Pulling Back the Covers: Technical Lessons of a Real-World Health Information Exchange

Several nations and local communities are striving to achieve widespread, secure exchange of clinical data between various health care providers and public health organizations. Most of the literature on health information exchange focuses on the financial, political, and privacy aspects of these initiatives. Perhaps just as important are the technical and organizational factors that have influenced development of data exchange methods and results. One mature network in the Midwestern United States has had success in establishing consistent, secure exchange of clinical data for more than ten years. Presented here are the technical lessons learned and design decisions made from this initiative with the hope that they can be used by others striving to connect disparate clinical information systems for the improvement of health care quality and safety

Job stress among community health workers: a multi-method study from Pakistan

<p>Abstract</p> <p>Background</p> <p>In low income countries, the task of providing primary health care is often the responsibility of community health workers. In Pakistan, community workers called Lady Health Workers (LHW) deliver basic health care at the doorstep in the rural areas and urban slums. Evaluations show that it is a successful programme but point out inconsistencies in the quality of service provided. In order achieve this, it would be important to obtain the workers' viewpoint on their job-description, the problems they face and the levels of stress they encounter.</p> <p>Methods</p> <p>We conducted a multi-method study to investigate the aforementioned issues. All LHWs from one typical rural sub-district in Rawalpindi were surveyed. Focus group discussions with a sub-set of these workers were also conducted.</p> <p>Results</p> <p>About a quarter of the LHWs were found to have significant occupational stress. Factors associated with stress included having low socio-economic status and having to travel long distances for work. Inconsistent medical supplies, inadequate stipends, lack of career structure and not being equipped to communicate effectively with families were the main factors for job dissatisfaction among these workers.</p> <p>Recommendations</p> <p>Improvement in remuneration, better administration of supplies and a structured career path should be ensured for better performance of community health workers. In addition, communication skills learning should be an essential part of their training programme.</p

Cytokine Registry Database of Stroke Patients (CRISP)

Purpose/Background: The aim of the study is to identify molecular biomarkers involve in patients who present with stroke and to determine their clinical usefulness as potential biomarkers in stroke patients as compared to patients without stroke. Materials & Methods: All patients presenting with ischemic stroke and hemorrhagic stroke at University of New Mexico Hospital (UNMH) will be screened for potential participation in this study based on following inclusion and exclusion criteria: Inclusion criteria: male/female of ages ≥ 18 years, patients whose standard stroke admission order sets are obtained for clinical care. Exclusion criteria: Patients \u3c18 year, with the history of prior stroke or any neurodegenerative or neuroinflammatory disease except multiple sclerosis (MS), pregnant women and prisoners. Cytokines will be measured in serum at two different time points: on admission and after 24 hours of admission. The biomarkers which will measured in serum will include interleukin (IL)-1, 4, 6, 10, 17, 23, 33, 36, 37, PDGF, VEGFM, TNF-a, ANNULIN, MMP-9, 12, NFk-B, MPO and glial factors; GMF, SI000-B and GM-6001. These biomarkers will be evaluated using enzyme linked immunosorbent assay (ELISA). Twenty-five percent of the total stroke patient serum samples will be matched by controls without ischemic or hemorrhagic stroke. The study was approved by UNM institutional review board (IRB). All sample and data collection is being done after patient or legally authorized individual sign the informed consent form. All the data is being collected on secured RedCAP database. Results: A total of 105 patients will be enrolled during the study period. Two sets of samples; one at baseline and the other after 24 hours of admission, will collected from each enrolled patient. At present, two patients are enrolled and their samples have been collected and stored per study protocol. The study is currently under recruitment phase and it is anticipated that the enrollment will be completed within next 2 months. Biomarker analysis will be done sequentially as patients will be enrolled per study protocol. Discussion/Conclusion: The CRISP study will give us understanding about the role of various cytokines and/or other biomarkers in the pathogenesis of formation of stroke. These biomarkers can potentially serve as identifiers in the clinical surveillance for acute stroke patients. The data from this study can be beneficial in the acute management of stroke patients

Development of a Taxonomy for Health Information Technology

Taxonomies provide schemas to help classify entities and define the relationships between them. Early computing enabled the development of ontologies and Medical Subject Headings (MeSH), the first modern classification of medical terminology as applied to medical literature. Later developments, such as MEDLINE, expanded MeSH to include a number of medical informatics terms. However, a lack of specificity in MeSH and other existing informatics taxonomies for terminology used to describe the growing field of health information technology (health IT) created the need for the development of a specialized taxonomy. Experts associated with the Agency for Healthcare Research and Qualitys (AHRQs) National Resource Center for Health Information Technology (NRC) created and evaluated a taxonomy for health IT, to enable users of a public health IT Web site to efficiently identify resources within an online, searchable repository

With No Deliberate Speed: The Segregation of Roma Children in Europe

In this study, by taking the advantage of both inorganic ZnO nanoparticles and the organic material chitosan as a composite seed layer, we have fabricated well-aligned ZnO nanorods on a gold-coated glass substrate using the hydrothermal growth method. The ZnO nanoparticles were characterized by the Raman spectroscopic techniques, which showed the nanocrystalline phase of the ZnO nanoparticles. Different composites of ZnO nanoparticles and chitosan were prepared and used as a seed layer for the fabrication of well-aligned ZnO nanorods. Field emission scanning electron microscopy, energy dispersive X-ray, high-resolution transmission electron microscopy, X-ray diffraction, and infrared reflection absorption spectroscopic techniques were utilized for the structural characterization of the ZnO nanoparticles/chitosan seed layer-coated ZnO nanorods on a gold-coated glass substrate. This study has shown that the ZnO nanorods are well-aligned, uniform, and dense, exhibit the wurtzite hexagonal structure, and are perpendicularly oriented to the substrate. Moreover, the ZnO nanorods are only composed of Zn and O atoms. An optical study was also carried out for the ZnO nanoparticles/chitosan seed layer-coated ZnO nanorods, and the obtained results have shown that the fabricated ZnO nanorods exhibit good crystal quality. This study has provided a cheap fabrication method for the controlled morphology and good alignment of ZnO nanorods, which is of high demand for enhancing the working performance of optoelectronic devices

Transient Global Amnesia as the First Clinical Symptom for Malignant B-Cell Lymphoma with Central Nervous System Involvement

We present the case of an elderly male who was diagnosed with transient global amnesia (TGA), only to be diagnosed with B-cell lymphoma with central nervous system involvement a few weeks later. This is the first ever case reported in literature with lymphoma presenting as TGA. Literature review and pertinent points regarding high-yield imaging protocol for presumed TGA patients are discussed

The effectiveness of Technology-assisted Cascade Training and Supervision of community health workers in delivering the Thinking Healthy Program for perinatal depression in a post-conflict area of Pakistan - study protocol for a randomized controlled trial

BACKGROUND: Rates of perinatal depression in low and middle income countries are reported to be very high. Perinatal depression not only has profound impact on women’s health, disability and functioning, it is associated with poor child health outcomes such as pre-term birth, under-nutrition and stunting, which ultimately have an adverse trans-generational impact. There is strong evidence in the medical literature that perinatal depression can be effectively managed with psychological treatments delivered by non-specialists. Our previous research in Pakistan led to the development of a successful perinatal depression intervention, the Thinking Healthy Program (THP). The THP is a psychological treatment delivered by community health workers. The burden of perinatal depression can be reduced through scale-up of this proven intervention; however, training of health workers at scale is a major barrier. To enhance access to such interventions there is a need to look at technological solutions to training and supervision. METHODS/DESIGN: This is a non-inferiority, single-blinded randomized controlled trial. Eighty community health workers called Lady Health Workers (LHWs) working in a post-conflict rural area in Pakistan (Swat) will be recruited through the LHW program. LHWs will be randomly allocated to Technology-assisted Cascade Training and Supervision (TACTS) or to specialist-delivered training (40 in each group). The TACTS group will receive training in THP through LHW supervisors using a tablet-based training package, whereas the comparison group will receive training directly from mental health specialists. Our hypothesis is that both groups will achieve equal competence. Primary outcome measure will be competence of health workers at delivering THP using a modified ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale immediately post training and after 3 months of supervision. Independent assessors will be blinded to the LHW allocation status. DISCUSSION: Women living in post-conflict areas are at higher risk of depression compared to the general population. Implementation of evidence-based interventions for depression in such situations is a challenge because health systems are weak and human resources are scarce. The key innovation to be tested in this trial is a Technology-assisted Cascade Training and Supervision system to assist scale-up of the THP. TRIAL REGISTRATION: Registered with ClinicalTrials.gov as GCC-THP-TACTS-2015, Identifier: NCT02644902

Capillary and viscous forces during CO2 flooding in tight reservoirs

In this study, the multiphase multicomponent Shan-Chen lattice Boltzmann method is employed to analyze the impact of capillary force on oil-CO2-water  fluid flow and enhanced oil recovery. Various sizes of the single throat are designed to  simulate the interaction between displacing and displaced phases as well as their mechanical  equilibrium. Several sensitivities are taken into account, such as wettability, miscibility,  interfacial tension, and pore aperture. Based on the objective reservoir conditions,  supercritical CO2 as an injection fluid is adopted to study the influence of different displacement  patterns on the mechanical equilibrium in both homogenous and heterogeneous porous media, in  which enhanced oil recovery is also quantitatively estimated. The results show that the  water-alternating-gas injection pattern reduces the moving speed of the leading edge by  increasing the swept area of the residual oil, and inhibits the breakthrough effect of the  gas, making it the optimal displacement method in terms of the degree of oil production. Compared with the results of different displacement patterns, the enhanced oil recovery  of water-alternatinggas injection is the highest, followed by supercritical CO2 flooding after  water flooding, and lastly, continuous supercritical CO2 flooding.Cited as: Zhang, C., Zhang, Q., Wang, W., Xie, Q., Su, Y., Zafar, A. Capillary and viscous forces during CO2 flooding in tight reservoirs. Capillarity, 2022, 5(6): 105-114. https://doi.org/10.46690/capi.2022.06.0

Bioinformatics: A Way Forward to Explore “Plant Omics”

Bioinformatics, a computer-assisted science aiming at managing a huge volume of genomic data, is an emerging discipline that combines the power of computers, mathematical algorithms, and statistical concepts to solve multiple genetic/biological puzzles. This science has progressed parallel to the evolution of genome-sequencing tools, for example, the next-generation sequencing technologies, that resulted in arranging and analyzing the genome-sequencing information of large genomes. Synergism of “plant omics” and bioinformatics set a firm foundation for deducing ancestral karyotype of multiple plant families, predicting genes, etc. Second, the huge genomic data can be assembled to acquire maximum information from a voluminous “omics” data. The science of bioinformatics is handicapped due to lack of appropriate computational procedures in assembling sequencing reads of the homologs occurring in complex genomes like cotton (2n = 4x = 52), wheat (2n = 6x = 42), etc., and shortage of multidisciplinary-oriented trained manpower. In addition, the rapid expansion of sequencing data restricts the potential of acquisitioning, storing, distributing, and analyzing the genomic information. In future, inventions of high-tech computational tools and skills together with improved biological expertise would provide better insight into the genomes, and this information would be helpful in sustaining crop productivities on this planet