Providing developmental feedback to individuals from different ethnic minority groups using expert systems

The paper is an account of a commercially successful and viable expert system entitled FRED (Feedback Reporter Evaluating Development). Expert systems offer a consistent approach to providing feedback to individuals that people with personal biases and emotions may find difficult to achieve. The text used in the expert system is sensitive and carefully worded by a team of skilled professionals, many of whom were from ethnic and cultural minorities. This is especially important when dealing with internal applicants from ethnic minorities as feedback given is consistent, fair, non-judgemental and devoid of possible ethnic prejudices and emotional statements. FRED offers a sensitive, comprehensive and cost-effective method of producing feedback reports for individuals from an ethnic minority and the paper details FRED's design, use and evaluation in an organizational setting. Future research is recommended in utilizing expert systems to provide feedback in assessment and development settings

Stakeholders’ perceptions of digital health platform ecosystem generativity

This paper discusses findings from a study of healthcare stakeholders’ perceptions of the enablers and barriers of core-periphery systems and solutions in the digital platform of a Private Tertiary Health Service (PTHS). Using critical realism as a lens, the study involved an embedded case study of three departments in PTHS. The findings show that the platformisation of digital health infrastructure enhanced generativity, including innovation, adoption, and scaling. Further, the research identified platform governance as the area that requires enhancements. This research adds to the limited literature on digital health platform ecosystems by revealing healthcare stakeholders’ perceptions. Our findings can inform strategy for health organisations seeking platformisation of their digital infrastructures. Further, state and national digital healthcare policymakers can use this research to address digital health platform ecosystems challenges, especially in the private sector

Prescriptions for Alpha Agonists and Antipsychotics in Children and Youth with Tic Disorders: A Pharmacoepidemiologic Study

Background: Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods: IQVIA’s Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results: Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion: The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications

Printable and flexible graphene pH sensors utilising thin film melanin for physiological applications

The application of highly sensitive pH sensors manufactured in volume at low cost has great commercial interest due to an extensive array of potential applications. Such areas include industrial processing, biotechnology and medical diagnostics particularly in the development of point of care (POC) devices. A novel printable electrochemical pH sensor based on graphene and pigment melanin (PGM), was designed and produced by using a screen printing process that enables up scaling for potential commercial application. We demonstrate a highly sensitive pH sensor (62 mV pH−1  ±  7) over a pH range from 5 to 8, with high stability and superior performance when compared with a number of existing devices and making it suitable for physiological applications

Large-area printed supercapacitor technology for low-cost domestic green energy storage

In this research we demonstrate that a flexible ultra-thin supercapacitor can be fabricated using high volume screen printing process. This has enabled the sequential deposition of current collector, electrode, electrolyte materials and adhesive onto a Polyethylene terephthalate (PET) substrate in order to form flexible electrodes for reliable energy storage applications. The electrodes were based on an activated carbon ink and gel electrolyte each of which were formulated for this application. Supercapacitors that have surface areas from 100 to 1600 mm2 and an assembled device thickness of 375 μm were demonstrated. The capacitance ranged from 50 to 400 mF. Capacitance of printed carbon electrodes is rarely reported in literature and no references were found. The chemistry developed during this study displayed long-term cycling potential and demonstrated the stability of the capacitor for continued usage. The gel electrolyte developed within this work showed comparable performance to that of a liquid counterpart. This improvement resulted in the reduction in gel resistance from 90Ω to 0.5Ω. Significant reduction was observed for all resistances. The solid-state supercapacitors with the gel electrolyte showed comparable performance to the supercapacitors that used a liquid electrolyte. This large area printed device can be used in future houses for reliable green energy storage

An unusual stroke-like clinical presentation of Creutzfeldt-Jakob disease: acute vestibular syndrome

INTRODUCTION Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week. The patient had no focal neurological symptoms or signs. The presence of direction-fixed, horizontal nystagmus suppressed by visual fixation without vertical ocular misalignment (skew deviation) was consistent with an acute peripheral vestibulopathy, but bilaterally normal vestibuloocular reflexes, confirmed by quantitative horizontal head impulse testing, strongly indicated a central localization. Because of a long delay in care, the patient left the emergency department without treatment. He returned 1 week later with progressive gait disturbance, limb ataxia, myoclonus, and new cognitive deficits. His subsequent course included a rapid neurological decline culminating in home hospice placement and death within 1 month. Magnetic resonance imaging revealed restricted diffusion involving the basal ganglia and cerebral cortex. Spinal fluid 14-3-3 protein was elevated. The rapidly progressive clinical course with dementia, ataxia, and myoclonus plus corroborative neuroimaging and spinal fluid findings confirmed a clinicoradiographic diagnosis of Creutzfeldt-Jacob disease. CONCLUSIONS To our knowledge, this is the first report of an initial presentation of Creutzfeldt-Jacob disease closely mimicking vestibular neuritis, expanding the known clinical spectrum of prion disease presentations. Despite the initial absence of neurological signs, the central lesion location was differentiated from a benign peripheral vestibulopathy at the first visit using simple bedside vestibular tests. Familiarity with these tests could help providers prevent initial misdiagnosis of important central disorders in patients presenting vertigo or dizziness

Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments

Objectives Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department ( ED ). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. Methods This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined public‐use ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey ( NHAMCS ) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey ( MEPS ). We calculated total visits, test utilization, and ED diagnoses from NHAMCS . Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit cost‐per‐diagnosis‐group from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. Results The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [ CI ] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography ( CT ), magnetic resonance imaging ( MRI ), or both in 2011 was estimated to be 39.9% (39.4% CT , 2.3% MRI ). The mean per‐ ED ‐dizziness‐visit cost was $1,004 in 2011 dollars. The total extrapolated 2011 national costs were$3.9 billion. HCUP ‐ CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, cost‐per‐ ED ‐visit, attributable annual national costs): otologic/vestibular (25.7%; $768;$757 million), cardiovascular (16.5%, $1,489;$941 million), and cerebrovascular (3.1%; $1059;$127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 ( CT scans $360 million, MRI scans$110 million). Conclusions Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced. Resumen Incremento Anual de los Costes de las Atenciones por Mareo en los Servicios de Urgencias de Estados Unidos Objectivos El mareo y el vértigo suman aproximadamente el 4% de los motivos de consulta en el servicio de urgencias ( SU ). Se conoce poco sobre los costes globales de las evaluaciones del SU en estos pacientes. Se buscó estimar los costes anuales nacionales asociados con las visitas al SU por mareo. Metodología Este estudio de costes de visitas al SU de adultos norteamericanos que acudieron con mareo o vértigo combinó los datos públicos de las visitas a los SU (1995 a 2009) recogidos por el National Hospital Ambulatory Medical Care Survey ( NHAMCS ) y los costes (2003 a 2008) recogidos por el Medical Expenditure Panel Survey ( MEPS ). Se calcularon el total de visitas, el uso de pruebas diagnósticas y los diagnósticos del SU del NHAMCS . Los grupos diagnósticos se definieron según el Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Los datos del año 2011 se documentaron en dólares de 2011. El total de visitas y la proporción de neuroimagen llevada a cabo en los futuros años se extrapoló usando un modelo predictivo autorregresivo. La media del coste por visita al SU por grupo diagnóstico del MEPS se calculó, ajustándose a dólares de 2011, mediante el índice de precios de los Hospital Personal Health Care Expenditures. Se utilizó una media ponderada global entre los grupos diagnósticos para estimar los costes totales nacionales. Resultados El número de visitas al SU en Estados Unidos en 2011 por mareo o vértigo fue de 3,9 millones ( IC 95% = 3,6 a 4,2 millones). El porcentaje de pruebas diagnósticas de imagen llevadas a cabo por tomografía computarizada ( TC ), resonancia magnética ( RM ) o ambas en 2011 se estimó en un 39,9% (39,4% TC , 2,3% RM ). La media de coste por visita al SU por mareo fue de 1.004 dólares de 2011. Los costes totales, extrapolados para todo el país, fueron de 3.900 millones de dólares. Los grupos diagnósticos HCUP ‐ CCS para aquéllos que presentaron mareo o vértigo incluyeron los siguientes (proporción de visitas por mareo; coste por visita al SU ; costes anuales nacionales atribuibles): otológico/vestibular (25,7%; 768 dólares; 757 millones de dólares), cardiovascular (16,5%, 1.489 dólares; 941 millones de dólares) y cerebrovascular (3,1%; 1.059 dólares; 127 millones de dólares). Se estimó una suma en la neuroimagen del 12% del total de costes para las visitas por mareo en 2011 (360 millones de dólares para la TC y 110 millones de dólares para la RM ). Conclusiones Los costes totales en Estados Unidos para los pacientes que acuden por mareo al SU son sustanciales, y se estima que sobrepasan en estos momentos los 4.000 millones de dólares por año (aproximadamente un 4% de los costes totales del SU ). El incremento de los costes con el paso del tiempo parece reflejar el crecimiento de la prevalencia de las visitas al SU por mareo y el aumento de porcentajes de utilización de la neuroimagen. Futuros estudios económicos deberían centrarse en el desglose de los costes totales, y hacer énfasis en las áreas de alto uso y coste que pueden ser reducidas sin riesgo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/1/acem12168.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/2/acem12168-sup-0001-DataSupplementS1.pd