Nursing-related medication errors: A review of factors that facilitate and hinder error reporting, and recommendations for improvement

Medication errors, one of the most frequent types of medical errors, are a common cause of patient harm in hospital systems today. Nurses at the bedside are in a position to encounter many of these errors since they are there at the start of the process (ordering/prescribing) and the end of the process (administration). One of the recommendations from the IOM (Institute of Medicine) report, "To Err is Human," was for organizations to identify and learn from medical errors through event reporting systems. While many organizations have reporting systems in place, research studies report a significant amount of underreporting by nurses. A systematic review of the literature was performed to identify contributing factors related to the reporting and not reporting of medication errors by nurses at the bedside.^ Articles included in the literature review were primary or secondary studies, dated January 1, 2000 – July 2009, related to nursing medication error reporting. All 634 articles were reviewed with an algorithm developed to standardize the review process and help filter out those that did not meet the study criteria. In addition, 142 article bibliographies were reviewed to find additional studies that were not found in the original literature search.^ After reviewing the 634 articles and the additional 108 articles discovered in the bibliography review, 41 articles met the study criteria and were used in the systematic literature review results.^ Fear of punitive reactions to medication errors was a frequent barrier to error reporting. Nurses fear reactions from their leadership, peers, patients and their families, nursing boards, and the media. Anonymous reporting systems and departments/organizations with a strong safety culture in place helped to encourage the reporting of medication errors by nursing staff.^ Many of the studies included in this literature review do not allow results that can be generalized. The majority of them took place in single institutions/organizations with limited sample sizes. Stronger studies with larger sample sizes need to be performed, utilizing data collection methods that have been validated, to determine stronger correlations between safety cultures and nurse error reporting.^

Cell survival in early embryogenesis requires proper dosage of GCN5 and p300

Histone acetylation is a central event in transcriptional activation. The importance of this modification in mammalian development is highlighted by knockout studies that revealed loss of the histone acetyltransferases GCN5, p300, or CBP results in embryonic lethality. Furthermore, early embryogenesis is sensitive to the dosage of p300 and CBP since double p300 +/−CBP+/− heterozygotes die in utero, although either single heterozygote survives. PCAF and GCN5 physically interact with p300 and CBP in vitro. To determine whether these two groups of HATs interact functionally in vivo, we created mice lacking one or more allele of p300, GCN5 or PCAF. As expected, we found that mice heterozygous for any one of these null alleles are viable. The majority of GCN5 p300 double heterozygotes also survive to adulthood with no apparent abnormalities. However, a portion of these mice die prior to birth. These embryos are developmentally stunted and exhibit increased apoptosis compared to wild type or single GCN5 or p300 heterozygous littermates at E8.5. Tissue specification is unaffected in these embryos but organ formation is compromised. In contrast, no abnormalities were observed in mice harboring mutations in both PCAF and p300 , emphasizing the specificity of HAT functions in mammalian development. ^ Since GCN5 null embryos die early in embryogenesis because of a marked increase in apoptosis, studies of its function and mechanism in late development and in tissue specific differentiation are precluded. Here, we also report the establishment of a GCN5 null embryonic stem cell line and a conditional floxGCN5 mouse line, which will serve as powerful genetic tools to examine in depth the function of GCN5 in mammalian development and in adult tissues. ^

Petrological parameters of sands and sandstones from DSDP and ODP holes in arc-related areas

Detrital modes for 524 deep-marine sand and sandstone samples recovered on circum-Pacific, Caribbean, and Mediterranean legs of the Deep Sea Drilling Project and the Ocean Drilling Program form the basis for an actualistic model for arc-related provenance. This model refines the Dickinson and Suczek (1979) and Dickinson and others (1983) models and can be used to interpret the provenance/tectonic history of ancient arc-related sedimentary sequences. Four provenance groups are defined using QFL, QmKP, LmLvLs, and LvfLvmiLvl ternary plots of site means: (1) intraoceanic arc and remnant arc, (2) continental arc, (3) triple junction, and (4) strike-slip-continental arc. Intraoceanic- and remnant-arc sands are poor in quartz (mean QFL%Q < 5) and rich in lithics (QFL%L > 75); they are predominantly composed of plagioclase feldspar and volcanic lithic fragments. Continental-arc sand can be more quartzofeldspathic than the intraoceanic- and remnant-arc sand (mean QFL%Q values as much as 10, mean QFL%F values as much as 65, and mean QmKP%Qm as much as 20) and has more variable lithic populations, with minor metamorphic and sedimentary components. The triple-junction and strike-slip-continental groups compositionally overlap; both are more quartzofeldspathic than the other groups and show highly variable lithic proportions, but the strike-slip-continental group is more quartzose. Modal compositions of the triple junction group roughly correlate with the QFL transitional-arc field of Dickinson and others (1983), whereas the strike-slip-continental group approximately correlates with their dissected-arc field.

Analysis of an ancient global warming event, the Paleocene-Eocene thermal maximum, under examination from ODP Holes 113-689B and 113-690B

Spatiotemporal patterns of carbonate dissolution provide a critical constraint on carbon input during an ancient (~55.5 Ma) global warming event known as the Paleocene-Eocene thermal maximum (PETM), yet the magnitude of lysocline shoaling in the Southern Ocean is poorly constrained due to limited spatial coverage in the circum-Antarctic region. This shortcoming is partially addressed by comparing patterns of carbonate sedimentation at the Site 690 PETM reference section to those herein reconstructed for nearby Site 689. Biochemostratigraphic correlation of the two records reveals that the first ~36 ka of the carbon isotope excursion (CIE) signaling PETM conditions is captured by the Site 689 section, while the remainder of the CIE interval and nearly all of the CIE recovery are missing due to a coring gap. A relatively expanded stratigraphy and higher carbonate content at mid-bathyal Site 689 indicate that dissolution was less severe than at Site 690. Thus, the bathymetric transect delimited by these two PETM records indicates that the lysocline shoaled above Site 689 (~1,100 m) while the calcite compensation depth remained below Site 690 (~1,900 m) in the Weddell Sea region. The ensuing recovery of carbonate sedimentation conforms to a bathymetric trend best explained by gradual lysocline deepening as negative feedback mechanisms neutralized ocean acidification. Further, biochemostratigraphic evidence indicates the tail end of the CIE recovery interval at both sites has been truncated by a hiatus most likely related to vigorous production and advection of intermediate waters.

(Table 2) Production characteristics of phytoplankton and selected related factors at bottle sampling stations in the subtropical and tropical Atlantic Ocean

In October and November 2002, high and relatively high values of chlorophyll a concentration at the sea surface (Cchl) were observed in the English Channel (0.47 mg/m**3), in waters of the North Atlantic Current (0.25 mg/m**3 ), in the tropical and subtropical anticyclonic gyres (0.07-0.42 mg/m**3), and also in the southwestern region of the southern subtropical anticyclonic gyre (usually 0.11-0.23 mg/m**3). The central regions of the southern subtropical anticyclonic gyre (SATG) and the North Atlantic tropical gyre (NATR) were characterized by lower values of Cchl (0.02-0.08 mg/m**3 for the SATG and 0.07-0.14 mg/m**3 for the NATR). At most of the SATG stations, values of surface primary production (Cphs) varied from 2.5 to 5.5 mg C/m**3 per day and were mainly defined by fluctuations of Cchl (r = +0.78) rather than by those of the assimilation number (r = +0.54). Low assimilation activity of phytoplankton in these waters (1.3-4.6 mg chl a per hour) pointed to a lack of nutrients. Analysis of variability of their concentration and composition of photosynthetic pigments showed that, in waters north of 30°N, the growth of phytoplankton was mostly restricted by deficiency of nitrogen, while, in more southern areas, at the majority of stations (about 60%), phosphorus concentrations were minimal. At low concentrations of nitrates and nitrites, ammonium represented itself as a buffer that prevented planktonic algae from extreme degrees of nitric starvation. In tropical waters and in waters of the SATG, primary production throughout the water column varied from 240 to 380 mg C/m**2 30° per day. This level of productivity at stations with low values of C chl (<0.08 mg/m**3) was provided by a well-developed deep chlorophyll maximum and high transparency of water. Light curves of photosynthesis based on in situ measurements point to high efficiency of utilizing penetrating solar radiation by phytoplankton on cloudy days.

Nitrogen isotope gradients off Peru and Ecuador related to upwelling, productivity, nutrient uptake and oxygen deficiency

We present new nitrogen isotope data from the water column and surface sediments for paleo-proxy validation collected along the Peruvian and Ecuadorian margins between 1°N and 18°S. Productivity proxies in the bulk sediment (organic carbon, total nitrogen, biogenic opal, C37 alkenone concentrations) and 15N/14N ratios were measured at more than 80 locations within and outside the present-day Peruvian oxygen minimum zone (OMZ). Microbial N-loss to N2 in subsurface waters under O2 deficient conditions leaves a characteristic 15N-enriched signal in underlying sediments. We find that phytoplankton nutrient uptake in surface waters within the high nutrient, low chlorophyll (HNLC) regions of the Peruvian upwelling system influences the sedimentary signal as well. How the d15Nsed signal is linked to these processes is studied by comparing core-top values to the 15N/14N of nitrate and nitrite (d15N[NOx]) in the upper 200 m of the water column. Between 1°N and 10°S, subsurface O2 is still high enough to suppress N-loss keeping d15NNOx values relatively low in the subsurface waters. However d15N[NOx] values increase toward the surface due to partial nitrate utilization in the photic zone in this HNLC portion of the system. d15N[sed] is consistently lower than the isotopic signature of upwelled [NO3]-, likely due to the corresponding production of 15N depleted organic matter. Between 10°S and 15°S, the current position of perennial upwelling cells, HNLC conditions are relaxed and biological production and near-surface phytoplankton uptake of upwelled [NO3]- are most intense. In addition, subsurface O2 concentration decreases to levels sufficient for N-loss by denitrification and/or anammox, resulting in elevated subsurface d15N[NOx] values in the source waters for coastal upwelling. Increasingly higher production southward is reflected by various productivity proxies in the sediments, while the north-south gradient towards stronger surface [NO3]- utilization and subsurface N-loss is reflected in the surface sediment 15N/14N ratios. South of 10°S, d15N[sed] is lower than maximum water column d15N[NOx] values most likely because only a portion of the upwelled water originates from the depths where highest d15N[NOx] values prevail. Though the enrichment of d15N[NOx] in the subsurface waters is unambiguously reflected in d15N[sed] values, the magnitude of d15N[sed] enrichment depends on both the depth of upwelled waters and high subsurface d15N[NOx] values produce by N-loss. Overall, the degree of N-loss influencing subsurface d15N[NOx] values, the depth origin of upwelled waters, and the degree of near-surface nitrate utilization under HNLC conditions should be considered for the interpretation of paleo d15N[sed] records from the Peruvian oxygen minimum zone.

(Table 3) Age-related trends of desert pavement properties in the Transantarctic Mountains

Compared to mid-latitude deserts, the properties, formation and evolution of desert pavements and the underlying vesicular layer in Antarctica are poorly understood. This study examines the desert pavements and the vesicular layer from seven soil chronosequences in the Transantarctic Mountains that have developed on two contrasting parent materials: sandstone-dolerite and granite-gneiss. The pavement density commonly ranges from 63 to 92% with a median value of 80% and does not vary significantly with time of exposure or parent material composition. The dominant size range of clasts decreases with time of exposure, ranging from 16-64 mm on Holocene and late Quaternary surfaces to 8-16 mm on surfaces of middle Quaternary and older age. The proportion of clasts with ventifaction increases progressively through time from 20% on drifts of Holocene and late Quaternary age to 35% on Miocene-aged drifts. Desert varnish forms rapidly, especially on dolerite clasts, with nearly 100% cover on surfaces of early Quaternary and older age. Macropitting occurs only on clasts that have been exposed since the Miocene. A pavement development index, based on predominant clast-size class, pavement density, and the proportion of clasts with ventifaction, varnish, and pits, readily differentiated pavements according to relative age. From these findings we judge that desert pavements initially form from a surficial concentration of boulders during till deposition followed by a short period of deflation and a longer period of progressive chemical and physical weathering of surface clasts. The vesicular layer that underlies the desert pavement averages 4 cm in thickness and is enriched in silt, which is contributed primarily by weathering rather than eolian deposition. A comparison is made between desert pavement properties in mid-latitude deserts and Antarctic deserts.

Geochemistry and isotopic ratios of boninites and related rocks of the Izu-Bonin Forearc

Twenty-six samples representing the wide range of lithologies (low- and intermediate-Ca boninites and bronzite andesites, high-Ca boninites, basaltic andesites-rhyolites) drilled during Leg 125 at Sites 782 and 786 on the Izu-Bonin outer-arc high have been analyzed for Sr, Nd, and Pb isotopes. Nd-Sr isotope covariations show that most samples follow a trend parallel to a line from Pacific MORB mantle (PMM) to Pacific Volcanogenic sediment (PVS) but displaced slightly toward more radiogenic Sr. Pb isotope covariations show that all the Eocene-Oligocene samples plot along the Northern Hemisphere Reference Line, indicating little or no Pb derived from subducted pelagic sediment in their source. Two young basaltic andesite clasts within sediment do have a pelagic sediment signature but this may have been gained by alteration rather than subduction. In all isotopic projections, the samples form consistent groupings: the tholeiites from Site 782 and Hole 786A plot closest to PMM, the boninites and related rocks from Sites 786B plot closest to PVS, and the boninite lavas from Hole 786A and late boninitic dikes from Hole 786B occupy an intermediate position. Isotope-trace element covariations indicate that these isotopic variations can be explained by a three-component mixing model. One component (A) has the isotopic signature of PMM but is depleted in the more incompatible elements. It is interpreted as representing suboceanic mantle lithosphere. A second component (B) is relatively radiogenic (epsilon-Nd = ca 4-6; 206Pb/204Pb = ca 19.0-19.3; epsilon-Sr = ca -10 to -6)). Its trace element pattern has, among other characteristics, a high Zr/Sm ratio, which distinguishes it from the ìnormalî fluid components associated with subduction and hotspot activity. There are insufficient data at present to tie down its origin: probably it was either derived from subducted lithosphere or volcanogenic sediment fused in amphibolite facies; or it represents an asthenospheric melt component that has been fractionated by interaction with amphibole-bearing mantle. The third component (C) is characterized by high contents of Sr and high epsilon-Sr values and is interpreted as a subducted fluid component. The mixing line on a diagram of Zr/Sr against epsilon-Sr suggests that component C may have enriched the lithosphere (component A) before component B. These components may also be present on a regional basis but, if so, may not have had uniform compositions. Only the boninitic series from nearby Chichijima would require an additional, pelagic sediment component. In general, these results are consistent with models of subduction of ridges and young lithosphere during the change from a ridge-transform to subduction geometry at the initiation of subduction in the Western Pacific.

Conflict and cognitive control during sentence comprehension: recruitment of a frontal network during the processing of Spanish object-first sentences.

During sentence processing there is a preference to treat the first noun phrase found as the subject and agent, unless marked the other way. This preference would lead to a conflict in thematic role assignment when the syntactic structure conforms to a non-canonical object-before-subject pattern. Left perisylvian and fronto-parietal brain networks have been found to be engaged by increased computational demands during sentence comprehension, while event-reated brain potentials have been used to study the on-line manifestation of these demands. However, evidence regarding the spatiotemporal organization of brain networks in this domain is scarce. In the current study we used Magnetoencephalography to track spatio-temporally brain activity while Spanish speakers were reading subject- and object-first cleft sentences. Both kinds of sentences remained ambiguous between a subject-first or an object-first interpretation up to the appearance of the second argument. Results show the time-modulation of a frontal network at the disambiguation point of object-first sentences. Moreover, the time windows where these effects took place have been previously related to thematic role integration (300–500 ms) and to sentence reanalysis and resolution of conflicts during processing (beyond 500 ms post-stimulus). These results point to frontal cognitive control as a putative key mechanism which may operate when a revision of the sentence structure and meaning is necessary