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Documentation of code status and advance directives for end-of-life (EOL) care improves care and quality of life, decreases cost of care, and increases the likelihood of an experience desired by the patient and his/her family. However, the use of advance directives and code status remains low and only a few organizations maintain code status in electronic form. Members of the American Medical Informatics Association’s Ethics Committee identified a need for a patient’s EOL care wishes to be documented correctly and communicated easily through the electronic health record (EHR) using a minimum data set for the storage and exchange of code status information. After conducting an environmental scan that produced multiple resources, Ethics Committee members used multiple conference calls and a shared document to arrive at consensus on the proposed minimum data set. Ethics Committee members developed a minimum required data set with links to the HL7 C_CDA Advance Directives Module. Data categories include information on the organization obtaining the code status information, the patient, any supporting documentation, and finally the desired code status information including mandatory, optional, and conditional elements. The “minimum set of attributes” to exchange advance directive / code status data described in this manuscript enables communication of patient wishes across multiple providers and health care settings. The data elements described serve as a starting point for a dialog among informatics professionals, physicians experienced in EOL care, and EHR vendors, with the goal of developing standards for incorporating this functionality into the EHR systems.
A function ƒ(z) is said to be p-valent in a region if it is regular in if the equation
has p distinct roots in for some particular w0, and if for each complex w0, equation (1) does not have more than p roots in . The function ƒ(z) is also said to have valence p in . In the case when p = 1, the function is said to be univalent in .
Geometrically, a graph is a collection of points (or vertices) together with a set of edges (or curves) each of which joins two distinct vertices of the graph, and no two of which have points in common except possibly end points. Two given vertices of the graph may be joined by no edge or one edge, but may not be joined by more than one edge. From an abstract point of view, a graph G is a collection of elements ﹛x1, x2, …﹜ called points or vertices, together with a second collection of certain pairs (xα, Xβ) of distinct points of G. It is helpful to retain the geometric language, and refer to any pair in as an edge (or a curve) of G that joins the points xα and Xβ.
1. Introduction. Let S denote the family of functions f(z) regular and univalent in ∣z∣ < 1, with the expansion f(z) = z + a2z2 + … about z = 0, and let Af denote the area of the intersection of the open circle ∣ω∣ < 1 with Df, the image of ∣z∣ < 1 under f(z). A few years ago one of the authors (1) proved that if
Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded.
Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress.
Exclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up.
We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.
Health information technology, sometimes called biomedical informatics, is the use of computers and networks in the health professions. This technology has become widespread, from electronic health records to decision support tools to patient access through personal health records. These computational and information-based tools have engendered their own ethics literature and now present an opportunity to shape the standard medical and nursing ethics curricula. It is suggested that each of four core components in the professional education of clinicians—privacy, end-of-life care, access to healthcare and valid consent, and clinician–patient communication—offers an opportunity to leverage health information technology for curricular improvement. Using informatics in ethics education freshens ethics pedagogy and increases its utility, and does so without additional demands on overburdened curricula.
Associations between infants' frontal EEG asymmetry and temperamental negative affectivity (NA) across infants' first year of life and the potential moderating role of maternal prenatal depressive symptoms were examined prospectively in infants (n = 242) of mothers at elevated risk for perinatal depression. In predicting EEG, in the context of high prenatal depressive symptoms, infant NA and frontal EEG asymmetry were negatively associated at 3 months of age and positively associated by 12 months of age. By contrast, for low depression mothers, infant NA and EEG were not significantly associated at any age. Postnatal depressive symptoms did not add significantly to the models. Dose of infants' exposure to maternal depression mattered: infants exposed either pre- or postnatally shifted from a positive association at 3 months to a negative association at 12 months; those exposed both pre- and postnatally shifted from a negative association at 3 months to a positive association at 12 months. Prenatal relative to postnatal exposure did not matter for patterns of association between NA and EEG. The findings highlight the importance of exploring how vulnerabilities at two levels of analysis, behavioral and psychophysiological, co-occur over the course of infancy and in the context of mothers' depressive symptomatology.
The Ursa Major molecular cloud complex lies in the direction of an expanding HI shell known as the North Celestial Pole loop. The NCP loop, which is centered at (l, b) ∼ (138°,30°) and easily seen in IRAS 100 μm emission, is some 60 pc across and 150 pc distant (Meyerdierks et. al 1991). At 100 μm, the Ursa Major clouds appear in projection as “finger” (l ∼ 140, b ∼ 38) which “hangs down” towards the center of the loop and the plane of the Galaxy. Distance estimates to the molecular clouds (Penprase 1993) are consistent with that of the NCP loop, indicating that the clouds are physically associated with the loop.