Decision support system through automatic algorithms and electronic request in diagnosis of anaemia for primary care patients

An appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential “shotgun” approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients. When a request contained an “Anaemia Suspicion Study” profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report. From all the studies performed, only 12% were positive being “iron deficiency” and “anaemia of chronic disease” the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests. Our system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs

The United States and the Pacific: History of a Frontier. By Jean Heffer. Notre Dame, IN: University of Notre Dame Press, 2002. Pp. xii, 509. $ 48.95.

Jean Heffer s book is a translation from a French edition published in 1995 in the collection L Evolution de l humanit by Editions Albin Michel. The work is a synthesis of United States history in the Pacific.The author uses the concept of a dynamic frontier moving from the American shores to Asia. Heffer considers the Pacific Ocean, as it is usually defined by oceanologists, i.e., ending at the Bering Strait in the north and including the seas along the Asian continent in the west, from the Sea of Okhotsk to the Java Sea, and washing the eastern coast of Australia (p. 5). This choice avoids the customary pitfalls of studies that ignore some of the identifiable regions that form part of the Pacific.

Born Again: Globalization’s Sixteenth-Century Origins (Asian/Global versus European Dynamics)

A revised version of this paper appears in the Pacific Economic Review, 2008. By courtesy of Wiley Interscience and authors, an online version of the Pacific Economic Review paper is accessible at no charge at: http://www3.interscience.wiley.com/journal/118545351/home . Please refer to and cite the published version! Globalization began when all heavily-populated land masses began interacting – both directly with each other and indirectly via other land masses – in a sustained manner with deep consequences for all interacting regions; global interactions emerged during the 16th century when modern globalization was born. Dynamism emanating from within China played a pivotal role, while Europeans were (crucial) global intermediaries. Valid hypotheses concerning the emergence and sustenance of such a profound phenomenon as 'globalization' must accommodate evidence from numerous disciplinary debates. Any attempt to limit discussion of globalization's birth to strictly economic issues alone – such as the 1820's price-convergence hypothesis of O'Rourke and Williamson – are doomed. Instead, the central role of global economic history – and Chinese economic history in particular – becomes salient when located in a global/historical context that draws upon all disciplines

グローバリゼーション ハ 1571ネン ニ ハジマッタ

平山篤子/

Multi-purpose fossils? The reappraisal of an Elephas antiquus molar from El Pirulejo (Magdalenian; Cordoba, Spain)

Fossil gathering by humans has been rarely documented in the Iberian Peninsula. In the present paper, a multidisciplinary approach has been taken to analyze a straight-tusked elephant (Elephas antiquus) molar retrieved in a Magdalenian deposit at the rock shelter of El Pirulejo in southern Spain. The taphonomical analyses revealed a multifarious use of a tooth that had not only been worked into an anvil-sort-of-tool but also used as a core and partly tainted with a composite pigment. The dating and geochemical analyses further evidenced that the molar derived from an animal that had lived in a rather arid landscape with a temperature range between 12.3 and 14.3 A degrees C coincident with a cold episode within marine isotope stage (MIS) 6.6 and probably fed on herbaceous plants. These analyses evidence the potential fossils from archaeological sites bear for addressing a wide range of issues that include both the cultural and paleoenvironmental realms.Spanish Ministerio de Economia y Competividad [HAR2013-44269-P, HAR 2014-55722-P, HAR2012-34620]Programa Seneca [19438/PI/14]University of SevilleMarie Curie Intra-European Fellowship within the 7th Framework Program for Research, Technological Development and Demonstration (European Commission) [PIEF-GA-2013-623027