A Process Improvement Project: Demonstrating a Patient Portal to Increase Enrollment and Use in an Underserved Population with Chronic Illness

High risk, high cost chronic conditions such as diabetes, asthma, and congestive heart failure are prevalent in the United States. Nearly half of all Americans have at least one chronic condition (Centers for Disease Control and Prevention, 2009). Almost four-fifths of total health care spending in the U.S. is related to high risk, chronic conditions (Baker, Johnson, Macaulay, & Birnbaum, 2011). The use of patient portals in ambulatory care may be an avenue toward improving chronic disease management. Portals can be used by patients to schedule appointments, send secure messages to their providers, request medication refills, review lab and test results, make payments, and other activities. The purpose of this quality improvement project was to evaluate whether combining portal demonstration to patients during clinic visits with immediate enrollment would increase the use of a portal in a safety-net primary care clinic. Most of the participants (N = 51) were Caucasian aged 38 to 47 years, high school graduates, and diabetic with no comorbid conditions. Over half were daily internet users. Participants’ use of the portal was recorded over three months. The use rate improved from none prior to portal demonstration to 39.2%. The demonstration was timed and a cost analysis was performed to present a sustainability plan for demonstration adoption in the primary care clinic. Increased portal use rates may over time equate to improved patient-provider communication and increased patient self-care, leading to improved chronic condition management

Jonathan Gibson

Professor Jonathan Gibson MB BS MD FRCSEd, FRCOphth (1966-1971) is a Consultant Ophthalmic Surgeon for the Heart of England NHS Trust, Birmingham and a Professor of Ophthalmology at the University of Aston. He looks back at his time at Merchant Taylors’ and his career

Diversity oriented synthesis : substitution at C5 in unreactive pyrimidines by Claisen rearrangement and reactivity in nucleophilic substitution at C2 and C4 in pteridines and pyrido[2,3-d]pyrimidines

Diversity oriented synthesis of fused pyrimidines leads to scaffolds with many biological activities. In the case of the preparation of pyrido[2,3-d]pyrimidines from 2-alkylthiopyrimidines, the formation of a new carbon-carbon bond at C5 is required, a reaction that is very limited in scope. However Claisen type rearrangement of simple 4-allylic ethers affords C5 substituted pyrimidines readily; in cases with an ester substituent, rearrangement occurs at room temperature. Subsequent cyclisation to afford 6-methylpyrido[2,3-d]pyrimidin-7(8H)-ones was achieved in high yield. Using allylic ethers derived from 3-chloromethyl-4-arylbut-3-en-2-ones as substrates, a new titanium[IV]chloride catalysed reaction affording 6-arylmethyl-7-methylpyrido[2,3-d]pyrimidines was discovered. In contrast, 2-alkylthiopteridines are readily available. In both cases, substitution at C2 and C4 to generate diversity has been carried out and the reactivity compared; yields of substitution products were generally higher with pteridine substrates. In biological assays unexpected hits were found for activity against the Gram positive bacterium, Nocardia farcinia, and against the parasite Trypanosoma brucei brucei, illustrating the value of diversity oriented synthesis in the discovery of biologically active compound

Applications of percolation theory to fungal spread with synergy

There is increasing interest in the use of the percolation paradigm to analyze and predict the progress of disease spreading in spatially-structured populations of animals and plants. The wider utility of the approach has been limited, however, by several restrictive assumptions, foremost of which is a strict requirement for simple nearest-neighbour transmission, in which the disease history of an individual is in uenced only by that of its neighbours. In a recent paper the percolation paradigm has been generalised to incorporate synergistic interactions in host infectivity and susceptibility and the impact of these interactions on the invasive dynamics of an epidemic has been demonstrated. In the current paper we elicit evidence that such synergistic interactions may underlie transmission dynamics in real-world systems by rst formulating a model for the spread of a ubiquitous parasitic and saprotrophic fungus through replicated populations of nutrient sites and subsequently tting and testing the model using data from experimental microcosms. Using Bayesian computational methods for model tting, we demonstrate that synergistic interactions are necessary to explain the dynamics observed in the replicate experiments. The broader implications of this work in identifying disease control strategies that de ect epidemics from invasive to non-invasive regimes are discussed

Imaging of the human fundus in the clinical setting:past present and future

The human fundus is a complex structure that can be easily visualized and the world of ophthalmology is going through a golden era of new and exciting fundus imaging techniques; recent advances in technology have allowed a significant improvement in the imaging modalities clinicians have available to formulate a diagnostic and treatment plan for the patient, but there is constant on-going work to improve current technology and create new ideas in order to gather as much information as possible from the human fundus. In this article we shall summarize the imaging techniques available in the standard medical retina clinic (i.e. not limited to the research lab) and delineate the technologies that we believe will have a significant impact on the way clinicians will assess retinal and choroidal pathology in the not too distant future

Recent advances in topical therapeutics for vitreoretinal diseases

Eye drops are convenient for patients, but achieving therapeutic doses and maintaining sustained drug release without frequent re-application to treat diseases of the retina has been largely unsuccessful. Topical administration of drugs is hindered by the anatomy, physiology, and biochemistry of the eye and its highly effective defence mechanisms. Advances in nanotechnology have led to the experimental use of topical permeation-enhancing liposomes, emulsions, and microspheres to enhance absorption and penetration of drugs across membranes; allow controlled release of the drug; and to target drugs at distinct tissues to allow sufficient local bioavailability. In the near future it is hoped that improved technologies may provide means of sustained topical drug delivery for retinal therapy, with improved side-effect profiles and reduced cost compared with currently available clinical treatments

Platelet-mediated metabolism of the common dietary flavonoid, quercetin.

BACKGROUND: Flavonoid metabolites remain in blood for periods of time potentially long enough to allow interactions with cellular components of this tissue. It is well-established that flavonoids are metabolised within the intestine and liver into methylated, sulphated and glucuronidated counterparts, which inhibit platelet function. METHODOLOGY/PRINCIPAL FINDINGS: We demonstrate evidence suggesting platelets which contain metabolic enzymes, as an alternative location for flavonoid metabolism. Quercetin and a plasma metabolite of this compound, 4'-O-methyl quercetin (tamarixetin) were shown to gain access to the cytosolic compartment of platelets, using confocal microscopy. High performance liquid chromatography (HPLC) and mass spectrometry (MS) showed that quercetin was transformed into a compound with a mass identical to tamarixetin, suggesting that the flavonoid was methylated by catechol-O-methyl transferase (COMT) within platelets. CONCLUSIONS/SIGNIFICANCE: Platelets potentially mediate a third phase of flavonoid metabolism, which may impact on the regulation of the function of these cells by metabolites of these dietary compounds

Fuzzing to Identify Undiscovered Bugs in Scientific Software

Scientific software is defined as software that aids in research, testing or design of scientific models that are used to explain and predict the behavior of real objects or systems in a variety of scientific disciplines. Bugs in scientific software can cause large-scale consequences, for example, error-prone scientific results can lead to ineffectual projects and embarrassing retractions, incorrect financial transactions can cause tremendous monetary loss, etc. However, scientific software is typically developed by novices who are not well-equipped with bug finding tools. In this research, we investigate methods to systematically find undiscovered bugs in scientific software packages written in Julia. Julia is a programming language designed specifically for scientific and numeric computing. The goal of our research is to help scientific software developers find undiscovered bugs using fuzzing. Fuzzing is defined as a software testing technique which incorporates automated random input generation and injection to a software in the hopes of triggering an error condition or fault. We investigate 20 open-source Julia repositories collected from GitHub and apply fuzzing on these repositories. We have developed fuzzers in Python for four programs and have done some preliminary analysis on the documented crash reports. We find that there are several unhandled exception conditions in them, for example, we found 5 bugs in the Julia FFTW package, and 4 bugs in the Julia HTTP package