Possibilities and implications of using the ICF and other vocabulary standards in electronic health records

There is now widespread recognition of the powerful potential of electronic health record (EHR) systems to improve the health-care delivery system. The benefits of EHRs grow even larger when the health data within their purview are seamlessly shared, aggregated and processed across different providers, settings and institutions. Yet, the plethora of idiosyncratic conventions for identifying the same clinical content in different information systems is a fundamental barrier to fully leveraging the potential of EHRs. Only by adopting vocabulary standards that provide the lingua franca across these local dialects can computers efficiently move, aggregate and use health data for decision support, outcomes management, quality reporting, research and many other purposes. In this regard, the International Classification of Functioning, Disability, and Health (ICF) is an important standard for physiotherapists because it provides a framework and standard language for describing health and health-related states. However, physiotherapists and other health-care professionals capture a wide range of data such as patient histories, clinical findings, tests and measurements, procedures, and so on, for which other vocabulary standards such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature Of Medicine Clinical Terms are crucial for interoperable communication between different electronic systems. In this paper, we describe how the ICF and other internationally accepted vocabulary standards could advance physiotherapy practise and research by enabling data sharing and reuse by EHRs. We highlight how these different vocabulary standards fit together within a comprehensive record system, and how EHRs can make use of them, with a particular focus on enhancing decision-making. By incorporating the ICF and other internationally accepted vocabulary standards into our clinical information systems, physiotherapists will be able to leverage the potent capabilities of EHRs and contribute our unique clinical perspective to other health-care providers within the emerging electronic health information infrastructure

A study of the kinetics of the oxidative coupling of methane over a Li/Sn/MgO catalyst

The rate of reaction of methane with oxygen in the presence of a Li/Sn/MgO catalyst has been studied as a function of the partial pressures of CH4, O2 and CO2 using a well-mixed reaction system which is practically gradientless with respect to gas-phase concentrations. It is concluded that the rate-determining step involves reaction of a molecule of CH4 adsorbed on the catalyst surface with an adsorbed di-atomic oxygen species. The kinetics are consistent with a Langmuir-Hinshelwood type mechanism involving competitive adsorption of CH4, O2 and CO2 on a single site. A comparison is made with previously published results for the Li/MgO material

A corpus-based approach for automated LOINC mapping

Objective To determine whether the knowledge contained in a rich corpus of local terms mapped to LOINC (Logical Observation Identifiers Names and Codes) could be leveraged to help map local terms from other institutions. Methods We developed two models to test our hypothesis. The first based on supervised machine learning was created using Apache's OpenNLP Maxent and the second based on information retrieval was created using Apache's Lucene. The models were validated by a random subsampling method that was repeated 20 times and that used 80/20 splits for training and testing, respectively. We also evaluated the performance of these models on all laboratory terms from three test institutions. Results For the 20 iterations used for validation of our 80/20 splits Maxent and Lucene ranked the correct LOINC code first for between 70.5% and 71.4% and between 63.7% and 65.0% of local terms, respectively. For all laboratory terms from the three test institutions Maxent ranked the correct LOINC code first for between 73.5% and 84.6% (mean 78.9%) of local terms, whereas Lucene's performance was between 66.5% and 76.6% (mean 71.9%). Using a cut-off score of 0.46 Maxent always ranked the correct LOINC code first for over 57% of local terms. Conclusions This study showed that a rich corpus of local terms mapped to LOINC contains collective knowledge that can help map terms from other institutions. Using freely available software tools, we developed a data-driven automated approach that operates on term descriptions from existing mappings in the corpus. Accurate and efficient automated mapping methods can help to accelerate adoption of vocabulary standards and promote widespread health information exchange

Festive medical myths

In the pursuit of scientific truth, even widely held medical beliefs require examination or re-examination. Both physicians and non-physicians sometimes believe things about our bodies that just are not true. As a reminder of the need to apply scientific investigation to conventional wisdom, we previously discussed the evidence disputing seven commonly held medical myths.1 The holiday season presents a further opportunity to probe medical beliefs recounted during this time of the year. We generated a list of common medical or health beliefs related to the holidays and winter season and searched Medline for scientific evidence to support or refute these beliefs. If we couldn’t find any evidence in the medical literature, we searched the internet using Google

Oxidative coupling of methane over Ba/CaO catalysts: a comparison with Li/MgO

A comparison has been made of the behaviour in the oxidative coupling of methane of a Ba/CaO catalyst with that of a Li/MgO material. Doping of CaO with BaCO3 resulted in a catalyst which is more active at lower reaction temperatures than is BaCO3. The active oxygen entity in the case of Ba/CaO is probably an O2−2 species. Ba/CaO is more stable but less selective than is Li/MgO. The effect of residence time was studied for both Ba/CaO and Li/MgO. The direct oxidation of methyl radicals to give carbon monoxide and carbon dioxide plays a more important role in the case of Ba/CaO than is the case with Li /MgO

A Systematic Review of Portable Electronic Technology for Health Education in Resource-limited Settings

poster abstractObjective: The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with off-line functionality are perceived and used to provide health education in resource-limited settings. Methods: Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device in low- or middle-income countries (defined by World Bank criteria) not requiring constant internet connection. Data extracted included type of technology, method of education, improvement in provider/patient knowledge, impact on provider/patient attitude towards care, and overall health outcomes. Results: Searches yielded 6,790 titles, 5 met inclusion criteria. Four studies were qualitative, relying on surveys, interviews, questionnaires, or focus group discussions. The remaining quantitative study was a two-arm comparative study that assessed the use of internet-based versus locally loaded smartphone applications. A common educational use of mobile technology involved locally loaded, point-of-care applications used at the bedside and for self-directed learning at home. Study populations had small sample sizes (n=7-31) and were made up primarily of medical trainees or providers. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for tablet-based health education, frequently reporting increased provider/patient knowledge, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs and fear of theft of the device. Conclusions: While the research is limited, portable electronic educational resources present promising avenues to increase access to effective healthcare education in resource-limited settings, contingent on the development of culturally adapted and functional materials to be used on such devices

The Need for Pediatric Formulations to Treat Children with HIV

Over 3.2 million children worldwide are infected with HIV, but only 24% of these children receive antiretroviral therapy (ART). ART adherence among children is a crucial part of managing human-immunodeficiency virus (HIV) infection and extending the life and health of infected children. Important causes of poor adherence are formulation- and regimen-specific properties, including poor palatability, large pill burden, short dosing intervals, and the complex storage and transportation of drugs. This review aims to summarize the various regimen- and formulation-based barriers to ART adherence among children to support the need for new and innovative pediatric formulations for antiretroviral therapy (ART). Detailing the arguments both for and against investing in the development of pediatric HIV medications, as well as highlighting recent advances in pediatric ART formulation research, provides a synopsis of the current data related to pediatric ART formulations and adherence

Pediatric assent for a study of antiretroviral therapy dosing for children in western Kenya: a case study in international research collaboration

Multinational collaborators in health research face particular ethical challenges when conducting studies involving vulnerable populations such as children. We use an example from our first attempt to implement pediatric assent in the context of a longstanding research and clinical partnership between Kenyan and American medical schools to highlight the ethical and procedural issues related to pediatric assent that must be considered for multinational, pediatric studies. We consider relevant domestic, professional, and international guidelines for assent in pediatric research subjects, and we discuss the particular ethical challenges related to pediatric assent in the Kenyan context. Finally, we propose a way forward for approaching pediatric assent within our collaborative research program in Kenya that may apply to other multinational research partnerships.Fogarty International Center at the National Institutes of Health [R25TW006070]; USAID-AMPATH Partnership, United States Agency for International Developmen