Integration of HeartSmart Kids into Clinical Practice: A Quality Improvement Project

Presented to the Faculty of the University of Alaska, Anchorage in partial fulfillment of requirements for the degree of MASTER OF SCIENCE, FAMILY PRACTICE NURSEIn 2009, the Centers for Medicare & Medicaid (CMS), established “Meaningful Use” regulations through an incentive program, as part of the American Recovery and Reinvestment Act of 2009 (Gance-Cleveland, Gilbert, Gilbert, Dandreaux, & Russell, 2014). Meaningful Use (MU) is tied to reimbursement and focuses on how the Electronic Health Record (EHR) is being used (Center for Disease Control and Prevention, 2012). The goal of MU is to transform the use of the EHR from a documentation tool, to a data reservoir which allows for meaningful reviews and interpretations of the quality of care (Gance-Cleveland et al, 2014).Project / Background / Significance / Review of Literature / Problem Overview / Problem Statement / Purpose / Design / Method / Plan Do Study Act (PDSA) / Ethical Considerations / Significance to Nursing / Dissemination / Conclusion

Antara Mengelabuhi atau Mencari Untung: Adakah Fraud Accounting dibalik Permainan Angka diatas Kertas?

The practice of fraud is certainly not a new phenomenon in people's lives, this practice is like an epidemic that spreads to various circles and levels. The practice of fraud plunges a person into the abyss of loss which will certainly have an impact on prosperity and the economy whose consequences can be felt by many people. Enriching yourself is the goal of this practice, because there is a feeling of dissatisfaction with what you already have. Fraudulent practices can be found in all agencies and organizations as well as other businesses, one of which is the photocopy shop business. Methods of collecting and analyzing data in this study with interviews, observation, and documentation. The results of this study indicate that there are fraudulent practices in the photocopying business and that the average customer who requests blank notes comes from all walks of life. In this study it was found that the practice of fraud occurred in the photocopy shop business by manipulating blank notes using various reasons, such as cigarette money, transportation money or other personal interests. However, there are also photocopy shop businesses that don't want to do this because they think it can hurt the store's image

ρ\rho and K∗K^* resonances on the lattice at nearly physical quark masses and Nf=2N_f=2

Working with a pion mass $m_\pi \approx 150$ MeV, we study $\pi\pi$ and $K\pi$ scattering using two flavours of non-perturbatively improved Wilson fermions at a lattice spacing $a\approx 0.071$ fm. Employing two lattice volumes with linear spatial extents of $N_s=48$ and $N_s=64$ points and moving frames, we extract the phase shifts for p-wave $\pi\pi$ and $K\pi$ scattering near the $\rho$ and $K^*$ resonances.Comparing our results to those of previous lattice studies, that used pion masses ranging from about 200 MeV up to 470 MeV, we find that the coupling $g_{\rho\pi\pi}$ appears to be remarkably constant as a function of $m_{\pi}$.Comment: 16 pages, 8 figures, v2: "and $N_f=2$" added to the title, references updated, some figures replaced, including improved summary plots, alternative parametrizations are considered and analytical continations are performed to determine pole positions on the second Riemann shee

Review of HIV-Related Cytopathology

Exfoliative and aspiration cytologies play a major role in the management of patients with human immunodeficiency virus infection. Common cytology samples include cervicovaginal and anal Papanicolaou tests, fine needle aspirations, respiratory specimens, body fluids, Tzanck preparations, and touch preparations from brain specimens. While the cytopathologists need to be aware of specific infections and neoplasms likely to be encountered in this setting, they should be aware of the current shift in the pattern of human immunodeficiency virus-related diseases, as human immunodeficiency virus patients are living longer with highly active antiretroviral therapy and suffering fewer opportunistic infections with better antimicrobial prophylaxis. There is a rise in nonhuman immunodeficiency virus-defining cancers (e.g., anal cancer, Hodgkin's lymphoma) and entities (e.g., gynecomastia) from drug-related side effects. Given that fine needle aspiration is a valuable, noninvasive, and cost-effective tool, it is frequently employed in the evaluation and diagnosis of human immunodeficiency virus-related diseases. Anal Papanicolaou tests are also increasing as a result of enhanced screening of human immunodeficiency virus-positive patients for cancer. This paper covers the broad spectrum of disease entities likely to be encountered with human immunodeficiency virus-related cytopathology

The price of usability: Designing operationalizable strategies for security games

We consider the problem of allocating scarce security resources among heterogeneous targets to thwart a possible attack. It is well known that deterministic solutions to this problem being highly predictable are severely suboptimal. To mitigate this predictability, the game-theoretic security game model was proposed which randomizes over pure (deterministic) strategies, causing confusion in the adversary. Unfortunately, such mixed strategies typically randomize over a large number of strategies, requiring security personnel to be familiar with numerous protocols, making them hard to operationalize. Motivated by these practical considerations, we propose an easy to use approach for computing strategies that are easy to operationalize and that bridge the gap between the static solution and the optimal mixed strategy. These strategies only randomize over an optimally chosen subset of pure strategies whose cardinality is selected by the defender, enabling them to conveniently tune the trade-off between ease of operationalization and efficiency using a single design parameter. We show that the problem of computing such operationalizable strategies is NP-hard, formulate it as a mixed-integer optimization problem, provide an algorithm for computing ϵ-optimal equilibria, and an efficient heuristic. We evaluate the performance of our approach on the problem of screening for threats at airport checkpoints and show that the Price of Us-ability, i.e., the loss in optimality to obtain a strategy that is easier to operationalize, is typically not high

Mining directional drug interaction effects on myopathy using the FAERS database

Mining high-order drug-drug interaction (DDI) induced adverse drug effects from electronic health record (EHR) databases is an emerging area, and very few studies have explored the relationships between high-order drug combinations. We investigate a novel pharmacovigilance problem for mining directional DDI effects on myopathy using the FDA Adverse Event Reporting System (FAERS) database. Our work provides information on the risk of myopathy associated with adding new drugs on the already prescribed medication, and visualizes the identified directional DDI patterns as user-friendly graphical representation. We utilize the Apriori algorithm to extract frequent drug combinations from the FAERS database. We use odds ratio (OR) to estimate the risk of myopathy associated with directional DDI. We create a tree-structured graph to visualize the findings for easy interpretation. Our method confirmed myopathy association with previously reported HMG-CoA reductase inhibitors like rosuvastatin, fluvastatin, simvastatin and atorvastatin. New, previously unidentified but mechanistically plausible associations with myopathy were also observed, such as the DDI between pamidronate and levofloxacin. Additional top findings are gadolinium-based imaging agents, which however are often used in myopathy diagnosis. Other DDIs with no obvious mechanism are also reported, such as that of sulfamethoxazole with trimethoprim and potassium chloride. This study shows the feasibility to estimate high-order directional DDIs in a fast and accurate manner. The results of the analysis could become a useful tool in the specialists' hands through an easy-to-understand graphic visualization

IR Sounder Small Satellite for Polar Orbit Weather Measurements

The National Environmental Satellite, Data, and Information Service (NESDIS) acquires and manages the Nation\u27s operational environmental satellites. NESDIS environmental satellite observations support a variety of civil and military environmental monitoring missions, including weather and climate prediction. A key input to weather forecast and climate models are atmospheric sounder observations from polar-orbiting satellites. These satellites are traditionally large, complex, and expensive, and take several years to design and build. The community must look for ways to reduce the cost and complexity of environmental satellites while meeting weather and climate sensing needs. This paper describes a new IR sounder concept that significantly reduces the size, mass, complexity, and consequent costs. This is accomplished through higher spectral resolution and the use of new large-area focal plane arrays, combined with novel dispersive optical design. In this design, one spectrometer with one FPA is required to perform both temperature and humidity sounding by imaging both bands onto the same FPA with an order sorting filter to separate the two bands. This paper details the design of the sensor and validation of sensor noise performance. Additionally, a thermal and spacecraft design are discussed to show the feasibility of a small-satellite scale instrument

Clinical and radiological outcome 1-year after cervical total disc replacement using the Signus ROTAIO - Prosthesis.

INTRODUCTION The instantaneous center of rotation (iCOR) of a motion segment has been shown to correlate with its total range of motion (ROM). Importantly, a correlation of the correct placement of cervical total disc replacement (cTDR) to preserve a physiological iCOR has been previously identified. However, changes of these parameters and the corresponding clinical relevance have hardly been analyzed. This study assesses the radiological and clinical correlation of iCOR and ROM following cTDR. MATERIALS/METHODS A retrospective multi-center observational study was conducted and radiological as well as clinical parameters were evaluated preoperatively and 1 year after cTDR with an unconstrained device. Radiographic parameters including flexion/extension X-rays (flex/ex), ROM, iCOR and the implant position in anterior-posterior direction (IP ap), as well as corresponding clinical parameters [(Neck Disability Index (NDI) and the visual analogue scale (VAS)] were assessed. RESULTS 57 index segments of 53 patients treated with cTDR were analyzed. Pre- and post-operative ROM showed no significant changes (8.0° vs. 10.9°; p > 0.05). Significant correlations between iCOR and IP (Pearson's R: 0.6; p < 0.01) as well as between ROM and IP ap (Pearson's R: - 0.3; p = 0.04) were identified. NDI and VAS improved significantly (p < 0.01). A significant correlation between NDI and IP ap after 12 months (Pearson's R: - 0.39; p < 0.01) was found. CONCLUSION Implantation of the tested prosthesis maintains the ROM and results in a physiological iCOR. The exact position of the device correlates with the clinical outcome and emphasize the importance of implant design and precise implant positioning

Tangential Flow Filtration for Highly Efficient Concentration of Extracellular Vesicles from Large Volumes of Fluid

Concentration of extracellular vesicles (EVs) from biological fluids in a scalable and reproducible manner represents a major challenge. This study reports the use of tangential flow filtration (TFF) for the highly efficient isolation of EVs from large volumes of samples. When compared to ultracentrifugation (UC), which is the most widely used method to concentrate EVs, TFF is a more efficient, scalable, and gentler method. Comparative assessment of TFF and UC of conditioned cell culture media revealed that the former concentrates EVs of comparable physicochemical characteristics, but with higher yield, less single macromolecules and aggregates (<15 nm in size), and improved batch-to-batch consistency in half the processing time (1 h). The TFF protocol was then successfully implemented on fluids derived from patient lipoaspirate. EVs from adipose tissue are of high clinical relevance, as they are expected to mirror the regenerative properties of the parent cells

Translational high-dimensional drug Interaction discovery and validation using health record databases and pharmacokinetics models

Polypharmacy increases the risk of drug-drug interactions (DDI's). Combining epidemiological studies with pharmacokinetic modeling, we detected and evaluated high-dimensional DDI's among thirty frequent drugs. Multi-drug combinations that increased risk of myopathy were identified in the FDA Adverse Event Reporting System (FAERS) and electronic medical record (EMR) databases by a mixture drug-count response model. CYP450 inhibition was estimated among the 30 drugs in the presence of 1 to 4 inhibitors using in vitro in vivo extrapolation. Twenty-eight 3-way and 43 4-way DDI's had significant myopathy risk in both databases and predicted increases in the area under the concentration time curve ratio (AUCR) >2-fold. The HD-DDI of omeprazole, fluconazole and clonidine was associated with a 6.41-fold (FAERS) and 18.46-fold (EMR) increase risk of myopathy (LFDR<0.005); the AUCR of omeprazole in this combination was 9.35.The combination of health record informatics and pharmacokinetic modeling is a powerful translational approach to detect high-dimensional DDI's