Emerging electronic health record models present numerous challenges to health care systems, physicians, and regulators. This article provides explanation of some of the reasons driving the ...development of the electronic health record, describes two national electronic health record models (currently developing in the United States and Australia) and one distributed, personal model. The US and Australian models are contrasted in their different architectures ("pull" versus "push") and their different approaches to patient autonomy, privacy, and confidentiality. The article also discusses some of the professional, practical, and legal challenges that health care providers potentially face both during and after electronic health record implementation.
To examine epigenetic processes linking childhood sex abuse to symptoms of antisocial personality disorder (ASPD) in adulthood and to investigate the possibility that the link between childhood sex ...abuse and deoxyribonucleic acid methylation at the 5HTT promoter might represent a pathway of long-term impact on symptoms of ASPD.
Deoxyribonucleic acid was prepared from lymphoblast cell lines derived from 155 female participants in the latest wave of the Iowa Adoptee Study. Methylation at 71 CpG residues was determined by quantitative mass spectroscopy, and the resulting values were averaged to produce an average CpG ratio for each participant. Simple associations and path analyses within an Mplus framework were examined to characterize the relationships among childhood sex abuse, overall level of methylation among women, and subsequent antisocial behavior in adulthood. Direct effects of biological parent psychopathology and 5HTT genotype were controlled.
Replicating prior work, we found that a significant effect of childhood sex abuse on methylation of the 5HTT promoter region emerged for women. In addition, a significant effect of methylation at 5HTT on symptoms of ASPD emerged.
Child sex abuse may create long-lasting changes in methylation of the promoter region of 5HTT in women. Furthermore, hypermethylation may be one mechanism linking childhood sex abuse to changes in risk for adult antisocial behavior in women. Better understanding of the methylome may prove critical in understanding the role of childhood environments on long-term psychiatric sequelae.
Abstract Background Teaching hospitals often employ advanced practice providers (nurse practitioners and physician assistants or APPs) to counteract residents' work-hour restrictions. With increased ...utilization of APPs in labor-intense areas, such as intensive care units (ICUs), APPs may have an impact on resident education and experience. No studies have investigated the direct role an APP plays on the training experience of a surgical resident in the ICU. Materials and methods An institutional review board-approved survey was emailed to residents in Accreditation Council for Graduate Medical Education-accredited general surgery programs. Surveys asked about demographics, residency and/or ICU characteristics, and the effects of APPs on patient care, workflow, and educational experience. Regression analysis determined predictors of resident perception. Results A total of 354 of 1178 residents responded to the survey (30%). Some residents felt that nurses calling APPs preferentially for patient-care issues interfered with education (17%) and residents' ability to follow patients (12%) and was associated with overall detrimental effects to ICU experience on regression (odds ratio, 3.7; confidence interval, 1.5–9.1). Most residents reported positive effects of APPs, such as reduced resident workload (79.8%), teaching protocols and/or guidelines (60.3%), enhanced patient care (60.3%), and enhanced communication (50.5%). When asked how APPs affected their overall ICU experience, 48.4% reported positive effects, 20.6% reported “no effect,” and 31% reported detrimental effects. Conclusions Only a minority of residents perceived that APPs detract from training, particularly those who felt excluded when nurses preferentially contact APPs with patient-care issues. APPs have the potential to enhance training and ICU experience, as reflected in many of the responses. Strategies to maintain direct nurse and resident communication might preserve residents' perception of the educational value of APPs.
The Polaris-LAMP multi-modal 3-D gamma-ray imager is a radiation mapping and imaging platform which uses a commercial off-the-shelf (COTS) detector integrated with a contextual sensor localization ...and mapping platform. The integration of these systems enables a free-moving radiation imaging capability with proximity mapping, coded-aperture, and Compton imaging modalities, which can create 3-D reconstruction of photon sources from tens of keV to several MeV. Gamma-ray events are recorded using a segmented cadmium zinc telluride (CZT) detector (Polaris-H Quad by H3D Inc., Ann Arbor, MI, USA), while scene data are derived from a contextual sensor and computation package developed by Lawrence Berkeley National Laboratory which includes GPS, laser ranging, and inertial measurement sensors. An onboard computer uses these inputs to create rapidly updating pose (10 Hz) and 3-D scene estimates using a simultaneous localization and mapping (SLAM) algorithm. The precise gamma-ray event location and timing resolution of the Polaris CZT sensor enables Compton imaging above several hundred keV, while photon sources at lower images are localized using coded-aperture imaging techniques. The multi-modal imaging concept enables imaging of diverse radiation sources spanning from the 59-keV emission of 241 Am to the 1.1 and 1.3 MeV lines of 60 Co. This work focuses on the description of the operational principles of the detector system and demonstrating the 3-D imaging performance in a variety of source detection and mapping scenarios. As a proof of concept, we demonstrate mapping complex environments, including both point source and distributed-source environments using proximity, coded-aperture, and Compton imaging modalities. Furthermore, we show the successful use of the system to perform measurements in high-background environments through analysis of arrays of uranium hexafluoride cylinders at the Paducah UF6 project site.
The pore space of deep saline aquifers in the Alberta (sedimentary) Basin offers a significant volume for waste storage by “hydrodynamic trapping”. Furthermore, given the slow regional fluid flow in ...these deep saline aquifers, ample time exists for waste-water/rock chemical reactions to take place. A geochemical computer model (PATHARC) was used to compute the interaction of industrial waste streams comprising CO
2, H
2SO
4 and H
2S with the minerals in typical carbonate and sandstone aquifers from the Alberta Basin. The results support the idea that these acids can be neutralized by such reactions and that new mineral products are formed, such as calcite, siderite, anhydrite/gypsum and pyrrhotite, thereby trapping the CO
3, SO
4 and S ions that are formed when the acid gases dissolve in the formation water. Siliciclastic aquifers appear to be a better host for “mineral trapping” than carbonate aquifers, especially with regard to CO
2. Carbonate aquifers may be more prone to leakage due to high CO
2 pressures generated by reaction with H
2SO
4 and H
2S. Even though permeability decreases are expected due to this “mineral trapping”, they can be partially controlled so that plugging of the aquifer does not occur.
Riding the RAFT Gunter, Melissa D
Mathematics teaching in the middle school,
10/2016, Letnik:
22, Številka:
3
Journal Article
Recenzirano
RAFT, an acronym for Role of the Writer, Audience, Format, and Topic—a tool borrowed from English teachers—gives students practice using different voices and topics as they write in math class.
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