UNDERSTANDING METHODS TO REDUCING REDUNDANT MEDICAL LAB TEST ORDERING ? A CASE STUDY ON VISTA/CPRS AND THE VETERANS HEALTH ADMINISTRATION

Reducing redundant medical lab tests has been discussed in the literature as a cost saving benefit of Electronic Health Record (EHR) adoption; however the literature does not provide a great deal of information on the mechanics of achieving this goal. Laboratory ordering using an EHR occurs within a complex socio-technical context that can be difficult to understand. A case study was performed on an EHR that provided insight into the interplay of these elements as well as the current state of laboratory ordering guidelines. A theoretical framework, using Strong Structuration Theory was used to guide the research. The result was improved insight into required technological capabilities to support clinical care and the environmental contexts that shape them

Intrinsic and Rashba Spin-orbit Interactions in Graphene Sheets

Starting from a microscopic tight-binding model and using second order perturbation theory, we derive explicit expressions for the intrinsic and Rashba spin-orbit interaction induced gaps in the Dirac-like low-energy band structure of an isolated graphene sheet. The Rashba interaction parameter is first order in the atomic carbon spin-orbit coupling strength $\xi$ and first order in the external electric field $E$ perpendicular to the graphene plane, whereas the intrinsic spin-orbit interaction which survives at E=0 is second order in $\xi$. The spin-orbit terms in the low-energy effective Hamiltonian have the form proposed recently by Kane and Mele. \textit{Ab initio} electronic structure calculations were performed as a partial check on the validity of the tight-binding model.Comment: 5 pages, 2 figures; typos corrected, references update

Dependence of ozone production on NO and hydrocarbons in the troposphere

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95525/1/grl10419.pd

First Principles Calculation of Anomalous Hall Conductivity in Ferromagnetic bcc Fe

We perform a first principles calculation of the anomalous Hall effect in ferromagnetic bcc Fe. Our theory identifies an intrinsic contribution to the anomalous Hall conductivity and relates it to the k-space Berry phase of occupied Bloch states. The theory is able to account for both dc and magneto-optical Hall conductivities with no adjustable parameters.Comment: 4 pages, 6 figures, author list correcte

First Results from the Swarms Survey. SDSS 1257+5428: A Nearby, Massive White Dwarf Binary with a Likely Neutron Star or Black Hole Companion

We present the first results from SWARMS (Sloan White dwArf Radial velocity data Mining Survey), an ongoing project to identify compact white dwarf (WD) binaries in the spectroscopic catalog of the Sloan Digital Sky Survey. The first object identified by SWARMS, SDSS 1257+5428, is a single-lined spectroscopic binary in a circular orbit with a period of 4.56 hr and a semiamplitude of 322.7+-6.3 km/s. From the spectrum and photometry, we estimate a WD mass of 0.92(+0.28,-0.32) Msun. Together with the orbital parameters of the binary, this implies that the unseen companion must be more massive than 1.62(+0.20,-0.25) Msun, and is in all likelihood either a neutron star or a black hole. At an estimated distance of 48(+10,-19) pc, this would be the closest known stellar remnant of a supernova explosion.Comment: 8 pages, 8 figures, ApJ in pres

The influence of surface stress on the equilibrium shape of strained quantum dots

The equilibrium shapes of InAs quantum dots (i.e., dislocation-free, strained islands with sizes >= 10,000 atoms) grown on a GaAs (001) substrate are studied using a hybrid approach which combines density functional theory (DFT) calculations of microscopic parameters, surface energies, and surface stresses with elasticity theory for the long-range strain fields and strain relaxations. In particular we report DFT calculations of the surface stresses and analyze the influence of the strain on the surface energies of the various facets of the quantum dot. The surface stresses have been neglected in previous studies. Furthermore, the influence of edge energies on the island shapes is briefly discussed. From the knowledge of the equilibrium shape of these islands, we address the question whether experimentally observed quantum dots correspond to thermal equilibrium structures or if they are a result of the growth kinetics.Comment: 7 pages, 8 figures, submitted to Phys. Rev. B (February 2, 1998). Other related publications can be found at http://www.rz-berlin.mpg.de/th/paper.htm

A draft framework for measuring progress towards the development of a national health information infrastructure

BACKGROUND: American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal. DISCUSSION: The NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself. SUMMARY: The NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question

What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh

Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important factor to understand them. This being an exploratory study, further research is recommended to validate the nuances of the findings. It can be a guideline for responsiveness practices, and a tipping point for future research