The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting

Background Experts suggest that formulary alerts at the time of medication order entry are the most effective form of clinical decision support to automate formulary management. Objective Our objectives were to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved. Methods Alert overrides of the top 11 (n = 206) most-utilized and highest-costing NFMs, from January 1 to December 31, 2012, were randomly selected for appropriateness evaluation. Using an empirically developed appropriateness algorithm, appropriateness of NFM alert overrides was assessed by 2 pharmacists via chart review. Appropriateness agreement of overrides was assessed with a Cohen’s kappa. We also assessed which types of NFMs were most likely to be inappropriately overridden, the override reasons that were disproportionately provided in the inappropriate overrides, and the specific reasons the overrides were considered inappropriate. Results Approximately 17.2% (n = 35.4/206) of NFM alerts were inappropriately overridden. Non-oral NFM alerts were more likely to be inappropriately overridden compared to orals. Alerts overridden with “blank” reasons were more likely to be inappropriate. The failure to first try a formulary alternative was the most common reason for alerts being overridden inappropriately. Conclusion Approximately 1 in 5 NFM alert overrides are overridden inappropriately. Future research should evaluate the impact of mandating a valid override reason and adding a list of formulary alternatives to each NFM alert; we speculate these NFM alert features may decrease the frequency of inappropriate overrides

Climate change threatens the world's marine protected areas

Marine protected areas (MPAs) are a primary management tool for mitigating threats to marine biodiversity 1,2 . MPAs and the species they protect, however, are increasingly being impacted by climate change. Here we show that, despite local protections, the warming associated with continued business-as-usual emissions (RCP8.5) 3 will likely result in further habitat and species losses throughout low-latitude and tropical MPAs 4,5 . With continued business-as-usual emissions, mean sea-surface temperatures within MPAs are projected to increase 0.035 °C per year and warm an additional 2.8 °C by 2100. Under these conditions, the time of emergence (the year when sea-surface temperature and oxygen concentration exceed natural variability) is mid-century in 42% of 309 no-take marine reserves. Moreover, projected warming rates and the existing 'community thermal safety margin' (the inherent buffer against warming based on the thermal sensitivity of constituent species) both vary among ecoregions and with latitude. The community thermal safety margin will be exceeded by 2050 in the tropics and by 2150 for many higher latitude MPAs. Importantly, the spatial distribution of emergence is stressor-specific. Hence, rearranging MPAs to minimize exposure to one stressor could well increase exposure to another. Continued business-as-usual emissions will likely disrupt many marine ecosystems, reducing the benefits of MPAs

Susceptibility amplitude ratio for generic competing systems

We calculate the susceptibility amplitude ratio near a generic higher character Lifshitz point up to one-loop order. We employ a renormalization group treatment with $L$ independent scaling transformations associated to the various inequivalent subspaces in the anisotropic case in order to compute the ratio above and below the critical temperature and demonstrate its universality. Furthermore, the isotropic results with only one type of competition axes have also been shown to be universal. We describe how the simpler situations of $m$-axial Lifshitz points as well as ordinary (noncompeting) systems can be retrieved from the present framework.Comment: 20 pages, no figure

Climate resilience in marine protected areas and the ‘Protection Paradox’

Restricting human activities through Marine Protected Areas (MPAs) is assumed to create more resilient biological communities with a greater capacity to resist and recover following climate events. Here we review the evidence linking protection from local pressures (e.g., fishing and habitat destruction) with increased resilience. Despite strong theoretical underpinnings, studies have only rarely attributed resilience responses to the recovery of food webs and habitats, and increases in the diversity of communities and populations. When detected, resistance to ocean warming and recovery after extreme events in MPAs have small effect sizes against a backdrop of natural variability. By contrast, large die-offs are well described from MPAs following climate stress events. This may be in part because protection from one set of pressures or drivers (such as fishing) can select for species that are highly sensitive to others (such as warming), creating a ‘Protection Paradox’. Given that climate change is overwhelming the resilience capacity of marine ecosystems, the only primary solution is to reduce carbon emissions. High-quality monitoring data in both space and time can also identify emergent resilience signals that do exist, in combination with adequate reference data to quantify the initial system state. This knowledge will allow networks of diverse protected areas to incorporate spatial refugia against climate change, and identify resilient biological components of natural systems. Sufficient spatial replication further offers insurance against losses in any given MPA, and the possibility for many weak signals of resilience to accumulate

Geographic information retrieval in a mobile environment: evaluating the needs of mobile individuals

This paper describes research that aims to define the information needs of mobile individuals, to implement a mobile information system that can satisfy those needs, and finally to evaluate the performance of that system with end-users. First a review of the emerging discipline of geographic information retrieval (GIR) is presented as background to the more specific issue of mobile information retrieval. Following this, a user needs study is described evaluating the requirements of potential users of a mobile information system; the study finds that there is a strong geographic component to users' information needs. Next, four geographic post-query filters are described which attempt to represent the region of space associated with an individual's query made at some specific spatial location. These filters are spatial proximity (distance in space), temporal proximity (travel time), speed-heading prediction surfaces (likelihood of visiting locations) and visibility (locations that can be seen). Two of these filters — spatial proximity and speed-heading prediction surfaces — are implemented in a mobile information system and subsequently evaluated with users in an outdoor setting. The results of evaluation suggest that retrieved information to which post-query geographic filters have been applied is considered more relevant than unfiltered information, and that users find information sorted by spatial proximity to be more relevant than that sorted by a prediction surface of likely future locations. The paper closes with a discussion of the wider implications of these results for developers of mobile information systems and location-based services

Search for direct production of charginos and neutralinos in events with three leptons and missing transverse momentum in √s = 7 TeV pp collisions with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with three electrons or muons and missing transverse momentum is presented. The analysis is based on 4.7 fb−1 of proton–proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with Standard Model expectations in three signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric models and in simplified models, significantly extending previous results

Jet size dependence of single jet suppression in lead-lead collisions at sqrt(s(NN)) = 2.76 TeV with the ATLAS detector at the LHC

Measurements of inclusive jet suppression in heavy ion collisions at the LHC provide direct sensitivity to the physics of jet quenching. In a sample of lead-lead collisions at sqrt(s) = 2.76 TeV corresponding to an integrated luminosity of approximately 7 inverse microbarns, ATLAS has measured jets with a calorimeter over the pseudorapidity interval |eta| < 2.1 and over the transverse momentum range 38 < pT < 210 GeV. Jets were reconstructed using the anti-kt algorithm with values for the distance parameter that determines the nominal jet radius of R = 0.2, 0.3, 0.4 and 0.5. The centrality dependence of the jet yield is characterized by the jet "central-to-peripheral ratio," Rcp. Jet production is found to be suppressed by approximately a factor of two in the 10% most central collisions relative to peripheral collisions. Rcp varies smoothly with centrality as characterized by the number of participating nucleons. The observed suppression is only weakly dependent on jet radius and transverse momentum. These results provide the first direct measurement of inclusive jet suppression in heavy ion collisions and complement previous measurements of dijet transverse energy imbalance at the LHC.Comment: 15 pages plus author list (30 pages total), 8 figures, 2 tables, submitted to Physics Letters B. All figures including auxiliary figures are available at http://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/HION-2011-02

Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS

The chi_b(nP) quarkonium states are produced in proton-proton collisions at the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS detector. Using a data sample corresponding to an integrated luminosity of 4.4 fb^-1, these states are reconstructed through their radiative decays to Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes. This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table, corrected author list, matches final version in Physical Review Letter

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters

Reducing heterotic M-theory to five dimensional supergravity on a manifold with boundary

This paper constructs the reduction of heterotic $M$-theory in eleven dimensions to a supergravity model on a manifold with boundary in five dimensions using a Calabi-Yau three-fold. New results are presented for the boundary terms in the action and for the boundary conditions on the bulk fields. Some general features of dualisation on a manifold with boundary are used to explain the origin of some topological terms in the action. The effect of gaugino condensation on the fermion boundary conditions leads to a `twist' in the chirality of the gravitino which can provide an uplifting mechanism in the vacuum energy to cancel the cosmological constant after moduli stabilisation.Comment: 16 pages, RevTe