Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration.

WHAT IS KNOWN AND OBJECTIVE: Anticoagulation consultations provided by a pharmacist-staffed inpatient service, similar to the experience reported in outpatient anticoagulation clinics, can potentially improve anticoagulation control and outcomes. At Tan Tock Seng Hospital, a 1200-bed acute care teaching hospital in Singapore, pharmacist-managed anticoagulation clinics have been in place since 1997. Pharmacist-managed services were extended to inpatient consultations in anticoagulation management from April 2006. Our objective was to assess the effect of implementing a pharmacist-managed inpatient anticoagulation service. METHODS: This was a single-centre cohort study. Baseline data from 1 January 2006 to 31 March 2006 were collected and compared with post-implementation data from 1 April 2006 to 31 March 2007. Patients newly started on warfarin for deep vein thrombosis, pulmonary embolism or atrial fibrillation in general medicine and surgery departments were included. The three endpoints were as follows: (i) percentage of international normalized ratios (INRs) achieving therapeutic range within 5 days, (ii) INRs more than 4 during titration and (iii) subtherapeutic INRs on discharge. RESULTS AND DISCUSSION: A total of 26 patients in the control period were compared with 144 patients who had received dosing consultations by a pharmacist during the initiation of warfarin. The provision of pharmacist consult resulted in 88% compared to 38% (P < 0·001) of INR values achieving therapeutic range within 5 days. There was a reduction in INR values of more than 4 during titration from 27% to 2% (P < 0·001), and subtherapeutic INR values on discharge without low molecular weight heparin from 15% to 0% (P < 0·001). The mean time to therapeutic INR was reduced from 6·5 to 3·9 days (P < 0·001) and mean length of stay after initiation of warfarin from 11 to 7·7 days (P = 0·004). WHAT IS NEW AND CONCLUSION: Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist-managed anticoagulation service. The time to therapeutic INR was achieved appropriately and efficiently without compromising patient's safety.

The measurement of bisphenol A and its analogues, perfluorinated compounds in twenty species of freshwater and marine fishes, a time-trend comparison and human health based assessment.

Our previous study in 2011 reported the detection of BPA and PFAAs in 20 species of marine and freshwater fishes. With an emerging evidence to suggest the metabolic-disrupting effects of BPA/PFAAs in animals, the present study was aimed to provide a time-trend analysis to determine the current concentrations of PFAAs and BPA in 20 commercially available Hong Kong species of fishes. Since the manufacture and use of BPA is being prohibited in most nations, the introduction of BPA alternatives has recently been incorporated in the markets. Therefore, the concentrations of BPB, BPF and BPS were determined. In the present study, all freshwater and seawater fish samples showed quantified concentrations [>Limit of Quantification (LOQ<0.5ng/g)] of BPA. BPF was detected in some marine (yellow seafin, bigeye, goldspotted rabbitfish, snubnose pompano, tongue sole, Bleeker's grouper and orange-spotted grouper) and freshwater fishes (mud carp, crucian carp, tilapia, catfish, mandarin fish, grass carp, grey mullet and spotted snakehead). Two of the compounds, BPS and BPB could only be identified in the marine fishes (snubnose pompano, yellow seafin). In PFAA analysis, PFOA, PFDA, PFOS, PFUdA and PFDoA were found in most of the marine and freshwater fishes. PFOS and PFOA were shown to be the two predominant PFAAs in fishes. On the basis of the measured concentrations of bisphenols, BPs (BPA, BPB, BPF, BPS) and PFAAs, the average daily intake for BPs (20.5-31.5ng/kgb.w./day) and PFAAs (1.17-1.83ng/kgb.w./day) were calculated and found to be lower than values of tolerable daily intake (TDI) established in Europe. However, as compared with our previous study in 2011, the present study revealed an approximate 10-fold increase in the concentrations of BPA in the fish samples. Although the hazard ratio of consuming fishes for BPA and PFAA exposure is expected to remain low, possible additive metabolic-disrupting effect of BPA and its analogues as well PFAAs should be taken into consideration for human health risk assessment.

The double peak-to-peak analysis for determining EMG onset of muscle contraction.

PURPOSE: Identification of the onset of muscle contraction with EMG signal amplitude double of the baseline value (DP-P) has been recently reported for determining the temporal parameters of muscular activity. Due to its convenience, it is suitable for clinical application. However, there is a lack of report on the reliability and comparability of this method to other established methods. Therefore, this study examined the test-retest reliability of the DP-P method and compared it with an established method that used the mean + 3 standard deviations (mean + 3 s.d.) over the baseline value for muscles of the knee. METHODS: The onset of contraction of vastus medialis obliquus (VMO) and vastus lateralis (VL) of eleven able-bodied volunteers performing isometric knee extension at 50%, 75% and 100% of MVC in 30-minute and 7-day intervals were analyzed with both the DP-P and mean + 3 s.d. methods. RESULTS: The ICC for within-day measurements of DP-P method ranged from 0.64 to 0.86 and that for between-day measurements ranged from 0.63-0.81. The ICC values were higher with submaximal than maximal contractions. There was a consistent delay of about 3 ms in EMG onset detection with the DP-P as compared to the mean + 3 s.d method. CONCLUSION: The DP-P method is a reliable method for muscle onset determination but the absolute onset time of muscle contraction obtained from this method should not be directly compared with other methods such as the mean + 3 s.d.

Termination of early pregnancy (menstrual induction) with 16-phenoxy-omega-tetranor PGE2 methylsulfonylamide.

PIP: The efficacy and side effects of a new synthetic compound, 16-phenoxy-W-17, 18, 19, 20-tetranor prostaglandin E2 methylsulfonylamide, for menstrual induction. The study was conducted in an outpatient clinic in 240 patients with a delay in menstruation of 6-14 days. In 206 patients (86%) the immunologic pregnancy test was positive before prostaglandin administration. Most of the remaining 34 (14%) patients with a negative pregnancy test had symptoms suggestive of pregnancy. Whenever there was doubt that amenorrhea was due to reasons other than pregnancy, the patients were not treated with prostaglandins. The patients' age range was 16-32 years; the parity range was 0-6. The treatment was successful in 228 patients (95%), i.e., there was uterine bleeding after prostaglandin administration followed by a negative pregnancy test within 14 days. In 6 patients with failed treatment, there was uterine bleeding after prostaglandin administration lasting for 2-13 days but the pregnancy remained positive. Prostaglandin failed to induce bleeding in 4 patients. In 3 of the patients the pregnancy test was positive before and 14 days after prostaglandin administration. The uterus was evacuated by vacuum aspiration in 9 patients. In 1 patient who had no uterine bleeding, pregnancy test was negative both before and 2 weeks after prostaglandin administration. 2 patients were admitted to the hospital the day after prostaglandin treatment for excessive bleeding. Curettage was carried out in both these patients and the bleeding stopped. 1 patient was readmitted to the hospital 8 hours after prostaglandin administration with severe pain in the lower abdominal region. On further examination a tubal pregnancy was diagnosed and confirmed by laparotomy. 2 patients were successfully treated for pelvic infection with antibiotics 7-10 days after prostaglandin administration. All patients experienced mild uterine pain a few minutes after prostaglandin administration. 16 patients required analgesics. The majority of the patients described the bleeding as heavier and longer in duration than their normal menstrual period. The average length of bleeding was 7.3 days with a range of 2-13 days. Side effects included 1 or 2 episodes of vomiting in 13 patients and headache in 9 patients.^ieng

A two-step alignment method for 3D computer-aided reconstruction based on fiducial markers and applied to mouse embryonic hearts.

An accurate three dimensional computer reconstruction of microscopic biological objects or distribution of molecules identified on serial sections must solve two major problems: 1) the alignment of sections using adequate extrinsic references (fiducial markers); 2) the impossibility of observing these references and the cellular or molecular structures in the microscope at the same magnification. To provide extrinsic references for objects embedded in soft media, we have modified and simplified the charcoal-paraffin method described by Langemeijer and Simons (1973). It consists of drilling three or four small holes into the paraffin block, sealing this block at the extremity of a glass holder and, from the other extremity of the holder attached to a rubber hose, aspirating a liquefied mixture of charcoal-paraffin to fill these cylindrical holes. An alignment procedure was developed using serial sections of mouse embryonic hearts with bromodeoxyuridine-labelled DNA synthesizing cells. From each fourth section, two sets of contours have been drawn and digitized: 1) at low magnification (about 40x), embryo body wall, heart, neural tube and extrinsic reference marks (black dots); 2) at higher magnification (240-300x): heart contours alone (without extrinsic references, but with individual labelled cells). Different operations of the computer-aided alignment, as well as checking of results by inverse alignment, are described in detail. This two-step alignment method offers a practical, efficient compromise between: a) purely subjective alignment based only on tissular landmarks interpreted by the operator; b) ideal perfect alignment based not only on adequate references, but on computerized correction of section deformation, as well.

A review on thromboprophylaxis in pregnancy.

Thromboembolic disease remains an important cause of maternal mortality worldwide. The risk assessments for prevention of thromboembolism in pregnancy are controversial due to lack of large-scale randomised controlled trials. Unfractionated heparin is at present, the anticoagulant of choice during pregnancy. However, it may be superseded by low-molecular-weight heparin in the near future because of its safety and efficacy.

Draft Genome Sequence of Clostridium perfringens Strain JJC, a Highly Efficient Hydrogen Producer Isolated from Landfill Leachate Sludge.

Clostridium perfringens strain JJC is an effective biohydrogen and biochemical producer that was isolated from landfill leachate sludge. Here, we present the assembly and annotation of its genome, which may provide further insights into the gene interactions involved in efficient biohydrogen production.

Draft Genome Sequence of Clostridium bifermentans Strain WYM, a Promising Biohydrogen Producer Isolated from Landfill Leachate Sludge.

Clostridium bifermentans strain WYM is an effective biohydrogen producer isolated from landfill leachate sludge. Here, we present the assembly and annotation of its genome, which may provide further insights into the metabolic pathways involved in efficient biohydrogen production.

Draft Genome Sequence of Clostridium sp. Strain Ade.TY, a New Biohydrogen- and Biochemical-Producing Bacterium Isolated from Landfill Leachate Sludge.

Clostridium sp. strain Ade.TY is potentially a new biohydrogen-producing species isolated from landfill leachate sludge. Here we present the assembly and annotation of its genome, which may provide further insights into its gene interactions for efficient biohydrogen production.

Resistance training alters the sensorimotor control of vasti muscles.

The present study examined and compared two modes of weight training (bodybuilding and power-lifting) on the surface EMG of vasti muscles, knee joint position sense and isometric knee extension force in 48 able-bodied subjects. Subjects were randomly allocated into either a moderate loading and repetitions (bodybuilding) training or a high loading and low repetitions (power-lifting) training, or a no training control group. Training was conducted on alternate days with individual supervision. After 8 weeks of training, subjects from both training groups showed significantly earlier EMG onset timing and higher amplitude of vastus medialis obliquus relative to vastus lateralis (p=0.005 or <0.001), and improved knee joint position sense (p<0.001), but no such changes were found in the control group. However, the changes were not significantly different (p>0.05) between the two training groups. The findings suggested that the neuromotor control of the vasti muscles could be altered by regular weight training.

Forms and behaviour of vacuum emission electronic devices comprising diamond or other carbon cold cathode emitters.

Nanocarbon-derived electron emission devices, specifically nanodiamond lateral field emission (FE) diodes and gated carbon nanotube (CNT) triodes, are new configurations for robust nanoelectronic devices. These novel micro/nanostructures provide an alternative and efficient means of accomplishing electronics that are impervious to temperature and radiation. For example, nitrogen-incorporated nanocrystalline diamond has been lithographically micropatterned to use the material as an electron field emitter. Arrays of laterally arranged 'finger-like' nanodiamond emitters constitute the cathode in a versatile diode configuration with a small interelectrode separation. A low diode turn-on voltage of 7V and a high emission current of 90 microA at an anode voltage of 70V (electric field of approx. 7V microm(-1)) are reported for the nanodiamond lateral device. Also, a FE triode amplifier based on aligned CNTs with a low turn-on voltage and a small gate leakage current has been developed.

C. elegans SIN-3 and its associated HDAC corepressor complex act as mediators of male sensory ray development.

Mab21 gene family members are required for embryonic development and sensory organ formation in both invertebrates and vertebrates. However, their mechanistic role on differentiation is largely unexplored. We report here the isolation of SIN-3 as a MAB-21 interacting molecule. sin-3 is co-expressed with mab-21 in the ray structural cells and genetically interacts with mab-21 to control sensory organ development. Using pharmacological and RNAi approaches, we demonstrated that histone deacetylase and conserved SIN-3-associated components are required for ray patterning. Conserved physical interactions between these components were also observed, implicating the recruitment of HDAC complex by MAB-21/SIN-3 may occur to determine ray identity in males.

Adolescent sexuality in Singapore.

PIP: Rapid industrialization and modernization in Singapore have created a number of tensions, including an increase in problems related to adolescent sexuality such as sharp increase in the teenage legal abortion rate and high incidence of female teen age marriages with subsequent high divorce rate. Lack of parental supervision, the declining importance of the extended family, the growth of a "peer-group" culture, increased contact between the sexes, and the declining age of menarche are factors in the problem. The teenage abortion rate increased between 1971 and 1976 from 0.8 to 8.1 per 1000, representing a ten-fold numerical increase. A 1978 survey of teenage girls undergoing abortions found that over half had never used contraception due to ignorance, carefreeness, unpreparedness, unavailability of contraceptives, and fear of side effects. The teenage marriage rate rose from 19.1 to 32 per 1000 in 1974 and then fell to 19.8 per 1000 in 1977. The divorce rate for marriages in which 1 or both partners is below 18 is 18.7%, compared to 4.4% for older couples. The government has developed a comprehensive program of family life education for school-children in order to combat the problems of adolescent sexuality.^ieng

The changing nature of elective laparoscopic surgery: a review over a 7 year period in a reproductive surgery unit.

There was a significant increase in the number of laparoscopic procedures performed in the Reproductive and Surgery Unit at the Jessop Hospital for Women over the 7 year period from 1991 to 1997. The three most common procedures were adhesiolysis/salpingo-ovariolysis, treatment of endometriosis and ovarian drilling, which together constituted over 80% of all cases. The duration of surgery and the complexity of the cases gradually increased with time. The determinants of patients staying overnight after laparoscopic surgery in decreasing order of importance were: (i) whether they had undergone surgery in the morning or in the afternoon; (ii) the operating time; and (iii) the number of entry ports used. Most (75%) of the laparoscopic procedures were performed or supervised directly by a consultant. In this study period the major complication rate was 0.7%.

Menstrual induction--termination of early pregnancy with a new prostaglandin analogue SHB 286.

PIP: The efficacy and side effects of a new synthetic analogue, 16 phenoxy 17, 18, 19, 20 tetranor prostaglandin E2 methyl sulphonylamide (SH 286) for menstrual induction was studied at the Kandang Kerbau Hospital in Singapore. Subjects were 150 patients with a delay in menstruation of 7-14 days. In 128 patients the pregnancy test before prostaglandin administration was positive and in 22 patients it was negative. Most of the 22 patients with a delay in menstruation had other symptoms suggestive of pregnancy. The prostaglandin analogue (50 mcg in 1 cc of saline) was instilled into the uterine cavity via a 6 mm catheter introduced through the cervix. The catheter was flushed with 1.5 cc of saline and immediately withdrawn. The patients were observed for the next 6 hours and allowed to go home. At the follow-up visit 10-14 days later, the pregnancy test was repeated. The criteria for successful treatment was vaginal bleeding after prostaglandin administration followed by a negative pregnancy test at the follow-up visit. The treatment was successful in 144 patients (96%). Of the remaining 6 patients, 4 had uterine bleeding for 2-13 days but pregnancy test remained positive. The prostaglandin failed to induce bleeding in 2 patients. The uterus was evacuated in these 6 patients by vacuum aspiration. The interval between prostaglandin administration and onset of bleeding ranged between 30 minutes and 6 hours. The average length of uterine bleeding was 7.3 days with a range of 2-13 days. All patients experienced mild uterine pain a few minutes after prostaglandin administration, but only 11 patients required analgesics. Side effects included 1 or 2 episodes of vomiting in 9 patients and headache in 6 patients. There were no changes in blood pressure, pulse, or respiration. 1 patient was treated for pelvic infection 10 days after prostaglandin administration, and curettage was performed in 2 patients for intermittent bleeding 2 weeks after successful treatment with prostaglandin. 16 phenoxy 17, 18, 19, 20 tetranor prostaglandin E2 methyl sulphonylamide was found to be effective in inducing menstruation when this was delayed by up to 2 weeks.^ieng