Usability problems do not heal by themselves: National survey on physicians’ experiences with EHRs in Finland

AbstractPurposeSurvey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians’ experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors?MethodsIn the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents’ user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland.ResultsPhysicians’ assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 (‘fail’) to 7 (‘excellent’) the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient’s health status, prevention of errors associated with medication ordering, patient’s medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010.ConclusionsSurveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician’s ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician’s routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys

Influence of elevated radiative lifetime on efficiency of CdSe/CdTe Type II colloidal quantum dot based solar cells

AbstractColloidal quantum dots (CQDs) are promising materials for solar cells because their optoelectronic properties are easily adjusted by control of their size, structure and composition. We present calculations of the band gap and radiative lifetime for varying core diameter and shell thickness of CdSe/CdTe core/shell Type II CQDs using a combination of single particle (2,6)-band k·p and many-electron configuration interaction (CI) Hamiltonians. These calculations are validated by comparison with experimental absorption spectra and photoluminescence decay data. The results are then incorporated into a model of photovoltaic efficiency which demonstrates how the overall performance of a solar cell based on Type II CQDs is affected by changes in the core/shell geometry. The largest effect on photovoltaic efficiency is found to be due to the longer radiative lifetime produced by increasing the shell thickness

Inhibiting poly ADP-ribosylation increases fatty acid oxidation and protects against fatty liver disease

Background & AimsTo date, no pharmacological therapy has been approved for non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to evaluate the therapeutic potential of poly ADP-ribose polymerase (PARP) inhibitors in mouse models of NAFLD.MethodsAs poly ADP-ribosylation (PARylation) of proteins by PARPs consumes nicotinamide adenine dinucleotide (NAD+), we hypothesized that overactivation of PARPs drives NAD+ depletion in NAFLD. Therefore, we assessed the effectiveness of PARP inhibition to replenish NAD+ and activate NAD+-dependent sirtuins, hence improving hepatic fatty acid oxidation. To do this, we examined the preventive and therapeutic benefits of the PARP inhibitor (PARPi), olaparib, in different models of NAFLD.ResultsThe induction of NAFLD in C57BL/6J mice using a high-fat high-sucrose (HFHS)-diet increased PARylation of proteins by PARPs. As such, increased PARylation was associated with reduced NAD+ levels and mitochondrial function and content, which was concurrent with elevated hepatic lipid content. HFHS diet supplemented with PARPi reversed NAFLD through repletion of NAD+, increasing mitochondrial biogenesis and β-oxidation in liver. Furthermore, PARPi reduced reactive oxygen species, endoplasmic reticulum stress and fibrosis. The benefits of PARPi treatment were confirmed in mice fed with a methionine- and choline-deficient diet and in mice with lipopolysaccharide-induced hepatitis; PARP activation was attenuated and the development of hepatic injury was delayed in both models. Using Sirt1hep−/− mice, the beneficial effects of a PARPi-supplemented HFHS diet were found to be Sirt1-dependent.ConclusionsOur study provides a novel and practical pharmacological approach for treating NAFLD, fueling optimism for potential clinical studies.Lay summaryNon-alcoholic fatty liver disease (NAFLD) is now considered to be the most common liver disease in the Western world and has no approved pharmacological therapy. PARP inhibitors given as a treatment in two different mouse models of NAFLD confer a protection against its development. PARP inhibitors may therefore represent a novel and practical pharmacological approach for treating NAFLD

Compression testing spherical particles for strength: Theory of the meridian crack test and implementation for microscopic fused quartz

AbstractWe show that uniaxial compression testing of spherical particles can give unambiguous access to their tensile strength as governed by surface flaws if one uses pairs of elasto-plastic platens, tailoring their hardness in order to control the relative area of particle-to-platen contact during the test. This eliminates the development of contact microcracks that are typically found to govern particle fracture when hard platens are used. We show that, if the platen materials are well chosen, one can probe a range of stress states for which it is known that particle failure was initiated along the surface, under elevated hoop stress within a region situated remote from the points of load application. Specifically, platens must be chosen such that particles tend to fracture when the ratio of projected contact area radius to particle radius exceeds a specific value that depends on the Poisson ratio of the particles. With fused quartz of Poisson ratio 0.17, this specific ratio value equals 0.65. We demonstrate the approach using microscopic fused quartz spheres 40±20µm in diameter as a testbench material; with those particles hardened steel serves as an appropriate platen material. Their strength values are statistically distributed; this is addressed using several platen materials. The resulting bank of data is interpreted using established survival-analysis methods, namely the non-parametric product-limit estimator. We also give a maximum likelihood estimation of the particle strength Weibull distribution parameters derived from the ensemble of data after left-truncation and/or right-censoring of data points situated inside of the range of unambiguous surface fracture strength measurement for each platen material. This gives a Weibull modulus of 6.3 and characteristic strength of 890MPa for the fused quartz particles. These values are significantly lower than what is produced in high-strength fused quartz fibers of comparable diameter; the difference is most likely a result of surface damage caused during powder storage and manipulation in the absence of a protective coating

Global surface temperature change analysis based on MODIS data in recent twelve years

AbstractGlobal surface temperature change is one of the most important aspects in global climate change research. In this study, in order to overcome shortcomings of traditional observation methods in meteorology, a new method is proposed to calculate global mean surface temperature based on remote sensing data. We found that (1) the global mean surface temperature was close to 14.35°C from 2001 to 2012, and the warmest and coldest surface temperatures of the global in the recent twelve years occurred in 2005 and 2008, respectively; (2) the warmest and coldest surface temperatures on the global land surface occurred in 2005 and 2001, respectively, and on the global ocean surface in 2010 and 2008, respectively; and (3) in recent twelve years, although most regions (especially the Southern Hemisphere) are warming, global warming is yet controversial because it is cooling in the central and eastern regions of Pacific Ocean, northern regions of the Atlantic Ocean, northern regions of China, Mongolia, southern regions of Russia, western regions of Canada and America, the eastern and northern regions of Australia, and the southern tip of Africa. The analysis of daily and seasonal temperature change indicates that the temperature change is mainly caused by the variation of orbit of celestial body. A big data model based on orbit position and gravitational-magmatic change of celestial body with the solar or the galactic system should be built and taken into account for climate and ecosystems change at a large spatial-temporal scale

Self-harm risk between adolescence and midlife in people who experienced separation from one or both parents during childhood

AbstractBackgroundExperience of child-parent separation predicts adverse outcomes in later life. We conducted a detailed epidemiological examination of this complex relationship by modelling an array of separation scenarios and trajectories and subsequent risk of self-harm.MethodsThis cohort study examined persons born in Denmark during 1971–1997. We measured child-parent separations each year from birth to 15th birthday via complete residential address records in the Civil Registration System. Self-harm episodes between 15th birthday and early middle age were ascertained through linkage to psychiatric and general hospital registers. Incidence rate ratios (IRRs) from Poisson regression models were estimated against a reference category of individuals not separated from their parents.ResultsAll exposure models examined indicated an association with raised self-harm risk. For example, large elevations in risk were observed in relation to separation from both parents at 15th birthday (IRR 5.50, 95% CI 5.25–5.77), experiencing five or more changes in child-parent separation status (IRR 5.24, CI 4.88–5.63), and having a shorter duration of familial cohesion during upbringing. There was no significant evidence for varying strength of association according to child's gender.LimitationsMeasuring child-parent separation according to differential residential addresses took no account of the reason for or circumstances of these separations.ConclusionsThese novel findings suggest that self-harm prevention initiatives should be tailored toward exposed persons who remain psychologically distressed into adulthood. These high-risk subgroups include individuals with little experience of familial cohesion during their upbringing, those with the most complicated trajectories who lived through multiple child-parent separation transitions, and those separated from both parents during early adolescence

Comparação das técnicas transforaminal e interlaminar de injeções epidurais de esteroides para o tratamento de dor lombar crônica

ResumoDesenho do estudoEstudo transversal.ObjetivoComparamos os desfechos de 12 meses de injeções peridurais de esteroides usando a técnica transforaminal (IPETF) guiada por fluoroscopia com as injeções peridurais de esteroides usando a técnica interlaminar (IPEIL) para o tratamento da dor lombar crônica. A dor lombar crônica é uma doença multifatorial com muitas etiologias possíveis. Relata‐se que a prevalência de dor na coluna durante a vida é de 65%‐80% no pescoço e parte inferior das costas. A injeção peridural de corticosteroides é uma intervenção comumente usada para controlar a dor crônica da coluna vertebral.MétodosPacientes que não obtiveram benefício de tratamentos anteriores foram incluídos neste estudo. As injeções foram realizadas de acordo com os achados em Ressonância Magnética (RM) ao nível mais próximo da patologia lombar; 173 pacientes receberam IPEIL e 126 pacientes receberam IPETF. Todos os pacientes foram acompanhados regularmente por 12 meses, usando uma escala numérica verbal (ENV) para a classificação. Achados em RM, complicações, escores ENV e índices de satisfação foram registrados.ResultadosPatologia em disco lombar foi o problema mais frequentemente encontrado. IPEIL foi preferido ao nível intervertebral de L4‐L5. Os escores da ENV diminuíram significativamente durante o período de 12 meses em comparação com os valores basais (p<0,001). Não houve diferenças significativas entre os dois grupos de acordo com a ENV e os índices de satisfação (p>0,05). Não houve grandes complicações, mas houve complicações menores em 22 (12,7%) no grupo IPEIL e 12 (9,5%) no grupo IPETF.ConclusõesEste estudo mostrou que IPEIL pode ser tão eficaz como IPETF quando realizadas ao nível mais próximo da patologia lombar usando a fluoroscopia em intervalos de 12 meses.AbstractStudy designA cross‐sectional study.ObjectiveWe compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65–80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain.MethodsPatients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded.ResultsLumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4–L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12‐month period compared to basal scores (p<0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p>0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications.ConclusionsThis study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12‐month intervals

Mechanism investigation of the reaction between triphenylphosphine, dialkyl acetylenedicarboxylates and 2-hydroxybenzimidazole: Experimental and theoretical study

AbstractIn the recent work, NMR study and the stability of the Z- and the E- isomers were undertaken for the two rotational isomers of phosphorus ylides involving 2-hydroxybenzimidazole [namely dimethyl-2-(2-hydroxybenzimidazole-n-yl)-3-(triphenylphosp hanylidene) succinate] by natural population analysis (NPA) and atoms in molecules (AIM) methods. Quantum mechanical calculation was clarified how the ylides exist in solution as a mixture of the two geometrical isomers (Z- and E-) as a minor or major form. In addition, Kinetic studies were performed for the reaction between triphenylphosphine and dialkyl acetylenedicarboxilate in the presence of NH– heterocyclic compound, such as 2-hydroxybenzimidazole. To determine the kinetic parameters of the reaction, it was monitored by UV spectrophotometry. Useful information was obtained from studies of the effect of solvent and concentration of reactants on the rate of reaction. Proposed mechanism was confirmed according to the obtained results and steady state approximation and first step (k2) and third step of reaction were recognized as a rate determining step and fast step, respectively on the basis of experimental data

Association between adverse mental health and an unhealthy lifestyle in rural-to-urban migrant workers in Shanghai

Background/purposeThe association between adverse mental health and unhealthy lifestyle behaviors in migrant workers remains poorly defined in Chinese rural-to-urban migrants.MethodsA cross-sectional study was conducted regarding health-related behaviors in 5484 migrants (51.3% males) employed in Shanghai for at least 6 months. The Chinese version of the Symptom Checklist-90-Revised (SCL-90-R) was used to assess migrant mental health status. Logistic regression was applied to determine the contribution of adverse mental health to lifestyle behaviors.ResultsOf the 5484 migrants, 21.1% had potential mental health problems and 63.1% had an unhealthy lifestyle. The three most prevalent mental disorders were obsessions–compulsions (O–C; 13.7%; 751/5484), interpersonal sensitivity (I-S; 11.0%; 603/5484), and hostility (HOS; 10.8%; 590/5484). Compared with the male participants, the female participants exhibited significantly increased mean scores for phobic anxiety (PHOB) and anxiety (ANX) (p < 0.001). Logistic regression indicated that after adjustment for potential confounding factors in both genders, an unhealthy lifestyle score was significantly associated with all nine subscales of the SCL-90-R. The male participants with psychoticism [PSY; odds ratio (OR) = 4.908, 95% confidence interval (CI) 2.474–9.735], ANX (OR = 4.022, 95% CI 2.151–7.518), or depression (DEP; OR = 3.378, 95% CI 2.079–5.487) were the most likely to have an unhealthy lifestyle. In the female participants, an unhealthy lifestyle was most associated with HOS (OR = 2.868, 95% CI 2.155–3.819), PSY (OR = 2.783, 95% CI 1.870–4.141), or DEP (OR = 2.650, 95% CI 1.960–3.582).ConclusionLifestyle behaviors were significantly associated with mental health in rural-to-urban migrant workers, and these findings indicate the need to develop targeted psychological interventions to foster healthy lifestyles in migrants

Enhancement of corrosion protection effect in mechanochemically synthesized Polyaniline/MMT clay nanocomposites

AbstractNanocomposite material that consists of DBSA (dodecylbenzensulfonic acid) doped polyaniline (PANI) was prepared by solvent free mechanochemical intercalation method. Organic aniline monomer was first intercalated into the interlayer regions of Na-MMT (sodium montmorillonite) clay hosts and followed by one-step oxidative polymerization. The as synthesized polyaniline clay nanocomposites were treated with DBSA to get PANI-DBSA clay nanocomposites. PANI-DBSA clay nanocomposites in the form of coatings at different concentrations of DBSA on C45 steel were found much superior in corrosion protection over those of conventional polyaniline, based on the series of electrochemical measurement of corrosion potential, polarization resistance and corrosion current in 3.5% aqueous NaCl electrolyte. UV–visible spectroscopy, FT-IR and SEM studies confirm the formation of intercalated polyaniline clay nanocomposites inside the clay nanolayers