Are We Making Smart Pumps Smarter?

Background: Medication errors comprise a significant proportion of medical errors, and are abundant, costly, and associated with causing harm to patients via adverse drug events. The most serious medication errors often involve IV medications. Smart pumps were developed to improve patient safety by reducing medication errors. While some studies have found that smart pumps do not decrease medication errors, most have found they are effective to some degree. It is believed that routinely analyzing data on smart pump alerts, making corresponding adjustments in the drug libraries, and analyzing those adjustments can reduce alarm fatigue, which may then decrease medication errors by resulting in less smart pump users overriding the alerts and utilizing workarounds of smart pump safety features. Objective: The objective of this study is to assess if changes made to the Indiana University Health system smart pump drug library decreased nuisance alerts by comparing the actions taken in response to alerts before and after the changes were made. Methods: For a given change made to the Indiana University Health smart pump drug library on April 1, 2016, actions taken in response to alerts corresponding to that change three months prior to and three months after the change were analyzed. The primary outcome was the percent of total alerts that were overrides. Using data from the smart pumps, the number of overrides, reprograms, cancels, and total alerts for each drug in the first and second quarter were recorded. The percentage of total alerts that were overrides, the percentage of total alerts that were reprograms, and the ratio of overrides to reprograms for each quarter were calculated. Results: Analysis was conducted on 8 drugs: carboplatin, fentanyl PCA, hydromorphone PCA, morphine PCA, morphine PCA 10-24kg, morphine PCA \u3e40kg, naloxone, and octreotide. From the first quarter to the second quarter, the percent of overrides increased for 3 drugs, but for all 3, the number of overrides and total alerts decreased. Of the 5 drugs that had a decrease in the percent of overrides, 3 had an increase in the number of overrides and total alerts. Only 2 drugs had a decrease in the percent of overrides and the number of overrides and total alerts. Statistical significance was achieved only for hydromorphone PCA and morphine PCA. The difference between the first and second quarters in the all the measured outcomes varied between the drugs. Conclusions: Forming any definitive conclusions was difficult due to the results containing a significant amount of variation. The literature suggests methods to improve smart pump usage, and improve medication safety by extension. These methods are interfacing smart pumps with computerized physician order entry, clinical decision support systems, electronic medical record/electronic medication administration record, pharmacy information systems, bar-coded medication administration, and laboratory data, as well as improving smart pump safety features compliance through education of smart pump users, leadership support, including/consulting smart pump users in drug library design, and routinely using the event log data as a component of a continuous quality improvement program. These methods are all in line with the current, trending belief that the best method for preventing medication errors is making changes to the medication use system as a whole to correct underlying systems failures instead of addressing a single point, such a smart pump alerts

Congestion-clearing payments to passengers

This paper reports on a project that considers whether the goals of (de)congestion pricing could be achieved in whole or in part by incentivizing mode-shift rather than using charging to force it: buying rather than selling decongestion. The project developed a method for estimating the net present value of the costs and benefits of a permanent ITS-enabled program of paying people to travel as passengers rather than as drivers-to reduce existing congestion in a target corridor to a target maximum level of delay-taking into account the mix of the traffic and the potential impact of latent demand and induced trips. This is relevant for making better use of existing infrastructure (a build nothing alternative to expansion, but not a do nothing one), for decarbonizing transport, and in the run up to automated vehicles where the possibility exists that new infrastructure investments in the 1-20-year timeframe will become stranded assets under some future scenarios. The project incorporated: a thorough review of the literature; focus groups; and a survey in a case study corridor in California to test the theory, develop the method, and determine the likely costs and benefits. The main insights include 1) the significance of an \u27intra-peak demand shift\u27 that would occur if congestion was removed; 2) the need for four major components in a congestion-clearing payments program: a) incentives to switch from driving to being a passenger, b) incentives to travel at less preferred times, c) park and ride/pool facilities near the bottleneck to ease the passenger switch, and d) some limitation on single-occupant vehicle travel in the peak-of-the-peak in order to reserve space for vehicles carrying passengers; and 3) the possible need for different land-use regulations in a successful payments to passengers environment where the amount of traffic might no longer be an obvious constraint for expanding the local economy. The case study benefit cost analysis delivers a benefit cost ratio of 4.5 to 1

Congestion-Clearing Payments to Passengers

Peak period motor vehicle traffic volume congests roads all over the world. This project hypothesizes implementing congestion- clearing payments to passengers as a permanent congestion-management solution. Ongoing congestion-free travel would be achieved by removing existing congestion, and absorbing (re)generated demand, at costs that would be expected to increase as the total number of travelers increases over time. The project develops a comprehensive, step-by-step methodology to calculate the benefits and costs of paying for drivers to become passengers at a congestion-clearing level and to maintain this level over time. The method is derived from the literature, analysis by the project team, and development of a case study. The case study, based on a long-standing bottleneck location in California, enabled the project team to think through the real challenges of developing and evaluating such a solution. The project finds that the conceptual underpinning of the solution is sound. Based on a survey, the case study finds that there is a level of payment that could clear congestion and maintain free-flow for twenty years, with benefits that outweigh costs on a net present value basis by about four to one—though calibration is required. After the initial reward clears the queue at the bottleneck, a significant intra-peak demand shift would occur as existing and new travelers depart home at times that are more to their liking, potentially causing the queue to re-form. A second incentive manages time of travel, rewarding people for traveling as passengers earlier (or later) than the preferred high demand peak-of-the-peak. In the case study, the high proportion of people who say they will only drive alone would eventually result in some periods of single-occupant-vehicle-only traffic during peak, which is an unintended and undesirable consequence. For the case study route, a limit on single-occupant-vehicle travel during the peak- of-the-peak would ensure that high-occupancy-vehicle travel is given preference and would reduce the overall cost of the solution. For the case study, the cost of the congestion-clearing payments-to-passengers solution on a net present value basis is within the estimated range of costs of the alternative of expanding the facility, and the benefits are expected to be greater than for facility expansion. Congestion-clearing payments to passengers can be implemented much sooner and will have greater positive long-term economic impacts. Facility expansion would provide lower and shorter-term benefits and would be expected to return to congested conditions within a year. The project team proposes a pilot project on the case study route to test and calibrate the solution, as well as recommending development of further case study routes to find out how different routes vary and determine the causes of any variations

At Least Ten Genes Define the Imprinted Dlk1-Dio3 Cluster on Mouse Chromosome 12qF1

Background: Genomic imprinting is an exception to Mendelian genetics in that imprinted genes are expressed monoallelically, dependent on parental origin. In mammals, imprinted genes are critical in numerous developmental and physiological processes. Aberrant imprinted gene expression is implicated in several diseases including Prader-Willi/ Angelman syndromes and cancer. Methodology/Principal Findings: To identify novel imprinted genes, transcription profiling was performed on two uniparentally derived cell lines, androgenetic and parthenogenetic primary mouse embryonic fibroblasts. A maternally expressed transcript termed Imprinted RNA near Meg3/Gtl2 (Irm) was identified and its expression studied by Northern blotting and whole mounts in situ hybridization. The imprinted region that contains Irm has a parent of origin effect in three mammalian species, including the sheep callipyge locus. In mice and humans, both maternal and paternal uniparental disomies (UPD) cause embryonic growth and musculoskeletal abnormalities, indicating that both alleles likely express essential genes. To catalog all imprinted genes in this chromosomal region, twenty-five mouse mRNAs in a 1.96Mb span were investigated for allele specific expression. Conclusions/Significance: Ten imprinted genes were elucidated. The imprinting of three paternally expressed protein coding genes (Dlk1, Peg11, and Dio3) was confirmed. Seven noncoding RNAs (Meg3/Gtl2, Anti-Peg11, Meg8, Irm/‘‘Rian’’

Development and testing of a model for risk and protective factors for eating disorders and higher weight among emerging adults: A study protocol

© 2019 Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18–30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors – both cross-sectionally and longitudinally – of both ED and higher weight, and how these vary across countries and gender

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Qualitative Rubric Scores and Grammatical Complexity in Language Samples

The purpose of this project is to obtain a measure of grammatical complexity language samples that were collected from a school SLP and asked participants to complete five narrative and expository tasks to obtain the language sample. Additionally, we used a qualitative rubric that is used to assess a child\u27s oral narrative skills in terms of language. We explored traditional language sample analysis of grammatical complexity versus a qualitative rubric in order to determine more efficient progress monitoring tools

Behavioral and Psychological Aspects of Exercise Across Stages of Eating Disorder Recovery

This study examined the relationship between behavioral and psychological aspects of exercise and eating disorder recovery. Participants were categorized as having an eating disorder (n = 53), partially recovered (n = 15), fully recovered (n = 20), or non-eating disorder controls (n = 67). Groups did not differ significantly in time spent exercising, but did differ in exercise intensity, guilt-related exercise, obsessive exercise cognitions, and appearance/weight management and stress/mood management motivations for exercise. Results support the importance of measuring psychological aspects of exercise in particular across the course of an eating disorder

Behavioral and Psychological Aspects of Exercise Across Stages of Eating Disorder Recovery

This study examined the relationship between behavioral and psychological aspects of exercise and eating disorder recovery. Participants were categorized as having an eating disorder (n = 53), partially recovered (n = 15), fully recovered (n = 20), or non-eating disorder controls (n = 67). Groups did not differ significantly in time spent exercising, but did differ in exercise intensity, guilt-related exercise, obsessive exercise cognitions, and appearance/weight management and stress/mood management motivations for exercise. Results support the importance of measuring psychological aspects of exercise in particular across the course of an eating disorder