Radiolaria in the surface layer of bottom sediments from the northern sector of the Benguela upwelling

Quantitative data on radiolarian assemblages from the Benguela upwelling at 17-25°S were obtained from analysis of 18 bottom sediment samples. The maximum abundance of Radiolaria (20000-40000 individuals per 1 g of sediment) was determined in sediments of the open ocean at depth 2000-4100 m. Species of tropical zones dominate in the assemblages; however content of species of subpolar and moderate zones reaches considerable values. In shelf sediments at depth 60-160 m abundance of Radiolaria (up to 5000 ind./g) is greater than in sediments of the continental slope. In shelf assemblages species of subpolar and temperate zones dominate. A characteristic feature of the shelf upwelling assemblages of Radiolaria is expressed by predominance of Lithomelissa setosa (Joerg.) (up to 50-80% at 23-25°S). L. setosa is a common representative of radiolarian assemblages of subpolar and temperate regions of the World Ocean. It is presumably regarded as an eurybiont species. Probably, it propagates with subantarctic intermediate water masses from the circumantarctic area to the Benguela upwelling region where there are favorable living conditions: subsurface water temperature is not higher than 10°C and there are high concentrations of nutrients.

Johann Rudolph Ahles ausgewählte Gesangswerke mit und ohne Begleitung von Instrumenten.

27. Motette: Unser keiner lebet ihm selber.--28. Dialog: Wer ist der, so von Edom kommet.--29. Ich hab's gewagt.--30. Fürchtet euch nicht.--31. Auf das fest der himmelfahrt.--32. Auf das fest des erzengels Michael.--33. Communion-andacht.--34. Von gnad' und recht. Ps. 101.--35. Cum Maria diluculo.--36. Wir glauben all' an einen Gott.--37. Magnificat.--38. Merk auf mein herz.--39. Zwingt die saiten in cithara.

School of Nursing Class of 1998

Top Row: Kathleen S. Allen, Elizabeth Anderson, Mary Assenmacher, Deana Barrett, Laurie Barringer, Linda Baty, Holidae Bauman, Leila Beach, Liesha Beachum, Jacquline S. Bean, Jane Betten, Melanie Black, Kari Blouin, Kelly Bottger, Nancy Bowman, JoAnn Britenfeld, Ruth C. Brower

Row 2: Melanie Mai Brown, Estera Carp, Christine Haveman, Kimberly Webster, Rebecca Amo, Tina K. Ciricola, Gerard A. Castaneda, Steven J. Bednarski, Michelle Kuo, Kathleen Szymanski, Alissa Enriquez, Kristin Snow, Jennifer Berk, Erica Reese, Angela Cassadime, Lynn Chacko

Row 3: Anne chambers, Mechele Chau, Marcy Christensen, Regi Colthorp, Kellie Conover, Jenny Cwiek, Michele DeMaagd, Kristin Diotte, Amanda Dressel, Kimberly Dunlap, Esther DuRussel, Katrina Ehr

Row 4: Holly M. Greenough, Eileen Gumayagay, Sheila Habib, Allison Hale, Kristi Hale, Amy Hollis, Rebecca Hostman, Marilynn Huizinga, Jennifer Ivinson, Christine Jodoin, Christine Kaetz, Kimberly Kenny-Sherlock, Andrea Latva, Kathleen Levin

Row 5: Shawna Mangan, Sofia Marquez, Paul Mazurek, Charla McMichael, Tina Marie Meeks, Richard W. Redman, Beverly Jones, Ada Sue Hinshaw, Susan Boehm, Nola Pender, Jeffrey Mendoza, Melissa Meulenberg, Cheryl Milekovich, Amanda Miller, Amy Miller

Row 6: Nicole Miller, Bonnie Mobley, Kara More, Cherylann Mortzfield, Leslie Nance, Ruby Nzoma, Megan Oleszek, Larah Faye Ostonal, Jean C. Palad, Danielle Pankowski, Nancy Penrose, Laurie Pierce, Heather Polsen, Julie Marie Postma, Amy Prielipp, Martha Quigley, Aimee Racette

Row 7: Marty Rauser, Nekia Robinson, Kimberly Rowe, Janice Rybski, Ricardo Salazar, Marie Sanderson, Kimberly Scholma, Bonnie Schweitzer, Veena Shewakramani, Julie Showers, Olga Simanovskaya, Emily Simon, Lakeeta Smith, Amy Stewart, Robert Strudgeon, Jaime Sulek

Row 8: Charity Sutherland, William Ten Haaf, Mark Thomas, Nichole Thomas, Donna Thompson, Tonya Tomski, Michele Uller, Celina Uranga, Sarah Volkhardt, Larna Welch, Melanie White, Michelle White, Britt Williams, Stephanie Windisch, Brian Wright, Christina Wyrybkowski, Lisa Ziegelmann

Telemedical support for Iraq

The Swinfen Charitable Trust (SCT) provided two kinds of telemedical support to Iraq during 2004. Starting in January 2004, the Al-Yarmouk Teaching Hospital in Baghdad was able to refer cases into the well established global e-health network that the SCT has operated for the last five years. (In the first quarter of 2004, the SCT dealt with a total of 57 referrals from 15 hospitals in eight countries.) Two cases were referred from Baghdad in March 2004, both gynaecological, which were dealt with by consultants from the UK and Australia. The SCT administrators visited Basrah during April 2004 and met Iraqi doctors at the Shaibah Hospital as part of the international initiatives to improve health care there. Following this visit, the SCT network expanded to include another four hospitals in Iraq (Table 1). In addition, the SCT provided an electronic health records (EHR) system to support the rebuilding of maternity services, which has been led by the British Royal Colleges. The maternity records system is a Web-based EHR system, running on a secure server, which allows integrated access from antenatal clinics, from hospitals and from postnatal clinics in Iraq. Patients can view their own notes, thus promoting ownership of medical information, and doctors can view the notes of their own patients, from any Internet-connected PC. No special software is required by the user.

Mobile case-based decision support for intelligent patient knowledge management

Hospitals everywhere are integrating health data using electronic health record (EHR) systems, and disparate and multimedia patient data can be input by different caregivers at different locations as encapsulated patient profiles. Healthcare institutions are also using the flexibility and speed of wireless computing to improve quality and reduce costs. We are developing a mobile application that allows doctors to efficiently record and access complete and accurate real-time patient information. The system integrates medical imagery with textual patient profiles as well as expert interactions by healthcare personnel using knowledge management and case-based reasoning techniques. The application can assist other caregivers in searching large repositories of previous patient cases. Patients' symptoms can be input to a portable device and the application can quickly retrieve similar profiles which can be used to support effective diagnoses and prognoses by comparing symptoms, treatments, diagnosis, test results and other patient information. © 2007 Sage Publications.

Information Discovery on Electronic Health Records Using Authority Flow Techniques

Background As the use of electronic health records (EHRs) becomes more widespread, so does the need to search and provide effective information discovery within them. Querying by keyword has emerged as one of the most effective paradigms for searching. Most work in this area is based on traditional Information Retrieval (IR) techniques, where each document is compared individually against the query. We compare the effectiveness of two fundamentally different techniques for keyword search of EHRs. Methods We built two ranking systems. The traditional BM25 system exploits the EHRs' content without regard to association among entities within. The Clinical ObjectRank (CO) system exploits the entities' associations in EHRs using an authority-flow algorithm to discover the most relevant entities. BM25 and CO were deployed on an EHR dataset of the cardiovascular division of Miami Children's Hospital. Using sequences of keywords as queries, sensitivity and specificity were measured by two physicians for a set of 11 queries related to congenital cardiac disease. Results Our pilot evaluation showed that CO outperforms BM25 in terms of sensitivity (65% vs. 38%) by 71% on average, while maintaining the specificity (64% vs. 61%). The evaluation was done by two physicians. Conclusions Authority-flow techniques can greatly improve the detection of relevant information in EHRs and hence deserve further study.

Building an alternative economic network? Consumer cooperation in Scotland from the 1870s to the 1960s

Peer reviewed

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.

Behavioral Perspectives on Organizational Change: Practice Adoption, Product Culling, and Technological Search

This dissertation explores the complex process of organizational change, applying a behavioral lens to understand change in processes, products, and search behaviors. Chapter 1 examines new practice adoption, exploring factors that predict the extent to which routines are adopted “as designed” within the organization. Using medical record data obtained from the hospital’s Electronic Health Record (EHR) system I develop a novel measure of the “gap” between routine “as designed” and routine “as realized.” I link this to a survey administered to the hospital’s professional staff following the adoption of a new EHR system and find that beliefs about the expected impact of the change shape fidelity of the adopted practice to its design. This relationship is more pronounced in care units with experienced professionals and less pronounced when the care unit includes departmental leadership. This research offers new insights into the determinants of routine change in organizations, in particular suggesting the beliefs held by rank-and-file members of an organization are critical in new routine adoption. Chapter 2 explores changes to products, specifically examining culling behaviors in the mobile device industry. Using a panel of quarterly mobile device sales in Germany from 2004-2009, this chapter suggests that the organization’s response to performance feedback is conditional upon the degree to which decisions are centralized. While much of the research on product exit has pointed to economic drivers or prior experience, these central finding of this chapter—that performance below aspirations decreases the rate of phase-out—suggests that firms seek local solutions when doing poorly, which is consistent with behavioral explanations of organizational action. Chapter 3 uses a novel text analysis approach to examine how the allocation of attention within organizational subunits shapes adaptation in the form of search behaviors in Motorola from 1974-1997. It develops a theory that links organizational attention to search, and the results suggest a trade-off between both attentional specialization and coupling on search scope and depth. Specifically, specialized unit attention to a more narrow set of problems increases search scope but reduces search depth; increased attentional coupling also increases search scope at the cost of depth. This novel approach and these findings help clarify extant research on the behavioral outcomes of attention allocation, which have offered mixed results.

A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

INTRODUCTION: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. METHOD: Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. FRAMEWORK: An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. NEXT STEPS: We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

Women of an uncertain age: quantifying human capital accumulation in rural Ireland in the nineteenth century

Geary and Stark find that Ireland’s post-Famine per capita GDP converged with British levels, and that this convergence was largely due to total factor productivity growth rather than mass emigration. In this article, new long-run measurements of human capital accumulation in Ireland are devised in order to facilitate a better assessment of sources of this productivity growth, including the relative contribution of men and women. This is done by exploiting the frequency at which age data heap at round ages, widely interpreted as an indicator of a population’s basic numeracy skills. Because Földvári, van Leeuwen, and van Leeuwen-Li find that gender-specific trends in this measure derived from census returns are biased by who is reporting and recording the age information, any computed numeracy trends are corrected using data from prison and workhouse registers, sources in which women ostensibly self-reported their age. The findings show that rural Irish women born early in the nineteenth century had substantially lower levels of human capital than uncorrected census data would otherwise suggest. These results are large in magnitude and thus economically significant. The speed at which women converged is consistent with Geary and Stark’s interpretation of Irish economic history; Ireland probably graduated to Europe’s club of advanced economies thanks in part to rapid advances in female human capital.

Divided Conquerors: the Rump Parliament, Cromwell's Army and Ireland

This article reassesses the relationship that existed in the period 1649–53 between war in Ireland and politics in England. Drawing upon a largely overlooked Irish army petition, it seeks to remedy an evident disconnect between the respective historiographies of the Cromwellian conquest of Ireland on the one hand and the Rump Parliament on the other. The article reconstructs some of the various disputes over religion, authority and violence that undermined the unity of the English wartime regime in Ireland. It then charts the eventual spilling over of these disputes into Westminster politics, arguing that their impact on deteriorating army-parliament relations in the year prior to Oliver Cromwell’s expulsion of the Rump in April 1653 has not been fully appreciated. The key driver of these developments was John Weaver, a republican MP and commissioner for the civil government of Ireland. The article explains how his efforts both to place restraints on the excessive violence of the conquest and to exert civilian control over the military evolved, by 1652, into a determined campaign at Westminster to strengthen the powers of Ireland’s civil government and to limit the army’s share in the prospective Irish land settlement. Weaver’s campaign forced the army officers in Ireland to intervene at Westminster, thus placing increased pressure on the Rump Parliament. This reassessment also enables the early 1650s to be viewed more clearly as a key phase in the operation of the longer-term relationships of mutual influence that existed between Dublin and London in the seventeenth century.

Improving Readability of Swedish Electronic Health Records through Lexical Simplification : First Results

This paper describes part of an ongoing effort to improve the readability of Swedish electronic health records (EHRs). An EHR contains systematic documentation of a single patient’s medical history across time, entered by healthcare professionals with the purpose of enabling safe and informed care. Linguistically, medical records exemplify a highly specialised domain, which can be superficially characterised as having telegraphic sentences involving displaced or missing words, abundant abbreviations, spelling variations including misspellings, and terminology. We report results on lexical simplification of Swedish EHRs, by which we mean detecting the unknown, out-ofdictionary words and trying to resolve them either as compounded known words, abbreviations or misspellings.

Validation of Electronic Health Record Phenotyping of Bipolar Disorder Cases and Controls

Objective: The study was designed to validate use of elec-tronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. Method: EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype di- agnoses was calculated against diagnoses from direct semi- structured interviews of 190 patients by trained clinicians blind to EHR diagnosis. Results: The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR- classified control subject received a diagnosis of bipolar dis- order on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based clas- sifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. Conclusions: Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.

Enhancing the Availability of Electronic Health Records for Secondary Purposes – A Case Study

Due to the sensitive nature of patient data, the secondary use of electronic health records (EHR) is restricted in scientific research and product development. Such restrictions pursue to preserve the privacy of respective patients by limiting the availability and variety of sensitive patient data. Current limitations do not correspond with the actual needs requested by the potential secondary users. In this thesis, the secondary use of Finnish and Swedish EHR data is explored for the purpose of enhancing the availability of such data for clinical research and product development. Involved EHR-related procedures and technologies are analysed to identify the issues limiting the secondary use of patient data. Successful secondary use of patient data increases the data value. To explore the identified circumstances, a case study of potential secondary users and use intentions regarding EHR data was carried out in Finland and Sweden. The data collection for the conducted case study was performed using semi-structured interviews. In total, 14 Finnish and Swedish experts representing scientific research, health management, and business were interviewed. The motivation for the corresponding interviews was to evaluate the protection of EHR data used for secondary purposes. The efficiency of implemented procedures and technologies was analysed in terms of data availability and privacy preserving. The results of the conducted case study show that the factors affecting EHR availability are divided to three categories: management of patient data, preservation of patients' privacy, and potential secondary users. Identified issues regarding data management included laborious and inconsistent data request procedures and the role and effect of external service providers. Based on the study findings, two secondary use approaches enabling the secondary use of EHR data are identified: data alteration and protected processing environment. Data alteration increases the availability of relevant EHR data, further decreasing the value of such data. Protected processing approach restricts the amount of potential users and use intentions while providing more valuable data content.