From Caregiver to Computer Geek: The Design of a Web Resource for Novice Clinical Informaticians

Introduction: Throughout the United States, there are massive initiatives in place to reform healthcare through the implementation of electronic health records. The goals are to improve patient care through improved access to records, the improvement of business and reimbursement processes, streamlining of clinician workflows for increased efficiency, and reducing the variability in the delivery of patient care. [See PDF for complete abstract]

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

User-definable resource usage bounds analysis for java bytecode

Automatic cost analysis of programs has been traditionally concentrated on a reduced number of resources such as execution steps, time, or memory. However, the increasing relevance of analysis applications such as static debugging and/or certiflcation of user-level properties (including for mobile code) makes it interesting to develop analyses for resource notions that are actually application-dependent. This may include, for example, bytes sent or received by an application, number of files left open, number of SMSs sent or received, number of accesses to a datábase, money spent, energy consumption, etc. We present a fully automated analysis for inferring upper bounds on the usage that a Java bytecode program makes of a set of application programmer-deflnable resources. In our context, a resource is defined by programmer-provided annotations which state the basic consumption that certain program elements make of that resource. From these deflnitions our analysis derives functions which return an upper bound on the usage that the whole program (and individual blocks) make of that resource for any given set of input data sizes. The analysis proposed is independent of the particular resource. We also present some experimental results from a prototype implementation of the approach covering a signiflcant set of interesting resources.

Electronic, structural, and optical properties of the host and Cr-doped cadmium thioindate

The cadmium thioindate spinel CdIn2S4 semiconductor has potential applications for optoelectronic devices. We present a theoretical study of the structural and optoelectronic properties of the host and of the Cr-doped ternary spinel. For the host spinel, we analyze the direct or indirect character of the energy bandgap, the change of the energy bandgap with the anion displacement parameter and with the site cation distribution, and the optical properties. The main effect of the Cr doping is the creation of an intermediate band within the energy bandgap. The character and the occupation of this band are analyzed for two substitutions: Cr by In and Cr by Cd. This band permits more channels for the photon absorption. The optical properties are obtained and analyzed. The absorption coefficients are decomposed into contributions from the different absorption channels and from the inter-and intra-atomic components.

Development of the DORI-TBI: An Investigation to Develop a New Screening Measure to Determine Consultation with a School-Based Brain Injury Resource Team

Brain injury is the leading cause of disability and death in children in the United States. Student re-entry into the school setting following a traumatic brain injury is crucial to student success. Multidisciplinary teams within the school district comprised of individuals with expertise in brain injury are ideal in implementing student specific treatment plans given their specialized training and wide range of expertise addressing student needs. Therefore, the purpose of this study is to develop and initially validate a quantitative instrument that school personnel can use to determine if a student, identified as having a traumatic brain injury, will benefit from district-level consultation from a brain injury team. Three studies were designed to investigate the research questions. In study one, the planning and construction of the DORI-TBI was completed. Study two addressed the content validity of the DORI-TBI through a comparison analysis with other referral forms, content review with experts in the field of TBI, and cognitive interviews with professionals to test the usability of the new screening tool. In study three, a field administration was conducted using vignettes to measure construct validity. Results produced a valid and reliable new screening instrument that can aid school-based teams to more efficiently utilize district level consultation with a brain injury support team.

An Investigation of Electronic Recruitment in Germany: Toward Efficacy and Opportunities

Globalization and the spread of Information and Communication Technology (ICT), particularly Internet usage, have changed the practice of recruiting employees. The Internet has become an integral part of Human Resource (HR) talent management, and as a result, a majority of business organizations in Germany have adopted an online recruitment initiative. However, technology alone no longer provides a competitive advantage. To meet their talent requirements, business organizations have turned to recruiting alternatives such as electronic recruitment or e-recruitment, which is a form of recruitment using electronic media tools to attract, hire, and retain job seekers. In this investigation, the author examined the efficacy and opportunities of e-recruitment in medium-sized German business organizations.. The author determined that many medium-sized German companies are using the Internet to recruit online but not effectively enough to create and maintain a sustainable strategic advantage. The author concluded that several areas for improvements exist in e-recruitment processes.

Determining resource quality and potential reasons for impairment of Illinois streams, inland lakes, and Lake Michigan : (Methods used for 2002 305(b) reporting).

According to Section 305(b) of the Clean Water Act (i.e. a generic name that refers to the Federal Water Pollution Control Act of 1972, the Clean Water Act of 1977, and subsequent amendments) and guidance provided by the United States Environmental Protection Agency (USEPA), each state must prepare and submit annually to the U.S. Congress and the USEPA report that describes the resource quality of the surface waters of the state. Every other year, this report, commonly referred to as the "305(b) report," must be provided in written form, whereas in alternate years each state may submit an electronic database to meet the reporting requirement. In the 305(b) report, states must also explain how they determined the resource quality of the waters of the state in terms of the degree to which predefined beneficial uses of those waters are supported. Also, in the 305(b) report when any designated use for any water body is not fully supported, the state must report potential reasons for the impairment. Herein, is explained how the Illinois Environmental Protection Agency determines the resource quality of Illinois streams, inland lakes, and Lake Michigan.

Control of electronic channel affiliates:an exploratory study and research propositions

Electronic channel affiliates are important online intermediaries between customers and host retailers. However, no work has studied how online retailers control online intermediaries. By conducting an exploratory content analysis of 85 online contracts between online retailers and their online intermediaries, and categorizing the governing mechanisms used, insights into the unique aspects of the control of online intermediaries are presented. Findings regarding incentives, monitoring, and enforcement are presented. Additionally, testable research propositions are presented to guide further theory development, drawing on contract theory, resource dependence theory and agency theory. Managerial implications are discussed. © 2012 Elsevier Inc.

An investigation into the adoption and implementation of electronic commerce in Saudi Arabian small and medium enterprises

Saudi Arabian Small and Medium Enterprises (SMEs) will face fierce competition from new entrants to local markets as a result of their accession to the Word Trade Organisation (WTO), and electronic commerce (e-commerce) technologies can reinforce SME’s competitive edge. This study investigates the state of e-commerce adoption and analyses the factors that determine the extent to which SMEs in Saudi Arabia are inclined towards deploying e-commerce technologies. This could assist future firms in designing effective implementation projects. Seven SMEs’ e-commerce adoption levels are studied as a case. The Technology-Organization-Environment (TOE) framework was used as the major source of inspiration in our analysis of e-commerce adoption amongst Saudi SMEs. In addition to advancing research on e-commerce in Saudi Arabia, this chapter also highlights several directions for future inquiry and implications for managers and policymakers.

Fuzzy Modeling and Control Based Virtual Machine Resource Management

Virtual machines (VMs) are powerful platforms for building agile datacenters and emerging cloud systems. However, resource management for a VM-based system is still a challenging task. First, the complexity of application workloads as well as the interference among competing workloads makes it difficult to understand their VMs’ resource demands for meeting their Quality of Service (QoS) targets; Second, the dynamics in the applications and system makes it also difficult to maintain the desired QoS target while the environment changes; Third, the transparency of virtualization presents a hurdle for guest-layer application and host-layer VM scheduler to cooperate and improve application QoS and system efficiency. This dissertation proposes to address the above challenges through fuzzy modeling and control theory based VM resource management. First, a fuzzy-logic-based nonlinear modeling approach is proposed to accurately capture a VM’s complex demands of multiple types of resources automatically online based on the observed workload and resource usages. Second, to enable fast adaption for resource management, the fuzzy modeling approach is integrated with a predictive-control-based controller to form a new Fuzzy Modeling Predictive Control (FMPC) approach which can quickly track the applications’ QoS targets and optimize the resource allocations under dynamic changes in the system. Finally, to address the limitations of black-box-based resource management solutions, a cross-layer optimization approach is proposed to enable cooperation between a VM’s host and guest layers and further improve the application QoS and resource usage efficiency. The above proposed approaches are prototyped and evaluated on a Xen-based virtualized system and evaluated with representative benchmarks including TPC-H, RUBiS, and TerraFly. The results demonstrate that the fuzzy-modeling-based approach improves the accuracy in resource prediction by up to 31.4% compared to conventional regression approaches. The FMPC approach substantially outperforms the traditional linear-model-based predictive control approach in meeting application QoS targets for an oversubscribed system. It is able to manage dynamic VM resource allocations and migrations for over 100 concurrent VMs across multiple hosts with good efficiency. Finally, the cross-layer optimization approach further improves the performance of a virtualized application by up to 40% when the resources are contended by dynamic workloads.

Effects of resource limitation on the essential oil production in Ledum palustre ssp decumbens (Ait.) Hultén

To understand the relationship between resource limitation and essential oil production of the widely-distributed boreal/arctic shrub, Ledum palustre ssp decumbens, I documented naturally occurring variation of essential oils over a growing season withfield collections along a latitudinal transect spanning boreal forest to arctic tundra. Collections from a long-term resource manipulation experiment at a single tundra site served as a means of teasing apart those factors that might be influencing the essential oil production of the species. The essential oil composition varied significantly along thetransect in the number of detectable components, but the relationships among resources and essential oil production were complex. In the manipulation experiment, essential oil components varied greatly among the treatments, with significant differences in the qualitative expression of the specific essential oil components. Both studies suggest that future climate changes have the potential for large changes in production and quality of essential oils.

Resource, Strategies, Location Determinants, And Host Country Location Choice By Emerging Market Firms

The extant literature had studied the determinants of the firms’ location decisions with help of host country characteristics and distances between home and host countries. Firm resources and its internationalization strategies had found limited attention in this literature. To address this gap, the research question in this dissertation was whether and how firms’ resources and internationalization strategies impacted the international location decisions of emerging market firms. To explore the research question, data were hand-collected from Indian software firms on their location decisions taken between April 2000 and March 2009. To analyze the multi-level longitudinal dataset, hierarchical linear modeling was used. The results showed that the internationalization strategies, namely market-seeking or labor-seeking had direct impact on firms’ location decision. This direct relationship was moderated by firm resource which, in case of Indian software firms, was the appraisal at CMMI level-5. Indian software firms located in developed countries with a market-seeking strategy and in emerging markets with a labor-seeking strategy. However, software firms with resource such as CMMI level-5 appraisal, when in a labor-seeking mode, were more likely to locate in a developed country over emerging market than firms without the appraisal. Software firms with CMMI level-5 appraisal, when in market-seeking mode, were more likely to locate in a developed country over an emerging market than firms without the appraisal. It was concluded that the internationalization strategies and resources of companies predicted their location choices, over and above the variables studied in the theoretical field of location determinants.

Freshwater Resource Supply Modeling for Developed and Undeveloped Watersheds

Globally, the current state of freshwater resource management is insufficient and impeding the chance at a sustainable future. Human interference within the natural hydrologic cycle is becoming dangerously irreversible and the need to redefine resource managerial approaches is imminent. This research involves the development of a coupled natural-human freshwater resource supply model using a System Dynamics approach. The model was applied to two case studies, Somalia, Africa and the Phoenix Active Management Area in Arizona, USA. It is suggested that System Dynamic modeling would be an invaluable tool for achieving sustainable freshwater resource management in individual watersheds. Through a series of thought experiments, a thorough understanding of the systems’ dynamic behaviors is obtainable for freshwater resource managers and policy-makers to examine various courses of action for alleviating freshwater supply concerns. This thesis reviews the model, its development and an analysis of several thought experiments applied to the case studies.

Attitudes towards the Marine Environment and Implications for Marine Resource Management in Seward, Alaska

This research, conducted in 2006-2008, examines the ways in which various groups involved with the marine resources of Seward, Alaska construct attitudes towards the environment. Participant observation and semi-structured interviews are used to assess how commercial halibut fishers, tour boat operators, local residents and government officials understand the marine environment based on their previous experiences. This study also explores how ideologies relate to the current practices of each group. Two theories orient the analyses: The first, cultural modeling provided a theoretical and methodological framework for pursuing a more comprehensive analysis of resource management. The second, Theory of Reasoned Action (Ajzen and Fishbein 1980), guided the analysis of the ways in which each participant’s ideology towards the marine environment relates to their practice. Aside from contributing to a better understanding of a coastal community’s ideologies and practices, this dissertation sought to better understand the role of ecological ideologies and behaviors in fisheries management. The research illustrates certain domains where ideologies and practices concerning Pacific halibut and the marine environment differ among commercial fishers, government, and management officials, tour boat operators and residents of Seward, AK. These differences offer insights into how future collaborative efforts between government officials, managers and local marine resource users might better incorporate local ideology into management, and provide ecological information to local marine resource users in culturally appropriate ways.

Validation of Electronic Health Record Phenotyping of Bipolar Disorder Cases and Controls

Objective: The study was designed to validate use of elec-tronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. Method: EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype di- agnoses was calculated against diagnoses from direct semi- structured interviews of 190 patients by trained clinicians blind to EHR diagnosis. Results: The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR- classified control subject received a diagnosis of bipolar dis- order on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based clas- sifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. Conclusions: Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.