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Background: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol.Methods/design: MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff.Discussion: This study evaluates factors that are critical to successful implementation of a web-based risk assessment tool into routine clinical care in a variety of healthcare settings. The result will identify resource needs and potential barriers and solutions to implementation in each setting as well as an understanding potential effectiveness.Trial Registration: NCT01956773. [ABSTRACT FROM AUTHOR]

This study determined whether a torso-vest forced ambient air body ventilation system (BVS) reduced physiological strain during exercise-heat stress. Seven heat-acclimated volunteers attempted nine, 2-h treadmill walks at 200 W m(-2) in three environments, -40 degrees C, 20% rh (HD), 35 degrees C, 75% rh (HW), and 30 degrees C, 50% rh, (WW) wearing the Army Combat Uniform, interceptor body armor (IBA) and Kevlar helmet. Three trials in each environment were BVS turned on (BVS(On)), BVS turned off (BVS(Off)), and no BVS (IBA). In HD, BVS(On) significantly lowered core temperature (T (re)), heart rate (HR), mean skin temperature (T (sk)), mean torso skin temperature (T (torso)), thermal sensation (TS), heat storage (S), and physiological strain index (PSI), versus BVS(Off) and IBA (P < 0.05). For HW (n = 6), analyses were possible only through 60 min. Exercise tolerance time (min) during HW was significantly longer for BVS(On) (116 +/- 10 min) versus BVS(Off) (95 +/- 22 min) and IBA (96 +/- 18 min) (P < 0.05). During HW, BVS(On) lowered HR at 60 min versus IBA, T (sk) from 30 to 60 min versus BVS(Off) and IBA, and PSI from 45 to 60 min versus BVS(Off) and at 60 min versus IBA (P < 0.05). BVS(On) changes in T (re) and HR were lower in HD and HW. During WW, BVS(On) significantly lowered HR, T (sk), and T (torso) versus BVS(Off) and IBA (P < 0.05) during late exercise. Sweating rates were significantly lower for BVS(On) versus BVS(Off) and IBA in both HD and WW (P < 0.05), but not HW. These results indicate that BVS(On) reduces physiological strain in all three environments by a similar amount; however, in hot-dry conditions the BVS(Off) increases physiological strain. [ABSTRACT FROM AUTHOR]