Quality through the pharmaceutical chain of care

Many medical professionals are involved in patient care processes. For pharmaceutical care this results in many information transfer moments. To provide optimal care, communication and information the transfer should be conducted in a timely manner, fully transparent, complete and relevant. The TRANSFORM project is directed towards the development of a reference information model of the pharmaceutical care chain with the aim to improve the availability (time, place, completeness) and access of pharmaceutical information regarding patients, thereby resulting in continuity and quality of pharmaceutical care, reduction in medical errors and improvement in patient safety through the design of a safer healthcare system. TRANSFORM leads to improved insight into the processes and data transfer points in the pharmaceutical chain of care. Focussed on laboratory medicine and pharmacy, the implementation of the integration of laboratory test and pharmacy information may result in major improvements in drug therapy monitoring and guidance (i.e. drug impact monitoring). Because of the overwhelming amount of data generated by this integration of drugs, drug effects and laboratory test results, an online decision support system is warranted.Presented at the 9th Conference on Quality in the Spotlight, 18–19 March 2004, Antwerp, Belgium.The following paper may appear at first sight not to be specifically within the realm of ACQUAL. It has been accepted for publication anyway as it is about reliable handling of data, incl. measurement results, which lead to important decisions (in this case related to a patient). The reliability of handling (a large amount of) measurement results towards a basis for important decisions, is a very important feature of the use of such results.Paul De Bièvre, Editor in Chief     

通过脱碳控制全球平均温度

Establishing a reliable method to predict the global mean temperature (T_e) is of great importance because CO₂ reduction activities require political and global cooperation and significant financial resources. The current climate models all seem to predict that the earth's temperature will continue to increase, mainly based on the assumption that CO₂ emissions cannot be lowered significantly in the foreseeable future. Given the earth's multifactor climate system, attributing atmospheric CO₂ as the only cause for the observed temperature anomaly is most likely an oversimplification; the presence of water (H₂O) in the atmosphere should at least be considered. As such, T_e is determined by atmospheric water content controlled by solar activity, along with anthropogenic CO₂ activities. It is possible that the anthropogenic CO₂ activities can be reduced in the future. Based on temperature measurements and thermodynamic data, a new model for predicting T_e has been developed. Using this model, past, current, and future CO₂ and H₂O data can be analyzed and the associated T_e calculated. This new, esoteric approach is more accurate than various other models, but has not been reported in the open literature. According to this model, by 2050, T_e may increase to 15.5 ℃ under "business-as-usual" emissions. By applying a reasonable green technology activity scenario, T_e may be reduced to approximately 14.2 ℃. To achieve CO₂ reductions, the scenario described herein predicts a CO₂ reduction potential of 513 gigatons in 30 years. This proposed scenario includes various CO₂ reduction activities, carbon capturing technology, mineralization, and bio-char production; the most important CO₂ reductions by 2050 are expected to be achieved mainly in the electricity, agriculture, and transportation sectors. Other more aggressive and plausible drawdown scenarios have been analyzed as well, yielding CO₂ reduction potentials of 1051 and 1747 gigatons, respectively, in 30 years, but they may reduce global food production. It is emphasized that the causes and predictions of the global warming trend should be regarded as open scientific questions because several details concerning the physical processes associated with global warming remain uncertain. For example, the role of solar activities coupled with Milankovitch cycles are not yet fully understood. In addition, other factors, such as ocean CO₂ uptake and volcanic activity, may not be negligible.     

The existence of sensitive optimal policies in two multi-dimensional queueing models

Recently Dekker and Hordijk [3,4] introduced conditions for the existence of deterministic Blackwell optimal policies in denumerable Markov decision chains with unbounded rewards. These conditions include- uniform geometric recurrence.The-uniform geometric recurrence property also implies the existence of average optimal policies, a solution to the average optimality equation with explicit formula's and convergence of the value iteration algorithm for average rewards. For this reason, the verification of-uniform geometric convergence is also useful in cases where average and-discounted rewards are considered.On the other hand,-uniform geometric recurrence is a heavy condition on the Markov decision chain structure for negative dynamic programming problems. The verification of-uniform geometric recurrence for the Markov chain induced by some deterministic policy together with results by Sennott [14] yields the existence of a deterministic policy that minimizes the expected average cost for non-negative immediate cost functions.In this paper-uniform geometric recurrence will be proved for two queueing models: theK competing queues and the two centre open Jackson network with control of the service rates.The research of the author is supported by the Netherlands Organization for Scientific Research N.W.O.     

Logging damage and injured tree mortality in tropical forest management

Using insights from the forest ecology literature, we analyze the effect of injured trees on stand composition and carbon stored in above‐ground biomass and the implications for forest management decisions. Results from a Faustmann model with data for a tropical forest on Kalimantan show that up to 50% of the basal area of the stand before harvest can consist of injured trees. Considering injured trees leads to an increase in the amount of carbon in above‐ground biomass of up to 165%. These effects are larger under reduced impact logging than under conventional logging. The effects on land expectation value and cutting cycle are relatively small. The results suggest that considering injured trees in models for tropical forest management is important for the correct assessment of the potential of financial programs to store carbon and conserve forest ecosystem services in managed tropical forests, such as reducing emissions from deforestation and forest degradation and payment for ecosystem services. Recommendations for Resource Managers

• Considering the role of injured trees is important for managing tropical forests
• These trees can cover up to 50% of basal area and contain more than 50% of the carbon stored in above‐ground biomass
• Reduced impact logging leads to a larger basal area of injured trees and more carbon stored in injured trees than conventional logging
• Injured trees play an important role when assessing the potential for carbon storage in the context of payment for forest ecosystem services.

     

Thickness and morphology of polyelectrolyte coatings on silica surfaces before and after protein exposure studied by atomic force microscopy

Analyte–wall interaction is a significant problem in capillary electrophoresis (CE) as it may compromise separation efficiencies and migration time repeatability. In CE, self-assembled polyelectrolyte multilayer films of Polybrene (PB) and dextran sulfate (DS) or poly(vinylsulfonic acid) (PVS) have been used to coat the capillary inner wall and thereby prevent analyte adsorption. In this study, atomic force microscopy (AFM) was employed to investigate the layer thickness and surface morphology of monolayer (PB), bilayer, (PB-DS and PB-PVS), and trilayer (PB-DS-PB and PB-PVS-PB) coatings on glass surfaces. AFM nanoshaving experiments providing height distributions demonstrated that the coating procedures led to average layer thicknesses between 1 nm (PB) and 5 nm (PB-DS-PB), suggesting the individual polyelectrolytes adhere flat on the silica surface. Investigation of the surface morphology of the different coatings by AFM revealed that the PB coating does not completely cover the silica surface, whereas full coverage was observed for the trilayer coatings. The DS-containing coatings appeared on average 1 nm thicker than the corresponding PVS-containing coatings, which could be attributed to the molecular structure of the anionic polymers applied. Upon exposure to the basic protein cytochrome c, AFM measurements showed an increase of the layer thickness for bare (3.1 nm) and PB-DS-coated (4.6 nm) silica, indicating substantial protein adsorption. In contrast, a very small or no increase of the layer thickness was observed for the PB and PB-DS-PB coatings, demonstrating their effectiveness against protein adsorption. The AFM results are consistent with earlier obtained CE data obtained for proteins using the same polyelectrolyte coatings.     

On Dwork's accessory parameter problem

We study the question which ordinary second order linear differential equation allows power series solutions whose p-adic radius of convergence is at least one, a question raised by B.Dwork. In particular we shall consider the case of Fuchsian equations with four singularities and local exponent differences 0. Received: 28 August 2000; final form: 20 November 2001/ Published online: 17 June 2002 RID="*" ID="*" Part of this work was supported by EPSRC grant L99920