Entrepreneurial IT governance in a rural family practice residency program

This study describes and assesses the evolution of IT governance practices in a rural family practice residency program. The need to establish IT governance was driven by the practice\u27s desire to implement electronic medical records capability. The authors employed a prominent information technology (IT) governance framework to conduct this assessment and exposed significant strengths and weaknesses in terms of the suitability of the IT gover nance framework within the rural healthcare setting as described. Given the relatively slow adoption rates within the healthcare industry in general, and among rural health providers more specifically, we present local knowledge (Geertz, 1985). In doing so, we provide an additional perspective for those seeking to construct theoretical bases for the formulation of health policy intended to promote the adoption of IT as a means of improving healthcare in the rural United States. In addition, this chapter describes the role of IT in enabling the residency practice to embrace current practice improvement initiatives. © 2008, IGI Global

Incomplete quantum state estimation: a comprehensive study

We present a detailed account of quantum state estimation by joint maximization of the likelihood and the entropy. After establishing the algorithms for both perfect and imperfect measurements, we apply the procedure to data from simulated and actual experiments. We demonstrate that the realistic situation of incomplete data from imperfect measurements can be handled successfully.Comment: 11 pages, 10 figure

Foraging for foundations in decision neuroscience: insights from ethology

Modern decision neuroscience offers a powerful and broad account of human behaviour using computational techniques that link psychological and neuroscientific approaches to the ways that individuals can generate near-optimal choices in complex controlled environments. However, until recently, relatively little attention has been paid to the extent to which the structure of experimental environments relates to natural scenarios, and the survival problems that individuals have evolved to solve. This situation not only risks leaving decision-theoretic accounts ungrounded but also makes various aspects of the solutions, such as hard-wired or Pavlovian policies, difficult to interpret in the natural world. Here, we suggest importing concepts, paradigms and approaches from the fields of ethology and behavioural ecology, which concentrate on the contextual and functional correlates of decisions made about foraging and escape and address these lacunae

Kv2.1 channels play opposing roles in regulating membrane potential, Ca2+ channel function, and myogenic tone in arterial smooth muscle.

The accepted role of the protein Kv2.1 in arterial smooth muscle cells is to form K+ channels in the sarcolemma. Opening of Kv2.1 channels causes membrane hyperpolarization, which decreases the activity of L-type CaV1.2 channels, lowering intracellular Ca2+ ([Ca2+]i) and causing smooth muscle relaxation. A limitation of this model is that it is based exclusively on data from male arterial myocytes. Here, we used a combination of electrophysiology as well as imaging approaches to investigate the role of Kv2.1 channels in male and female arterial myocytes. We confirmed that Kv2.1 plays a canonical conductive role but found it also has a structural role in arterial myocytes to enhance clustering of CaV1.2 channels. Less than 1% of Kv2.1 channels are conductive and induce membrane hyperpolarization. Paradoxically, by enhancing the structural clustering and probability of CaV1.2-CaV1.2 interactions within these clusters, Kv2.1 increases Ca2+ influx. These functional impacts of Kv2.1 depend on its level of expression, which varies with sex. In female myocytes, where expression of Kv2.1 protein is higher than in male myocytes, Kv2.1 has conductive and structural roles. Female myocytes have larger CaV1.2 clusters, larger [Ca2+]i, and larger myogenic tone than male myocytes. In contrast, in male myocytes, Kv2.1 channels regulate membrane potential but not CaV1.2 channel clustering. We propose a model in which Kv2.1 function varies with sex: in males, Kv2.1 channels control membrane potential but, in female myocytes, Kv2.1 plays dual electrical and CaV1.2 clustering roles. This contributes to sex-specific regulation of excitability, [Ca2+]i, and myogenic tone in arterial myocytes

Identifying challenges in the use of urine-diverting toilets: a case study from Rukungiri Municipality (S.W. Uganda)

In Rukungiri Municipality, the installation of pit latrines is hindered by limited space, rocky soils, and a high water table. A limited water supply eliminates flush toilets as a feasible option. Through surveys of users of Urine-Diverting Dry Toilets (UDDTs), the authors discovered that, although residents have been strongly encouraged by the Municipality to install these facilities, they have received limited education and training regarding their construction and operation. Other challenges identified include a lack of desiccating materials and the need to establish a safe, effective system for emptying and disposing of fecal material. To address these issues, the possibility of desiccant delivery and toilet emptying services should be explored, and further sensitization should occur, perhaps through public gatherings and the distribution of low-cost signs describing proper operation. The authors hope that, through these recommendations, UDDTs will become a safer, better understood, and more widespread sanitation option within Rukungiri Municipality

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program.

BACKGROUND: Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials. METHODS: We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis. RESULTS: We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients. CONCLUSION: This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs

Carbon Nanotube Electron Windmills: A Novel Design for Nanomotors

We propose a new drive mechanism for carbon nanotube (CNT) motors, based upon the torque generated by a flux of electrons passing through a chiral nanotube. The structure of interest comprises a double-walled CNT, formed from, for example, an achiral outer tube encompassing a chiral inner tube. Through a detailed analysis of electrons passing through such a "windmill", we find that the current due to a potential difference applied to the outer CNT generates sufficient torque to overcome the static and dynamic frictional forces that exists between the inner and outer walls, thereby causing the inner tube to rotate.Comment: 10 pages and 4 figure

Kv2.1 mediates spatial and functional coupling of L-type calcium channels and ryanodine receptors in mammalian neurons.

The voltage-gated K+ channel Kv2.1 serves a major structural role in the soma and proximal dendrites of mammalian brain neurons, tethering the plasma membrane (PM) to endoplasmic reticulum (ER). Although Kv2.1 clustering at neuronal ER-PM junctions (EPJs) is tightly regulated and highly conserved, its function remains unclear. By identifying and evaluating proteins in close spatial proximity to Kv2.1-containing EPJs, we discovered that a significant role of Kv2.1 at EPJs is to promote the clustering and functional coupling of PM L-type Ca2+ channels (LTCCs) to ryanodine receptor (RyR) ER Ca2+ release channels. Kv2.1 clustering also unexpectedly enhanced LTCC opening at polarized membrane potentials. This enabled Kv2.1-LTCC-RyR triads to generate localized Ca2+ release events (i.e., Ca2+ sparks) independently of action potentials. Together, these findings uncover a novel mode of LTCC regulation and establish a unique mechanism whereby Kv2.1-associated EPJs provide a molecular platform for localized somatodendritic Ca2+ signals in mammalian brain neurons