Integrating Clinical Decision Support into Workflow

Purpose: The aims were to (1) identify barriers and facilitators related to integration of clinical decision support (CDS) into workflow and (2) develop and test CDS design alternatives. Scope: To better understand CDS integration, we studied its use in practice, focusing on CDS for colorectal cancer (CRC) screening and followup. Phase 1 involved outpatient clinics of four different systems—120 clinic staff and providers and 118 patients were observed. In Phase 2, prototyped design enhancements to the Veterans Administration’s CRC screening reminder were compared against its current reminder in a simulation experiment. Twelve providers participated. Methods: Phase 1 was a qualitative project, using key informant interviews, direct observation, opportunistic interviews, and focus groups. All data were analyzed using a coding template, based on the sociotechnical systems theory, which was modified as coding proceeded and themes emerged. Phase 2 consisted of rapid prototyping of CDS design alternatives based on Phase 1 findings and a simulation experiment to test these design changes in a within-subject comparison. Results: Very different CDS types existed across sites, yet there are common barriers: (1) lack of coordination of “outside” results and between primary and specialty care; (2) suboptimal data organization and presentation; (3) needed provider and patient education; (4) needed interface flexibility; (5) needed technological enhancements; (6) unclear role assignments; (7) organizational issues; and (8) disconnect with quality reporting. Design enhancements positively impacted usability and workflow integration but not workload. Conclusions: Effective CDS design and integration requires: (1) organizational and workflow integration; (2) integrating outside results; (3) improving data organization and presentation in a flexible interface; and (4) providing just-in time education, cognitive support, and quality reporting

Geochemical characterization of shallow groundwater at the Cranfield aquifer and numerical simulation: Can pH and carbonate parameters be used to detect potential CO2 leakage at geological CO2 sequestration sites?

Bureau of Economic Geolog

Detection of the Power Spectrum of Cosmic Microwave Background Lensing by the Atacama Cosmology Telescope

We report the first detection of the gravitational lensing of the cosmic microwave background through a measurement of the four-point correlation function in the temperature maps made by the Atacama Cosmology Telescope. We verify our detection by calculating the levels of potential contaminants and performing a number of null tests. The resulting convergence power spectrum at 2-degree angular scales measures the amplitude of matter density fluctuations on comoving length scales of around 100 Mpc at redshifts around 0.5 to 3. The measured amplitude of the signal agrees with Lambda Cold Dark Matter cosmology predictions. Since the amplitude of the convergence power spectrum scales as the square of the amplitude of the density fluctuations, the 4-sigma detection of the lensing signal measures the amplitude of density fluctuations to 12%.Comment: 4 pages, 4 figures, replaced title and author list with version accepted by Physical Review Letters. Likelihood code can be downloaded from http://bccp.lbl.gov/~sudeep/ACTLensLike.htm

Premating Reproductive Barriers between Hybridising Cricket Species Differing in Their Degree of Polyandry

Understanding speciation hinges on understanding how reproductive barriers arise between incompletely isolated populations. Despite their crucial role in speciation, prezygotic barriers are relatively poorly understood and hard to predict. We use two closely related cricket species, Gryllus bimaculatus and G. campestris, to experimentally investigate premating barriers during three sequential mate choice steps. Furthermore, we experimentally show a significant difference in polyandry levels between the two species and subsequently test the hypothesis that females of the more polyandrous species, G. bimaculatus, will be less discriminating against heterospecific males and hence hybridise more readily. During close-range mating behaviour experiments, males showed relatively weak species discrimination but females discriminated very strongly. In line with our predictions, this discrimination is asymmetric, with the more polyandrous G. bimaculatus mating heterospecifically and G. campestris females never mating heterospecifically. Our study shows clear differences in the strength of reproductive isolation during the mate choice process depending on sex and species, which may have important consequences for the evolution of reproductive barriers

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

CMB-S4

We describe the stage 4 cosmic microwave background ground-based experiment CMB-S4

INVASIVE RATS AND BUBONIC PLAGUE IN NORTHWEST UGANDA

Major introductions of roof rats (Rattus rattus) likely occurred in the ports of East Africa during the Third Plague Pandemic in the late 1800’s. Transport via trains, boats, and trucking likely introduced this species to inland areas of East Africa, ultimately including Northwest Uganda. Historic plague outbreaks occurred during the early part of the 20th century and continue to cause a human disease burden in the West Nile region of NW Uganda via the bubonic, septicemic, and pneumonic forms. Four field sites in this area were trapped to determine the rodent species composition in commensal and peridomestic areas of villages and associated flea burdens of the rodents. Rattus rattus were the most prevalent rodent trapped in commensal areas followed by the Nile rat (Arvicanthis niloticus). The most common peridomestic species of rodent was the Nile rat. Other peridomestic rodent species captured included, Mastomys natalensis, Lophuromys flavopunctatus, L. sikapusi, Gerbil (Tatera spp.), Lemniscomys spp., and 4 unknown species. Flea burdens on commensal R. rattus averaged 1.7±1.2 fleas per animal and on all peridomestic rodents, average 2.0±0.7 per animal. Additionally, commensal areas were sampled to determine free-living flea populations. Burrow swabbing indicated an average 0.19±0.12 fleas/burrow. Lighted flea traps averaged 1.3±0.6 fleas per household and dark flea traps averaged 0.5±0.4 fleas per household

Acute cough due to acute bronchitis in immunocompetent adult outpatients: CHEST Expert Panel Report

BACKGROUND: The evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guideline Cough due to Acute Bronchitis.METHODS: Acute bronchitis was defined as an acute lower respiratory tract infection manifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical PICO (Population, Intervention, Comparison, Outcome) questions were addressed by systematic review in July 2017: firstly, the role of investigations beyond the clinical assessment of patients presenting with suspected acute bronchitis; and secondly, the efficacy and safety of prescribing medication for cough in acute bronchitis. An updated search was undertaken in May 2018.RESULTS: No eligible studies relevant to the first question were identified. For the second question, only one relevant study met eligibility criteria. This study found no difference in number of days with cough between patients treated with an antibiotic or an oral non-steroidal anti-inflammatory agent compared with placebo. Clinical suggestions and research recommendations were made based on the consensus opinion of the CHEST Expert Cough Panel.CONCLUSION: The panelists suggested that no routine investigations be ordered and no routine medications be prescribed in immunocompetent adult outpatients first presenting with cough due to suspected acute bronchitis, until such investigations and treatments have been shown to be safe and effective at making cough less severe or resolve sooner. If the cough due to suspected acute bronchitis persists or worsens, a reassessment and consideration of targeted investigations should be considered