Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review.

INTRODUCTION: There is limited research available on safe medication management practices in emergency medical services (EMS) practice, with most evidence-based medication safety guidelines based on research in nursing, operating theater and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment. METHODS AND ANALYSIS: The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality; however, this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and "qualitized" quantitative data. RESULTS: Fifty-six articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified. DISCUSSION: The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication error occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.

Deterministic Nanoassembly of Quasi-Three-Dimensional Plasmonic Nanoarrays with Arbitrary Substrate Materials and Structures.

Guided manipulation of light through periodic nanoarrays of three-dimensional (3D) metal-dielectric patterns provides remarkable opportunities to harness light in a way that cannot be obtained with conventional optics yet its practical implementation remains hindered by a lack of effective methodology. Here we report a novel 3D nanoassembly method that enables deterministic integration of quasi-3D plasmonic nanoarrays with a foreign substrate composed of arbitrary materials and structures. This method is versatile to arrange a variety of types of metal-dielectric composite nanoarrays in lateral and vertical configurations, providing a route to generate heterogeneous material compositions, complex device layouts, and tailored functionalities. Experimental, computational, and theoretical studies reveal the essential design features of this approach and, taken together with implementation of automated equipment, provide a technical guidance for large-scale manufacturability. Pilot assembly of specifically engineered quasi-3D plasmonic nanoarrays with a model hybrid pixel detector for deterministic enhancement of the detection performances demonstrates the utility of this method.

High-Speed Planar GaAs Nanowire Arrays with fmax > 75 GHz by Wafer-Scale Bottom-up Growth.

Wafer-scale defect-free planar III-V nanowire (NW) arrays with ∼100% yield and precisely defined positions are realized via a patterned vapor-liquid-solid (VLS) growth method. Long and uniform planar GaAs NWs were assembled in perfectly parallel arrays to form double-channel T-gated NW array-based high electron mobility transistors (HEMTs) with DC and RF performance surpassing those for all field-effect transistors (FETs) with VLS NWs, carbon nanotubes (CNTs), or graphene channels in-plane with the substrate. For a planar GaAs NW array-based HEMT with 150 nm gate length and 2 V drain bias, the on/off ratio (ION/IOFF), cutoff frequency (fT), and maximum oscillation frequency (fmax) are 10(4), 33, and 75 GHz, respectively. By characterizing more than 100 devices on a 1.5 × 1.5 cm(2) chip, we prove chip-level electrical uniformity of the planar NW array-based HEMTs and verify the feasibility of using this bottom-up planar NW technology for post-Si large-scale nanoelectronics.

High-speed electro-optic modulator integrated with graphene-boron nitride heterostructure and photonic crystal nanocavity.

Nanoscale and power-efficient electro-optic (EO) modulators are essential components for optical interconnects that are beginning to replace electrical wiring for intra- and interchip communications.1-4 Silicon-based EO modulators show sufficient figures of merits regarding device footprint, speed, power consumption, and modulation depth.5-11 However, the weak electro-optic effect of silicon still sets a technical bottleneck for these devices, motivating the development of modulators based on new materials. Graphene, a two-dimensional carbon allotrope, has emerged as an alternative active material for optoelectronic applications owing to its exceptional optical and electronic properties.12-14 Here, we demonstrate a high-speed graphene electro-optic modulator based on a graphene-boron nitride (BN) heterostructure integrated with a silicon photonic crystal nanocavity. Strongly enhanced light-matter interaction of graphene in a submicron cavity enables efficient electrical tuning of the cavity reflection. We observe a modulation depth of 3.2 dB and a cutoff frequency of 1.2 GHz.

Overcoming the diffraction limit of imaging nanoplasmonic arrays by microspheres and microfibers.

Super-resolution microscopy by microspheres emerged as a simple and broadband imaging technique; however, the mechanisms of imaging are debated in the literature. Furthermore, the resolution values were estimated based on semi-quantitative criteria. The primary goals of this work are threefold: i) to quantify the spatial resolution provided by this method, ii) to compare the resolution of nanoplasmonic structures formed by different metals, and iii) to understand the imaging provided by microfibers. To this end, arrays of Au and Al nanoplasmonic dimers with very similar geometry were imaged using confocal laser scanning microscopy at λ = 405 nm through high-index (n~1.9-2.2) liquid-immersed BaTiO3 microspheres and through etched silica microfibers. We developed a treatment of super-resolved images in label-free microscopy based on using point-spread functions with subdiffraction-limited widths. It is applicable to objects with arbitrary shapes and can be viewed as an integral form of the super-resolution quantification widely accepted in fluorescent microscopy. In the case of imaging through microspheres, the resolution ~λ/6-λ/7 is demonstrated for Au and Al nanoplasmonic arrays. In the case of imaging through microfibers, the resolution ~λ/6 with magnification M~2.1 is demonstrated in the direction perpendicular to the fiber with hundreds of times larger field-of-view in comparison to microspheres.

High-contrast electrooptic modulation of a photonic crystal nanocavity by electrical gating of graphene.

We demonstrate high-contrast electro-optic modulation of a photonic crystal nanocavity integrated with an electrically gated monolayer graphene. A silicon air-slot nanocavity provides strong overlap between the resonant optical field and graphene. Tuning the Fermi energy of the graphene layer to 0.85 eV enables strong control of its optical conductivity at telecom wavelengths, which allows modulation of cavity reflection in excess of 10 dB for a swing voltage of only 1.5 V. The cavity resonance at 1570 nm is found to undergo a shift in wavelength of nearly 2 nm, together with a 3-fold increase in quality factor. These observations enable a cavity-enhanced determination of graphene's complex optical sheet conductivity at different doping levels. Our simple device demonstrates the feasibility of high-contrast, low-power, and frequency-selective electro-optic modulators in graphene-integrated silicon photonic integrated circuits.

Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol.

INTRODUCTION: There is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment. METHODS AND ANALYSIS: The review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and 'qualitised' quantitative data. ETHICS AND DISSEMINATION: No ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations.

Brugada syndrome in an active duty Air Force senior pilot.

INTRODUCTION: Brugada syndrome describes a subgroup of patients at risk for polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death and is likely underdiagnosed among aviators. CASE REPORT: A 40-year-old male pilot presented to the clinic for his physical. He denied any symptoms on initial questioning. Subsequent electrocardiogram (ECG) revealed premature ventricular couplets with ST-segment elevation in V1 and V2 of the precordial leads with T-wave abnormalities. DISCUSSION: Special care must be taken if ECG demonstrates a Brugada pattern-especially in patients with a history of syncope or a family history of sudden death. Recent studies have confirmed a significant risk reduction in symptomatic patients with type 1 Brugada to as low as 0.8% to 3% with an implantable cardioverter defibrillator. CONCLUSION: Symptomatic patients displaying type 1 Brugada ECG (spontaneous or after sodium channel blockade) should receive an implantable cardioverter defibrillator and must be permanently disqualified. The Aeromedical Consultation Service should review all cases of Brugada syndrome and render a return to fly for asymptomatic nondiagnostic Brugada types.

Flexible Gallium Nitride for High-Performance, Strainable Radio-Frequency Devices.

Flexible gallium nitride (GaN) thin films can enable future strainable and conformal devices for transmission of radio-frequency (RF) signals over large distances for more efficient wireless communication. For the first time, strainable high-frequency RF GaN devices are demonstrated, whose exceptional performance is enabled by epitaxial growth on 2D boron nitride for chemical-free transfer to a soft, flexible substrate. The AlGaN/GaN heterostructures transferred to flexible substrates are uniaxially strained up to 0.85% and reveal near state-of-the-art values for electrical performance, with electron mobility exceeding 2000 cm2 V-1 s-1 and sheet carrier density above 1.07 × 1013 cm-2 . The influence of strain on the RF performance of flexible GaN high-electron-mobility transistor (HEMT) devices is evaluated, demonstrating cutoff frequencies and maximum oscillation frequencies greater than 42 and 74 GHz, respectively, at up to 0.43% strain, representing a significant advancement toward conformal, highly integrated electronic materials for RF applications.