Use of complete medication history to identify and correct transitions-of-care medication errors at psychiatric hospital admission.

Methods for categorizing the scale and severity of medication errors corrected by pharmacy staff during admission medication reconciliation using complete medication history continue to evolve. We established a rating scale that is effective for generating error reports to health system quality leadership. These reports are needed to quantify the value of investment in transitions-of-care pharmacy staff. All medication errors that were reported by pharmacy staff in the admission medication reconciliation process during a period of 6 months were eligible for inclusion. Complete medication history data source was utilized by admitting providers and all pharmacist staff and a novel medication error scoring methodology was developed. This methodology included: medication error category, medication error type, potential medication error severity, and medication non-adherence. We determined that 82 medication errors were detected from 72 patients and assessed that 74 of these errors may have harmed patients if they were not corrected through pharmacist intervention. Most of these errors were dosage discrepancies and omissions. With hospital system budgets continually becoming leaner, it is important to measure the effectiveness and value of staff resources to optimize patient care. Pharmacists performing admission medication reconciliation can detect subtle medication discrepancies that may be overlooked by other clinician types. This methodology can serve as a foundation for error reporting and predicting the severity of adverse drug events.

A randomised controlled trial to test the effects of fish aggregating devices (FADs) and SBC activities promoting fish consumption in Timor-Leste: A study protocol.

Timor-Leste is one of the world's most malnourished nations where micronutrient-deficient diets are a contributing factor to the prevalence of child stunting, currently estimated to be 45.6% of children under five. Fish are an important source of nutrients and one that may assist the country's predominantly rural population of agriculturalists to exit poverty and malnutrition. However, a small national fishing fleet producing low catch volumes places fish out of reach of most inland and upland populations where it is needed most. Fish consumption is very low in rural, inland areas compared to coastal, regional, and global averages. This study is a one-year, partially masked, cluster-randomized controlled trial among families living in rural, inland Timor-Leste. We aim to test and compare the effects of two treatments, alone and in combination, on the frequency and volume of household fish consumption in rural, inland areas as a proxy for improved dietary diversity and micronutrient intake. Treatment 1 is the installation of nearshore, moored fish aggregating devices (FADs) to improve catch rates with existing fishing gears. Treatment 2 is a social and behaviour change (SBC) activity to promote fish consumption. Villages in inland communities will be randomized to receive treatment 1, treatment 2, both treatments, or neither treatment. Data will be collected at baseline (prior to the rollout of the treatments) and endline. Our study will determine the impact of an improved supply of fish, along with nutrition-oriented SBC activities, on the fish purchasing and consumption practices of rural, inland households. Findings from this study are urgently needed by Small Island Developing States to guide policy and investment decisions on how best to improve households' diets using locally available, nutrient-dense foods such as fish. Investments such as these are needed to break the cycle of malnutrition. This trial is registered at clinicaltrials.gov (NCT04729829). Trial registration: Trial registered at clinicaltrials.gov Identifier: NCT04729829.

Enhancement of eruption explosivity by heterogeneous bubble nucleation triggered by magma mingling.

We present new evidence that shows magma mingling can be a key process during highly explosive eruptions. Using fractal analysis of the size distribution of trachybasaltic fragments found on the inner walls of bubbles in trachytic pumices, we show that the more mafic component underwent fracturing during quenching against the trachyte. We propose a new mechanism for how this magmatic interaction at depth triggered rapid heterogeneous bubble nucleation and growth and could have enhanced eruption explosivity. We argue that the data support a further, and hitherto unreported contribution of magma mingling to highly explosive eruptions. This has implications for hazard assessment for those volcanoes in which evidence of magma mingling exists.

Topological inversions in coalescing granular media control fluid-flow regimes.

Sintering-or coalescence-of viscous droplets is an essential process in many natural and industrial scenarios. Current physical models of the dynamics of sintering are limited by the lack of an explicit account of the evolution of microstructural geometry. Here, we use high-speed time-resolved x-ray tomography to image the evolving geometry of a sintering system of viscous droplets, and use lattice Boltzmann simulations of creeping fluid flow through the reconstructed pore space to determine its permeability. We identify and characterize a topological inversion, from spherical droplets in a continuous interstitial gas, to isolated bubbles in a continuous liquid. We find that the topological inversion is associated with a transition in permeability-porosity behavior, from Stokes permeability at high porosity, to percolation theory at low porosity. We use these findings to construct a unified physical description that reconciles previously incompatible models for the evolution of porosity and permeability during sintering.

Sintering of viscous droplets under surface tension.

We conduct experiments to investigate the sintering of high-viscosity liquid droplets. Free-standing cylinders of spherical glass beads are heated above their glass transition temperature, causing them to densify under surface tension. We determine the evolving volume of the bead pack at high spatial and temporal resolution. We use these data to test a range of existing models. We extend the models to account for the time-dependent droplet viscosity that results from non-isothermal conditions, and to account for non-zero final porosity. We also present a method to account for the initial distribution of radii of the pores interstitial to the liquid spheres, which allows the models to be used with no fitting parameters. We find a good agreement between the models and the data for times less than the capillary relaxation timescale. For longer times, we find an increasing discrepancy between the data and the model as the Darcy outgassing time-scale approaches the sintering timescale. We conclude that the decreasing permeability of the sintering system inhibits late-stage densification. Finally, we determine the residual, trapped gas volume fraction at equilibrium using X-ray computed tomography and compare this with theoretical values for the critical gas volume fraction in systems of overlapping spheres.

An Iterative CT Reconstruction Algorithm for Fast Fluid Flow Imaging.

The study of fluid flow through solid matter by computed tomography (CT) imaging has many applications, ranging from petroleum and aquifer engineering to biomedical, manufacturing, and environmental research. To avoid motion artifacts, current experiments are often limited to slow fluid flow dynamics. This severely limits the applicability of the technique. In this paper, a new iterative CT reconstruction algorithm for improved a temporal/spatial resolution in the imaging of fluid flow through solid matter is introduced. The proposed algorithm exploits prior knowledge in two ways. First, the time-varying object is assumed to consist of stationary (the solid matter) and dynamic regions (the fluid flow). Second, the attenuation curve of a particular voxel in the dynamic region is modeled by a piecewise constant function over time, which is in accordance with the actual advancing fluid/air boundary. Quantitative and qualitative results on different simulation experiments and a real neutron tomography data set show that, in comparison with the state-of-the-art algorithms, the proposed algorithm allows reconstruction from substantially fewer projections per rotation without image quality loss. Therefore, the temporal resolution can be substantially increased, and thus fluid flow experiments with faster dynamics can be performed.