Preparation and Use of Preconstructed Orders, Order Sets, and Order Menus in a Computerized Provider Order Entry System

Objective: To describe the configuration and use of the computerized provider order entry (CPOE) system used for inpatient and outpatient care at the authors' facility. Design: Description of order configuration entities, use patterns, and configuration changes in a production CPOE system. Measurements: The authors extracted and analyzed the content of order configuration entities (order dialogs, preconfigured [quick] orders, order sets, and order menus) and determined the number of orders entered in their production order entry system over the previous three years. The authors measured use of these order configuration entities over a six-month period. They repeated the extract two years later to measure changes in these entities. Results: CPOE system configuration, conducted before and after first production use, consisted of preparing 667 order dialogs, 5,982 preconfigured (quick) orders, and 513 order sets organized in 703 order menus for particular contexts, such as admission for a particular diagnosis. Fifty percent of the order dialogs, 57% of the quick orders, and 13% of the order sets were used within a six-month period. Over the subsequent two years, the volume of order configuration entities increased by 26%. Conclusions: These order configuration steps were time-consuming, but the authors believe they were important to increase the ordering speed and acceptability of the order entry software. Lessons learned in the process of configuring the CPOE ordering system are given. Better understanding of ordering patterns may make order configuration more efficient because many of the order configuration entities that were created were not used by clinician

The Spin Temperature of Warm Interstellar H I

Collisional excitation of the 21cm HI hyperfine transition is not strong enough to thermalize it in warm neutral (``intercloud'') interstellar gas, which we show by simultaneously solving the equations of ionization and collisional equilibrium under typical conditions. Coupling of the 21cm excitation temperature and local gas motions may be established by the Ly-alpha radiation field, but only if strong Galactic Ly-alpha radiation permeates the gas in question. The Ly-alpha radiation tends to impart to the gas its own characteristic temperature, which is determined by the range of gas motions that occur on the spatial scale of the Ly-alpha scattering. In general, the calculation of H I spin temperatures is a more difficult and interesting problem than might have been expected, as is any interpretation of H I spin temperature measurements.Comment: 11 pages, 8 figures, accepted for A&

Incorporating Ethics in Computing Courses: Perspectives from Educators

Incorporating ethics into computing education has become a priority for the SIGCSE community. Many computing departments and educators have contributed to this endeavor by creating standalone computing ethics courses or integrating ethics modules and discussions into preexisting curricula. In this study, we hope to support this effort by reporting on computing educators' attitudes toward including ethics in their computing classroom, with a special focus on the structures that hinder or help this endeavor. We surveyed 138 higher education computing instructors to understand their attitudes toward including ethics in their classes, what barriers might be preventing them from doing so, and which structures best support them. We found that even though instructors were generally positive about ethics as a component of computing education, there are specific barriers preventing ethics from being included in some computing courses. In this work, we explore how to alleviate these barriers and outline support structures that could encourage further integration of ethics and computing in higher education

Evaluation of a Command-line Parser-based Order Entry Pathway for the Department of Veterans Affairs Electronic Patient Record

Objective: To improve and simplify electronic order entry in an existing electronic patient record, the authors developed an alternative system for entering orders, which is based on a command- interface using robust and simple natural-language techniques. Design: The authors conducted a randomized evaluation of the new entry pathway, measuring time to complete a standard set of orders, and users' satisfaction measured by questionnaire. A group of 16 physician volunteers from the staff of the Department of Veterans Affairs Puget Sound Health Care System-Seattle Division participated in the evaluation. Results: Thirteen of the 16 physicians (81%) were able to enter medical orders more quickly using the natural-language-based entry system than the standard graphical user interface that uses menus and dialogs (mean time spared, 16.06 ± 4.52 minutes; P=0.029). Compared with the graphical user interface, the command--based pathway was perceived as easier to learn (P<0.01), was considered easier to use and faster (P<0.01), and was rated better overall (P<0.05). Conclusion: Physicians found the command- interface easier to learn and faster to use than the usual menu-driven system. The major advantage of the system is that it combines an intuitive graphical user interface with the power and speed of a natural-language analyze

Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project

BACKGROUND: Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300). RESULTS: Differences in smoking cessation outcomes between the intervention (stories DVD + routine clinical treatment) and control (routine clinical treatment) arms were compared using self-report and carbon monoxide measurement at 6-months. Compared to control, individuals who viewed the intervention stories DVD reported greater intentions to quit. Although continuous quitting marginally favored the intervention, our main result did not reach statistical significance (p = 0.16). CONCLUSION: Narrative communication via storytelling to promote smoking cessation among African-Americans in the South is one method to communicate smoking cessation. Results suggest this may not be sufficient as a stand-alone augmentation of routine clinical treatment for continuous smoking cessation. Smoking cessation efforts need to continually assess different means of communicating to smokers about quitting. CLINICAL TRIALS REGISTRATION: The ClinicalTrials.gov Identifier is NCT00101491. This trial was registered January 10, 2005

Nicotiana alata defensin chimeras reveal differences in the mechanism of fungal and tumor cell killing and an enhanced antifungal variant

The plant defensin NaD1 is a potent antifungal molecule that also targets tumor cells with a high efficiency. We examined the features of NaD1 that contribute to these two activities by producing a series of chimeras with NaD2, a defensin that has relatively poor activity against fungi and no activity against tumor cells. All plant defensins have a common tertiary structure known as a cysteine-stabilized alpha-beta motif which consists of an alpha helix and a triple-stranded beta-sheet stabilized by four disulfide bonds. The chimeras were produced by replacing loops 1 to 7, the sequences between each of the conserved cysteine residues on NaD1, with the corresponding loops from NaD2. The loop 5 swap replaced the sequence motif (SKILRR) that mediates tight binding with phosphatidylinositol 4,5-bisphosphate [PI(4,5)P-2] and is essential for the potent cytotoxic effect of NaD1 on tumor cells. Consistent with previous reports, there was a strong correlation between PI(4,5)P-2 binding and the tumor cell killing activity of all of the chimeras. However, this correlation did not extend to antifungal activity. Some of the loop swap chimeras were efficient antifungal molecules, even though they bound poorly to PI(4,5)P-2, suggesting that additional mechanisms operate against fungal cells. Unexpectedly, the loop 1B swap chimera was 10 times more active than NaD1 against filamentous fungi. This led to the conclusion that defensin loops have evolved as modular components that combine to make antifungal molecules with variable mechanisms of action and that artificial combinations of loops can increase antifungal activity compared to that of the natural variants

Bichromatic electromagnetically induced transparency in cold rubidium atoms

In a three-level atomic system coupled by two equal-amplitude laser fields with a frequency separation 2$\delta$, a weak probe field exhibits a multiple-peaked absorption spectrum with a constant peak separation $\delta$. The corresponding probe dispersion exhibits steep normal dispersion near the minimum absorption between the multiple absorption peaks, which leads to simultaneous slow group velocities for probe photons at multiple frequencies separated by $\delta$. We report an experimental study in such a bichromatically coupled three-level $\Lambda$ system in cold $^{87}$Rb atoms. The multiple-peaked probe absorption spectra under various experimental conditions have been observed and compared with the theoretical calculations.Comment: RevTex, 4 pages, 6 figures, Email address: [email protected]