Experimental evaluation of thermal energy storage

The technical performance of commercially available thermal energy storage (TES) residential heating units under severe weather conditions is discussed. The benefits and costs of TES to the user and utility companies were assessed. The TES issues, research and development needs, and barriers to commercialization were identified. The field tests which determined the performance characteristics for the TES are described and the TES systems, which included both ceramic and hydronic systems, are compared

Subsequent Pregnancy in Women with a History of Postpartum Psychosis

Postpartum psychosis stands out among the psychiatric syndromes associated with child birth, not able for the variability of its symptom profile and the potential severity of its course, if unrecognized. Significant questions regarding nosology, etiology, prevention and treatment remain only partially answered (1). While controversy surrounds many of the critical issues regarding postpartum psychosis, including its definition, current epidemiologic data indicates severe, frequently psychotic episodes occur following 1-2 per 1,000 of all births (2). As diagnosis and treatment of puerperal conditions have evolved, clinicians now are frequently involved in assisting women with a history of postpartum psychosis with decision making about subsequent pregnancies. The purpose of this paper is to review the fundamental issues related to postpartum psychosis, examine the risk of subsequent episodes of psychiatric illness in postpartum and non-postpartum periods, and review three cases of women hospitalized with postpartum psychosis who went on to deliver a second child without incident, focusing on issues of prediction, prophylax is and intervention

Development and application of an antibiotic spectrum index for benchmarking antibiotic selection patterns across hospitals

Standard metrics for antimicrobial use consider volume but not spectrum of antimicrobial prescribing. We developed an antibiotic spectrum index (ASI) to classify commonly used antibiotics based on activity against important pathogens. The application of this index to hospital antibiotic use reveals how this tool enhances current antimicrobial stewardship metrics.Infect Control Hosp Epidemiol 2017;38:993–997</jats:p

How APIs Create Growth by Inverting the Firm

Traditional asset management strategy has emphasized building barriers to entry or closely guarding unique assets to maintain a firm’s comparative advantage. A new “Inverted Firm” paradigm, however, has emerged. Under this strategy, firms share data seeking to become platforms by opening digital services to third-parties and capturing part of their external surplus. This contrasts with a “pipeline” strategy where the firm itself creates value. This paper quantitatively estimates the effect of adopting an inverted firm strategy through the lens of Application Programming Interfaces (APIs), a key enabling technology. Using both public data and that of a private API development firm, we document rapid growth of the API network and connecting apps since 2005. We then perform difference-in-difference and synthetic control analyses and find that public firms adopting public APIs grew an additional 38.7% relative to similar nonadopters. We find no significant effect from the use of APIs purely for internal productivity, the pipeline strategy. Within the subset of firms that adopt public APIs, those that attract more third-party complementors and those that become more central to the network see faster growth. Using variation in network centrality caused by API degradation, an instrumental variables analysis confirms a causal role for APIs in firm market value. Finally, we document an important downside of external API adoption: increased risk of data breach. Overall, these facts lead us to conclude that APIs have a large and positive impact on economic growth and do so primarily by enabling an inverted firm as opposed to pipeline strategy

Variability in antifungal and antiviral use in hospitalized children

We analyzed antifungal and antiviral prescribing among high-risk children across freestanding children’s hospitals. Antifungal and antiviral days of therapy varied across hospitals. Benchmarking antifungal and antiviral use and developing antimicrobial stewardship strategies to optimize use of these high cost agents is needed.Infect Control Hosp Epidemiol2017;38:743–746</jats:p

Current state of antimicrobial stewardship in children’s hospital emergency departments

BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children's hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469-475

Association of Cumulative Lead Exposure with Parkinson's Disease

BACKGROUND. Research using reconstructed exposure histories has suggested an association between heavy metal exposures, including lead, and Parkinson's disease (PD), but the only study that used bone lead, a biomarker of cumulative lead exposure, found a nonsignificant increase in risk of PD with increasing bone lead. OBJECTIVES. We sought to assess the association between bone lead and PD. METHODS. Bone lead concentrations were measured using 109Cd excited K-shell X-ray fluorescence from 330 PD patients (216 men, 114 women) and 308 controls (172 men, 136 women) recruited from four clinics for movement disorders and general-community cohorts. Adjusted odds ratios (ORs) for PD were calculated using logistic regression. RESULTS. The average age of cases and controls at bone lead measurement was 67 (SD = 10) and 69 (SD = 9) years of age, respectively. In primary analyses of cases and controls recruited from the same groups, compared with the lowest quartile of tibia lead, the OR for PD in the highest quartile was 3.21 [95% confidence interval (CI), 1.17-8.83]. Results were similar but slightly weaker in analyses restricted to cases and controls recruited from the movement disorders clinics only (fourth-quartile OR = 2.57; 95% CI, 1.11-5.93) or when we included controls recruited from sites that did not also contribute cases (fourth-quartile OR = 1.91; 95% CI, 1.01-3.60). We found no association with patella bone lead. CONCLUSIONS. These findings, using an objective biological marker of cumulative lead exposure among typical PD patients seen in our movement disorders clinics, strengthen the evidence that cumulative exposure to lead increases the risk of PD.National Institutes of Health (R01-ES010798, K01-ES01265

Quantitative evaluation of recall and precision of CAT Crawler, a search engine specialized on retrieval of Critically Appraised Topics

BACKGROUND: Critically Appraised Topics (CATs) are a useful tool that helps physicians to make clinical decisions as the healthcare moves towards the practice of Evidence-Based Medicine (EBM). The fast growing World Wide Web has provided a place for physicians to share their appraised topics online, but an increasing amount of time is needed to find a particular topic within such a rich repository. METHODS: A web-based application, namely the CAT Crawler, was developed by Singapore's Bioinformatics Institute to allow physicians to adequately access available appraised topics on the Internet. A meta-search engine, as the core component of the application, finds relevant topics following keyword input. The primary objective of the work presented here is to evaluate the quantity and quality of search results obtained from the meta-search engine of the CAT Crawler by comparing them with those obtained from two individual CAT search engines. From the CAT libraries at these two sites, all possible keywords were extracted using a keyword extractor. Of those common to both libraries, ten were randomly chosen for evaluation. All ten were submitted to the two search engines individually, and through the meta-search engine of the CAT Crawler. Search results were evaluated for relevance both by medical amateurs and professionals, and the respective recall and precision were calculated. RESULTS: While achieving an identical recall, the meta-search engine showed a precision of 77.26% (±14.45) compared to the individual search engines' 52.65% (±12.0) (p < 0.001). CONCLUSION: The results demonstrate the validity of the CAT Crawler meta-search engine approach. The improved precision due to inherent filters underlines the practical usefulness of this tool for clinicians

Interprofessional clinical placement involving speech pathology and counselling psychology

This paper examines the interprofessional learning of a speech pathology and counselling psychology student in an interprofessional placement within an institution of the Department of Corrective Services in Perth, Western Australia. The institution is a pre-release centre that promotes rehabilitation and community reintegration in which up to six women are able to have their children, aged 0–4 years of age, live with them. The students provided a program to the mothers to facilitate development of a healthy mother–child relationship and the children’s communication development. This paper utilised qualitative descriptive analysis to explore two examples of student learning and found perceived growth in the students’ clinical skills, their understanding of the other profession and the concept of interprofessional collaboration. While students experience growth in a range of placements, the journey described in this paper is unusual in both the nature of the student collaboration and the placement itself. The research highlights the importance of joint clinical placements in the development of interprofessional collaborative relationships

Interprofessional clinical placement involving speech pathology and counselling psychology

This paper examines the interprofessional learning of a speech pathology and counselling psychology student in an interprofessional placement within an institution of the Department of Corrective Services in Perth, Western Australia. The institution is a pre-release centre that promotes rehabilitation and community reintegration in which up to six women are able to have their children, aged 0–4 years of age, live with them. The students provided a program to the mothers to facilitate development of a healthy mother–child relationship and the children’s communication development. This paper utilised qualitative descriptive analysis to explore two examples of student learning and found perceived growth in the students’ clinical skills, their understanding of the other profession and the concept of interprofessional collaboration. While students experience growth in a range of placements, the journey described in this paper is unusual in both the nature of the student collaboration and the placement itself. The research highlights the importance of joint clinical placements in the development of interprofessional collaborative relationships