Organizational Strategies for the Adoption of Electronic Medical Records: Toward an Understanding of Outcome Variation in Nursing Homes

[Excerpt] An important element in president-elect Obama\u27s economic stimulus proposal is his plan to invest a significant proportion of federal dollars in installing electronic medical records (EMR) in U.S. healthcare institutions. In emphasizing the need for EMR, Obama is following the advice of numerous healthcare experts who have pointed out that the healthcare sector lags behind other industries in the use of computer technology. They believe the widespread use of EMR would help reduce medical errors, control the costs of healthcare, and lead to significant improvements in the quality of care Americans receive. In this paper we present preliminary results of an ongoing study of the introduction of EMR in 20 nursing homes in the New York City area. Although most observers believe EMR holds great promise for the improvement of healthcare, in fact recent studies have found mixed evidence regarding the effect of EMR on patient outcomes. The evidence we have gathered to date suggests that whether EMR has beneficial effects on the costs and quality of healthcare depends very much on the purposes and objectives nursing home managers and administrators intend to achieve through its use. That is, management strategy and style, we believe, strongly influences healthcare outcomes associated with technological innovation

Simplicity in simplicial phase space

A key point in the spin foam approach to quantum gravity is the implementation of simplicity constraints in the partition functions of the models. Here, we discuss the imposition of these constraints in a phase space setting corresponding to simplicial geometries. On the one hand, this could serve as a starting point for a derivation of spin foam models by canonical quantisation. On the other, it elucidates the interpretation of the boundary Hilbert space that arises in spin foam models. More precisely, we discuss different versions of the simplicity constraints, namely gauge-variant and gauge-invariant versions. In the gauge-variant version, the primary and secondary simplicity constraints take a similar form to the reality conditions known already in the context of (complex) Ashtekar variables. Subsequently, we describe the effect of these primary and secondary simplicity constraints on gauge-invariant variables. This allows us to illustrate their equivalence to the so-called diagonal, cross and edge simplicity constraints, which are the gauge-invariant versions of the simplicity constraints. In particular, we clarify how the so-called gluing conditions arise from the secondary simplicity constraints. Finally, we discuss the significance of degenerate configurations, and the ramifications of our work in a broader setting.Comment: Typos and references correcte

Evidence of a Plasmoid-Looptop Interaction and Magnetic Inflows During a Solar Flare/CME Eruptive Event

Observational evidence is presented for the merging of a downward-propagating plasmoid with a looptop kernel during an occulted limb event on 2007 January 25. RHESSI lightcurves in the 9-18 keV energy range, as well as that of the 245 MHz channel of the Learmonth Solar Observatory, show enhanced nonthermal emission in the corona at the time of the merging suggesting that additional particle acceleration took place. This was attributed to a secondary episode of reconnection in the current sheet that formed between the two merging sources. RHESSI images were used to establish a mean downward velocity of the plasmoid of 12 km/s. Complementary observations from the SECCHI suite of instruments onboard STEREO-Behind showed that this process occurred during the acceleration phase of the associated CME. From wavelet-enhanced EUVI, images evidence of inflowing magnetic field lines prior to the CME eruption is also presented. The derived inflow velocity was found to be 1.5 km/s. This combination of observations supports a recent numerical simulation of plasmoid formation, propagation and subsequent particle acceleration due to the tearing mode instability during current sheet formation.Comment: 8 pages, 9 figures, ApJ (Accepted

False discovery rate regression: an application to neural synchrony detection in primary visual cortex

Many approaches for multiple testing begin with the assumption that all tests in a given study should be combined into a global false-discovery-rate analysis. But this may be inappropriate for many of today's large-scale screening problems, where auxiliary information about each test is often available, and where a combined analysis can lead to poorly calibrated error rates within different subsets of the experiment. To address this issue, we introduce an approach called false-discovery-rate regression that directly uses this auxiliary information to inform the outcome of each test. The method can be motivated by a two-groups model in which covariates are allowed to influence the local false discovery rate, or equivalently, the posterior probability that a given observation is a signal. This poses many subtle issues at the interface between inference and computation, and we investigate several variations of the overall approach. Simulation evidence suggests that: (1) when covariate effects are present, FDR regression improves power for a fixed false-discovery rate; and (2) when covariate effects are absent, the method is robust, in the sense that it does not lead to inflated error rates. We apply the method to neural recordings from primary visual cortex. The goal is to detect pairs of neurons that exhibit fine-time-scale interactions, in the sense that they fire together more often than expected due to chance. Our method detects roughly 50% more synchronous pairs versus a standard FDR-controlling analysis. The companion R package FDRreg implements all methods described in the paper

Integrative genomic mining for enzyme function to enable engineering of a non-natural biosynthetic pathway.

The ability to biosynthetically produce chemicals beyond what is commonly found in Nature requires the discovery of novel enzyme function. Here we utilize two approaches to discover enzymes that enable specific production of longer-chain (C5-C8) alcohols from sugar. The first approach combines bioinformatics and molecular modelling to mine sequence databases, resulting in a diverse panel of enzymes capable of catalysing the targeted reaction. The median catalytic efficiency of the computationally selected enzymes is 75-fold greater than a panel of naively selected homologues. This integrative genomic mining approach establishes a unique avenue for enzyme function discovery in the rapidly expanding sequence databases. The second approach uses computational enzyme design to reprogramme specificity. Both approaches result in enzymes with >100-fold increase in specificity for the targeted reaction. When enzymes from either approach are integrated in vivo, longer-chain alcohol production increases over 10-fold and represents >95% of the total alcohol products

University ‘Pay-for-grades’: the bait and switch search engine optimization strategies of contract cheating websites in the United States

This paper presents the first systematic investigation into the search engine optimization practices of major contract cheating websites in the United States. From a business perspective, visibility in organic search engine results is considered one of the top client recruitment tools. The current understanding of student recruitment strategies by these companies remains largely unexplored in both academic literature and popular press. Replicating the business research practices used in the search engine optimization industry, comprehensive search engine ranking and traffic data was obtained for the 38 largest contract cheating websites in the US. The overall objective was to illuminate the strategies that these companies take to get their services at the top of the search results of as many students as possible – not just the relatively small proportion of students actively cheating. The results show that these companies dominate the search results for not just students searching to cheat, but also for naïve search efforts, when students are simply doing genuine research or classwork. These nefarious companies use highly sophisticated search engine manipulation strategies to bait naïve student searchers onto their sites, thus enabling the potential to switch them to cheaters. Higher education institutions, armed with the specific details provided in this study, can use the strategies outlined in the discussion to directly and negatively impact on the success of these contract cheating services