Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience

<p>Abstract</p> <p>Background</p> <p>Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way.</p> <p>Method</p> <p>In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor.</p> <p>Results</p> <p>From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it.</p> <p>Conclusions</p> <p>Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health.</p

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey

Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than –2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.Open Access Fundin

Strain engineering and one-dimensional organization of metal-insulator domains in single-crystal VO2 beams

Spatial phase inhomogeneity at the nano- to microscale is widely observed in strongly-correlated electron materials. The underlying mechanism and possibility of artificially controlling the phase inhomogeneity are still open questions of critical importance for both the phase transition physics and device applications. Lattice strain has been shown to cause the coexistence of metallic and insulating phases in the Mott insulator VO2. By continuously tuning strain over a wide range in single-crystal VO2 micro- and nanobeams, here we demonstrate the nucleation and manipulation of one-dimensionally ordered metal-insulator domain arrays along the beams. Mott transition is achieved in these beams at room temperature by active control of strain. The ability to engineer phase inhomogeneity with strain lends insight into correlated electron materials in general, and opens opportunities for designing and controlling the phase inhomogeneity of correlated electron materials for micro- and nanoscale device applications.Comment: 14 pages, 4 figures, with supplementary informatio

Radiative contribution to neutrino masses and mixing in μν\mu\nuSSM

In an extension of the minimal supersymmetric standard model (popularly known as the $\mu\nu$SSM), three right handed neutrino superfields are introduced to solve the $\mu$-problem and to accommodate the non-vanishing neutrino masses and mixing. Neutrino masses at the tree level are generated through $R-$parity violation and seesaw mechanism. We have analyzed the full effect of one-loop contributions to the neutrino mass matrix. We show that the current three flavour global neutrino data can be accommodated in the $\mu\nu$SSM, for both the tree level and one-loop corrected analyses. We find that it is relatively easier to accommodate the normal hierarchical mass pattern compared to the inverted hierarchical or quasi-degenerate case, when one-loop corrections are included.Comment: 51 pages, 14 figures (58 .eps files), expanded introduction, other minor changes, references adde

Fluctuations in granular gases

A driven granular material, e.g. a vibrated box full of sand, is a stationary system which may be very far from equilibrium. The standard equilibrium statistical mechanics is therefore inadequate to describe fluctuations in such a system. Here we present numerical and analytical results concerning energy and injected power fluctuations. In the first part we explain how the study of the probability density function (pdf) of the fluctuations of total energy is related to the characterization of velocity correlations. Two different regimes are addressed: the gas driven at the boundaries and the homogeneously driven gas. In a granular gas, due to non-Gaussianity of the velocity pdf or lack of homogeneity in hydrodynamics profiles, even in the absence of velocity correlations, the fluctuations of total energy are non-trivial and may lead to erroneous conclusions about the role of correlations. In the second part of the chapter we take into consideration the fluctuations of injected power in driven granular gas models. Recently, real and numerical experiments have been interpreted as evidence that the fluctuations of power injection seem to satisfy the Gallavotti-Cohen Fluctuation Relation. We will discuss an alternative interpretation of such results which invalidates the Gallavotti-Cohen symmetry. Moreover, starting from the Liouville equation and using techniques from large deviation theory, the general validity of a Fluctuation Relation for power injection in driven granular gases is questioned. Finally a functional is defined using the Lebowitz-Spohn approach for Markov processes applied to the linear inelastic Boltzmann equation relevant to describe the motion of a tracer particle. Such a functional results to be different from injected power and to satisfy a Fluctuation Relation.Comment: 40 pages, 18 figure

Survivin expression in oral squamous cell carcinoma

A series of 110 cases of oral squamous cell carcinoma (SCC) together with six lymph node and one distant metastatic lesions was analysed for expression of survivin, a recent apoptosis inhibitor, by immunohistochemistry and Western blotting. In total, 91 cases (82.7%) of carcinoma and all metastasis (seven cases, 100%) were positive for survivin expression, with weighted survivin scores ranging from 1 to 4. In contrast, normal oral epithelium did not express survivin. There was no significant correlation between survivin expression and age, sex, tumour size, the presence of lymph node and distant metastases. Survivin expression was increased in poorly differentiated tumours, even if differences were not statistically significant. In contrast, when analysed for prognostic significance, patients with low survivin expression had statistically significant better survival rates than the group with high survivin expression (P < 0.05). These data suggest that survivin expression may identify cases of oral SCC with more aggressive and invasive phenotype

Dark matter scenarios in the minimal SUSY B-L model

We perform a study of the dark matter candidates of a constrained version of the minimal R-parity-conserving supersymmetric model with a gauged $U(1)_{B-L}$. It turns out that there are four additional candidates for dark matter in comparison to the MSSM: two kinds of neutralino, which either correspond to the gaugino of the $U(1)_{B-L}$ or to a fermionic bilepton, as well as "right-handed" CP-even and -odd sneutrinos. The correct dark matter relic density of the neutralinos can be obtained due to different mechanisms including new co-annihilation regions and resonances. The large additional Yukawa couplings required to break the $U(1)_{B-L}$ radiatively often lead to large annihilation cross sections for the sneutrinos. The correct treatment of gauge kinetic mixing is crucial to the success of some scenarios. All candidates are consistent with the exclusion limits of Xenon100.Comment: 45 pages, 22 figures; v2: extended discussion of direct detection cross section, matches published versio

Modulation of enhancer looping and differential gene targeting by Epstein-Barr virus transcription factors directs cellular reprogramming

Epstein-Barr virus (EBV) epigenetically reprogrammes B-lymphocytes to drive immortalization and facilitate viral persistence. Host-cell transcription is perturbed principally through the actions of EBV EBNA 2, 3A, 3B and 3C, with cellular genes deregulated by specific combinations of these EBNAs through unknown mechanisms. Comparing human genome binding by these viral transcription factors, we discovered that 25% of binding sites were shared by EBNA 2 and the EBNA 3s and were located predominantly in enhancers. Moreover, 80% of potential EBNA 3A, 3B or 3C target genes were also targeted by EBNA 2, implicating extensive interplay between EBNA 2 and 3 proteins in cellular reprogramming. Investigating shared enhancer sites neighbouring two new targets (WEE1 and CTBP2) we discovered that EBNA 3 proteins repress transcription by modulating enhancer-promoter loop formation to establish repressive chromatin hubs or prevent assembly of active hubs. Re-ChIP analysis revealed that EBNA 2 and 3 proteins do not bind simultaneously at shared sites but compete for binding thereby modulating enhancer-promoter interactions. At an EBNA 3-only intergenic enhancer site between ADAM28 and ADAMDEC1 EBNA 3C was also able to independently direct epigenetic repression of both genes through enhancer-promoter looping. Significantly, studying shared or unique EBNA 3 binding sites at WEE1, CTBP2, ITGAL (LFA-1 alpha chain), BCL2L11 (Bim) and the ADAMs, we also discovered that different sets of EBNA 3 proteins bind regulatory elements in a gene and cell-type specific manner. Binding profiles correlated with the effects of individual EBNA 3 proteins on the expression of these genes, providing a molecular basis for the targeting of different sets of cellular genes by the EBNA 3s. Our results therefore highlight the influence of the genomic and cellular context in determining the specificity of gene deregulation by EBV and provide a paradigm for host-cell reprogramming through modulation of enhancer-promoter interactions by viral transcription factors

Charged-Higgs phenomenology in the Aligned two-Higgs-doublet model

The alignment in flavour space of the Yukawa matrices of a general two-Higgs-doublet model results in the absence of tree-level flavour-changing neutral currents. In addition to the usual fermion masses and mixings, the aligned Yukawa structure only contains three complex parameters, which are potential new sources of CP violation. For particular values of these three parameters all known specific implementations of the model based on discrete Z_2 symmetries are recovered. One of the most distinctive features of the two-Higgs-doublet model is the presence of a charged scalar. In this work, we discuss its main phenomenological consequences in flavour-changing processes at low energies and derive the corresponding constraints on the parameters of the aligned two-Higgs-doublet model.Comment: 46 pages, 19 figures. Version accepted for publication in JHEP. References added. Discussion slightly extended. Conclusions unchange