Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BackgroundDocumenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record.MethodsKotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed.ResultsKotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element.ConclusionChange strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care.Practical implicationsA practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture

Quantum critical behavior in the heavy Fermion single crystal Ce(Ni0.935_{0.935}Pd0.065_{0.065})2_2Ge2_2

We have performed magnetic susceptibility, specific heat, resistivity, and inelastic neutron scattering measurements on a single crystal of the heavy Fermion compound Ce(Ni$_{0.935}$Pd$_{0.065}$)$_2$Ge$_2$, which is believed to be close to a quantum critical point (QCP) at T = 0. At lowest temperature(1.8-3.5 K), the magnetic susceptibility behaves as $\chi(T)-\chi (0)$ $\propto$ $T^{-1/6}$ with $\chi (0) = 0.032 \times 10^{-6}$ m$^3$/mole (0.0025 emu/mole). For $T<$ 1 K, the specific heat can be fit to the formula $\Delta C/T = \gamma_0 - T^{1/2}$ with $\gamma_0$ of order 700 mJ/mole-K$^2$. The resistivity behaves as $\rho = \rho_0 + AT^{3/2}$ for temperatures below 2 K. This low temperature behavior for $\gamma (T)$ and $\rho (T)$ is in accord with the SCR theory of Moriya and Takimoto\cite{Moriya}. The inelastic neutron scattering spectra show a broad peak near 1.5 meV that appears to be independent of $Q$; we interpret this as Kondo scattering with $T_K =$ 17 K. In addition, the scattering is enhanced near $Q$=(1/2, 1/2, 0) with maximum scattering at $\Delta E$ = 0.45 meV; we interpret this as scattering from antiferromagnetic fluctuations near the antiferromagnetic QCP.Comment: to be published in J. Phys: Conference Serie

Reduction of the size of datasets by using evolutionary feature selection: the case of noise in a modern city

Smart city initiatives have emerged to mitigate the negative effects of a very fast growth of urban areas. Most of the population in our cities are exposed to high levels of noise that generate discomfort and different health problems. These issues may be mitigated by applying different smart cities solutions, some of them require high accurate noise information to provide the best quality of serve possible. In this study, we have designed a machine learning approach based on genetic algorithms to analyze noise data captured in the university campus. This method reduces the amount of data required to classify the noise by addressing a feature selection optimization problem. The experimental results have shown that our approach improved the accuracy in 20% (achieving an accuracy of 87% with a reduction of up to 85% on the original dataset).Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. This research has been partially funded by the Spanish MINECO and FEDER projects TIN2016-81766-REDT (http://cirti.es), and TIN2017-88213-R (http://6city.lcc.uma.es)

Stimulation of Adenosine A 3 Receptors in Cerebral Ischemia: Neuronal Death, Recovery, or Both?

The role of the adenosine A 3 receptor continues to baffle, and, despite an increasing number of studies, the currently available data add to, rather than alleviate, the existing confusion. The reported effects of adenosine A 3 receptor stimulation appear to depend on the pattern of drug administration (acute vs. chronic), dose, and type of the target tissue. Thus, while acute exposure to A 3 receptor agonists protects against myocardial ischemia, it is severely damaging when these agents are given shortly prior to cerebral ischemia. Mast cells degranulate when their A 3 receptors are stimulated. Degranulation of neutrophils is, on the other hand, impaired. While reduced production of reactive nitrogen species has been reported following activation of A 3 receptors in collagen-induced arthritis, the process appears to be enhanced in cerebral ischemia. Indeed, immunocytochemical studies indicate that both pre- and postischemic treatment with A 3 receptor antagonist dramatically reduces nitric oxide synthase in the affected hippocampus. Even more surprisingly, low doses of A 3 receptor agonists seem to enhance astrocyte proliferation, while high doses induce their apoptosis. This review concentrates on the studies of cerebral A 3 receptors and, based on the available evidence, discusses the possibility of adenosine A 3 receptor serving as an integral element of the endogenous cerebral neuroprotective complex consisting of adenosine and its receptors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75391/1/j.1749-6632.1999.tb07984.x.pd

Towards an Accurate Identification of Pyloric Neuron Activity with VSDi

Voltage-sensitive dye imaging (VSDi) which enables simultaneous optical recording of many neurons in the pyloric circuit of the stomatogastric ganglion is an important technique to supplement electrophysiological recordings. However, utilising the technique to identify pyloric neurons directly is a computationally exacting task that requires the development of sophisticated signal processing procedures to analyse the tri-phasic pyloric patterns generated by these neurons. This paper presents our work towards commissioning such procedures. The results achieved to date are most encouraging

The equation of state of solid nickel aluminide

The pressure-volume-temperature equation of state of the intermetallic compound NiAl was calculated theoretically, and compared with experimental measurements. Electron ground states were calculated for NiAl in the CsCl structure, using density functional theory, and were used to predict the cold compression curve and the density of phonon states. The Rose form of compression curve was found to reproduce the ab initio calculations well in compression but exhibited significant deviations in expansion. A thermodynamically-complete equation of state was constructed for NiAl. Shock waves were induced in crystals of NiAl by the impact of laser-launched Cu flyers and by launching NiAl flyers into transparent windows of known properties. The TRIDENT laser was used to accelerate the flyers to speeds between 100 and 600m/s. Point and line-imaging laser Doppler velocimetry was used to measure the acceleration of the flyer and the surface velocity history of the target. The velocity histories were used to deduce the stress state, and hence states on the principal Hugoniot and the flow stress. Flyers and targets were recovered from most experiments. The effect of elasticity and plastic flow in the sample and window was assessed. The ambient isotherm reproduced static compression data very well, and the predicted Hugoniot was consistent with shock compression data

Shadowing in the nuclear photoabsorption above the resonance region

A model based on the hadronic fluctuations of the real photon is developed to describe the total photonucleon and photonuclear cross sections in the energy region above the nucleon resonances. The hadronic spectral function of the photon is derived including the finite width of vector-meson resonances and the quark-antiquark continuum. The shadowing effect is evaluated considering the effective interaction of the hadronic component with the bound nucleons within a Glauber-Gribov multiple scattering theory. The low energy onset of the shadowing effect is interpreted as a possible signature of a modification of the hadronic spectral function in the nuclear medium. A decrease of the $\rho$-meson mass in nuclei is suggested for a better explanation of the experimental data.Comment: 8 pages, 7 figure

Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services

OBJECTIVE: This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. METHODS: We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. RESULTS: We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. CONCLUSION: This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems

Efficacy and Tolerability of Second-Generation Antipsychotics in Children and Adolescents With Schizophrenia

Early-onset schizophrenia-spectrum (EOSS) disorders (onset of psychotic symptoms before 18 years of age) represent a severe variant associated with significant chronic functional impairment and poor response to antipsychotic treatment. All drugs with proven antipsychotic effects block dopamine D2 receptors to some degree. The ongoing development of the dopamine and other neurotransmitter receptor systems during childhood and adolescence may affect clinical response and susceptibility to side effects in youth. A literature search was conducted of clinical trials of antipsychotics in children and adolescents with EOSS disorders between 1980 and 2007 from the Medline database, reference lists, and conference proceedings. Trials were limited to double-blind studies of duration of 4 or more weeks that included 15 or more patients. Ten clinical trials were identified. Antipsychotic medications were consistently found to reduce the severity of psychotic symptoms in children and adolescents when compared with placebo. The superiority of clozapine has been now demonstrated relative to haloperidol, standard-dose olanzapine, and “high-dose” olanzapine for EOSS disorders. However, limited comparative data are available regarding whether there are differences among the remaining second-generation antipsychotics (SGAs) in clinical effectiveness. The available data from short-term studies suggest that youth might be more sensitive than adults to developing antipsychotic-related adverse side effects (eg, extrapyramidal side effects, sedation, prolactin elevation, weight gain). In addition, preliminary data suggest that SGA use can lead to the development of diabetes in some youth, a disease which itself carries with it significant morbidity and mortality. Such a substantial risk points to the urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain and diabetes early in the course of treatment in this population