Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience

Objective There have been growing concerns about the impact of drug allergy alerts on patient safety and provider alert fatigue. The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts. Design: Retrospective observational cross-sectional study (2004–2013). Materials and Methods Drug allergy alert data (n = 611,192) were collected from two large academic hospitals in Boston, MA (USA). Results Overall, the authors found an increase in the rate of drug allergy alert overrides, from 83.3% in 2004 to 87.6% in 2013 (P < .001). Alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8% and 74.1% of the time, respectively. However, providers were less likely to override these alerts compared to possible (cross-sensitivity) or probable (allergen group) matches (P < .001). The most common drug allergy alerts were triggered by allergies to narcotics (48%) and other analgesics (6%), antibiotics (10%), and statins (2%). Only slightly more than one-third of the reactions (34.2%) were potentially immune mediated. Finally, more than half of the overrides reasons pointed to irrelevant alerts (i.e., patient has tolerated the medication before, 50.9%) and providers were significantly more likely to override repeated alerts (89.7%) rather than first time alerts (77.4%, P < .001). Discussion and Conclusions These findings underline the urgent need for more efforts to provide more accurate and relevant drug allergy alerts to help reduce alert override rates and improve alert fatigue

Lower Extremity Musculoskeletal Injury in US Military Academy Cadet Basic Training: A Survival Analysis Evaluating Sex, History of Injury, and Body Mass Index

Background: Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors. Purpose/Hypothesis: The purpose of this study was to report both the incidence and timing of lower extremity injuries during cadet basic training. We hypothesized that women, those with a history of injury, and those in underweight and obese body mass index (BMI) categories would sustain lower extremity musculoskeletal injury earlier in the training period than men, those without injury history, and those in the normal-weight BMI category. Study Design: Cohort study; Level of evidence, 2. Methods: Cadets from the class of 2022, arriving in 2018, served as the study population. Baseline information on sex and injury history was collected via questionnaire, and BMI was calculated from height and weight taken during week 1 at the United States Military Academy. Categories were underweight (BMI <20), middleweight (20-29.99), and obese (≥30). Injury surveillance was performed over the first 60 days of training via electronic medical record review and monitoring. Kaplan-Meier survival curves were used to estimate group differences in time to the first musculoskeletal injury. Cox proportional hazard regression was used to estimate hazard ratios (HRs). Results: A total of 595 cadets participated. The cohort was 76.8% male, with 29.9% reporting previous injury history and 93.3% having a BMI between 20 and 30. Overall, 16.3% of cadets (12.3% of male cadets and 29.7% of female cadets) experienced an injury during the follow-up period. Women experienced significantly greater incident injury than did men (P <.001). Separation of survival curves comparing the sexes and injury history occurred at weeks 3 and 4, respectively. Hazards for first musculoskeletal injury were significantly greater for women versus men (HR, 2.63; 95% CI, 1.76-3.94) and for those who reported a history of injury versus no injury history (HR, 1.76; 95% CI, 1.18-2.64). No differences were observed between BMI categories. Conclusion: Female cadets and those reporting previous musculoskeletal injury demonstrated a greater hazard of musculoskeletal injury during cadet basic training. This study did not observe an association between BMI and injury

Cluster structure of 13C probed via the 7Li(9Be,13C*->9Be+alpha) reaction

A study of the 7Li(9Be,4He9Be)3H reaction at E{beam}=70 MeV has been performed using resonant particle spectroscopy techniques and provides a measurement of alpha-decaying states in 13C. Excited states are observed at 12.0, 13.4, 14.1, 14.6, 15.2, 16.8, 17.9, 18.7, 21.3 and 23.9 MeV. This study provides the first measurement of the three highest energy states. Angular distribution measurements have been performed and have been employed to indicate the transferred angular momentum for the populated states. These data are compared with recent speculations of the presence of chain-like structures in 13C.Comment: accepted for publication in Nuclear Physics

Evidence of Color Coherence Effects in W+jets Events from ppbar Collisions at sqrt(s) = 1.8 TeV

We report the results of a study of color coherence effects in ppbar collisions based on data collected by the D0 detector during the 1994-1995 run of the Fermilab Tevatron Collider, at a center of mass energy sqrt(s) = 1.8 TeV. Initial-to-final state color interference effects are studied by examining particle distribution patterns in events with a W boson and at least one jet. The data are compared to Monte Carlo simulations with different color coherence implementations and to an analytic modified-leading-logarithm perturbative calculation based on the local parton-hadron duality hypothesis.Comment: 13 pages, 6 figures. Submitted to Physics Letters

Search for electroweak production of single top quarks in ppˉp\bar{p} collisions.

We present a search for electroweak production of single top quarks in the electron+jets and muon+jets decay channels. The measurements use ~90 pb^-1 of data from Run 1 of the Fermilab Tevatron collider, collected at 1.8 TeV with the DZero detector between 1992 and 1995. We use events that include a tagging muon, implying the presence of a b jet, to set an upper limit at the 95% confidence level on the cross section for the s-channel process ppbar->tb+X of 39 pb. The upper limit for the t-channel process ppbar->tqb+X is 58 pb. (arXiv

Search for first-generation scalar and vector leptoquarks

We describe a search for the pair production of first-generation scalar and vector leptoquarks in the eejj and enujj channels by the D0 Collaboration. The data are from the 1992--1996 ppbar run at sqrt{s} = 1.8 TeV at the Fermilab Tevatron collider. We find no evidence for leptoquark production; in addition, no kinematically interesting events are observed using relaxed selection criteria. The results from the eejj and enujj channels are combined with those from a previous D0 analysis of the nunujj channel to obtain 95% confidence level (C.L.) upper limits on the leptoquark pair-production cross section as a function of mass and of beta, the branching fraction to a charged lepton. These limits are compared to next-to-leading-order theory to set 95% C.L. lower limits on the mass of a first-generation scalar leptoquark of 225, 204, and 79 GeV/c^2 for beta=1, 1/2, and 0, respectively. For vector leptoquarks with gauge (Yang-Mills) couplings, 95% C.L. lower limits of 345, 337, and 206 GeV/c^2 are set on the mass for beta=1, 1/2, and 0, respectively. Mass limits for vector leptoquarks are also set for anomalous vector couplings

Hard Single Diffraction in pbarp Collisions at root-s = 630 and 1800 GeV

Using the D0 detector, we have studied events produced in proton-antiproton collisions that contain large forward regions with very little energy deposition (``rapidity gaps'') and concurrent jet production at center-of-mass energies of root-s = 630 and 1800 Gev. The fractions of forward and central jet events associated with such rapidity gaps are measured and compared to predictions from Monte Carlo models. For hard diffractive candidate events, we use the calorimeter to extract the fractional momentum loss of the scattered protons.Comment: 11 pages 4 figures. submitted to PR

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

The self-organising clock pattern of Messor pergandei (Formicidae, Myrmicinae)

SCOPUS: ar.jinfo:eu-repo/semantics/publishe