Beyond the Medical Record

Studies before and since the 1999 Institute of Medicine report have noted the limitations of using medical record reporting for reliably quantifying and understanding medical error. Quantitative macro analyses of large datasets should be supplemented by small-scale qualitative studies to provide insight into micro-level daily events in clinical and hospital practice that contribute to errors and adverse events and how they are reported. Design : The study design involved semistructured face-to-face interviews with residents about the medical errors in which they recently had been involved and included questions regarding how those errors were acknowledged. Objective : This paper reports the ways in which medical error is or is not reported and residents' responses to a perceived medical error. Participants : Twenty-six residents were randomly sampled from a total population of 85 residents working in a 600-bed teaching hospital. Measurements : Outcome measures were based on analysis of cases residents described. Using Ethnograph and traditional methods of content analysis, cases were categorized as Documented, Discussed, and Uncertain. Results : Of 73 cases, 30 (41.1%) were formally acknowledged and Documented in the medical record; 24 (32.9%) were addressed through Discussions but not documented; 19 cases (26%) cases were classified as Uncertain. Twelve cases involved medication errors, which were acknowledged in different categories. Conclusions : The supervisory discussion, the informal discussion, and near-miss contain important information for improving clinical care. Our study also shows the need to improve residents' education to prepare them to recognize and address medical errors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72013/1/j.1525-1497.2005.0098.x.pd

Resident Perceptions of Medical Errors in the Emergency Department

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73541/1/S1069-6563_03_00559-1.pd

How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts

We estimate the increment in Massachusetts Medicaid program costs attributable to smoking from December 20, 1991, to 1998. We describe how our methods improve upon earlier estimates of analogous costs at the national level. Current costs to the Massachusetts Medicaid program approximate the payments to Massachusetts under the tobacco settlement of November 1998. Whether these payments are viewed as appropriate compensation for Medicaid costs over time depends upon the rate of increase in future health care costs, the rate of decline in smoking, the proportion of smoking that should be attributed to the actions of the tobacco companies and the liklihood that state would have prevailed at trial. The costs to the Medicaid program are dwarfed by the internal costs to smokers themselves.

Comparative PCET Study of a Donor-Acceptor Pair Linked by Ionized and Nonionized Asymmetric Hydrogen-Bonded Interfaces

A Zn(II) porphyrin-amidinium is the excited state electron donor (D) to a naphthalene diimide acceptor (A) appended with either a carboxylate or sulfonate functionality. The two-point hydrogen bond (---[H+]---) formed between the amidinium and carboxylate or sulfonate establishes a proton-coupled electron transfer (PCET) pathway for charge transfer. The two D---[H+]---A assemblies differ only by the proton configuration within the hydrogen bonding interface. Specifically, the amidinium transfers a proton to the carboxylate to form a non-ionized amidine-carboxylic acid two-point hydrogen network whereas the amidinium maintains both protons when bound to the sulfonate functionality forming an ionized amidinium-sulfonate two-point hydrogen network. These two interface configurations within the dyads thus allow for a direct comparison of PCET kinetics for the same donor and acceptor juxtaposed by an ionized and non-ionized hydrogen-bonded interface. Analysis of PCET kinetics ascertained from transient absorption and transient emission spectroscopy reveal that the ionized interface is more strongly impacted by the local solvent environment, thus establishing that the initial static configuration of the proton interface is a critical determinant to the kinetics of PCET.Chemistry and Chemical Biolog

The Pudding of Trust

Trust - "reliance on the integrity, ability, or character of a person or thing" - is pervasive in social systems. We constantly apply it in interactions between people, organizations, animals, and even artifacts. We use it instinctively and implicitly in closed and static systems, or consciously and explicitly in open or dynamic systems. An epitome for the former case is a small village, where everybody knows everybody, and the villagers instinctively use their knowledge or stereotypes to trust or distrust their neighbors. A big city exemplifies the latter case, where people use explicit rules of behavior in diverse trust relationships. We already use trust in computing systems extensively, although usually subconsciously. The challenge for exploiting trust in computing lies in extending the use of trust-based solutions, first to artificial entities such as software agents or subsystems, then to human users' subconscious choices

Discovery of spirooxadiazoline oxindoles with dual-stage antimalarial activity

© 2022 Published by Elsevier Masson SAS.Malaria remains a prevalent infectious disease in developing countries. The first-line therapeutic options are based on combinations of fast-acting artemisinin derivatives and longer-acting synthetic drugs. However, the emergence of resistance to these first-line treatments represents a serious risk, and the discovery of new effective drugs is urgently required. For this reason, new antimalarial chemotypes with new mechanisms of action, and ideally with activity against multiple parasite stages, are needed. We report a new scaffold with dual-stage (blood and liver) antiplasmodial activity. Twenty-six spirooxadiazoline oxindoles were synthesized and screened against the erythrocytic stage of the human malaria parasite P. falciparum. The most active compounds were also tested against the liver-stage of the murine parasite P. berghei. Seven compounds emerged as dual-stage antimalarials, with IC50 values in the low micromolar range. Due to structural similarity with cipargamin, which is thought to inhibit blood-stage P. falciparum growth via inhibition of the Na + efflux pump PfATP4, we tested one of the most active compounds for anti-PfATP4 activity. Our results suggest that this target is not the primary target of spirooxadiazoline oxindoles and further studies are ongoing to identify the main mechanism of action of this scaffold.This work was supported by FCT (Fundação para a Ciência e a Tecnologia, I.P.) through iMed.ULisboa (UID/DTP/04138/2019), project PTDC/QUI-QOR/29664/2017, and PhD fellowship SFRH/BD/137544/2018 (E. Lopes). The NMR spectrometers are part of the National NMR Network (PTNMR) and are partially supported by Infrastructure Project Nº 022161 (co-financed by FEDER through COMPETE 2020, POCI and PORL and FCT through PIDDAC). Financial support from FCT and Portugal 2020 to the Portuguese Mass Spectrometry Network (Rede Nacional de Espectrometria de Massa – RNEM; LISBOA-01-0145-FEDER-402-022125) is also acknowledged.info:eu-repo/semantics/publishedVersio

Novos catalisadores a base de argilas para a produção do biodiesel.

Nas últimas décadas uma quantidade substancial de pesquisas foi realizada a fim de encontrar novas fontes de energia renovável e sustentável para substituir o diesel de petróleo. Uma fonte alternativa promissora de energia é o biodiesel, que é um combustível renovável que pode ser produzido a partir dos óleos e gorduras animais/vegetais ou mesmo ácidos graxos reciclados da indústria de alimentos. Os catalisadores heterogêneos podem melhorar os métodos de síntese eliminando os custos adicionais associados aos catalisadores homogêneos e minimizando a produção de poluentes. As argilas ativadas têm atraído atenção como catalisadores para uma variedade de reações ácidas. O comportamento físico-químico dos minerais argilosos tem sido estudado devido a sua relação como adsorvente e/ou propriedades catalíticas. Diante do exposto verifica-se a necessidade de desenvolver estudos sobre a utilização de argilas como catalisador na produção do biodiesel, tornando-se, portanto, fundamental conhecer a estabilidade e propriedades do biodiesel produzido a partir desses catalisadores. Visando avaliar a eficiência das argilas como catalisadores no processo de transesterificação deste combustível, foram estudados nesse trabalho 27 tipos de argilas, fornecidas pela empresa BENTONISA- Bentonita do Nordeste S.A, para produção do biodiesel na rota etílica e metílica, utilizando óleo de soja. Inicialmente foi realizada uma pré-seleção das argilas, utilizando as análises de umidade e pH, onde foram escolhidos 15 tipos de amostras, as mesmas foram submetidas a ensaios nos sistemas reacionais S1 e S2 e utilizando as técnicas de cor do óleo (aspecto visual) e viscosidade, optou-se pelos dois melhores catalisadores argilosos (A23 e A24) a serem testados no sistema padrão para produção do biodiesel, denominado S3. Os catalisadores A23 e A24 foram caracterizados por : fluorescência de raios-X (FRX); difração de raios-X (DRX); espectroscopia de absorção no infravermelho (IV); microscopia eletrônica de varredura (MEV); energia dispersiva de raios-X (EDS) e área específica pelo método BET. O óleo de soja e o biodiesel formado foram caracterizados através das seguintes técnicas: composição química, umidade, acidez, densidade 20ºC, glicerol total e viscosidade 40ºC, teor de éster, teor de álcool e cromatografia gasosa. Os resultados mostraram que é possível obter o biodiesel a partir de catalisadores argilosos.In the last decades a substantial amount of research has been undertaken to find new sources of renewable and sustainable energy to replace Diesel. A promising alternative energy source is biodiesel, which is a renewable fuel produced from vegetable oils and animal fats or even from recycled fat from the food industry. Heterogeneous catalysts can improve the synthesis methods eliminating additional costs associated with the homogeneous catalysts and minimizing the production of pollutants. Activated clays have attracted attention as catalysts for a variety of acid reactions. The physical and chemical behavior of clay minerals has been studied because of their property as adsorbent and / or catalysts. Therefore the need to develop studies on the use of clays as a catalyst in the production of biodiesel, making it, therefore, necessary to know the stability and properties of biodiesel produced by these catalysts. To evaluate the efficiency of clays as catalysts in the transesterification process of this fuel, 27 types of clay supplied by the company BENTONISA- Bentonite Nordeste SA, were studied in this work. The biodiesel was produced on the ethyl and methyl route, using soybean oil as raw material. The initial preselection for the clays was carried out on moisture and pH analysis, whereby 15 samples were selected. These were submitted to the testing systems in the S1 and S2, using the techniques of oil color (visual aspect) and viscosity. The two best clay catalysts (A23 and A24) were chosen to be tested in the standard system for production of biodiesel called S3. The catalysts A23 and A24 were characterized by: FRX; XRD; IR, SEM, EDS and BET. The soybean oil and biodiesel were characterized by the following techniques: chemical composition, moisture, acidity, density 20ºC, viscosity 40ºC, total glycerol, ester content, alcohol content and gas chromatography. The results showed that it is possible to get biodiesel from clay catalysts

Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York

Purpose New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. Methods We conducted a statewide seroprevalence study in a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first poststratification weighting and then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing the number of diagnoses by the number of estimated infection-experienced adults. Results Based on 1887 of 15,101 (12.5%) reactive results, estimated cumulative incidence through March 29 was 14.0% (95% confidence interval [CI]: 13.3%–14.7%), corresponding to 2,139,300 (95% CI: 2,035,800–2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City 22.7% (95% CI: 21.5%–24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, P \u3c .0001). An estimated 8.9% (95% CI: 8.4%–9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults aged 55 years or older (11.3%, 95% CI: 10.4%–12.2%). Conclusions From the largest U.S. serosurvey to date, we estimated \u3e2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained less than herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies

Duration of androgen suppression before radiotherapy for localized prostate cancer: Radiation therapy oncology group randomized clinical trial 9910

Purpose To determine whether prolonged androgen suppression (AS) duration before radiotherapy improves survival and disease control in prostate cancer. Patients and Methods One thousand five hundred seventy-nine men with intermediate-risk prostate cancer were randomly assigned to 8 weeks of AS followed by radiotherapy with an additional 8 weeks of concurrent AS (16 weeks total) or to 28 weeks of AS followed by radiotherapy with an additional 8 weeks of AS (36 weeks total). The trial sought primarily to detect a 33% reduction in the hazard of prostate cancer death in the 28-week assignment. Time-to-event end points are reported for up to 10 years of follow-up. Results There were no between-group differences in baseline characteristics of 1,489 eligible patients with follow-up. For the 8- and 28-week assignments, 10-year disease-specific survival rates were 95% (95% CI, 93.3% to 97.0%) and 96% (95% CI, 94.6% to 98.0%; hazard ratio [HR], 0.81; P = .45), respectively, and 10-year overall survival rates were66%(95% CI, 62.0% to 69.9%) and67%(95% CI, 63.0% to 70.8%; HR, 0.95; P = .62), respectively. For the 8- and 28-week assignments, 10-year cumulative incidences of locoregional progression were 6% (95% CI, 4.3% to 8.0%) and 4% (95% CI, 2.5% to 5.7%; HR, 0.65; P = .07), respectively; 10-year distant metastasis cumulative incidences were 6% (95% CI, 4.0% to 7.7%) and 6% (95% CI, 4.0% to 7.6%; HR, 1.07; P = .80), respectively; and 10-year prostate-specific antigen-based recurrence cumulative incidences were 27% (95% CI, 23.1% to 29.8%) and 27% (95% CI, 23.4% to 30.3%; HR, 0.97; P = .77), respectively. Conclusion Extending AS duration from 8 weeks to 28 weeks before radiotherapy did not improve outcomes. A lower than expected prostate cancer death rate reduced ability to detect a between-group difference in disease-specific survival. The schedule of 8 weeks of AS before radiotherapy plus 8 weeks of AS during radiotherapy remains a standard of care in intermediate-risk prostate cancer