Bingham, C. Raymond; Ouimet, Marie Claude; Pradhan, Anuj; Chen, Rusan; Barretto, Andrea; Shope, Jean

    2012-01-01

    Purpose Teenage risky driving may be due to teenagers not knowing what is risky, preferring risk, or the lack of consequences. Elevated gravitational-force (g-force) events, caused mainly by hard braking and sharp turns, provide a valid measure of risky driving and are the target of interventions using in-vehicle data recording and feedback devices. The effect of two forms of feedback about risky driving events to teenagers only or to teenagers and their parents was tested in a randomized controlled trial. Methods Ninety parent-teen dyads were randomized to one of two groups: (1) immediate feedback to teens (Lights Only); or (2) immediate feedback to teens plus family access to event videos and ranking of the teen relative to other teenage drivers (Lights Plus). Participants’ vehicles were instrumented with data recording devices and events exceeding 0.5 g were assessed for two weeks of baseline and 13 weeks of feedback. Results Growth analysis with random slopes yielded a significant decrease in event rates for the Lights Plus group (slope = −.11, p teenagers did not. Implications and Contribution Reducing elevated g-force events due to hard stops and sharp turns could reduce crash rates among novice teenage drivers. Using materials from the DriveCam For Families Program we found that feedback to both teens and parents significantly reduced rates, while feedback only to teens did not. PMID:23375825

  11. Preclinical optimization of a broad-spectrum anti-bladder cancer tri-drug regimen via the Feedback System Control (FSC) platform

    Science.gov (United States)

    Liu, Qi; Zhang, Cheng; Ding, Xianting; Deng, Hui; Zhang, Daming; Cui, Wei; Xu, Hongwei; Wang, Yingwei; Xu, Wanhai; Lv, Lei; Zhang, Hongyu; He, Yinghua; Wu, Qiong; Szyf, Moshe; Ho, Chih-Ming; Zhu, Jingde

    2015-06-01

    Therapeutic outcomes of combination chemotherapy have not significantly advanced during the past decades. This has been attributed to the formidable challenges of optimizing drug combinations. Testing a matrix of all possible combinations of doses and agents in a single cell line is unfeasible due to the virtually infinite number of possibilities. We utilized the Feedback System Control (FSC) platform, a phenotype oriented approach to test 100 options among 15,625 possible combinations in four rounds of assaying to identify an optimal tri-drug combination in eight distinct chemoresistant bladder cancer cell lines. This combination killed between 82.86% and 99.52% of BCa cells, but only 47.47% of the immortalized benign bladder epithelial cells. Preclinical in vivo verification revealed its markedly enhanced anti-tumor efficacy as compared to its bi- or mono-drug components in cell line-derived tumor xenografts. The collective response of these pathways to component drugs was both cell type- and drug type specific. However, the entire spectrum of pathways triggered by the tri-drug regimen was similar in all four cancer cell lines, explaining its broad spectrum killing of BCa lines, which did not occur with its component drugs. Our findings here suggest that the FSC platform holdspromise for optimization of anti-cancer combination chemotherapy.

  12. Auditory feedback of one’s own voice is used for high-level semantic monitoring: the self-comprehension hypothesis

    Directory of Open Access Journals (Sweden)

    Andreas eLind

    2014-03-01

    Full Text Available What would it be like if we said one thing, and heard ourselves saying something else? Would we notice something was wrong? Or would we believe we said the thing we heard? Is feedback of our own speech only used to detect errors, or does it also help to specify the meaning of what we say? Comparator models of self-monitoring favor the first alternative, and hold that our sense of agency is given by the comparison between intentions and outcomes, while inferential models argue that agency is a more fluent construct, dependent on contextual inferences about the most likely cause of an action. In this paper, we present a theory about the use of feedback during speech. Specifically, we discuss inferential models of speech production that question the standard comparator assumption that the meaning of our utterances is fully specified before articulation. We then argue that auditory feedback provides speakers with a channel for high-level, semantic self-comprehension. In support of this we discuss results using a method we recently developed called Real-time Speech Exchange (RSE. In our first study using RSE (Lind et al, submitted participants were fitted with headsets and performed a computerized Stroop task. We surreptitiously recorded words they said, and later in the test we played them back at the exact same time that the participants uttered something else, while blocking the actual feedback of their voice. Thus, participants said one thing, but heard themselves saying something else. The results showed that when timing conditions were ideal, more than two thirds of the manipulations went undetected. Crucially, in a large proportion of the non-detected manipulated trials, the inserted words were experienced as self-produced by the participants. This indicates that our sense of agency for speech has a strong inferential component, and that auditory feedback of our own voice acts as a pathway for semantic monitoring.

  13. Therapeutic drug monitoring of infliximab : performance evaluation of three commercial ELISA kits

    NARCIS (Netherlands)

    Schmitz, E.M.H.; van de Kerkhof, D.; Hamann, D.; van Dongen, J.L.J.; Kuijper, P.H.M.; Brunsveld, L.; Scharnhorst, V.; Broeren, M.A.C.

    2016-01-01

    BACKGROUND: Therapeutic drug monitoring (TDM) of infliximab (IFX, Remicade®) can aid to optimize therapy efficacy. Many assays are available for this purpose. However, a reference standard is lacking. Therefore, we evaluated the analytical performance, agreement and clinically relevant differences

  14. Mass Spectrometry for Research and Application in Therapeutic Drug Monitoring or Clinical and Forensic Toxicology.

    Science.gov (United States)

    Maurer, Hans H

    2018-04-30

    This paper reviews current applications of various hyphenated low- and high-resolution mass spectrometry techniques in the field of therapeutic drug monitoring and clinical/forensic toxicology in both research and practice. They cover gas chromatography, liquid chromatography, matrix-assisted laser desorption ionization, or paper spray ionization coupled to quadrupole, ion trap, time-of-flight, or Orbitrap mass analyzers.

  15. Predicting the usefulness of therapeutic drug monitoring of mycophenolic acid: a computer simulation

    NARCIS (Netherlands)

    van Hest, Reinier; Mathot, Ron; Vulto, Arnold; Weimar, Willem; van Gelder, Teun

    2005-01-01

    The usefulness of therapeutic drug monitoring (TDM) of mycophenolate mofetil (MMF) was investigated with a computer simulation model. For a fixed-dose (FD) and a concentration-controlled (CC) MMF dosing regimen exposure to mycophenolic acid (MPA) was compared. A nonlinear mixed-effects model

  16. Can fluconazole concentrations in saliva be used for therapeutic drug monitoring?

    NARCIS (Netherlands)

    Koks, C. H.; Crommentuyn, K. M.; Hoetelmans, R. M.; Mathôt, R. A.; Beijnen, J. H.

    2001-01-01

    The saliva/plasma concentration ratio of fluconazole was investigated in 22 HIV-1-infected individuals with an oropharyngeal Candida infection to determine whether saliva fluconazole concentrations could provide useful information for therapeutic drug monitoring in this population. Steady-state

  17. Psychotropic Drug Use among College Students: Patterns of Use, Misuse, and Medical Monitoring

    Science.gov (United States)

    Oberleitner, Lindsay M. S.; Tzilos, Golfo K.; Zumberg, Kathryn M.; Grekin, Emily R.

    2011-01-01

    Objective: To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed. Participants: Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009.…

  18. Web-based cognitive behavioral relapse prevention program with tailored feedback for people with methamphetamine and other drug use problems: protocol for a multicenter randomized controlled trial in Japan.

    Science.gov (United States)

    Takano, Ayumi; Miyamoto, Yuki; Kawakami, Norito; Matsumoto, Toshihiko; Shinozaki, Tomohiro; Sugimoto, Takashi

    2016-04-04

    Despite the effectiveness of psychosocial programs for recovery from drug use problems, there have been challenges in implementation of treatment. Internet-based and computerized approaches have been known to be effective in treatment dissemination. The study purpose is to assess the effects of a web-based psychosocial relapse prevention program with a multicenter randomized controlled trial. Recruitment began in January 2015 for outpatient participants diagnosed with drug abuse or dependence who have used a primary abused drug in the past year at psychiatric hospitals and a clinic. Participants are randomized either to a web-based relapse prevention program or a self-monitoring group. The intervention is a web-based relapse prevention program named "e-SMARPP" that consists of six relapse prevention program modules with tailored feedback from health care professionals and 8 weeks of self-monitoring. The content is adapted from a face-to-face relapse prevention program which is based on cognitive behavioral therapy and motivational enhancement. The primary outcomes are relapse risk assessed by the Stimulant Relapse Risk Scale (baseline, 2-, 5- and 8-month) and the longest duration of consecutive abstinent days from primary abused drug during the intervention. Secondary outcomes will include motivation to change, self-efficacy for drug use and craving, abstinent days in the past 28 or 56 days, quality of life, sense of coherence, cost of substance use, medical cost, retention of treatment and use of self-help group. Completion, usability and satisfaction of the program will be also assessed to explore feasibility. This study protocol was approved by the Ethics Committee of The University of Tokyo and each recruiting hospital and clinic. To our knowledge, this study is the first clinical trial to assess the effects of a web-based therapeutic program for drug users in Japan. If successful, this program is a promising approach for drug user treatment in Japan, where the

  19. Microdialysis Monitoring in Clinical Traumatic Brain Injury and Its Role in Neuroprotective Drug Development.

    Science.gov (United States)

    Thelin, Eric Peter; Carpenter, Keri L H; Hutchinson, Peter J; Helmy, Adel

    2017-03-01

    Injuries to the central nervous system continue to be vast contributors to morbidity and mortality; specifically, traumatic brain injury (TBI) is the most common cause of death during the first four decades of life. Several modalities are used to monitor patients suffering from TBI in order to prevent detrimental secondary injuries. The microdialysis (MD) technique, introduced during the 1990s, presents the treating physician with a robust monitoring tool for brain chemistry in addition to conventional intracranial pressure monitoring. Nevertheless, some limitations remain, such as limited spatial resolution. Moreover, while there have been several attempts to develop new potential pharmacological therapies in TBI, there are currently no available drugs which have shown clinical efficacy that targets the underlying pathophysiology, despite various trials investigating a plethora of pharmaceuticals. Specifically in the brain, MD is able to demonstrate penetration of the drug through the blood-brain barrier into the brain extracellular space at potential site of action. In addition, the downstream effects of drug action can be monitored directly. In the future, clinical MD, together with other monitoring modalities, can identify specific pathological substrates which require tailored treatment strategies for patients suffering from TBI.

  20. Drug monitoring in child and adolescent psychiatry for improved efficacy and safety of psychopharmacotherapy

    Directory of Open Access Journals (Sweden)

    Fegert Jörg M

    2009-04-01

    Full Text Available Abstract Most psychotropic drugs used in the treatment of children and adolescents are applied "off label" with a direct risk of under- or overdosing and a delayed risk of long-term side effects. The selection of doses in paediatric psychiatric patients requires a consideration of pharmacokinetic parameters and the development of central nervous system, and warrants specific studies in children and adolescents. Because these are lacking for most of the psychotropic drugs applied in the Child and Adolescent and Psychiatry, therapeutic drug monitoring (TDM is a valid tool to optimise pharmacotherapy and to enable to adjust the dosage of drugs according to the characteristics of the individual patient. Multi-centre TDM studies enable the identification of age- and development-dependent therapeutic ranges of blood concentrations and facilitate a highly qualified standardized documentation in the child and adolescent health care system. In addition, they will provide data for future research on psychopharmacological treatment in children and adolescents, as a baseline for example for clinically relevant interactions with various co-medications. Therefore, a German-Austrian-Swiss "Competence Network on Therapeutic Drug Monitoring in Child and Adolescent Psychiatry" was founded 1 introducing a comprehensive internet data base for the collection of demographic, safety and efficacy data as well as blood concentrations of psychotropic drugs in children and adolescents.

  1. Therapeutic drug monitoring of isoniazid and rifampicin during anti-tuberculosis treatment in Auckland, New Zealand.

    Science.gov (United States)

    Maze, M J; Paynter, J; Chiu, W; Hu, R; Nisbet, M; Lewis, C

    2016-07-01

    There is uncertainty as to the optimal therapeutic concentrations of anti-tuberculosis drugs to achieve cure. To characterise the use of therapeutic drug monitoring (TDM), and identify risk factors and outcomes for those with concentrations below the drug interval. Patients treated for tuberculosis (TB) who had rifampicin (RMP) or isoniazid (INH) concentrations measured between 1 January 2005 and 31 December 2012 were studied retrospectively. Matched concentrations and drug dosing time were assessed according to contemporary regional drug intervals (RMP > 6 μmol/l, INH > 7.5 μmol/l) and current international recommendations (RMP > 10 μmol/l, INH > 22 μmol/l). Outcomes were assessed using World Health Organization criteria. Of 865 patients, 121 had concentrations of either or both medications. RMP concentrations were within the regional drug intervals in 106/114 (93%) and INH in 91/100 (91%). Concentrations were within international drug intervals for RMP in 76/114 (67%) and INH in 53/100 (53%). Low weight-based dose was the only statistically significant risk factor for concentrations below the drug interval. Of the 35 patients with low concentrations, 21 were cured, 9 completed treatment and 5 transferred out. There were no relapses during follow-up (mean 66.5 months). There were no clinically useful characteristics to guide use of TDM. Many patients had concentrations below international therapeutic intervals, but were successfully treated.

  2. A Novel Chronic Opioid Monitoring Tool to Assess Prescription Drug Steady State Levels in Oral Fluid.

    Science.gov (United States)

    Shaparin, Naum; Mehta, Neel; Kunkel, Frank; Stripp, Richard; Borg, Damon; Kolb, Elizabeth

    2017-11-01

    Interpretation limitations of urine drug testing and the invasiveness of blood toxicology have motivated the desire for the development of simpler methods to assess biologically active drug levels on an individualized patient basis. Oral fluid is a matrix well-suited for the challenge because collections are based on simple noninvasive procedures and drug concentrations better correlate to blood drug levels as oral fluid is a filtrate of the blood. Well-established pharmacokinetic models were utilized to generate oral fluid steady state concentration ranges to assess the interpretive value of the alternative matrix to monitor steady state plasma oxycodone levels. Paired oral fluid and plasma samples were collected from patients chronically prescribed oxycodone and quantitatively analyzed by liquid chromatography tandem mass spectrometry. Steady state plasma concentration ranges were calculated for each donor and converted to an equivalent range in oral fluid. Measured plasma and oral fluid oxycodone concentrations were compared with respective matrix-matched steady state ranges, using each plasma steady state classification as the control. A high degree of correlation was observed between matrices when classifying donors according to expected steady state oxycodone concentration. Agreement between plasma and oral fluid steady state classifications was observed in 75.6% of paired samples. This study supports novel application of basic pharmacokinetic knowledge to the pain management industry, simplifying and improving individualized drug monitoring and risk assessment through the use of oral fluid drug testing. Many benefits of established therapeutic drug monitoring in plasma can be realized in oral fluid for patients chronically prescribed oxycodone at steady state. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Dried blood spot analysis for therapeutic drug monitoring of linezolid in patients with multidrug-resistant tuberculosis

    NARCIS (Netherlands)

    Vu, D H; Bolhuis, M S; Koster, R A; Greijdanus, B; de Lange, W C M; van Altena, R; Brouwers, J R B J; Uges, D R A; Alffenaar, J W C

    2012-01-01

    Linezolid is a promising antimicrobial agent for the treatment of multidrug-resistant tuberculosis (MDR-TB), but its use is limited by toxicity. Therapeutic drug monitoring (TDM) may help to minimize toxicity while adequate drug exposure is maintained. Conventional plasma sampling and monitoring

  4. Rule Based Expert System for Monitoring Real Time Drug Supply in Hospital Using Radio Frequency Identification Technology

    Science.gov (United States)

    Driandanu, Galih; Surarso, Bayu; Suryono

    2018-02-01

    A radio frequency identification (RFID) has obtained increasing attention with the emergence of various applications. This study aims to examine the implementation of rule based expert system supported by RFID technology into a monitoring information system of drug supply in a hospital. This research facilitates in monitoring the real time drug supply by using data sample from the hospital pharmacy. This system able to identify and count the number of drug and provide warning and report in real time. the conclusion is the rule based expert system and RFID technology can facilitate the performance in monitoring the drug supply quickly and precisely.

  5. Enhancement of Self-Monitoring in a Web-Based Weight Loss Program by Extra Individualized Feedback and Reminders: Randomized Trial.

    Science.gov (United States)

    Hutchesson, Melinda Jane; Tan, Chor Yin; Morgan, Philip; Callister, Robin; Collins, Clare

    2016-04-12

    Self-monitoring is an essential behavioral strategy for effective weight loss programs. Traditionally, self-monitoring has been achieved using paper-based records. However, technology is now more frequently used to deliver treatment programs to overweight and obese adults. Information technologies, such as the Internet and mobile phones, allow innovative intervention features to be incorporated into treatment that may facilitate greater adherence to self-monitoring processes, provide motivation for behavior change, and ultimately lead to greater weight loss success. The objective of our study was to determine whether the consistency of self-monitoring differed between participants randomly assigned to a basic or an enhanced 12-week commercial Web-based weight loss program. We randomly assigned a sample of 301 adults (mean age 42.3 years; body mass index 31.3 kg/m2; female 176/301, 58.5%) to the basic or enhanced group. The basic program included tools for self-monitoring (online food and exercise diary, and a weekly weigh-in log) with some feedback and reminders to weigh in (by text or email). The enhanced program included the basic components, as well as extra individualized feedback on self-monitoring entries and reminders (by text, email, or telephone) to engage with self-monitoring tools. We evaluated the level of self-monitoring by examining the consistency of self-monitoring of food, exercise, and weight during the 12 weeks. Consistency was defined as the number of weeks during which participants completed a criterion number of entries (ie, ≥3 days of online food or exercise diary records per week and ≥1 weigh-in per week). The enhanced group's consistency of use of self-monitoring tools was significantly greater than that of the basic group throughout the 12 weeks (median consistency for food 8 vs 3 weeks, respectively, Pself-monitoring behaviors in a Web-based weight loss program. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN

  6. Building a structured monitoring and evaluating system of postmarketing drug use in Shanghai.

    Science.gov (United States)

    Du, Wenmin; Levine, Mitchell; Wang, Longxing; Zhang, Yaohua; Yi, Chengdong; Wang, Hongmin; Wang, Xiaoyu; Xie, Hongjuan; Xu, Jianglong; Jin, Huilin; Wang, Tongchun; Huang, Gan; Wu, Ye

    2007-01-01

    In order to understand a drug's full profile in the post-marketing environment, information is needed regarding utilization patterns, beneficial effects, ADRs and economic value. China, the most populated country in the world, has the largest number of people who are taking medications. To begin to appreciate the impact of these medications, a multifunctional evaluation and surveillance system was developed, the Shanghai Drug Monitoring and Evaluative System (SDMES). Set up by the Shanghai Center for Adverse Drug Reaction Monitoring in 2001, the SDMES contains three databases: a population health data base of middle aged and elderly persons; hospital patient medical records; and a spontaneous ADR reporting database. Each person has a unique identification and Medicare number, which permits record-linkage within and between these three databases. After more than three years in development, the population health database has comprehensive data for more than 320,000 residents. The hospital database has two years of inpatient medical records from five major hospitals, and will be increasing to 10 hospitals in 2007. The spontaneous reporting ADR database has collected 20,205 cases since 2001 from approximately 295 sources, including hospitals, pharmaceutical companies, drug wholesalers and pharmacies. The SDMES has the potential to become an important national and international pharmacoepidemiology resource for drug evaluation.

  7. Isothermal microcalorimetry, a new tool to monitor drug action against Trypanosoma brucei and Plasmodium falciparum.

    Directory of Open Access Journals (Sweden)

    Tanja Wenzler

    Full Text Available Isothermal microcalorimetry is an established tool to measure heat flow of physical, chemical or biological processes. The metabolism of viable cells produces heat, and if sufficient cells are present, their heat production can be assessed by this method. In this study, we investigated the heat flow of two medically important protozoans, Trypanosoma brucei rhodesiense and Plasmodium falciparum. Heat flow signals obtained for these pathogens allowed us to monitor parasite growth on a real-time basis as the signals correlated with the number of viable cells. To showcase the potential of microcalorimetry for measuring drug action on pathogenic organisms, we tested the method with three antitrypanosomal drugs, melarsoprol, suramin and pentamidine and three antiplasmodial drugs, chloroquine, artemether and dihydroartemisinin, each at two concentrations on the respective parasite. With the real time measurement, inhibition was observed immediately by a reduced heat flow compared to that in untreated control samples. The onset of drug action, the degree of inhibition and the time to death of the parasite culture could conveniently be monitored over several days. Microcalorimetry is a valuable element to be added to the toolbox for drug discovery for protozoal diseases such as human African trypanosomiasis and malaria. The method could probably be adapted to other protozoan parasites, especially those growing extracellularly.

  8. Analysis of abused drugs by selected ion monitoring: quantitative comparison of electron impact and chemical ionization

    International Nuclear Information System (INIS)

    Foltz, R.L.; Knowlton, D.A.; Lin, D.C.K.; Fentiman, A.F. Jr.

    1975-01-01

    A comparison was made of the relative sensitivities of electron impact and chemical ionization when used for selected ion monitoring analysis of commonly abused drugs. For most of the drugs examined chemical ionization using ammonia as the reactant gas gave the largest single m/e ion current response per unit weight of sample. However, if maximum sensitivity is desired it is important to evaluate electron impact and chemical ionization with respect to both maximum response and degree of interference from background and endogenous materials

  9. Fast and Highly Selective LC-MS/MS Screening for THC and 16 Other Abused Drugs and Metabolites in Human Hair to Monitor Patients for Drug Abuse

    NARCIS (Netherlands)

    Koster, Remco A.; Alffenaar, Jan-Willem C.; Greijdanus, Ben; VanDerNagel, Joanneke E. L.; Uges, Donald R. A.

    Background:To facilitate the monitoring of drug abuse by patients, a method was developed and validated for the analysis of amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, methylenedioxyamphetamine, methylenedioxyethylamphetamine, methylphenidate, cocaine, benzoylecgonine, morphine,

  10. Optical drug monitoring: photoacoustic imaging of nanosensors to monitor therapeutic lithium in vivo.

    Science.gov (United States)

    Cash, Kevin J; Li, Chiye; Xia, Jun; Wang, Lihong V; Clark, Heather A

    2015-02-24

    Personalized medicine could revolutionize how primary care physicians treat chronic disease and how researchers study fundamental biological questions. To realize this goal, we need to develop more robust, modular tools and imaging approaches for in vivo monitoring of analytes. In this report, we demonstrate that synthetic nanosensors can measure physiologic parameters with photoacoustic contrast, and we apply that platform to continuously track lithium levels in vivo. Photoacoustic imaging achieves imaging depths that are unattainable with fluorescence or multiphoton microscopy. We validated the photoacoustic results that illustrate the superior imaging depth and quality of photoacoustic imaging with optical measurements. This powerful combination of techniques will unlock the ability to measure analyte changes in deep tissue and will open up photoacoustic imaging as a diagnostic tool for continuous physiological tracking of a wide range of analytes.

  11. Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse

    Science.gov (United States)

    Zuccato, Ettore; Chiabrando, Chiara; Castiglioni, Sara; Calamari, Davide; Bagnati, Renzo; Schiarea, Silvia; Fanelli, Roberto

    2005-01-01

    Background Cocaine use seems to be increasing in some urban areas worldwide, but it is not straightforward to determine the real extent of this phenomenon. Trends in drug abuse are currently estimated indirectly, mainly by large-scale social, medical, and crime statistics that may be biased or too generic. We thus tested a more direct approach based on 'field' evidence of cocaine use by the general population. Methods Cocaine and its main urinary metabolite (benzoylecgonine, BE) were measured by mass spectrometry in water samples collected from the River Po and urban waste water treatment plants of medium-size Italian cities. Drug concentration, water flow rate, and population at each site were used to estimate local cocaine consumption. Results We showed that cocaine and BE are present, and measurable, in surface waters of populated areas. The largest Italian river, the Po, with a five-million people catchment basin, steadily carried the equivalent of about 4 kg cocaine per day. This would imply an average daily use of at least 27 ± 5 doses (100 mg each) for every 1000 young adults, an estimate that greatly exceeds official national figures. Data from waste water treatment plants serving medium-size Italian cities were consistent with this figure. Conclusion This paper shows for the first time that an illicit drug, cocaine, is present in the aquatic environment, namely untreated urban waste water and a major river. We used environmental cocaine levels for estimating collective consumption of the drug, an approach with the unique potential ability to monitor local drug abuse trends in real time, while preserving the anonymity of individuals. The method tested here – in principle extendable to other drugs of abuse – might be further refined to become a standardized, objective tool for monitoring drug abuse. PMID:16083497

  12. Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse

    Directory of Open Access Journals (Sweden)

    Bagnati Renzo

    2005-08-01

    Full Text Available Abstract Background Cocaine use seems to be increasing in some urban areas worldwide, but it is not straightforward to determine the real extent of this phenomenon. Trends in drug abuse are currently estimated indirectly, mainly by large-scale social, medical, and crime statistics that may be biased or too generic. We thus tested a more direct approach based on 'field' evidence of cocaine use by the general population. Methods Cocaine and its main urinary metabolite (benzoylecgonine, BE were measured by mass spectrometry in water samples collected from the River Po and urban waste water treatment plants of medium-size Italian cities. Drug concentration, water flow rate, and population at each site were used to estimate local cocaine consumption. Results We showed that cocaine and BE are present, and measurable, in surface waters of populated areas. The largest Italian river, the Po, with a five-million people catchment basin, steadily carried the equivalent of about 4 kg cocaine per day. This would imply an average daily use of at least 27 ± 5 doses (100 mg each for every 1000 young adults, an estimate that greatly exceeds official national figures. Data from waste water treatment plants serving medium-size Italian cities were consistent with this figure. Conclusion This paper shows for the first time that an illicit drug, cocaine, is present in the aquatic environment, namely untreated urban waste water and a major river. We used environmental cocaine levels for estimating collective consumption of the drug, an approach with the unique potential ability to monitor local drug abuse trends in real time, while preserving the anonymity of individuals. The method tested here – in principle extendable to other drugs of abuse – might be further refined to become a standardized, objective tool for monitoring drug abuse.

  13. MONITORING POTENTIAL DRUG INTERACTIONS AND REACTIONS VIA NETWORK ANALYSIS OF INSTAGRAM USER TIMELINES.

    Science.gov (United States)

    Correia, Rion Brattig; Li, Lang; Rocha, Luis M

    2016-01-01

    Much recent research aims to identify evidence for Drug-Drug Interactions (DDI) and Adverse Drug reactions (ADR) from the biomedical scientific literature. In addition to this "Bibliome", the universe of social media provides a very promising source of large-scale data that can help identify DDI and ADR in ways that have not been hitherto possible. Given the large number of users, analysis of social media data may be useful to identify under-reported, population-level pathology associated with DDI, thus further contributing to improvements in population health. Moreover, tapping into this data allows us to infer drug interactions with natural products-including cannabis-which constitute an array of DDI very poorly explored by biomedical research thus far. Our goal is to determine the potential of Instagram for public health monitoring and surveillance for DDI, ADR, and behavioral pathology at large. Most social media analysis focuses on Twitter and Facebook, but Instagram is an increasingly important platform, especially among teens, with unrestricted access of public posts, high availability of posts with geolocation coordinates, and images to supplement textual analysis. Using drug, symptom, and natural product dictionaries for identification of the various types of DDI and ADR evidence, we have collected close to 7000 user timelines spanning from October 2010 to June 2015.We report on 1) the development of a monitoring tool to easily observe user-level timelines associated with drug and symptom terms of interest, and 2) population-level behavior via the analysis of co-occurrence networks computed from user timelines at three different scales: monthly, weekly, and daily occurrences. Analysis of these networks further reveals 3) drug and symptom direct and indirect associations with greater support in user timelines, as well as 4) clusters of symptoms and drugs revealed by the collective behavior of the observed population. This demonstrates that Instagram

  14. MONITORING POTENTIAL DRUG INTERACTIONS AND REACTIONS VIA NETWORK ANALYSIS OF INSTAGRAM USER TIMELINES

    Science.gov (United States)

    CORREIA, RION BRATTIG; LI, LANG; ROCHA, LUIS M.

    2015-01-01

    Much recent research aims to identify evidence for Drug-Drug Interactions (DDI) and Adverse Drug reactions (ADR) from the biomedical scientific literature. In addition to this “Bibliome”, the universe of social media provides a very promising source of large-scale data that can help identify DDI and ADR in ways that have not been hitherto possible. Given the large number of users, analysis of social media data may be useful to identify under-reported, population-level pathology associated with DDI, thus further contributing to improvements in population health. Moreover, tapping into this data allows us to infer drug interactions with natural products—including cannabis—which constitute an array of DDI very poorly explored by biomedical research thus far. Our goal is to determine the potential of Instagram for public health monitoring and surveillance for DDI, ADR, and behavioral pathology at large. Most social media analysis focuses on Twitter and Facebook, but Instagram is an increasingly important platform, especially among teens, with unrestricted access of public posts, high availability of posts with geolocation coordinates, and images to supplement textual analysis. Using drug, symptom, and natural product dictionaries for identification of the various types of DDI and ADR evidence, we have collected close to 7000 user timelines spanning from October 2010 to June 2015. We report on 1) the development of a monitoring tool to easily observe user-level timelines associated with drug and symptom terms of interest, and 2) population-level behavior via the analysis of co-occurrence networks computed from user timelines at three different scales: monthly, weekly, and daily occurrences. Analysis of these networks further reveals 3) drug and symptom direct and indirect associations with greater support in user timelines, as well as 4) clusters of symptoms and drugs revealed by the collective behavior of the observed population. This demonstrates that

  15. Business Activity Monitoring: Real-Time Group Goals and Feedback Using an Overhead Scoreboard in a Distribution Center

    Science.gov (United States)

    Goomas, David T.; Smith, Stuart M.; Ludwig, Timothy D.

    2011-01-01

    Companies operating large industrial settings often find delivering timely and accurate feedback to employees to be one of the toughest challenges they face in implementing performance management programs. In this report, an overhead scoreboard at a retailer's distribution center informed teams of order selectors as to how many tasks were…

  16. A Critical Commentary on the 2017 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology.

    Science.gov (United States)

    de Leon, Jose

    2018-01-01

    In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology. The writer hopes the time is right for a TDM guideline in psychiatry, which is indicated for: 1) psychiatric researchers ready to value how TDM can contribute to moving psychopharmacology forward, 2) flexible clinicians ready to improve their patient care by personalizing dosing, and 3) today's psychiatry residents prepared as a new generation ready to be trained in TDM and willing to continue incorporating TDM as new psychiatric drugs are marketed. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Integrated hollow microneedle-optofluidic biosensor for therapeutic drug monitoring in sub-nanoliter volumes

    Science.gov (United States)

    Ranamukhaarachchi, Sahan A.; Padeste, Celestino; Dübner, Matthias; Häfeli, Urs O.; Stoeber, Boris; Cadarso, Victor J.

    2016-07-01

    Therapeutic drug monitoring (TDM) typically requires painful blood drawn from patients. We propose a painless and minimally-invasive alternative for TDM using hollow microneedles suitable to extract extremely small volumes (microneedle is functionalized to be used as a micro-reactor during sample collection to trap and bind target drug candidates during extraction, without requirements of sample transfer. An optofluidic device is integrated with this microneedle to rapidly quantify drug analytes with high sensitivity using a straightforward absorbance scheme. Vancomycin is currently detected by using volumes ranging between 50-100 μL with a limit of detection (LoD) of 1.35 μM. The proposed microneedle-optofluidic biosensor can detect vancomycin with a sample volume of 0.6 nL and a LoD of <100 nM, validating this painless point of care system with significant potential to reduce healthcare costs and patients suffering.

  18. Drug-induced cellular death dynamics monitored by a highly sensitive organic electrochemical system.

    Science.gov (United States)

    Romeo, Agostino; Tarabella, Giuseppe; D'Angelo, Pasquale; Caffarra, Cristina; Cretella, Daniele; Alfieri, Roberta; Petronini, Pier Giorgio; Iannotta, Salvatore

    2015-06-15

    We propose and demonstrate a sensitive diagnostic device based on an Organic Electrochemical Transistor (OECT) for direct in-vitro monitoring cell death. The system efficiently monitors cell death dynamics, being able to detect signals related to specific death mechanisms, namely necrosis or early/late apoptosis, demonstrating a reproducible correlation between the OECT electrical response and the trends of standard cell death assays. The innovative design of the Twell-OECT system has been modeled to better correlate electrical signals with cell death dynamics. To qualify the device, we used a human lung adenocarcinoma cell line (A549) that was cultivated on the micro-porous membrane of a Transwell (Twell) support, and exposed to the anticancer drug doxorubicin. Time-dependent and dose-dependent dynamics of A549 cells exposed to doxorubicin are evaluated by monitoring cell death upon exposure to a range of doses and times that fully covers the protocols used in cancer treatment. The demonstrated ability to directly monitor cell stress and death dynamics upon drug exposure using simple electronic devices and, possibly, achieving selectivity to different cell dynamics is of great interest for several application fields, including toxicology, pharmacology, and therapeutics. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care: a user-centered design.

    Science.gov (United States)

    van der Weegen, Sanne; Verwey, Renée; Spreeuwenberg, Marieke; Tange, Huibert; van der Weijden, Trudy; de Witte, Luc

    2013-07-02

    Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. This study

  20. Drug persistence and need for dose intensification to adalimumab therapy; the importance of therapeutic drug monitoring in inflammatory bowel diseases.

    Science.gov (United States)

    Gonczi, Lorant; Kurti, Zsuzsanna; Rutka, Mariann; Vegh, Zsuzsanna; Farkas, Klaudia; Lovasz, Barbara D; Golovics, Petra A; Gecse, Krisztina B; Szalay, Balazs; Molnar, Tamas; Lakatos, Peter L

    2017-08-08

    Therapeutic drug monitoring (TDM) aid therapeutic decision making in patients with inflammatory bowel disease (IBD) who lose response to anti-TNF therapy. Our aim was to evaluate the frequency and predictive factors of loss of response (LOR) to adalimumab using TDM in IBD patients. One hundred twelve IBD patients (with 214 TDM measurements, CD/UC 84/28, male/female 50/62, mean age CD/UC: 36/35 years) were enrolled in this consecutive cohort from two referral centres in Hungary. Demographic data were comprehensively collected and harmonized monitoring strategy was applied. Previous and current therapy, laboratory data and clinical activity were recorded at the time of TDM. Patients were evaluated either at the time of suspected LOR or during follow-up. TDM measurements were determined by commercial ELISA (LISA TRACKER, Theradiag, France). Among 112 IBD patients, LOR/drug persistence was 25.9%/74.1%. The cumulative ADA positivity (>10 ng/mL) and low TL (<5.0 μg/mL) was 12.1% and 17.8% after 1 year and 17.3% and 29.5% after 2 years of adalimumab therapy. Dose intensification was needed in 29.5% of the patients. Female gender and ADA positivity were associated with LOR (female gender: p < 0.001, OR:7.8 CI 95%: 2.5-24.3, ADA positivity: p = 0.007 OR:3.6 CI 95%: 1.4-9.5). ADA development, low TL and need for dose intensification were frequent during adalimumab therapy and support the selective use of TDM in IBD patients treated with adalimumab. ADA positivity and gender were predictors of LOR.

  1. Analysis of veterinary drug residue monitoring results for commercial livestock products in Taiwan between 2011 and 2015

    Directory of Open Access Journals (Sweden)

    Hsin-Chun Lee

    2018-04-01

    Full Text Available Antibiotics have been widely used in the treatment of livestock diseases. However, the emergence of issues related to drug resistance prompted governments to enact a series of laws regulating the use of antibiotics in livestock. Following control of the problem of drug resistant bacteria, public attention has shifted to the recurring incidence of human health and safety issues caused by residual veterinary drugs in livestock products. To guarantee the safety and hygiene of meat, milk, and eggs from food-producing animals, governments and relevant agencies established laws and regulations for the use of veterinary drugs. It is, therefore, necessary to monitor the content of residual drugs in livestock products at regular intervals to assess whether the regulations have resulted in the effective management of food product safety, and to prevent and manage sudden problems related to this issue. A 2011–2015 livestock product post-marketing monitoring program launched by the Taiwan Food and Drug Administration (TFDA inspected 1487 livestock products. Over the past 5 years, there were 34 samples identified that did not conform to the regulations; these samples included residue drugs such as β-agonists, chloramphenicols, β-lactam antibiotics, sulfa drugs, enrofloxacin, and lincomycin. Inspections of commercial livestock products with the consistent cooperation of agricultural authorities did not detect the drugs that were banned by the government, whereas the detection of other drugs decreased annually with an increase in the post-market monitoring sample size. In the future, the TFDA will continue to monitor the status of residual veterinary drugs in commercial livestock products, adjust the sampling of food products annually according to monitoring results, and closely cooperate with agricultural authorities on source management. Keywords: Agricultural authorities, Livestock products, Post-market monitoring, Veterinary drug residues

  2. Possible roles for frequent salivary antiepileptic drug monitoring in the management of epilepsy.

    Science.gov (United States)

    Herkes, G K; Eadie, M J

    1990-07-01

    Salivary levels of phenytoin, phenobarbitone, carbamazepine and carbamazepine-epoxide correlate with the simultaneous plasma water levels of these substances, after correcting for the effects of pH differences between saliva and plasma in the case of phenobarbitone. Saliva is easy and painless to collect, and salivary levels of the drugs are conveniently measured. Frequent (often daily) monitoring of pre-dose morning anticonvulsant drug concentrations in saliva over periods of weeks or months in 3 groups of epileptic subjects showed that (i) in some but not all poorly controlled epileptic patients seizures tended to occur on days when salivary anticonvulsant levels were lower than on non-seizure days, (ii) in such subjects it was possible to estimate an anticipated optimal drug concentration and dose to minimize seizure activity from the plot of seizure frequency against drug concentrations, (iii) in women with 'catamenial' epilepsy, salivary anticonvulsant levels were lower on perimenstrual days than at mid-cycle in half of the subjects studied, and (iv) in pregnant epileptic women the time course of the change in drug levels relative to dose could be followed more closely throughout pregnancy and the post-natal period than was practicable when using blood level measurements. Frequent measurement of salivary anticonvulsant concentrations appears a promising and inexpensive adjunct to the investigation and management of certain problem areas in epilepsy.

  3. Oral Fluid vs. Urine Analysis to Monitor Synthetic Cannabinoids and Classic Drugs Recent Exposure.

    Science.gov (United States)

    Blandino, Vincent; Wetzel, Jillian; Kim, Jiyoung; Haxhi, Petrit; Curtis, Richard; Concheiro, Marta

    2017-01-01

    Urine is a common biological sample to monitor recent drug exposure, and oral fluid is an alternative matrix of increasing interest in clinical and forensic toxicology. Limited data are available about oral fluid vs. urine drug disposition, especially for synthetic cannabinoids. To compare urine and oral fluid as biological matrices to monitor recent drug exposure among HIV-infected homeless individuals. Seventy matched urine and oral fluid samples were collected from 13 participants. Cannabis, amphetamines, benzodiazepines, cocaine and opiates were analyzed in urine by the enzyme-multipliedimmunoassay- technique and in oral fluid by liquid chromatography tandem mass spectrometry (LCMSMS). Eleven synthetic cannabinoids were analyzed in urine and in oral fluid by LC-MSMS. Five oral fluid samples were positive for AB-FUBINACA. In urine, 4 samples tested positive for synthetic cannabinoids PB-22, 5-Fluoro-PB-22, AB-FUBINACA, and metabolites UR-144 5-pentanoic acid and UR-144 4-hydroxypentyl. In only one case, oral fluid and urine results matched, both specimens being AB-FUBINACA positive. For cannabis, 40 samples tested positive in urine and 30 in oral fluid (85.7% match). For cocaine, 37 urine and 52 oral fluid samples were positive (75.7% match). Twenty-four urine samples were positive for opiates, and 25 in oral fluid (81.4% match). For benzodiazepines, 23 samples were positive in urine and 25 in oral fluid (85.7% match). These results offer new information about drugs disposition between urine and oral fluid. Oral fluid is a good alternative matrix to urine for monitoring cannabis, cocaine, opiates and benzodiazepines recent use; however, synthetic cannabinoids showed mixed results. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. An audit of therapeutic drug monitoring services of anticonvulsants at a tertiary care hospital in India.

    Science.gov (United States)

    Taur, Santosh R; Kulkarni, Namrata B; Gogtay, Nithya J; Thatte, Urmila M

    2013-04-01

    Therapeutic drug monitoring (TDM) is an important adjunct to the treatment of epilepsy. However, few studies have actually correlated plasma levels of antiepileptic drugs (AEDs) with treatment response. The present audit aimed to study (i) the association between seizure control and number of AEDs, plasma AED concentration, and concomitant use of antitubercular drugs; (ii) the pattern of indications for TDM requisitions; and (iii) the association between referral for toxicity and plasma AED concentration. This observational and retrospective study was carried out to analyze the TDM data of patients referred between January 2008 and December 2011. As per the International League Against Epilepsy Task Force 2009, patients were categorized into responders and nonresponders. Plasma AED levels were interpreted as below, within, and above the reference range. Of 3206 TDM requisitions, 67% were monotherapy and 33% were 2 or more AEDs. Only 8% were responders as against 92% nonresponders. Of 95 patients on concomitant antituberculosis treatment, 72 were nonresponders, with odds ratio (95% confidence interval) 3.71 [2.19 to 6.23]. Breakthrough seizure (37%) was the most common indication followed by suspected toxicity and routine monitoring in 22% each and suspected nonadherence in 11% of the total requests. In 52% of patients, plasma levels were below the reference range, and they were equally distributed amongst responders and nonresponders. Among patients referred for suspected phenytoin toxicity, only 59% (50.6 to 67.8) had plasma concentrations above the reference range. TDM continues to remain an important tool to support dose individualization when the patient is receiving multiple AEDs or other drugs such as antitubercular medicines, to assess compliance, and to monitor and treat toxicity.

  5. Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.

    LENUS (Irish Health Repository)

    Egan, Sean

    2012-08-07

    BACKGROUND: Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. METHODS: A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. RESULTS: The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg\\/kg to 4.78 mg\\/kg\\/day. CONCLUSIONS: Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.

  6. Clinical outcomes of the inclusion of the therapeutic drug monitoring report in the electronic clinical record

    Directory of Open Access Journals (Sweden)

    Marina Sáez Belló

    2016-12-01

    Full Text Available Objectives: To assess the inclusion of the Therapeutic Drug Monitoring Report (TDMR in the Electronic Clinical Record (ECR. Method: An observational ambispective cohort study with a duration of 149 days: PRE (retrospective, 49 days with the TDMR printed in paper, and POST (prospective, 100 days with the TDMR included in the ECR. Exclusion criteria: Patients not hospitalized, applications for Therapeutic Drug Monitoring by Critical Care and Neonatal Units, as well as monitoring with an objective other than dose adjustment. Variables: Number of TDMRs prepared, number of patients admitted with TDMR, time of delay for treatment adjustment, defined as the number of adjustments made to the treatment within over or under 24 hours from the time of TDMR preparation, and medication errors (MEs associated with said delay, as well as the degree of acceptance of the TDMR. Results: 690 TDMRs were conducted in 391 patients, 339 in PRE (n = 206 and 351 in POST (n = 185. The number of treatment modifications made in under 24 hours increased from 73.9% in PRE to 87.3% in POST [RR = 1.2 (CI95% = 0.97-1.43. We identified 35 patients with ME, 9.7% of them in PRE and 8.1% in POST (RR = 0.84 (CI95% = 0.44-1.58]. The degree of acceptance of the pharmacist recommendation increased from 53.3% in PRE to 68.3% in POST [RR = 1.3 (CI95% = 1.02- 1.62]. Conclusions: The inclusion of the Therapeutic Drug Monitoring Report (TDMR in the Electronic Clinical Record increases the degree of acceptance of recommendations, and may reduce the delay in treatment modifications, reducing MEs and improving the process quality in terms of efficacy and safety

  7. Cutaneous adverse drug reactions in a tertiary care teaching hospital in India: An intensive monitoring study

    Directory of Open Access Journals (Sweden)

    Sejal Thakkar

    2017-01-01

    Full Text Available Background: The epidemiological data based on intensive monitoring studies are limited for the cutaneous adverse drug reactions (CADRs in terms of incidence. Most of earlier Indian studies focused only on types and causative drugs of CADRs. Aim: The aim of this study is to analyze the CADRs with reference to the incidence, its subgroup analysis, causative drugs, and other clinical characteristics in Indian population. Methodology: Intensive monitoring study was carried out over a period of 3 years in the dermatology outpatient and inpatient department. CADRs due to only systematically administered drugs were considered. The WHO definition for CADR, the WHO causality definitions, modified Schumock and Thornton's criteria for preventability, and International Conference on Harmonisation E2A guidelines for seriousness were considered. Incidence was expressed in percentage and its 95% confidence interval. The incidence was analyzed on basis of characteristics of study population and CADRs. Results: A total of 171 CADRs were observed from 37,623 patients. The CADR incidence was 0.45% (95% CI: 0.39–0.53. The incidence did not significantly differ in different age groups and gender. Commonly observed CADRs were maculopapular rash (23.98%, urticaria (21.64%, and fixed drug eruptions (FDEs (18.13%. Antimicrobials (35.18% and nonsteroidal anti-inflammatory drugs (NSAIDs were suspected in all common CADRs. Anti-infective and NSAIDs were most commonly suspected drugs in overall CADRs, maculopapular rash, urticaria, FDEs, and erythema multiforme. The exact nature of drugs remained inaccessible in one-fourth cases due to use of the over-the-counter self-medications. The incidence of preventable and serious and fatal CADRs was 0.08% (95% CI: 0.05–0.11, 0.04% (95% CI: 0.02–0.06, and 0.003% (95% CI: 0.000–0.001, respectively. Conclusion: Ethnic characteristics should be considered while interpreting incidence from the international studies. The

  8. Optical sensors for therapeutic drug monitoring of antidepressants for a better medication adjustment

    Science.gov (United States)

    Krieg, Anne K.; Hess, Stefan; Gauglitz, Günter

    2013-05-01

    Therapeutic drug monitoring provides the attending physicians with detailed information on a patient's individual serum level especially during long-term medication. Due to the fact that each patient tolerates drugs or their metabolites differently a medication adjustment can reduce the number and intensity of noticeable side-effects. In particular, psychotropic drugs can cause unpleasant side-effects that affect a patient's life almost as much as the mental disease itself. The tricyclic antidepressants amitriptyline is commonly used for treatment of depressions and was selected for the development of an immunoassay using the direct optical sensor technique Reflectometric Interference Spectroscopy (RIfS). RIfS is a simple, robust and label-free method for direct monitoring of binding events on glass surfaces. Binding to the surface causes a shift of the interference spectrum by a change of the refractive index or physical thickness. This technique can be used for time-resolved observation of association and dissociation of amitriptyline (antigen) and a specific antibody using the binding inhibition test format. An amitriptyline derivative is immobilized on the sensor surface and a specific amount of antibodies can bind to the surface unless the binding is inhibited by free amitriptyline in a sample. No fluorescent label is needed making the whole assay less expensive than label-based methods. With this recently developed immunoassay amitriptyline concentrations in buffer (PBS) can easily be detected down to 500 ng/L.

  9. Insufficient fluconazole exposure in pediatric cancer patients and the need for therapeutic drug monitoring in critically ill children

    NARCIS (Netherlands)

    van der Elst, Kim CM; Pereboom, Marieke; van den Heuvel, Edwin R; Kosterink, Jos G W; Scholvinck, Elisabeth H.; Alffenaar, Jan-Willem C

    2014-01-01

    Background. Fluconazole is recommended as first-line treatment in invasive candidiasis in children and infants. Although timely achievement of adequate exposure of fluconazole improves outcome, therapeutic drug monitoring is currently not recommended. Methods. We conducted a retrospective study of

  10. Optimizing urine drug testing for monitoring medication compliance in pain management.

    Science.gov (United States)

    Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D

    2013-12-01

    It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.

  11. Laboratory monitoring of patients treated with antihypertensive drugs and newly exposed to non steroidal anti-inflammatory drugs: a cohort study.

    Directory of Open Access Journals (Sweden)

    Jean-Pascal Fournier

    Full Text Available BACKGROUND: Drug-Drug Interactions between Non Steroidal Anti-Inflammatory Drugs (NSAIDs and Angiotensin Converting Enzyme Inhibitors (ACEIs, Angiotensin Receptor Blocker (ARBs or diuretics can lead to renal failure and hyperkalemia. Thus, monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs. METHODS: We conducted a pharmacoepidemiological retrospective cohort study using data from the French Health Insurance Reimbursement Database to evaluate the proportion of serum creatinine and potassium laboratory monitoring in patients treated with ACEI, ARB or diuretic and receiving a first dispensing of NSAID. We described the first dispensing of NSAID among 3,500 patients of a 4-year cohort (6,633 patients treated with antihypertensive drugs and analyzed serum creatinine and potassium laboratory monitoring within the 3 weeks after the first NSAID dispensing. RESULTS: General Practitioners were the most frequent prescribers of NSAIDs (85.5%, 95% CI: 84.3-86.6. The more commonly prescribed NSAIDs were ibuprofen (20%, ketoprofen (15%, diclofenac (15% and piroxicam (12%. Serum creatinine and potassium monitoring was 10.7% (95% CI: 9.5-11.8 in patients treated by ACEIs, ARBs or diuretics. Overall, monitoring was more frequently performed to women aged over 60, treated with digoxin or glucose lowering drugs, but not to patients treated with ACEIs, ARBs or diuretics. Monitoring was more frequent when NSAIDs' prescribers were cardiologists or anesthesiologists. CONCLUSION: Monitoring of serum creatinine and potassium of patients treated with ACEIs, ARBs or diuretics and receiving a first NSAID dispensing is insufficiently performed and needs to be reinforced through specific interventions.

  12. [Chemical analysis of wastewater as a new way of monitoring drugs and medicines consumption at workplace].

    Science.gov (United States)

    Wiergowski, Marek; Sołtyszewski, Ireneusz; Sein Anand, Jacek

    2015-01-01

    The available information on the quality and frequency of illegal psychoactive substances used or medicines misused by workers, are often out of date at the time of its publication. This is due to the dynamic introduction of new synthetic drugs on the black market, changes in trends in the recreational use of medicines and the lack of readily available and reliable tests for fast identification. Strategy for detection of narcotic and non-medical psychoactive drugs use at workplace should embrace all possible sources of information. Classical sources of information on the use of psychoactive substances at the workplace include: statistical data (general information on trends and magnitude of drug and medicine addiction collected by the Polish National Police, the National Bureau for Drug Prevention and emergency medical services), surveys, psychomotor tests and qualitative and quantitative analyses of biological material. Of the new and promising methods, used throughout the world in recent years, chemical-toxicological analysis of surface water and wastewater deserve special mention. An increasing interest in the study of urban waste water can significantly complement the source of knowledge about drug and medicine addiction using obtainable conventional methods. In recent years, a municipal wastewater analysis has become a new and very promising way of collecting updated information on the use of psychoactive substances and medicines. It seems that this kind of study may play an important role in the ongoing monitoring of drug and/or medicines use by selected groups of population (e.g., students, military, firemen, policemen, etc.). This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  13. Chemical analysis of wastewater as a new way of monitoring drugs and medicines consumption at workplace

    Directory of Open Access Journals (Sweden)

    Marek Wiergowski

    2015-12-01

    Full Text Available The available information on the quality and frequency of illegal psychoactive substances used or medicines misused by workers, are often out of date at the time of its publication. This is due to the dynamic introduction of new synthetic drugs on the black market, changes in trends in the recreational use of medicines and the lack of readily available and reliable tests for fast identification. Strategy for detection of narcotic and non-medical psychoactive drugs use at workplace should embrace all possible sources of information. Classical sources of information on the use of psychoactive substances at the workplace include: statistical data (general information on trends and magnitude of drug and medicine addiction collected by the Polish National Police, the National Bureau for Drug Prevention and emergency medical services, surveys, psychomotor tests and qualitative and quantitative analyses of biological material. Of the new and promising methods, used throughout the world in recent years, chemical-toxicological analysis of surface water and wastewater deserve special mention. An increasing interest in the study of urban waste water can significantly complement the source of knowledge about drug and medicine addiction using obtainable conventional methods. In recent years, a municipal wastewater analysis has become a new and very promising way of collecting updated information on the use of psychoactive substances and medicines. It seems that this kind of study may play an important role in the ongoing monitoring of drug and/or medicines use by selected groups of population (e.g., students, military, firemen, policemen, etc.. Med Pr 2015;66(6:837–847

  14. The investigation of specific biochemical markers in monitoring kidney function of drug addicts.

    Science.gov (United States)

    Gąsiorowski, Jacek; Marchewka, Zofia; Łapiński, Łukasz; Szymańska, Beata; Głowacka, Krystyna; Knysz, Brygida; Długosz, Anna; Wiela-Hojeńska, Anna

    2013-12-05

    An increasingly important issue in the Polish population is drug abuse. It leads to extensive damage of parenchymal organs, including kidney. Establishing early markers of organ damage and their monitoring during rehabilitation therapy is therefore of pivotal importance. This study evaluated the utility of highly specific and selective markers (NGAL, IL-18, a and π-GST isoenzyme, and ß2-M). The influence of opioid drugs and other factors on kidney function (HIV and HCV infections, duration and the kind of drugs abused) was determined. Urine collected from 83 subjects who abused drugs and 33 healthy volunteers was tested with ELISA using specific antibodies (IBL, Biotron, Bioporto-Diagnostics). HIV infection was confirmed with western-blotting and HCV with PCR. CD4 lymphocytes were quantified with flow cytometry. RFLP and PCR were used to determine the viral load of HIV and HCV (genotype). A significant increase of IL-18, NGAL and β2M activity in heroin addicts compared to the control group was noted as well as the influence of HIV infection on NGAL and β2M excretion. A statistically significant (p=0.04) correlation between the viral load and IL-18 concentration was noted while no significant influence of the duration and the kind of drugs abused, the route of intake or the age of addicts was seen. Only the NGAL concentration was sex dependent and significantly higher in women. This study showed the specific, clinical utility of IL-18, NGAL, and β2M in the evaluation of renal function in drug addicts. Early detection of nephropathy with biochemical indicators might help prevent severe conditions that require hospitalization and intensive care.

  15. Use of a Computerized Tracking System to Monitor and Provide Feedback on Dietary Goals for Calorie-Restricted Diets: The POUNDS LOST Study

    Science.gov (United States)

    Anton, Stephen D.; LeBlanc, Eric; Allen, H. Raymond; Karabetian, Christy; Sacks, Frank; Bray, George; Williamson, Donald A.

    2012-01-01

    The use of self-monitoring as a tool to facilitate behavioral modification is common in many lifestyle-based weight loss interventions. Electronic tracking programs, including computer-based systems and smart phone applications, have been developed to allow individuals to self-monitor their behavior digitally. These programs offer an advantage over traditional self-report modalities in that they can provide users with direct feedback about dietary and/or physical activity adherence levels and thereby assist them in real-time decision making. This article describes the use of an Internet-based computerized tracking system (CTS) that was developed specifically for the POUNDS LOST study, a 2-year randomized controlled trial designed to test the efficacy of four macronutrient diets for weight and fat reduction in healthy, overweight men and women (body mass index range = 25.0–39.9 kg/m2). The CTS served many functions in this study, including data collection, dietary and exercise assessment and feedback, messaging system, and report generation. Across all groups, participants with high usage of the CTS during the initial 8 weeks lost greater amounts of weight than participants with low usage (8.7% versus 5.5% of initial body weight, respectively; p < .001) at week 32. Rates of CTS utilization were highest during the first year of this 2-year intervention, and utilization of the CTS declined steadily over time. The unique features of the CTS combined with technological developments, such as smart phone applications, offer significant potential to improve the user’s self-monitoring experience and adherence to health promotion programs designed specifically for individuals with obesity and type 2 diabetes. PMID:23063049

  16. Mass Spectrometry in Clinical Laboratory: Applications in Therapeutic Drug Monitoring and Toxicology.

    Science.gov (United States)

    Garg, Uttam; Zhang, Yan Victoria

    2016-01-01

    Mass spectrometry (MS) has been used in research and specialized clinical laboratories for decades as a very powerful technology to identify and quantify compounds. In recent years, application of MS in routine clinical laboratories has increased significantly. This is mainly due to the ability of MS to provide very specific identification, high sensitivity, and simultaneous analysis of multiple analytes (>100). The coupling of tandem mass spectrometry with gas chromatography (GC) or liquid chromatography (LC) has enabled the rapid expansion of this technology. While applications of MS are used in many clinical areas, therapeutic drug monitoring, drugs of abuse, and clinical toxicology are still the primary focuses of the field. It is not uncommon to see mass spectrometry being used in routine clinical practices for those applications.

  17. Biochemical sensor tubing for point-of-care monitoring of intravenous drugs and metabolites.

    Science.gov (United States)

    Choi, Charles J; Wu, Hsin-Yu; George, Sherine; Weyhenmeyer, Jonathan; Cunningham, Brian T

    2012-02-07

    In medical facilities, there is strong motivation to develop detection systems that can provide continuous analysis of fluids in medical tubing used to either deliver or remove fluids from a patient's body. Possible applications include systems that increase the safety of intravenous (IV) drug injection and point-of-care health monitoring. In this work, we incorporated a surface-enhanced Raman scattering (SERS) sensor comprised of an array of closely spaced metal nanodomes into flexible tubing commonly used for IV drug delivery and urinary catheters. The nanodome sensor was fabricated by a low-cost, large-area process that enables single use disposable operation. As exemplary demonstrations, the sensor was used to kinetically detect promethazine (pain medication) and urea (urinary metabolite) within their clinically relevant concentration ranges. Distinct SERS peaks for each analyte were used to demonstrate separate detection and co-detection of the analytes.

  18. Optimizing Treatment with TNF Inhibitors in Inflammatory Bowel Disease by Monitoring Drug Levels and Antidrug Antibodies

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Bendtzen, Klaus; Brynskov, Jørn

    2016-01-01

    costs. The objective is to review optimization of anti-TNF therapy by use of personalized treatment strategies based on circulating drug levels and antidrug antibodies (Abs), i.e. therapeutic drug monitoring (TDM). Furthermore, to outline TDM-related pitfalls and their prevention. METHODS: Literature...... inflammatory phenotype influencing the pharmacodynamic (PD) responses to TNF inhibitors also affect treatment outcomes. As an alternative to handling anti-TNF-treated patients by empiric strategies, TDM identifies underlying PK and PD-related reasons for treatment failure and aids decision making to secure...... of chronology between changes in PK versus symptomatic and objective disease activity manifestations. Biases can be accommodated by knowledgeable interpretation of results obtained by validated assays with clinically established thresholds, and by repeated assessments over time using complimentary techniques...

  19. Analysis of veterinary drug residue monitoring results for commercial livestock products in Taiwan between 2011 and 2015.

    Science.gov (United States)

    Lee, Hsin-Chun; Chen, Chi-Min; Wei, Jen-Ting; Chiu, Hsiu-Yi

    2018-04-01

    Antibiotics have been widely used in the treatment of livestock diseases. However, the emergence of issues related to drug resistance prompted governments to enact a series of laws regulating the use of antibiotics in livestock. Following control of the problem of drug resistant bacteria, public attention has shifted to the recurring incidence of human health and safety issues caused by residual veterinary drugs in livestock products. To guarantee the safety and hygiene of meat, milk, and eggs from food-producing animals, governments and relevant agencies established laws and regulations for the use of veterinary drugs. It is, therefore, necessary to monitor the content of residual drugs in livestock products at regular intervals to assess whether the regulations have resulted in the effective management of food product safety, and to prevent and manage sudden problems related to this issue. A 2011-2015 livestock product post-marketing monitoring program launched by the Taiwan Food and Drug Administration (TFDA) inspected 1487 livestock products. Over the past 5 years, there were 34 samples identified that did not conform to the regulations; these samples included residue drugs such as β-agonists, chloramphenicols, β-lactam antibiotics, sulfa drugs, enrofloxacin, and lincomycin. Inspections of commercial livestock products with the consistent cooperation of agricultural authorities did not detect the drugs that were banned by the government, whereas the detection of other drugs decreased annually with an increase in the post-market monitoring sample size. In the future, the TFDA will continue to monitor the status of residual veterinary drugs in commercial livestock products, adjust the sampling of food products annually according to monitoring results, and closely cooperate with agricultural authorities on source management. Copyright © 2017. Published by Elsevier B.V.

  20. Therapeutic drug monitoring in pediatric IBD: current application and future perspectives.

    Science.gov (United States)

    Lega, Sara; Bramuzzo, Matteo; Dubinsky, Marla

    2017-09-11

    As the paradigm for IBD management is evolving from symptom control to the more ambitious goal of complete deep remission, the concept of personalized medicine, as a mean to deliver individualized treatment with the best effectiveness and safety profile, is becoming paramount. Therapeutic drug monitoring (TDM) is an essential part of personalized medicine wherein serum drug concentrations are used to guide drug dosing on an individual basis. The concept of TDM has been introduced in the field of IBD along with thiopurines, over a decade ago, and evolved around anti-TNFs therapies. In the era of biologics, TDM entered the clinical field to assist clinicians managing anti-TNF failure and its role is now moving toward the concept of "proactive" TDM with the goal to optimize drug exposure and prevent loss of response. Research in TDM is rapidly expanding: while the role of TDM with new biologics is under investigation, preliminary data suggest that software-systems support tools could be an opportunity to guide dosing choices and maximize the cost-benefit profile of therapies in the near future. The review discusses the current knowledge that poses the rationale for the use of TDM and the present and future role of TDM-based approaches in the management of pediatric IBD. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. Development of a metrics dashboard for monitoring involvement in the 340B Drug Pricing Program.

    Science.gov (United States)

    Karralli, Rusol; Tipton, Joyce; Dumitru, Doina; Scholz, Lisa; Masilamani, Santhi

    2015-09-01

    An electronic tool to support hospital organizations in monitoring and addressing financial and compliance challenges related to participation in the 340B Drug Pricing Program is described. In recent years there has been heightened congressional and regulatory scrutiny of the federal 340B program, which provides discounted drug prices on Medicaid-covered drugs to safety net hospitals and other 340B-eligible healthcare organizations, or "covered entities." Historically, the 340B program has lacked a metrics-driven reporting framework to help covered entities capture the value of 340B program involvement, community benefits provided to underserved populations, and costs associated with compliance with 340B eligibility requirements. As part of an initiative by a large health system to optimize its 340B program utilization and regulatory compliance efforts, a team of pharmacists led the development of an electronic dashboard tool to help monitor 340B program activities at the system's 340B-eligible facilities. After soliciting input from an array of internal and external 340B program stakeholders, the team designed the dashboard and associated data-entry tools to facilitate the capture and analysis of 340B program-related data in four domains: cost savings and revenue, program maintenance costs, community benefits, and compliance. A large health system enhanced its ability to evaluate and monitor 340B program-related activities through the use of a dashboard tool capturing key metrics on cost savings achieved, maintenance costs, and other aspects of program involvement. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  2. Longitudinal monitoring of the safety of drugs by using a web-based system : the case of pregabalin

    NARCIS (Netherlands)

    Harmark, Linda; van Puijenbroek, Eugene; van Grootheest, Kees

    Purpose Information about the time course of adverse drug reactions (ADRs) is often lacking. If this information would be available, it could help increase patient's adherence to drugs when experiencing an ADR. The aim of this study was to demonstrate how a web-based intensive monitoring system

  3. Monitoring the Future National Survey Results on Drug Use, 1975-2010. Volume I, Secondary School Students

    Science.gov (United States)

    Johnston, Lloyd D.; O'Malley, Patrick M.; Bachman, Jerald G.; Schulenberg, John E.

    2011-01-01

    The Monitoring the Future (MTF) study involves an ongoing series of national surveys of American adolescents and adults that has provided the nation with a vital window into the important, but largely hidden, problem behaviors of illegal drug use, alcohol use, tobacco use, anabolic steroid use, and psychotherapeutic drug use. For more than a third…

  4. Requirements for drug monitoring of verapamil: experience from an unselected group of patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Husum, D; Johnsen, A; Jensen, Gorm Boje

    1990-01-01

    variation (variation coefficient 35.8, 1.9, and 7.4, at the dosage levels 120, 240 and 340 mg per day). No significant correlation was found between serum verapamil levels age, sex, or weight. No significant effect of digoxin on the concentration of serum verapamil was found. No relation was observed...... 620 and D 617 indicated saturation of the first-pass metabolism. In conclusion, therapeutic drug monitoring is not indicated during routine verapamil treatment, whereas single measurements of verapamil may be warranted in patients not responding to treatment in order to identify fast metabolizers...

  5. The significance of sampling time in therapeutic drug monitoring of clozapine

    DEFF Research Database (Denmark)

    Jakobsen, M I; Larsen, J R; Svensson, C K

    2017-01-01

    OBJECTIVE: Therapeutic drug monitoring (TDM) of clozapine is standardized to 12-h postdose samplings. In clinical settings, sampling time often deviates from this time point, although the importance of the deviation is unknown. To this end, serum concentrations (s-) of clozapine and its metabolite...... N-desmethyl-clozapine (norclozapine) were measured at 12 ± 1 and 2 h postdose. METHOD: Forty-six patients with a diagnosis of schizophrenia, and on stable clozapine treatment, were enrolled for hourly, venous blood sampling at 10-14 h postdose. RESULTS: Minor changes in median percentage values were...

  6. Monitoring quality and coverage of harm reduction services for people who use drugs

    DEFF Research Database (Denmark)

    Wiessing, Lucas; Ferri, Marica; Běláčková, Vendula

    2017-01-01

    indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems......BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological...... before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service...

  7. Information selection and signal probability in multisource monitoring under the influence of centrally active drugs : Phentermine versus pentobarbital

    NARCIS (Netherlands)

    Volkerts, E.R; van Laar, M.W; Verbaten, M.N; Mulder, G.; Maes, R.A A

    1996-01-01

    The present study is concerned with the relationship between drug-induced arousal shifts and sampling [(monitoring)] behaviour in a three-source task with an a priori signal occurrence probability of 0.6, 0.3, and 0.1. The multisource monitoring task and procedure was adopted from Hockey (1973) who

  8. Long-term climate monitoring by the global climate observing system: report of breakout group 1 - climate forcings and feedbacks

    International Nuclear Information System (INIS)

    Miller, C.; Bretherton, F.

    1995-01-01

    The assignment for Breakout Group A was to re-visit and expand upon the plenary session discussion on climate forcings and feedbacks and to develop a set of recommendations for each of the science disciplines or activities covered within this breakout category. Working guidelines for the group included identifying: (1) what has to be done; (2) why it has to be done, i.e. who is the customer? (3) the process for remedying deficiencies and, specifically, how to leverage the activities at operational centers; and (4) priorities (recognizing that it is premature to distinguish between major systems). The science ares addressed included: greenhouse gases (GHGs); radiation budget; water vapor; aerosols; clouds; precipitation; tropospheric ozone; and solar radiation. The role of climate satellites was also noted

  9. Simultaneous Determination of Antipsychotic Drugs and Their Active Metabolites by LC-MS-MS and its Application to Therapeutic Drug Monitoring.

    Science.gov (United States)

    Miroshnichenko, Igor I; Baymeeva, Natalia V

    2018-04-07

    A quantitative method was developed to support therapeutic drug monitoring of eight antipsychotic drugs: chlorpromazine, haloperidol, zuclopenthixol, clozapine, risperidone, quetiapine, aripiprazole or olanzapine and some active metabolites (dehydroaripiprazole, N-desmethylclozapine and 9-hydroxyrisperidone) in human serum. Separation of the compounds was achieved using a Zorbax SB-C18 (150 mm × 4.6 mm, 5 μm) column and mass-spectrometric detection in multiple reaction monitoring mode. Human blood samples were collected in vacutainer tubes and the analytes were extracted with methyl-tert-butyl ether. The lower limits of quantitation were equal 0.5-1 ng/mL for all analytes. The method was applied with success to serum samples from schizophrenic patients undergoing polypharmacy with two or more different antipsychotic drugs. Precision data, accuracy results were satisfactory, and no interference from other psychotropic drugs was found. Hence, the method is suitable for the TDM of the analytes in psychotic patients' serum.

  10. Design of a surface plasmon resonance immunoassay for therapeutic drug monitoring of amikacin.

    Science.gov (United States)

    Losoya-Leal, Adrian; Estevez, M-Carmen; Martínez-Chapa, Sergio O; Lechuga, Laura M

    2015-08-15

    The therapeutic drug monitoring (TDM) of pharmaceutical drugs with narrow therapeutic ranges is of great importance in the clinical setting. It provides useful information towards the enhancement of drug therapies, aiding in dosage control and toxicity risk management. Amikacin is an aminoglycoside antibiotic commonly used in neonatal therapies that is indicated for TDM due to the toxicity risks inherent in its use. Current techniques for TDM such as high performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) are costly, time consuming, and cannot be performed at the site of action. Over the last decades, surface plasmon resonance (SPR) biosensors have become increasingly popular in clinical diagnostics due to their ability to detect biomolecular interactions in real-time. We present an SPR-based competitive immunoassay for the detection of the antibiotic amikacin, suitable for TDM in both adults and neonates. We have obtained high specificity and sensitivity levels with an IC50 value of 1.4ng/mL and a limit of detection of 0.13ng/mL, which comfortably comply with the drug's therapeutic range. Simple dilution of serum can therefore be sufficient to analyze low-volume real samples from neonates, increasing the potential of the methodology for TDM. Compared to current TDM conventional methods, this SPR-based immunoassay can provide advantages such as simplicity, potential portability, and label-free measurements with the possibility of high throughput. This work is the foundation towards the development of an integrated, simple use, highly sensitive, fast, and point-of-care sensing platform for the opportune TDM of antibiotics and other drugs in a clinical setting. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Self-Monitoring Using Continuous Glucose Monitors with Real-Time Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study.

    Science.gov (United States)

    Bailey, Kaitlyn J; Little, Jonathan P; Jung, Mary E

    2016-03-01

    Exercise helps individuals with prediabetes or type 2 diabetes (T2D) manage their blood glucose (BG); however, exercise adherence in this population is dismal. In this pilot study we tested the efficacy of a self-monitoring group-based intervention using continuous glucose monitors (CGMs) at increasing exercise adherence in individuals with impaired BG. Thirteen participants with prediabetes or T2D were randomized to an 8-week standard care exercise program (CON condition) (n = 7) or self-monitoring exercise intervention (SM condition) (n = 6). Participants in the SM condition were taught how to self-monitor their exercise and BG, to goal set, and to use CGM to observe how exercise influences BG. We hypothesized that compared with the CON condition, using a real-time CGM would facilitate self-monitoring behavior, resulting in increased exercise adherence. Repeated-measures analysis of variance revealed significant Condition × Time interactions for self-monitoring (P goal setting (P = 0.01), and self-efficacy to self-monitor (P = 0.01), such that the SM condition showed greater increases in these outcomes immediately after the program and at the 1-month follow-up compared with the CON condition. The SM condition had higher program attendance rates (P = 0.03), and a greater proportion of participants reregistered for additional exercise programs (P = 0.048) compared with the CON condition. Participants in both conditions experienced improvements in health-related quality of life, waist circumference, and fitness (P values exercise behavior in individuals living with prediabetes or T2D.

  12. In-line Raman spectroscopic monitoring and feedback control of a continuous twin-screw pharmaceutical powder blending and tableting process.

    Science.gov (United States)

    Nagy, Brigitta; Farkas, Attila; Gyürkés, Martin; Komaromy-Hiller, Szofia; Démuth, Balázs; Szabó, Bence; Nusser, Dávid; Borbás, Enikő; Marosi, György; Nagy, Zsombor Kristóf

    2017-09-15

    The integration of Process Analytical Technology (PAT) initiative into the continuous production of pharmaceuticals is indispensable for reliable production. The present paper reports the implementation of in-line Raman spectroscopy in a continuous blending and tableting process of a three-component model pharmaceutical system, containing caffeine as model active pharmaceutical ingredient (API), glucose as model excipient and magnesium stearate as lubricant. The real-time analysis of API content, blend homogeneity, and tablet content uniformity was performed using a Partial Least Squares (PLS) quantitative method. The in-line Raman spectroscopic monitoring showed that the continuous blender was capable of producing blends with high homogeneity, and technological malfunctions can be detected by the proposed PAT method. The Raman spectroscopy-based feedback control of the API feeder was also established, creating a 'Process Analytically Controlled Technology' (PACT), which guarantees the required API content in the produced blend. This is, to the best of the authors' knowledge, the first ever application of Raman-spectroscopy in continuous blending and the first Raman-based feedback control in the formulation technology of solid pharmaceuticals. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. High-performance liquid chromatographic quantification of rifampicin in human plasma: method for Therapecutic drug monitoring

    International Nuclear Information System (INIS)

    Sameh, T.; Hanene, E.; Jebali, N.

    2013-01-01

    A high performance liquid chromatography (HPLC) method has been developed that allows quantification of Rifampicin in human plasma. The method is based on the precipitation of proteins in human plasma with methanol. Optimal assay conditions were found with a C18 column and a simple mobile phase consisting of 0.05 M dipotassic hydrogen phosphate buffer and acetonitrile (53/47, V/V) with 0.086 % diethylamin, pH = 4.46. The flow-rate was 0.6 ml /mm and the drug was monitored at 340 nm. Results from the HPLC analyses showed that the assay method is linear in the concentration range of 1-40 micro g/ml, (r2 >0.99). The limit of quantification and limit of detection of Rifampicin were 0.632 micro g/ml and 0.208 micro g/ml, respectively. Intraday and interday coefficient of variation and bias were below 10% for all samples, suggesting good precision and accuracy of the method. Recoveries were greater than 90% in a plasma sample volume of 100 micro l. The method is being successfully applied to therapeutic drug monitoring of Rifapicin in plasma samples of tuberculosis and staphylococcal infections patients. (author)

  14. Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Medeiros Barros

    2014-01-01

    Full Text Available Objective: To compare two analytical techniques used in the determination of plasma digoxin (LC-MS/MS and immunoassay and to verify which one better answer the need of the clinical monitoring routine of patients with cardiac heart failure. Method: The clinical findings in 15 cardiac heart failure (CHF outpatients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital were investigated. Blood samples of the patients were collected and analysed by Immunoassay and by Liquid Chromatography coupled to Mass Spectrometry (LC-MS/MS. Results: The results of the statistic test (Student p = 0,05 showed a significant difference between the analytical methods: immunoassay concentrations were higher than the concentrations determined by LCMS/ MS. The explanation may be because immunoassay method measures digoxin plus other metabolites and endogenous substances, while the LC-MS/MS method measures only the digoxin molecule. None of the patients, showed relevant clinical data suggestive of digitalis intoxication, even several drugs with potential interaction were associated with treatment. Conclusion: It was concluded, therefore, that LC-MS/MS me thod is safer, more selective and specific than immunoassay, being an option for therapeutic drug monitoring of digoxin, since the reference values would be obtain for digoxinemia by LC-MS/MS.

  15. Fully automatic flow-based device for monitoring of drug permeation across a cell monolayer.

    Science.gov (United States)

    Zelená, Lucie; Marques, Sara S; Segundo, Marcela A; Miró, Manuel; Pávek, Petr; Sklenářová, Hana; Solich, Petr

    2016-01-01

    A novel flow-programming setup based on the sequential injection principle is herein proposed for on-line monitoring of temporal events in cell permeation studies. The permeation unit consists of a Franz cell with its basolateral compartment mixed under mechanical agitation and thermostated at 37 °C. The apical compartment is replaced by commercially available Transwell inserts with a precultivated cell monolayer. The transport of drug substances across epithelial cells genetically modified with the P-glycoprotein membrane transporter (MDCKII-MDR1) is monitored on-line using rhodamine 123 as a fluorescent marker. The permeation kinetics of the marker is obtained in a fully automated mode by sampling minute volumes of solution from the basolateral compartment in short intervals (10 min) up to 4 h. The effect of a P-glycoprotein transporter inhibitor, verapamil as a model drug, on the efficiency of the marker transport across the cell monolayer is thoroughly investigated. The analytical features of the proposed flow method for cell permeation studies in real time are critically compared against conventional batch-wise procedures and microfluidic devices.

  16. Decommissioning of the nuclear licensed facilities at the Fontenay aux Roses CEA Center; cleanup of nuclear licensed facility 57 and monitoring of operations and operating feedback

    International Nuclear Information System (INIS)

    Estivie, D.; Bohar, M.P.; Jeanjacques, M.; Binet, C.; Bremond, M.P.; Poyau, C.; Mandard, L.; Boissonneau, J.F.; Fouquereau, A.; Pichereau, E.

    2008-01-01

    This is a summary of the program for the decommissioning of all the CEA Licensed Nuclear Facilities in Fontenay aux Roses. The particularity of this center is now it is located in a built-up area. It is presented like example the operations to clean up the equipment of the Nuclear Licensed Facility 57 (NLF 57). Due to the diversity of the research and development work carried out on the reprocessing of spent fuel in it, this installation is emblematic of many of the technical and organizational issues liable to be encountered in the final closure of nuclear facilities. It was developed a method applied to establish the multi-annual budget, monitor the progress of operations and integrate, as work continues, the operating feedback. (author)

  17. Development of a High Precision Displacement Measurement System by Fusing a Low Cost RTK-GPS Sensor and a Force Feedback Accelerometer for Infrastructure Monitoring.

    Science.gov (United States)

    Koo, Gunhee; Kim, Kiyoung; Chung, Jun Yeon; Choi, Jaemook; Kwon, Nam-Yeol; Kang, Doo-Young; Sohn, Hoon

    2017-11-28

    A displacement measurement system fusing a low cost real-time kinematic global positioning system (RTK-GPS) receiver and a force feedback accelerometer is proposed for infrastructure monitoring. The proposed system is composed of a sensor module, a base module and a computation module. The sensor module consists of a RTK-GPS rover and a force feedback accelerometer, and is installed on a target structure like conventional RTK-GPS sensors. The base module is placed on a rigid ground away from the target structure similar to conventional RTK-GPS bases, and transmits observation messages to the sensor module. Then, the initial acceleration, velocity and displacement responses measured by the sensor module are transmitted to the computation module located at a central monitoring facility. Finally, high precision and high sampling rate displacement, velocity, and acceleration are estimated by fusing the acceleration from the accelerometer, the velocity from the GPS rover, and the displacement from RTK-GPS. Note that the proposed displacement measurement system can measure 3-axis acceleration, velocity as well as displacement in real time. In terms of displacement, the proposed measurement system can estimate dynamic and pseudo-static displacement with a root-mean-square error of 2 mm and a sampling rate of up to 100 Hz. The performance of the proposed system is validated under sinusoidal, random and steady-state vibrations. Field tests were performed on the Yeongjong Grand Bridge and Yi Sun-sin Bridge in Korea, and the Xihoumen Bridge in China to compare the performance of the proposed system with a commercial RTK-GPS sensor and other data fusion techniques.

  18. Development of a High Precision Displacement Measurement System by Fusing a Low Cost RTK-GPS Sensor and a Force Feedback Accelerometer for Infrastructure Monitoring

    Directory of Open Access Journals (Sweden)

    Gunhee Koo

    2017-11-01

    Full Text Available A displacement measurement system fusing a low cost real-time kinematic global positioning system (RTK-GPS receiver and a force feedback accelerometer is proposed for infrastructure monitoring. The proposed system is composed of a sensor module, a base module and a computation module. The sensor module consists of a RTK-GPS rover and a force feedback accelerometer, and is installed on a target structure like conventional RTK-GPS sensors. The base module is placed on a rigid ground away from the target structure similar to conventional RTK-GPS bases, and transmits observation messages to the sensor module. Then, the initial acceleration, velocity and displacement responses measured by the sensor module are transmitted to the computation module located at a central monitoring facility. Finally, high precision and high sampling rate displacement, velocity, and acceleration are estimated by fusing the acceleration from the accelerometer, the velocity from the GPS rover, and the displacement from RTK-GPS. Note that the proposed displacement measurement system can measure 3-axis acceleration, velocity as well as displacement in real time. In terms of displacement, the proposed measurement system can estimate dynamic and pseudo-static displacement with a root-mean-square error of 2 mm and a sampling rate of up to 100 Hz. The performance of the proposed system is validated under sinusoidal, random and steady-state vibrations. Field tests were performed on the Yeongjong Grand Bridge and Yi Sun-sin Bridge in Korea, and the Xihoumen Bridge in China to compare the performance of the proposed system with a commercial RTK-GPS sensor and other data fusion techniques.

  19. Cost evaluation of therapeutic drug monitoring of gentamicin at a teaching hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Ibrahim MI

    2014-03-01

    Full Text Available Background: Therapeutic drug monitoring (TDM makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i cost of laboratory and clinical investigations, (ii cost associated with each gentamicin dose, (iii fixed and operating costs of TDM service, (iv cost of providing medical care, and (v cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5% had TDM service for gentamicin. Seventy-three percent (49/67 patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02. Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization.

  20. Revolutionizing Therapeutic Drug Monitoring with the Use of Interstitial Fluid and Microneedles Technology

    Science.gov (United States)

    Kiang, Tony K.L.; Ranamukhaarachchi, Sahan A.; Ensom, Mary H.H.

    2017-01-01

    While therapeutic drug monitoring (TDM) that uses blood as the biological matrix is the traditional gold standard, this practice may be impossible, impractical, or unethical for some patient populations (e.g., elderly, pediatric, anemic) and those with fragile veins. In the context of finding an alternative biological matrix for TDM, this manuscript will provide a qualitative review on: (1) the principles of TDM; (2) alternative matrices for TDM; (3) current evidence supporting the use of interstitial fluid (ISF) for TDM in clinical models; (4) the use of microneedle technologies, which is potentially minimally invasive and pain-free, for the collection of ISF; and (5) future directions. The current state of knowledge on the use of ISF for TDM in humans is still limited. A thorough literature review indicates that only a few drug classes have been investigated (i.e., anti-infectives, anticonvulsants, and miscellaneous other agents). Studies have successfully demonstrated techniques for ISF extraction from the skin but have failed to demonstrate commercial feasibility of ISF extraction followed by analysis of its content outside the ISF-collecting microneedle device. In contrast, microneedle-integrated biosensors built to extract ISF and perform the biomolecule analysis on-device, with a key feature of not needing to transfer ISF to a separate instrument, have yielded promising results that need to be validated in pre-clinical and clinical studies. The most promising applications for microneedle-integrated biosensors is continuous monitoring of biomolecules from the skin’s ISF. Conducting TDM using ISF is at the stage where its clinical utility should be investigated. Based on the advancements described in the current review, the immediate future direction for this area of research is to establish the suitability of using ISF for TDM in human models for drugs that have been found suitable in pre-clinical experiments. PMID:29019915

  1. Revolutionizing Therapeutic Drug Monitoring with the Use of Interstitial Fluid and Microneedles Technology

    Directory of Open Access Journals (Sweden)

    Tony K.L. Kiang

    2017-10-01

    Full Text Available While therapeutic drug monitoring (TDM that uses blood as the biological matrix is the traditional gold standard, this practice may be impossible, impractical, or unethical for some patient populations (e.g., elderly, pediatric, anemic and those with fragile veins. In the context of finding an alternative biological matrix for TDM, this manuscript will provide a qualitative review on: (1 the principles of TDM; (2 alternative matrices for TDM; (3 current evidence supporting the use of interstitial fluid (ISF for TDM in clinical models; (4 the use of microneedle technologies, which is potentially minimally invasive and pain-free, for the collection of ISF; and (5 future directions. The current state of knowledge on the use of ISF for TDM in humans is still limited. A thorough literature review indicates that only a few drug classes have been investigated (i.e., anti-infectives, anticonvulsants, and miscellaneous other agents. Studies have successfully demonstrated techniques for ISF extraction from the skin but have failed to demonstrate commercial feasibility of ISF extraction followed by analysis of its content outside the ISF-collecting microneedle device. In contrast, microneedle-integrated biosensors built to extract ISF and perform the biomolecule analysis on-device, with a key feature of not needing to transfer ISF to a separate instrument, have yielded promising results that need to be validated in pre-clinical and clinical studies. The most promising applications for microneedle-integrated biosensors is continuous monitoring of biomolecules from the skin’s ISF. Conducting TDM using ISF is at the stage where its clinical utility should be investigated. Based on the advancements described in the current review, the immediate future direction for this area of research is to establish the suitability of using ISF for TDM in human models for drugs that have been found suitable in pre-clinical experiments.

  2. Dried Blood Spot Analysis Suitable for Therapeutic Drug Monitoring of Voriconazole, Fluconazole, and Posaconazole

    Science.gov (United States)

    van der Elst, Kim C. M.; Span, Lambert F. R.; van Hateren, Kai; Vermeulen, Karin M.; van der Werf, Tjip S.; Greijdanus, Ben; Kosterink, Jos G. W.; Uges, Donald R. A.

    2013-01-01

    Invasive aspergillosis and candidemia are important causes of morbidity and mortality in immunocompromised and critically ill patients. The triazoles voriconazole, fluconazole, and posaconazole are widely used for the treatment and prophylaxis of these fungal infections. Due to the variability of the pharmacokinetics of the triazoles among and within individual patients, therapeutic drug monitoring is important for optimizing the efficacy and safety of antifungal treatment. A dried blood spot (DBS) analysis was developed and was clinically validated for voriconazole, fluconazole, and posaconazole in 28 patients. Furthermore, a questionnaire was administered to evaluate the patients' opinions of the sampling method. The DBS analytical method showed linearity over the concentration range measured for all triazoles. Results for accuracy and precision were within accepted ranges; samples were stable at room temperature for at least 12 days; and different hematocrit values and blood spot volumes had no significant influence. The ratio of the drug concentration in DBS samples to that in plasma was 1.0 for voriconazole and fluconazole and 0.9 for posaconazole. Sixty percent of the patients preferred DBS analysis as a sampling method; 15% preferred venous blood sampling; and 25% had no preferred method. There was significantly less perception of pain with the DBS sampling method (P = 0.021). In conclusion, DBS analysis is a reliable alternative to venous blood sampling and can be used for therapeutic drug monitoring of voriconazole, fluconazole, and posaconazole. Patients were satisfied with DBS sampling and had less pain than with venous sampling. Most patients preferred DBS sampling to venous blood sampling. PMID:23896473

  3. Monitoring of Adverse Drug Reactions Associated with Antihypertensive Medicines at a University Teaching Hospital in New Delhi

    Directory of Open Access Journals (Sweden)

    Fowad Khurshid

    2012-09-01

    Full Text Available Aim To monitor the adverse drug reactions (ADRs caused by antihypertensive medicines prescribed in a university teaching hospital.Methods:he present work was an open, non-comparative, observational study conducted on hypertensive patients attending the Medicine OPD of Majeedia Hospital, Jamia Hamdard, New Delhi, India by conducting patient interviews and recording the data on ADR monitoring form as recommended by Central Drugs Standard Control Organization (CDSCO, Government of India.Results:A total of 21 adverse drug reactions were observed in 192 hypertensive patients. Incidence of adverse drug reactions was found to be higher in patients more than 40 years in age, and females experienced more ADRs (n = 14, 7.29 % than males, 7 (3.64 %. Combination therapy was associated with more number of adverse drug reactions (66.7 % as against monotherapy (33.3 %. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n = 7, followed by diuretics (n = 5, and beta- blockers (n = 4. Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 7, followed by torasemide (n = 3. Adverse drug reactions associated with central nervous system were found to be the most frequent (42.8 % followed by musculo-skeletal complaints (23.8 % and gastro-intestinal disorders (14.3 %. Conclusions:The present pharmacovigilance study represents the adverse drug reaction profile of the antihypertensive medicines prescribed in our university teaching hospital. The above findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions.

  4. Affordable HIV drug-resistance testing for monitoring of antiretroviral therapy in sub-Saharan Africa.

    Science.gov (United States)

    Inzaule, Seth C; Ondoa, Pascale; Peter, Trevor; Mugyenyi, Peter N; Stevens, Wendy S; de Wit, Tobias F Rinke; Hamers, Raph L

    2016-11-01

    Increased provision of antiretroviral therapy in sub-Saharan Africa has led to a growing number of patients with therapy failure and acquired drug-resistant HIV, driving the demand for more costly further lines of antiretroviral therapy. In conjunction with accelerated access to viral load monitoring, feasible and affordable technologies to detect drug-resistant HIV could help maximise the durability and rational use of available drug regimens. Potential low-cost technologies include in-house Sanger and next-generation sequencing in centralised laboratories, and point mutation assays and genotype-free systems that predict response to antiretroviral therapy at point-of-care. Strengthening of centralised high-throughput laboratories, including efficient systems for sample referral and results delivery, will increase economies-of-scale while reducing costs. Access barriers can be mitigated by standardisation of in-house assays into commercial kits, use of polyvalent instruments, and adopting price-reducing strategies. A stepwise rollout approach should improve feasibility, prioritising WHO-recommended population-based surveillance and management of complex patient categories, such as patients failing protease inhibitor-based antiretroviral therapy. Implementation research, adaptations of existing WHO guidance, and political commitment, will be key to support the appropriate investments and policy changes. In this Personal View, we discuss the potential role of HIV drug resistance testing for population-based surveillance and individual patient management in sub-Saharan Africa. We review the strengths and challenges of promising low-cost technologies and how they can be implemented. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014.

    Science.gov (United States)

    McCall, Kenneth; Nichols, Stephanie D; Holt, Christina; Ochs, Leslie; Cattabriga, Gary; Tu, Chunhao

    2016-06-01

    To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse. © 2016 Pharmacotherapy Publications, Inc.

  6. Assessment of the use of oral fluid as a matrix for drug monitoring in patients undergoing treatment for opioid addiction.

    Science.gov (United States)

    Kunkel, Frank; Fey, Elizabeth; Borg, Damon; Stripp, Richard; Getto, Christine

    2015-01-01

    Drug testing is an important clinical tool that is available to physicians who are assessing the effectiveness of drug treatment as well as patient compliance to the administered program. While urine has traditionally been the matrix of choice for drug monitoring, oral fluid, a filtrate of the blood, has shown great promise as an alternative matrix for such applications. Oral fluid collection can be accomplished without the need for highly trained medical staff through the use of a simple, noninvasive oral fluid collection device, which obtains an adequate sample in only a few minutes. There has been a significant amount of research performed on the use of oral fluid for forensic toxicology application; however, more studies assessing the use of oral fluid drug testing are required to validate its ability to achieve clinical drug monitoring goals. Testing for various drugs in oral fluid may yield a different result when compared to the same drugs in urine, requiring an assessment of the utility of oral fluid for such practices. The purpose of this study was to examine the application of oral fluid drug testing in patients undergoing buprenorphine treatment for opioid dependence. A retrospective analysis of drug testing results obtained from 6,928 patients (4,560 unobserved urine collections and 2,368 observed oral fluid collections) monitored for heroin metabolite, amphetamine, benzodiazepines, buprenorphine, tetrahydrocannabinol, cocaine, codeine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone was completed. Results of this statistical exercise indicated that patients undergoing observed oral fluid collection tested positive more frequently than those unobserved urine collections for several illicit drugs and prescription medications targeted. Oral fluid was shown to detect illicit drug use as well as noncompliance in this patient population under the studied conditions more often than the urine specimens.

  7. Performance evaluation of enzyme immunoassay for voriconazole therapeutic drug monitoring with automated clinical chemistry analyzers

    Directory of Open Access Journals (Sweden)

    Yongbum Jeon

    2017-08-01

    Full Text Available Objective: Voriconazole is a triazole antifungal developed for the treatment of fungal infectious disease, and the clinical utility of its therapeutic drug monitoring has been evaluated. Recently, a new assay for analyzing the serum voriconazole concentration with an automated clinical chemistry analyzer was developed. We evaluated the performance of the new assay based on standardized protocols. Methods: The analytical performance of the assay was evaluated according to its precision, trueness by recovery, limit of quantitation, linearity, and correlation with results from liquid chromatography-tandem mass spectrometry (LC-MS/MS. The evaluation was performed with the same protocol on two different routine chemistry analyzers. All evaluations were performed according to CLSI Guidelines EP15, EP17, EP6, and EP9 [1–4]. Results: Coefficients of variation for within-run and between-day imprecision were 3.2–5.1% and 1.5–3.0%, respectively, on the two different analyzers for pooled serum samples. The recovery rates were in the range of 95.4–102.2%. The limit of blank was 0.0049 μg/mL, and the limit of detection of the samples was 0.0266–0.0376 μg/mL. The percent recovery at three LoQ levels were 67.9–74.6% for 0.50 μg/mL, 75.5–80.2% for 0.60 μg/mL, and 89.9–96.6% for 0.70 μg/mL. A linear relationship was demonstrated between 0.5 μg/mL and 16.0 μg/mL (R2=0.9995–0.9998. The assay correlated well with LC-MS/MS results (R2=0.9739–0.9828. Conclusions: The assay showed acceptable precision, trueness, linearity, and limit of quantification, and correlated well with LC-MS/MS. Therefore, its analytical performance is satisfactory for monitoring the drug concentration of voriconazole. Keywords: Voriconazole, Antifungal agents, Therapeutic drug monitoring

  8. Influence of local calibration on the quality of online wet weather discharge monitoring: feedback from five international case studies.

    Science.gov (United States)

    Caradot, Nicolas; Sonnenberg, Hauke; Rouault, Pascale; Gruber, Günter; Hofer, Thomas; Torres, Andres; Pesci, Maria; Bertrand-Krajewski, Jean-Luc

    2015-01-01

    This paper reports about experiences gathered from five online monitoring campaigns in the sewer systems of Berlin (Germany), Graz (Austria), Lyon (France) and Bogota (Colombia) using ultraviolet-visible (UV-VIS) spectrometers and turbidimeters. Online probes are useful for the measurement of highly dynamic processes, e.g. combined sewer overflows (CSO), storm events, and river impacts. The influence of local calibration on the quality of online chemical oxygen demand (COD) measurements of wet weather discharges has been assessed. Results underline the need to establish local calibration functions for both UV-VIS spectrometers and turbidimeters. It is suggested that practitioners calibrate locally their probes using at least 15-20 samples. However, these samples should be collected over several events and cover most of the natural variability of the measured concentration. For this reason, the use of automatic peristaltic samplers in parallel to online monitoring is recommended with short representative sampling campaigns during wet weather discharges. Using reliable calibration functions, COD loads of CSO and storm events can be estimated with a relative uncertainty of approximately 20%. If no local calibration is established, concentrations and loads are estimated with a high error rate, questioning the reliability and meaning of the online measurement. Similar results have been obtained for total suspended solids measurements.

  9. Quantitative Analysis of Therapeutic Drugs in Dried Blood Spot Samples by Paper Spray Mass Spectrometry: An Avenue to Therapeutic Drug Monitoring

    Science.gov (United States)

    Manicke, Nicholas Edward; Abu-Rabie, Paul; Spooner, Neil; Ouyang, Zheng; Cooks, R. Graham

    2011-09-01

    A method is presented for the direct quantitative analysis of therapeutic drugs from dried blood spot samples by mass spectrometry. The method, paper spray mass spectrometry, generates gas phase ions directly from the blood card paper used to store dried blood samples without the need for complex sample preparation and separation; the entire time for preparation and analysis of blood samples is around 30 s. Limits of detection were investigated for a chemically diverse set of some 15 therapeutic drugs; hydrophobic and weakly basic drugs, such as sunitinib, citalopram, and verapamil, were found to be routinely detectable at approximately 1 ng/mL. Samples were prepared by addition of the drug to whole blood. Drug concentrations were measured quantitatively over several orders of magnitude, with accuracies within 10% of the expected value and relative standard deviation (RSD) of around 10% by prespotting an internal standard solution onto the paper prior to application of the blood sample. We have demonstrated that paper spray mass spectrometry can be used to quantitatively measure drug concentrations over the entire therapeutic range for a wide variety of drugs. The high quality analytical data obtained indicate that the technique may be a viable option for therapeutic drug monitoring.

  10. [The therapeutic drug monitoring network server of tacrolimus for Chinese renal transplant patients].

    Science.gov (United States)

    Deng, Chen-Hui; Zhang, Guan-Min; Bi, Shan-Shan; Zhou, Tian-Yan; Lu, Wei

    2011-07-01

    This study is to develop a therapeutic drug monitoring (TDM) network server of tacrolimus for Chinese renal transplant patients, which can facilitate doctor to manage patients' information and provide three levels of predictions. Database management system MySQL was employed to build and manage the database of patients and doctors' information, and hypertext mark-up language (HTML) and Java server pages (JSP) technology were employed to construct network server for database management. Based on the population pharmacokinetic model of tacrolimus for Chinese renal transplant patients, above program languages were used to construct the population prediction and subpopulation prediction modules. Based on Bayesian principle and maximization of the posterior probability function, an objective function was established, and minimized by an optimization algorithm to estimate patient's individual pharmacokinetic parameters. It is proved that the network server has the basic functions for database management and three levels of prediction to aid doctor to optimize the regimen of tacrolimus for Chinese renal transplant patients.

  11. Are ECG monitoring recommendations before prescription of QT-prolonging drugs applied in daily practice?

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Rutten, Frans Hendrik; Souverein, Patrick Cyriel

    2015-01-01

    PURPOSE: Monitoring of the QT duration by electrocardiography (ECG) prior to treatment is frequently recommended in the label of QT-prolonging drugs. It is, however, unknown how often general practitioners in daily clinical practice are adhering to these risk-minimization measures. We assessed...... the frequency of ECG measurements in patients where haloperidol was initiated in primary care. METHODS: Patients (≥18 years) with a first prescription of haloperidol in the UK Clinical Practice Research Datalink (2009-2013) were included. The proportion of ECGs made was determined in two blocks of 4 weeks......: during the exposure period when haloperidol was initiated, and during the control period, 1 year before. Conditional logistic regression analysis was applied to calculate the relative risk of having an ECG in the exposure period compared with the control period. Subgroup analyses were performed to assess...

  12. Combined approach with therapeutic drug monitoring and pharmacogenomics in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    S Manvizhi

    2013-01-01

    Full Text Available In patients undergoing renal transplantation, dose individualization for tacrolimus is routinely achieved with therapeutic drug monitoring (TDM. The patient started on 5.5 mg/day of tacrolimus had a significantly elevated tacrolimus trough concentration. The tacrolimus dose was regularly reduced following TDM at many time periods in the post transplant period but the tacrolimus concentration was consistently elevated. Genomic analysis done after four years revealed mutations in the genes encoding for CYP3A5 and MDR1 (2677G > T. Pharmacogenomics alongside TDM, will soon emerge as the backbone of dose individualization. But for genomics to be beneficial, it should be advocated in the pre-transplant or early post transplant period.

  13. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis

    Science.gov (United States)

    Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J. Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

    2014-01-01

    Background The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. Methods We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. Results After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). Interpretation For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern. PMID:25485251

  14. Control, communication and monitoring of intravaginal drug delivery in dairy cows.

    Science.gov (United States)

    Cross, Peter S; Künnemeyer, Rainer; Bunt, Craig R; Carnegie, Dale A; Rathbone, Michael J

    2004-09-10

    We present the design of an electronically controlled drug delivery system. The intravaginally located device is a low-invasive platform that can measure and react inside the cow vagina while providing external control and monitoring ability. The electronics manufactured from off the shelf components occupies 16 mL of a Theratron syringe. A microcontroller reads and logs sensor data and controls a gascell. The generated gas pressure propels the syringe piston and releases the formulation. A two way radio link allows communication between other devices or a base station. Proof of principle experiments confirm variable-rate, arbitrary profile drug delivery qualified by internal sensors. A total volume of 30 mL was dispensed over a 7-day-period with a volume error of +/- 1 mL or +/- 7% for larger volumes. Delivery was controlled or overridden via the wireless link, and proximity to other devices was detected and recorded. The results suggest that temperature and activity sensing or social grouping determined via proximity can be used to detect oestrus and trigger appropriate responses.

  15. Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Garrett DePalma

    2018-02-01

    Full Text Available The opioid epidemic is the most significant modern-day, public health crisis. Physicians and lawmakers have developed methods and practices to curb opioid use. This article describes one method, prescription drug monitoring programs (PDMP, through the lens of how to optimize use for emergency departments (ED. EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. These improvements may help improve clinical decision-making for emergency physicians through better data, data presentation, and accessibility.

  16. Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality.

    Science.gov (United States)

    Phillips, Elyse; Gazmararian, Julie

    To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation. Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation. Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates. Multivariate repeated measures analysis performed with software and services. Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013). When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.

  17. Ambulatory Feedback System

    Science.gov (United States)

    Finger, Herbert; Weeks, Bill

    1985-01-01

    This presentation discusses instrumentation that will be used for a specific event, which we hope will carry on to future events within the Space Shuttle program. The experiment is the Autogenic Feedback Training Experiment (AFTE) scheduled for Spacelab 3, currently scheduled to be launched in November, 1984. The objectives of the AFTE are to determine the effectiveness of autogenic feedback in preventing or reducing space adaptation syndrome (SAS), to monitor and record in-flight data from the crew, to determine if prediction criteria for SAS can be established, and, finally, to develop an ambulatory instrument package to mount the crew throughout the mission. The purpose of the Ambulatory Feedback System (AFS) is to record the responses of the subject during a provocative event in space and provide a real-time feedback display to reinforce the training.

  18. Bioanalysis of tobramycin for therapeutic drug monitoring by solid-phase extraction and capillary zone electrophoresis.

    Science.gov (United States)

    Fonge, Humphrey; Kaale, Eliangiringa; Govaerts, Cindy; Desmet, Koenraad; Van Schepdael, Ann; Hoogmartens, Jos

    2004-10-25

    A method based on solid-phase extraction (SPE) and capillary zone electrophoresis (CZE) for the analysis of tobramycin in human serum is presented. An off-line SPE employing a carboxypropyl bonded phase (CBA) cartridge was used for the extraction of tobramycin from human serum. Adsorbed tobramycin was eluted from the CBA cartridge using a mixture of NH(3) (25%, w/v)-methanol (30:70, v/v). After evaporation, the analyte was reconstituted and derivatized with o-phthaldialdehyde (OPA)/3-mercaptopropionic acid (MPA). The resulting tobramycin-OPA/MPA derivative was purified, and then identified by mass spectrometry. The tobramycin-OPA/MPA derivative was then analysed by CZE with a background electrolyte (BGE) comprising of 30 mM sodium tetraborate pH 10.0-acetonitrile (ACN) (80:20, v/v) with ultraviolet detection at 230 nm. A linear response was observed in the range of 0.3-30 microg/ml with r(2) = 0.992. The sensitivity of the method was determined by its limit of quantitation (LOQ) and limit of detection (LOD) of 0.3 microg/ml and 0.1 microg/ml, respectively. SPE recovery ranged from 68 to 79% at the trough levels to 98% at the peak levels found in serum. Furosemide has been added as internal standard (IS) to improve precision. For the therapeutic range of tobramycin in serum (2-10 microg/ml) the relative standard deviation (R.S.D.) was less than 11% for the entire SPE/CE process. The method demonstrated excellent selectivity as shown by the lack of interference from a total of 20 drugs investigated. The method was then used in therapeutic drug monitoring of patients receiving the drug.

  19. Therapeutic Drug Monitoring of Lacosamide in Norway: Focus on Pharmacokinetic Variability, Efficacy and Tolerability.

    Science.gov (United States)

    Svendsen, Torleiv; Brodtkorb, Eylert; Baftiu, Arton; Burns, Margrete Larsen; Johannessen, Svein I; Johannessen Landmark, Cecilie

    2017-07-01

    Lacosamide (LCM) is a new antiepileptic drug (AED). Experience from therapeutic drug monitoring (TDM) in clinical practice is limited. The purpose of this study is to evaluate the pharmacokinetic variability of LCM in relation to efficacy and tolerability in patients with refractory epilepsy in a real-life setting. Variables included age, gender, daily doses and serum concentrations of LCM and other AEDs from the TDM-database at the National Center for Epilepsy in Norway. Clinical data regarding efficacy and tolerability were collected from medical records. The Norwegian Prescription Database (NorPD) was used to include population-based numbers of users. TDM-data from 344 patients were included. The median dose, serum concentration, and concentration/dose (C/D)-ratio of LCM was 350 (range 25-700) mg/day, 19.7 (range 8.1-56.2) µmol/L, and 0.06 (0.02-0.82) µmol/L/mg, respectively. Serum concentrations were reduced by 28% by concomitant use of enzyme inducers and increased by 30% in patients aged >65 years. Efficacy and tolerability were assessed in 227 patients: 29% had >50% seizure reduction (eight seizure free), 30% had no effect, and 44% reported adverse effects. In Norway, there were on average 500 patients per year using LCM in this period based on NorPD. The study demonstrated pharmacokinetic variability and use of TDM of LCM in Norway. Data were collected from multiple sources for improved pharmacovigilance. Serum concentrations were influenced by enzyme inducers and ageing, indicating the usefulness of TDM. Effect and tolerability were favorable within a suggested reference range of 10-40 µmol/L given drug-fasting conditions.

  20. Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

    Directory of Open Access Journals (Sweden)

    Richard M. Reisman

    2009-01-01

    Full Text Available Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set in 14 states with PDMPs (intervention group and 36 states without PDMPs (control group for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001. PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063. A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785. Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

  1. Therapeutic drug monitoring of caffeine in preterm infants: Could saliva be an alternative to serum?

    Science.gov (United States)

    Chaabane, Amel; Chioukh, Fatma Z; Chadli, Zohra; Ben Fredj, Nadia; Ben Ameur, Karim; Ben Hmida, Hayet; Boughattas, Naceur A; Monastiri, Kamel; Aouam, Karim

    2017-12-01

    Evaluate whether saliva could be a useful alternative to serum for routine therapeutic drug monitoring of caffeine in preterm infants using the enzyme multiplied immunoassay technique (EMIT) assay. We conducted a prospective study including preterm infants (less than 34 weeks' amenorrhea) admitted to the intensive care and neonatal medicine department. All infants received 5, 10, 15, 20 and 25mg/kg/day of citrate caffeine intravenously from the first to the fifth day of birth, respectively. For each patient, two concomitant blood and saliva samples corresponding to the trough concentrations were collected 24hours after each caffeine dose. The caffeine concentrations were determined using the EMIT ® 2000 caffeine assay. Thirteen preterm infants were included. The saliva and the serum caffeine concentration increased proportionally to the administered dose. Saliva and serum kinetics were comparable and the saliva caffeine concentrations were correlated to the serum ones (r 2 =0.76). Saliva caffeine monitoring by EMIT is a valid, useful and safe alternative to serum in preterm infants. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  2. U.S. Food and Drug Administration's dioxin monitoring program

    Energy Technology Data Exchange (ETDEWEB)

    South, P.; S. Kathleen Egan; Troxell, T.; P. Michael Bolger [U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park (United States)

    2004-09-15

    Dioxin-like compounds (DLCs) are a group of environmental contaminants whose primary route of human exposure occurs via the consumption of fatty foods of animal origin. Recent safety risk assessments conducted by national and international organizations broadly agree that risk management actions should be developed to decrease DLC exposure. Since the mid-1990s, the U.S. Food and Drug Administration (FDA) has tested specific foods with the goal of describing and reducing DLC exposure. In 2001, FDA developed a strategy for DLCs (http://vm.cfsan.fda.gov/{proportional_to}lrd/dioxstra.html) and substantially expanded its dioxin monitoring program to obtain more comprehensive data on background levels of DLCs in specific food and feed samples as well as to identify and reduce pathways of DLC contamination. FDA's dioxin monitoring program analyzes food collected under its Total Diet Study (TDS) and food and feed from targeted sampling. The TDS is FDA's ongoing market basket survey of approximately 280 core foods in the U.S. food supply. FDA targeted sampling collects and analyzes foods suspected of having both higher DLC levels and more variability in those levels than other foods. The contribution of dietary DLCs to overall exposure and the possible introduction of DLCs in animalbased food via the use of particular feed components was recently identified by the National Academy of Sciences Committee on the Implications of Dioxin in the Food Supply and confirmed FDA's approach articulated in its dioxin strategy.

  3. Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone

    Directory of Open Access Journals (Sweden)

    Hodges Mary H

    2012-10-01

    Full Text Available Abstract Background Since 2007 Sierra Leone has conducted mass drug administration (MDA for the elimination of lymphatic filariasis (LF implemented by unpaid community health volunteers (CHVs. Other health campaigns such as Mother and Child Health Weeks (MCHW pay for services to be implemented at community level and these persons are then known as community health workers (CHWs. In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR in both urban and rural locations where vulnerable populations reside. Methods Independent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments. Results Only one town had reached effective program coverage (≥80% after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65% was reported in all districts and overall was significantly higher in males versus

  4. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

    OpenAIRE

    Islam, M Mofizul; McRae, Ian S

    2014-01-01

    Background In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriat...

  5. The drug situation in Europe: an overview of data available on illicit drugs and new psychoactive substances from European monitoring in 2015.

    Science.gov (United States)

    Mounteney, Jane; Griffiths, Paul; Sedefov, Roumen; Noor, Andre; Vicente, Julián; Simon, Roland

    2016-01-01

    A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of

  6. Formativ Feedback

    DEFF Research Database (Denmark)

    Hyldahl, Kirsten Kofod

    Denne bog undersøger, hvordan lærere kan anvende feedback til at forbedre undervisningen i klasselokalet. I denne sammenhæng har John Hattie, professor ved Melbourne Universitet, udviklet en model for feedback, hvilken er baseret på synteser af meta-analyser. I 2009 udgav han bogen "Visible...

  7. Drug Safety

    Science.gov (United States)

    ... over-the-counter drug. The FDA evaluates the safety of a drug by looking at Side effects ... clinical trials The FDA also monitors a drug's safety after approval. For you, drug safety means buying ...

  8. Role of therapeutic drug monitoring in pulmonary infections : use and potential for expanded use of dried blood spot samples

    NARCIS (Netherlands)

    Hofman, Susan; Bolhuis, Mathieu S.; Koster, Remco A.; Akkerman, Onno W.; van Assen, Sander; Stove, Christophe; Alffenaar, Jan-Willem C.

    Respiratory tract infections are among the most common infections in men. We reviewed literature to document their pharmacological treatments, and the extent to which therapeutic drug monitoring (TDM) is needed during treatment. We subsequently examined potential use of dried blood spots as sample

  9. Validation of limited sampling models (LSM) for estimating AUC in therapeutic drug monitoring - is a separate validation group required?

    NARCIS (Netherlands)

    Proost, J. H.

    Objective: Limited sampling models (LSM) for estimating AUC in therapeutic drug monitoring are usually validated in a separate group of patients, according to published guidelines. The aim of this study is to evaluate the validation of LSM by comparing independent validation with cross-validation

  10. Performance evaluation of enzyme immunoassay for voriconazole therapeutic drug monitoring with automated clinical chemistry analyzers.

    Science.gov (United States)

    Jeon, Yongbum; Han, Minje; Han, Eun Young; Lee, Kyunghoon; Song, Junghan; Song, Sang Hoon

    2017-08-01

    Voriconazole is a triazole antifungal developed for the treatment of fungal infectious disease, and the clinical utility of its therapeutic drug monitoring has been evaluated. Recently, a new assay for analyzing the serum voriconazole concentration with an automated clinical chemistry analyzer was developed. We evaluated the performance of the new assay based on standardized protocols. The analytical performance of the assay was evaluated according to its precision, trueness by recovery, limit of quantitation, linearity, and correlation with results from liquid chromatography-tandem mass spectrometry (LC-MS/MS). The evaluation was performed with the same protocol on two different routine chemistry analyzers. All evaluations were performed according to CLSI Guidelines EP15, EP17, EP6, and EP9 [1-4]. Coefficients of variation for within-run and between-day imprecision were 3.2-5.1% and 1.5-3.0%, respectively, on the two different analyzers for pooled serum samples. The recovery rates were in the range of 95.4-102.2%. The limit of blank was 0.0049 μg/mL, and the limit of detection of the samples was 0.0266-0.0376 μg/mL. The percent recovery at three LoQ levels were 67.9-74.6% for 0.50 μg/mL, 75.5-80.2% for 0.60 μg/mL, and 89.9-96.6% for 0.70 μg/mL. A linear relationship was demonstrated between 0.5 μg/mL and 16.0 μg/mL ( R 2 =0.9995-0.9998). The assay correlated well with LC-MS/MS results ( R 2 =0.9739-0.9828). The assay showed acceptable precision, trueness, linearity, and limit of quantification, and correlated well with LC-MS/MS. Therefore, its analytical performance is satisfactory for monitoring the drug concentration of voriconazole.

  11. Benchmarking therapeutic drug monitoring software: a review of available computer tools.

    Science.gov (United States)

    Fuchs, Aline; Csajka, Chantal; Thoma, Yann; Buclin, Thierry; Widmer, Nicolas

    2013-01-01

    Therapeutic drug monitoring (TDM) aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic and clinical capabilities. Bayesian calculations currently represent the gold standard TDM approach but require computation assistance. In recent decades computer programs have been developed to assist clinicians in this assignment. The aim of this survey was to assess and compare computer tools designed to support TDM clinical activities. The literature and the Internet were searched to identify software. All programs were tested on personal computers. Each program was scored against a standardized grid covering pharmacokinetic relevance, user friendliness, computing aspects, interfacing and storage. A weighting factor was applied to each criterion of the grid to account for its relative importance. To assess the robustness of the software, six representative clinical vignettes were processed through each of them. Altogether, 12 software tools were identified, tested and ranked, representing a comprehensive review of the available software. Numbers of drugs handled by the software vary widely (from two to 180), and eight programs offer users the possibility of adding new drug models based on population pharmacokinetic analyses. Bayesian computation to predict dosage adaptation from blood concentration (a posteriori adjustment) is performed by ten tools, while nine are also able to propose a priori dosage regimens, based only on individual patient covariates such as age, sex and bodyweight. Among those applying Bayesian calculation, MM-USC*PACK© uses the non-parametric approach. The top two programs emerging from this benchmark were MwPharm© and TCIWorks. Most other programs evaluated had good potential while being less sophisticated or less user friendly. Programs vary in complexity and might not fit all healthcare

  12. All about the money – External performance monitoring is affected by monetary, but not by socially conveyed feedback cues in more antisocial individuals

    Directory of Open Access Journals (Sweden)

    Daniela Melitta Pfabigan

    2011-09-01

    Full Text Available This study investigated the relationship between feedback processing and antisocial personality traits measured by the PSSI questionnaire (Kuhl & Kazén, 1997 in a healthy undergraduate sample. While event-related potentials (Feedback Related Negativity [FRN], P300 were recorded, participants encountered expected and unexpected feedback during a gambling task. As recent findings suggest learning problems and deficiencies during feedback processing in clinical populations of antisocial individuals, we performed two experiments with different healthy participants in which feedback about monetary gains or losses consisted either of social-emotional (facial emotion displays or non-social cues (numerical stimuli. Since the FRN and P300 are both sensitive to different aspects of feedback processing we hypothesized that they might help to differentiate between individuals scoring high and low on an antisocial trait measure.In line with previous evidence FRN amplitudes were enhanced after negative and after unexpected feedback stimuli. Crucially, participants scoring high on antisocial traits displayed larger FRN amplitudes than those scoring low only in response to expected and unexpected negative numerical feedback, but not in response to social-emotional feedback - irrespective of expectancy. P300 amplitudes were not modulated by antisocial traits at all, but by subjective reward probabilities. The present findings indicate that individuals scoring high on antisociality attribute higher motivational salience to monetary compared to emotional-social feedback which is reflected in FRN amplitude enhancement. Contrary to recent findings, however, no processing deficiencies concerning social-emotional feedback stimuli were apparent in those individuals. This indicates that stimulus salience is an important aspect in learning and feedback processes in individuals with antisocial traits which has potential implications for therapeutic interventions in

  13. Feedback Networks

    OpenAIRE

    Zamir, Amir R.; Wu, Te-Lin; Sun, Lin; Shen, William; Malik, Jitendra; Savarese, Silvio

    2016-01-01

    Currently, the most successful learning models in computer vision are based on learning successive representations followed by a decision layer. This is usually actualized through feedforward multilayer neural networks, e.g. ConvNets, where each layer forms one of such successive representations. However, an alternative that can achieve the same goal is a feedback based approach in which the representation is formed in an iterative manner based on a feedback received from previous iteration's...

  14. Multifunctional nanomedicine with silica: Role of silica in nanoparticles for theranostic, imaging, and drug monitoring.

    Science.gov (United States)

    Chen, Fang; Hableel, Ghanim; Zhao, Eric Ruike; Jokerst, Jesse V

    2018-07-01

    The idea of multifunctional nanomedicine that enters the human body to diagnose and treat disease without major surgery is a long-standing dream of nanomaterials scientists. Nanomaterials show incredible properties that are not found in bulk materials, but achieving multi-functionality on a single material remains challenging. Integrating several types of materials at the nano-scale is critical to the success of multifunctional nanomedicine device. Here, we describe the advantages of silica nanoparticles as a tool for multifunctional nano-devices. Silica nanoparticles have been intensively studied in drug delivery due to their biocompatibility, degradability, tunable morphology, and ease of modification. Moreover, silica nanoparticles can be integrated with other materials to obtain more features and achieve theranostic capabilities and multimodality for imaging applications. In this review, we will first compare the properties of silica nanoparticles with other well-known nanomaterials for bio-applications and describe typical routes to synthesize and integrate silica nanoparticles. We will then highlight theranostic and multimodal imaging application that use silica-based nanoparticles with a particular interest in real-time monitoring of therapeutic molecules. Finally, we will present the challenges and perspective on future work with silica-based nanoparticles in medicine. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Prescription Drug Monitoring Programs and Pharmacist Orientation Toward Dispensing Controlled Substances.

    Science.gov (United States)

    Fendrich, Michael; Bryan, Janelle K; Hooyer, Katinka

    2018-01-03

    We sought to understand how pharmacists viewed and used a newly implemented prescription drug monitoring program (PDMP). We also sought to understand pharmacist orientation toward dispensing of controlled substances and the people who obtain them. We conducted three mini focus groups. The focus group findings were used to inform the design of a structured survey. We emailed a survey to 160 pharmacists who were employed in one statewide community chain store; we obtained 48 survey responses. Focus groups findings suggested that, in relation to the dispensing of scheduled prescription medication, pharmacists were either "healthcare" oriented, "law-enforcement" oriented, or an orientation that combined these two perspectives. Surveys suggested that pharmacists found PDMPs easy to use and that they used them frequently - often to contact physicians directly. Surveys suggested that pharmacists were typically either "healthcare" oriented or "mixed" (combined perspectives). Pharmacist orientation was associated with the frequency with which they counseled patients about medication risk and the frequency with which they used the PDMP as the basis for contacting prescribers. Ongoing tracking of pharmacists' use of PDMPs is important both at the implementation stage and as PDMPs develop over time. The orientation construct developed here is useful in understanding pharmacist behavior and attitudes towards patients potentially at risk for misuse of controlled substance medications. Further research on this construct could shed light on barriers and incentives for pharmacist PDMP participation and use and provide guidance for pharmacist training, ultimately enhancing patient care.

  16. Impact of antiepileptic drugs on bone health: Need for monitoring, treatment, and prevention strategies

    Directory of Open Access Journals (Sweden)

    Ekta Arora

    2016-01-01

    Full Text Available Epilepsy is the most common neurological disorder affecting approximately 50 million people worldwide. In India, overall prevalence of epilepsy is reported to be 5.59/1000 population. Antiepileptic drugs (AEDs constitute the main-stay of treatment with a large number of AEDs available in the market. High incidence of adverse effects is a major limitation with AEDs. One of the major concerns is significant metabolic effects on the bone. However, little attention has been paid to this issue because most of the bone effects remain subclinical for a long time and may take years to manifest clinically. The main effects include hypocalcemia, hypophosphatemia, reduced serum levels of Vitamin D, increase in parathormone (PTH levels, and alterations in bone turnover markers. The CYP450 enzyme-inducing AEDs such as phenytoin, phenobarbital, carbamazepine, and primidone are the most common AEDs associated with bone disorders while the data regarding the effect of valproate and newer AEDs such as lamotrigine, gabapentin, vigabatrin, levetiracetam, and topiramate on bone metabolism and bone density are scanty and controversial. Deficiency of Vitamin D is commonly described as a cause for the bone loss in epileptic patients while others being decreased absorption of calcium, increased PTH levels, and inhibition of calcitonin secretion, etc. However, there are no formal practical guidelines for the management of bone disease among those taking AEDs. Evidence-based strategies regarding monitoring, prevention, and treatment of bone diseases in patients on AED therapy are needed.

  17. Therapeutic drug monitoring of flucytosine in serum using a SERS-active membrane system

    Science.gov (United States)

    Berger, Adam G.; White, Ian M.

    2017-02-01

    A need exists for near real-time therapeutic drug monitoring (TDM), in particular for antibiotics and antifungals in patient samples at the point-of-care. To truly fit the point-of-care need, techniques must be rapid and easy to use. Here we report a membrane system utilizing inkjet-fabricated surface enhanced Raman spectroscopy (SERS) sensors that allows sensitive and specific analysis despite the elimination of sophisticated chromatography equipment, expensive analytical instruments, and other systems relegated to the central lab. We utilize inkjet-fabricated paper SERS sensors as substrates for 5FC detection; the use of paper-based SERS substrates leverages the natural wicking ability and filtering properties of microporous membranes. We investigate the use of microporous membranes in the vertical flow assay to allow separation of the flucytosine from whole blood. The passive vertical flow assay serves as a valuable method for physical separation of target analytes from complex biological matrices. This work further establishes a platform for easy, sensitive, and specific TDM of 5FC from whole blood.

  18. Responding to the challenge of antimalarial drug resistance by routine monitoring to update national malaria treatment policies

    DEFF Research Database (Denmark)

    Vestergaard, Lasse S; Ringwald, Pascal

    2007-01-01

    of rational and updated malaria treatment policies, but defining and updating such policies requires a sufficient volume of high-quality drug-resistance data collected at national and regional levels. Three main tools are used for drug resistance monitoring, including therapeutic efficacy tests, in vitro...... additional information about changing patterns of resistance. However, some of the tests are technically demanding, and thus there is a need for more resources for training and capacity building in endemic countries to be able to adequately respond to the challenge of drug resistance.......Reduced sensitivity of Plasmodium falciparum to formerly recommended cheap and well-known antimalarial drugs places an increasing burden on malaria control programs and national health systems in endemic countries. The high costs of the new artemisinin-based combination treatments underline the use...

  19. A novel high throughput assay for anthelmintic drug screening and resistance diagnosis by real-time monitoring of parasite motility.

    Directory of Open Access Journals (Sweden)

    Michael J Smout

    Full Text Available BACKGROUND: Helminth parasites cause untold morbidity and mortality to billions of people and livestock. Anthelmintic drugs are available but resistance is a problem in livestock parasites, and is a looming threat for human helminths. Testing the efficacy of available anthelmintic drugs and development of new drugs is hindered by the lack of objective high-throughput screening methods. Currently, drug effect is assessed by observing motility or development of parasites using laborious, subjective, low-throughput methods. METHODOLOGY/PRINCIPAL FINDINGS: Here we describe a novel application for a real-time cell monitoring device (xCELLigence that can simply and objectively assess anthelmintic effects by measuring parasite motility in real time in a fully automated high-throughput fashion. We quantitatively assessed motility and determined real time IC(50 values of different anthelmintic drugs against several developmental stages of major helminth pathogens of humans and livestock, including larval Haemonchus contortus and Strongyloides ratti, and adult hookworms and blood flukes. The assay enabled quantification of the onset of egg hatching in real time, and the impact of drugs on hatch rate, as well as discriminating between the effects of drugs on motility of drug-susceptible and -resistant isolates of H. contortus. CONCLUSIONS/SIGNIFICANCE: Our findings indicate that this technique will be suitable for discovery and development of new anthelmintic drugs as well as for detection of phenotypic resistance to existing drugs for the majority of helminths and other pathogens where motility is a measure of pathogen viability. The method is also amenable to use for other purposes where motility is assessed, such as gene silencing or antibody-mediated killing.

  20. Real-time Monitoring of Sustained Drug Release using the Optical Properties of Porous Silicon Photonic Crystal Particles

    Science.gov (United States)

    Wu, E.C.; Andrew, J.S.; Cheng, L; Freeman, W.R.; Pearson, L; Sailor, M.J.

    2011-01-01

    A controlled and observable drug delivery system that enables long-term local drug administration is reported. Biodegradable and biocompatible drug-loaded porous Si microparticles were prepared from silicon wafers, resulting in a porous 1-dimensional photonic crystal (rugate filter) approx. 12 micrometers thick and 35 micrometers across. An organic linker, 1-undecylenic acid, was attached to the Si-H terminated inner surface of the particles by hydrosilylation and the anthracycline drug daunorubicin was bound to the carboxy terminus of the linker. Degradation of the porous Si matrix in vitro was found to release the drug in a linear and sustained fashion for 30 d. The bioactivity of the released daunorubicin was verified on retinal pigment epithelial (RPE) cells. The degradation/drug delivery process was monitored in situ by digital imaging or spectroscopic measurement of the photonic resonance reflected from the nanostructured particles, and a simple linear correlation between observed wavelength and drug release was observed. Changes in the optical reflectance spectrum were sufficiently large to be visible as a distinctive red to green color change. PMID:21122914

  1. Urine colorimetry for therapeutic drug monitoring of pyrazinamide during tuberculosis treatment.

    Science.gov (United States)

    Zentner, Isaac; Modongo, Chawangwa; Zetola, Nicola M; Pasipanodya, Jotam G; Srivastava, Shashikant; Heysell, Scott K; Mpagama, Stellah; Schlect, Hans P; Gumbo, Tawanda; Bisson, Gregory P; Vinnard, Christopher

    2018-03-01

    Pyrazinamide is a key drug in the first-line treatment regimen for tuberculosis, with a potent sterilizing effect. Although low pyrazinamide peak serum concentrations (C max ) are associated with poor treatment outcomes, many resource-constrained settings do not have sufficient laboratory capacity to support therapeutic drug monitoring (TDM). The objective of this study was to determine whether a colorimetric test of urine can identify tuberculosis patients with adequate pyrazinamide exposures, as defined by serum C max above a target threshold. In the derivation study of healthy volunteers, three dose sizes of pyrazinamide were evaluated, and intensive pharmacokinetic blood sampling was performed over an 8-h period, with a timed urine void at 4h post-dosing. Pyrazinamide in urine was isolated by spin column centrifugation with an exchange resin, followed by colorimetric analysis; the absorbance peak at 495nm was measured. The urine assay was then evaluated in a study of 39 HIV/tuberculosis patients in Botswana enrolled in an intensive pharmacokinetic study. Receiver operating characteristics (ROC) curves were used to measure diagnostic accuracy. The guideline-recommended pyrazinamide serum C max target of 35mg/l was evaluated in the primary analysis; this target was found to be predictive of favorable outcomes in a clinical study. Following this, a higher serum C max target of 58mg/l was evaluated in the secondary analysis. At the optimal cut-off identified in the derivation sample, the urine colorimetric assay was 97% sensitive and 50% specific to identify 35 of 39 HIV/tuberculosis patients with pharmacokinetic target attainment, with an area under the ROC curve of 0.81 (95% confidence interval 0.60-0.97). Diagnostic accuracy was lower at the 58mg/l serum C max target, with an area under the ROC curve of 0.68 (95% confidence interval 0.48-0.84). Men were less likely than women to attain either serum pharmacokinetic target. The urine colorimetric assay was

  2. A simple dried blood spot method for therapeutic drug monitoring of the tricyclic antidepressants amitriptyline, nortriptyline, imipramine, clomipramine, and their active metabolites using LC-MS/MS

    NARCIS (Netherlands)

    Berm, E. J. J.; Paardekooper, J.; Brummel-Mulder, E.; Hak, E.; Wilffert, B.; Maring, J. G.

    2015-01-01

    Therapeutic drug monitoring (TOM) of tricyclic antidepressants (TCAs) is considered useful in patients with major depressive disorder, since these drugs display large individual differences in clearance, and the therapeutic windows of these drugs are relatively small. We developed an assay for

  3. Drug companies monitor prescriptions and sales to fine-tune their marketing strategies.

    Science.gov (United States)

    2010-06-01

    Market research companies analyse drug prescriptions and sales in community and hospital pharmacies, thus enabling drug companies to refine their marketing strategies. Some information of interest to drug companies is provided directly by healthcare professionals, sometimes unwittingly, and sometimes in return for small "favours".

  4. Enantioselective assay for therapeutic drug monitoring of eslicarbazepine acetate: no interference with carbamazepine and its metabolites.

    Science.gov (United States)

    Alves, Gilberto; Fortuna, Ana; Sousa, Joana; Direito, Rosa; Almeida, Anabela; Rocha, Marília; Falcão, Amílcar; Soares-da-Silva, Patrício

    2010-08-01

    As add-on therapy, phase III clinical trials of eslicarbazepine acetate (ESL) conducted in patients with refractory partial-onset seizures have shown good efficacy, safety, and tolerability, even in patients taking carbamazepine (CBZ) at baseline (approximately 60% of the enrolled patients). Thus, considering the pharmacological disadvantages of CBZ and the similar efficacy spectrum of CBZ and ESL, switching to ESL may be successful in many patients. As ESL is a prodrug almost instantaneously converted to S-licarbazepine (S-Lic; approximately 95%), an interest in therapeutic drug monitoring (TDM) of S-Lic is likely to develop in the future. This study investigated the plasma concentrations of S-Lic and R-licarbazepine (R-Lic) enantiomers in patients under CBZ long-term treatment to assess the potential interference of CBZ or its metabolites in the enantioselective TDM of ESL (using S-Lic concentrations). A chiral high-performance liquid chromatography assay with ultraviolet detection (HPLC-UV) previously developed and validated by our research group was used. Twenty-four patients admitted to the Coimbra University Hospital and supposedly receiving CBZ long-term treatment were identified. Blood samples were collected from patients and serum CBZ concentrations were measured by the usual TDM protocol. Aliquots of plasma from such patients were also submitted to a chiral HPLC-UV analysis. The bioanalytical data indicated that S-Lic and R-Lic were not present at detectable concentrations in plasma samples of the CBZ-treated patients. The chromatograms generated by the analysis of patient plasma samples, when compared with those obtained from blank plasma samples spiked with S-Lic and R-Lic, clearly showed the absence of interferences at the retention times of both Lic enantiomers. These data support the usefulness of the chiral HPLC-UV method used for the enantioselective TDM of ESL (using S-Lic) for programs in which switching from CBZ to ESL is implemented.

  5. Clinical usefulness of therapeutic drug monitoring of voriconazole in a university hospital.

    Science.gov (United States)

    Cabral-Galeano, Evelyn; Ruiz-Camps, Isabel; Len-Abad, Oscar; Pou-Clavé, Leonor; Sordé-Masip, Roger; Meije-Castillo, Yolanda; Blanco-Grau, Albert; Barba-Suñol, Pere; Monforte-Torres, Victor; Román-Broto, Antonio; Pahissa-Berga, Albert; Gavaldà-Santapau, Joan

    2015-05-01

    The aim of this study was to assess the clinical usefulness of therapeutic drug monitoring (TDM) of voriconazole (VOR) in a university hospital. A retrospective review was conducted on the clinical records of 52 patients treated with VOR and on whom TDM was performed. Steady-state trough plasma VOR concentration was measured at least 5 days after starting treatment. The therapeutic range of plasma VOR concentration was defined as 1-5.5μg/mL. The most frequent underlying conditions in the study population were lung transplant (48.1%) and hematological malignancies (26.9%). At the first TDM in each patient, VOR levels were outside the therapeutic range in 16 (30.7%) cases: 5.5μg/mL in 6 (11.5%). Eleven patients (21.2%) experienced severe muscle weakness and had considerable difficulty walking. All these patients were receiving concomitant treatment with corticosteroids. Age younger than 30 years (p=.005) and cystic fibrosis as the underlying disease (p=.04) were factors associated with low VOR levels. Almost all patients who had VOR concentrations >1μg/mL at the first TDM had a successful outcome (96%). Plasma VOR concentrations were outside the therapeutic range at the first TDM in 30% (16/52) of patients. Age younger than 30 years and cystic fibrosis were factors associated with low VOR levels. The potential interactions between corticosteroids and VOR should be highlighted, as they could be responsible for a high rate of muscle weakness observed in our patients. Prospective trials are needed to investigate VOR TDM and corticosteroid pharmacokinetics. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  6. Energy drink consumption and the perceived risk and disapproval of drugs: Monitoring the Future, 2010-2016.

    Science.gov (United States)

    Jackson, Dylan B; Leal, Wanda E

    2018-07-01

    Energy drinks have become quite popular in recent years among adolescents, prompting a wealth of recent research examining the potential deleterious consequences of energy drink consumption among youth. The present study adds to this body of work by exploring perceptions of risk and disapproval of soft and hard drugs among adolescents and whether such attitudes are predicted by patterns of energy drink/shot consumption. Data were derived from the seven most recent cohorts (2010-2016) of the Monitoring the Future (MTF) study, a nationally representative survey of U.S. youth. The significance of associations between energy drink/shot consumption and drug perceptions/attitudes was tested using logistic regression techniques employing adjustments for covariates and cohort-specific fixed effects. Energy drink/shot consumption was largely associated with significant increases in the odds of failing to perceive any risk of drug use and failing to disapprove of drug use among youths, regardless of whether attitudes concerning soft or hard drugs were examined. These associations were particularly robust in the case of habitual energy drink/shot consumers (relative to occasional consumers or abstainers). Additional efforts should be made to heighten awareness and education concerning the potential dangers of energy drink consumption among youth, particularly as it pertains to drug attitudes and diminished perceptions of substance use risk. Policies that minimize energy drink consumption among youth as well as programs that educate parents and teachers about the drug attitudes of youths who regularly consume energy drinks and promote active monitoring of these adolescents may be worthwhile. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. An introduction to predictive modelling of drug concentration in anaesthesia monitors.

    Science.gov (United States)

    DeCou, J; Johnson, K

    2017-01-01

    A significant amount of anaesthetists' work involves the prediction of drug effects and interactions to produce a smooth general anaesthetic that minimises drug side effects and promotes rapid emergence. Successfully managing this process requires a basic understanding of drug effects, experience and inevitably some guesswork, since it is difficult (and in some cases impossible) to anticipate all relevant patient and surgical factors. Although data are generally available to allow calculation of plasma drug and effect site concentrations, this is often difficult to apply in complex clinical contexts, particularly when multiple drug types are used. In recent years, manufacturers have developed and incorporated into anaesthetic workstations technologies that use drug pharmacodynamic and pharmacokinetic data to predict drug effects and interactions. Such systems can predict the duration and effects of drugs during anaesthesia and assist the anaesthetist to understand complex drug interactions. With this information available, different drug types, doses and combinations may be tailored in a scientific way to maximise useful effects whilst minimising overdose and side-effects, particularly in high-risk patients. Examples are used to illustrate how such systems can be used in practice, and how drug effects and interactions can be simulated to "rehearse" an anaesthetic before any drugs are actually administered. At present only a small number of anaesthetic workstations use this technology, and as yet they are not able to manage all drugs used in anaesthetic practice. However, such systems have the potential to help anaesthetists manage the complexity of their work, and to provide information on predicted drug effects in a way that is useful and relevant to both experienced anaesthetists and trainees. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  8. The importance of monitoring adverse drug reactions in pediatric patients: the results of a national surveillance program in Italy.

    Science.gov (United States)

    Carnovale, Carla; Brusadelli, Tatiana; Zuccotti, GianVincenzo; Beretta, Silvia; Sullo, Maria Giuseppa; Capuano, Annalisa; Rossi, Francesco; Moschini, Martina; Mugelli, Alessandro; Vannacci, Alfredo; Laterza, Marcella; Clementi, Emilio; Radice, Sonia

    2014-09-01

    To gain information on safety of drugs used in pediatrics through a 4-year post-marketing active pharmacovigilance program. The program sampled the Italian population and was termed 'Monitoring of the Adverse Effects in Pediatric population' (MEAP). Adverse drug reactions (ADRs) were collected for individuals aged 0 - 17 years treated in hospitals and territorial health services in Lombardy, Tuscany, Apulia and Campania; located to gain an appropriate sampling of the population. ADRs were evaluated using the Adverse Drug Reaction Probability Scale (Naranjo) and analyzed with respect to time, age, sex, category of ADR, seriousness, suspected medicines, type of reporter and off-label use. We collected and analyzed reports from 3539 ADRs. Vaccines, antineoplastic and psychotropic drugs were the most frequently pharmacotherapeutic subgroups involved. Seventeen percent of reported ADRs were serious; of them fever, vomiting and angioedema were the most frequently reported. Eight percent of ADRs were associated with off-label use, and 10% were unknown ADRs. Analysis of these revealed possible strategies of therapy optimization. The MEAP project demonstrated that active post-marketing pharmacovigilance programs are a valid strategy to increase awareness on pediatric pharmacology, reduce underreporting and provide information on drug actions in pediatrics. This information enhances drug therapy optimization in the pediatric patients.

  9. The use of liquid chromatography-tandem mass spectrometry for therapeutic drug monitoring of antibiotics in cancer patients.

    Science.gov (United States)

    El-Najjar, Nahed; Jantsch, Jonathan; Gessner, André

    2017-08-28

    Cancer remains a leading cause of mortality and morbidity worldwide. In addition to organ failure, the most frequent reasons for admission of cancer patients to intensive care units (ICU) are: infections and sepsis. As critically ill, the complexity of the health situation of cancer patients renders the standard antimicrobial regimen more complex and even inadequate which results in increased mortality rates. This is due to pathophysiological changes in the volume of distribution, increased clearance, as well as to organ dysfunction. While in the former cases a decrease in drug efficacy is observed, the hallmark of the latter one is overdosing leading to increased toxicity at the expense of efficacy. Furthermore, an additional risk factor is the potential drug-drug interaction between antibiotics and antineoplastic agents. Therefore, therapeutic drug monitoring (TDM) is a necessity to improve the clinical outcome of antimicrobial therapy in cancer patients. To be applied in routine analysis the method used for TDM should be cheap, fast and highly accurate/sensitive. Furthermore, as ICU patients are treated with a cocktail of antibiotics the method has to cover the simultaneous analysis of antibiotics used as a first/second line of treatment. The aim of the current review is to briefly survey the pitfalls in the current antimicrobial therapy and the central role of TDM in dose adjustment and drug-drug interaction's evaluation. A major section is dedicated to summarize the currently published analytical methods and to shed light on the difficulties and potential problems that can be encountered during method development.

  10. Successful treatment of methicillin-resistant Staphylococcus aureus osteomyelitis with combination therapy using linezolid and rifampicin under therapeutic drug monitoring.

    Science.gov (United States)

    Ashizawa, Nobuyuki; Tsuji, Yasuhiro; Kawago, Koyomi; Higashi, Yoshitsugu; Tashiro, Masato; Nogami, Makiko; Gejo, Ryuichi; Narukawa, Munetoshi; Kimura, Tomoatsu; Yamamoto, Yoshihiro

    2016-05-01

    Linezolid is an effective antibiotic against most gram-positive bacteria including drug-resistant strains such as methicillin-resistant Staphylococcus aureus. Although linezolid therapy is known to result in thrombocytopenia, dosage adjustment or therapeutic drug monitoring of linezolid is not generally necessary. In this report, however, we describe the case of a 79-year-old woman with recurrent methicillin-resistant S. aureus osteomyelitis that was successfully treated via surgery and combination therapy using linezolid and rifampicin under therapeutic drug monitoring for maintaining an appropriate serum linezolid concentration. The patient underwent surgery for the removal of the artificial left knee joint and placement of vancomycin-impregnated bone cement beads against methicillin-resistant S. aureus after total left knee implant arthroplasty for osteoarthritis. We also initiated linezolid administration at a conventional dose of 600 mg/h at 12-h intervals, but reduced it to 300 mg/h at 12-h intervals on day 9 because of a decrease in platelet count and an increase in serum linezolid trough concentration. However, when the infection exacerbated, we again increased the linezolid dose to 600 mg/h at 12-h intervals and performed combination therapy with rifampicin, considering their synergistic effects and the control of serum linezolid trough concentration via drug interaction. Methicillin-resistant S. aureus infection improved without reducing the dose of or discontinuing linezolid. The findings in the present case suggest that therapeutic drug monitoring could be useful for ensuring the therapeutic efficacy and safety of combination therapy even in patients with osteomyelitis who require long-term antibiotic administration. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  11. Phototoxicity free quantum dot-based niosome formulation for controlled drug release and its monitoring

    Science.gov (United States)

    Kumar, Sunil; Kang, T. W.; Bala, Suman; Kamboj, Sunil; Jeon, H. C.

    2018-04-01

    A novel niosomes-based system composed of Hypromellose (HPMC) functionalized fluorescent, biocompatible ZnS:Mn quantum dots (QDs), and anti-HIV drug Tenofovir disoproxil fumarate (TDF) was designed. An appropriate ratio of surfactant Sorbitan Monostearate (SPAN-60) and cholesterol was used to obtain an optimal entrapment efficiency. Initially, after observing the successful interaction of HPMC with SPAN-60, the noisome formulation including (QDs + drug) and HPMC-coated QDs was synthesized by a wet chemical route and characterized by X-ray diffraction (XRD), Transmission electron microscope (TEM) and Selected Electron Diffraction (SAED). Secondly, (QDs + drug) loaded niosome formulations were studied by varying the ratio of SPAN-60 and cholesterol. Multiple studies were done to characterize the shape, size, viscosity, colloidal stability, and entrapment efficiency of (QDs + drug) loaded niosomes. Lastly, pH-dependent (QDs + drug) release profiles were studied by a spectroscopic technique considering the pH of the human gastrointestinal region to obtain the formulation stability of (QDs + drug) release from the niosome vesicles. These studies also include pH-dependent photo-stability measurements based on laser-induced multiphoton excitation technique in the Infrared region. The multiphoton time-resolved studies were completed to avoid the UV induced phototoxicity in the drug delivery modules. Current studies on the formulation of niosomes-based (QDs + drug) system laid a foundation to make a complete phototoxicity free system for tracking controlled drug release and its imaging.

  12. Incorporating therapeutic drug monitoring into the World Health Organization hierarchy of tuberculosis diagnostics

    NARCIS (Netherlands)

    Ghimire, Samiksha; Bolhuis, Mathieu S; Sturkenboom, Marieke G G; Akkerman, Onno W; de Lange, Wiel C M; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    Tuberculosis (TB), once considered as a disease of the past generally afflicting poor people, still claims 1.5 million lives annually [1]. Although 86% of patients with drug susceptible TB are cured with established first-line drugs, treatment is often longer than 6 months due to slow response,

  13. Drug Safety Monitoring in Children: Performance of Signal Detection Algorithms and Impact of Age Stratification

    NARCIS (Netherlands)

    O.U. Osokogu (Osemeke); C. Dodd (Caitlin); A.C. Pacurariu (Alexandra C.); F. Kaguelidou (Florentia); D.M. Weibel (Daniel); M.C.J.M. Sturkenboom (Miriam)

    2016-01-01

    textabstractIntroduction: Spontaneous reports of suspected adverse drug reactions (ADRs) can be analyzed to yield additional drug safety evidence for the pediatric population. Signal detection algorithms (SDAs) are required for these analyses; however, the performance of SDAs in the pediatric

  14. Consensus report on therapeutic drug monitoring of mycophenolic acid in solid organ transplantation

    NARCIS (Netherlands)

    D. Kuypers (Dirk); Y. le Meur (Yann); M. Cantarovich (Marcelo); M.J. Tredger (Michael); S.E. Tett (Susan); D. Cattaneo (Dario); B. Tönshoff (Burkhard); D.W. Holt (David); J. Chapman (Jeremy); T. van Gelder (Teun)

    2010-01-01

    textabstractWith the increasing use of mycophenolic acid (MPA) in solid organ transplantation, the need for more accurate drug dosing has become evident. Personalized immunosuppressive therapy requires better strategies for avoidance of drug-related toxicity while maintaining efficacy. Few studies

  15. Role of laboratory biomarkers in monitoring and prediction of the effectiveness of treatment of rheumatic diseases using genetically engineered drugs

    Directory of Open Access Journals (Sweden)

    Elena Nikolayevna Aleksandrova

    2014-03-01

    Full Text Available Significant progress in treating immunoinflammatory rheumatic diseases (RD is related to the design of a novel family of drugs, genetically engineered (GE drugs. Molecular and cellular biomarkers (antibodies, indicators of acute inflammation, cytokines, chemokines, growth factors, endothelial activation markers, immunoglobulins, cryoglobulins, T- and B-cell subpopulations, products of bone and cartilage metabolism, genetic and metabolic markers that allow one to conduct immunological monitoring and prediction of the effectiveness of RD therapy using tumor necrosis factor α inhibitors (infliximab, adalimumab, golimumab, etanercept, anti-B-cell drugs (rituximab, belimumab, interleukin-6 receptor antagonist (tocilizumab, and T-cell costimulation blocker (abatacept have been detected in blood, synovial fluid, urine, and bioptates of the affected tissues. In addition to the conventional uniplex immunodiagnostics techniques, multiplex analysis of marker, which is based on genetic, transcriptomic and proteomic technologies using DNA and protein microarrays, polymerase chain reaction, and flow cytometry, is becoming increasingly widespread. The search for and validation of immunological predictors of the effective response to GE drug therapy make it possible to optimize and reduce the cost of therapy using these drugs in future.

  16. Role of laboratory biomarkers in monitoring and prediction of the effectiveness of treatment of rheumatic diseases using genetically engineered drugs

    Directory of Open Access Journals (Sweden)

    Elena Nikolayevna Aleksandrova

    2014-01-01

    Full Text Available Significant progress in treating immunoinflammatory rheumatic diseases (RD is related to the design of a novel family of drugs, genetically engineered (GE drugs. Molecular and cellular biomarkers (antibodies, indicators of acute inflammation, cytokines, chemokines, growth factors, endothelial activation markers, immunoglobulins, cryoglobulins, T- and B-cell subpopulations, products of bone and cartilage metabolism, genetic and metabolic markers that allow one to conduct immunological monitoring and prediction of the effectiveness of RD therapy using tumor necrosis factor α inhibitors (infliximab, adalimumab, golimumab, etanercept, anti-B-cell drugs (rituximab, belimumab, interleukin-6 receptor antagonist (tocilizumab, and T-cell costimulation blocker (abatacept have been detected in blood, synovial fluid, urine, and bioptates of the affected tissues. In addition to the conventional uniplex immunodiagnostics techniques, multiplex analysis of marker, which is based on genetic, transcriptomic and proteomic technologies using DNA and protein microarrays, polymerase chain reaction, and flow cytometry, is becoming increasingly widespread. The search for and validation of immunological predictors of the effective response to GE drug therapy make it possible to optimize and reduce the cost of therapy using these drugs in future.

  17. A modular, prospective, semi-automated drug safety monitoring system for use in a distributed data environment.

    Science.gov (United States)

    Gagne, Joshua J; Wang, Shirley V; Rassen, Jeremy A; Schneeweiss, Sebastian

    2014-06-01

    The aim of this study was to develop and test a semi-automated process for conducting routine active safety monitoring for new drugs in a network of electronic healthcare databases. We built a modular program that semi-automatically performs cohort identification, confounding adjustment, diagnostic checks, aggregation and effect estimation across multiple databases, and application of a sequential alerting algorithm. During beta-testing, we applied the system to five databases to evaluate nine examples emulating prospective monitoring with retrospective data (five pairs for which we expected signals, two negative controls, and two examples for which it was uncertain whether a signal would be expected): cerivastatin versus atorvastatin and rhabdomyolysis; paroxetine versus tricyclic antidepressants and gastrointestinal bleed; lisinopril versus angiotensin receptor blockers and angioedema; ciprofloxacin versus macrolide antibiotics and Achilles tendon rupture; rofecoxib versus non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) and myocardial infarction; telithromycin versus azithromycin and hepatotoxicity; rosuvastatin versus atorvastatin and diabetes and rhabdomyolysis; and celecoxib versus ns-NSAIDs and myocardial infarction. We describe the program, the necessary inputs, and the assumed data environment. In beta-testing, the system generated four alerts, all among positive control examples (i.e., lisinopril and angioedema; rofecoxib and myocardial infarction; ciprofloxacin and tendon rupture; and cerivastatin and rhabdomyolysis). Sequential effect estimates for each example were consistent in direction and magnitude with existing literature. Beta-testing across nine drug-outcome examples demonstrated the feasibility of the proposed semi-automated prospective monitoring approach. In retrospective assessments, the system identified an increased risk of myocardial infarction with rofecoxib and an increased risk of rhabdomyolysis with cerivastatin years

  18. Clinical utility of therapeutic drug monitoring in biological disease modifying anti-rheumatic drug treatment of rheumatic disorders: a systematic narrative review.

    Science.gov (United States)

    Van Herwaarden, Noortje; Van Den Bemt, Bart J F; Wientjes, Maike H M; Kramers, Cornelis; Den Broeder, Alfons A

    2017-08-01

    Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have improved the treatment outcomes of inflammatory rheumatic diseases including Rheumatoid Arthritis and spondyloarthropathies. Inter-individual variation exists in (maintenance of) response to bDMARDs. Therapeutic Drug Monitoring (TDM) of bDMARDs could potentially help in optimizing treatment for the individual patient. Areas covered: Evidence of clinical utility of TDM in bDMARD treatment is reviewed. Different clinical scenarios will be discussed, including: prediction of response after start of treatment, prediction of response to a next bDMARD in case of treatment failure of the first, prediction of successful dose reduction or discontinuation in case of low disease activity, prediction of response to dose-escalation in case of active disease and prediction of response to bDMARD in case of flare in disease activity. Expert opinion: The limited available evidence does often not report important outcomes for diagnostic studies, such as sensitivity and specificity. In most clinical relevant scenarios, predictive value of serum (anti-) drug levels is absent, therefore the use of TDM of bDMARDs cannot be advocated. Well-designed prospective studies should be done to further investigate the promising scenarios to determine the place of TDM in clinical practice.

  19. BOKP: A DNA Barcode Reference Library for Monitoring Herbal Drugs in the Korean Pharmacopeia

    Directory of Open Access Journals (Sweden)

    Jinxin Liu

    2017-12-01

    Full Text Available Herbal drug authentication is an important task in traditional medicine; however, it is challenged by the limitations of traditional authentication methods and the lack of trained experts. DNA barcoding is conspicuous in almost all areas of the biological sciences and has already been added to the British pharmacopeia and Chinese pharmacopeia for routine herbal drug authentication. However, DNA barcoding for the Korean pharmacopeia still requires significant improvements. Here, we present a DNA barcode reference library for herbal drugs in the Korean pharmacopeia and developed a species identification engine named KP-IDE to facilitate the adoption of this DNA reference library for the herbal drug authentication. Using taxonomy records, specimen records, sequence records, and reference records, KP-IDE can identify an unknown specimen. Currently, there are 6,777 taxonomy records, 1,054 specimen records, 30,744 sequence records (ITS2 and psbA-trnH and 285 reference records. Moreover, 27 herbal drug materials were collected from the Seoul Yangnyeongsi herbal medicine market to give an example for real herbal drugs authentications. Our study demonstrates the prospects of the DNA barcode reference library for the Korean pharmacopeia and provides future directions for the use of DNA barcoding for authenticating herbal drugs listed in other modern pharmacopeias.

  20. In vivo real-time monitoring system of electroporation mediated control of transdermal and topical drug delivery.

    Science.gov (United States)

    Blagus, Tanja; Markelc, Bostjan; Cemazar, Maja; Kosjek, Tina; Preat, Veronique; Miklavcic, Damijan; Sersa, Gregor

    2013-12-28

    Electroporation (EP) is a physical method for the delivery of molecules into cells and tissues, including the skin. In this study, in order to control the degree of transdermal and topical drug delivery, EP at different amplitudes of electric pulses was evaluated. A new in vivo real-time monitoring system based on fluorescently labeled molecules was developed, for the quantification of transdermal and topical drug delivery. EP of the mouse skin was performed with new non-invasive multi-array electrodes, delivering different amplitudes of electric pulses ranging from 70 to 570 V, between the electrode pin pairs. Patches, soaked with 4 kDa fluorescein-isothiocyanate labeled dextran (FD), doxorubicin (DOX) or fentanyl (FEN), were applied to the skin before and after EP. The new monitoring system was developed based on the delivery of FD to and through the skin. FD relative quantity was determined with fluorescence microscopy imaging, in the treated region of the skin for topical delivery and in a segment of the mouse tail for transdermal delivery. The application of electric pulses for FD delivery resulted in enhanced transdermal delivery. Depending on the amplitude of electric pulses, it increased up to the amplitude of 360 V, and decreased at higher amplitudes (460 and 570 V). Topical delivery steadily enhanced with increasing the amplitude of the delivered electric pulses, being even higher than after tape stripping used as a positive control. The non-invasive monitoring of the delivery of DOX, a fluorescent chemotherapeutic drug, qualitatively and quantitatively confirmed the effects of EP at 360 and 570 V pulse amplitudes on topical and transdermal drug delivery. Delivery of FEN at 360 and 570 V pulse amplitudes verified the observed effects as obtained with FD and DOX, by the measured physiological responses of the mice as well as FEN plasma concentration. This study demonstrates that with the newly developed non-invasive multi-array electrodes and with the

  1. Evaluation of Flexible Tacrolimus Drug Concentration Monitoring Approach in Patients Receiving Extended-Release Once-Daily Tacrolimus Tablets.

    Science.gov (United States)

    Philosophe, Benjamin; Leca, Nicolae; West-Thielke, Patricia M; Horwedel, Timothy; Culkin-Gemmell, Christine; Kistler, Kristin; Stevens, Daniel R

    2018-02-20

    The majority of United States kidney transplant patients are treated with tacrolimus, a drug effective in preventing graft rejection, but with a narrow therapeutic range, necessitating close monitoring to avoid increased risks of transplant rejection or toxicity if the tacrolimus concentration is too low or too high, respectively. The trough drug concentration tests are time sensitive; patients treated on a twice-daily basis have blood draws exactly 12 hours after their previous dose. The schedule's rigidity causes problems for both patients and health care providers. Novel once-daily tacrolimus formulations such as LCPT (an extended-release tablet by Veloxis Pharmaceuticals, Inc., Cary, North Carolina) have allowed for blood draws on a once-daily basis; however, even that schedule can be restrictive. Results from tests taken either before or after that 24-hour target time may be discarded, or worse, may lead to inappropriate dose changes. Data from ASTCOFF, a phase 3B pharmacokinetic clinical trial (NCT02339246), demonstrated that the unique pharmacokinetic curve of LCPT may allow for a therapeutic monitoring window that extends for 3 hours before or after the 24-hour monitoring target. Furthermore, important tools to help clinicians interpret these levels, such as formulas to estimate the 24-hour trough level if an alternative monitoring time is used, were constructed from these data. These study results give treating clinicians access to data that allow them to safely use and monitor LCPT in their patients and expand the body of evidence surrounding differentiation and practical application of the novel LCPT tacrolimus formulation. © 2018, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

  2. Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

    Directory of Open Access Journals (Sweden)

    William A Prescott

    2014-01-01

    Full Text Available Once-daily dosing intravenous tobramycin is commonly used to treat cystic fibrosis pulmonary exacerbations. Clinicians often utilize historical therapeutic drug monitoring data to individualize the dose among patients who have been treated with tobramycin previously. This case series involves three patients with cystic fibrosis who had supra-therapeutic tobramycin levels despite use of a once-daily dosing that produced therapeutic drug levels during a previous hospital admission, raising questions about the validity of these levels. Investigation into several potential sources of error led to the discovery of an analyzer error in the laboratory. Once the laboratory’s tobramycin analyzer was recalibrated, the reported levels were comparable to historical levels. This case series emphasizes the clinical importance of critically analyzing reported levels, and specifically, the importance of utilizing past therapeutic drug monitoring data, if available, for all patients treated with intravenous tobramycin. If a patient was therapeutic on a similar dose of tobramycin during a previous admission, a dose adjustment may not be necessary, and clinicians should consider repeating levels while pursuing alternative explanations for the discrepant serum levels.

  3. Central site monitoring: results from a test of accuracy in identifying trials and sites failing Food and Drug Administration inspection.

    Science.gov (United States)

    Lindblad, Anne S; Manukyan, Zorayr; Purohit-Sheth, Tejashri; Gensler, Gary; Okwesili, Paul; Meeker-O'Connell, Ann; Ball, Leslie; Marler, John R

    2014-04-01

    Site monitoring and source document verification account for 15%-30% of clinical trial costs. An alternative is to streamline site monitoring to focus on correcting trial-specific risks identified by central data monitoring. This risk-based approach could preserve or even improve the quality of clinical trial data and human subject protection compared to site monitoring focused primarily on source document verification. To determine whether a central review by statisticians using data submitted to the Food and Drug Administration (FDA) by clinical trial sponsors can identify problem sites and trials that failed FDA site inspections. An independent Analysis Center (AC) analyzed data from four anonymous new drug applications (NDAs) where FDA had performed site inspections overseen by FDA's Office of Scientific Investigations (OSI). FDA team members in the OSI chose the four NDAs from among all NDAs with data in Study Data Tabulation Model (SDTM) format. Two of the NDAs had data that OSI had deemed unreliable in support of the application after FDA site inspections identified serious data integrity problems. The other two NDAs had clinical data that OSI deemed reliable after site inspections. At the outset, the AC knew only that the experimental design specified two NDAs with significant problems. FDA gave the AC no information about which NDAs had problems, how many sites were inspected, or how many were found to have problems until after the AC analysis was complete. The AC evaluated randomization balance, enrollment patterns, study visit scheduling, variability of reported data, and last digit reference. The AC classified sites as 'High Concern', 'Moderate Concern', 'Mild Concern', or 'No Concern'. The AC correctly identified the two NDAs with data deemed unreliable by OSI. In addition, central data analysis correctly identified 5 of 6 (83%) sites for which FDA recommended rejection of data and 13 of 15 sites (87%) for which any regulatory deviations were

  4. Comments on the Eslicarbazepine Acetate Section of the Article ‘Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications’

    Directory of Open Access Journals (Sweden)

    Patricio Soares-da-Silva

    2010-12-01

    Full Text Available The recent review of Matthew D. Krasowski on ‘Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications’ is a useful foundation of comparative interpretations on our current knowledge about therapeutic drug monitoring. Within the review, the statement that therapeutic drug monitoring has a minimal role in the therapeutic use of eslicarbazepine acetate due to its relatively predictable pharmacokinetics reflects the existing body of evidence although some information such as eslicarbazepine acetate’s chemical structure, proportions of its metabolites, their pharmacokinetics and chiral method of plasma level measurement need to be revised. These critical characteristics differentiate the novel compound from former dibenzazepines such as carbamazepine and oxcarbazepine in its clinical effects and needs for therapeutic drug monitoring.

  5. A General LC-MS/MS Method for Monitoring Potential β-Lactam Contamination in Drugs and Drug-Manufacturing Surfaces.

    Science.gov (United States)

    Qiu, Chen; Zhu, Hongbin; Ruzicka, Connie; Keire, David; Ye, Hongping

    2018-05-15

    Penicillins and some non-penicillin β-lactams may cause potentially life-threatening allergic reactions. Thus, possible cross contamination of β-lactams in food or drugs can put people at risk. Therefore, when there is a reasonable possibility that a non-penicillin product could be contaminated by penicillin, the drug products are tested for penicillin contamination. Here, a sensitive and rapid method for simultaneous determination of multiple β-lactam antibiotics using high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated. Mass spectral acquisition was performed on a Q-Exactive HF mass spectrometer in positive ion mode with parallel reaction monitoring (PRM). The method was validated for seven β-lactam antibiotics including one or two from each class and a synthetic intermediate. The quantification precision and accuracy at 200 ppb were in the range of ± 1.84 to ± 4.56 and - 5.20 to 3.44%, respectively. The limit of detection (LOD) was 0.2 ppb, and the limit of quantitation (LOQ) was 2 ppb with a linear dynamic range (LDR) of 2-2000 ppb for all eight β-lactams. From various drug products, the recoveries of eight β-lactams at 200 and 2 ppb ranged from 93.8 ± 3.2 to 112.1 ± 4.2% and 89.7 ± 4.6 to 110.6 ± 1.9%, respectively. The application of the method for detecting cross contamination of trace β-lactams (0.2 ppb) and for monitoring facility surface cleaning was also investigated. This sensitive and fast method was fit-for-purpose for detecting and quantifying trace amount of β-lactam contamination, monitoring cross contamination in manufacturing processes, and determining potency for regulatory purposes and for quality control.

  6. Frequency Locking and Monitoring Based on Bi-directional Terahertz Radiation of a 3rd-Order Distributed Feedback Quantum Cascade Laser

    NARCIS (Netherlands)

    Van Marrewijk, N.; Mirzaei, B.; Hayton, D.; Gao, J.R.; Kao, T.Y.; Hu, Q.; Reno, J.L.

    2015-01-01

    We have performed frequency locking of a dual, forward reverse emitting third-order distributed feedback quantum cascade laser (QCL) at 3.5 THz. By using both directions of THz emission in combination with two gas cells and two power detectors, we can for the first time perform frequency

  7. Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir.

    LENUS (Irish Health Repository)

    Caswell, R J

    2011-01-01

    The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and\\/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.

  8. Development of Analytical Method and Monitoring of Veterinary Drug Residues in Korean Animal Products.

    Science.gov (United States)

    Song, Jae-Sang; Park, Su-Jeong; Choi, Jung-Yun; Kim, Jin-Sook; Kang, Myung-Hee; Choi, Bo-Kyung; Hur, Sun Jin

    2016-01-01

    This study was conducted to determine the residual amount of veterinary drugs such as meloxicam, flunixin, and tulathromycin in animal products (beef, pork, horsemeat, and milk). Veterinary drugs have been widely used in the rearing of livestock to prevent and treat diseases. A total of 152 samples were purchased from markets located in major Korean cities (Seoul, Busan, Incheon, Daegu, Daejeon, Gwangju, Ulsan and Jeju), including Jeju. Veterinary drugs were analyzed by liquid chromatography-tandem mass spectrometry according to the Korean Food Standards Code. The resulting data, which are located within 70-120% of recovery range and less than 20% of relative standard deviations, are in compliance with the criteria of CODEX. A total of five veterinary drugs were detected in 152 samples, giving a detection rate of approximately 3.3%; and no food source violated the guideline values. Our result indicated that most of the veterinary drug residues in animal products were below the maximum residue limits specified in Korea.

  9. Demographic Subgroup Trends among Adolescents in the Use of Various Licit and Illicit Drugs, 1975-2016. Monitoring the Future Occasional Paper Series. Paper 88

    Science.gov (United States)

    Johnston, Lloyd D.; O'Malley, Patrick M.; Miech, Richard A.; Bachman, Jerald G.; Schulenberg, John E.

    2017-01-01

    This occasional paper presents national demographic subgroup data for the 1975-2016 Monitoring the Future (MTF) national survey results on 8th , 10th, and 12th graders' use of drugs, alcohol, and tobacco. MTF is funded by the National Institute on Drug Abuse at the National Institutes of Health under a series of investigator-initiated, competitive…

  10. Demographic Subgroup Trends among Adolescents in the Use of Various Licit and Illicit Drugs, 1975-2015. Monitoring the Future Occasional Paper Series. Paper 86

    Science.gov (United States)

    Johnston, Lloyd D.; O'Malley, Patrick M.; Miech, Richard A.; Bachman, Jerald G.; Schulenberg, John E.

    2016-01-01

    This occasional paper presents national demographic subgroup data for the 1975-2015 Monitoring the Future (MTF) national survey results on 8th, 10th, and 12th graders' use of drugs, alcohol, and tobacco. MTF is funded by the National Institute on Drug Abuse at the National Institutes of Health under a series of investigator-initiated, competitive…

  11. Demographic Subgroup Trends among Adolescents in the Use of Various Licit and Illicit Drugs, 1975-2014. Monitoring the Future Occasional Paper Series. Paper 83

    Science.gov (United States)

    Johnston, Lloyd D.; O'Malley, Patrick M.; Miech, Richard A.; Bachman, Jerald G.; Schulenberg, John E.

    2015-01-01

    This occasional paper presents national demographic subgroup data for the 1975-2014 Monitoring the Future (MTF) national survey results on 8th, 10th, and 12th graders' use of drugs, alcohol, and tobacco. MTF is funded by the National Institute on Drug Abuse at the National Institutes of Health under a series of investigator-initiated, competitive…

  12. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: A decision-maker-researcher partnership systematic review

    Directory of Open Access Journals (Sweden)

    Weise-Kelly Lorraine

    2011-08-01

    Full Text Available Abstract Background Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing. Methods We conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14, insulin (6, theophylline/aminophylline (4, aminoglycosides (3, digoxin (2, lidocaine (1, or as part of a multifaceted approach (3. Cluster randomization was rarely used (18% and CCDSSs were usually stand-alone systems (76% primarily used by physicians (85%. Overall, 18 of 30 studies (60% showed an improvement in the process of care and 4 of 19 (21% an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range. Conclusions CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing

  13. HIV-1 drug resistance mutations among antiretroviral-naive HIV-1-infected patients in Asia: results from the TREAT Asia Studies to Evaluate Resistance-Monitoring Study.

    Science.gov (United States)

    Sungkanuparph, Somnuek; Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Li, Patrick C K; Kantipong, Pacharee; Lee, Christopher K C; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G; Phanuphak, Praphan

    2011-04-15

    Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia.

  14. Therapeutic drug monitoring of nevirapine in saliva in Uganda using high performance liquid chromatography and a low cost thin-layer chromatography technique

    NARCIS (Netherlands)

    Lamorde, M.; Fillekes, Q.; Sigaloff, K.; Kityo, C.; Buzibye, A.; Kayiwa, J.; Merry, C.; Nakatudde-Katumba, L.; Burger, D.M.; Wit, T.F. de

    2014-01-01

    BACKGROUND: In resource limited settings access to laboratory monitoring of HIV treatment is limited and therapeutic drug monitoring is generally unavailable. This study aimed to evaluate nevirapine concentrations in saliva using low-cost thin-layer chromatography (TLC) and nevirapine concentrations

  15. Therapeutic drug monitoring of nevirapine in saliva in Uganda using high performance liquid chromatography and a low cost thin-layer chromatography technique

    NARCIS (Netherlands)

    Lamorde, Mohammed; Fillekes, Quirine; Sigaloff, Kim; Kityo, Cissy; Buzibye, Allan; Kayiwa, Joshua; Merry, Concepta; Nakatudde-Katumba, Lillian; Burger, David; Rinke de Wit, Tobias F.

    2014-01-01

    In resource limited settings access to laboratory monitoring of HIV treatment is limited and therapeutic drug monitoring is generally unavailable. This study aimed to evaluate nevirapine concentrations in saliva using low-cost thin-layer chromatography (TLC) and nevirapine concentrations in plasma

  16. Therapeutic drug monitoring to individualize the dosing of pazopanib: a pharmacokinetic feasibility study

    NARCIS (Netherlands)

    Wit, D. de; Erp, N. van; Hartigh, J. den; Wolterbeek, R..; Hollander-van Deursen, M. den; Labots, M.; Guchelaar (LUMC), H.J.; Verheul, H.M.; Gelderblom, H.

    2015-01-01

    BACKGROUND: Patients treated with the standard dose of pazopanib show a large interpatient variability in drug exposure defined as the area under the plasma concentration-time curve (AUC0-24h). The primary objective of this study was to evaluate the feasibility of pharmacokinetics (PK)-guided

  17. Assessment of MEKC suitability for residue drug monitoring on pharmaceutical manufacturing equipment

    CSIR Research Space (South Africa)

    Boca, MB

    2008-03-01

    Full Text Available obtained for all compounds. The method could be used as part of a cleaning validation study when assaying trace levels of co-trimoxazole drug, some of its decomposition products and detergent in the swab samples collected from pharmaceutical manufacturing...

  18. Limited Sampling Strategies for Therapeutic Drug Monitoring of Linezolid in Patients With Multidrug-Resistant Tuberculosis

    NARCIS (Netherlands)

    Alffenaar, Jan-Willem C.; Kosterink, Jos G. W.; van Altena, Richard; van der Werf, Tjip S.; Uges, Donald R. A.; Proost, Johannes H.

    Introduction: Linezolid is a potential drug for the treatment of multidrug-resistant tuberculosis but its use is limited because of severe adverse effects such as anemia, thrombocytopenia, and peripheral neuropathy. This study aimed to develop a model for the prediction of linezolid area. under the

  19. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions.

    Science.gov (United States)

    Islam, M Mofizul; McRae, Ian S

    2014-08-16

    In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together

  20. Video and non-video feedback interventions for teen drivers.

    Science.gov (United States)

    2016-07-01

    In-vehicle feedback technologies, including some that use video, help parents monitor and mentor their young drivers. While different feedback technologies have been shown to reduce some risky driving behaviors, teens and parents cite privacy concern...

  1. Dual-color bioluminescent sensor proteins for therapeutic drug monitoring of antitumor antibodies

    NARCIS (Netherlands)

    van Rosmalen, M.; Ni, Y.; Vervoort, D.F.M.; Arts, R.; Ludwig, S.K.J.; Merkx, M.

    2018-01-01

    Monitoring the levels of therapeutic antibodies in individual patients would allow patient-specific dose optimization, with the potential for major therapeutic and financial benefits. Our group recently developed a new platform of bioluminescent sensor proteins (LUMABS; LUMinescent AntiBody Sensor)

  2. Fluorodeoxyglucose-based positron emission tomography imaging to monitor drug responses in hematological tumors

    NARCIS (Netherlands)

    Newbold, Andrea; Martin, Ben P.; Cullinane, Carleen; Bots, Michael

    2014-01-01

    Positron emission tomography (PET) can be used to monitor the uptake of the labeled glucose analog fluorodeoxyglucose (¹⁸F-FDG), a process that is generally believed to reflect viable tumor cell mass. The use of ¹⁸F-FDG PET can be helpful in documenting over time the reduction in tumor mass volume

  3. Ambulatory Blood Pressure Monitoring for the Effective Management of Antihypertensive Drug Treatment.

    Science.gov (United States)

    O'Brien, Eoin; Dolan, Eamon

    2016-10-01

    This purpose of this article is to review the current recommendations for ambulatory blood pressure measurement (ABPM) and the use of ABPM in assessing treatment. We review current international guidelines and undertake a critical review of evidence supporting the clinical use of ABPM in effectively managing antihypertensive drug treatment. Current guidelines emphasize the diagnostic superiority of ABPM, mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of white-coat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of blood pressure, such as dipping and nondipping, reverse dipping, and excessive dipping, and the presence of nocturnal hypertension; although less attention is given to the nocturnal behavior of blood pressure in clinical practice, the nocturnal patterns of blood pressure have particular relevance in assessing the response to blood pressure-lowering medication. Surprisingly, although the current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of blood pressure-lowering therapy in clinical practice and virtually no recommendations on how it might be used to assess the efficacy of drug treatment. In view of a deficiency in the literature on the role of ABPM in assess the efficacy of drug treatment, we put forward proposals to correct this deficiency and guide the prescribing physician on the most appropriate drug administration and dosage over time. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  4. The Last State to Grant Nurse Practitioners DEA Licensure: An Education Improvement Initiative on the Florida Prescription Drug Monitoring Program.

    Science.gov (United States)

    Kellams, Joni R; Maye, John P

    Nurse practitioners (NPs) now have prescriptive authority for controlled substances in all 50 states in the United States. Florida, the last state to grant NPs DEA licensure, has been wrought with prescription diversion practices for a number of years as pill mills, doctor shopping, and overprescribing proliferated. Prescription Drug Monitoring Programs (PDMPs) help curb drug diversion activity and play a key role in reducing the abuse of controlled substances. The primary objective of this education improvement initiative was to increase knowledge of actively licensed NPs in the state of Florida regarding the state's PDMP. The main themes included the drug abuse problem, description and progression of the PDMP, and how to use the Florida PDMP. Upon approval from the institutional review board, this education improvement initiative gauged NP knowledge of the PDMP and main themes before and after an educational PowerPoint intervention. A pretest/posttest questionnaire was administered for assessment of all knowledge questions. One hundred forty-five NPs with active advanced registered NP licenses in Florida completed both the pretest and posttest questionnaires. Descriptive statistics and paired t tests were used for statistical significance testing. Knowledge of the PDMP and the main themes of the education improvement initiative significantly increased (p < .001) from pretest to posttest results. This education improvement initiative had positive effects for NPs on the knowledge of the Florida PDMP and the main themes. This indicated that Florida NPs are able to acquire greater comprehension of the PDMP by an education intervention.

  5. Importance of Therapeutic Drug Monitoring in the Treatment of Active Tuberculosis - A Retrospective Study of 4 Cases

    Directory of Open Access Journals (Sweden)

    Sanaa HAMMI

    2016-06-01

    Full Text Available Background: In the treatment of active tuberculosis, therapeutic drug monitoring (TDM is used to optimize dosing that maximizes therapeutic benefit while minimizing toxicity. In Morocco, TDM is not routinely used, yet low levels of anti-TB drugs can be associated with poorer treatment outcomes.Methods: We retrospectively checked our archives for patients with active TB for whom TDM was performed during 2014. Medical records were reviewed to abstract demographic, clinical, radiographic and microbiological data including time until smear and culture conversion. Then, we looked for cases with delay of TB conversion.Results: In total, 24 patients were identified, for whom TDM was performed, they all had low serum drug levels. Among them, 4 patients showed delayed bacteriological conversion.Conclusions: Our study cases are showing the benefit of serum dosage in the follow-up of the patients showing a delay of sputum examination conversion, both direct and culture, during their evolutions. TDM is potentially useful for the treatment of active TB, but is currently underused in Morocco.

  6. A Bioinformatic Pipeline for Monitoring of the Mutational Stability of Viral Drug Targets with Deep-Sequencing Technology.

    Science.gov (United States)

    Kravatsky, Yuri; Chechetkin, Vladimir; Fedoseeva, Daria; Gorbacheva, Maria; Kravatskaya, Galina; Kretova, Olga; Tchurikov, Nickolai

    2017-11-23

    The efficient development of antiviral drugs, including efficient antiviral small interfering RNAs (siRNAs), requires continuous monitoring of the strict correspondence between a drug and the related highly variable viral DNA/RNA target(s). Deep sequencing is able to provide an assessment of both the general target conservation and the frequency of particular mutations in the different target sites. The aim of this study was to develop a reliable bioinformatic pipeline for the analysis of millions of short, deep sequencing reads corresponding to selected highly variable viral sequences that are drug target(s). The suggested bioinformatic pipeline combines the available programs and the ad hoc scripts based on an original algorithm of the search for the conserved targets in the deep sequencing data. We also present the statistical criteria for the threshold of reliable mutation detection and for the assessment of variations between corresponding data sets. These criteria are robust against the possible sequencing errors in the reads. As an example, the bioinformatic pipeline is applied to the study of the conservation of RNA interference (RNAi) targets in human immunodeficiency virus 1 (HIV-1) subtype A. The developed pipeline is freely available to download at the website http://virmut.eimb.ru/. Brief comments and comparisons between VirMut and other pipelines are also presented.

  7. A Bioinformatic Pipeline for Monitoring of the Mutational Stability of Viral Drug Targets with Deep-Sequencing Technology

    Directory of Open Access Journals (Sweden)

    Yuri Kravatsky

    2017-11-01

    Full Text Available The efficient development of antiviral drugs, including efficient antiviral small interfering RNAs (siRNAs, requires continuous monitoring of the strict correspondence between a drug and the related highly variable viral DNA/RNA target(s. Deep sequencing is able to provide an assessment of both the general target conservation and the frequency of particular mutations in the different target sites. The aim of this study was to develop a reliable bioinformatic pipeline for the analysis of millions of short, deep sequencing reads corresponding to selected highly variable viral sequences that are drug target(s. The suggested bioinformatic pipeline combines the available programs and the ad hoc scripts based on an original algorithm of the search for the conserved targets in the deep sequencing data. We also present the statistical criteria for the threshold of reliable mutation detection and for the assessment of variations between corresponding data sets. These criteria are robust against the possible sequencing errors in the reads. As an example, the bioinformatic pipeline is applied to the study of the conservation of RNA interference (RNAi targets in human immunodeficiency virus 1 (HIV-1 subtype A. The developed pipeline is freely available to download at the website http://virmut.eimb.ru/. Brief comments and comparisons between VirMut and other pipelines are also presented.

  8. Real-time potentiometric sensor; an innovative tool for monitoring hydrolysis of chemo/bio-degradable drugs in pharmaceutical sciences.

    Science.gov (United States)

    Ma'mun, Ahmed; Abd El-Rahman, Mohamed K; Abd El-Kawy, Mohamed

    2018-05-30

    In recent years, the whole field of ion-selective electrodes(ISEs) in pharmaceutical sciences has expanded far beyond its original roots. The diverse range of opportunities offered by ISEs was broadly used in a number of pharmaceutical applications, with topics presented ranging from bioanalysis of drugs and metabolites, to protein binding studies, green analytical chemistry, impurity profiling, and drug dissolution in biorelevant media. Inspired from these advances and with the aim of extending the functional capabilities of ISEs, the primary focus of the present paper is the utilization of ISE as a tool in personalized medicine. Given the opportunity to explore biological events in real-time (such as drug metabolism) could be central to personalized medicine. (ATR) is a chemo-degradable and bio-degradable pharmaceutically active drug. Laudanosine (LDS) is the major degradation product and metabolite of ATR and is potentially toxic and reported to possess epileptogenic activity which increases the risk of convulsive effects. In this work, ATR have been subjected to both chemical and biological hydrolysis, and the course of the reactions is monitored by means of a ISE. In this study, we have designed an efficient real-time tracking strategy which substantially resolve the challenges of the ATR chemical and biological degradation kinetics. By utilizing a potentiometric sensor, tracking of ATR chemical and biological degradation kinetics can be performed in a very short time with excellent accuracy. The LOD was calculated to be 0.23 μmol L -1 , the potential drift was investigated over a period of 60 min and the value was 0.25 mV h -1 . Real serum samples for measurement the rate of in vitro metabolism of ATR was performed. Furthermore, a full description of the fabricated screen-printed sensor was presented. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Electrochemical approach for monitoring the effect of anti tubulin drugs on breast cancer cells based on silicon nanograss electrodes.

    Science.gov (United States)

    Zanganeh, Somayeh; Khosravi, Safoora; Namdar, Naser; Amiri, Morteza Hassanpour; Gharooni, Milad; Abdolahad, Mohammad

    2016-09-28

    One of the most interested molecular research in the field of cancer detection is the mechanism of drug effect on cancer cells. Translating molecular evidence into electrochemical profiles would open new opportunities in cancer research. In this manner, applying nanostructures with anomalous physical and chemical properties as well as biocompatibility would be a suitable choice for the cell based electrochemical sensing. Silicon based nanostructure are the most interested nanomaterials used in electrochemical biosensors because of their compatibility with electronic fabrication process and well engineering in size and electrical properties. Here we apply silicon nanograss (SiNG) probing electrodes produced by reactive ion etching (RIE) on silicon wafer to electrochemically diagnose the effect of anticancer drugs on breast tumor cells. Paclitaxel (PTX) and mebendazole (MBZ) drugs have been used as polymerizing and depolymerizing agents of microtubules. PTX would perturb the anodic/cathodic responses of the cell-covered biosensor by binding phosphate groups to deformed proteins due to extracellular signal-regulated kinase (ERK(1/2)) pathway. MBZ induces accumulation of Cytochrome C in cytoplasm. Reduction of the mentioned agents in cytosol would change the ionic state of the cells monitored by silicon nanograss working electrodes (SiNGWEs). By extending the contacts with cancer cells, SiNGWEs can detect minor signal transduction and bio recognition events, resulting in precise biosensing. Effects of MBZ and PTX drugs, (with the concentrations of 2 nM and 0.1 nM, respectively) on electrochemical activity of MCF-7 cells are successfully recorded which are corroborated by confocal and flow cytometry assays. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Electrochemical approach for monitoring the effect of anti tubulin drugs on breast cancer cells based on silicon nanograss electrodes

    International Nuclear Information System (INIS)

    Zanganeh, Somayeh; Khosravi, Safoora; Namdar, Naser; Amiri, Morteza Hassanpour; Gharooni, Milad; Abdolahad, Mohammad

    2016-01-01

    One of the most interested molecular research in the field of cancer detection is the mechanism of drug effect on cancer cells. Translating molecular evidence into electrochemical profiles would open new opportunities in cancer research. In this manner, applying nanostructures with anomalous physical and chemical properties as well as biocompatibility would be a suitable choice for the cell based electrochemical sensing. Silicon based nanostructure are the most interested nanomaterials used in electrochemical biosensors because of their compatibility with electronic fabrication process and well engineering in size and electrical properties. Here we apply silicon nanograss (SiNG) probing electrodes produced by reactive ion etching (RIE) on silicon wafer to electrochemically diagnose the effect of anticancer drugs on breast tumor cells. Paclitaxel (PTX) and mebendazole (MBZ) drugs have been used as polymerizing and depolymerizing agents of microtubules. PTX would perturb the anodic/cathodic responses of the cell-covered biosensor by binding phosphate groups to deformed proteins due to extracellular signal-regulated kinase (ERK"1"/"2) pathway. MBZ induces accumulation of Cytochrome C in cytoplasm. Reduction of the mentioned agents in cytosol would change the ionic state of the cells monitored by silicon nanograss working electrodes (SiNGWEs). By extending the contacts with cancer cells, SiNGWEs can detect minor signal transduction and bio recognition events, resulting in precise biosensing. Effects of MBZ and PTX drugs, (with the concentrations of 2 nM and 0.1 nM, respectively) on electrochemical activity of MCF-7 cells are successfully recorded which are corroborated by confocal and flow cytometry assays. - Highlights: • Electrochemical effect of MBZ and PTX (anti tubulin drugs) on breast cancer cells was detected. • Detection was carried by silicon nanograss electrodes(SiNGEs). • Signaling pathways activated in the cells by drug treatment, change the anodic

  11. Electrochemical approach for monitoring the effect of anti tubulin drugs on breast cancer cells based on silicon nanograss electrodes

    Energy Technology Data Exchange (ETDEWEB)

    Zanganeh, Somayeh; Khosravi, Safoora; Namdar, Naser; Amiri, Morteza Hassanpour; Gharooni, Milad [Nano Electronic Center of Excellence, Nano Bio Electronic Devices Lab, School of Electrical and Computer Eng, University of Tehran, P.O. Box 14395/515, Tehran (Iran, Islamic Republic of); Nano Electronic Center of Excellence, Thin Film and Nanoelectronic Lab, School of Electrical and Computer Eng, University of Tehran, P.O. Box 14395/515, Tehran (Iran, Islamic Republic of); Abdolahad, Mohammad, E-mail: m.abdolahad@ut.ac.ir [Nano Electronic Center of Excellence, Nano Bio Electronic Devices Lab, School of Electrical and Computer Eng, University of Tehran, P.O. Box 14395/515, Tehran (Iran, Islamic Republic of); Nano Electronic Center of Excellence, Thin Film and Nanoelectronic Lab, School of Electrical and Computer Eng, University of Tehran, P.O. Box 14395/515, Tehran (Iran, Islamic Republic of)

    2016-09-28

    One of the most interested molecular research in the field of cancer detection is the mechanism of drug effect on cancer cells. Translating molecular evidence into electrochemical profiles would open new opportunities in cancer research. In this manner, applying nanostructures with anomalous physical and chemical properties as well as biocompatibility would be a suitable choice for the cell based electrochemical sensing. Silicon based nanostructure are the most interested nanomaterials used in electrochemical biosensors because of their compatibility with electronic fabrication process and well engineering in size and electrical properties. Here we apply silicon nanograss (SiNG) probing electrodes produced by reactive ion etching (RIE) on silicon wafer to electrochemically diagnose the effect of anticancer drugs on breast tumor cells. Paclitaxel (PTX) and mebendazole (MBZ) drugs have been used as polymerizing and depolymerizing agents of microtubules. PTX would perturb the anodic/cathodic responses of the cell-covered biosensor by binding phosphate groups to deformed proteins due to extracellular signal-regulated kinase (ERK{sup 1/2}) pathway. MBZ induces accumulation of Cytochrome C in cytoplasm. Reduction of the mentioned agents in cytosol would change the ionic state of the cells monitored by silicon nanograss working electrodes (SiNGWEs). By extending the contacts with cancer cells, SiNGWEs can detect minor signal transduction and bio recognition events, resulting in precise biosensing. Effects of MBZ and PTX drugs, (with the concentrations of 2 nM and 0.1 nM, respectively) on electrochemical activity of MCF-7 cells are successfully recorded which are corroborated by confocal and flow cytometry assays. - Highlights: • Electrochemical effect of MBZ and PTX (anti tubulin drugs) on breast cancer cells was detected. • Detection was carried by silicon nanograss electrodes(SiNGEs). • Signaling pathways activated in the cells by drug treatment, change the

  12. Monitoring early tumor response to drug therapy with diffuse optical tomography

    Science.gov (United States)

    Flexman, Molly L.; Vlachos, Fotios; Kim, Hyun Keol; Sirsi, Shashank R.; Huang, Jianzhong; Hernandez, Sonia L.; Johung, Tessa B.; Gander, Jeffrey W.; Reichstein, Ari R.; Lampl, Brooke S.; Wang, Antai; Borden, Mark A.; Yamashiro, Darrell J.; Kandel, Jessica J.; Hielscher, Andreas H.

    2012-01-01

    Although anti-angiogenic agents have shown promise as cancer therapeutics, their efficacy varies between tumor types and individual patients. Providing patient-specific metrics through rapid noninvasive imaging can help tailor drug treatment by optimizing dosages, timing of drug cycles, and duration of therapy--thereby reducing toxicity and cost and improving patient outcome. Diffuse optical tomography (DOT) is a noninvasive three-dimensional imaging modality that has been shown to capture physiologic changes in tumors through visualization of oxygenated, deoxygenated, and total hemoglobin concentrations, using non-ionizing radiation with near-infrared light. We employed a small animal model to ascertain if tumor response to bevacizumab (BV), an anti-angiogenic agent that targets vascular endothelial growth factor (VEGF), could be detected at early time points using DOT. We detected a significant decrease in total hemoglobin levels as soon as one day after BV treatment in responder xenograft tumors (SK-NEP-1), but not in SK-NEP-1 control tumors or in non-responder control or BV-treated NGP tumors. These results are confirmed by magnetic resonance imaging T2 relaxometry and lectin perfusion studies. Noninvasive DOT imaging may allow for earlier and more effective control of anti-angiogenic therapy.

  13. Local orbit feedback

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Critically aligned experiments are sensitive to small changes in the electron beam orbit. At the NSLS storage rings, the electron beam and photon beam motions have been monitored over the past several years. In the survey conducted in 1986 by the NSLS Users Executive Committee, experimenters requested the vertical beam position variation and the vertical angle variation, within a given fill, remain within 10 μm and 10 μr, respectively. This requires improvement in the beam stability by about one order of magnitude. At the NSLS and SSRL storage rings, the beam that is originally centered on the position monitor by a dc orbit correction is observed to have two kinds of motion: a dc drift over a storage period of several hours and a beam bounce about its nominal position. These motions are a result of the equilibrium orbit not being held perfectly stable due to time-varying errors introduced into the magnetic guide field by power supplies, mechanical vibration of the magnets, cooling water temperature variations, etc. The approach to orbit stabilization includes (1) identifying and suppressing as many noise sources on the machine as possible, (2) correcting the beam position globally (see Section 6) by controlling a number of correctors around the circumference of the machine, and (3) correcting the beam position and angle at a given source location by position feedback using local detectors and local orbit bumps. The third approach, called Local Orbit Feedback will be discussed in this section

  14. Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse

    Directory of Open Access Journals (Sweden)

    Bharath Chakravarthy

    2012-12-01

    Full Text Available The Center for Disease Control and Prevention (CDC has published significant data and trendsrelated to opioid prescription pain relievers (OPR. In 2008, 20,044 deaths were attributedto prescription drug overdose of which 14,800 (73.8% were due to OPR, an amount greaterthan the number of overdose deaths from heroin and cocaine combined. The majority of thesedeaths were unintentional. Between 1999-2008, overdose deaths from OPR increased almostfour-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Mostsignificant to emergency physicians is the estimate that 39% of all opioids prescribed, administeredor continued come from the emergency department (ED. We present findings from theCDC’s Morbidity and Mortality Weekly Report (MMWR with commentary on current recommendationsand policies for curtailing the OPR epidemic.1

  15. Feedback and Incentives

    DEFF Research Database (Denmark)

    Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie Claire

    2009-01-01

    This paper experimentally investigates the impact of different pay schemes and relative performance feedback policies on employee effort. We explore three feedback rules: no feedback on relative performance, feedback given halfway through the production period, and continuously updated feedback. ...... behind, and front runners do not slack off. But in both pay schemes relative performance feedback reduces the quality of the low performers' work; we refer to this as a "negative quality peer effect"....

  16. Monitoring of drug resistance amplification and attenuation with the use of tetracycline-resistant bacteria during wastewater treatment

    Science.gov (United States)

    Harnisz, Monika; Korzeniewska, Ewa; Niestępski, Sebastian; Osińska, Adriana; Nalepa, Beata

    2017-11-01

    The objective of this study was to monitor changes (amplification or attenuation) in antibiotic resistance during wastewater treatment based on the ecology of tetracycline-resistant bacteria. The untreated and treated wastewater were collected in four seasons. Number of tetracycline-(TETR) and oxytetracycline-resistant (OTCR) bacteria, their qualitative composition, minimum inhibitory concentrations (MICs), sensitivity to other antibiotics, and the presence of tet (A, B, C, D, E) resistance genes were determined. TETR and OTCR counts in untreated wastewater were 100 to 1000 higher than in treated effluent. OTCR bacterial counts were higher than TETR populations in both untreated and treated wastewater. TETR isolates were not dominated by a single bacterial genus or species, whereas Aeromonas hydrophila and Aeromonas sobria were the most common in OTCR isolates. The treatment process attenuated the drug resistance of TETR bacteria and amplified the resistance of OTCR bacteria. In both microbial groups, the frequency of tet(A) gene increased in effluent in comparison with untreated wastewater. Our results also indicate that treated wastewater is a reservoir of multiple drug-resistant bacteria as well as resistance determinants which may pose a health hazard for humans and animals when released to the natural environment.

  17. A luciferase-based assay for rapid assessment of drug activity against Mycobacterium tuberculosis including monitoring of macrophage viability.

    Science.gov (United States)

    Larsson, Marie C; Lerm, Maria; Ängeby, Kristian; Nordvall, Michaela; Juréen, Pontus; Schön, Thomas

    2014-11-01

    The intracellular (IC) effect of drugs against Mycobacterium tuberculosis (Mtb) is not well established but increasingly important to consider when combining current and future multidrug regimens into the best possible treatment strategies. For this purpose, we developed an IC model based on a genetically modified Mtb H37Rv strain, expressing the Vibrio harvei luciferase (H37Rv-lux) infecting the human macrophage like cell line THP-1. Cells were infected at a low multiplicity of infection (1:1) and subsequently exposed to isoniazid (INH), ethambutol (EMB), amikacin (AMI) or levofloxacin (LEV) for 5days in a 96-well format. Cell viability was evaluated by Calcein AM and was maintained throughout the experiment. The number of viable H37Rv-lux was determined by luminescence and verified by a colony forming unit analysis. The results were compared to the effects of the same drugs in broth cultures. AMI, EMB and LEV were significantly less effective intracellularly (MIC90: >4mg/L, 8mg/L and 2mg/L, respectively) compared to extracellularly (MIC90: 0.5mg/L for AMI and EMB; 0.25mg/L for LEV). The reverse was the case for INH (IC: 0.064mg/L vs EC: 0.25mg/L). In conclusion, this luciferase based method, in which monitoring of cell viability is included, has the potential to become a useful tool while evaluating the intracellular effects of anti-mycobacterial drugs. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Pharmacogenetics-Oriented Therapeutic drug monitoring of Digoxin in critically ill patients

    International Nuclear Information System (INIS)

    Ebid, Abdel-Hameed I.; Mokhtar, Mohammed Sherif; Abdel-Shafi, Sana'a; El-Feky, Gina Samy

    2006-01-01

    This study was performed to outline the different MDR-1 (Multi-Drug Resistance-1) genotypes in a sample of 37 Egyptian patients, suffering from atrial fibrillation (AF) and/or congestive heart failure (CHF) and is using digoxin, to assess the role of MDR-1 genotypes polymorphism in affecting steady state serum digoxin therapeutic levels, and studying the consequences on patient's clinical outcome. Two venous blood samples were drawn from each patient; the 1st sample was taken, on admission, for DNA extraction and genotyping and the 2nd was taken, 6 hours post dose after reaching steady state concentration, for serum digoxin assay. Serum digoxin levels were assayed using EMIT 2000 analyzer, and MDR-1 genotyping was done using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Twenty patients (54.1%) showed serum digoxin levels within the therapeutic range, 12 patients (32.4%) showed serum digoxin levels under the minimum effective concentration ( 2 ng/ml), with P value of 0.0001 among three groups. MDR-1 genotyping revealed ten patients (27%) carrying the homozygous mutant TT genotype, 27 patients (73%) carrying the heterozygous mutant CT genotype, with no patient showing the wild CC genotype Allelic distribution showed 42% for the wild type C allele while 58% for the homozygous mutant C allele. Patients carrying the homozygous mutant TT genotype showed significantly lower serum digoxin levels compared with those carrying the heterozygous mutant CT genotype (P value: 0.009). Patients with significant improvement carried the CT genotype and had serum digoxin levels within the therapeutic range. In conclusion, patients with different MDR-1 genotypes had variations in their serum digoxin levels and identification of MDR-1 variations was found useful in predicting therapy outcome. We recommend further extensive work on large samples to study the important role of MDR-1 gene in affecting the disposition of different substrates, to

  19. Handwriting Movement Analyses for Monitoring Drug-Induced Motor Side Effects in Schizophrenia Patients Treated with Risperidone

    Science.gov (United States)

    Caligiuri, Michael P.; Teulings, Hans-Leo; Dean, Charles E.; Niculescu, Alexander B.; Lohr, James

    2009-01-01

    Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 46 healthy comparison participants were enrolled. Participants performed a 20-minute handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r = .91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients. PMID:19692133

  20. Characterizing Focused-Ultrasound Mediated Drug Delivery to the Heterogeneous Primate Brain In Vivo with Acoustic Monitoring

    Science.gov (United States)

    Wu, Shih-Ying; Sanchez, Carlos Sierra; Samiotaki, Gesthimani; Buch, Amanda; Ferrera, Vincent P.; Konofagou, Elisa E.

    2016-11-01

    Focused ultrasound with microbubbles has been used to noninvasively and selectively deliver pharmacological agents across the blood-brain barrier (BBB) for treating brain diseases. Acoustic cavitation monitoring could serve as an on-line tool to assess and control the treatment. While it demonstrated a strong correlation in small animals, its translation to primates remains in question due to the anatomically different and highly heterogeneous brain structures with gray and white matteras well as dense vasculature. In addition, the drug delivery efficiency and the BBB opening volume have never been shown to be predictable through cavitation monitoring in primates. This study aimed at determining how cavitation activity is correlated with the amount and concentration of gadolinium delivered through the BBB and its associated delivery efficiency as well as the BBB opening volume in non-human primates. Another important finding entails the effect of heterogeneous brain anatomy and vasculature of a primate brain, i.e., presence of large cerebral vessels, gray and white matter that will also affect the cavitation activity associated with variation of BBB opening in different tissue types, which is not typically observed in small animals. Both these new findings are critical in the primate brain and provide essential information for clinical applications.

  1. Assessment of Knowledge of Self Blood Glucose Monitoring and Extent of Self Titration of Anti-Diabetic Drugs among Diabetes Mellitus Patients - A Cross Sectional, Community Based Study.

    Science.gov (United States)

    Krishnan, V; Thirunavukkarasu, J

    2016-03-01

    Self blood glucose monitoring is an important context of self care in the management of diabetes mellitus. All the guidelines must be followed while performing self blood glucose monitoring and tracking of values is essential to facilitate the physician while titrating the drugs and /or doses of anti diabetes medication. Self titration by patients following self monitoring must be discouraged. To assess the knowledge and practice of self blood glucose monitoring among diabetes patients and extent of self titration of anti diabetes medicines among diabetes patients based on self blood glucose monitoring. This pilot, cross-sectional, observational study was conducted using a validated questionnaire among adult male and female diabetes patients performing self blood glucose monitoring at home. Diabetes patients with complications and juvenile diabetes patients were excluded. Out of 153 patients surveyed, only 37 (24.1%) (20 males, 17 females) patients were aware and have been following self blood glucose monitoring appropriately. About 116 (75.8%) (64 males, 52 females) of patients were devoid of adequate knowledge and did not practice self blood glucose monitoring in a proper way. Ninety eight (64.05%) accepted that they self titrate their anti diabetic medicines based on self monitoring. Self monitoring of blood glucose should be encouraged and patients should be taught importance of following correct steps and tracking of self monitoring by physician or diabetes educator.

  2. An Advanced Multifunctional Hydrogel-Based Dressing for Wound Monitoring and Drug Delivery.

    Science.gov (United States)

    Mirani, Bahram; Pagan, Erik; Currie, Barbara; Siddiqui, Mohammad Ali; Hosseinzadeh, Reihaneh; Mostafalu, Pooria; Zhang, Yu Shrike; Ghahary, Aziz; Akbari, Mohsen

    2017-10-01

    Wound management is a major global challenge and poses a significant financial burden to the healthcare system due to the rapid growth of chronic diseases such as diabetes, obesity, and aging population. The ability to detect pathogenic infections and release drug at the wound site is of the utmost importance to expedient patient care. Herein, this study presents an advanced multifunctional dressing (GelDerm) capable of colorimetric measurement of pH, an indicator of bacterial infection, and release of antibiotic agents at the wound site. This study demonstrates the ability of GelDerm to detect bacterial infections using in vitro and ex vivo tests with accuracies comparable to the commercially available systems. Wireless interfaces to digital image capture hardware such as smartphones serve as a means for quantitation and enable the patient to record the wound condition at home and relay the information to the healthcare personnel for following treatment strategies. Additionally, the dressing is integrated within commercially available patches and can be placed on the wound without chemical or physical irritation. This study demonstrates the ability of GelDerm to eradicate bacteria by the sustained release of antibiotics. The proposed technology holds great promise in managing chronic and acute injuries caused by trauma, surgery, or diabetes. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Real-time monitoring of magnetic drug targeting using fibered confocal fluorescence microscopy.

    Science.gov (United States)

    Bai, Jie; Wang, Julie Tzu-Wen; Mei, Kuo-Ching; Al-Jamal, Wafa T; Al-Jamal, Khuloud T

    2016-12-28

    Magnetic drug targeting has been proposed as means of concentrating therapeutic agents at a target site and the success of this approach has been demonstrated in a number of studies. However, the behavior of magnetic carriers in blood vessels and tumor microcirculation still remains unclear. In this work, we utilized polymeric magnetic nanocapsules (m-NCs) for magnetic targeting in tumors and dynamically visualized them within blood vessels and tumor tissues before, during and after magnetic field exposure using fibered confocal fluorescence microscopy (FCFM). Our results suggested that the distribution of m-NCs within tumor vasculature changed dramatically, but in a reversible way, upon application and removal of a magnetic field. The m-NCs were concentrated and stayed as clusters near a blood vessel wall when tumors were exposed to a magnetic field but without rupturing the blood vessel. The obtained FCFM images provided in vivo in situ microvascular observations of m-NCs upon magnetic targeting with high spatial resolution but minimally invasive surgical procedures. This proof-of-concept descriptive study in mice is envisaged to track and quantify nanoparticles in vivo in a non-invasive manner at microscopic resolution. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study.

    Science.gov (United States)

    Radomski, Thomas R; Bixler, Felicia R; Zickmund, Susan L; Roman, KatieLynn M; Thorpe, Carolyn T; Hale, Jennifer A; Sileanu, Florentina E; Hausmann, Leslie R M; Thorpe, Joshua M; Suda, Katie J; Stroupe, Kevin T; Gordon, Adam J; Good, Chester B; Fine, Michael J; Gellad, Walid F

    2018-03-08

    The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. Qualitative study using semi-structured interviews. Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania). From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use. VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff. Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.

  5. Point-of-care detection and real-time monitoring of intravenously delivered drugs via tubing with an integrated SERS sensor.

    Science.gov (United States)

    Wu, Hsin-Yu; Cunningham, Brian T

    2014-05-21

    We demonstrate an approach for detection, identification, and kinetic monitoring of drugs flowing within tubing, through the use of a plasmonic nanodome array (PNA) surface. The PNA structures are fabricated using a low-cost nanoreplica molding process upon a flexible plastic substrate that is subsequently integrated with a flow cell that connects in series with ordinary intravenous (IV) drug delivery tubing. To investigate the potential clinical applications for point-of-care detection and real-time monitoring, we perform SERS detection of ten pharmaceutical compounds (hydrocodone, levorphanol, morphine, oxycodone, methadone, phenobarbital, dopamine, diltiazem, promethazine, and mitoxantrone). We demonstrate dose-dependent SERS signal magnitude, resulting in detection limits (ng ml(-1)) well below typical administered dosages (mg ml(-1)). Further, we show that the detected drugs are not permanently attached to the PNA surface, and thus our approach is capable of performing continuous monitoring of drug delivery as materials flow through IV tubing that is connected in series with the sensor. Finally, we demonstrate the potential co-detection of multiple drugs when they are mixed together, and show excellent reproducibility and stability of SERS measurements for periods extending at least five days. The capabilities reported here demonstrate the potential to use PNA SERS surfaces for enhancing the safety of IV drug delivery.

  6. The determination of phenazone in blood plasma for obtained sistem suitable test of monitoring drug level

    Directory of Open Access Journals (Sweden)

    Mochamad Lazuardi

    2007-09-01

    Full Text Available The determining of Phenazone to human blood plasma from healthy man after separated by solid phase extraction (SPE and spectroscopic measurements has been investigated. The objective of that research was to obtain system suitable test for determine the Phenazone level in biological fluids (human blood plasma, for new performed dosage regimented in clinical dentistry. The method can be divided into the following four steps. 1. Centrifugation the blood sample, 2. Extraction from blood plasma and, 3. Separation by SPE with manual pressured, 4. Elution to SPE followed by the measurement on a spectrophotometer in the ultra violet region. The critical value of  │t │at the 5% confidence level indicates that there is no systematic error in the linearity proposed method. Recoveries for this research were obtained at ranging 93.460 to 95.598%. The coefficient variation precision of this procedure was clearly good at smallest than 2%. The analytical procedure can be carried out in one working operation as a monitored therapeutic activity.

  7. Wireless motion sensor network for monitoring motion in a process, wireless sensor node, reasoning node, and feedback and/or actuation node for such wireless motion sensor network

    NARCIS (Netherlands)

    Havinga, Paul J.M.; Marin Perianu, Raluca; Marin Perianu, Mihai

    2010-01-01

    Wireless motion sensor network for monitoring motion in a process comprising at least one wireless sensor node for measuring at least one physical quantity related to motion or orientation, feature extraction means for deriving a feature for the measured quantities, a wireless transmitter connected

  8. Skriftlig feedback i engelskundervisningen

    DEFF Research Database (Denmark)

    Kjærgaard, Hanne Wacher

    2017-01-01

    The article describes useful feedback strategies in language teaching and describes the feedback practices of lower-seconday teachers in Denmark. The article is aimed at language teahcers in secondary schools.......The article describes useful feedback strategies in language teaching and describes the feedback practices of lower-seconday teachers in Denmark. The article is aimed at language teahcers in secondary schools....

  9. Student Engagement with Feedback

    Science.gov (United States)

    Scott, Jon; Shields, Cathy; Gardner, James; Hancock, Alysoun; Nutt, Alex

    2011-01-01

    This report considers Biological Sciences students' perceptions of feedback, compared with those of the University as a whole, this includes what forms of feedback were considered most useful and how feedback used. Compared with data from previous studies, Biological Sciences students gave much greater recognition to oral feedback, placing it on a…

  10. The Moderating Role of Parental Monitoring on the Influence of Peer Pro-Drug Norms on Alcohol and Cigarette Use among Adolescents in Mexico

    Science.gov (United States)

    Becerra, David; Castillo, Jason T.; Ayón, Cecilia; Blanchard, Kelly N.

    2014-01-01

    This study utilized data drawn from a study of 980 adolescents living in Tijuana, Mexico, in February 2009 to examine whether parental monitoring had a moderating impact on the influence of peer pro-drug norms on lifetime and past-30-day alcohol and cigarette use among a group of adolescents living along the United States-Mexico border. The…

  11. An LC-MS Assay with Isocratic Separation and On-Line Solid Phase Extraction to Improve the Routine Therapeutic Drug Monitoring of Busulfan in Plasma

    Directory of Open Access Journals (Sweden)

    Ialongo Cristiano

    2017-04-01

    Full Text Available Background: Busulfan (Bu requires therapeutic drug monitoring (TDM in subjects undergoing a conditioning regimen for hematopoietic stem cell transplantation (HSCT. To speed up the procedure and increase reproducibility, we improved our routine LC-MS/MS assay using the on-line solid-phase extraction (SPE of samples.

  12. Parenting Practices and Problem Behavior across Three Generations: Monitoring, Harsh Discipline, and Drug Use in the Intergenerational Transmission of Externalizing Behavior

    Science.gov (United States)

    Bailey, Jennifer A.; Hill, Karl G.; Oesterle, Sabrina; Hawkins, J. David

    2009-01-01

    Using data from grandparents (G1), parents (G2), and children (G3), this study examined continuity in parental monitoring, harsh discipline, and child externalizing behavior across generations, and the contribution of parenting practices and parental drug use to intergenerational continuity in child externalizing behavior. Structural equation and…

  13. A new concept of efficient therapeutic drug monitoring using the high-resolution continuum source absorption spectrometry and the surface enhanced Raman spectroscopy

    Science.gov (United States)

    Xing, Yanlong; Fuss, Harald; Lademann, Jürgen; Huang, Mao Dong; Becker-Ross, Helmut; Florek, Stefan; Patzelt, Alexa; Meinke, Martina C.; Jung, Sora; Esser, Norbert

    2018-04-01

    In this study, a new therapeutic drug monitoring approach has been tested based on the combination of CaF molecular absorption using high-resolution continuum source absorption spectrometry (HR-CSAS) and surface enhanced Raman spectroscopy (SERS). HR-CSAS with mini graphite tube was successfully tested for clinical therapeutic drug monitoring of the fluorine-containing drug capecitabine in sweat samples of cancer patients: It showed advantageous features of high selectivity (no interference from Cl), high sensitivity (characteristic mass of 0.1 ng at CaF 583.069 nm), low sample consumption (down to 30 nL) and fast measurement (no sample pretreatment and less than 1 min of responding time) in tracing the fluorine signal out of capecitabine. However, this technique has the disadvantage of the total loss of the drug's structure information after burning the sample at very high temperature. Therefore, a new concept of combining HR-CSAS with a non-destructive spectroscopic method (SERS) was proposed for the sensitive sensing and specific identification of capecitabine. We tested and succeed in obtaining the molecular characteristics of the metabolite of capecitabine (named 5-fluorouracil) by the non-destructive SERS technique. With the results shown in this work, it is demonstrated that the combined spectroscopic technique of HR-CSAS and SERS will be very useful in efficient therapeutic drug monitoring in the future.

  14. Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone.

    Science.gov (United States)

    Sajid, Ayesha; Whiteman, Aaron; Bell, Richard L; Greene, Marion S; Engleman, Eric A; Chambers, R Andrew

    2016-10-01

    Fourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university-affiliated integrated mental health-addiction treatment clinic. Repeated measure parametrics examined PDMP and urine drug screening (UDS) data before and after first injection for all patients (N = 68) who received at least one long-acting naltrexone injection (380 mg/IM) according to diagnostic groupings of having either (i) alcohol (control); (ii) opioid; or (iii) combined alcohol and opioid use disorders. There were no group differences post-injection in treatment days, injections delivered, or treatment service encounters. UDS and PDMP measures of opioid exposures were greater in opioid compared to alcohol-only patients. Post-first injection, UDS's positive for opioids declined (p opioid prescriptions (p Opioid patients without alcohol disorders showed the best outcomes with 50% to 80% reductions in PDMP-measures of opioids, down to levels of alcohol-only patients. This study shows PDMP utility for measuring opioid addiction treatment outcomes, supporting the routine use of PDMPs in clinical and research settings. These findings demonstrate that opioid addiction in patients with complex addictions and mental illnesses comorbidities can show effective treatment responses as measured by PDMP tracking of decreases in opioid prescriptions to those patients. (Am J Addict 2016;25:557-564). © 2016 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP).

  15. Tacrolimus concentration/dose ratio as a therapeutic drug monitoring strategy: The influence of gender and comedication

    Directory of Open Access Journals (Sweden)

    Rančić Nemanja

    2015-01-01

    Full Text Available Background/Aim. A combination of tacrolimus and other drugs such as corticosteroids has been commonly used immunosuppresive regimens. On the other hand, there is a growing body of evidence that male and female may differ in their response to the equal drug treatment. The aim of the study was to estimated the use of tacrolimus concentration/dose (C/D ratio for the assessment of the influence of gender differences and comedication on tacrolimus exposure in renal transplant recipients. Methods. This prospective case series study included 54 patients, in which the unit of monitoring was outpatient examination (1,872 of the renal transplant patients. The patients were monitored in the period 2010-2014, starting one month after the transplantation. Tacrolimus trough concentrations (TTC were measured by chemiluminescence microparticles immunoassay. Results. TTC and the tacrolimus C/D ratio were significantly lower in the females comparing with the males. Contrary to the males, in the females a significant increase of the tacrolimus daily dose (TDD per body weight and TTC, along with the corticosteroid dose increase, was not accompanied by any significant changes in the tacrolimus C/D ratio; in different corticosteroid doses faster elimination of tacrolimus was found with the exception of the doses > 0.25 mg/kg. In the patients treated with proton pump inhibitors, mainly with pantoprazole TDD per body weight and TTC were significantly higher, while the tacrolimus C/D ratio was significantly lower compared to the patients without this treatment. In the patients treated with calcium channel blockers, TDD per body weight was significantly lower (particularly with amlodipine while the tacrolimus C/D ratio was higher compared to the patients who were not treated by them. Conclusion. A lower tacrolimus exposure was detected in females in comparison to males. When gender differences were considered in the context of different corticosteroid doses, faster

  16. Enabling social listening for cardiac safety monitoring: Proceedings from a drug information association-cardiac safety research consortium cosponsored think tank.

    Science.gov (United States)

    Seifert, Harry A; Malik, Raleigh E; Bhattacharya, Mondira; Campbell, Kevin R; Okun, Sally; Pierce, Carrie; Terkowitz, Jeffrey; Turner, J Rick; Krucoff, Mitchell W; Powell, Gregory E

    2017-12-01

    This white paper provides a summary of the presentations and discussions from a think tank on "Enabling Social Listening for Cardiac Safety Monitoring" trials that was cosponsored by the Drug Information Association and the Cardiac Safety Research Consortium, and held at the White Oak headquarters of the US Food and Drug Administration on June 3, 2016. The meeting's goals were to explore current methods of collecting and evaluating social listening data and to consider their applicability to cardiac safety surveillance. Social listening is defined as the act of monitoring public postings on the Internet. It has several theoretical advantages for drug and device safety. First, these include the ability to detect adverse events that are "missed" by traditional sources and the ability to detect adverse events sooner than would be allowed by traditional sources, both by affording near-real-time access to data from culturally and geographically diverse sources. Social listening can also potentially introduce a novel patient voice into the conversation about drug safety, which could uniquely augment understanding of real-world medication use obtained from more traditional methodologies. Finally, it can allow for access to information about drug misuse and diversion. To date, the latter 2 of these have been realized. Although regulators from the Food and Drug Administration and the United Kingdom's Medicines and Healthcare Products Regulatory Agency participated in the think tank along with representatives from industry, academia, and patient groups, this article should not be construed to constitute regulatory guidance. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial.

    Science.gov (United States)

    Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Phillips, Emma C; Uutela, Kimmo; Peltola, Petra; Cole, Stephen; Quasim, Tara; Ruddy, James; McDougall, Marcia; Davidson, Alan; Rutherford, John; Richards, Jonathan; Weir, Christopher J

    2016-10-01

    Optimal sedation of patients in intensive care units (ICUs) requires the avoidance of pain, agitation, and unnecessary deep sedation, but these outcomes are challenging to achieve. Excessive sedation can prolong ICU stay, whereas light sedation can increase pain and frightening memories, which are commonly recalled by ICU survivors. We aimed to assess the effectiveness of three interventions to improve sedation and analgesia quality: an online education programme; regular feedback of sedation-analgesia quality data; and use of a novel sedation-monitoring technology (the Responsiveness Index [RI]). We did a cluster randomised trial in eight ICUs, which were randomly allocated to receive education alone (two ICUs), education plus sedation-analgesia quality feedback (two ICUs), education plus RI monitoring technology (two ICUs), or all three interventions (two ICUs). Randomisation was done with computer-generated random permuted blocks, stratified according to recruitment start date. A 45 week baseline period was followed by a 45 week intervention period, separated by an 8 week implementation period in which the interventions were introduced. ICU and research staff were not masked to study group assignment during the intervention period. All mechanically ventilated patients were potentially eligible. We assessed patients' sedation-analgesia quality for each 12 h period of nursing care, and sedation-related adverse events daily. Our primary outcome was the proportion of care periods with optimal sedation-analgesia, defined as being free from excessive sedation, agitation, poor limb relaxation, and poor ventilator synchronisation. Analysis used multilevel generalised linear mixed modelling to explore intervention effects in a single model taking clustering and patient-level factors into account. A concurrent mixed-methods process evaluation was undertaken to help understand the trial findings. The trial is registered with ClinicalTrials.gov, number NCT01634451. Between

  18. Polypyrrole solid phase microextraction: A new approach to rapid sample preparation for the monitoring of antibiotic drugs

    International Nuclear Information System (INIS)

    Szultka, Malgorzata; Kegler, Ricarda; Fuchs, Patricia; Olszowy, Pawel; Miekisch, Wolfram; Schubert, Jochen K.; Buszewski, Boguslaw; Mundkowski, Ralf G.

    2010-01-01

    Simple or even rapid bioanalytical methods are rare, since they generally involve complicated, time-consuming sample preparation from the biological matrices like LLE or SPE. SPME provides a promising approach to overcome these limitations. The full potential of this innovative technique for medical diagnostics, pharmacotherapy or biochemistry has not been tapped yet. In-house manufactured SPME probes with polypyrrole (PPy) coating were evaluated using three antibiotics of high clinical relevance - linezolid, daptomycin, and moxifloxacin - from PBS, plasma, and whole blood. The PPy coating was characterised by scanning electron microscopy. Influences of pH, inorganic salt, and blood anticoagulants were studied for optimum performance. Extraction yields were determined from stagnant media as well as re-circulating human blood using the heart-and-lung machine model system. The PPy-SPME fibres showed high extraction yields, particularly regarding linezolid. The reproducibility of the method was optimised to achieve RSDs of 9% or 17% and 7% for SPME from stagnant or re-circulating blood using fresh and re-used fibres, respectively. The PPy-SPME approach was demonstrated to meet the requirements of therapeutic monitoring of the drugs tested, even from re-circulating blood at physiological flow rates. SPME represents a rapid and simple dual-step procedure with potency to significantly reduce the effort and expenditure of complicated sample preparations in biomedical analysis.

  19. Polypyrrole solid phase microextraction: A new approach to rapid sample preparation for the monitoring of antibiotic drugs

    Energy Technology Data Exchange (ETDEWEB)

    Szultka, Malgorzata [Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus, Copernicus University, Gagarin 7, 87-100 Torun (Poland); Kegler, Ricarda [Institute of Clinical Pharmacology, University of Rostock, Schillingallee 70, D-18057 Rostock (Germany); Fuchs, Patricia [Department of Anaesthesia and Intensive Care, University of Rostock, Schillingallee 35, D-18057 Rostock (Germany); Olszowy, Pawel [Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus, Copernicus University, Gagarin 7, 87-100 Torun (Poland); Miekisch, Wolfram; Schubert, Jochen K. [Department of Anaesthesia and Intensive Care, University of Rostock, Schillingallee 35, D-18057 Rostock (Germany); Buszewski, Boguslaw [Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus, Copernicus University, Gagarin 7, 87-100 Torun (Poland); Mundkowski, Ralf G., E-mail: ralf.mundkowski@med.uni-rostock.de [Institute of Clinical Pharmacology, University of Rostock, Schillingallee 70, D-18057 Rostock (Germany)

    2010-05-14

    Simple or even rapid bioanalytical methods are rare, since they generally involve complicated, time-consuming sample preparation from the biological matrices like LLE or SPE. SPME provides a promising approach to overcome these limitations. The full potential of this innovative technique for medical diagnostics, pharmacotherapy or biochemistry has not been tapped yet. In-house manufactured SPME probes with polypyrrole (PPy) coating were evaluated using three antibiotics of high clinical relevance - linezolid, daptomycin, and moxifloxacin - from PBS, plasma, and whole blood. The PPy coating was characterised by scanning electron microscopy. Influences of pH, inorganic salt, and blood anticoagulants were studied for optimum performance. Extraction yields were determined from stagnant media as well as re-circulating human blood using the heart-and-lung machine model system. The PPy-SPME fibres showed high extraction yields, particularly regarding linezolid. The reproducibility of the method was optimised to achieve RSDs of 9% or 17% and 7% for SPME from stagnant or re-circulating blood using fresh and re-used fibres, respectively. The PPy-SPME approach was demonstrated to meet the requirements of therapeutic monitoring of the drugs tested, even from re-circulating blood at physiological flow rates. SPME represents a rapid and simple dual-step procedure with potency to significantly reduce the effort and expenditure of complicated sample preparations in biomedical analysis.

  20. A novel assay for discovery and characterization of pro-apoptotic drugs and for monitoring apoptosis in patient sera.

    Science.gov (United States)

    Bivén, K; Erdal, H; Hägg, M; Ueno, T; Zhou, R; Lynch, M; Rowley, B; Wood, J; Zhang, C; Toi, M; Shoshan, M C; Linder, S

    2003-06-01

    We have developed an apoptosis assay based on measurement of a neoepitope of cytokeratin-18 (CK18-Asp396) exposed after caspase-cleavage and detected by the monoclonal antibody M30. The total amount of caspase-cleaved CK18 which has accumulated in cells and tissue culture media during apoptosis is measured by ELISA. The sensitivity is sufficient for use in the 96-well format to allow high-through-put screening of drug libraries. We here describe strategies allowing classification of pro-apoptotic compounds according to their profiles of induction of apoptosis in the presence of pharmacological inhibitors. The time course of induction of CK18 cleavage can furthermore be used to distinguish structurally similar compounds. We propose that compounds that induce rapid CK18 cleavage have mechanisms of actions distinct from conventional genotoxic and microtubuli-targeting agents, and we present one example of an agent that induces almost immediate mitochondrial depolarization and cytochrome c release. Finally, CK18-Asp396 cleavage products are released from cells in tissue culture, and presumably from tumor cells in vivo. These products can be measured in sera from cancer patients. We present evidence suggesting that it will be possible to use the M30-ELISA assay for measuring chemotherapy-induced apoptosis in patient sera, opening possibilities for monitoring therapy.

  1. Monitoring Utilization of a Large Scale Addiction Treatment System: The Drug and Alcohol Treatment Information System (DATIs

    Directory of Open Access Journals (Sweden)

    Nooshin Khobzi Rotondi

    2012-01-01

    Full Text Available Client-based information systems can yield data to address issues of system accountability and planning, and contribute information related to changing patterns of substance use in treatment and, indirectly, general populations. The Drug and Alcohol Treatment Information System (DATIS monitors the number/types of clients treated in approximately 170 publicly-funded addiction treatment agencies in Ontario. The purpose of this study was to estimate the caseload of addiction treatment agencies, and describe important characteristics of clients, their patterns of service utilization and trends over-time from 2005 to 2010. In 2009–2010, 47,065 individuals were admitted to treatment. Since 2005–2006, there has been an increase in adolescents/youth in treatment, and a decrease in the male-female gender ratio. Alcohol problems predominated, but an increasing proportion of clients used cannabis and prescription opioids. DATIS is an evolving system and an integral component of Ontario's performance measurement system. Linkages with healthcare information systems will allow for longitudinal tracking of client health-related outcomes.

  2. Remote monitoring of inhaled bronchodilator use and weekly feedback about asthma management: an open-group, short-term pilot study of the impact on asthma control.

    Directory of Open Access Journals (Sweden)

    David Van Sickle

    Full Text Available OBJECTIVE: Adequate symptom control is a problem for many people with asthma. We asked whether weekly email reports on monitored use of inhaled, short-acting bronchodilators might improve scores on composite asthma-control measures. METHODS: Through an investigational electronic medication sensor attached to each participant's inhaler, we monitored 4 months' use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test(TM (ACT, to assess asthma control at entry and monthly thereafter. After the first month, participants received weekly email reports for 3 months. The reports summarized inhaled bronchodilator use during the preceding week and provided suggestions derived from National Asthma Education and Prevention Program (NAEPP guidelines. Paired t-tests and random-effects mixed models were implemented to assess changes in primary asthma endpoints. RESULTS: Thirty individuals participated in the 4-month study; 29 provided complete asthma control information. Mean age was 36.8 years (range: 19-74 years; 52% of respondents were female. Mean ACT scores were 17.6 (Standard Deviation [SD]  = 3.35 at entry and 18.4 (SD = 3.60 at completion of the first month. No significant difference appeared between ACT values at entry and completion of the first month (p = 0.66; however, after participants began receiving email reports and online information about their inhaler use, mean ACT scores increased 1.40 points (95% CI: 0.61, 2.18 for each subsequent study month. Significant decreases occurred in 2-week histories of daytime symptoms (β = -1.35, 95% CI: -2.65, -0.04 and nighttime symptoms (β = -0.84, 95% CI: -1.25, -0.44; no significant change in activity limitation (β = -0.21, 95% CI: -0.69, 0.26 was observed. Participants reported increased awareness and understanding of asthma patterns, level of control, bronchodilator use (timing, location and triggers, and improved

  3. Ontology-Based Generation of Dynamic Feedback on Physical Activity

    NARCIS (Netherlands)

    Wieringa, Wilko; op den Akker, Harm; Jones, Valerie M.; Hermens, Hermanus J.; op den Akker, Hendrikus J.A.

    2011-01-01

    This article describes a new, AI-inspired telemedicine system for providing feedback on daily activity. Optimising daily levels of physical activity is an important focus in the treatment of chronic illnesses. An ambulatory monitoring and feedback system has been developed to monitor activity and

  4. Fault Tolerant Feedback Control

    DEFF Research Database (Denmark)

    Stoustrup, Jakob; Niemann, H.

    2001-01-01

    An architecture for fault tolerant feedback controllers based on the Youla parameterization is suggested. It is shown that the Youla parameterization will give a residual vector directly in connection with the fault diagnosis part of the fault tolerant feedback controller. It turns out...... that there is a separation be-tween the feedback controller and the fault tolerant part. The closed loop feedback properties are handled by the nominal feedback controller and the fault tolerant part is handled by the design of the Youla parameter. The design of the fault tolerant part will not affect the design...... of the nominal feedback con-troller....

  5. Feedback on Feedback--Does It Work?

    Science.gov (United States)

    Speicher, Oranna; Stollhans, Sascha

    2015-01-01

    It is well documented that providing assessment feedback through the medium of screencasts is favourably received by students and encourages deeper engagement with the feedback given by the language teacher (inter alia Abdous & Yoshimura, 2010; Brick & Holmes, 2008; Cann, 2007; Stannard, 2007). In this short paper we will report the…

  6. A review on development of analytical methods to determine monitorable drugs in serum and urine by micellar liquid chromatography using direct injection.

    Science.gov (United States)

    Esteve-Romero, Josep; Albiol-Chiva, Jaume; Peris-Vicente, Juan

    2016-07-05

    Therapeutic drug monitoring is a common practice in clinical studies. It requires the quantification of drugs in biological fluids. Micellar liquid chromatography (MLC), a well-established branch of Reverse Phase-High Performance Liquid Chromatography (RP-HPLC), has been proven by many researchers as a useful tool for the analysis of these matrices. This review presents several analytical methods, taken from the literature, devoted to the determination of several monitorable drugs in serum and urine by micellar liquid chromatography. The studied groups are: anticonvulsants, antiarrhythmics, tricyclic antidepressants, selective serotonin reuptake inhibitors, analgesics and bronchodilators. We detail the optimization strategy of the sample preparation and the main chromatographic conditions, such as the type of column, mobile phase composition (surfactant, organic solvent and pH), and detection. The finally selected experimental parameters, the validation, and some applications have also been described. In addition, their performances and advantages have been discussed. The main ones were the possibility of direct injection, and the efficient chromatographic elution, in spite of the complexity of the biological fluids. For each substance, the measured concentrations were accurate and precise at their respective therapeutic range. It was found that the MLC-procedures are fast, simple, inexpensive, ecofriendly, safe, selective, enough sensitive and reliable. Therefore, they represent an excellent alternative for the determination of drugs in serum and urine for monitoring purposes. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Alizarin Complexone Functionalized Mesoporous Silica Nanoparticles: A Smart System Integrating Glucose-Responsive Double-Drugs Release and Real-Time Monitoring Capabilities.

    Science.gov (United States)

    Zou, Zhen; He, Dinggeng; Cai, Linli; He, Xiaoxiao; Wang, Kemin; Yang, Xue; Li, Liling; Li, Siqi; Su, Xiaoya

    2016-04-06

    The outstanding progress of nanoparticles-based delivery systems capable of releasing hypoglycemic drugs in response to glucose has dramatically changed the outlook of diabetes management. However, the developed glucose-responsive systems have not offered real-time monitoring capabilities for accurate quantifying hypoglycemic drugs released. In this study, we present a multifunctional delivery system that integrates both delivery and monitoring issues using glucose-triggered competitive binding scheme on alizarin complexone (ALC) functionalized mesoporous silica nanoparticles (MSN). In this system, ALC is modified on the surface of MSN as the signal reporter. Gluconated insulin (G-Ins) is then introduced onto MSN-ALC via benzene-1,4-diboronic acid (BA) mediated esterification reaction, where G-Ins not only blocks drugs inside the mesopores but also works as a hypoglycemic drug. In the absence of glucose, the sandwich-type boronate ester structure formed by BA binding to the diols of ALC and G-Ins remains intact, resulting in an fluorescence emission peak at 570 nm and blockage of pores. Following a competitive binding, the presence of glucose cause the dissociation of boronate ester between ALC and BA, which lead to the pores opening and disappearance of fluorescence. As proof of concept, rosiglitazone maleate (RSM), an insulin-sensitizing agent, was doped into the MSN to form a multifunctional MSN (RSM@MSN-ALC-BA-Ins), integrating with double-drugs loading, glucose-responsive performance, and real-time monitoring capability. It has been demonstrated that the glucose-responsive release behaviors of insulin and RSM in buffer or in human serum can be quantified in real-time through evaluating the changes of fluorescence signal. We believe that this developed multifunctional system can shed light on the invention of a new generation of smart nanoformulations for optical diagnosis, individualized treatment, and noninvasive monitoring of diabetes management.

  8. Antiretroviral therapeutic drug monitoring

    African Journals Online (AJOL)

    Winnie

    hepatotoxicity, particularly among women with a lower body mass index, reported in ... limitations of TDM. Lastly, the potential role of TDM in southern Africa will be discussed. ... higher rates of virological suppression in the TDM arms. However ...

  9. Therapeutic Drug Monitoring

    Science.gov (United States)

    ... 27 weeks) Pregnancy: Third Trimester (28 weeks to delivery) Primary Aldosteronism (Conn Syndrome) Prostate Cancer Protein in Urine (Proteinuria) Reactive Arthritis Rheumatoid Arthritis Sarcoidosis ...

  10. Bayesian feedback versus Markovian feedback in a two-level atom

    International Nuclear Information System (INIS)

    Wiseman, H.M.; Mancini, Stefano; Wang Jin

    2002-01-01

    We compare two different approaches to the control of the dynamics of a continuously monitored open quantum system. The first is Markovian feedback, as introduced in quantum optics by Wiseman and Milburn [Phys. Rev. Lett. 70, 548 (1993)]. The second is feedback based on an estimate of the system state, developed recently by Doherty and Jacobs [Phys. Rev. A 60, 2700 (1999)]. Here we choose to call it, for brevity, Bayesian feedback. For systems with nonlinear dynamics, we expect these two methods of feedback control to give markedly different results. The simplest possible nonlinear system is a driven and damped two-level atom, so we choose this as our model system. The monitoring is taken to be homodyne detection of the atomic fluorescence, and the control is by modulating the driving. The aim of the feedback in both cases is to stabilize the internal state of the atom as close as possible to an arbitrarily chosen pure state, in the presence of inefficient detection and other forms of decoherence. Our results (obtained without recourse to stochastic simulations) prove that Bayesian feedback is never inferior, and is usually superior, to Markovian feedback. However, it would be far more difficult to implement than Markovian feedback and it loses its superiority when obvious simplifying approximations are made. It is thus not clear which form of feedback would be better in the face of inevitable experimental imperfections

  11. Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies.

    Science.gov (United States)

    Pham, Quang Duy; Wilson, David P; Nguyen, Thuong Vu; Do, Nhan Thi; Truong, Lien Xuan; Nguyen, Long Thanh; Zhang, Lei

    2016-05-01

    The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario. Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30. Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. The impact of an educational intervention, the New GP Contract and NICE guidelines on anti-epilepsy therapeutic drug monitoring.

    Science.gov (United States)

    Minshall, I; Berry, D; Smith, D

    2011-03-01

    Since the early 1970s therapeutic drug monitoring (TDM) of anti-epilepsy drug (AED) levels has been available to assist in the review process of patients with epilepsy. Routine blood levels were not part of the Quality and Outcomes Framework in the New GP Contract, neither have they been generally recommended in National Guidelines (NICE and SIGN) for the management of patients with epilepsy. To assess the impact of an educational intervention, the New GP Contract and NICE guidelines on the number of requests for TDM. Retrospective study. 39 general practices serving Chester (13), the Rural area surrounding Chester (13) and Ellesmere Port (13). An educational intervention took place in the individual Chester practices between December 2001 and March 2003. For the Rural and Ellesmere Port practices there was one combined event in March 2004 and in March 2007, respectively. Practices were encouraged, not to routinely request TDM, except in certain circumstances. The number of TDM requests for Chester, Rural and Ellesmere Port were obtained from the local laboratory in Chester, plus other nearby hospitals, to provide control groups. The number of TDM requests from primary care for Chester, Rural, Ellesmere Port, Wirral, Crewe, Warrington and Wrexham, April to April, 2002 through to 2008, where available. There has been a fall in the number requests in all districts. The most significant falls were in Chester (47%), Rural (34%) and Ellesmere Port (47%), and corresponded to the time of their educational intervention. The fall has been less marked in Wirral (25%), Crewe (27%), Wrexham (10%) and Warrington (9%). In 2004, the first year after the introduction of the New GP Contract, TDM in Chester and the Rural fell significantly, while those in Ellesmere Port, Wirral, Crewe and Wrexham increased. TDM dropped significantly in Ellesmere Port in the year after their educational intervention. Despite the valproate assay being clinically unhelpful there were still 611 requests

  13. Rateless feedback codes

    DEFF Research Database (Denmark)

    Sørensen, Jesper Hemming; Koike-Akino, Toshiaki; Orlik, Philip

    2012-01-01

    This paper proposes a concept called rateless feedback coding. We redesign the existing LT and Raptor codes, by introducing new degree distributions for the case when a few feedback opportunities are available. We show that incorporating feedback to LT codes can significantly decrease both...... the coding overhead and the encoding/decoding complexity. Moreover, we show that, at the price of a slight increase in the coding overhead, linear complexity is achieved with Raptor feedback coding....

  14. The Mythology of Feedback

    Science.gov (United States)

    Adcroft, Andy

    2011-01-01

    Much of the general education and discipline-specific literature on feedback suggests that it is a central and important element of student learning. This paper examines feedback from a social process perspective and suggests that feedback is best understood through an analysis of the interactions between academics and students. The paper argues…

  15. Who wants feedback? An investigation of the variables influencing residents' feedback-seeking behavior in relation to night shifts.

    Science.gov (United States)

    Teunissen, Pim W; Stapel, Diederik A; van der Vleuten, Cees; Scherpbier, Albert; Boor, Klarke; Scheele, Fedde

    2009-07-01

    The literature on feedback in clinical medical education has predominantly treated trainees as passive recipients. Past research has focused on how clinical supervisors can use feedback to improve a trainee's performance. On the basis of research in social and organizational psychology, the authors reconceptualized residents as active seekers of feedback. They investigated what individual and situational variables influence residents' feedback-seeking behavior on night shifts. Early in 2008, the authors sent obstetrics-gynecology residents in the Netherlands--both those in their first two years of graduate training and those gaining experience between undergraduate and graduate training--a questionnaire that assessed four predictor variables (learning and performance goal orientation, and instrumental and supportive leadership), two mediator variables (perceived feedback benefits and costs), and two outcome variables (frequency of feedback inquiry and monitoring). They used structural equation modeling software to test a hypothesized model of relationships between variables. The response rate was 76.5%. Results showed that residents who perceive more feedback benefits report a higher frequency of feedback inquiry and monitoring. More perceived feedback costs result mainly in more feedback monitoring. Residents with a higher learning goal orientation perceive more feedback benefits and fewer costs. Residents with a higher performance goal orientation perceive more feedback costs. Supportive physicians lead residents to perceive more feedback benefits and fewer costs. This study showed that some residents actively seek feedback. Residents' feedback-seeking behavior partially depends on attending physicians' supervisory style. Residents' goal orientations influence their perceptions of the benefits and costs of feedback-seeking.

  16. Hydrogel-Forming Microneedle Arrays Allow Detection of Drugs and Glucose In Vivo: Potential for Use in Diagnosis and Therapeutic Drug Monitoring.

    Directory of Open Access Journals (Sweden)

    Ester Caffarel-Salvador

    Full Text Available We describe, for the first time the use of hydrogel-forming microneedle (MN arrays for minimally-invasive extraction and quantification of drug substances and glucose from skin in vitro and in vivo. MN prepared from aqueous blends of hydrolysed poly(methyl-vinylether-co-maleic anhydride (11.1% w/w and poly(ethyleneglycol 10,000 daltons (5.6% w/w and crosslinked by esterification swelled upon skin insertion by uptake of fluid. Post-removal, theophylline and caffeine were extracted from MN and determined using HPLC, with glucose quantified using a proprietary kit. In vitro studies using excised neonatal porcine skin bathed on the underside by physiologically-relevant analyte concentrations showed rapid (5 min analyte uptake. For example, mean concentrations of 0.16 μg/mL and 0.85 μg/mL, respectively, were detected for the lowest (5 μg/mL and highest (35 μg/mL Franz cell concentrations of theophylline after 5 min insertion. A mean concentration of 0.10 μg/mL was obtained by extraction of MN inserted for 5 min into skin bathed with 5 μg/mL caffeine, while the mean concentration obtained by extraction of MN inserted into skin bathed with 15 μg/mL caffeine was 0.33 μg/mL. The mean detected glucose concentration after 5 min insertion into skin bathed with 4 mmol/L was 19.46 nmol/L. The highest theophylline concentration detected following extraction from a hydrogel-forming MN inserted for 1 h into the skin of a rat dosed orally with 10 mg/kg was of 0.363 μg/mL, whilst a maximum concentration of 0.063 μg/mL was detected following extraction from a MN inserted for 1 h into the skin of a rat dosed with 5 mg/kg theophylline. In human volunteers, the highest mean concentration of caffeine detected using MN was 91.31 μg/mL over the period from 1 to 2 h post-consumption of 100 mg Proplus® tablets. The highest mean blood glucose level was 7.89 nmol/L detected 1 h following ingestion of 75 g of glucose, while the highest mean glucose concentration

  17. Simultaneous UHPLC-UV analysis of hydroxychloroquine, minocycline and doxycycline from serum samples for the therapeutic drug monitoring of Q fever and Whipple's disease.

    Science.gov (United States)

    Armstrong, Nicholas; Richez, Magali; Raoult, Didier; Chabriere, Eric

    2017-08-15

    A fast UHPLC-UV method was developed for the simultaneous analysis of Hydroxychloroquine, Minocycline and Doxycycline drugs from 100μL of human serum samples. Serum samples were extracted by liquid-liquid extraction and injected into a phenyl hexyl reverse phase column. Compounds were separated using a mobile phase linear gradient and monitored by UV detection at 343nm. Chloroquine and Oxytetracycline were used as internal standards. Lower and upper limits of quantifications, as well as the other levels of calibration, were validated with acceptable accuracy (<15% deviation) and precision (<15% coefficient of variation) according to the European Medicines Agency guidelines. This new method enables cost and time reduction and was considered suitable for the clinical laboratory. It is the first published assay for the therapeutic drug monitoring of patients diagnosed with Q fever or Whipple's disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Prospective drug safety monitoring using the UK primary-care General Practice Research Database: theoretical framework, feasibility analysis and extrapolation to future scenarios.

    Science.gov (United States)

    Johansson, Saga; Wallander, Mari-Ann; de Abajo, Francisco J; García Rodríguez, Luis Alberto

    2010-03-01

    Post-launch drug safety monitoring is essential for the detection of adverse drug signals that may be missed during preclinical trials. Traditional methods of postmarketing surveillance such as spontaneous reporting have intrinsic limitations, many of which can be overcome by the additional application of structured pharmacoepidemiological approaches. However, further improvement in drug safety monitoring requires a shift towards more proactive pharmacoepidemiological methods that can detect adverse drug signals as they occur in the population. To assess the feasibility of using proactive monitoring of an electronic medical record system, in combination with an independent endpoint adjudication committee, to detect adverse events among users of selected drugs. UK General Practice Research Database (GPRD) information was used to detect acute liver disorder associated with the use of amoxicillin/clavulanic acid (hepatotoxic) or low-dose aspirin (acetylsalicylic acid [non-hepatotoxic]). Individuals newly prescribed these drugs between 1 October 2005 and 31 March 2006 were identified. Acute liver disorder cases were assessed using GPRD computer records in combination with case validation by an independent endpoint adjudication committee. Signal generation thresholds were based on the background rate of acute liver disorder in the general population. Over a 6-month period, 8148 patients newly prescribed amoxicillin/clavulanic acid and 5577 patients newly prescribed low-dose aspirin were identified. Within this cohort, searches identified 11 potential liver disorder cases from computerized records: six for amoxicillin/clavulanic acid and five for low-dose aspirin. The independent endpoint adjudication committee refined this to four potential acute liver disorder cases for whom paper-based information was requested for final case assessment. Final case assessments confirmed no cases of acute liver disorder. The time taken for this study was 18 months (6 months for

  19. Parenting practices and problem behavior across three generations: Monitoring, harsh discipline, and drug use in the intergenerational transmission of externalizing behavior

    OpenAIRE

    Bailey, Jennifer A.; Hill, Karl G.; Oesterle, Sabrina; Hawkins, J. David

    2009-01-01

    Using data from grandparents (G1), parents (G2), and children (G3), this study examined continuity in parental monitoring, harsh discipline, and child externalizing behavior across generations, and the contribution of parenting practices and parental drug use to intergenerational continuity in child externalizing behavior. Structural equation and path modeling of prospective, longitudinal data from 808 G2 participants, their G1 parents, and their school-aged G3 children (n = 136) showed that ...

  20. TDM in psychiatry and neurology: A comprehensive summary of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology, update 2017; a tool for clinicians.

    Science.gov (United States)

    Schoretsanitis, Georgios; Paulzen, Michael; Unterecker, Stefan; Schwarz, Markus; Conca, Andreas; Zernig, Gerald; Gründer, Gerhard; Haen, Ekkerhard; Baumann, Pierre; Bergemann, Niels; Clement, Hans Willi; Domschke, Katharina; Eckermann, Gabriel; Egberts, Karin; Gerlach, Manfred; Greiner, Christine; Havemann-Reinecke, Ursula; Hefner, Gudrun; Helmer, Renate; Janssen, Ger; Jaquenoud-Sirot, Eveline; Laux, Gerd; Messer, Thomas; Mössner, Rainald; Müller, Matthias J; Pfuhlmann, Bruno; Riederer, Peter; Saria, Alois; Schoppek, Bernd; Silva Gracia, Margarete; Stegmann, Benedikt; Steimer, Werner; Stingl, Julia C; Uhr, Manfred; Ulrich, Sven; Waschgler, Roland; Zurek, Gabriela; Hiemke, Christoph

    2018-04-01

    Therapeutic drug monitoring (TDM) combines the quantification of drug concentrations in blood, pharmacological interpretation and treatment guidance. TDM introduces a precision medicine tool in times of increasing awareness of the need for personalized treatment. In neurology and psychiatry, TDM can guide pharmacotherapy for patient subgroups such as children, adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance use disorders, individuals with pharmacokinetic peculiarities and forensic patients. Clear indications for TDM include lack of clinical response in the therapeutic dose range, assessment of drug adherence, tolerability issues and drug-drug interactions. Based upon existing literature, recommended therapeutic reference ranges, laboratory alert levels, and levels of recommendation to use TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dose-related drug concentrations and metabolite-to-parent ratios were calculated. This summary of the updated consensus guidelines by the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie offers the practical and theoretical knowledge for the integration of TDM as part of pharmacotherapy with neuropsychiatric agents into clinical routine. The present guidelines for TDM application for neuropsychiatric agents aim to assist clinicians in enhancing safety and efficacy of treatment.

  1. Quantification of imatinib in human serum: validation of a high-performance liquid chromatography-mass spectrometry method for therapeutic drug monitoring and pharmacokinetic assays

    Directory of Open Access Journals (Sweden)

    Rezende VM

    2013-08-01

    Full Text Available Vinicius Marcondes Rezende,1 Ariane Rivellis,1 Mafalda Megumi Yoshinaga Novaes,1 Dalton de Alencar Fisher Chamone,2 Israel Bendit1,21Laboratory of Tumor Biology, 2Department of Hematology, School of Medicine, University of São Paulo, São Paulo, BrazilBackground: Imatinib mesylate has been a breakthrough treatment for chronic myeloid leukemia. It has become the ideal tyrosine kinase inhibitor and the standard treatment for chronic-phase leukemia. Striking results have recently been reported, but intolerance to imatinib and noncompliance with treatment remain to be solved. Molecular monitoring by quantitative real-time polymerase chain reaction is the gold standard for monitoring patients, and imatinib blood levels have also become an important tool for monitoring.Methods: A fast and cheap method was developed and validated using high-performance liquid chromatography-mass spectrometry for quantification of imatinib in human serum and tamsulosin as the internal standard. Remarkable advantages of the method includes use of serum instead of plasma, less time spent on processing and analysis, simpler procedures, and requiring reduced amounts of biological material, solvents, and reagents. Stability of the analyte was also studied. This research also intended to drive the validation scheme in clinical centers. The method was validated according to the requirements of the US Food and Drug Administration and Brazilian National Health Surveillance Agency within the range of 0.500–10.0 µg/mL with a limit of detection of 0.155 µg/mL. Stability data for the analyte are also presented.Conclusion: Given that the validated method has proved to be linear, accurate, precise, and robust, it is suitable for pharmacokinetic assays, such as bioavailability and bioequivalence, and is being successfully applied in routine therapeutic drug monitoring in the hospital service.Keywords: imatinib, high-performance liquid chromatography-mass spectrometry, therapeutic

  2. Analysis of veterinary drug residue monitoring results for commercial livestock products in Taiwan between 2011 and 2015

    OpenAIRE

    Hsin-Chun Lee; Chi-Min Chen; Jen-Ting Wei; Hsiu-Yi Chiu

    2018-01-01

    Antibiotics have been widely used in the treatment of livestock diseases. However, the emergence of issues related to drug resistance prompted governments to enact a series of laws regulating the use of antibiotics in livestock. Following control of the problem of drug resistant bacteria, public attention has shifted to the recurring incidence of human health and safety issues caused by residual veterinary drugs in livestock products. To guarantee the safety and hygiene of meat, milk, and egg...

  3. Uninterrupted monitoring of drug effects in human-induced pluripotent stem cell-derived cardiomyocytes with bioluminescence Ca2+ microscopy.

    Science.gov (United States)

    Suzuki, Kazushi; Onishi, Takahito; Nakada, Chieko; Takei, Shunsuke; Daniels, Matthew J; Nakano, Masahiro; Matsuda, Tomoki; Nagai, Takeharu

    2018-05-18

    Cardiomyocytes derived from human-induced pluripotent stem cells are a powerful platform for high-throughput drug screening in vitro. However, current modalities for drug testing, such as electrophysiology and fluorescence imaging have inherent drawbacks. To circumvent these problems, we report the development of a bioluminescent Ca 2+ indicator GmNL(Ca 2+ ), and its application in a customized microscope for high-throughput drug screening. GmNL(Ca 2+ ) gives a 140% signal change with Ca 2+ , and can image drug-induced changes of Ca 2+ dynamics in cultured cells. Since bioluminescence requires application of a chemical substrate, which is consumed over ~ 30 min we made a dedicated microscope with automated drug dispensing inside a light-tight box, to control drug addition. To overcome thermal instability of the luminescent substrate, or small molecule, dual climate control enables distinct temperature settings in the drug reservoir and the biological sample. By combining GmNL(Ca 2+ ) with this adaptation, we could image spontaneous Ca 2+ transients in cultured cardiomyocytes and phenotype their response to well-known drugs without accessing the sample directly. In addition, the bioluminescent strategy demonstrates minimal perturbation of contractile parameters and long-term observation attributable to lack of phototoxicity and photobleaching. Overall, bioluminescence may enable more accurate drug screening in a high-throughput manner.

  4. Quantification of imatinib in human serum: validation of a high-performance liquid chromatography-mass spectrometry method for therapeutic drug monitoring and pharmacokinetic assays.

    Science.gov (United States)

    Rezende, Vinicius Marcondes; Rivellis, Ariane; Novaes, Mafalda Megumi Yoshinaga; de Alencar Fisher Chamone, Dalton; Bendit, Israel

    2013-01-01

    Imatinib mesylate has been a breakthrough treatment for chronic myeloid leukemia. It has become the ideal tyrosine kinase inhibitor and the standard treatment for chronic-phase leukemia. Striking results have recently been reported, but intolerance to imatinib and noncompliance with treatment remain to be solved. Molecular monitoring by quantitative real-time polymerase chain reaction is the gold standard for monitoring patients, and imatinib blood levels have also become an important tool for monitoring. A fast and cheap method was developed and validated using high-performance liquid chromatography-mass spectrometry for quantification of imatinib in human serum and tamsulosin as the internal standard. Remarkable advantages of the method includes use of serum instead of plasma, less time spent on processing and analysis, simpler procedures, and requiring reduced amounts of biological material, solvents, and reagents. Stability of the analyte was also studied. This research also intended to drive the validation scheme in clinical centers. The method was validated according to the requirements of the US Food and Drug Administration and Brazilian National Health Surveillance Agency within the range of 0.500-10.0 μg/mL with a limit of detection of 0.155 μg/mL. Stability data for the analyte are also presented. Given that the validated method has proved to be linear, accurate, precise, and robust, it is suitable for pharmacokinetic assays, such as bioavailability and bioequivalence, and is being successfully applied in routine therapeutic drug monitoring in the hospital service.

  5. FEEDBACK AND LOGISTICS CONTROLLING

    Directory of Open Access Journals (Sweden)

    Mehesne Berek Szilvia

    2015-07-01

    Full Text Available The following things led to that the feedback, the supervision and improvement of the processes have become more pronounced: continuous rise in the importance of logistics; increase in complexity of its content; its activity becoming more complex. These activities are necessary for the optimum information supply. The intensification of market competition requires the corporations to possess exact and up-to-date information about their activities. Complexity of the logistics system presumes a parallel application of an effective feedback, supervision and management system simultaneously with the given logistics system. The indispensability of logistics is also proved by the fact that it can be found sporadically (in the form of logistics departments or in a complex way in case of each organization. The logistical approach means a huge support in the management since it contains the complexity, the handling as a unit in order to ensure a harmony of the different corporate departments and part activities. In addition to the professional application of a logistics system, there is an opportunity to coordinate the relations inside an organization as well as between the organizations and to handle them as a unit. The sine qua non of the success of logistical processes is a harmony of the devices applied. The controlling system is a device for feeding back the processes of a corporate system. By means of the checkpoints intercalated into the processes, the logistics controlling provides information for the leadership which contributes even more to the complex approach of logistics system. By dint of the logistics controlling, the monitoring and coordination of every logistical part activity become possible with the help of information supply ensured by the logistics controlling. The logistics controlling reviews, assesses and coordinates; these activities have an effect on the cost and income management. Its reason is to be searched in the built

  6. Follower-Centered Perspective on Feedback: Effects of Feedback Seeking on Identification and Feedback Environment

    OpenAIRE

    Gong, Zhenxing; Li, Miaomiao; Qi, Yaoyuan; Zhang, Na

    2017-01-01

    In the formation mechanism of the feedback environment, the existing research pays attention to external feedback sources and regards individuals as objects passively accepting feedback. Thus, the external source fails to realize the individuals’ need for feedback, and the feedback environment cannot provide them with useful information, leading to a feedback vacuum. The aim of this study is to examine the effect of feedback-seeking by different strategies on the supervisor-feedback environme...

  7. Role for therapeutic drug monitoring during induction therapy with TNF antagonists in IBD: evolution in the definition and management of primary nonresponse.

    Science.gov (United States)

    Papamichael, Konstantinos; Gils, Ann; Rutgeerts, Paul; Levesque, Barrett G; Vermeire, Séverine; Sandborn, William J; Vande Casteele, Niels

    2015-01-01

    : Primary nonresponse and primary nonremission are important limitations of tumor necrosis factor (TNF) antagonists, occurring in 10% to 40% and 50% to 80% of patients with inflammatory bowel disease, respectively. The magnitude of primary nonresponse differs between phase III clinical trials and cohort studies, indicating differences, e.g., in definition, patient population or blinding. The causes of nonresponse can be attributed to the drug (pharmacokinetics, immunogenicity), the patient (genetics, disease activity), the disease (type, location, severity), and/or the treatment strategy (dosing regimen, combination therapy). Primary nonresponse has been attributed to "non-TNF-driven disease" which is an overly simplified and potentially misleading approach to the problem. Many patients with primary nonresponse could successfully be treated with dose optimization during the induction phase or switching to another TNF antagonist. Therefore, primary nonresponse is frequently not a non-TNF-driven disease. Recent studies from rheumatoid arthritis and preliminary data from inflammatory bowel disease evaluating therapeutic drug monitoring have suggested that early measurement of drug and anti-drug antibody concentrations could help to define primary nonresponse and rationalize patient management of this problem. Moreover, a modeling approach including pharmacological parameters and patient-related covariants could potentially be predictive for response to the treatment. We describe an overview of this evolution in thinking, underpinned by previous findings, and assess the potential role of early measurement of drug and antidrug antibody concentrations in the definition and management of primary nonresponse.

  8. RF feedback for KEKB

    Energy Technology Data Exchange (ETDEWEB)

    Ezura, Eizi; Yoshimoto, Shin-ichi; Akai, Kazunori [National Lab. for High Energy Physics, Tsukuba, Ibaraki (Japan)

    1996-08-01

    This paper describes the present status of the RF feedback development for the KEK B-Factory (KEKB). A preliminary experiment concerning the RF feedback using a parallel comb-filter was performed through a choke-mode cavity and a klystron. The RF feedback has been tested using the beam of the TRISTAN Main Ring, and has proved to be effective in damping the beam instability. (author)

  9. Neural cryptography with feedback.

    Science.gov (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Shacham, Lanir; Kanter, Ido

    2004-04-01

    Neural cryptography is based on a competition between attractive and repulsive stochastic forces. A feedback mechanism is added to neural cryptography which increases the repulsive forces. Using numerical simulations and an analytic approach, the probability of a successful attack is calculated for different model parameters. Scaling laws are derived which show that feedback improves the security of the system. In addition, a network with feedback generates a pseudorandom bit sequence which can be used to encrypt and decrypt a secret message.

  10. Feedback and Incentives:

    DEFF Research Database (Denmark)

    Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie-Claire

    This paper experimentally investigates the impact of different pay and relative performance information policies on employee effort. We explore three information policies: No feedback about relative performance, feedback given halfway through the production period, and continuously updated feedba...... of positive peer effects since the underdogs almost never quit the competition even when lagging significantly behind, and frontrunners do not slack off. Moreover, in both pay schemes information feedback reduces the quality of the low performers' work....

  11. Dual turn-on fluorescence signal-based controlled release system for real-time monitoring of drug release dynamics in living cells and tumor tissues.

    Science.gov (United States)

    Kong, Xiuqi; Dong, Baoli; Song, Xuezhen; Wang, Chao; Zhang, Nan; Lin, Weiying

    2018-01-01

    Controlled release systems with capabilities for direct and real-time monitoring of the release and dynamics of drugs in living systems are of great value for cancer chemotherapy. Herein, we describe a novel dual turn-on fluorescence signal-based controlled release system ( CDox ), in which the chemotherapy drug doxorubicin ( Dox ) and the fluorescent dye ( CH ) are conjugated by a hydrazone moiety, a pH-responsive cleavable linker. CDox itself shows nearly no fluorescence as the fluorescence of CH and Dox is essentially quenched by the C=N isomerization and N-N free rotation. However, when activated under acidic conditions, CDox could be hydrolyzed to afford Dox and CH , resulting in dual turn-on signals with emission peaks at 595 nm and 488 nm, respectively. Notably, CDox exhibits a desirable controlled release feature as the hydrolysis rate is limited by the steric hindrance effect from both the Dox and CH moieties. Cytotoxicity assays indicate that CDox shows much lower cytotoxicity relative to Dox , and displays higher cell inhibition rate to cancer than normal cells. With the aid of the dual turn-on fluorescence at different wavelengths, the drug release dynamics of CDox in living HepG2 and 4T-1 cells was monitored in double channels in a real-time fashion. Importantly, two-photon fluorescence imaging of CDox in living tumor tissues was also successfully performed by high-definition 3D imaging. We expect that the unique controlled release system illustrated herein could provide a powerful means to investigate modes of action of drugs, which is critical for development of much more robust and effective chemotherapy drugs.

  12. Policy Feedback System (PFS)

    Data.gov (United States)

    Social Security Administration — The Policy Feedback System (PFS) is a web application developed by the Office of Disability Policy Management Information (ODPMI) team that gathers empirical data...

  13. Feedback stabilization initiative

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes.

  14. Feedback stabilization initiative

    International Nuclear Information System (INIS)

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes

  15. Feedback Loop Gains and Feedback Behavior (1996)

    DEFF Research Database (Denmark)

    Kampmann, Christian Erik

    2012-01-01

    Linking feedback loops and system behavior is part of the foundation of system dynamics, yet the lack of formal tools has so far prevented a systematic application of the concept, except for very simple systems. Having such tools at their disposal would be a great help to analysts in understanding...... large, complicated simulation models. The paper applies tools from graph theory formally linking individual feedback loop strengths to the system eigenvalues. The significance of a link or a loop gain and an eigenvalue can be expressed in the eigenvalue elasticity, i.e., the relative change...... of an eigenvalue resulting from a relative change in the gain. The elasticities of individual links and loops may be found through simple matrix operations on the linearized system. Even though the number of feedback loops can grow rapidly with system size, reaching astronomical proportions even for modest systems...

  16. Systematic, digital student feedback for differentiated teaching

    DEFF Research Database (Denmark)

    Graf, Stefan Ting; Carlsen, Dorthe

    2017-01-01

    The article reports results from a qualitative study of Elevbaro, a prototype of a digital tool for student feedback developed in connection with the demonstration school project, inclusion, and differentiated teaching in digital learning environments. At the same time the study represents...... the first step of validating Elevbaro as a systematic feedback tool. There is general consensus that feedback is central to the quality of teaching, but the focus on and the exploration of systematic student feedback is an overlooked topic. Especially as regards differentiated teaching and complex teaching...... patterns, there is a need for supplementary and digital monitoring of a group of students and of individual students. The article examines how students and teachers understand and use Elevbaro, which is built on frequent ratings of five set statements in connection with teaching over a certain period...

  17. RHIC 10 Hz global orbit feedback system

    International Nuclear Information System (INIS)

    Michnoff, R.; Arnold, L.; Carboni, L.; Cerniglia, P.; Curcio, A.; DeSanto, L.; Folz, C.; Ho, C.; Hoff, L.; Hulsart, R.; Karl, R.; Luo, Y.; Liu, C.; MacKay, W.; Mahler, G.; Meng, W.; Mernick, K.; Minty, M.; Montag, C.; Olsen, R.; Piacentino, J.; Popken, P.; Przybylinski, R.; Ptitsyn, V.; Ritter, J.; Schoenfeld, R.; Thieberger, P.; Tuozzolo, J.; Weston, A.; White, J.; Ziminski, P.; Zimmerman, P.

    2011-01-01

    Vibrations of the cryogenic triplet magnets at the Relativistic Heavy Ion Collider (RHIC) are suspected to be causing the horizontal beam perturbations observed at frequencies around 10 Hz. Several solutions to counteract the effect have been considered in the past, including a local beam feedback system at each of the two experimental areas, reinforcing the magnet base support assembly, and a mechanical servo feedback system. However, the local feedback system was insufficient because perturbation amplitudes outside the experimental areas were still problematic, and the mechanical solutions are very expensive. A global 10 Hz orbit feedback system consisting of 36 beam position monitors (BPMs) and 12 small dedicated dipole corrector magnets in each of the two 3.8 km circumference counter-rotating rings has been developed and commissioned in February 2011. A description of the system architecture and results with beam will be discussed.

  18. Drugged Driving

    Science.gov (United States)

    ... Survey Results Synthetic Cannabinoids (K2/Spice) Unpredictable Danger Drug and Alcohol Use in College-Age Adults in 2016 Monitoring the Future 2016 Survey Results Drug and Alcohol Use in College-Age Adults in 2015 View All NIDA Home ...

  19. Milrinone therapeutic drug monitoring in a pediatric population: Development and validation of a quantitative liquid chromatography-tandem mass spectrometry method.

    Science.gov (United States)

    Raizman, Joshua E; Taylor, Katherine; Parshuram, Christopher; Colantonio, David A

    2017-05-01

    Milrinone is a potent selective phosphodiesterase type III inhibitor which stimulates myocardial function and improves myocardial relaxation. Although therapeutic monitoring is crucial to maintain therapeutic outcome, little data is available. A proof-of-principle study has been initiated in our institution to evaluate the clinical impact of optimizing milrinone dosing through therapeutic drug monitoring (TDM) in children following cardiac surgery. We developed a robust LC-MS/MS method to quantify milrinone in serum from pediatric patients in real-time. A liquid-liquid extraction procedure was used to prepare samples for analysis prior to measurement by LC-MS/MS. Performance characteristics, such as linearity, limit of quantitation (LOQ) and precision, were assessed. Patient samples were acquired post-surgery and analyzed to determine the concentration-time profile of the drug as well as to track turn-around-times. Within day precision was milrinone levels were either sub-therapeutic or in the toxic range, highlighting the importance for milrinone TDM. This simplified and quick method proved to be analytically robust and able to provide therapeutic monitoring of milrinone in real-time in patients post-cardiac surgery. Copyright © 2017. Published by Elsevier B.V.

  20. Isothermal microcalorimetry - A quantitative method to monitor Trypanosoma congolense growth and growth inhibition by trypanocidal drugs in real time.

    Science.gov (United States)

    Gysin, M; Braissant, O; Gillingwater, K; Brun, R; Mäser, P; Wenzler, T

    2018-03-16

    Trypanosoma congolense is a protozoan parasite that is transmitted by tsetse flies, causing African Animal Trypanosomiasis, also known as Nagana, in sub-Saharan Africa. Nagana is a fatal disease of livestock that causes severe economic losses. Two drugs are available, diminazene and isometamidium, yet successful treatment is jeopardized by drug resistant T. congolense. Isothermal microcalorimetry is a highly sensitive tool that can be used to study growth of the extracellular T. congolense parasites or to study parasite growth inhibition after the addition of antitrypanosomal drugs. Time of drug action and time to kill can be quantified in a simple way by real time heat flow measurements. We established a robust protocol for the microcalorimetric studies of T. congolense and developed mathematical computations in R to calculate different parameters related to growth and the kinetics of drug action. We demonstrate the feasibility and benefit of the method exemplary with the two standard drugs, diminazene aceturate and isometamidium chloride. The method and the mathematical approach can be translated to study other pathogenic or non-pathogenic cells if they are metabolically active and grow under axenic conditions. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Simultaneous determination of ten antiepileptic drugs in human plasma by liquid chromatography and tandem mass spectrometry with positive/negative ion-switching electrospray ionization and its application in therapeutic drug monitoring.

    Science.gov (United States)

    Yin, Lei; Wang, Tingting; Shi, Meiyun; Zhang, Ying; Zhao, Xiaojun; Yang, Yan; Gu, Jingkai

    2016-03-01

    A simple, rapid, and high-throughput liquid chromatography with tandem mass spectrometry method for the simultaneous quantitation of ten antiepileptic drugs in human plasma has been developed and validated. The method required only 10 μL of plasma. After simple protein precipitation using acetonitrile, the analytes and internal standard diphenhydramine were separated on a Zorbax SB-C18 column (50 × 4.6 mm, 2.7 μm) using acetonitrile/water as the mobile phase at a flow rate of 0.9 mL/min. The total run time was 6 min for each sample. The validation results of specificity, matrix effects, recovery, linearity, precision, and accuracy were satisfactory. The lower limit of quantification was 0.04 μg/mL for carbamazepine, 0.02 μg/mL for lamotrigine, 0.01 μg/mL for oxcarbazepine, 0.4 μg/mL for 10-hydroxycarbazepine, 0.1 μg/mL for carbamazepine-10,11-epoxide, 0.15 μg/mL for levetiracetam, 0.06 μg/mL for phenytoin, 0.3 μg/mL for valproic acid, 0.03 μg/mL for topiramate, and 0.15 μg/mL for phenobarbital. The intraday precision and interday precision were less than 7.6%, with the accuracy ranging between -8.1 and 7.9%. The method was successfully applied to therapeutic drug monitoring of 1237 patients with epilepsy after administration of standard antiepileptic drugs. The method has been proved to meet the high-throughput requirements in therapeutic drug monitoring. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Effects of feedback reliability on feedback-related brain activity: A feedback valuation account.

    Science.gov (United States)

    Ernst, Benjamin; Steinhauser, Marco

    2018-04-06

    Adaptive decision making relies on learning from feedback. Because feedback sometimes can be misleading, optimal learning requires that knowledge about the feedback's reliability be utilized to adjust feedback processing. Although previous research has shown that feedback reliability indeed influences feedback processing, the underlying mechanisms through which this is accomplished remain unclear. Here we propose that feedback processing is adjusted by the adaptive, top-down valuation of feedback. We assume that unreliable feedback is devalued relative to reliable feedback, thus reducing the reward prediction errors that underlie feedback-related brain activity and learning. A crucial prediction of this account is that the effects of feedback reliability are susceptible to contrast effects. That is, the effects of feedback reliability should be enhanced when both reliable and unreliable feedback are experienced within the same context, as compared to when only one level of feedback reliability is experienced. To evaluate this prediction, we measured the event-related potentials elicited by feedback in two experiments in which feedback reliability was varied either within or between blocks. We found that the fronto-central valence effect, a correlate of reward prediction errors during reinforcement learning, was reduced for unreliable feedback. But this result was obtained only when feedback reliability was varied within blocks, thus indicating a contrast effect. This suggests that the adaptive valuation of feedback is one mechanism underlying the effects of feedback reliability on feedback processing.

  3. Feedback For Helpers

    Science.gov (United States)

    Stromer, Walter F.

    1975-01-01

    The author offers some feedback to those in the helping professions in three areas: (1) forms and letters; (2) jumping to conclusions; and (3) blaming and belittling, in hopes of stimulating more feedback as well as more positive ways of performing their services. (HMV)

  4. 'Peer feedback' voor huisartsopleiders

    NARCIS (Netherlands)

    Damoiseaux, R A M J; Truijens, L

    2016-01-01

    In medical specialist training programmes it is common practice for residents to provide feedback to their medical trainers. The problem is that due to its anonymous nature, the feedback often lacks the specificity necessary to improve the performance of trainers. If anonymity is to be abolished,

  5. Feedback og interpersonel kommunikation

    DEFF Research Database (Denmark)

    Dindler, Camilla

    2016-01-01

    Som interpersonel kommunikationsform handler feedback om at observere, mærke og italesætte det, som handler om relationen mellem samtaleparterne mere end om samtaleemnet. Her er fokus på, hvad der siges og hvordan der kommunikeres sammen. Feedback er her ikke en korrigerende tilbagemelding til...

  6. Quantum learning by measurement and feedback

    DEFF Research Database (Denmark)

    Gammelmark, Søren; Mølmer, Klaus

    2009-01-01

    We investigate an approach to quantum computing in which quantum gate strengths are parametrized by quantum degrees of freedom. The capability of the quantum computer to perform desired tasks is monitored by measurements of the output and gradually improved by successive feedback modifications...

  7. Quantum Learning by Measurement and Feedback

    DEFF Research Database (Denmark)

    Gammelmark, Søren

    We investigate an approach to quantum computing in which quantum gate strengths are parametrized by quantum degrees of freedom. The capability of the quantum computer to perform desired tasks is monitored by measurements of the output and gradually improved by successive feedback modifications...

  8. Problems with drugs in Croatia.

    Science.gov (United States)

    Vrhovac, B

    1997-01-01

    Croatia has 4.8 million inhabitants, 11,800 physicians, 2000 pharmacists, two now shareholding, pharmaceutical companies (about 6500 employees, total sales of about 350 million US dollars). There are a number of problems due to the war (GNP fell from 3800 to about 1500 US dollars), occupation of 25% of its territory, 0.5 million refugees and lack of resources (139 US dollars/capita for health, about 40 US dollars i.e. 30%!! for drugs)--about three times less than before the aggression. The drug situation is controlled with the help of: (1) donations (approximate value of 600 million US dollars since 1991 from Europe and US), (2) (essential) drug formularies--250 for outpatients, and 580 generic names for various levels of hospital use, (3) special efforts to purchase drugs of good quality at a reasonable price (a kind of tender), (4) control of prescribing (prescriptions, specialists referral) especially by GPs. A new Medicines Act is in preparation and about 1000 generic names are on the market. DRUG EDUCATION: Pharmaca: the Croatian journal of pharmacotherapy has been published since 1962, there are several Drug bulletins (one published since 1975); special chapters on clinical pharmacology in textbooks, translation of three editions of Laurence's textbook with special commentary and adaptation to local needs; ADR spontaneous and intensive monitoring (WHO programme) with a personal feedback to the reporters and regular articles on drug use in a number of periodicals. Data on drug consumption indicates that there is room for improvement of prescribing. There is an enthusiasm for 'vasoactive drugs'--after dipirydamole came oxpentifylline and antimicrobials are always overprescribed. All these problems will hopefully decrease when the war finally stops and when industry (especially tourism) starts being fruitful again. In any case the importance of teaching of pharmacotherapy at the under- and postgraduate level should be recognized. Copyright 1997 by John Wiley

  9. Velocity Feedback Experiments

    Directory of Open Access Journals (Sweden)

    Chiu Choi

    2017-02-01

    Full Text Available Transient response such as ringing in a control system can be reduced or removed by velocity feedback. It is a useful control technique that should be covered in the relevant engineering laboratory courses. We developed velocity feedback experiments using two different low cost technologies, viz., operational amplifiers and microcontrollers. These experiments can be easily integrated into laboratory courses on feedback control systems or microcontroller applications. The intent of developing these experiments was to illustrate the ringing problem and to offer effective, low cost solutions for removing such problem. In this paper the pedagogical approach for these velocity feedback experiments was described. The advantages and disadvantages of the two different implementation of velocity feedback were discussed also.

  10. Feedback i matematik

    DEFF Research Database (Denmark)

    Sortkær, Bent

    2017-01-01

    Feedback bliver i litteraturen igen og igen fremhævet som et af de mest effektive midler til at fremme elevers præstationer i skolen (Hartberg, Dobson, & Gran, 2012; Hattie & Timperley, 2007; Wiliam, 2015). Dette på trods af, at flere forskere påpeger, at feedback ikke altid er læringsfremmende...... (Hattie & Gan, 2011), og nogle endda viser, at feedback kan have en negativ virkning i forhold til præstationer (Kluger & DeNisi, 1996). Artiklen vil undersøge disse tilsyneladende modstridende resultater ved at stille spørgsmålet: Under hvilke forudsætninger virker feedback i matematik læringsfremmende......? Dette gøres ved at dykke ned i forskningslitteraturen omhandlende feedback ud fra en række temaer for på den måde at besvare ovenstående spørgsmål....

  11. A Smart Europium-Ruthenium Complex as Anticancer Prodrug: Controllable Drug Release and Real-Time Monitoring under Different Light Excitations.

    Science.gov (United States)

    Li, Hongguang; Xie, Chen; Lan, Rongfeng; Zha, Shuai; Chan, Chi-Fai; Wong, Wing-Yan; Ho, Ka-Lok; Chan, Brandon Dow; Luo, Yuxia; Zhang, Jing-Xiang; Law, Ga-Lai; Tai, William C S; Bünzli, Jean-Claude G; Wong, Ka-Leung

    2017-11-09

    A unique, dual-function, photoactivatable anticancer prodrug, RuEuL, has been tailored that features a ruthenium(II) complex linked to a cyclen-europium chelate via a π-conjugated bridge. Under irradiation at 488 nm, the dark-inactive prodrug undergoes photodissociation, releasing the DNA-damaging ruthenium species. Under evaluation-window irradiation (λ irr = one-photon 350 nm or two-photon 700 nm), the drug delivery process can be quantitatively monitored in real-time because of the long-lived red europium emission. Linear relationships between released drug concentration and ESI-MS or luminescence responses are established. Finally, the efficiency of the new prodrug is demonstrated both in vitro RuEuL anticancer prodrug over some existing ones and open the way for decisive improvements in multipurpose prodrugs.

  12. Novel insights in the fecal egg count reduction test for monitoring drug efficacy against soil-transmitted helminths in large-scale treatment programs.

    Directory of Open Access Journals (Sweden)

    Bruno Levecke

    2011-12-01

    Full Text Available The fecal egg count reduction test (FECRT is recommended to monitor drug efficacy against soil-transmitted helminths (STHs in public health. However, the impact of factors inherent to study design (sample size and detection limit of the fecal egg count (FEC method and host-parasite interactions (mean baseline FEC and aggregation of FEC across host population on the reliability of FECRT is poorly understood.A simulation study was performed in which FECRT was assessed under varying conditions of the aforementioned factors. Classification trees were built to explore critical values for these factors required to obtain conclusive FECRT results. The outcome of this analysis was subsequently validated on five efficacy trials across Africa, Asia, and Latin America. Unsatisfactory (<85.0% sensitivity and specificity results to detect reduced efficacy were found if sample sizes were small (<10 or if sample sizes were moderate (10-49 combined with highly aggregated FEC (k<0.25. FECRT remained inconclusive under any evaluated condition for drug efficacies ranging from 87.5% to 92.5% for a reduced-efficacy-threshold of 90% and from 92.5% to 97.5% for a threshold of 95%. The most discriminatory study design required 200 subjects independent of STH status (including subjects who are not excreting eggs. For this sample size, the detection limit of the FEC method and the level of aggregation of the FEC did not affect the interpretation of the FECRT. Only for a threshold of 90%, mean baseline FEC <150 eggs per gram of stool led to a reduced discriminatory power.This study confirms that the interpretation of FECRT is affected by a complex interplay of factors inherent to both study design and host-parasite interactions. The results also highlight that revision of the current World Health Organization guidelines to monitor drug efficacy is indicated. We, therefore, propose novel guidelines to support future monitoring programs.

  13. Monitoring the size and protagonists of the drug market: combining supply and demand data sources and estimates.

    Science.gov (United States)

    Rossi, Carla

    2013-06-01

    The size of the illicit drug market is an important indicator to assess the impact on society of an important part of the illegal economy and to evaluate drug policy and law enforcement interventions. The extent of illicit drug use and of the drug market can essentially only be estimated by indirect methods based on indirect measures and on data from various sources, as administrative data sets and surveys. The combined use of several methodologies and data sets allows to reduce biases and inaccuracies of estimates obtained on the basis of each of them separately. This approach has been applied to Italian data. The estimation methods applied are capture-recapture methods with latent heterogeneity and multiplier methods. Several data sets have been used, both administrative and survey data sets. First, the retail dealer prevalence has been estimated on the basis of administrative data, then the user prevalence by multiplier methods. Using information about behaviour of dealers and consumers from survey data, the average amount of a substance used or sold and the average unit cost have been estimated and allow estimating the size of the drug market. The estimates have been obtained using a supply-side approach and a demand-side approach and have been compared. These results are in turn used for estimating the interception rate for the different substances in term of the value of the substance seized with respect to the total value of the substance to be sold at retail prices.

  14. Parallel monitoring of plasma and intraluminal drug concentrations in man after oral administration of fosamprenavir in the fasted and fed state.

    Science.gov (United States)

    Brouwers, Joachim; Tack, Jan; Augustijns, Patrick

    2007-10-01

    The purpose of this study was to explore the feasibility of linking the pharmacokinetic profile of a drug with its gastrointestinal behavior by simultaneously monitoring plasma and intraluminal drug concentrations. Fosamprenavir, a phosphate ester prodrug of the poorly water-soluble HIV-inhibitor amprenavir, was selected as model compound. A single tablet of fosamprenavir (Telzir) was administered to 5 volunteers in the fasted and fed state (simulated by intake of a nutritional drink). Gastric and duodenal fluids were aspirated in function of time and characterized with respect to the concentration of (fos)amprenavir, inorganic phosphate and pH. In parallel, blood samples were collected and analyzed for amprenavir. The observed plasma concentration-time profiles suggested a food-induced delay in the absorption of amprenavir: in the fed state, mean tmax increased by more than 150 min compared to the fasted state. A similar delay was seen in the duodenal appearance of fosamprenavir (concentrations in mM-range) and, after dephosphorylation, amprenavir (concentrations below 160 microM). This observation could be related to the behavior of fosamprenavir in the stomach. In the fasted state, gastric dissolution of fosamprenavir started immediately, resulting in a Cmax of 4 +/- 2 mM after 43 +/- 15 min; however, in the fed state, the fosamprenavir concentration remained below 20 microM for the first 90 min after drug intake. The postponed gastric dissolution may be attributed to a food-induced delay in tablet disintegration. For the first time, the pharmacokinetic profile of a drug was monitored in parallel with its gastrointestinal concentrations. The observed food effect in the plasma concentration-time profile of amprenavir after intake of its phosphate ester prodrug could be related to a food-induced delay in gastric dissolution of fosamprenavir.

  15. Validity evidence and reliability of a simulated patient feedback instrument.

    NARCIS (Netherlands)

    Schlegel, C.; Woermann, U.; Rethans, J.J.; Vleuten, C.P.M. van der

    2012-01-01

    BACKGROUND: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it

  16. Development and characterization of a small electromembrane extraction probe coupled with mass spectrometry for real-time and online monitoring of in vitro drug metabolism

    DEFF Research Database (Denmark)

    Dugstad, Helene Bonkerud; Petersen, Nickolaj J.; Jensen, Henrik

    2014-01-01

    A small and very simple electromembrane extraction probe (EME-probe) was developed and coupled directly to electrospray ionization mass spectrometry (ESI-MS), and this system was used to monitor in real time in vitro metabolism by rat liver microsomes of drug substances from a small reaction...... (soft extraction). Soft extraction was mandatory in order not to affect the reaction kinetics by sample composition changes induced by the EME-probe. The EME-probe/MS-system was used to establish kinetic profiles for the in vitro metabolism of promethazine, amitriptyline and imipramine as model...

  17. Field validity and feasibility of four techniques for the detection of Trichuris in simians: a model for monitoring drug efficacy in public health?

    Directory of Open Access Journals (Sweden)

    Bruno Levecke

    Full Text Available BACKGROUND: Soil-transmitted helminths, such as Trichuris trichiura, are of major concern in public health. Current efforts to control these helminth infections involve periodic mass treatment in endemic areas. Since these large-scale interventions are likely to intensify, monitoring the drug efficacy will become indispensible. However, studies comparing detection techniques based on sensitivity, fecal egg counts (FEC, feasibility for mass diagnosis and drug efficacy estimates are scarce. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, the ether-based concentration, the Parasep Solvent Free (SF, the McMaster and the FLOTAC techniques were compared based on both validity and feasibility for the detection of Trichuris eggs in 100 fecal samples of nonhuman primates. In addition, the drug efficacy estimates of quantitative techniques was examined using a statistical simulation. Trichuris eggs were found in 47% of the samples. FLOTAC was the most sensitive technique (100%, followed by the Parasep SF (83.0% [95% confidence interval (CI: 82.4-83.6%] and the ether-based concentration technique (76.6% [95% CI: 75.8-77.3%]. McMaster was the least sensitive (61.7% [95% CI: 60.7-62.6%] and failed to detect low FEC. The quantitative comparison revealed a positive correlation between the four techniques (Rs = 0.85-0.93; p<0.0001. However, the ether-based concentration technique and the Parasep SF detected significantly fewer eggs than both the McMaster and the FLOTAC (p<0.0083. Overall, the McMaster was the most feasible technique (3.9 min/sample for preparing, reading and cleaning of the apparatus, followed by the ether-based concentration technique (7.7 min/sample and the FLOTAC (9.8 min/sample. Parasep SF was the least feasible (17.7 min/sample. The simulation revealed that the sensitivity is less important for monitoring drug efficacy and that both FLOTAC and McMaster were reliable estimators. CONCLUSIONS/SIGNIFICANCE: The results of this study

  18. HIV-1 Drug Resistance Mutations Among Antiretroviral-Naïve HIV-1–Infected Patients in Asia: Results From the TREAT Asia Studies to Evaluate Resistance-Monitoring Study

    Science.gov (United States)

    Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Kantipong, Pacharee; Lee, Christopher K. C.; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G.; Phanuphak, Praphan

    2011-01-01

    (See editorial commentary by Jordan on pages 1058–1060.) Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia. PMID:21460324

  19. Feedback and efficient behavior.

    Directory of Open Access Journals (Sweden)

    Sandro Casal

    Full Text Available Feedback is an effective tool for promoting efficient behavior: it enhances individuals' awareness of choice consequences in complex settings. Our study aims to isolate the mechanisms underlying the effects of feedback on achieving efficient behavior in a controlled environment. We design a laboratory experiment in which individuals are not aware of the consequences of different alternatives and, thus, cannot easily identify the efficient ones. We introduce feedback as a mechanism to enhance the awareness of consequences and to stimulate exploration and search for efficient alternatives. We assess the efficacy of three different types of intervention: provision of social information, manipulation of the frequency, and framing of feedback. We find that feedback is most effective when it is framed in terms of losses, that it reduces efficiency when it includes information about inefficient peers' behavior, and that a lower frequency of feedback does not disrupt efficiency. By quantifying the effect of different types of feedback, our study suggests useful insights for policymakers.

  20. Feedback - fra et elevperspektiv

    DEFF Research Database (Denmark)

    Petersen, Benedikte Vilslev; Pedersen, Bent Sortkær

    Feedback bliver i litteraturen igen og igen fremhævet som et af de mest effektive midler til at fremme elevers præstationer i skolen (Hattie og Timperley, 2007). Andre studier er dog inde på at feedback ikke altid er læringsfremmende og nogle viser endda at feedback kan have en negativ virkning i...... forhold til præstationer (Kluger & DeNisi, 1996). I forsøget på at forklare hvordan og hvorfor feedback virker (forskelligt), er der undersøgt flere dimensioner og forhold omkring feedback (se bl.a. Black og Wiliam, 1998; Hattie og Timperley, 2007; Shute, 2008). Dog er der få studier der undersøger...... hvordan feedback opleves fra et elevperspektiv (Ruiz-Primo og Li, 2013). Samtidig er der i feedbacklitteraturen en mangel på kvalitative studier, der kommer tæt på fænomenet feedback, som det viser sig i klasserummet (Ruiz-Primo og Li, 2013) i naturlige omgivelser (Black og Wiliam, 1998), og hvordan...

  1. Monitoring drug use among HIV/AIDS patients in Brazil: should we combine self-report and urinalysis?

    Science.gov (United States)

    Malbergier, Andre; do Amaral, Ricardo A; Cardoso, Luciana R D; Castel, Saulo

    2012-12-01

    Illicit drug use in HIV-infected patients can be linked to impairment of physical and mental health, low health related quality of life, and suboptimal adherence to HIV treatment. This study aimed to evaluate the correlation of self report illicit drug use, urinalysis for cocaine and cannabis metabolites, and severity of dependence among HIV-infected patients on antiretroviral therapy (ART) in a treatment center in Brazil. Four hundred and thirty-eight outpatients of an HIV referral center were interviewed and assessed for drug use (lifetime, last year and last month). Urinalysis was performed to detect the presence of cocaine and cannabis metabolites in urine samples. Overall agreement between self report and urinalysis was almost 68% for cannabis and higher than 85% for cocaine. Positive urinalysis was significantly associated with more than once a week cannabis (pdrugs were correlated. Our findings suggest that positive self-report is a reliable predictor of positive urine sample both for cannabis and cocaine, but since the agreement was not perfect, there is a role for urine drug screening in the care of patients with HIV-related conditions.

  2. Lab-on-fiber optofluidic platform for in situ monitoring of drug release from therapeutic eluting polyelectrolyte multilayers

    Czech Academy of Sciences Publication Activity Database

    Tian, F.; Min, J.; Kaňka, Jiří; Li, X.; Hammond, P. T.; Du, H.

    2015-01-01

    Roč. 23, č. 15 (2015), s. 20132-20142 ISSN 1094-4087 R&D Projects: GA MŠk(CZ) LH11038 Institutional support: RVO:67985882 Keywords : long-period grating * drug release * thin film Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering Impact factor: 3.148, year: 2015

  3. Drugs of abuse and tranquilizers in Dutch surface waters, drinking water and wastewater: Results of screening monitoring 2009

    NARCIS (Netherlands)

    van der Aa, N.G.F.M.; Dijkman, E.; Bijlsma, L.; Emke, E.; van de Ven, B.M.; van Nuijs, A.L.N.; de Voogt, P.

    2011-01-01

    In the surface waters of the rivers Rhine and Meuse, twelve drugs that are listed in the Dutch Opium act were detected at low concentrations. They are from the groups amphetamines, tranquilizers (barbiturates and benzodiazepines) opiates and cocaine. During drinking water production, most compounds

  4. Antineoplastic Drugs

    Science.gov (United States)

    Sadée, Wolfgang; El Sayed, Yousry Mahmoud

    The limited scope of therapeutic drug-level monitoring in cancer chemotherapy results from the often complex biochemical mechanisms that contribute to antineoplastic activity and obscure the relationships among drug serum levels and therapeutic benefits. Moreover, new agents for cancer chemotherapy are being introduced at a more rapid rate than for the treatment of other diseases, although the successful application of therapeutic drug-level monitoring may require several years of intensive study of the significance of serum drug levels. However, drug level monitoring can be of considerable value during phase I clinical trials of new antineoplastic agents in order to assess drug metabolism, bioavailability, and intersubject variability; these are important parameters in the interpretation of clinical studies, but have no immediate benefit to the patient. High performance liquid chromatography (HPLC) probably represents the most versatile and easily adaptable analytical technique for drug metabolite screening (1). HPLC may therefore now be the method of choice during phase I clinical trials of antineoplastic drugs. For example, within a single week we developed an HPLC assay—using a C18 reverse-phase column, UV detection, and direct serum injection after protein precipitation—for the new radiosensitizer, misonidazole (2).

  5. Training effectiveness feedback

    International Nuclear Information System (INIS)

    Wiggin, N.A.

    1987-01-01

    A formal method of getting feedback about the job performance of employees is a necessary part of all the authors training programs. The formal process may prove to be inadequate if it is the only process in use. There are many ways and many opportunities to get good feedback about employee performance. It is important to document these methods and specific instances to supplement the more formalized process. The key is to identify them, encourage them, use them, and document the training actions that result from them. This paper describes one plant's method of getting feedback about performance of technicians in the field

  6. Feedback System Theory

    Science.gov (United States)

    1978-11-01

    R 2. GOVT A $ SION NO. 3 RIEqLPýIVT’S.;TALOG NUMBER r/ 4. TITLE (and wbiFflT, -L M4 1 , FEEDBACK SYSTEM THEORY ~r Inter in- 6. PERFORMING ORG. REPORT...ANNUAL REPORT FEEDBACK SYSTEM THEORY AFOSR GRANT NO. 76-2946B Air Force Office of Scientific Research for year ending October 31, 1978 79 02 08 L|I...re less stringent than in other synthesis techniques which cannot handle significant parameter uncertainty. _I FEEDBACK SYSTEM THEORY 1. Introduction

  7. Brugbar peer feedback

    DEFF Research Database (Denmark)

    Hvass, Helle; Heger, Stine

    Studerende kan være medskabere af undervisning i akademisk skrivning, når de modtager og giver feedback til hinandens ufærdige akademiske tekster. Det ser vi i et udviklingsprojekt, hvor vi afprøver kollektive vejledningsformater. Vi har dog erfaret: 1. at studerende mangler træning i at give og ...... modtage feedback 2. at den manglende træning kan stå i vejen for realiseringen af læringspotentialet ved peer feedback....

  8. A prototype home robot with an ambient facial interface to improve drug compliance.

    Science.gov (United States)

    Takacs, Barnabas; Hanak, David

    2008-01-01

    We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation.

  9. Clinical Validation of Therapeutic Drug Monitoring of Imipenem in Spent Effluent in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Pilot Study.

    Science.gov (United States)

    Wen, Aiping; Li, Zhe; Yu, Junxian; Li, Ren; Cheng, Sheng; Duan, Meili; Bai, Jing

    2016-01-01

    The primary objective of this pilot study was to investigate whether the therapeutic drug monitoring of imipenem could be performed with spent effluent instead of blood sampling collected from critically ill patients under continuous renal replacement therapy. A prospective open-label study was conducted in a real clinical setting. Both blood and effluent samples were collected pairwise before imipenem administration and 0.5, 1, 1.5, 2, 3, 4, 6, and 8 h after imipenem administration. Plasma and effluent imipenem concentrations were determined by reversed-phase high-performance liquid chromatography with ultraviolet detection. Pharmacokinetic and pharmacodynamic parameters of blood and effluent samples were calculated. Eighty-three paired plasma and effluent samples were obtained from 10 patients. The Pearson correlation coefficient of the imipenem concentrations in plasma and effluent was 0.950 (Pimipenem concentration ratio was 1.044 (95% confidence interval, 0.975 to 1.114) with Bland-Altman analysis. No statistically significant difference was found in the pharmacokinetic and pharmacodynamic parameters tested in paired plasma and effluent samples with Wilcoxon test. Spent effluent of continuous renal replacement therapy could be used for therapeutic drug monitoring of imipenem instead of blood sampling in critically ill patients.

  10. Monitoring the Future National Survey Results on Drug Use, 1975-2016. Volume I, Secondary School Students

    Science.gov (United States)

    Miech, Richard A.; Johnston, Lloyd D.; O'Malley, Patrick M.; Bachman, Jerald G.; Schulenberg, John E.; Patrick, Megan E.

    2017-01-01

    Monitoring the Future (MTF) is designed to give sustained attention to substance use among the nation's youth and adults. It is an investigator-initiated study that originated with and is conducted by a team of research professors at the University of Michigan's Institute for Social Research. Since its onset in 1975, MTF has been continuously…

  11. Feedback Valence Affects Auditory Perceptual Learning Independently of Feedback Probability

    Science.gov (United States)

    Amitay, Sygal; Moore, David R.; Molloy, Katharine; Halliday, Lorna F.

    2015-01-01

    Previous studies have suggested that negative feedback is more effective in driving learning than positive feedback. We investigated the effect on learning of providing varying amounts of negative and positive feedback while listeners attempted to discriminate between three identical tones; an impossible task that nevertheless produces robust learning. Four feedback conditions were compared during training: 90% positive feedback or 10% negative feedback informed the participants that they were doing equally well, while 10% positive or 90% negative feedback informed them they were doing equally badly. In all conditions the feedback was random in relation to the listeners’ responses (because the task was to discriminate three identical tones), yet both the valence (negative vs. positive) and the probability of feedback (10% vs. 90%) affected learning. Feedback that informed listeners they were doing badly resulted in better post-training performance than feedback that informed them they were doing well, independent of valence. In addition, positive feedback during training resulted in better post-training performance than negative feedback, but only positive feedback indicating listeners were doing badly on the task resulted in learning. As we have previously speculated, feedback that better reflected the difficulty of the task was more effective in driving learning than feedback that suggested performance was better than it should have been given perceived task difficulty. But contrary to expectations, positive feedback was more effective than negative feedback in driving learning. Feedback thus had two separable effects on learning: feedback valence affected motivation on a subjectively difficult task, and learning occurred only when feedback probability reflected the subjective difficulty. To optimize learning, training programs need to take into consideration both feedback valence and probability. PMID:25946173

  12. NAIP 2015 Imagery Feedback

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — The NAIP 2015 Imagery Feedback web application allows users to make comments and observations about the quality of the 2015 National Agriculture Imagery Program...

  13. Feedback in analog circuits

    CERN Document Server

    Ochoa, Agustin

    2016-01-01

    This book describes a consistent and direct methodology to the analysis and design of analog circuits with particular application to circuits containing feedback. The analysis and design of circuits containing feedback is generally presented by either following a series of examples where each circuit is simplified through the use of insight or experience (someone else’s), or a complete nodal-matrix analysis generating lots of algebra. Neither of these approaches leads to gaining insight into the design process easily. The author develops a systematic approach to circuit analysis, the Driving Point Impedance and Signal Flow Graphs (DPI/SFG) method that does not require a-priori insight to the circuit being considered and results in factored analysis supporting the design function. This approach enables designers to account fully for loading and the bi-directional nature of elements both in the feedback path and in the amplifier itself, properties many times assumed negligible and ignored. Feedback circuits a...

  14. [A security protocol for the exchange of personal medical data via Internet: monitoring treatment and drug effects].

    Science.gov (United States)

    Viviani, R; Fischer, J; Spitzer, M; Freudenmann, R W

    2004-04-01

    We present a security protocol for the exchange of medical data via the Internet, based on the type/domain model. We discuss two applications of the protocol: in a system for the exchange of data for quality assurance, and in an on-line database of adverse reactions to drug use. We state that a type/domain security protocol can successfully comply with the complex requirements for data privacy and accessibility typical of such applications.

  15. Monitoring drug effectiveness in kala-azar in Bihar, India: cost and feasibility of periodic random surveys vs. a health service-based reporting system.

    Science.gov (United States)

    Malaviya, P; Singh, R P; Singh, S P; Hasker, E; Ostyn, B; Shankar, R; Boelaert, M; Sundar, S

    2011-09-01

    In 2009, a random survey was conducted in Muzaffarpur district to document the clinical outcomes of visceral leishmaniasis patients (VL) treated by the public health care system in 2008, to assess the effectiveness of miltefosine against VL. We analysed the operational feasibility and cost of such periodic random surveys as compared with health facility-based routine monitoring. A random sample of 150 patients was drawn from registers kept at Primary Health Care centres. Patient records were examined, and the patients were located at their residence. Patients and physicians were interviewed with the help of two specifically designed questionnaires by a team of one supervisor, one physician and one field worker. Costs incurred during this survey were properly documented, and vehicle log books maintained for analysis. Hundred and 39 (76.7%) of the patients could be located. Eleven patients were not traceable. Per patient, follow-up cost was US$ 15.51 and on average 2.27 patients could be visited per team-day. Human resource involvement constituted 75% of the total cost whereas involvement of physician costs 51% of the total cost. A random survey to document clinical outcomes is costly and labour intensive but gives probably the most accurate information on drug effectiveness. A health service-based retrospective cohort reporting system modelled on the monitoring system developed by tuberculosis programmes could be a better alternative. Involvement of community health workers in such monitoring would offer the additional advantage of treatment supervision and support. © 2011 Blackwell Publishing Ltd.

  16. Gastro-esophageal reflux and antisecretory drugs use among patients with chronic autoimmune atrophic gastritis: a study with pH-impedance monitoring.

    Science.gov (United States)

    Tenca, A; Massironi, S; Pugliese, D; Consonni, D; Mauro, A; Cavalcoli, F; Franchina, M; Spampatti, M; Conte, D; Penagini, R

    2016-02-01

    Patients with chronic autoimmune atrophic gastritis (CAAG) often refer digestive symptoms and are prescribed antisecretory medications. Aims were to investigate: (i) gastro-esophageal reflux (GER), (ii) psychopathological profile, (iii) frequency of use and clinical benefit of antisecretory drugs. Prospective observational study on 41 CAAG patients who underwent: 24 h multichannel intra-luminal impedance-pH (MII-pH) monitoring off-therapy, standardized medical interview and psychological questionnaire (i.e., SCL-90R). The medical interview was repeated at least 1 month after MII-pH in patients who were using antisecretory drugs. Statistical analysis was performed calculating median (10th-90th percentiles) and risk ratios (RR) with 95% confidence interval. Median intra-gastric pH was 6.2 (4.6-7.0). One patient had acid reflux (AC) associated with symptoms, five had increased total reflux number and four had symptoms associated to non-acid reflux (NA) (patients referred as 'GER positive'). Using patients 'GER negative' with normal SCL-90R as reference, the RR of being symptomatic in patients GER positive was 2.1 (1.1-4.1) if SCL-90R was normal and 0.9 (0.5-1.7) if it was altered (difference in RR significant being p = 0.04). Seventeen/28 (61%) symptomatic patients were on antisecretory drugs, which were stopped in 16 of them according to results of MII-pH and clinical evaluation after 574 days (48-796) showed that symptoms were unchanged. In patients with CAAG (i) AC reflux rarely occurred whereas increased NA reflux was not infrequent both being related to symptoms in some patients, (ii) psychopathological profile has a role in symptoms' occurrence, (iii) antisecretory drugs were generally inappropriately used and clinically ineffective. © 2015 John Wiley & Sons Ltd.

  17. PEP-II Transverse Feedback Electronics Upgrade

    International Nuclear Information System (INIS)

    Weber, J.; Chin, M.; Doolittle, L.; Akre, R.

    2005-01-01

    The PEP-II B Factory at the Stanford Linear Accelerator Center (SLAC) requires an upgrade of the transverse feedback system electronics. The new electronics require 12-bit resolution and a minimum sampling rate of 238 Msps. A Field Programmable Gate Array (FPGA) is used to implement the feedback algorithm. The FPGA also contains an embedded PowerPC 405 (PPC-405) processor to run control system interface software for data retrieval, diagnostics, and system monitoring. The design of this system is based on the Xilinx(R) ML300 Development Platform, a circuit board set containing an FPGA with an embedded processor, a large memory bank, and other peripherals. This paper discusses the design of a digital feedback system based on an FPGA with an embedded processor. Discussion will include specifications, component selection, and integration with the ML300 design

  18. PEP-II Transverse Feedback Electronics Upgrade

    International Nuclear Information System (INIS)

    Weber, J.M.; Chin, M.J.; Doolittle, L.R.; Akre, R.

    2006-01-01

    The PEP-II B Factory at the Stanford Linear Accelerator Center (SLAC) requires an upgrade of the transverse feedback system electronics. The new electronics require 12-bit resolution and a minimum sampling rate of 238 Msps. A Field Programmable Gate Array (FPGA) is used to implement the feedback algorithm. The FPGA also contains an embedded PowerPC 405 (PPC-405) processor to run control system interface software for data retrieval, diagnostics, and system monitoring. The design of this system is based on the Xilinx(reg s ign) ML300 Development Platform, a circuit board set containing an FPGA with an embedded processor, a large memory bank, and other peripherals. This paper discusses the design of a digital feedback system based on an FPGA with an embedded processor. Discussion will include specifications, component selection, and integration with the ML300 design

  19. PEP-II Transverse Feedback Electronics Upgrade

    CERN Document Server

    Weber, Jonah; Chin, Michael; Doolittle, Lawrence

    2005-01-01

    The PEP-II B Factory at the Stanford Linear Accelerator Center (SLAC) requires an upgrade of the transverse feedback system electronics. The new electronics require 12-bit resolution and a minimum sampling rate of 238 Msps. A Field Programmable Gate Array (FPGA) is used to implement the feedback algorithm. The FPGA also contains an embedded PowerPC 405 (PPC-405) processor to run control system interface software for data retrieval, diagnostics, and system monitoring. The design of this system is based on the Xilinx® ML300 Development Platform, a circuit board set containing an FPGA with an embedded processor, a large memory bank, and other peripherals. This paper discusses the design of a digital feedback system based on an FPGA with an embedded processor. Discussion will include specifications, component selection, and integration with the ML300 design.

  20. Zebrafish on a chip: a novel platform for real-time monitoring of drug-induced developmental toxicity.

    Directory of Open Access Journals (Sweden)

    Yinbao Li

    Full Text Available Pharmaceutical safety testing requires a cheap, fast and highly efficient platform for real-time evaluation of drug toxicity and secondary effects. In this study, we have developed a microfluidic system for phenotype-based evaluation of toxic and teratogenic effects of drugs using zebrafish (Danio rerio embryos and larvae as the model organism. The microfluidic chip is composed of two independent functional units, enabling the assessment of zebrafish embryos and larvae. Each unit consists of a fluidic concentration gradient generator and a row of seven culture chambers to accommodate zebrafish. To test the accuracy of this new chip platform, we examined the toxicity and teratogenicity of an anti-asthmatic agent-aminophylline (Apl on 210 embryos and 210 larvae (10 individuals per chamber. The effect of Apl on zebrafish embryonic development was quantitatively assessed by recording a series of physiological indicators such as heart rate, survival rate, body length and hatch rate. Most importantly, a new index called clonic convulsion rate, combined with mortality was used to evaluate the toxicities of Apl on zebrafish larvae. We found that Apl can induce deformity and cardiovascular toxicity in both zebrafish embryos and larvae. This microdevice is a multiplexed testing apparatus that allows for the examination of indexes beyond toxicity and teratogenicity at the sub-organ and cellular levels and provides a potentially cost-effective and rapid pharmaceutical safety assessment tool.

  1. Compact microelectrode array system: tool for in situ monitoring of drug effects on neurotransmitter release from neural cells.

    Science.gov (United States)

    Chen, Yu; Guo, Chunxian; Lim, Layhar; Cheong, Serchoong; Zhang, Qingxin; Tang, Kumcheong; Reboud, Julien

    2008-02-15

    This paper presents a compact microelectrode array (MEA) system, to study potassium ion-induced dopamine release from PC12 neural cells, without relying on a micromanipulator and a microscope. The MEA chip was integrated with a custom-made "test jig", which provides a robust electrical interfacing tool between the microchip and the macroenvironment, together with a potentiostat and a microfluidic syringe pump. This integrated system significantly simplifies the operation procedures, enhances sensing performance, and reduces fabrication costs. The achieved detection limit for dopamine is 3.8 x 10-2 muM (signal/noise, S/N = 3) and the dopamine linear calibration range is up to 7.39 +/- 0.06 muM (mean +/- SE). The effects of the extracelluar matrix collagen coating of the microelectrodes on dopamine sensing behaviors, as well as the influences of K+ and l-3,4-digydroxyphenylalanine concentrations and incubation times on dopamine release, were extensively studied. The results show that our system is well suited for biologists to study chemical release from living cells as well as drug effects on secreting cells. The current system also shows a potential for further improvements toward a multichip array system for drug screening applications.

  2. Current status of therapeutic drug monitoring in Australia and New Zealand: a need for improved assay evaluation, best practice guidelines, and professional development.

    Science.gov (United States)

    Norris, Ross L; Martin, Jennifer H; Thompson, Erin; Ray, John E; Fullinfaw, Robert O; Joyce, David; Barras, Michael; Jones, Graham R; Morris, Raymond G

    2010-10-01

    The measurement of drug concentrations, for clinical purposes, occurs in many diagnostic laboratories throughout Australia and New Zealand. However, the provision of a comprehensive therapeutic drug monitoring (TDM) service requires the additional elements of pre- and postanalytical advice to ensure that concentrations reported are meaningful, interpretable, and clinically applicable to the individual patient. The aim of this project was to assess the status of TDM services in Australia and New Zealand. A range of professions involved in key aspects of TDM was surveyed by questionnaire in late 2007. Information gathered included: the list of drugs assayed; analytical methods used; interpretation services offered; interpretative methods used; and further monitoring advice provided. Fifty-seven responses were received, of which 42% were from hospitals (public and/or private); 11% a hospital (public and/or private) and pathology provider; and 47% a pathology provider only (public and/or private). Results showed that TDM is applied to a large number of different drugs. Poorly performing assay methods were used in some cases, even when published guidelines recommended alternative practices. Although there was a wide array of assays available, the evidence suggested a need for better selection of assay methods. In addition, only limited advice and/or interpretation of results was offered. Of concern, less than 50% of those providing advice on aminoglycoside dosing in adults used pharmacokinetic tools with six of 37 (16.2%) respondents using Bayesian pharmacokinetic tools, the method recommended in the Australian Therapeutic Guidelines: Antibiotic. In conclusion, the survey highlighted deficiencies in the provision of TDM services, in particular assay method selection and both quality and quantity of postanalytical advice. A range of recommendations, some of which may have international implications, are discussed. There is a need to include measures of impact on clinical

  3. Global climate feedbacks

    Energy Technology Data Exchange (ETDEWEB)

    Manowitz, B.

    1990-10-01

    The important physical, chemical, and biological events that affect global climate change occur on a mesoscale -- requiring high spatial resolution for their analysis. The Department of Energy has formulated two major initiatives under the US Global Change Program: ARM (Atmospheric Radiation Measurements), and CHAMMP (Computer Hardware Advanced Mathematics and Model Physics). ARM is designed to use ground and air-craft based observations to document profiles of atmospheric composition, clouds, and radiative fluxes. With research and models of important physical processes, ARM will delineate the relationships between trace gases, aerosol and cloud structure, and radiative transfer in the atmosphere, and will improve the parameterization of global circulation models. The present GCMs do not model important feedbacks, including those from clouds, oceans, and land processes. The purpose of this workshop is to identify such potential feedbacks, to evaluate the uncertainties in the feedback processes (and, if possible, to parameterize the feedback processes so that they can be treated in a GCM), and to recommend research programs that will reduce the uncertainties in important feedback processes. Individual reports are processed separately for the data bases.

  4. Therapeutic drug monitoring of nevirapine in saliva in Uganda using high performance liquid chromatography and a low cost thin-layer chromatography technique.

    Science.gov (United States)

    Lamorde, Mohammed; Fillekes, Quirine; Sigaloff, Kim; Kityo, Cissy; Buzibye, Allan; Kayiwa, Joshua; Merry, Concepta; Nakatudde-Katumba, Lillian; Burger, David; de Wit, Tobias F Rinke

    2014-09-01

    In resource limited settings access to laboratory monitoring of HIV treatment is limited and therapeutic drug monitoring is generally unavailable. This study aimed to evaluate nevirapine concentrations in saliva using low-cost thin-layer chromatography (TLC) and nevirapine concentrations in plasma and saliva using high performance liquid chromatography (HPLC) methods; and to correlate nevirapine plasma concentrations to HIV treatment outcomes in Ugandan patients. Paired plasma and stimulated saliva samples were obtained from Ugandan, HIV-infected adults on nevirapine-based ART. Nevirapine concentrations were measured using a validated HPLC method and a novel TLC method. Plasma nevirapine concentrations HPLC were considered subtherapeutic. Negative/positive predictive values of different thresholds for subtherapeutic nevirapine concentrations in saliva were determined. Virologic testing and, if applicable, HIV drug resistance testing was performed. Median (interquartile range, IQR) age of 297 patients was 39.1 (32.8-45.2) years. Three hundred saliva and 287 plasma samples were available for analysis. Attempts failed to determine nevirapine saliva concentrations by TLC. Using HPLC, median (IQR) nevirapine concentrations in saliva and plasma were 3.40 (2.59-4.47) mg/L and 6.17 (4.79-7.96) mg/L, respectively. The mean (coefficient of variation,%) nevirapine saliva/plasma ratio was 0.58 (62%). A cut-off value of 1.60 mg/L nevirapine in saliva was associated with a negative/positive predictive value of 0.99/0.72 and a sensitivity/specificity of 87%/98% for predicting subtherapeutic nevirapine plasma concentrations, respectively. Only 5% (15/287) of patients had subtherapeutic nevirapine plasma concentrations, of which 3 patients had viral load results > 400 copies/mL. Patients with nevirapine concentrations in plasma 400 copies/mL). The low-cost TLC technique for monitoring nevirapine in saliva was unsuccessful but monitoring nevirapine saliva and plasma

  5. Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study.

    Science.gov (United States)

    Dijkstra, Nienke Elske; Sino, Carolina Geertruida Maria; Heerdink, Eibert Rob; Schuurmans, Marieke Joanna

    2018-03-07

    Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice-based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic

  6. The risk/benefit profile of biologic drugs in real-world rheumatology practice. From ANTARES to MonitorNet

    Directory of Open Access Journals (Sweden)

    C.M. Montecucco

    2011-09-01

    Full Text Available Le principali artriti croniche ad eziopatogenesi immunoflogistica, nelle quali trovano applicazione i farmaci “biologici” (v. oltre sono la reumatoide e le sieronegative: artrite psoriasica, spondilite anchilosante, artriti reattive ed artriti “enteropatiche” (1-7. L’artrite reumatoide (AR è una malattia cronica progressiva delle articolazioni associata a significativa morbilità, deformità e riduzione della qualità di vita. La prevalenza nella popolazione, a livello mondiale, è compresa tra 0,3 ed 1%. Pur interessando in modo elettivo le articolazioni, l’AR è una malattia sistemica che può condurre a severa disabilità ed a complicanze talora fatali. La terapia farmacologica tradizionale si basa su varie combinazioni di farmaci definiti sintomatici, come gli anti-infiammatori non-steroidei (FANS, gli analgesici ed i corticosteroidi e quelli “di fondo” chiamati correntemente DMARDs (disease modifying anti-rheumatic drugs...

  7. SYTO-13, a Viability Marker as a New Tool to Monitor In Vitro Pharmacodynamic Parameters of Anti-Pneumocystis Drugs.

    Directory of Open Access Journals (Sweden)

    Annie Standaert-Vitse

    Full Text Available While Pneumocystis pneumonia (PcP still impacts the AIDS patients, it has a growing importance in immunosuppressed HIV-negative patients. To determine the anti-Pneumocystis therapeutic efficacy of new compounds, animal and in vitro models have been developed. Indeed, well-designed mouse or rat experimental models of pneumocystosis can be used to describe the in vivo anti-Pneumocystis activity of new drugs. In vitro models, which enable the screening of a large panel of new molecules, have been developed using axenic cultures or co-culture with feeder cells; but no universally accepted standard method is currently available to evaluate anti-Pneumocystis molecules in vitro. Thus, we chose to explore the use of the SYTO-13 dye, as a new indicator of Pneumocystis viability. In the present work, we established the experimental conditions to define the in vitro pharmacodynamic parameters (EC50, Emax of marketed compounds (trimethoprim/sulfamethoxazole, pentamidine, atovaquone in order to specifically measure the intrinsic activity of these anti-P. carinii molecules using the SYTO-13 dye for the first time. Co-labelling the fungal organisms with anti-P. carinii specific antibodies enabled the measurement of viability of Pneumocystis organisms while excluding host debris from the analysis. Moreover, contrary to microscopic observation, large numbers of fungal cells can be analyzed by flow cytometry, thus increasing statistical significance and avoiding misreading during fastidious quantitation of stained organisms. In conclusion, the SYTO-13 dye allowed us to show a reproducible dose/effect relationship for the tested anti-Pneumocystis drugs.

  8. Feedback Conversations: Creating Feedback Dialogues with a New Textual Tool for Industrial Design Student Feedback

    Science.gov (United States)

    Funk, Mathias; van Diggelen, Migchiel

    2017-01-01

    In this paper, the authors describe how a study of a large database of written university teacher feedback in the department of Industrial Design led to the development of a new conceptual framework for feedback and the design of a new feedback tool. This paper focuses on the translation of related work in the area of feedback mechanisms for…

  9. Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis.

    Science.gov (United States)

    Chang, Hsien-Yen; Murimi, Irene; Faul, Mark; Rutkow, Lainie; Alexander, G Caleb

    2018-04-01

    We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed. Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions. Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients. Copyright © 2018 John Wiley & Sons, Ltd.

  10. Situated Formative Feedback

    DEFF Research Database (Denmark)

    Lukassen, Niels Bech; Wahl, Christian; Sorensen, Elsebeth Korsgaard

    refer to this type of feedback as, Situated Formative Feedback (SFF). As a basis for exploring, identifying and discussing relevant aspects of SFF the paper analyses qualitative data from a Moodle dialogue. Data are embedded in the qualitative analytic program Nvivo and are analysed with a system...... theoretical textual analysis method. Asynchronous written dialogue from an online master’s course at Aalborg University forms the empirical basis of the study. The findings suggests in general that students play an essential role in SFF and that students and educators are equal in the COP, but holds different...

  11. Plasmodium falciparum resistance to anti-malarial drugs in Papua New Guinea: evaluation of a community-based approach for the molecular monitoring of resistance

    Directory of Open Access Journals (Sweden)

    Reeder John C

    2010-01-01

    Full Text Available Abstract Background Molecular monitoring of parasite resistance has become an important complementary tool in establishing rational anti-malarial drug policies. Community surveys provide a representative sample of the parasite population and can be carried out more rapidly than accrual of samples from clinical cases, but it is not known whether the frequencies of genetic resistance markers in clinical cases differ from those in the overall population, or whether such community surveys can provide good predictions of treatment failure rates. Methods Between 2003 and 2005, in vivo drug efficacy of amodiaquine or chloroquine plus sulphadoxine-pyrimethamine was determined at three sites in Papua New Guinea. The genetic drug resistance profile (i.e., 33 single nucleotide polymorphisms in Plasmodium falciparum crt, mdr1, dhfr, dhps, and ATPase6 was concurrently assessed in 639 community samples collected in the catchment areas of the respective health facilities by using a DNA microarray-based method. Mutant allele and haplotype frequencies were determined and their relationship with treatment failure rates at each site in each year was investigated. Results PCR-corrected in vivo treatment failure rates were between 12% and 28% and varied by site and year with variable longitudinal trends. In the community samples, the frequencies of mutations in pfcrt and pfmdr1 were high and did not show significant changes over time. Mutant allele frequencies in pfdhfr were moderate and those in pfdhps were low. No mutations were detected in pfATPase6. There was much more variation between sites than temporal, within-site, variation in allele and haplotype frequencies. This variation did not correlate well with treatment failure rates. Allele and haplotype frequencies were very similar in clinical and community samples from the same site. Conclusions The relationship between parasite genetics and in vivo treatment failure rate is not straightforward. The

  12. A Prospective Randomized Trial on the Effect of Using an Electronic Monitoring Drug Dispensing Device to Improve Adherence and Compliance.

    Science.gov (United States)

    Henriksson, Jarmo; Tydén, Gunnar; Höijer, Jonas; Wadström, Jonas

    2016-01-01

    Outcome after renal transplantation depends on patient compliance and adherence for early detection of complications and identification of intervention opportunities. Compliance describes the degree to which patients follow medical advice and take their medications. Adherence has been defined as the extent to which a patients' behavior coincides with clinical prescriptions. Patients were randomized 7 to 14 days after transplantation into groups with (n = 40) and without (n = 40) an electronic medication dispenser (EMD). The EMD, which was used for the 1-year study period, recorded the date and time the patient took their medications and was monitored via a web-based application. Patients were monitored for 1 year regarding outpatient follow-up visits, emergency hospitalizations, renal biopsies, rejection episodes, renal function, and blood concentration of medications. Compliance in the intervention group was 97.8% (the control group was not assessed). Number of missed doses varied significantly by weekday (P = 0.033); patients were most likely to miss doses on Saturdays and Thursdays. Patients missed a total of 11 follow-up visits. During the study, 92 biopsies were performed on 55 patients (intervention group: 32 [17]; control group, 60 [38]). Biopsy-verified rejection was three times more common among controls (13 patients vs. 4; P = 0.054, not significant). Average P-creatinine level was slightly lower in the intervention group than the control group (131 vs. 150 μmol/L, not significant), whereas mean tacrolimus was similar (7.32 vs. 7.22 ng/mL, n.s.). The EMD is associated with high compliance, and there are also indications of a lower rejection rate.

  13. Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance

    Directory of Open Access Journals (Sweden)

    Ogunwande Isiaka A

    2011-08-01

    Full Text Available Abstract Background Adverse drug reactions (ADRs contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone technology to report ADRs following drug exposures were investigated in Sagamu - a peri-urban community in Southwest Nigeria. Methods Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP and four Patent and Proprietary Medicine Stores (PPMS in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period. Results and Discussion A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases; of this number, purchases of sulphadoxine-pyrimethamine (SP and chloroquine (CQ were highest (39.3 and 25.2% respectiuvely. Other anti-malarials purchased were artesunate monotherapy (AS - 16.1%, artemether-lumefantrine (AL 10.0%, amodiaquine (AQ - 6.6%, quinine (QNN - 1.9%, halofantrine (HF - 0.2% and proguanil (PR - 0.2%. CQ was the cheapest (USD 0.3 and halofantrine the most expensive (USD 7.7. AL was 15.6 times ($4.68 more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1 after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%. Conclusion The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource

  14. The Utility of Infliximab Therapeutic Drug Monitoring among Patients with Inflammatory Bowel Disease and Concerns for Loss of Response: A Retrospective Analysis of a Real-World Experience

    Directory of Open Access Journals (Sweden)

    Robert A. Mitchell

    2016-01-01

    Full Text Available Background. Infliximab (IFX therapeutic drug monitoring (TDM allows for objective decision making in patients with inflammatory bowel disease (IBD and loss of response. Questions remain about whether IFX TDM improves outcomes. Methods. Patients with IBD who had IFX TDM due to concerns for loss of response were considered for inclusion. Serum IFX trough concentration and anti-drug antibody (ADA concentrations were measured. Patients were grouped by TDM results: group 1, low IFX/high ADA; group 2, low IFX/low ADA; group 3, therapeutic IFX. Changes in management were analyzed according to groupings; remission rates were assessed at 6 months. Results. 71 patients were included of whom 37% underwent an appropriate change in therapy. Groups 1 (67% and 2 (83% had high adherence compared to only 9% in group 3. At 6 months, 57% had achieved remission. More patients who underwent an appropriate change in therapy achieved remission, though this did not reach statistical significance (69% versus 49%; P=0.098. Conclusions. A trend towards increased remission rates was associated with appropriate changes in management following TDM results. Many patients with therapeutic IFX concentrations did not undergo an appropriate change in management, potentially reflecting a lack of available out-of-class options at the time of TDM or due to uncertainty of the meaning of the reported therapeutic range.

  15. Parenting practices and problem behavior across three generations: monitoring, harsh discipline, and drug use in the intergenerational transmission of externalizing behavior.

    Science.gov (United States)

    Bailey, Jennifer A; Hill, Karl G; Oesterle, Sabrina; Hawkins, J David

    2009-09-01

    Using data from grandparents (G1), parents (G2), and children (G3), this study examined continuity in parental monitoring, harsh discipline, and child externalizing behavior across generations, and the contribution of parenting practices and parental drug use to intergenerational continuity in child externalizing behavior. Structural equation and path modeling of prospective, longitudinal data from 808 G2 participants, their G1 parents, and their school-age G3 children (n = 136) showed that parental monitoring and harsh discipline demonstrated continuity from G1 to G2. Externalizing behavior demonstrated continuity from G2 to G3. Continuity in parenting practices did not explain the intergenerational continuity in externalizing behavior. Rather, G2 adolescent externalizing behavior predicted their adult substance use, which was associated with G3 externalizing behavior. A small indirect effect of G1 harsh parenting on G3 was observed. Interparental abuse and socidemographic risk were included as controls but did not explain the intergenerational transmission of externalizing behavior. Results highlight the need for preventive interventions aimed at breaking intergenerational cycles in poor parenting practices. More research is required to identify parental mechanisms influencing the continuity of externalizing behavior across generations.

  16. Antimicrobial drug resistance evaluations and monitoring in Escherichia coli isolated from poultry environment at different time intervals

    International Nuclear Information System (INIS)

    Anwar, R.; Khan, M.A.

    2004-01-01

    A high prevalence of multiple drug resistance was observed in population of E. coli isolated in 1992-93 from poultry carcasses, fluff, hatchery environment and water at different broiler farms in Karachi, Pakistan. Five hundred isolate of E. coli were made of which 375 were tested for their sensitivity of five antimicrobials using the tube dilution method. Similarly, during 1995-1996, 430 E. coli isolates were made (from the same farms) of which 315 were tested for their sensitivity to the same antimicrobials studied in 1992-93. E. coli isolates during 1992-93 and 1995-96 showed increase in resistance from 50 to 56% against amoxicillin, from 62 to 71% against neomycin, from 97 to 100% against oxytetracycline, from 95 to 100% against tetracycline and from 95 to 98% against trimethoprim. It appears that exposure of E. coli of poultry origin in Pakistan to the five studies antimicrobials could well be the cause of increasing antimicrobials resistance. This data supports the growing contention that subtherapeutic doses of antimicrobials should be eliminated as a means of promoting rapid growth. (author)

  17. Antimicrobial drug resistance evaluations and monitoring in Escherichia coli isolated from poultry environment at different time intervals

    Energy Technology Data Exchange (ETDEWEB)

    Anwar, R; Khan, M A [University of Karachi (Pakistan). Inst. of Environmental Studies

    2004-06-01

    A high prevalence of multiple drug resistance was observed in population of E. coli isolated in 1992-93 from poultry carcasses, fluff, hatchery environment and water at different broiler farms in Karachi, Pakistan. Five hundred isolate of E. coli were made of which 375 were tested for their sensitivity of five antimicrobials using the tube dilution method. Similarly, during 1995-1996, 430 E. coli isolates were made (from the same farms) of which 315 were tested for their sensitivity to the same antimicrobials studied in 1992-93. E. coli isolates during 1992-93 and 1995-96 showed increase in resistance from 50 to 56% against amoxicillin, from 62 to 71% against neomycin, from 97 to 100% against oxytetracycline, from 95 to 100% against tetracycline and from 95 to 98% against trimethoprim. It appears that exposure of E. coli of poultry origin in Pakistan to the five studies antimicrobials could well be the cause of increasing antimicrobials resistance. This data supports the growing contention that subtherapeutic doses of antimicrobials should be eliminated as a means of promoting rapid growth. (author)

  18. Credit Market Information Feedback

    OpenAIRE

    Balasubramanyan, Lakshmi; Craig, Ben R.; Thomson, James B.; Zaman, Saeed

    2015-01-01

    We examine how a combination of credit market and asset quality information can jointly be used in assessing bank franchise value. We find that expectations of future credit demand and future asset quality explain contemporaneous bank franchise value, indicative of the feedback in credit market information and its consequent impact on bank franchise value.

  19. Continuous feedback fluid queues

    NARCIS (Netherlands)

    Scheinhardt, Willem R.W.; van Foreest, N.D.; Mandjes, M.R.H.

    2003-01-01

    We investigate a fluid buffer which is modulated by a stochastic background process, while the momentary behavior of the background process depends on the current buffer level in a continuous way. Loosely speaking the feedback is such that the background process behaves `as a Markov process' with

  20. Feedback i undervisningen

    DEFF Research Database (Denmark)

    Kirkegaard, Preben Olund

    2015-01-01

    undervisningsdifferentiering, feedback på læreprocesser, formativ og summativ evaluering, observationer og analyse af undervisning samt lærernes teamsamarbejde herom. Praktikken udgør et særligt læringsrum i læreruddannelsen. Samspillet mellem studerende, praktiklærere og undervisere giver den studerende en unik mulighed...

  1. Portfolio, refleksion og feedback

    DEFF Research Database (Denmark)

    Hansen, Jens Jørgen; Qvortrup, Ane; Christensen, Inger-Marie F.

    2017-01-01

    Denne leder definerer indledningsvist begrebet portfolio og gør rede for anvendelsesmuligheder i en uddannelseskontekst. Dernæst behandles portfoliometodens kvalitet og effekt for læring og undervisning og de centrale begreber refleksion, progression og feedback præsenteres og diskuteres. Herefter...

  2. Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes

    Directory of Open Access Journals (Sweden)

    Phillips CJ

    2015-10-01

    Full Text Available Cameron J Phillips,1–3 David L Gordon3,4 1Division of Pharmacy, SA Pharmacy, Flinders Medical Centre, Bedford Park, 2School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 3Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, 4Department of Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia Background: Vancomycin is the antibiotic of choice for the treatment of serious infections such as methicillin-resistant Staphylococcus aureus (MRSA. Inappropriate prescribing of vancomycin can lead to therapeutic failure, antibiotic resistance, and drug toxicity. Objective: To examine the effectiveness of pharmacist-led implementation of a clinical practice guideline for vancomycin dosing and monitoring in a teaching hospital. Methods: An observational pre–post study design was undertaken to evaluate the implementation of the vancomycin guideline. The implementation strategy principally involved education, clinical vignettes, and provision of pocket guidelines to accompany release of the guideline to the hospital Intranet. The target cohort for clinical behavioral change was junior medical officers, as they perform the majority of prescribing and monitoring of vancomycin in hospitals. Assessment measures were recorded for vancomycin prescribing, therapeutic drug monitoring, and patient outcomes. Results: Ninety-nine patients, 53 pre- and 46 post-implementation, were included in the study. Prescribing of a loading dose increased from 9% to 28% (P=0.02, and guideline adherence to starting maintenance dosing increased from 53% to 63% (P=0.32. Dose adjustment by doctors when blood concentrations were outside target increased from 53% to 71% (P=0.12, and correct timing of initial concentration measurement increased from 43% to 57% (P=0.23. Appropriately timed trough concentrations improved from 73% to 81% (P=0.08. Pre-dose (trough

  3. Beam bunch feedback

    International Nuclear Information System (INIS)

    Lambertson, G.

    1995-09-01

    When the electromagnetic fields that are excited by the passage of a bundle of charged particles persist to act upon bunches that follow, then the motions of the bunches are coupled. This action between bunches circulating on a closed orbit can generate growing patterns of bunch excursions. Such growth can often be suppressed by feedback systems that detect the excursion and apply corrective forces to the bunches. To be addressed herein is feedback that acts on motions of the bunch body centers. In addition to being useful for suppressing the spontaneous growth of coupled-bunch motions, such feedback can be used to damp transients in bunches injected into an accelerator or storage ring; for hadrons which lack strong radiation damping, feedback is needed to avoid emittance growth through decoherence. Motions excited by noise in magnetic fields or accelerating rf can also be reduced by using this feedback. Whether the action is on motions that are transverse to the closed orbit or longitudinal, the arrangement is the same. Bunch position is detected by a pickup and that signal is processed and directed to a kicker that may act upon the same bunch or some other portion of the collective beam pattern. Transverse motion is an oscillation with angular frequency ν perpendicular ω o where ω o is the orbital frequency 2π line-integral o. Longitudinal synchrotron oscillation occurs at frequency ω s = ν s ω o . The former is much more rapid, ν perpendicular being on the order of 10 while ν s is typically about 10 minus 1 to 10 minus 2

  4. Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Riel, Henrik; Matthews, Mark; Vicenzino, Bill

    2016-01-01

    BACKGROUND: Patellofemoral pain is one of the most frequent knee conditions among adolescents with a prevalence of 7 %. Evidence-based treatment consists of patient education combined with hip and quadriceps strengthening. Recent evidence suggests that a large proportion of adolescents does...... not follow their exercise prescription, performing too few repetitions or too fast below the prescribed time under tension. Live feedback, such as a metronome or exercise games, has previously shown promising results in improving the quality of exercises. The aim of this study is to investigate if live...... feedback from a sensor (BandCizer™) and an iPad will improve the ability of adolescents with PFP to perform exercises as prescribed. METHODS: This study is a randomized, controlled, participant-blinded, superiority trial with a 2-group parallel design. Forty 15 to 19 year old adolescents...

  5. Drugs reviews

    African Journals Online (AJOL)

    Angel_D

    tests (LFTs) to monitor hepatotoxicity (liver [hepatic] damage) is uncommon in many resource-poor ... cholesterol ester storage disease. ... The problem with many patients is that they are taking several drugs often ... Urine, saliva and other body fluids may be coloured orange-red: this can be very alarming to patients.

  6. Extensive intestinal first-pass metabolism of arctigenin: evidenced by simultaneous monitoring of both parent drug and its major metabolites.

    Science.gov (United States)

    Gao, Qiong; Zhang, Yufeng; Wo, Siukwan; Zuo, Zhong

    2014-03-01

    The current study aims to investigate intestinal absorption and metabolism of arctigenin (AR) through simultaneous monitoring of AR and its major metabolites in rat plasma. An UPLC/MS/MS assay was developed with chromatographic separation of all analytes achieved by a C18 Column (3.9mm×150mm, 3.5μm) and a gradient elution with acetonitrile and 0.1% formic acid within 9min. Sample extraction with acetonitrile was optimized to achieve satisfactory recovery for both AR and its major metabolites. The lower limit of quantification (LLOQ) for all analytes was 25ng/ml. The intra-day and inter-day precision and accuracy of each analyte at LLOQ and three quality control (QC) concentrations (low, middle and high) in rat plasma was within 15.0% RSD and 15.0% bias. The extraction recoveries were within the range of 83.8-94.0% for all analytes. The developed and validated assay was then applied to the absorption study of AR in both Caco-2 cell monolayer model and in situ single-pass rat intestinal perfusion model. High absorption permeability of AR was demonstrated in both models with Papp of (1.76±0.48)×10(-5) (A→B) (Caco-2) and Pblood of (8.6±3.0)×10(-6)cm/s (intestinal perfusion). Extensive first-pass metabolism of AR to arctigenic acid (AA) and arctigenin-4'-O-glucuronide (AG) was identified in rat intestinal perfusion study with Cummins's extraction ratios of 0.458±0.012 and 0.085±0.013, respectively. The current assay method demonstrated to be a practical tool for pharmacokinetics investigation of AR with complicated metabolism pathways and multiple metabolites. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Monitoring nicotine intake from e-cigarettes: measurement of parent drug and metabolites in oral fluid and plasma.

    Science.gov (United States)

    Papaseit, Esther; Farré, Magí; Graziano, Silvia; Pacifici, Roberta; Pérez-Mañá, Clara; García-Algar, Oscar; Pichini, Simona

    2017-03-01

    Electronic cigarettes (e-cig) known as electronic nicotine devices recently gained popularity among smokers. Despite many studies investigating their safety and toxicity, few examined the delivery of e-cig-derived nicotine and its metabolites in alternative biological fluids. We performed a randomized, crossover, and controlled clinical trial in nine healthy smokers. Nicotine (NIC), cotinine (COT), and trans-3'-hydroxycotinine (3-HCOT) were measured in plasma and oral fluid by liquid chromatography-tandem mass spectrometry after consumption of two consecutive e-cig administrations or two consecutive tobacco cigarettes. NIC and its metabolites were detected both in oral fluid and plasma following both administration conditions. Concentrations in oral fluid resulted various orders of magnitude higher than those observed in plasma. Oral fluid concentration of tobacco cigarette and e-cig-derived NIC peaked at 15 min after each administration and ranged between 1.0 and 1396 μg/L and from 0.3 to 860 μg/L; those of COT between 52.8 and 110 μg/L and from 33.8 to 94.7 μg/L; and those of 3-HCOT between 12.4 and 23.5 μg/L and from 8.5 to 24.4 μg/L. The oral fluid to plasma concentration ratio of both e-cig- and tobacco cigarette-derived NIC peaked at 15 min after both administrations and correlated with oral fluid NIC concentration. The obtained results support the measurement of NIC and metabolites in oral fluid in the assessment of intake after e-cig use and appear to be a suitable alternative to plasma when monitoring nicotine delivery from e-cig for clinical and toxicological studies.

  8. Cloud CCN feedback

    International Nuclear Information System (INIS)

    Hudson, J.G.

    1992-01-01

    Cloud microphysics affects cloud albedo precipitation efficiency and the extent of cloud feedback in response to global warming. Compared to other cloud parameters, microphysics is unique in its large range of variability and the fact that much of the variability is anthropogenic. Probably the most important determinant of cloud microphysics is the spectra of cloud condensation nuclei (CCN) which display considerable variability and have a large anthropogenic component. When analyzed in combination three field observation projects display the interrelationship between CCN and cloud microphysics. CCN were measured with the Desert Research Institute (DRI) instantaneous CCN spectrometer. Cloud microphysical measurements were obtained with the National Center for Atmospheric Research Lockheed Electra. Since CCN and cloud microphysics each affect the other a positive feedback mechanism can result

  9. Anti-malarial drug safety information obtained through routine monitoring in a rural district of South-Western Senegal

    Directory of Open Access Journals (Sweden)

    Brasseur Philippe

    2012-12-01

    Full Text Available Abstract Background Knowing the safety profile of anti-malarial treatments in routine use is essential; millions of patients receive now artemisinin combination therapy (ACT annually, but the return on information through current systems is as yet inadequate. Cohort event monitoring (CEM is a WHO (World Health Organization-recommended practice; testing its performance and feasibility in routine practice in malaria-endemic is important. Methods A nine-year CEM-based study of the safety of artesunate-amodiaquine (ASAQ at five peripheral health facilities in a rural district of South-western Senegal. Staff (nurses, health workers were trained to collect actively and systematically information on the patient, treatment and events on a purposely designed questionnaire. The occurrence and severity of events was collected before, during and after treatment up to 28 days in order to generate information on all adverse events (AEs as well as treatment-emerging signs/symptoms (TESS. Laboratory tests (haematology, liver and renal was planned for at least 10% of cases. Results During 2001–2009, 3,708 parasitologically-confirmed malaria cases (mean age = 16.0 ± 12.7 years were enrolled (26% and 52% of all and parasitologically-confirmed ASAQ treatments, respectively. Treatment was supervised in 96% of cases. Products changed over time: 49% were a loose combination of individually-packaged products (available 2001–03, 42% co-blistered products (2004–09 and 9% a fixed-dose co-formulation (2006–09; dosing was age-based for 42%, weight-based for 58%. AS and AQ were correctly dosed in 97% and 82% of cases with the loose and 93% and 86% with the fixed combination, but only 50% and 42% with the co-blistered product. Thirty-three per cent (33% of patients had at least one sign/symptom pre-treatment, 12% had at least one AE and 9% a TESS (total events 3,914, 1,144 and 693, respectively. AEs overestimated TESS by 1.2-2 fold (average 1.7. Changes in

  10. Classroom observation and feedback

    Directory of Open Access Journals (Sweden)

    Ana GOREA

    2016-12-01

    Full Text Available Classroom observation is a didactic activity from which both the observer and the observed teacher are to win. The present article comments on and discusses the aims of observation, the stages of observation, the methodological recommendations of offering feedback and the need to introduce a system of classroom observation at institutional or even national level, which would contribute to improving the teaching/learning process.

  11. Regenerative feedback resonant circuit

    Science.gov (United States)

    Jones, A. Mark; Kelly, James F.; McCloy, John S.; McMakin, Douglas L.

    2014-09-02

    A regenerative feedback resonant circuit for measuring a transient response in a loop is disclosed. The circuit includes an amplifier for generating a signal in the loop. The circuit further includes a resonator having a resonant cavity and a material located within the cavity. The signal sent into the resonator produces a resonant frequency. A variation of the resonant frequency due to perturbations in electromagnetic properties of the material is measured.

  12. Engaging Students with Audio Feedback

    Science.gov (United States)

    Cann, Alan

    2014-01-01

    Students express widespread dissatisfaction with academic feedback. Teaching staff perceive a frequent lack of student engagement with written feedback, much of which goes uncollected or unread. Published evidence shows that audio feedback is highly acceptable to students but is underused. This paper explores methods to produce and deliver audio…

  13. Feedback, Incentives and Peer Effects

    DEFF Research Database (Denmark)

    Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie Claire

    This paper experimentally investigates the impact of different pay and relative performance information policies on employee effort. We explore three information policies: No feedback, feedback given halfway through the production period, and continuously updated feedback about relative performan...... behind, and frontrunners do not slack off....

  14. Bunch by bunch feedback systems

    International Nuclear Information System (INIS)

    Tobiyama, Makoto

    2006-01-01

    Outlines of bunch-by-bunch feedback systems for suppressing multibunch instabilities in electron/positron storage rings are presented. The design principles and functions of the feedback components are reviewed. Recent topics of applying very fast and dense FPGA as feedback signal processor are also shown. (author)

  15. Det ved vi om Feedback

    DEFF Research Database (Denmark)

    Christensen, Vibeke; Bærenholdt, Jørgen

    Præsentation af forskningsviden om feedback i forskellige personkonstellationer i undervisningen: Feedback fra lærer til elev, fra elever til lærer, fra elev til elev og elevens eget arbejde med feedback til sig selv. De præsenterede forskningsresultater er udvalgt dels inden for en kognitivistisk...

  16. A Journey towards Sustainable Feedback

    Science.gov (United States)

    Mutch, Allyson; Young, Charlotte; Davey, Tamzyn; Fitzgerald, Lisa

    2018-01-01

    Meeting students' expectations associated with the provision of feedback is a perennial challenge for tertiary education. Efforts to provide comprehensive, timely feedback within our own first year undergraduate public health courses have not always met students' expectations. In response, we sought to develop peer feedback activities to support…

  17. Quality assurance feedback as a nursing management strategy.

    Science.gov (United States)

    Brannon, D; Bucher, J A

    1989-01-01

    Quality assurance and effective nurse management can be viewed as intersecting goals. Objective feedback derived from quality assurance data is a potentially powerful means of enhancing nurses' performance and job satisfaction. The use of automated information systems to provide such direct feedback offers the additional advantage of recognizing nurses as self-monitoring, self-correcting professionals. The need, opportunity, and challenge involved in meshing quality assurance with human resource management through computer-generated feedback are discussed in the context of the home health care setting.

  18. [Comparison of health education and drug therapy monitoring interventions in patients with cardiovascular risk factors attending a community pharmacy (FISFTES-PM Study)].

    Science.gov (United States)

    Bofí Martínez, Patricia; García Jiménez, Emilio; Martínez Martínez, Fernando

    2015-03-01

    To compare health education (HE) and drug therapy monitoring (DTM) interventions in patients with cardiovascular risk factors (CVRF). Randomised experimental studys: 100 patients per group. Playa-Miramar pharmacy (Valencia, Spain). March 2010-November 2011. Patients with one or more CVRF detected based on medication they were taking or questions they asked when drugs were dispensed. Patients were assigned to one of the two groups (HE or DTM) using a random number table. 100 patients by group were included. Six months of DTM (DTMG) or health education (HEG) per patient. The primary variables were modifiable CVRF: hypertension, dyslipidaemia, diabetes, smoking, obesity and low physical activity. Secondary variables were non modifiable CVRF (age, sex, cardiovascular disease), heart rate, body mass index, waist measurement, waist-to-hip ratio, waist-to-height ratio, body fat, treatment compliance. The differences in the reduction percentages were statistically greater in DTMG than in HEG for the following variables: systolic pressure 5.40% (p=0.001); heart rate 2.95%(p=0.015); weight 2.00% (p=0.002); BMI 2.24% (p=0.003); fasting glucose 8.65% (p=0.004); total cholesterol 6.45% (p=0.002); waist measurement 1.85% (p=0.010); and waist-to-height ratio 1.66% (p=0.002). Triglycerides and body fat were reduced by 12.78% (p<0.001) and 1.84% (p<0.001) more, respectively, in DTMG. These differences were not statistically significant. The reduction percentages were generally higher for all variables in DTMG except diastolic blood pressure, which decreased by 4.7% (P<.001) more in HEG because the baseline values were higher. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  19. Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.

    Science.gov (United States)

    Hawk, Kathryn; D'Onofrio, Gail; Fiellin, David A; Chawarski, Marek C; O'Connor, Patrick G; Owens, Patricia H; Pantalon, Michael V; Bernstein, Steven L

    2017-11-22

    Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p Medicine.

  20. Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India?

    Directory of Open Access Journals (Sweden)

    Sharath Burugina Nagaraja

    Full Text Available BACKGROUND: In India, the Revised National Tuberculosis Control Programme (RNTCP has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB patients. OBJECTIVES: To determine the incremental yield of the second sputum specimen during follow-up culture examinations among patients with MDR-TB and the effect on case management on changing from two to one specimen follow-up strategy. METHODS: A cross sectional record review of MDR-TB patients registered during 2008-09 under RNTCP was undertaken in three MDR-TB treatment sites of India. RESULTS: Of 1721 pairs of follow-up sputum culture examinations done among 220 MDR-TB patients, 451(26% were positive with either of the two specimens; 29(1.7% were culture positive only on the second specimen indicating the incremental yield. To detect one additional culture positive result on the second specimen, 59 specimens needed to be processed. If we had examined only one specimen, we would have missed 29 culture-positive results. By current RNTCP guidelines, however, a single specimen policy would have altered case management in only 3(0.2% instances, where patients would have missed a one month extension of the intensive phase of MDR-TB treatment. There is no meaningful advantage in using two specimens for the monitoring of MDR-TB patients. A single specimen policy could be safely implemented with negligible clinical effect on MDR-TB patients and favourable resource implications for RNTCP.

  1. Closed orbit feedback with digital signal processing

    International Nuclear Information System (INIS)

    Chung, Y.; Kirchman, J.; Lenkszus, F.

    1994-01-01

    The closed orbit feedback experiment conducted on the SPEAR using the singular value decomposition (SVD) technique and digital signal processing (DSP) is presented. The beam response matrix, defined as beam motion at beam position monitor (BPM) locations per unit kick by corrector magnets, was measured and then analyzed using SVD. Ten BPMs, sixteen correctors, and the eight largest SVD eigenvalues were used for closed orbit correction. The maximum sampling frequency for the closed loop feedback was measured at 37 Hz. Using the proportional and integral (PI) control algorithm with the gains Kp = 3 and K I = 0.05 and the open-loop bandwidth corresponding to 1% of the sampling frequency, a correction bandwidth (-3 dB) of approximately 0.8 Hz was achieved. Time domain measurements showed that the response time of the closed loop feedback system for 1/e decay was approximately 0.25 second. This result implies ∼ 100 Hz correction bandwidth for the planned beam position feedback system for the Advanced Photon Source storage ring with the projected 4-kHz sampling frequency

  2. Self-esteem, performance feedback, and cardiovascular stress reactivity.

    Science.gov (United States)

    Hughes, Brian M

    2007-09-01

    This study sought to establish the impact of performance-related feedback on cardiovascular responses to stressors, and whether this impact is influenced by individual differences in self-esteem. A total of 66 college women were categorized as either high or low in self-esteem on the basis of their scores in a standardized psychometric test. They then took part in a laboratory experiment, in which they were assigned to one of three performance-feedback manipulations. Following the provision of feedback on an initial laboratory task (picture-matching), they undertook a second task (mental arithmetic). Cardiovascular functioning was monitored throughout. Provision of negative feedback to the initial task exerted an adverse impact on cardiovascular responses, suggestive of unhappiness with performance. Provision of positive feedback to the initial task exerted an impact on cardiovascular functioning during the second task, suggestive of task engagement. Importantly, low self-esteem exacerbated the adverse impact of negative feedback. The impact of feedback and the buffering role of self-esteem may have important consequences for cardiovascular health. Further, discrepancies in the findings of previous feedback research may be accounted for by dispositional individual differences.

  3. Feedback on Feedback: Eliciting Learners' Responses to Written Feedback through Student-Generated Screencasts

    Science.gov (United States)

    Fernández-Toro, María; Furnborough, Concha

    2014-01-01

    Despite the potential benefits of assignment feedback, learners often fail to use it effectively. This study examines the ways in which adult distance learners engage with written feedback on one of their assignments. Participants were 10 undergraduates studying Spanish at the Open University, UK. Their responses to feedback were elicited by means…

  4. Feedback på arbejdspladser

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    Feedback på arbejdspladser er vigtig. Men feedback er også et populært begreb mange taler med om uden dog at vide sig helt sikker på hvad det er. Formålet med denne bog er at bidrage til en bedre forståelse af hvad feedback er, hvordan det fungerer og dermed hvordan arbejdspladser bedst muligt bør...... understøtte feedback. Med udgangspunkt i forskningen identificeres centrale udfordringer ved feedback, bl.a. hvorfor det kan være svært at give præcis feedback, hvordan forholdet mellem lederen og den ansatte påvirker den feedback der gives, og hvad der kendetegner en feedback kultur. Bogen er skrevet til...... undervisere og studerende på videregående uddannelser samt praktikere der ønsker en systematisk og forskningsbaseret forståelse af feedback på arbejdspladser. Bogen er således ikke en kogebog til bedre feedback, men en analyse og diskussion af hvad forskningen ved om feedback, og bidrager med inspiration og...

  5. Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback.

    Science.gov (United States)

    Whitney, Paul; Hinson, John M; Jackson, Melinda L; Van Dongen, Hans P A

    2015-05-01

    To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Twenty-six subjects (22-40 y of age; 10 women). Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important

  6. Driver feedback mobile APP

    Energy Technology Data Exchange (ETDEWEB)

    Soriguera Marti, F.; Miralles Miquel, E.

    2016-07-01

    This paper faces the human factor in driving and its consequences for road safety. It presents the concepts behind the development of a smartphone app capable of evaluating drivers’ performance. The app provides feedback to the driver in terms of a grade (between 0 and 10) depending on the aggressiveness and risks taken while driving. These are computed from the cumulative probability distribution function of the jerks (i.e. the time derivative of acceleration), which are measured using the smartphones’ accelerometer. Different driving contexts (e.g. urban, freeway, congestion, etc.) are identified applying cluster analysis to the measurements, and treated independently. Using regression analysis, the aggressiveness indicator is related to the drivers' safety records and to the probability of having an accident, through the standard DBQ - Driving Behavior Questionnaire. Results from a very limited pilot test show a strong correlation between the 99th percentile of the jerk measurements and the DBQ results. A linear model is fitted. This allows quantifying the safe driving behavior only from smartphone measurements. Finally, this indicator is translated into a normalized grade and feedback to the driver. This feedback will challenge the driver to train and to improve his performance. The phone will be blocked while driving and will incorporate mechanisms to prevent bad practices, like competition in aggressive driving. The app is intended to contribute to the improvement of road safety, one of the major public health problems, by tackling the human factor which is the trigger of the vast majority of traffic accidents. Making explicit and quantifying risky behaviors is the first step towards a safer driving. (Author)

  7. PLS beam position measurement and feedback system

    International Nuclear Information System (INIS)

    Huang, J.Y.; Lee, J.; Park, M.K.; Kim, J.H.; Won, S.C.

    1992-01-01

    A real-time orbit correction system is proposed for the stabilization of beam orbit and photon beam positions in Pohang Light Source. PLS beam position monitoring system is designed to be VMEbus compatible to fit the real-time digital orbit feedback system. A VMEbus based subsystem control computer, Mil-1553B communication network and 12 BPM/PS machine interface units constitute digital part of the feedback system. With the super-stable PLS correction magnet power supply, power line frequency noise is almost filtered out and the dominant spectra of beam obtit fluctuations are expected to appear below 15 Hz. Using DSP board in SCC for the computation and using an appropriate compensation circuit for the phase delay by the vacuum chamber, PLS real-time orbit correction system is realizable without changing the basic structure of PLS computer control system. (author)

  8. The Endogenous Feedback Network

    DEFF Research Database (Denmark)

    Augustenborg, Claudia Carrara

    2010-01-01

    proposals, it will first be considered the extents of their reciprocal compatibility, tentatively shaping an integrated, theoretical profile of consciousness. A new theory, the Endogenous Feedback Network (EFN) will consequently be introduced which, beside being able to accommodate the main tenets...... of the reviewed theories, appears able to compensate for the explanatory gaps they leave behind. The EFN proposes consciousness as the phenomenon emerging from a distinct network of neural paths broadcasting the neural changes associated to any mental process. It additionally argues for the need to include a 5th...

  9. Drug interactions with radiopharmaceuticals

    International Nuclear Information System (INIS)

    Hesslewood, S.; Leung, E.

    1994-01-01

    Considerable information on documented drug and radiopharmaceutical interactions has been assembled in a tabular form, classified by the type of nuclear medicine study. The aim is to provide a rapid reference for nuclear medicine staff to look for such interactions. The initiation of drug chart monitoring or drug history taking of nuclear medicine patients and the reporting of such events are encouraged. (orig.)

  10. Neural correlates of anticipation and processing of performance feedback in social anxiety.

    Science.gov (United States)

    Heitmann, Carina Y; Peterburs, Jutta; Mothes-Lasch, Martin; Hallfarth, Marlit C; Böhme, Stephanie; Miltner, Wolfgang H R; Straube, Thomas

    2014-12-01

    Fear of negative evaluation, such as negative social performance feedback, is the core symptom of social anxiety. The present study investigated the neural correlates of anticipation and perception of social performance feedback in social anxiety. High (HSA) and low (LSA) socially anxious individuals were asked to give a speech on a personally relevant topic and received standardized but appropriate expert performance feedback in a succeeding experimental session in which neural activity was measured during anticipation and presentation of negative and positive performance feedback concerning the speech performance, or a neutral feedback-unrelated control condition. HSA compared to LSA subjects reported greater anxiety during anticipation of negative feedback. Functional magnetic resonance imaging results showed deactivation of medial prefrontal brain areas during anticipation of negative feedback relative to the control and the positive condition, and medial prefrontal and insular hyperactivation during presentation of negative as well as positive feedback in HSA compared to LSA subjects. The results indicate distinct processes underlying feedback processing during anticipation and presentation of feedback in HSA as compared to LSA individuals. In line with the role of the medial prefrontal cortex in self-referential information processing and the insula in interoception, social anxiety seems to be associated with lower self-monitoring during feedback anticipation, and an increased self-focus and interoception during feedback presentation, regardless of feedback valence. © 2014 Wiley Periodicals, Inc.

  11. Feedback reliability calculation for an iterative block decision feedback equalizer

    OpenAIRE

    Huang, G; Nix, AR; Armour, SMD

    2009-01-01

    A new class of iterative block decision feedback equalizer (IB-DFE) was pioneered by Chan and Benvenuto. Unlike the conventional DFE, the IB-DFE is optimized according to the reliability of the feedback (FB) symbols. Since the use of the training sequence (TS) for feedback reliability (FBR) estimation lowers the bandwidth efficiency, FBR estimation without the need for additional TS is of considerable interest. However, prior FBR estimation is limited in the literature to uncoded M-ary phases...

  12. Feedback Cheerleader, Mean-Spirited Feedback Estudio Critico Discursivo De Ideologias Sobre El Feedback Escrito En Un Departamento Universitario De Espanol En Estados Unidos

    Science.gov (United States)

    Dominguez-Mujica, Maria Eugenia

    2012-01-01

    The aim of this research is to investigate ideologies that monitor and control styles of written feedback as well as discursive resources used in the expression of those ideologies. Using socio-cognitive analysis, a development of critical discourse studies, I have analyzed 44 sessions of chat on the Internet, 78 journal notes, 31 emails and 12…

  13. Comparison between xCELLigence biosensor technology and conventional cell culture system for real-time monitoring human tenocytes proliferation and drugs cytotoxicity screening.

    Science.gov (United States)

    Chiu, Chih-Hao; Lei, Kin Fong; Yeh, Wen-Ling; Chen, Poyu; Chan, Yi-Sheng; Hsu, Kuo-Yao; Chen, Alvin Chao-Yu

    2017-10-16

    Local injections of anesthetics, NSAIDs, and corticosteroids for tendinopathies are empirically used. They are believed to have some cytotoxicity toward tenocytes. The maximal efficacy dosages of local injections should be determined. A commercial 2D microfluidic xCELLigence system had been developed to detect real-time cellular proliferation and their responses to different stimuli and had been used in several biomedical applications. The purpose of this study is to determine if human tenocytes can successfully proliferate inside xCELLigence system and the result has high correlation with conventional cell culture methods in the same condition. First passage of human tenocytes was seeded in xCELLigence and conventional 24-well plates. Ketorolac tromethamine, bupivacaine, methylprednisolone, and betamethasone with different concentrations (100, 50, and 10% diluted of clinical usage) were exposed in both systems. Gene expression of type I collagen, type III collagen, tenascin-C, decorin, and scleraxis were compared between two systems. Human tenocytes could proliferate both in xCELLigence and conventional cell culture systems. Cytotoxicity of each drug revealed dose-dependency when exposed to tenocytes in both systems. Significance was found between groups. All the four drugs had comparable cytotoxicity in their 100% concentration. When 50% concentration was used, betamethasone had a relatively decreased cytotoxicity among them in xCELLigence but not in conventional culture. When 10% concentration was used, betamethasone had the least cytotoxicity. Strong and positive correlation was found between cell index of xCELLigence and result of WST-1 assay (Pearson's correlation [r] = 0.914). Positive correlation of gene expression between tenocytes in xCELLigence and conventional culture was also observed. Type I collagen: [r] = 0.823; type III collagen: [r] = 0.899; tenascin-C: [r] = 0.917; decorin: [r] = 0.874; and scleraxis: [r] = 0.965. Human

  14. GIVING AND RECEIVING CONSTRUCTIVE FEEDBACK

    Directory of Open Access Journals (Sweden)

    Ірина Олійник

    2015-05-01

    Full Text Available The article scrutinizes the notion of feedback applicable in classrooms where team teaching is provided. The experience of giving and receiving feedback has been a good practice in cooperation between a U.S. Peace Corps volunteer and a Ukrainian counterpart. Giving and receiving feedback is an effective means of classroom observation that provides better insight into the process of teaching a foreign language. The article discusses the stages of feedback and explicates the notion of sharing experience between two teachers working simultaneously in the same classroom. The guidelines for giving and receiving feedback have been provided as well as the most commonly used vocabulary items have been listed. It has been proved that mutual feedback leads to improving teaching methods and using various teaching styles and techniques.

  15. Emotional feedback for mobile devices

    CERN Document Server

    Seebode, Julia

    2015-01-01

    This book investigates the functional adequacy as well as the affective impression made by feedback messages on mobile devices. It presents an easily adoptable experimental setup to examine context effects on various feedback messages, and applies it to auditory, tactile and auditory-tactile feedback messages. This approach provides insights into the relationship between the affective impression and functional applicability of these messages as well as an understanding of the influence of unimodal components on the perception of multimodal feedback messages. The developed paradigm can also be extended to investigate other aspects of context and used to investigate feedback messages in modalities other than those presented. The book uses questionnaires implemented on a Smartphone, which can easily be adopted for field studies to broaden the scope even wider. Finally, the book offers guidelines for the design of system feedback.

  16. Hvad siger forskningen om feedback?

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    2016-01-01

    Feedback skal serveres ligesom en gammeldags sandwich. Først lidt brød, så det lidt sejere kød og til sidst igen til lidt brød”. Sådan nogenlunde lyder en pragmatisk løsning på udfordringerne ved at give feedback. Når medarbejdere skal have negativ feedback, skal denne altså pakkes ind, så...... feedbacken indledes med let fordøjeligt positiv feedback, derefter kommer den negative – og noget sværere fordøjelige – feedback, og til sidst afrundes feedbacken med en god udgangsreplik, nemlig den positive feedback....

  17. Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

    Science.gov (United States)

    Whitney, Paul; Hinson, John M.; Jackson, Melinda L.; Van Dongen, Hans P.A.

    2015-01-01

    Study Objectives: To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Design: Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Setting: Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Subjects: Twenty-six subjects (22–40 y of age; 10 women). Interventions: Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Results: Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Conclusions: Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback

  18. Dynamics of nonlinear feedback control

    OpenAIRE

    Snippe, H.P.; Hateren, J.H. van

    2007-01-01

    Feedback control in neural systems is ubiquitous. Here we study the mathematics of nonlinear feedback control. We compare models in which the input is multiplied by a dynamic gain (multiplicative control) with models in which the input is divided by a dynamic attenuation (divisive control). The gain signal (resp. the attenuation signal) is obtained through a concatenation of an instantaneous nonlinearity and a linear low-pass filter operating on the output of the feedback loop. For input step...

  19. Multi-bunch Feedback Systems

    OpenAIRE

    Lonza, M.; Schmickler, H.

    2016-01-01

    Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides importa...

  20. The nuts and bolts of pills and portions: the functions of a drug safety working group.

    Science.gov (United States)

    Nath, Noleen S; Jones, Ellen H; Stride, Peter; Premaratne, Manuja; Thaker, Darshit; Lim, Ivan

    2011-11-01

    Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital.

  1. Population pharmacokinetics analysis of olanzapine for Chinese psychotic patients based on clinical therapeutic drug monitoring data with assistance of meta-analysis.

    Science.gov (United States)

    Yin, Anyue; Shang, Dewei; Wen, Yuguan; Li, Liang; Zhou, Tianyan; Lu, Wei

    2016-08-01

    The aim of this study was to build an eligible population pharmacokinetic (PK) model for olanzapine in Chinese psychotic patients based on therapeutic drug monitoring (TDM) data, with assistance of meta-analysis, to facilitate individualized therapy. Population PK analysis for olanzapine was performed using NONMEM software (version 7.3.0). TDM data were collected from Guangzhou Brain Hospital (China). Because of the limitations of TDM data, model-based meta-analysis was performed to construct a structural model to assist the modeling of TDM data as prior estimates. After analyzing related covariates, a simulation was performed to predict concentrations for different types of patients under common dose regimens. A two-compartment model with first-order absorption and elimination was developed for olanzapine oral tablets, based on 23 articles with 390 data points. The model was then applied to the TDM data. Gender and smoking habits were found to be significant covariates that influence the clearance of olanzapine. To achieve a blood concentration of 20 ng/mL (the lower boundary of the recommended therapeutic range), simulation results indicated that the dose regimen of olanzapine should be 5 mg BID (twice a day), ≥ 5 mg QD (every day) plus 10 mg QN (every night), or >10 mg BID for female nonsmokers, male nonsmokers and male smokers, respectively. The population PK model, built using meta-analysis, could facilitate the modeling of TDM data collected from Chinese psychotic patients. The factors that significantly influence olanzapine disposition were determined and the final model could be used for individualized treatment.

  2. Cost-effectiveness of drug monitoring of anti-TNF therapy in inflammatory bowel disease and rheumatoid arthritis: a systematic review.

    Science.gov (United States)

    Martelli, Laura; Olivera, Pablo; Roblin, Xavier; Attar, Alain; Peyrin-Biroulet, Laurent

    2017-01-01

    Therapeutic drug monitoring (TDM) of anti-TNF is increasingly used to manage inflammatory bowel diseases (IBD) and rheumatoid arthritis (RA). The cost-effectiveness of this strategy is debated. All studies comparing the cost-effectiveness of a TDM-based strategy and an empirical dose management of anti-TNF in IBD or RA were screened. Studies were identified through the MEDLINE electronic database (up to July 2016), and annual international meeting abstracts were also manually reviewed. Seven studies were included: two randomized controlled trials (RCTs) enrolling 332 patients [247 Crohn's disease (CD) and 85 ulcerative colitis (UC)] and five modeling approaches. Four studies included only CD patients, one included both CD and UC patients, and two included only RA patients. Three studies compared the cost-effectiveness of the two strategies in patients with secondary infliximab (IFX) failure (dose-escalation strategy), one in patients in remission on optimized IFX (de-escalation strategy), one in patients starting adalimumab, and two in patients with clinical response to maintenance anti-TNF therapy. The two RCTs demonstrated that a TDM strategy led to major cost savings, ranging from 28 to 34 %. The three modeling approaches with regard to CD patients demonstrated cost savings ranging from $5396 over a 1-year period to €13,130 per patient at 5 years of follow-up. A TDM strategy also led to major cost savings in the two modeling approaches in RA patients. Available evidence indicates that a TDM strategy leads to major cost savings related to anti-TNF therapy in both IBD and RA patients, with no negative impact on efficacy.

  3. Doxorubicin-modified magnetic nanoparticles as a drug delivery system for magnetic resonance imaging-monitoring magnet-enhancing tumor chemotherapy.

    Science.gov (United States)

    Liang, Po-Chin; Chen, Yung-Chu; Chiang, Chi-Feng; Mo, Lein-Ray; Wei, Shwu-Yuan; Hsieh, Wen-Yuan; Lin, Win-Li

    2016-01-01

    In this study, we developed functionalized superparamagnetic iron oxide (SPIO) nanoparticles consisting of a magnetic Fe3O4 core and a shell of aqueous stable polyethylene glycol (PEG) conjugated with doxorubicin (Dox) (SPIO-PEG-D) for tumor magnetic resonance imaging (MRI) enhancement and chemotherapy. The size of SPIO nanoparticles was ~10 nm, which was visualized by transmission electron microscope. The hysteresis curve, generated with vibrating-sample magnetometer, showed that SPIO-PEG-D was superparamagnetic with an insignificant hysteresis. The transverse relaxivity (r 2) for SPIO-PEG-D was significantly higher than the longitudinal relaxivity (r 1) (r 2/r 1 >10). The half-life of Dox in blood circulation was prolonged by conjugating Dox on the surface of SPIO with PEG to reduce its degradation. The in vitro experiment showed that SPIO-PEG-D could cause DNA crosslink more serious, resulting in a lower DNA expression and a higher cell apoptosis for HT-29 cancer cells. The Prussian blue staining study showed that the tumors treated with SPIO-PEG-D under a magnetic field had a much higher intratumoral iron density than the tumors treated with SPIO-PEG-D alone. The in vivo MRI study showed that the T2-weighted signal enhancement was stronger for the group under a magnetic field, indicating that it had a better accumulation of SPIO-PEG-D in tumor tissues. In the anticancer efficiency study for SPIO-PEG-D, the results showed that there was a significantly smaller tumor size for the group with a magnetic field than the group without. The in vivo experiments also showed that this drug delivery system combined with a local magnetic field could reduce the side effects of cardiotoxicity and hepatotoxicity. The results showed that the developed SPIO-PEG-D nanoparticles own a great potential for MRI-monitoring magnet-enhancing tumor chemotherapy.

  4. Novel Approaches for Visualizing and Analyzing Dose-Timing Data from Electronic Drug Monitors, or "How the 'Broken Window' Theory Pertains to ART Adherence".

    Science.gov (United States)

    Gill, Christopher J; DeSilva, Mary Bachman; Hamer, Davidson H; Keyi, Xu; Wilson, Ira B; Sabin, Lora

    2015-11-01

    Adherence to antiretroviral medications is usually expressed in terms of the proportion of doses taken. However, the timing of doses taken may also be an important dimension to overall adherence. Little is known about whether patients who mistime doses are also more likely to skip doses. Using data from the completed Adherence for Life randomized controlled trial, we created visual and statistical models to capture and analyze dose timing data collected longitudinally with electronic drug monitors (EDM). From scatter plots depicting dose time versus calendar date, we identified dominant patterns of dose taking and calculated key features [slope of line over calendar date; residual mean standard error (RMSE)]. Each was assessed for its ability to categorize subjects with 'sub-optimal' (<95 % of doses taken) using area under the receiver operating characteristic (AROC) curve analysis. Sixty eight subjects contributed EDM data, with ~300 to 400 observations/subject. While regression line slopes did not predict 'sub-optimal' adherence (AROC 0.51, 95 % CI 0.26-0.75), the variability in dose timing (RMSE) was strongly predictive (AROC 0.79, 95 % CI 0.62-0.97). Compared with the lowest quartile of RMSE (minimal dose time variability), each successive quartile roughly doubled the odds of 'sub-optimal' adherence (OR 2.1, 95 % CI 1.3-3.4). Patterns of dose timing and mistiming are strongly related to overall adherence behavior. Notably, individuals who skip doses are more likely to mistime doses, with the degree of risk positively correlated with the extent of dose timing variability.

  5. A Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia.

    Science.gov (United States)

    Chen, Eric Y; Sukumar, Nitin; Dai, Feng; Akhtar, Shamsuddin; Schonberger, Robert B

    2018-04-01

    The types of agents used for monitored anesthesia care (MAC) and their possible differential effects on outcomes have received less study despite increased use over general anesthesia (GA) in transfemoral aortic valve replacements (TAVRs). In this pilot analysis of patients undergoing TAVR using MAC, the authors described the anesthetic agents used and sought to investigate the possible association of anesthetic agent choice with outcomes and the extent to which total weight and time-adjusted doses of anesthetics declined with increasing 10-year age increments. Retrospective observational study. Tertiary teaching hospital. Ninety-three participants scheduled to undergo TAVR, with a primary plan of conscious sedation between November 2014 and June 2016, were included. None. Types of MAC were divided into 4 primary groups, but 2 groups were focused: propofol (n = 39) and dexmedetomidine plus propofol (n = 34). Conversion to GA occurred in 6 participants (6.45%) and was not associated with the type of sedation received. The authors also compared patients who received dexmedetomidine with those who did not in accordance with their a priori analytic plan. There were no associations between the use of dexmedetomidine and postoperative delirium or intensive care unit/hospital length of stay. No significant trends in medication dose adjustments were seen across increasing 10-year age increments. A wide breadth of MAC medications is in use among TAVR patients and does not support differences in outcomes. Despite recommendations to reduce anesthetic drug dosing in the elderly, no significant trends in dose reduction with increasing age were noted. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.

    Science.gov (United States)

    Suffoletto, Brian; Lynch, Michael; Pacella, Charissa B; Yealy, Donald M; Callaway, Clifton W

    2018-04-01

    Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis. This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  7. Fast feedback for linear colliders

    International Nuclear Information System (INIS)

    Hendrickson, L.; Adolphsen, C.; Allison, S.; Gromme, T.; Grossberg, P.; Himel, T.; Krauter, K.; MacKenzie, R.; Minty, M.; Sass, R.

    1995-01-01

    A fast feedback system provides beam stabilization for the SLC. As the SLC is in some sense a prototype for future linear colliders, this system may be a prototype for future feedbacks. The SLC provides a good base of experience for feedback requirements and capabilities as well as a testing ground for performance characteristics. The feedback system controls a wide variety of machine parameters throughout the SLC and associated experiments, including regulation of beam position, angle, energy, intensity and timing parameters. The design and applications of the system are described, in addition to results of recent performance studies

  8. Status of Digital Orbit Feedback for SPEAR

    International Nuclear Information System (INIS)

    Hettel, Robert

    2003-01-01

    The present global orbit feedback system for SPEAR can adjust the electron beam position with a cycle time of 5 s. In addition, 50 Hz analog local servos stabilize the vertical photon beam position at monitors situated in the ten SSRL beamlines. The global and local systems will soon be merged into a single unified system operating from a dedicated DSP board. The goal is to acquire orbits, process the data, and correct beam position in a 1-2 ms interval to achieve a 30-50 Hz closed-loop bandwidth

  9. Feedback and starbursts

    International Nuclear Information System (INIS)

    Wiklind, T.

    1987-01-01

    A simple phenomenological model of the regulatory coupling between the star formation rate and the molecular gas fraction is presented. The model can in a qualitative way explain both the constant star formation rate observed in most galaxies and the starbursting behaviour seen in some systems. Formation of massive stars are thought to have both a positive and a negative feedback on further stellar formation. A sudden increase in the gas available for star formation will cause a strong increase in the star formation rate lasting for ∼ 3.10 7 yrs. Both the star formation rate and the molecular gas friction will then perform damped oscillations over a period of a few x 10 8 yrs. This general behaviour is valid for a large range of parameter values

  10. KEKB bunch feedback systems

    Energy Technology Data Exchange (ETDEWEB)

    Tobiyama, M; Kikutani, E [National Lab. for High Energy Physics, Tsukuba, Ibaraki (Japan)

    1996-08-01

    Design and the present status of the bunch by bunch feedback systems for KEKB rings are shown. The detection of the bunch oscillation are made with the phase detection for longitudinal plane, the AM/PM method for transverse plane. Two GHz component of the bunch signal which is extracted with an analog FIR filter is used for the detection. Hardware two-tap FIR filter systems to shift the phase of the oscillation by 90deg will be used for the longitudinal signal processing. The same system will be used with no filtering but with only digital delay for transverse system. The candidate for the kicker and the required maximum power are also estimated. (author)

  11. Reviewing operational experience feedback

    International Nuclear Information System (INIS)

    1991-04-01

    The purpose of this document is to provide detailed supplementary guidance to OSART experts to aid in the evaluation of operational experience feedback (OEF) programmes at nuclear power plants. The document begins by describing the objectives of an OEF programme. It goes on to indicate preparatory work and investigatory guidance for the expert. Section 5 describes attributes of an excellent OEF programme. Appended to these guidelines are examples of OEF documents from various plants. These are intended to help the expert by demonstrating the actual implementation of OEF in practice. These guidelines are in no way intended to conflict with existing national regulations and rules. A comprehensive OEF programme, as described in Section 2, would be impossible to evaluated in detail in the amount of time typically allocated for assessing OEF in an OSART review. The expert must use his or her time wisely by concentrating on those areas that appear to be the weakest

  12. Analytic robust stability analysis of SVD orbit feedback

    CERN Document Server

    Pfingstner, Jürgen

    2012-01-01

    Orbit feedback controllers are indispensable for the operation of modern particle accelerators. Many such controllers are based on the decoupling of the inputs and outputs of the system to be controlled with the help of the singular value decomposition (SVD controller). It is crucial to verify the stability of SVD controllers, also in the presence of mismatches between the used accelerator model and the real machine (robust stability problem). In this paper, analytical criteria for guaranteed stability margins of SVD orbit feedback systems for three different types of model mismatches are presented: scaling errors of actuators and BPMs (beam position monitors) and additive errors of the orbit response matrix. For the derivation of these criteria, techniques from robust control theory have been used, e.g the small gain theorem. The obtained criteria can be easily applied directly to other SVD orbit feedback systems. As an example, the criteria were applied to the orbit feedback system of the Compact Linear ...

  13. Drug Facts

    Medline Plus

    Full Text Available ... Why Is It So Hard to Quit Drugs? Effects of Drugs Drug Use and Other People Drug ... Unborn Children Drug Use and Your Health Other Effects on the Body Drug Use Hurts Brains Drug ...

  14. Feedback matters current feedback practices in the EFL classroom

    CERN Document Server

    Reitbauer, Margit; Mercer, Sarah; Schumm-Fauster, Jennifer

    2013-01-01

    This varied collection of papers is concerned with feedback in the language learning context. With its blend of theoretical overviews, action research-based empirical studies and practical implications, this will be a valuable resource for all academics and practitioners concerned with generating feedback that matters.

  15. What higher education students do with teacher feedback: Feedback ...

    African Journals Online (AJOL)

    Writing pedagogy research has constantly maintained that feedback is 'an essential component of virtually every model of the writing process' (Hall, 1990: 43) as it motivates writers to improve their next draft. Feedback during the writing process improves not only student attitude to writing but writing performance if students ...

  16. Alcohol impairs brain reactivity to explicit loss feedback.

    Science.gov (United States)

    Nelson, Lindsay D; Patrick, Christopher J; Collins, Paul; Lang, Alan R; Bernat, Edward M

    2011-11-01

    Alcohol impairs the brain's detection of performance errors as evidenced by attenuated error-related negativity (ERN), an event-related potential (ERP) thought to reflect a brain system that monitors one's behavior. However, it remains unclear whether alcohol impairs performance-monitoring capacity across a broader range of contexts, including those entailing external feedback. This study sought to determine whether alcohol-related monitoring deficits are specific to internal recognition of errors (reflected by the ERN) or occur also in external cuing contexts. We evaluated the impact of alcohol consumption on the feedback-related negativity (FRN), an ERP thought to engage a similar process as the ERN but elicited by negative performance feedback in the environment. In an undergraduate sample randomly assigned to drink alcohol (n = 37; average peak BAC = 0.087 g/100 ml, estimated from breath alcohol sampling) or placebo beverages (n = 42), ERP responses to gain and loss feedback were measured during a two-choice gambling task. Time-frequency analysis was used to parse the overlapping theta-FRN and delta-P3 and clarified the effects of alcohol on the measures. Alcohol intoxication attenuated both the theta-FRN and delta-P3 brain responses to feedback. The theta-FRN attenuation was stronger following loss than gain feedback. Attenuation of both theta-FRN and delta-P3 components indicates that alcohol pervasively attenuates the brain's response to feedback in this task. That theta-FRN attenuation was stronger following loss trials is consistent with prior ERN findings and suggests that alcohol broadly impairs the brain's recognition of negative performance outcomes across differing contexts.

  17. Multi-bunch Feedback Systems

    International Nuclear Information System (INIS)

    Lonza, M; Schmickler, H

    2014-01-01

    Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. We first introduce coupled-bunch instabilities, analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedback systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback systems. The main components of a feedback system and the related issues will also be analysed. Finally, we shall focus on digital feedback systems, their characteristics, and features, as well as on how they can be concretely exploited for both the optimization of feedback performance and for beam dynamics studies

  18. Feedback Systems for Linear Colliders

    International Nuclear Information System (INIS)

    1999-01-01

    Feedback systems are essential for stable operation of a linear collider, providing a cost-effective method for relaxing tight tolerances. In the Stanford Linear Collider (SLC), feedback controls beam parameters such as trajectory, energy, and intensity throughout the accelerator. A novel dithering optimization system which adjusts final focus parameters to maximize luminosity contributed to achieving record performance in the 1997-98 run. Performance limitations of the steering feedback have been investigated, and improvements have been made. For the Next Linear Collider (NLC), extensive feedback systems are planned as an integral part of the design. Feedback requirements for JLC (the Japanese Linear Collider) are essentially identical to NLC; some of the TESLA requirements are similar but there are significant differences. For NLC, algorithms which incorporate improvements upon the SLC implementation are being prototyped. Specialized systems for the damping rings, rf and interaction point will operate at high bandwidth and fast response. To correct for the motion of individual bunches within a train, both feedforward and feedback systems are planned. SLC experience has shown that feedback systems are an invaluable operational tool for decoupling systems, allowing precision tuning, and providing pulse-to-pulse diagnostics. Feedback systems for the NLC will incorporate the key SLC features and the benefits of advancing technologies

  19. Fast feedback in classroom practice

    NARCIS (Netherlands)

    Emmett, K.M.; Klaassen, K.; Eijkelhof, H.

    2009-01-01

    In this article we describe one application of the fast feedback method (see Berg 2003 Aust. Sci. Teach. J. 28–34) in secondary mechanics education. Two teachers tried out a particular sequence twice, in consecutive years, once with and once without the use of fast feedback. We found the method to

  20. Dynamics of nonlinear feedback control

    NARCIS (Netherlands)

    Snippe, H.P.; Hateren, J.H. van

    Feedback control in neural systems is ubiquitous. Here we study the mathematics of nonlinear feedback control. We compare models in which the input is multiplied by a dynamic gain (multiplicative control) with models in which the input is divided by a dynamic attenuation (divisive control). The gain

  1. Student Interpretations of Diagnostic Feedback

    Science.gov (United States)

    Doe, Christine

    2015-01-01

    Diagnostic assessment is increasingly being recognized as a potentially beneficial tool for teaching and learning (Jang, 2012). There have been calls in the research literature for students to receive diagnostic feedback and for researchers to investigate how such feedback is used by students. Therefore, this study examined how students…

  2. Videoer om feedback i undervisningen

    DEFF Research Database (Denmark)

    Jensen, Hanne Nexø

    2017-01-01

    I denne video bliver du introduceret til en måde at praktisere og rammesætte klyngevejledning på i bachelorundervisning. Klyngefeedbackformen til de studerende er valgt, da de studerende lærer meget af både at give og om modtage feedback fra medstuderende. Fokus på feedback ligger derfor primært i...

  3. Designing feedback: multimodality and specificity

    NARCIS (Netherlands)

    Ludden, Geke Dina Simone; Sugiyama, Kazuo

    2013-01-01

    Now that many of us carry around devices that are equipped with sensors (e.g., smartphones with accelerometers) we can use these sensors to measure behavior. The data thus captured can be used to give someone feedback about this behavior. These feedback mechanisms are often used in so called smart

  4. Using feedback through digital technology to disrupt and change habitual behavior : a critical review of current literature

    NARCIS (Netherlands)

    Sander Hermsen; Reint-Jan Renes; Jeana Frost; Peter Kerkhof

    2016-01-01

    Habitual behavior is often hard to change because of a lack of self-monitoring skills. Digital technologies offer an unprecedented chance to facilitate self-monitoring by delivering feedback on undesired habitual behavior. This review analyzed the results of 72 studies in which feedback from digital

  5. LHC beam stability and feedback control

    Energy Technology Data Exchange (ETDEWEB)

    Steinhagen, Ralph

    2007-07-20

    This report presents the stability and the control of the Large Hadron Collider's (LHC) two beam orbits and their particle momenta using beam-based feedback systems. The aim of this report is to contribute to a safe and reliable LHC commissioning and machine operation. The first part of the analysis gives an estimate of the expected sources of orbit and energy perturbations that can be grouped into environmental sources, machine-inherent sources and machine element failures: the slowest perturbation due to ground motion, tides, temperature fluctuations of the tunnel and other environmental influences are described in this report by a propagation model that is both qualitatively and quantitatively supported by geophone and beam motion measurements at LEP and other CERN accelerators. The second part of this analysis deals with the control of the two LHC beams' orbit and energy through automated feedback systems. Based on the reading of the more than 1056 beam position monitors (BPMs) that are distributed over the machine, a central global feedback controller calculates new deflection strengths for the more than 1060 orbit corrector magnets (CODs) that are suitable to correct the orbit and momentum around their references. this report provides an analysis of the BPMs and CODs involved in the orbit and energy feedback. The BPMs are based on a wide-band time normaliser circuit that converts the transverse beam position reading of each individual particle bunch into two laser pulses that are separated by a time delay and transmitted through optical fibres to an acquisition card that converts the delay signals into a digital position. A simple error model has been tested and compared to the measurement accuracy of LHC type BPMs, obtained through beam-based measurements in the SPS. The average beam position is controlled through 1060 superconducting and individually powered corrector dipole magnets. The proposed correction in 'time-domain' consists of a

  6. LHC beam stability and feedback control

    International Nuclear Information System (INIS)

    Steinhagen, Ralph

    2007-01-01

    This report presents the stability and the control of the Large Hadron Collider's (LHC) two beam orbits and their particle momenta using beam-based feedback systems. The aim of this report is to contribute to a safe and reliable LHC commissioning and machine operation. The first part of the analysis gives an estimate of the expected sources of orbit and energy perturbations that can be grouped into environmental sources, machine-inherent sources and machine element failures: the slowest perturbation due to ground motion, tides, temperature fluctuations of the tunnel and other environmental influences are described in this report by a propagation model that is both qualitatively and quantitatively supported by geophone and beam motion measurements at LEP and other CERN accelerators. The second part of this analysis deals with the control of the two LHC beams' orbit and energy through automated feedback systems. Based on the reading of the more than 1056 beam position monitors (BPMs) that are distributed over the machine, a central global feedback controller calculates new deflection strengths for the more than 1060 orbit corrector magnets (CODs) that are suitable to correct the orbit and momentum around their references. this report provides an analysis of the BPMs and CODs involved in the orbit and energy feedback. The BPMs are based on a wide-band time normaliser circuit that converts the transverse beam position reading of each individual particle bunch into two laser pulses that are separated by a time delay and transmitted through optical fibres to an acquisition card that converts the delay signals into a digital position. A simple error model has been tested and compared to the measurement accuracy of LHC type BPMs, obtained through beam-based measurements in the SPS. The average beam position is controlled through 1060 superconducting and individually powered corrector dipole magnets. The proposed correction in 'time-domain' consists of a proportional

  7. Multi-bunch feedback systems

    CERN Document Server

    Lonza, M

    2008-01-01

    Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. The advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. The lecture will first introduce coupled-bunch instabilities analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedbacks systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback sy...

  8. Feedback systems for linear colliders

    CERN Document Server

    Hendrickson, L; Himel, Thomas M; Minty, Michiko G; Phinney, N; Raimondi, Pantaleo; Raubenheimer, T O; Shoaee, H; Tenenbaum, P G

    1999-01-01

    Feedback systems are essential for stable operation of a linear collider, providing a cost-effective method for relaxing tight tolerances. In the Stanford Linear Collider (SLC), feedback controls beam parameters such as trajectory, energy, and intensity throughout the accelerator. A novel dithering optimization system which adjusts final focus parameters to maximize luminosity contributed to achieving record performance in the 1997-98 run. Performance limitations of the steering feedback have been investigated, and improvements have been made. For the Next Linear Collider (NLC), extensive feedback systems are planned as an intregal part of the design. Feedback requiremetns for JLC (the Japanese Linear Collider) are essentially identical to NLC; some of the TESLA requirements are similar but there are significant differences. For NLC, algorithms which incorporate improvements upon the SLC implementation are being prototyped. Specialized systems for the damping rings, rf and interaction point will operate at hi...

  9. Multi-bunch Feedback Systems

    CERN Document Server

    Lonza, M.

    2014-12-19

    Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. We first introduce coupled-bunch instabilities, analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedback systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback systems. The main co...

  10. Targeted Feedback in the Milestones Era: Utilization of the Ask-Tell-Ask Feedback Model to Promote Reflection and Self-Assessment.

    Science.gov (United States)

    French, Judith C; Colbert, Colleen Y; Pien, Lily C; Dannefer, Elaine F; Taylor, Christine A

    2015-01-01

    The Accreditation Council for Graduate Medical Education's Milestones Project focuses trainee education on the formation of valued behaviors and skills believed to be necessary for trainees to become independent practitioners. The development and refinement of behaviors and skills outlined within the milestones will require learners to monitor, reflect, and assess their own performance over time. External feedback provides an opportunity for learners to recalibrate their self-assessments, thereby enabling them to develop better self-monitoring and self-assessment skills. Yet, feedback to trainees is frequently generic, such as "great job," "nice work," or "you need to read more." In this article, we describe a feedback model that faculty can use to provide specific feedback, while increasing accountability for learners. We offer practical examples of its use in a variety of settings in the milestone era. The Ask-Tell-Ask (ATA) patient communication skills strategy, which was adapted for use as a trainee feedback model 10 years ago at our institution, is a learner-centered approach for reinforcing and modifying behaviors. The model is efficient, promotes learner accountability, and helps trainees develop reflection and self-assessment skills. A feedback agreement further enhances ATA by establishing a shared understanding of goals for the educational encounter. The ATA feedback model, combined with a feedback agreement, encourages learners to self-identify strengths and areas for improvement, before receiving feedback. Personal monitoring, reflection, self-assessment, and increased accountability make ATA an ideal learner-centered feedback model for the milestones era, which focuses on performance improvement over time. We believe the introduction of the ATA feedback model in surgical training programs is a step in the right direction towards meaningful programmatic culture change. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier

  11. Moving Feedback Forward: Theory to Practice

    Science.gov (United States)

    Orsmond, Paul; Maw, Stephen J.; Park, Julian R.; Gomez, Stephen; Crook, Anne C.

    2013-01-01

    There is substantial research interest in tutor feedback and students' perception and use of such feedback. This paper considers some of the major issues raised in relation to tutor feedback and student learning. We explore some of the current feedback drivers, most notably the need for feedback to move away from simply a monologue from a tutor to…

  12. Understanding feedback: A learning theory perspective

    NARCIS (Netherlands)

    Thurlings, Marieke; Vermeulen, Marjan; Bastiaens, Theo; Stijnen, Sjef

    2018-01-01

    This article aims to review literature on feedback to teachers. Because research has hardly focused on feedback among teachers, the review’s scope also includes feedback in class- rooms. The review proposes that the effectiveness of feedback and feedback processes depend on the learning theory

  13. TFTR plasma feedback systems

    International Nuclear Information System (INIS)

    Efthimion, P.; Hawryluk, R.J.; Hojsak, W.; Marsala, R.J.; Mueller, D.; Rauch, W.; Tait, G.D.; Taylor, G.; Thompson, M.

    1985-01-01

    The Tokamak Fusion Test Reactor employs feedback control systems for four plasma parameters, i.e. for plasma current, for plasma major radius, for plasma vertical position, and for plasma density. The plasma current is controlled by adjusting the rate of change of current in the Ohmic Heating (OH) coil system. Plasma current is continuously sensed by a Rogowski coil and its associated electronics; the error between it and a preprogrammed reference plasma current history is operated upon by a ''proportional-plusintegral-plus-derivative'' (PID) control algorithm and combined with various feedforward terms, to generate compensating commands to the phase-controlled thyristor rectifiers which drive current through the OH coils. The plasma position is controlled by adjusting the currents in Equilibrium Field and Horizontal Field coil systems, which respectively determine the vertical and radial external magnetic fields producing J X B forces on the plasma current. The plasma major radius position and vertical position, sensed by ''B /sub theta/ '' and ''B /sub rho/ '' magnetic flux pickup coils with their associated electronics, are controlled toward preprogrammed reference histories by allowing PID and feedforward control algorithms to generate commands to the EF and HF coil power supplies. Plasma density is controlled by adjusting the amount of gas injected into the vacuum vessel. Time-varying gains are used to combine lineaveraged plasma density measurements from a microwave interferometer plasma diagnostic system with vacuum vessel pressure measurements from ion gauges, with various other measurements, and with preprogrammed reference histories, to determine commands to piezoelectric gas injection valves

  14. Giving Feedback: Development of Scales for the Mum Effect, Discomfort Giving Feedback, and Feedback Medium Preference

    Science.gov (United States)

    Cox, Susie S.; Marler, Laura E.; Simmering, Marcia J.; Totten, Jeff W.

    2011-01-01

    Research in organizational behavior and human resources promotes the view that it is critical for managers to provide accurate feedback to employees, yet little research addresses rater tendencies (i.e., the "mum effect") and attitudes that influence how performance feedback is given. Because technology has changed the nature of…

  15. How Attributes of the Feedback Message affect Subsequent Feedback Seeking: The interactive effects of feedback sign and type

    OpenAIRE

    Medvedeff, Megan; Gregory, Jane Brodie; Levy, Paul E

    2008-01-01

    In the current study, we examined the interactive effects of feedback type and sign on feedback-seeking behaviour, as well as the moderating role of regulatory focus. Using a behavioural measure of feedback seeking, we demonstrated a strong interaction between feedback type and sign, such that individuals subsequently sought the most feedback after they were provided with negative process feedback. Additionally, results suggested that an individual's chronic regulatory focus has implications ...

  16. Drug Facts

    Medline Plus

    Full Text Available ... Get Addicted to Drugs? Does Addiction Run in Families? Why Is It So Hard to Quit Drugs? ... Drug Use and Other People Drug Use and Families Drug Use and Kids Drug Use and Unborn ...

  17. Drug Facts

    Medline Plus

    Full Text Available ... Facts Search form Search Menu Home Drugs That People Abuse Alcohol Facts Bath Salts Facts Cocaine (Coke, ... Drugs? Effects of Drugs Drug Use and Other People Drug Use and Families Drug Use and Kids ...

  18. Drug Facts

    Medline Plus

    Full Text Available ... People Drug Use and Families Drug Use and Kids Drug Use and Unborn Children Drug Use and ... Children and Teens Stay Drug-Free Talking to Kids About Drugs: What to Say if You Used ...

  19. Feedback systems in the SLC

    International Nuclear Information System (INIS)

    Thompson, K.A.; Jobe, R.K.; Johnson, R.; Phinney, N.

    1987-02-01

    Two classes of computer-controlled feedback have been implemented to stabilize parameters in subsystems of the SLC: (1) ''slow'' (time scales ∼ minutes) feedback, and (2) ''fast'', i.e., pulse-to-pulse, feedback. The slow loops run in a single FEEDBACK process in the SLC host VAX, which acquires signals and sets control parameters via communication with the database and the network of normal SLC microprocessors. Slow loops exist to stabilize beam energy and energy spread, beam position and angle, and timing of kicker magnets, and to compensate for changes in the phase length of the rf drive line. The fast loops run in dedicated microprocessors, and may sample and/or feedback on particular parameters as often as every pulse of the SLC beam. The first implementations of fast feedback are to control transverse beam blow-up and to stabilize the energy and energy spread of bunches going into the SLC arcs. The overall architecture of the feedback software and the operator interface for controlling loops are discussed

  20. Styrket feedback gennem studerendes selvevaluering

    DEFF Research Database (Denmark)

    Andersen, Lars Bo

    2016-01-01

    Studerende er ofte utilfredse med såvel kvaliteten som kvantiteten af feedback på skriftligt arbejde. Ligeledes kan det som underviser være svært at afgive feedback, der tager udgangspunkt i de studerendes respektive læringssituationer, hvis man ikke har andet afsæt end opgavetekster. Denne artikel...... beskriver derfor to eksperimenter med brug af selvevaluering som kvalificerende mellemled i ekstern feedback på skriveøvelser. Eksperimenternes formål er at styrke den formative læring ved skriftligt arbejde. I det første eksperiment bestod feedbacken af underviser-feedback, mens det andet eksperiment...... indebar peer-feedback og fælles feedback. I begge tilfælde blev selvevalueringen foretaget med udgangspunkt i en kriteriebaseret retteguide. Eksperimenterne medførte, at den eksterne feedback blev målrettet og kvalificeret i forhold til den enkelte studerende, mens selve skriveprocessen mod forventning...

  1. Improving drug treatment in general practice

    NARCIS (Netherlands)

    Veninga, CCM; Denig, P; Zwaagstra, R; Haaijer-Ruskamp, FM

    In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer

  2. [Real-time feedback systems for improvement of resuscitation quality].

    Science.gov (United States)

    Lukas, R P; Van Aken, H; Engel, P; Bohn, A

    2011-07-01

    The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

  3. Optimal allocation of reviewers for peer feedback

    DEFF Research Database (Denmark)

    Wind, David Kofoed; Jensen, Ulf Aslak; Jørgensen, Rasmus Malthe

    2017-01-01

    feedback to be effective students should give and receive useful feedback. A key challenge in peer feedback is allocating the feedback givers in a good way. It is important that reviewers are allocated to submissions such that the feedback distribution is fair - meaning that all students receive good......Peer feedback is the act of letting students give feedback to each other on submitted work. There are multiple reasons to use peer feedback, including students getting more feedback, time saving for teachers and increased learning by letting students reflect on work by others. In order for peer...... indicated the quality of the feedback. Using this model together with historical data we calculate the feedback-giving skill of each student and uses that as input to an allocation algorithm that assigns submissions to reviewers, in order to optimize the feedback quality for all students. We test...

  4. Drug therapy smartens up

    Science.gov (United States)

    Martin, Christian

    2015-11-01

    The submission of the first 'smart pill' for market approval, combined with progress in the European nanomedicine landscape, illustrates the positive outlook for drug therapy and health monitoring, explains Christian Martin.

  5. Surgical Trainee Feedback-Seeking Behavior in the Context of Workplace-Based Assessment in Clinical Settings.

    Science.gov (United States)

    Gaunt, Anne; Patel, Abhilasha; Fallis, Simon; Rusius, Victoria; Mylvaganam, Seni; Royle, T James; Almond, Max; Markham, Deborah H; Pawlikowska, Teresa R B

    2017-06-01

    To investigate surgical trainee feedback-seeking behaviors-directly asking for feedback (inquiry) and observing and responding to situational clues (monitoring)-in the context of workplace-based assessment (WBA). A hypothetical model of trainee feedback-seeking behavior was developed using existing literature. A questionnaire, incorporating previously validated instruments from organizational psychology, was distributed to general surgical trainees at 23 U.K. hospitals in 2012-2013. Statistical modeling techniques compared the data with 12 predetermined hypothetical relationships between feedback-seeking behaviors and predictive variables (goal orientation, supervisory style) through mediating variables (perceptions of personal benefits and costs of feedback) to develop a final model. Of 235 trainees invited, 178 (76%) responded. Trainees completed 48 WBAs/year on average, and 73% reported receiving feedback via WBA. The final model was of good fit (chi-square/degree of freedom ratio = 1.620, comparative fit index = 0.953, root mean square error of approximation = 0.059). Modeled data showed trainees who perceive personal benefits to feedback use both feedback inquiry and monitoring to engage in feedback interactions. Trainees who seek feedback engage in using WBA. Trainees' goal orientations and perceptions of trainers' supervisory styles as supportive and instrumental are associated with perceived benefits and costs to feedback. Trainees actively engage in seeking feedback and using WBA. Their perceptions of feedback benefits and costs and supervisory style play a role in their feedback-seeking behavior. Encouraging trainees to actively seek feedback by providing specific training and creating a supportive environment for feedback interactions could positively affect their ability to seek feedback.

  6. Why Are Drugs So Hard to Quit?

    Medline Plus

    Full Text Available ... in your brain and makes it hard to feel OK without the drug. This video from NIDA ... Advertise Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign in to ...

  7. Negative feedback and adaptive resistance to the targeted therapy of cancer.

    Science.gov (United States)

    Chandarlapaty, Sarat

    2012-04-01

    Mutational activation of growth factor signaling pathways is commonly observed and often necessary for oncogenic transformation. Under physiologic conditions, these pathways are subject to tight regulation through negative feedback, which limits the extent and duration of signaling events after physiologic stimulation. Until recently, the role of these negative feedback pathways in oncogene-driven cancers has been poorly understood. In this review, I discuss the evidence for the existence and relevance of negative feedback pathways within oncogenic signaling networks, the selective advantages such feedback pathways may confer, and the effects such feedback might have on therapies aimed at inhibiting oncogenic signaling. Negative feedback pathways are ubiquitous features of growth factor signaling networks. Because growth factor signaling networks play essential roles in the majority of cancers, their therapeutic targeting has become a major emphasis of clinical oncology. Drugs targeting these networks are predicted to inhibit the pathway but also to relieve the negative feedback. This loss of negative feedback can itself promote oncogenic signals and cancer cell survival. Drug-induced relief of feedback may be viewed as one of the major consequences of targeted therapy and a key contributor to therapeutic resistance.

  8. A beam position feedback system for beam lines at the photon factory

    International Nuclear Information System (INIS)

    Katsura, T.; Kamiya, Y.; Haga, K.; Mitsuhashi, T.

    1987-01-01

    The beam position of the synchrotron radiation produced from the Storage Ring was stabilized by a twofold position feedback system. A digital feedback system was developed to suppress the diurnal beam movement (one cycle of sin-like drifting motion per day) which became a serious problem in low-emittance operation. The feedback was applied to the closed-orbit-distortion (COD) correction system in order to cancel the position variation at all the beam lines proportionately to the variation monitored at one beam line. An analog feedback system is also used to suppress frequency components faster than the slow diurnal movement

  9. Design of the ILC Prototype FONT4 Digital Intra-Train Beam-Based Feedback System

    International Nuclear Information System (INIS)

    Burrows, P.; Queen Mary, U. of London; Christian, G.B.; Hartin, A.F.; Dabiri Khah, H.; White, G.R.; Oxford U.; Clarke, C.C.; Perry, C.; Oxford Instruments; Kalinin, A.; Daresbury; McCormick, D.J.; Molloy, S.; Ross, M.C.; SLAC

    2007-01-01

    We present the design of the FONT4 digital intra-train beam position feedback system prototype and preliminary results of initial beam tests at the Accelerator Test Facility (ATF) at KEK. The feedback system incorporates a fast analogue beam position monitor (BPM) front-end signal processor, a digital feedback board, and a kicker driver amplifier. The short bunchtrain, comprising 3 electron bunches separated by c. 150ns, in the ATF extraction line was used to test components of the prototype feedback system

  10. NAIP 2015 Imagery Feedback Map

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — The NAIP 2015 Imagery Feedback map allows users to make comments and observations about the quality of the 2015 National Agriculture Imagery Program (NAIP)...

  11. NAIP 2017 Imagery Feedback Map

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — The NAIP 2017 Imagery Feedback map allows users to make comments and observations about the quality of the 2017 National Agriculture Imagery Program (NAIP)...

  12. Feedback and household energy use

    Energy Technology Data Exchange (ETDEWEB)

    Mauser, G A; Kendall, K W; Filiatrault, P

    1979-06-01

    The literature is reviewed relevant to the use of (a) information campaigns through the mass media; and (b) immediate feedback about the results of consumer behavior, to influence consumer energy use. The study focuses on residential energy use. (MHR)

  13. Validity evidence and reliability of a simulated patient feedback instrument.

    Science.gov (United States)

    Schlegel, Claudia; Woermann, Ulrich; Rethans, Jan-Joost; van der Vleuten, Cees

    2012-01-27

    In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

  14. Feedback stabilization of plasma instabilities

    International Nuclear Information System (INIS)

    Cap, F.F.

    1977-01-01

    This paper reviews the theoretical and experimental aspects of feedback stabilization. After giving an outline of a general theoretical model for electrostatic instabilities the author provides a theoretical analysis of the suppression of various types of instability. Experiments which have been carried out on the feedback stabilization of various types of plasma instability are reported. An extensive list of references is given. (B.R.H.)

  15. Operating experience feedback in TVO

    Energy Technology Data Exchange (ETDEWEB)

    Piirto, A [Teollisuuden Voima Oy (Finland)

    1997-12-31

    TVO is a power company operating with two 710 MW BWR units at Olkiluoto. For operating experience feedback TVO has not established a separate organizational unit but rather relies on a group of persons representing various technical disciplines. The ``Operating Experience Group`` meets at about three-week intervals to handle the reports of events (in plant and external) which have been selected for handling by an engineer responsible for experience feedback. 7 charts.

  16. Collective irrationality and positive feedback.

    Science.gov (United States)

    Nicolis, Stamatios C; Zabzina, Natalia; Latty, Tanya; Sumpter, David J T

    2011-04-26

    Recent experiments on ants and slime moulds have assessed the degree to which they make rational decisions when presented with a number of alternative food sources or shelter. Ants and slime moulds are just two examples of a wide range of species and biological processes that use positive feedback mechanisms to reach decisions. Here we use a generic, experimentally validated model of positive feedback between group members to show that the probability of taking the best of options depends crucially on the strength of feedback. We show how the probability of choosing the best option can be maximized by applying an optimal feedback strength. Importantly, this optimal value depends on the number of options, so that when we change the number of options the preference of the group changes, producing apparent "irrationalities". We thus reinterpret the idea that collectives show "rational" or "irrational" preferences as being a necessary consequence of the use of positive feedback. We argue that positive feedback is a heuristic which often produces fast and accurate group decision-making, but is always susceptible to apparent irrationality when studied under particular experimental conditions.

  17. Collective irrationality and positive feedback.

    Directory of Open Access Journals (Sweden)

    Stamatios C Nicolis

    Full Text Available Recent experiments on ants and slime moulds have assessed the degree to which they make rational decisions when presented with a number of alternative food sources or shelter. Ants and slime moulds are just two examples of a wide range of species and biological processes that use positive feedback mechanisms to reach decisions. Here we use a generic, experimentally validated model of positive feedback between group members to show that the probability of taking the best of options depends crucially on the strength of feedback. We show how the probability of choosing the best option can be maximized by applying an optimal feedback strength. Importantly, this optimal value depends on the number of options, so that when we change the number of options the preference of the group changes, producing apparent "irrationalities". We thus reinterpret the idea that collectives show "rational" or "irrational" preferences as being a necessary consequence of the use of positive feedback. We argue that positive feedback is a heuristic which often produces fast and accurate group decision-making, but is always susceptible to apparent irrationality when studied under particular experimental conditions.

  18. Theory of feedback controlled brain stimulations for Parkinson's disease

    Science.gov (United States)

    Sanzeni, A.; Celani, A.; Tiana, G.; Vergassola, M.

    2016-01-01

    Limb tremor and other debilitating symptoms caused by the neurodegenerative Parkinson's disease are currently treated by administering drugs and by fixed-frequency deep brain stimulation. The latter interferes directly with the brain dynamics by delivering electrical impulses to neurons in the subthalamic nucleus. While deep brain stimulation has shown therapeutic benefits in many instances, its mechanism is still unclear. Since its understanding could lead to improved protocols of stimulation and feedback control, we have studied a mathematical model of the many-body neural network dynamics controlling the dynamics of the basal ganglia. On the basis of the results obtained from the model, we propose a new procedure of active stimulation, that depends on the feedback of the network and that respects the constraints imposed by existing technology. We show by numerical simulations that the new protocol outperforms the standard ones for deep brain stimulation and we suggest future experiments that could further improve the feedback procedure.

  19. Monitoring in beeld: een studie naar de doorwerking van monitors in interbestuurlijke relaties

    NARCIS (Netherlands)

    D. de Kool (Dennis)

    2007-01-01

    textabstractMonitoring in the Dutch public sector An increasing stream of monitoring activities has entered the public sector. A lot of different monitors have been implemented in the Netherlands, like the police monitor, drugs monitor, integration monitor and the emancipation monitor. Although

  20. Beam stability in synchrotrons with digital filters in the feedback loop of a transverse damper

    International Nuclear Information System (INIS)

    Zhabitskij, V.M.

    2009-01-01

    The stability of an ion beam in synchrotrons with digital filters in the feedback loop of a transverse damper is treated. Solving the characteristic equation allows one to calculate the achievable damping rates as a function of instability growth rate, feedback gain and parameters of the signal processing. A transverse feedback system (TFS) is required in synchrotrons to stabilize the high intensity ion beams against transverse instabilities and to damp the beam injection errors. The TFS damper kicker (DK) corrects the transverse momentum of a bunch in proportion to its displacement from the closed orbit at the location of the beam position monitor (BPM). The digital signal processing unit in the feedback loop between BPM and DK ensures a condition to achieve optimal damping. Damping rates of the feedback systems with digital notch, Hilbert and all-pass filters are analyzed in comparison with those in an ideal feedback system