Implementing clinical guidelines in an organizational setup

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines

Metallic monoclinic phase in VO2_2 induced by electrochemical gating: in-situ Raman study

We report in-situ Raman scattering studies of electrochemically top gated VO$_2$ thin film to address metal-insulator transition (MIT) under gating. The room temperature monoclinic insulating phase goes to metallic state at a gate voltage of 2.6 V. However, the number of Raman modes do not change with electrolyte gating showing that the metallic phase is still monoclinic. The high frequency Raman mode A$_g$(7) near 616 cm$^{-1}$ ascribed to V-O vibration of bond length 2.06 \AA~ in VO$_6$ octahedra hardens with increasing gate voltage and the B$_g$(3) mode near 654 cm$^{-1}$ softens. This shows that the distortion of the VO$_6$ octahedra in the monoclinic phase decreases with gating. The time dependent Raman data at fixed gate voltages of 1 V (for 50 minute, showing enhancement of conductivity by a factor of 50) and 2 V (for 130 minute, showing further increase in conductivity by a factor of 5) show similar changes in high frequency Raman modes A$_g$(7) and B$_g$(3) as observed in gating. This slow change in conductance together with Raman frequency changes show that the governing mechanism for metalization is more likely to the diffusion controlled oxygen vacancy formation due to the applied electric field.Comment: 5 pages, 6 figure

Six questions on the construction of ontologies in biomedicine

(Report assembled for the Workshop of the AMIA Working Group on Formal Biomedical Knowledge Representation in connection with AMIA Symposium, Washington DC, 2005.) Best practices in ontology building for biomedicine have been frequently discussed in recent years. However there is a range of seemingly disparate views represented by experts in the field. These views not only reflect the different uses to which ontologies are put, but also the experiences and disciplinary background of these experts themselves. We asked six questions related to biomedical ontologies to what we believe is a representative sample of ontologists in the biomedical field and came to a number conclusions which we believe can help provide an insight into the practical problems which ontology builders face today

Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM-HFpEF study.

BackgroundApproximately half of the patients presenting with new-onset heart failure (HF) have HF with preserved left ventricular ejection fraction (HFpEF) and HF with mid-range left ventricular ejection fraction (HFmrEF). These patients have neurohormonal activation like that of HF with reduced ejection fraction; however, beta-blockers and angiotensin-converting enzyme inhibitors have not been shown to improve their outcomes, and current treatment for these patients is symptom based and empiric. Sympathoinhibition using parasympathetic stimulation has been shown to improve central and peripheral aspects of the cardiac nervous system, reflex control, induce myocyte cardioprotection, and can lead to regression of left ventricular hypertrophy. Beneficial effects of autonomic regulation therapy (ART) using vagus nerve stimulation (VNS) have also been observed in several animal models of HFpEF, suggesting a potential role for ART in patients with this disease.MethodsThe Autonomic Neural Regulation Therapy to Enhance Myocardial Function in Patients with Heart Failure and Preserved Ejection Fraction (ANTHEM-HFpEF) study is designed to evaluate the feasibility, tolerability, and safety of ART using right cervical VNS in patients with chronic, stable HFpEF and HFmrEF. Patients with symptomatic HF and HFpEF or HFmrEF fulfilling the enrolment criteria will receive chronic ART with a subcutaneous VNS system attached to the right cervical vagus nerve. Safety parameters will be continuously monitored, and cardiac function and HF symptoms will be assessed every 3 months during a post-titration follow-up period of at least 12 months.ConclusionsThe ANTHEM-HFpEF study is likely to provide valuable information intended to expand our understanding of the potential role of ART in patients with chronic symptomatic HFpEF and HFmrEF

Human health risk assessment of temporal and spatial variations of ground water quality at a densely industrialized commercial complex at Haridwar, India

The observations of present investigation revealed that the groundwater regime at State Infrastructure and Industrial Development Corporation of Uttarakhand Limited (SIDCUL) Industrial Estate (IE) was highly responsive to the anthropogenic stress of recharge and discharge parameters concerning the distressing industrial activities. The present study on groundwater characteristics of SIDCUL-IE, Haridwar in year 2013-2014 showed that the water of Sampling station-D (SSD) had relatively poor quality in comparison to the groundwater collected from Sampling station-A (SSA), Sampling station-B (SSB) and Sampling station-C (SSC). The samples had a high mineral load with relatively wider pH range. The physico-chemical parameters like pH (6.35 in October) at SSA, TDS (553.5 mg/l in November) at SSC, TH (600.0 mg/l in July) at SSB and alkalinity (525.0 mg/l in October) at SSD were beyond the prescribed limits of Bureau of Indian Standards (BIS). The Karl Pearson correlation matrix showed moderate to significantly positive correlation between various parameters like COD-phosphorus (r=0.629), temperature-DO (r=-0.477) at SSA; pH and bicarbonate (r=0.668) at SSB; pH-temperature (r=-0.551),turbidity-BOD (r=0.467), BOD-phosphorus (r=0.518), bicarbonate-acidity (r=-0.833) at SSC and TSS-turbidity (r=0.616), BOD-COD (r=0.6771) at SSD and temperature-DO (r=-0.666), hardness-acidity (r=-0.6542) BOD-COD (r=0.654) at control site. The overall quality of groundwater, though hard, was found acceptable for drinking purpose. The divergence in the results of groundwater samples taken from SIDCUL-IE and the Control site, 2 km away from SIDCUL-IE, indicated that groundwater pollution is increasing alarmingly which may have serious threats to human health in near future

Tropical storm off Myanmar coast sweeps reefs in Ritchie’s Archipelago, Andaman

The reefs in some islands of Andaman and Nicobar suffered severe damage following a tropical storm in the Bay of Bengal off Myanmar coast during 13–17 March 2011. Surveys were conducted at eight sites in Andaman, of which five were located in the Ritchie’s Archipelago where maximum wind speeds of 11 ms-1 was observed; and three around Port Blair which lay on the leeward side of the storm and had not experienced wind speeds of more than 9 ms-1. Corals in the shallow inshore reefs were broken and dislodged by the thrust of the waves. Significant damage in the deeper regions and offshore reefs were caused by the settlement of debris and sand brought down from the shallower regions. The fragile branching corals (Acropora sp.) were reduced to rubbles and the larger boulder corals (Porites sp.) were toppled over or scarred by falling debris. The reefs on the windward side and directly in the path of the storm winds were the worst affected. The investigation exposes the vulnerability of the reefs in Andaman to the oceanographic features which generally remain unnoticed unless the damage is caused to the coastal habitats

Enhanced hard x-ray emission from microdroplet preplasma

We perform a comparative study of hard x-ray emission from femtosecond laser plasmas in 15 mu m methanol microdroplets and Perspex target. The hard x-ray yield from droplet plasmas is similar or equal to 68 times more than that obtained from solid plasmas at 2x10(15) W cm(-2). A 10 ns prepulse at about 5% of the main pulse appears to be essential for hard x-ray generation from droplets. Hot electron temperature of 36 keV is measured from the droplets at 8x10(14) W cm(-2), whereas a three times higher intensity is needed to obtain similar hot electron temperatures from Perspex plasmas. Particle-in-cell simulations with very long scale-length density profiles support experimental observations. (c) 2006 American Institute of Physics