A Series of Cation-Modified Robust Zirconium-Based Metal-Organic Frameworks for Carbon Dioxide Capture

Metal-organic frameworks (MOFs) represent one of the most promising porous solids for possible use as sorbents to control and reduce the greenhouse gas emission. Studies have shown that open metal...

Shared Longitudinal Health Records for Clinical and Population Health

The ability of a health information exchange to consolidate information, collected in multiple, disparate information systems, into a single, person-centric health record can provide a comprehensive and longitudinal representation of an individual’s medical history. Shared, longitudinal health records can be leveraged to enhance the delivery of individual clinical care and provide opportunities to improve health outcomes at the population level. This chapter will describe the clinical benefits imparted by the shared health record (SHR) component of the OpenHIE infrastructure. It will also characterize the potential population health benefits of the aggregate level data contained and distributed by the Health Management Information System component of OpenHIE. The chapter will further discuss the implementation of these systems.

By the end of the chapter, the reader should be able to:●

Identify and describe the differences among an electronic medical record, electronic health record, and a shared heath record.

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Explain the role of a shared health record in a health information exchange.

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List and describe the components of a shared health record.

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Discuss the role and benefits of a health management information system within a health information exchange.

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Define a population health indicator.

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Identify and describe application domains for a health management information system.

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Define a database management system.

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Compare the implications of implementing a shared health record using an electronic health record system versus a database management system.

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Discuss emerging trends likely to shape the evolution of shared health records and health management information systems.

Comprehensive yet scalable health information systems for low resource settings: a collaborative effort in sierra leone

We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone.

Delivery at 34 weeks is more costly than at 35 weeks in pregnancies with premature rupture of membranes

OBJECTIVE

To assess the relative risks and costs of delivery at 34 vs. 35 weeks with preterm premature rupture of membranes (PROM).

STUDY DESIGN

Retrospective study of singleton gestations with preterm PROM over a 5-year period. Patients who delivered at 34 vs. 35 weeks were compared.

RESULTS

Sixty-five patients were identified in each group. There were no significant differences in maternal demographics or complications. Direct costs of mother-infant pairs at 34 weeks were significantly higher (dollars 6687 +/- 4273 vs. dollars 4089 +/- 3037, p = 0.0001). Newborn intensive care unit stay was significantly longer for infants born at 34 weeks (8.4 +/- 7.1 vs. 3.5 +/- 4.6 days, p < 0.0001).

CONCLUSIONS

There was a significant increase in neonatal interventions, neonatal length of stay and cost for infants delivered at 34 vs. 35 weeks. Prospective data are necessary to evaluate the actual maternal and neonatal morbidity incurred by delay of delivery.

Cell culture influenza vaccine: an Australian perspective

The Australia Influenza Vaccine Committee makes independent decisions concerning the influenza vaccine formulation for Australia. Large-scale cell culture using MDCK cells would improve response time for vaccine production in the face of a new pandemic. There must be a consensus with respect to the use of MDCK or other cells before the next pandemic. It is unrealistic to expect any national regulatory authority to determine what safety requirements should be met before approving a cell substrate for vaccine production during an influenza pandemic. Regulatory issues seen as obstacles to the approval of MDCK cells as an accepted cell substrate for influenza vaccine production are identified.

The development of an enzyme-linked immunosorbent assay for measuring the potency of vaccines containing Clostridium chauvoei antigens

Current standards (British Pharmacopeia (Veterinary) 1985) for vaccines containing Clostridium chauvoei require a potency test based on a challenge assay in guinea-pigs. Animal welfare and cost considerations favour the development of alternatives. Most veterinary clostridial vaccines are multi component, requiring assays in rabbits to test the potency of components other than C. chauvoei. We describe the application of an ELISA to measure the response to C. chauvoei vaccines in rabbits. The antigen is a sonicated extract of C. chauvoei strain CH4, intended to include a mixture of cellular and soluble antigens. The rabbit response to more than 70 vaccines containing C. chauvoei has been assessed against a reference serum which has been assigned an arbitrary potency of 100 units ml-1. The antibody titres of rabbit sera have been compared with the results of guinea-pig challenge potency tests on the same vaccines. The pass level in the guinea-pig potency test is equivalent to a rabbit ELISA titre of 50 units ml-1.

The identity, distribution and epizootiological significance of brucella isolates in Australia, 1981 to 1985

Results listing the identification of brucella isolates received by the National Brucellosis Reference Centre, National Biological Standards Laboratory, Canberra from 1981 to 1985 are presented. The distribution of brucella species and biotypes is shown on a host and state basis. Cultures isolated in Australia were identified as Brucella abortus biotypes 1, 2 and 4, and Strain 19; B. suis biotype 1, and B. ovis. B. melitensis biotype 3 was recovered from man infected in the Mediterranean area. B. abortus biotype 1 was the most frequent isolate. Atypical cultures isolated from cattle included B. suis biotype 1, and erythritol-utilising mutants of Strain 19. The epizootiological implications of these findings are discussed in relation to their impact on the national campaign to eradicate bovine brucellosis.

Standards for Clostridium chauvoei vaccine--the relationship between the response of guinea pigs and sheep following vaccination and challenge with virulent C. chauvoei

Twelve commercial 5-component clostridial vaccines with known variations in potency of the blackleg (Clostridium chauvoei) component, were simultaneously tested in sheep and guinea pigs. Controlled challenge experiments provided evidence of a highly significant correlation in the response of the 2 species. The guinea pig laboratory model is considered to be a valid indicator of field performance for vaccines containing blackleg antigen.

Subcellular localization of transferrin protein and iron in the perfused rat liver. Effect of Triton WR 1339, digitonin and temperature

The subcellular localization of 3H-labelled 59Fe-loaded transferrin accumulated by the liver has been studied by means of cell fractionation techniques. More than 96% of the 59Fe present in the liver of rats perfused with 59Fe-labelled transferrin is recovered in the parenchymal cells. Rat livers were perfused with 10 micrograms/ml 3H-labelled 59Fe-saturated transferrin, homogenized separated in nuclear (N), mitochondrial (M), light mitochondrial (L), microsomal (P) and supernatant (S) fractions; M, L and P fractions were further analysed by isopycnic centrifugation in sucrose gradients. 3H label distributes essentially around densities of 1.13-1.14 g/ml overlapping to a large extent with the distribution of galactosyltransferase, the marker enzyme of the Golgi complex. However, after treatment with low concentrations of digitonin the 3H label dissociates from galactosyltransferase and is shifted to higher densities, suggesting an association of transferrin with cholesterol-rich endocytic vesicles which could derive from the plasma membrane. 59Fe is mostly found in the supernatant fraction largely in the form of ferritin, as indicated by its reaction with antiferritin antibodies. In the mitochondrial fraction the density distribution of 59Fe suggests an association with lysosomes and/or mitochondria. In contrast to the lysosomal enzyme cathepsin B, the density distribution of 59Fe was only slightly affected by pretreatment of the rats with Triton WR 1339, suggesting its association with the mitochondria. At 15 degrees C, 59Fe and 3H labels are recovered together in low-density endocytic vesicles. On the basis of our results we suggest that, at low extracellular transferrin concentration, iron uptake by the liver involves endocytosis of the transferrin protein. The complex is interiorized in low-density acidic vesicles where iron is released. The iron passes into the cytosol, where it is incorporated into ferritin and into the mitochondria. The iron-depleted transferrin molecule would then be returned to the extracellular medium during the recycling of the plasma membrane.

Early and late scavenging of anaesthetic gases

The effectiveness of two waste gas scavenger devices, the Carstens box and the Ventex apparatus, with regard to nitrous oxide pollution was studied under comparable conditions in an operating theatre. The scavengers were brought into use in the early and late stages of induction of anesthesia, and nitrous oxide concentrations in the breathing zone and theatre peripheral air were measured. Both scavengers reduced nitrous oxide pollution at the sampling points. Similar reductions in nitrous oxide pollution in the breathing zone were obtained with both scavengers, but the Carstens box was more effective in reducing nitrous oxide pollution in the peripheral air.

Comparison of sampling techniques for studies of nitrous oxide pollution

The retention of nitrous oxide in samples of nitrous oxide in air held in disposable plastic syringes, glass syringes and custom-made nylon film bags was studied by means of gas chromatography at intervals of 90 min, 24, 48 and 120 h after filling the containers. After 24 h the nylon bags retained a mean concentration of 94.5% of the original concentration of nitrous oxide. The disposable plastic syringes and glass syringes were unsatisfactory and retained only 80% of the original concentration of nitrous oxide after 90 min. These values decreased to 51% and 31% of the original concentration of nitrous oxide respectively at 24 and 48 h.

Nitrous oxide contamination in dental surgeries using relative analgesia

The concentrations of nitrous oxide were determined at various positions in four dental surgeries in which nitrous oxide sedation was used without scavenging. Contamination was present in all the surgeries, the greatest concentration being recorded at the dentist's nose and the least in the peripheral air. The reception area adjoining the surgeries was found also to be contaminated by nitrous oxide.