Understanding Contrasting Approaches to Nationwide Implementations of Electronic Health Record Systems:England, the USA and Australia

As governments commit to national electronic health record (EHR) systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes - ‘top-down’, ‘bottom-up’ and ‘middle-out’ - to review EHR implementation strategies in three exemplar countries: England, the USA and Australia. In comparing and contrasting three approaches, we show how different healthcare systems, national policy contexts and anticipated benefits have shaped initial strategies. We reflect on progress and likely developments in the face of continually changing circumstances. Our review shows that irrespective of the initial strategy, over time there is likely to be convergence on the negotiated, devolved middle-out approach, which aims to balance the interests and responsibilities of local healthcare constituencies and national government to achieve national connectivity. We conclude that, accepting the current lack of empirical evidence, the flexibility offered by the middle-out approach may make this the best initial national strategy

More Chips to Nitroolefins: Decatungstate Photocatalysed Hydroalkylation Under Batch and Flow Conditions

The hydroalkylation of nitroalkenes and β-nitroacrylates via a photocatalytic strategy has been optimised under both batch and continuous flow conditions. This target has been achieved by exploiting the potentialities of the decatungstate anion as a versatile hydrogen atom transfer (HAT) photocatalyst for the generation of alkyl radicals from aliphatic heterocycles, amides and cycloalkanes

Vibrational spectrum of solid picene (C_22H_14)

Recently, Mitsuhashi et al., have observed superconductivity with transition temperature up to 18 K in potassium doped picene (C22H14), a polycyclic aromatic hydrocarbon compound [Nature 464 (2010) 76]. Theoretical analysis indicate the importance of electron-phonon coupling in the superconducting mechanisms of these systems, with different emphasis on inter- and intra-molecular vibrations, depending on the approximations used. Here we present a combined experimental and ab-initio study of the Raman and infrared spectrum of undoped solid picene, which allows us to unanbiguously assign the vibrational modes. This combined study enables the identification of the modes which couple strongly to electrons and hence can play an important role in the superconducting properties of the doped samples

Metformin-induced lactic acidosis: no one left behind

Metformin is a safe drug when correctly used in properly selected patients. In real life, however, associated lactic acidosis has been repeatedly, although rarely, reported. The term metformin-induced lactic acidosis refers to cases that cannot be explained by any major risk factor other than drug accumulation, usually due to renal failure. Treatment consists of vital function support and drug removal, mainly achieved by renal replacement therapy. Despite dramatic clinical presentation, the prognosis of metformin-induced lactic acidosis is usually surprisingly good

Assessment of capillary volumetric blood microsampling for the analysis of central nervous system drugs and metabolites

Therapeutic drug monitoring (TDM) is an important tool for correlating the administered drug dose to drug and metabolite concentrations in the body and to therapeutic and adverse effects. In the case of treatment with drugs active on the central nervous system (CNS), frequent TDM becomes really useful, especially for patient compliance checking and for therapy optimisation. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and sertraline, chosen as target compounds for this study, are two antidepressants mainly used for major depression, but also for obsessive-compulsive disorder associated with neurodegenerative diseases and for eating disorders. Microsampling approaches can be used to make TDM patient-friendly, by means of minimally invasive fingerpricking instead of classic invasive venipuncture. In this study, an innovative volumetric microsampling approach based on the use of hemaPEN technology is proposed to simultaneously obtain four identical dried whole blood microsamples by means of a single capillary sampling. The developed strategy shows significant advantages in terms of blood collection and storage, fast and feasible extraction procedure and sensitive LC-MS/MS analysis, also providing satisfactory validation results (extraction yield >81%, RSD <12.0%, and <6.3% loss in analyte stability after 3 months). The proposed methodology has proven to be sound and reliable for application to the TDM of psychiatric patients treated with antidepressant drugs such as fluoxetine and sertraline. The original capillary volumetric microsampling procedure using hemaPEN has been demonstrated to be suitable for the accurate sampling of capillary whole blood, in order to be successfully exploited in self- and home-sampling procedures in future and to pave the way for precision medicine approaches for the treatment of CNS disorders

Central American Subduction System

Workshop to Integrate Subduction Factory and Seismogenic Zone Studies in Central America, Heredia, Costa Rica, 18–22 June 2007 The driving force for great earthquakes and the cycling of water and climate-influencing volatiles (carbon dioxide, sulfur, halogens) across the convergent margin of Central America have been a focus of international efforts for over 8 years, as part of the MARGINS program of the U.S. National Science Foundation, the Collaborative Research Center (SFB 574) of the German Science Foundation, and the Central American science community. Over 120 scientists and students from 10 countries met in Costa Rica to synthesize this intense effort spanning from land to marine geological and geophysical studies

Width Parameterizations for Knot-free Vertex Deletion on Digraphs

A knot in a directed graph $G$ is a strongly connected subgraph $Q$ of $G$ with at least two vertices, such that no vertex in $V(Q)$ is an in-neighbor of a vertex in $V(G)\setminus V(Q)$. Knots are important graph structures, because they characterize the existence of deadlocks in a classical distributed computation model, the so-called OR-model. Deadlock detection is correlated with the recognition of knot-free graphs as well as deadlock resolution is closely related to the {\sc Knot-Free Vertex Deletion (KFVD)} problem, which consists of determining whether an input graph $G$ has a subset $S \subseteq V(G)$ of size at most $k$ such that $G[V\setminus S]$ contains no knot. In this paper we focus on graph width measure parameterizations for {\sc KFVD}. First, we show that: (i) {\sc KFVD} parameterized by the size of the solution $k$ is W[1]-hard even when $p$, the length of a longest directed path of the input graph, as well as $\kappa$, its Kenny-width, are bounded by constants, and we remark that {\sc KFVD} is para-NP-hard even considering many directed width measures as parameters, but in FPT when parameterized by clique-width; (ii) {\sc KFVD} can be solved in time $2^{O(tw)}\times n$, but assuming ETH it cannot be solved in $2^{o(tw)}\times n^{O(1)}$, where $tw$ is the treewidth of the underlying undirected graph. Finally, since the size of a minimum directed feedback vertex set ($dfv$) is an upper bound for the size of a minimum knot-free vertex deletion set, we investigate parameterization by $dfv$ and we show that (iii) {\sc KFVD} can be solved in FPT-time parameterized by either $dfv+\kappa$ or $dfv+p$; and it admits a Turing kernel by the distance to a DAG having an Hamiltonian path.Comment: An extended abstract of this paper was published in IPEC 201

Pathophysiology of hypoxemia in mechanically-ventilated patients with COVID-19: A computed tomography study

The pathogenesis of hypoxemia during acute respiratory distress syndrome caused by SARS-CoV-2 infection (C-ARDS) is debated. Some observations led to hypothesize ventilation to perfusion mismatch, rather than anatomical shunt, as the main determinant of hypoxemia. In this observational study 24 C-ARDS patients were studied 1 (0–1) days after intubation. Patients underwent a CT scan analysis to estimate anatomical shunt and a clinical test to measure venous admixture at two fractions of inspired oxygen (FiO2), to eliminate oxygen-responsive mechanisms of hypoxemia (ventilation to perfusion mismatch and diffusion limitation). In 10 out of 24 patients venous admixture was higher than anatomical shunt both at clinical (≈50 %) and 100 % FiO2. These patients were ventilated with a higher PEEP and had lower amount of anatomical shunt compared with patients with venous admixture equal/lower than anatomical shunt. In a subset of C-ARDS patients early after endotracheal intubation, hypoxemia might be explained by an abnormally high perfusion of a relatively low anatomical shunt