Meaningful Use – Is It Worth It?

The world of medicine has long been an ever changing environment. The advancements and progress in both knowledge and techniques has made patient care and treatment an increasingly successful endeavor. Physicians are often eager to embrace any new technology in the medical field that allows them to better care for their patients. The problem with new medical technology is that unless this technology can be shared or related to others, it is somewhat useless. The medical profession has been somewhat reluctant to come to terms with the use of computer technology and its many benefits. Generally embedded in the use of paper records and being untrusting of electronic technology, healthcare professionals were reluctant to adopt or even try this new technology. The concept of Meaningful Use brings all the arguments of Pro’s and Con’s concerning health information technology into perspective. The use of health information technology (HIT) via electronic health records (EHR) to promote the collection, enhancement and sharing of medical health records to advance patient care is inevitable for successful healthcare in the future. This will not be an easy task and there will be many obstacles to overcome. The progression of Meaningful Use, like any other major endeavor will be slow, sometimes relying on a trial and error system and there will be the ever present delays as well as adjustments, upgrades and mistakes. This research will attempt to provide the reader with an accurate viewpoint of both sides of the Meaningful Use program in an effort to deliver a clear concept of whether all this new technology and work is clearly worth all the time, aggravation, confusion and monetary investment of the medical profession to allow cost effective, reliable and successful patient care

Determinants of Disparities in the Colorectal Cancer Burden

Colorectal cancer (CRC) is the third leading cause of cancer incidence and mortality in the United States, with an estimated 140,000 new cases and 51,000 deaths expected in 2018. Like most cancers, the burden of CRC is unequally distributed among population groups. The current dissertation included two studies filling gaps in knowledge about CRC disparities. Study 1 characterized the relationship between educational attainment and CRC mortality by race/ethnicity. Six years of CRC mortality data (2012-2017) from the diverse state of California, with 30,180 deaths were analyzed. Sex-specific mortality rate ratios (MRR) stratified by race/ethnicity as well as by educational level were computed using negative binomial regression models. Among Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, and Asian/Pacific Islander (API) men and women, those with only a high school education had between 8%-45% higher CRC mortality than those with at least an Associate’s Degree. Mortality advantages for APIs and Hispanics, typically reported in the literature, were limited to the lower levels of education. At the highest educational level, Filipino men had 17% (MRR:1.17; 95% CI: 1.01-1.37) higher mortality than NHWs. Study 2, using 12,413 CRC cases in Nevada from 2003-2013, calculated five-year cause-specific, age-adjusted, overall survival from CRC, stratified by sex, race/ethnicity, and region of Nevada using the life tables method. Cox Proportional Hazards regression modelling computed determinants of CRC survival. Five-year CRC survival was low: 56.0% (95% CI: 54.6-57.5) among males and 59.5% (95% CI: 58.0-61.1) among females; significantly lower than national 5-year survival. No survival disparities were found between NHW and NHB populations in Nevada. Low survival was driven by populous Southern Nevada: After adjustment for all covariates, Southern Nevadans were at 17% higher risk of death than their counterparts in Northwestern Nevada (HR: 1.17; 95% CI: 1.08-1.27). CRC screening, comparatively low among Nevadans, immigrants, minorities, and people with lower levels of education, is one modifiable factor that has the potential to improve CRC outcomes. Collaboratively, all stakeholders must aggressively approach any opportunities to improve primary prevention of CRC as well as to maximize the CRC survival potential, thus, reducing the number of deaths from this potentially preventable cancer

Practice and Lived Experience of Menstrual Exiles (Chhaupadi) among Adolescent Girls in Far Western Nepal. December 2018

Background: Menstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi. Methods: We collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. We also conducted a focus group discussion with seven girls, held key informant interviews, and observed the girls’ living spaces during Chhaupadi, using a checklist. Descriptive statistics of the quantitative survey and thematic analyses of qualitative interviews are presented. Results: The majority of the girls (n = 77, 72%) practiced exile, or Chhaupadi, during their menstruation, including 3 (4%) exiled to traditional Chhau sheds, 63 (82%) to livestock sheds, and 11 (14%) to courtyards outside their home. The remaining girls (n = 30, 28%) stayed inside the house, yet practiced some form of menstrual taboos. Of the 77 observed living spaces where the girls stayed during exile, only 30% (n = 23) had a toilet facility. Most exiled girls (97.4%) were restricted from eating dairy products. Participants reported having various psychological problems, including lonliness and difficulty sleeping while practicing Chhaupadi. Three of the girls were physically abused; nine were bitten by a snake. Notably high proportions of the living spaces lacked ventilation/windows (n = 20, 26%), electricity (n = 29, 38%), toilets (n = 54, 70%) and a warm blanket and mattress for sleeping (n = 29, 38%). Our qualitative findings supported our quantitative results. Conclusions: Chhaupadi has been condemned by human rights organizations. While the government has banned the practice, implementation on the ban is proceeding slowly, especially in far-western Nepal. Thus, as a temporary measure, public health professionals must work towards promoting the health and safety of Nepalese women and girls still practicing Chhaupadi

Inducing Employees to Leave: A Comparison of Four Severance Options

This study examines the demographic, economic, and psychographic characteristics of 324 blue‐collar workers who were offered four options for either retirement or severance from the organization. Consistent with previous research, individuals who accepted retirement options have more organizational tenure and believed that the packages would provide stable financial futures. A key finding for those who accepted the nonretirement options is that comparable employment would be available. The study concludes with research limitations and suggestions for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97191/1/21526_ftp.pd

Early Neolithic Wine of Georgia in the South Caucasus

Chemical analyses of ancient organic compounds absorbed into the pottery fabrics from sites in Georgia in the South Caucasus region, dating to the early Neolithic period (ca. 6,000–5,000 BC), provide the earliest biomolecular archaeological evidence for grape wine and viniculture from the Near East, at ca. 6,000–5,800 BC. The chemical findings are corroborated by climatic and environmental reconstruction, together with archaeobotanical evidence, including grape pollen, starch, and epidermal remains associated with a jar of similar type and date. The very large-capacity jars, some of the earliest pottery made in the Near East, probably served as combination fermentation, aging, and serving vessels. They are the most numerous pottery type at many sites comprising the so-called “Shulaveri-Shomutepe Culture” of the Neolithic period, which extends into western Azerbaijan and northern Armenia. The discovery of early sixth millennium BC grape wine in this region is crucial to the later history of wine in Europe and the rest of the world

Intra-Ethnic Diversity in Ischemic Heart Disease and Stroke Mortality among Hispanics in the United States

Introduction: Hispanics are the largest racial/ethnic minority group in the United States (US), comprising 17% of the total US population in 2014, and projected to increase to 28.6% by 2060. Yet, the intra-ethnic heterogeneity for the second and fourth leading causes of death among Hispanic populations, heart disease and stroke, has never been comprehensively studied. We examined ischemic heart disease (IHD) and stroke mortality among distinct Hispanic subgroups: Caribbean Hispanics (including Puerto Ricans, Cubans, and Dominicans), Mexicans, Central Americans and South Americans, comparing their mortality with non-Hispanic whites (NHWs). Methods: Five years (2008-2012) of death certificate data from Florida and California were used to calculate age-adjusted cause-specific mortality rates for ischemic heart disease and stroke. Mortality outcomes were compared with age-adjusted mortality rate ratios computed using negative binomial regression. Results: Hispanics had stroke mortality rates equivalent to or higher than NHWs. The highest rate was seen in US-born Mexicans in California, 41.9 deaths per 100,000 (95% CI: 40.0- 44.0), compared to 36.3 (95% CI: 35.8-36.9) in NHWs. In Florida, Puerto Rican men had the greatest stroke mortality risk, 19% higher than NHWs. In aggregate, Hispanics had lower ischemic heart disease mortality rates than NHWs, 32% and 25% lower among females and males in Florida, respectively. South American men and women had the lowest IHD and stroke rates in both states. Discussion: There was notable intra-ethnic variability in mortality, with the worst Hispanic outcomes seen among Cuban men and Puerto Rican women in Florida and US-born Mexicans and Caribbeans of both sexes in California. Our results for both IHD and stroke demonstrate that among Hispanics, US-born and/or those with a longer stay in the US were the most disadvantaged, suggesting the importance of looking at acculturation patterns that negatively influence health, including diet and obesity

The ISS Water Processor Catalytic Reactor as a Post Processor for Advanced Water Reclamation Systems

Advanced water processors being developed for NASA s Exploration Initiative rely on phase change technologies and/or biological processes as the primary means of water reclamation. As a result of the phase change, volatile compounds will also be transported into the distillate product stream. The catalytic reactor assembly used in the International Space Station (ISS) water processor assembly, referred to as Volatile Removal Assembly (VRA), has demonstrated high efficiency oxidation of many of these volatile contaminants, such as low molecular weight alcohols and acetic acid, and is considered a viable post treatment system for all advanced water processors. To support this investigation, two ersatz solutions were defined to be used for further evaluation of the VRA. The first solution was developed as part of an internal research and development project at Hamilton Sundstrand (HS) and is based primarily on ISS experience related to the development of the VRA. The second ersatz solution was defined by NASA in support of a study contract to Hamilton Sundstrand to evaluate the VRA as a potential post processor for the Cascade Distillation system being developed by Honeywell. This second ersatz solution contains several low molecular weight alcohols, organic acids, and several inorganic species. A range of residence times, oxygen concentrations and operating temperatures have been studied with both ersatz solutions to provide addition performance capability of the VRA catalyst

Preliminary Feasibility Testing of the BRIC Brine Water Recovery Concept

The Brine Residual In-Containment (BRIC) concept is being developed as a new technology to recover water from spacecraft wastewater brines. Such capability is considered critical to closing the water loop and achieving a sustained human presence in space. The intention of the BRIC concept is to increase the robustness and efficiency of the dewatering process by performing drying inside the container used for the final disposal of the residual brine solid. Recent efforts in the development of BRIC have focused on preliminary feasibility testing using a laboratory- assembled pre-prototype unit. Observations of the drying behavior of actual brine solutions processed under BRIC-like conditions has been of particular interest. To date, experiments conducted with three types of analogue spacecraft wastewater brines have confirmed the basic premise behind the proposed application of in-place drying. Specifically, the dried residual mass from these solutions have tended to exhibit characteristics of adhesion and flow that are expected to continue to challenge process stream management designs typically used in spacecraft systems. Yet, these same characteristics may favor the development of capillary- and surface-tension-based approaches currently envisioned as part of an ultimate microgravity-compatible BRIC design. In addition, preliminary feasibility testing of the BRIC pre-prototype confirmed that high rates of water recovery, up to 98% of the available brine water, may be possible while still removing the majority of the brine contaminants from the influent brine stream. These and other early observations from testing are reported

Development of Biomarkers Based on Diet-Dependent Metabolic Serotypes: Concerns and Approaches for Cohort and Gender Issues in Serum Metabolome Studies

This is the publisher's version, also available electronically from: http://online.liebertpub.com/doi/pdfplus/10.1089/omi.2004.8.209Mathematical models that reflect the effects of dietary restriction (DR) on the sera metabolome may have utility in understanding the mechanisms of DR and in applying this knowledge to human epidemiological studies. Previous studies demonstrated both the feasibility of identifying biomarkers through metabolome analysis and the validity of our approach in independent cohorts of 6-month-oId male and female ad libitum fed or DR rats. Cross-cohort studies showed that cohort-specific effects distorted the dataset The present study extends these observations across the entire sample set, thereby validating our markers independently of specific cohorts. Metabolites originally identified in males were examined in females and vice-versa. DR's effect on the metabolom e is partially gender-specific and is modulated by environmental factors. DR reduces inter-gender differences in the metabolome. Univariate statistical methods showed that 56/93 metabolites in the female samples and 39/93 metabolites in the male samples were significantly altered (using our previous cut-off criteria of p ^ 0.2) by DR. The metabolites modulated by DR present a wide spectrum of concentration, redox reactivity and hydrophilicity, suggesting that our serotype is broadly representative of the metabolome and that DR has broad effects on the metabolome. These studies, coupled with those in the preceding and following reports, also highlight the utility for consideration of the metabolome as a network of metabolites using appropriate data analysis approaches. The inter-cohort and inter-gender differences addressed herein suggest potential cautions, and potential approaches, for identification of multivariate biomarker profiles that reflect changes in physiological status, such as a metabolism that predisposes to increased risk of neoplasia

Advances in Spacecraft Brine Water Recovery: Development of a Radial Vaned Capillary Drying Tray

Technology improvements in the recovery of water from brine are critical to establishing closed-loop water recovery systems, enabling long-duration missions, and achieving a sustained human presence in space. A genre of 'in-place drying' brine water recovery concepts, collectively referred to herein as Brine Residual In-Containment, are under development. These brine water recovery concepts aim to increase the overall robustness and reliability of the brine recovery process by performing drying inside the container used for final disposal of the solid residual waste. Implementation of in-place drying techniques have been demonstrated for applications where gravity is present and phase separation occurs naturally by buoyancy-induced effects. In this work, a microgravity-compatible analogue of the gravity-driven phase separation process is considered by exploiting capillarity in the form of surface wetting, surface tension, and container geometry. The proposed design consists of a series of planar radial vanes aligned about a central slotted core. Preliminary testing of the fundamental geometry in a reduced gravity environment has shown the device to spontaneously fill and saturate rapidly, thereby creating a free surface from which evaporation and phase separation can occur similar to a terrestrial-like 'cylindrical pool' of fluid. Mathematical modeling and analysis of the design suggest predictable rates of filling and stability of fluid containment as a function of relevant system dimensions; e.g., number of vanes, vane length, width, and thickness. A description of the proposed capillary design solution is presented along with preliminary results from testing, modeling, and analysis of the system