Rubidium and lead abundances in giant stars of the globular clusters M4 and M5

We present measurements of the neutron-capture elements Rb and Pb for bright giants in the globular clusters M4 and M5. The clusters are of similar metallicity ([Fe/H] = -1.2) but M4 is decidedly s-process enriched relative to M5: [Ba/Fe] = +0.6 for M4 but 0.0 for M5. The Rb and Pb abundances were derived by comparing synthetic spectra with high-resolution, high signal-to-noise ratio spectra obtained with MIKE on the Magellan telescope. Abundances of Y, Zr, La, and Eu were also obtained. In M4, the mean abundances from 12 giants are [Rb/Fe] = 0.39 +/- 0.02 (sigma = 0.07), [Rb/Zr] = 0.17 +/- 0.03 (sigma = 0.08), and [Pb/Fe] = 0.30 +/- 0.02 (sigma = 0.07). In M5, the mean abundances from two giants are [Rb/Fe] = 0.00 +/- 0.05 (sigma = 0.06), [Rb/Zr] = 0.08 +/- 0.08 (sigma = 0.11), and [Pb/Fe] = -0.35 +/- 0.02 (sigma = 0.04). Within the measurement uncertainties, the abundance ratios [Rb/Fe], [Pb/Fe] and [Rb/X] for X = Y, Zr, La are constant from star-to-star in each cluster and none of these ratios are correlated with O or Na abundances. While M4 has a higher Rb abundance than M5, the ratios [Rb/X] are similar in both clusters indicating that the nature of the s-products are very similar for each cluster but the gas from which M4's stars formed had a higher concentration of these products.Comment: Accepted for publication in Ap

Indication Alerts Intercept Drug Name Confusion Errors during Computerized Entry of Medication Orders

Background: Confusion between similar drug names is a common cause of potentially harmful medication errors. Interventions to prevent these errors at the point of prescribing have had limited success. The purpose of this study is to measure whether indication alerts at the time of computerized physician order entry (CPOE) can intercept drug name confusion errors. Methods and Findings: A retrospective observational study of alerts provided to prescribers in a public, tertiary hospital and ambulatory practice with medication orders placed using CPOE. Consecutive patients seen from April 2006 through February 2012 were eligible if a clinician received an indication alert during ordering. A total of 54,499 unique patients were included. The computerized decision support system prompted prescribers to enter indications when certain medications were ordered without a coded indication in the electronic problem list. Alerts required prescribers either to ignore them by clicking OK, to place a problem in the problem list, or to cancel the order. Main outcome was the proportion of indication alerts resulting in the interception of drug name confusion errors. Error interception was determined using an algorithm to identify instances in which an alert triggered, the initial medication order was not completed, and the same prescriber ordered a similar-sounding medication on the same patient within 5 minutes. Similarity was defined using standard text similarity measures. Two clinicians performed chart review of all cases to determine whether the first, non-completed medication order had a documented or non-documented, plausible indication for use. If either reviewer found a plausible indication, the case was not considered an error. We analyzed 127,458 alerts and identified 176 intercepted drug name confusion errors, an interception rate of 0.14±.01%. Conclusions: Indication alerts intercepted 1.4 drug name confusion errors per 1000 alerts. Institutions with CPOE should consider using indication prompts to intercept drug name confusion errors

Rubidium and Lead Abundances in Giant Stars of the Globular Clusters M4 and M5

We present measurements of the neutron-capture elements Rb and Pb for bright giants in the globular clusters M4 and M5. The clusters are of similar metallicity ([Fe/ H] similar or equal to -1.2), but M4 is decidedly s-process enriched relative to M5: [Ba/Fe] = +0.6 for M4 but 0.0 for M5. The Rb and Pb abundances were derived by comparing synthetic spectra with high-resolution, high signal-to-noise ratio spectra obtained with MIKE on the Magellan Telescope. Abundances of Y, Zr, La, and Eu were also obtained. In M4, the mean abundances from 12 giants are [Rb/Fe] = 0.39 +/- 0.02 (sigma = 0.07), [Rb/Zr] = 0.17 +/- 0.03 (sigma = 0.08), and [Pb/Fe] = 0.30 +/- 0.02 (sigma = 0.07). In M5, the mean abundances from two giants are [Rb/Fe] = 0.00 +/- 0.05 (sigma = 0.06), [Rb/Zr] = 0.08 +/- 0: 08 (sigma = 0.11), and [Pb/Fe] = -0.35 +/- 0.02 (sigma = 0.04). Within the measurement uncertainties, the abundance ratios [Rb/Fe], [Pb/Fe], and [Rb/X] for X = Y, Zr, and La are constant from star to star in each cluster, and none of these ratios are correlated with O or Na abundances. While M4 has a higher Rb abundance than M5, the ratios [Rb/X] are similar in both clusters, indicating that the nature of the s-products is very similar for each cluster but the gas from which M4's stars formed had a higher concentration of these products

Spectroscopic Study of IRAS 19285+0517(PDS 100): A Rapidly Rotating Li-Rich K Giant

We report on photometry and high-resolution spectroscopy for IRAS 19285+0517. The spectral energy distribution based on visible and near-IR photometry and far-IR fluxes shows that the star is surrounded by dust at a temperature of $T_{\rm {d}}$ $\sim$ 250 K. Spectral line analysis shows that the star is a K giant with a projected rotational velocity $v sin i$ = 9 $\pm$ 2 km s$^{-1}$. We determined the atmospheric parameters: $T_{\rm {eff}}$ = 4500 K, log $g$ = 2.5, $\xi_{t}$ = 1.5 km s$^{-1}$, and [Fe/H] = 0.14 dex. The LTE abundance analysis shows that the star is Li-rich (log $\epsilon$(Li) = 2.5$\pm$0.15), but with essentially normal C, N, and O, and metal abundances. Spectral synthesis of molecular CN lines yields the carbon isotopic ratio $^{12}$C/$^{13}$C = 9 $\pm$3, a signature of post-main sequence evolution and dredge-up on the RGB. Analysis of the Li resonance line at 6707 \AA for different ratios $^{6}$Li/$^{7}$Li shows that the Li profile can be fitted best with a predicted profile for pure $^{7}$Li. Far-IR excess, large Li abundance, and rapid rotation suggest that a planet has been swallowed or, perhaps, that an instability in the RGB outer layers triggered a sudden enrichment of Li and caused mass-loss.Comment: To appear in AJ; 40 pages, 9 figure

A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial

BackgroundThe Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is ‘Tools for Optimizing Medication Safety.’ Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the ‘Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use’.Methods/DesignThe overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only).DiscussionThrough this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the multifaceted challenges related to medication self-management among patients with chronic conditions.Trial registrationClinicaltrials.gov NCT01669473

Elemental Abundance Ratios in Stars of the Outer Galactic Disk. II. Field Red Giants

We summarize a selection process to identify red giants in the direction of the southern warp of the Galactic disk, employing VI_C photometry and multi-object spectroscopy. We also present results from follow-up high-resolution, high-S/N echelle spectroscopy of three field red giants, finding [Fe/H] values of about -0.5. The field stars, with Galactocentric distances estimated at 10 to 15 kpc, support the conclusion of Yong, Carney, & de Almeida (2005) that the Galactic metallicity gradient disappears beyond R_GC values of 10 to 12 kpc for the older stars and clusters of the outer disk. The field and cluster stars at such large distances show very similar abundance patterns, and, in particular, all show enhancements of the "alpha" elements O, Mg, Si, Ca, and Ti and the r-process element Eu. These results suggest that Type II supernovae have been significant contributors to star formation in the outer disk relative to Type Ia supernovae within the past few Gyrs. We also compare our results with those available for much younger objects. The limited results for the H II regions and B stars in the outer disk also suggest that the radial metallicity gradient in the outer disk is shallow or absent. The much more extensive results for Cepheids confirm these trends, and that the change in slope of the metallicity gradient may occur at a larger Galactocentric distance than for the older stars and clusters. However, the younger stars also show rising alpha element enhancements with increasing R_GC, at least beyond 12 kpc. These trends are consistent with the idea of a progressive growth in the size of the Galactic disk with time, and episodic enrichment by Type II supernovae as part of the disk's growth. [Abridged]Comment: Accepted for publication in A

Metal-poor Field Blue Stragglers: More Evidence for Mass Transfer

We report radial velocity studies of five candidate metal-poor field blue stragglers, all known to be deficient in lithium. Four of the five stars are single-lined spectroscopic binaries, with periods ranging from 302 to 840 days, and low orbital eccentricities, in agreement with similar behavior found for other blue straggler candidates by Preston & Sneden (2000) and Carney et al. (2001). The limited data available for lithium abundances indicate that all blue straggler candidates have depleted lithium abundances. Our results show higher values of v(rot) sin i for the binary stars than comparable temperature constant-velocity stars. The orbital periods are too long for tidal effects to now be important, implying that spin-up during mass transfer when the orbital separations and periods were smaller is that cause of the enhanced rotation.Comment: To appear in Astronomical Journal (January 2005 issue

A preliminary study of the effect of closed incision management with negative pressure wound therapy over high-risk incisions

Background Certain postoperative wounds are recognised to be associated with more complications than others and may be termed high-risk. Wound healing can be particularly challenging following high-energy trauma where wound necrosis and infection rates are high. Surgical incision for joint arthrodesis can also be considered high-risk as it requires extensive and invasive surgery and postoperative distal limb swelling and wound dehiscence are common. Recent human literature has investigated the use of negative pressure wound therapy (NPWT) over high-risk closed surgical incisions and beneficial effects have been noted including decreased drainage, decreased dehiscence and decreased infection rates. In a randomised, controlled study twenty cases undergoing distal limb high-energy fracture stabilisation or arthrodesis were randomised to NPWT or control groups. All cases had a modified Robert-Jones dressing applied for 72 h postoperatively and NPWT was applied for 24 h in the NPWT group. Morphometric assessment of limb circumference was performed at six sites preoperatively, 24 and 72 h postoperatively. Wound discharge was assessed at 24 and 72 h. Postoperative analgesia protocol was standardised and a Glasgow Composite Measure Pain Score (GCPS) carried out at 24, 48 and 72 h. Complications were noted and differences between groups were assessed. Results Percentage change in limb circumference between preoperative and 24 and 72 h postoperative measurements was significantly less at all sites for the NPWT group with exception of the joint proximal to the surgical site and the centre of the operated bone at 72 h. Median discharge score was lower in the NPWT group than the control group at 24 h. No significant differences in GCPS or complication rates were noted. Conclusions Digital swelling and wound discharge were reduced when NPWT was employed for closed incision management. Larger studies are required to evaluate whether this will result in reduced discomfort and complication rates postoperatively

A Prescription for Improving Drug Formulary Decision Making

Gordon Schiff and colleagues present a new tool and checklist to help formularies make decisions about drug inclusion and to guide rational drug use