Electronic health records: essential tools in integrating substance abuse treatment with primary care.

While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.

Developing a framework for mobile payments integration

This paper derives a theoretical framework for consideration of both the technologically driven dimensions of mobile payment solutions, and the associated value proposition for customers. Banks promote traditional payment instruments whose value proposition is the management of risk for both consumers and merchants. These instruments are centralised, costly and lack decision support functionality. The ubiquity of the mobile phone has provided a decentralised platform for managing payment processes in a new way, but the value proposition for customers has yet to be elaborated clearly. This inertia has stalled the design of sustainable revenue models for a mobile payments ecosystem. Merchants and consumers in the meantime are being seduced by the convenience of on-line and mobile payment solutions. Adopting the purchase and payment process as the unit of analysis, the current mobile payment landscape is reviewed with respect to the creation and consumption of customer value. From this analysis, a framework is derived juxtaposing customer value, related to what is being paid for, with payment integration, related to how payments are being made. The framework provides a theoretical and practical basis for considering the contribution of mobile technologies to the payment industry. The framework is then used to describe the components of a mobile payments pilot project being run on a trial population of 250 students on a campus in Ireland. In this manner, weaknesses in the value proposition for consumers and merchants were highlighted. Limitations of the framework as a research tool are also discussed.

Effective Knowledge Integration in Emergency Response Organizations

Natural and man-made disasters have gained attention at all levels of policy-making in recent years. Emergency management tasks are inherently complex and unpredictable, and often require coordination among multiple organizations across different levels and locations. Effectively managing various knowledge areas and the organizations involved has become a critical emergency management success factor. However, there is a general lack of understanding about how to describe and assess the complex nature of emergency management tasks and how knowledge integration can help managers improve emergency management task performance. The purpose of this exploratory research was first, to understand how emergency management operations are impacted by tasks that are complex and inter-organizational and second, to investigate how knowledge integration as a particular knowledge management strategy can improve the efficiency and effectiveness of the emergency tasks. Three types of specific knowledge were considered: context-specific, technology-specific, and context-and-technology-specific. The research setting was the Miami-Dade Emergency Operations Center (EOC) and the study was based on the survey responses from the participants in past EOC activations related to their emergency tasks and knowledge areas. The data included task attributes related to complexity, knowledge area, knowledge integration, specificity of knowledge, and task performance. The data was analyzed using multiple linear regressions and path analyses, to (1) examine the relationships between task complexity, knowledge integration, and performance, (2) the moderating effects of each type of specific knowledge on the relationship between task complexity and performance, and (3) the mediating role of knowledge integration. As per theory-based propositions, the results indicated that overall component complexity and interactive complexity tend to have a negative effect on task performance. But surprisingly, procedural rigidity tended to have a positive effect on performance in emergency management tasks. Also as per our expectation, knowledge integration had a positive relationship with task performance. Interestingly, the moderating effects of each type of specific knowledge on the relationship between task complexity and performance were varied and the extent of mediation of knowledge integration depended on the dimension of task complexity.

Integration of cad/ tool path data for 5-axis step-nc machining of free form / irrregular contoured surfaces

This research paper presents the work on feature recognition, tool path data generation and integration with STEP-NC (AP-238 format) for features having Free form / Irregular Contoured Surface(s) (FICS). Initially, the FICS features are modelled / imported in UG CAD package and a closeness index is generated. This is done by comparing the FICS features with basic B-Splines / Bezier curves / surfaces. Then blending functions are caculated by adopting convolution theorem. Based on the blending functions, contour offsett tool paths are generated and simulated for 5 axis milling environment. Finally, the tool path (CL) data is integrated with STEP-NC (AP-238) format. The tool path algorithm and STEP- NC data is tested with various industrial parts through an automated UFUNC plugin.

The art of building trust via e-communication channels: Post-acquisition integration as a special context

This study discusses the importance of establishing trust in post-acquisition integration context and how the use of e-channels facilitates or inhibits this process. The objective of this study is to analyze how the use of electronic communication channels influences the post-acquisition integration process in terms of trust establishment and overall integration efficiency, developing a framework as a result. Three sub-objectives are introduced: to find out the building blocks of trust in M&A’s, to analyse how the use of e-channels influence the process of trust establishment in post-acquisition integration context, and to define the consequences trust and use of e-channels have for the process. The theoretical background of the study includes literature and theories relating to trust establishment in post-acquisition integration context and how the use of e-channels influences the process of trust development on a general level. The empirical research is conducted as a single case study, based on key informant interviews. The interview data was collected between October 2015 and January 2016. Altogether nine interviews were realised; six with representatives from the acquiring firm and three with target firm members. Thematic analysis was selected as the main method for analysing and processing the qualitative data. This study finds that trust has an essential role in post-acquisition integration context, facilitating the integration process in various different ways. Hence, identifying the different building blocks of trust is important in order for members of the organisations to be better able establish and maintain trust. In today’s international business, the role of electronic communication channels has also increased in importance significantly and it was confirmed that these pose both challenges and possibilities for the development of interpersonal trust. One of the most important underlying factors influencing the trust levels via e-communication channels is the level of user’s comfort in using the different e-channels. Without sufficient and meaningful training, the communication conducted via these channels in inhibited in a number of ways. Hence, understanding the defining characteristics of e-communication together with the risks and opportunities related to the use of these can have far-reaching consequences for the post-acquisition integration process as a whole. The framework based on the findings and existing theory introduces the most central factors influencing the trust establishment together with the positive and negative consequences these have for the integration process. Moreover, organizational level consistency and the existence of shared guidelines on appropriate selection of communication channels according to the nature of the task at hand are seen as important

Automated generic integration of flight logbook data into aircraft maintenance systems

The automated transfer of flight logbook information from aircrafts into aircraft maintenance systems leads to reduced ground and maintenance time and is thus desirable from an economical point of view. Until recently, flight logbooks have not been managed electronically in aircrafts or at least the data transfer from aircraft to ground maintenance system has been executed manually. Latest aircraft types such as the Airbus A380 or the Boeing 787 do support an electronic logbook and thus make an automated transfer possible. A generic flight logbook transfer system must deal with different data formats on the input side – due to different aircraft makes and models – as well as different, distributed aircraft maintenance systems for different airlines as aircraft operators. This article contributes the concept and top level distributed system architecture of such a generic system for automated flight log data transfer. It has been developed within a joint industry and applied research project. The architecture has already been successfully evaluated in a prototypical implementation.

Federated architecture for biomedical data integration

The last decades have been characterized by a continuous adoption of IT solutions in the healthcare sector, which resulted in the proliferation of tremendous amounts of data over heterogeneous systems. Distinct data types are currently generated, manipulated, and stored, in the several institutions where patients are treated. The data sharing and an integrated access to this information will allow extracting relevant knowledge that can lead to better diagnostics and treatments. This thesis proposes new integration models for gathering information and extracting knowledge from multiple and heterogeneous biomedical sources. The scenario complexity led us to split the integration problem according to the data type and to the usage specificity. The first contribution is a cloud-based architecture for exchanging medical imaging services. It offers a simplified registration mechanism for providers and services, promotes remote data access, and facilitates the integration of distributed data sources. Moreover, it is compliant with international standards, ensuring the platform interoperability with current medical imaging devices. The second proposal is a sensor-based architecture for integration of electronic health records. It follows a federated integration model and aims to provide a scalable solution to search and retrieve data from multiple information systems. The last contribution is an open architecture for gathering patient-level data from disperse and heterogeneous databases. All the proposed solutions were deployed and validated in real world use cases.

Integration of a Sedimentation Module to a Hydrologic Model and its Application to a Mercury TMDL Analysis

This research is part of continued efforts to correlate the hydrology of East Fork Poplar Creek (EFPC) and Bear Creek (BC) with the long term distribution of mercury within the overland, subsurface, and river sub-domains. The main objective of this study was to add a sedimentation module (ECO Lab) capable of simulating the reactive transport mercury exchange mechanisms within sediments and porewater throughout the watershed. The enhanced model was then applied to a Total Maximum Daily Load (TMDL) mercury analysis for EFPC. That application used historical precipitation, groundwater levels, river discharges, and mercury concentrations data that were retrieved from government databases and input to the model. The model was executed to reduce computational time, predict flow discharges, total mercury concentration, flow duration and mercury mass rate curves at key monitoring stations under various hydrological and environmental conditions and scenarios. The computational results provided insight on the relationship between discharges and mercury mass rate curves at various stations throughout EFPC, which is important to best understand and support the management mercury contamination and remediation efforts within EFPC.

Integration Of Parking Assist Module with Body Computer Module.

This dissertation is focussed on integration of a Parking assist module ECU inside a Body computer Module. This project is aligned with the development of current electrical architecture into the next generation Lumped electrical architecture.

Electronic And Structural Study Of Pt-modified Au Vicinal Surfaces: A Model System For Pt-au Catalysts.

Two single crystalline surfaces of Au vicinal to the (111) plane were modified with Pt and studied using scanning tunneling microscopy (STM) and X-ray photoemission spectroscopy (XPS) in ultra-high vacuum environment. The vicinal surfaces studied are Au(332) and Au(887) and different Pt coverage (θPt) were deposited on each surface. From STM images we determine that Pt deposits on both surfaces as nanoislands with heights ranging from 1 ML to 3 ML depending on θPt. On both surfaces the early growth of Pt ad-islands occurs at the lower part of the step edge, with Pt ad-atoms being incorporated into the steps in some cases. XPS results indicate that partial alloying of Pt occurs at the interface at room temperature and at all coverage, as suggested by the negative chemical shift of Pt 4f core line, indicating an upward shift of the d-band center of the alloyed Pt. Also, the existence of a segregated Pt phase especially at higher coverage is detected by XPS. Sample annealing indicates that the temperature rise promotes a further incorporation of Pt atoms into the Au substrate as supported by STM and XPS results. Additionally, the catalytic activity of different PtAu systems reported in the literature for some electrochemical reactions is discussed considering our findings.

[strategies For Integration Of Health Care Practices And Sanitary Surveillance In The Context Of The Implementation Of Rede Cegonha - A Brazilian Mother And Infant Health Care Network].

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.

Motivating Medical Students To Learn Basic Science Concepts Using Chronic Myeloid Leukemia As An Integration Theme.

To report on the use of chronic myeloid leukemia as a theme of basic clinical integration for first year medical students to motivate and enable in-depth understanding of the basic sciences of the future physician. During the past thirteen years we have reviewed and updated the curriculum of the medical school of the Universidade Estadual de Campinas. The main objective of the new curriculum is to teach the students how to learn to learn. Since then, a case of chronic myeloid leukemia has been introduced to first year medical students and discussed in horizontal integration with all themes taught during a molecular and cell biology course. Cell structure and components, protein, chromosomes, gene organization, proliferation, cell cycle, apoptosis, signaling and so on are all themes approached during this course. At the end of every topic approached, the students prepare in advance the corresponding topic of clinical cases chosen randomly during the class, which are then presented by them. During the final class, a paper regarding mutations in the abl gene that cause resistance to tyrosine kinase inhibitors is discussed. After each class, three tests are solved in an interactive evaluation. The course has been successful since its beginning, 13 years ago. Great motivation of those who participated in the course was observed. There were less than 20% absences in the classes. At least three (and as many as nine) students every year were interested in starting research training in the field of hematology. At the end of each class, an interactive evaluation was performed and more than 70% of the answers were correct in each evaluation. Moreover, for the final evaluation, the students summarized, in a written report, the molecular and therapeutic basis of chronic myeloid leukemia, with scores ranging from 0 to 10. Considering all 13 years, a median of 78% of the class scored above 5 (min 74%-max 85%), and a median of 67% scored above 7. Chronic myeloid leukemia is an excellent example of a disease that can be used for clinical basic integration as this disorder involves well known protein, cytogenetic and cell function abnormalities, has well-defined diagnostic strategies and a target oriented therapy.

A quantitative and qualitative evaluation of reports of clinical trials published in six Brazilian dental journals indexed in the Scientific Electronic Library Online (SciELO)

INTRODUCTION: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals many of which provide open access to full-text articles.This library includes a number of dental journals some of which may include reports of clinical trials in English, Portuguese and/or Spanish. Thus, SciELO could play an important role as a source of evidence for dental healthcare interventions especially if it yields a sizeable number of high quality reports. OBJECTIVE: The aim of this study was to identify reports of clinical trials by handsearching of dental journals that are accessible through SciELO, and to assess the overall quality of these reports. MATERIAL AND METHODS: Electronic versions of six Brazilian dental Journals indexed in SciELO were handsearched at www.scielo.br in September 2008. Reports of clinical trials were identified and classified as controlled clinical trials (CCTs - prospective, experimental studies comparing 2 or more healthcare interventions in human beings) or randomized controlled trials (RCTs - a random allocation method is clearly reported), according to Cochrane eligibility criteria. CRITERIA TO ASSESS METHODOLOGICAL QUALITY INCLUDED: method of randomization, concealment of treatment allocation, blinded outcome assessment, handling of withdrawals and losses and whether an intention-to-treat analysis had been carried out. RESULTS: The search retrieved 33 CCTs and 43 RCTs. A majority of the reports provided no description of either the method of randomization (75.3%) or concealment of the allocation sequence (84.2%). Participants and outcome assessors were reported as blinded in only 31.2% of the reports. Withdrawals and losses were only clearly described in 6.5% of the reports and none mentioned an intention-to-treat analysis or any similar procedure. CONCLUSIONS: The results of this study indicate that a substantial number of reports of trials and systematic reviews are available in the dental journals listed in SciELO, and that these could provide valuable evidence for clinical decision making. However, it is clear that the quality of a number of these reports is of some concern and that improvement in the conduct and reporting of these trials could be achieved if authors adhered to internationally accepted guidelines, e.g. the CONSORT statement.

Accuracy of three electronic apex locators in the presence of different irrigating solutions

The present study compared the accuracy of three electronic apex locators (EALs) - Elements Diagnostic®, Root ZX® and Apex DSP® - in the presence of different irrigating solutions (0.9% saline solution and 1% sodium hypochlorite). The electronic measurements were carried out by three examiners, using twenty extracted human permanent maxillary central incisors. A size 10 K file was introduced into the root canals until reaching the 0.0 mark, and was subsequently retracted to the 1.0 mark. The gold standard (GS) measurement was obtained by combining visual and radiographic methods, and was set 1 mm short of the apical foramen. Electronic length values closer to the GS (± 0.5 mm) were considered as accurate measures. Intraclass correlation coefficients (ICCs) were used to verify inter-examiner agreement. The comparison among the EALs was performed using the McNemar and Kruskal-Wallis tests (p < 0.05). The ICCs were generally high, ranging from 0.8859 to 0.9657. Similar results were observed for the percentage of electronic measurements closer to the GS obtained with the Elements Diagnostic® and the Root ZX® EALs (p > 0.05), independent of the irrigating solutions used. The measurements taken with these two EALs were more accurate than those taken with Apex DSP®, regardless of the irrigating solution used (p < 0.05). It was concluded that Elements Diagnostic® and Root ZX® apex locators are able to locate the cementum-dentine junction more precisely than Apex DSP®. The presence of irrigating solutions does not interfere with the performance of the EALs.

Analyzing the n→π* Electronic Transition of Formaldehyde in Water. A Sequential Monte Carlo/Time-Dependent Density Functional Theory

The n→π* absorption transition of formaldehyde in water is analyzed using combined and sequential classical Monte Carlo (MC) simulations and quantum mechanics (QM) calculations. MC simulations generate the liquid solute-solvent structures for subsequent QM calculations. Using time-dependent density functional theory in a localized set of gaussian basis functions (TD-DFT/6-311++G(d,p)) calculations are made on statistically relevant configurations to obtain the average solvatochromic shift. All results presented here use the electrostatic embedding of the solvent. The statistically converged average result obtained of 2300 cm-1 is compared to previous theoretical results available. Analysis is made of the effective dipole moment of the hydrogen-bonded shell and how it could be held responsible for the polarization of the solvent molecules in the outer solvation shells.