Understanding the dispensary workflow at the Birmingham Free Clinic: A proposed framework for an informatics intervention

Background: The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However, pharmacists' tasks involving medication management and dispensing have become more challenging since EMR implementation due to its inability to support workflows between the medical and pharmaceutical services. To inform the design of a systematic intervention, we conducted a needs assessment study to identify workflow challenges and process inefficiencies in the dispensary. Methods: We used contextual inquiry to document the dispensary workflow and facilitate identification of critical aspects of intervention design specific to the user. Pharmacists were observed according to contextual inquiry guidelines. Graphical models were produced to aid data and process visualization. We created a list of themes describing workflow challenges and asked the pharmacists to rank them in order of significance to narrow the scope of intervention design. Results: Three pharmacists were observed at the BFC. Observer notes were documented and analyzed to produce 13 themes outlining the primary challenges pharmacists encounter during dispensation at the BFC. The dispensary workflow is labor intensive, redundant, and inefficient when integrated with the clinical service. Observations identified inefficiencies that may benefit from the introduction of informatics interventions including: medication labeling, insufficient process notification, triple documentation, and inventory control. Conclusions: We propose a system for Prescription Management and General Inventory Control (RxMAGIC). RxMAGIC is a framework designed to mitigate workflow challenges and improve the processes of medication management and inventory control. While RxMAGIC is described in the context of the BFC dispensary, we believe it will be generalizable to pharmacies in other low-resource settings, both domestically and internationally

Forefronts in portion size. An overview and synthesis of a roundtable discussion

Establishing eating habits in early life that include appropriate portion sizes of foods which are nutrient dense and low in energy density is considered important in the prevention of obesity in children. This special supplement presents the proceedings of a symposium focusing on advances in scientific understanding of the development of healthy food portion sizes in children and their families. Recent basic research highlights individual differences in children's responsiveness to portion size as well as potential mechanisms of portion size effects. Quantitative approaches highlight the influence of maternal serving in determining intake, while qualitative approaches seek to elaborate caregiver decisions around child portion sizes at meals and snacks. Family-based environmental interventions for child weight control involving food portion size are outlined. An overview of the overarching issues and roundtable discussion on the forefronts of portion size research are presented as well as policy considerations to promote healthy portion control

High current-carrying capability in c-axis-oriented superconducting MgB2 thin films

In high-quality c-axis-oriented MgB2 thin films, we observed high critical current densities (Jc) of 16 MA/cm^2 at 15 K under self fields comparable to those of cuprate high-temperature superconductors. The extrapolated value of Jc at 5 K was estimated to be 40 MA/cm^2. For a magnetic field of 5 T, a Jc of 0.1 MA/cm^2 was detected at 15 K, suggesting that this compound would be a very promising candidate for practical applications at high temperature and lower power consumption. The vortex-glass phase is considered to be a possible explanation for the observed high current-carrying capability.Comment: 3 pages and 4 figures, to be published in Physical Review Letter

Generalized Transformation for Decorated Spin Models

The paper discusses the transformation of decorated Ising models into an effective \textit{undecorated} spin models, using the most general Hamiltonian for interacting Ising models including a long range and high order interactions. The inverse of a Vandermonde matrix with equidistant nodes $[-s,s]$ is used to obtain an analytical expression of the transformation. This kind of transformation is very useful to obtain the partition function of decorated systems. The method presented by Fisher is also extended, in order to obtain the correlation functions of the decorated Ising models transforming into an effective undecorated Ising models. We apply this transformation to a particular mixed spin-(1/2,1) and (1/2,2) square lattice with only nearest site interaction. This model could be transformed into an effective uniform spin-$S$ square lattice with nearest and next-nearest interaction, furthermore the effective Hamiltonian also include combinations of three-body and four-body interactions, particularly we considered spin 1 and 2.Comment: 16 pages, 4 figure

Mycobacterium tuberculosis from chronic murine infections that grows in liquid but not on solid medium

BACKGROUND: Old, stationary cultures of Mycobacterium tuberculosis contain a majority of bacteria that can grow in broth cultures but cannot grow on solid medium plates. These may be in a non-replicating, dormant growth phase. We hypothesised that a similar population might be present in chronic, murine tuberculosis. METHODS: Estimates of the numbers of viable M. tuberculosis, strain H37Rv, in the spleens and lungs of mice in a 7-day acute infection and in a 10-month chronic infection were made by conventional plate counts and, as broth counts, by noting presence or absence of growth in serial replicate dilutions in liquid medium. RESULTS: Plate and broth counts in 6 mice gave similar mean values in the acute infection, 7 days after infection. However, the broth counts were much higher in 36 mice with a chronic infection at 10 months. Broth counts averaged 5.290 log(10 )cfu /organ from spleens and 5.523 log(10 )cfu/organ from lungs, while plate counts were 3.858 log(10 )cfu/organ from spleens and 3.662 log(10 )cfu/organ from lungs, indicating that the total bacterial population contained only 3.7% bacilli in spleens and 1.4% bacilli in lungs, capable of growth on plates. CONCLUSION: The proportion growing on plates might be a measure of the "dormancy" of the bacilli equally applicable to cultural and animal models

Cell Competition Boosts Clonal Evolution and Hypoxic Selection in Cancer

The comparison of fitness between cells leads to the elimination of less competent cells in the presence of more competent neighbors via cell competition (CC). This phenomenon has been linked with several cancer-related genes and thus may play an important role in cancer. Various processes are involved in the regulation of tumor initiation and growth, including tumor hypoxia, clonal stem cell selection, and immune cell response, all of which have been recently shown to have a potential connection with the mechanisms involved in CC. This review aims to unravel the relation between these processes and competitive cell interactions and how this affects disease progression