Closing the Meaningful Use Gap between Small and Large Practices

The Lack of Meaningful Use Awareness in small practices is very prevalent. One may ask why there is such a gap in MU Awareness amongst small and large practices. The answer is quite the same across the board for small practices, “Cost”. This misfortune has resulted in many small practice physicians and staff being objective to the adoption of an electronic health record system. They are indifferent about the penalties that will be enforced soon, if they do not follow suite with the guidelines mandated by the ARRA. Essentially, this thesis will provide statistical data on the adoption rate of small practices and financial options for financing EHR systems prior to incentive payment. It will shed light on small practices prospective of Meaningful Use, address their concerns with adoption, and provide guidance on seeking loans and technical assistance from local Regional Extension Centers

A Strategic Approach to Public Health Workforce Development and Capacity Building

In February 2010, CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention (NCHHSTP) formally institutionalized workforce development and capacity building (WDCB) as one of six overarching goals in its 2010–2015 Strategic Plan. Annually, workforce team members finalize an action plan that lays the foundation for programs to be implemented for NCHHSTP’s workforce that year. This paper describes selected WDCB programs implemented by NCHHSTP during the last 4 years in the three strategic goal areas: (1) attracting, recruiting, and retaining a diverse and sustainable workforce; (2) providing staff with development opportunities to ensure the effective and innovative delivery of NCHHSTP programs; and (3) continuously recognizing performance and achievements of staff and creating an atmosphere that promotes a healthy work–life balance. Programs have included but are not limited to an Ambassador Program for new hires, career development training for all staff, leadership and coaching for mid-level managers, and a Laboratory Workforce Development Initiative for laboratory scientists. Additionally, the paper discusses three overarching areas—employee communication, evaluation and continuous review to guide program development, and the implementation of key organizational and leadership structures to ensure accountability and continuity of programs. Since 2010, many lessons have been learned regarding strategic approaches to scaling up organization-wide public health workforce development and capacity building. Perhaps the most important is the value of ensuring the high-level strategic prioritization of this issue, demonstrating to staff and partners the importance of this imperative in achieving NCHHSTP’s mission

\u3ci\u3eStaphylococcus aureus\u3c/i\u3e Hyaluronidase Is a CodY-Regulated Virulence Factor

Staphylococcus aureus is a Gram-positive pathogen that causes a diverse range of bacterial infections. Invasive S. aureus strains secrete an extensive arsenal of hemolysins, immunomodulators, and exoenzymes to cause disease. Our studies have focused on the secreted enzyme hyaluronidase (HysA), which cleaves the hyaluronic acid polymer at the β-1,4 glycosidic bond. In the study described in this report, we have investigated the regulation and contribution of this enzyme to S. aureus pathogenesis. Using the Nebraska Transposon Mutant Library (NTML), we identified eight insertions that modulate extracellular levels of HysA activity. Insertions in the sigB operon, as well as in genes encoding the global regulators SarA and CodY, significantly increased HysA protein levels and activity. By altering the availability of branched-chain amino acids, we further demonstrated CodY-dependent repression of HysA activity. Additionally, through mutation of the CodY binding box upstream of hysA, the repression of HysA production was lost, suggesting that CodY is a direct repressor of hysA expression. To determine whether HysA is a virulence factor, a ΔhysA mutant of a community-associated methicillin-resistant S. aureus (CA-MRSA) USA300 strain was constructed and found to be attenuated in a neutropenic, murine model of pulmonary infection. Mice infected with this mutant strain exhibited a 4-log-unit reduction in bacterial burden in their lungs, as well as reduced lung pathology and increased levels of pulmonary hyaluronic acid, compared to mice infected with the wild-type, parent strain. Taken together, these results indicate that S. aureus hyaluronidase is a CodY-regulated virulence factor

Supporting Less-Proficent Writers through Linguistically-Aware Teaching

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.Whilst historically there has been a widespread consensus that teaching grammar has no impact on students’ attainment in writing, more recent research suggests that where a functionally-oriented approach to grammar is meaningfully embedded within the teaching of writing, significant improvements in writing can be secured. A recent study ((Myhill et al 2012), using a functionally-oriented approach, which found a statistically significant positive effect of such an approach, also found that the approach appeared to benefit higher-attaining writers more than lower-attaining writers. The study reported here set out to investigate specifically whether functionally-oriented approach to teaching grammar in the context of writing might support less proficient writers. A quasi-experimental design was adopted, repeating the principles of the parent study but with the intervention adapted to meet the identified writing needs of less proficient writers. The statistical analysis indicated a positive effect for the intervention group (p<0.05), and an effect size of 0.33 on students’ sentence structure and punctuation. The study demonstrates that explicit attention to grammar within the teaching of writing can support learners in developing their writing, but taken with the parent study, it also highlights that pedagogical choices need to be well-matched to writers’ needs.This parent study referred to in this article was supported by the Economic and Social Research Council.Funding Agency under Grant ES/FO15313/1. The study reported in this article was funded by Pearson

Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations

As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects’ responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual’s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine

Revised Architecture and Two New Super-Earths in the HD 134606 Planetary System

© 2024. The Author(s). Published by the American Astronomical Society. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Multiplanet systems exhibit a diversity of architectures that diverge from the solar system and contribute to the topic of exoplanet demographics. Radial velocity (RV) surveys form a crucial component of exoplanet surveys, as their long observational baselines allow for searches for more distant planetary orbits. This work provides a significantly revised architecture for the multiplanet system HD 134606 using both HARPS and UCLES RVs. We confirm the presence of previously reported planets b, c, and d with periods of 12.0897 − 0.0018 + 0.0019 , 58.947 − 0.054 + 0.056 , and 958.7 − 5.9 + 6.3 days and masses of 9.14 − 0.63 + 0.65 , 11.0 ± 1, and 44.5 ± 2.9 Earth masses, respectively, with the planet d orbit significantly revised to over double that originally reported. We report two newly detected super-Earths, e and f, with periods of 4.31943 − 0.00068 + 0.00075 and 26.9 − 0.017 + 0.019 days and masses of 2.31 − 0.35 + 0.36 and 5.52 − 0.73 + 0.74 Earth masses, respectively. In addition, we identify a linear trend in the RV time series, and the cause of this acceleration is deemed to be a newly detected massive companion with a very long orbital period. HD 134606 now displays four low-mass planets in a compact region near the star, one gas giant further out in the habitable zone, an additional companion in the outer regime, and a low-mass M dwarf stellar companion at large separation, making it an intriguing target for system formation/evolution studies. The location of planet d in the habitable zone proves to be an exciting candidate for future space-based direct imaging missions, whereas continued RV observations of this system are recommended for understanding the nature of the massive, long-period companion.Peer reviewe

Teacher knowledge and beliefs about grammar: a case study of an English primary school

This case study of developing teacher attitudes, beliefs and content knowledge at one primary school in the North-West of England deals with the new spelling, punctuation and grammar (SPaG) elements of the National Curriculum, focusing on grammatical terms and concepts. It uses data collected over 10 months from June 2014 to March 2015, including surveys, interviews and comments made during post-observation discussions and during SPaG CPD sessions. The findings suggest that, while much work remains to be done in developing teachers’ knowledge base, attitudes are largely supportive of teaching children grammar terms and concepts

The COS Legacy Archive Spectroscopy SurveY (CLASSY) Treasury Atlas

Far-ultraviolet (FUV; ~1200-2000 angstroms) spectra are fundamental to our understanding of star-forming galaxies, providing a unique window on massive stellar populations, chemical evolution, feedback processes, and reionization. The launch of JWST will soon usher in a new era, pushing the UV spectroscopic frontier to higher redshifts than ever before, however, its success hinges on a comprehensive understanding of the massive star populations and gas conditions that power the observed UV spectral features. This requires a level of detail that is only possible with a combination of ample wavelength coverage, signal-to-noise, spectral-resolution, and sample diversity that has not yet been achieved by any FUV spectral database. We present the COS Legacy Spectroscopic SurveY (CLASSY) treasury and its first high level science product, the CLASSY atlas. CLASSY builds on the HST archive to construct the first high-quality (S/N_1500 >~ 5/resel), high-resolution (R~15,000) FUV spectral database of 45 nearby (0.002 < z < 0.182) star-forming galaxies. The CLASSY atlas, available to the public via the CLASSY website, is the result of optimally extracting and coadding 170 archival+new spectra from 312 orbits of HST observations. The CLASSY sample covers a broad range of properties including stellar mass (6.2 < logM_star(M_sol) < 10.1), star formation rate (-2.0 < log SFR (M_sol/yr) < +1.6), direct gas-phase metallicity (7.0 < 12+log(O/H) < 8.8), ionization (0.5 < O_32 < 38.0), reddening (0.02 < E(B-V < 0.67), and nebular density (10 < n_e (cm^-3) < 1120). CLASSY is biased to UV-bright star-forming galaxies, resulting in a sample that is consistent with z~0 mass-metallicity relationship, but is offset to higher SFRs by roughly 2 dex, similar to z >~2 galaxies. This unique set of properties makes the CLASSY atlas the benchmark training set for star-forming galaxies across cosmic time.Comment: Accepted for publication in Ap