Use of Best Practice Alerts to Improve Adherence to Evidence-Based Screening in Pediatric Diabetes Care

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to \u3e90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR). Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database of TCH patients to obtain the following baseline percentages: 1) urine microalbumin-to-creatinine ratio, 2) thyroid function screen, 3) lipid panel, and 4) retinopathy screen. In the TCH EMR, we developed BPAs to alert providers and provide decision support on ADA-based screening recommendations at each clinic encounter. Comparisons were made to screening rates for each category pre- and post-intervention. Results: In the four years following the BPA build, the screening percentage for each category improved from a baseline of 90%, which has been maintained for three consecutive fiscal years. Conclusions: The use of EMR-based BPAs to alert providers of the need for evidenced-based screening is effective in increasing adherence to standard of care guidelines. With this quality improvement intervention, we achieved our goal of \u3e90% for each category. Similar tools for decision support may be effectively utilized for evidence-based screening in other disease states

Operational status of TAMA300 with the seismic attenuation system (SAS)

TAMA300 has been upgraded to improve the sensitivity at low frequencies after the last observation run in 2004. To avoid the noise caused by seismic activities, we installed a new seismic isolation system —- the TAMA seismic attenuation system (SAS). Four SAS towers for the test-mass mirrors were sequentially installed from 2005 to 2006. The recycled Fabry–Perot Michelson interferometer was successfully locked with the SAS. We confirmed the reduction of both length and angular fluctuations at frequencies higher than 1 Hz owing to the SAS

Genome Sequence of Magnetospirillum magnetotacticum Strain MS-1

Here, we report the genome sequence of Magnetospirillum magnetotacticum strain MS-1, which consists of of 36 contigs and 4,136 protein-coding genes

The dependence of test-mass thermal noises on beam shape in gravitational-wave interferometers

In second-generation, ground-based interferometric gravitational-wave detectors such as Advanced LIGO, the dominant noise at frequencies $f \sim 40$ Hz to $\sim 200$ Hz is expected to be due to thermal fluctuations in the mirrors' substrates and coatings which induce random fluctuations in the shape of the mirror face. The laser-light beam averages over these fluctuations; the larger the beam and the flatter its light-power distribution, the better the averaging and the lower the resulting thermal noise. In semi-infinite mirrors, scaling laws for the influence of beam shape on the four dominant types of thermal noise (coating Brownian, coating thermoelastic, substrate Brownian, and substrate thermoelastic) have been suggested by various researchers and derived with varying degrees of rigour. Because these scaling laws are important tools for current research on optimizing the beam shape, it is important to firm up our understanding of them. This paper (1) gives a summary of the prior work and of gaps in the prior analyses, (2) gives a unified and rigorous derivation of all four scaling laws, and (3) explores, relying on work by J. Agresti, deviations from the scaling laws due to finite mirror size.Comment: 25 pages, 10 figures, submitted to Class. Quantum Gra

Seismic topographic scattering in the context of GW detector site selection

In this paper, we present a calculation of seismic scattering from irregular surface topography in the Born approximation. Based on US-wide topographic data, we investigate topographic scattering at specific sites to demonstrate its impact on Newtonian-noise estimation and subtraction for future gravitational-wave detectors. We find that topographic scattering at a comparatively flat site in Oregon would not pose any problems, whereas scattering at a second site in Montana leads to significant broadening of wave amplitudes in wavenumber space that would make Newtonian-noise subtraction very challenging. Therefore, it is shown that topographic scattering should be included as criterion in the site-selection process of future low-frequency gravitational-wave detectors.Comment: 16 pages, 7 figure

Feasibility of measuring the Shapiro time delay over meter-scale distances

The time delay of light as it passes by a massive object, first calculated by Shapiro in 1964, is a hallmark of the curvature of space-time. To date, all measurements of the Shapiro time delay have been made over solar-system distance scales. We show that the new generation of kilometer-scale laser interferometers being constructed as gravitational wave detectors, in particular Advanced LIGO, will in principle be sensitive enough to measure variations in the Shapiro time delay produced by a suitably designed rotating object placed near the laser beam. We show that such an apparatus is feasible (though not easy) to construct, present an example design, and calculate the signal that would be detectable by Advanced LIGO. This offers the first opportunity to measure space-time curvature effects on a laboratory distance scale.Comment: 13 pages, 6 figures; v3 has updated instrumental noise curves plus a few text edits; resubmitted to Classical and Quantum Gravit

Charge neutralization in vacuum for non-conducting and isolated objects using directed low-energy electron and ion beams

We propose using ions and electrons of energy 1 eV–10 eV for neutralizing the charges on the non-conducting or isolated surfaces of high-sensitivity experiments. The mirror surfaces of the test masses of the laser interferometer gravitational observatory are used as an example of the implementation of this method. By alternatively directing beams of positive and negative charges towards the mirror surfaces, we ensure the neutralization of the total charge as well as the equalization of the surface charge distribution to within a few eV of the potential of the ground reference of the vacuum system. This method is compatible with operation in high vacuum, does not require measuring the potential of the mirrors and is expected not to damage sensitive optical surfaces

A comparative encyclopedia of DNA elements in the mouse genome

The laboratory mouse shares the majority of its protein-coding genes with humans, making it the premier model organism in biomedical research, yet the two mammals differ in significant ways. To gain greater insights into both shared and species-specific transcriptional and cellular regulatory programs in the mouse, the Mouse ENCODE Consortium has mapped transcription, DNase I hypersensitivity, transcription factor binding, chromatin modifications and replication domains throughout the mouse genome in diverse cell and tissue types. By comparing with the human genome, we not only confirm substantial conservation in the newly annotated potential functional sequences, but also find a large degree of divergence of sequences involved in transcriptional regulation, chromatin state and higher order chromatin organization. Our results illuminate the wide range of evolutionary forces acting on genes and their regulatory regions, and provide a general resource for research into mammalian biology and mechanisms of human diseases