Information technologies that facilitate care coordination: provider and patient perspectives

Health information technology is a core infrastructure for the chronic care model, integrated care, and other organized care delivery models. From the provider perspective, health information exchange (HIE) helps aggregate and share information about a patient or population from several sources. HIE technologies include direct messages, transfer of care, and event notification services. From the patient perspective, personal health records, secure messaging, text messages, and other mHealth applications may coordinate patients and providers. Patient-reported outcomes and social media technologies enable patients to share health information with many stakeholders, including providers, caregivers, and other patients. An information architecture that integrates personal health record and mHealth applications, with HIEs that combine the electronic health records of multiple healthcare systems will create a rich, dynamic ecosystem for patient collaboration

Devolution and the economy : a Scottish perspective

In their interesting and challenging chapter John Adams and Peter Robinson assess the consequences for economic development policy of the devolution measures enacted by the UK Labour government post 1997. Their chapter ranges widely over current UK regional disparities, the link between devolution and economic growth, the balance of responsibilities in policy between Whitehall and the devolved administrations, and finally, they raise questions about the developing "quasi-federal" role of Whitehall in regulating or coordinating the new devolved policy landscape. In response, we propose to focus on four issues that we believe are key to understanding the economic consequences of devolution both at the Scottish and UK levels. First, we argue that the view of Scotland's devolutionary experience in economic policy is partial and so does not fully capture the nature and extent of change post 1999. Secondly, we examine the role of devolution in regional economic performance. There is much in their paper on this topic with which we agree but we contend that there are significant omissions in the analysis, which are important for policy choice. Our third section highlights an area not discussed in depth by Adams and Robinson's paper: the funding of the devolution settlement. Here we consider some of the implications of funding arrangements for economic performance and the options for a new funding settlement. Finally, we deal with the difficult issue of co-ordination between the centre and the devolved regions. We contend that co-ordination is largely conspicuous by its absence. Moreover, where coordination is deployed it reflects an inadequate understanding of the extent to which the economies of the regions and devolved territories of the UK are linked

Application of High-precision Timing Systems to Distributed Survey Systems

In any hydrographic survey system that consists of more than one computer, one of the most difficult integration problems is to ensure that all components maintain a coherent sense of time. Since virtually all modern survey systems are of this type, timekeeping and synchronized timestamping of data as it is created is of significant concern. This paper describes a method for resolving this problem based on the IEEE 1588 Precise Time Protocol (PTP) implemented by hardware devices, layered with some custom software called the Software Grandmaster (SWGM) algorithm. This combination of hardware and software maintains a coherent sense of time between multiple ethernet-connected computers, on the order of 100 ns (rms) in the best case, of the timebase established by the local GPS-receiver clock. We illustrate the performance of this techniques in a practical survey system using a Reson 7P sonar processor connected to a Reson 7125 Multibeam Echosounder (MBES), integrated with an Applanix POS/MV 320 V4 and a conventional data capture computer. Using the timing capabilities of the PTP hardware implementations, we show that the timepieces achieve mean (hardware based) synchronization and timestamping within 100-150 ns (rms), and that the data created at the Reson 7P without hardware timestamps has a latency variability of 28 µs (rms) due to software constraints within the capture system. This compares to 288 ms (rms) using Reson’s standard hybrid hardware/software solution, and 13.6 ms (rms) using a conventional single-oscillator timestamping model

Involvement of deprivation and environmental lead in neural tube defects:a matched case-control study.

OBJECTIVE. To analyse the prevalence of neural tube defects in small geographical areas and seek to explain any spatial variations with reference to environmental lead and deprivation. SETTING. The Fylde of Lancashire in the north west of England. DESIGNCases were ascertained as part of a prospective survey of major congenital malformations in babies born in the Fylde to residents there between 1957 and 1981. A matched case-control analysis used infants with cardiovascular system, alimentary tract, and urinary system malformations as controls. Conditional logistic regression was used to assess the effects of more than 10 µg/l lead in drinking water and the Townsend deprivation score. RESULTS. The prevalence of neural tube defects in 1957-73 was higher in Blackpool, Fleetwood, and North Fylde, whereas the three control groups showed no significant spatial variation. In 1957-81 mothers living in electoral wards with either a higher proportion of houses with more than 10 µg/l lead in the water or a higher deprivation score had a greater risk of having a baby with a neural tube defect. For spina bifida and cranium bifidum alone, this was also true. For anencephaly, deprivation was less important although the effect of lead was still seen. In some neural tube defects, lead may act independently of other possible factors associated with deprivation. It seemed unlikely that lead levels changed significantly during the survey. The percentage of houses with 10 µg/l or more of lead in the water in 1984-5 was similar to that found in Great Britain 10 years previously. CONCLUSION. There is evidence to suggest that lead is one cause of neural tube defects, especially anencephaly. This could link the known preventive actions of hard water and folic acid. Calcium is a toxicological antagonist of lead. One cause of a deficiency of folic acid is impaired absorption secondary to zinc deficiency, which may be produced or exacerbated by lead

Modifications to the Method of Modal Strain Energy for Improved Estimates of Loss Factors for Damped Structures

The method of Modal Strain Energy (MSE) enables predictions of modal loss factors for vibrating systems from finite element analyses without evaluation of a complex-valued frequency response or a complex-valued frequency. While the method is simple, some error results; especially if the dissipative material has the high loss factor characteristic of materials added to increase system damping. Several methods for reducing this error through modifications to MSE have been suggested. In this work, the exact loss factor for a simple mechanical system is found. The method of Modal Strain Energy (MSE) is then used to find the loss factor for that prototype system and errors are evaluated in terms of system parameters. Comparisons are also made to predictions with several modifications to MSE. A modification due to Rongong is found to provide significant improvement. The use of this modification together with MSE is shown to lead to lower and upper bounds for the system loss factor. As the prototype system is shown to be mechanically equivalent to constrained layer damping configurations, the findings are applicable to the analysis and design of optimized sandwich beams, plates, and damping tapes. Results are given for beams and plates with constrained layer treatments

Studies in the cycloproparene series: cycloaddition reactions of diarylmethylidenecycloproparenes

Journal ArticleDiarylmethylidenecyclopropanaphthalenes 4b-d add diphenylisobenzofuran (DPIBF) and α-pyrone across the exocyclic double bond to give ring expanded products 11b-d and 13b-d that result from subsequent relief of ring strain in the non-isolable spirocyclic intermediates 10 and 12, respectively. The benzene homologues 3b and 3c add DPIBF across the bridge bond to give the norcaradiene adducts 19b and 19c

Real-world Quantum Sensors: Evaluating Resources for Precision Measurement

Quantum physics holds the promise of enabling certain tasks with better performance than possible when only classical resources are employed. The quantum phenomena present in many experiments signify nonclassical behavior, but do not always imply superior performance. Quantifying the enhancement achieved from quantum behavior requires careful analysis of the resources involved. We analyze the specific case of parameter estimation using an optical interferometer, where increased precision can be achieved using quantum probe states. Common performance measures are examined and it is shown that some overestimate the improvement. For the simplest experimental case we compare the different measures and show this overestimate explicitly. We give the preferred analysis of real-world experiments and calculate benchmark values for experimental parameters necessary to realize a precision enhancement.Comment: 8 pages, 3 figure