Creating a Protocol for Patient Outreach at a Primary Care Clinic

Purpose. The way that patient care is being delivered is evolving. One way in which this is happening is through patient centered medical homes (PCMH). PCMH represent a model of care that is accountable for meeting a patient’s care needs, including prevention and wellness, acute care and chronic care. To obtain status as a recognized PCMH, practices must fulfill specific quality care initiatives including patient outreach. Another way in which patient care is changing is through MACRA. This government initiative changes the way that practices are reimbursed for their services from fee-for-service to outcomes based measurements. Practices are now responsible for reporting on 4 different measures, with this project focusing on the quality improvement and meaningful use. This protocol is meant to fulfill these requirements. This project outlines specific guidelines for 12 different patient outreach topics including: pap smears, hypertension, colorectal cancer screening, pneumonia vaccinations, depression screening, smoking cessation in patients with COPD, hepatitis vaccination, Tdap vaccination, INR in patients on coumadin, mammograms, HgA1C, and influenza vaccination. These guidelines determine the criteria for creating lists of patients via the electronic health record (EHR), that need to be contacted for each of the 12 topics. Methods. It was planned to use reporting tools and data mining capabilities from the EHR in use at the clinic to develop lists of patients who met specific criteria pertaining to each topic and its associated guideline and to contact patients electronically via MyHealthOnline (a profile used to securely communicate from provider to patient and vice versa). The goal was to encourage them to contact the office to make an appointment to address that specific health maintenance topic. Outcome measures were determined to be the number of patients who needed to perform each of these activities at the beginning of implementation, versus those who have them completed after patient outreach within a 4-month period. Results. Electronic communication was not feasible as many of the patients at the practice were not signed up for MyHealthOnline. Instead, a smaller sample size of 64 patients was contacted across 4 selected health maintenance topics: colonoscopies, pneumococcal vaccines, Hemoglobin A1C’s \u3e8%, and hypertension. Twenty patients were contacted about colonoscopies, 6 for pneumococcal vaccines, 18 for HgbA1C \u3e8% and 20 for hypertension. Of those contacted, 34 answered their phone and 30 were left voicemails – 2 of whom immediately called back. Average time spent per phone call was 2 minutes, with outliers of 17 seconds and 20 minutes. Currently, 2 months have passed since the intervention was implemented. Outcomes will be calculated once 4 months have passed since implementation. Conclusion. Reliable methods of communication between care providers and patients are vital to patient outreach. Organization of clinical data and protocols for doing such activities are vital for ease of submission of required data for clinics wishing to maintain their status as a patient centered medical home and to achieve maximum reimbursement from Medicare/Medicaid. Patient outreach has other benefits including presenting a unique opportunity for education and motivation

Separating true range measurements from multi-path and scattering interference in commercial range cameras

Time-of-flight range cameras acquire a three-dimensional image of a scene simultaneously for all pixels from a single viewing location. Attempts to use range cameras for metrology applications have been hampered by the multi-path problem, which causes range distortions when stray light interferes with the range measurement in a given pixel. Correcting multi-path distortions by post-processing the three-dimensional measurement data has been investigated, but enjoys limited success because the interference is highly scene dependent. An alternative approach based on separating the strongest and weaker sources of light returned to each pixel, prior to range decoding, is more successful, but has only been demonstrated on custom built range cameras, and has not been suitable for general metrology applications. In this paper we demonstrate an algorithm applied to both the Mesa Imaging SR-4000 and Canesta Inc. XZ-422 Demonstrator unmodified off-the-shelf range cameras. Additional raw images are acquired and processed using an optimization approach, rather than relying on the processing provided by the manufacturer, to determine the individual component returns in each pixel. Substantial improvements in accuracy are observed, especially in the darker regions of the scene

Useful applications of earth-oriented satellites - Systems for remote-sensing information and distribution, panel 8

Problems and potential use of data gathered by remote sensing from satellites or aircraf

DNA structural deformations in the interaction of the controller protein C.AhdI with its operator sequence

Controller proteins such as C.AhdI regulate the expression of bacterial restriction–modification genes, and ensure that methylation of the host DNA precedes restriction by delaying transcription of the endonuclease. The operator DNA sequence to which C.AhdI binds consists of two adjacent binding sites, OL and OR. Binding of C.AhdI to OL and to OL + OR has been investigated by circular permutation DNA-bending assays and by circular dichroism (CD) spectroscopy. CD indicates considerable distortion to the DNA when bound by C.AhdI. Binding to one or two sites to form dimeric and tetrameric complexes increases the CD signal at 278 nm by 40 and 80% respectively, showing identical local distortion at both sites. In contrast, DNA-bending assays gave similar bend angles for both dimeric and tetrameric complexes (47 and 38°, respectively). The relative orientation of C.AhdI dimers in the tetrameric complex and the structural role of the conserved Py-A-T sequences found at the centre of C-protein-binding sites are discussed

Discovering Valuable Items from Massive Data

Suppose there is a large collection of items, each with an associated cost and an inherent utility that is revealed only once we commit to selecting it. Given a budget on the cumulative cost of the selected items, how can we pick a subset of maximal value? This task generalizes several important problems such as multi-arm bandits, active search and the knapsack problem. We present an algorithm, GP-Select, which utilizes prior knowledge about similarity be- tween items, expressed as a kernel function. GP-Select uses Gaussian process prediction to balance exploration (estimating the unknown value of items) and exploitation (selecting items of high value). We extend GP-Select to be able to discover sets that simultaneously have high utility and are diverse. Our preference for diversity can be specified as an arbitrary monotone submodular function that quantifies the diminishing returns obtained when selecting similar items. Furthermore, we exploit the structure of the model updates to achieve an order of magnitude (up to 40X) speedup in our experiments without resorting to approximations. We provide strong guarantees on the performance of GP-Select and apply it to three real-world case studies of industrial relevance: (1) Refreshing a repository of prices in a Global Distribution System for the travel industry, (2) Identifying diverse, binding-affine peptides in a vaccine de- sign task and (3) Maximizing clicks in a web-scale recommender system by recommending items to users

DNA structural deformations in the interaction of the controller protein C.AhdI with its operator sequence

Controller proteins such as C.AhdI regulate the expression of bacterial restriction–modification genes, and ensure that methylation of the host DNA precedes restriction by delaying transcription of the endonuclease. The operator DNA sequence to which C.AhdI binds consists of two adjacent binding sites, OL and OR. Binding of C.AhdI to OL and to OL + OR has been investigated by circular permutation DNA-bending assays and by circular dichroism (CD) spectroscopy. CD indicates considerable distortion to the DNA when bound by C.AhdI. Binding to one or two sites to form dimeric and tetrameric complexes increases the CD signal at 278 nm by 40 and 80% respectively, showing identical local distortion at both sites. In contrast, DNA-bending assays gave similar bend angles for both dimeric and tetrameric complexes (47 and 38°, respectively). The relative orientation of C.AhdI dimers in the tetrameric complex and the structural role of the conserved Py-A-T sequences found at the centre of C-protein-binding sites are discussed

Inflammation predicts accelerated brachial arterial wall changes in patients with recent-onset rheumatoid arthritis

Introduction Patients with recent-onset rheumatoid arthritis (RA) have impaired brachial artery endothelial function compared with controls matched for age, sex and cardiovascular risk factors. The present study examined endothelium-dependent (flow-mediated dilatation (FMD)) and independent (glyceryl trinitrate (GTN)-mediated dilatation (GMD)) structural responses in early RA patients, and determined progress over one year

Pilot, Rollout and Monte Carlo Tree Search Methods for Job Shop Scheduling

Greedy heuristics may be attuned by looking ahead for each possible choice, in an approach called the rollout or Pilot method. These methods may be seen as meta-heuristics that can enhance (any) heuristic solution, by repetitively modifying a master solution: similarly to what is done in game tree search, better choices are identified using lookahead, based on solutions obtained by repeatedly using a greedy heuristic. This paper first illustrates how the Pilot method improves upon some simple well known dispatch heuristics for the job-shop scheduling problem. The Pilot method is then shown to be a special case of the more recent Monte Carlo Tree Search (MCTS) methods: Unlike the Pilot method, MCTS methods use random completion of partial solutions to identify promising branches of the tree. The Pilot method and a simple version of MCTS, using the $\varepsilon$-greedy exploration paradigms, are then compared within the same framework, consisting of 300 scheduling problems of varying sizes with fixed-budget of rollouts. Results demonstrate that MCTS reaches better or same results as the Pilot methods in this context.Comment: Learning and Intelligent OptimizatioN (LION'6) 7219 (2012

Evaluation of Two Implant Strategies, Revalor- XH or a Combination Revalor- IH/Revalor- 200 on Heifer Growth Performance and Carcass Characteristics

A commercial feedlot trial examined effects of two implant strategies (Revalor- IH on d 1 and re- implanted with Revalor- 200 on d 101 or Revalor- XH on d 1) on growth performance and carcass characteristics of heifers fed 183 days. Th ere were no differences between implant strategies for final body weight, dry matter intake, and average daily gain. Heifers implanted with the combination IH/200 treatment had improved carcassadjusted feed conversion, greater LM area, and lower calculated yield grade compared to heifers implanted with XH. Th e response in growth performance between the two implant strategies suggests that the partiallycoated Revalor- XH implant can be used in place of a more aggressive implant strategy when heifers are fed to similar days