The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Fitness vs Fatness and Cardiovascular Health in Adolescents

Background: Adolescent obesity has been on the rise with studies showing obesity tracks into adulthood. Obesity is an independent risk factor for cardiovascular disease (CVD); CVD is the leading cause of adult death in the U.S. Previous research shows a strong positive relationship between physical activity (PA) and cardiovascular (CV) health even in an obese adult population. Thus, the relationship between adolescent physical fitness and lifetime risk for CVD and all-cause mortality should be investigated. Purpose: The purpose of this study is to determine associations between PA and adiposity with cardiovascular health in obese and non-obese weight adolescents, with the hypothesis that physical activity will be positively associated with cardiovascular health independent of adiposity. Methodology: A convenience sample of 30 adolescents (ages 12-18) from the community completed assessments of height, weight, a dual x-ray absorptiometry (DXA) scan, resting blood pressure, and a flow-mediated dilation ultrasound (FMD) as a measure of endothelial function and cardiac health. Participants wore an accelerometer for one week to track PA. Participants were assigned to non-obese and obese categories from DXA, the gold standard, measure of body fat. Activity level was also grouped by minutes of moderate-to-vigorous PA (MVPA) per day based on a median split of 15 minutes per day. FMD value was calculated as (maximum diameter – baseline diameter)/ baseline diameter x 100. Comparisons in FMD (dependent variable) between body fat and MVPA groups (independent variables) were made using t-tests and associations between body fat and MVPA were tested using linear regression adjusted for sex. Results: FMD data was only available for 10 participants: average age=14.6 (SD 1.8), 50% female, BMI=20.9 (2.6), FMD%=11.9 (8.5). There were no differences (p=.943) in FMD between the obese (mean FMD% = 12.2, SE 4.1) and non-obese (11.8, SE 3.4) groups. Similarly, when percent body fat was examined as a continuous variable, percent body fat was not associated with FMD (coefficient =0.16 (SE 0.31), p=.612). Those with greater than 15 minutes of MVPA per day had a higher FMD (15.0, SE 3.3) compared to those with less than 15 minutes of MVPA per day (8.9, SE 3.3, p=.024). When MVPA was examined as a continuous variable, MVPA was positively associated with MVPA (coefficient =.32 (SE 15), p=.067, however, not statistically significant. Discussion: Despite the small sample size, there does appear to be a positive association between FMD and MVPA in adolescents but not an association between FMD and percent body fat. These results suggest an important correlation between PA and cardiac health and may also support the notion that PA may be more important in overall CV health when compared to body composition. Clinicians should emphasize promoting physical activity among adolescents, and not just focus solely on body fat

Lines of Flight: An Atomic Memoir by Julie Salverson

Review of Julie Salverson’s Lines of Flight: An Atomic Memoir

Animals Among Us: The Lives of Humans and Animals in Contemporary American Fiction edited by John Yunker

Review of Animals Among Us: The Lives of Humans and Animals in Contemporary American Fiction, edited by John Yunker

Investigation of the Progenitors of the Type Ia Supernovae Associated With the LMC Supernova Remnants 0505-67.9 and 0509-68.7

Although Type Ia supernovae have been heavily scrutinized due to their use in making cosmological distance estimates, we are still unable to definitively identify the progenitors for the entire population. While answers have been presented for certain specific systems, a complete solution remains elusive. We present observations of two supernova remnants (SNRs) in the Large Magellanic Cloud, SNR 0505-67.9 and SNR 0509-68.7, for which we have identified the center of the remnant and the 99.73% containment central region in which any companion star left over after the supernova must be located. Both remnants have a number of potential ex-companion stars near their centers; all possible single and double degenerate progenitor models remain viable for these two supernovae. Future observations may be able to identify the true ex-companions for both remnants.Comment: 8 pages, 4 figures, 4 tables, ApJ In Press; Table 2 truncated, full version available in published paper or directly from author

Identifying and Quantifying Recurrent Novae Masquerading as Classical Novae

Recurrent novae (RNe) are cataclysmic variables with two or more nova eruptions within a century. Classical novae (CNe) are similar systems with only one such eruption. Many of the so-called 'CNe' are actually RNe for which only one eruption has been discovered. Since RNe are candidate Type Ia supernova progenitors, it is important to know whether there are enough in our galaxy to provide the supernova rate, and therefore to know how many RNe are masquerading as CNe. To quantify this, we collected all available information on the light curves and spectra of a Galactic, time-limited sample of 237 CNe and the 10 known RNe, as well as exhaustive discovery efficiency records. We recognize RNe as having (a) outburst amplitude smaller than 14.5 - 4.5 * log(t_3), (b) orbital period >0.6 days, (c) infrared colors of J-H > 0.7 mag and H-K > 0.1 mag, (d) FWHM of H-alpha > 2000 km/s, (e) high excitation lines, such as Fe X or He II near peak, (f) eruption light curves with a plateau, and (g) white dwarf mass greater than 1.2 M_solar. Using these criteria, we identify V1721 Aql, DE Cir, CP Cru, KT Eri, V838 Her, V2672 Oph, V4160 Sgr, V4643 Sgr, V4739 Sgr, and V477 Sct as strong RN candidates. We evaluate the RN fraction amongst the known CNe using three methods to get 24% +/- 4%, 12% +/- 3%, and 35% +/- 3%. With roughly a quarter of the 394 known Galactic novae actually being RNe, there should be approximately a hundred such systems masquerading as CNe.Comment: 3 figures, 7 tables, accepted for publication in Ap