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

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

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines. METHODS: A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). PARTICIPANTS: consentable nonadopted adults with upcoming appointments. PRIMARY OUTCOME: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. MEASURES: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis. RESULTS: Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. CONCLUSION: MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce "overuse" and "underuse" of increased-risk services.Genet Med 18 10, 1020-1028.

Solution structure of the N-terminal transactivation domain of ERM modified by SUMO-1.

ERM is a member of the PEA3 group of the Ets transcription factor family that plays important roles in development and tumorigenesis. The PEA3s share an N-terminal transactivation domain (TADn) whose activity is inhibited by small ubiquitin-like modifier (SUMO). However, the consequences of sumoylation and its underlying molecular mechanism remain unclear. The domain structure of ERM TADn alone or modified by SUMO-1 was analyzed using small-angle X-ray scattering (SAXS). Low resolution shapes determined ab initio from the scattering data indicated an elongated shape and an unstructured conformation of TADn in solution. Covalent attachment of SUMO-1 does not perturb the structure of TADn as indicated by the linear arrangement of the SUMO moiety with respect to TADn. Thus, ERM belongs to the growing family of proteins that contain intrinsically unstructured regions. The flexible nature of TADn may be instrumental for ERM recognition and binding to diverse molecular partners.

Desarrollo instrumental y medición de la resistencia a la rotura de costras de suelo

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Desarrollo del pensamiento covariacional en un ambiente gráfico dinámico. Hacia una génesis instrumental

La tecnología puede resultar un recurso didáctico para que los estudiantes examinen situaciones y problemas desde diversos ángulos, específicamente, el uso de software dinámico ofrece un medio útil para que ellos visualicen, exploren y construyan relaciones matemáticas. Estos apoyos modifican tan fuertemente el medio ambiente de trabajo que no basta con adaptar situaciones matemáticas clásicas, hay que concebir nuevas situaciones que tomen en consideración las potencialidades y las restricciones de la tecnología. Esto ha llevado a la creación de una génesis instrumental que estudia la construcción hecha por el estudiante cuando interactúa con un artefacto, convirtiéndolo en instrumento, a través de un proceso, de manera tal que se lo apropia y lo hace parte de su actividad matemática, actividad que en esta investigación está relacionada con el desarrollo del pensamiento covariacional.

CAPLib - A 'thin layer' message passing library to support computational mechanics codes on distributed memory parallel systems

The Computer Aided Parallelisation Tools (CAPTools) [Ierotheou, C, Johnson SP, Cross M, Leggett PF, Computer aided parallelisation tools (CAPTools)-conceptual overview and performance on the parallelisation of structured mesh codes, Parallel Computing, 1996;22:163±195] is a set of interactive tools aimed to provide automatic parallelisation of serial FORTRAN Computational Mechanics (CM) programs. CAPTools analyses the user's serial code and then through stages of array partitioning, mask and communication calculation, generates parallel SPMD (Single Program Multiple Data) messages passing FORTRAN. The parallel code generated by CAPTools contains calls to a collection of routines that form the CAPTools communications Library (CAPLib). The library provides a portable layer and user friendly abstraction over the underlying parallel environment. CAPLib contains optimised message passing routines for data exchange between parallel processes and other utility routines for parallel execution control, initialisation and debugging. By compiling and linking with different implementations of the library, the user is able to run on many different parallel environments. Even with today's parallel systems the concept of a single version of a parallel application code is more of an aspiration than a reality. However for CM codes the data partitioning SPMD paradigm requires a relatively small set of message-passing communication calls. This set can be implemented as an intermediate `thin layer' library of message-passing calls that enables the parallel code (especially that generated automatically by a parallelisation tool such as CAPTools) to be as generic as possible. CAPLib is just such a `thin layer' message passing library that supports parallel CM codes, by mapping generic calls onto machine specific libraries (such as CRAY SHMEM) and portable general purpose libraries (such as PVM an MPI). This paper describe CAPLib together with its three perceived advantages over other routes: - as a high level abstraction, it is both easy to understand (especially when generated automatically by tools) and to implement by hand, for the CM community (who are not generally parallel computing specialists); - the one parallel version of the application code is truly generic and portable; - the parallel application can readily utilise whatever message passing libraries on a given machine yield optimum performance.

Models and tools for an integrated European environmental management and decision support system, (IEEMDSS)

This work proceeds from the assumption that a European environmental information and communication system (EEICS) is already established. In the context of primary users (land-use planners, conservationists, and environmental researchers) we ask what use may be made of the EEICS for building models and tools which is of use in building decision support systems for the land-use planner. The complex task facing the next generation of environmental and forest modellers is described, and a range of relevant modelling approaches are reviewed. These include visualization and GIS; statistical tabulation and database SQL, MDA and OLAP methods. The major problem of noncomparability of the definitions and measures of forest area and timber volume is introduced and the possibility of a model-based solution is considered. The possibility of using an ambitious and challenging biogeochemical modelling approach to understanding and managing European forests sustainably is discussed. It is emphasised that all modern methodological disciplines must be brought to bear, and a heuristic hybrid modelling approach should be used so as to ensure that the benefits of practical empirical modelling approaches are utilised in addition to the scientifically well-founded and holistic ecosystem and environmental modelling. The data and information system required is likely to end up as a grid-based-framework because of the heavy use of computationally intensive model-based facilities.

Use of Web Logs (Blogs) in Learning Environments: Blogs for Student Support

Innovation in technology and communications and particularly the advent of the Web is changing the structure of teaching and learning today. While there is much debate about the use of technology in learning and how e-learning is creating new approaches to delivery of learning there is been very little if any work on the use of of the emerging technologies in providing student support through their learning process. This paper reports on research and development undertaken by the eCentre based at the University of Greenwich School Of Computing in designing and developing a "Project Blog System" in order to address some long standing issues related to supervision of final year degree student projects. The paper will report on the methodology used to design the system and will discuss some of the results from students and staff evaluation of the system developed.

Generic support for policy-based self-adaptive systems

This paper presents a policy definition language which forms part of a generic policy toolkit for autonomic computing systems in which the policies themselves can be modified dynamically and automatically. Targeted enhancements to the current state of practice include: policy self-adaptation where the policy itself is dynamically modified to match environmental conditions; improved support for non autonomics-expert developers; and facilitating easy deployment of adaptive policies into legacy code. The policy definition language permits powerful expression of self-managing behaviours and facilitates a diverse policy behaviour space. Features include support for multiple versions of a given policy type, multiple configuration templates, and meta policies to dynamically select between policy instances. An example deployment scenario illustrates advanced functionality in the context of a multi policy stock trading system which is sensitive to environmental volatility.

Data collection in support of the modelling of naval vessels

Evacuation analysis of passenger and commercial shipping can be undertaken using computer-based simulation tools such as maritimeEXODUS. These tools emulate human shipboard behaviour during emergency scenarios; however it is largely based around the behaviour of civilian passengers and fixtures and fittings of merchant vessels. If these tools and procedures are to be applied to naval vessels there is a clear requirement to understand the behaviour of well-trained naval personnel interacting with the fixtures and fittings that are exclusive to warships. Human factor trials using Royal Navy training facilities were recently undertaken to collect data to improve our understanding of the performance of naval personnel in warship environments. The trials were designed and conducted by staff from the Fire Safety Engineering Group (FSEG) of the University of Greenwich on behalf of the Sea Technology Group (STG), Defence Procurement Agency. The trials involved a selection of RN volunteers with sea-going experience in warships, operating and traversing structural components under different angles of heel. This paper describes the trials and some of the collected data.

Decision support systems for eco-friendly electronic products

This paper discusses an optimisation based decision support system and methodology for electronic packaging and product design and development which is capable of addressing in efficient manner specified environmental, reliability and cost requirements. A study which focuses on the design of a flip-chip package is presented. Different alternatives for the design of the flip-chip package are considered based on existing options for the applied underfill and volume of solder material used to form the interconnects. Variations in these design input parameters have simultaneous effect on package aspects such as cost, environmental impact and reliability. A decision system for the design of the flip-chip that uses numerical optimisation approach is used to identify the package optimal specification which satisfies the imposed requirements. The reliability aspect of interest is the fatigue of solder joints under thermal cycling. Transient nonlinear finite element analysis (FEA) is used to simulate the thermal fatigue damage in solder joints subject to thermal cycling. Simulation results are manipulated within design of experiments and response surface modelling framework to provide numerical model for reliability which can be used to quantify the package reliability. Assessment of the environmental impact of the package materials is performed by using so called Toxic Index (TI). In this paper we demonstrate the evaluation of the environmental impact only for underfill and lead-free solder materials. This evaluation is based on the amount of material per flip-chip package. Cost is the dominant factor in contemporary flip-chip packaging industry. In the optimisation based decision support system for the design of the flip-chip package, cost of materials which varies as a result of variations in the design parameters is considered.

Support vector machines for regression and applications to software quality prediction

Software metrics are the key tool in software quality management. In this paper, we propose to use support vector machines for regression applied to software metrics to predict software quality. In experiments we compare this method with other regression techniques such as Multivariate Linear Regression, Conjunctive Rule and Locally Weighted Regression. Results on benchmark dataset MIS, using mean absolute error, and correlation coefficient as regression performance measures, indicate that support vector machines regression is a promising technique for software quality prediction. In addition, our investigation of PCA based metrics extraction shows that using the first few Principal Components (PC) we can still get relatively good performance.

Can the use of supplementary video and audio materials support student understanding of 3D animation? Some results, analysis and conclusions

A project within a computing department at the University of Greenwich, has been carried out to identify whether podcasting can be used to help understanding and learning of a subject (3D Animation). We know that the benefits of podcasting in education (HE) can be justified, [1]; [2]; [3]; [4]; [5]; [6] and that some success has been proven, but this paper aims to report the results of a term-long project that provided podcast materials for students to help support their learning using Xserve and Podcast Producer technology. Findings in a previous study [6] identified podcasting as a way to diversify learning and provde a more personalised learning experience for students, as well as being able to provide access to a greater mix of learning styles [7]. Finally this paper aims to present the method of capture and distribution, the methodologies of the study, analysis of results, and conclusions that relate to podcasting and enhanced supported learning.