Does Presenting Patients’ BMI Increase Documentation of Obesity?

Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart) will increase physician documentation of obesity in the medical record. Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note. Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully

Modern Approaches to Exact Diagonalization and Selected Configuration Interaction with the Adaptive Sampling CI Method.

Recent advances in selected configuration interaction methods have made them competitive with the most accurate techniques available and, hence, creating an increasingly powerful tool for solving quantum Hamiltonians. In this work, we build on recent advances from the adaptive sampling configuration interaction (ASCI) algorithm. We show that a useful paradigm for generating efficient selected CI/exact diagonalization algorithms is driven by fast sorting algorithms, much in the same way iterative diagonalization is based on the paradigm of matrix vector multiplication. We present several new algorithms for all parts of performing a selected CI, which includes new ASCI search, dynamic bit masking, fast orbital rotations, fast diagonal matrix elements, and residue arrays. The ASCI search algorithm can be used in several different modes, which includes an integral driven search and a coefficient driven search. The algorithms presented here are fast and scalable, and we find that because they are built on fast sorting algorithms they are more efficient than all other approaches we considered. After introducing these techniques, we present ASCI results applied to a large range of systems and basis sets to demonstrate the types of simulations that can be practically treated at the full-CI level with modern methods and hardware, presenting double- and triple-ζ benchmark data for the G1 data set. The largest of these calculations is Si2H6 which is a simulation of 34 electrons in 152 orbitals. We also present some preliminary results for fast deterministic perturbation theory simulations that use hash functions to maintain high efficiency for treating large basis sets

Sodium Consumption: An Individual's Choice?

Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions

Medication Adherence in Renal Transplant Recipients: A Latent Variable Model of Psychosocial and Neurocognitive Predictors

Objective Estimates indicate that 20–70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. Methods Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. ResultsEveryday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. Conclusions We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients

Finding a Disappearing Nontimber Forest Resource: Using Grounded Visualization to Explore Urbanization Impacts on Sweetgrass Basketmaking in Greater Mt. Pleasant, South Carolina

Despite growing interest in urbanization and its social and ecological impacts on formerly rural areas, empirical research remains limited. Extant studies largely focus either on issues of social exclusion and enclosure or ecological change. This article uses the case of sweetgrass basketmaking in Mt. Pleasant, South Carolina, to explore the implications of urbanization, including gentrification, for the distribution and accessibility of sweetgrass, an economically important nontimber forest product (NTFP) for historically African American communities, in this rapidly growing area. We explore the usefulness of grounded visualization for research efforts that are examining the existence of fringe ecologies associated with NTFP. Our findings highlight the importance of integrated qualitative and quantitative analyses for revealing the complex social and ecological changes that accompany both urbanization and rural gentrification

The MASSE Project: Applications of Biotechnology for Planetary Exploration

Automated life-detection experiments for solar system exploration have been previously. proposed and used onboard the. Viking, Mars lander,s, although. with ambiguous results. The recent advances in biotechnology such as biosensors, protein microarrays, and microfluidics alongside increased. knowledge in biomarker science have led to vastly improved sophistication and sensitivity for a new approach in life detection. The MASSE project has taken the challenge of integrating all of this knowledge into a new generation of interplanetary flight instrumentation for the main purpose.ot combining several mutually. confirming tests for life, organic/microbial contamination, prebiotic and abiotic chemicals into a small low powered instrument. Although the primary goal is interplanetary exploration, several terrestrial applications have become apparent specifically in point-of-care medical technology, bio-warfare, environmental sensing and microbial monitoring of manned space-flight vehicles

Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014

Migration then assembly: Formation of Neptune mass planets inside 1 AU

We demonstrate that the observed distribution of `Hot Neptune'/`Super-Earth' systems is well reproduced by a model in which planet assembly occurs in situ, with no significant migration post-assembly. This is achieved only if the amount of mass in rocky material is $\sim 50$--$100 M_{\oplus}$ interior to 1 AU. Such a reservoir of material implies that significant radial migration of solid material takes place, and that it occur before the stage of final planet assembly. The model not only reproduces the general distribution of mass versus period, but also the detailed statistics of multiple planet systems in the sample. We furthermore demonstrate that cores of this size are also likely to meet the criterion to gravitationally capture gas from the nebula, although accretion is rapidly limited by the opening of gaps in the gas disk. If the mass growth is limited by this tidal truncation, then the scenario sketched here naturally produces Neptune-mass objects with substantial components of both rock and gas, as is observed. The quantitative expectations of this scenario are that most planets in the `Hot Neptune/Super-Earth' class inhabit multiple-planet systems, with characteristic orbital spacings. The model also provides a natural division into gas-rich (Hot Neptune) and gas-poor (Super-Earth) classes at fixed period. The dividing mass ranges from $\sim 3 M_{\oplus}$ at 10 day orbital periods to $\sim 10 M_{\oplus}$ at 100 day orbital periods. For orbital periods $< 10$ days, the division is less clear because a gas atmosphere may be significantly eroded by stellar radiation.Comment: 41 pages in preprint style, 15 figures, final version accepted to Ap