Assessment of the Chad guinea worm surveillance information system: A pivotal foundation for eradication

BackgroundIn the absence of a vaccine or pharmacological treatment, prevention and control of Guinea worm disease is dependent on timely identification and containment of cases to interrupt transmission. The Chad Guinea Worm Eradication Program (CGWEP) surveillance system detects and monitors Guinea worm disease in both humans and animals. Although Guinea worm cases in humans has declined, the discovery of canine infections in dogs in Chad has posed a significant challenge to eradication efforts. A foundational information system that supports the surveillance activities with modern data management practices is needed to support continued program efficacy.MethodsWe sought to assess the current CGWEP surveillance and information system to identify gaps and redundancies and propose system improvements. We reviewed documentation, consulted with subject matter experts and stakeholders, inventoried datasets to map data elements and information flow, and mapped data management processes. We used the Information Value Cycle (IVC) and Data-Information System-Context (DISC) frameworks to help understand the information generated and identify gaps.ResultsFindings from this study identified areas for improvement, including the need for consolidation of forms that capture the same demographic variables, which could be accomplished with an electronic data capture system. Further, the mental models (conceptual frameworks) IVC and DISC highlighted the need for more detailed, standardized workflows specifically related to information management.ConclusionsBased on these findings, we proposed a four-phased roadmap for centralizing data systems and transitioning to an electronic data capture system. These included: development of a data governance plan, transition to electronic data entry and centralized data storage, transition to a relational database, and cloud-based integration. The method and outcome of this assessment could be used by other neglected tropical disease programs looking to transition to modern electronic data capture systems.     

皮肤病专科医院电子病历的设计与应用

???????目的 研究与开发具有皮肤病专科特色的电子病历系统,以实现皮肤科病人医疗信息的采集、加工、存储、传输和服务。方法 以windows sqlserver2005为后台数据库,以XML、C#为开发语言,建立皮肤病结构化病历。结果 该系统运行良好,安全稳定、易维护、通用性好。有效地提高了医生书写病历的速度和质量,并具有皮疹数码照片嵌入等功能。结论 本研究实现了具有皮肤病专科特色的电子病历系统,值得皮肤病医院推荐使用。     

A Study of Cultural Bias in Field Guide Determinations of Mushroom Edibility Using the Iconic Mushroom, Amanita muscaria, as an Example

A Study of Cultural Bias in Field Guide Determinations of Mushroom Edibility Using the Iconic Mushroom, Amanita muscaria , as an Example. Mushroom field guides teach identification skills as well as provide information on the edible or toxic qualities of each species of wild mushroom. As such they function as modern-day village elders for an increasingly urban, nature-ignorant population. This paper identifies underlying cultural bias in the determination of mushroom edibility in English-language field guides, using the iconic mushroom, Amanita muscaria, as an example. We explore a selection of ethnographic and medical texts that report the use of A. muscaria as a food, and we accept parboiling as a safe method of detoxifying it for the dinner table. Mushroom field guides, however, almost universally label the mushroom as poisonous. We discuss the cultural underpinnings and literary form of mushroom field guides and demonstrate that they work within a mostly closed intellectual system that ironically shares many of the same limitations of cultural bias found in traditional folk cultures, but with the pretense of being modern and scientific. An erratum to this article can be found at     

基于循证评价的现代化综合性中医院医疗质量评价指标体系的建立

目的 建立一套科学合理、量化可比、简便易行的现代化综合性中医院医疗质量评价指标体系。方法 对我国现有的医疗质量评价的文献进行循证分析,按循证医学的标准和引用频率提取综合性医院的共性指标和中医院特有的非共性指标,从而拟定指标体系草案。运用德尔菲法,进行3轮专家咨询,采用相乘模型的综合指数法筛选指标,用层次分析法和比例分配法确定指标权重。结果 指标体系由5个一级指标、23个二级指标构成,其中反映中医院特色的二级指标6个,占26%。结论 整套指标体系既有医院的共性指标,又强调了综合性中医院的特性指标,既能突出中医医疗质量管理与质量控制的特色,又能结合中医医院现代化发展的需要。     

临床路径医疗管理模式的应用研究

对临床路径管理的现实需求、实施途径、问题与挑战等方面进行了论述。通过采用套餐的方式进行部署,以信息化平台作为实现手段是最为可行有效的办法。临床路径管理系统是多系统的集成平台,将会大大减少临床开医嘱时间;提高医务工作人员的工作效率;系统的预警功能将降低医疗差错的风险,确保医疗质量。在我国医药卫生体制改革和医疗保险制度逐步完善的背景下,临床路径具有巨大的实现价值和发展潜力。     

An Integrated High-density Linkage Map of Soybean with RFLP, SSR, STS, and AFLP Markers Using A Single F2 Population

Soybean [Glycine max (L.) Merrill] is the most important leguminouscrop in the world due to its high contents of high-quality proteinand oil for human and animal consumption as well as for industrialuses. An accurate and saturated genetic linkage map of soybeanis an essential tool for studies on modern soybean genomics.In order to update the linkage map of a F₂ population derivedfrom a cross between Misuzudaizu and Moshidou Gong 503 and tomake it more informative and useful to the soybean genome researchcommunity, a total of 318 AFLP, 121 SSR, 108 RFLP, and 126 STSmarkers were newly developed and integrated into the frameworkof the previously described linkage map. The updated geneticmap is composed of 509 RFLP, 318 SSR, 318 AFLP, 97 AFLP-derivedSTS, 29 BAC-end or EST-derived STS, 1 RAPD, and five morphologicalmarkers, covering a map distance of 3080 cM (Kosambi function)in 20 linkage groups (LGs). To our knowledge, this is presentlythe densest linkage map developed from a single F₂ populationin soybean. The average intermarker distance was reduced to2.41 from 5.78 cM in the earlier version of the linkage map.Most SSR and RFLP markers were relatively evenly distributedamong different LGs in contrast to the moderately clusteredAFLP markers. The number of gaps of more than 25 cM was reducedto 6 from 19 in the earlier version of the linkage map. Thecoverage of the linkage map was extended since 17 markers weremapped beyond the distal ends of the previous linkage map. Inparticular, 17 markers were tagged in a 5.7 cM interval betweenCE47M5a and Satt100 on LG C2, where several important QTLs wereclustered. This newly updated soybean linkage map will enableto streamline positional cloning of agronomically importanttrait locus genes, and promote the development of physical maps,genome sequencing, and other genomic research activities.     

Smartphones and tablets: Reshaping radiation oncologists’ lives

BackgroundSmartphones and tablets are new handheld devices always connected to an information source and capable of providing instant updates, they allow doctors to access the most updated information and provide decision support at the point of care.AimThe practice of radiation oncology has always been a discipline that relies on advanced technology. Smartphones provide substantial processing power, incorporating innovative user interfaces and applications.Materials and methodsThe most popular smartphone and tablet app stores were searched for “radiation oncology” and “oncology” related apps. A web search was also performed searching for smartphones, tablets, oncology, radiology and radiation oncology.ResultsSmartphones and tablets allow rapid access to information in the form of podcasts, apps, protocols, reference texts, recent research and more.ConclusionWith the rapidly changing advances in radiation oncology, the trend toward accessing resources via smartphones and tablets will only increase, future will show if this technology will improve clinical care.     

NTD Health: An electronic medical record system for neglected tropical diseases

Introduction: The use of technological resources to support processes in health systems has generated robust, interoperable, and dynamic platforms. In the case of institutions working with neglected tropical diseases, there is a need for specific customizations of these diseases.Objectives: To establish a medical record platform specialized in neglected tropical diseases which could facilitate the analysis of treatment evolution in patients, as well as generate more accurate data about various clinical aspects.Materials and methods: A set of requirements to develop state of the art forms, concepts, and functionalities to include neglected tropical diseases were compiled. An OpenMRS distribution (version 2.3) was used as reference to build the platform, following the recommended guidelines and shared-community modules.Results: All the customized information was developed in a platform called NTD Health, which is web-based and can be upgraded and improved by users without technological barriers.Conclusions: The electronic medical record system can become a useful tool for other institutions to improve their health practices as well as the quality of life for neglected tropical disease patients, simplifying the customization of healthcare systems able to interoperate with other platforms.     

Quality of web based information on treatment of depression: cross sectional survey

ObjectivesTo evaluate quality of web based information on treatment of depression, to identify potential indicators of content quality, and to establish if accountability criteria are indicators of quality.DesignCross sectional survey.ResultsAlthough the sites contained useful information, their overall quality was poor: the mean guideline, issues, and global scores were only 4.7 (range 0-13) out of 43, 9.8 (6-14) out of 17, and 3 (0.5-7.5) out of 10 respectively. Sites typically did not cite scientific evidence in support of their conclusions. The guideline score correlated with the two other quality of content measures, but none of the content measures correlated with the Silberg accountability score. Content quality was superior for sites owned by organisations and sites with an editorial board.ConclusionsThere is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality. Ownership by an organisation and the involvement of a professional editorial board may be useful indicators. The study methodology may be useful for exploring these issues in other health related subjects.     

Evaluating Varied Label Designs for Use with Medical Devices: Optimized Labels Outperform Existing Labels in the Correct Selection of Devices and Time to Select

PurposeEffective standardization of medical device labels requires objective study of varied designs. Insufficient empirical evidence exists regarding how practitioners utilize and view labeling.ObjectiveMeasure the effect of graphic elements (boxing information, grouping information, symbol use and color-coding) to optimize a label for comparison with those typical of commercial medical devices.DesignParticipants viewed 54 trials on a computer screen. Trials were comprised of two labels that were identical with regard to graphics, but differed in one aspect of information (e.g., one had latex, the other did not). Participants were instructed to select the label along a given criteria (e.g., latex containing) as quickly as possible. Dependent variables were binary (correct selection) and continuous (time to correct selection).ParticipantsEighty-nine healthcare professionals were recruited at Association of Surgical Technologists (AST) conferences, and using a targeted e-mail of AST members.ResultsSymbol presence, color coding and grouping critical pieces of information all significantly improved selection rates and sped time to correct selection (α = 0.05). Conversely, when critical information was graphically boxed, probability of correct selection and time to selection were impaired (α = 0.05). Subsequently, responses from trials containing optimal treatments (color coded, critical information grouped with symbols) were compared to two labels created based on a review of those commercially available. Optimal labels yielded a significant positive benefit regarding the probability of correct choice ((P<0.0001) LSM; UCL, LCL: 97.3%; 98.4%, 95.5%)), as compared to the two labels we created based on commercial designs (92.0%; 94.7%, 87.9% and 89.8%; 93.0%, 85.3%) and time to selection.ConclusionsOur study provides data regarding design factors, namely: color coding, symbol use and grouping of critical information that can be used to significantly enhance the performance of medical device labels.     

Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution

ObjectivesTo discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other.DesignReview of medical and military records of servicemen and cluster analysis of symptoms.ResultsThree varieties of post-combat disorder were identified—a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership.ConclusionsAll modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.

What is already known on this topic

Service in the Gulf war is associated with an increased rate of reported symptoms and worsening subjective healthPost-combat syndromes have been described after most modern conflicts from the US civil war onwards

What this study adds

There seems to be no single post-combat syndrome but a number of variations on a themeThe ever changing form of post-combat syndromes seems to be related to advances in medical understanding, the developing nature of warfare, and cultural undercurrentsBecause reported symptoms are subject to bias and changing emphasis related to advances in medical science or the discovery of new diseases, the characterisation of individual syndromes has to be treated with cautionAttributions by servicemen are generally consistent with symptom characteristics, though there seems to be a growing reluctance to consider the stress of military service as a cause     

Sequence-based ultra-dense genetic and physical maps reveal structural variations of allopolyploid cotton genomes

BackgroundSNPs are the most abundant polymorphism type, and have been explored in many crop genomic studies, including rice and maize. SNP discovery in allotetraploid cotton genomes has lagged behind that of other crops due to their complexity and polyploidy. In this study, genome-wide SNPs are detected systematically using next-generation sequencing and efficient SNP genotyping methods, and used to construct a linkage map and characterize the structural variations in polyploid cotton genomes.ResultsWe construct an ultra-dense inter-specific genetic map comprising 4,999,048 SNP loci distributed unevenly in 26 allotetraploid cotton linkage groups and covering 4,042 cM. The map is used to order tetraploid cotton genome scaffolds for accurate assembly of G. hirsutum acc. TM-1. Recombination rates and hotspots are identified across the cotton genome by comparing the assembled draft sequence and the genetic map. Using this map, genome rearrangements and centromeric regions are identified in tetraploid cotton by combining information from the publicly-available G. raimondii genome with fluorescent in situ hybridization analysis.ConclusionsWe report the genotype-by-sequencing method used to identify millions of SNPs between G. hirsutum and G. barbadense. We construct and use an ultra-dense SNP map to correct sequence mis-assemblies, merge scaffolds into pseudomolecules corresponding to chromosomes, detect genome rearrangements, and identify centromeric regions in allotetraploid cottons. We find that the centromeric retro-element sequence of tetraploid cotton derived from the D subgenome progenitor might have invaded the A subgenome centromeres after allotetrapolyploid formation. This study serves as a valuable genomic resource for genetic research and breeding of cotton.

Electronic supplementary material

The online version of this article (doi:10.1186/s13059-015-0678-1) contains supplementary material, which is available to authorized users.     

基于CIS的医疗质量安全监管系统应用效果

?????? 目的 探讨以临床信息系统（CIS）为基础构建医疗质量安全监管系统的实际应用效果。方法 对照分析应用CIS及医疗质量信息化监管系统前后的医疗服务效率与质量安全指标变化。结果 实施CIS及信息化医疗质量安全监管系统后医疗效率和质量安全指标均有显著性提升。结论 基于临床信息系统建立健全医疗质量安全监管系统,是深入挖掘利用CIS、充分发挥其持续改进医疗质量、保障患者安全、提升服务效能的重要支持和保证。     

An autosomal genetic linkage map of the domestic cat,Felis silvestris catus

We report on the completion of an autosomal genetic linkage (GL) map of the domestic cat (Felis silvestris catus). Unlike two previous linkage maps of the cat constructed with a hybrid pedigree between the domestic cat and the Asian leopard cat, this map was generated entirely with domestic cats, using a large multi-generational pedigree (n = 256) maintained by the Nestlé Purina PetCare Company. Four hundred eighty-three simple tandem repeat (STR) loci have been assigned to linkage groups on the cat's 18 autosomes. A single linkage group spans each autosome. The length of the cat map, estimated at 4370 cM, is long relative to most reported mammalian maps. A high degree of concordance in marker order was observed between the third-generation map and the 1.5 Mb-resolution radiation hybrid (RH) map of the cat. Using the cat 1.9 × whole-genome sequence, we identified map coordinates for 85% of the loci in the cat assembly, with high concordance observed in marker order between the linkage map and the cat sequence assembly. The present version represents a marked improvement over previous cat linkage maps as it (i) nearly doubles the number of markers that were present in the second-generation linkage map in the cat, (ii) provides a linkage map generated in a domestic cat pedigree which will more accurately reflect recombination distances than previous maps generated in a hybrid pedigree, and (iii) provides single linkage groups spanning each autosome. Marker order was largely consistent between this and the previous maps, though the use of a hybrid pedigree in the earlier versions appears to have contributed to some suppression of recombination. The improved linkage map will provide an added resource for the mapping of phenotypic variation in the domestic cat and the use of this species as a model system for biological research.     

A Physical Map of Arabidopsis thaliana Chromosome 3 Represented by Two Contigs of CIC YAC, P1, TAC and BAC Clones

We have constructed a physical map of Arabidopsis thaliana chromosome3 by ordering the clones from CIC YAC, P1, TAC and BAC librariesusing the sequences of a variety of genetic and EST markersand terminal sequences of clones. The markers used were 112DNA markers, 145 YAC end sequences, and 156 end sequences ofP1, TAC and BAC clones. The entire genome of chromosome 3, exceptfor the centromeric and telomeric regions, was covered by twolarge contigs, 13.6 Mb and 9.2 Mb long. This physical map willfacilitate map-based cloning experiments as well as genome sequencingof chromosome 3. The map and end sequence information are availableon the KAOS (Kazusa Arabidopsis data Opening Site) web siteat http://www.kazusa.or.jp/arabi/.