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1.
Sensors (Basel) ; 24(3)2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38339582

RESUMO

Mobile cloud computing (MCC) provides resources to users to handle smart mobile applications. In MCC, task scheduling is the solution for mobile users' context-aware computation resource-rich applications. Most existing approaches have achieved a moderate service reliability rate due to a lack of instance-centric resource estimations and task offloading, a statistical NP-hard problem. The current intelligent scheduling process cannot address NP-hard problems due to traditional task offloading approaches. To address this problem, the authors design an efficient context-aware service offloading approach based on instance-centric measurements. The revised machine learning model/algorithm employs task adaptation to make decisions regarding task offloading. The proposed MCVS scheduling algorithm predicts the usage rates of individual microservices for a practical task scheduling scheme, considering mobile device time, cost, network, location, and central processing unit (CPU) power to train data. One notable feature of the microservice software architecture is its capacity to facilitate the scalability, flexibility, and independent deployment of individual components. A series of simulation results show the efficiency of the proposed technique based on offloading, CPU usage, and execution time metrics. The experimental results efficiently show the learning rate in training and testing in comparison with existing approaches, showing efficient training and task offloading phases. The proposed system has lower costs and uses less energy to offload microservices in MCC. Graphical results are presented to define the effectiveness of the proposed model. For a service arrival rate of 80%, the proposed model achieves an average 4.5% service offloading rate and 0.18% CPU usage rate compared with state-of-the-art approaches. The proposed method demonstrates efficiency in terms of cost and energy savings for microservice offloading in mobile cloud computing (MCC).

2.
Microorganisms ; 11(10)2023 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-37894120

RESUMO

Anthrax, a severe zoonotic disease, is infrequently reported in anthrax-endemic regions of Pakistan. Despite clinical reports indicating its presence, particularly cutaneous anthrax, there is insufficient laboratory evidence regarding disease occurrence and environmental persistence. The present study aimed to confirm Bacillus anthracis presence, accountable for animal mortality and human infection, while exploring environmental transmission factors. Between March 2019 and July 2021, a total of 19 outbreaks were documented. Of these, 11 affected sheep/goats in Zhob district and 8 affected cattle/sheep in Bajour Agency. Clinical signs suggestive of Bacillus anthracis outbreak were observed in 11 animals. Blood and swab samples were collected for confirmation. The study followed a One Health approach, analyzing animal, environmental (soil/plant), and human samples. Of the 19 outbreaks, 11 were confirmed positive for anthrax based on growth characteristics, colony morphology, and PCR. Soil and plant root samples from the outbreak areas were collected and analyzed microscopically and molecularly. Cutaneous anthrax was observed in six humans, and swab samples were taken from the lesions. Human serum samples (n = 156) were tested for IgG antibodies against PA toxin and quantitative analysis of anthrax toxin receptor 1 (ANTXR1). Bacillus anthracis was detected in 65 out of 570 (11.40%) soil samples and 19 out of 190 (10%) plant root samples from the outbreak areas. Four out of six human samples from cutaneous anthrax lesions tested positive for Bacillus anthracis. Human anthrax seroprevalence was found to be 11% and 9% in two districts, with the highest rates among butchers and meat consumers. The highest ANTXR1 levels were observed in butchers, followed by meat consumers, farm employees, meat vendors, veterinarians, and farm owners. These findings highlight the persistence of anthrax in the region and emphasize the potential public health risks.

3.
Precis Agric ; : 1-28, 2023 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-37363792

RESUMO

Field size and shape constrain spatial and temporal management of agriculture with implications for farm profitability, field biodiversity and environmental performance. Large, conventional equipment struggles to farm small, irregularly shaped fields efficiently. The study hypothesized that autonomous crop machines would make it possible to farm small, non-rectangular fields profitably, thereby preserving field biodiversity and other environmental benefits. Using the experience of the Hands Free Hectare (HFH) demonstration project, this study developed algorithms to estimate field times (h/ha) and field efficiency (%) subject to field size and shape in grain-oil-seed farms of the United Kingdom using four different equipment sets. Results show that field size and shape had a substantial impact on technical and economic performance of all equipment sets, but autonomous machines were able to farm small 1 ha rectangular and non-rectangular fields profitably. Small fields with equipment of all sizes and types required more time, but for HFH equipment sets field size and shape had least impact. Solutions of HFH linear programming model show that autonomous machines decreased wheat production cost by €15/ton to €29/ton and €24/ton to €46/ton for small rectangular and non-rectangular fields respectively, but larger 112 kW and 221 kW equipment with human operators was not profitable for small fields. Sensitivity testing shows that the farms using autonomous machines adapted easily and profitably to scenarios with increasing wage rates and reduced labour availability, whilst farms with conventional equipment struggled. Technical and economic feasibility in small fields imply that autonomous machines could facilitate biodiversity and improve environmental performance. Supplementary Information: The online version contains supplementary material available at 10.1007/s11119-023-10016-w.

4.
J Vasc Surg ; 78(4): 845-851, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37327950

RESUMO

BACKGROUND: The National Institutes of Health (NIH) is an essential source of funding for vascular surgeons conducting research. NIH funding is frequently used to benchmark institutional and individual research productivity, help determine eligibility for academic promotion, and as a measure of scientific quality. We sought to appraise the current scope of NIH funding to vascular surgeons by appraising the characteristics of NIH-funded investigators and projects. In addition, we also sought to determine whether funded grants addressed recent Society for Vascular Surgery (SVS) research priorities. METHODS: In April 2022, we queried the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database for active projects. We only included projects that had a vascular surgeon as a principal investigator. Grant characteristics were extracted from the NIH Research Portfolio Online Reporting Tools Expenditures and Results database. Principal investigator demographics and academic background information were identified by searching institution profiles. RESULTS: There were 55 active NIH awards given to 41 vascular surgeons. Only 1% (41/4037) of all vascular surgeons in the United States receive NIH funding. Funded vascular surgeons are an average of 16.3 years out of training; 37% (n = 15) are women. The majority of awards (58%; n = 32) were R01 grants. Among the active NIH-funded projects, 75% (n = 41) are basic or translational research projects, and 25% (n = 14) are clinical or health services research projects. Abdominal aortic aneurysm and peripheral arterial disease are the most commonly funded disease areas and together accounted for 54% (n = 30) of projects. Three SVS research priorities are not addressed by any of the current NIH-funded projects. CONCLUSIONS: NIH funding of vascular surgeons is rare and predominantly consists of basic or translational science projects focused on abdominal aortic aneurysm and peripheral arterial disease research. Women are well-represented among funded vascular surgeons. Although the majority of SVS research priorities receive NIH funding, three SVS research priorities are yet to be addressed by NIH-funded projects. Future efforts should focus on increasing the number of vascular surgeons receiving NIH grants and ensuring all SVS research priorities receive NIH funding.


Assuntos
Pesquisa Biomédica , Cirurgiões , Humanos , Estados Unidos , Feminino , Masculino , National Institutes of Health (U.S.) , Organização do Financiamento , Pesquisadores
5.
Molecules ; 28(8)2023 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-37110582

RESUMO

The oxidation of food emulsions causes rancidity, which reduces their shelf life. To prevent rancidity, synthetic antioxidants are widely used in the food industry. However, due to their potential health risks, researchers are exploring natural alternatives. This study aimed to investigate whether Rosa canina fruit extract (RCFE) could be used as a natural antioxidant to extend the shelf life of mayonnaise. Mayonnaise containing varying concentrations of RCFE [0.125% (T1), 0.25% (T2), 0.50% (T3), 0.75% (T4)] was compared to a mayonnaise control sample (C1) and a mayonnaise sample containing 0.02% BHT (C2) for 60 days of storage at 4 °C. RCFE was found to have high levels of total phenols content (52.06 ± 1.14 mg GAE g-1), total flavonoids content (26.31 ± 1.03 mg QE g-1), and free radical scavenging activity. The GC-MS analysis of RCFE revealed 39 different peaks, whereas the HPLC analysis showed the presence of 13 polyphenolic compounds in RCFE. The pH values of T2, T3, and T4 mayonnaise samples substantially declined as storage progressed; however, the reduction was less than that of C1 and C2. After 60 days, mayonnaise samples T2, T3, and T4 had greatly reduced peroxide and free fatty acid levels compared to C1 and C2. The mayonnaise enriched with RCFE (T3 and T4) had the most potent antioxidative ability and the lowest value of lipid hydroperoxides (peroxide value, POV) and the lowest value of thiobarbituric-acid-reactive substances (TBARS). The sensory evaluation revealed that the T3 sample exhibited the highest overall acceptability. In conclusion, this study recommends that RCFE could be used as a natural preservative to enhance the shelf life of functional foods.


Assuntos
Antioxidantes , Rosa , Antioxidantes/farmacologia , Antioxidantes/química , Rosa/química , Frutas , Extratos Vegetais/farmacologia , Extratos Vegetais/química , Peróxidos , Compostos Fitoquímicos
6.
J Hosp Infect ; 121: 49-56, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34813874

RESUMO

INTRODUCTION: Biomedical waste management (BMWM) has attracted attention across the world as improper management can pose a serious threat for healthcare workers (HCWs), the general population and the environment. This study aimed to analyse the effectiveness of a multi-modal intervention (MMI) to upgrade BMWM practices at healthcare facilities across Bangladesh. METHODS: This quasi-experimental study, with a pre- and post-test design, was undertaken at nine healthcare facilities (five public, three private and one autonomous) over three phases, and concluded in 2019. The MMI included various strategies including: (i) system change; (ii) education and training; (iii) visual reminders; (iv) monitoring and feedback; and (v) ensuring sustainability at the study hospitals. Data collected from 2726 HCWs and waste handlers through direct observation were analysed using Statistical Package for Social Sciences Version 24. RESULTS: Significant improvements were seen in waste segregation practices using colour-coded bins (from 1% to 79%). The use of personal protective equipment during transportation and final management/disposal increased from 3% to 55%. Compliance with the use of standardized methods for collecting and transporting biomedical waste (BMW) increased substantially from 0% to 78%, while compliance with standardized methods for final management/disposal of BMW improved by 39%. CONCLUSION: Compliance with BMWM practices is very poor in Bangladesh due to a lack of knowledge, manpower and resources. Nevertheless, this MMI can be used as a tool to significantly improve BMWM practices in healthcare facilities. Initiatives such as this MMI will help the Government of Bangladesh to achieve Sustainable Development Goal 3.3 and universal health coverage by 2030.


Assuntos
Eliminação de Resíduos de Serviços de Saúde , Gerenciamento de Resíduos , Bangladesh , Atenção à Saúde , Países em Desenvolvimento , Instalações de Saúde , Humanos , Eliminação de Resíduos de Serviços de Saúde/métodos , Gerenciamento de Resíduos/métodos
7.
Nat Commun ; 12(1): 3429, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34103514

RESUMO

Neuroscience research in Africa remains sparse. Devising new policies to boost Africa's neuroscience landscape is imperative, but these must be based on accurate data on research outputs which is largely lacking. Such data must reflect the heterogeneity of research environments across the continent's 54 countries. Here, we analyse neuroscience publications affiliated with African institutions between 1996 and 2017. Of 12,326 PubMed indexed publications, 5,219 show clear evidence that the work was performed in Africa and led by African-based researchers - on average ~5 per country and year. From here, we extract information on journals and citations, funding, international coauthorships and techniques used. For reference, we also extract the same metrics from 220 randomly selected publications each from the UK, USA, Australia, Japan and Brazil. Our dataset provides insights into the current state of African neuroscience research in a global context.


Assuntos
Neurociências/tendências , Publicações/tendências , África , Autoria , Internacionalidade , Fator de Impacto de Revistas , Neurociências/economia , Apoio à Pesquisa como Assunto/economia
8.
Med Phys ; 47(4): 1949-1957, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31985827

RESUMO

PURPOSE: There is a growing interest in extending the axial fields-of-view (AFOV) of PET scanners. One major limitation for the widespread clinical adoption of such systems is the multifold increase in the associated material costs. In this study, we propose a cost-effective solution to extend the PET AFOV using a sparse detector rings configuration. The corresponding physical performance was validated using Monte Carlo simulations. METHODS: Monte Carlo model of the Siemens BiographTM mCT PET/CT, with a 21.8 cm AFOV and a set of compact rings of LSO crystals was developed as a gold standard. The mCT configuration was then modified by interleaving the LSO crystals in the axial direction within each detector block with 4 mm physical gaps (equivalent to the LSO crystal axial dimension) thus extending the AFOV to 43.6 cm (Ex-mCT). The physical performances of the two MC models were assessed and then compared using NEMA NU 2-2007 standards. RESULTS: Ex-mCT showed <0.2 mm difference in transaxial spatial resolution, and, 0.8 mm and 0.3 mm deterioration in axial spatial resolution, compared to the mCT, at 1 and 10 cm off-center of the transaxial field-of-view respectively. The system sensitivities for the mCT and Ex-mCT models were 9.4 ± 0.2 and 10.75 ± 0.2 cps/kBq respectively. The higher sensitivity of Ex-mCT was due to four additional detector rings required to double the mCT AFOV. PET images of the NEMA Image Quality (IQ) phantom showed no artifacts due to detector rings sparsity, and all spheres were visible in both configurations. Ex-mCT achieved percent contrast recoveries within 5.6% of those of the mCT for all spheres and a maximum of 36% higher background variability at the center of the AFOV. The Ex-mCT, however, showed a more uniform noise distribution over an axial range of almost twice the length of the mCT AFOV. CONCLUSIONS: Using the proposed sparse detector-ring configuration, the AFOV of current generation PET systems can be doubled while maintaining the original number and volume of detector crystal elements, and without jeopardizing the system's overall physical performance. Despite an increase in the noise level, the Ex-mCT exhibited an improved noise uniformity.


Assuntos
Método de Monte Carlo , Tomografia por Emissão de Pósitrons/instrumentação , Razão Sinal-Ruído
9.
Br J Dermatol ; 181(2): 275-281, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30422314

RESUMO

BACKGROUND: Hidradenitis suppurativa (HS) is associated with pain, disfigurement, psychosocial distress and poor quality of life, all of which may lead to a higher likelihood of mental health (MH) disorders. However, little is known about the MH comorbidities of HS. OBJECTIVES: To determine the MH disorders and cost burden associated with HS. METHODS: Data were examined from the 2002-2012 National Inpatient Sample, comprising approximately a 20% sample of all U.S. paediatric and adult hospitalizations (87 053 155 admissions). RESULTS: MH disorders were much more common in inpatients with vs. without HS (34·27% vs. 20·05%). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, HS was associated with significantly higher odds of an MH disorder (adjusted odds ratio 2·53, 95% confidence interval 2·42-2·63), including 10 of 15 MH disorders examined. In contrast, HS was not associated with primary hospitalization for an MH disorder overall (odds ratio 0·95, 95% confidence interval 0·84-1·07), but it was associated with primary hospitalization for eight of 15 MH disorders examined. Among inpatients with HS, primary admission for an MH disorder was associated with female sex, public or no insurance and more chronic diseases, but inversely associated with older age and nonwhite race/ethnicity. HS was associated with > $38 million (USD) of excess mean annual costs of hospitalization for MH disorders. CONCLUSIONS: Inpatients with HS had increased odds of comorbid MH disorders, overall, and multiple primary MH admissions, in particular, which were associated with considerable excess costs.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hidradenite Supurativa/epidemiologia , Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Hidradenite Supurativa/economia , Hidradenite Supurativa/psicologia , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental/economia , Pessoa de Meia-Idade , Qualidade de Vida , Estados Unidos/epidemiologia , Adulto Jovem
10.
Am J Clin Pathol ; 151(4): 377-385, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423023

RESUMO

OBJECTIVES: We evaluated the performance of the Elecsys HIV combi PT assay on the cobas e 602 analyzer for diagnosing human immunodeficiency virus (HIV; part of the US Food and Drug Administration [FDA] submission). METHODS: The HIV combi PT and reference (ARCHITECT HIV Ag/Ab Combo) assays were assessed at four independent clinical laboratories/one reference laboratory (United States; July 2014 to November 2015). Clinical performance was evaluated using four reagent lots. Analytical performance was evaluated per Clinical and Laboratory Standards Institute EP05-A3 guidelines. Serum/plasma samples from 18 clinical sites/vendors (United States and outside the United States) were tested. RESULTS: Sensitivity (95% confidence interval [CI]) in HIV-1 antibody-positive individuals (United States and outside the United States; n = 1,460) was 100.00% (99.75%-100.00%). Specificity was 99.94% (95% CI, 99.85%-99.98%) in low-risk individuals (United States; n = 6,843), 98.19% (95% CI, 96.93%-99.04%) in high-risk individuals (United States and outside the United States; n = 758), and 97.43% (95% CI, 95.32%-98.76%) in pregnant women (United States and outside the United States; n = 440). Analytical performance was acceptable. CONCLUSIONS: We demonstrate the robustness of the FDA-approved Elecsys HIV combi PT assay on the cobas e 602 analyzer for HIV testing in the United States.


Assuntos
Anticorpos Anti-HIV/sangue , Infecções por HIV/diagnóstico , HIV-1/imunologia , Grupos Diagnósticos Relacionados , Feminino , Infecções por HIV/sangue , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , Tempo de Internação , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Gravidez , Tempo de Protrombina , Sensibilidade e Especificidade , Estados Unidos
11.
J Surg Educ ; 76(1): 93-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30093331

RESUMO

OBJECTIVE: To evaluate the perceptions of current and former fellows in obstetrics and gynecology (OBG) subspecialties of their readiness for fellowship training. METHODS: A previously used survey was modified and distributed in 2016 to current and former fellows in gynecologic oncology, maternal-fetal medicine, reproductive endocrinology-infertility, and female pelvic medicine and reconstructive surgery. The survey explored domains of professionalism, independent practice, psychomotor ability, clinical evaluation, and scholarship. A standard Likert scale was employed and domains/responses were tailored to each subspecialty. Standard statistical models were utilized. RESULTS: A total of 478 fellows responded to the survey. Nearly 75% of fellows from each specialty reported feeling prepared or very prepared for fellowship. More than 65% of fellows from each specialty reported feeling very prepared to perform core surgical procedures. More than 90% of respondents reported having opportunities during residency to independently develop a plan of action for patients on labor and delivery. Fewer respondents reported opportunities to independently manage postoperative complications-40.7% of gynecologic oncology and 44.7% of female pelvic medicine and reconstructive surgery reported having such opportunities, whereas 91.9% of maternal-fetal medicine respondents reported having had such opportunities. While 46.4% of respondents received education on scientific writing during residency, 80% reported writing a manuscript as a resident. CONCLUSIONS: The majority of current and former fellows in OBG subspecialties report feeling prepared for fellowship in terms of clinical and surgical skills. Their feedback reveals opportunities for improvement of independent practice in gynecologic scenarios, as well as formal education on scientific research, for OBG residencies.


Assuntos
Atitude , Bolsas de Estudo , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Autorrelato
13.
Front Microbiol ; 7: 1185, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27551278

RESUMO

Coral reefs perform a major role in regulating marine biodiversity and serve as hotspot for highly dynamic and diverse microbiomes as holobionts. Corals around Ishigaki, however, are at risk due to tremendous stressors including elevation of seawater temperature, eutrophication and so on. However, no information is currently available on how Vibrio diversity fluctuates spatially and temporally due to environmental determinants in Ishigaki coral reef ecosystems. The aim of this study is to elucidate spatiotemporal Vibrio diversity dynamic at both community and population levels and to assess the environmental drivers correlated to Vibrio abundance and diversity. The Vibrio community identified based on pyrH gene phylogeny of 685 isolates from seawater directly connecting to Ishigaki coral holobionts consisted of 22 known and 12 potential novel Vibrionaceae species. The most prominent species were V. hyugaensis, V. owensii and V. harveyi followed by V. maritimus/V. variabillis, V. campbellii, V. coralliilyticus, and Photobacterium rosenbergii. The Vibrio community fluctuations, assessed by PCoA with UniFrac distance and clustering with Euclidiean distance were varied less not only by year but also by site. Interestingly, significant positive correlation was observed between rising seawater temperature and the abundance of V. campbellii (r = 0.62; P < 0.05) whereas the opposite was observed for V. owensii (r = -0.58; P < 0.05) and the C6 group of V. hyugaensis (r = -0.62; P < 0.05). AdaptML-based microhabitat differentiation revealed that V. harveyi, V. campbellii, P. rosenbergii, and V. coralliilyticus populations were less-ecologically distinctive whereas V. astriarenae and V. ishigakensis were ecologically diverse. This knowledge could be important clue for the future actions of coral conservation.

14.
J Pharm Belg ; (3): 32-45, 2013 Sep.
Artigo em Francês | MEDLINE | ID: mdl-24804411

RESUMO

In France, central IV admixture of chemotherapy (CT) treatments at the hospital is now required by law. We have previously shown that the shaping of Therapeutic Objects (TOs) could profit from an Analytical Quality Assurance (AQA), closely linked to the batch release, for the three key parameters: identity, purity, and initial concentration of the compound of interest. In the course of recent and diversified works, we showed the technical superiority of non-intrusive Raman Spectroscopy (RS) vs. any other analytical option and, especially for both HPLC and vibrational method using a UV/visible-FTIR coupling. An interconnected qualitative and economic assessment strongly helps to enrich these relevant works. The study compares in operational situation, the performance of three analytical methods used for the AQC of TOs. We used: a) a set of evaluation criteria, b) the depreciation tables of the machinery, c) the cost of disposables, d) the weight of equipment and technical installations, e) the basic accounting unit (unit of work) and its composite costs (Euros), which vary according to the technical options, the weight of both human resources and disposables; finally, different combinations are described. So, the unit of work can take 12 different values between 1 and 5.5 Euros, and we provide various recommendations. A qualitative evaluation grid constantly places the SR technology as superior or equal to the 2 other techniques currently available. Our results demonstrated: a) the major interest of the non-intrusive AQC performed by RS, especially when it is not possible to analyze a TO with existing methods e.g. elastomeric portable pumps, and b) the high potential for this technique to be a strong contributor to the security of the medication circuit, and to fight the iatrogenic effects of drugs especially in the hospital. It also contributes to the protection of all actors in healthcare and of their working environment.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Preparações Farmacêuticas/análise , Espectrofotometria Ultravioleta/economia , Espectrofotometria Ultravioleta/métodos , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Análise Espectral Raman/métodos , Cromatografia Líquida de Alta Pressão/economia , Custos e Análise de Custo , Injeções , Espectroscopia de Infravermelho com Transformada de Fourier/economia
18.
19.
Clin Chim Acta ; 411(23-24): 2062-6, 2010 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-20832393

RESUMO

BACKGROUND: Glycosylated hemoglobin evaluation is very important for assessing the control of diabetes. Since the use of point-of-care (POC) devices for monitoring HbA1c is increasing, it is important to determine how these devices compare in relation to instrumentation used in the central laboratory (CL). METHODS: Eighty-eight randomly selected samples previously analyzed using the Bio-Rad Variant™ II Hemoglobin Testing System were run on three POC Analyzers (Siemens DCA Vantage™ Analyzer, Axis-Shield Afinion™ AS100 Analyzer, and Bio-Rad In2it™ Analyzer). RESULTS: All POC instruments showed good correlation to the CL method (R(2)>0.95 for all methods). HbA1c levels obtained using Variant II (mean=7.9; 95% CI=7.5-8.3%) and In2it (mean=7.9; 95% C.I.=7.5-8.2%) instruments were found to have no statistical mean difference (p=0.21), while the values obtained using DCA Vantage (mean=7.2% C.I.=6.9-7.5%) and Afinion (mean=7.3% C.I.=7.0-7.6%) instruments were different (p<0.001) from those of the CL method. The Afinion and DCA Vantage instruments increasingly underestimated the HbA1c compared to the CL as the HbA1c values increased. These differences were even more striking when the estimated average glucose is calculated. CONCLUSIONS: Despite significant variation of results among the POC instruments evaluated relative to the CL method and pending resolution of HbA1c standardization issues, we conclude that all of the POC instruments can be used for HbA1c determination if clinicians are given instrument specific reference ranges.


Assuntos
Análise Química do Sangue/métodos , Análise Química do Sangue/normas , Hemoglobinas Glicadas/análise , Laboratórios/normas , Sistemas Automatizados de Assistência Junto ao Leito , Análise de Variância , Análise Química do Sangue/instrumentação , Humanos , Padrões de Referência , Fatores de Tempo
20.
Thromb Res ; 125(6): 513-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19931121

RESUMO

INTRODUCTION: Despite the existence of evidence-based guidelines for venous thromboembolism (VTE) prevention, prophylaxis is often inappropriately prescribed. This study compared the efficacy, safety, and cost of appropriate (ACCP-recommended) prophylaxis with partial prophylaxis (not completely conforming to ACCP guidelines) in patients at-risk of VTE receiving enoxaparin or unfractionated heparin. METHODS: The MarketScan((R)) Hospital Drug Database from Thomson Reuters (January 2004-March 2007), was queried for medical and surgical patients at high risk of VTE, aged > or =40years, and with a hospital stay > or =6days. Univariate and multivariate analyses compared hospital-acquired VTE events, adverse events, and hospital costs between appropriate or partial prophylaxis discharges. RESULTS: Of the 21,001 discharge records included, appropriate prophylaxis was received by 5136 (24.5%) patients. Compared with partial prophylaxis, appropriate prophylaxis was associated with significantly lower incidences of hospital-acquired pulmonary embolism (0.9% vs 0.5%; adjusted odds ratio [OR] 0.55, 95% confidence intervals [CI] 0.35-0.87, P=0.010), and bleeding events (10.7% vs 5.1%; adjusted OR 0.57, 95% CI 0.50-0.66, P<0.001). Total costs per discharge were lower for appropriate prophylaxis ($17,386+/-12,004) than partial prophylaxis ($23,823+/-19,783) with an adjusted mean difference of $6370 in favor of appropriate prophylaxis (P<0.001). CONCLUSION: This retrospective study suggests that ACCP-guideline recommended appropriate prophylaxis reduces hospital-acquired pulmonary embolism and bleeding events in patients at-risk of VTE and is cost-saving when total direct medical costs are considered. The substantial US clinical and economic VTE burden may, therefore, be reduced by improving prophylaxis adherence with guideline recommendations.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Pré-Medicação/métodos , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Custos e Análise de Custo , Coleta de Dados , Enoxaparina/uso terapêutico , Feminino , Fidelidade a Diretrizes/economia , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Heparina/uso terapêutico , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pré-Medicação/economia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Estudos Retrospectivos , Segurança , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico
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