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

Conservative Constraints on Dark Matter from the Fermi-LAT Isotropic Diffuse Gamma-Ray Background Spectrum

We examine the constraints on final state radiation from Weakly Interacting Massive Particle (WIMP) dark matter candidates annihilating into various standard model final states, as imposed by the measurement of the isotropic diffuse gamma-ray background by the Large Area Telescope aboard the Fermi Gamma-Ray Space Telescope. The expected isotropic diffuse signal from dark matter annihilation has contributions from the local Milky Way (MW) as well as from extragalactic dark matter. The signal from the MW is very insensitive to the adopted dark matter profile of the halos, and dominates the signal from extragalactic halos, which is sensitive to the low mass cut-off of the halo mass function. We adopt a conservative model for both the low halo mass survival cut-off and the substructure boost factor of the Galactic and extragalactic components, and only consider the primary final state radiation. This provides robust constraints which reach the thermal production cross-section for low mass WIMPs annihilating into hadronic modes. We also reanalyze limits from HESS observations of the Galactic Ridge region using a conservative model for the dark matter halo profile. When combined with the HESS constraint, the isotropic diffuse spectrum rules out all interpretations of the PAMELA positron excess based on dark matter annihilation into two lepton final states. Annihilation into four leptons through new intermediate states, although constrained by the data, is not excluded.Comment: 11 pages, 5 figures. v3: minor revisions, matches version to appear in JCA

Generalizations of entanglement based on coherent states and convex sets

Unentangled pure states on a bipartite system are exactly the coherent states with respect to the group of local transformations. What aspects of the study of entanglement are applicable to generalized coherent states? Conversely, what can be learned about entanglement from the well-studied theory of coherent states? With these questions in mind, we characterize unentangled pure states as extremal states when considered as linear functionals on the local Lie algebra. As a result, a relativized notion of purity emerges, showing that there is a close relationship between purity, coherence and (non-)entanglement. To a large extent, these concepts can be defined and studied in the even more general setting of convex cones of states. Based on the idea that entanglement is relative, we suggest considering these notions in the context of partially ordered families of Lie algebras or convex cones, such as those that arise naturally for multipartite systems. The study of entanglement includes notions of local operations and, for information-theoretic purposes, entanglement measures and ways of scaling systems to enable asymptotic developments. We propose ways in which these may be generalized to the Lie-algebraic setting, and to a lesser extent to the convex-cones setting. One of our original motivations for this program is to understand the role of entanglement-like concepts in condensed matter. We discuss how our work provides tools for analyzing the correlations involved in quantum phase transitions and other aspects of condensed-matter systems.Comment: 37 page

Recent advances in alcohol-related liver disease (ALD): summary of a Gut roundtable meeting

Alcohol-related liver disease (ALD), which includes a range of disorders of different severity and is one of the most prevalent types of liver disease worldwide, has recently regained increased attention. Among other reasons, the realisation that any alcohol intake, regardless of type of beverage represents a health risk, and the new therapeutic strategies tested in recently published or undergoing clinical trials spur scientific interest in this area. In April 2019, Gut convened a round table panel of experts during the European Association for the Study of the Liver (EASL) International Liver Congress (ILC) in Vienna to discuss critical and up-to-date issues and clinical trial data regarding ALD, its epidemiology, diagnosis, management, pathomechanisms, possible future treatments and prevention. This paper summarises the discussion and its conclusions

Location-Aware Quality of Service Measurements for Service-Level Agreements

We add specifications of location-aware measurements to performance models in a compositional fashion, promoting precision in performance measurement design. Using immediate actions to send control signals between measurement components we are able to obtain more accurate measurements from our stochastic models without disturbing their structure. A software tool processes both the model and the measurement specifications to give response time distributions and quantiles, an essential calculation in determining satisfaction of service-level agreements (SLAs)

D* Production in Deep Inelastic Scattering at HERA

This paper presents measurements of D^{*\pm} production in deep inelastic scattering from collisions between 27.5 GeV positrons and 820 GeV protons. The data have been taken with the ZEUS detector at HERA. The decay channel $D^{*+}\to (D^0 \to K^- \pi^+) \pi^+$ (+ c.c.) has been used in the study. The $e^+p$ cross section for inclusive D^{*\pm} production with $5<Q^2<100 GeV^2$ and $y<0.7$ is 5.3 \pms 1.0 \pms 0.8 nb in the kinematic region {$1.3<p_T(D^{*\pm})<9.0$ GeV and $| \eta(D^{*\pm}) |<1.5$}. Differential cross sections as functions of p_T(D^{*\pm}), $\eta(D^{*\pm}), W$ and $Q^2$ are compared with next-to-leading order QCD calculations based on the photon-gluon fusion production mechanism. After an extrapolation of the cross section to the full kinematic region in p_T(D^{*\pm}) and $\eta$(D^{*\pm}), the charm contribution $F_2^{c\bar{c}}(x,Q^2)$ to the proton structure function is determined for Bjorken $x$ between 2 $\cdot$ 10$^{-4}$ and 5 $\cdot$ 10$^{-3}$.Comment: 17 pages including 4 figure

Observation of Scaling Violations in Scaled Momentum Distributions at HERA

Charged particle production has been measured in deep inelastic scattering (DIS) events over a large range of $x$ and $Q^2$ using the ZEUS detector. The evolution of the scaled momentum, $x_p$, with $Q^2,$ in the range 10 to 1280 $GeV^2$, has been investigated in the current fragmentation region of the Breit frame. The results show clear evidence, in a single experiment, for scaling violations in scaled momenta as a function of $Q^2$.Comment: 21 pages including 4 figures, to be published in Physics Letters B. Two references adde

Observation of hard scattering in photoproduction events with a large rapidity gap at HERA

Events with a large rapidity gap and total transverse energy greater than 5 GeV have been observed in quasi-real photoproduction at HERA with the ZEUS detector. The distribution of these events as a function of the $\gamma p$ centre of mass energy is consistent with diffractive scattering. For total transverse energies above 12 GeV, the hadronic final states show predominantly a two-jet structure with each jet having a transverse energy greater than 4 GeV. For the two-jet events, little energy flow is found outside the jets. This observation is consistent with the hard scattering of a quasi-real photon with a colourless object in the proton.Comment: 19 pages, latex, 4 figures appended as uuencoded fil

Extragalactic Inverse Compton Light from Dark Matter Annihilation and the Pamela Positron Excess

We calculate the extragalactic diffuse emission originating from the up-scattering of cosmic microwave photons by energetic electrons and positrons produced in particle dark matter annihilation events at all redshifts and in all halos. We outline the observational constraints on this emission and we study its dependence on both the particle dark matter model (including the particle mass and its dominant annihilation final state) and on assumptions on structure formation and on the density profile of halos. We find that for low-mass dark matter models, data in the X-ray band provide the most stringent constraints, while the gamma-ray energy range probes models featuring large masses and pair-annihilation rates, and a hard spectrum for the injected electrons and positrons. Specifically, we point out that the all-redshift, all-halo inverse Compton emission from many dark matter models that might provide an explanation to the anomalous positron fraction measured by the Pamela payload severely overproduces the observed extragalactic gamma-ray background.Comment: Version accepted for publication in JCAP, one new figure and text added; 19 pages, 5 figure

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe