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In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.
Placebo research investigated the underlying mechanisms of placebo effects, but they are rarely used to optimize treatments. Ethical and legal concerns have been raised, but research demonstrated that placebo mechanisms can be used without patients’ deception: Experimental studies showed that half of drugs in treatment of attention-deficit/hyperactivity disorder (ADHD) combined with open-label placebos could be as effective as standard medication to reduce ADHD symptoms.
To estimate the health economic advantages of harnessing the combination of open-label placebos with standard medication in ADHD.
For preliminary estimation of the mean treatment costs, the 12-months prevalence of ADHD in children and adolescents aged 5 to 14 years as well as the percentage of medication treatments were extracted from the literature. Mean treatment costs per patient and year were calculated for four treatment plans (different drugs and dosages) with both treatment with standard medication and half of drugs in combination with placebos.
A 12-months prevalence of 4.3% equals around 260,000 children and adolescents with a compulsory health insurance in Germany. Of those, around 40-50% are equally treated with two standard drugs and two different dosages. Full standard drug treatments cost around 119 million EUR, and treatment with half of drugs in combination with placebos cost around 66 million EUR.
The combination of open-label placebos with half of standard medication could considerably reduce health costs. Reduction of side effects still must be considered. However, current studies are of experimental nature and lasted for no longer than two weeks.
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework’s major proposition is that it situates D&I sciences as targeted “sub-sciences” of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
Background and objective: Quality of acute pain management is far from being satisfactory. These deficits are not caused by the complexity of the medical problem but by difficulties in organization and hospital structures, sand procedures. Continuous quality improvement is a recommended tool to overcome such difficulties and to increase quality in the long run. This study reports the implementation of benchmarking-based continuous quality improvement to improve postoperative pain management at a university hospital. Methods: A specialised pain nurse interviewed patients of three surgical departments on the first day after surgery, and continuously assessed process and outcome quality parameters. A multidisciplinary team of anaesthetists, surgeons, nurses and pharmacists implemented a regular procedure of data analysing and internal benchmarking. Results and suggested improvements were fed back to the healthcare teams. Results: From 1998 to 2002, 6756 patients were assessed. Average pain on ambulation and maximal pain were 3.7 ± 2.4 and 5.0 ± 2.5 (mean ± SD) on a 11-point numeric rating scale. Pain intensity at rest was 1.9 ± 1.8. Over time, pain intensity on ambulation decreased (P = 0.022) whereas maximal pain and pain at rest remained unchanged. There was an increase in the number of patients who received non-opioid analgesia (P < 0.001). Conclusions: A continuous quality improvement process could be established and is now successfully used in clinical routine. Cornerstones of this project were frequent assessments of process and outcome parameters, regular benchmarking and implementation of feedback mechanisms. Changes in organization of medical management and multidisciplinary teamwork seem to be more important than medical or technical aspects.
Collective excitations, such as plasmons, rotons, electron-hole liquid, and excitonic Molecules, have been extensively studied in condensed Matter.1 Wannier excitons in inorganic semiconductors are bound by the exchange interactions between two electrons of the exciton, and the bound state of More than two excitons is not possible. We demonstrate here a new type of collective excitations,2 bound states of Multiple charge-transfer (CT) excitons. Coulomb interactions in one dimension are shown to bind a train of several (More than two) CT excitons. Experimental evidence for these new type of elementary excitations is reported in a quasi-one-dimensional CT crystal of anthracene PMDA. High density excitation by femtosecond light pulses generates Multi-exciton chains, which we refer to as excitonic n-strings with n = 1, 2, 3, etc., along the stack axis of the crystal. Both the n = 2 excitonic string (biexciton) and the n = 3 string (tri-exciton) are observed. This report provides evidence for an n > 2 exciton chain in this system.2 The stability of the n-string exciton is supported by our theoretical calculations based on the extended Hubbard Hamiltonian in one dimension.
The formation of Pd-Ge layers was studied as a function of deposition and annealing using synchrotron Ultraviolet Photoemission Spectroscopy (UPS). Pd depositions ranging in thickness from 0.5 monolayers (ML) to 44 ML were examined in-situ on Ge (111) cleaved in ultra-high vacuum. The primary reaction components appear to be Pd2Ge and PdGe. Comparison of bulk and surface sensitive Ge 3d core levels for even the highest coverages indicates that Ge segregates to the surface at room temperature. Such low temperature segregation suggests that Ge can diffuse via a rapid diffusion mechanism.
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