Strategies Among Health Care Business Professionals to Increase Productivity and Revenue

Health care business professionals have been slow to implement electronic medical records (EMRs), although this is a federal requirement tied to reimbursement from Medicare and Medicaid. Guided by the conceptual framework of the technology acceptance model (TAM), the purpose of this single-case study was to explore EMR strategies that health care business professionals use to increase productivity and revenue. The target population was comprised of health care business professionals with EMR strategies in Orange County, New York. Methodological triangulation included analysis of semistructured interviews with 7 health care business professionals and review of organizational documents consisting of emails, meeting minutes, and a handbook. The recruitment strategy used was random sampling and snowball sampling. Analysis included compiling data, coding the data by disassembling into categories, and reassembling the data into emergent themes. The findings of the study included 5 themes or strategies focused on EMR implementation, leaders\u27 efforts to support and sustain the EMR, helping users accept the EMR, communication and efficiency for increasing productivity and revenue, and helping users improve health care safety. Health care business organizations can benefit by knowing where to focus their resources, maximizing return on investment. The findings could effect social change by enumerating strategies that businesses can use to improve performance, and productivity for health care business professionals and improve quality, care coordination, and management of population health and safety of health care for patients

Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presentedThis work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 under Grant Agreement No. 633053. It has been partially funded by the Ministerio de Ciencia, Inovación y Universidades of Spain under projects ENE2013-48109-P, ENE2015-70142-P and FIS2017-88892-P. It has also received funds from the Spanish Government via mobility grant PRX17/00425. The authors thankfully acknowledge the computer resources at MareNostrum and the technical support provided by the Barcelona S.C. It has been supported as well by The Science and Technology Center in Ukraine (STCU), Project P-507F

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Cyber Attacks: Is Artificial Intelligence the New Defence?

From drones and ransomware to disinformation, new technologies are enabling new kinds of conflict. Is a cyber attack an act of war? With artificial intelligence poised to revolutionise the speed and impact of attacks, how can we prevent cyberspace turning into a battleground? Our expert panel discusses these and other issues. Anthony Finkelstein, Professor of Software Systems Engineering, UCL part of their defence and security research programme at the Alan Turing Institute. He has occupied various roles over a number of years advising on national security and undertaking associated research. Cal Leeming, In his early 20s, Cal worked with visionary entrepreneurs to build PixelMags, the first company to put a digital magazine on the iPhone, and The Zebra, a car insurance comparison website which collectively raised over $100m in funding. Cal now works as a Security Advisor at River Oakfield, a cyber security company which provides bespoke security solutions for private clients and recently on featured on BBC Horizon’s hard-hitting documentary about cyber-attacks on the UKs National Health Service, otherwise known as “The Day the NHS Stopped”. After a nefarious start where his natural curiosity and obsession to understand how things work led him astray, Cal was caught hacking at the age of 12, making him the youngest child ever to be prosecuted under the Computer Misuse Act in the U.K. Ganna Pogrebna, Fellow at The Alan Turing Institute and Professor of Behavioural Economics and Data Science, University of Birmingham. Her research interests in cybersecurity are around understanding and optimising human behaviour in cyber spaces. Mariarosaria Taddeo, Fellow of The Alan Turing Institute and Research Fellow and Deputy Director at the Digital Ethics Lab in the Oxford Internet Institute, University of Oxford. Her primary research area is digital ethics, with a particular focus on ethics of cyber conflicts and cybersecurity. The Debate will be chaired by writer and broadcaster Timandra Harkness. Timandra presents BBC Radio 4 series, FutureProofing, and has presented the documentaries, Data, Data Everywhere, Personality Politics & The Singularity

Cyber Attacks: Is Artificial Intelligence the New Defence?

From drones and ransomware to disinformation, new technologies are enabling new kinds of conflict. Is a cyber attack an act of war? With artificial intelligence poised to revolutionise the speed and impact of attacks, how can we prevent cyberspace turning into a battleground? Our expert panel discusses these and other issues. Anthony Finkelstein, Professor of Software Systems Engineering, UCL part of their defence and security research programme at the Alan Turing Institute. He has occupied various roles over a number of years advising on national security and undertaking associated research. Cal Leeming, In his early 20s, Cal worked with visionary entrepreneurs to build PixelMags, the first company to put a digital magazine on the iPhone, and The Zebra, a car insurance comparison website which collectively raised over $100m in funding. Cal now works as a Security Advisor at River Oakfield, a cyber security company which provides bespoke security solutions for private clients and recently on featured on BBC Horizon’s hard-hitting documentary about cyber-attacks on the UKs National Health Service, otherwise known as “The Day the NHS Stopped”. After a nefarious start where his natural curiosity and obsession to understand how things work led him astray, Cal was caught hacking at the age of 12, making him the youngest child ever to be prosecuted under the Computer Misuse Act in the U.K. Ganna Pogrebna, Fellow at The Alan Turing Institute and Professor of Behavioural Economics and Data Science, University of Birmingham. Her research interests in cybersecurity are around understanding and optimising human behaviour in cyber spaces. Mariarosaria Taddeo, Fellow of The Alan Turing Institute and Research Fellow and Deputy Director at the Digital Ethics Lab in the Oxford Internet Institute, University of Oxford. Her primary research area is digital ethics, with a particular focus on ethics of cyber conflicts and cybersecurity. The Debate will be chaired by writer and broadcaster Timandra Harkness. Timandra presents BBC Radio 4 series, FutureProofing, and has presented the documentaries, Data, Data Everywhere, Personality Politics & The Singularity

Enhanced chlorhexidine skin penetration with eucalyptus oil

Background Chlorhexidine digluconate (CHG) is a widely used skin antiseptic, however it poorly penetrates the skin, limiting its efficacy against microorganisms residing beneath the surface layers of skin. The aim of the current study was to improve the delivery of chlorhexidine digluconate (CHG) when used as a skin antiseptic. Method Chlorhexidine was applied to the surface of donor skin and its penetration and retention under different conditions was evaluated. Skin penetration studies were performed on full-thickness donor human skin using a Franz diffusion cell system. Skin was exposed to 2% (w/v) CHG in various concentrations of eucalyptus oil (EO) and 70% (v/v) isopropyl alcohol (IPA). The concentration of CHG (μg/mg of skin) was determined to a skin depth of 1500 μm by high performance liquid chromatography (HPLC). Results The 2% (w/v) CHG penetration into the lower layers of skin was significantly enhanced in the presence of EO. Ten percent (v/v) EO in combination with 2% (w/v) CHG in 70% (v/v) IPA significantly increased the amount of CHG which penetrated into the skin within 2 min. Conclusion The delivery of CHG into the epidermis and dermis can be enhanced by combination with EO, which in turn may improve biocide contact with additional microorganisms present in the skin, thereby enhancing antisepsis

Mechanism and cleavage specificity of the H-N-H endonuclease colicin E9

Colicin endonucleases and the H-N-H family of homing enzymes share a common active site structural motif that has similarities to the active sites of a variety of other nucleases such as the non-specific endonuclease from Serratia and the sequence-specific His-Cys box homing enzyme I-PpoI. In contrast to these latter enzymes, however, it remains unclear how H-N-H enzymes cleave nucleic acid substrates. Here, we show that, the H-N-H enzyme from colicin E9 (the E9 DNase) shares many of the same basic enzymological characteristics as sequence-specific H-N-H enzymes including a dependence for high concentrations of Mg2+ or Ca2+ with double-stranded substrates, a high pH optimum (pH 8-9) and inhibition by monovalent cations. We also show that this seemingly nonspecific enzyme preferentially nicks double-stranded DNA at thymine producing 3'-hydroxy and 5'-phosphate termini, and that the enzyme does not cleave small substrates, such as dinucleotides or nucleotide analogues, which has implications for its mode of inhibition in bacteria by immunity proteins. The E9 DNase will also bind single-stranded DNA above a certain length and in a sequence-independent manner, with transition metals such as Ni2+ optimal for cleavage but Mg2+ a poor cofactor. Ironically, the H-N-H motif of the E9 DNase although resembling the zinc binding site of a metalloenzyme does not support zinc-mediated hydrolysis of any DNA substrate. Finally, we demonstrate that the E9 DNase also degrades RNA in the absence of metal ions. In the context of current structural information, our data show that the H-N-H motif is an adaptable catalytic centre able to hydrolyse nucleic acid by different mechanisms depending on the substrate and metal ion regime