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In order to facilitate patient information, patient involvement, and to support patient-centered care, healthcare organizations are increasingly offering access to patient data that are stored in the institution-specific electronic health record (EHR). Patients can access these data, read, and print them, or download and integrate them into any type of patient-held record. This EHR access is typically web-based and called “patient portal” allowing the independent access via the Internet from everywhere. A patient portal may also offer additional features such as prescription requests, appointment booking, messaging, personal health-related reminders, individual therapeutic recommendations, personal diaries, and social networking with other patients. In a Cochrane review, we assessed the effects of providing access to EHR for adult patients on patient empowerment and health-related outcomes compared to usual care.
According to the methods of evidence-based medicine, we developed a protocol for a Cochrane review, which is published in the Cochrane database.
We identified ten randomized controlled trials (RCTs) including 6,668 randomized participants. Seven RCTs took place in the USA, two in Canada, and one in Japan. Additional functionalities of interventions and disease conditions were heterogeneous. Three studies (n = 601) reported on patient empowerment. The risk differences reported were neither statistically significant nor clinically relevant. Eight studies (n = 2,070) reported on nine different risk factors (blood pressure, blood glucose, poor asthma control, 10-year Framingham risk score, cholesterol, body mass index, composite score of eight variables, intraocular pressure, composite score of three variables). The results were heterogeneous. Mostly there were no statistically significant risk differences between study groups.
Overall, there is no evidence for a clear positive effect of patient portals on patient empowerment and health related outcomes (mainly risk factors). However, we identified only a small number of studies. The usage of portals was often low and several studies were older.
Multidimensional effects are essential for the success of the neutrino-driven explosion mechanism of core-collapse supernovae. Although astrophysical phenomena in nature involve three spatial dimensions, the huge computational demands still allow only for a few self-consistent, three-dimensional (3D) simulations focusing on specific aspects of the explosion physics, whereas systematic studies of larger sets of progenitor models or detailed investigations of different explosion parameters are restricted to the axisymmetric (2D) modeling approach at the moment. Employing state-of-the-art neutrino physics, we present the results of self-consistent core-collapse supernova simulations performed with the Prometheus-Vertex code in 2D and 3D. The 2D study of 18 successfully exploding pre-supernova models in the range of 11 to 28 solar masses shows the progenitor dependence of the explosion dynamics: if the progenitor exhibits a pronounced decline of the density at the Si/Si-O composition shell interface, the rapid drop of the mass-accretion rate at the time the interface arrives at the shock induces a steep reduction of the accretion ram pressure. This causes a strong shock expansion supported by neutrino heating and thus favors an early explosion. In case of a more gradually decreasing accretion rate, it takes longer for the neutrino heating to overcome the accretion ram pressure and explosions set in later. By considering the effects of turbulent pressure in the gain layer, we derive a generalized condition for the critical neutrino luminosity that captures the explosion behavior of all models very well. We show that this concept can also be extended to describe the effects of rotation as well as the behavior of recent 3D simulations and that the conditions necessary for the onset of explosion can be defined in a similar way.
We present the first successful simulations of neutrino-driven supernova explosions in three dimensions (3D) using the Vertex-Prometheus code including sophisticated energy-dependent neutrino transport. The simulated models of 9.6 and 20 solar-mass iron-core stars demonstrate that successful explosions can be obtained in self-consistent 3D simulations, where previous models have failed. New insights into the supernova mechanism can be gained from these explosions. The first 3D model (Melson et al. 2015a) explodes at the same time but more energetically than its axially symmetric (2D) counterpart. Turbulent energy cascading reduces the kinetic energy dissipation in the cooling layer and therefore suppresses neutrino cooling. The consequent inward shift of the gain radius increases the gain layer mass, whose recombination energy provides the surplus for the explosion energy.
The second explosion (Melson et al. 2015b) is obtained through a moderate reduction of the neutral-current neutrino opacity motivated by strange-quark contributions to the nucleon spin. A corresponding reference model without these corrections failed, which demonstrates how close current 3D models are to explosion. The strangeness adjustment is meant as a prototype for remaining neutrino opacity uncertainties.
Electronically active block polymers based on π-conjugated macromolecules have been investigated for applications where nanostructured electrodes are of prime import; however, controlling the nanoscale order of these materials has proven challenging. Here, we demonstrate that diblock copolymers that utilize a non-conjugated radical polymer moiety as the electronically active block assemble into ordered thin-film nanostructures. Specifically, the diblock copolymer polydimethylsiloxane-b-poly(2,2,6,6-tetramethylpiperidinyloxy methacrylate) (PDMS–PTMA) was synthesized via atom transfer radical polymerization to generate polymers with readily controlled molecular properties. Importantly, solvent annealing of the PDMS–PTMA thin films led to well-defined nanostructures with domain spacings of the order of ~30–40 nm.
To establish the source and contamination routes resulting in positive clinical and surveillance microbiological cultures with carbapenem-resistant, GIM-1 metallo-β-lactamase–positive Acinetobacter pitii and Acinetobacter radioresistens from 21 patients in 8 departments
Retrospective, descriptive study.
A 1,300-bed tertiary care academic medical facility consisting of 90 buildings linked by a pneumatic transport system (PTS).
Microbiological workup of the cluster strains included matrix-assisted laser desorption/ionization time-of-flight species identification, phenotypic carbapenemase tests, polymerase chain reaction–based genotyping of carbapenemase, and pulsed-field gel electrophoresis. Outbreak management procedures were employed according to institutional regulations.
The rarity of GIM-1 Acinetobacter species in the hospital and region, the lack of epidemiological links between patients, and the fact that in some patients the apparent colonization was clearly nonnosocomial prompted the suspicion of a pseudo-outbreak. Numerous environmental cultures were positive for GIM-1-positive Acinetobacter (including archived sample requisition forms, PTS capsules, cultures from line-diverter and dispenser stations, and sterilized transport capsules following PTS delivery). Moreover, it was observed that condensation fluid from subterranean PTS tubing resulted in water entry in PTS capsules, possibly conferring specimen contamination. After extensive system disinfection, environmental surveys of the PTS were negative, and no further positive patient specimens were encountered.
This is the first report of a PTS-associated pseudo-outbreak. The large number of falsely positive patient-related specimens in conjunction with the potential hazard of airborne and contact spread of multidrug-resistant microorganisms (in this case, GIM-1 carbapenem-resistant Acinetobacter species) underscores the need for implementation of infection control–based monitoring and operating procedures in a hospital PTS.
Japanese bindweed was found to be one of the most abundant and most difficult-to-control weed species during a 2-yr weed survey in more than 100 winter wheat fields in the North China Plain region. Multivariate data analysis showed that Japanese bindweed is most abundant at sites with comparative low nitrogen (N) fertilization intensities and low crop densities. To gain deeper insights into the biology of Japanese bindweed under various N fertilization intensities, winter wheat seeding rates, herbicide treatments, and their interactions, a 2-yr field experiment was performed. In nonfertilized plots, a herbicide efficacy (based on density reduction) of 22% for 2,4-D, and of 25% for tribenuron-methyl was found. The maximum herbicide efficacy in Nmin-fertilized plots (target N value based on expected crop yield minus soil mineral nitrogen content, ) was 32% for 2,4-D and 34% for tribenuron-methyl. In plots fertilized according to the farmer's practices, a maximum herbicide efficacy of 72% for 2,4-D and of 64% for tribenuron-methyl could be observed. Furthermore, medium and high seeding rates improved the herbicide efficacy by at least 39% for tribenuron-methyl and 44% for 2,4-D compared to the low seeding rate. Winter wheat yield was not significantly affected by seeding rate itself, whereas at low and medium seeding rates, Nmin fertilization was decreasing winter wheat yield significantly compared to the farmer's usual fertilization practice. At the highest seeding rate, Nmin fertilization resulted in equal yields compared to the farmer's practices of fertilization.
In this study the nanomorphology of P3HT:PC61BM absorber layers of organic solar cells was studied as a function of the processing parameters and for P3HT with different molecular weight. For this purpose we apply scanning transmission electron microscopy (STEM) at low electron energies in a scanning electron microscope. This method exhibits sensitive material contrast in the high-angle annular dark-field (HAADF) mode, which is well suited to distinguish materials with similar densities and mean atomic numbers. The images taken with low-energy HAADF STEM are compared with conventional transmission electron microscopy and atomic force microscopy images to illustrate the capabilities of the different techniques. For the interpretation of the low-energy HAADF STEM images, a semiempirical equation is used to calculate the image intensities. The experiments show that the nanomorphology of the P3HT:PC61BM blends depends strongly on the molecular weight of the P3HT. Low-molecular-weight P3HT forms rod-like domains during annealing. In contrast, only small globular features are visible in samples containing high-molecular-weight P3HT, which do not change significantly after annealing at 150°C up to 30 min.
A previous paper portrayed sample preparation by fusion methodology and the XRF analysis conditions for the calibration of cement materials [Bouchard et al., 2009. “Global cement and raw materials fusion/XRF analytical solution,” Adv. X-Ray Anal. 53, 263–279]. The results of two well known cement chemical analysis Standard Methods were also presented. These results proved that this robust analytical method is able to qualify by the ASTM C114 [ASTM C114-08 (2008). “Standard test methods for chemical analysis of hydraulic cement,” Annual Book of ASTM Standards Vol. 04.01 (ASTM International, West Conshohocken, PA), pp. 150–157)] and ISO/DIS 29581-2 [Draft Standard, 2007-07 (2007). “Methods of testing cement—Chemical analysis of cement—Part 2: Analysis by X-ray fluorescence” ISO/DIS 29581-2, 2007, pp. 1–30]. This robust analytical method was developed using an automated fusion instrument for the sample preparation and a WDXRF spectrometer for the determination of all elements of interest relating to the cement industry. This method was used to prepare finished products, process materials, as well as a very large range of raw materials. The first part of this second paper examines all the XRF analysis conditions for the calibration of the raw materials using the robust fusion sample preparation methodology as well as the numerous reference materials (RMs) used for this analytical application. All interesting results will be presented. The second part of this paper reveals the rapid analytical method results using sample preparation by fusion on nonignited samples. It will also be proven that this faster method, combined with the WDXRF spectrometer, complies with both cement analysis Standard Methods: ASTM C114 and ISO/DIS 29581-2.
ϵ Eridani hosts one known inner planet and an outer Kuiper belt analog. Further, Spitzer/IRS measurements indicate that warm dust is present at distances as close as a few AU from the star. Its origin is puzzling, since an “asteroid belt” that could produce this dust would be unstable because of the inner planet. We tested a hypothesis that the observed warm dust is generated by collisions in the outer belt and is transported inward by P-R drag and strong stellar winds. With numerical simulation we investigated how the dust streams from the outer ring into the inner system, and calculated the thermal emission of the dust. We show that the observed warm dust can indeed stem from the outer belt. Our models reproduce the shape and magnitude of the observed SED from mid-IR to sub-mm wavelengths, as well as the Spitzer/MIPS radial brightness profiles.
The male hypothalamic-pituitary-gonadal (HPG) axis is a finely controlled system whose role is to promote spermatogenesis and androgen biosynthesis. Testosterone is thought to feed back to restrain activity of the gonadotropin-releasing hormone (GnRH)-gonadotrope secretory unit. GnRH is released from the hypothalamus in a pulsatile pattern, and the stimulation of gonadotropin biosynthesis and secretion by GnRH is dependent on the pulsatile nature of GnRH delivery to the anterior pituitary. Gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are glycoproteins consisting of a common a subunit and a hormone-specific β subunit that are associated through noncovalent interactions. GnRH stimulates in vitro the synthesis of gonadotropin subunits and increases a, LH-β, and FSH-β subunit mRNA levels as well as the transcriptional activity of corresponding gene promoters. Testosterone seems to exert a direct feedback control of LH secretion, while its action on FSH secretion is mostly indirect.
Excitons in semiconductor alloys feel a random disorder potential leading to inhomogeneous line broadening and a lack of knowledge about the dominating recombination processes. Nevertheless, we demonstrate competing localization effects due to disorder (random potential fluctuations) and shallow point defects. We were able to spectrally separate donor-bound and quasi-free excitons within the whole wurtzite-type composition range of MgxZn1-xO (0 ≤ x ≤ 0.33) using spectrally resolved (x ≤ 0.06) and time-resolved photoluminescence (x ≥ 0.08). We found out that donor-bound excitons dominate photoluminescence spectra even for Mg-contents up to x = 0.18 and still appear for x = 0.33.