A Time Series Analysis of Air Pollution and Preterm Birth in Pennsylvania, 1997–2001

Preterm delivery can lead to serious infant health outcomes, including death and lifelong disability. Small increases in preterm delivery risk in relation to spatial gradients of air pollution have been reported, but previous studies may have controlled inadequately for individual factors. Using a time-series analysis, which eliminates potential confounding by individual risk factors that do not change over short periods of time, we investigated the effect of ambient outdoor particulate matter with diameter ≤10 μm (PM(10)) and sulfur dioxide on risk for preterm delivery. Daily counts of preterm births were obtained from birth records in four Pennsylvania counties from 1997 through 2001. We observed increased risk for preterm delivery with exposure to average PM(10) and SO(2) in the 6 weeks before birth [respectively, relative risk (RR) = 1.07; 95% confidence interval (CI), 0.98–1.18 per 50 μg/m(3) increase; RR = 1.15; 95% CI, 1.00–1. 32 per 15 ppb increase], adjusting for long-term preterm delivery trends, co-pollutants, and offsetting by the number of gestations at risk. We also examined lags up to 7 days before the birth and found an acute effect of exposure to PM(10) 2 days and 5 days before birth (respectively, RR = 1.10; 95% CI, 1.00–1.21; RR = 1.07; 95% CI, 0.98–1.18) and SO(2) 3 days before birth (RR = 1.07; 95% CI, 0.99–1.15), adjusting for covariates, including temperature, dew point temperature, and day of the week. The results from this time-series analysis, which provides evidence of an increase in preterm birth risk with exposure to PM(10) and SO(2), are consistent with prior investigations of spatial contrasts

Using spatiotemporal modulation to draw tactile patterns in mid-air

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An Unbiased ALMA Spectral Survey of the LkCa 15 and MWC 480 Protoplanetary Disks

The volatile contents of protoplanetary disks both set the potential for planetary chemistry and provide valuable probes of defining disk system characteristics such as stellar mass, gas mass, ionization, and temperature structure. Current disk molecular inventories are fragmented, however, giving an incomplete picture: unbiased spectral line surveys are needed to assess the volatile content. We present here an overview of such a survey of the protoplanetary disks around the Herbig Ae star MWC 480 and the T Tauri star LkCa 15 in ALMA Band 7, spanning ~36 GHz from 275 to 317 GHz and representing an order of magnitude increase in sensitivity over previous single-dish surveys. We detect 14 molecular species (including isotopologues), with five species (C34S, 13CS, H2CS, DNC, and C2D) detected for the first time in protoplanetary disks. Significant differences are observed in the molecular inventories of MWC 480 and LkCa 15, and we discuss how these results may be interpreted in light of the different physical conditions of these two disk systems

The TW Hya Rosetta Stone Project IV: A Hydrocarbon-rich Disk Atmosphere

Connecting the composition of planet-forming disks with that of gas giant exoplanet atmospheres, in particular through C/O ratios, is one of the key goals of disk chemistry. Small hydrocarbons like C2H and C3H2 have been identified as tracers of C/O, as they form abundantly under high C/O conditions. We present resolved c–C3H2 observations from the TW Hya Rosetta Stone Project, a program designed to map the chemistry of common molecules at 15–20 au resolution in the TW Hya disk. Augmented by archival data, these observations comprise the most extensive multi-line set for disks of both ortho and para spin isomers spanning a wide range of energies, Eu = 29–97 K. We find the ortho-to-para ratio of c–C3H2 is consistent with 3 throughout extent of the emission, and the total abundance of both c–C3H2 isomers is (7.5–10) × 10−11 per H atom, or 1%–10% of the previously published C2H abundance in the same source. We find c–C3H2 comes from a layer near the surface that extends no deeper than z/r = 0.25. Our observations are consistent with substantial radial variation in gas-phase C/O in TW Hya, with a sharp increase outside ~30 au. Even if we are not directly tracing the midplane, if planets accrete from the surface via, e.g., meridional flows, then such a change should be imprinted on forming planets. Perhaps interestingly, the HR 8799 planetary system also shows an increasing gradient in its giant planets' atmospheric C/O ratios. While these stars are quite different, hydrocarbon rings in disks are common, and therefore our results are consistent with the young planets of HR 8799 still bearing the imprint of their parent disk's volatile chemistry

The TW Hya Rosetta Stone Project. II. Spatially Resolved Emission of Formaldehyde Hints at Low-temperature Gas-phase Formation

Formaldehyde (H2CO) is an important precursor to organics like methanol (CH3OH). It is important to understand the conditions that produce H2CO and prebiotic molecules during star and planet formation. H2CO possesses both gas-phase and solid-state formation pathways, involving either UV-produced radical precursors or CO ice and cold (lesssim20 K) dust grains. To understand which pathway dominates, gaseous H2CO's ortho-to-para ratio (OPR) has been used as a probe, with a value of 3 indicating "warm" conditions and <3 linked to cold formation in the solid state. We present spatially resolved Atacama Large Millimeter/submillimeter Array observations of multiple ortho- and para-H2CO transitions in the TW Hya protoplanetary disk to test H2CO formation theories during planet formation. We find disk-averaged rotational temperatures and column densities of 33 ± 2 K, (1.1 ± 0.1) × 1012 cm−2 and 25 ± 2 K, (4.4 ± 0.3) × 1011 cm−2 for ortho- and para-H2CO, respectively, and an OPR of 2.49 ± 0.23. A radially resolved analysis shows that the observed H2CO emits mostly at rotational temperatures of 30–40 K, corresponding to a layer with z/R ≥ 0.25. The OPR is consistent with 3 within 60 au, the extent of the pebble disk, and decreases beyond 60 au to 2.0 ± 0.5. The latter corresponds to a spin temperature of 12 K, well below the rotational temperature. The combination of relatively uniform emitting conditions, a radial gradient in the OPR, and recent laboratory experiments and theory on OPR ratios after sublimation, led us to speculate that gas-phase formation is responsible for the observed H2CO across the TW Hya disk

Coupling computer-interpretable guidelines with a drug-database through a web-based system – The PRESGUID project

BACKGROUND: Clinical Practice Guidelines (CPGs) available today are not extensively used due to lack of proper integration into clinical settings, knowledge-related information resources, and lack of decision support at the point of care in a particular clinical context. OBJECTIVE: The PRESGUID project (PREScription and GUIDelines) aims to improve the assistance provided by guidelines. The project proposes an online service enabling physicians to consult computerized CPGs linked to drug databases for easier integration into the healthcare process. METHODS: Computable CPGs are structured as decision trees and coded in XML format. Recommendations related to drug classes are tagged with ATC codes. We use a mapping module to enhance computerized guidelines coupling with a drug database, which contains detailed information about each usable specific medication. In this way, therapeutic recommendations are backed up with current and up-to-date information from the database. RESULTS: Two authoritative CPGs, originally diffused as static textual documents, have been implemented to validate the computerization process and to illustrate the usefulness of the resulting automated CPGs and their coupling with a drug database. We discuss the advantages of this approach for practitioners and the implications for both guideline developers and drug database providers. Other CPGs will be implemented and evaluated in real conditions by clinicians working in different health institutions

Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

<p>Abstract</p> <p>Background</p> <p>The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.</p> <p>Methods</p> <p>A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information.</p> <p>Results</p> <p>The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers.</p> <p>Conclusions</p> <p>Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.</p

Mann and gender in Old English prose : a pilot study

It has long been known that OE mann was used in gender-neutral as well as gender-specific contexts. Because of the enormous volume of its attestations in Old English prose, the more precise usage patterns of mann remain, however, largely uncharted, and existing lexicographical tools provide only a basic picture. This article aims to present a preliminary study of the various uses of mann as attested in Old English prose, particularly in its surprisingly consistent use by an individual author, namely that of the ninth-century Old English Martyrology. Patterns emerging from this text are then tested against other prose material. Particular attention is paid to gender-specific usage, examples of which are shown to be exceptional for a word which largely occurs in gender-neutral contexts.Publisher PDFPeer reviewe

The meaning of quality work from the general practitioner's perspective: an interview study

BACKGROUND: The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective. METHODS: Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements. RESULTS: Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs. CONCLUSIONS: The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled