Characteristics of Local Health Departments Associated with Their Implementation of Electronic Health Records and Other Informatics System

Background: Information technology and information systems (IT/IS) play a critical role in the daily operation of local health departments (LHDs). Assessing LHDs’ informatics capacities is important, especially within the context of broader, system-level health reform efforts. Research Objective: This study assesses a nationally representative sample of LHDs’ level of adoption of information systems, technology, and the factors associated with adoption/implementation. Specifically, five areas of public health informatics were examined: electronic health records (EHRs), health information exchange (HIE), immunization registry (IR), electronic disease reporting system (EDRS), and electronic lab reporting (ELR). Data Sets and Sources: Data from NACCHO’s 2013 National Profile of LHDs was used. Descriptive statistics and multinomial logistic regression were performed for the five implementation-oriented outcome variables of interest, with three levels of implementation. Independent variables included infrastructural capacity, financial capacity, and other characteristics theoretically associated with informatics capacity. Study Design: This study uses a cross-sectional survey research design. Principal Findings: Thirteen percent of LHDs had implemented HIEs. About 22 % had implemented EHRs, 47% ELR, 72.2% EDRS, and 82% had implemented Immunization Registry. Significant determinants of health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, having health information system specialists on staff, having larger population size, having decentralized governance system, having one and more local boards of health, and having top executive with greater number of years in the job. Conclusions: The capacity of LHDs to use real-time, local data and information is critical. Many LHDs do not have this capacity. This may be due to lack of specialized staff, availability of data systems, or a host of other political or organizational constraints. This is especially the case for smaller jurisdictions. Cross-jurisdictional sharing or regionalization of some informatics and surveillance functions may be a reasonable approach to address these shortfalls. Implications for Public Health Practice and Policy: A combination of investment in public health informatics infrastructure, additional training of new informatics staff and existing epidemiologists, and better integration with healthcare systems is needed to augment LHD informatics capacity and ensure governmental public health can meet the information needs of the 21st century

Photoresponse from noble metal nanoparticles-multi walled carbon nanotube composites

In this Letter, we investigated the photo-response of multi wall carbon nanotube-based composites obtained from in situ thermal evaporation of noble metals (Au, Ag, and Cu) on the nanotube films. The metal deposition process produced discrete nanoparticles on the nanotube outer walls. The nanoparticle-carbon nanotube films were characterized by photo-electrochemical measurements in a standard three electrode cell. The photocurrent from the decorated carbon nanotubes remarkably increased with respect to that of bare multiwall tubes. With the aid of first-principle calculations, these results are discussed in terms of metal nanoparticle–nanotube interactions and electronic charge transfer at the interface.VC 2012 American Institute of Physics

Applications of three-dimensional carbon nanotube

In this paper, we show that it is possible to synthesize carbon-based three-dimensional networks by adding sulfur, as growth enhancer, during the synthesis process. The obtained material is self-supporting and consists of curved and interconnected carbon nanotubes and to lesser extent of carbon fibers. Studies on the microstructure indicate that the assembly presents a marked variability in the tube external diameter and in the inner structure. We study the relationship between the observed microscopic properties and some potential applications. In particular, we show that the porous nature of the network is directly responsible for the hydrophobic and the lipophilic behavior. Moreover, we used a cut piece of the produced carbon material as working electrode in a standard electrochemical cell and, thus, demonstrating the capability of the system to respond to incident light in the visible and near-ultraviolet region and to generate a photocurrent

Multidisciplinary Conservative Treatment of Difficult Bile Duct Stones: A Real Alternative to Surgery

56 patients with large CBD or intrahepatic stones underwent endoscopic and/or percutaneous treatment followed by extracorporeal shock wave lithotripsy. Percutaneous access to the biliary tract was chosen when an endoscopic approach was not possible (hepaticojejunostomy in 5 patients, 1 juxtapapillary diverticulum and I inflammatory bile duct stricture). Visualization of stones was achieved radiologically in 32 patients and by ultrasound in 24. The procedure was successful in 47 of 56 treated patients (83.9%). Clearance of the biliary tract was obtained in 25 cases (53%), whereas in 22 cases (47%) complete clearing of biliary tract was obtained only after endoscopic extraction of fragments (17 cases) or percutaneous (5 cases). The median number of shock waves in each session was 1725 (range 300–3166), which were applied during one (n=30), two (n=22) or three sessions (n=4). The only complications were 1 case of symptomatic hyperamylasemia and 3 cases of macrohematuria. In conclusion, extracorporeal lithotripsy combined with endoscopic and/or percutaneous treatment is a real alternative to surgery for difficult stones

Ultrafast dynamics in unaligned MWCNTs decorated with metal nanoparticles

The relaxation dynamics of unaligned multi-walled carbon nanotubes decorated with metallic nanoparticles have been studied by using transient optical measurements. The fast dynamics due to the short-lived free-charge carriers excited by the pump are not affected by the presence of nanoparticles. Conversely, a second long dynamics, absent in bare carbon nanotubes, appears only in the decorated samples. A combination of experiment and theory allows us to ascribe this long dynamics to relaxation channels involving electronic states localized at the tube-nanoparticle interface

QoS management and control for an all-IP WiMAX network architecture: Design, implementation and evaluation

The IEEE 802.16 standard provides a specification for a fixed and mobile broadband wireless access system, offering high data rate transmission of multimedia services with different Quality-of-Service (QoS) requirements through the air interface. The WiMAX Forum, going beyond the air interface, defined an end-to-end WiMAX network architecture, based on an all-IP platform in order to complete the standards required for a commercial rollout of WiMAX as broadband wireless access solution. As the WiMAX network architecture is only a functional specification, this paper focuses on an innovative solution for an end-to-end WiMAX network architecture offering in compliance with the WiMAX Forum specification. To our best knowledge, this is the first WiMAX architecture built by a research consortium globally and was performed within the framework of the European IST project WEIRD (WiMAX Extension to Isolated Research Data networks). One of the principal features of our architecture is support for end-to-end QoS achieved by the integration of resource control in the WiMAX wireless link and the resource management in the wired domains in the network core. In this paper we present the architectural design of these QoS features in the overall WiMAX all-IP framework and their functional as well as performance evaluation. The presented results can safely be considered as unique and timely for any WiMAX system integrator

Nanometric moiré stripes on the surface of Bi2Se3 topological insulator

Mismatch between adjacent atomic layers in low-dimensional materials, generating moiré patterns, has recently emerged as a suitable method to tune electronic properties by inducing strong electron correlations and generating novel phenomena. Beyond graphene, van der Waals structures such as three-dimensional (3D) topological insulators (TIs) appear as ideal candidates for the study of these phenomena due to the weak coupling between layers. Here we discover and investigate the origin of 1D moiré stripes on the surface of Bi2Se3TI thin films and nanobelts. Scanning tunneling microscopy and high-resolution transmission electron microscopy reveal a unidirectional strained top layer, in the range 14-25%, with respect to the relaxed bulk structure, which cannot be ascribed to the mismatch with the substrate lattice but rather to strain induced by a specific growth mechanism. The 1D stripes are characterized by a spatial modulation of the local density of states, which is strongly enhanced compared to the bulk system. Density functional theory calculations confirm the experimental findings, showing that the TI surface Dirac cone is preserved in the 1D moiré stripes, as expected from the topology, though with a heavily renormalized Fermi velocity that also changes between the top and valley of the stripes. The strongly enhanced density of surface states in the TI 1D moiré superstructure can be instrumental in promoting strong correlations in the topological surface states, which can be responsible for surface magnetism and topological superconductivity

Co-circulation of the two influenza B lineages during 13 consecutive influenza surveillance seasons in Italy, 2004-2017

BACKGROUND: Since 1985, two antigenically distinct lineages of influenza B viruses (Victoria-like and Yamagata-like) have circulated globally. Trivalent seasonal influenza vaccines contain two circulating influenza A strains but a single B strain and thus provide limited immunity against circulating B strains of the lineage not included in the vaccine. In this study, we describe the characteristics of influenza B viruses that caused respiratory illness in the population in Italy over 13 consecutive seasons of virological surveillance, and the match between the predominant influenza B lineage and the vaccine B lineage, in each season. METHODS: From 2004 to 2017, 26,886 laboratory-confirmed influenza cases were registered in Italy, of which 18.7% were type B. Among them, the lineage of 2465 strains (49%) was retrieved or characterized in this study by a real-time RT-PCR assay and/or sequencing of the hemagglutinin (HA) gene. RESULTS: Co-circulation of both B lineages was observed each season, although in different proportions every year. Overall, viruses of B/Victoria and B/Yamagata lineages caused 53.3 and 46.7% of influenza B infections, respectively. A higher proportion of infections with both lineages was detected in children, and there was a declining frequency of B/Victoria detections with age. A mismatch between the vaccine and the predominant influenza B lineage occurred in eight out of thirteen influenza seasons under study. Considering the seasons when B accounted for >\u200920% of all laboratory-confirmed influenza cases, a mismatch was observed in four out of six seasons. Phylogenetic analysis of the HA1 domain confirmed the co-circulation of both lineages and revealed a mixed circulation of distinct evolutionary viral variants, with different levels of match to the vaccine strains. CONCLUSIONS: This study contributes to the understanding of the circulation of influenza B viruses in Italy. We found a continuous co-circulation of both B lineages in the period 2004-2017, and determined that children were particularly vulnerable to Victoria-lineage influenza B virus infections. An influenza B lineage mismatch with the trivalent vaccine occurred in about two-thirds of cases

Optimization of a high work function solution processed vanadium oxide hole-extracting layer for small molecule and polymer organic photovoltaic cells

We report a method of fabricating a high work function, solution processable vanadium oxide (V2Ox(sol)) hole-extracting layer. The atmospheric processing conditions of film preparation have a critical influence on the electronic structure and stoichiometry of the V2Ox(sol), with a direct impact on organic photovoltaic (OPV) cell performance. Combined Kelvin probe (KP) and ultraviolet photoemission spectroscopy (UPS) measurements reveal a high work function, n-type character for the thin films, analogous to previously reported thermally evaporated transition metal oxides. Additional states within the band gap of V2Ox(sol) are observed in the UPS spectra and are demonstrated using X-ray photoelectron spectroscopy (XPS) to be due to the substoichiometric nature of V2Ox(sol). The optimized V2Ox(sol) layer performance is compared directly to bare indium–tin oxide (ITO), poly(ethyleneoxythiophene):poly(styrenesulfonate) (PEDOT:PSS), and thermally evaporated molybdenum oxide (MoOx) interfaces in both small molecule/fullerene and polymer/fullerene structures. OPV cells incorporating V2Ox(sol) are reported to achieve favorable initial cell performance and cell stability attributes