Medication discrepancies at transitions in pediatrics:a review of the literature

Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm. © 2013 Springer International Publishing Switzerland.

Computation of rare transitions in the barotropic quasi-geostrophic equations

We investigate the theoretical and numerical computation of rare transitions in simple geophysical turbulent models. We consider the barotropic quasi-geostrophic and two-dimensional Navier–Stokes equations in regimes where bistability between two coexisting large-scale attractors exist. By means of large deviations and instanton theory with the use of an Onsager–Machlup path integral formalism for the transition probability, we show how one can directly compute the most probable transition path between two coexisting attractors analytically in an equilibrium (Langevin) framework and numerically otherWe adapt a class of numerical optimization algorithms known as minimum action methods to simple geophysical turbulent models. We show that by numerically minimizing an appropriate action functional in a large deviation limit, one can predict the most likely transition path for a rare transition between two states. By considering examples where theoretical predictions can be made, we show that the minimum action method successfully predicts the most likely transition path. Finally, we discuss the application and extension of such numerical optimization schemes to the computation of rare transitions observed in direct numerical simulations and experiments and to other, more complex, turbulent systems.

Antidepressant/anxiolytic and anti-nociceptive effects of novel 2-substituted 1,4-benzodiazepine-2-ones

Oxazepam (4a) has been used as overall starting material in the synthesis of novel 2-substituted 1,4-benzodiazepines. By reacting Oxazepam 4a with commercially available hydrazines, hydrazides, semicarbazide, aminoguanidine and N,N-dimethylamino aniline in ethanol under acetic conditions, a series of diazenyl-1,4-benzodiazepines 5a-5i and 2-amino- 1,4-benzodiazepine 5k were obtained in good yields. These novel compounds served as new chemical entities (NCE) for testing in mice. The diazo-benzodiazepine 5d has shown a promising antidepressant effect in initial experiments in vivo at a dose of 5 mg/kg. The highly coloured 2-aminobenzodiazepine derivative 5k showed over a dose range from 5-50 mg/kg an analgesic effect in mice. © Singh et al.

Designed for Patience. The Significance of International Factors in the Ukrainian and Belarusian Transitions

This paper focuses on Belarus in order to find explanation as to why could Lukashenko remain the authoritarian leader of Belarus, while in Ukraine the position of the political elite had proved less stable and collapsed in 2004. We seek to determine whether the internal factors (macroeconomic conditions, standard of living, the oppressive nature of the political system) play a significant role in the operation of the domino effect. This article emphasises the determining role of immanent internal factors, thus the political stability in Belarus can be explained by the role of the suppressing political regime, the hindrance of democratic rights and the relatively good living conditions that followed the transformational recession. Whilst in Ukraine, the markedly different circumstances brought forth the success of the Orange Revolution.

French Truffles and Forest Transitions

Truffle production in France has declined by more than 90% over the last 100 years. Commonly cited causes include a massive rural exodus that led to more open canopy forests becoming less intensively managed and reverting to closed canopy forests, the latter which do not favor truffle production. Scholars have labeled such a process as a forest transition, when a location goes from previously losing forest cover to regrowth and net gains in forest cover. Scholars have single out France as a place with a marked forest transition. Commonly these increases in forest cover are assumed to be a beneficial public good. Here, I question if it is accurate to view forest transitions as being universally beneficial, especially considering that this changing ecology has had strongly deleterious impacts on truffle production and those who rely on it for revenue. In this study I will use remote sensed images to examine if a forest transition did in fact occur in the department of Lot, France and what are the impacts forest trends have had on truffle cultivation. I will further estimates potential losses of revenue from truffle production which has resulted from any existing forest transition.

Last Interglacial synthesis of high-latitude temperature: temperature anomalies and associated errors for 4 time slices

The Last Interglacial (LIG, 129-116 thousand of years BP, ka) represents a test bed for climate model feedbacks in warmer-than-present high latitude regions. However, mainly because aligning different palaeoclimatic archives and from different parts of the world is not trivial, a spatio-temporal picture of LIG temperature changes is difficult to obtain. Here, we have selected 47 polar ice core and sub-polar marine sediment records and developed a strategy to align them onto the recent AICC2012 ice core chronology. We provide the first compilation of high-latitude temperature changes across the LIG associated with a coherent temporal framework built between ice core and marine sediment records. Our new data synthesis highlights non-synchronous maximum temperature changes between the two hemispheres with the Southern Ocean and Antarctica records showing an early warming compared to North Atlantic records. We also observe warmer than present-day conditions that occur for a longer time period in southern high latitudes than in northern high latitudes. Finally, the amplitude of temperature changes at high northern latitudes is larger compared to high southern latitude temperature changes recorded at the onset and the demise of the LIG. We have also compiled four data-based time slices with temperature anomalies (compared to present-day conditions) at 115 ka, 120 ka, 125 ka and 130 ka and quantitatively estimated temperature uncertainties that include relative dating errors. This provides an improved benchmark for performing more robust model-data comparison. The surface temperature simulated by two General Circulation Models (CCSM3 and HadCM3) for 130 ka and 125 ka is compared to the corresponding time slice data synthesis. This comparison shows that the models predict warmer than present conditions earlier than documented in the North Atlantic, while neither model is able to produce the reconstructed early Southern Ocean and Antarctic warming. Our results highlight the importance of producing a sequence of time slices rather than one single time slice averaging the LIG climate conditions.

(Table 1, page 1376) Chemical analyses of manganese nodules and crusts from the Pacific Ocean

A compilation of chemical analyses of Pacific Ocean nodules using an x-ray fluorescence technique. The equipment used was a General Electric XRD-5 with a tungsten tube. Lithium fluoride was used as the diffraction element in assaying for all elements above calcium in the atomic table and EDDT was used in conjunction with a helium path for all elements with an atomic number less than calcium. Flow counters were used in conjunction with a pulse height analyzer to eliminate x-ray lines of different but integral orders in gathering count data. The stability of the equipment was found to be excellent by the author. The equipment was calibrated by the use of standard ores made from pure oxide forms of the elements in the nodules and carefully mixed in proportion to the amounts of these elements generally found in the manganese nodules. Chemically analyzed standards of the nodules themselves were also used. As a final check, a known amount of the element in question was added to selected samples of the nodules and careful counts were taken on these samples before and after the addition of the extra amount of the element. The method involved the determination and subsequent use of absorption and activation factors for the lines of the various elements. All the absorption and activation factors were carefully determined using the standard ores. The chemically analyzed samples of the nodules by these methods yielded an accuracy to at least three significant figures.

Testing of Interposer-Based 2.5D Integrated Circuits

The unprecedented and relentless growth in the electronics industry is feeding the demand for integrated circuits (ICs) with increasing functionality and performance at minimum cost and power consumption. As predicted by Moore's law, ICs are being aggressively scaled to meet this demand. While the continuous scaling of process technology is reducing gate delays, the performance of ICs is being increasingly dominated by interconnect delays. In an effort to improve submicrometer interconnect performance, to increase packing density, and to reduce chip area and power consumption, the semiconductor industry is focusing on three-dimensional (3D) integration. However, volume production and commercial exploitation of 3D integration are not feasible yet due to significant technical hurdles.

At the present time, interposer-based 2.5D integration is emerging as a precursor to stacked 3D integration. All the dies and the interposer in a 2.5D IC must be adequately tested for product qualification. However, since the structure of 2.5D ICs is different from the traditional 2D ICs, new challenges have emerged: (1) pre-bond interposer testing, (2) lack of test access, (3) limited ability for at-speed testing, (4) high density I/O ports and interconnects, (5) reduced number of test pins, and (6) high power consumption. This research targets the above challenges and effective solutions have been developed to test both dies and the interposer.

The dissertation first introduces the basic concepts of 3D ICs and 2.5D ICs. Prior work on testing of 2.5D ICs is studied. An efficient method is presented to locate defects in a passive interposer before stacking. The proposed test architecture uses e-fuses that can be programmed to connect or disconnect functional paths inside the interposer. The concept of a die footprint is utilized for interconnect testing, and the overall assembly and test flow is described. Moreover, the concept of weighted critical area is defined and utilized to reduce test time. In order to fully determine the location of each e-fuse and the order of functional interconnects in a test path, we also present a test-path design algorithm. The proposed algorithm can generate all test paths for interconnect testing.

In order to test for opens, shorts, and interconnect delay defects in the interposer, a test architecture is proposed that is fully compatible with the IEEE 1149.1 standard and relies on an enhancement of the standard test access port (TAP) controller. To reduce test cost, a test-path design and scheduling technique is also presented that minimizes a composite cost function based on test time and the design-for-test (DfT) overhead in terms of additional through silicon vias (TSVs) and micro-bumps needed for test access. The locations of the dies on the interposer are taken into consideration in order to determine the order of dies in a test path.

To address the scenario of high density of I/O ports and interconnects, an efficient built-in self-test (BIST) technique is presented that targets the dies and the interposer interconnects. The proposed BIST architecture can be enabled by the standard TAP controller in the IEEE 1149.1 standard. The area overhead introduced by this BIST architecture is negligible; it includes two simple BIST controllers, a linear-feedback-shift-register (LFSR), a multiple-input-signature-register (MISR), and some extensions to the boundary-scan cells in the dies on the interposer. With these extensions, all boundary-scan cells can be used for self-configuration and self-diagnosis during interconnect testing. To reduce the overall test cost, a test scheduling and optimization technique under power constraints is described.

In order to accomplish testing with a small number test pins, the dissertation presents two efficient ExTest scheduling strategies that implements interconnect testing between tiles inside an system on chip (SoC) die on the interposer while satisfying the practical constraint that the number of required test pins cannot exceed the number of available pins at the chip level. The tiles in the SoC are divided into groups based on the manner in which they are interconnected. In order to minimize the test time, two optimization solutions are introduced. The first solution minimizes the number of input test pins, and the second solution minimizes the number output test pins. In addition, two subgroup configuration methods are further proposed to generate subgroups inside each test group.

Finally, the dissertation presents a programmable method for shift-clock stagger assignment to reduce power supply noise during SoC die testing in 2.5D ICs. An SoC die in the 2.5D IC is typically composed of several blocks and two neighboring blocks that share the same power rails should not be toggled at the same time during shift. Therefore, the proposed programmable method does not assign the same stagger value to neighboring blocks. The positions of all blocks are first analyzed and the shared boundary length between blocks is then calculated. Based on the position relationships between the blocks, a mathematical model is presented to derive optimal result for small-to-medium sized problems. For larger designs, a heuristic algorithm is proposed and evaluated.

In summary, the dissertation targets important design and optimization problems related to testing of interposer-based 2.5D ICs. The proposed research has led to theoretical insights, experiment results, and a set of test and design-for-test methods to make testing effective and feasible from a cost perspective.

Étude exploratoire des transitions de milieux de vie en communauté des personnes présentant une déficience intellectuelle

Cette étude exploratoire dresse un portrait des transitions de milieux de vie (MDV) dans des Centres de réadaptation en déficience intellectuelle et en troubles envahissants du développement (CRDITED) de la grande région de Montréal. Elle permet d’identifier 1) les pratiques de transition de MDV des intervenants pivots en CRDITED, 2) les critères de succès de la transition de MDV et les moyens de les évaluer selon les personnes présentant une déficience intellectuelle et les intervenants pivots et 3) l’écart entre les pratiques souhaitées et les pratiques actuelles à partir du point de vue des deux types de participants. Des personnes présentant une déficience intellectuelle (N = 9) et des intervenants pivots (N = 19) se sont exprimés sur leurs expériences de transition de MDV en participant à des entretiens de groupe. Une analyse qualitative de contenu a permis d’identifier une typologie des expériences de transition de MDV du point de vue des intervenants pivots. Un seul type de transition de MDV parmi les cinq identifiés, le type préparée, offre des conditions favorisant la réalisation de la transition dans des conditions satisfaisantes pour les intervenants pivots. Les autres types de transitions (types dernière minute, explosive, clé en main et salle d’attente) offrent peu d’occasions pour la personne présentant une déficience intellectuelle de s’impliquer dans le processus de transition. Les propos des intervenants pivots permettent d’identifier les caractéristiques d’une transition de MDV qu’ils jugent idéale (type comme si c’était moi). Les types de transitions sont comparés entre eux sur deux axes, soit sur l’axe représentant un continuum d’implication de la personne présentant une déficience intellectuelle dans sa propre transition et sur l’axe identifiant les grandes étapes de réalisation de la transition. Les résultats permettent de déceler un écart important entre les transitions actuellement effectuées et les politiques, intentions et engagements de l’offre de service auprès de cette clientèle, notamment au regard de l’implication de la personne présentant une déficience intellectuelle dans les décisions relatives à sa transition de MDV. L’étude permet aussi d’identifier trois dimensions importantes de l’évaluation du succès de la transition selon les perspectives des personnes présentant une déficience intellectuelle et des intervenants pivots. Les dimensions identifiées sont : bien-être psychologique et comportement, santé physique et collaboration. Les propos des intervenants pivots permettent de constater qu’il existe parfois un paradoxe entre leurs perceptions du succès de la transition de MDV et celles des personnes présentant une déficience intellectuelle. L’interprétation des résultats a permis d’élaborer des recommandations afin de favoriser de meilleures pratiques de transition.

Understanding near Fermi-level electronic structure through x-ray emission spectroscopy

Thesis (Ph.D.)--University of Washington, 2016-08

410 - Phase transitions induced by coloured voltage noise in nerve membranes

Quantitative conditions are derived under which electrically excitable membranes can undergo a phase transition induced by an externally applied voltage noise. The results obtained for a non-cooperative and a cooperative form of the two-state model are compared. © 1981.

Phase Transitions in Engineered Ultracold Quantum Systems

The study of quantum degenerate gases has many applications in topics such as condensed matter dynamics, precision measurements and quantum phase transitions. We built an apparatus to create 87Rb Bose-Einstein condensates (BECs) and generated, via optical and magnetic interactions, novel quantum systems in which we studied the contained phase transitions. For our first experiment we quenched multi-spin component BECs from a miscible to dynamically unstable immiscible state. The transition rapidly drives any spin fluctuations with a coherent growth process driving the formation of numerous spin polarized domains. At much longer times these domains coarsen as the system approaches equilibrium. For our second experiment we explored the magnetic phases present in a spin-1 spin-orbit coupled BEC and the contained quantum phase transitions. We observed ferromagnetic and unpolarized phases which are stabilized by the spin-orbit coupling’s explicit locking between spin and motion. These two phases are separated by a critical curve containing both first-order and second-order transitions joined at a critical point. The narrow first-order transition gives rise to long-lived metastable states. For our third experiment we prepared independent BECs in a double-well potential, with an artificial magnetic field between the BECs. We transitioned to a single BEC by lowering the barrier while expanding the region of artificial field to cover the resulting single BEC. We compared the vortex distribution nucleated via conventional dynamics to those produced by our procedure, showing our dynamical process populates vortices much more rapidly and in larger number than conventional nucleation.