Optimisation of medication reconciliation using queueing theory: a computer experiment.

BACKGROUND: Medication reconciliation (MedRec) in hospitals is an important tool to enhance the continuity of care, but completing MedRec is challenging. AIM: The aim of this study was to investigate whether queueing theory could be used to compare various interventions to optimise the MedRec process to ultimately reduce the number of patients discharged prior to MedRec being completed. Queueing theory, the mathematical study of waiting lines or queues, has not been previously applied in hospital pharmacies but enables comparisons without interfering with the baseline workflow. METHOD: Possible interventions to enhance the MedRec process (replacing in-person conversations with telephone conversations, reallocating pharmacy technicians (PTs) or adjusting their working schedule) were compared in a computer experiment. The primary outcome was the percentage of patients with an incomplete discharge MedRec. Due to the COVID-19 pandemic, it was possible to add a real-life post hoc intervention (PTs starting their shift later) to the theoretical interventions. Descriptive analysis was performed. RESULTS: The queueing model showed that the number of patients with an incomplete discharge MedRec decreased from 37.2% in the original scenario to approximately 16% when the PTs started their shift 2 h earlier and 1 PT was reassigned to prepare the discharge MedRec. The number increased with the real-life post hoc intervention (PTs starting later), which matches a decrease in the computer experiment when started earlier. CONCLUSION: Using queueing theory in a computer experiment could identify the most promising theoretical intervention to decrease the percentage of patients discharged prior to MedRec being completed.

Relationships of quality indices with wooden breast myopathy severity in chicken breast meat under refrigerated storage.

1. This study investigated the relationships of quality indices with the severity of wooden breast (WB) myopathy in chicken breast meat under refrigerated storage. The physicochemical properties, water-holding capacity (WHC), microbial quality and fatty acid profiles of normal chicken breast meat samples (NOR samples, n = 63), moderate WB (MWB, n = 63) myopathy and severe WB (SWB, n = 63) myopathy (MWB and SWB samples, respectively) were evaluated immediately after sampling and after 4 and 8 d of refrigerated storage at 4°C.2. Total collagen, fat, saturated and monounsaturated fatty acid contents, redness and pH of the SWB and MWB samples were higher than the NOR samples. The SWB samples that were stored for 8 d had poor WHC, total viable counts (TVC) of higher than 7.0log colony-forming units, total volatile basic nitrogen (TVB-N) content of greater than 15 mg/100 g and a thiobarbituric acid - reactive substance level of higher than 1 mg/kg malondialdehyde.3. No significant difference was observed in the TVB-N content and TVC of the MWB and NOR samples during storage. Polyunsaturated fatty acid content was lower in the SWB and MWB samples than in the NOR samples. The SWB samples were tougher than the MWB and NOR samples after 8 d of refrigeration.4. In conclusion, the quality of chicken breast meat with SWB myopathy degraded considerably over time; thus, such meat should not be subjected to extended refrigeration for storage.

Large-Scale Surveys of Blackleg of Oilseed Rape (Leptosphaeria biglobosa) Revealed New Insights into Epidemics of This Disease in China.

Blackleg of oilseed rape caused by Leptosphaeria maculans/L. biglobosa is a worldwide important disease. L. maculans is more virulent than L. biglobosa, so it causes a great concern for oilseed rape production. In China, blackleg (L. biglobosa) of oilseed rape was reported in the 2000s, but epidemiological features of blackleg have not been well elucidated. Moreover, whether L. maculans exists in China is still an open question. Therefore, a 5-year survey was done in China to collect blackleg-occurrence data for characterizing the features of blackleg epidemics and to identify the blackleg pathogens for assessing the risk of L. maculans invasion. The results showed that all the 19 surveyed provinces had blackleg on oilseed rape, and the most frequently occurring provinces are Gansu, Qinghai, Shaanxi, and Hubei. Phoma stem canker was the most common symptom, which was associated with stem cracks on winter oilseed rape and with stem-weevil activities on spring oilseed rape. Temperature and rainfall were the main factors for blackleg epidemics on winter oilseed rape, whereas rainfall was the main factor for blackleg epidemics on spring oilseed rape. Brassica campestris and B. juncea oilseed rapes were more susceptible than B. napus to blackleg. Oilseed rapes cultivated under the continuous dry land-cropping pattern were more prone to blackleg than those cultivated under the paddy land/dry land-cropping pattern. All 6,015 fungal isolates from blackleg plant tissues belonged to L. biglobosa. These results are helpful for understanding the blackleg epidemics of oilseed rapes and for management of this disease in China.

An experimental study on the effect of preoperative autologous blood donation on bone marrow hematopoiesis and hematopoietic stem cells.

To evaluate the effect of autologous blood transfusion (ABT) on hematopoietic stem cells through the observation of the changes in the number and activity of bone marrow CD34+ cells after preoperative autologous blood donation (PABD). Rabbit bone marrow specimens were collected preoperatively (T2), 6 h postoperatively (T3), and 24 h postoperatively (T4). Next, the percentages of CD34+ cells, the cell cycle, and the relative expression of telomeric DNA were measured in each group of rabbits. Peripheral blood specimens were collected before PABD (T1) and at T4 to measure reticulocytes. At T3 and T4, the percentages of CD34+ cells and the expressions of telomeric DNA were significantly higher, and the percentages of cells in the G1 phase were significantly lower in each experimental group compared with those in the blank control group (group A) (P<0.05). Compared with the surgical blood collection group (group C), the CD34+ cells and the expressions of telomeric DNA were significantly higher, and the percentages of cells in the G1 phase were significantly lower in the preoperative autologous whole blood group (group D) and the preoperative autologous blood component group (group E) (P<0.05). Compared with group D, the CD34+ cells and the expressions of telomeric DNA were significantly lower, and the percentages of cells in the G1 phase were significantly higher in group E (P<0.05). At T4, the reticulocyte percentages in the surgery group (group B) and group C were significantly higher than in group E and group D, and the reticulocyte percentages in group E were higher than in group D (P<0.05). This study's findings indicated that ABT suppressed bone marrow hematopoiesis, while autologous blood component transfusion had less of an effect than that of whole blood transfusion. Therefore, PABD blood component transfusion would be superior to autologous whole blood transfusion.

Up-regulation of miR-190b promoted growth, invasion, migration and inhibited apoptosis of Wilms' tumor cells by repressing the PTEN expression.

OBJECTIVE: Wilms' tumor (WT) is the most common malignant tumor in the children's urogenital system. MiR-190b was found to participate in the development and progression of several cancers. However, the molecular mechanism of miR-190b in WT is still unclear. PATIENTS AND METHODS: We detected the miR-190b in WT tissue samples compared to adjacent normal samples as well as in WT patients' blood sample compared to normal volunteers using qRT-PCR. With over-expression and knockdown of miR-190b in WT-derived cell line SK-NEP-1, we next studied cell proliferation, cell circle, apoptosis, invasion and migration abilities change caused by miR-190b ectopic expression. Dual-luciferase assay and Western-blot analysis were used to explain the mechanism of miR-190b in WT. RESULTS: MiR-190b was over-expressed in WT tissue and blood samples compared to normal group, relatively. Up-regulation of miR-190b in SK-NEP-1 cells significantly increased the growth and decreased the apoptosis of cells, while its down-regulation reduced cell proliferation and promoted cell apoptosis of SK-NEP-1. Also, cell invasion and migration abilities were significantly improved after miR-190b over-expression. Moreover, PTEN was proved to be a direct target of miR-190b and its protein level was remarkably decreased after miR-190b up-regulation. CONCLUSIONS: miR-190b over-expressed in WT and promoted cell proliferation, invasion and migration while reduced cell apoptosis of WT cells by repressing PTEN repression, which might provide a potential target for WT diagnosis and therapy.

Botrytis pyriformis sp. nov., a novel and likely saprophytic species of Botrytis.

A novel species of Botrytis from Sedum sarmentosum was described based on morphology and analyses of DNA sequences of nuc rDNA ITS regions and three nuclear genes (G3PDH, HSP60, RPB2). Meanwhile pathogenicity in 32 plant species, response to temperature for growth and conidial germination for the species were determined. The Botrytis species was named Botrytis pyriformis sp. nov. It was characterized by formation of grayish mycelia, brownish conidia and melanized sclerotia on PDA. The conidia are pear-shaped, melanized and covered with abundant villiform appendages on the conidial surface. Comparison of the ITS sequences confirmed its placement in the genus Botrytis Phylogenetic analysis based on DNA sequences of G3PDH, HSP60 and RPB2 genes indicated that B. pyriformis and other 30 Botrytis species form a monophyletic clade, which was further divided into three subclades. Subclade I comprised B. pyriformis alone, whereas subclades II and III comprised six and 24 Botrytis species, respectively. Botrytis pyriformis could not infect 32 plant species including S. sarmentosum, possibly due to deficiency in formation of infection cushions. This study presents a formal description and illustrations for B. pyriformis and provides experimental evidence, indicating that B. pyriformis might be a saprophytic species.

First Report of Botrytis pseudocinerea Causing Gray Mold on Tomato (Lycopersicon esculentum) in Central China.

A tomato field in Qianjiang County, Hubei Province, China, was surveyed for gray mold in April 2013. Diseased leaves with V-shaped lesions along the margin and masses of grayish hyphae and conidia on the surface were collected from different plants. Eight Botrytis isolates were obtained from eight symptomatic leaves by plating the conidia from each leaf onto potato dextrose agar (PDA). A representative isolate (No. 116) was compared to two reference isolates, B. cinerea B05.10 (from Z. H. Ma, Zhejiang University, China) and B. pseudocinerea 10091 (from A. S. Walker, INRA, France) for morpho-cultural and molecular features. On PDA at 20°C, isolate 116 grew 13.8 mm/day (n = 9), which was similar to those of isolates 10091 (13.7 mm/day), and B05.10 (14.6 mm/day). The isolates all formed black sclerotia of similar shape and size (2 to 13 × 1 to 7 mm). To induce conidia production, the isolates each were inoculated onto tomato fruit (cv. Hezuo 903, Jiangsu Seed Co., China) using colonized agar plugs (each 6 mm in diameter), with four plugs per fruit and four fruits tested per isolate. After incubation of the fruit for 10 days (20°C), abundant conidia were produced on the fruit surface. The conidial size of isolate 116 (6.8 to 14.3 × 6.1 to 10.2 µm) was similar to that of isolates 10091 (7.7 to 12.2 × 7.0 to 9.8 µm) and B05.10 (7.0 to 14 × 6.6 to 10.5 µm). The three isolates were indistinguishable morphologically. The sequences of each of four nuclear genes (Bc-hch, G3PDH, HSP60, and MS547) and the microsatellite Bc6 locus (1,4) were determined and analyzed for each isolate. DNA was extracted from mycelium of each isolate and used as a template to amplify each gene by PCR using specific primers (1,2,4). Bc-hch-RFLP genotyping of the 1,171-bp amplicon (2,4) showed that isolates 116 and 10091 had a 601-bp DNA product, whereas B05.10 had a 517-bp product. The G3PDH, HSP60, and MS547 sequences of isolate 116 (GenBank Accession Nos. KJ534270, KJ534271, and KJ534273, respectively) and those of B. aclada, B. calthae, B. cinerea, B. pseudocinerea, and Sclerotinia sclerotiorum (3) were used for phylogenetic analysis. Isolate 116 and eight B. pseudocinerea isolates formed a subclade with 100% bootstrap support. Furthermore, two DNA markers, 86 bp for isolates 116 and 10091 vs. 170 bp for B05.10 were identified at the Bc6 locus. These results suggest that isolate 116 belongs to B. pseudocinerea (1,4). Pathogenicity of each isolate was tested by inoculation of each of five newly expanded tomato leaves on a 50-day-old plant (cv. Hezuo 903, Jiangsu Seed Co) with a 20-µl droplet of a conidial suspension (1 × 105 conidia/ml), using a pipette. Five noninoculated control leaves were treated similarly with water. The plants were all maintained at 20°C and 100% RH for 72 h, and lesion diameter was then measured. While control leaves remained asymptomatic, leaves inoculated with isolates 116, 10091, and B05.10 developed necrotic lesions averaging 19 to 20 mm in diameter. A fungus re-isolated from the lesions on isolate-116-inoculated leaves formed colonies with morphology identical to that of the original isolate 116. To our knowledge, this is the first report of B. pseudocinerea on tomato in China. The remaining seven isolates were identified as B. cinerea based on Bc-hch-RFLP genotyping (data not shown), suggesting that B. pseudocinerea may infect tomato plants at a low frequency in this region of China. References: (1) E. Fournier et al. Mol. Ecol. Notes 2:253, 2002. (2) E. Fournier et al. Mycologia 95:251, 2003. (3) P. R. Johnston et al. Plant Pathol. 63:888, 2014. (4) A. S. Walker et al. Phytopathology 101:1433, 2011.

A retrospective clinical study of bevacizumab combined with gemcibabine or paclitaxel in the treatment of recurrent ovarian cancer.

BACKGROUND: Bevacizumab, a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A, was described to be effective in the treatment of recurrent or platinum-resistance ovarian cancer. The present retrospective study was performed to further evaluate the clinical efficacy and toxicity of bevacizumab in the treatment of Chinese recurrent ovarian cancer patients who had been previously treated by platinum-based chemotherapy. MATERIALS AND METHODS: We reviewed the hospital database and finally included 26 recurrent ovarian cancer patients who were treated with bevacizumab combined with gemcibabine or paclitaxel or single agent. All included patients received >3 cycle of bevacizumab treatment. The tumor response, overall survival, and toxicities were documented. RESULTS: Under the treatment of bevacizumab combined with gemcibabine or paclitaxel, 2 complete response (7.7%), 8 partial response (30.8%), 7 stable disease (26.9%) and 9 progression disease (34.6%) was documented with the objective response rate of 38.5% and disease control rate of 65.4%. The median overall survival from the first application of bevacizumab was 15.3 months [Figure 1] for all of the 26 patients. The median overall survival time was 16.2 and 14.0 months for bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment schedule respectively. The overall survival was not different between bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment regimen hazard ratio = 0.80 (95% confidence interval: 0.32-2, P = 0.64). The hypertension and proteinuria were the major bevacizumab related toxicities. CONCLUSIONS: Bevacizumab combined with gemcibabine or paclitaxel was a promising treatment schedule for platinum-resistance recurrent ovarian cancer.

First Report of Pestalotiopsis microspora Causing Leaf Blight of Reineckea carnea in Central China.

Pink reineckia (Reineckea carnea (Andrews) Kunth) is an evergreen herbaceous perennial plant widely grown as groundcover or for medical purposes in southern China. In 2006 and 2007, severe leaf blight was observed on pink reineckia in Wuhan, China. On newly formed pink reineckia leaves, symptoms were first noted in early May as grayish to dark brown, oval or irregular-shaped lesions, 1.5 to 0.2 × 0.5 to 0.1 cm (n = 50), on the leaf margin or leaf tip. A yellowish halo surrounded each lesion. Lesions enlarged and coalesced and diseased leaves became blighted during the fall and winter. In severely infected plots, most plants became straw-colored and had to be replaced with healthy seedlings. A fungus was isolated from surface-disinfested lesions on potato dextrose agar (PDA) at a frequency of 85.7%. One of 30 isolates, designated C2, was characterized further. The fungus growing on PDA at 20°C for 14 days formed zonate white colonies and black acervular conidiomata. Conidia of the fungus aggregated on acervuli as droplets. Conidia were fusiform and 20.7 to 32.2 × 5.8 to 9.8 µm (n = 50). Each conidium had one hyaline apical cell, one hyaline basal cell, and three dark brown median cells. There were two to four hyaline filamentous appendages 8.1 to 20.4 µm long attached to each apical cell and one hyaline appendage 2.4 to 7.1 µm long attached to each basal cell. The cultural and morphological characteristics of isolate C2 matched the description for Pestalotiopsis microspora (Speg.) Batista & Peres (1,2). The internal transcribed spacer (ITS) region of the ribosomal DNA (ITS1-5.8S-ITS2) was PCR-amplified and sequenced. The ITS sequence (606 bp) for isolate C2 (GenBank Accession No. EU935587) was 100% similar to P. microspora isolates TA-57 (GenBank Accession No. AY924267) and LK32 (GenBank Accession No. DQ001002). Pathogenicity of isolate C2 was tested with the method described by Keith et al. (2). Four detached leaves were wound inoculated or inoculated without wounding with mycelia on agar plugs (4 mm in diameter; three plugs per leaf) or conidial suspensions (107 conidia per ml; 20 µl on each of three sites per leaf). Control leaves were wound inoculated with PDA or sterile water. All inoculated leaves were maintained in a moist enamel tray under fluorescent light for 7 days at 20°C. The test was performed twice. After 4 days of incubation, necrotic leaf lesions resembling symptoms that occurred in the field were observed on the wound-inoculated leaves, whereas the control leaves and C2-inoculated leaves without wounding remained healthy. Therefore, wounding was necessary for symptom development (2). A fungus was reisolated from the C2-induced leaf lesions and the morphology of colonies and conidia were identical to that for isolate C2 of P. microspora. On the basis of the results of isolations, inoculations, and fungal identification, P. microspora was determined to be the causal agent for leaf blight of pink reineckia occurring in Wuhan, China. This fungus previously has been reported as the causal agent of scab disease of Psidium guajava in Hawaii (2), decline of Torreya taxifolia in Florida (3), and leaf blight of Lindera obtusiloba in Korea (1). To our knowledge, this is the first report of the occurrence of P. microspora on R. carnea. References: (1) Y. H. Jeon et al. Plant Pathol. 56:349, 2007. (2) L. M. Keith et al. Plant Dis. 90:16, 2006. (3) M. W. Schwartz et al. Plant Dis. 80:600, 1996.

Hypovirulence and Double-Stranded RNA in Botrytis cinerea.

ABSTRACT Twenty-one strains of Botrytis cinerea isolated from 13 species of plants grown in China were compared for pathogenicity on Brassica napus, mycelial growth on potato dextrose agar, and presence of double-stranded (ds)RNA. The results showed that the strain CanBc-1 was severely debilitated in pathogenicity and mycelial growth, compared with the 20 virulent strains. A dsRNA of approximately 3.0 kb in length was detected in CanBc-1 and 4 hypovirulent single-conidium (SC) isolates of CanBc-1, but was not detected in the 20 virulent strains of B. cinerea and 4 virulent SC isolates of CanBc-1. Results of the horizontal transmission experiment showed that the hypovirulent trait of CanBc-1 was transmissible and the 3.0-kb dsRNA was involved in the transmission of hypovirulence. Analysis of a 920-bp cDNA sequence generated from the 3.0-kb dsRNA of CanBc-1 indicated that the dsRNA element was a mycovirus, designated as B. cinerea debilitation-related virus (BcDRV). Further analyses showed that BcDRV is closely related to Ophiostoma mitovirus 3b infecting O. novo-ulmi, the causal agent of Dutch elm disease. Mitochondria and cytoplasm in hyphal cells of CanBc-1 became degenerated, compared with the virulent isolate CanBc-1c-66 of B cinerea. This is the first report on the occurrence of Mitovirus-associated hypovirulence in B. cinerea.

Schizanrins [corrected] B, C, D, and E, four new lignans from Kadsura matsudai and their antihepatitis activities.

Bioassay-directed fractionation of ethanolic extract of Kadsura matsudai Hayata has resulted in the isolation of four novel C(18) dibenzocyclooctadiene lignans, schizanrin B (1), schizanrin C (2), schizanrin D (3), and schizanrin E (4). Schizanrin B (1) showed moderate to strong activity for antihepatitis in both anti-HBsAg and anti-HBeAg assays, and 3 and 4 also were active in the latter assay [corrected]. Compounds 1--4 were inactive in vitro against HIV replication in H9 lymphocytes. All new structures were elucidated using spectral analysis. Their structural elucidation by spectral and structure--activity relationships is also discussed.

Comments on "Constraining the optimization of a fuzzy logic controller".

Genetic algorithms (GAs) are a highly effective and efficient means of solving optimization problems. Gene encoding, fitness landscape and genetic operations are vital to successfully developing a GA. F. Cheong and R. Lai (see ibid., vol. 30, p. 31-46 (2000)) described a novel method, which employed an enhanced genetic algorithm with multiple populations, to optimize a fuzzy controller, and the experimental results revealed that their method was effective in producing a well-formed fuzzy rule-base. However, their encoding method and fitness function appear unnatural and inefficient. This study proposes an alternative method of concise genetic encoding and fitness design.

A novel anti-HBeAg homolignan, taiwanschirin D from Kadsura matsudai.

A novel C19 homolignan, taiwanschirin D (1), possessing a 3,4-(1-[(Z)-2-methoxy-2-oxoethylidenel)pentano (2,3-dihydrobenzo[b]furan)-3(2-oxoacetate) skeleton, was isolated from the stem of Kadsura matsudai Hayata. Its structure was determined from physical and spectral data including 2D NMR spectra. The Anti-HBeAg test revealed that taiwanschirin D (1) had moderate activity at a concentration of 94.3 microM (50 microg/ml).

A new anti-HBeAg lignan, kadsumarin A, from Kadsura matsudai and Schizandra arisanensis.

A new C18 dibenzocyclooctadiene lignan, kadsumarin A (1) was isolated from Kadsura matsudai Hayata and Schizandra arisanensis Hayata. The anti-HBeAg test revealed that kadsumarin A had activity at a concentration of 40 micrograms/ml (= 90.1 microM). Its structural elucidation by spectral analysis was discussed in this note.

Effect of aging on the expression of iNOS and cell death in the mouse cochlear spiral ganglion.

The age-related induction of inducible nitric synthase (iNOS) and apoptotic cell death in spiral ganglion cells (SGCs) of ddy strain mice were studied with immunohistochemical method and TdT-mediated dUTP-biotin nick end labeling (TUNEL), respectively. A large amount of iNOS was expressed in SGCs of 18- to 24-month-old mice, but not in those of the mice less than 12 months of age. Moreover, these mice were accompanied by a great rise in auditory brainstem response threshold as well as a great decrease in the number of SGCs that seemed to be due to preceding cell death of the cells. However, we were unable to find apoptotic TUNEL-positive cells in the spiral ganglions. This was assumed to be due to a very short clearance time of the dead cell bodies of less than one hour. As has been known, NO produced by iNOS can implicate in causes for either protection of cells from peroxidation and cell death. In the present study, therefore, the steep augmentation of iNOS in the SGCs of senescent mice implies that the iNOS initially induced to protect SGCs from the cytotoxicity of cellular peroxidation eventually contribute to the cell death of SGCs themselves.

Floating fetal head in primiparas at term.

A total of 924 pelvimetries made for floating fetal head at term in primiparas was analyzed according to the pelvic parameters and outcomes. More android and platypelloid type pelves, and more OP position and Naegele's obliquities were found. Significant shortening of obstetrical conjugate. A-P diameter of actual inlet and reduced Mengert area of the inlet were the common characteristics in this series. One third of the patients required abdominal delivery, and half of the vaginal deliveries needed instrumental help.