Clinical decision support for intervention reduction in neonatal patients: A usability assessment

Objective This study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify. Method A human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings. Results Evaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol\u27s data is currently being shown. Conclusion Independent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3\u27s new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician\u27s cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use

O, Give Me A Home: Kids, Stability, & Education

Examines the state of homelessness in Oregon, with special focus on special needs for homeless students. Looks at factors affecting housing instability, student stability rates, and what schools should do to best serve homeless students. Calls for a re-examination of homeless stereotypes, in light of the fact that one third of the homeless in Oregon are children

A Case Study of the Baldock Restoration Project

Since the 1980s, homelessness has become an increasingly visible and seemingly intransigent part of American society. It affects not only those who experience it directly, as a condition in their own lives, but also a broad spectrum of interests that deal with its effects. One such interest is owners and managers of public land, where homeless individuals commonly seek refuge, sometimes forming communities. Although their business may be transportation, natural resources management, recreation or some other public service, managers of public land are called upon to deal with this complex environmental, legal and human problem. This is a case study of the Baldock Restoration Project, in which a team of people from the travel, transportation, law enforcement and social services professions came together to help homeless individuals leave their long-standing community located in an Oregon highway rest area, thus restoring the rest area to its original function. This case study is part of a larger project to analyze ways in which transportation agencies address the challenge of homeless encampments on public rights of way. A best practices guide of potential strategies and interventions for a variety of contexts will also be prepared. The case study was prepared over a six-month period that began approximately one year after the conclusion of the project. Primary sources included semi-structured interviews with eleven key informants who were part of the team working on the project and three former members of the homeless community. Documentary sources included media accounts, meeting minutes and reports written by key informants. Sources were triangulated to promote accuracy

Biomarkers of Inflammation and Fibrosis in Kawasaki Disease Patients Years After Initial Presentation With Low Ejection Fraction.

Background Coronary artery aneurysms and myocarditis are well-recognized complications of Kawasaki disease (KD) but no systematic evaluation of the consequences of myocarditis has been performed in the subset presenting with low ejection fraction (EF). We postulated that more severe myocardial inflammation as evidenced by low EF during the acute phase could lead to late myocardial fibrosis. Methods and Results We measured the carboxyterminal propeptide of procollagen type I (PIPC), soluble suppressor of tumorigenicity 2, galectin-3 (Gal-3), growth-differentiation factor-15, and calprotectin by ELISA in late convalescent blood samples from 16 KD patients who had an EF ≤55% on their initial echocardiogram. Results were compared with samples from sex- and age-matched KD patients with initial EF >60%. In the univariate analysis, the median Gal-3 and PIPC levels in the low EF group were significantly higher than those in the normal EF group (Gal-3: low EF 6.216 versus normal EF 4.976 mg/dL P=0.038, PIPC: low EF 427.4 versus normal EF 265.2 mg/dL, P=0.01). In a multivariable analysis, there were significant differences for Gal-3 and PIPC levels between the low and normal EF groups, adjusting for age, sex, and worst z score. Conclusions Convalescent KD patients with a history of low EF during the acute illness had significantly elevated levels of Gal-3 and PIPC when compared with matched-control KD patients with normal EF. These findings raise concern for myocardial fibrosis as a potential late sequela of the more severe myocarditis experienced by a subset of KD patients during the acute phase

The Footbridge

Short stor

Hydrodynamic limit for the velocity flip model

We study the diffusive scaling limit for a chain of $N$ coupled oscillators. In order to provide the system with good ergodic properties, we perturb the Hamiltonian dynamics with random flips of velocities, so that the energy is locally conserved. We derive the hydrodynamic equations by estimating the relative entropy with respect to the local equilibrium state modified by a correction term

Differences in GlycA and lipoprotein particle parameters may help distinguish acute kawasaki disease from other febrile illnesses in children.

BackgroundGlycosylation patterns of serum proteins, such as α1-acid glycoprotein, are modified during an acute phase reaction. The response of acute Kawasaki disease (KD) patients to IVIG treatment has been linked to sialic acid levels on native IgG, suggesting that protein glycosylation patterns vary during the immune response in acute KD. Additionally, the distribution and function of lipoprotein particles are altered during inflammation. Therefore, the aim of this study was to explore the potential for GlycA, a marker of protein glycosylation, and the lipoprotein particle profile to distinguish pediatric patients with acute KD from those with other febrile illnesses.MethodsNuclear magnetic resonance was used to quantify GlycA and lipoprotein particle classes and subclasses in pediatric subjects with acute KD (n = 75), post-treatment subacute (n = 36) and convalescent (n = 63) KD, as well as febrile controls (n = 48), and age-similar healthy controls (n = 48).ResultsGlycA was elevated in acute KD subjects compared to febrile controls with bacterial or viral infections, IVIG-treated subacute and convalescent KD subjects, and healthy children (P <0.0001). Acute KD subjects had increased total and small low density lipoprotein particle numbers (LDL-P) (P <0.0001) and decreased total high density lipoprotein particle number (HDL-P) (P <0.0001) compared to febrile controls. Consequently, the ratio of LDL-P to HDL-P was higher in acute KD subjects than all groups tested (P <0.0001). While GlycA, CRP, erythrocyte sedimentation rate, LDL-P and LDL-P/HDL-P ratio were able to distinguish patients with KD from those with other febrile illnesses (AUC = 0.789-0.884), the combinations of GlycA and LDL-P (AUC = 0.909) or GlycA and the LDL-P/HDL-P ratio (AUC = 0.910) were best at discerning KD in patients 6-10 days after illness onset.ConclusionsHigh levels of GlycA confirm enhanced protein glycosylation as part of the acute phase response in KD patients. When combined with common laboratory tests and clinical characteristics, GlycA and NMR-measured lipoprotein particle parameters may be useful for distinguishing acute KD from bacterial or viral illnesses in pediatric patients

Author Correction: Clustering and climate associations of Kawasaki Disease in San Diego County suggest environmental triggers.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper