Collaborative use of informatics among hospitals to benchmark medication use processes

BACKGROUND: In spring 1995 pharmacists representing each of the 23 member hospitals in Synernet, a hospital cooperative in Maine, decided to collaborate in developing a multihospital medication use evaluation (MUE) program. The committee set up task forces for adverse drug reaction reporting and prevention, MUE plans, and medication error reporting and prevention, for exploration of opportunities to eliminate duplication of efforts, compare performance, and share best practices. PLANNING THE PROGRAM: The members retained a consulting firm to manage the SynRx medication use program from conceptualization through implementation. Modules--on individual drug dosing, switching from intravenous to oral administration, pharmacists' clinical recommendations, and surgical antibiotic prophylaxis--were designed so that participants could adopt the entire plan as a turnkey procedure by inserting their hospital name in the appropriate blanks, modify it to more closely fit their own organizations, use portions of it for inclusion in their current plans, or not use it at all. The goal was to build in maximum flexibility to accommodate the variations in the participating hospital pharmacies and their respective hospitals. RESULTS: Early program benefits include improvements in medication event reporting, documentation of the measured aspects of medication use, delivery of care processes, and administrative efficiency. LESSONS LEARNED AND CONCLUSIONS: The participants, consultants, and programmers involved in the SynRx program learned firsthand the complexity and magnitude of hospital medication use processes. Yet it is possible to overcome the wide variability in systems among hospitals to create standards that allow for more meaningful comparisons of medication use.     

Immunolocalization of natriuretic peptide receptor B in the rat kidney

The natriuretic peptide receptor (NPR) family consists of three receptor subtypes: two transmembrane forms that contain a guanylyl cyclase intracellular domain (NPR-A and NPR-B), and one truncated form (NPR-C). Because of the lack of specific agonists and antagonists for each receptor subtype and to the difficulty to detect the presence of small quantities of NPR-B by ligand binding studies, polyclonal antibodies against a peptide whose sequence was chosen from a region of the extracellular domain of rat NPR-B that is not homologous to sequences in NPR-A and NPR-C were developed. Western blotting with affinity-purified anti-NPR-B (413-426)-Tyr revealed a polypeptide of approximately 120 kD on COS-1 cell membranes transfected with rat NPR-B cDNA. The antibody recognized a second polypeptide, approximately 5 to 10 kD smaller, which probably represents the unglycosylated receptor. Anti-NPR-B (413-426)-Tyr did not show crossreactivity to any other NPR. Western blotting analysis with anti-NPR-B (413-426)-Tyr also identified a protein of appropriate size in renal vascular membranes. These results were supported by immunohistochemistry findings that demonstrated staining for NPR-B on papillary and medullary capillaries, glomeruli, and renal arteries. This study concludes that NPR-B is present in the rat kidney, although it was only detected in vascular structures.     

Reducing the overhead of dynamic compilation

The execution model for mobile, dynamically‐linked, object‐oriented programs has evolved from fast interpretation to a mix of interpreted and dynamically compiled execution. The primary motivation for dynamic compilation is that compiled code executes significantly faster than interpreted code. However, dynamic compilation, which is performed while the application is running, introduces execution delay. In this paper we present two dynamic compilation techniques that enable high performance execution while reducing the effect of this compilation overhead. These techniques can be classified as (1) decreasing the amount of compilation performed, and (2) overlapping compilation with execution. We first present and evaluate lazy compilation, an approach used in most dynamic compilation systems in which individual methods are compiled on‐demand upon their first invocation. This is in contrast to eager compilation, in which all methods in a class are compiled when a new class is loaded. In this work, we describe our experience with eager compilation, as well as the implementation and transition to lazy compilation. We empirically detail the effectiveness of this decision. Our experimental results using the SpecJVM Java benchmarks and the Jalapeño JVM show that, compared to eager compilation, lazy compilation results in 57% fewer methods being compiled and reductions in total time of 14 to 26%. Total time in this context is compilation plus execution time. Next, we present profile‐driven, background compilation, a technique that augments lazy compilation by using idle cycles in multiprocessor systems to overlap compilation with application execution. With this approach, compilation occurs on a thread separate from that of application threads so as to reduce intermittent, and possibly substantial, delay in execution. Profile information is used to prioritize methods as candidates for background compilation. Methods are compiled according to this priority scheme so that performance‐critical methods are invoked using optimized code as soon as possible. Our results indicate that background compilation can achieve the performance of off‐line compiled applications and masks almost all compilation overhead. We show significant reductions in total time of 14 to 71% over lazy compilation. Copyright © 2001 John Wiley & Sons, Ltd.     

Control volume based modelling in one space dimension of oscillating, compressible flow in reciprocating machines

We present an approach for modelling unsteady, primarily one-dimensional, compressible flow. The conservation laws for mass, energy, and momentum are applied to a staggered mesh of control volumes and loss mechanisms are included directly as extra terms. Heat transfer, flow friction, and multidimensional effects are calculated using empirical correlations. Transformations of the conservation equations into new variables, artificial dissipation for dissipating acoustic phenomena, and an asymmetric interpolation method for minimising numerical diffusion and non physical temperature oscillations are presented. The capabilities of the approach are illustrated with an example solution and an experimental validation of a Stirling engine model.     

Protecting the integrity of the legal system: The admissibility of testimony from mental health experts under Daubert/Kumho analyses.

The authors discussed to what degree testimony from social science and mental health experts (psychologists, psychiatrists, social workers, therapists, others) meets admissibility requirements expressed by the U.S. Supreme Court in Daubert (1993), Joiner ( General Electric Co. v. Joiner , 1997) and the recent Kumho (1999) decision. They reviewed data on Daubert/Kumho indicia of reliability using 2 exemplar areas of mental health testimony: psychodiagnostic assessment by means of the Rorschach and other "projective" assessment techniques and the diagnoses of posttraumatic stress disorder and multiple personality disorder (dissociative identity disorder). They concluded that some testimony offered by mental health professionals relating to these concepts should not survive scrutiny under the framework of Daubert , Joiner , and Kumho . (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speaking for the environment

Communicators have special opportunities to promote environmental ethics. This paper shows how environmental ethics relates to the workplace and gives ideas about how communicators can help the environment in their work     

Semiconductor random-access memories

In the last few years, semiconductor random-access memory (RAM) components have been introduced into high-speed scratchpad applications and small buffer memory systems, where the performance or cost advantage of semiconductor components is greatest. More recently, developments in the technology of large-scale integrated (LSI) circuits have resulted in cost-performance characteristics of semiconductor RAMs that are competitive in computer main-frame memories as well. This article reviews the basic circuit concepts used in these components, representative products that are presently available, and some systems considerations involved in their use.     

Early specification and autonomous development of cortical fields in the mouse hippocampus

Studies of the specification of distinct areas in the developing cerebral cortex have until now focused mainly on neocortex. We demonstrate that the hippocampus, an archicortical structure, offers an elegant, alternative system in which to explore cortical area specification. Individual hippocampal areas, called CA fields, display striking molecular differences in maturity. We use these distinct patterns of gene expression as markers of CA field identity, and show that the two major hippocampal fields, CA1 and CA3, are specified early in hippocampal development, during the period of neurogenesis. Two field-specific markers display consistent patterns of expression from the embryo to the adult. Presumptive CA1 and CA3 fields (Pca1, Pca3) can therefore be identified between embryonic days 14.5 and 15.5 in the mouse, a week before the fields are morphologically distinct. No other individual cortical areas have been detected by gene expression as early in development. Indeed, other features that distinguish between the CA fields appear after birth, indicating that mature CA field identity is acquired over at least 3 weeks. To determine if Pca1 and Pca3 are already specified to acquire mature CA field identities, the embryonic fields were isolated from further potential specification cues by maintaining them in slice culture. CA field development proceeds in slices of the entire embryonic hippocampus. More strikingly, slices restricted to Pca1 or Pca3 alone also develop appropriate mature features of CA1 or CA3. Pca1 and Pca3 are therefore able to develop complex characteristics of mature CA field identity autonomously, that is, without contact or innervation from other fields or other parts of the brain. Because Pca1 and Pca3 can be identified before major afferents grow into the hippocampus, innervation may also be unnecessary for the initial division of the hippocampus into separate fields. Providing a clue to the source of the true specifying signals, the earliest field markers appear first at the poles of the hippocampus, then progress inwards. General hippocampal development does not follow this pronounced pattern. We suggest that the sources of signals that specify hippocampal field identity lie close to the hippocampal poles, and that the signals operate first on cells at the poles, then move inwards.