Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective was (...) to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

The near-interface region of an epitaxial Ba 0.3 Sr 0.7 TiO 3 thin film grown on LaAlO 3 was found to consist of a high density of stacking faults bounded by partial dislocations. The stacking faults can extend over large distances . Various possible atomic configurations of the faults were considered. The atomic structures of the faults were identified using high-resolution electron microscopy and simulation as well as energy-filtered imaging. The and faults were found to lie predominately on the {100} (...) and {110} planes. The faults on , or have never been observed before in perovskites. The stacking faults on {100} have a structure consisting of a double layer of edge-sharing TiO 6 octahedra. The excess of Ti was detected by energy-filtered imaging. The formation of the extended stacking faults is probably related to a small amount of excess Ti during the film deposition, which may originate from the non-stoichiometry of the ceramic targets BaTiO 3 and SrTiO 3 . It is also enhanced by the misfit-induced compressive strain in the early stages of the film growth. (shrink)

The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to (...) a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care. (shrink)

Florian A.G. Lützen untersucht in dieser Studie den Religionsbegriff ( din) bei Aḥmad Ibn Aǧība (gest. 1224/1809), seine Synthese von Sufitum und Theologie. Den Religionsbegriff beschreibt er insbesondere anhand der im "Gabriel-Hadith" dargestellten Ebenen: islam, iman und i san - Hingabe, Glaube und Vervollkommnung. Dieses Stufengebilde, von vielen Gelehrten in der späten Phase der Islamischen Theologie (etwa 1400-1800) für fundamental erachtet, eignet sich zum einen dazu, die Religion aus der Perspektive der Theologie darzustellen, und zum anderen, um den Weg des (...) Menschen zu Gott zu beschreiben. In seiner Analyse macht der Autor deutlich, wie Ibn Agiba, aufbauend auf seiner Tradition, eine Theologie konzipiert, die das Sufitum ins Zentrum stellt, ohne die anderen Disziplinen der Theologie auszuklammern. (shrink)

Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of (...) the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates. (shrink)

On Buddhist ethics for better conduct of life.

Lower plasma levels of high-density lipoproteins in adolescents with type 2 diabetes have been associated with a higher pulse wave velocity, a marker of arterial stiffness. Evidence suggests that HDL proteins or particle subspecies are altered in T2D and these may drive these relationships. In this work, we set out to reveal any specific proteins and subspecies that are related to arterial stiffness in youth with T2D from proteomics data. Plasma and PWV measurements were previously acquired from lean and T2D (...) adolescents. Each plasma sample was separated into 18 fractions and evaluated by mass spectrometry. Then, we applied a validated network-based computational approach to reveal HDL subspecies associated with PWV. Among 68 detected phospholipid-associated proteins, we found that seven were negatively correlated with PWV, indicating that they may be atheroprotective. Conversely, nine proteins show positive correlation with PWV, suggesting that they may be related to arterial stiffness. Intriguingly, our results demonstrate that apoA-I and histidine-rich glycoprotein may reverse their protective roles and become antagonistic in the setting of T2D. Furthermore, we revealed two arterial stiffness-associated HDL subspecies, each of which contains multiple PWV-related proteins. Correlation and disease association analyses suggest that these HDL subspecies might link T2D to its cardiovascular-related complications. (shrink)

With an increasing number of international schools, traditional EFL teaching methods may not satisfy students’ needs. This study aims to investigate perceptions of social media technologies and willingness to adopt such technologies to collaborate and communicate in multicultural classrooms among novice EFL schoolteachers in the Czech Republic. The participants were 100 novice EFL schoolteachers in Prague and the South Moravian regions of the Czech Republic. The study used a mixed research method consisting of a survey and a semi-structured interview. The (...) survey examined the participants’ appraisal and concerns of using social media technologies to collaborate and to communicate as well as the level of willingness to use social media technologies. A hierarchical cluster analysis using participants’ responses regarding their attitudes and behavioural tendency towards using Web 2.0 social media technologies in language classrooms identified three clusters of teachers. The teachers who were most likely to adopt social Web 2.0 technologies were those who had the highest ratings on both appraisals and concerns regarding the use of social media in language classrooms. The results from the semi-structured interviews were consistent with those from the survey. Together, the results from the two stages demonstrated that most pre-service teachers favoured using Web 2.0 technology for collaboration and communication among colleagues and stakeholders in a broader community, but they displayed contrasting levels of appraisal of and concerns towards using social media technologies. Participants believed that this might be due to their different levels of ICT proficiency, workload, and working environment. The political and practical implications in K-12 education in the Czech context are also discussed. (shrink)

The thin set theorem for n-tuples and k colors states that every k-coloring of $[\mathbb {N}]^n$ admits an infinite set of integers H such that $[H]^n$ avoids at least one color. In this paper, we study the combinatorial weakness of the thin set theorem in reverse mathematics by proving neither $\operatorname {\mathrm {\sf {TS}}}^n_k$, nor the free set theorem imply the Erdős–Moser theorem whenever k is sufficiently large. Given a problem $\mathsf {P}$, a computable instance of $\mathsf {P}$ is universal (...) iff its solution computes a solution of any other computable $\mathsf {P}$ -instance. It has been established that most of Ramsey-type problems do not have a universal instance, but the case of Erdős–Moser theorem remained open so far. We prove that Erdős–Moser theorem does not admit a universal instance. (shrink)

The fuzzy clustering algorithm has been widely used in the research area and production and life. However, the conventional fuzzy algorithms have a disadvantage of high computational complexity. This article proposes an improved fuzzy C-means algorithm based on K-means and principle of granularity. This algorithm is aiming at solving the problems of optimal number of clusters and sensitivity to the data initialization in the conventional FCM methods. The initialization stage of the K-medoid cluster, which is different from others, has a (...) strong representation and is capable of detecting data with different sizes. Meanwhile, through the combination of the granular computing and FCM, the optimal number of clusters is obtained by choosing accurate validity functions. Finally, the detailed clustering process of the proposed algorithm is presented, and its performance is validated by simulation tests. The test results show that the proposed improved FCM algorithm has enhanced clustering performance in the computational complexity, running time, cluster effectiveness compared with the existing FCM algorithms. (shrink)

In this paper, a normalized robust FOPID controller regulation algorithm is proposed. Only one parameter k is necessary to be tuned in the controller regulation process, so the proposed control algorithm is convenient to be applied on both fractional-order systems and integer-order systems. A robustness evaluation function is constructed based on the small gain theorem. Larger robustness evaluation function value will help the system achieve better robustness performance. Another parameter, β, is also available to serve as a tuning knob when (...) larger robust evaluation function value is needed. Therefore, the controlled systems can be stabilized and can achieve quite satisfactory robust control performance using the proposed algorithm. The corresponding robust analysis results are obtained according to different conditions in the discussion. For a special case of widely used fractional-order systems, the FOPI and FOID controllers are presented based on the same tuning scheme together with their robustness discussion. Some examples are shown to verify the robustness of systems controlled by the proposed algorithm. (shrink)

Author's observation and views on technology and civilization in relation to the moral and ethical aspects.