Integrated care and the working record

By default, many discussions and specifications of electronic health records or integrated care records often conceptualize the record as a passive information repository. This article presents data from a case study of work in a medical unit in a major metropolitan hospital. It shows how the clinicians tailored, re-presented and augmented clinical information to support their own roles in the delivery of care for individual patients. This is referred to as the working record: a set of complexly interrelated clinician-centred documents that are locally evolved, maintained and used to support delivery of care in conjunction with the more patient-centred chart that will be stored in the medical records department on the patient’s discharge. Implications are drawn for how an integrated care record could support the local tailorability and flexibility that underpin this working record and hence underpin practice

Spacecraft instrument calibration and stability

The following topics are covered: instrument degradation; the Solar Backscatter Ultraviolet (SBUV) Experiment; the Total Ozone Mapping Spectrometer (TOMS); the Stratospheric Aerosol and Gas Experiment 1 (SAGE-1) and SAGE-2 instruments; the Solar Mesosphere Explorer (SME) UV ozone and near infrared airglow instruments; and the Limb Infrared Monitor of the Stratosphere (LIMS)

Stratified Charge Rotary Engine Critical Technology Enablement, Volume 1

This report summarizes results of a critical technology enablement effort with the stratified charge rotary engine (SCRE) focusing on a power section of 0.67 liters (40 cu. in.) per rotor in single and two rotor versions. The work is a continuation of prior NASA Contracts NAS3-23056 and NAS3-24628. Technical objectives are multi-fuel capability, including civil and military jet fuel and DF-2, fuel efficiency of 0.355 Lbs/BHP-Hr. at best cruise condition above 50 percent power, altitude capability of up to 10Km (33,000 ft.) cruise, 2000 hour TBO and reduced coolant heat rejection. Critical technologies for SCRE's that have the potential for competitive performance and cost in a representative light-aircraft environment were examined. Objectives were: the development and utilization of advanced analytical tools, i.e. higher speed and enhanced three dimensional combustion modeling; identification of critical technologies; development of improved instrumentation, and to isolate and quantitatively identify the contribution to performance and efficiency of critical components or subsystems

Highly Sensitive Dual-Core Photonic Metal Fiber

In this study, we propose an all-solid cladding dual-core metal fiber (DC-MF) filled with toluene and ethanol for temperature sensing applications. Instead of using air holes in the cladding region, we employ fluorine doped silica glass to form an all-solid cladding. By selectively filling toluene and ethanol into three air holes near the core region, we investigate the temperature sensing characteristics numerically. Simulation results demonstrate that the average sensitivity of the temperature sensing can reach -11.64 and -7.41 nm/C within the temperature ranges of 0 to 70 C and -80 to 0 C, respectively, even with a short DC-MF length of 1.6 mm. The maximum sensitivity in the considered temperature ranges can reach up to -15 and -9 nm/C, respectively. Furthermore, the proposed temperature sensor exhibits insensitivity to hydrostatic pressure

Frequency of Rare Allelic Variation in Candidate Genes among Individuals with Low and High Urinary Calcium Excretion

Our study investigated the association of rare allelic variants with extremes of 24-hour urinary calcium excretion because higher urinary calcium excretion is a dominant risk factor for calcium-based kidney stone formation. We resequenced 40 candidate genes potentially related to urinary calcium excretion in individuals from the Nurses' Health Studies I & II and the Health Professionals Follow-up Study. A total of 960 participants were selected based on availability of 24-hour urine collection data and level of urinary calcium excretion (low vs. high). We utilized DNA sample pooling, droplet-based target gene enrichment, multiplexing, and high-throughput sequencing. Approximately 64% of samples (n = 615) showed both successful target enrichment and sequencing data with >20-fold deep coverage. A total of 259 novel allelic variants were identified. None of the rare gene variants (allele frequencies <2%) were found with increased frequency in the low vs. high urinary calcium groups; most of these variants were only observed in single individuals. Unadjusted analysis of variants with allele frequencies ≥2% suggested an association of the Claudin14 SNP rs113831133 with lower urinary calcium excretion (6/520 versus 29/710 haplotypes, P value = 0.003). Our data, together with previous human and animal studies, suggest a possible role for Claudin14 in urinary calcium excretion. Genetic validation studies in larger sample sets will be necessary to confirm our findings for rs113831133. In the tested set of candidate genes, rare allelic variants do not appear to contribute significantly to differences in urinary calcium excretion between individuals

Children, family and the state : revisiting public and private realms

The state is often viewed as part of the impersonal public sphere in opposition to the private family as a locus of warmth and intimacy. In recent years this modernist dichotomy has been challenged by theoretical and institutional trends which have altered the relationship between state and family. This paper explores changes to both elements of the dichotomy that challenge this relationship: a more fragmented family structure and more individualised and networked support for children. It will also examine two new elements that further disrupt any clear mapping between state/family and public/private dichotomies: the third party role of the child in family/state affairs and children's application of virtual technology that locates the private within new cultural and social spaces. The paper concludes by examining the rise of the 'individual child' hitherto hidden within the family/state dichotomy and the implications this has for intergenerational relations at personal and institutional levels

Engineering calculations for solving the orbital allotment problem

Four approaches for calculating downlink interferences for shaped-beam antennas are described. An investigation of alternative mixed-integer programming models for satellite synthesis is summarized. Plans for coordinating the various programs developed under this grant are outlined. Two procedures for ordering satellites to initialize the k-permutation algorithm are proposed. Results are presented for the k-permutation algorithms. Feasible solutions are found for 5 of the 6 problems considered. Finally, it is demonstrated that the k-permutation algorithm can be used to solve arc allotment problems

Improved validation framework and R-package for artificial neural network models

Validation is a critical component of any modelling process. In artificial neural network (ANN) modelling, validation generally consists of the assessment of model predictive performance on an independent validation set (predictive validity). However, this ignores other aspects of model validation considered to be good practice in other areas of environmental modelling, such as residual analysis (replicative validity) and checking the plausibility of the model in relation to a priori system understanding (structural validity). In order to address this shortcoming, a validation framework for ANNs is introduced in this paper that covers all of the above aspects of validation. In addition, the validann R-package is introduced that enables these validation methods to be implemented in a user-friendly and consistent fashion. The benefits of the framework and R-package are demonstrated for two environmental modelling case studies, highlighting the importance of considering replicative and structural validity in addition to predictive validity

Insulin-stimulated phosphorylation of endothelial nitric oxide synthase at serine-615 contributes to nitric oxide synthesis

Insulin stimulates endothelial NO (nitric oxide) synthesis via PKB (protein kinase B)/Akt-mediated phosphorylation and activation of eNOS (endothelial NO synthase) at Ser-1177. In previous studies, we have demonstrated that stimulation of eNOS phosphorylation at Ser-1177 may be required, yet is not sufficient for insulin-stimulated NO synthesis. We therefore investigated the role of phosphorylation of eNOS at alternative sites to Ser-1177 as candidate parallel mechanisms contributing to insulin-stimulated NO synthesis. Stimulation of human aortic endothelial cells with insulin rapidly stimulated phosphorylation of both Ser-615 and Ser-1177 on eNOS, whereas phosphorylation of Ser-114, Thr-495 and Ser-633 was unaffected. Insulin-stimulated Ser-615 phosphorylation was abrogated by incubation with the PI3K (phosphoinositide 3-kinase) inhibitor wortmannin, infection with adenoviruses expressing a dominant-negative mutant PKB/Akt or pre-incubation with TNFα (tumour necrosis factor α), but was unaffected by high culture glucose concentrations. Mutation of Ser-615 to alanine reduced insulin-stimulated NO synthesis, whereas mutation of Ser-615 to aspartic acid increased NO production by NOS in which Ser-1177 had been mutated to an aspartic acid residue. We propose that the rapid PKB-mediated stimulation of phosphorylation of Ser-615 contributes to insulin-stimulated NO synthesis

Role of thyroid hormones in early postnatal development of skeletal muscle and its implications for undernutrition

Published online by Cambridge University Press 09 Mar 2007Energy intake profoundly influences many endocrine axes which in turn play a central role in development. The specific influence of a short period of mild hypothyroidism, similar to that induced by undernutrition, in regulating muscle development has been assessed in a large mammal during early postnatal life. Hypothyroidism was induced by providing methimazole and iopanoic acid in the feed of piglets between 4 and 14 d of age, and controls were pair-fed to the energy intake of their hypothyroid littermates. Thyroid status was evaluated, and myofibre differentiation and cation pump concentrations were then assessed in the following functionally distinct muscles: longissimus dorsi (l. dorsi), soleus and rhomboideus. Reductions in plasma concentrations of thyroxine (T4; 32%, P < O·Ol), triiodothyronine (T3;48%, P < 0·001), free T3, (58%, P < 0·001)and hepatic 5'-monodeiodinase (EC 1.11.1.8) activity (74%, P < 0·001) occurred with treatment. Small, although significant, increases in the proportion of type I slow-twitch oxidative fibres occurred with mild hypothyroidism, in l. dorsi (2%, P < 0·01) and soleus(7%, P < 0·01). Nuclear T3-receptor concentration in l. dorsi of hypothyroid animals compared with controls increased by 46% (P < 0·001), a response that may represent a homeostatic mechanism making muscle more sensitive to low levels of circulating thyroid hormones. Nevertheless, Na+, K+-ATPase (EC 3.6.1.37) concentration was reduced by 15–16% in all muscles (l.dorsi P< 0·05,soleus P < 0·001, rhomboideus P < 0·05), and Ca2+-ATPase (EC 3.6.1.38) concentration was significantly reduced in the two slow-twitch muscles: by 22% in rhomboideus (P < 0·001) and 23% in soleus (P < 0·05). It is concluded that during early postnatal development of large mammals a period of mild hypothyroidism, comparable with that found during undernutrition, induces changes in myofibre differentiation and a down-regulation of cation pumps in skeletal muscle. Such changes would result in slowness of movement and muscle weakness, and also reduce ATP hydrolysis with a concomitant improvement in energetic efficiency.A. P. Harrison, D. R. Tivey, T. Clausen, C. Duchamp and M. J. Daunce