Improving Asthma Care Documentation with a Digital Tool-Experience in a Pediatric Institution.

BACKGROUND: Asthma affects approximately 10% of Australian children. Electronic medical record (EMR) systems and clinical decision support initiatives have been shown to improve the delivery of asthma care. Our institution implemented an EMR-based asthma "hub," which collates asthma-related information to a central location within a patient's record, provides a template to collect relevant clinical information, allows clinicians to evaluate a patient's history and presentation in a systematic manner and prompts relevant actions. OBJECTIVE: The aim of the study is to measure year-on-year improvement in asthma-related documentation and provide a key gold-standard aspects of asthma management after the introduction of an EMR asthma "hub" tool in the outpatient setting. METHODS: The asthma "hub" was introduced in November 2020. A chart review was conducted of all patients who attended the Complex Asthma Clinic between January-April 2020 and January-April 2021. The provision and presence of documentation of core aspects of asthma care were described in percentages and comparisons of pre- and post-introduction of the asthma "hub" were assessed. RESULTS: There was a significant increase in the documentation of asthma triggers, including smoking/smoker exposure, (47.5-92.6%, p <0.001), current asthma action plans (70.4-86.3%, p = 0.02), and severity scores (46.3-81%, p <0.001) post the introduction of the asthma "hub." There was no significant difference in documentation of reliever (as required) or regular preventer medications. CONCLUSION: An evidence-based EMR intervention improved the documentation and provision of aspects of asthma care in an outpatient clinic setting at a tertiary pediatric hospital, suggesting replication in the inpatient and emergency settings would be worthwhile. Further research is required to understand the tool's impact on clinical outcomes and on clinical efficiency and workflow.

Roadmap on emerging hardware and technology for machine learning.

Recent progress in artificial intelligence is largely attributed to the rapid development of machine learning, especially in the algorithm and neural network models. However, it is the performance of the hardware, in particular the energy efficiency of a computing system that sets the fundamental limit of the capability of machine learning. Data-centric computing requires a revolution in hardware systems, since traditional digital computers based on transistors and the von Neumann architecture were not purposely designed for neuromorphic computing. A hardware platform based on emerging devices and new architecture is the hope for future computing with dramatically improved throughput and energy efficiency. Building such a system, nevertheless, faces a number of challenges, ranging from materials selection, device optimization, circuit fabrication and system integration, to name a few. The aim of this Roadmap is to present a snapshot of emerging hardware technologies that are potentially beneficial for machine learning, providing the Nanotechnology readers with a perspective of challenges and opportunities in this burgeoning field.

Impact of an integrated electronic handover tool on pediatric junior medical staff (JMS) handover.

BACKGROUND: Clinical medical handover between doctors forms a critical part of the patient care process. However, with the evolution of junior medical staff (JMS) working conditions, time pressure and increasing clinical and administrative loads mean that quality clinical handover is increasingly important yet more challenging to achieve. This study evaluated the impact of a newly integrated electronic handover tool on JMS adoption and usage of the tool, as well as impacts on the quality (accuracy and redundancy) of handover data, JMS perceived workflow (time management and communication) and JMS satisfaction. FINDINGS: The majority of JMS surveyed used the tool at 1 (87.0%) and 3 (67.4%) months post implementation. After the introduction of the electronic handover tool, 67.5% of users spent less than 15min updating handover data in the electronic handover tool, compared to just 6.7% prior to the introduction. 28.3% of respondents noted that there was >25% redundant data, compared to more than half (52.2%) prior to introduction of the electronic tool. Overall JMS satisfaction with their handover process was significantly higher post implementation of the integrated electronic handover report (17.4% pre, 80.4% at 1 month, 67.4% at 3 months). CONCLUSION: A newly introduced integrated electronic medical record handover tool had a high uptake amongst JMS, and resulted in improvement in perceived handover efficiency, a reduction in redundant data entry and improved JMS handover satisfaction.

Assessing fabrication tolerances for a multilevel 2D binary grating for 3D multifocus microscopy.

We perform a comprehensive theoretical assessment of fabrication tolerances for a 2D eight-level binary phase grating that is the central element of a multi-focal plane 3D microscopy apparatus. The fabrication process encompasses a sequence of aligned lithography and etching steps with stringent requirements on layer-to-layer overlay, etch depth and etched sidewall slope, which we show are nonetheless achievable with state-of-the-art optical lithography and etching tools. We also perform broadband spectroscopic diffraction pattern measurements on a fabricated grating, and show how such measurements can be valuable in determining small fabrication errors in diffractive optical elements.

Optical Fluorescence Microscopy for Spatially Characterizing Electron Transfer across a Solid-Liquid Interface on Heterogeneous Electrodes.

Heterogeneous catalytic materials and electrodes are used for (electro)chemical transformations, including those important for energy storage and utilization.1, 2 Due to the heterogeneous nature of these materials, activity measurements with sufficient spatial resolution are needed to obtain structure/activity correlations across the different surface features (exposed facets, step edges, lattice defects, grain boundaries, etc.). These measurements will help lead to an understanding of the underlying reaction mechanisms and enable engineering of more active materials. Because (electro)catalytic surfaces restructure with changing environments,1 it is important to perform measurements in operando. Sub-diffraction fluorescence microscopy is well suited for these requirements because it can operate in solution with resolution down to a few nm. We have applied sub-diffraction fluorescence microscopy to a thin cell containing an electrocatalyst and a solution containing the redox sensitive dye p-aminophenyl fluorescein to characterize reaction at the solid-liquid interface. Our chosen dye switches between a nonfluorescent reduced state and a one-electron oxidized bright state, a process that occurs at the electrode surface. This scheme is used to investigate the activity differences on the surface of polycrystalline Pt, in particular to differentiate reactivity at grain faces and grain boundaries. Ultimately, this method will be extended to study other dye systems and electrode materials.

High-Resolution Imaging and Spectroscopy at High Pressure: A Novel Liquid Cell for the Transmission Electron Microscope.

We demonstrate quantitative core-loss electron energy-loss spectroscopy of iron oxide nanoparticles and imaging resolution of Ag nanoparticles in liquid down to 0.24 nm, in both transmission and scanning transmission modes, in a novel, monolithic liquid cell developed for the transmission electron microscope (TEM). At typical SiN membrane thicknesses of 50 nm the liquid-layer thickness has a maximum change of only 30 nm for the entire TEM viewing area of 200×200 µm.

An introduction to evolutionary developmental psychology.

Evolutionary developmental psychology represents a synthesis of modern evolutionary theory and developmental psychology. Here we introduce the special issue on evolutionary developmental psychology by briefly discussing the history of this field and then summarizing the variety of topics that are covered. In this special issue, leading researchers provide a collection of theoretical and empirical articles that highlight recent findings and propose promising areas for future research.

Understanding the mind from an evolutionary perspective: an overview of evolutionary psychology.

UNLABELLED: The theory of evolution by natural selection provides the only scientific explanation for the existence of complex adaptations. The design features of the brain, like any organ, are the result of selection pressures operating over deep time. Evolutionary psychology posits that the human brain comprises a multitude of evolved psychological mechanisms, adaptations to specific and recurrent problems of survival and reproduction faced over human evolutionary history. Although some mistakenly view evolutionary psychology as promoting genetic determinism, evolutionary psychologists appreciate and emphasize the interactions between genes and environments. This approach to psychology has led to a richer understanding of a variety of psychological phenomena, and has provided a powerful foundation for generating novel hypotheses. Critics argue that evolutionary psychologists resort to storytelling, but as with any branch of science, empirical testing is a vital component of the field, with hypotheses standing or falling with the weight of the evidence. Evolutionary psychology is uniquely suited to provide a unifying theoretical framework for the disparate subdisciplines of psychology. An evolutionary perspective has provided insights into several subdisciplines of psychology, while simultaneously demonstrating the arbitrary nature of dividing psychological science into such subdisciplines. Evolutionary psychologists have amassed a substantial empirical and theoretical literature, but as a relatively new approach to psychology, many questions remain, with several promising directions for future research. For further resources related to this article, please visit the WIREs website. CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article.

Setting up an alcohol treatment centre.

In the emergency unit at University Hospital of Wales (UHW), Cardiff, a rise in the number of patients presenting with alcohol intoxication was reducing the amount of clinical space available to, and affecting the care of, other patients. In response, an alcohol treatment centre (ATC) staffed by emergency nurse practitioners, healthcare assistants and police officers was set up and piloted for three months in the city centre to ensure that people who were severely intoxicated could be managed safely without attending the emergency unit at UHW. This article describes the collaborative approach adopted to launch the three-month pilot project and discusses findings from a review of the ATC conducted when the pilot had ended. These findings indicate that severely intoxicated patients at low or moderate risk had been diverted from the emergency unit to the ATC and that clinical care in the unit, and police and ambulance services, had improved as a result.

Individual differences in women's rape avoidance behaviors.

Rape can exact severe psychological, physical, and reproductive costs on women, and likely was a recurrent adaptive problem over human evolutionary history. Therefore, women may have evolved psychological mechanisms that motivate rape avoidance behaviors. Guided heuristically by an evolutionary perspective, we tested the hypothesis that women's rape avoidance behaviors would vary with several individual difference variables. Specifically, we predicted that rape avoidance behaviors would covary positively with (1) women's attractiveness, (2) women's involvement in a committed romantic relationship, and (3) the number of family members living nearby. We also predicted that women's rape avoidance behaviors would covary negatively with age. We administered the Rape Avoidance Inventory (McKibbin et al., Pers Indiv Differ 39:336-340, 2009) and a demographic survey to a sample of women (n = 144). The results of correlational and regression analyses were consistent with the predictions, with the exception that women's rape avoidance behaviors did not covary with women's age. Discussion highlighted limitations of the current research and directions for future research on women's rape avoidance psychology and behaviors.

Understanding suicide terrorism: premature dismissal of the religious-belief hypothesis.

We comment on work by Ginges, Hansen, and Norenzayan (2009), in which they compare two hypotheses for predicting individual support for suicide terrorism: the religious-belief hypothesis and the coalitional-commitment hypothesis. Although we appreciate the evidence provided in support of the coalitional-commitment hypothesis, we argue that their method of testing the religious-belief hypothesis is conceptually flawed, thus calling into question their conclusion that the religious-belief hypothesis has been disconfirmed. In addition to critiquing the methodology implemented by Ginges et al., we provide suggestions on how the religious-belief hypothesis may be properly tested. It is possible that the premature and unwarranted conclusions reached by Ginges et al. may deter researchers from examining the effect of specific religious beliefs on support for terrorism, and we hope that our comments can mitigate this possibility.