Antimicrobial-related medication safety incidents : a regional retrospective study in West of Scotland hospitals

Medication-related incidents are an important consideration in enhancing patient safety in hospital care. The wide utilisation of antimicrobial therapy in this population renders these medications particularly vulnerable to errors and adverse events. To analyse the characteristics of antimicrobial therapy-related incident reports across a group of secondary care hospitals. Reports for antimicrobial-related incidents from April 2010 to December 2013 were obtained from a regional area of hospitals in National Health Service (NHS) Scotland. Reports were analysed at-large, with subset analyses of incidents resulting in patient harm/injury and those included in a multivariable regression adjusted by occupied bed days (OBD) and defined daily doses (DDD) to better ascertain areas to target for antimicrobial safety. A total of 1345 incidents were reported at a crude rate of 0.98 reports/day (95% CI: 0.93-1.03 reports/day). Penicillins (371 reports; 27.6%), aminoglycosides (358; 26.6%) and glycopeptides (210; 15.6%) were the most commonly involved classes of medications. Most incidents involved no injury/harm (514; 38.2%), but 72 reports (5.4%) did result in patient harm. Rehabilitation/Assessment (RR: 2.61, 95% CI: 1.70-4.03) and Women/Childrens (RR: 2.61, 95% CI: 1.70-4.03) had higher incident reporting rates compared to other hospital services, likely as a function of at-risk patient populations. Among the types of incidents reported, those involving issues with administration/supply were most common (RR: 2.07, 95% CI: 1.51-2.84). Incident reporting for antimicrobials identified several key areas for quality improvement in the hospital setting which can guide safety efforts

A comparison of neck bending and flexion measurement methods for assessment of ergonomic risk

Head movements of workers were measured in the sagittal plane in order to establish a precise and accurate assessment method to be used in real work situations. Measurements were performed using two inclinometers connected to an embedded recording system. Two quantitative analysis methods were tested, i.e., measurement of bending with an inclinometer attached to the head, and measurement of flexion/extension by using an additional inclinometer located at C7/T1. The results were also compared with a video observation method (qualitative). The results showed that bending measurements were significantly different from those of flexion/extension for angles between 0° and 20°, and angles >45°. There were also significant differences between workers for flexion >45°, reflecting individual variability. Additionally, several limitations of observational methods were revealed by this study

Extrapulmonary nontuberculous mycobacterial infections: a guide for the general physician.

Non-tuberculous mycobacteria (NTM) infections predominantly present as pulmonary disease. Although relatively rare, 20-30 % originate from extrapulmonary sites resulting in a wide range of clinical syndromes. Immunocompromised individuals are particularly susceptible. Clinical manifestations include skin and soft-tissue infections, lymphadenitis, musculoskeletal infections and disseminated disease. Diagnosing extrapulmonary NTM is challenging, and management is complex, often involving multiple radiological and microbiological investigations, long courses of combination antibiotic regimens and may require adjuvant surgical interventions. We highlight both the importance of involving NTM experts at an early stage and the role of a multidisciplinary approach in the diagnosis and management of these infections

Nucleation and growth of Ag3Sn in Sn-Ag and Sn-Ag-Cu solder alloys

Large Ag3Sn plates in solder joints can affect the reliability of electronics, however, the factors affecting their nucleation and morphology are not well understood. Here, the faceted solidification of Ag3Sn was studied as a function of melt undercooling, revealing transitions from single crystal {001} plates to cyclic twinned plates and then to highly branched structures created by twin mediated branching. Real-time X-ray imaging proved that Ag3Sn cyclic twins come from a common point, indicating they initiate in the process of nucleation or in the very early stages of growth in the undercooled melt. Soldering to copper substrates significantly catalysed Ag3Sn nucleation. This is shown to be due to constitutional supercooling generated by Ag solute rejection into the liquid ahead of the Cu6Sn5 reaction layer, with additional contributions from geometrical catalysis in the grooves between Cu6Sn5 scallops and heterogeneous nucleation of Ag3Sn on Cu6Sn5. The relative ease of Ag3Sn nucleation on the Cu6Sn5 reaction layer is responsible for the large plates often reported in electronic solder joints

Continuous twin screw rheo-extrusion of an AZ91D magnesium alloy

© The Minerals, Metals & Materials Society and ASM International 2012The twin screw rheo-extrusion (TSRE) is designed to take advantage of the nondendritc microstructure and thixotropic characterization of semisolid-metal slurries and produce simple metal profiles directly from melts. The extrusion equipment consists of a rotor-stator high shear slurry maker, a twin screw extruder, and a die assembly. The process is continuous and has a potential for significantly saving energy, manufacturing cost, and enhancing efficiency. The present investigation was carried out to study the process performance for processing rods of an AZ91D magnesium alloy and the microstructure evolution during processing. The semisolid slurry prepared by the process was characterized by uniformly distributed nondendritic granular primary phase particles. AZ91D rods with uniform and fine microstructures and moderate mechanical properties were produced. For the given slurry making parameters, decreasing extrusion temperature was found to improve microstructures and properties. The mechanisms of particle granulation and refinement and the effect of processing parameters on process performance and thermal management are discussed. © 2012 The Minerals, Metals & Materials Society and ASM International.EPSRC (UK) and Rautomead Lt

Clinical performance of osteoporosis risk assessment tools in women aged 67 years and older

Clinical performance of osteoporosis risk assessment tools was studied in women aged 67 years and older. Weight was as accurate as two of the tools to detect low bone density. Discriminatory ability was slightly better for the OST risk tool, which is based only on age and weight

Tripled critical current in racetrack coils made of Bi-2212 Rutherford cables with overpressure processing and leakage control

We fabricated three racetrack coils (RC1, RC2, and RC3) from Bi-2212 Rutherford cables (17-strand, thickness × width = 1.44 mm × 7.8 mm, strand diameter = 0.8 mm) and applied overpressure processing heat treatment (OPHT). The quench currents of RC1 and RC2 reached 5268 A and 5781 A, respectively, despite them still, surprisingly, exhibiting some Bi-2212 leakage to the surface. After removing most of the leakages using a simple-to-implement insulation scheme, the quench current of RC3 improved to 6485 A, which is about three times the average quench current of a dozen racetrack coils that had been fabricated and reacted using the conventional 1 bar heat treatment. The results confirm the effectiveness of the OPHT technology and the new leakage control scheme for coils made from Bi-2212 Rutherford cables. Coils exhibited an increased quench current with increasing the current ramp rate from 5 to 200 A s ; they were quite stable against point and transient disturbances, and were capable of adsorbing persistent Joule heating at ∼80 mW for >15 s before quenching. These behaviors are different from Nb-Ti and Nb Sn accelerator magnets. Overall, our results provide a critical evaluation and verification of Bi-2212 wire and magnet technologies (wire, insulation, heat treatment, coil fabrication, and coil operation), reveal crucial new stability features of Bi-2212 magnets, and demonstrate technological options for it to become a practical high-field magnet technology. -1

A Phylogenetic Analysis of HIV-1 Sequences in Kiev: Findings among Key Populations

BACKGROUND: The HIV epidemic in Ukraine has been driven by a rapid rise among people who inject drugs, but recent studies have shown an increase through sexual transmission. METHODS: Protease and RT sequences from 876 new HIV diagnoses (April 2013 - March 2015) in Kiev were linked to demographic data. We constructed phylogenetic trees for 794 subtype A1 and 64 subtype B sequences and identified factors associated with transmission clustering. Clusters were defined as ≥ 2 sequences, ≥ 80% local branch support and maximum genetic distance of all sequence pairs in the cluster ≤ 2.5%. Recent infection was determined through the LAg avidity EIA assay. Sequences were analysed for transmitted drug resistance (TDR) mutations. RESULTS: 30% of subtype A1 and 66% of subtype B sequences clustered. Large clusters (maximum 11 sequences) contained mixed risk groups. In univariate analysis, clustering was significantly associated with subtype B compared to A1 (OR 4.38 [95% CI 2.56-7.50]), risk group (OR 5.65 [3.27-9.75]) for men who have sex with men compared to heterosexual males, recent, compared to long-standing, infection (OR 2.72 [1.64-4.52]), reported sex work contact (OR 1.93 [1.07-3.47]) and younger age groups compared to age ≥36 (OR 1.83 [1.10-3.05] for age ≤25). Females were associated with lower odds of clustering than heterosexual males (OR 0.49 [0.31-0.77]). In multivariate analysis, risk group, subtype and age group were independently associated with clustering (p<0.001, p=0.007 and p=0.033). 18 sequences (2.1%) indicated evidence of TDR. CONCLUSIONS: Our findings suggest high levels of transmission and bridging between risk groups

Transverse Λ0\Lambda^0 polarization in inclusive quasi-real photoproduction at the current fragmentation

It is shown that the recent HERMES data on the transverse $\Lambda^0$ polarization in the inclusive quasi-real photoproduction at $x_F>0$ can be accommodated by the strange quark scattering model. Relations with the quark recombination approach are discussed.Comment: 5 pages, 3 figures, accepted by Eur. Phys. J.