Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

BACKGROUND: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol. METHODS/DESIGN: MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff. DISCUSSION: This study evaluates factors that are critical to successful implementation of a web-based risk assessment tool into routine clinical care in a variety of healthcare settings. The result will identify resource needs and potential barriers and solutions to implementation in each setting as well as an understanding potential effectiveness. TRIAL REGISTRATION: NCT01956773.

An introduction to China's rail transport Part 1: History, present and future of China's railways

In this paper an introduction is given to the history, current situation and future plans of China's railway industry. The history of China's railway is divided into four development phases: the phase in Imperial China, the phase in the Republic of China and the phases before and after the economic rejuvenation of the People's Republic of China. An introduction to the current situation and future plans includes the major projects under construction and development trends of China's railways. The environment of China's railways is also presented. This is the first of two papers on the railway scene in China.

Multi-physics modelling for the fabrication, packaging and reliability of micro-systems components

The latest advances in multi-physics modelling both using high fidelity techniques and reduced order and behavioural models will be discussed. Particular focus will be given to the application and validation of these techniques for modelling the fabrication, packaging and subsequent reliability of micro-systems based components. The paper will discuss results from a number of research projects with particular emphasis on the techniques being developed in a major UK Goverment funded project - 3D-MINTEGRATION (www.3d-mintegration.com).

The role of human demographic history in determining the distribution and frequency of transferase-deficient galactosaemia mutations

Classical or transferase-deficient galactosaemia is an inherited metabolic disorder caused by mutation in the human Galactose-1-phosphate uridyl transferase (GALT) gene. Of some 170 causative mutations reported, fewer than 10% are observed in more than one geographic region or ethnic group. To better understand the population history of the common GALT mutations, we have established a haplotyping system for the GALT locus incorporating eight single nucleotide polymorphisms and three short tandem repeat markers. We analysed haplotypes associated with the three most frequent GALT gene mutations, Q188R, K285N and Duarte-2 (D2), and estimated their age. Haplotype diversity, in conjunction with measures of genetic diversity and of linkage disequilibrium, indicated that Q188R and K285N are European mutations. The Q188R mutation arose in central Europe within the last 20 000 years, with its observed east-west cline of increasing relative allele frequency possibly being due to population expansion during the re-colonization of Europe by Homo sapiens in the Mesolithic age. K285N was found to be a younger mutation that originated in Eastern Europe and is probably more geographically restricted as it arose after all major European population expansions. The D2 variant was found to be an ancient mutation that originated before the expansion of Homo sapiens out of Africa. Heredity (2010) 104, 148-154; doi:10.1038/hdy.2009.84; published online 29 July 2009

Fabrication and characterisation of high resistivity SOI substrates for monolithic high energy physics detectors

Silicon on Insulator (SOI) substrates offer a promising platform for monolithic high energy physics detectors with integrated read-out electronics and pixel diodes. This paper describes the fabrication and characterisation of specially-configured SOI substrates using improved bonded wafer ion split and grind/polish technologies. The crucial interface between the high resistivity handle silicon and the SOI buried oxide has been characterised using both pixel diodes and circular geometry MOS transistors. Pixel diode breakdown voltages were typically greater than 100V and average leakage current densities at 70 V were only 55 nA/ sq cm. MOS transistors subjected to 24 GeV proton irradiation showed an increased SOI buried oxide trapped charge of only 3.45x1011cn-2 for a dose of 2.7Mrad