Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support

Background: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT. Objective: To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs. Methods: We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length of stay and returns within 7 days after ED release. Results: There were 2,878 patients with head trauma (1,329 PRE and 1,549 POST) included. Statistical process control charts confirmed decreased CT rates over time POST that was not present PRE. Secondary statistical analyses confirmed that CT scan utilization rates decreased from 26.8% to 18.9% (unadjusted Odds Ratio [OR], 0.64; 95% Confidence Interval [CI], 0.53 -0.76; adjusted OR, 0.71; 95% CI, 0.58 -0.86). Length of stay was unchanged. There was no increase in returns within 7 days and no significant missed diagnoses. Conclusions: Implementation of EHR-integrated decision support for children with head trauma presenting to the ED is associated with a decrease in CT utilization and no increase in significant safety events

Numerical Solution of the Nonlinear Ship Wave Problem

Coordinated Science Laboratory changed its name from Control Systems LaboratoryOffice of Naval Research / N00014-80-C-0740 (NR334-004)Ope

Habitat Characteristics of Eastern Wild Turkey Nest and Ground-roost Sites in 2 Longleaf Pine Forests

Managing and restoring longleaf pine forests throughout the Southeast is a conservation priority. Prescribed fire is an integral part of these activities, as it is the primary means of controlling hardwood encroachment and maintaining native groundcover. Nest site and preflight brood groundroost site selection of eastern wild turkeys (Meleagris gallopavo silvestris) has not been well studied in longleaf pine systems. Therefore, we determined habitat characteristics associated with wild turkey nests and ground-roosts in 2 longleaf pine forests in southwestern Georgia. We radio-tagged 45 female turkeys and evaluated habitat characteristics associated with 84 nests and 51 ground-roosts during the 2011–2013 nesting seasons. Nests were located farther from mature pine and mature pine-hardwood stands and closer to shrub/scrub habitats than expected. Nests were also negatively associated with percent canopy closure and positively associated with percent woody ground cover and vegetation height. Ground-roosts were closer to mature pine-hardwood stands and open water than were random sites. We suggest that management of longleaf pine forests should focus on maintaining open-canopied forests with adequate understory vegetation to serve as nesting and brood-rearing cover. Our findings suggest that frequent prescribed fire (≤ 2 years), when the management goal is to optimize restoration of longleaf ecosystems, is conducive to maintaining wild turkey populations

Origin of intermittent accretion-powered X-ray oscillations in neutron stars with millisecond spin periods

We have shown previously that many of the properties of persistent accretion-powered millisecond pulsars can be understood if their X-ray emitting areas are near their spin axes and move as the accretion rate and structure of the inner disk vary. Here we show that this "nearly aligned moving spot model" may also explain the intermittent accretion-powered pulsations that have been detected in three weakly magnetic accreting neutron stars. We show that movement of the emitting area from very close to the spin axis to about 10 degrees away can increase the fractional rms amplitude from less than about 0.5 percent, which is usually undetectable with current instruments, to a few percent, which is easily detectable. The second harmonic of the spin frequency usually would not be detected, in agreement with observations. The model produces intermittently detectable oscillations for a range of emitting area sizes and beaming patterns, stellar masses and radii, and viewing directions. Intermittent oscillations are more likely in stars that are more compact. In addition to explaining the sudden appearance of accretion-powered millisecond oscillations in some neutron stars with millisecond spin periods, the model explains why accretion-powered millisecond oscillations are relatively rare and predicts that the persistent accretion-powered millisecond oscillations of other stars may become undetectable for brief intervals. It suggests why millisecond oscillations are frequently detected during the X-ray bursts of some neutron stars but not others and suggests mechanisms that could explain the occasional temporal association of intermittent accretion-powered oscillations with thermonuclear X-ray bursts.Comment: 5 pages, 1 figure; includes additional discussion and updated references; accepted for publication in ApJ

Communications Biophysics

Contains reports on four research projects.National Institutes of Health (Grant 1 P01 GM-14940-02)Joint Services Electronics Programs (U. S. Army, U. S. Navy, and U. S. Air Force) under Contract DA 28-043-AMC-02536(E)National Institutes of Health (Grant 5 TO1 GM-01555-02

Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study

Abstract Background Visual inspection with acetic acid (VIA) to identify and treat pre-cancerous lesions is effective for cervical cancer prevention. Screening programs also facilitate screening and diagnosis of invasive cancers that must be referred for radiation therapy or chemotherapy. This study compared characteristics of women diagnosed with invasive cervical cancer by a VIA screening program who did and did not follow up for treatment and who did and did not complete treatment at the Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania. Methods We conducted a retrospective cohort study of ORCI screening referrals from the period November 2002 to June 2011. Women referred for treatment of invasive disease (n = 980) were identified from an existing database of all women attending the screening clinic during this period (n = 20,131) and matched to a dataset of all cervical cancer patients attending ORCI in this period (n = 8,240). Treatment information was abstracted from patient records of women who followed up. Records of a random sample (n = 333) of unscreened patients were reviewed for disease stage. Results Of the 980 women referred women, 829 (84.6%) sought treatment. Most of those women (82.8%) completed their prescribed radiation. Lower disease stage, having a skilled occupation, residence in Dar es Salaam, and younger age were independently associated with loss to follow-up. Higher disease stage, residence in Dar es Salaam, older age, and later year of first treatment appointment were independently associated with incomplete treatment among those who followed up. Significantly more screened women had stage 1 disease (14.0%) than unscreened women (7.8%). Conclusions Most women referred from the screening clinic completed treatment for their cancer at ORCI. Some of those lost to follow-up may have sought treatment elsewhere. In most cases, the screening clinic appears to facilitate diagnosis and treatment, rather than screening, for women with invasive cervical cancer.http://deepblue.lib.umich.edu/bitstream/2027.42/109468/1/12889_2013_Article_7027.pd

The linked survival prospects of siblings : evidence for the Indian states

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother’s (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights