759–5 Use of an Interactive Electronic Whiteboard to Teach Clinical Cardiology Decision Analysis to Medical Students

We used innovative state-of-the-art computer and collaboration technologies to teach first-year medical students an analytic methodology to solve difficult clinical cardiology problems to make informed medical decisions. Clinical examples included the decision to administer thrombolytic therapy considering the risk of hemorrhagic stroke, and activity recommendations for athletes at risk for sudden death. Students received instruction on the decision-analytic approach which integrates pathophysiology, treatment efficacy, diagnostic test interpretation, health outcomes, patient preferences, and cost-effectiveness into a decision-analytic model.The traditional environment of a small group and blackboard was significantly enhanced by using an electronic whiteboard, the Xerox LiveBoard™. The LiveBoard features an 80486-based personal computer, large (3’×4’) display, and wireless pens for input. It allowed the integration of decision-analytic software, statistical software, digital slides, and additional media. We developed TIDAL (Team Interactive Decision Analysis in the Large-screen environment), a software package to interactively construct decision trees, calculate expected utilities, and perform one- and two-way sensitivity analyses using pen and gesture inputs. The Live Board also allowed the novel incorporation of Gambler, a utility assessment program obtained from the New England Medical Center. Gambler was used to obtain utilities for outcomes such as non-disabling hemorrhagic stroke. The interactive nature of the LiveBoard allowed real-time decision model development by the class, followed by instantaneous calculation of expected utilities and sensitivity analyses. The multimedia aspect and interactivity were conducive to extensive class participation.Ten out of eleven students wanted decision-analytic software available for use during their clinical years and all students would recommend the course to next year's students. We plan to experiment with the electronic collaboration features of this technology and allow groups separated by time or space to collaborate on decisions and explore the models created

Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS

Louisiana is severely affected by HIV/AIDS, ranking fifth in AIDS rates in the USA. The Louisiana Public Health Information Exchange (LaPHIE) is a novel, secure bi-directional public health information exchange, linking statewide public health surveillance data with electronic medical record data. LaPHIE alerts medical providers when individuals with HIV/AIDS who have not received HIV care for >12 months are seen at any ambulatory or inpatient facility in an integrated delivery network. Between 2/1/2009 and 1/31/2011, 488 alerts identified 345 HIV positive patients. Of those identified, 82% had at least one CD4 or HIV viral load test over the study follow-up period. LaPHIE is an innovative use of health information exchange based on surveillance data and real time clinical messaging, facilitating rapid provider notification of those in need of treatment. LaPHIE successfully reduces critical missed opportunities to intervene with individuals not in care, leveraging information historically collected solely for public health purposes, not health care delivery, to improve public health

Time-frequency scaling transformation of the phonocardiogram based of the matching pursuit method.

International audienceA time-frequency scaling transformation based on the matching pursuit (MP) method is developed for the phonocardiogram (PCG). The MP method decomposes a signal into a series of time-frequency atoms by using an iterative process. The modification of the time scale of the PCG can be performed without perceptible change in its spectral characteristics. It is also possible to modify the frequency scale without changing the temporal properties. The technique has been tested on 11 PCG's containing heart sounds and different murmurs. A scaling/inverse-scaling procedure was used for quantitative evaluation of the scaling performance. Both the spectrogram and a MP-based Wigner distribution were used for visual comparison in the time-frequency domain. The results showed that the technique is suitable and effective for the time-frequency scale transformation of both the transient property of the heart sounds and the more complex random property of the murmurs. It is also shown that the effectiveness of the method is strongly related to the optimization of the parameters used for the decomposition of the signals

Worldwide distribution of NAT2 diversity: Implications for NAT2 evolutionary history

<p>Abstract</p> <p>Background</p> <p>The N-acetyltransferase 2 (<it>NAT2</it>) gene plays a crucial role in the metabolism of many drugs and xenobiotics. As it represents a likely target of population-specific selection pressures, we fully sequenced the <it>NAT2 </it>coding region in 97 Mandenka individuals from Senegal, and compared these sequences to extant data on other African populations. The Mandenka data were further included in a worldwide dataset composed of 41 published population samples (6,727 individuals) from four continental regions that were adequately genotyped for all common <it>NAT2 </it>variants so as to provide further insights into the worldwide haplotype diversity and population structure at <it>NAT2</it>.</p> <p>Results</p> <p>The sequencing analysis of the <it>NAT2 </it>gene in the Mandenka sample revealed twelve polymorphic sites in the coding exon (two of which are newly identified mutations, C345T and C638T), defining 16 haplotypes. High diversity and no molecular signal of departure from neutrality were observed in this West African sample. On the basis of the worldwide genotyping survey dataset, we found a strong genetic structure differentiating East Asians from both Europeans and sub-Saharan Africans. This pattern could result from region- or population-specific selective pressures acting at this locus, as further suggested in the HapMap data by extremely high values of <it>F</it>_STfor a few SNPs positions in the <it>NAT2 </it>coding exon (T341C, C481T and A803G) in comparison to the empirical distribution of <it>F</it>_STvalues accross the whole 400-kb region of the <it>NAT </it>gene family.</p> <p>Conclusion</p> <p>Patterns of sequence variation at <it>NAT2 </it>are consistent with selective neutrality in all sub-Saharan African populations investigated, whereas the high level of population differentiation between Europeans and East Asians inferred from SNPs could suggest population-specific selective pressures acting at this locus, probably caused by differences in diet or exposure to other environmental signals.</p

Positive Selection in East Asians for an EDAR Allele that Enhances NF-κB Activation

Genome-wide scans for positive selection in humans provide a promising approach to establish links between genetic variants and adaptive phenotypes. From this approach, lists of hundreds of candidate genomic regions for positive selection have been assembled. These candidate regions are expected to contain variants that contribute to adaptive phenotypes, but few of these regions have been associated with phenotypic effects. Here we present evidence that a derived nonsynonymous substitution (370A) in EDAR, a gene involved in ectodermal development, was driven to high frequency in East Asia by positive selection prior to 10,000 years ago. With an in vitro transfection assay, we demonstrate that 370A enhances NF-κB activity. Our results suggest that 370A is a positively selected functional genetic variant that underlies an adaptive human phenotype

Use of a health information exchange system in the emergency care of children

<p>Abstract</p> <p>Background</p> <p>Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.</p> <p>Methods</p> <p>Using data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage.</p> <p>Results</p> <p>Users accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months.</p> <p>Conclusions</p> <p>HIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.</p

Human Population Differentiation Is Strongly Correlated with Local Recombination Rate

Allele frequency differences across populations can provide valuable information both for studying population structure and for identifying loci that have been targets of natural selection. Here, we examine the relationship between recombination rate and population differentiation in humans by analyzing two uniformly-ascertained, whole-genome data sets. We find that population differentiation as assessed by inter-continental FST shows negative correlation with recombination rate, with FST reduced by 10% in the tenth of the genome with the highest recombination rate compared with the tenth of the genome with the lowest recombination rate (P≪10−12). This pattern cannot be explained by the mutagenic properties of recombination and instead must reflect the impact of selection in the last 100,000 years since human continental populations split. The correlation between recombination rate and FST has a qualitatively different relationship for FST between African and non-African populations and for FST between European and East Asian populations, suggesting varying levels or types of selection in different epochs of human history