To the Struggles Ahead

Dibbi Barua, 17 at the time of writing, tries to capture his reality after arriving in America—struggling to make friends at first, finding himself in ELD with his brother and close friends, feeling like an imposter just trying to blend in, and finally breaking through in high school. Now in college at Cal State LA, Barua finds himself struggling with a different kind of imposter syndrome as the youngest person in his class trying to make it in the world of adults and fighting against the lowered expectations people seem to have for the “TikTok generation.” In this piece, Barua offers honest insight into first-gen experience and his drive to prove there’s much more to him than his immigration status or his age

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Medication errors in the Middle East countries: a systematic review of the literature

Background: Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods: A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. Results: Forty-five studies from 10 of the 15 Middle Eastern countries met the inclusion criteria. Nine (20%) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1% to 90.5% for prescribing and from 9.4% to 80% for administration. The most common types of prescribing errors reported were incorrect dose (with an incidence rate from 0.15% to 34.8% of prescriptions), wrong frequency and wrong strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs). Most studies did not assess the clinical severity of the medication errors. Conclusion: Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed

Efficient stock cutting for laminated manufacturing

When an object is made using Laminated Manufacturing (LM), the output is a rectangular block with the required object trapped inside. In order to enable extraction of the object, the remaining sheet in each layer is cut into square grids that grow into tiny tiles. Thus, the remaining stock inside and surrounding the object is in the form of tiled fragments. The operator 'decubes' or removes these tiles using sharp tools and extracts the object. Making use of the remaining stock as support structure and grid cutting to enable extraction of the object are very innovative ideas in the 'paste-and-cut' LM approach. However, this method is very inefficient for two reasons: firstly, cutting efficiency is poor since laser spends most of its time in grid cutting; secondly, decubing takes several hours. In this paper, an efficient method of cutting the remaining stock to extract the object is presented. Extraction of the object from the stock block has analogy with the extraction of casting from its mold-the present and proposed methods respectively being analogous to sand casting and permanent mold casting processes. In the proposed method, rather than fragmenting the remaining stock into tiny tiles, it is segmented into two stock halves that open about a parting surface of minimum area. This optimal parting surface is obtained for the convex hull of the object, rather than for the object itself, due to its complete visibility along any pair opposite directions. The convex hull is further segmented into the object and plugs. The plugs are so shaped that they do not get entangled inside the concave portions of the object. The plugs whose drawing directions coincide with the opening direction of the stock halves are merged with the corresponding stock halves. The object, all the plugs and both the stock halves form the stock block. All these pieces are made together in the LM machine. For disassembly, first the convex hull will be extracted by opening the stock halves. Subsequently the plugs that fill the concave portions of the object will be extracted from the convex hull. Thus, grid cutting and decubing are eliminated in the proposed method resulting in drastic reduction in prototyping time and improved quality of the prototype. (C) 2002 .

45,X/46,XY mosaicism: report on 14 patients from a Brazilian hospital. A retrospective study

CONTEXT AND OBJECTIVE: 45,X/46,XY mosaicism, or mixed gonadal dysgenesis, is considered to be a rare disorder of sex development. The aim of our study was to investigate the clinical and cytogenetic characteristics of patients with this mosaicism.DESIGN AND SETTING: A retrospective study in a referral hospital in southern Brazil.METHODS: Our sample consisted of patients diagnosed at the clinical genetics service of a referral hospital in southern Brazil, from 1975 to 2012. Clinical and cytogenetic data were collected from the medical records.RESULTS: Fourteen patients were included in the sample, with ages at the first evaluation ranging from 2 days to 38 years. Nine of them had female sex of rearing and five, male. Regarding the external genitalia, most were ambiguous (n = 10). One patient presented male phenotype and was treated for a history of azoospermia, while three patients presented female phenotype, of whom two had findings of Turner syndrome and one presented secondary amenorrhea alone. Some findings of Turner syndrome were observed even among patients with ambiguous genitalia. None presented gonadal malignancy. One patient underwent surgical correction for genital ambiguity and subsequent exchange of sex of rearing. Regarding cytogenetics, we did not observe any direct correlation between percentages of cell lines and phenotype.CONCLUSIONS: 45,X/46,XY mosaicism can present with a wide variety of phenotypes resulting from the involvement of different aspects of the individual. All these observations have important implications for early recognition of these patients and their appropriate management