Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

The success of worksite nutrition and physical activity interventions with environmental modifications A systematic review

Background: As obesity increases among U.S. workers, employers are implementing programs to increase physical activity and improve diets. Although programs to address individual determinants of obesity have been evaluated, less is known about the effects of workplace programs that change environmental factors, because most reviews have not isolated environmental programs; the one that did was published in 2005. ^ Objective: To update the 2005 review to determine the effectiveness of workplace environmental interventions. ^ Methods: The Medline database was searched for published English language reports (2003-2011) of randomized controlled (RCTs) or quasi-experimental trials (NRCTs) that evaluated strategies to modify physical activity opportunities or food services, targeting employees at least 18 years, not including retirees and that provided data for at least one physical activity, dietary, or health risk indicator. Three coders independently extracted study characteristics and scored the quality of study methods. Program effectiveness was determined using the 2005 review's best evidence approach. ^ Results: Seven studies represented in nine reports met eligibility criteria; three focused on diet and the remainder targeted diet and physical activity interventions. All but one study received a high quality score for internal validity. The evidence for the effectiveness of workplace environmental interventions was at best, inconclusive for diet and physical activity and limited for health risk indicators. The outcome constructs were inconsistent across the studies. ^ Conclusions: Limitations in the methods of the 2005 review made it challenging to draw conclusions about findings for this review that include: variation in outcome measures, reliance on distal measures without proximal behavior change measures, no distinction between changes at the workplace versus outside the workplace, and inappropriate analyses of cluster designs that biased findings toward statistical significance. The best evidence approach relied on vote-counting, using statistical significance alone rather than effect size and confidence intervals. Future research should address these limitations and use more rigorous methods; systematic reviews should use methods of meta-analysis to summarize study findings. These recommendations will help employers to better understand how environmental modifications in the workplace can support their efforts to combat the effects of obesity among employees.^

The impact of parent acculturation on parental fruit and vegetable intake, child fruit and vegetable intake, and child perceived access and availability to fruits and vegetables in the home environment

The purpose of this thesis was to investigate the association between parent acculturation and parental fruit and vegetable intake, child fruit and vegetable intake, and child access and availability to fruits and vegetables. Secondary data analysis was performed on a convenience sample of low-income Hispanic-identifying parents (n = 177) and children from a baseline survey from the Sprouting Healthy Kids intervention. T tests were used to examine the association between parent acculturation status (acculturated or non-acculturated) and fruit intake, vegetable intake and combined fruit and vegetable intake of both the parent and the child. T tests were also used to determine the relationship between parent acculturation and child access and availability to fruits, vegetables, and combined fruits and vegetables. Statistical significance was set at a p level of 0.05. The mean FVI for the parents and children were 3.41 servings and 2.96 servings, respectively. Statistical significance was found for the relationships between parent acculturation and parent fruit intake and parent acculturation and child fruit access. Lower acculturation of the parent was significantly related to higher fruit intake. Counter to the hypothesis, higher acculturation was found to be associated with greater access to fruits for the child. These findings suggest the necessity for not only culturally specific nutrition interventions, but the need for interventions to target behaviors for specific levels of acculturation within a culture. ^

Assessing high-priority mixtures: A review of methanol as influenced by ethanol

The intent of this research was to identify the level of risk methanol posed to a fetus during an ethanol co-exposure. This investigation was prompted by the known competitive inhibition properties of ethanol and the developmental toxicity of methanol. Integrated into this research was the practicality necessitated by regulatory processes, namely: does the risk justify the expense of additional research. To this end, the scope and nature of exposures were summarized to illustrate the ubiquity of these chemicals and the potential for dual exposure. Similarly, severity of outcome was evaluated by systematically reviewing the LOAELs, NOAELs, and statistical significance contained in methanol-induced developmental studies. Results. Blood methanol levels corresponding to developmental effects in laboratory studies were found to be substantially higher than the blood methanol levels predicted in high-risk methanol-ethanol exposure scenarios. This indicates that ethanol would not likely exacerbate methanol toxicity to the point of teratogenicity; however, it is important to note that the developmental toxicity of ethanol—an established human teratogen—was not included in the evaluation. Ethanol's contribution as a developmental toxicant rather than merely as an attenuator of methanol toxicity undermines the severity of effects possible from this chemical combination. Therefore further evaluation is needed to assess the developmental toxicities following dual exposures before rendering methanol and ethanol a high-priority mixture.^

Estado funcional y mortalidad en pacientes neoplásicos hospitalizados

Objetivos: Analizar el estado funcional y su relación con morbimortalidad en pacientes con neoplasias internados en Cínica Médica. Material y métodos: Estudio descriptivo, protocolizado y observacional. Se analizaron variables clínicas, estado funcional, situación anímica y morbimortalidad en pacientes oncológicos hospitalizados y se compararon pacientes con Índice de Karnofsky <40 puntos (grupo A) y >40 puntos (grupo B). Los datos fueron analizados en EPI Info 6.04. Informe de los primeros 3 meses. Resultados: En el período de estudio, ingresaron 66 pacientes con neoplasias, 21 (31.8%) en A, con Karnofsky promedio de 25 puntos (DS±12.09) y 45 (68.2%) en B, con Karnofsky promedio de 77 puntos (DS±16.65). El 77.3% presentó tumores sólidos y el 22.7% hematológicos y las neoplasias más frecuentes fueron del tracto gastrointestinal (19.6%), mama (12.1%), pulmón (9.1%) y primario oculto (7.6%). El estadio tumoral IV fue el más frecuente en ambos grupos (89.5% de A y 88.9% de B)(pNS). La edad media en A fue de 59.57 (DS±13.71) y 52.48 años (DS±15.65) en B (pNS) y el género masculino fue más frecuente en A (66.7 y 44.4% respectivamente) (p<0.05). La permanencia media fue de 17.57 en A (DS±20.84) y de 13.53 días (DS±16.29) en B (pNS). La evaluación de Actividades Básicas de la Vida Diaria [0.81 (DS±1.25) vs 4.57 puntos (DS±1.15)] y Actividades Instrumentales [0.57 (DS±0.74) vs 4 puntos (DS±1.37)] fue superior en B (p<0.05) y no hubo diferencias en la comorbilidad (85.7 vs 82.2%)(pNS). Las infecciones (52.4 vs 26.7%), causa social (38.1 vs 4.4%), complicaciones neoplásicas (81 vs 51.1%) y dolor (81 vs 51.1%) fueron los motivos de internación más frecuentes en A (p<0.05). Los pacientes de A recibieron con mayor frecuencia cuidados paliativos (90.5 vs46.7%) y quimioterapia (90.5 vs 46.7%)(p<0.05), sin diferencias en radioterapia (23.8 vs 13.3%) y cirugía (33.3 vs 33.3%)(pNS). No hubo diferencias entre ambos grupos en la presencia de depresión clínica (69.9 vs 53.3%) y pérdida de peso (86.4 vs 84.2%)(pNS). El síndrome confusional (85.7 vs 11.1%), postración (61.9 vs 6.7%) y escaras (23.8 vs 4.4%) fueron más frecuentes en A (p<0.05). La mortalidad hospitalaria fue 52.4% en A y 8.9% en B (p<0.05). Conclusiones: El grado de estado funcional evaluado por Karnofsky menor de 40 puntos se asoció significativamente a: mayor mortalidad, uso de quimioterapia, cuidados paliativos, internación por infecciones, dolor y complicaciones neoplásicas y presencia de síndrome confusional, postración y escaras de decúbito (p<0.05).

Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

Background: Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment. Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants. Results: Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol Conclusion: A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH. Trial Registration: Clinical trials.gov, Registry No. NCT00116480

Sociedad, familia y aprendizaje. El papel de los contextos hogareños

En este trabajo se aborda el estudio de las relaciones entre sociedad, familia y aprendizaje. Particularmente refiere a las características del contexto alfabetizador hogareño de poblaciones carenciadas y sus repercusiones en las habilidades y conocimientos prelectores de sus hijos. Para examinar dichas relaciones, se seleccionaron aleatoriamente 62 niños de 4/5 años de edad y sus madres. Las madres fueron entrevistadas con una adaptación de una encuesta sobre contexto familiar alfabetizador (Whitehurst, 1992). Los niños fueron evaluados utilizando pruebas específicas que permitieran estimar la dimensión `alfabetización temprana'. Los resultados encontrados informan sobre una gran variabilidad en las prácticas y características del contexto hogareño de las familias examinadas y sobre conocimientos y habilidades prelectores infantiles muy incipientes. Las relaciones entre las dos dimensiones bajo estudio, si bien alcanzan significación estadística, muestran valores de bajos a moderados, circunstancia cuya interpretación se discute. Por último, la caracterización de los niños y de los hogares de donde provienen, tiene como finalidad última encontrar indicadores específicos que permitan diseñar estrategias de intervención adecuadas, oportunas y sistemáticas para la prevención de dificultades en el aprendizaje del lenguaje escrito en situaciones que pueden ser consideradas de riesgo

Society, family and learning. The role of home literacy environments

This paper explores the relation between society, family, and learning. In particular, it addresses the features of home literacy environments in low income families and their impact on children's pre-literacy skills and knowledge. Sixty-two four/five-year-old children and their mothers were randomly selected for this study. The mothers were interviewed using an adaptation of a family literacy environment survey (Whitehurst, 1992). The children were assessed with specific tests to examine the scope of their 'early literacy'. The results revealed significant variability in the features and practices of home literacy environments as well as in the children's emerging pre-literacy skills and knowledge. The correlation between the two variables shows low to moderate statistical significance. The implications of such findings are discussed. Additionally, the purpose of isolating relevant features of the children and their home environments is to identify specific indicators related to the literacy fostering process. Ultimately, the goal is to design adequate, timely, and systematic intervention strategies aimed at preventing difficulties related to written language learning in children that could be considered at risk.

Sociedad, familia y aprendizaje. El papel de los contextos hogareños

En este trabajo se aborda el estudio de las relaciones entre sociedad, familia y aprendizaje. Particularmente refiere a las características del contexto alfabetizador hogareño de poblaciones carenciadas y sus repercusiones en las habilidades y conocimientos prelectores de sus hijos. Para examinar dichas relaciones, se seleccionaron aleatoriamente 62 niños de 4/5 años de edad y sus madres. Las madres fueron entrevistadas con una adaptación de una encuesta sobre contexto familiar alfabetizador (Whitehurst, 1992). Los niños fueron evaluados utilizando pruebas específicas que permitieran estimar la dimensión `alfabetización temprana'. Los resultados encontrados informan sobre una gran variabilidad en las prácticas y características del contexto hogareño de las familias examinadas y sobre conocimientos y habilidades prelectores infantiles muy incipientes. Las relaciones entre las dos dimensiones bajo estudio, si bien alcanzan significación estadística, muestran valores de bajos a moderados, circunstancia cuya interpretación se discute. Por último, la caracterización de los niños y de los hogares de donde provienen, tiene como finalidad última encontrar indicadores específicos que permitan diseñar estrategias de intervención adecuadas, oportunas y sistemáticas para la prevención de dificultades en el aprendizaje del lenguaje escrito en situaciones que pueden ser consideradas de riesgo

Society, family and learning. The role of home literacy environments

This paper explores the relation between society, family, and learning. In particular, it addresses the features of home literacy environments in low income families and their impact on children's pre-literacy skills and knowledge. Sixty-two four/five-year-old children and their mothers were randomly selected for this study. The mothers were interviewed using an adaptation of a family literacy environment survey (Whitehurst, 1992). The children were assessed with specific tests to examine the scope of their 'early literacy'. The results revealed significant variability in the features and practices of home literacy environments as well as in the children's emerging pre-literacy skills and knowledge. The correlation between the two variables shows low to moderate statistical significance. The implications of such findings are discussed. Additionally, the purpose of isolating relevant features of the children and their home environments is to identify specific indicators related to the literacy fostering process. Ultimately, the goal is to design adequate, timely, and systematic intervention strategies aimed at preventing difficulties related to written language learning in children that could be considered at risk.

Sociedad, familia y aprendizaje. El papel de los contextos hogareños

En este trabajo se aborda el estudio de las relaciones entre sociedad, familia y aprendizaje. Particularmente refiere a las características del contexto alfabetizador hogareño de poblaciones carenciadas y sus repercusiones en las habilidades y conocimientos prelectores de sus hijos. Para examinar dichas relaciones, se seleccionaron aleatoriamente 62 niños de 4/5 años de edad y sus madres. Las madres fueron entrevistadas con una adaptación de una encuesta sobre contexto familiar alfabetizador (Whitehurst, 1992). Los niños fueron evaluados utilizando pruebas específicas que permitieran estimar la dimensión `alfabetización temprana'. Los resultados encontrados informan sobre una gran variabilidad en las prácticas y características del contexto hogareño de las familias examinadas y sobre conocimientos y habilidades prelectores infantiles muy incipientes. Las relaciones entre las dos dimensiones bajo estudio, si bien alcanzan significación estadística, muestran valores de bajos a moderados, circunstancia cuya interpretación se discute. Por último, la caracterización de los niños y de los hogares de donde provienen, tiene como finalidad última encontrar indicadores específicos que permitan diseñar estrategias de intervención adecuadas, oportunas y sistemáticas para la prevención de dificultades en el aprendizaje del lenguaje escrito en situaciones que pueden ser consideradas de riesgo

Society, family and learning. The role of home literacy environments

This paper explores the relation between society, family, and learning. In particular, it addresses the features of home literacy environments in low income families and their impact on children's pre-literacy skills and knowledge. Sixty-two four/five-year-old children and their mothers were randomly selected for this study. The mothers were interviewed using an adaptation of a family literacy environment survey (Whitehurst, 1992). The children were assessed with specific tests to examine the scope of their 'early literacy'. The results revealed significant variability in the features and practices of home literacy environments as well as in the children's emerging pre-literacy skills and knowledge. The correlation between the two variables shows low to moderate statistical significance. The implications of such findings are discussed. Additionally, the purpose of isolating relevant features of the children and their home environments is to identify specific indicators related to the literacy fostering process. Ultimately, the goal is to design adequate, timely, and systematic intervention strategies aimed at preventing difficulties related to written language learning in children that could be considered at risk.

Planktonic foraminiferal d18O values and apparent calcification depths of core-top samples along an east-west transect across the tropical Atlantic/Caribbean

D18O values of nine tropical-subtropical planktonic foraminiferal species with different preferential habitat depths collected from 62 core-top samples along an east-west transect across the tropical Atlantic/Caribbean were used to test the applicability of interspecific d18O gradients for reconstructions of tropical upper ocean stratification. In general, the d18O difference (Delta d18O) between intermediate- and shallow-dwelling species decreases, and Delta d18O between deep and intermediate dwellers increases with increasing thermocline depth towards the west. The statistical significance of regional differences in Delta d18O highlights Delta d18O between the intermediate dwellers (in particular Globorotalia scitula and Globorotalia tumida) and the shallow dweller Globigerinoides ruber pink, as well as Delta d18O between the deep dwellers Globorotalia crassaformis or Globorotalia truncatulinoides dextral and intermediate dwellers as most sensitive to changes in tropical Atlantic thermocline depth. Based on the observed regional variations in interspecific Delta d18O, we propose a multispecies stratification index "STRAtrop" = (d18Ointermediate - d18Oshallow) / (d18Odeep - d18Oshallow) for the tropical ocean. Statistically significant differences in STRAtrop values between the E-Atlantic and the Caribbean suggest that this index may be a useful tool to monitor variations in tropical upper ocean stratification in the geological record.

Physics potential of a long-baseline neutrino oscillation experiment using a J-PARC neutrino beam and Hyper-Kamiokande

Hyper-Kamiokande will be a next generation underground water Cherenkov detector with a total (fiducial) mass of 0.99 (0.56) million metric tons, approximately 20 (25) times larger than that of Super-Kamiokande. One of the main goals of HyperKamiokande is the study of CP asymmetry in the lepton sector using accelerator neutrino and anti-neutrino beams. In this paper, the physics potential of a long baseline neutrino experiment using the Hyper-Kamiokande detector and a neutrino beam from the J-PARC proton synchrotron is presented. The analysis uses the framework and systematic uncertainties derived from the ongoing T2K experiment. With a total exposure of 7.5 MW × 10⁷ s integrated proton beam power (corresponding to 1.56 × 10²² protons on target with a 30 GeV proton beam) to a 2.5-degree off-axis neutrino beam, it is expected that the leptonic CP phase δCP can be determined to better than 19 degrees for all possible values of δCP , and CP violation can be established with a statistical significance of more than 3 σ (5 σ) for 76% (58%) of the δCP parameter space. Using both νe appearance and νµ disappearance data, the expected 1σ uncertainty of sin²θ₂₃ is 0.015(0.006) for sin²θ₂₃ = 0.5(0.45).

An empirical analysis of the money demand function in India

This paper empirically analyzes India’s money demand function during the period of 1980 to 2007 using monthly data and the period of 1976 to 2007 using annual data. Cointegration test results indicated that when money supply is represented by M1 and M2, a cointegrating vector is detected among real money balances, interest rates, and output. In contrast, it was found that when money supply is represented by M3, there is no long-run equilibrium relationship in the　money demand function. Moreover, when the money demand function was estimated using　dynamic OLS, the sign onditions of the coefficients of output and interest rates were found to be　consistent with theoretical rationale, and statistical significance was confirmed when money supply was represented by either M1 or M2. Consequently, though India’s central bank presently uses M3 as an indicator of future price movements, it is thought appropriate to focus on M1 or M2, rather than M3, in managing monetary policy.