Newborn hearing screening: A retrospective analysis of hit and false positive rates in the NICU and how they are influenced by risk factors for hearing loss in a suburban birthing hospital

The purpose of this study was to evaluate the effectiveness of a hearing screening program, particularly focusing on hit and false positive rates in the NICU and WBN at a top-rated birthing hospital in Saint Louis, MO. Additionally, the study examined how these rates may be influenced by risk factors for hearing loss.

Physical and perceived noise levels within the neonatal intensive care unit of St. Louis Children's Hospital

This paper studies the success of the renovation of the Neonatal Intensive Care Unit at St. Louis Children's Hospital in reducing noise levels and improving the work environment.

Digitisation, representation, and formalisation - Digital libraries of mathematics

One of the main tasks of the mathematical knowledge management community must surely be to enhance access to mathematics on digital systems. In this paper we present a spectrum of approaches to solving the various problems inherent in this task, arguing that a variety of approaches is both necessary and useful. The main ideas presented are about the differences between digitised mathematics, digitally represented mathematics and formalised mathematics. Each has its part to play in managing mathematical information in a connected world. Digitised material is that which is embodied in a computer file, accessible and displayable locally or globally. Represented material is digital material in which there is some structure (usually syntactic in nature) which maps to the mathematics contained in the digitised information. Formalised material is that in which both the syntax and semantics of the represented material, is automatically accessible. Given the range of mathematical information to which access is desired, and the limited resources available for managing that information, we must ensure that these resources are applied to digitise, form representations of or formalise, existing and new mathematical information in such a way as to extract the most benefit from the least expenditure of resources. We also analyse some of the various social and legal issues which surround the practical tasks.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

Errors associated with preparation of adult and paediatric parenteral nutrition in UK hospital pharmacies

Rationale: In UK hospitals, the preparation of all total parenteral nutrition (TPN) products must be made in the pharmacy as TPNs are categorised as high-risk injectables (NPSA/2007/20). The National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors in the UK since August 2003. This study reports on types of error associated with the preparation of TPNs, including the stage at which these were identified and potential and actual patient outcomes. Methods: Reports of compounding errors for the period 1/2004 - 3/2007 were analysed on an Excel spreadsheet. Results: Of a total of 3691 compounding error reports, 674 (18%) related to TPN products; 548 adult vs. 126 paediatric. A significantly higher proportion of adult TPNs (28% vs. 13% paediatric) were associated with labelling errors and a significantly higher proportion of paediatric TPNs (25% vs. 15% adult) were associated with incorrect transcriptions (Chi-Square Test; p<0.005). Labelling errors were identified equally by pharmacists (42%) and technicians (48%) with technicians detecting mainly at first check and pharmacists at final check. Transcription errors were identified mainly by technicians (65% vs. 27% pharmacist) at first check. Incorrect drug selection (13%) and calculation errors (9%) were associated with adult and paediatric TPN preparations in the same ratio. One paediatric TPN error detected at first check was considered potentially catastrophic; 31 (5%) errors were considered of major and 38 (6%) of moderate potential consequence. Five errors (2 moderate, 1 minor) were identified during or after administration. Conclusions: While recent UK patient safety initiatives are aimed at improving the safety of injectable medicines in clinical areas, the current study highlights safety problems that exist within pharmacy production units. This could be used in the creation of an error management tool for TPN compounding processes within hospital pharmacies.

Libraries and literature in Rome

A chapter of 6,000 words on books, literary culture, and public and private libraries in the ancient city of Rome

Public libraries in the cities of the Roman Empire

A chapter based on a paper given at major conference, arguing that the civic and architectural contexts of many public libraries in the Roman world contributed strongly to their status as conspicuous 'public' buildings, and should inform the way we think of library functions in the Roman world

Galen and libraries in the Peri Alupias

A long (12,000 word) article on the evidence for library function and usage in the newly-discovered Peri Alupias of Galen

Bibliotheca Latina Graecaque: on the possible division of Roman libraries by language

An article challenging the frequent assumption that Roman public libraries consisted of architecturally separated spaces divided by language (Latin and Greek). While the evidence for such a division is reasonably strong in some cases, in others it is convention rather than evidence that prompts the labelling of buildings as 'Latin' and 'Greek' libraries. The article is based on a paper given at a major international conference in Paris

Combinatorial peptide ligand libraries and plant proteomics: a winning strategy at a price

The mechanism of action and properties of a solid-phase ligand library made of hexapeptides (combinatorial peptide ligand libraries or CPLL), for capturing the "hidden proteome", i.e. the low- and very low-abundance proteins constituting the vast majority of species in any proteome, as applied to plant tissues, are reviewed here. Plant tissues are notoriously recalcitrant to protein extraction and to proteome analysis. Firstly, rigid plant cell walls need to be mechanically disrupted to release the cell content and, in addition to their poor protein yield, plant tissues are rich in proteases and oxidative enzymes, contain phenolic compounds, starches, oils, pigments and secondary metabolites that massively contaminate protein extracts. In addition, complex matrices of polysaccharides, including large amount of anionic pectins, are present. All these species compete with the binding of proteins to the CPLL beads, impeding proper capture and identification / detection of low-abundance species. When properly pre-treated, plant tissue extracts are amenable to capture by the CPLL beads revealing thus many new species among them low-abundance proteins. Examples are given on the treatment of leaf proteins, of corn seed extracts and of exudate proteins (latex from Hevea brasiliensis). In all cases, the detection of unique gene products via CPLL capture is at least twice that of control, untreated sample.