Integrating Clinical Decision Support into Workflow

Purpose: The aims were to (1) identify barriers and facilitators related to integration of clinical decision support (CDS) into workflow and (2) develop and test CDS design alternatives. Scope: To better understand CDS integration, we studied its use in practice, focusing on CDS for colorectal cancer (CRC) screening and followup. Phase 1 involved outpatient clinics of four different systems—120 clinic staff and providers and 118 patients were observed. In Phase 2, prototyped design enhancements to the Veterans Administration’s CRC screening reminder were compared against its current reminder in a simulation experiment. Twelve providers participated. Methods: Phase 1 was a qualitative project, using key informant interviews, direct observation, opportunistic interviews, and focus groups. All data were analyzed using a coding template, based on the sociotechnical systems theory, which was modified as coding proceeded and themes emerged. Phase 2 consisted of rapid prototyping of CDS design alternatives based on Phase 1 findings and a simulation experiment to test these design changes in a within-subject comparison. Results: Very different CDS types existed across sites, yet there are common barriers: (1) lack of coordination of “outside” results and between primary and specialty care; (2) suboptimal data organization and presentation; (3) needed provider and patient education; (4) needed interface flexibility; (5) needed technological enhancements; (6) unclear role assignments; (7) organizational issues; and (8) disconnect with quality reporting. Design enhancements positively impacted usability and workflow integration but not workload. Conclusions: Effective CDS design and integration requires: (1) organizational and workflow integration; (2) integrating outside results; (3) improving data organization and presentation in a flexible interface; and (4) providing just-in time education, cognitive support, and quality reporting

Detection of the Power Spectrum of Cosmic Microwave Background Lensing by the Atacama Cosmology Telescope

We report the first detection of the gravitational lensing of the cosmic microwave background through a measurement of the four-point correlation function in the temperature maps made by the Atacama Cosmology Telescope. We verify our detection by calculating the levels of potential contaminants and performing a number of null tests. The resulting convergence power spectrum at 2-degree angular scales measures the amplitude of matter density fluctuations on comoving length scales of around 100 Mpc at redshifts around 0.5 to 3. The measured amplitude of the signal agrees with Lambda Cold Dark Matter cosmology predictions. Since the amplitude of the convergence power spectrum scales as the square of the amplitude of the density fluctuations, the 4-sigma detection of the lensing signal measures the amplitude of density fluctuations to 12%.Comment: 4 pages, 4 figures, replaced title and author list with version accepted by Physical Review Letters. Likelihood code can be downloaded from http://bccp.lbl.gov/~sudeep/ACTLensLike.htm

Using Ranked Auxiliary Covariate as a More Efficient Sampling Design for ANCOVA Model: Analysis of a Psychological Intervention to Buttress Resilience

Drawing a sample can be costly or time consuming in some studies. However, it may be possible to rank the sampling units according to some baseline auxiliary covariates, which are easily obtainable, and/or cost efficient. Ranked set sampling (RSS) is a method to achieve this goal. In this paper, we propose a modified approach of the RSS method to allocate units into an experimental study that compares L groups. Computer simulation estimates the empirical nominal values and the empirical power values for the test procedure of comparing L different groups using modified RSS based on the regression approach in analysis of covariance (ANCOVA) models. A comparison to simple random sampling (SRS) is made to demonstrate efficiency. The results indicate that the required sample sizes for a given precision are smaller under RSS than under SRS. The modified RSS protocol was applied to an experimental study. The experimental study was designed to obtain a better understanding of the pathways by which positive experiences (i.e., goal completion) contribute to higher levels of happiness, well-being, and life satisfaction. The use of the RSS method resulted in a cost reduction associated with smaller sample size without losing the precision of the analysis

Geochemical characterization of shallow groundwater at the Cranfield aquifer and numerical simulation: Can pH and carbonate parameters be used to detect potential CO2 leakage at geological CO2 sequestration sites?

Bureau of Economic Geolog

Premating Reproductive Barriers between Hybridising Cricket Species Differing in Their Degree of Polyandry

Understanding speciation hinges on understanding how reproductive barriers arise between incompletely isolated populations. Despite their crucial role in speciation, prezygotic barriers are relatively poorly understood and hard to predict. We use two closely related cricket species, Gryllus bimaculatus and G. campestris, to experimentally investigate premating barriers during three sequential mate choice steps. Furthermore, we experimentally show a significant difference in polyandry levels between the two species and subsequently test the hypothesis that females of the more polyandrous species, G. bimaculatus, will be less discriminating against heterospecific males and hence hybridise more readily. During close-range mating behaviour experiments, males showed relatively weak species discrimination but females discriminated very strongly. In line with our predictions, this discrimination is asymmetric, with the more polyandrous G. bimaculatus mating heterospecifically and G. campestris females never mating heterospecifically. Our study shows clear differences in the strength of reproductive isolation during the mate choice process depending on sex and species, which may have important consequences for the evolution of reproductive barriers

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

CMB-S4

We describe the stage 4 cosmic microwave background ground-based experiment CMB-S4

INVASIVE RATS AND BUBONIC PLAGUE IN NORTHWEST UGANDA

Major introductions of roof rats (Rattus rattus) likely occurred in the ports of East Africa during the Third Plague Pandemic in the late 1800’s. Transport via trains, boats, and trucking likely introduced this species to inland areas of East Africa, ultimately including Northwest Uganda. Historic plague outbreaks occurred during the early part of the 20th century and continue to cause a human disease burden in the West Nile region of NW Uganda via the bubonic, septicemic, and pneumonic forms. Four field sites in this area were trapped to determine the rodent species composition in commensal and peridomestic areas of villages and associated flea burdens of the rodents. Rattus rattus were the most prevalent rodent trapped in commensal areas followed by the Nile rat (Arvicanthis niloticus). The most common peridomestic species of rodent was the Nile rat. Other peridomestic rodent species captured included, Mastomys natalensis, Lophuromys flavopunctatus, L. sikapusi, Gerbil (Tatera spp.), Lemniscomys spp., and 4 unknown species. Flea burdens on commensal R. rattus averaged 1.7±1.2 fleas per animal and on all peridomestic rodents, average 2.0±0.7 per animal. Additionally, commensal areas were sampled to determine free-living flea populations. Burrow swabbing indicated an average 0.19±0.12 fleas/burrow. Lighted flea traps averaged 1.3±0.6 fleas per household and dark flea traps averaged 0.5±0.4 fleas per household

Den lokala profilen [Elektronisk resurs] : Person, plats och kulturarv

The aim of this study is to examine the use of famous historical or fictional persons in place branding. It seeks to analyze the images of places that are produced, and the representations of persons that are used in branding practices. Largely this use is located within a tourist discourse, begging the question how tourists take part in the shaping of these cities. In sum, the study aims to examine constructions of the past and the present, as well as representations of gender. The main question is which parts of the history of a city are described and which sites are highlighted.Four cases studies are presented. First, the uses of the heritage connected with author Selma Lagerlöf in and around Sunne are examined, in particular her former residence, Mårbacka, now musealized. Second, Uppsala's and Småland's uses of the Carl Linnaeus heritage are surveyed. Third, the uses of inventor Johan Petter Johansson in Enköping are studied, and fourth the tourist and heritage practices around fictional police detective Kurt Wallander in Ystad are examined. Taken at face value, these examples differ from each other in many ways. The aim of the dissertation is to track these differences, but also the likenesses in practices, meaning production and visualizations. In sum, the aim of this dissertation is to examine how the productions of meaning are influenced through the use of these individuals. How do visitors influence the production on these heritage sites? Is there room for change in descriptions of persons and places? How are ideas of authenticity produced when places are viewed through one individual? What ideas of gender and masculinity are produced?</p