Electronic Health Records and Support For Primary Care Teamwork

This study examined primary care practices' experiences using electronic health records (EHRs) as they strive to function as teams in patientcentered medical homes (PCMHs). We identify how EHRs facilitate and pose challenges to teamwork and how practices overcame such challenges. We describe solutions and identify opportunities to improve care processes as well as EHR functionalities and policies, to support teamwork

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

Electrified thin film flow at finite Reynolds number on planar substrates featuring topography

The flow of a gravity-driven thin liquid film over a substrate containing topography, in the presence of a normal electric field, is investigated. The liquid is assumed to be a perfect conductor and the air above it a perfect dielectric. Of particular interest is the interplay between inertia, for finite values of the Reynolds number, Re, and electric field strength, expressed in terms of the Weber number, We, on the resultant free-surface disturbance away from planarity. The hydrodynamics of the film are modelled via a depth-averaged form of the Navier–Stokes equations which is coupled to a Fourier series separable solution of Laplace’s equation for the electric potential: detailed steady-state solutions of the coupled equation set are obtained numerically. The case of two-dimensional flow over different forms of discrete and periodically varying spanwise topography is explored. In the case of the familiar free-surface capillary peaks and depressions that arise for steep topography, and become more pronounced with increasing Re, greater electric field strength affects them differently. In particular, it is found that for topography heights commensurate with the long-wave approximation: (i) the capillary ridge associated with a step-down topography at first increases before decreasing, both monotonically, with increasing We and (ii) the free-surface hump which arises at a step-up topography continues to increase monotonically with increasing We, the increase achieved being smaller the larger the value of Re. A series of results for the more practically relevant problem of three-dimensional film flow over substrate containing a localised square trench topography is provided. These exhibit behaviour and features consistent with those observed for two-dimensional flow, in that as We is increased the primary free-surface capillary ridges and depressions are at first enhanced, with a corresponding narrowing, before becoming suppressed. In addition, it is found that, while the well-known horse-shoe shaped disturbance characteristic of such flows continues to persist with increasing Re in the absence of an electric field, when the latter is present and We increased in value the associated comet tail disappears as does the related downstream surge. The phenomenon is explained with reference to the competition between the corresponding capillary pressure and Maxwell stress distributions

A Qualitative Analysis of Women's Satisfaction with Primary Care from a Panel of Focus Groups in the National Centers of Excellence in Women's Health

Health issues unique to women and differences in healthcare experiences have recently gained attention as health plans and systems seek to extend and improve health promotion and disease prevention in the population. Successful efforts focused on enhancing quality of care will require information from the patient's perspective on how to improve such services to best support women's attempts to lead healthy and productive lives. The National Centers of Excellence in Women's Health program (CoE), sponsored by the Office on Women's Health within the Department of Health and Human Services, is based on an integrated model uniting research, training, healthcare, and community education and outreach. To examine women's concept and definitions of healthcare quality, 18 focus groups comprising 137 women were conducted nationwide on experiences and attributes of healthcare that women value in primary care. Following the focus groups, a woman-focused healthcare satisfaction instrument was developed for the purpose of assessing and improving healthcare delivery. We describe the qualitative results of the focus group study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63264/1/15246090152563515.pd

Optical and EPR spectroscopy of Er3+ in lithium yttrium borate, Li6Y(BO3)3:Er single crystals

The energy levels of Er3+ ions have been determined in lithium yttrium borate (Li6Y(BO3)3) single crystals in a wide spectral range between 6000 and 40000 cm-1 together with an analysis of the ground state, using optical and EPR spectroscopy. The crystal field splittings of the 4I15/2 ground state and those of nearly all excited states up to the 4D7/2 manifold have been obtained at low temperature from luminescence (T = 5 K) and absorption (T = 9 K) measurements, respectively. The numbers of experimentally observed Stark sublevels agree well with those expected theoretically for Er3+ ions occupying a single low symmetry (C1) site. A full set of g- and 167Er hyperfine tensor parameters are presented for the ground state characterized by EPR; the measured Orbach-type spin-relaxation rates viz. the involved activation energies correspond to the optically derived lowest excited sublevels

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

Associations between age and sleep apnea risk among newborn infants

ObjectiveAmong older children, sleep‐disordered breathing (SDB) is associated with measurable neurocognitive consequences. However, diagnostic SDB thresholds are lacking for infants < 12 months. We sought to evaluate the relationship between SDB indices, gestational age (GA), and postmenstrual age (PMA) for infants who underwent clinically‐indicated polysomnograms at a tertiary care center.MethodsEvery infant < 3‐months chronological age whose first clinically‐indicated polysomnogram was between 2/2012 and 2/2017 was included. Linear regression was used to evaluate associations between apnea‐hypopnea index (AHI), obstructive‐apnea index (OAI), and GA and PMA for infants with and without obvious clinical risk factors for SDB (eg, micrognathia and cleft palate).ResultsFor 53 infants without obvious SDB risk factors (GA 35.6 ± 4.5 weeks; PMA 41.2 ± 4.0 weeks), mean AHI was 27 ± 18 and OAI 2.9 ± 4.5. There was a weak inverse relationship between AHI and PMA (r2 = 0.12, P = 0.01), but AHI was not predicted by GA (r2 = 0.04, P = 0.13). Conversely, OAI was more strongly associated with GA (r2 = 0.33, P < 0.0001) than PMA (r2 = 0.08, P = 0.036). For 28 infants with congenital structural anomalies that predispose to SDB (GA 38.0 ± 3.1 weeks, PMA 43.1 ± 3.3 weeks, AHI 37.7 ± 30, OAI 8.2 ± 11.8), neither AHI nor OAI were related to PMA or GA.ConclusionsAmong infants who received clinically‐indicated polysomnograms but did not have obvious structural risk for SDB, AHI declined with advancing PMA, but obstructive‐apnea was best predicted by prematurity. In contrast, the SDB risk did not improve with increasing GA or PMA for infants with congenital structural risk factors; such infants may not outgrow their risk for SDB.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150552/1/ppul24354_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150552/2/ppul24354.pd

The Effect of Epstein-Barr Virus Latent Membrane Protein 2 Expression on the Kinetics of Early B Cell Infection

Infection of human B cells with wild-type Epstein-Barr virus (EBV) in vitro leads to activation and proliferation that result in efficient production of lymphoblastoid cell lines (LCLs). Latent Membrane Protein 2 (LMP2) is expressed early after infection and previous research has suggested a possible role in this process. Therefore, we generated recombinant EBV with knockouts of either or both protein isoforms, LMP2A and LMP2B (Δ2A, Δ2B, Δ2A/Δ2B) to study the effect of LMP2 in early B cell infection. Infection of B cells with Δ2A and Δ2A/Δ2B viruses led to a marked decrease in activation and proliferation relative to wild-type (wt) viruses, and resulted in higher percentages of apoptotic B cells. Δ2B virus infection showed activation levels comparable to wt, but fewer numbers of proliferating B cells. Early B cell infection with wt, Δ2A and Δ2B viruses did not result in changes in latent gene expression, with the exception of elevated LMP2B transcript in Δ2A virus infection. Infection with Δ2A and Δ2B viruses did not affect viral latency, determined by changes in LMP1/Zebra expression following BCR stimulation. However, BCR stimulation of Δ2A/Δ2B cells resulted in decreased LMP1 expression, which suggests loss of stability in viral latency. Long-term outgrowth assays revealed that LMP2A, but not LMP2B, is critical for efficient long-term growth of B cells in vitro. The lowest levels of activation, proliferation, and LCL formation were observed when both isoforms were deleted. These results suggest that LMP2A appears to be critical for efficient activation, proliferation and survival of EBV-infected B cells at early times after infection, which impacts the efficient long-term growth of B cells in culture. In contrast, LMP2B did not appear to play a significant role in these processes, and long-term growth of infected B cells was not affected by the absence of this protein. © 2013 Wasil et al