Barriers and facilitators to chemotherapy patients' engagement in medical error prevention

Background: Medical errors are a serious threat to chemotherapy patients. Patients can make contributions to safety but little is known about the acceptability of error-preventing behaviors and its predictors. Patients and methods: A cross-sectional survey study among chemotherapy patients treated at the oncology/hematology unit of a regional hospital was conducted. Patients were presented vignettes of errors and unsafe acts and responded to measures of attitudes, behavioral control, norms, barriers, and anticipated reaction. Results: A total of 479 patients completed the survey (52% response rate). Patients reported a high level of anticipated activity but intentions to engage for safety varied considerably between the hypothetical scenarios (range: 57%-96%, χ2 P < 0.001). Health, knowledge and staff time pressure were perceived as most important barriers. Instrumental [odds ratio (OR) = 1.3, P = 0.046] and experiential attitudes (OR = 1.4, P < 0.001), expectations attributed to clinical staff (OR = 1.2, P = 0.024) and behavioral control (OR = 1.8, P < 0.001) were predictors for patients' behaviors. Conclusions: Patients are affirmative toward engaging for safety but perceive considerable barriers. Intentions to engage in error prevention vary by clinical context and are strongly influenced by attitudes, normative and control beliefs. To successfully involve patients in medical error, prevention clinicians need to address their patients' beliefs and reduce barriers through educatio

A novel model to predict the physical state of atmospheric H2SO4/NH3/H2O aerosol particles

Colberg CA, Luo BP, Wernli H, Koop T, Peter T. A novel model to predict the physical state of atmospheric H2SO4/NH3/H2O aerosol particles. ATMOSPHERIC CHEMISTRY AND PHYSICS. 2003;3(4):909-924.The physical state of the tropospheric aerosol is largely unknown despite its importance for cloud formation and for the aerosol's radiative properties. Here we use detailed microphysical laboratory measurements to perform a systematic global modelling study of the physical state of the H2SO4/NH3/H2O aerosol, which constitutes an important class of aerosols in the free troposphere. The Aerosol Physical State Model (APSM) developed here is based on Lagrangian trajectories computed from ECMWF (European Centre for Medium Range Weather Forecasts) analyses, taking full account of the deliquescence/efflorescence hysteresis. As input APSM requires three data sets: (i) deliquescence and efflorescence relative humidities from laboratory measurements, (ii) ammonia-to-sulfate ratios (ASR) calculated by a global circulation model, and (iii) relative humidities determined from the ECMWF analyses. APSM results indicate that globally averaged a significant fraction (17-57%) of the ammoniated sulfate aerosol particles contain solids with the ratio of solid-containing to purely liquid particles increasing with altitude (between 2 and 10 km). In our calculations the most abundant solid is letovicite, (NH4)(3)H(SO4)(2), while there is only little ammonium sulfate, (NH4)(2)SO4. Since ammonium bisulfate, NH4HSO4, does not nucleate homogeneously, it can only form via heterogeneous crystallization. As the ammonia-to-sulfate ratios of the atmospheric H2SO4/NH3/H2O aerosol usually do not correspond to the stoichiometries of known crystalline substances, all solids are expected to occur in mixed-phase aerosol particles. This work highlights the potential importance of letovicite, whose role as cloud condensation nucleus (CCN) and as scatterer of solar radiation remains to be scrutinized

Analysis of a jet stream induced gravity wave associated with an observed ice cloud over Greenland

International audienceA polar stratospheric ice cloud (PSC type II) was observed by airborne lidar above Greenland on 14 January 2000. It was the unique observation of an ice cloud over Greenland during the SOLVE/THESEO 2000 campaign. Mesoscale simulations with the hydrostatic HRM model are presented which, in contrast to global analyses, are capable to produce a vertically propagating gravity wave that induces the low temperatures at the level of the PSC afforded for the ice formation. The simulated minimum temperature is ~8 K below the driving analyses and ~4.5 K below the frost point, exactly coinciding with the location of the observed ice cloud. Despite the high elevations of the Greenland orography the simulated gravity wave is not a mountain wave. Analyses of the horizontal wind divergence, of the background wind profiles, of backward gravity wave ray-tracing trajectories, of HRM experiments with reduced Greenland topography and of several diagnostics near the tropopause level provide evidence that the wave is emitted from an intense, rapidly evolving, anticyclonically curved jet stream. The precise physical process responsible for the wave emission could not be identified definitely, but geostrophic adjustment and shear instability are likely candidates. In order to evaluate the potential frequency of such non-orographic polar stratospheric cloud events, the non-linear balance equation diagnostic is performed for the winter 1999/2000. It indicates that ice-PSCs are only occasionally generated by gravity waves emanating from spontaneous adjustment

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol.

Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes. A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim. Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations

A numerical process study on the rapid transport of stratospheric air down to the surface over western North America and the Tibetan Plateau

Upper-level fronts are often associated with the rapid transport of stratospheric air along tilted isentropes to the middle or lower troposphere, where this air leads to significantly enhanced ozone concentrations. These plumes of originally stratospheric air can only occasionally be observed at the surface because (i) stable boundary layers prevent an efficient vertical transport down to the surface, and (ii) even if boundary layer turbulence were strong enough to enable this transport, the originally stratospheric air mass can be diluted by mixing, such that only a weak stratospheric signal can be recorded at the surface. Most documented examples of stratospheric air reaching the surface occurred in mountainous regions. This study investigates two such events, using a passive stratospheric air mass tracer in a mesoscale model to explore the processes that enable the transport down to the surface. The events occurred in early May 2006 in the Rocky Mountains and in mid-June 2006 on the Tibetan Plateau. In both cases, a tropopause fold associated with an upper-level front enabled stratospheric air to enter the troposphere. In our model simulation of the North American case, the strong frontal zone reaches down to 700&thinsp;hPa and leads to a fairly direct vertical transport of the stratospheric tracer along the tilted isentropes to the surface. In the Tibetan Plateau case, however, no near-surface front exists and a reservoir of high stratospheric tracer concentrations initially forms at 300–400&thinsp;hPa, without further isentropic descent. However, entrainment at the top of the very deep boundary layer (reaching to 300&thinsp;hPa over the Tibetan Plateau) and turbulence within the boundary layer allows for downward transport of stratospheric air to the surface. Despite the strongly differing dynamical processes, stratospheric tracer concentrations at the surface reach peak values of 10&thinsp;%–20&thinsp;% of the imposed stratospheric value in both cases, corroborating the potential of deep stratosphere-to-troposphere transport events to significantly influence surface ozone concentrations in these regions.</p

Un campus en mouvement : Les pratiques de mobilité des étudiant-e-s et du personnel de l'Université de Lausanne

Les universités génèrent d’importants flux de mobilité et la gestion des transports constitue un défi majeur pour leur fonctionnement. Cette recherche aborde cette problématique dans le cas de l’Université de Lausanne. Dans un premier temps, l’étude porte sur l’évolution du campus et de son accessibilité. Elle montre comment ce site suburbain a été relié au reste de l’agglomération et aborde les mesures prises pour réguler la mobilité. Deuxièmement, elle s’intéresse à la demande, soit aux choix modaux des 18’000 personnes qui travaillent et étudient à l’Université de Lausanne. Des enquêtes réalisées chaque année depuis 2005 permettent de mesurer les pratiques de mobilité et les différences au sein de la communauté universitaire. En conclusion sont esquissées les tendances qui influenceront à terme les flux de mobilité à destination du campus

Ultrathin Tropical Tropopause Clouds (UTTCs) : I. Cloud morphology and occurrence

Subvisible cirrus clouds (SVCs) may contribute to dehydration close to the tropical tropopause. The higher and colder SVCs and the larger their ice crystals, the more likely they represent the last efficient point of contact of the gas phase with the ice phase and, hence, the last dehydrating step, before the air enters the stratosphere. The first simultaneous in situ and remote sensing measurements of SVCs were taken during the APE-THESEO campaign in the western Indian ocean in February/March 1999. The observed clouds, termed Ultrathin Tropical Tropopause Clouds (UTTCs), belong to the geometrically and optically thinnest large-scale clouds in the Earth´s atmosphere. Individual UTTCs may exist for many hours as an only 200--300 m thick cloud layer just a few hundred meters below the tropical cold point tropopause, covering up to 105 km2. With temperatures as low as 181 K these clouds are prime representatives for defining the water mixing ratio of air entering the lower stratosphere

Treatment of hairy cell leukemia with cladribine (2-chlorodeoxyadenosine) by subcutaneous bolus injection: a phase II study

Background: To assess the activity and toxicity of 2-chlorodeoxyadenosine (cladribine, CDA) given by subcutaneous bolus injections to patients with hairy cell leukemia (HCL). Patients and methods: Sixty-two eligible patients with classic or prolymphocytic HCL (33 non-pretreated patients, 15 patients with relapse after previous treatment, and 14 patients with progressive disease during a treatment other than CDA) were treated with CDA 0.14 mg/kg/day by subcutaneous bolus injections for five consecutive days. Response status was repeatedly assessed according to the Consensus Resolution criteria. Results: Complete and partial remissions were seen in 47 (76%) and 13 (21%) patients, respectively, for a response rate of 97%. All responses were achieved with a single treatment course. Most responses occurred early (i.e. within 10 weeks) after start of CDA therapy, but response quality improved during weeks and even months after treatment completion. The median time to treatment failure for all patients was 38 months. Leukopenia was the main toxicity. Granulocyte nadir (median 0.2 × 109/l) was strongly associated with the incidence of infections (P = 0.0013). Non-specific lymphopenia occurred early after CDA treatment, and normal lymphocytes recovered slowly over several months. No significant associations were found between infections and nadir count of lymphocytes or any lymphocyte subpopulation. No opportunistic infections were observed. Conclusions: One course of CDA given by subcutaneous bolus injections is very effective in HCL. The subcutaneous administration is more convenient for patients and care providers, and has a similar toxicity profile to continuous intravenous infusion. The subcutaneous administration of CDA is a substantial improvement and should be offered to every patient with HCL requiring treatment with CD