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Objective An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction. Background Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction. Methods Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey. Results Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved. Conclusion Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.

Purpose The traditional forces of change in health care are no longer working as they did in the past. Political gridlock has destroyed Washington's ability to create sensible policy for reforming the medical marketplace, creating chaos for providers. Fortunately, chaos creates opportunity. The idea of creating one's future has never been more relevant and necessary. Materials and Methods Predicting—the science of extrapolating future values from historical data—is not a valid method for looking ahead when causal relationships that explained change in the past are themselves being redefined (the current situation). Forecasting—the art of estimating probabilities of possibilities—is the appropriate method for anticipating futures when causality is being redefined. With its focus on identifying a range of possibilities, forecasting identifies many different outcomes that are simultaneously possible for radiology. Results Health care's new climate is being shaped by four defining trends: 1) revolution in biological science that is shifting caregivers' mission from acute care to disease management; 2) proliferation of information and communications technologies that are transforming the way care is delivered; 3) end of economic growth in the medical marketplace that is reshaping demand for care; and 4) political dysfunction that forces caregivers and their business partners to develop successful futures on their own. Conclusions Radiology 3.0 is nicely aligned with the transformational trends. Staying focused on implementing Radiology 3.0 is supported as the optimal strategy for creating the profession's futures. Diagnostic convergence, establishing a unified diagnostic science with laboratory medicine, is proposed as a complementary initiative.

The Ordovician 87 Sr/ 86 Sr isotope seawater curve is well established and shows a decreasing trend until the mid-Katian. However, uncertainties in calibration of this curve to biostratigraphy and geochronology have made it diffi cult to determine how the rates of 87 Sr/ 86 Sr decrease may have varied, which has implications for both the stratigraphic resolution possible using Sr isotope stratigraphy and efforts to model the effects of Ordovician geologic events. We measured 87 Sr/ 86 Sr in conodont apatite in North American Ordovician sections that are well studied for conodont biostratigraphy, primarily in Nevada, Oklahoma, the Appalachian region, and Ohio Valley. Our results indicate that conodont apatite may provide an accurate medium for Sr isotope stratigraphy and strengthen previous reports that point toward a signifi cant increase in the rate of fall in seawater 87 Sr/ 86 Sr during the Middle Ordovician Darriwilian Stage. Our 87 Sr/ 86 Sr results suggest that Sr isotope stratigraphy will be most useful as a high-resolution tool for global correlation in the mid-Darriwilian to mid-Sandbian, when the maximum rate of fall in Sr/

Objective . To assess the relationship between foot alignment and transverse plane knee motion during a single leg-landing task. Design . Clinical trial. Setting . Hospital biomechanics laboratory. Participants . Seven healthy young women without excessive forefoot, arch, or rear-foot malalignments. Methods and measures . Varus and valgus foot malalignments were mimicked by placing 8° medial and lateral posted orthotics into the shoes before participants performed three landings from a drop jump off a 43cm high platform. The change in tibiofemoral rotation relative to the no orthotic condition was measured. Results . The medial posted orthotic resulted in 3.1±5.5° less internal tibiofemoral rotation as compared to the nonorthotic condition, while the lateral posting produced 2.6±2.2° more internal tibiofemoral rotation ( t 6 =−2.51, p ≤0.03). Conclusions . Orthotic induced malalignments altered the magnitude of tibiofemoral rotation during a closed kinematic chain activity. Orthotic posting may be used to reduce the rotary stress on the knee during landing activities.

The primary purpose of this unique evaluation of cadaveric skeletal geometry was to compare intercondylar notch geometry between males and females. One hundred male skeletons and 100 female skeletons were evaluated. Three indices of notch geometry were calculated from digital photographs of the distal femur: notch width index, notch area index, and notch shape index. Notch shape index for males exceeded that for females (P

Background Health care is being changed dramatically by the marriage of computers and telecommunications. Implications for hospitals and physicians already have received extensive media attention, but comparatively little has been said about the impact of information technology on dentistry. This article illustrates how the digital transformation will likely affect dentists and their patients. Conclusions Based on recent experiences of hospitals and medical practices, dentists can expect to encounter revolutionary changes as a result of the digital transformation. The Internet, the World Wide Web and other developments of the information revolution will redefine patient care, referral relationships, practice management, quality, professional organizations and competition. Practice Implications To respond proactively to the digital transformation of oral health care, dentists must become familiar with its technologies and concepts. They must learn what new information technology can do for them and their patients and then develop creative applications that promote the profession and their approaches to care.

Three soccer header types (shooting, clearing and passing) and two heading approaches (standing and jumping) were manipulated to quantify impact forces and neck muscle activity in elite female soccer players. The 15 participants were Division I intercollegiate soccer players. Impact forces were measured by a 15-sensor pressure array secured on the forehead. The electromyographic (EMG) activity of the left and right sternocleidomastoid and trapezius muscles was recorded using surface electrodes. Maximum impact forces and impulses as well as the EMG data were analysed with separate repeated-measures analyses of variance. Impact forces and impulses did not differ among the header types or approaches. Higher values were found for jumping versus standing headers in the mean normalized EMG for the right sternocleidomastoid. In addition, the integrated EMG was greater for the right sternocleidomastoid and right and left trapezius (P < 0.05). The sternocleidomastoid became active earlier than the trapezius and showed greater activity before ball contact. The trapezius became active just before ball contact and showed greater activity after ball contact. The increased muscle activity observed in the neck during the jumping approach appears to stabilize the connection between the head and body, thereby increasing the stability of the head-neck complex.

Lower back discomfort is common among users of standard vertical stair-climbing machines. A partially reclined stair-climbing machine (PRSC) has been designed to provide more comfort and protection to the lower back while providing the same exercise benefits. Ten individuals were recruited to exercise on both machines while their erector spinae electromyographic activity and heart rates were recorded. There was no significant difference (p <.05) in erector spinae muscle activity during exercise on either machine. Workout intensity levels necessary to achieve target heart rates were established during a familiarization session and tracked during exercise. The mean heart rates for both groups remained within the target zones throughout the exercise sessions, but a nonsignificant (p >.05) trend toward increased heart rate on both machines was observed in the women participants. Because of the high incidence of low back pain and injury, we need exercise modalities that provide both cardiovascular and muscular fitness development without placing additional stress on this region.

This study investigated the applicability of using surface electromyography (EMG) as a tool for differentiating between persons suffering from lateral tennis elbow and the healthy age-matched adults. Temporal muscle activation patterns of the tennis elbow group were evaluated to determine if they varied between subject groups and if noted variations might be interpreted as arresting or exacerbating the injury. Sixteen subjects (Healthy Controls, n = 6; Tennis Elbow, n = 10) were tested under simulated tennis playing conditions. All subjects were males (Healthy group (CON) 38.8 +/- 13.1, Injured group (INJ) 40.8 +/- 10.8 yrs). EMG response data, temporal and spatial muscle activities, of the forearm extensors (Ext), the forearm flexors (Flex) and the triceps (Tri) were recorded for each subject during a single test session using all combinations of three different velocities on three different racket head impact locations. Data were collected at a frequency of 1000 Hz. Statistical analysis was performed using a 2 x 3 x 3 (Health status x Impact velocity x Impact location) ANOVA with repeated measures. Results indicated statistically significant differences (p0.05) between the CON and INJ subject groups for the response variables associated with forearm extensor muscle activation. During simulated play, the INJ group employed an earlier, longer, and greater activation of Ext than the CON group, such changes may be considered detrimental to the healing process. These results support the use of surface EMG to quantify differences in muscle activation strategies employed by individuals suffering from soft tissue muscle microtrauma injuries and healthy controls.

Few health professionals need to stay up-to-date on as many different problems and solutions as risk managers do. Consequently, a single solution that resolves several problems at once is really helpful for job performance, especially when it doesn't require duplicating effort in multiple areas. This article summarizes current literature about one such technology that helps risk managers address 3 of today's biggest challenges for healthcare delivery organizations: reducing costs, improving quality, and preventing harm across the continuum of clinical care; ensuring valid and reliable data for healthcare clinical and managerial decision makers; and adopting technologies that improve the medical marketplace.

The purpose of this study was to determine whether compression shorts affected vertical jump performance. Subjects, 18 men and 18 women varsity volleyball players, were thoroughly familiarized with the jump tests and experimental techniques. Testing utilized compression shorts of normal fit (CS), undersized compression shorts (UCS), and loose fitting gym shorts as the control garment (CT). All tests were conducted on the same day using a balanced, randomized block design to remove day-to-day variation. Jumps were performed on an AMTI force plate interfaced to a computer with customized software to determine jump force and power. Ten consecutive maximal countermovement jumps with hands held at waist level were evaluated. The garments had no effect on maximal force or power of the highest jump. However, mean force and power production over the 10 jumps when wearing the CS were significantly (p

The purpose of this study was to provide an in-depth sports medicine profile of women college tennis players and determine the relationships among an array of performance and clinical variables. Thirty-eight non-resistance-trained women from NCAA Divisions I and III collegiate tennis teams participated. A comprehensive battery of performance tests was conducted on each subject, including measurements of dynamic, isometric, and isokinetic strength; joint laxity and flexibility; speed; agility; power and power endurance; peak oxygen consumption; body composition; and ball velocities of the serve, forehand, and backhand. It was found that no single variable strongly explains tennis performance. The low amount of shared variance of strength measures with ball velocities suggests that tennis skills play a large role in producing peak ball velocities in this group. Due to the large range observed in profiled variables, individual evaluation is needed for clinical and conditioning recommendations.

Forty-seven samples of the Bromide Formation (Simpson Group) of south-central Oklahoma produced a collection of 10,216 conodonts assigned to 46 species. The conodont fauna is dominated by species ofPhragmodusandPlectodinaand indicates a latest Whiterockian to early Mohawkian (Black Riveran) or late Llandeilian to early Caradocian age. Five new species are named includingAnsella crassa, Bryantodina aequalis, Plectodina edentula, Walliserodus declivis, andPharagmodus ambiguus.The latter species is distinct fromPhragmodus flexuosusMoskalenko, a species to which it has been assigned in past reports.Analysis of conodont distribution with respect to the shallow-water Bromide lithofacies distinguishes shallow to deeper water conodont associations. Samples from shallower water facies containAnsella crassan. sp.,Cahabagnathus sweeti(Bergström),Curtognathusspp.,Eoplacognathus elongatus(Bergström),Erismodus typusBranson and Mehl,Oneotodus?ovatus(Stauffer),Phragmodus ambiguusn. sp.,Phragmodus flexuosus, andStaufferella falcata(Stauffer). Samples from deeper water facies contain forms such asAnsella nevadensis(Ethington and Schumacher) andBaltoniodus gerdae(Bergström).

Two X-29A aircraft were flown at the NASA Dryden Flight Research Facility over a period of eight years. The airplanes' unique features are the forward-swept wing, variable incidence close-coupled canard and highly relaxed longitudinal static stability (up to 35% negative static margin at subsonic conditions). This paper describes the primary flight control system and significant modifications made to this system, flight test techniques used during envelope expansion, and results for the low and high angle-of-attack programmes. Throughout the paper, lessons learned will be discussed to illustrate the problems associated with the implementation of complex flight control systems.

The fibronectin receptor, alpha 5 beta 1, has been shown to be required for fibronectin matrix assembly and plays an important role in cell migration on fibronectin. However, it is not clear whether other fibronectin binding integrins can take the place of alpha 5 beta 1 during matrix assembly and cell migration. To test this, we expressed the human alpha v subunit in the CHO cell line CHO-B2 that lacks the alpha 5 subunit. We found that the human alpha v combined with CHO cell beta 1 to form the integrin alpha v beta 1. Cells that expressed alpha v beta 1 attached to and spread well on fibronectin-coated dishes, but did so less well on vitronectin-coated dishes. This, along with other data, indicated that alpha v beta 1 functions as a fibronectin receptor in CHO-B2 cells. The alpha v beta 1-expressing cells failed to produce a fibronectin matrix or to migrate on fibronectin, although the same cells transfected with alpha 5 do produce a matrix and migrate on fibronectin. The affinity of the alpha v beta 1-expressing cells for fibronectin was fourfold lower than that of the alpha 5 beta 1-expressing cells. In addition, alpha v beta 1 was distributed diffusely throughout the cell surface, whereas alpha 5 beta 1 was localized to focal adhesions when cells were seeded onto fibronectin-coated surfaces. Thus, of the two fibronectin receptors, alpha v beta 1 and alpha 5 beta 1, only alpha 5 beta 1 supports fibronectin matrix assembly and promotes cell migration on fibronectin in the CHO-B2 cells. Possible reasons for this difference in the activities of alpha v beta 1 and alpha 5 beta 1 include the lower affinity of alpha v beta 1 for fibronectin and the failure of this integrin to localize in adhesion plaques on a fibronectin substrate. These results show that two integrins with similar ligand specificities and cell attachment functions may be quite different in their ability to support fibronectin matrix assembly and cell motility on fibronectin.

Self-imposed cost containment is not part of providers' heritage. The payer business model and its problems are complicated; simplistic reforms won't help. Health reform needs to be refocused on policies that allow providers and payers to align their cultures so that all parties benefit from potential synergies to provide top-quality care as inexpensively as possible.

People look to medical tourism to save money and to get treatments that are not approved or that are not available at home due to political prohibitions. Medical tourism will be affected by the global economic downturn, concern about lower quality of care, and political instability. The international marketplace could be rewarding to American providers, payers, vendors, and other healthcare stakeholders that can efficiently and effectively respond to the current crisis.

Healthcare leaders need to reform the way health care is produced more than the way it is reimbursed. Reform efforts should be directed toward improving performance of the healthcare delivery system. A promising approach to reform would be to impose a formal performance improvement process as a criterion for provider accreditation.