Mandatory Pharmacy Residencies: One way to reduce medication errors

We read with disbelief about a newly graduated pharmacist dispensing 30 times the amount of injectable sodium bicarbonate intended, an error that led to a patient’s death.1 As clinicians, we wondered what clinical scenario might mandate the large amount of sodium bicarbonate dispensed—the answer was none. So why did the pharmacist dispense it? The answer is all too clear: With rare exceptions, institutional pharmacists nationwide are largely focused on dispensing. Postgraduate clinical training in the basic aspects of pharmacotherapy is scarce and not viewed as essential. Inadequate pharmacist training and a staffing shortage were suggested as contributing to the death of a six-day-old infant who received 10 times the prescribed dose of i.v. potassium chloride at a university hospital.2 These two sobering misadventures hint at a link between pharmacists’ clinical training and patient safety

Discrete Element Method Simulation of a Boulder Extraction From an Asteroid

The force required to pull 7t and 40t polyhedral boulders from the surface of an asteroid is simulated using the discrete element method considering the effects of microgravity, regolith cohesion and boulder acceleration. The connection between particle surface energy and regolith cohesion is estimated by simulating a cohesion sample tearing test. An optimal constant acceleration is found where the peak net force from inertia and cohesion is a minimum. Peak pulling forces can be further reduced by using linear and quadratic acceleration functions with up to a 40% reduction in force for quadratic acceleration

Current Sheet and Reconnection Inflow-Outflow Observations During Solar Eruptions

Magnetic reconnection is widely accepted as a dominant source of energy during solar flares; however, observations of it have been indirect and/or incomplete. Using the suite of instruments available spanning wavelength space, we will provide observations and measurements of both the inputs and outputs predicted from reconnection in the form of inflows preceding outflows (i.e. supra-arcade downflows, supra-arcade downflowing loops, upflows, and disconnection events). We will also present evidence for current sheets through which reconnection is expected to occur and discuss current sheet motion during flare progression

Asteroid Redirect Mission Proximity Operations for Reference Target Asteroid 2008 EV5

NASA's Asteroid Redirect Mission (ARM) is composed of two segments, the Asteroid Redirect Robotic Mission (ARRM), and the Asteroid Redirect Crewed Mission (ARCM). In March of 2015, NASA selected the Robotic Boulder Capture Option1 as the baseline for the ARRM. This option will capture a multi-ton boulder, (typically 2-4 meters in size) from the surface of a large (greater than approx.100 m diameter) Near-Earth Asteroid (NEA) and return it to cis-lunar space for subsequent human exploration during the ARCM. Further human and robotic missions to the asteroidal material would also be facilitated by its return to cis-lunar space. In addition, prior to departing the asteroid, the Asteroid Redirect Vehicle (ARV) will perform a demonstration of the Enhanced Gravity Tractor (EGT) planetary defense technique2. This paper will discuss the proximity operations which have been broken into three phases: Approach and Characterization, Boulder Capture, and Planetary Defense Demonstration. Each of these phases has been analyzed for the ARRM reference target, 2008 EV5, and a detailed baseline operations concept has been developed

Enhanced Gravity Tractor Technique for Planetary Defense

Given sufficient warning time, Earth-impacting asteroids and comets can be deflected with a variety of different "slow push/pull" techniques. The gravity tractor is one technique that uses the gravitational attraction of a rendezvous spacecraft to the impactor and a low-thrust, high-efficiency propulsion system to provide a gradual velocity change and alter its trajectory. An innovation to this technique, known as the Enhanced Gravity Tractor (EGT), uses mass collected in-situ to augment the mass of the spacecraft, thereby greatly increasing the gravitational force between the objects. The collected material can be a single boulder, multiple boulders, regolith or a combination of different sources. The collected mass would likely range from tens to hundreds of metric tons depending on the size of the impactor and warning time available. Depending on the propulsion system's capability and the mass collected, the EGT approach can reduce the deflection times by a factor of 10 to 50 or more, thus reducing the deflection times of several decades to years or less and overcoming the main criticism of the traditional gravity tractor approach. Additionally, multiple spacecraft can orbit the target in formation to provide the necessary velocity change and further reduce the time needed by the EGT technique to divert hazardous asteroids and comets. The robotic segment of NASA's Asteroid Redirect Mission (ARM) will collect a multi-ton boulder from the surface of a large Near-Earth Asteroid (NEA) and will provide the first ever demonstration of the EGT technique and validate one method of collecting in-situ mass on an asteroid of hazardous size

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

An Ultra-High-Resolution Survey of the Interstellar ^7Li-to-^6Li Isotope Ratio in the Solar Neighborhood

In an effort to probe the extent of variations in the interstellar ^7Li/^6Li ratio seen previously, ultra-high-resolution (R ~ 360,000), high signal-to-noise spectra of stars in the Perseus OB2 and Scorpius OB2 Associations were obtained. These measurements confirm our earlier findings of an interstellar ^7Li/^6Li ratio of about 2 toward o Per, the value predicted from models of Galactic cosmic ray spallation reactions. Observations of other nearby stars yield limits consistent with the isotopic ratio ~ 12 seen in carbonaceous chondrite meteorites. If this ratio originally represented the gas toward o Per, then to decrease the original isotope ratio to its current value an order of magnitude increase in the Li abundance is expected, but is not seen. The elemental K/Li ratio is not unusual, although Li and K are formed via different nucleosynthetic pathways. Several proposals to account for the low ^7Li/^6Li ratio were considered, but none seems satisfactory. Analysis of the Li and K abundances from our survey highlighted two sight lines where depletion effects are prevalent. There is evidence for enhanced depletion toward X Per, since both abundances are lower by a factor of 4 when compared to other sight lines. Moreover, a smaller Li/H abundance is observed toward 20 Aql, but the K/H abundance is normal, suggesting enhanced Li depletion (relative to K) in this direction. Our results suggest that the ^7Li/^6Li ratio has not changed significantly during the last 4.5 billion years and that a ratio ~ 12 represents most gas in the solar neighborhood. In addition, there appears to be a constant stellar contribution of ^7Li, indicating that one or two processes dominate its production in the Galaxy.Comment: 54 pages, accepted for publication in the Astrophysical Journa

NOx and O3 above a tropical rainforest: an analysis with a global and box model

A cross-platform field campaign, OP3, was conducted in the state of Sabah in Malaysian Borneo between April and July of 2008. Among the suite of observations recorded, the campaign included measurements of NOx and O3 – crucial outputs of any model chemistry mechanism. We describe the measurements of these species made from both the ground site and aircraft. We then use the output from two resolutions of the chemistry transport model p-TOMCAT to illustrate the ability of a global model chemical mechanism to capture the chemistry at the rainforest site. The basic model performance is good for NOx and poor for ozone. A box model containing the same chemical mechanism is used to explore the results of the global model in more depth and make comparisons between the two. Without some parameterization of the nighttime boundary layer – free troposphere mixing (i.e. the use of a dilution parameter), the box model does not reproduce the observations, pointing to the importance of adequately representing physical processes for comparisons with surface measurements. We conclude with a discussion of box model budget calculations of chemical reaction fluxes, deposition and mixing, and compare these results to output from p-TOMCAT. These show the same chemical mechanism behaves similarly in both models, but that emissions and advection play particularly strong roles in influencing the comparison to surface measurements