Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems

Importance: The indication (reason for use) for a medication is rarely included on prescriptions despite repeated recommendations to do so. One barrier has been the way existing electronic prescribing systems have been designed. Objective: To evaluate, in comparison with the prescribing modules of 2 leading electronic health record prescribing systems, the efficiency, error rate, and satisfaction with a new computerized provider order entry prototype for the outpatient setting that allows clinicians to initiate prescribing using the indication. Design, Setting, and Participants: This quality improvement study used usability tests requiring internal medicine physicians, residents, and physician assistants to enter prescriptions electronically, including indication, for 8 clinical scenarios. The tool order assignments were randomized and prescribers were asked to use the prototype for 4 of the scenarios and their usual system for the other 4. Time on task, number of clicks, and order details were captured. User satisfaction was measured using posttask ratings and a validated system usability scale. The study participants practiced in 2 health systems\u27 outpatient practices. Usability tests were conducted between April and October of 2017. Main Outcomes and Measures: Usability (efficiency, error rate, and satisfaction) of indications-based computerized provider order entry prototype vs the electronic prescribing interface of 2 electronic health record vendors. Results: Thirty-two participants (17 attending physicians, 13 residents, and 2 physician assistants) used the prototype to complete 256 usability test scenarios. The mean (SD) time on task was 1.78 (1.17) minutes. For the 20 participants who used vendor 1\u27s system, it took a mean (SD) of 3.37 (1.90) minutes to complete a prescription, and for the 12 participants using vendor 2\u27s system, it took a mean (SD) of 2.93 (1.52) minutes. Across all scenarios, when comparing number of clicks, for those participants using the prototype and vendor 1, there was a statistically significant difference from the mean (SD) number of clicks needed (18.39 [12.62] vs 46.50 [27.29]; difference, 28.11; 95% CI, 21.47-34.75; P \u3c .001). For those using the prototype and vendor 2, there was also a statistically significant difference in number of clicks (20.10 [11.52] vs 38.25 [19.77]; difference, 18.14; 95% CI, 11.59-24.70; P \u3c .001). A blinded review of the order details revealed medication errors (eg, drug-allergy interactions) in 38 of 128 prescribing sessions using a vendor system vs 7 of 128 with the prototype. Conclusions and Relevance: Reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way, which may be associated with saved time and effort, reduced medication errors, and increased clinician satisfaction

Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems

Importance: The indication (reason for use) for a medication is rarely included on prescriptions despite repeated recommendations to do so. One barrier has been the way existing electronic prescribing systems have been designed. Objective: To evaluate, in comparison with the prescribing modules of 2 leading electronic health record prescribing systems, the efficiency, error rate, and satisfaction with a new computerized provider order entry prototype for the outpatient setting that allows clinicians to initiate prescribing using the indication. Design, Setting, and Participants: This quality improvement study used usability tests requiring internal medicine physicians, residents, and physician assistants to enter prescriptions electronically, including indication, for 8 clinical scenarios. The tool order assignments were randomized and prescribers were asked to use the prototype for 4 of the scenarios and their usual system for the other 4. Time on task, number of clicks, and order details were captured. User satisfaction was measured using posttask ratings and a validated system usability scale. The study participants practiced in 2 health systems\u27 outpatient practices. Usability tests were conducted between April and October of 2017. Main Outcomes and Measures: Usability (efficiency, error rate, and satisfaction) of indications-based computerized provider order entry prototype vs the electronic prescribing interface of 2 electronic health record vendors. Results: Thirty-two participants (17 attending physicians, 13 residents, and 2 physician assistants) used the prototype to complete 256 usability test scenarios. The mean (SD) time on task was 1.78 (1.17) minutes. For the 20 participants who used vendor 1\u27s system, it took a mean (SD) of 3.37 (1.90) minutes to complete a prescription, and for the 12 participants using vendor 2\u27s system, it took a mean (SD) of 2.93 (1.52) minutes. Across all scenarios, when comparing number of clicks, for those participants using the prototype and vendor 1, there was a statistically significant difference from the mean (SD) number of clicks needed (18.39 [12.62] vs 46.50 [27.29]; difference, 28.11; 95% CI, 21.47-34.75; P \u3c .001). For those using the prototype and vendor 2, there was also a statistically significant difference in number of clicks (20.10 [11.52] vs 38.25 [19.77]; difference, 18.14; 95% CI, 11.59-24.70; P \u3c .001). A blinded review of the order details revealed medication errors (eg, drug-allergy interactions) in 38 of 128 prescribing sessions using a vendor system vs 7 of 128 with the prototype. Conclusions and Relevance: Reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way, which may be associated with saved time and effort, reduced medication errors, and increased clinician satisfaction

Evaluasi Kinerja Dosen Menggunakan Metode Extend Analysis pada Fuzzy Analytic Hierarchy Process (FAHP) (Studi kasus pada Politeknik Negeri Nusa Utara)

Dosen merupakan salah satu unsur penting dalam menunjang mutu pendidikan sebuah perguruan tinggi sehingga peningkatan kualitas kerja dosen secara langsung ataupun tidak langsung dapat mempengaruhi peningkatan kualitas lulusan. Karena pentingnya posisi dosen dalam suatu perguruan tinggi sehingga perlu adanya evaluasi untuk mempertahankan ataupun meningkatkan standar mutu dosen melalui suatu kajian evaluasi kinerja dari setiap dosen. Kinerja dosen seperti termuat dalam Tri Darma perguruan tinggi yang terdiri dari pendidikan dan pengajaran, penelitian, pengabdian pada masyarakat dan lainnya. Tujuan penelitian ini adalah untuk melakukan evaluasi kinerja dosen yang dititikberatkanpada kriteria pendidikan dan pengajaran dengan memfokuskan pada opini dari mahasiswa sebagai pelaku yang bersinggungan langsung dengan dosen. Kategori ini terdiri dari kriteria pedagogik, kepribadian, sosial dan profesional yang masing-masing memiliki sub-attribute sesuai dengan karakteristik masingmasing. Metode Extend Analysis digunakan pada Fuzzy-Analytical hierarchy process (F-AHP), dimana metode ini dapat menentukan tingkat kekaburan dari sebuah data secara akurat yang dapat memberikan proses perangkingan dengan tepat. Terdapat sepuluh partisipan (mahasiswa) yang melakukan pengisian data kuisioner secara serentak dan terdapat lima dosen yang memberikan opini menyangkut tingkat kepentingan untuk kriteria dan sub-attribute, serta lima dosen yang akan dievaluasi untuk mendapatkan perangkingan. Sistem dikembangkan menggunakan framework Qt/C++ dengan IDE QtCreator serta menggunakan teknik parallel programming dengan QThread untuk menjaga kestabilan thread utama dari sistem. Berdasarkan pengujian yang dilakukan hasil perangkingan secara berurutan adalah GL, ST, AT, CKdan AP dengan rata-rata nilai secara berurutan adalah 0.256373, 0.214040, 0.190877, 0.177651 dan 0.161058, dengan kecepatan waktu proses sebesar ± 33 detik 58 milisecond. Kesimpulannya, sistem yang telah dibuat dapat digunakan untuk mengevaluasi kinerja dosen dengan jumlah sub-attribute yang relatif banyak dengan waktu pemrosessan yang relatif cepat

High heterogeneity of malaria transmission and a large sub-patent and diverse reservoir of infection in Wusab As Safil district, Republic of Yemen.

BACKGROUND: Yemen remains the country with the highest malaria transmission within the Arabian Peninsula and a source of imported cases to neighbouring countries. METHODS: This study collected samples from individuals resident in a valley in Western Yemen as a baseline to examine infection prevalence for a future trial. As well as rapid diagnostic test (RDT) and microscopy, a filter paper blood spot was collected for molecular and serological analyses. RESULTS: Samples were collected from 2261 individuals from 12 clusters across a study area of approximately 100 km(2). Plasmodium falciparum infection prevalence was 12.4, 11.1 and 19.6% by RDT, microscopy and polymerase chain reaction (PCR), respectively. RDT and microscopy did not detect 45% of infections present, suggesting many infections were low-density. Infection prevalence and seroprevalence were highly heterogeneous between clusters, with evidence of higher exposure in clusters close to the wadi. The mean multiplicity of infection (MOI) was 2.3 and high heterozygosity and allelic richness were detected. CONCLUSIONS: This highly diverse parasite population suggests a high degree of transmissibility and coupled with the substantial proportion of low-density infections, may pose challenges for malaria control and elimination efforts

Organizing to Address Housing Deterioration and Abandonment in Central Phillips.

Conducted on behalf of Phillips Neighborhood Network. Sponsored by Neighborhood Planning for Community Revitalization, Center for Urban and Regional Affairs, University of Minnesota

Recent Advances in Reducing Food Losses in the Supply Chain of Fresh Agricultural Produce

Fruits and vegetables are highly nutritious agricultural produce with tremendous human health benefits. They are also highly perishable and as such are easily susceptible to spoilage, leading to a reduction in quality attributes and induced food loss. Cold chain technologies have over the years been employed to reduce the quality loss of fruits and vegetables from farm to fork. However, a high amount of losses (≈50%) still occur during the packaging, transportation, and storage of these fresh agricultural produce. This study highlights the current state-of-the-art of various advanced tools employed to reducing the quality loss of fruits and vegetables during the packaging, storage, and transportation cold chain operations, including the application of imaging technology, spectroscopy, multi-sensors, electronic nose, radio frequency identification, printed sensors, acoustic impulse response, and mathematical models. It is shown that computer vision, hyperspectral imaging, multispectral imaging, spectroscopy, X-ray imaging, and mathematical models are well established in monitoring and optimizing process parameters that affect food quality attributes during cold chain operations. We also identified the Internet of Things (IoT) and virtual representation models of a particular fresh produce (digital twins) as emerging technologies that can help monitor and control the uncharted quality evolution during its postharvest life. These advances can help diagnose and take measures against potential problems affecting the quality of fresh produce in the supply chains. Plausible future pathways to further develop these emerging technologies and help in the significant reduction of food losses in the supply chain of fresh produce are discussed. Future research should be directed towards integrating IoT and digital twins in order to intensify real-time monitoring of the cold chain environmental conditions, and the eventual optimization of the postharvest supply chains. This study gives promising insight towards the use of advanced technologies in reducing losses in the postharvest supply chain of fruits and vegetables

Artificial Intelligence Fairness in the Context of Accessibility Research on Intelligent Systems for People who are Deaf or Hard of Hearing

We discuss issues of Artificial Intelligence (AI) fairness for people with disabilities, with examples drawn from our research on human-computer interaction (HCI) for AI-based systems for people who are Deaf or Hard of Hearing (DHH). In particular, we discuss the need for inclusion of data from people with disabilities in training sets, the lack of interpretability of AI systems, ethical responsibilities of access technology researchers and companies, the need for appropriate evaluation metrics for AI-based access technologies (to determine if they are ready to be deployed and if they can be trusted by users), and the ways in which AI systems influence human behavior and influence the set of abilities needed by users to successfully interact with computing systems

Molecular characterisation of Salmonella enterica serovar Typhimurium and Campylobacter jejuni faecal carriage by captured rangeland goats

Western Australian rangeland goats were surveyed for faecal carriage of Salmonella enterica and Campylobacter spp. Faecal samples were collected from 125 goats on four occasions. The first sample was collected immediately upon arrival at a commercial goat depot (feedlot). Subsequent samples were collected at one month intervals thereafter. Frequency of detection and faecal carriage intensity were determined using qPCR targeting the S. enterica outer membrane protein (ompF) and Campylobacter spp. purine biosynthesis gene (purA). Salmonella enterica were identified in 40/500 of faecal samples, with S. enterica faecal carriage detected in 30% (38/125) goats over the duration of the study. Campylobacter spp. were identified in 12/500 of samples, with Campylobacter spp. detected in 10% (12/125) goats over duration of the study. Frequency of detection was highest at the first sample collection for both S. enterica (26%) and Campylobacter spp. (8%). Repeat detection of Salmonella was observed for only a single goat (0.8%). Salmonella qPCR positive samples were characterised at ompF and invA genes as S. enterica. Further characterisation at STM2755 and STM4497 genes confirmed the isolates were S. enterica serovar Typhimurium. Characterization at the 16S rRNA and hippuricase (hipO) genes revealed all Campylobacter spp. positive samples were C. jejuni. This study demonstrates that qPCR can be used for rapid identification of faecal carriage in goat faecal samples and showed evidence of carriage of zoonotic S. Typhimurium and C. jejuni by captured rangeland goats. The findings have implications for management of goats at abattoirs and in confined feeding facilities

Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016

BACKGROUND: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. OBJECTIVE: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. DESIGN: Descriptive, using GeoSentinel records. SETTING: 63 travel and tropical medicine clinics in 30 countries. PATIENTS: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. MEASUREMENTS: Frequencies of demographic, trip, and clinical characteristics and complications. RESULTS: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain–Barre syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). LIMITATION: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. CONCLUSION: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission