Standardized direct oral anticoagulants prescription for treatment of acute venous thromboembolism in the emergency department: A quality improvement initiative.

INTRODUCTION: Direct oral anticoagulants (DOACs) are commonly used for the treatment and prevention of venous thromboembolism (VTE). However, prescription errors with DOACs can lead to patient dissatisfaction and harm. This study aimed to evaluate the impact of a standardized prescription for DOACs for VTE on prescription appropriateness. MATERIALS AND METHODS: The study included patients discharged from the Emergency Department (ED) with a DOAC prescription for an acute VTE. A standardized prescription tool was developed and implemented, and patients were divided into pre- and post-intervention groups. The appropriateness of prescriptions was assessed using the Medication Appropriateness Index (MAI). RESULTS: A total of 161 patients with VTE were included in the study. The post-intervention group showed a significant increase in prescriptions with an MAI rating of "appropriate" and a decrease in ratings of "inappropriate." Improvements were observed in loading dose duration, maintenance dose frequency and duration, and inclusion of necessary drug coverage codes. CONCLUSION: The implementation of a standardized prescription for DOACs in the management of VTE in the ED significantly improved medication appropriateness and reduced inappropriate prescriptions. Standardized prescriptions have the potential to enhance patient safety and optimize care by providing clear and uniform guidance to healthcare providers. Further research is needed to explore the effectiveness of medication prescription software systems in real-world clinical settings to improve prescribing practices.

Beam and installation improvements of the NIO1 ion source.

The NIO1 (Negative Ion Optimization phase 1) source can provide continuous beam operation, which is convenient for systematic parameter and equipment studies. Even in the pure volume production regime, the source yield was found to depend on conditioning procedures. Magnetic configuration tests continued adding magnets to the existing setup; the filter field component Bx has been progressively extended to span the -12 to 5 mT range, and as a trend, source performances improved with |Bx|. The progress of camera beam diagnostics and of the quality of the volume-produced H- beam is also shown. The status, off-line results, and reliability of a first NIO1 cesium oven are discussed; other upgrades in preparation (cavity ring down spectrometer, the end calorimeter, and conceptual tests of the energy recovery system) are also listed.

Final design of the beam source for the MITICA injector.

The megavolt ITER injector and concept advancement experiment is the prototype and the test bed of the ITER heating and current drive neutral beam injectors, currently in the final design phase, in view of the installation in Padova Research on Injector Megavolt Accelerated facility in Padova, Italy. The beam source is the key component of the system, as its goal is the generation of the 1 MeV accelerated beam of deuterium or hydrogen negative ions. This paper presents the highlights of the latest developments for the finalization of the MITICA beam source design, together with a description of the most recent analyses and R&D activities carried out in support of the design.

Steady state thermal-hydraulic analyses of the MITICA cooling circuits.

Megavolt ITER Injector Concept Advancement is the full scale prototype of the heating and current drive neutral beam injectors for ITER, to be built at Consorzio RFX (Padova). The engineering design of its components is challenging: the total heat loads they will be subjected to (expected between 2 and 19 MW), the high heat fluxes (up to 20 MW/m(2)), and the beam pulse duration up to 1 h, set demanding requirements for reliable active cooling circuits. In support of the design, the thermo-hydraulic behavior of each cooling circuit under steady state condition has been investigated by using one-dimensional models. The final results, obtained considering a number of optimizations for the cooling circuits, show that all the requirements in terms of flow rate, temperature, and pressure drop are properly fulfilled.

Castellated tiles as the beam-facing components for the diagnostic calorimeter of the negative ion source SPIDER.

This paper presents the results of numerical simulations and experimental tests carried out to assess the feasibility and suitability of graphite castellated tiles as beam-facing component in the diagnostic calorimeter of the negative ion source SPIDER (Source for Production of Ions of Deuterium Extracted from Radio frequency plasma). The results indicate that this concept could be a reliable, although less performing, alternative for the present design based on carbon fiber composite tiles, as it provides thermal measurements on the required spatial scale.

First negative ion beam measurement by the Short-Time Retractable Instrumented Kalorimeter Experiment (STRIKE).

The Source for Production of Ion of Deuterium Extracted from Rf plasma (SPIDER) test facility is under construction in Padova to optimise the operation of the beam source of ITER neutral beam injectors. The SPIDER beam will be characterised by the instrumented calorimeter STRIKE, whose main components are one-directional carbon-fibre-carbon-composite tiles. A small-scale version of the entire system has been employed in the BAvarian Test MAchine for Negative ions (BATMAN) testbed by arranging two prototype tiles in the vertical direction. The paper presents a description of the mini-STRIKE system and of the data analysis procedures, as well as some results concerning the BATMAN beam under varying operating conditions.

Diagnostics of the ITER neutral beam test facility.

The ITER heating neutral beam (HNB) injector, based on negative ions accelerated at 1 MV, will be tested and optimized in the SPIDER source and MITICA full injector prototypes, using a set of diagnostics not available on the ITER HNB. The RF source, where the H(-)∕D(-) production is enhanced by cesium evaporation, will be monitored with thermocouples, electrostatic probes, optical emission spectroscopy, cavity ring down, and laser absorption spectroscopy. The beam is analyzed by cooling water calorimetry, a short pulse instrumented calorimeter, beam emission spectroscopy, visible tomography, and neutron imaging. Design of the diagnostic systems is presented.

Progress in the MITICA beam source design.

In the framework of the development of the ITER neutral beam (NB) system, a test facility is planned to be built in Padova. A full size prototype of the ITER heating NB injector (MITICA) shall be built and tested at full beam power (17 MW) as per ITER requirements. The design of the MITICA beam source has further progressed following updated optimization and overall integration criteria. In the paper, the major design choices and revisions are presented, together with some results of numerical analyses carried out in order to assess the electrostatic and thermo-mechanical behaviour of the source.

Design and specifications of the diagnostics for the instrumented calorimeter of source for the production of ions of deuterium extracted from radio frequency plasma.

In the development of the neutral beam injector for ITER experiment, the test facility SPIDER is going to be built. To measure the beam parameters, several diagnostics are used. One of them is the Short-Time Retractable Instrumented Kalorimeter Experiment (STRIKE) which measures beam uniformity, beamlet divergence, and stripping losses. This contribution gives an overview of the diagnostics dedicated to these measurements: thermal cameras, thermocouples, current sensors, and electrostatic sensors. The specifications of these diagnostics have been defined according to the results of electrostatic and thermal simulations. A failure modes and effects analysis has been performed during the design. Consequently the project of the STRIKE diagnostics has been optimized to reduce the possible failure risks.

Thermal and electrostatic simulations of the diagnostic calorimeter for the source for production of ion of deuterium extracted from RF plasma beam.

To study and optimise negative ion production for the ITER neutral beam injectors, a test facility is under construction in Padova with the aim of testing beam characteristics and to verify the source proper operation. The instrumented calorimeter STRIKE (short-time retractable instrumented kalorimeter experiment) is being developed to characterise the SPIDER (Source for Production of Ion of Deuterium Extracted from RF plasma) beam during short operations. The paper presents an investigation of the response of STRIKE measurement systems. It results that biasing is necessary to cope with the influence of secondary electrons on current measurements; moreover, despite the discretisation of the recorded thermal patterns introduced by the pixels of thermal cameras, a sufficient spatial resolution is expected.

Antioxidant activity of tomato products as studied by model reactions using xanthine oxidase, myeloperoxidase, and copper-induced lipid peroxidation.

The antioxidant content and activity of commercial tomato products differing in variety and processing were studied. Two procedures for extracting hydrophilic and lipophilic antioxidants, namely, two-step 0.1 M phosphate buffer (pH 3.0 and 7.4) extraction and tetrahydrofuran extraction followed by petroleum ether fractionation, were developed. Carotenoids (lycopene, beta-carotene, and lutein) and ascorbic acid were analyzed by HPLC with spectrophotometric and electrochemical detectors, respectively. Total phenolics were determined by using the Folin-Ciocalteu reagent. The antioxidant activity was studied by the following three model systems: (a) the xanthine oxidase (XOD)/xanthine system, which generates superoxide radical and hydrogen peroxide; (b) the myeloperoxidase (MPO)/NaCl/H(2)O(2) system, which produces hypochloric acid; and (c) the linoleic acid/CuSO(4) system, which promotes lipid peroxidation. Results showed that the hydrophilic and lipophilic fractions of all tomato products were able to affect model reactions, whatever reactive oxygen species and catalysts were used to drive oxidation. In the XOD/xanthine system both the hydrophilic and lipophilic fractions displayed an inhibitory activity. The hydrophilic fractions were more effective (I(50) ranging from 680 to 3200 microg, dry weight) than the lipophilic fractions (I(50) ranging from 4000 to 7750 microg, dry weight). In the MPO/NaCl/H(2)O(2) system the hydrophilic fractions inhibited oxidation (I(50) ranging from 2300 to 2900 microg, dry weight), whereas the lipophilic fractions had a lower inhibitory effect at the same concentration. Conversely, in the copper-catalyzed lipid peroxidation only the lipophilic fractions were effective (I(50) ranging from 1030 to 2100 microg, dry weight), whereas the hydrophilic fractions had a pro-oxidant effect in the same concentration range. The extent of inhibition varied according to the tomato sample in the superoxide and hydrogen peroxide generating system and in lipid peroxidation, but was substantially the same in the HClO generating system. Fresh tomato varieties differed considerably in the antioxidant activities of their hydrophilic and lipophilic fractions. Processed tomatoes showed a significantly lower antioxidant activity than fresh tomatoes in their hydrophilic fractions but had a high antioxidant activity in their lipophilic fractions. Because the oxidative reactions produced by the above-mentioned model systems are also involved in the pathogenesis of several chronic diseases, the antioxidant activity of tomato fractions might be related to their in vivo activity. Hence, these measurements may be used for optimizing tomato technologies.

Chromatographic determination of vitamins in foods.

Chromatographic methods for the determination of water- and fat-soluble vitamins in foods are reviewed. For each vitamin, sample preparation, detection problems and chromatographic conditions are presented and discussed. High-performance liquid chromatography (HPLC) is becoming a standard method in vitamin assay, especially for routine work. HPLC systems can be automated using in-line solid-phase extraction and column switchings, resulting in very sensitive methods, even when simple UV detection is employed.

Nutritional and technological characteristics of new broad bean flaked products.

The effects of the technological processes (soaking in water or alkaline solutions, drying, puree preparation) and the supplementation with maize flour on the nutritional value and on the organoleptic characteristics of broad bean (Vicia faba, L. major) flakes have been studied. Protein content was not affected by technological process. The addition of maize flour decreased the protein content of the final product depending on the amount of the maize flour added. Amino acid composition showed a decrease of tryptophan due to technological processing. Supplementation with maize flour improved the amino acid pattern and, except for tryptophan, the amount of essential amino acids in the flakes supplemented with 25% or more maize flour well compared with the provisional pattern by F.A.O. In vitro digestibility trials did not evidence significant changes due to technological processes or to integration of broad beans with maize flour. Broad bean toxic factors (vicine and convicine glycosides) were only slightly affected by the alkaline treatment of the flakes. Glycosides content decreased with the increasing supplementation with maize flour but the relationship was not linear. The organoleptic tests were positive for texture and taste, whereas the appearance of the products should be improved.