Outlier or handover: outcomes for General Medicine inpatients.

Objective Patients admitted from the emergency department may be co-located on the treating team's 'home ward'. If no bed is available, patients may be sent to another ward, where they may remain under the admitting team as an 'outlier'. Conversely, care may be handed over to the team on whose home ward they are located. We conducted a retrospective analysis to understand the impact of outlier status and handovers of care on outcomes for General Medicine inpatients. Methods General Medicine admissions at the Royal Adelaide Hospital between September 2020 and November 2021 were analysed. We examined the rate of hospital-acquired complications, inpatient mortality rate, mortality within 48 h of admission, Relative Stay Index, time of discharge from hospital and rate of adverse events within 28 days of discharge. Results A total of 3109 admissions were analysed. Handovers within 24 h of admission were associated with a longer length of stay. There was a trend towards higher rates of adverse events within 28 days of discharge with handovers of care. Outlier status did not affect any outcome measures. Conclusions Handovers within the first 24 h of admission are associated with longer than expected length of stay.

Chemical etching of silicon carbide in pure water by using platinum catalyst.

Chemical etching of SiC was found to proceed in pure water with the assistance of a Pt catalyst. A 4H-SiC (0001) wafer was placed and slid on a polishing pad in pure water, on which a thin Pt film was deposited to give a catalytic nature. Etching of the wafer surface was observed to remove protrusions preferentially by interacting with the Pt film more frequently, thus flattening the surface. In the case of an on-axis wafer, a crystallographically ordered surface was obtained with a straight step-and-terrace structure, the height of which corresponds to that of an atomic bilayer of Si and C. The etching rate depended upon the electrochemical potential of Pt. The vicinal surface was observed at the potential at which the Pt surface was bare. The primary etching mechanism was hydrolysis with the assistance of a Pt catalyst. This method can, therefore, be used as an environmentally friendly and sustainable technology.

Pharmacogenomic diversity in Singaporean populations and Europeans.

Differences in the frequency of pharmacogenomic variants may influence inter-population variability in drug efficacy and risk of adverse drug reactions (ADRs). We investigated the diversity of ∼ 4500 genetic variants in key drug-biotransformation and -response genes among three South East Asian populations compared with individuals of European ancestry. We compared rates of reported ADRs in these Asian populations to determine if the allelic differentiation corresponded to an excess of the associated ADR. We identified an excess of ADRs related to clopidogrel in Singaporean Chinese, consistent with a higher frequency of a known risk variant in CYP2C19 in that population. We also observed an excess of ADRs related to platinum compounds in Singaporean CHS, despite a very low frequency of known ADR risk variants, suggesting the presence of additional genetic and non-genetic risk factors. Our results point to substantial diversity at specific pharmacogenomic loci that may contribute to inter-population variability in drug response phenotypes.

Building pharmacogenetics into a pharmacovigilance program in Singapore: using serious skin rash as a pilot study.

To study the possible genetic associations with adverse drug reactions (ADR), the Singapore Health Sciences Authority (HSA) has piloted a program to collect DNA and phenotype data of ADR cases as part of its pharmacovigilance program. Between 2009 and 2012, HSA screened 158 cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To assess the association between HLA-B*1502 and carbamazepine (CBZ)-induced SJS/TEN, 13 cases and 26 drug-tolerant controls were analyzed. All 13 CBZ-SJS/TEN cases and 3/26 controls were HLA-B*1502 positive (odds ratio 181, 95% confidence interval: 8.7-3785, P=6.9 × 10(-8)). Discussions of the finding with the Ministry of Health and an expert panel led to the decision to make HLA-B*1502 testing the standard of care prior to first use of CBZ in Asians and to subsidize the genotyping test at public hospitals. This program illustrates the role of a regulatory authority in advancing the use of pharmacogenetics for drug safety.

Systems analysis of a quorum sensing network: design constraints imposed by the functional requirements, network topology and kinetic constants.

Understanding the relationship between the structural organization of intracellular decision networks and the observable phenotypes they control is one of the exigent problems of modern systems biology. Here we perform a systems analysis of a prototypic quorum sensing network whose operation allows bacterial populations to activate certain patterns of gene expression cooperatively. We apply structural perturbations to the model and analyze the resulting changes in the network behavior with the aim to identify the contribution of individual network elements to the functional fitness of the whole network. Specifically, we demonstrate the importance of the dimerization of the transcription factor and the presence of the auxiliary positive feedback loop on the switch-like behavior of the network and the stability of its "on" and "off" states under the influence of molecular noise.