EHR-Based Care Coordination Performance Measures in Ambulatory Care

Describes electronic health record-based measures for assessing coordination in referrals, including information communicated with referral, communication to patient, and specialist report to primary care physician. Offers preliminary evaluation findings

Geochemical constraints on the origin of enigmatic cemented chalks, Norfolk, UK

Very hard cemented chalk stacks and crusts found locally in the upper part of the Cretaceous Chalk of north Norfolk, UK, are related to solution features. The solution features, mainly pipes and caves, formed after deposition of the overlying Middle Pleistocene Wroxham Crag, probably by routing of sub-glacial, or glacial, melt-waters derived from late Pleistocene glaciers. New geochemical (particularly stable isotope) data shows that cementation of the chalks, although related spatially to the solution features, was not caused by glacier-derived waters. The carbon isotope composition of the chalk cements is typically around -9.5‰, indicative of biologically active soils. Moreover, the oxygen isotope compositions of the cements, around -5‰, are incompatible with water d18O values much below -9 to -10‰ (which probably precludes isotopically negative glacier-derived water), as resulting palaeo-temperatures are below zero. Taken together, the isotope data suggest chalk cementation occurred under interglacial conditions similar to the present. Dissolved calcium carbonate for cementation came from dissolution of reworked chalk in overlying MIS 12 glacial tills

Quality of Child Health: Expanding the Scope and Flexibility of Measurement Approaches

Proposes a measurement framework to make data collection on the quality of children's health care more efficient and comprehensive. Considerations include focusing on measures with the greatest potential impact and adding new content or methods

Eddy genesis and manipulation in plane laminar shear flow

Eddy formation and presence in a plane laminar shear flow configuration consisting of two infinitely long plates orientated parallel to each other is investigated theoretically. The upper plate, which is planar, drives the flow; the lower one has a sinusoidal profile and is fixed. The governing equations are solved via a full finite element formulation for the general case and semi-analytically at the Stokes flow limit. The effects of varying geometry (involving changes in the mean plate separation or the amplitude and wavelength of the lower plate) and inertia are explored separately. For Stokes flow and varying geometry, excellent agreement between the two methods of solution is found. Of particular interest with regard to the flow structure is the importance of the clearance that exists between the upper plate and the tops of the corrugations forming the lower one. When the clearance is large, an eddy is only present at sufficiently large amplitudes or small wavelengths. However, as the plate clearance is reduced, a critical value is found which triggers the formation of an eddy in an otherwise fully attached flow for any finite amplitude and arbitrarily large wavelength. This is a precursor to the primary eddy to be expected in the lid-driven cavity flow which is formed in the limit of zero clearance between the plates. The influence of the flow driving mechanism is assessed by comparison with corresponding solutions for the case of gravity-driven fluid films flowing over an undulating substrate. When inertia is present, the flow generally becomes asymmetrical. However, it is found that for large mean plate separations the flow local to the lower plate becomes effectively decoupled from the inertia dominated overlying flow if the wavelength of the lower plate is sufficiently small. In such cases the local flow retains its symmetry. A local Reynolds number based on the wavelength is shown to be useful in characterising these large-gap flows. As the mean plate separation is reduced, the form of the asymmetry caused by inertia changes, and becomes strongly dependent on the plate separation. For lower plate wavelengths which do not exhibit a cinematically induced secondary eddy, an inertially induced secondary eddy can be created if the mean plate separation is sufficiently small and the global Reynolds number sufficiently large

Mesozoic climates and oceans – a tribute to Hugh Jenkyns and Helmut Weissert

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.The study of past greenhouse climate intervals in Earth history, such as the Mesozoic, is an important, relevant and dynamic area of research for many sedimentary geologists, geochemists, palaeontologists and climate modellers. The Mesozoic sedimentary record provides key insights into the mechanics of how the Earth system works under warmer conditions, providing examples of natural climate change and perturbations to ocean chemistry, including anoxia, that are of societal relevance for understanding and contextualizing ongoing and future environmental problems. Furthermore, the deposition of widespread organic-carbon-rich sediments (‘black shales’) during the Mesozoic means that this is an era of considerable economic interest. In July 2015, an international group of geoscientists attended a workshop in Ascona, Switzerland, to discuss all aspects of the Mesozoic world and to celebrate the four-decade-long contributions made by Hugh Jenkyns (University of Oxford) and Helmut Weissert (ETH Zürich) to our understanding of this fascinating era in Earth history. This volume of Sedimentology arose from that meeting and contains papers inspired by (and co-authored by!) Hugh and Helmi. Here, a brief introduction to the volume is provided that reviews aspects of Hugh and Helmi's major achievements; contextualizes the papers of the Thematic Issue; and discusses some of the outstanding questions and areas for future research

Numerical modeling of lathanide-ion doped fibre lasers operating within mid-infrared wavelength region

We discuss the numerical modelling of lanthanide-ion doped chalcogenide glass fibre lasers for operation in the mid-infrared wavelength region. We extract the modelling parameters from emission and absorption measurements using Judd-Ofelt and McCumber theory. Numerical algorithms are developed based on the experimentally extracted fibre parameters. The simulation results predict lasing with slope efficiency of at least 20 % provided, that the fibre loss can be kept at the level of 1 dB/m or less

Use of Nutritional Supplements in Youth with Medicated and Unmedicated Attention-Deficit/Hyperactivity Disorder

Objective: To find out whether use of nutritional supplements (NUS) differs between children and adolescents with attention-deficit/hyperactivity disorder (ADHD; medicated or unmedicated), compared with those without the disorder. Methods: We used cross-sectional data from the population-based I.Family study conducted between 2013 and 2014 in eight European countries. Parents completed questionnaires and participated in interviews, for example, on health and medical history of their child. Data from 5067 children and adolescents aged 5-17 years were included. Exposures were medicated (with ADHD-approved medication) and unmedicated ADHD. The outcome was the use of NUS, measured by use of any or multiple different NUS. Multivariable logistic regression adjusted for sociodemographics and health determinants was used to find ADHD-depending differences. Results: The study sample comprised 4490 children and adolescents without ADHD and 51 medicated and 76 unmedicated subjects with ADHD. Regarding the use of any NUS, no statistically significant differences were found between children and adolescents without ADHD (18%) and those with medicated (18%) or unmedicated ADHD (22%). However, discrepancies appear when considering multiple use of NUS, not reported for any medicated ADHD subject but remarkably often for unmedicated ADHD subjects (13%), resulting in an adjusted odds ratio of 2.6 (95% confidence interval, 1.2-5.6) when compared with those without ADHD (5%). Conclusion: Children and adolescents who were not using medication for treating ADHD potentially took NUS as oral remedies. Given the potential for a delay of indicated treatments and for use of those NUS which have no proven effectiveness, pediatricians should actively explore whether NUS have been used to treat ADHD core symptoms, and families should be informed that the average effect size has to be considered small