Reducing prescribing errors through creatinine clearance alert redesign

Background Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts. Methods Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors. Results There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently. Conclusions Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment

Laboratory And Field Assessment Of Some Kairomone Blends For Host-Seeking \u3ci\u3eAedes Aegypti\u3c/i\u3e

Using laboratory Y-tube olfactometers, the attractiveness of lactic acid and 2 kairomone blends from the United States Department of Agriculture (USDA) and BioGents GmbH (BG) was assessed for attractiveness to Aedes aegypti. Four geographically disparate populations were assessed: North Queensland Australia (NQA), Florida USA, Minas Gerais Brazil (MGB), and Singapore. In descending order, populations were attracted to USE)A, BG blends, and lactic acid. MGB was poorly attracted to lactic acid alone. The blends were less attractive than human odor. Proprietary blends were modified, and their attractiveness was assessed to find the optimum attractive mixture for NQA. Adding acetone to BG, and ammonia and caproic acid to USDA, improved attractiveness in the laboratory. Field attractiveness was assessed by coupling the blends with a newly developed BG-Sentinel Ae. aegypti trap. Trials were carried out using the BG blend, BG blend plus acetone, USDA blend, USDA blend plus ammonia and caproic acid, and a control trap with no kairomones. The traps were highly effective, with mean 24-h collections up to 11.15 Ae. aegypti per trap, and this species made up 91.7% of collections. However, the effectiveness of the unbaited control trap indicated that the BG-Sentinel has visual attractive properties for Ae. aegypti and that the kairomone lures added little to trap performance in NQA

The effect of sound lure frequency and habitat type on male Aedes albopictus (Diptera: Culicidae) capture rates with the male Aedes sound trap

The global distribution of Aedes albopictus (Skuse) is rapidly expanding which has contributed to the emergence and re-emergence of dengue and chikungunya outbreaks. Improvements in vector surveillance are necessary to facilitate optimized, evidence-based vector control operations. Current trapping technology used to target Ae. albopictus and other Aedes species for vector surveillance are limited in both scale and scope, thus novel tools are required. Here, we evaluated the Male Aedes Sound Trap (MAST) for its capacity to sample male Ae. albopictus. Aims of this study were twofold: 1) to determine the most effective frequency for capturing male Ae. albopictus and 2) to investigate fine-scale variations in male Ae. albopictus abundance. MASTs which produced sound lure frequencies between 500 and 650 Hz captured significantly more male Ae. albopictus than those with sound lure frequencies set to 450 Hz. Further, the higher sound lure frequency of 700 Hz significantly reduced catches relative to 650 Hz. MASTs placed in woodland habitats captured significantly more male Ae. albopictus than MASTs placed near houses. These results provide baseline information for optimizing sound lure frequencies and placement of the MAST to sample male Ae. albopictus in remote areas

A literature review of dispersal pathways of Aedes albopictus across different spatial scales: implications for vector surveillance

Background: Aedes albopictus is a highly invasive species and an important vector of dengue and chikungunya viruses. Indigenous to Southeast Asia, Ae. albopictus has successfully invaded every inhabited continent, except Antarctica, in the past 80 years. Vector surveillance and control at points of entry (PoE) is the most critical front line of defence against the introduction of Ae. albopictus to new areas. Identifying the pathways by which Ae. albopictus are introduced is the key to implementing effective vector surveillance to rapidly detect introductions and to eliminate them. Methods: A literature review was conducted to identify studies and data sources reporting the known and suspected dispersal pathways of human-mediated Ae. albopictus dispersal between 1940-2020. Studies and data sources reporting the first introduction of Ae. albopictus in a new country were selected for data extraction and analyses. Results: Between 1940-2020, Ae. albopictus was reported via various dispersal pathways into 86 new countries. Two main dispersal pathways were identified: (1) at global and continental spatial scales, maritime sea transport was the main dispersal pathway for Ae. albopictus into new countries in the middle to late 20th Century, with ships carrying used tyres of particular importance during the 1980s and 1990s, and (2) at continental and national spatial scales, the passive transportation of Ae. albopictus in ground vehicles and to a lesser extent the trade of used tyres and maritime sea transport appear to be the major drivers of Ae. albopictus dispersal into new countries, especially in Europe. Finally, the dispersal pathways for the introduction and spread of Ae. albopictus in numerous countries remains unknown, especially from the 1990s onwards. Conclusions: This review identified the main known and suspected dispersal pathways of human-mediated Ae. albopictus dispersal leading to the first introduction of Ae. albopictus into new countries and highlighted gaps in our understanding of Ae. albopictus dispersal pathways. Relevant advances in vector surveillance and genomic tracking techniques are presented and discussed in the context of improving vector surveillance

Structural and functional characterization of the oxidoreductase a-DsbA1 from wolbachia pipientis

The &alpha;-proteobacterium Wolbachia pipientis is a highly successful intracellular endosymbiont of invertebrates that manipulates its host\u27s reproductive biology to facilitate its own maternal transmission. The fastidious nature of Wolbachia and the lack of genetic transformation have hampered analysis of the molecular basis of these manipulations. Structure determination of key Wolbachia proteins will enable the development of inhibitors for chemical genetics studies. Wolbachia encodes a homologue (&alpha;-DsbA1) of the Escherichia coli dithiol oxidase enzyme EcDsbA, essential for the oxidative folding of many exported proteins. We found that the active-site cysteine pair of Wolbachia &alpha;-DsbA1 has the most reducing redox potential of any characterized DsbA. In addition, Wolbachia &alpha;-DsbA1 possesses a second disulfide that is highly conserved in &alpha;-proteobacterial DsbAs but not in other DsbAs. The &alpha;-DsbA1 structure lacks the characteristic hydrophobic features of EcDsbA, and the protein neither complements EcDsbA deletion mutants in E. coli nor interacts with EcDsbB, the redox partner of EcDsbA. The surface characteristics and redox profile of &alpha;-DsbA1 indicate that it probably plays a specialized oxidative folding role with a narrow substrate specificity. This first report of a Wolbachia protein structure provides the basis for future chemical genetics studies.<br /

Robust estimates of soil moisture and latent heat flux coupling strength obtained from triple collocation

Land surface models (LSMs) are often applied to predict the one-way coupling strength between surface soil moisture (SM) and latent heat (LH) flux. However, the ability of LSMs to accurately represent such coupling has not been adequately established. Likewise, the estimation of SM/LH coupling strength using ground-based observational data is potentially compromised by the impact of independent SM and LH measurements errors. Here we apply a new statistical technique to acquire estimates of one-way SM/LH coupling strength which are nonbiased in the presence of random error using a triple collocation approach based on leveraging the simultaneous availability of independent SM and LH estimates acquired from (1) LSMs, (2) satellite remote sensing, and (3) ground-based observations. Results suggest that LSMs do not generally overestimate the strength of one-way surface SM/LH coupling

A symmetry breaking mechanism for selecting the speed of relativistic solitons

We propose a mechanism for fixing the velocity of relativistic soliton based on the breaking of the Lorentz symmetry of the sine-Gordon (SG) model. The proposal is first elaborated for a molecular chain model, as the simple pendulum limit of a double pendulums chain. It is then generalized to a full class of two-dimensional field theories of the sine-Gordon type. From a phenomenological point of view, the mechanism allows one to select the speed of a SG soliton just by tuning elastic couplings constants and kinematical parameters. From a fundamental, field-theoretical point of view we show that the characterizing features of relativistic SG solitons (existence of conserved topological charges and stability) may be still preserved even if the Lorentz symmetry is broken and a soliton of a given speed is selected.Comment: 23 pages, no figure

Acute hepatitis in three patients with systemic juvenile idiopathic arthritis taking interleukin-1 receptor antagonist

<p>Abstract</p> <p>Purpose</p> <p>We investigated the etiology of acute hepatitis in three children with systemic Juvenile Idiopathic Arthritis (sJIA) taking Interleukin-1 receptor antagonist (IL1RA).</p> <p>Methods</p> <p>Laboratory and clinical data for three children with sJIA diagnosed at ages 13 months to 8 years who developed acute hepatitis during treatment with IL1RA were reviewed for evidence of sJIA flare, infection, macrophage activation syndrome (MAS), malignancy, and drug reaction.</p> <p>Results</p> <p>In all patients, hepatitis persisted despite cessation of known hepatotoxic drugs and in absence of known infectious triggers, until discontinuation of IL1RA. Liver biopsies had mixed inflammatory infiltrates with associated hepatocellular injury suggestive of an exogenous trigger. At the time of hepatitis, laboratory data and liver biopsies were not characteristic of MAS. In two patients, transaminitis resolved within one week of discontinuing IL1RA, the third improved dramatically in one month.</p> <p>Conclusions</p> <p>Although sJIA symptoms improved significantly on IL1RA, it appeared that IL1RA contributed to the development of acute hepatitis. Hepatitis possibly occurred as a result of an altered immune response to a typical childhood infection while on IL1RA. Alternatively, hepatitis could have represented an atypical presentation of MAS in patients with sJIA taking IL1RA. Further investigation is warranted to determine how anti-IL1 therapies alter immune responsiveness to exogenous triggers in patients with immune dysfunction such as sJIA. Our patients suggest that close monitoring for hepatic and other toxicities is indicated when treating with IL1RA.</p

Hypoxia during maintenance hemodialysis; the critical role of pH

Background The impact and management of subclinical hypoxia during hemodialysis is a significant medical challenge. As key determinants of O2 availability and delivery, proposed mechanisms contributing to hypoxia include ischemia, alkalemia and pulmonary leukocyte sequestration. However, no study has comprehensively investigated and compared these interrelated mechanisms throughout a typical hemodialysis treatment week. This study aimed to comprehensively assess the physiological mechanisms that contribute to hypoxia during hemodialysis. Methods In 76 patients, we measured arterial blood gases and pH at four time-points during hemodialysis (start, 15 min, 60 min, end) over the course of a standard treatment week. For the mid-week hemodialysis session, we additionally measured central hemodynamics (non-invasive cardiac output monitoring) and white blood cell count. Results Linear regression modelling identified changes in pH, but not central hemodynamics or white blood cell count, to be predictive of changes in PaO2 throughout hemodialysis (e.g. at 60 min, β standardized coefficient pH = 0.45, model R2 = 0.25, P < .001). Alkalemia, hypokalemia, decreased calcium and increased hemoglobin–O2 affinity (leftward shift in the oxyhemoglobin dissociation curve) were evident at the end of hemodialysis. pH and hemoglobin–O2 affinity at the start of hemodialysis increased incrementally over the course of a standard treatment week. Conclusion These data highlight the important role of pH in regulating O2 availability and delivery during hemodialysis. Findings support routine pH monitoring and personalized dialysate bicarbonate prescription to mitigate the significant risk of alkalemia and subclinical hypoxia

Smallest Anopheles farauti occur during the peak transmission season in the Solomon Islands

Background: Malaria transmission varies in intensity amongst Solomon Island villages where Anopheles farauti is the only vector. This variation in transmission intensity might be explained by density-dependent processes during An. farauti larval development, as density dependence can impact adult size with associated fitness costs and daily survivorship. Methods: Adult anophelines were sampled from six villages in Western and Central Provinces, Solomon Islands between March 2014 and February 2017. The size of females was estimated by measuring wing lengths, and then analysed for associations with biting densities and rainfall. Results: In the Solomon Islands, three anopheline species, An. farauti, Anopheles hinesorum and Anopheles lungae, differed in size. The primary malaria vector, An. farauti, varied significantly in size among villages. Greater rainfall was directly associated with higher densities of An. farauti biting rates, but inversely associated with body size with the smallest mean sized mosquitoes present during the peak transmission period. A measurable association between body size and survivorship was not found. Conclusions: Density dependent effects are likely impacting the size of adult An. farauti emerging from a range of larval habitats. The data suggest that rainfall increases An. farauti numbers and that these more abundant mosquitoes are significantly smaller in size, but without any reduced survivorship being associated with smaller size. The higher malaria transmission rate in a high malaria focus village appears to be determined more by vector numbers than size or survivorship of the vectors