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. ^

Demystifying the information reconciliation protocol cascade

Cascade is an information reconciliation protocol proposed in the context of secret key agreement in quantum cryptography. This protocol allows removing discrepancies in two partially correlated sequences that belong to distant parties, connected through a public noiseless channel. It is highly interactive, thus requiring a large number of channel communications between the parties to proceed and, although its efficiency is not optimal, it has become the de-facto standard for practical implementations of information reconciliation in quantum key distribution. The aim of this work is to analyze the performance of Cascade, to discuss its strengths, weaknesses and optimization possibilities, comparing with some of the modified versions that have been proposed in the literature. When looking at all design trade-offs, a new view emerges that allows to put forward a number of guidelines and propose near optimal parameters for the practical implementation of Cascade improving performance significantly in comparison with all previous proposals.

Information reconciliation for Quantum Key Distribution

Secret-key agreement, a well-known problem in cryptography, allows two parties holding correlated sequences to agree on a secret key communicating over a public channel. It is usually divided into three different procedures: advantage distillation, information reconciliation and privacy amplification. The efficiency of each one of these procedures is needed if a positive key rate is to be attained from the legitimate parties? correlated sequences. Quantum key distribution (QKD) allows the two parties to obtain correlated sequences, provided that they have access to an authenticated channel. The new generation of QKD devices is able to work at higher speeds and in noisier or more absorbing environments. This exposes the weaknesses of current information reconciliation protocols, a key component to their performance. Here we present a new protocol based in low-density parity-check (LDPC) codes that presents the advantages of low interactivity, rate adaptability and high efficiency,characteristics that make it highly suitable for next generation QKD devices.

Hippocampal, but not amygdala, activity at encoding correlates with long-term, free recall of nonemotional information

Participation of two medial temporal lobe structures, the hippocampal region and the amygdala, in long-term declarative memory encoding was examined by using positron emission tomography of regional cerebral glucose. Positron emission tomography scanning was performed in eight healthy subjects listening passively to a repeated sequence of unrelated words. Memory for the words was assessed 24 hr later with an incidental free recall test. The percentage of words freely recalled then was correlated with glucose activity during encoding. The results revealed a striking correlation (r = 0.91, P < 0.001) between activity of the left hippocampal region (centered on the dorsal parahippocampal gyrus) and word recall. No correlation was found between activity of either the left or right amygdala and recall. The findings provide evidence for hippocampal involvement in long-term declarative memory encoding and for the view that the amygdala is not involved with declarative memory formation for nonemotional material.

A Mixture model with random-effects components for clustering correlated gene-expression profiles

Motivation: The clustering of gene profiles across some experimental conditions of interest contributes significantly to the elucidation of unknown gene function, the validation of gene discoveries and the interpretation of biological processes. However, this clustering problem is not straightforward as the profiles of the genes are not all independently distributed and the expression levels may have been obtained from an experimental design involving replicated arrays. Ignoring the dependence between the gene profiles and the structure of the replicated data can result in important sources of variability in the experiments being overlooked in the analysis, with the consequent possibility of misleading inferences being made. We propose a random-effects model that provides a unified approach to the clustering of genes with correlated expression levels measured in a wide variety of experimental situations. Our model is an extension of the normal mixture model to account for the correlations between the gene profiles and to enable covariate information to be incorporated into the clustering process. Hence the model is applicable to longitudinal studies with or without replication, for example, time-course experiments by using time as a covariate, and to cross-sectional experiments by using categorical covariates to represent the different experimental classes. Results: We show that our random-effects model can be fitted by maximum likelihood via the EM algorithm for which the E(expectation) and M(maximization) steps can be implemented in closed form. Hence our model can be fitted deterministically without the need for time-consuming Monte Carlo approximations. The effectiveness of our model-based procedure for the clustering of correlated gene profiles is demonstrated on three real datasets, representing typical microarray experimental designs, covering time-course, repeated-measurement and cross-sectional data. In these examples, relevant clusters of the genes are obtained, which are supported by existing gene-function annotation. A synthetic dataset is considered too.

Neighborhood environmental factors correlated with walking near home: Using SPACES

Purpose: The physical environment plays an important role in influencing participation in physical activity, although the specific factors that are correlated with different patterns of walking remain to be determined We examined correlations between physical environmental factors and self-reported walking for recreation and transport near home. Methods: The local neighborhood environments (defined as a 400-m radius from the respondent's home) of 1678 adults were assessed for their suitability for walking. The environmental data were collected during 2000 using the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument together with information from other sources. We used logistic regression modeling to examine the relationship between the attributes of the physical environment and the self-reported walking behavior undertaken near home. Results: Functional features were correlated with both walking for recreation (odds ratio (OR) 1.62; 95% confidence interval (Cl): 1.20-2.19) and for transport (OR 1.30; 95% Cl: 0.97-1.73). A well-maintained walking surface was the main functional factor associated with walking for recreation (OR 2.04; 95% Cl: 1.43-2.91) and for transport (OR 2.13; 95% Cl: 1.53-2.96). Destination factors, such as shops and public transport, were significantly correlated with walking for transport (OR 1.80; 95% Cl: 1.33-2.44), but not recreation. Conclusion: The findings suggest that neighborhoods with pedestrian facilities that are attractive and comfortable and where there are local destinations (such as shops and public transport) are associated with walking near home.

On the distributed compression of quantum information

The problem of distributed compression for correlated quantum sources is considered. The classical version of this problem was solved by Slepian and Wolf, who showed that distributed compression could take full advantage of redundancy in the local sources created by the presence of correlations. Here it is shown that, in general, this is not the case for quantum sources, by proving a lower bound on the rate sum for irreducible sources of product states which is stronger than the one given by a naive application of Slepian-Wolf. Nonetheless, strategies taking advantage of correlation do exist for some special classes of quantum sources. For example, Devetak and Winter demonstrated the existence of such a strategy when one of the sources is classical. Optimal nontrivial strategies for a different extreme, sources of Bell states, are presented here. In addition, it is explained how distributed compression is connected to other problems in quantum information theory, including information-disturbance questions, entanglement distillation and quantum error correction.

Optimal design for correlated processes with input-dependent noise

Optimal design for parameter estimation in Gaussian process regression models with input-dependent noise is examined. The motivation stems from the area of computer experiments, where computationally demanding simulators are approximated using Gaussian process emulators to act as statistical surrogates. In the case of stochastic simulators, which produce a random output for a given set of model inputs, repeated evaluations are useful, supporting the use of replicate observations in the experimental design. The findings are also applicable to the wider context of experimental design for Gaussian process regression and kriging. Designs are proposed with the aim of minimising the variance of the Gaussian process parameter estimates. A heteroscedastic Gaussian process model is presented which allows for an experimental design technique based on an extension of Fisher information to heteroscedastic models. It is empirically shown that the error of the approximation of the parameter variance by the inverse of the Fisher information is reduced as the number of replicated points is increased. Through a series of simulation experiments on both synthetic data and a systems biology stochastic simulator, optimal designs with replicate observations are shown to outperform space-filling designs both with and without replicate observations. Guidance is provided on best practice for optimal experimental design for stochastic response models. © 2013 Elsevier Inc. All rights reserved.

Study on Robustness of Correlated Frailty Model

2000 Mathematics Subject Classifi cation: 62J12.

The impact of information technology on organizations: A study of enterprise resource planning system influences on job design and organizational culture

The primary purpose of this research is to study the linkage between perceived job design characteristics and information system environment characteristics before and after the replacement of a legacy information system with a new type of information system (referred to as an Enterprise Resource Planning or ERP system). A public state University implementing an academic version of an ERP system was selected for the study. Three survey instruments were used to examine the perception of the information system, the job characteristics, and the organizational culture before and after the system implementation. The research participants included two large departments resulting in a sample of 130 workers. Research questions were analyzed using multivariate procedures including factor analysis, path analysis, step-wise regression, and matched pair analysis. ^ Results indicated that the ERP system has introduced new elements into the working environment that has changed the perception of how the job design characteristics and organization culture dimensions are viewed by the workers. The understanding of how the perceived system characteristics align with an individual's perceived job design characteristics is supported by each of the system characteristics significantly correlated in the proposed direction. The stronger support of this relationship becomes visible in the causal flow of the effects seen in the path diagram and in the step-wise regression. The perceived job design characteristics aligning with dimensions of organizational culture are not as strong as the literature suggests. Although there are significant correlations between the job and culture variables, only one relationship can be seen in the causal flow. ^ This research has demonstrated that system characteristics of ERP do contribute to the perception of change in an organization and do support organizational culture behaviors and job characteristics. ^

Online information seeking by patients with bipolar disorder:results from an international multisite survey

Background: Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. Methods: A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data. Results: 976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor. Conclusion: Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.

Eliciting and Aggregating Forecasts When Information is Shared

Using the wisdom of crowds---combining many individual forecasts to obtain an aggregate estimate---can be an effective technique for improving forecast accuracy. When individual forecasts are drawn from independent and identical information sources, a simple average provides the optimal crowd forecast. However, correlated forecast errors greatly limit the ability of the wisdom of crowds to recover the truth. In practice, this dependence often emerges because information is shared: forecasters may to a large extent draw on the same data when formulating their responses.

To address this problem, I propose an elicitation procedure in which each respondent is asked to provide both their own best forecast and a guess of the average forecast that will be given by all other respondents. I study optimal responses in a stylized information setting and develop an aggregation method, called pivoting, which separates individual forecasts into shared and private information and then recombines these results in the optimal manner. I develop a tailored pivoting procedure for each of three information models, and introduce a simple and robust variant that outperforms the simple average across a variety of settings.

In three experiments, I investigate the method and the accuracy of the crowd forecasts. In the first study, I vary the shared and private information in a controlled environment, while the latter two studies examine forecasts in real-world contexts. Overall, the data suggest that a simple minimal pivoting procedure provides an effective aggregation technique that can significantly outperform the crowd average.

Macro-epibenthic communities, bathymetry and enviromental information at the tip of the Antarctic Peninsula

The Southern Ocean ecosystem at the Antarctic Peninsula has steep natural environmental gradients, e.g. in terms of water masses and ice cover, and experiences regional above global average climate change. An ecological macroepibenthic survey was conducted in three ecoregions in the north-western Weddell Sea, on the continental shelf of the Antarctic Peninsula in the Bransfield Strait and on the shelf of the South Shetland Islands in the Drake Passage, defined by their environmental envelop. The aim was to improve the so far poor knowledge of the structure of this component of the Southern Ocean ecosystem and its ecological driving forces. It can also provide a baseline to assess the impact of ongoing climate change to the benthic diversity, functioning and ecosystem services. Different intermediate-scaled topographic features such as canyon systems including the corresponding topographically defined habitats 'bank', 'upper slope', 'slope' and 'canyon/deep' were sampled. In addition, the physical and biological environmental factors such as sea-ice cover, chlorophyll-a concentration, small-scale bottom topography and water masses were analysed. Catches by Agassiz trawl showed high among-station variability in biomass of 96 higher systematic groups including ecological key taxa. Large-scale patterns separating the three ecoregions from each other could be correlated with the two environmental factors, sea-ice and depth. Attribution to habitats only poorly explained benthic composition, and small-scale bottom topography did not explain such patterns at all. The large-scale factors, sea-ice and depth, might have caused large-scale differences in pelagic benthic coupling, whilst small-scale variability, also affecting larger scales, seemed to be predominantly driven by unknown physical drivers or biological interactions.

Information and communication technology demands at work : the association with job strain, effort-reward imbalance and self-rated health in different socio-economic strata

PURPOSE: The use of information and communication technology (ICT) is common in modern working life. ICT demands may give rise to experience of work-related stress. Knowledge about ICT demands in relation to other types of work-related stress and to self-rated health is limited. Consequently, the aim of this study was to examine the association between ICT demands and two types of work-related stress [job strain and effort-reward imbalance (ERI)] and to evaluate the association between these work-related stress measures and self-rated health, in general and in different SES strata. METHODS: This study is based on cross-sectional data from the Swedish Longitudinal Occupational Survey of Health collected in 2014, from 14,873 gainfully employed people. ICT demands, job strain, ERI and self-rated health were analysed as the main measures. Sex, age, SES, lifestyle factors and BMI were used as covariates. RESULTS: ICT demands correlated significantly with the dimensions of the job strain and ERI models, especially with the demands (r = 0.42; p < 0.01) and effort (r = 0.51; p < 0.01) dimensions. ICT demands were associated with suboptimal self-rated health, also after adjustment for age, sex, SES, lifestyle and BMI (OR 1.49 [95 % CI 1.36-1.63]), but job strain (OR 1.93 [95 % CI 1.74-2.14) and ERI (OR 2.15 [95 % CI 1.95-2.35]) showed somewhat stronger associations with suboptimal self-rated health. CONCLUSION: ICT demands are common among people with intermediate and high SES and associated with job strain, ERI and suboptimal self-rated health. ICT demands should thus be acknowledged as a potential stressor of work-related stress in modern working life.

HOLDING DECISIONS FOR CORRELATED VEHICLE ARRIVALS AT INTERMODAL FREIGHT TRANSFER TERMINALS

A vehicle holding method is proposed for mitigating the effect of service disruptions on coordinated intermodal freight operations. Existing studies are extended mainly by (1) modeling correlations among vehicle arrivals and (2) considering decision risks with a mean-standard deviation optimization model. It is shown that the expected value of the total cost in the proposed formulation is not affected by the correlations, while the variance can be miscomputed when arrival correlations are neglected. Some implications of delay propagation are also identified when optimizing vehicle holding decisions in real-time. General criteria are provided for determining the boundary of the affected region and length of the numerical search, based on the frequency of information updates. Theoretical analyses are supported by three numerical examples.