A review on reactive oxygen species-induced mechanism pathways of pharmaceutical waste degradation: Acetaminophen as a drug waste model.

Innately designed to induce physiological changes, pharmaceuticals are foreknowingly hazardous to the ecosystem. Advanced oxidation processes (AOPs) are recognized as a set of contemporary and highly efficient methods being used as a contrivance for the removal of pharmaceutical residues. Since reactive oxygen species (ROS) are formed in these processes to interact and contribute directly toward the oxidation of target contaminant(s), a profound insight regarding the mechanisms of ROS leading to the degradation of pharmaceuticals is fundamentally significant. The conceptualization of some specific reaction mechanisms allows the design of an effective and safe degradation process that can empirically reduce the environmental impact of the micropollutants. This review mainly deliberates the mechanistic reaction pathways for ROS-mediated degradation of pharmaceuticals often leading to complete mineralization, with a focus on acetaminophen as a drug waste model.

Metagenomics reveals the resistance patterns of electrochemically treated erythromycin fermentation residue.

Erythromycin fermentation residue (EFR) represents a typical hazardous waste produced by the microbial pharmaceutical industry. Although electrolysis is promising for EFR disposal, its microbial threats remain unclear. Herein, metagenomics was coupled with the random forest technique to decipher the antibiotic resistance patterns of electrochemically treated EFR. Results showed that 95.75% of erythromycin could be removed in 2 hr. Electrolysis temporarily influenced EFR microbiota, where the relative abundances of Proteobacteria and Actinobacteria increased, while those of Fusobacteria, Firmicutes, and Bacteroidetes decreased. A total of 505 antibiotic resistance gene (ARG) subtypes encoding resistance to 21 antibiotic types and 150 mobile genetic elements (MGEs), mainly including plasmid (72) and transposase (52) were assembled in EFR. Significant linear regression models were identified among microbial richness, ARG subtypes, and MGE numbers (r2=0.50-0.81, p< 0.001). Physicochemical factors of EFR (Total nitrogen, total organic carbon, protein, and humus) regulated ARG and MGE assembly (%IncMSE value = 5.14-14.85). The core ARG, MGE, and microbe sets (93.08%-99.85%) successfully explained 89.71%-92.92% of total ARG and MGE abundances. Specifically, gene aph(3')-I, transposase tnpA, and Mycolicibacterium were the primary drivers of the resistance dissemination system. This study also proposes efficient resistance mitigation measures, and provides recommendations for future management of antibiotic fermentation residue.

A perspectiva do consumo de plantas medicinais porpacientes idosos em tratamento quimioterápico / The perspective of the consumption of medicinal plants byelderly patients undergoing chemotherapy treatment

O câncer, frequentemente relacionado ao envelhecimento, impulsiona pacientes a buscarem tratamento hospitalar ou métodos alternativos, como plantas medicinais. Este estudo visou avaliar os perfis sociodemográfico e clínico e o consumo de plantas para fins medicinais entre pacientes idosos em tratamento oncológico no Hospital Araújo Jorge (HAJ). Dados de 55 pacientes foram analisados, abrangendo informações sociodemográficas, tipos de câncer, tratamento, a utilização de plantas medicinais, o objetivo de uso, as fontes de informações sobre plantas e se notaram alguma reação adversa após o consumo. A faixa etária mais encontrada foi 61 a 70 anos (67,27%), a maioria dos pacientes eram homens (63,64%), com ensino fundamental incompleto (32,73%), casados (56,36%) e que moram no interior de Goiás (43,64%). Quanto ao tratamento, a maioria realizava quimioterapia (40,00%) e o câncer gástrico foi mais relatado (14,54%). Sobre o uso de plantas medicinais, a maioria relatou simpatizar com o consumo (58,18%), e acredita em sua segurança devido à origem natural (59,37%). Informações sobre o uso de plantas medicinais eram obtidas com amigos, vizinhos e familiares (21,81%). Ao relatar sobre o consumo de plantas medicinais durante a quimioterapia, a maioria não percebeu nenhum efeito (40,63%). Foram citadas 17 plantas, que eram utilizadas no tratamento anticâncer (29,00%) e preparadas como infusões (18,75%) pelo uso das folhas frescas (60,00%), principalmente para uso interno (46,87%). Diante disso, a atenção farmacêutica se mostra vital para guiar pacientes nas práticas seguras e eficazes de consumo. Isso inclui direcionar sobre doses adequadas, efeitos colaterais e interações, garantindo bem-estar e prevenindo riscos à saúde.

Cancer, which is often related to ageing, drives patients to seek hospital treatment or alternative methods such as medicinal plants. This study aimed to evaluate the sociodemographic and clinical profile and the consumption of plants for medicinal purposes among elderly patients undergoing cancer treatment at the Araújo Jorge Hospital (AJH). Data from 55 patients was analyzed, covering sociodemographic information, types of cancer, treatment, the use of medicinal plants, the purpose of use, the source of information about plants and whether they noticed any adverse reactions after consumption. The most common age group was 61 to 70 years (67.27%), the majority of patients were men (63.64%), had incomplete primary education (32.73%), were married (56.36%) and lived in the interior of Goiás (43.63%). With regard to treatment, the majority were undergoing chemotherapy (40,00%) and gastric cancer was the most frequently reported (14.54%). With regard to the use of medicinal plants, the majority were sympathetic to their consumption (58.18%) and believed them to be safe due to their natural origin (59.37%). Information on the use of medicinal plants was obtained from friends, neighbors and family members (21.81%). When reporting on the consumption of medicinal plants during chemotherapy, the majority did not notice any effect (40.63%). Seventeen plants were mentioned, which were used for anticancer treatment (29,00%) and prepared as infusions (18.75%) with fresh leaves (60,00%), mainly for internal use (46.87%). In view of this, pharmaceutical care is vital to guide patients in safe and effective consumption practices. This includes guidance on appropriate doses, side effects and interactions, ensuring well-being and preventing health risks.

Towards a comprehensive COVID-19 non-pharmaceutical interventions' index for the province of Québec.

OBJECTIVES: The primary objective of this project was to develop a comprehensive COVID-19 non-pharmaceutical interventions' index for the province of Québec (QCnPI-Index). The resulting database systematically categorizes, multiple non-pharmaceutical interventions implemented in the 17 administrative regions (AR) of the province of Québec to mitigate the spread of COVID-19 in the form of an index. DATA DESCRIPTION: Data represent interventions and groups of interventions implemented during the COVID-19 period in Québec. They are a compilation of policies, guidelines, and governmental interventions related to COVID-19, considering temporal and geographical dimensions. Data were collected for all 17 AR of Québec using dates as unit of analysis, from March 2020 to April 2022. They were first collected and then coded by an interdisciplinary research team to form the foundation of the QCnPI-Index. CONTRIBUTION: This quantitative instrument offers the necessary granularity for nuanced spatial and temporal studies within the province of Québec, using AR, for instance, as unit of analysis. With this database, pre-, during-, and post-COVID periods can thus be better analyzed. Additionally, the innovative methodologies employed for data collection, coding, and weighting offer valuable insights that may have broader applications in public health, epidemiology, and other research domains. The QCnPI-Index could be instrumental for public health, epidemiology, and transportation researchers investigating the multifaceted impacts of non-pharmaceutical interventions on various societal domains, such as road safety, alcohol and cannabis consumption, and/or mental health, in the province of Québec.

Assessing the effects of interprofessional education by hospital pharmacists on pharmaceutical students using a self-evaluation scale.

BACKGROUND: Understanding the roles and competencies of professions outside of one's specialty is essential for providing efficient healthcare. However, it is difficult for medical professionals to understand the roles and competencies of other related professions while performing their duties. This study examined the impact of clinical practice-based interprofessional education (IPE) on pharmacy students, who are future medical professionals. METHODS: Sixty-eight pharmaceutical students undergoing clinical practice were divided into non-IPE or IPE groups, with the IPE group attending an educational program with medical students conducted by doctors, pharmacists, and teachers during the clinical practice period. The effect was evaluated through a group survey using self-administered questionnaires focusing on contributing to multidisciplinary team medicine based on the Readiness for Interprofessional Learning Scale. The survey included specific behavioral objectives (SBOs), the Readiness for Interpersonal Learning Scale (RIPLS), and Kikuchi's Scale of Social Skills (KiSS-18). RESULTS: Regardless of group, SBOs [non-IPE: 3.2, 95% CI (2.6-3.8), p < 0.001; IPE: 3.7, 95% CI (2.5-4.9), p < 0.001] and social skills [non-IPE: 4.0, 95% CI (2.5-6.1), p < 0.001; IPE: 6.7 95% CI (3.0-10.4), p < 0.001] showed improvement after the clinical practice. In RIPLS Factor 3, pharmacy students with IPE awareness scored significantly higher by 1.5 points [95% CI (0.2-2.8), p = 0.025] post-practice than those without IPE awareness. CONCLUSIONS: This study suggests that IPE for students during clinical practice could enhance their expertise in multidisciplinary medicine and facilitate the development of seamless team care in the future. TRIAL REGISTRATION: This study was retrospectively registered and conducted in compliance with the "Ethical Guidelines for Medical Research Involving Human Subjects" and was approved by The Ethics Committee of Tokushima University Hospital (approval number: 3544).

Medical and pharmaceutical activities in occupied territories: legal assessment and Ukraine's experience.

International armed conflicts often involve the occupation of territories of the state under aggression, where some of the population begins to voluntarily cooperate with the enemy. Currently, under the legislation of certain EU countries, such actions may be deemed collaboration or treason. This article examines the scenarios faced by medical or pharmaceutical workers in occupied territories, using the example of Ukraine, which is currently experiencing armed aggression from the Russian Federation. Despite the declared norms of International Humanitarian Law (IHL), medical and pharmaceutical workers find themselves in quite difficult situations. They have taken an oath and have obligations under the Geneva Conventions and Additional Protocols, and thus are required to continue performing their professional duties during the occupation and are de jure granted medical neutrality. However, they also face limited resources, pressure, and, in some cases, their duties may involve illegal actions that could lead to legal responsibility. The study identifies when medical and pharmaceutical activities are lawful during occupation and when they may constitute unlawful behaviour that results in legal accountability. The authors conclude that the current policies of Russia and its occupation authorities deliberately violate IHL norms. Furthermore, they intentionally create conditions where individuals in occupied territories commit actions that will be recognized as crimes. It is based on dialectical, analytic, synthetic, comprehensive methods, and also uses the case-method and the method of content analysis.

Public sector replacement of privately funded pharmaceutical R&D: cost and efficiency considerations.

AIMS: Economic studies have found that public support of basic medical research provides important long-term benefits. In response to suggestions that private pharmaceutical research and development (R&D) funding could be totally replaced by public funding, we investigate the economic implications of such a substitution in funding roles that maintain the recent pace of pharmaceutical innovation. MATERIALS AND METHODS: Total lifecycle R&D costs were estimated using the latest available R&D expenditures per novel molecule entering clinical trials, likelihood of approval, pre-clinical and post-approval expenditures, using a published survey and a review of publicly available financial accounts from US-listed multinational developers. This estimate was then stratified by the average number of annual FDA approvals to estimate total costs of R&D funding born by the private sector. RESULTS: We find total lifecycle R&D costs were US$2.83 billion per approved medicine. Estimated uncapitalized costs to replace private R&D funding for one year of FDA approvals were $139.6 billion. These additional costs are equivalent to 302% of the entire National Institute for Health 2022 budget of $46.2 billion, and around 25 times NIH's estimated annual $5.6 billion currently dedicated to clinical research trials for pharmaceuticals. Further assessing the policy proposition through a literature review, we found little evidence for improvements in economic efficiency via public funding substitution, while there may be additional challenges including asymmetric information, adverse selection, yardstick competition, hold-up, under-rewarding of incremental innovation and political rent-seeking. LIMITATIONS: Our calculations may undervalue full replacement costs, by excluding non-R&D expenses for manufacturing, distribution, or financing. CONCLUSIONS: The bulk of investment in R&D is underwritten by the private sector. Political discourse portraying the NIH as the central force in bringing a new drug to market may underappreciate the pivotal role of private at-risk capital. Replacing such investment while maintaining the current innovation output in terms of approved therapies would necessitate substantial increases in taxpayer financing.

Ampullaviruses: From Extreme Environments to Biotechnological Innovation.

Ampullaviruses are unique among viruses. They live in extreme environments and have special bottle-shaped architecture. These features make them useful tools for biotechnology. These viruses have compact genomes. They encode a range of enzymes and proteins. Their natural environment highlights their suitability for industrial applications. Ongoing research explores ways in which these viruses can improve enzyme stability. They are also employed in the creation of new biosensors and the development of new bioremediation techniques. High coinfection rates and the ecology of ampullaviruses at larger scales can also reveal new viral vectors. They can also help improve phage therapy. Here, we have explored the structure and function of ampullaviruses. We have focused on their use in biotechnology. We have also identified their characteristics that could prove to be useful. We have also pointed out key knowledge gaps and bridging them could further extend the biotechnological uses.

Radio frequency identification technology; A method of analysis of falsified pharmaceutical products: Literature review.

Quality has been a concern of the World Health Organization since its inception and is defined as fitness for use. Since our ancestors began trading several millennia ago, Falsified Pharmaceutical Products has been a recurring problem and still threatens economic stability and public health. Its definition various from country to country and according to World Health Organization, 2017, it is 'a product that is deliberately and fraudulently mislabelled with respect to identity and/or source'. The implementation of anti-falsified nanomaterial technologies is the prominent preventive measure to track and/or detect Falsified Pharmaceutical Products. Software and hardware companies had made encouraging progress towards implementing Radio Frequency Identification devices for ensuring the authenticity of pharmaceutical products. The purpose of the review was to critically appraise Radio Frequency Identification devices technology for the purpose of track and trace Falsified Pharmaceutical Products circulating in the market. Different search engines such as Google Scholar, Science Direct and PubMed were applied and mesh terms and keywords were searched. Different guides and related books were investigated in addition to the articles. Radio Frequency Identification devices technology is a compact electronic device that contains a small chip and reader with antenna that enables wireless transmission of identity of pharmaceutical products. The authenticated Radio Frequency Identification devices model is used for pharmaceutical products' authentication from origin of pharmaceutical industry to the pharmacy at any point along the chain of the distribution. Popular pharmaceutical products, such as OxyContin and Sildenafil Citrate, which are particular targets of falsification have mandated the use of Radio Frequency Identification devices technology.

Crystal structures and properties of derivatives of the alkaloid matrine: salts and hydrate forms.

We report the crystal structures of three matrine derivatives, namely, the salts (1R,2R,9S,17S)-6-oxo-7,13-diazatetracyclo[7.7.1.02,7.013,17]heptadecan-13-ium (2E)-3-(3,4-dihydroxyphenyl)prop-2-enoate (matrine caffeinate) sesquihydrate, C15H25N2O+·C9H7O4-·1.5H2O (Matrine-CA), and the 2-hydroxybenzoate (salicylate) monohydrate, C15H25N2O+·C7H5O3-·H2O (Matrine-SA), as well as the 1.75-hydrate form, (1R,2R,9S,17S)-7,13-diazatetracyclo[7.7.1.02,7.013,17]heptadecan-6-one 1.75-hydrate, C15H24N2O·1.75H2O (Matrine-H). Each derivative exhibited a consistent molecular conformation for the matrine core, which is notably distinct from that of the anhydrous form. Notably, both salts crystallized in the orthorhombic space group P212121, with an asymmetric unit featuring one cation and one anion. Within the two salt structures, intermolecular proton transfer between matrine and the acid is observed, culminating in the formation of a matrine cation protonated at the tertiary amine N site. The Matrine-CA crystal packing is manifested as a three-dimensional (3D) network arising from one-dimensional (1D) supramolecular helical chains, stabilized by N-H...O and O-H...O hydrogen bonds. In the case of Matrine-SA, the matrine cation is interconnected via hydrogen bonds with salicylate anions and water molecules, also forming a 1D helical motif. The structure of the hydrate form, Matrine-H, is reported again with the disordered solvent molecules accurately located. To further elucidate the structural attributes, Hirshfeld surface analysis and fingerprint plots are employed, offering a nuanced perspective on the intermolecular contacts and interactions within these crystalline forms.

Availability and financing of CAR-T cell therapies: A cross-country comparative analysis.

Chimeric antigen receptor T-cell therapies (CAR-T therapies) are a type of advanced therapy medicinal product (ATMP) that belong to a new generation of personalised cancer immunotherapies. This paper compares the approval, availability and financing of CAR-T cell therapies in ten countries. It also examines the implementation of this type of ATMP within the health care system, describing the organizational elements of CAR-T therapy delivery and the challenges of ensuring equitable access to all those in need, taking a more systems-oriented view. It finds that the availability of CAR-T therapies varies across countries, reflecting the heterogeneity in the organization and financing of specialised care, particularly oncology care. Countries have been cautious in designing reimbursement models for CAR-T cell therapies, establishing limited managed entry arrangements under public payers, either based on outcomes or as an evidence development scheme to allow for the study of real-world therapeutic efficacy. The delivery model of CAR-T therapies is concentrated around existing experienced cancer centres and highlights the need for high networking and referral capacity. Some countries have transparent and systematic eligibility criteria to help ensure more equitable access to therapies. Overall, as with other pharmaceuticals, there is limited transparency in pricing, eligibility criteria and budgeting decisions in this therapeutic area.

Transformation products of diclofenac: Formation, occurrence, and toxicity implication in the aquatic environment.

Diclofenac (DCF) is the first drug on the EU Watch List of Priority Substances due to its extensive uses, incomplete removal in wastewater treatment plants (WWTPs), and toxic effects. Once in the environment, DCF undergoes processes that yield various transformation products (TPs) or metabolites, whichcan be more toxic than DCF. While these TPs or metabolites often dominate the majority of the drug load in municipal wastewater, they have been largely ignored. This review critically examines recent data on the formation, occurrence, fate, and toxicology of DCF TPs in the aquatic environment. This review reveals some important findings. First, DCF TPs may constitute >57 % of DCF in wastewater influent, ∼60 % in effluent, and ∼30 % in surface waters. Second, TPs persistently retain the core structure of DCF and may pose greater environmental risks than the parent drug. Third, some metabolites may revert back to the parent drug. Fourth, WWTPs serve as a consistent source that release DCF and its by-products into the environment. Fifth, mixtures of DCF and its metabolites, along with other contaminants, may pose elevated and synergistic environmental risks than individual compounds. These findings suggest that current risk assessment practices, which ignore the impacts of the metabolites and the chemical interactions/synergies, may seriously underestimate the overall toxicity of DCF and likely other pharmaceuticals. Further studies are needed to monitor the long-term fate and toxicity of the metabolites, as well as new analytical methods and standards to unveil the hidden metabolites and the associated environmental risks.

Effects of long-term fluoxetine exposure on morphology, but not behaviour or metabolic rate, in male guppies (Poecilia reticulata).

Contamination of aquatic ecosystems by pharmaceuticals is a growing threat worldwide. The antidepressant fluoxetine is one such pharmaceutical that is frequently detected in aquatic ecosystems, and has been found to alter the behaviour and physiology of exposed wildlife. Few studies, however, have investigated potential combined effects on behaviour and metabolic rate. In addition, exposures are often short in duration and rarely conducted under ecologically relevant conditions. Here, we examined the impacts of long-term fluoxetine exposure on boldness (exploration, activity, and antipredator behaviour), metabolic rate, and morphology in male guppies (Poecilia reticulata). Specifically, fish were exposed for 8 months (corresponding to approximately two overlapping generations) in semi-natural mesocosms to one of three treatments: an unexposed control (0 ng L-1), or low or high fluoxetine (mean measured concentrations: 30 ng L-1 and 292 ng L-1, respectively). Following exposure, we quantified male exploratory behaviour and activity in a novel environment (maze arena) and antipredator behaviour in the presence or absence of a live predator (spangled perch, Leiopotherapon unicolor), as well as metabolic rate and morphology (mass, standard length, and scaled mass index). Fluoxetine exposure did not significantly alter boldness, metabolic rate, mass, or standard length. However, fluoxetine exposure did alter body condition, whereby fish in the high treatment had a higher scaled mass index than control fish. Our results, considered alongside previous work, underscore the importance of exposure duration in mediating the effects of fluoxetine on fitness-related traits. Continued research under extended exposure periods (i.e., spanning multiple generations) is essential if we are to accurately predict the ecological impacts of fluoxetine on exposed wildlife, and their underlying mechanism(s).

Characteristics and functional bacteria of an efficient benzocaine-mineralizing bacterial consortium.

The extensive use of pharmaceutical and personal care products (PPCPs) has led to widespread residual pollution, which increases the risk of the development of drug resistance in pathogenic microorganisms. Benzocaine is a PPCP that is widely used medical anesthesia and in sunscreen. Microorganisms are essential for the degradation of residual PPCPs. However, no studies have reported the microbial degradation of benzocaine. In this study, through continuous enrichment of the initial consortium HJ1, the highly efficient benzocaine-degrading consortium HJ7 was obtained, HJ7 exhibited a degradation rate that was 1.92 times greater than that of HJ1. Methyl 4-aminobenzoate and 4-aminobenzoic acid were identified as major intermediate products during benzocaine biodegradation by consortium HJ1 or HJ7. Methylobacillus (57.8 % ± 0.9 %) and Pseudomonas (22.1 % ± 0.7 %), which are thought to harbor essential species for benzocaine degradation, were significantly enriched in consortium HJ7. Two benzocaine-degrading strains, Pseudomonas sp. A8 and Microbacterium sp. A741, and one methyl 4-aminobenzoate-degrading strain, Achromobacter sp. A5, were isolated from consortium HJ7, and they synergistically mineralized benzocaine. These findings not only provide new insights into the biotransformation of benzocaine but also provide strain resources for the bioremediation of residual benzocaine in the environment.

Pharmacoeconomic and clinical impact of pharmaceutical service in the intensive care unit: a systematic review.

Clinical pharmacy is a fast-growing discipline in Europe, ensuring optimisation and a guarantee of safety in therapeutic management. Within a hospital the intensive care unit (ICU) typically admits the most severely ill patients who require expensive medications. These patients may be at risk for potentially serious adverse events, especially when medication errors occur. This study aims to evaluate the pharmacoeconomic and clinical impact of pharmaceutical care and service within ICUs. A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology was conducted to identify pharmacoeconomic studies published from 2017 to 2021 in Pubmed, Web of Science, and Science Direct. A qualitative methodological assessment of the studies was made using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) grid. Among the 525 articles identified from the databases, 11 were selected. Clinical benefits were mostly measured in terms of a reduction in the risk of adverse events related to care and reductions in the duration of mechanical ventilation and in-ICU and in-hospital length-of-stays. No impact on the mortality rate was demonstrated. All studies reported cost-benefit ratios ranging from €2.48 to €24.20 per €1 invested. The avoided costs per patient ranged from €29.73 to €194.24 per day of hospitalisation. The mean CHEERS compliance score was 63%±17%, demonstrating the heterogeneous quality of these analyses. International pharmacoeconomic evaluations on the impact of the clinical pharmacist operating in the ICU revealed both economic and clinical benefits for the patient. Larger randomised studies are required to confirm the major role of the pharmacist in the ICU.

A novel, scenario-based approach to comparing non-pharmaceutical intervention strategies across nations.

Comparing COVID-19 response strategies across nations is a key step in preparing for future pandemics. Conventional comparisons, which rank individual non-pharmaceutical intervention (NPI) effects, are limited by: (i) a focus on epidemiological outcomes; (ii) NPIs typically being applied as packages of interventions; and (iii) different political, economic and social conditions among nations. Here, we develop a coupled epidemiological-behavioural-macroeconomic model that can transfer NPI effects from a reference nation to a focal nation. This approach quantifies epidemiological, behavioural and economic outcomes while accounting for both packaged NPIs and differing conditions among nations. As a first proof of concept, we take Germany as our focal nation during Spring 2020, and New Zealand and Switzerland as reference nations with contrasting NPI strategies. Our results suggest that, while New Zealand's more aggressive strategy would have yielded modest epidemiological gains in Germany, it would have resulted in substantially higher economic costs while dramatically reducing social contacts. In contrast, Switzerland's more lenient strategy would have prolonged the first wave in Germany, but would also have increased relative costs. More generally, these findings indicate that our approach can provide novel, multifaceted insights on the efficacy of pandemic response strategies, and therefore merits further exploration and development.

Proposal for a new study design and endpoint in research on medication history taking.

Introduction: Medication history errors at hospital admission are common and effective strategies to improve the quality of medication histories are still being researched. However, studies on new approaches regarding medication history taking are often time-consuming and resource-intensive. The gold standard when evaluating the quality of medication histories is the comparison of a Best Possible Medication History to the original. However, this double collection requires significant resources, disrupts clinical procedures, and places an additional burden on patients. Therefore, more efficient study designs need to be explored. We aimed to develop a design for future studies on medication history taking that uses fewer research resources and places less strain on patients and staff. Discussion: We first identified shortcomings of the established study designs on medication history taking and subsequently defined requirements for a new design. A pragmatic study with an alternative endpoint was identified in a previous literature search. It served as the starting point from which we developed a new study design to assess the quality of approaches to medication history taking. Instead of taking a second medication history, a patient's pre-existing medication document can be used as comparator to determine the quality of the medication history. Furthermore, we defined a new primary endpoint, i.e. the number of updates per patient. Updates are differences between the newly acquired medication history and the comparator. They include discontinued, initiated, and changed medications. To enhance our proposed design, we recommend a preparatory phase to identify a suitable comparator document, and a baseline phase to assess the current process. Conclusion: We propose a more resource-efficient study design with a new endpoint. We plan to test its feasibility and evaluate whether it could enhance the efficacy of research on medication history taking in a pilot project.

Contaminant mass discharge estimation of a sulfonamide plume by use of hydraulic profiling tool (HPT) and fluorescence techniques.

The contaminant mass discharge is a relevant metric to evaluate the risk that a groundwater plume poses to water resources. However, this assessment is often vitiated by a high uncertainty inherent to the assessment method and often limited number of measurement points to carry out the assessment. Direct-Push techniques in combination with profiling tools and dedicated sampling can be an interesting alternative to increase the measurement point density and hence reduce the mass discharge uncertainty. The main objective of our study was to assess if DP logging and sampling could be employed to get a reasonable estimate of contaminant mass discharge in a large sulfonamide contaminant plume (> 1500 m wide), compared to a more traditional approach based on monitoring wells. To do so, an Hydraulic Profiling Tool (HPT) logging with a dedicated site calibration was used to estimate the hydraulic conductivity field. The sulfonamide concentrations were inferred from the compound fluorescence properties measured by laboratory spectrofluorometry (λEx / λEm = 255/340 nm) and a dedicated log-log linear regression model. Our results show that HPT-derived hydraulic conductivity values are in good agreement with the monitoring well results, and within the order of magnitude reported in similar studies or indirect geophysical techniques. Fluorescence appears as a powerful proxy for the sulfonamide concentration levels. Ultimately, the contaminant mass discharge estimate from HPT and fluorescence techniques lies within a factor 2 from the estimate by monitoring wells, with 549 [274-668] and 776 [695-879] kg/yr respectively. Overall, this study highlights that DP logging tools combined with indirect methods (correlation with fluorescence) could provide a relevant contaminant mass discharge estimate for some optically active substances, given that a proper calibration phase is carried out.

Revolutionizing Ophthalmic Care: A Review of Ocular Hydrogels from Pathologies to Therapeutic Applications.

PURPOSE: This comprehensive review is designed to elucidate the transformative role and multifaceted applications of ocular hydrogels in contemporary ophthalmic therapeutic strategies, with a particular emphasis on their capability to revolutionize drug delivery mechanisms and optimize patient outcomes. METHODS: A systematic and structured methodology is employed, initiating with a succinct exploration of prevalent ocular pathologies and delineating the corresponding therapeutic agents. This serves as a precursor for an extensive examination of the diverse methodologies and fabrication techniques integral to the design, development, and application of hydrogels specifically tailored for ophthalmic pharmaceutical delivery. The review further scrutinizes the pivotal manufacturing processes that significantly influence hydrogel efficacy and delves into an analysis of the current spectrum of hydrogel-centric ocular formulations. RESULTS: The review yields illuminating insights into the escalating prominence of ocular hydrogels within the medical community, substantiated by a plethora of ongoing clinical investigations. It reveals the dynamic and perpetually evolving nature of hydrogel research and underscores the extensive applicability and intricate progression of transposing biologics-loaded hydrogels from theoretical frameworks to practical clinical applications. CONCLUSIONS: This review accentuates the immense potential and promising future of ocular hydrogels in the realm of ophthalmic care. It not only serves as a comprehensive guide but also as a catalyst for recognizing the transformative potential of hydrogels in augmenting drug delivery mechanisms and enhancing patient outcomes. Furthermore, it draws attention to the inherent challenges and considerations that necessitate careful navigation by researchers and clinicians in this progressive field.