pinecone/core-2020-05-10-deduplication huggingface dataset:
Development, implementation and outcome analysis of semi-automated alerts for metformin dose adjustment in hospitalized patients with renal impairment

PURPOSE Overdosing of the oral antidiabetic metformin in impaired renal function is an important contributory cause to life-threatening lactic acidosis. The presented project aimed to quantify and prevent this avoidable medication error in clinical practice. METHODS We developed and implemented an algorithm into a hospital's clinical information system that prospectively identifies metformin prescriptions if the estimated glomerular filtration rate is below 60 mL/min. Resulting real-time electronic alerts are sent to clinical pharmacologists and pharmacists, who validate cases in electronic medical records and contact prescribing physicians with recommendations if necessary. RESULTS The screening algorithm has been used in routine clinical practice for 3 years and generated 2145 automated alerts (about 2 per day). Validated expert recommendations regarding metformin therapy, i.e., dose reduction or stop, were issued for 381 patients (about 3 per week). Follow-up was available for 257 cases, and prescribers' compliance with recommendations was 79%. Furthermore, during 3 years, we identified eight local cases of lactic acidosis associated with metformin therapy in renal impairment that could not be prevented, e.g., because metformin overdosing had occurred before hospitalization. CONCLUSIONS Automated sensitive screening followed by specific expert evaluation and personal recommendations can prevent metformin overdosing in renal impairment with high efficiency and efficacy. Repeated cases of metformin-associated lactic acidosis in renal impairment underline the clinical relevance of this medication error. Our locally developed and customized alert system is a successful proof of concept for a proactive clinical drug safety program that is now expanded to other clinically and economically relevant medication errors
Prescribing trends and indications of antipsychotic medication in Hong Kong from 2004 to 2014: General and vulnerable patient groups

PURPOSE: Antipsychotic-prescribing patterns remain unclear in Asia. The aims of our study were to investigate prescribing trends of antipsychotic medication in the general population, children, and older patients by drug generation (first or second), the prescribing trend in pregnant women, the probable indication for antipsychotic prescription, and the prescribing trend by dosage form.
METHODS: This descriptive study identified and included all patients prescribed with antipsychotic in Hong Kong from 2004 to 2014 using the Clinical Data Analysis and Report System. This study calculated and reported the prevalence of antipsychotic prescribing in patient groups of interest, the percentage with diagnoses of mental disorders were derived, and the prevalence of antipsychotic by dosage forms.
RESULTS: The study included 10 109 206 prescriptions of any antipsychotics to 256 903 patients. Over the study period, the prevalence of antipsychotic prescribing increased from 1.06% to 1.54% in the general population, from 0.10% to 0.23% in children (3-17 years old), and from 2.61% to 3.26% in older patients (≥65 years old). The prevalence of second-generation antipsychotics increased, but the prevalence of first-generation antipsychotics did not. Prevalence of antipsychotic prescribing in prepregnancy, pregnancy, and postpartum timeframes varied from 0.18% to 0.38%. The percentage of incident prescriptions with a diagnosis of psychosis decreased from 54.1% to 47.5%.
CONCLUSIONS: Antipsychotics have been increasingly prescribed in the general population, children, and older patients. There is an increase in second-generation antipsychotic prescribing. Over half of incident users had a recent diagnosis of a nonpsychotic mental disorder in 2014, suggesting that off-label prescribing of antipsychotics might be common.
Copyright © 2017 John Wiley & Sons, Ltd
CodeMapper: semiautomatic coding of case definitions. A contribution from the ADVANCE project

Background: Assessment of drug and vaccine effects by combining information from different healthcare databases in the European Union requires extensive efforts in the harmonization of codes as different vocabularies are being used across countries. In this paper, we present a web application called CodeMapper, which assists in the mapping of case definitions to codes from different vocabularies, while keeping a transparent record of the complete mapping process. Methods: CodeMapper builds upon coding vocabularies contained in the Metathesaurus of the Unified Medical Language System. The mapping approach consists of three phases. First, medical concepts are automatically identified in a free-text case definition. Second, the user revises the set of medical concepts by adding or removing concepts, or expanding them to related concepts that are more general or more specific. Finally, the selected concepts are projected to codes from the targeted coding vocabularies. We evaluated the application by comparing codes that were automatically generated from case definitions by applying CodeMapper's concept identification and successive concept expansion, with reference codes that were manually created in a previous epidemiological study. Results: Automated concept identification alone had a sensitivity of 0.246 and positive predictive value (PPV) of 0.420 for reproducing the reference codes. Three successive steps of concept expansion increased sensitivity to 0.953 and PPV to 0.616. Conclusions: Automatic concept identification in the case definition alone was insufficient to reproduce the reference codes, but CodeMapper's operations for concept expansion provide an effective, efficient, and transparent way for reproducing the reference codes
Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland : applying a coherent framework to drug utilisation studies

Purpose: To report the use of direct oral anticoagulants (DOAC) for stroke prevention in patients with atrial fibrillation (AF) in Scotland and advocate the standardisation of drug utilisation research methods. Methods: Retrospective cohort study using linked administrative data. Patients included those with a diagnosis of AF (confirmed in hospital) who received a first prescription for a DOAC (dabigatran, rivaroxaban, apixaban) from September 2011 to June 2014. Drug utilisation measures included discontinuation, persistence, and adherence. Results: 5398 patients (mean CHA2DS2-VASc score 2.98 [SD 1.71], 89.7% with ≥ 6 concomitant medicines) were treated with DOACs for a median of 228 days (IQR 105 – 425). Of 35.6% who discontinued DOAC treatment, 11.0% switched to warfarin and 48.3% re-initiated DOACs. Persistence after 12 and 18 months were 75.9% and 69.8%, respectively. Differences between individual DOACs were observed: discontinuation rates ranged from 20.4% (apixaban) to 60.6% (dabigatran), and 12 months persistence from 60.1% (dabigatran) to 85.5% (apixaban). Adherence to treatment with all DOACs was good: overall DOAC median medication refill adherence (MRA) was 102.9% (IQR 88.9% – 115.5%), and 82.3% of patients had an MRA > 80%. Conclusions: In Scotland, adherence to DOAC treatment was good and switching from DOAC to warfarin was low. However, discontinuation and persistence rates were variable – although treatment interruptions were often temporary. To decrease the inconsistencies in drug utilisation methods and facilitate meaningful study comparison, the use of a coherent framework – using a combination of discontinuation, persistence and adherence – and the standardisation of measurements is advocated
Reporting to Improve Reproducibility and Facilitate Validity Assessment for Healthcare Database Studies V1.0

Purpose: Defining a study population and creating an analytic dataset from longitudinal healthcare databases involves many decisions. Our objective was to catalogue scientific decisions underpinning study execution that should be reported to facilitate replication and enable assessment of validity of studies conducted in large healthcare databases. Methods: We reviewed key investigator decisions required to operate a sample of macros and software tools designed to create and analyze analytic cohorts from longitudinal streams of healthcare data. A panel of academic, regulatory, and industry experts in healthcare database analytics discussed and added to this list. Conclusion: Evidence generated from large healthcare encounter and reimbursement databases is increasingly being sought by decision-makers. Varied terminology is used around the world for the same concepts. Agreeing on terminology and which parameters from a large catalogue are the most essential to report for replicable research would improve transparency and facilitate assessment of validity. At a minimum, reporting for a database study should provide clarity regarding operational definitions for key temporal anchors and their relation to each other when creating the analytic dataset, accompanied by an attrition table and a design diagram. A substantial improvement in reproducibility, rigor and confidence in real world evidence generated from healthcare databases could be achieved with greater transparency about operational study parameters used to create analytic datasets from longitudinal healthcare databases
A tool for assessment of heart failure prescribing quality: A systematic review and meta-analysis

Introduction: Heart failure (HF) guidelines aim to standardise patient care. Internationally, prescribing practice in HF may deviate from guidelines and so a standardised tool is required to assess prescribing quality. A systematic review and meta‐analysis were performed to identify a quantitative tool for measuring adherence to HF guidelines and its clinical implications. Methods: Eleven electronic databases were searched to include studies reporting a comprehensive tool for measuring adherence to prescribing guidelines in HF patients aged ≥18 years. Qualitative studies or studies measuring prescription rates alone were excluded. Study quality was assessed using the Good ReseArch for Comparative Effectiveness Checklist. Results: In total, 2455 studies were identified. Sixteen eligible full‐text articles were included (n = 14 354 patients, mean age 69 ± 8 y). The Guideline Adherence Index (GAI), and its modified versions, was the most frequently cited tool (n = 13). Other tools identified were the Individualised Reconciled Evidence Recommendations, the Composite Heart Failure Performance, and the Heart Failure Scale. The meta‐analysis included the GAI studies of good to high quality. The average GAI‐3 was 62%. Compared to low GAI, high GAI patients had lower mortality rate (7.6% vs 33.9%) and lower rehospitalisation rates (23.5% vs 24.5%); both P ≤ .05. High GAI was associated with reduced risk of mortality (hazard ratio = 0.29, 95% confidence interval, 0.06‐0.51) and rehospitalisation (hazard ratio = 0.64, 95% confidence interval, 0.41‐1.00). No tool was used to improve prescribing quality. Conclusion: The GAI is the most frequently used tool to assess guideline adherence in HF. High GAI is associated with improved HF outcomes
Medication and fitness to drive

Producción CientíficaPurpose The aim of this study is to analyze the consumption patterns of medicaments among motor vehicle drivers who
attend ‘Medical Driving Test Centres’ and the relation between habitual consumption of medicaments and fitness to drive.
Methods The study was carried out on 8043 drivers who attended 25 Medical Driving Test Centres.
Results 24.7% of drivers chronically consume medicaments while 6.8% consume medicaments along with alcohol every
day. Of those who chronically consume medicaments with a warning about the medications on driving, 65.8% were considered
‘fit’ to drive, 27.3% ‘fit with restrictions’, 5.1% ‘suspended’ and 0.4% ‘unfit’.
Conclusions The results show how frequent the consumption of medicaments along with alcohol is and that the great
majority of drivers who take medicaments are considered fit to drive
Tools for multiaxial validation of behavior laws chosen for modeling hyper-elasticity of rubber-like materials

International audienceWe present an experimental approach to discriminate hyper-elastic models describing the mechanical behavior of rubber-like materials. An evaluation of the displacement field obtained by digital image correlation allows us to evaluate the heterogeneous strain field observed during these tests. We focus on the particular case of hyper-elastic models to simulate the behavior of some rubber-like materials. Assuming incompressibility of the material, the hyper-elastic potential is determined from tension and compression tests. A biaxial loading condition is obtained in a multiaxial testing machine and model predictions are compared with experimental results
Ejection force of tubular injection moldings. Part II : a prediction model

The integrated knowledge of the injection molding process
and the material changes induced by processing is
essential to guarantee the quality of technical parts. In
the case of parts with deep cavities, quite often the
ejection phase of the molding cycle is critical. Thus, in
the mold design stage, the aspects associated with the
ejection system will require special consideration. In
particular, the prediction of the ejection force will contribute
to optimizing the mold design and to guarantee
the integrity of the moldings. In this work, a simulation
algorithm based on a thermomechanical model is described
and their predictions are compared with experimental
data obtained from a fully-instrumented mold
(pressure, temperature, and force). Three common thermoplastics
polymers were used for the tubular moldings:
a semicrystalline polypropylene and two amorphous
thermoplastics: polystyrene and polycarbonate.
The thermomechanical model is based on the assumption
of the polymer behavior changing from purely viscous
to purely elastic below a transition point. This point
corresponds to solidification determined by temperature
in the case of amorphous materials and by critical crystallinity
for semicrystalline polymers. The model results
for the ejection force closely agree with the experimental
data for the three materials used
Film extrusion of sunflower protein isolate

Film extrusion of sunflower protein isolate (SFPI) was studied. The influence of die temperature (85 to 160°C), water and glycerol contents were investigated through appearance, mechanical and thermo-mechanical properties and swelling behavior in water of films. It was demonstrated that highest temperature, well above SFPI denaturation temperature in the compound, highest glycerol content (70 parts for 100 parts of SFPI) and medium water content (20 parts for 100 parts of SFPI) gave the most regular and smoothest film (as seen on SEM micrographs). Its ultimate tensile strength, Young’s modulus and strain at break were respectively: 3.2 MPa, 17.7 MPa and 73%. Soaked in water, its swelling was about 186% w/w but the film was quiet insoluble. Effect of temperature and plasticizer content were discussed in relation to the kinetic of SFPI denaturation. These first results are very promising for the development of biodegradable protein-based films
Wear of poly (methyl methacrylate) against a metallic surface in dry conditions

International audienceWear of Poly (methyl methacrylate), PMMA, against a metallic surface, AISI 316L stainless steel (SS) has been investigated in dry conditions. These materials have been used to simulate the degradation of the contact, femoral stem-bone cement in the field of hip prosthesis. First of all, no significant wear was observed on the 316L SS. PMMA wear has been quantified: the energy wear coefficient, slope of the line, and wear volume according to the cumulated dissipated energy, don't depend on the normal load, FN. This energy analysis allows predicting the PMMA wear depth. According to the comparison between the measured dissipated energy and the energy breaking polymer chains, mechanical dissipated energy is used essentially to transform third body structure and to expel it from the contact between the two materials. Moreover, the experimental results have highlighted the stick-slip phenomenon. Lastly, Attenuated Total Reflectance-Fourier Transform InfraRed and Reflection Absorption-Fourier Transform InfraRed have shown that PMMA debris configuration and conformation have changed after wear against 316L SS. The driving force of these changes seems to be the acid-base interactions between PMMA and hydroxyl groups of the SS surface
Processability studies of silica-thermoset polymer matrix nanocomposites

The aim of this study is to investigate the processability of silica-thermoset polymer matrix nanocomposites in terms of dispersion of silica nanoparticles and their effect on curing. Two thermosetting resins were considered, an epoxy and a polyester resin, with 5 % silica, although 1% silica was also used in preliminary studies in the polyester system. Various combinations of mechanical mixing and sonication were investigated for the dispersion of silica nanoparticles under different processing conditions and times in solvent-free and solvent-containing systems. It was found that the best dispersion route involved a solvent-aided dispersion technique. Consequently, different procedures for the solvent removal were investigated. Optical microscopy and SEM were used to characterize the resulting nanocomposites. DSC and rheological DMTA tests demonstrated that the silica nanoparticles shorten the gel time and promote curing in these thermosetting systems
Microstructure changes in poly(ethylene terephthalate) in thick specimens under complex biaxial loading

International audienceWe present an experimental investigation into the strain-induced crystalline microstructure, under biaxial elongation in Polyethylene terephthalate (PET). The aim of our study is to achieve both mechanical tests representative from the blow-moulding process, and micro- structural measurements. We therefore examine how the microstructure of a polymer subjected to a complex strain field evolves in terms of its crystalline ratio, its molecular orientation and the size of its crystallites. PET injection-moulded thick specimens were subjected to bi-axial elongation tests, both equibiaxial and sequential, using several elongation speeds, draw ratios and temperatures (above and close to Tg). The strain field was determined using a home-developed image correlation technique that allowed us to identify all the strain components at each point of the specimen, even when the strain field was not homogeneous. After the completion of the strain path, the specimens were either quenched at room temperature or cooled down very quickly using liquid nitrogen, in order to dissociate the contribution of stretching from that of relaxation. Microstructure observations were achieved by means of differential densimetry and WAXD (Wide Angle X-ray Diffraction) using a synchrotron beam. The results obtained confirm the strong link between the stress tensor and the crystals orientation and the crucial influence of molecular orientation on final microstructure (crystalinity ratio, crystals morphology)
Multiscale Roughness Analysis in Injection-Molding Process

The roughness of polymer surfaces is often investigated to guarantee both the surface integrity and the surface functionality. One of the major problems in roughness measurement analyses consists in determining both the evaluation length and the reference line (i.e., the degree of the polynomial equation) from which roughness parameters are computed. This article outlines an original generic method based on the generalized analysis of variance and experimental design methodology for estimating the most relevant roughness parameter p, the most pertinent scale, s, and finally, the degree of the polynomial fitting, d. This methodology is then applied to characterize the influence of four process parameters on the final roughness of poly(polypropylene) samples obtained by injection molding. This method allows us to determine the most efficient triplet (p, s, d) that best discriminates the effect of a process parameter q. It is shown that different (p, s, d) values are affected to each process parameter giving finally the scale on which each process parameter modifies the roughness of a polymeric surface obtained by injection molding. POLYM. ENG. SCI., 2008. © 2008 Society of Plastics Engineer
A Modeling Approach to the Effect of Resin Characteristics on Parison Formation in Extrusion Blow Molding

The most critical stage in the extrusion blow-molding process is the parison formation, as the dimensions of the blow-molded part are directly related to the parison dimensions. The swelling due to stress relaxation and sagging due to gravity are strongly influenced by the resin characteristics, die geometry, and operating conditions. These factors significantly affect the parison dimensions. This could lead to a considerable amount of time and cost through trial and error experiments to get the desired parison dimensions based upon variations in the resin characteristics, die geometry, and operating conditions. The availability of a modeling technique ensures a more accurate prediction of the entire blow-molding process, as the proper prediction of the parison formation is the input for the remaining process phases. This study considers both the simulated and the experimental effects of various high-density polyethylene resin grades on parison dimensions. The resins were tested using three different sets of die geometries and operating conditions. The target parison length was achieved by adjusting the extrusion time for a preset die gap opening. The finite element software BlowParison\uae was used to predict the parison formation, taking into account the swell and sag. Good agreements were found between the predicted parison dimensions and the experimental dataPeer reviewed: YesNRC publication: Ye
Needleless Electrospinning of nanofibers with a conical wire coil

In this article, we have demonstrated a novel needleless electrospinning of PVA nanofibers by using a conical metal wire-coil as spinneret. Multiple polymer jets were observed to generate on the coil surface. Up to 70 kV electric voltage can be applied to this needleless electrospinning nozzle without causing corona discharge. Compared with conventional needle electrospinning, this needleless electrospinning system produced finer nanofibers on a much larger scale, and the fiber processing ability showed a much greater dependence on the applied voltage. Finite element calculation indicates that the electric field intensity profiles for the two systems are also quite different. This novel concept of using wire coil as the electrospinning nozzle will contribute to the further development of new large-scale needleless electrospinning system for nanofiber production. <br /