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ObjectiveThis report describes our experience in electronic health record (EHR) note modification and creation of an external dashboard to create a local learning health system that contributes to quality improvement and patient care within our pediatric rheumatology clinic.MethodsWe applied quality improvement methodology to develop a more reliable and accurate system to identify patients with juvenile idiopathic arthritis and track important measures that aide in improving patient care and performance outcomes. From 2019 to 2021, we iteratively modified our outpatient clinic EHR note to include structured data elements to improve longitudinal monitoring. We then validated data transferred to an electronic dashboard external to the EHR and demonstrated utility for identifying an accurate patient population and tracking quality improvement initiatives.ResultsCreation of the structured data elements improved the identification of patients with JIA with >99% accuracy and without requiring manual review of the chart. Using the dashboard to monitor performance, we improved documentation of critical disease activity measures that resulted in improvement in those scores across the local population of patients with JIA. The structured data elements also enabled us to automate electronic data transfer to a multicenter learning network registry.ConclusionThe structured data element modifications made to our outpatient EHR note populate a local dashboard that allows real time access to critical information for patient care, population management, and improvement in quality metrics. The collection and monitoring of structured data can be scaled to other quality improvement initiatives in our clinic and shared with other centers.

Abstract BackgroundAdverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. ObjectiveThis study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. MethodsPatient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases2 ResultsComplete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59% female; n=1198, 50% non-White). Roughly 8% (n=179) reported housing insecurity, 30% (n=710) reported resource needs (food, health care, or utilities), and 49% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9%); (2) adverse neighborhood SDoH (n=1353, 56%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95% CI 1.06‐1.33), hypertension (PR 1.14, 95% CI 1.02‐1.27), peripheral vascular disease (PR 1.46, 95% CI 1.09‐1.97), and heart failure (PR 1.46, 95% CI 1.20‐1.79). ConclusionsPatients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal.

Housing is a pervasive determinant of physical and mental health. Studies indicate the importance of social support to the mental and physical health of individuals who are unhoused; however, to date, little is known about this relationship in persons who are housed in unaffordable accommodations. As the demand for subsidized housing continues to increase far beyond sustainable levels in many countries, investigations of the implications of social support on the health and wellbeing of those waiting for access to subsidized accommodations becomes important to generate evidence-based policy responses. Using data from the NB Housing Study, this paper presents an analysis of the relationships between perceived social support, depression, and self-reported physical health in individuals who wait for access to subsidized housing in New Brunswick, Canada ( n = 271). Hierarchical linear regression of Oslo Social Support Scale (OSSS-3) scores on Centre for Epidemiologic Studies Depression Scale 10 (CES-D-10) scores and of OSSS-3 scores on self-reported physical health scores finds increases in social support are associated with decreased depression ( F [1, 260] = 26.34, p

Abstract. This paper presents version 1.0 of the World Atlas ofLast Interglacial Shorelines (WALIS), a global database of sea-level proxiesand samples dated to marine isotope stage 5 (∼ 80 to 130 ka).The database includes a series of datasets compiled in the framework of aspecial issue published in this journal (https://essd.copernicus.org/articles/special_issue1055.html, last access: 15 December 2022). This paper collates the individual contributions (archivedin a Zenodo community at https://zenodo.org/communities/walis_database/, last access: 15 December 2022) into anopen-access, standalone database (Rovere et al., 2022,https://doi.org/10.5281/zenodo.7348242). The release of WALIS 1.0 includescomplete documentation and scripts to download, analyze, and visualize thedata (https://alerovere.github.io/WALIS/, last access: 15 December 2022). The databasecontains 4545 sea-level proxies (e.g., marine terraces or fossil beachdeposits), 4110 dated samples (e.g., corals dated with U-series), and 280other time constraints (e.g., biostratigraphic constraints or tephralayers) interconnected with several tables containing accessory data andmetadata. By creating a centralized database of sea-level proxy data for theLast Interglacial, the WALIS database will be a valuable resource to thebroader paleoclimate community to facilitate data–model integration andintercomparisons, assessments of sea-level reconstructions between differentstudies and different regions, as well as comparisons between past sea-levelhistory and other paleoclimate proxy data.

Human untargeted metabolomics studies annotate only ~10% of molecular features. We introduce reference-data-driven analysis to match metabolomics tandem mass spectrometry (MS/MS) data against metadata-annotated source data as a pseudo-MS/MS reference library. Applying this approach to food source data, we show that it increases MS/MS spectral usage 5.1-fold over conventional structural MS/MS library matches and allows empirical assessment of dietary patterns from untargeted data.

Aims: Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures. Methods: The HUmeral SHaft (HUSH) fracture study is a multicentre, prospective randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures in adult patients. Participants will be randomized to receive either functional bracing or surgery. With 334 participants, the trial will have 90% power to detect a clinically important difference for the Disabilities of the Arm, Shoulder and Hand questionnaire score, assuming 20% loss to follow-up. Secondary outcomes will include function, pain, quality of life, complications, cost-effectiveness, time off work, and ability to drive. Discussion: The results of this trial will provide evidence regarding clinical and cost-effectiveness between surgical and non-surgical treatment of humeral shaft fractures. Ethical approval has been obtained from East of England – Cambridge Central Research Ethics Committee. Publication is anticipated to occur in 2024. Cite this article: Bone Jt Open 2024;5(4):343–349.

Abstract Background Statisticians are fundamental in ensuring clinical research, including clinical trials, are conducted with quality, transparency, reproducibility and integrity. Good Clinical Practice (GCP) is an international quality standard for the conduct of clinical trials research. Statisticians are required to undertake training on GCP but existing training is generic and, crucially, does not cover statistical activities. This results in statisticians undertaking training mostly unrelated to their role and variation in awareness and implementation of relevant regulatory requirements with regards to statistical conduct. The need for role-relevant training is recognised by the UK NHS Health Research Authority and the Medicines and Healthcare products Regulatory Agency (MHRA). Methods The Good Statistical Practice (GCP for Statisticians) project was instigated by the UK Clinical Research Collaboration (UKCRC) Registered Clinical Trials Unit (CTU) Statisticians Operational Group and funded by the National Institute for Health and Care Research (NIHR), to develop materials to enable role-specific GCP training tailored to statisticians. Review of current GCP training was undertaken by survey. Development of training materials were based on MHRA GCP. Critical review and piloting was conducted with UKCRC CTU and NIHR researchers with comment from MHRA. Final review was conducted through the UKCRC CTU Statistics group. Results The survey confirmed the need and desire for the development of dedicated GCP training for statisticians. An accessible, comprehensive, piloted training package was developed tailored to statisticians working in clinical research, particularly the clinical trials arena. The training materials cover legislation and guidance for best practice across all clinical trial processes with statistical involvement, including exercises and real-life scenarios to bridge the gap between theory and practice. Comprehensive feedback was incorporated. The training materials are freely available for national and international adoption. Conclusion All research staff should have training in GCP yet the training undertaken by most academic statisticians does not cover activities related to their role. The Good Statistical Practice (GCP for Statisticians) project has developed and extensively piloted new, role-specific, comprehensive, accessible GCP training tailored to statisticians working in clinical research, particularly the clinical trials arena. This role-specific training will encourage best practice, leading to transparent and reproducible statistical activity, as required by regulatory authorities and funders.

The COVID-19 global pandemic created new challenges for teachers and school systems as teachers were forced to rapidly transition to remote learning using new digital tools and resources. Teaching elementary science in "normal times" is challenging due to issues involving teacher preparation, limited access to materials and lack of administrative support due to emphasis on tested subjects, among others. Using reform-based, inquiry practices is challenging when teaching science face-to-face and even more so in an online environment. Compounded with issues of access and equity, teachers faced many problems with moving elementary science instruction online due to COVID-19. This study reports on the experiences of 10 early career teachers who were graduates of a specialized elementary science concentration. Teachers reflect on the challenges faced, how they adapted, and how they designed new learning contexts to teach science. Teachers report on resources they found beneficial, assess needs for the future, and explain how they worked to maintain a sense of community for their students during this unprecedented critical time.

As we continue to electrify space- and water-heating, the electricity demand profile of manybuildings will change significantly, and periods of high electricity demand will likely not alignwith renewable energy generation. We expect electricity demands will increase substantiallyin the winter, annual maximum electricity demands will increase, and more regions willexperience annual peak electrical demands – and higher wholesale electricity prices – in thewinter. This is especially important for cold climates where 60% of site energy use in buildingsis for heating, and where heat pumps perform least efficiently. This paper focuses on onepromising solution among the many paths to electrification: the use of phase change materials(PCM) for compact low-cost thermal energy storage (TES). We present the design andsimulation of a combi heat pump and phase change thermal storage system used for space- andwater-heating in a multifamily residence in a cold climate. To assess the benefits of thistechnology, we compare its annual performance to that of a current state-of-the-art air-to-airheat pump and separate heat pump water heater. Simulation results for IECC Climate Zone 6Areveal that the combi heat pump with phase change thermal storage can reduce the design sizefor heat pumps by 40-60%, reduce maximum electric demand by 30-50%, reduce electricityuse during 4-12-hour load shed periods by 50%, and avoid the need for auxiliary electricresistance for both space- and water-heating. Tariff structures are highly varied betweendifferent utilities and currently reflect higher wholesale market prices for electricity duringsummer days. Consequently, although this system design provides large electric demandreductions during hypothetical 4-12-hour load shed periods, it does not provide energy costreductions with current winter residential time-of-use tariffs.