Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

Draft Genome Sequences of Strains of Pasteurella multocida Isolated from the United Kingdom and the United States

Pasteurella multocida is a major pathogen of farm animals and has worldwide distribution. Here we report the draft genome sequences of four strains that were isolated from animals in the United Kingdom and the United States and represent pathogenic and commensal presentation of the bacterium

Mesoscopic Transport: The Electron-Gas Sum Rules in a Driven Quantum Point Contact

The nature of the electron gas is characterized, above all, by its multi-particle correlations. The conserving sum rules for the electron gas have been thoroughly studied for many years, and their centrality to the physics of metallic conduction is widely understood (at least in the many-body community). We review the role of the conserving sum rules in mesoscopic transport, as normative criteria for assessing the conserving status of mesoscopic models. In themselves, the sum rules are specific enough to rule out any such theory if it fails to respect the conservation laws. Of greater interest is the capacity of the compressibility sum rule, in particular, to reveal unexpected fluctuation effects in nonuniform mesoscopic structures.Comment: TeX, 11pp, no fi

The X-ray Ridge Surrounding Sgr A* at the Galactic Center

We present the first detailed simulation of the interaction between the supernova explosion that produced Sgr A East and the wind-swept inner ~ 2-pc region at the Galactic center. The passage of the supernova ejecta through this medium produces an X-ray ridge ~ 9'' to 15'' to the NE of the supermassive black hole Sagittarius A* (Sgr A*). We show that the morphology and X-ray intensity of this feature match very well with recently obtained Chandra images, and we infer a supernova remnant age of less than 2,000 years. This young age--a factor 3--4 lower than previous estimates--arises from our inclusion of stellar wind effects in the initial (pre-explosion) conditions in the medium. The supernova does not clear out the central ~ 0.2-pc region around Sgr~A* and does not significantly alter the accretion rate onto the central black hole upon passage through the Galactic center.Comment: 10 pages, 3 figures, submitted to ApJ

Doppler Probe of Accretion onto a T Tauri star

The YY Ori stars are T Tauri stars with prominent time-variable redshifted absorption components that flank certain emission lines. One of the brightest in this class is S CrA, a visual double star. We have obtained a series of high-resolution spectra of the two components during four nights with the UVES spectrograph at the Very Large Telescope. We followed the spectral changes occurring in S CrA to derive the physical structure of the accreting gas. We found that both stars are very similar with regard to surface temperature, radius, and mass. Variable redshifted absorption components are particularly prominent in the SE component. During one night, this star developed a spectrum unique among the T Tauri stars: extremely strong and broad redshifted absorption components appeared in many lines of neutral and ionized metals, in addition to those of hydrogen and helium. The absorption depths of cooler, low ionization lines peak at low velocities - while more highly ionized lines have peak absorption depths at high velocities. The different line profiles indicate that the temperature and density of the accretion stream increase as material approaches the star. We derive the physical conditions of the flow at several points along the accretion funnel directly from the spectrum of the infalling gas. We estimated mass accretion rates of about 10^(-7) solar masses per year, which is similar to that derived from the relation based on the strength of H alpha emission line. This is the first time the density and temperature distributions in accretion flows around a T Tauri star have been inferred from observations. Compared with predictions from standard models of accretion in T Tauri stars, which assume a dipole stellar magnetic field, we obtained higher densities and a steeper temperature rise toward the star.Comment: Replaces 1408.1846 4 pages, 4 figures. Appears in Astronomy and Astrophysics, 201

Absolute Dynamical Limit to Cooling Weakly-Coupled Quantum Systems

Cooling of a quantum system is limited by the size of the control forces that are available (the "speed" of control). We consider the most general cooling process, albeit restricted to the regime in which the thermodynamics of the system is preserved (weak coupling). Within this regime, we further focus on the most useful control regime, in which a large cooling factor, and good ground-state cooling can be achieved. We present a control protocol for cooling, and give clear structural arguments, as well as strong numerical evidence, that this protocol is globally optimal. From this we obtain simple expressions for the limit to cooling that is imposed by the speed of control.Comment: 4 pages, Revetex4-1, 2 png figure

Whitney Numbers of the Second Kind for the Star Poset

The integers W0, ..., Wt are called Whitney numbers of the second kind for a ranked poset if Wk is the number of elements of rank k. The set of transpositions T = {(1, n), (2, n), ..., (n - 1, n)} generates Sn, the symmetric group. We define the star poset, a ranked poset the elements of which are those of Sn and the partial order of which is obtained from the Cayley graph using T. We characterize minimal factorizations of elements of Sn as products of generators in T and provide recurrences, generating functions and explicit formulae for the Whitney numbers of the second kind for the star poset

EC92-1555-C Insect Pest Management Strategies for Yards and Gardens

Extension circular 92-1555-C: This circular discusses how integrated pest management can be applied to insect and mite management in yards and gardens

Opportunistic life histories and genetic systems in marine benthic polychaetes

The decline in benthic marine fauna following an oil spill in West Falmouth, Massachusetts, permitted us to follow the responses of a number of polychaete and other invertebrate species to an environmental disturbance. Species with the most opportunistic life histories increased and declined at the two stations with the greatest reduction in species diversity. The stations with an intermediate reduction in diversity showed increases and declines of somewhat less opportunistic species...