Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

HYBRID VIGOUR IN BRINJAL (SOLANUM MELONGENA L.)

The present investigation was undertaken in brinjal to estimate the magnitude of heterosis of some economically important traits. 36 F1 hybrids generated by half diallel crosses of nine pure diverse parent and these F1s along with 9 parents and 2 checks were evaluated in a randomized block design with three replication at Research farm of Department of Horticulture. The results showed considerable heterobeltiosis for traits viz. fruit diameter 60.73 % (Local C-1 x GADB-1), fruit weight 136.67 % (Asond Long x GADB-1), yield/plant 83.33 % (Local-3 x Local-2) and days to 50% flower -24.72% (Asond Long x GADB-1); moderate estimate for infestation of shoot and fruit borer -40.33 % (Asond Long x Selection-167) and chlorophyll content. Crosses displaying significant heterobeltiosis for yield also possessed marked heterotic advantage in one or more component characters emphasizing their role in increasing yield. The present study reveals good scope for isolation of pure lines from the progenies of heterotic F1s as well as commercial exploitation of heterosis in brinjal

Activation of store-operated calcium entry in airway smooth muscle cells: insight from a mathematical model

Intracellular dynamics of airway smooth muscle cells (ASMC) mediate ASMC contraction and proliferation, and thus play a key role in airway hyper-responsiveness (AHR) and remodelling in asthma. We evaluate the importance of store-operated entry (SOCE) in these dynamics by constructing a mathematical model of ASMC signaling based on experimental data from lung slices. The model confirms that SOCE is elicited upon sufficient depletion of the sarcoplasmic reticulum (SR), while receptor-operated entry (ROCE) is inhibited in such conditions. It also shows that SOCE can sustain agonist-induced oscillations in the absence of other influx. SOCE up-regulation may thus contribute to AHR by increasing the oscillation frequency that in turn regulates ASMC contraction. The model also provides an explanation for the failure of the SERCA pump blocker CPA to clamp the cytosolic of ASMC in lung slices, by showing that CPA is unable to maintain the SR empty of . This prediction is confirmed by experimental data from mouse lung slices, and strongly suggests that CPA only partially inhibits SERCA in ASMC

First nest record of the White-winged crossbill in Hispaniola

On 2 April 1971, while we were camping in southwestern Dominican Republic above El Aguacate in the Sierra de Baoruco (the eastern extension of the Massif de la Selle, the only known crossbill location in Haiti), one of us (A. D.) was attracted to a chattering pair of crossbills carrying small twigs in their bills to a nest they were constructing. The habitat was open Pinus occidentalis forest, at 1475 m elevation...

A Small Angle Scattering Sensor System for the Characterization of Combustion Generated Particulate

One of the critical issues for the US space program is fire safety of the space station and future launch vehicles. A detailed understanding of the scattering signatures of particulate is essential for the development of a false alarm free fire detection system. This paper describes advanced optical instrumentation developed and applied for fire detection. The system is being designed to determine four important physical properties of disperse fractal aggregates and particulates including size distribution, number density, refractive indices, and fractal dimension. Combustion generated particulate are the primary detection target; however, in order to discriminate from other particulate, non-combustion generated particles should also be characterized. The angular scattering signature is measured and analyzed using two photon optical laser scattering. The Rayleigh-Debye-Gans (R-D-G) scattering theory for disperse fractal aggregates is utilized. The system consists of a pulsed laser module, detection module and data acquisition system and software to analyze the signals. The theory and applications are described

A Candidate Subspecies Discrimination System Involving a Vomeronasal Receptor Gene with Different Alleles Fixed in M. m. domesticus and M. m. musculus

Assortative mating, a potentially efficient prezygotic reproductive barrier, may prevent loss of genetic potential by avoiding the production of unfit hybrids (i.e., because of hybrid infertility or hybrid breakdown) that occur at regions of secondary contact between incipient species. In the case of the mouse hybrid zone, where two subspecies of Mus musculus (M. m. domesticus and M. m. musculus) meet and exchange genes to a limited extent, assortative mating requires a means of subspecies recognition. We based the work reported here on the hypothesis that, if there is a pheromone sufficiently diverged between M. m. domesticus and M. m. musculus to mediate subspecies recognition, then that process must also require a specific receptor(s), also sufficiently diverged between the subspecies, to receive the signal and elicit an assortative mating response. We studied the mouse V1R genes, which encode a large family of receptors in the vomeronasal organ (VNO), by screening Perlegen SNP data and identified one, Vmn1r67, with 24 fixed SNP differences most of which (15/24) are nonsynonymous nucleotide substitutions between M. m. domesticus and M. m. musculus. We observed substantial linkage disequilibrium (LD) between Vmn1r67 and Abpa27, a mouse salivary androgen-binding protein gene that encodes a proteinaceous pheromone (ABP) capable of mediating assortative mating, perhaps in conjunction with its bound small lipophilic ligand. The LD we observed is likely a case of association rather than residual physical linkage from a very recent selective sweep, because an intervening gene, Vmn1r71, shows significant intra(sub)specific polymorphism but no inter(sub)specific divergence in its nucleotide sequence. We discuss alternative explanations of these observations, for example that Abpa27 and Vmn1r67 are coevolving as signal and receptor to reinforce subspecies hybridization barriers or that the unusually divergent Vmn1r67 allele was not a product of fast positive selection, but was derived from an introgressed allele, possibly from Mus spretus

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). DESIGN: Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. PARTICIPANTS: A total of 2,358 adults, aged 18–64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. MAIN MEASURES: We defined “usual provider” as a primary care provider/practice, and “PCMH provider” as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. RESULTS: Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2–13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4–21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7–14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5–15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0–19.0). CONCLUSIONS: Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling

Widespread Over-Expression of the X Chromosome in Sterile F1 Hybrid Mice

The X chromosome often plays a central role in hybrid male sterility between species, but it is unclear if this reflects underlying regulatory incompatibilities. Here we combine phenotypic data with genome-wide expression data to directly associate aberrant expression patterns with hybrid male sterility between two species of mice. We used a reciprocal cross in which F1 males are sterile in one direction and fertile in the other direction, allowing us to associate expression differences with sterility rather than with other hybrid phenotypes. We found evidence of extensive over-expression of the X chromosome during spermatogenesis in sterile but not in fertile F1 hybrid males. Over-expression was most pronounced in genes that are normally expressed after meiosis, consistent with an X chromosome-wide disruption of expression during the later stages of spermatogenesis. This pattern was not a simple consequence of faster evolutionary divergence on the X chromosome, because X-linked expression was highly conserved between the two species. Thus, transcriptional regulation of the X chromosome during spermatogenesis appears particularly sensitive to evolutionary divergence between species. Overall, these data provide evidence for an underlying regulatory basis to reproductive isolation in house mice and underscore the importance of transcriptional regulation of the X chromosome to the evolution of hybrid male sterility

An enterprise engineering approach for the alignment of business and information technology strategy

Information systems and information technology (IS/IT, hereafter just IT) strategies usually depend on a business strategy. The alignment of both strategies improves their strategic plans. From an external perspective, business and IT alignment is the extent to which the IT strategy enables and drives the business strategy. This article reviews strategic alignment between business and IT, and proposes the use of enterprise engineering (EE) to achieve this alignment. The EE approach facilitates the definition of a formal dialog in the alignment design. In relation to this, new building blocks and life-cycle phases have been defined for their use in an enterprise architecture context. This proposal has been adopted in a critical process of a ceramic tile company for the purpose of aligning a strategic business plan and IT strategy, which are essential to support this process. © 2011 Taylor & Francis.Cuenca, L.; Boza, A.; Ortiz, A. (2011). An enterprise engineering approach for the alignment of business and information technology strategy. International Journal of Computer Integrated Manufacturing. 24(11):974-992. https://doi.org/10.1080/0951192X.2011.579172S9749922411(1993). CIMOSA: Open System Architecture for CIM. doi:10.1007/978-3-642-58064-2Ang, J., Shaw, N., & Pavri, F. (1995). Identifying strategic management information systems planning parameters using case studies. International Journal of Information Management, 15(6), 463-474. doi:10.1016/0268-4012(95)00049-dAvison, D., Jones, J., Powell, P., & Wilson, D. (2004). Using and validating the strategic alignment model. The Journal of Strategic Information Systems, 13(3), 223-246. doi:10.1016/j.jsis.2004.08.002Avgerou, & McGrath. (2007). Power, Rationality, and the Art of Living through Socio-Technical Change. MIS Quarterly, 31(2), 295. doi:10.2307/25148792Bergeron, F., Raymond, L., & Rivard, S. (2004). Ideal patterns of strategic alignment and business performance. Information & Management, 41(8), 1003-1020. doi:10.1016/j.im.2003.10.004Bernus, P., Nemes, L., & Schmidt, G. (Eds.). (2003). Handbook on Enterprise Architecture. doi:10.1007/978-3-540-24744-9Bleistein, S. J., Cox, K., Verner, J., & Phalp, K. T. (2006). B-SCP: A requirements analysis framework for validating strategic alignment of organizational IT based on strategy, context, and process. Information and Software Technology, 48(9), 846-868. doi:10.1016/j.infsof.2005.12.001Buchanan, S., & Gibb, F. (1998). The information audit: An integrated strategic approach. International Journal of Information Management, 18(1), 29-47. doi:10.1016/s0268-4012(97)00038-8Buchanan, S., & Gibb, F. (2007). The information audit: Role and scope. International Journal of Information Management, 27(3), 159-172. doi:10.1016/j.ijinfomgt.2007.01.002Chen, D., & Vernadat, F. (2004). Standards on enterprise integration and engineering—state of the art. International Journal of Computer Integrated Manufacturing, 17(3), 235-253. doi:10.1080/09511920310001607087Chen, D., Doumeingts, G., & Vernadat, F. (2008). Architectures for enterprise integration and interoperability: Past, present and future. Computers in Industry, 59(7), 647-659. doi:10.1016/j.compind.2007.12.016Chen, H.-M., Kazman, R., & Garg, A. (2005). BITAM: An engineering-principled method for managing misalignments between business and IT architectures. Science of Computer Programming, 57(1), 5-26. doi:10.1016/j.scico.2004.10.002Cuenca, L., Ortiz, A., & Vernadat, F. (2006). From UML or DFD models to CIMOSA partial models and enterprise components. International Journal of Computer Integrated Manufacturing, 19(3), 248-263. doi:10.1080/03081070500065841Davis, G. B. (2000). Information Systems Conceptual Foundations: Looking Backward and Forward. IFIP Advances in Information and Communication Technology, 61-82. doi:10.1007/978-0-387-35505-4_5Gindy, N., Morcos, M., Cerit, B., & Hodgson, A. (2008). Strategic technology alignment roadmapping STAR® aligning R&D investments with business needs. International Journal of Computer Integrated Manufacturing, 21(8), 957-970. doi:10.1080/09511920801927148Goethals, F. G., Lemahieu, W., Snoeck, M., & Vandenbulcke, J. A. (2007). The data building blocks of the enterprise architect. Future Generation Computer Systems, 23(2), 269-274. doi:10.1016/j.future.2006.05.004Greefhorst, D., Koning, H., & Vliet, H. van. (2006). The many faces of architectural descriptions. Information Systems Frontiers, 8(2), 103-113. doi:10.1007/s10796-006-7975-xGregor, S., Hart, D., & Martin, N. (2007). Enterprise architectures: enablers of business strategy and IS/IT alignment in government. Information Technology & People, 20(2), 96-120. doi:10.1108/09593840710758031Hartono, E., Lederer, A. L., Sethi, V., & Zhuang, Y. (2003). Key predictors of the implementation of strategic information systems plans. ACM SIGMIS Database, 34(3), 41-53. doi:10.1145/937742.937747Henderson, J. C., & Venkatraman, H. (1993). Strategic alignment: Leveraging information technology for transforming organizations. IBM Systems Journal, 32(1), 472-484. doi:10.1147/sj.382.0472Hirschheim, R., & Sabherwal, R. (2001). Detours in the Path toward Strategic Information Systems Alignment. California Management Review, 44(1), 87-108. doi:10.2307/41166112Hoogervorst, J. A. P. (2009). Enterprise Governance and Enterprise Engineering. doi:10.1007/978-3-540-92671-9Johnson, A. M., & Lederer, A. L. (2010). CEO/CIO mutual understanding, strategic alignment, and the contribution of IS to the organization. Information & Management, 47(3), 138-149. doi:10.1016/j.im.2010.01.002JONKERS, H., LANKHORST, M., VAN BUUREN, R., HOPPENBROUWERS, S., BONSANGUE, M., & VAN DER TORRE, L. (2004). CONCEPTS FOR MODELING ENTERPRISE ARCHITECTURES. International Journal of Cooperative Information Systems, 13(03), 257-287. doi:10.1142/s0218843004000985King, W. R. (1978). Strategic Planning for Management Information Systems. MIS Quarterly, 2(1), 27. doi:10.2307/249104Leonard, J. (2007). Sharing a Vision: comparing business and IS managers’ perceptions of strategic alignment issues. Australasian Journal of Information Systems, 15(1). doi:10.3127/ajis.v15i1.299Luftman, J. N., Lewis, P. R., & Oldach, S. H. (1993). Transforming the enterprise: The alignment of business and information technology strategies. IBM Systems Journal, 32(1), 198-221. doi:10.1147/sj.321.0198Luftman, J., Ben-Zvi, T., Dwivedi, R., & Rigoni, E. H. (2010). IT Governance. International Journal of IT/Business Alignment and Governance, 1(2), 13-25. doi:10.4018/jitbag.2010040102Melville, Kraemer, & Gurbaxani. (2004). Review: Information Technology and Organizational Performance: An Integrative Model of IT Business Value. MIS Quarterly, 28(2), 283. doi:10.2307/25148636Newkirk, H. E., & Lederer, A. L. (2006). Incremental and Comprehensive Strategic Information Systems Planning in an Uncertain Environment. IEEE Transactions on Engineering Management, 53(3), 380-394. doi:10.1109/tem.2006.877446Noran, O. (2003). An analysis of the Zachman framework for enterprise architecture from the GERAM perspective. Annual Reviews in Control, 27(2), 163-183. doi:10.1016/j.arcontrol.2003.09.002Noran, O. (2005). A systematic evaluation of the C4ISR AF using ISO15704 Annex A (GERAM). Computers in Industry, 56(5), 407-427. doi:10.1016/j.compind.2004.12.005Ortiz, A., Lario, F., & Ros, L. (1999). Enterprise Integration—Business Processes Integrated Management: a proposal for a methodology to develop Enterprise Integration Programs. Computers in Industry, 40(2-3), 155-171. doi:10.1016/s0166-3615(99)00021-4Panetto, H., Baïna, S., & Morel, G. (2007). Mapping the IEC 62264 models onto the Zachman framework for analysing products information traceability: a case study. Journal of Intelligent Manufacturing, 18(6), 679-698. doi:10.1007/s10845-007-0040-xPapp, R. (Ed.). (2001). Strategic Information Technology. doi:10.4018/978-1-87828-987-2Peñaranda, N., Mejía, R., Romero, D., & Molina, A. (2010). Implementation of product lifecycle management tools using enterprise integration engineering and action-research. International Journal of Computer Integrated Manufacturing, 23(10), 853-875. doi:10.1080/0951192x.2010.495136Reich, B. H., & Benbasat, I. (2000). Factors That Influence the Social Dimension of Alignment between Business and Information Technology Objectives. MIS Quarterly, 24(1), 81. doi:10.2307/3250980Sledgianowski, D., & Luftman, J. (2005). IT-Business Strategic Alignment Maturity. Journal of Cases on Information Technology, 7(2), 102-120. doi:10.4018/jcit.2005040107Sowa, J. F., & Zachman, J. A. (1992). Extending and formalizing the framework for information systems architecture. IBM Systems Journal, 31(3), 590-616. doi:10.1147/sj.313.0590Van Grembergen, W., & De Haes, S. (2010). A Research Journey into Enterprise Governance of IT, Business/IT Alignment and Value Creation. International Journal of IT/Business Alignment and Governance, 1(1), 1-13. doi:10.4018/jitbag.2010120401Xueying Wang, Xiongwei Zhou, & Longbin Jiang. (2008). A method of business and IT alignment based on Enterprise Architecture. 2008 IEEE International Conference on Service Operations and Logistics, and Informatics. doi:10.1109/soli.2008.468649