Reducing adverse drug events: lessons from a breakthrough series collaborative

BACKGROUND: In January 1996, 38 hospitals and health care organizations (for a total of 40 hospitals) in the United States came together in an Institute for Healthcare Improvement (IHI; Boston) Breakthrough Series collaborative to reduce adverse drug events-injuries related to the use or nonuse of medications. METHODS: The participants were taught the Model for Improvement, a method for rapid-cycle change and evaluation, and were then coached on how to identify their own problem areas and develop changes in practice for rapid-cycle testing. These changes could be implementation of one or more known medication error prevention practices or new practices developed. RESULTS: During a 15-month period the 40 hospitals conducted a total of 739 tests of changes. Process changes accounted for 63% of the cycles; the remainder consisted of preliminary data gathering, consensus-building, or education cycles. Eight types of changes were implemented by seven or more hospitals, with a success rate of 70%. These changes included non-punitive reporting, ensuring documentation of allergy information, standardizing medication administration times, and implementing chemotherapy protocols. DISCUSSION: Success in making significant changes was associated with strong leadership, effective processes, and appropriate choice of intervention. Successful teams were able to define, clearly state, and relentlessly pursue their aims, and then chose practical interventions and moved early into changing a process. They did not spend months collecting data before beginning a change. Changes that were most successful were those that attempted to change processes, not people. Health care organizations committed to patient safety need not regard current performance limits as inevitable.     

Trapping of bead-based reagents within microfluidic systems: on-chip solid-phase extraction and electrochromatography

A 330-pL chromatographic bed was fabricated on a glass substrate as part of an electroosmotically pumped microfluidic system. Two weirs within a sample channel formed a cavity in which octadecylsilane (ODS) coated silica beads (1.5-4 microns diameter) were trapped. ODS beads were mobilized into and out of the cavity using electroosmotic flow through a bead-introduction channel which accessed the cavity. This procedure allowed the beads in the cavity to be repeatedly exchanged. A 1 nM solution of a nonpolar analyte (BODIPY 493/503) in buffer was loaded onto the beads for different lengths of time using an electroosmotic flow of 1.2 nL/s. The material retained on the ODS phase was then eluted by electroosmotic flow of acetonitrile with a concentration enhancement of up to 500 times. Capillary electrochromatography was conducted using a similar device. BODIPY and fluorescein were loaded onto a 200-micron-long chromatographic bed and then separated in an isocratic CEC run with an acetonitrile/buffer mobile phase. Complete separation was achieved in less than 20 s with a 2-micron plate height.     

Finite element analysis of a deformable array transducer

Deformable array transducers have previously been described to implement 2-D phase aberration correction of near-field aberrators with only a 1xN or 2xN array configuration. This transducer design combines mechanical phase correction using an actuator with electronic phase correction for a 2-D correction with significantly fewer elements than a full 2-D array. We have previously reported the fabrication and results of a 1x32 deformable array fabricated with a RAINBOW (Reduced And INternally Biased Wafer) actuator. Because of the complicated construction of deformable arrays, we propose to use finite element analysis (FEA) as a design tool for array development. In this paper, we use 2-D and 3-D FEA to model the experimental results of the deformable array as the first step toward development of a design tool. Because the deformable array combines a mechanical actuator with a medical ultrasound transducer, improvement in performance must consider both the ultrasound characterization along with the low frequency actuator characterization. For the ultrasound characterization, time domain FEA simulations of electrical vector impedance accurately predicted the measurements of single array elements. Additionally, simulations of pulse-echo sensitivity and bandwidth were also well matched to measurements. For the low frequency actuator characterization, time domain simulation of the low frequency vector impedance accurately predicted measurement and confirmed the fundamental flexure resonance of the cantilever configuration at 1.3 kHz. Frequency domain FEA included thermal processing effects and predicted actuator curvature arising during fabrication. Finally, frequency domain FEA simulations of voltage-induced displacement accurately predicted measured displacement.     

In situ spectral monitoring of mRNA translation in embryonic stem cells during differentiation in vitro

Raman microspectroscopy was used to determine biochemical markers during the differentiation of embryonic murine stem cells (mES) in vitro. Such markers are useful to determine the differentiation status of ES cells cultured on biomaterials. Raman spectra of mES cells as undifferentiated, spontaneously differentiated (4 days), and differentiated cells via formation of embryoid bodies (16, 20 days) were analyzed. Unsupervised hierarchical cluster analysis and principal component analysis were used to determine biochemical differences between mES cells in various states of differentiation. The undifferentiated cells were characterized by high scores of the first principal component (PC1, 49% variance). Similarity between the PC1 loading and the Raman spectrum of RNA indicated a high concentration of RNA in mES cells compared to differentiated cells. The ratio between the peak areas of RNA and proteins was used as a measure of mRNA translation. Using the same peak area ratio, it was possible to differentiate even between mES as undifferentiated and in early stages of differentiation (4 days). These findings were correlated with biological studies reporting high levels of nontranslated mRNA during early embryonic development. Therefore, the RNA translation obtained from the Raman spectra can be used as marker of differentiation state of mES cells.     

An examination of exposure control and content balancing restrictions on item selection in CATs using the partial credit model

The purpose of the present investigation was to systematically examine the effectiveness of the Sympson-Hetter technique and rotated content balancing relative to no exposure control and no content rotation conditions in a computerized adaptive testing system (CAT) based on the partial credit model. A series of simulated fixed and variable length CATs were run using two data sets generated to multiple content areas for three sizes of item pools. The 2 (exposure control) X 2 (content rotation) X 2 (test length) X 3 (item pool size) X 2 (data sets) yielded a total of 48 conditions. Results show that while both procedures can be used with no deleterious effect on measurement precision, the gains in exposure control, pool utilization, and item overlap appear quite modest. Difficulties involved with setting the exposure control parameters in small item pools make questionable the utility of the Sympson-Hetter technique with similar item pools.     

Real-time total integrated scattering measurements on the Mir spacecraft to evaluate sample degradation in space

An instrument to measure total integrated scattering (TIS) in space was built as part of the Optical Properties Monitor instrument package and flown on the Russian Mir Space Station in a low Earth orbit. TIS at two wavelengths was measured in space at approximately weekly intervals from 29 April to 26 December 1997 and telemetered to Earth during the mission. Of the 20 TIS samples, 13 are described here to illustrate the performance of the TIS instrument. These include ten optical samples and three thermal control samples. Two optical samples and one thermal control sample were severely degraded by atomic oxygen. All samples received a light dusting of particles during the mission and an additional heavier layer after the samples returned to Earth. The initial brassboard instrument and the validation tests of the flight instrument are also described.     

Phosphate binding protein as the biorecognition element in a biosensor for phosphate

This work explores the potential use of a member of the periplasmic family of binding proteins, the phosphate binding protein (PBP), as the biorecognition element in a sensing scheme for the detection of inorganic phosphate (Pi). The selectivity of this protein originates from its natural role which, in Escherichia coli, is to serve as the initial receptor for the highly specific translocation of Pi to the cytoplasm. The single polypeptide chain of PBP is folded into two similar domains connected by three short peptide linkages that serve as a hinge. The Pi binding site is located deep within the cleft between the two domains. In the presence of the ligand, the two globular domains engulf the former in a hinge-like manner. The resultant conformational change constitutes the basis of the sensor development. A mutant of PBP (MPBP), where an alanine was replaced by a cysteine residue, was prepared by site-directed mutagenesis using the polymerase chain reaction (PCR). The mutant was expressed, from plasmid pSD501, in the periplasmic space of E. coli and purified in a single chromatographic step on a perfusion anion-exchange column. Site-specific labeling was achieved by attaching the fluorophore, N-[2-(1-maleimidyl)ethyl]-7-(diethylamino)coumarin-3-carboxamide (MDCC), to the protein through the sulfhydryl group of the cysteine moiety. Steady-state fluorescence studies of the MPBP-MDCC conjugate showed a change in the intensity of the signal upon addition of Pi. Calibration curves for Pi were constructed by relating the intensity of the fluorescence signal with the amount of analyte present in the sample. The sensing system was first developed and optimized on a spectrofluorometer using ml volumes of sample. It was then adapted to be used on a microtiter plate arrangement with microliter sample volumes. The system's versatility was finally proven by developing a fiber optic fluorescence-based sensor for monitoring Pi. In all three cases the detection limits for the analyte were in the sub-microMolar range. It was also demonstrated that the sensing system was selective for phosphate over other structurally-similar anions, paving the way for the design and development of a new family of biosensors utilizing the specific binding properties of periplasmic proteins.     

抗硫输气管道选材

四川气田系我国典型的含硫气田，集输管道的腐蚀与防腐问题一直是一个重要的研究课题，文章主要从国外采用标准和国外大公司的实践经验两方面对抗硫输气管道的选材问题加以探讨。     

A nonstationary signal simulation model for continuous wave and pulsed Doppler ultrasound

A computer simulation model of the nonstationary Doppler ultrasound signals arising from pulsatile blood flow is presented. The model uses sinusoidal components that are modulated by a power spectral density function that varies over the cardiac cycle. An empirical model consisting of two exponential functions is used to represent both the continuous wave and pulsed Doppler power spectral density for normal carotid arteries. It is shown that the spectrogram speckle patterns of the synthesized Doppler signals compare very well with those clinically recorded.     

高清视频文件拷贝好帮手

Windows的资源管理器在拷贝文件时．会非常霸道地占用大量系统资源．遇到几十GB甚至数百GB的高清视频文件复制时．再想干点别的事情就很困难了。很显然．对于那些经常需要搬运大文件的高清爱好者们而言，系统自带的拷贝功能是不够的，这时第三方软件——Fastcopy就可帮大家解决这一烦恼。