The Development of Medical Record Items: a User-centered, Bottom-up Approach

Objectives: Clinical documents (CDs) have evolved from traditional paper documents containing narrative text information into the electronic record sheets composed of itemized records, where each record is expressed as an item with a specific value. We defined medical record (MR) items to be information entities with a specific value. These entities were then used to compile form-based clinical documents as part of an electronic health record system (EHR-s). Methods: We took a reusable bottom-up developmental approach for the MR items, which provided three things: efficient incorporation of the local needs and requirements of the medical professionals from various departments in the hospital, comprehensive inclusion of the essential concepts of the basic elements required in clinical documents, and the provision of a structured means for meaningful data entry and retrieval. This paper delineates our experiences in developing and managing medical records at a large tertiary university hospital in Korea. Results: We collected 63,232 MR items from paper records scanned into 962 CDs. The MR item database was constructed using 13,287 MR items after removing redundant items. During the first year of service users requested changes to be made to 235 (1.8%) attributes of the MR items and also requested the additional 9,572 new MR items. In the second year, the attributes of 70 (0.5%) of the existing MR items were changed and 3,704 new items were added. The number of registered MR items increased by 72.0 % in the first year and 27.9 % in the second year. Conclusions: The MR item concept provides an easier and more structured means of data entry within an EHR-s. By using these MR items, various kinds of clinical documents can be easily constructed and allows for medical information to be reused and retrieved as data

Assessment of Acacia Koa Forest Health across Environmental Gradients in Hawai‘i Using Fine Resolution Remote Sensing and GIS

Koa (Acacia koa) forests are found across broad environmental gradients in the Hawai‘ian Islands. Previous studies have identified koa forest health problems and dieback at the plot level, but landscape level patterns remain unstudied. The availability of high-resolution satellite images from the new GeoEye1 satellite offers the opportunity to conduct landscape-level assessments of forest health. The goal of this study was to develop integrated remote sensing and geographic information systems (GIS) methodologies to characterize the health of koa forests and model the spatial distribution and variability of koa forest dieback patterns across an elevation range of 600–1,000 m asl in the island of Kaua‘i, which correspond to gradients of temperature and rainfall ranging from 17–20 °C mean annual temperature and 750–1,500 mm mean annual precipitation. GeoEye1 satellite imagery of koa stands was analyzed using supervised classification techniques based on the analysis of 0.5-m pixel multispectral bands. There was clear differentiation of native koa forest from areas dominated by introduced tree species and differentiation of healthy koa stands from those exhibiting dieback symptoms. The area ratio of healthy koa to koa dieback corresponded linearly to changes in temperature across the environmental gradient, with koa dieback at higher relative abundance in warmer areas. A landscape-scale map of healthy koa forest and dieback distribution demonstrated both the general trend with elevation and the small-scale heterogeneity that exists within particular elevations. The application of these classification techniques with fine spatial resolution imagery can improve the accuracy of koa forest inventory and mapping across the islands of Hawai‘i. Such findings should also improve ecological restoration, conservation and silviculture of this important native tree species

The effects of Gliricidia-derived biochar on sequential maize and bean farming

The addition of biochar to soils can improve soil fertility and increase agricultural productivity. We carried out a field experiment in which biochar produced from Gliricidia sepium (Jacq.) Kunth ex Walp. was added to low-fertility Brazilian planosol and tested to increase the yield of maize (Zea mays) and snap beans (Phaseolus vulgaris L.) in sequential, organic cultivation. Biochar was applied at a 15 t/ha rate, combined or not with Azospirillum Brasiliense inoculation and organic fertilizer (Bokashi). The application of biochar resulted in an increase in soil pH and of the content of macronutrients such as phosphorus and potassium. Contrary to evidence from elsewhere, biochar had a limited effect on increasing maize yield. In the case of beans, when combined with fertilizer, biochar increased the production of beans pods and biomass, but the significant increase was observed only for inoculation. Beans are the principal component of Brazilian diet and increasing productivity of beans is of upmost importance for the poorest in Brazil, and in other tropical countries

Selecting information technology for physicians' practices: a cross-sectional study

BACKGROUND: Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any) between the software selection process and the office staff's perceptions of the software's impact on practice activities. METHODS: A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. RESULTS: Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than $10,000, or that provided learning time (most dramatic increase in odds ratio, 8.2) during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. CONCLUSION: Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step

Isotopic evidence of human mobility and diet in a prehistoric/protohistoric Fijian coastal environment (c. 750-150 BP)

OBJECTIVES: Bourewa, on the southwest coast of Viti Levu in Fiji, is a multi-period site that contained burials dated to the later Vuda Phase (750-150 BP), a period of climatic fluctuations that potentially impacted the availability of food resources. We aim to investigate diet and movement at this site during a time of possible ecological pressure and political change. MATERIALS AND METHODS: We analyzed δ(13) C, δ(15) N, and (87) Sr/(86) Sr of these Vuda Phase individuals (n = 25) interred at the site. By analyzing dentin and bone, both childhood diet and the diet within the past few years of adults' lives were examined. RESULTS: The paleodietary results suggested that adult diets consisted largely of low trophic level marine organisms. Dentin and bone isotopic values differed significantly: childhood diet involved consumption of more higher trophic level terrestrial foods. Most individuals displayed (87) Sr/(86) Sr ratios expected of people living along a marine coastline. However, a few individuals displayed (87) Sr/(86) Sr ratios and paleodietary values (δ(13) Cdentin , δ(15) Ndentin ) suggestive of living further inland or consuming a more terrestrial-based childhood diet. DISCUSSION: The results are compared with past studies of sites from Fiji and nearby archipelagoes, placing our interpretations into a wider regional context. The Bourewa community appears to have consumed more low trophic level marine foods than any nearby site, possibly because terrestrial foods were more difficult to acquire. Interpreting the childhood diet is challenging due to the paucity of ethnohistoric literature on Fijian childhood; small meals outside of communal mealtimes or feeding children terrestrial animal protein as a means of cultural buffering are potential explanations

A System Identification Approach to Process-Based Plant Growth Model Reduced-Order Parameter Estimation

In order to describe underlying biophysical mechanisms, process-based plant growth models often contain an excessive number of parameters when only considering the accuracy of the model outputs. Regarding their influence on the model output, parameters of complex nonlinear plant growth models interact in ways that cannot be easily predicted based upon their roles in the component submodels describing biophysical processes. Parameter estimation in plant growth models is often challenged by lack of a means to interpret the relative importance of parameters in complex nonlinear models. In multi-crop models such as for agroforestry, increased model complexity and lack of data for novel crop combinations in varying environments further exacerbate the difficulties of discerning which parameters are important for estimation. The approach is based upon foundational system identification theory applied to a class of deterministic process-based predictive growth models. Evaluating the Hessian of the quadratic cost function determines the relative importance of parameters to its curvature. Subject to a list of model requirements, the Hessian can be computed given the input-output data and an estimated location in the parameter space provided by research into underlying biophysical processes and expert knowledge. For this analysis, field data are not required, rather, reliable simulated climate data are used to drive the model, which itself provides a priori output data for analysis. The analysis method is presented as a procedure for determining a ranking of parameter importance that can be used by model developers to provide end users with guidance for parameter estimation given real data for novel crops and crop combinations. The goal of this procedure is to arrive at a reduced-order parameter space that can be estimated entirely from input-output data. Furthermore, the goal is for the reduced model to closely follow the outputs of the original system (with any feasible parameterization) when driven by any input in the input class. The procedure is demonstrated on the well-known Yield-SAFE predictive agroforestry growth model. The advantages of an input-output system identification approach may also carry over into field trial design or model structure revisions. Further, because model parameterization can be based only on readily accessible model outputs, relatively low-tech data collection strategies emphasizing on-farm participatory research become possible. Participatory approaches allow a broader range of useful data to be collected for evaluating complex crop combinations