The frequency of snowline-region planets from four-years of OGLE-MOA-Wise second-generation microlensing

We present a statistical analysis of the first four seasons from a "second-generation" microlensing survey for extrasolar planets, consisting of near-continuous time coverage of 8 deg² of the Galactic bulge by the OGLE, MOA, and Wise microlensing surveys. During this period, 224 microlensing events were observed by all three groups. Over 12% of the events showed a deviation from single-lens microlensing, and for ~1/3 of those the anomaly is likely caused by a planetary companion. For each of the 224 events we have performed numerical ray-tracing simulations to calculate the detection efficiency of possible companions as a function of companion-to-host mass ratio and separation. Accounting for the detection efficiency, we find that 55 - 22 + 34 % of microlensed stars host a snowline planet. Moreover, we find that Neptunes-mass planets are ~ 10 times more common than Jupiter-mass planets. The companion-to-host mass ratio distribution shows a deficit at q ~ 10^-2, separating the distribution into two companion populations, analogous to the stellar-companion and planet populations, seen in radial-velocity surveys around solar-like stars. Our survey, however, which probes mainly lower-mass stars, suggests a minimum in the distribution in the super-Jupiter mass range, and a relatively high occurrence of brown-dwarf companions.

Building a new process: Nursing verification of pediatric oral chemotherapy

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Background: While team-based safety checks ensure safe prescribing of parenteral chemotherapy, oral chemotherapy is usually prescribed by a single clinician. With the growing use of oral chemotherapy, processes are needed to protect these vulnerable patients from prescription errors. Methods: A team of nurses, clinicians, pharmacists and administrators developed a new process and checklist for nursing verification of oral chemotherapy prescriptions at Dana-Farber’s pediatric neuro-oncology program. Prescriptions are verified against the treatment plan by two pediatric oncology nurses. The verification checklist includes drug, dose with any modifications, height and weight, laboratory values and patient instructions. When available, the prescription bottle is also verified. Data was collected over a three-month pilot period. Results: From 6/18/15-9/16/15, 56 prescription verifications occurred. Verification rate of on-site retail pharmacy filled prescriptions was 47% (32/68 prescriptions). Median time for verification was 20 minutes (IQR 15, 40) per nurse. Nurses identified problems outside of prescription verification, including missing prior authorizations and unclear treatment plans. Medication bottles were not routinely available for verification. One identified near miss would have resulted in an 80% under-dose of everolimus. Conclusions: Prescription verification by nursing in a pediatric oncology clinic was feasible. While it was successful in identification of one medication error before it reached the patient, only 47% of prescriptions were verified. Since prescription bottles are usually obtained after a visit, verification of the actual bottles will require new workflows, such as additional clinic visits or uploading a picture via the patient portal. Involving the nurse in the review of oral chemotherapy not only identified a prescription error, but also highlighted issues within other aspects of patients’ care, including inconsistent documentation of the treatment plan. The inclusion of nursing in the review and management of oral chemotherapy has the potential to improve safety and outcomes for these patients.

Development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT') to assist youth with disabilities in managing information

BACKGROUND

This article presents findings from the development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT'). The Youth KIT is a resource intended to assist youth with disabilities during their teenage years and during the transition to adulthood to give information to others about themselves, get from others about themselves, and organize their own information to the best of their ability.

METHODS

Thirty-six youth between the ages of 12 and 25 with physical and developmental disabilities were active participants in the development of the Youth KIT and partnered with a multidisciplinary team to conduct the qualitative evaluation. Focus groups and individual interviews were used in three phases of evaluation.

RESULTS

The results of qualitative content analysis found the Youth KIT to be useful for a variety of youth in different contexts. The themes that emerged about the utility and impact of the Youth KIT were: (1) self-discovery for youth; and (2) the importance of the 'fit' between youth and mentors to support youth as they started to use the Youth KIT.

CONCLUSION

Clinical implications for healthcare providers working with youth during the transition to adulthood include recognition that discussions about adult goals should be a continuous dialogue throughout adolescence rather than a 'special' conversation occurring at the time of discharge from paediatric services.

Abstract T P290: Improvement in ICH Outcomes Not Detected During Emergence of a Comprehensive Stroke Center

Background: Our previous research has demonstrated improved acute ischemic stroke (AIS) care and outcomes as the program evolved to primary stroke center (PSC) and then comprehensive stroke center (CSC) certification from The Joint Commission. We explored the impact of program accreditation on patients with intra-cerebral hemorrhage (ICH) who presented directly to our center.

Methods: Patients admitted to Tulane University Medical Center (TUMC) from 07/2008-10/2013 for ICH were retrospectively assessed. Transfers were excluded. Patient outcomes were compared according to patient admission date: admitted while our center was an emerging PSC (ePSC, 07/08-03/10) or an emerging CSC (eCSC, 04/10-10/13).

Results: Out of the 273 patients with ICH during the study period, 12 (16.22%) and 29 (14.57%) transferred patients were excluded from ePSC and eCSC groups, respectively. ePSC and eCSC patients did not differ significantly in age, race, gender, baseline NIHSS, baseline ICH severity, or time to hospitalization. Short-term outcomes including poor functional outcome (modified Rankin scale 3-6), favorable discharge disposition (home or rehab facility), and in-hospital mortality did not differ. eCSC patients had a reduced incidence of nosocomial pneumonia (10.71% vs. 20.97%, p=0.043). eCSC patients received more CT angiograms (72.19% vs. 51.61%, p=0.003) with a notable decrease in spot signs (10.26% vs. 25.00%, p=0.030). Rates of any neurosurgical intervention did not significantly change.

Conclusion: Short-term outcomes for ICH patients did not significantly change as our center evolved into a certified CSC. While we were more aggressive with acute neuroimaging, we detected fewer patients with active bleeding, and the rate of neurosurgical intervention did not change. Overall, progression from PSC to CSC certification was associated with potential over-utilization of resources and no detected improvement in early outcomes for ICH, despite lower incidence of pneumonia. Additional research is needed to assess whether this pattern holds true at other centers.