Motion Primitive Approach to Spacecraft Trajectory Design in a Multi-body System.

The increasing number and variety of spacecraft that are expected to operate within cislunar space and other multi-body gravitational environments throughout the solar system necessitates the continued development of strategies for rapid trajectory design and design space exploration. In the field of robotics, similar needs have been addressed using motion primitives that capture the fundamental building blocks of motion and are used to rapidly construct complex paths. Inspired by this concept, this paper leverages motion primitives to construct a framework for rapid and informed spacecraft trajectory design in a multi-body gravitational system. First, motion primitives of fundamental solutions, e.g., selected periodic orbits and their stable and unstable manifolds, are generated via clustering to form a discrete summary of segments of the phase space. Graphs of motion primitives are then constructed and searched to produce primitive sequences that form candidate initial guesses for transfers of distinct geometries. Continuous transfers are computed from each initial guess using multi-objective constrained optimization and collocation. This approach is demonstrated by constructing an array of geometrically distinct transfers between libration point orbits in the Earth-Moon circular restricted three-body problem with impulsive maneuvers.

Troponin Elevation in Sickle Cell Disease.

OBJECTIVE: Sickle cell disease is associated with cardiovascular abnormalities. Troponin is not typically measured in this population, and thus the significance of abnormal levels of troponin is unknown. We wanted to evaluate the use of troponin and factors that predispose troponin elevation in patients admitted with sickle cell pain crisis (SCPC). METHODS: We reviewed data of consecutive patients admitted to a tertiary care hospital between 2006 and 2011 with a diagnosis of SCPC. Subjects with elevated troponin (ET) (troponin I >0.04 ng/mL) were compared with those with normal troponin (NT) for demographics, risk factors, presence of echocardiography-derived tricuspid regurgitant jet velocity (TRV) ≥3 m/s suggesting pulmonary hypertension, and laboratory tests. The Mann-Whitney U test was used to compare groups. RESULTS: Two hundred eighty-three of 724 patients admitted with SCPC had chest pain. Troponin I was measured in 63 patients: 51 had NT and 12 had ET ranging from 0.06 to 3.42 ng/ml. ET was associated lower hemoglobin (p = 0.02), lower hematocrit (p = 0.02), lower platelet number (p < 0.001), higher LDH (p = 0.012), higher AST levels (p = 0.004), higher bilirubin levels (p = 0.006), and TRV ≥3 m/s (p = 0.028). CONCLUSIONS: Troponin was measured in <10% of patients with SCPC, and 1 out of 5 of them had ET. Troponin elevation was not associated with traditional cardiovascular risk factors but was associated with lower hematocrit, elevated LDH, bilirubin levels, and TRV ≥3 m/s.

Possible varenicline withdrawal-induced akathisia: A case report.

Akathisia is a relatively common adverse effect that may emerge during treatment with antipsychotics and other medication classes. We present a case of akathisia that may have been induced by the abrupt discontinuation of varenicline and review existing literature related to this phenomenon. A 46-year-old female with a past psychiatric history of bipolar disorder and borderline personality disorder was admitted to the acute psychiatric services department for suicidal ideation after 3 weeks of a new course of varenicline. This was prescribed for smoking cessation and titrated to 1 mg twice daily. Upon admission, the varenicline was discontinued. Roughly 3 days later, the patient began to complain of akathisia. The patient had experienced akathisia previously while taking antipsychotics for her bipolar disorder and was able to recognize its emergence. As the akathisia worsened, propranolol 10 mg 3 times daily was ordered and was effective in relieving her symptoms. A PubMed search using the terms varenicline, akathisia, withdrawal, and discontinuation was conducted. No literature of this phenomenon was found; however, reports of other extrapyramidal symptoms were noted. Considering the timing of varenicline's discontinuation and its mechanism, a pharmacological link between its use and akathisia is possible. Akathisia is a severely uncomfortable sequela of medications that may produce severe outcomes, such as suicidal ideation. In this case, it is possible that the discontinuation of varenicline after 3 weeks of therapy led to akathisia, which was successfully treated with propranolol.

History repeats itself: the family medication history and pharmacogenomics.

Related to many drug gene-product interactions, application of pharmacogenomics can lead to improved medication efficacy while decreasing or avoiding adverse drug reactions. However, utilizing pharmacogenomics without other information does not allow for optimal medication therapy. Currently, there is a lack of documentation of family medication history, in other words, inefficacy and adverse reactions across family members throughout generations. The family medication history can serve as an impetus for pharmacogenomic testing to explain lack of medication efficacy or an adverse drug reaction and pre-emptive testing can drive recognition and documentation of medication response in family members. We propose combining the family medication history via pedigree construction with pharmacogenomics to further optimize medication therapy. We encourage clinicians to combine family medication history with pharmacogenomics.

Pharmacogenomics: Overview of Applications and Relation to Infusion Therapy.

Pharmacogenomics (PGx) describes the relationship between an individual's genes and his or her response to drug therapy. Data are accumulating that indicate that PGx has application in the clinical setting for drugs across therapeutic categories, including drugs that are administered intravenously and are of greater familiarity to infusion nurses. This article provides an overview of the science and presents common examples of PGx as it relates to drug and/or drug dose selection. Additionally, there are brief summaries of the role infusion nurses can play relative to toxicity monitoring, patient education, and other aspects of PGx.

Academic and professional pharmacy education: a pharmacogenomics certificate training program.

AIM: The aim of this study was to evaluate a pharmacogenomics certificate training program relative to pharmacist competencies in basic genetic concepts, genetics and disease, pharmacogenetics/pharmacogenomics and ethical, legal and social implication. METHODS: Participants, including pharmacists, pharmacy students and pharmacy educators completed a survey related to to the competency statements. Following the pre-program survey, participants completed a 6-week home self-study with subject matter including basic science (three chapters) and clinical application of pharmacogenomics (eight chapters). The participants completed a quiz for each of the self-study chapters. Following the self-study, participants completed a day-long, 7-h live program which included a review of the competency statements and counseling sessions with seven different simulated patients (primarily pharmacy students). Participants then completed a post-program survey which included the same items as the pre-program survey. RESULTS: Specifically, for the pharmacist participants, the average score of the self-study quizzes was 91%. For the pharmacists specifically, there was a statistically significant increase in self-assessed perception of competence related to pharmacogenomics. Additionally, it was observed that recommendations related to specific drug-gene interactions for the simulated patients were addressed correctly 95% of the time across all participant-patient encounters. CONCLUSION: Self-study and a live, interactive component in the certificate training program led to increased self-understanding of defined pharmacogenomics competencies. Additionally, pharmacy students, in the role of simulated patients gained knowledge during the live component of the program. This type of program, especially if made available through electronic-based platforms can serve to educate pharmacists and increase the uptake of pharmacogenomics in various healthcare settings.