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INTRODUCTION: The implementation of new drug safety information and Direct Healthcare Professional Communications (DHPCs) in hospitals is important for patient safety.OBJECTIVES: The aim of this study was to gain insight into which procedures and practices are in place to handle new drug safety information and particularly DHPCs in the Dutch hospital setting.METHODS: We first conducted focus groups including medical specialists and hospital pharmacists, focusing on handling of drug safety information at the individual and organisational level. A survey was then developed and distributed among hospital pharmacists in all Dutch hospitals to quantify the existence of specific procedures and committees to handle drug safety information and DHPCs.RESULTS: Eleven specialists and 14 pharmacists from six hospitals participated in focus groups. Drug safety information was usually considered before drugs were included in formularies or treatment protocols. Furthermore, drug safety information was consulted in response to patients experiencing adverse events. DHPCs were mostly dealt with by individual professionals. DHPCs could lead to actions but this was very uncommon. Completed surveys were received from 40 (53%) of the hospitals. In 32 (80%), the hospital pharmacy had procedures to deal with new drug safety information, whereas in 11 (28%) a hospital-wide procedure was in place. Drug safety was considered in committees concerning drug formulary decisions (69%) and antibiotic policies (63%). DHPCs were assessed by a hospital pharmacist in 50% of the hospitals.CONCLUSIONS: Drug safety information was used for evaluation of new treatments and in response to adverse events. Assessment of whether a DHPC requires action was primarily an individual task.

Human capital management is a complex and often misunderstood concept for today's military organization, which requires planning for accession, talent competition and cost controls within a dynamic environment. Throughout history, the manpower required to maintain a standing military during peacetime has always been subject to a combination of the external and internal effects of competing interests over budgetary concerns and the military requirement to support national strategy. Management science has shown how to design and implement the most effective policies, but in today's dynamic environment containing emerging threats and economic opportunity, military manpower struggles to meet strategic goals. This thesis fills a gap in the literature by examining human capital management from a warfare design perspective, with a systems approach interplay to address specific resource constraints and courses of action. Senior Master Sergeant, United States Air Force Approved for public release. Distribution is unlimited.

Brief overviewCurrent evidence suggests that Echinacea supplementation may decrease the duration and severity of acute respiratory tract infections; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Few adverse events were reported, suggesting that this herbal therapy is reasonably safe. Because Echinacea can increase immune function, there is a concern that it could worsen over-activation of the immune system in cytokine storm; however, clinical trials show that Echinacea decreases levels of immune molecules involved in cytokine storm.VerdictEchinacea supplementation may assist with the symptoms of acute respiratory infections (ARI) and the common cold, particularly when administered at the first sign of infection; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Previous studies have reported that Echinacea may decrease the severity and/or duration of ARI when taken at the onset of symptoms. The studies reporting benefit used E. purpurea or a combination of E. purpurea and E. angustifolia containing standardized amounts of active constituents.Few adverse events from the use of Echinacea were reported, suggesting that this herbal therapy is reasonably safe. No human trials could be located reporting evidence of cytokine storm when Echinacea was used for up to 4 months.When assessing all human trials which reported changes in cytokine levels in response to Echinacea supplementation, the results were largely consistent with a decrease in the pro-inflammatory cytokines that play a role in the progression of cytokine storm and Acute Respiratory Distress Syndrome (ARDS), factors that play a significant role in the death of COVID-19 patients. While there is currently no research on the therapeutic effects of Echinacea in the management of cytokine storm, this evidence suggests that further research is warranted.

International audience; Our study is therefore interested in a detailed characterization of the different zones within the Cuvette according to their flood dynamics using radar data. Two sensors were used: the PALSAR-2 image sensor from the JAXA ALOS satellite, and the Jason-2 satellite Poseidon altimeter radar sensor jointly developed by NASA and CNES. The use of high-resolution time series (25 m) from the ALOS PALSAR-2 sensor allowed a first characterization of the different zones according to their flooding over time. A second characterization was performed by analyzing time-series of radar altimetry-based water levels automatically generated from the Ku-band backscattering from Jason-2. This second analysis allowed not only to support the characterization coming from the image SAR data but also to provide information concerning the shape of the flood wave. The results given in this study were then compared to the results from the earlier studies performed over the Congo « Cuvette Centrale » using PALSAR-1 and 2 images to discuss it.

Background: The American Thyroid Association (ATA) recommended the establishment of population specific reference ranges for thyroid hormones during pregnancy. Initial studies conducted in the United Arab Emirates (UAE) in 2003 and 2004 on pregnant women published a considerably higher upper limit for thyroid stimulating hormone (TSH) than that proposed by ATA. The UAE was classified as a country with mild iodine deficiency at the time of this initial study. After the implementation of aggressive strategies to address iodine deficiency over the last decade, the UAE was recently declared as iodine sufficient. The current study re-evaluates the reference intervals for thyroid hormones for pregnant women in the UAE after the declaration of iodine sufficiency status. Methods: TSH and free thyroxin (FT4) from 414 UAE national pregnant females were analyzed to determine trimester specific reference ranges. Results: The upper limits of the TSH reference ranges were found to be significantly lower than previously reported, but still higher than those recommended by ATA in 2011.FT4 reference ranges were found to be slightly lower than previously reported. Conclusion: TSH trimester specific reference ranges in UAE national pregnant women are higher than those recommended by ATA in 2011 but in keeping with the latest guidelines published in 2017. This should be considered while interpreting thyroid function tests in this population. Further studies including urinary iodine measurement, body mass index and larger numbers per partition in this population are recommended. Keywords: Reference intervals, Gestation, Thyroid stimulating hormone, Pregnancy, Free thyroxin

Introduction: Excessive use of pesticides in agriculture is a major risk to respiratory health, especially for rural population. Sao Jose de Uba (SJU) is a small community and has its economy based...

About 90% of persons aged 55 and older would prefer to stay in their current residences as long as possible because older adults value their independence. However, aging-in-place is not always a choice. Recently, the Dutch government tightened the criteria for older adults to be admitted in a nursing home. Throughout the past 5 years TNO was requested by the trade association for building service contractors in the Netherlands to develop a number of tools for building service professionals. The 'dwelling check' was developed as a 'basic' check on the possibility for aging-in-place. A pilot study was conducted to assess the added value of the dwelling check for older adults. During this pilot study the occupants of over 200 dwellings were interviewed by 11 building services contractors using the dwelling check. Based on these interviews a personal advice was written. After which the interviewees were asked to evaluate this service, comprising the interview and written advice. The dwelling check contributed most to the awareness of and interest in possible alterations for aging-in-place. In a few cases the decision (17%) or even action (5%) was taken to make alterations. Overall the dwelling check was rated 8 out of 10 by the interviewees and may therefore be considered of added value.

Scenarios are used as tools in the development of smart home platforms and middleware for aging-in-place. In order to be effective, a set of scenarios that address all required functionalities are needed. The health condition of the majority of an aging population has been described by medical tools, such as WHO's International Classification of Functioning, Disability and Health (ICF) and local health profiles. However, this has not yet been fully implemented in the development of smart-homes. In this study we develop a Public Health Methodology (PHM) in which we use public health resources for the generation of scenarios. Specific user characteristics are taken from the medical tools. Common daily user activities were supplied by research into common activities as practiced by Dutch end-users. A functional scenario is generated by combining the user characteristics and user activities with the product goal, the physical and non-physical environment, and the product to be developed. Using this method a set of 10 scenarios covered all requirements. The scenarios were used in virtual tests for the validation of smart-home platforms. PHM is a promising tool in the development of smart environments that are more easily adopted by aging populations.

We examined mercury concentrations in three fish assemblages to estimate biomagnification rates in the Itenez main river, affected by anthropogenic activities, and two unperturbed rivers from the Itenez basin, Bolivian Amazon. Rivers presented low to moderate water mercury concentrations (from 1.25 ng L-1 to 2.96 ng L-1) and natural differences in terms of sediment load. Mercury biomagnification rates were confronted to trophic structure depicted by carbon and nitrogen stable isotopes composition (delta N-15; delta C-13) of primary trophic sources, invertebrates and fishes. Results showed a slight fish contamination in the Itenez River compared to the unperturbed rivers, with higher mercury concentrations in piscivore species (0.15 mu g g(-1) vs. 0.11 mu g g(-1) in the unperturbed rivers) and a higher biomagnification rate. Trophic structure analysis showed that the higher biomagnification rate in the Itenez River could not be attributed to a longer food chain. Nevertheless, it revealed for the Itenez River a higher contribution of periphyton to the diet of the primary consumers fish species; and more negative delta C-13 values for primary trophic sources, invertebrates and fishes that could indicate a higher contribution of methanotrophic bacteria. These two factors may enhance methylation and methyl mercury transfer in the food web and thus, alternatively or complementarily to the impact of the anthropogenic activities, may explain mercury differences observed in fishes from the Itenez River in comparison to the two other rivers.