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Hyperpolarized (HP) 13C MRI has shown promise as a valuable modality for in vivo measurements of metabolism and is currently in human trials at 15 research sites worldwide. With this growth, it is important to adopt standardized data storage practices as it will allow sites to meaningfully compare data. In this paper, we (1) describe data that we believe should be stored and (2) demonstrate pipelines and methods that utilize the Digital Imaging and Communications in Medicine (DICOM) standard. This includes proposing a set of minimum set of information that is specific to HP 13C MRI studies. We then show where the majority of these can be fit into existing DICOM attributes, primarily via the "Contrast/Bolus" module. We also demonstrate pipelines for utilizing DICOM for HP 13C MRI. DICOM is the most common standard for clinical medical image storage and provides the flexibility to accommodate the unique aspects of HP 13C MRI, including the HP agent information but also spectroscopic and metabolite dimensions. The pipelines shown include creating DICOM objects for studies on human and animal imaging systems with various pulse sequences. We also show a python-based method to efficiently modify DICOM objects to incorporate the unique HP 13C MRI information that is not captured by existing pipelines. Moreover, we propose best practices for HP 13C MRI data storage that will support future multi-site trials, research studies, and technical developments of this imaging technique.

Background: Chronic pain is highly prevalent in US military Veterans, and pain interdisciplinary teams (IDTs) are the gold standard in pain care. There is no standard or guidance for how best to develop and implement pain interdisciplinary teams within complex health care systems. Objectives: The purpose of this quality improvement project was to evaluate the effectiveness of the standard 9-step Lean 6 Sigma (LSS) methodology in redesigning a pre-existing VA outpatient pain clinic solely offering interventional pain services into an efficient, sustainable pain IDT program. Methods: The initial evaluation process at a VA Medical Center that primarily serves rural Veterans was redesigned with the a priori goal of developing an efficient, sustainable IDT program that decreased driving days (ie, in-person appointments) required for a comprehensive initial pain evaluation, decreased number of consults required for initial pain evaluations, increased the number of consults to Whole Health services, and increased compliance with policies and standards. Feedback from administrators, clinicians, and Veterans was used to identify inefficiencies then iteratively design, test, and finalize a redesigned service called the PREVAIL Interdisciplinary Team Track (PREVAIL IDT Track). Baseline data was collected for 1 year followed by sustainment data for 14 months. Results were analyzed using descriptive statistics. Results: PREVAIL IDT Track decreased the number of in-person appointments from 5 to 2, decreased consults required for evaluations from 5 to 1, increased the number of unique consults to Whole Health education classes, and made the VA fully compliant with policies and standards. To date, 486 Veterans have participated in the redesigned program, including 167 graduates and 212 current enrollees in this sustained clinical program. Conclusion: The success of PREVAIL IDT Track suggests that LSS may be a promising method for redesigning sustainable pain IDTs in VA that improve efficiency. [ABSTRACT FROM AUTHOR]

ABSTRACT Mental health service integration currently has no consensus definition and exists in a variety of settings, including primary care, addiction treatment and chronic disease management, and mental health nurses have often experienced efforts at service integration with varying degrees of success. The intent of mental health service integration is to enable collaboration between mental health services and other healthcare providers to improve service access and the care provided to individuals with mental health issues or mental illness. This scoping review aimed to explore service integration between mental health services and with a specific focus on those evaluated in peer‐reviewed, primary literature, to determine facilitators and barriers to service integration. Using the Arksey and O'Malley's framework for scoping reviews, we located 3148 studies, with screening narrowing final papers for inclusion to 18. Facilitators to service integration included clinician education, adequate resourcing and an interdisciplinary approach, while barriers included staff factors such as a reluctance to work with individuals with mental illness, consumer level barriers such as poor mental health literacy, ‘territorialism’ among staff and organisational climate. Research indicates that service integration is an effective means to detect and treat mental health issues in settings that do not traditionally provide mental health care, lowering the costs of providing healthcare and providing improved care for mental health needs; however, there are several barriers to be addressed to achieve full implementation of integration models. [ABSTRACT FROM AUTHOR]

Background: Our institution implemented acute-care obstetric (OB) telemedicine (TeleOB) to address rural disparities across our health system. We sought to determine whether in situ simulations with embedded TeleOB consultation increase participants' comfort managing OB emergencies and comfort with and likelihood of using TeleOB. Methods: Rural site care teams participated in multidisciplinary in situ OB emergency simulations. Physicians in OB and neonatology at the referral center assisted via telemedicine consultation. Participants were surveyed before and after the simulations and six months later regarding their experience during the simulations. Results: Participants reported increased comfort with TeleOB activation, indications, and workflow processes, as well as increased comfort managing OB emergencies. Participants also reported significantly increased likelihood of using TeleOB in the future. Conclusions: Consistent with previous work, in situ simulation with embedded telemedicine consultations is an effective approach to facilitate telemedicine implementation and promote use by rural clinicians. [ABSTRACT FROM AUTHOR]

Copyright of Arab Journal for Scientific Publishing is the property of Research & Development of Human Recourses Center (REMAH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Teaching introductory anatomy and physiology (A&P) requires a careful balance of conveying core content while at the same time fostering a deep interest in the subject matter. This is especially true in the laboratory where students are expected to not only master experimental procedures but also connect what they learn in the laboratory to course content. Traditional laboratory courses often have students follow "cookbook" style procedures. While these lab activities expose students to specific techniques or equipment, they are often at the expense of a deeper understanding of the content. The core concepts of physiology were developed to allow students to engage with course content in ways that build an integrated, conceptual understanding applicable to multiple physiological topics. In this article we describe the redesign of an undergraduate A&P laboratory course structured around three core concepts: scientific reasoning, structure/function, and systems integration. These concepts provide a framework whereby students can more effectively transfer concepts from one system to another. The course was redesigned into a "flipped" format in which students are first exposed to content prior to lab and laboratory activities were restructured to be inquiry- and problem-based. The goal of these curricular changes was to shift the focus from mastery of technical skills and declarative knowledge towards fostering critical thinking and clinical reasoning skills. An approach to the laboratory that includes the interrelated functional importance of systems and structures can create an engaging class atmosphere and deepen student's interest in the complex world of physiologic function. [ABSTRACT FROM AUTHOR]

The article discusses emerging technologies in information systems project management. Project management is a modern discipline that began to take shape from 1900 and has evolved and adapted to the needs of society and business. Emerging technologies such as artificial intelligence, blockchain, augmented and virtual reality, and process automation are transforming the way information systems projects are managed. These technologies can be used to analyze large amounts of data, ensure data integrity and security, visualize a project's design and perform virtual testing, and automate tasks to reduce project time and cost. It is important for companies to be aware of these technologies and use them effectively to improve the efficiency and profitability of their projects. [ABSTRACT FROM AUTHOR]

This article deals with project management in information systems, whose relevance lies in the vital importance of these systems in modern companies. Information systems are essential for decision making and data management in today's interconnected world. Project management, on the other hand, coordinates elements such as scope, resources, costs, schedules and risks to achieve defined objectives. The systems development life cycle (SDLC) structures the process, encompassing phases such as scope definition, planning, execution, monitoring and closure. These phases are integrated with risk management, which identifies, evaluates and mitigates threats and opportunities. Mitigation strategies act before adversity, while contingency planning prepares for the unforeseen. That is why risk management is integrated throughout the project life cycle to anticipate and address challenges. The combination of both aspects is critical in a constantly evolving technology environment. In addition, organizational culture and communication play a critical role. A culture of awareness and accountability, transparency in communication and active stakeholder participation are essential. Training and continuous adaptation allow learning from past experiences and improving practices. [ABSTRACT FROM AUTHOR]

The Gateway Program must meet NASA's Agency‐level human rating requirements, which are intended to accommodate human capabilities and limitations while protecting the safety of the crew, and providing to the maximum extent practical, the capability to safely recover the crew from hazardous situations. Human systems integration represents a key human rating component of Moon to Mars systems to support the execution of Artemis missions, including compliance with mandatory standards for Health and Medical, Safety and Mission Assurance, and Engineering. The human system requirements, together with the human systems integration plan, medical operations requirements, and Gateway subsystem specifications, represent the flow‐down of NASA Health and Medical Standards (NASA‐STD‐3001, Volumes 1 and 2) into the Gateway system. This paper discusses how these documents and other human systems integration activities provide full consideration of human capabilities and limitations as part of the total system design trade space, serving as an example on how the human must be effectively integrated as part of the system in order to achieve mission success. At a bigger scale, the paper contributes to the application of systems engineering standards to cutting‐edge space exploration initiatives and to the dialogue on how systems engineering can continue to evolve to meet the needs of such ambitious projects. [ABSTRACT FROM AUTHOR]

BackgroundGlobal health systems are confronting challenges that intersect climate change with evolving communicable and non-communicable public health risks. Addressing these challenges requires systems integration via citizen big data that exist outside health systems. However, systems integration across jurisdictions is a complex challenge that requires stakeholder input. This study’s purpose was to conduct rapid systems mapping with international health system stakeholders to inform the development and implementation of a global digital citizen science observatory (DiScO), which aims to catalyze digital transformation of health systems across jurisdictions.MethodsA rapid qualitative systems mapping study was conducted during the International Society for Behavioral Nutrition and Physical Activity Annual Global Summit in Uppsala, Sweden, in June 2023. The choice of the venue and approach was informed by three key criteria: (1) Established evidence linking physical activity and nutrition with non-communicable diseases; (2) Concrete existing methods of obtaining citizen big data by physical activity and nutrition researchers; (3) Precedence of physical activity and nutrition researchers conducting citizen science as well behavioral/clinical big data collection. The design of this study was an innovative pre-post systems map development, which consisted of (1) real-time rapid systems mapping (pre/initial map) by engaging with international stakeholders and (2) adjustment of the real-time systems map (post/final map) after analyzing stakeholder discussion data.ResultsRapid systems mapping resulted in a complex network that included key themes to successfully develop and implement DiScO: priorities, opportunities, risks, challenges, partnerships, and resources. Additionally, a new theme emerged organically through stakeholder group discussions – mitigation strategies. The adapted rapid systems map (i.e., after data analyses) depicts 23 key nodes of intervention across the seven key themes.ConclusionRapid systems mapping at international symposia is a novel methodological approach to capture stakeholder input, particularly to understand complexity across international jurisdictions – an approach that can be replicated across disciplines and sectors to inform digital transformation of health systems. The development and implementation of DiScO, a platform for decentralization and democratization of technology, will take into consideration all the key nodes of intervention identified in the rapid systems map to promote digital health for equity across global jurisdictions.

The convergence of information technology (IT) with operational technology (OT), within physical assets can enhance performance but also presents challenges due to higher performance expectations and increased complexity. This study reviews the research that has been conducted to address these convergence and integration challenges by using an in-depth review of academic papers, industry standards, and reports published during the last three decades. Our investigation reveals that about a third of the existing IT/OT research really focuses on the convergence of IT/OT, by including organizational aspects into the study. Three key research domains were identified: maintenance, cybersecurity, and configuration management. The introduction of IT in assets has necessitated changes in maintenance practices, as current approaches are not suitable for these converged lifecycles. Cybersecurity risks have received the most attention in the IT/OT domain. The integration requires the management of these changes; therefore, configuration management has become more crucial than it already is to keep of actual configuration of both the IT and the OT parts of the asset. This research hereby provides relevant observations for practitioners in industry and academics in the IT and the physical asset management domain. The identified gaps suggest the need for tools and methods to better align IT and OT standards, policies, tools, processes, and people throughout the lifecycle of an IT/OT converged physical asset in a sustainable way.

Abstract Background During the COVID-19 response in Norway, many municipalities used the Fiks contact tracing tool (FiksCT) to register positive individuals and follow-up contacts. This tool is based on DHIS2, an open source, web-based platform. In this study we examined if data completeness in FiksCT improved after integration with national registers between May 2020 and September 2021. Methods Data from municipalities using FiksCT was extracted from the Norwegian Emergency Preparedness Register for COVID-19 (Beredt C19). We linked FiksCT data to the Norwegian Surveillance System for Communicable Diseases (MSIS), the National Population Register (FREG), and the Norwegian Vaccine Registry (SYSVAK) using unique identification numbers (ID). Completeness for each variable linked with a national register was calculated before and after integration with these registers. Results Of the 125 municipalities using FiksCT, 87 (69.6%) agreed to share and upload their data to Beredt C19. Data completeness for positive individuals improved after integration with national registers. After integration with FREG, the proportion of missing values decreased from 12.5 to 1.6% for ID, from 4.5 to 0.9% for sex, and from 1.2 to 0.4% for date of birth. Missing values for vaccine type decreased from 63.0 to 15.2% and 39.3–36.7% for first and second dose, respectively. In addition, direct reporting from FiksCT to MSIS increased the proportion of complete records in MSIS (on the selected variables) from 68.6% before to 77.0% after integration. Conclusion The completeness of local contact tracing data can be improved by enabling integration with established national registers. In addition, providing the option to submit local data to the national registers could ease workload and reduce the need to collect duplicate data.

Radiology departments face challenges in delivering timely and accurate imaging reports, especially in high-volume, subspecialized settings. In this retrospective cohort study at a tertiary cancer center, we assessed the efficacy of an Automatic Assignment System (AAS) in improving radiology workflow efficiency by analyzing 232,022 CT examinations over a 12-month period post-implementation and compared it to a historical control period. The AAS was integrated with the hospital-wide scheduling system and set up to automatically prioritize and distribute unreported CT examinations to available radiologists based on upcoming patient appointments, coupled with an email notification system. Following this AAS implementation, despite a 9% rise in CT volume, coupled with a concurrent 8% increase in the number of available radiologists, the mean daily urgent radiology report requests (URR) significantly decreased by 60% (25 ± 12 to 10 ± 5, t = -17.6, p < 0.001), and URR during peak days (95th quantile) was reduced by 52.2% from 46 to 22 requests. Additionally, the mean turnaround time (TAT) for reporting was significantly reduced by 440 min for patients without immediate appointments and by 86 min for those with same-day appointments. Lastly, patient waiting time sampled in one of the outpatient clinics was not negatively affected. These results demonstrate that AAS can substantially decrease workflow interruptions and improve reporting efficiency. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 response in Norway, many municipalities used the Fiks contact tracing tool (FiksCT) to register positive individuals and follow-up contacts. This tool is based on DHIS2, an open source, web-based platform. In this study we examined if data completeness in FiksCT improved after integration with national registers between May 2020 and September 2021. Methods: Data from municipalities using FiksCT was extracted from the Norwegian Emergency Preparedness Register for COVID-19 (Beredt C19). We linked FiksCT data to the Norwegian Surveillance System for Communicable Diseases (MSIS), the National Population Register (FREG), and the Norwegian Vaccine Registry (SYSVAK) using unique identification numbers (ID). Completeness for each variable linked with a national register was calculated before and after integration with these registers. Results: Of the 125 municipalities using FiksCT, 87 (69.6%) agreed to share and upload their data to Beredt C19. Data completeness for positive individuals improved after integration with national registers. After integration with FREG, the proportion of missing values decreased from 12.5 to 1.6% for ID, from 4.5 to 0.9% for sex, and from 1.2 to 0.4% for date of birth. Missing values for vaccine type decreased from 63.0 to 15.2% and 39.3–36.7% for first and second dose, respectively. In addition, direct reporting from FiksCT to MSIS increased the proportion of complete records in MSIS (on the selected variables) from 68.6% before to 77.0% after integration. Conclusion: The completeness of local contact tracing data can be improved by enabling integration with established national registers. In addition, providing the option to submit local data to the national registers could ease workload and reduce the need to collect duplicate data. [ABSTRACT FROM AUTHOR]

In today's volatile, uncertain, and complex business environments, manufacturing companies must not only adapt to market demands but also minimize the time between problem occurrence and resolution. The implementation of lean manufacturing systems has been crucial in this regard. However, traditional approaches have shown notable inefficiencies that can be effectively addressed through digitalization. By embracing digital solutions, manufacturing companies can ensure efficient continuous improvement, driving performance to higher levels. This study aims to find a digital solution for a specific company that faces daily challenges associated with low visibility into production. An investigation revealed that the Lean tools used by the company were outdated, directly affecting the generated information and consequently, decision-making. The integration of a Manufacturing Execution System into the factory's dynamics was the solution found. In this context, a step-by-step methodology is proposed to guide the implementation. As a result, a prototype of the system was designed. The validation of the system by end-users demonstrates the success of the proposed methodology. [ABSTRACT FROM AUTHOR]

Abstract Smart cities driven by modern technologies are the need of the day to alleviate the urbanisation challenges and improve the overall experience of the citizens. As the role of data‐sharing to facilitate systems integration across city sectors for developing smart cities has grown ever so profoundly, there is a need for decentralisation, transparency, and openness in terms of integration of city sectors to have efficient data diffusion among them. This is extremely important as the requirements of smart sustainable cities are open data sharing to allow service providers to better serve the citizens. Blockchain technology offers these characteristics with the extremely important added advantage of maintaining data security via an immutable record. However, the notion of the use of Blockchain for smart sustainable cities is still in the early years and requires extensive efforts to research and test it. In this research, a state‐of‐the‐art review is conducted to explore the usefulness of Blockchain technology in smart sustainable city development with a specific focus on cross‐sectoral systems integration, highlighting the gaps in the existing body of knowledge. This leads to the proposal of a novel framework for the use of Blockchain for smart sustainable cities, linking together service providers and citizens.

Background: In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran. Methods: A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis. Results: According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital. Conclusion: Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

The key hallmark of a digitally minded organisation today is seen in their rapid advancement, globalisation, innovation and resilience to change. Companies that wish to thrive must be prepared to adapt to the new digital reality. Being digitally minded does not mean implementing new technology, investing in tools and upgrading current systems. These stages are critical, but they are not the entire picture. If a company wants to remain competitive, it must not just be able to adapt to changes, but also anticipate and drive innovation. Companies must plan ahead and be proactive architects of their future in order to achieve this vision. This is where a digital transformation strategy is crucial. A digital transformation strategy assists organisational leadership in addressing challenges about their business, such as the present level of digitisation and a digital maturity roadmap. Although diverse data capturing technologies and data-generating assets exist, material/chemical science domains, such as R&D and Manufacturing groups, struggle to harness the full power of their data. A typical industry will have significant data sources generating large amounts of data stored in siloed databases with minimal to non-existent cross-talk. This in part creates scenarios for researchers to be able to perform a deep dive in one set of data, but unable to co-populate and harness the interdependences or relationships amongst the different datasets. This paper seeks to define, distinguish, aggregate and propose an integrative approach to utilising the various types of disparate data sources commonly encountered by researchers in the field of their material science research. The main focus here is defining strategies to harness insights across integrative data to aid in efficient research in R&D organisations as these industries seek to embrace the power of digital transformation. Although the principles described here relate to industries in the applied science domain, the general strategies proposed can be applied to other industries on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Climate change is already a reality, and it is affecting the lives and livelihoods of many people globally. Many scientists argue that adaptation is, therefore, necessary to address the impact of climate change on life-supporting systems. Climate change adaptation, however, is a complex process that involves transformations implemented through governance at multiple levels. In this paper, the barriers to climate change adaptation in South Africa are presented and analysed. Semi-structured, in-depth interviews were conducted telephonically and online via Microsoft Teams with 13 government officials working at the Department of Forestry, Fisheries, and the Environment; the KwaZulu-Natal Department of Economic Development and Environmental Affairs; and the uMkhanyakude District Municipality. The findings suggest that the barriers to climate change adaptation in South Africa include inadequate financial resources, a lack of human capacity at the provincial and local levels, limited political will at the local level, limited understanding of climate change adaptation issues by communities, inadequate coordination across government levels and sectors, no legal mandate at the local level, no climate change unit at the district and local levels, a lack of knowledge by some staff members tasked with environmental duties at the local level, not enough climate change plans in place at the local level, and outdated information on climate change used in the IDPs. This paper, therefore, recommends that climate change be a standing item in the Integrated Development Plan for local governments, which will ensure that climate change is budgeted for appropriately. In addition, this paper suggests that a mandate for climate change adaptation be developed for all three government levels. There is also a need for the government to invest in capacity development and improve horizontal and vertical coordination to strengthen the weak climate governance capacity that exists. [ABSTRACT FROM AUTHOR]

Copyright of Problems of Mechatronics. Armament, Aviation, Safety Engineering / Problemy Mechatroniki. Uzbrojenie, lotnictwo, Inżynieria Bezpieczeństwa is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Transformation has become a prevailing and desirable concept in blue economy literature. In parallel, researchers have been considering ways to effectively engage stakeholders to support just transformational agendas. Globally, coastal communities are already being affected by the inevitable impacts of climate change and changes to the blue economy. These pressures present complex contexts for coastal zone stakeholder engagement. In this paper, I argue that taking a systems integration approach to interacting with stakeholders is needed to support just transformational change. Assessing stakeholder systems and their relationship to coastal resources is imperative for understanding dynamics that may promote or hinder just transformation. Taking an adaptive management approach to working alongside stakeholders through transitional processes, thus building capacity, is needed to generate momentum toward just transformational change. Lastly, I explain how applications of the subsidiarity principle in integrating stakeholder systems can support a just transformational process and can inform more durable transformational outcomes. [ABSTRACT FROM AUTHOR]

Although machine learning (ML) has made significant improvements in radiology, few algorithms have been integrated into clinical radiology workflow. Complex radiology IT environments and Picture Archiving and Communication System (PACS) pose unique challenges in creating a practical ML schema. However, clinical integration and testing are critical to ensuring the safety and accuracy of ML algorithms. This study aims to propose, develop, and demonstrate a simple, efficient, and understandable hardware and software system for integrating ML models into the standard radiology workflow and PACS that can serve as a framework for testing ML algorithms. A Digital Imaging and Communications in Medicine/Graphics Processing Unit (DICOM/GPU) server and software pipeline was established at a metropolitan county hospital intranet to demonstrate clinical integration of ML algorithms in radiology. A clinical ML integration schema, agnostic to the hospital IT system and specific ML models/frameworks, was implemented and tested with a breast density classification algorithm and prospectively evaluated for time delays using 100 digital 2D mammograms. An open-source clinical ML integration schema was successfully implemented and demonstrated. This schema allows for simple uploading of custom ML models. With the proposed setup, the ML pipeline took an average of 26.52 s per second to process a batch of 100 studies. The most significant processing time delays were noted in model load and study stability times. The code is made available at " http://bit.ly/2Z121hX ". We demonstrated the feasibility to deploy and utilize ML models in radiology without disrupting existing radiology workflow.

ObjectiveWhile there has been a substantial increase in health information exchange, levels of outside records use by frontline providers are low. We assessed whether integration between outside data and local data results in increased viewing of outside records, overall and by encounter, provider, and patient type.Materials and methodsUsing data from UCSF Health, we measured change in outside record views after integrating the list of local (UCSF) and outside (other health systems on Epic [Epic Systems, Verona, WI]) encounters on the Chart Review tab. Previously, providers only viewed records from outside encounters on a separate tab. We used an interrupted time series design (with outside record viewing event counts aggregated to the week level) to measure changes in the level and trend over a 1-year period.ResultsThere was a large increase in the level of outside record views of 22 920 per week (P

An overview of an integrated approach to improve noncommunicable disease (NCD) management is presented, along with tools on integrating NCD management as part of health system strengthening in the Americas. The study is based on an analysis of Pan American Health Organization/World Health Organization (PAHO/WHO) data and publicly available information on NCD care and capacity, disruptions in NCD services, and guidance on NCD management. Gaps in NCD care are highlighted, in which an estimated 43.0% of men and 28.0% of women with hypertension in Latin America remain undiagnosed; and for those with diabetes, 32.8% in Central and South America are undiagnosed. Yet, only 17/35 countries (49%) in the Americas report having evidence-based national guidelines for NCD management through a primary care approach and only 7/35 countries (20%) report provision of drug therapy, including glycaemic control for eligible persons. To improve NCD management, an integrated approach is needed to coordinate and deliver care across the levels of the health system. This includes increasing primary care capacity and competencies to address multiple chronic conditions, and integration with other complementary programs to avoid missing opportunities for NCD diagnosis and management. An integrated approach to NCD management, and implementation of available tools, should be part of rebuilding health systems after the COVID-19 pandemic.

Background: In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran. Methods: A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis. Results: According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of nonteaching to teaching hospital. Conclusion: Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to determine the perceived barriers of different community stakeholders' to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0–3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE–PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed. [ABSTRACT FROM AUTHOR]

BackgroundThe rapid proliferation of electronic health records (EHRs) in clinics has had mixed impact on patient-centered communication, yet few evaluated interventions exist to train practicing providers in communication practices.AimsWe extended the evidence-based Physician Asthma Care Education (PACE) program with EHR-specific communication strategies, and tested whether training providers with the extended program (EHR-PACE) would improve provider and patient perceptions of provider communication skills and asthma outcomes of patients.MethodA pilot randomized design was used to compare EHR-PACE with usual care. Participants were providers ( n = 18) and their adult patients with persistent asthma ( n = 126). Outcomes were assessed at baseline and 3- and 6-month postintervention, including patient perception of their provider's communication skills and provider confidence in using EHRs during clinical encounters.ResultsCompared with the control group, providers who completed the EHR-PACE program reported significant improvements at 3-month follow-up in their confidence with asthma counseling practices (estimate 0.90, standard error [ SE] 0.4); p < .05) and EHR-specific communication practices (estimate 2.3, SE 0.8; p < .01), and at 6-month follow-up, a significant decrease in perception that the computer interferes with the patient-provider relationship (estimate -1.0, SE 0.3; p < .01). No significant changes were observed in patient asthma outcomes or their perception of their provider's communication skills.DiscussionTraining providers with skills to accommodate EHR use in the exam room increases provider confidence and their perceived skills in maintaining patient-centered communications in the short term.ConclusionEvidence-supported training initiatives that can increase capacity of busy providers to manage increased computing demands shows promise. More research is needed to fully evaluate EHR-PACE on patients' health status and their perceptions of their provider's care through a large-scale trial.

Integrative structure determination is a powerful approach to modeling the structures of biological systems based on data produced by multiple experimental and theoretical methods, with implications for our understanding of cellular biology and drug discovery. This Primer introduces the theory and methods of integrative approaches, emphasizing the kinds of data that can be effectively included in developing models and using the nuclear pore complex as an example to illustrate the practice and challenges involved. These guidelines are intended to aid the researcher in understanding and applying integrative structural methods to systems of their interest and thus take advantage of this rapidly evolving field.