Purpose
For any improvement tool to be successfully integrated into an organizations’ quality improvement or risk management programme, it needs to be relatively easy-to-use and proven to provide ...benefits to the customer and organization. Many healthcare organizations are facing fiscal constraints and increasing complexity of tests, putting strains on resources, particularly for those on “the shop floor” who are “hands on” in the design, delivery and improvement of products or services. Within a laboratory setting, there is often limited time for formal extensive process reviews; with the pressure to meet “turn-around times” for often “clinically urgent” results. Preventative and corrective actions are often identified through audits or root-cause analysis in some cases after an event has occurred. The paper aims to discuss these issues.
Design/methodology/approach
Failure modes effect analysis (FMEA) is a risk management tool, used to identify prospective failures within processes or products, before they occur. Within laboratory healthcare, risk management for prevention of failure (particularly an inaccurate result) is imperative, and underpins the design of all steps of sample handling. FMEA was used to review a laboratory process for a “gene mutation test” initially considered to have few opportunities for improvement. Despite this perception, a previous review of the process, and the time restrictions for review, new improvements were identified with implications to patient management.
Findings
This study shows that FMEA can yield benefits, for prospective risk management and general process improvement, within a laboratory setting where time and team input is restricted, and within a process that was considered to have few “problems”.
Originality/value
The study was undertaken in a large metropolitan public health system laboratory – one of the largest in the country. This laboratory is a significant contributor to the health outcomes of patients in the local region, and through its contribution to national laboratory testing and reporting. This was the first use of FMEA in this laboratory setting.
Context.
Strong lenses are extremely useful probes of the distribution of matter on galaxy and cluster scales at cosmological distances, however, they are rare and difficult to find. The number of ...currently known lenses is on the order of 1000.
Aims.
The aim of this study is to use crowdsourcing to carry out a lens search targeting massive galaxies selected from over 442 square degrees of photometric data from the Hyper Suprime-Cam (HSC) survey.
Methods.
Based on the S16A internal data release of the HSC survey, we chose a sample of ∼300 000 galaxies with photometric redshifts in the range of 0.2 <
z
phot
< 1.2 and photometrically inferred stellar masses of log
M
*
> 11.2. We crowdsourced lens finding on this sample of galaxies on the Zooniverse platform as part of the Space Warps project. The sample was complemented by a large set of simulated lenses and visually selected non-lenses for training purposes. Nearly 6000 citizen volunteers participated in the experiment. In parallel, we used Y
ATTA
L
ENS
, an automated lens-finding algorithm, to look for lenses in the same sample of galaxies.
Results.
Based on a statistical analysis of classification data from the volunteers, we selected a sample of the most promising ∼1500 candidates, which we then visually inspected: half of them turned out to be possible (grade C) lenses or better. By including lenses found by Y
ATTA
L
ENS
or serendipitously noticed in the discussion section of the Space Warps website, we were able to find 14 definite lenses (grade A), 129 probable lenses (grade B), and 581 possible lenses. Y
ATTA
L
ENS
found half the number of lenses that were discovered via crowdsourcing.
Conclusions.
Crowdsourcing is able to produce samples of lens candidates with high completeness, when multiple images are clearly detected, and with higher purity compared to the currently available automated algorithms. A hybrid approach, in which the visual inspection of samples of lens candidates pre-selected by discovery algorithms or coupled to machine learning is crowdsourced, will be a viable option for lens finding in the 2020s, with forthcoming wide-area surveys such as LSST,
Euclid
, and WFIRST.
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FMFMET, NUK, UL, UM, UPUK
•We present the first results from the Planet Four: Terrains online citizen science project.•Over 10,000 volunteers participated in the visual inspection of CTX (Context Camera) images.•Volunteers ...identified araneiforms, erosional features characteristic of the South Polar Residual Cap, and craters.•We present the distributions of the classic spider araneiforms and Swiss cheese terrain identifications in 90 CTX images.•High resolution imaging confirms the discovery of araneiforms at locations outside of the South Polar Layered Deposits.
We present the results of a systematic mapping of seasonally sculpted terrains on the South Polar region of Mars with the Planet Four: Terrains (P4T) online citizen science project. P4T enlists members of the general public to visually identify features in the publicly released Mars Reconnaissance Orbiter Context Camera (CTX) images. In particular, P4T volunteers are asked to identify: (1) araneiforms (including features with a central pit and radiating channels known as ‘spiders’); (2) erosional depressions, troughs, mesas, ridges, and quasi-circular pits characteristic of the South Polar Residual Cap (SPRC) which we collectively refer to as ‘Swiss cheese terrain’, and (3) craters. In this work we present the distributions of our high confidence classic spider araneiforms and Swiss cheese terrain identifications in 90 CTX images covering 11% of the South polar regions at latitudes ≤ −75° N. We find no locations within our high confidence spider sample that also have confident Swiss cheese terrain identifications. Previously spiders were reported as being confined to the South Polar Layered Deposits (SPLD). Our work has provided the first identification of spiders at locations outside of the SPLD, confirmed with high resolution HiRISE (High Resolution Imaging Science Experiment) imaging. We find araneiforms on the Amazonian and Hesperian polar units and the Early Noachian highland units, with 75% of the identified araneiform locations in our high confidence sample residing on the SPLD. With our current coverage, we cannot confirm whether these are the only geologic units conducive to araneiform formation on the Martian South Polar region. Our results are consistent with the current CO2 jet formation scenario with the process exploiting weaknesses in the surface below the seasonal CO2 ice sheet to carve araneiform channels into the regolith over many seasons. These new regions serve as additional probes of the conditions required for channel creation in the CO2 jet process.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract only
In recent years, the global abuse of synthetic designer drugs has rapidly increased to become a public health threat. Popularized under the term ‘bath salts,’ synthetic cathinones ...continue to be one of the most frequently abused classes of designer drugs. According to DEA statistics, bath salts commonly contain one or a mixture of the following synthetic cathinones, 3, 4‐methylenedioxypyrovalerone (MDPV), 4‐methylmethcathinone (mephedrone), and 3, 4‐methylenedioxymethcathinone (methylone). Although these compounds were permanently classified as schedule I controlled substances in the Synthetic Drug Abuse Prevention Act of 2012 (DEA, 2011), they are currently not controlled by international laws and abuse continues to thrive with internet serving as a central marketplace (Karila, et. al. 2015). Pharmacological research regarding synthetic cathinone abuse has primarily focused on the individual mechanisms and associated toxicities of MDPV, mephedrone, and methylone, despite DEA statistics and numerous case reports indicating that many of the frequently abused bath salt ‘brands’ contain various mixtures of these compounds (Araujo, et. al. 2015; DEA, 2011). Given the reported dissimilarities between MDPV, mephedrone, and methylone in regards to selectivity and mechanism of action at the dopamine transporter, it was hypothesized that chronic co‐exposure to the synthetic cathinones would produce significantly altered effects on dopaminergic tone as compared to individual exposure. Our previous work has demonstrated that repeated, combined exposure to MDPV, mephedrone, and methylone, induces significant reductions in dopamine (DA) within the nucleus accumbens (NAc), striatum (STR), substantia nigra pars compacta (SNpc), and ventral tegmental area (VTA) brain regions, a result that was not observed following chronic individual administration. The present study aims to correlate the observed DA depletions following co‐synthetic cathinone exposure with changes in the expression of key proteins involved in DA synthesis, storage, release, and uptake. For this study, adolescent male Swiss‐Webster mice were administered 10 mg/kg intraperitoneal injections of MDPV, mephedrone, or the cathinone cocktail (comprised of MDPV, mephedrone, and methylone) every other day for 14 days (7 injections total). Although the transporter selectivity profile for methylone is similar to mephedrone, releasing assays have shown that it is only half as potent at the dopamine transporter (DAT) and thus was not individually examined in this study (Baumann, et. al. 2012). Brains were removed and microdissections of the NAc, STR, SNpc, and VTA were collected 48 hours after the final exposure. Tissue expression levels of tyrosine hydroxylase (TH), monoamine oxidase B (MAO‐B), catechol‐O‐methyltransferase (COMT), dopamine transporter (DAT‐1) and vesicular monoamine transporter 2 (VMAT2), were determined using Protein simple western blot analysis. Our analyses revealed significantly reduced expression levels of these key proteins involved in DA synthesis, metabolism, and transport in all collected brain regions following repeated dosing of the cathinone cocktail. These data, along with our previous findings, suggest that chronic combined exposure to MDPV, mephedrone, and methylone may be toxic to dopaminergic neurons of the mesolimibic and nigrostriatal brain pathways.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The drug supply chain is global and at risk of disruption and subsequent drug shortages, especially during unanticipated events.
Our objective was to determine the impact of coronavirus disease 2019 ...(COVID-19) on drug purchases overall, by class, and for specific countries.
A cross-sectional time series analysis of country-level drug purchase data from August 2014 to August 2020 from IQVIA MIDAS was conducted. Standardized units per 100 population and percentage increase in units purchased were assessed from 68 countries and jurisdictions in March 2020 (when the World Health Organization declared COVID-19 a pandemic). Analyses were compared by United Nations development status and drug class. Autoregressive integrated moving average models tested the significance of changes in purchasing trends.
Before COVID-19, standardized medication units per 100 population ranged from 3990 to 4760 monthly. In March 2020, there was a global 15% increase in units of drugs purchased to 5309.3 units per 100 population compared with the previous year; the increase was greater in developed countries (18.5%; P < 0.001) than in developing countries (12.8%; P < 0.0001). After the increase in March 2020, there was a correction in the global purchase rate decreasing by 4.7% (April to August 2020 rate, 21,334.6/100 population; P < 0.001). Globally, we observed high purchasing rates and large changes for respiratory medicines such as inhalers and systemic adrenergic drugs (March 2020 rate, 892.7/100 population; change from 2019, 28.5%; P < 0.001). Purchases for topical dermatologic products also increased substantially (42.2%), although at lower absolute rates (610.0/100 population in March 2020; P < 0.0001). Interestingly, purchases for systemic anti-infective agents (including antiviral drugs) increased in developing countries (11.3%; P < 0.001), but decreased in developed countries (1.0%; P = 0.06).
We observed evidence of global drug stockpiling in the early months of the COVID-19 pandemic, especially among developed countries. Actions toward equitable distribution of medicines through a resilient drug supply chain should be taken to increase global response to future unanticipated events, such as pandemics.
This paper presents the development of a new organisational excellence model specifically for use by small and medium-sized enterprises (SME). A literature review was undertaken examining the current ...state of business excellence models, and their content and use worldwide, including the identification of the key concepts that drive their development and implementation. In this paper, we do present a framework that was validated by a worldwide experts' panel in Organisational Excellence, taking into consideration the unique characteristics of SME and its industry contexts. It is hoped that the model will allow these enterprises to strive towards organisational excellence using a framework that better fits to their context and needs.
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BFBNIB, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
Rising health care spending has sparked new efforts to constrain health care expenditures.
To explore how health care spending is distributed across consumers and how utilization patterns compare ...across health care resource expenditures (eg, hospital, outpatient care).
Using the IQVIA PharMetrics Plus database, we conducted a retrospective claims analysis for the 2018 plan year to examine commercial health care spending and utilization across 5 settings of care: ambulatory services, inpatient services, office visits, pharmacy services, and additional services.
Consistent with findings from previous analyses of total health spending, total health care spending for a large commercially insured population was largely concentrated within a small population of high-intensity consumers. These patterns persist when looking at individual segments of spending, including spending on prescription drugs and inpatient and ambulatory services. Inpatient spending was the most concentrated, with 97% of spending occurring within the top tenth percentile of patients.
Our findings suggest that health care spending for commercial plans is predominantly concentrated within a small population of high-intensity consumers across all settings of care. Curbing rising health care spending will require systemwide evaluation of the value of spending within and across settings of care for a subset of high-resource-use patients. This is particularly important for health care settings with the highest concentration of spending, including inpatient care.
This study was funded by the National Pharmaceutical Council (NPC). Ciarametaro, Buelt, and Dubois are employed by the NPC. Kleinrock and Campbell are employed by IQVIA, which was contracted by the NPC for data analysis.
The objective of this study is to identify county-level characteristics that may be high-impact targets for opioid and antibiotic interventions to improve dental prescribing.
Prescriptions during ...2012–2017 were extracted from the IQVIA Longitudinal Prescription database. Primary outcomes were yearly county-level antibiotic and opioid prescribing rates. Multivariable negative binomial regression identified associations between prescribing rates and county-level characteristics. All analyses occurred in 2020.
Over time, dental opioid prescribing rates decreased by 20% (from 4.02 to 3.22 per 100 people), whereas antibiotic rates increased by 5% (from 6.85 to 7.19 per 100 people). Higher number of dentists per capita, higher proportion of female residents, and higher proportion of residents aged <65 years were associated with increased opioid rates. Relative to location in the West, location in the Northeast (59%, 95% CI=52, 65) and Midwest (64%, 95% CI=60, 70) was associated with lower opioid prescribing rates. Higher clinician density, median household income, proportion female, and proportion White were all independently associated with higher antibiotic rates. Location in the Northeast (149%, 95% CI=137, 162) and Midwest (118%, 95% CI=111, 125) was associated with higher antibiotic rates. Opioid and antibiotic prescribing rates were positively associated.
Dental prescribing of opioids is decreasing, whereas dental antibiotic prescribing is increasing. High prescribing of antibiotics is associated with high prescribing of opioids. Strategies focused on optimizing dental antibiotics and opioids are needed given their impact on population health.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract only
Synthetic cathinones, marketed as ‘bath salts’, are an emerging class of highly addictive designer drugs that can precipitate dangerous health effects when abused. DEA statistics and ...case reports indicate the three most commonly abused cathinones, 3, 4‐methylenedioxypyrovalerone (MDPV), 4‐methylmethcathinone (mephedrone), and 3, 4‐methylenedioxymethcathinone (methylone), are frequently found in combination with each other or with other illicit substances. Previous findings indicate that synthetic cathinones have analogous pharmocology to cocaine, the amphetamines, and MDMA. While much of the current ‘bath salt’ research has focused on elucidating the individual drug mechanisms, this study aimed to determine the individual and combined effects of MDPV, mephedrone, and methylone on monoaminergic tone in various brain regions. For this study, Swiss‐Webster mice were administered saline (control) or MDPV, mephedrone, or methylone individually or in combination at both low (1mg/kg) and high (10mg/kg) doses. Four groups were examined for each dose: 1) Acute individual cathinones; 2) Acute combined cathinones; 3) Chronic individual cathinones; 4) Chronic combined cathinones, and the following brain regions were collected from each mouse: frontal cortex (FCTX), striatum (STR), nucleus accumbens (NAC), hippocampus (HIP), substantia nigra (SN), and ventral tegmental area (VTA). High performance liquid chromatography (HPLC) equipped with electrochemical detection (ECD) was utilized to measure tissue concentrations of of monoamines (DA, NE, 5‐HT) and their metabolites (DOPAC, HVA, and 5‐HIAA). A number of differences were noted amongst the groups. Generally, acute individual exposure to cathinones (group 1) increased DA, NE, 5‐HT levels and decreased DA and 5‐HT turnover in certain brain regions, and a dose‐response relationship was observed. Following acute administration of MDPV, mephedrone, and methylone in combination (group 2), similar increases in monoamine levels and decreases in DA and 5‐HT turnover were observed, but in many regions, the combination treatment showed an additive effect (greater decreases in turnover compared to individual cathinones). Interestingly, chronic exposure to individual cathinones (group 3) appeared to have the opposite effect, decreasing monoamine levels and increasing DA and 5‐HT turnover in certain regions; however, while chronic combination treatment appeared to increase turnover as well, it did so to a lesser extent than individual chronic cathinone treatment. Taken together, these data suggest that synthetic cathinones individually function to decrease DA turnover within the brain reward pathway when delivered acutely and to increase both DA turnover and 5‐HT turnover in major serotonergic and dopaminergic targets, respectively, following chronic exposure. These data also suggest that combined administration of these drugs may intensify their associated neurochemical effects via a sustained increase in DA and 5‐HT in various brain regions.
Support or Funding Information
This project was supported by the Department of Pharmaceutical Sciences at the East Tennessee State University Bill Gatton College of Pharmacy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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