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John Alimamy Kabba,1– 3 Peter Bai James,4,5 Zongjie Li,1– 3 Christian Hanson,6,7 Jie Chang,1– 3 Chenai Kitchen,1– 3 Minghuan Jiang,1– 3 Mingyue Zhao,1– 3 Caijun Yang,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 3Shaanxi Center for Health Reform and Development Research, Xi’an, People’s Republic of China; 4Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; 6Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone; 7Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USACorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, People’s Republic of ChinaTel +86 29 82655132Email yufang@mail.xjtu.edu.cnPurpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.Materials and Methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.Keywords: prescribing pattern, rational drug use, drug utilisation, free healthcare, Sierra Leone

Corrine Hanson,1 Erica P Rutten,2 Emiel FM Wouters,2,3 Stephen Rennard41Division of Medical Nutrition Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA; 2Research and Education, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; 3Department of Pulmonary Diseases, University of Maastricht, Maastricht, The Netherlands; 4Division of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USAAbstract: The global increase in the prevalence and incidence of obesity has called serious attention to this issue as a major public health concern. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Independently of obesity, diet also plays a role as a risk factor for many chronic diseases, and evidence is accumulating to support a role for diet in the prevention and management of several lung diseases. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and diet appear to play roles in its pathophysiology. Obesity has been associated with decreased lung-function measures in population-based studies, with increased prevalence of several lung diseases and with compromised pulmonary function. In contrast, obesity has a protective effect against mortality in severe chronic obstructive pulmonary disease (COPD). Nutrient intake and dietary patterns have also been associated with lung-function measures and the development and progression of COPD. Taken together, this suggests that a focus on obesity and diet should be part of public health campaigns to reduce the burden of lung disease, and could have important implications for clinicians in the management of their patients. Future research should also focus on elucidating these relationships in diverse populations and age-groups, and on understanding the complex interaction between behavior, environment, and genetics in the development and progression of COPD. The goal of this article is to review current evidence regarding the role that obesity and diet play in the development of COPD, and in COPD-related outcomes.Keywords: diet, obesity, nutrition, lung function, COPD

Inertial waves occur naturally in rotating fluids such as the Sun and the Earth's atmosphere. Rossby waves in the Sun have the potential to shed fresh light on interior turbulence and convection that prior seismic methods, reliant on sound waves, have been unable to accomplish. Here, we utilize ∼13 years of observational products taken by the space-based helioseismic and magnetic imager, onboard the solar dynamics observatory, to characterize solar equatorial Rossby waves. By examining maps of motions at the surface using two different methods, we are able to identify Rossby modes up to azimuthal order m = 30, approximately up to twice the spatial wavenumber limit of previous studies. The dispersion relation of these modes departs significantly from the classical two-dimensional Rossby-Haurwitz description. A parameter study of the effect of superadiabaticity and viscous diffusion on these inertial modes indicates that each parameter plays a role in influencing both the frequencies and linewidths of high m modes. Using the Rhines-scale relation, we constrain the root mean square amplitude of turbulent convection more tightly to ∼ 2 m/s, adding more evidence to the paradigm of weakly convective amplitudes at large scales. [ABSTRACT FROM AUTHOR]

In chronic lymphocytic leukemia (CLL) the level of minimal residual disease (MRD) after therapy is an independent predictor of outcome. Given the increasing number of new agents being explored for CLL therapy, using MRD as a surrogate could greatly reduce the time necessary to assess their efficacy. In this European Research Initiative on CLL (ERIC) project we have identified and validated a flow-cytometric approach to reliably quantitate CLL cells to the level of 0.0010% (10(-5)). The assay comprises a core panel of six markers (i.e. CD19, CD20, CD5, CD43, CD79b and CD81) with a component specification independent of instrument and reagents, which can be locally re-validated using normal peripheral blood. This method is directly comparable to previous ERIC-designed assays and also provides a backbone for investigation of new markers. A parallel analysis of high-throughput sequencing using the ClonoSEQ assay showed good concordance with flow cytometry results at the 0.010% (10(-4)) level, the MRD threshold defined in the 2008 International Workshop on CLL guidelines, but it also provides good linearity to a detection limit of 1 in a million (10(-6)). The combination of both technologies would permit a highly sensitive approach to MRD detection while providing a reproducible and broadly accessible method to quantify residual disease and optimize treatment in CLL.

Although KITD816V occurs universally in adult systemic mastocytosis (SM), the clinical heterogeneity of SM suggests presence of additional phenotype-patterning mutations. Because up to 25% of SM patients have KITD816V-positive eosinophilia, we undertook whole-exome sequencing in a patient with aggressive SM with eosinophilia to identify novel genetic alterations. We conducted sequencing of purified eosinophils (clone/tumor sample), with T-lymphocytes as the matched control/non-tumor sample. In addition to KITD816V, we identified a somatic missense mutation in ethanolamine kinase 1 (ETNK1N244S) that was not present in 50 healthy controls. Targeted resequencing of 290 patients showed ETNK1 mutations to be distributed as follows: (i) SM (n=82; 6% mutated); (ii) chronic myelomonocytic leukemia (CMML; n=29; 14% mutated); (iii) idiopathic hypereosinophilia (n=137;

Massively Parallel Supercomputers are once again quickly outpacing our ability to organize, manage and understand the prodigious amounts of data they generate. Graphics technology and algorithms have greatly aided in analyzing the modest datasets of years past, but rarely with enough interactivity to squelch the enduser's exploratory questions. Will computer graphics and scientific visualization or even computional science proceed as status quo or are new paradigm sifts needed? What is the architecture of tomorrow's high-end visualization systems? How much data can we even expect to pull off of these masively parallel machines? What are the new computer graphics technologies that can aid in teracale visulaization? This panel, leverging the panelists past experience and their current knowledge of the field, will provide visions (or dilemma's) for what the next stage or stages of scientific visualization and data management will look like.