Health Information Technology in the United States: On the Cusp of Change, 2009

In this report we use the data collected for ONCHIT to focus on EHR adoption in the inpatient setting. We report on several important policy issues. These include the rate of adoption of EHRs among U.S. hospitals generally and among safety-net hospitals, changes in both state and federal policy, and the potential of EHRs to change the quality measurement enterprise

A search for transients in the Reionization Lensing Cluster Survey (RELICS): Three new supernovae

The Reionization Cluster Survey (RELICS) imaged 41 galaxy clusters with the Hubble Space Telescope (HST), in order to detect lensed and high-redshift galaxies. Each cluster was imaged to about 26.5 AB mag in three optical and four near-infrared bands, taken in two distinct visits separated by varying time intervals. We make use of the multiple near-infrared epochs to search for transient sources in the cluster fields, with the primary motivation of building statistics for bright caustic crossing events in gravitational arcs. Over the whole sample, we do not find any significant ($\gtrsim5 \sigma$) caustic crossing events, in line with expectations from semi-analytic calculations but in contrast to what may be naively expected from previous detections of some bright events, or from deeper transient surveys that do find high rates of such events. Nevertheless, we find six prominent supernova (SN) candidates over the 41 fields: three of them were previously reported and three are new ones reported here for the first time. Out of the six candidates, four are likely core-collapse (CC) SNe -- three in cluster galaxies, and among which only one was known before, and one slightly behind the cluster at $z\sim0.6-0.7$. The other two are likely Ia -- both of them previously known, one probably in a cluster galaxy, and one behind it at $z\simeq2$. Our study supplies empirical bounds for the rate of caustic crossing events in galaxy cluster fields to typical HST magnitudes, and lays the groundwork for a future SN rate study.Comment: Accepted for publication in MNRAS. 10 pages, 3 figure

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)a stepped wedge cluster randomized controlled trial in public hospitals

BackgroundEach year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement packageScaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)on intrapartum care and intrapartum-related mortality in public hospitals of Nepal.MethodsWe will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo (R)) and neonatal heart rate monitors (Neobeat (R)) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations.DiscussionWith the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings.Trial registration numberISRCTN16741720. Registered on 2 March 2019.</p

JWST Spectroscopy of SN H0pe: Classification and Time Delays of a Triply-imaged Type Ia Supernova at z = 1.78

SN H0pe is a triply imaged supernova (SN) at redshift $z=1.78$ discovered using the James Webb Space Telescope (JWST). In order to classify the SN spectroscopically and measure the relative time delays of its three images (designated A, B, and C), we acquired NIRSpec follow-up spectroscopy spanning 0.6 to 5 microns. From the high signal-to-noise spectra of the two bright images B and C, we first classify the SN, whose spectra most closely match those of SN 1994D and SN 2013dy, as a Type Ia SN. We identify prominent blueshifted absorption features corresponding to Si II $\lambda6355$ and Ca II H $\lambda3970$ and K $\lambda3935$. We next measure the absolute phases of the three images from our spectra, which allows us to constrain their relative time delays. The absolute phases of the three images, determined by fitting the three spectra to Hsiao07 SN templates, are $6.5_{-1.8}^{+2.4}$d, $24.3_{-3.9}^{+3.9}$d, and $50.6_{-15.3}^{+16.1}$d for the brightest to faintest images. These correspond to relative time delays between Image A and Image B and between Image B and Image C of $-122.3_{-43.8}^{+43.7}$d and $49.3_{-14.7}^{+12.2}$d, respectively. The SALT3-NIR model yields phases and time delays consistent with these values. After unblinding, we additionally explored the effect of using Hsiao07 template spectra for simulations through eighty instead of sixty days past maximum, and found a small (11.5 and 1.0 days, respectively) yet statistically insignificant ($\sim$0.25$\sigma$ and $\sim$0.1$\sigma$) effect on the inferred image delays.Comment: 27 pages (including appendices), 11 figures, 13 supplemental figure

Flashlights: More than A Dozen High-Significance Microlensing Events of Extremely Magnified Stars in Galaxies at Redshifts z=0.7-1.5

Once only accessible in nearby galaxies, we can now study individual stars across much of the observable universe aided by galaxy-cluster gravitational lenses. When a star, compact object, or multiple such objects in the foreground galaxy-cluster lens become aligned, they can magnify a background individual star, and the timescale of a magnification peak can limit its size to tens of AU. The number and frequency of microlensing events therefore opens a window into the population of stars and compact objects, as well as high-redshift stars. To assemble the first statistical sample of stars in order to constrain the initial mass function (IMF) of massive stars at redshift z=0.7-1.5, the abundance of primordial black holes in galaxy-cluster dark matter, and the IMF of the stars making up the intracluster light, we are carrying out a 192-orbit program with the Hubble Space Telescope called "Flashlights," which is now two-thirds complete owing to scheduling challenges. We use the ultrawide F200LP and F350LP long-pass WFC3 UVIS filters and conduct two 16-orbit visits separated by one year. Having an identical roll angle during both visits, while difficult to schedule, yields extremely clean subtraction. Here we report the discovery of more than a dozen bright microlensing events, including multiple examples in the famous "Dragon Arc" discovered in the 1980s, as well as the "Spocks" and "Warhol" arcs that have hosted already known supergiants. The ultradeep observer-frame ultraviolet-through-optical imaging is sensitive to hot stars, which will complement deep James Webb Space Telescope infrared imaging. We are also acquiring Large Binocular Telescope LUCI and Keck-I MOSFIRE near-infrared spectra of the highly magnified arcs to constrain their recent star-formation histories

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo

Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss