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Background Medication administration errors (MAEs) are a major cause of morbidity and mortality. An updated barcode medication administration (BCMA) technology on infusion pumps is implemented in the operating rooms to automate double check at a syringe exchange.Objective The aim of this mixed-methods before-and-after study is to understand the medication administrating process and assess the compliance with double check before and after implementation.Methods Reported MAEs from 2019 to October 2021 were analysed and categorised to the three moments of medication administration: (1) bolus induction, (2) infusion pump start-up and (3) changing an empty syringe. Interviews were conducted to understand the medication administration process with functional resonance analysis method (FRAM). Double check was observed in the operating rooms before and after implementation. MAEs up to December 2022 were used for a run chart.Results Analysis of MAEs showed that 70.9% occurred when changing an empty syringe. 90.0% of MAEs were deemed to be preventable with the use of the new BCMA technology. The FRAM model showed the extent of variation to double check by coworker or BCMA.Observations showed that the double check for pump start-up changed from 70.2% to 78.7% postimplementation (p=0.41). The BCMA double check contribution for pump start-up increased from 15.3% to 45.8% (p=0.0013). The double check for changing an empty syringe increased from 14.3% to 85.0% (p

In formal learning spaces, students must navigate making meaning of both new knowledge and potentially new worldviews. In this qualitative grounded theory study, we examined how adult Buddhist monastic students learned about and described the origin of biodiversity in an introductory biology course. The study was conducted at a Tibetan settlement in south India during an 8-day class that was offered as part of joint program between an American university and the Tibetan Buddhist monastic community. Informed by hybridity theory, we describe four findings regarding how the monks made meaning (i.e., deciding "what to learn," "framing what to learn," "why they should learn," and "how they could learn"). The monks (1) integrated the new knowledge about physical diversity into their worldview of "mental diversity;" (2) found similarities between their worldview and academic science; (3) were both intrinsically and extrinsically motivated to learn about biology; and (4) valued opportunities to engage in dialectical discourse to assist in meaning making. We conclude that the monks navigated different epistemologies demonstrating secured collateral learning. We encourage researchers to consider using a decolonized perspective when conducting studies of learning in hybrid or third spaces.

Introduction: This study evaluates the accuracy of iECGs in comparison to the gold standard ECG in adult patients with congenital heart disease and recommends the appropriate iECG derivation based on the patient's characteristics. Methods: In 106 adults (51 female, 55 male) with congenital heart disease, a gold standard 12-lead ECG was recorded, followed by three iECGs with the Apple Watch series 4, which correspond to Einthoven leads I, II, and III. Two experienced and independent cardiologists analyzed the time intervals, amplitudes, and polarities of the ECG parameters as well as the rhythm type and correlated the patient characteristics with the iECG parameters. Results: The iECG parameters of all three iECG leads correlate strongly with those of the gold standard ECG, with exception of the P and T wave durations. We demonstrated that the informative value of the individual iECGs was independent of the patient's characteristics, in particular the heart axis, anatomy, and situs, even if the quality of the Einthoven III-like derivation was partially inadequate. The automatic rhythm analysis of the Apple Watch and the heart rhythm classification of a standard ECG analyzed manually by a cardiologist corresponded in 77%. Conclusion: iECG recordings of adults with congenital heart disease provide comparable results with Einthoven recordings I, II, and III of the 12-lead ECG and current data encourage the use of the Apple Watch not only in patients with structurally normal hearts but also in patients with congenital heart disease.

The Emory-Tibet Science Initiative (ETSI) is a cross-cultural exchange of Western and Tibetan Buddhist education and scholarship. In this partnership between the Dalai Lama Foundation and Emory University, two visiting Western scientists to Sera, Gaden, and Drepung Monasteries and two monastics who studied at Emory University reflect on their experiences teaching and learning from Western and Buddhist perspectives as part of the ETSI program. Specifically, authors explore the power of story, metaphor, and altruism in Buddhist and Western ways of teaching and learning. Authors consider the pedagogical similarities between (1) the variations of the Greek Method of Loci (Memory Palace) and the paintings and temple decorations found throughout Tibetan architecture and (2) the role of altruism and intrinsic motivation in learning outcomes. Current psychological and neurobiological evidence for the increased recall of episodic memories present in both Buddhist and Western use of story, metaphor, and intrinsic motivation associated with altruism will highlight the underlying principles that support these ancient methods. Finally, considerations on how each perspective informs the other is discussed, as well as practical suggestions for integrating methods across cultures.

As in previous years, the consensus group to consider the use of biological agents was constituted by rheumatologists from the Universities of Erlangen, Leiden, and Vienna in Europe in cooperation with other Universities in the USA, Canada, and Europe. Pharmaceutical industry support was obtained from a number of companies, but these institutions had no part in the decisions about the specific programme or about the academic participants at this conference. The perspective of this consensus is from the treating physician’s point of view. The 128 rheumatologists and bioscientists who attended the consensus conference were chosen from a worldwide group of physicians and other scientists from 20 countries with expertise in the use of biological agents for the treatment of rheumatic diseases. The number of attendees and participants were limited so that not everyone who might have been interested could be invited. Additional information has come to light in the past year, corroborating the major positive effect these drugs have had in rheumatoid arthritis (RA) and other rheumatic diseases, as well as further documenting adverse events. Therefore an update of the previous consensus statement1 is appropriate. The consensus statement is annotated to document the credibility of the data supporting it as much as possible. This annotation is that of Shekelle et al2 and is described in appendix 3. As the number of possible references has become so large, sometimes reviews were used and, if they contained category A references, will be referred to as category A evidence. All participants reviewed relevant clinical published articles relating to tumour necrosis factor (TNF) and interleukin (IL)-1 blocking agents. They were given a draft consensus statement and were asked to revise the document in small discussion groups; open discussion of the revisions led to a final document, representing this updated consensus statement.

Tris(2-aminobenzimidazole) conjugates with antisense oligonucleotides are effective site-specific RNA cleavers. Their mechanism of action is independent of metal ions. Here we investigate conjugates with peptide nucleic acids (PNA). RNA degradation occurs with similar rates and substrate specificities as in experiments with DNA conjugates we performed earlier. Although aggregation phenomena are observed in some cases, proper substrate recognition is not compromised. While our previous synthesis of 2-aminobenzimidazoles required an HgO induced cyclization step, a mercury free variant is described herein.