A case study in open source innovation: developing the Tidepool Platform for interoperability in type 1 diabetes management.

OBJECTIVE:Develop a device-agnostic cloud platform to host diabetes device data and catalyze an ecosystem of software innovation for type 1 diabetes (T1D) management. MATERIALS AND METHODS:An interdisciplinary team decided to establish a nonprofit company, Tidepool, and build open-source software. RESULTS:Through a user-centered design process, the authors created a software platform, the Tidepool Platform, to upload and host T1D device data in an integrated, device-agnostic fashion, as well as an application ("app"), Blip, to visualize the data. Tidepool's software utilizes the principles of modular components, modern web design including REST APIs and JavaScript, cloud computing, agile development methodology, and robust privacy and security. DISCUSSION:By consolidating the currently scattered and siloed T1D device data ecosystem into one open platform, Tidepool can improve access to the data and enable new possibilities and efficiencies in T1D clinical care and research. The Tidepool Platform decouples diabetes apps from diabetes devices, allowing software developers to build innovative apps without requiring them to design a unique back-end (e.g., database and security) or unique ways of ingesting device data. It allows people with T1D to choose to use any preferred app regardless of which device(s) they use. CONCLUSION:The authors believe that the Tidepool Platform can solve two current problems in the T1D device landscape: 1) limited access to T1D device data and 2) poor interoperability of data from different devices. If proven effective, Tidepool's open source, cloud model for health data interoperability is applicable to other healthcare use cases

Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults

Hospital adverse events, such as falls, violence and aggression, security, self-harm, and suicide, are difficult to manage in older people with dementia. The purpose of the present study was to determine whether protected engagement time (PET) resulted in lower adverse events and incidents compared to comparable non-PET wards for people admitted to inpatient older people's mental health wards. Ten inpatient wards for older people were included. Five followed a PET-management pathway, while five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72weeks. Data were gathered from these records and analysed as rate per person per week to assess differences in frequency and type of adverse events between wards. A total of 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non-PET wards. No statistically-significant differences were found between PET and non-PET wards for adverse events (P=0.93), or for adverse events of any particular type (P≥0.15). Therefore, there is no evidence to suggest that PET has any impact on adverse events in older people's mental health wards. Further investigation with a larger cohort is warranted, using a definitive, phase 3, clinical trial

Follow‐Up Survey on Functionality of Nutrition Documentation and Ordering Nutrition Therapy in Currently Available Electronic Health Record Systems

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141915/1/ncp0401.pd

A simple model for the evolution of disc galaxies: The Milky Way

A simple model for the evolution of disc galaxies is presented. We adopt three numbers from observations of the Milky Way disc, the local surface mass density, the stellar scale length (of the assumedly exponential disc) and the amplitude of the (assumedly flat) rotation curve, and physically, the (local) dynamical Kennicutt star formation prescription, standard chemical evolution equations assuming and a model for spectral evolution of stellar populations. We can determine the detailed evolution of the model with only the addition of standard cosmological scalings with time of the dimensional parameters. A surprising wealth of detailed specifications follows from this prescription including the gaseous infall rate as a function of radius and time, the distribution of stellar ages and metallicities with time and radius, surface brightness profiles at different wavelengths, colours etc. At the solar neighbourhood stars start to form $\approx 10 Gyrs$ ago at an increasing rate peaking 4 billion years ago and then slowly declining in good agreement with observations. The mean age of long lived stars at the solar neighbourhood is about $4 Gyrs$. The local surface density of the stars and gas are 35 and $15 M_{\odot}pc^{-2}$, respectively. The metallicity distribution of the stars at the solar radius is narrow with a peak at $[Z/Z_{\odot}] = -0.1$.Both a Salpeter IMF and a Chabrier IMF are consistent with observations. Comparisons with the current and local fossil evidence provides support for the model which can then be used to assess other local disc galaxies, the evolution of disc galaxies in deep optical surveys and also for theoretical investigations such as simulations of merging disc galaxies (abbreviated).Comment: acceppted for publication in MNRA

A feasibility study comparing UK older adult mental health inpatient wards which use protected engagement time with other wards which do not: Study protocol

© 2016 Nolan et al. Background: Protected engagement time (PET) is a concept of managing staff time on mental health inpatient wards with the aim of increasing staff and patient interaction. Despite apparent widespread use of PET, there remains a dearth of evidence as to how it is implemented and whether it carries benefits for staff or patients. This protocol describes a study which is being carried out on mental health wards caring for older adults (aged over 65) in England. The study shares a large proportion of the procedures, measures and study team membership of a recently completed investigation of the impact of PET in adult acute mental health wards. The study aims to identify prevalence and components of PET to construct a model for the intervention, in addition to testing the feasibility of the measures and procedures in preparation for a randomised trial. Methods/design: The study comprises four modules and uses a mixed methods approach. Module 1 involves mapping all inpatient wards in England which provide care for older adults, including those with dementia, ascertaining how many of these provide PET and in what way. Module 2 uses a prospective cohort method to compare five older adult mental health wards that use PET with five that do not across three National Health Service (NHS) Foundation Trust sites. The comparison comprises questionnaires, observation tools and routinely collected clinical service data and combines validated measures with questions developed specifically for the study. Module 3 entails an in-depth case study evaluation of three of the participating PET wards (one from each NHS Trust site) using semi-structured interviews with patients, carers and staff. Module 4 describes the development of a model and fidelity scale for PET using the information derived from the other modules with a working group of patients, carers and staff. Discussion: This is a feasibility study to test the application of the measures and methods in inpatient wards for older adults and develop a draft model for the intervention. The next stage will prospectively involve testing of the model and fidelity scale in randomised conditions to provide evidence for the effectiveness of PET as an intervention

Neuropsychiatric Symptoms in Patients with Aortic Aneurysms

BACKGROUND: Emerging evidence suggests that vascular disease confers vulnerability to a late-onset of depressive illness and the impairment of specific cognitive functions, most notably in the domains of memory storage and retrieval. Lower limb athero-thrombosis and abdominal aortic aneurysm (AAA) have both been previously associated with neuropsychiatric symptoms possibly due to associated intracerebral vascular disease or systemic inflammation, hence suggesting that these illnesses may be regarded as models to investigate the vascular genesis of neuropsychiatric symptoms. The aim of this study was to compare neuropsychiatric symptoms such as depression, anxiety and a variety of cognitive domains in patients who had symptoms of peripheral athero-thrombosis (intermittent claudication) and those who had an asymptomatic abdominal aortic aneurysm AAA. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study, 26 participants with either intermittent claudication or AAA were assessed using a detailed neuropsychiatric assessment battery for various cognitive domains and depression and anxiety symptoms (Hamilton Depression and Anxiety Scales). Student t test and linear regression analyses were applied to compare neuropsychiatric symptoms between patient groups. AAA participants showed greater levels of cognitive impairment in the domains of immediate and delayed memory as compared to patients who had intermittent claudication. Cognitive dysfunction was best predicted by increasing aortic diameter. CRP was positively related to AAA diameter, but not to cognitive function. AAA and aortic diameter in particular were associated with cognitive dysfunction in this study. CONCLUSIONS/SIGNIFICANCE: AAA patients are at a higher risk for cognitive impairment than intermittent claudication patients. Validation of this finding is required in a larger study, but if confirmed could suggest that systemic factors peculiar to AAA may impact on cognitive function.Bernhard T. Baune, Steven J. Unwin, Frances Quirk and Jonathan Golledg

Formally Specifying Temporal Constraints and Error Recovery

Recent research has advocated the use of deontic logics in requirements specification. A form of deontic action logic is described, and it is shown how it can be used to specify both temporal constraints and error recovery. The logic includes a deontic predicate of bounded obligation, and normative predicates. Bounded obligation allows bounds to be placed on the performance of actions, and can be used to specify temporal constraints. The formalism also allows the removal and extension of obligations before they must be met. The normative predicates indicate when a system has performed an action normally or abnormally, and allow the specification of corrective actions that recover from error situation