Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

Zoocoenological state of microhabitats and its seasonal dynamics in an aquatic macroinvertebrate assembly (Hydrobiological case studies on lake Balaton, No. 1.)

In the years 2002, 2003 and 2004 we collected samples of macroinvertebrates on a total of 36 occasions in Badacsony bay, in areas of open water (in the years 2003 and 2004 reed-grassy) as well as populated by reed (Phragmites australis) and cattail (Typha angustifolia). Samples were taken using a stiff hand net. The sampling site includes three microhabitats differentiated only by the aquatic plants inhabiting these areas. Our data was gathered from processing 208 individual samples. The quantity of macroinvertebrates is represented by biovolume value based on volume estimates. We can identify taxa in abundant numbers found in all water types and ooze; as well as groups associated with individual microhabitats with various aquatic plants. We can observe a notable difference between the years in the volume of invertebrate macrofauna caused by the drop of water level, and the multiplication of submerged macrophytes. There are smaller differences between the samples taken in reeds and cattail stands. In the second half of 2003 – which was a year of drought – the Najas marina appeared in open waters and allowed to support larger quantities of macroinvertebrates. In 2004 with higher water levels, the Potamogeton perfoliatus occurring in the same area has had an even more significant effect. This type of reed-grass may support the most macroinvertebrates during the summer. From the aspect of diversity relations we may suspect different characteristics. The reeds sampling site proved to be the richest, while the cattail microhabitat is close behind, open water (with submerged macrophytes) is the least diverse microhabitat.

Juror need for cognition and sensitivity to methodological flaws in expert evidence

Two studies investigated the influence of juror need for cognition on the systematic and heuristic processing of expert evidence. U.S. citizens reporting for jury duty in South Florida read a 15-page summary of a hostile work environment case containing expert testimony. The expert described a study she had conducted on the effects of viewing sexualized materials on men's behavior toward women. Certain methodological features of the expert's research varied across experimental conditions. In Study 1 (N = 252), the expert's study was valid, contained a confound, or included the potential for experimenter bias (internal validity) and relied on a small or large sample (sample size) of college undergraduates or trucking employees (ecological validity). When the expert's study included trucking employees, high need for cognition jurors in Study 1 rated the expert more credible and trustworthy than did low need for cognition jurors. Jurors were insensitive to variations in the study's internal validity or sample size. Juror ratings of plaintiff credibility, plaintiff trustworthiness, and study quality were positively correlated with verdict. In Study 2 (N = 162), the expert's published or unpublished study (general acceptance) was either valid or lacked an appropriate control group (internal validity) and included a sample of college undergraduates or trucking employees (ecological validity). High need for cognition jurors in Study 2 found the defendant liable more often and evaluated the expert evidence more favorably when the expert's study was internally valid than when an appropriate control group was missing. Low need for cognition jurors did not differentiate between the internally valid and invalid study. Variations in the study's general acceptance and ecological validity did not affect juror judgments. Juror ratings of expert and plaintiff credibility, plaintiff trustworthiness, and study quality were positively correlated with verdict. The present research demonstrated that the need for cognition moderates juror sensitivity to expert evidence quality and that certain message-related heuristics influence juror judgments when ability or motivation to process systematically is low. ^

Mechanistic studies on the degradation of gasoline oxygenates by advanced oxidation technologies and the reaction of 4-methyl-1,2,4-triazoline-3,5-dione with tetracyclopropylethylene

Gasoline oxygenates (MTBE, methyl tert-butyl ether; DIPE, di-isopropyl ether; ETBE, ethyl tert-butyl ether; TAME, tert-amyl ether) are added to gasoline to boost octane and enhance combustion. The combination of large scale use, high water solubility and only minor biodegradability has now resulted in a significant gasoline oxygenate contamination occurring in surface, ground, and drinking water systems. Combination of hydroxyl radical formation and the pyrolytic environment generated by ultrasonic irradiation (665 kHz) leads to the rapid degradation of MTBE and other gasoline oxygenates in aqueous media. ^ The presence of oxygen promotes the degradation processes by rapid reaction with carbon centered radicals indicating radical processes involving O 2 are significant pathways. A number of the oxidation products were identified. The formation of products (alcohols, ketones, aldehydes, esters, peroxides, etc) could be rationalized by mechanisms which involve hydrogen abstraction by OH radical and/or pyrolysis to form carboncentered radicals which react with oxygen and follow standard oxidation chain processes. ^ The reactions of N-substituted R-triazolinediones (RTAD; R = CH 3 or phenyl) have attracted considerable interest because they exhibit a number of unusual mechanistic characteristics that are analogous to the reactions of singlet oxygen (1O2) and offer an easy way to provide C-N bond(s) formation. The reactions of triazolinedione with olefins have been widely studied and aziridinium imides are generally accepted to be the reactive intermediates. ^ We observed the rapid formation of an unusual intermediate upon mixing tetracyclopropylethylene with 4-methyl-1,2,4-triazoline-3,5-dione in CDCl 3. Detailed characterization by NMR (proton, 13C, 2-D NMRs) indicates the intermediate is 5,5,6,6-tetracyclopropyl-3-methyl-5,6-dihydro-oxazolo[3,2- b][1,2,4]-triazolium-2-olate. Such products are extremely rare and have not been studied. Upon warming the intermediate is converted to 2 + 2 diazetidine (major) and ene product (minor). ^ To further explore the kinetics and dynamics of the reaction activation energies were obtained using Arrhenius plots. Activation energies for the formation of the intermediate from reactants, and 2+2 adduct from the intermediate were determined as 7.48 kcal moll and 19.8 kcal mol−1 with their pre-exponential values of 2.24 × 105 dm 3 mol−1 sec−1 and 2.75 × 108 sec−1, respectively, meaning net slow reactions because of low pre-exponential values caused by steric hindrance. ^

Peptide-induced coalescence of bicellar lipid assemblies: sensitivity to anionic lipid and peptide properties

Bicellar lipid mixture dispersions progressively coalesce to larger structures on warming. This phase behaviour is particularly sensitive to interactions that perturb bilayer properties. In this study, ²H NMR was used to study the perturbation of bicellar lipid mixtures by two peptides (SP-B₆₃₋₇₈, a lung surfactant protein fragment and Magainin 2, an antimicrobial peptide) which are structurally similar. Particular attention was paid to the relation between peptide-induced perturbation and lipid composition. In bicellar dispersions containing only zwitterionic lipids (DMPC-d₅₄/DMPC/DHPC (3:1:1)) both peptides had little to no effect on the temperature at which coalescence to larger structures occurred. Conversely, in mixtures containing anionic lipids (DMPC-d₅₄/DMPG/DHPC (3:1:1)), both peptides modified bicellar phase behaviour. In mixtures containing SP-B₆₃₋₇₈, the presence of peptide decreased the temperature of the ribbon-like to extended lamellar phase transition. The addition of Magainin 2 to DMPCd₅₄/ DMPG/DHPC (3:1:1) mixtures, in contrast, increased the temperature of this transition and yielded a series of spectra resembling DMPC/DHPC (4:1) mixtures. Additional studies of lipid dispersions containing deuterated anionic lipids were done to determine whether the observed perturbation involved a peptide-induced separation of zwitterionic and anionic lipids. Comparison of DMPC/DMPG-d₅₄/DHPC (3:1:1) and DMPC-d₅₄/DMPG/DHPC (3:1:1) mixtures showed that DMPC and DMPG occupy similar environments in the presence of SP-B₆₃₋₇₈, but different lipid environments in the presence of Magainin 2. This might reflect the promotion of anionic lipid clustering by Magainin 2. These results demonstrate the variability of mechanisms of peptide-induced perturbation and suggest that lipid composition is an important factor in the peptide-induced perturbation of lipid structures.

Integrated sensitivity analysis, calibration, and uncertainty propagation analysis approaches for supporting hydrological modeling

The successful performance of a hydrological model is usually challenged by the quality of the sensitivity analysis, calibration and uncertainty analysis carried out in the modeling exercise and subsequent simulation results. This is especially important under changing climatic conditions where there are more uncertainties associated with climate models and downscaling processes that increase the complexities of the hydrological modeling system. In response to these challenges and to improve the performance of the hydrological models under changing climatic conditions, this research proposed five new methods for supporting hydrological modeling. First, a design of experiment aided sensitivity analysis and parameterization (DOE-SAP) method was proposed to investigate the significant parameters and provide more reliable sensitivity analysis for improving parameterization during hydrological modeling. The better calibration results along with the advanced sensitivity analysis for significant parameters and their interactions were achieved in the case study. Second, a comprehensive uncertainty evaluation scheme was developed to evaluate three uncertainty analysis methods, the sequential uncertainty fitting version 2 (SUFI-2), generalized likelihood uncertainty estimation (GLUE) and Parameter solution (ParaSol) methods. The results showed that the SUFI-2 performed better than the other two methods based on calibration and uncertainty analysis results. The proposed evaluation scheme demonstrated that it is capable of selecting the most suitable uncertainty method for case studies. Third, a novel sequential multi-criteria based calibration and uncertainty analysis (SMC-CUA) method was proposed to improve the efficiency of calibration and uncertainty analysis and control the phenomenon of equifinality. The results showed that the SMC-CUA method was able to provide better uncertainty analysis results with high computational efficiency compared to the SUFI-2 and GLUE methods and control parameter uncertainty and the equifinality effect without sacrificing simulation performance. Fourth, an innovative response based statistical evaluation method (RESEM) was proposed for estimating the uncertainty propagated effects and providing long-term prediction for hydrological responses under changing climatic conditions. By using RESEM, the uncertainty propagated from statistical downscaling to hydrological modeling can be evaluated. Fifth, an integrated simulation-based evaluation system for uncertainty propagation analysis (ISES-UPA) was proposed for investigating the effects and contributions of different uncertainty components to the total propagated uncertainty from statistical downscaling. Using ISES-UPA, the uncertainty from statistical downscaling, uncertainty from hydrological modeling, and the total uncertainty from two uncertainty sources can be compared and quantified. The feasibility of all the methods has been tested using hypothetical and real-world case studies. The proposed methods can also be integrated as a hydrological modeling system to better support hydrological studies under changing climatic conditions. The results from the proposed integrated hydrological modeling system can be used as scientific references for decision makers to reduce the potential risk of damages caused by extreme events for long-term water resource management and planning.

Molecular and functional studies of human immunodeficiency virus type 1 accessory protein

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Spectral sensitivity, spatial resolution and temporal resolution and their implications for conspecific signalling in cleaner shrimp.

Cleaner shrimp (Decapoda) regularly interact with conspecifics and client reef fish, both of which appear colourful and finely patterned to human observers. However, whether cleaner shrimp can perceive the colour patterns of conspecifics and clients is unknown, because cleaner shrimp visual capabilities are unstudied. We quantified spectral sensitivity and temporal resolution using electroretinography (ERG), and spatial resolution using both morphological (inter-ommatidial angle) and behavioural (optomotor) methods in three cleaner shrimp species: Lysmata amboinensis, Ancylomenes pedersoni and Urocaridella antonbruunii. In all three species, we found strong evidence for only a single spectral sensitivity peak of (mean ± s.e.m.) 518 ± 5, 518 ± 2 and 533 ± 3 nm, respectively. Temporal resolution in dark-adapted eyes was 39 ± 1.3, 36 ± 0.6 and 34 ± 1.3 Hz. Spatial resolution was 9.9 ± 0.3, 8.3 ± 0.1 and 11 ± 0.5 deg, respectively, which is low compared with other compound eyes of similar size. Assuming monochromacy, we present approximations of cleaner shrimp perception of both conspecifics and clients, and show that cleaner shrimp visual capabilities are sufficient to detect the outlines of large stimuli, but not to detect the colour patterns of conspecifics or clients, even over short distances. Thus, conspecific viewers have probably not played a role in the evolution of cleaner shrimp appearance; rather, further studies should investigate whether cleaner shrimp colour patterns have evolved to be viewed by client reef fish, many of which possess tri- and tetra-chromatic colour vision and relatively high spatial acuity.

Molecular and functional studies of human immunodeficiency virus type 1 accessory protein

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Improved Accuracy in Optical Motion Capture Measurements Leads to Increased Sensitivity to Kinematic Changes

Clinical optical motion capture allows us to obtain kinematic and kinetic outcome measures that aid clinicians in diagnosing and treating different pathologies affecting healthy gait. The long term aim for gait centres is for subject-specific analyses that can predict, prevent, or reverse the effects of pathologies through gait retraining. To track the body, anatomical segment coordinate systems are commonly created by applying markers to the surface of the skin over specific, bony anatomy that is manually palpated. The location and placement of these markers is subjective and precision errors of up to 25mm have been reported [1]. Additionally, the selection of which anatomical landmarks to use in segment models can result in large angular differences; for example angular differences in the trunk can range up to 53o for the same motion depending on marker placement [2]. These errors can result in erroneous kinematic outcomes that either diminish or increase the apparent effects of a treatment or pathology compared to healthy data. Our goal was to improve the accuracy and precision of optical motion capture outcome measures. This thesis describes two separate studies. In the first study we aimed to establish an approach that would allow us to independently quantify the error among trunk models. Using this approach we determined if there was a best model to accurately track trunk motion. In the second study we designed a device to improve precision for test, re-test protocols that would also reduce the set-up time for motion capture experiments. Our method to compare a kinematically derived centre of mass velocity to one that was derived kinetically was successful in quantifying error among trunk models. Our findings indicate that models that use lateral shoulder markers as well as limit the translational degrees of freedom of the trunk through shared pelvic markers result in the least amount of error for the tasks we studied. We also successfully reduced intra- and inter-operator anatomical marker placement errors using a marker alignment device. The improved accuracy and precision resulting from the methods established in this thesis may lead to increased sensitivity to changes in kinematics, and ultimately result in more consistent treatment outcomes.

D5.5 – First Version Scenario Arrangement Document – round 1

This deliverable outlines the implementation plan for each of the first-round studies of the RAGE pilots. The main goal of these pilots is to perform a small-scale test of the RAGE games with end-users and intermediary stakeholders in five different non-leisure domains to guide the further development of the games for the final validation studies. At the same time the pilots implement the pre-testing of the research instruments and methodology for answering the main evaluation questions in the five areas of investigation identified in D8.1: 1) usability, 2) game experience, 3) learning effectiveness, 4) transfer effect and 5) pedagogical costs and benefits. Finally, the pilots are aimed at collecting preliminary results for a first formative evaluation of the games and game technologies, with the goal of feeding back useful information to development for the final versions of games and assets. The results of the first pilot will be compared with the results of the final evaluation studies to demonstrate improvements of the game and game effects from first to final version. A revision of the deliverable will be done in the next few months to produce the final arrangement document (D5.1, due at M21).

Refining the diagnosis and EGFR status of non-small cell lung carcinoma in biopsy and cytologic material, using a panel of mucin staining, TTF-1, cytokeratin 5/6, and P63, and EGFR mutation analysis.

INTRODUCTION: The dichotomization of non-small cell carcinoma (NSCLC) subtype into squamous (SQCC) and adenocarcinoma (ADC) has become important in recent years and is increasingly required with regard to management. The aim of this study was to determine the utility of a panel of commercially available antibodies in refining the diagnosis on small biopsies and also to determine whether cytologic material is suitable for somatic EGFR genotyping in a prospectively analyzed series of patients undergoing investigation for suspected lung cancer. METHODS: Thirty-two consecutive cases of NSCLC were first tested using a panel comprising cytokeratin 5/6, P63, thyroid transcription factor-1, 34betaE12, and a D-PAS stain for mucin, to determine their value in refining diagnosis of NSCLC. After this test phase, two further pathologists independently reviewed the cases using a refined panel that excluded 34betaE12 because of its low specificity for SQCC, and refinement of diagnosis and concordance were assessed. Ten cases of ADC, including eight derived from cytologic samples, were sent for EGFR mutation analysis. RESULTS: There was refinement of diagnosis in 65% of cases of NSCLC to either SQCC or ADC in the test phase. This included 10 of 13 cases where cell pellets had been prepared from transbronchial needle aspirates. Validation by two further pathologists with varying expertise in lung pathology confirmed increased refinement and concordance of diagnosis. All samples were adequate for analysis, and they all showed a wild-type EGFR genotype. CONCLUSION: A panel comprising cytokeratin 5/6, P63, thyroid transcription factor-1, and a D-PAS stain for mucin increases diagnostic accuracy and agreement between pathologists when faced with refining a diagnosis of NSCLC to SQCC or ADC. These small samples, even cell pellets derived from transbronchial needle aspirates, seem to be adequate for EGFR mutation analysis.

Reprint: Learning With a Strategic Management Simulation Q2 Game: A Case Study

The use of simulation games as a pedagogic method is well established though its effective use is context-driven. This study adds to the increasing growing body of empirical evidence of the effectiveness of simulation games but more importantly emphasises why by explaining the instructional design implemented reflecting best practices. This multimethod study finds evidence that student learning was enhanced through the use of simulation games, reflected in the two key themes; simulation games as a catalyst for learning and simulation games as a vehicle for learning. In so doing the research provides one of the few empirically based studies that support simulation games in enhancing learning and, more importantly, contextualizes the enhancement in terms of the instructional design of the curriculum. This research should prove valuable for those with an academic interest in the use of simulation games and management educators who use, or are considering its use. Further, the findings contribute to the academic debate concerning the effective implementation of simulation game-based training in business and management education.

Trans-ethnic fine mapping highlights kidney-function genes linked to salt sensitivity

We analyzed genome-wide association studies (GWASs), including data from 71,638 individuals from four ancestries, for estimated glomerular filtration rate (eGFR), a measure of kidney function used to define chronic kidney disease (CKD). We identified 20 loci attaining genome-wide-significant evidence of association (p < 5 × 10(-8)) with kidney function and highlighted that allelic effects on eGFR at lead SNPs are homogeneous across ancestries. We leveraged differences in the pattern of linkage disequilibrium between diverse populations to fine-map the 20 loci through construction of "credible sets" of variants driving eGFR association signals. Credible variants at the 20 eGFR loci were enriched for DNase I hypersensitivity sites (DHSs) in human kidney cells. DHS credible variants were expression quantitative trait loci for NFATC1 and RGS14 (at the SLC34A1 locus) in multiple tissues. Loss-of-function mutations in ancestral orthologs of both genes in Drosophila melanogaster were associated with altered sensitivity to salt stress. Renal mRNA expression of Nfatc1 and Rgs14 in a salt-sensitive mouse model was also reduced after exposure to a high-salt diet or induced CKD. Our study (1) demonstrates the utility of trans-ethnic fine mapping through integration of GWASs involving diverse populations with genomic annotation from relevant tissues to define molecular mechanisms by which association signals exert their effect and (2) suggests that salt sensitivity might be an important marker for biological processes that affect kidney function and CKD in humans.

D5.1 – Scenario Arrangement Document – round 1

This deliverable is a confirmation and update of 'D5.5 - First Version Scenario Arrangement Document – round 1' after a revisions with game developers. It outlines the implementation plan for each of the first-round studies of the RAGE pilots. The main goal of these pilots is to perform a small-scale test of the RAGE games with end-users and intermediary stakeholders in five different non-leisure domains to guide the further development of the games for the final validation studies.