Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project

OBJECTIVE: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project. MATERIALS AND METHODS: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE). The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics. RESULTS: Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5]. DISCUSSION: We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects. CONCLUSIONS: ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools\u27 impact on medical decision making, clinical practice, and health outcomes

Structure, temporal evolution, and heat flux estimates from the Lucky Strike deep-sea hydrothermal field derived from seafloor image mosaics

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 13 (2012): Q04007, doi:10.1029/2011GC003990.Here we demonstrate with a study of the Lucky Strike hydrothermal field that image mosaicing over large seafloor areas is feasible with new image processing techniques, and that repeated surveys allow temporal studies of active processes. Lucky Strike mosaics, generated from >56,000 images acquired in 1996, 2006, 2008 and 2009, reveal the distribution and types of diffuse outflow throughout the field, and their association with high-temperature vents. In detail, the zones of outflow are largely controlled by faults, and we suggest that the spatial clustering of active zones likely reflects the geometry of the underlying plumbing system. Imagery also provides constraints on temporal variability at two time-scales. First, based upon changes in individual outflow features identified in mosaics acquired in different years, we document a general decline of diffuse outflow throughout the vent field over time-scales up to 13 years. Second, the image mosaics reveal broad patches of seafloor that we interpret as fossil outflow zones, owing to their association with extinct chimneys and hydrothermal deposits. These areas encompass the entire region of present-day hydrothermal activity, suggesting that the plumbing system has persisted over long periods of time, loosely constrained to hundreds to thousands of years. The coupling of mosaic interpretation and available field measurements allow us to independently estimate the heat flux of the Lucky Strike system at ~200 to 1000 MW, with 75% to >90% of this flux taken up by diffuse hydrothermal outflow. Based on these heat flux estimates, we propose that the temporal decline of the system at short and long time scales may be explained by the progressive cooling of the AMC, without replenishment. The results at Lucky Strike demonstrate that repeated image surveys can be routinely performed to characterize and study the temporal variability of a broad range of vent sites hosting active processes (e.g., cold seeps, hydrothermal fields, gas outflows, etc.), allowing a better understanding of fluid flow dynamics from the sub-seafloor, and a quantification of fluxes.This project was funded by CNRS/IFREMER through the 2006, 2008, 2009 and 2010 cruises within the MoMAR program (France), by ANR (France) Mothseim Project NT05-3 42213 to J. Escartín, and by grant CTM2010-15216/MAR from the Spanish Ministry of Science to R. Garcia and J. Escartín. T. Barreyre was supported by University Paris Diderot (Paris 7– France) and Institut de Physique du Globe de Paris (IPGP, France). E. Mittelstaedt was supported by the International Research Fellowship Program of the U.S. National Science Foundation (OISE-0757920).2012-10-1

25th annual computational neuroscience meeting: CNS-2016

The same neuron may play different functional roles in the neural circuits to which it belongs. For example, neurons in the Tritonia pedal ganglia may participate in variable phases of the swim motor rhythms [1]. While such neuronal functional variability is likely to play a major role the delivery of the functionality of neural systems, it is difficult to study it in most nervous systems. We work on the pyloric rhythm network of the crustacean stomatogastric ganglion (STG) [2]. Typically network models of the STG treat neurons of the same functional type as a single model neuron (e.g. PD neurons), assuming the same conductance parameters for these neurons and implying their synchronous firing [3, 4]. However, simultaneous recording of PD neurons shows differences between the timings of spikes of these neurons. This may indicate functional variability of these neurons. Here we modelled separately the two PD neurons of the STG in a multi-neuron model of the pyloric network. Our neuron models comply with known correlations between conductance parameters of ionic currents. Our results reproduce the experimental finding of increasing spike time distance between spikes originating from the two model PD neurons during their synchronised burst phase. The PD neuron with the larger calcium conductance generates its spikes before the other PD neuron. Larger potassium conductance values in the follower neuron imply longer delays between spikes, see Fig. 17.Neuromodulators change the conductance parameters of neurons and maintain the ratios of these parameters [5]. Our results show that such changes may shift the individual contribution of two PD neurons to the PD-phase of the pyloric rhythm altering their functionality within this rhythm. Our work paves the way towards an accessible experimental and computational framework for the analysis of the mechanisms and impact of functional variability of neurons within the neural circuits to which they belong

Grossesse et addiction aux opiacés (les effets délétères chez le futur enfant à naître)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Reliable and Safe, Gram-Scale Hydrogenation and Hydrogenolysis of O-Benzyl Ether Groups with In Situ Pd-0/C Catalyst

Hydrogenation of alkenes, alkynes, and hydrogenolysis of O-benzyl ethers with Pd-0/C catalyst generated in situ can be readily scaled up under safer conditions than with traditional procedures. The precise control of the palladium loading and the mild conditions developed allow the formation of a very active and reliable Pd-0/C catalyst, leading to highly reproducible results

Etude de faisabilité du plan d'aménagement du PEA n. 165 (IFB - BATALIMO)

L'objectif principal de l'aménagement consiste en l'approvisionnement durable de la scierie de la sociétéIFB pour obtenir une production rentable à partir de bois d'oeuvre contenu dans le PEA. Cet objectif ne sera atteint que par le respect d'un bloc de forêt permanent et nécessitera l'implication et la responsabilisation des populations riveraines dans le processus d'aménagement, ainsi que le respect d'une discipline de travail de la part de la société d'exploitatio

Radicaux iminyles. Nouvelles voies d'acces et applications en synthese organique

Available from INIST (FR), Document Supply Service, under shelf-number : T 79666 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc