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3-hydroxy fatty acids (3-OH FAs) with 10 to 18 C atoms are membrane lipids mainly produced by Gram-negative bacteria. They have been recently proposed as temperature and pH proxies in terrestrial settings. Nevertheless, the existing correlations between pH/temperature and indices derived from 3-OH FA distribution (RIAN, RAN15 and RAN17) are based on a small soil dataset (ca. 70 samples) and only applicable regionally. The aim of this study was to investigate the applicability of 3-OH FAs as mean annual air temperature (MAAT) and pH proxies at the global level. This was achieved using an extended soil dataset of 168 topsoils distributed worldwide, covering a wide range of temperatures (5 °C to 30 °C) and pH (3 to 8). The response of 3-OH FAs to temperature and pH was compared to that of established branched GDGT-based proxies (MBT'5Me/CBT). Strong linear relationships between 3-OH FA-derived indices (RAN15, RAN17 and RIAN) and MAAT/pH could only be obtained locally, for some of the individual transects. This suggests that these indices cannot be used as paleoproxies at the global scale using simple linear regression models, in contrast with the MBT'5Me and CBT. However, strong global correlations between 3-OH FA relative abundances and MAAT/pH were shown by using other algorithms (multiple linear regression, k-NN and random forest models). The applicability of the k-NN and random forest models for paleotemperature reconstruction was tested and compared with the MAAT record from a Chinese speleothem. The calibration based on the random forest model appeared to be the most robust. It showed similar trends with previously available records and highlighted known climatic events poorly visible when using local 3-OH FA calibrations. Altogether, these results demonstrate the potential of 3-OH FAs as paleoproxies in terrestrial settings.

BackgroundThe overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record.The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients.Research questionsThe fundamental question was “How does awareness of CHIE or usage of CHIE affect clinical decision-making?” The secondary questions were “What are the latent benefits of CHIE in frontline NHS operations?” and “What is the potential of CHIE to have an impact on major NHS cost pressures?”The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions.MethodsSemi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti.Results21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust.ConclusionsCHIE gives clinicians the “bigger picture” to understand the patient’s health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions.We propose the use of “recommender systems” to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

Sprinting and speed is a fundamental skill and physical attribute crucial in seam bowlers and batters within cricket. The aim of this study was to assess differences in mechanical properties during sprinting between youth and senior international cricketers and between seam bowlers and batters. Retrospective 40 m sprint times and anthropometric measures of 56 international cricketers (19 senior seam bowlers, 7 under-19 seam bowlers, 16 senior batters, 14 under-19 batters) were used to calculate the theoretical maximal force (F0), theoretical maximal velocity (V(0)), theoretical maximal power (Pmax), slope of the force-velocity relationship (F-V slope), maximal ratio of horizontal-to-resultant force (RFmax), decrease in the ratio of horizontal-to-resultant force (DRF) and optimum velocity (Vopt). There were no significant (P > 0.05) differences in sprint times nor sprint mechanical profile variables between position or age. However, there was a moderately greater F0 (N/Kg) (ES = 0.78; 90% CI 0.19–1.34) and RFmax (ES = 0.75; 90% CI 0.11–1.35) in senior seam bowlers when compared to batters. Furthermore, FV Slope (ES = 0.79; 90% CI 0.15–1.40) and DRF (ES = 0.75; 90% CI 0.11–1.35) were moderately greater in senior compared to under-19 batters. When expressed relative to body mass, it appears that senior international seam bowlers show trends towards a more force biased profile during sprinting when compared to batters. These findings will help coaches to optimise physical preparation strategies in youth and senior international cricketers.

The COVID-19 pandemic has created many challenges for health and care services worldwide and has led to one of the largest societal crises in last century. It has also been a test for the maturity of digital health technologies, be it for frontline care, surveillance or discovery of new strategies.

Background: Medical errors continue to be a major cause of concern often involving, among other things, communications breakdown, poor recording, flawed system design and implementation, and weak or non-existent interoperability of electronic records. Based on a socio-technical systems approach, the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 (1) is a “human factors framework for studying and improving the work of healthcare professionals and patients”, intended to enhance system design and implementation, one of the consequences of which should be reducing healthcare error. Aim: We propose an application of SEIPS 2.0 with specific reference to health and care record creation and use, incorporating the core features of SEIPS including psychological, task, technology and organization factors to enable a more nuanced understanding of how such factors influence records and the implications for improvements in quality of care.Discussion: Records are central to health and care. We argue that individual psychological considerations in both patient and clinician are importantly implicated in influencing performance and the content of the record, as well as having an impact on care. These considerations include cognitive biases, mood, temperament and stress interacting with other factors in the care ecology. Task details such as workflow, cognitive load and communication skills as well as the impacts of technology implementation, impact on what and how information is recorded and communicated, and their consequences. Organizational context in terms of structure, policy and processes further set the environment in which health and care records are co-created and curated as part of all care systems and influence the dynamics and outcomes of care practices.Conclusions: Our application of SEIPS offers a detailed systemic model of person factors, task factors, technology factors and organizational factors involved in record creation and use, and more widely in care performance. This model needs empirical validation but offers a useful framework for record system design and implementation as well as related organizational and behavioural change programmes needed to enhance quality and safety in care environments.

BackgroundNational Health Service policy suggests that increasing usage of electronic personal health records (PHR) by patients will result in cost savings and improved public health. Medication adherence means that patients take their prescribed medication as agreed with their doctors. Some of the claimed benefits of PHRs are decreasing healthcare costs and improving medication adherence and patient outcomes.MethodsThis is a mixed methods convergent study, primarily qualitative. The qualitative and quantitative data collection and analysis will occur in parallel, and then be synthesised. We are interviewing and surveying adults with long-term conditions to identify what are the most important and useful features of their current PHR. The data collection comprises patient demographics, the Medication Adherence Questionnaire, the personality scale Big Five Inventory-2 Extra-Short Form and the WHO Quality of Life-BREF scale. Qualitative data will be analysed using the Framework method.EthicsWe have received a favourable ethical opinion from the Health Research Authority/Research Ethics Committee.

This Editorial marks the launch of the UK Faculty of Clinical Informatics (FCI) at the time when non-clinically qualified informaticiance are anticipating the lauch of the Federation of Informatics Professionals in Health and Care (Fed-IP).

Objectives: The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data; and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data. Method: A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice. Conclusion: Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future.

Modern portable ultrasound machines provide the veterinary clinician with an inexpensive and non-invasive method to further examine sheep on farm, which would take no more than 2–5 min with results available immediately. Trans-abdominal ultrasonographic examination provides veterinarians with valuable information regarding bladder distension and uroperitoneum caused by obstructive urolithiasis, which greatly facilitates prompt corrective surgery. Advanced hydronephrosis, which affords a grave prognosis for urolithiasis cases, is readily identified by an increased renal pelvis and thinned cortex. Unless caused by large numbers of migrating immature liver flukes, accumulation of inflammatory exudate in the peritoneal cavity is uncommon in sheep. Unlike cattle, infection arising from the gastrointestinal tract, e.g., traumatic reticuloperitonitis, is rare in sheep. Renal, intestinal, kidney and bladder tumours can be identified during ultrasonographic examination, but these conditions affect individual sheep and are not a significant flock problem.

Modern portable ultrasonography machines provide veterinary clinicians with an inexpensive and non-invasive method to further examine the respiratory system of sheep on farm. The procedure would take no more than 2–5 min, with results immediately available. Repeated, regular ultrasonographic examination allows lung and pleural pathologies to be monitored over time, permitting accurate evaluation of various treatments regimens. Critically, ultrasonographic examination informs the clinician regarding the development/regression of lesions, rather than relying upon extrapolation of post-mortem findings regarding aetiology and progression of disease. Ultrasonographic examination presents no human health and safety restrictions. Lesion as small as 2–3 cm in diametre, involving the visceral pleura can be readily identified ultrasonographically. The distribution of lung pathology caused by ovine pulmonary adenocarcinoma can be accurately outlined during ultrasonographic examination of the chest, but the operator must be aware that secondary abscessation of the tumour mass and associated fibrinous pleurisy may prove misleading. Repeated 6- to 12-monthly ultrasonographic examination of the lungs of all adult sheep in a flock is an exciting development that may reduce, and potentially eliminate, pulmonary adenocarcinoma from closed sheep flocks, with effective biosecurity measures. With appropriate handling facilities, an experienced operator can examine both sides of the chest of 50–80 sheep per hour, making such screening affordable even to commercial farmers. Resolution of extensive unilateral fibrinous pleurisy over several months has been recorded and in some cases it has proven difficult to differentiate such resolving lesions from abscesses involving the lungs/pleurae.

Accurate ultrasonographic determination of foetal number between 45 to 90 days of gestation has revolutionised reproductive management in sheep over 30 years ago and is now established as an essential component of flock health planning and productivity. Ultrasonographic measurements of fat and muscle depths over ribs 12 and 13 in growing lambs can accurately reflect carcass composition and have been incorporated in breeding programmes in sheep meat breeds. These ultrasound services may often be delivered by para-professionals, who individually scan tens of thousands of sheep annually. Currently, ultrasonographic examination in small ruminant practice is largely confined to the investigation of individual valuable pedigree animals referred to veterinary schools or other centres of expertise, despite publication of clinical papers illustrating its application in a wide range of common diseases, including respiratory diseases, urolithiasis, liver and kidney pathologies. Typically, ultrasonographic examination of any organ system should take no more than 1–2 min with the results available immediately, affording a much more informed diagnosis and prognosis. Presently, examination of all adult sheep in the flock for ovine pulmonary adenocarcinoma is being researched in an attempt to eliminate this disease, which has no commercially available diagnostic test or obvious flock control measure. Ultrasonographic investigation is much cheaper than common clinical biochemistry tests, e.g., haematological examination or protein measurements (albumin and globulin, acute phase proteins, fibrinogen and haptoglobin). The ability to record ultrasonographic findings as images or video files directly to mobile telephones, tablets and laptops allows clinicians to transmit such data to a specialist should a second opinion prove necessary. Tele-medicine is well established in several veterinary disciplines and will become increasingly common for diagnostic imaging in small ruminant practice during the next decade. Comparison of images collected over a period of time allows a disease process to be accurately monitored. Re-evaluation of ultrasonographic recordings is an invaluable learning exercise should necropsy results become available.

This article presents ultrasonographic and post-mortem findings from a wide range of common ovine diseases, in which provisional veterinary diagnosis was confirmed by using ultrasonography at the time of the first clinical examination and without recourse to additional, potentially expensive, diagnostic facilities. Furthermore, cases studies are presented of conditions and diseases not previously reported in the veterinary literature, where further investigations and the eventual diagnosis was greatly facilitated by ultrasonographic findings. The article seeks to further develop the application of diagnositic ultrasonography in everyday small ruminant practice.

Summary Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon “Big Data” and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics.

Lawrence Weed proposed we develop computerised, problem-oriented medical records that guide and teach. The Bawa-Garba case outcomes might have been different if care had been supported by computerised medical record (CMR) systems. CMR systems can reduce prescribing errors and could be developed to flag gaps in supervision. However, CMR systems are not a panacea and need to be fit for purpose. Our informatics perspective on this case is to call for widespread use of CMR systems – designed to guide and protect.

The use of novel health information technology provides avenues for potentially significant patient benefit. However, it is also timely to take a step back and to consider whether the use of these technologies is safe – or more precisely what the current evidence for their safety is, and what kinds of evidence we should be looking for in order to create a convincing argument for patient safety. This special issue on patient safety includes eight papers that demonstrate an increasing focus on qualitative approaches and a growing recognition that the sociotechnical lens of examining health information technology–associated change is important. We encourage a balanced approach to technology adoption that embraces innovation, but nonetheless insists upon suitable concerns for safety and evaluation of outcomes.

ObjectivesThis systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions.Data sourcesPubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate.MethodsStudies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool.ResultsFrom a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient’s blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used.ConclusionAlthough we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process.PROSPERO registration numberCRD42017060542.

Objective To assess measurement practice in clinical decision support evaluation studies. Materials and Methods We identified empirical studies evaluating clinical decision support systems published from 1998 to 2017. We reviewed titles, abstracts, and full paper contents for evidence of attention to measurement validity, reliability, or reuse. We used Friedman and Wyatt’s typology to categorize the studies. Results There were 391 studies that met the inclusion criteria. Study types in this cohort were primarily field user effect studies (n = 210) or problem impact studies (n = 150). Of those, 280 studies (72%) had no evidence of attention to measurement methodology, and 111 (28%) had some evidence with 33 (8%) offering validity evidence; 45 (12%) offering reliability evidence; and 61 (16%) reporting measurement artefact reuse. Discussion Only 5 studies offered validity assessment within the study. Valid measures were predominantly observed in problem impact studies with the majority of measures being clinical or patient reported outcomes with validity measured elsewhere. Conclusion Measurement methodology is frequently ignored in empirical studies of clinical decision support systems and particularly so in field user effect studies. Authors may in fact be attending to measurement considerations and not reporting this or employing methods of unknown validity and reliability in their studies. In the latter case, reported study results may be biased and effect sizes misleading. We argue that replication studies to strengthen the evidence base require greater attention to measurement practice in health informatics research.

IntroductionPatient records are often fragmented across organisations and departments in UK health and care services, often due to substandard information technology. However, although government policy in the UK and internationally is strongly pushing ‘digital transformation’, the evidence for the positive impact of electronic information systems on cost, quality and safety of healthcare is far from clear. In particular, the mechanisms by which information availability is translated into better decision-making are not well understood. We do not know when a full interorganisational record is more useful than a key information summary or an institutional record. In this paper, we describe our scoping review of how interorganisational electronic health records affect decision-making by hospital physicians and pharmacists.Methods and analysisThis scoping review will follow the Arksey and O’Malley (2005) methodology. The review has adopted sociotechnical systems thinking and the notion of distributed cognition as its guiding conceptual models. The UK National Institute for Health and Care Excellence Healthcare Databases Advanced Search will be used, as it incorporates key sources including PubMed, Medline, Embase, HMIC and Health Business Elite. A hand search will be conducted using the reference lists of included studies to identify additional relevant articles. A two-part study selection process will be used: (1) a title and abstract review and (2) full text review. During the first step, two researchers separately will review the citations yielded from the search to determine eligibility based on the defined inclusion and exclusion criteria. Related articles will be included if they are empirical studies that address how interorganisational records affect decision-making by hospital physicians and pharmacists.Ethics and disseminationThe results will be disseminated through stakeholder meetings, conference presentations and peer-reviewed publication. The data used are from publicly available secondary sources, so this study does not require ethical review.

The differential response of chiral molecules to incident left- and right- handed circularly polarized light is used for sensing the handedness of molecules. Currently, significant effort is directed towards enhancing weak differential signals from the molecules, with the goal of extending the capabilities of chiral spectrometers to lower molecular concentrations or small analyte volumes. Previously, optical cavities for enhancing vibrational circular dichroism have been introduced. Their enhancements are mediated by helicity-preserving cavity modes which maintain the handedness of light due to their degenerate TE and TM components. In this article, we simplify the design of the cavity, and numerically compare it with the previous one using an improved model for the response of chiral molecules. We use parameters of molecular resonances to show that the cavities are capable of bringing the vibrational circular dichroism signal over the detection threshold of typical spectrometers for concentrations that are one to three orders of magnitude smaller than those needed without the cavities, for a fixed analyte volume. Frequency resolutions of current spectrometers result in enhancements of more than one order (two orders) of magnitude for the new (previous) design. With improved frequency resolution, the new design achieves enhancements of three orders of magnitude. We show that the TE/TM degeneracy in perfectly helicity preserving modes is lifted by factors that are inherent to the cavities. More surprisingly, this degeneracy is also lifted by the molecules themselves due to their lack of electromagnetic duality symmetry, that is, due to the partial change of helicity during the light-molecule interactions., This article may be downloaded for personal use only. Any other use requires prior permission of the author and AIP Publishing. This article appeared in Applied Physics Reviews 7, 041413 (2020) and may be found at https://aip.scitation.org/doi/abs/10.1063/5.0025006

In the interest of promoting the integration of hybrid-electric power train into the aviation industry, research is being conductedby North Carolina State University to establish the feasibility of electrified power train in a small scale unmanned aerial vehicle (UAV). To accomplish this, it is first necessary to understand dynamics of the system to calculate the requiredpower associated with each portions of the aircraft’s mission. Though research that has been conducted in the past basedpower required on published governing equations. However, in the interest of understand the system at its most fundamentallevel, it was deemed prudent to derive the governing equations from Newton’s second law. Using analytical dynamics, a rotating coordinate system was applied to the craft and a rotation matrix was applied to establishthe interaction of the aircraft’s external forces based on its Euler angles with respect to the inertial frame. The equations associated with the values and interactions of the aircraft’s external forces were combined and manipulatedto develop three governing parameters of maintaining flight during a typical UAV mission. These parameters are minimumairspeed, minimum power applied to the propeller, and the minimum roll angle required to accomplish a loitering maneuverwith set radius about a target. The next step of this research will be development of an optimization algorithm to match power train components to applythe necessary conditions derived in this paper. Glossary of Variables: kT – Thrust coefficient of the propeller ρ – Air density n – Rotational speed of the propeller (rev/s) D – Propeller’s Diameter (in) AP – Wing planform area CL – Wing coefficient of lift J – Propeller advance ratio (u/nD) AF – Aircraft frontal area CD – Sum of the parasitic (CDo) and lift induced (CDi) drag coefficients AR – Wing aspect ratio e – Oswald efficiency factor

ObjectivesRapid technology-driven innovation in the healthcare sector has led to an increasing ability to effectively respond to health challenges. However, the cognitive challenges faced by a person with dementia exacerbate the difficulty of designing enduring technological dementia care solutions. Despite this, and in the absence of a cure, facilitating well-being and improved quality of life becomes pivotal for those living with dementia and their caregivers. This review aimed to identify and consolidate the provision of technological solutions for dementia care, and how these are perceived to impact the quality of life of a person with dementia.MethodsArticles and journals were identified using keywords including those relating to quality of life, assistive technologies and technology adoption and acceptance. Greater priority was given to resources published after 2010 due to the speed of technological advancement, and peer-reviewed articles were preferred.Results91 resources were identified, with 38 contributing to the final review. In addition to multiple quality of life measurement tools, the literature identified a large variety of solutions that fell into three categories: those used ‘by’, ‘with’ or ‘on’ a person with dementia.ConclusionsThis review concludes that the ‘one size fits all’ approach to many solutions reflects the lack of supporting evidence, negatively impacting trust in their usefulness among caregivers and their subsequent adoption rates. This could be attributed to limited involvement of people with dementia in studies of effectiveness and adoption. Additional research is recommended to further consolidate research on quality of life and to understand the individuality and progression of dementia and its influence on dementia care solutions.

A great asset of any healthcare system is "information" which includes, but not limited to patient data, clinical history and treatments. It is no secret that there is a growing demand for healthcare, however, this demand is yet to be achieved due to the challenge in the limitation of resources and the complexity of the problem area.

Background: The National Health Service (NHS) England spent £15.5 billion on medication in 2015. More than a third of patients affected by at least one long-term condition do not adhere to their drug regime. Many interventions have been trialed to improve medication adherence. One promising innovation is the electronic personal health record. Objective: This systematic literature review aims to identify the important design features of personal health records to improve medication adherence for patients with long-term conditions. Methods: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P 2015) statement. The following databases will be searched for relevant articles: PubMed, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Studies published in the last fifteen years, in English, will be included if the participants are adults who were treated outside the hospital, have the ability to self-administer their medication, and have at least one long-term condition. The review will exclude commercial or political sources and papers without references. Papers that research pediatrics, pregnant, or terminally ill patients will also be excluded, since their medication management is typically more complex. Results: One reviewer will screen the included studies, extract the relevant data, and assess the quality of evidence utilizing the Grading of Recommendations Assessment, Development, and Evaluation system and the risk of bias using the Cochrane RevMan tool. The second reviewer will assess the quality of 25% of the included studies to assess interrater agreement. Any disagreement will be solved by a third reviewer. Only studies of high and moderate quality will be included for narrative synthesis. Conclusions: NHS policy assumes that increasing usage of personal health records by citizens will reduce demand on health care services. There is limited evidence, however, that the use of health apps can improve patient outcomes, and, to our knowledge, this is the first systematic literature review aiming to identify important design features of the personal health record which may improve medication adherence in the adult population with long-term conditions. Trial Registration: PROSPERO CRD42017060542; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60542 (Archived by WebCite at http://www.webcitation.org/6zeuWXxVh) Registered Report Identifier: RR1-10.2196/9778

BackgroundUK health research policy and plans for population health management are predicated upon transformative knowledge discovery from operational ‘Big Data’. Learning health systems require not only data, but feedback loops of knowledge into changed practice. This depends on knowledge management and application, which in turn depends upon effective system design and implementation. Biomedical informatics is the interdisciplinary field at the intersection of health science, social science and information science and technology that spans this entire scope.IssuesIn the UK, the separate worlds of health data science (bioinformatics, ‘Big Data’) and effective healthcare system design and implementation (clinical informatics, ‘Digital Health’) have operated as ‘two cultures’. Much National Health Service and social care data is of very poor quality. Substantial research funding is wasted on ‘data cleansing’ or by producing very weak evidence. There is not yet a sufficiently powerful professional community or evidence base of best practice to influence the practitioner community or the digital health industry.RecommendationThe UK needs increased clinical informatics research and education capacity and capability at much greater scale and ambition to be able to meet policy expectations, address the fundamental gaps in the discipline’s evidence base and mitigate the absence of regulation. Independent evaluation of digital health interventions should be the norm, not the exception.ConclusionsPolicy makers and research funders need to acknowledge the existing gap between the ‘two cultures’ and recognise that the full social and economic benefits of digital health and data science can only be realised by accepting the interdisciplinary nature of biomedical informatics and supporting a significant expansion of clinical informatics capacity and capability.

Summary Objectives: To review the potential contribution of Information and Communication Technology (ICT) to enable patient-centric and coordinated care, and in particular to explore the role of patient portals as a developing ICT tool, to assess the available evidence, and to describe the evaluation challenges. Methods: Reviews of IMIA, EFMI, and other initiatives, together with literature reviews. Results: We present the progression from care coordination to care integration, and from patient-centric to person-centric approaches. We describe the different roles of ICT as an enabler of the effective presentation of information as and when needed. We focus on the patient‘s role as a co-producer of health as well as the focus and purpose of care. We discuss the need for changing organisational processes as well as the current mixed evidence regarding patient portals as a logical tool, and the reasons for this dichotomy, together with the evaluation principles supported by theoretical frameworks so as to yield robust evidence. Conclusions: There is expressed commitment to coordinated care and to putting the patient in the centre. However to achieve this, new interactive patient portals will be needed to enable peer communication by all stakeholders including patients and professionals. Few portals capable of this exist to date. The evaluation of these portals as enablers of system change, rather than as simple windows into electronic records, is at an early stage and novel evaluation approaches are needed.

SummaryThis article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper “Evidence-based Health Informatics: How Do We Know What We Know?” written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor.With these comments on the paper “Evidence-based Health Informatics: How do we know what we know?”, written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

Systematic health IT evaluation studies are needed to ensure system quality and safety and to provide the basis for evidence-based health informatics. Well-trained health informatics specialists are required to guarantee that health IT evaluation studies are conducted in accordance with robust standards. Also, policy makers and managers need to appreciate how good evidence is obtained by scientific process and used as an essential justification for policy decisions. In a consensus-based approach with over 80 experts in health IT evaluation, recommendations for the structure, scope and content of health IT evaluation courses on the master or postgraduate level have been developed, supported by a structured analysis of available courses and of available literature. The recommendations comprise 15 mandatory topics and 15 optional topics for a health IT evaluation course.

Conference report, The Informatics for Health congress, 24-26 April 2017, in Manchester, UK. Introduction : The Informatics for Health congress, 24-26 April 2017, in Manchester, UK, brought together the Medical Informatics Europe (MIE) conference and the Farr Institute International Conference. This special issue of the Journal of Innovation in Health Informatics contains 113 presentation abstracts and 149 poster abstracts from the congress. Discussion : The twin programmes of “Big Data” and “Digital Health” are not always joined up by coherent policy and investment priorities. Substantial global investment in health IT and data science has led to sound progress but highly variable outcomes. Society needs an approach that brings together the science and the practice of health informatics. The goal is multi-level Learning Health Systems that consume and intelligently act upon both patient data and organizational intervention outcomes. Conclusions : Informatics for Health demonstrated the art of the possible, seen in the breadth and depth of our contributions. We call upon policy makers, research funders and programme leaders to learn from this joined-up approach. Publisher PDF

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication. Publisher PDF

Multi-order diffractive (MOD) lenslet arrays were characterized for Strehl ratio, focal ratio, and efficiency at multiple wavelengths. The focal ratios as a function of wavelength were deduced from analysis of images of illuminated lenslets.

Examination of the lungs of adult sheep with chronic respiratory diseases was readily achieved using both 5 MHz linear and sector scanners. Superficial lung abscesses in eight sheep appeared as anechoic areas containing multiple hyperechoic dots bordered distally by a broad hyperechoic capsule. Unilateral fibrinous pleurisy (2 sheep) appeared as an anechoic area containing a hyperechoic latticework. Ovine pulmonary adenocarcinoma (OPA) lesions appeared as sharply demarcated hypoechoic areas in the lung parenchyma initially in the cranioventral lung lobes (21 sheep) with lesions also present in the caudodorsal diaphragmatic lobe (11 sheep); abscesses and areas of calcification within the OPA tumour mass were also identified. Daily treatment with procaine penicillin for 30 consecutive days was successful in both sheep with unilateral fibrinous pleurisy and six sheep identified with superficial lung abscesses measuring 2–8 cm in diameter; only one of two sheep with more extensive lesions recovered. Auscultation of the chest failed to detect adventitious sounds in any of the ten sheep with lung abscesses; normal breath sounds were reduced over the area of fibrinous pleurisy; no pleuritic rubs were heard. Wheezes and crackles auscultated in some OPA cases and did not correlate well with lesions detected ultrasonographically.

Educational leaders, families, and politicians debate the methods for teaching, the materials taught, and the content learned (Benninga, Berkowitz, Kuehn, and Smith, 2006; Kohn, 1997). These stakeholders all agree, however, that a major goal for education is to produce learned, productive members of society (DeRoche and Williams, 2001). The goal of this research is to develop a framework that provides schools and division-level leaders with essential elements to resolve character education issues and to provide the means for implementing and evaluating those programs. I used the Delphi research method to collect information from notable researchers and practitioners in the educational world (Keeney, McKenna, and Hasson, 2010). Many of the panelists were selected because their previous research on character education formed a large part of my literature review in Chapter 2. The practitioners are current superintendents, principals, or program directors in representative school systems. The study itself consisted of three rounds of questionnaires; the first round consisted of three open-ended questions that then elicited responses on which the other two rounds were based. The panelists indicated that clearly defined goals and values, stakeholder buy-in, and inclusion of social/emotional issues were the essential elements needed for an effective character education program. Shared responsibilities by stakeholders and student-driven debates were seen as the keys to implementing said program. Finally, the panelists concurred that attendance and discipline data and surveys were the best tools/methods for evaluating character education programs. Ed. D.

Evidence-based thinking is sometimes misconceived as a barrier to innovation, when in fact both are vital.[1][1],[2][2] Merlo et al .[3][3] demonstrate the synergy of evidence and innovation, showing how a mobile application for children with attention-deficit hyperactivity disorder supports