We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
Methods:
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Results:
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Conclusions:
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
An n-dimensional analogue of the Klein bottle arose in our study of topological complexity of planar polygon spaces. We determine its integral cohomology algebra and stable homotopy type, and give an explicit immersion and embedding in Euclidean space.
Inflammatory bowel disease (IBD) is a collective term for conditions characterised by chronic inflammation of the gastrointestinal tract involving an inappropriate immune response to commensal micro-organisms in a genetically susceptible host. Previously, aqueous and ethyl acetate extracts of gold kiwifruit (Actinidia chinensis) or green kiwifruit (A. deliciosa) have demonstrated anti-inflammatory activity using in vitro models of IBD. The present study examined whether these kiwifruit extracts (KFE) had immune-modulating effects in vivo against inflammatory processes that are known to be increased in patients with IBD. KFE were used as a dietary intervention in IL-10-gene-deficient (Il10− / −) mice (an in vivo model of IBD) and the C57BL/6J background strain in a 3 × 2 factorial design. While all Il10− / − mice developed significant colonic inflammation compared with C57BL/6J mice, this was not affected by the inclusion of KFE in the diet. These findings are in direct contrast to our previous study where KFE reduced inflammatory signalling in primary cells isolated from Il10− / − and C57BL/6J mice. Whole-genome gene and protein expression level profiling indicated that KFE influenced immune signalling pathways and metabolic processes within the colonic tissue; however, the effects were subtle. In particular, expression levels across gene sets related to adaptive immune pathways were significantly reduced using three of the four KFE in C57BL/6J mice. The present study highlights the importance of investigating food components identified by cell-based assays with appropriate in vivo models before making dietary recommendations, as a food that looks promising in vitro may not be effective in vivo.
Edited by
David K. Stevenson, Stanford University School of Medicine, California,William E. Benitz, Stanford University School of Medicine, California,Philip Sunshine, Stanford University School of Medicine, California,Susan R. Hintz, Stanford University School of Medicine, California,Maurice L. Druzin, Stanford University School of Medicine, California
The goal of this chapter is to help the reader understand the fundamentals of neonatal electroencephalography (EEG), including the source of EEG signals and the technical aspects of a well-performed EEG. Particular attention will be paid to (1) maturational features which correlate with the infant's conceptional age, (2) abnormal findings indicative of encephalopathies of various causes, and (3) the value of the EEG in determining the prognosis for normal and abnormal neurological outcome. The role of EEG in neonatal seizures is covered more thoroughly in Chapter 43.
Value of the EEG
The EEG is a valuable tool for assessing neonatal brain function. It has unique properties compared to many other diagnostic tests of brain function. It can resolve temporal aspects of brain function more effectively than computed tomography (CT), magnetic resonance imaging (MRI), or even the bedside neurological examination. There is no other test that can so precisely discriminate between epileptic seizures and non-epileptic events in the neonate. It provides information about the severity of brain dysfunction (encephalopathy). Serial EEGs provide information about the course and effectiveness of treatment. Sometimes the EEG helps distinguish between various etiologies of encephalopathy.
Indication for EEG
An EEG in the neonate should be considered when questions arise regarding the cause of a child's abnormal neurological responses.
We prove the following two new optimal immersion results for complex projective space. First, if $n\equiv3\,\Mod 8$ but $n\not\equiv3\,\Mod 64$, and $\alpha(n)=7$, then $CP^{n}$ can be immersed in $\mathbb{R}^{4n-14}$. Second, if $n$ is even and $\alpha(n)=3$, then $CP^n$ can be immersed in $\mathbb{R}^{4n-4}$. Here $\alpha(n)$ denotes the number of 1s in the binary expansion of $n$. The first contradicts a result of Crabb, which said that such an immersion does not exist, apparently due to an arithmetical mistake. We combine Crabb's method with that developed by the author and Mahowald.
Although the majority of publications on extant nonmarine ostracode species in North America are concerned with lacustrine settings, many species that are potentially valuable as indicators of water quality changes live in non-lacustrine settings. Ostracode distributions in 157 springs, wetlands and streams in the United States are examined here in order to assess 1) species richness, 2) association with physical and chemical parameters of their habitats and 3) the presence of potentially useful biomonitors and environmental sentinels. The 157 non-lacustrine sites are a subset of a large database (North American Non-marine Ostracode Database: NANODe version 1) consisting of 611 mostly lacustrine sites with ostracode species, presence-absence data, hydrochemistry and climate data (Forester et al., in review). Of the 89 species represented in NANODe version 1, 51 species are found in springs, 59 species are found in wetlands and only 15 species are found in streams. Many species are found in at least two of these habitats and some in all three. Principal Components Analysis of these 157 sites indicates that 71% of the variance is explained by salinity (total ionic concentration), alkalinity and temperature, a result consistent with previously published analyses of natural water. Cluster analysis shows that spring species are most strongly tied to temperature, whereas wetlands and streams are most strongly tied to ionic composition. Three species are found to be potentially valuable biomonitors: Cavernocypris wardi in springs, Fabaeformiscandona rawsoni in wetlands and Physocypria globula in streams.
The observations of family members as well as the results of past research suggest that a variety of developmental pathways can precede the onset of schizophrenia in early adulthood. In this article, we describe recent findings from our research on the childhood precursors of schizophrenia. Taken together, the results indicate that childhood behavioral, emotional, and motoric dysfunction occur at a higher rate in preschizophrenia subjects when compared to control subjects. Further, there are developmental changes as well as significant variability among schizophrenia patients in the nature and severity of childhood impairment. Drawing on the prevailing diathesis-stress model, we explore the moderating role that stress exposure and reactivity may play in the expression of the organic diathesis for schizophrenia. Specifically, we consider the role of the biological stress response in the production of developmental changes and individual differences in the pathways to schizophrenia. Given extant models of dopamine involvement in the neuropathology of schizophrenia, stress-induced Cortisol release may alter the expression of subcortical abnormalities in dopamine neurotransmission. Thus, we present a neural mechanism for the hypothesized behavioral sensitivity to stress exposure in schizophrenia, and explore the capacity of the model to account for the changing behavioral manifestations of vulnerability.
Motions of nearby elliptical galaxies reveal a large-scale velocity flow relative to cosmic rest towards the point 1=307±10, b = 9±10. The data are fit best by a two-component flow model. The smaller component is due to Virgo, which induces a velocity at the Local Group of 250 km/s. The main flow is due to a more massive concentration located a distance of 4350±350 km/s towards 1=307, b=9, which induces a local velocity here of 570±60 km/s. This larger component falls off away from the mass concentration roughly as r−1. The Centaurus double cluster and its neighbors are in the direction of the mass concentration but are in the foreground and are falling into it. Galaxy counts, radial velocity surveys, and the motions of nearby spirals are consistent with the above model. The IRAS dipole results are less clear but may also be consistent. There is evidence that the distant mass concentration is non-spherical, with the Centaurus cloud a substantial sub-condensation in the foreground. The formal agreement of the large-scale flow with biased (b=2) cold dark matter is low, but the simple methods used so far to assess this are uncertain. The main weakness of the present data in comparing to theory is the fact that they do not penetrate far enough to show the velocity field on all sides of the mass concentration. Sphericity and total extent of the flow are therefore still unknown.
We have used a new distance estimator for elliptical galaxies to determine the peculiar velocities, with respect to a uniform Hubble flow, of approximately 400 galaxies. The relative distances of five clusters in common with those of Aaronson et al. (1981, 1986), based on the infrared Tully-Fisher relation for spirals, are in good agreement.
We do not see the reflex of the Local Group motion with respect to the microwave background out to recession velocities of 6000 km s−1. Rather, the frame of elliptical galaxies appears to be moving with respect to the microwave background with a velocity of 600 km s−1 towards 1 = 312°, b = +6°. This motion is consistent with a re-analysis of the Rubin et al. (1976) data on the magnitude-diameter relation for ScI galaxies and with the nearby and cluster samples of Aaronson et al. (1982, 1986).
There are spectra P−k constructed from stunted real projective spaces as in [1] such that H*(P−k) is the span in ℤ/2[x, x−1] of those xi with i ≥ −k. (All cohomology groups have ℤ/2-coefficients unless specified otherwise.) Using collapsing maps, these form an inverse system
which is similar to those of Lin ([15], p. 451). It is a corollary of Lin's work that there is an equivalence of spectra
where holim is the homotopy inverse limit ([3], ch. 5) and Ŝ–1 the 2-adic completion of a sphere spectrum. One may denote by this holim (P–κ), although one must constantly keep in mind that , but rather
Metolachlor [2-chloro-N-(2-ethyl-6-methylphenyl)-N-(2-methoxy-1-methylethyl)acetamide] at 1 × 10−5 and 1 × 10−4 M increased the leakage of previously absorbed, 32P-labeled orthophosphate from the roots of onion (Allium cepa L.), a susceptible species, by 14 and 41 times the control values, respectively. A significant amount of 32P leaked from the roots of the moderately susceptible species, cotton (Gossypium hirsutum L. ‘DPL 61′) and cucumber (Cucumis sativus L. ‘Ashley′), whereas no significant loss of 32P occurred from two tolerant species, soybean [Glycine max (L.) Merr. ‘Bragg′] and corn (Zea mays L. ‘Pioneer 3369A′). At either 1 × 10−7 or 1 × 10−6 M, 1,8-naphthalic anhydride (NA) prevented 32P leakage from onion roots in the presence of 1 × 10−5 M metolachlor. High concentrations of NA [0.1% (w/v) suspensions], however, promoted 32P leakage and did not protect onion roots from the leakage induced by high concentrations (1 × 10−4 M) of metolachlor. Neither metolachlor nor alachlor [2-chloro-2′,6′-diethyl-N-(methoxymethyl)acetanilide], at 1 × 10−4 M, inhibited the uptake of acetate-2-14C or malonic acid-2-14C into excised cotton root tips or the incorporation of the precursors into lipids. Similarly, neither herbicide inhibited phospholipid synthesis by cotton root tips. Incorporation of 14C-choline chloride into phosphatidylcholine was not significantly inhibited by metolachlor.
The Brown-Peterson spectrum BP has been used recently to establish some new information about the stable homotopy groups of spheres [9; 11]. The best results have been achieved by using the associated homology theory BP*( ), the Hopf algebra BP*(BP), and the Adams-Novikov spectral sequence