Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia.

Background/Objective: Reticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. Methods: This is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). Results: Compared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. Conclusion: Our findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.

Impact of Program Components on Perceived Organizational Support in Respiratory Care Education.

BACKGROUND: Perceived organizational support has been linked to employee commitment and job satisfaction. Understanding the effects of perceived organizational support on employees allows leaders to improve employees' performance and the success of their organizations. The purpose of this study was to identify the perceived organizational support across different respiratory care education programs in the United States. METHODS: All chairs and program directors of bachelor's of science and master's of science degree respiratory care education programs in the United States were surveyed (N = 97). The Survey of Perceived Organizational Support was modified after written approval, and the final instrument included 31 items with a Likert scale (1 = strongly disagree, 7 = strongly agree). Descriptive statistics, multiple regression, and topic modeling were used for data analysis (P < .05). RESULTS: A total of 67 respondents responded to the perceived organizational support survey; a 69% response rate. They were satisfied with their job and committed to their institutions. They also reported that faculty salaries were equitable relative to the national average, and their institutions encouraged teamwork among faculty. The respondents' titles, total years of administrative experience, students' scores on the national credentialing therapist multiple choice examination (TMC), and institutions that offer both bachelor's of science and master's of science degree programs had a direct relationship with perceived organizational support in respiratory care education programs. Age and sex were inversely related to perceived organizational support. A topic modeling analysis based on the respondents' opinions about perceived organizational support showed that the respondents frequently mentioned the words support, institution, budget, year, nursing, and experience. The respondents emphasized the importance of support, institution marketing, their years of experience, and the program budget. They also mentioned that nursing programs overshadowed respiratory care education programs at their institutions. CONCLUSIONS: Age, sex, job title, years of administrative experience, students' TMC scores, and the type of programs offered impacted perceived organizational support by respiratory care directors. Student-, program- and participant-related factors can be used to improve perceived organizational support in respiratory care education.

Excellent predictive-performances of photonic reservoir computers for chaotic time-series using the fusion-prediction approach.

In this work, based on two parallel reservoir computers realized by the two polarization components of the optically pumped spin-VCSEL with double optical feedbacks, we propose the fusion-prediction scheme for the Mackey-Glass (MG) and Lorenz (LZ) chaotic time series. Here, the direct prediction and iterative prediction results are fused in a weighted average way. Compared with the direct-prediction errors, the fusion-prediction errors appear great decrease. Their values are far less than the values of the direct-prediction errors when the iteration step-size are no more than 15. By the optimization of the temporal interval and the sampling period, under the iteration step-size of 3, the fusion-prediction errors for the MG and LZ chaotic time-series can be reduced to 0.00178 and 0.004627, which become 8.1% of the corresponding direct-prediction error and 28.68% of one, respectively. Even though the iteration step-size reaches to 15, the fusion-prediction errors for the MG and LZ chaotic time-series can be reduced to 55.61% of the corresponding direct-prediction error and 77.28% of one, respectively. In addition, the fusion-prediction errors have strong robustness on the perturbations of the system parameters. Our studied results can potentially apply in the improvement of prediction accuracy for some complex nonlinear time series.

Optical cascaded reservoir computing for realization of dual-channel high-speed OTDM chaotic secure communication via four optically pumped VCSEL.

In this work, we propose a chaotic secure communication system with optical time division multiplexing (OTDM), using two cascaded reservoir computing systems based on multi beams of chaotic polarization components emitted by four optically pumped VCSELs. Here, each level of reservoir layer includes four parallel reservoirs, and each parallel reservoir contains two sub-reservoirs. When the reservoirs in the first-level reservoir layer are well trained and the training errors are far less than 0.1, each group of chaotic masking signals can be effectively separated. When the reservoirs in the second reservoir layer are effectively trained and the training errors are far less than 0.1, the output for each reservoir can be well synchronized with the corresponding original delay chaotic carrier-wave. Here, the synchronization quality between them can be characterized by the correlation coefficients of more than 0.97 in different parameter spaces of the system. Under these high-quality synchronization conditions, we further discuss the performances of dual-channel OTDM with a rate of 4×60 Gb/s. By observing the eye diagram, bit error rate and time-waveform of each decoded message in detail, we find that there is a large eye-openings in the eye diagrams, low bit error rate and higher quality time-waveform for each decoded message. Except that the bit error rate of one decoded message is lower than 7 × 10-3 in different parameter spaces, and those of the other decoded messages are close to 0, indicating that high-quality data transmissions are expected to be realized in the system. The research results show that the multi-cascaded reservoir computing systems based on multiple optically pumped VCSELs provide an effective method for the realization of multi-channel OTDM chaotic secure communications with high-speed.

A Framework for Performance Comparison among Major Electronic Health Record Systems.

While nearly all hospitals have adopted electronic health record (EHR) systems, some are dissatisfied and considering replacement systems to better address unique organizational needs and priorities. With more than 4,000 certified health information technology products available, comparing the vast number of EHR options is complex. This study tested the hypothesis that various EHR systems demonstrate different financial and quality performance and presented a framework for comparison. Using a subscribed database containing US hospitals' observations from 2011 to 2016, we estimated an ordinary least squares regression model with robust standard errors and clustered by year. We regressed the selected finance and quality measures as dependent variables with the vendors' indicators as independent variables, with control variables. This study demonstrated an approach for analyzing performance data to help hospitals distinguish EHR systems on the basis of several organizational outcomes: return on assets, bed utilization rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) summary star rating, and value-based purchasing Total Performance Score. This framework will help EHR acquisition teams make informed decisions.

Usability of Web-based Personal Health Records: An Analysis of Consumers' Perspectives.

Personal health records (PHRs) have many benefits, including the ability to increase involvement of patients in their care, which provides better healthcare outcomes. Although issues related to usability of PHRs are a significant barrier to adoption, there is a paucity of research in this area. Thus, the researchers explored consumers' perspective on the usability of two commercially available web-based PHRs. Data from the Usefulness, Satisfaction, and Ease of Use questionnaire were collected from a sample of health information management students (N = 90). A one-way analysis of variance (ANOVA) showed that Microsoft HealthVault had higher scores in most usability categories when compared to Health Companion. Study results indicated that PHR developers should evaluate Microsoft HealthVault as a model for improving PHR usability.

Organizational factors influencing health information technology adoption in long-term-care facilities.

Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

Funding alternatives in EHR adoption: beyond HITECH incentives and traditional approaches.

The meaningful use incentives under HITECH may be inadequate to address the financial challenges many hospitals face in implementing electronic health records (EHRs). Hospitals can fill the capital gap between EHR costs and available funds by exploring other potential funding sources. These sources include additional grants, funding permissible under EHR regulations, vendor financing, and tax benefits under IRS Section 179.

Solve the puzzle of electronic health record implementation budgeting.

Health care organizations need to adopt an electronic health record (EHR) system for compliance with the Health Information Technology for Economic and Clinical Health Act. How to budget the EHR implementation is a challenging issue to the chief financial officers in health care organizations. This article uses a mock hospital to illustrate how to prepare an EHR implementation budget step by step in a hospital setting. After the project budget baseline is set, the budgeting steps are as follows: (1) estimating the cost for each project element, (2) aggregating all costs, and (3) revising budget to meet the budget baseline. Several budgeting techniques are discussed, including analogue, parametric, and unit cost based on effort. The budgeting methodology can also be applied to a physician/clinic EHR implementation budget.

Enhance the accuracy of medication histories for the elderly by using an electronic medication checklist.

Medication errors may result in serious safety issues for patients. Medication error issues are more prevalent among elderly patients, who take more medications and have prescriptions that change frequently. The challenge of obtaining accurate medication histories for the elderly at the time of hospital admission creates the potential for medication errors starting at admission.A study at a central Texas hospital was conducted to assess whether an electronic medication checklist can enhance the accuracy of medication histories for the elderly. The empirical outcome demonstrated that medication errors were significantly reduced by using an electronic medication checklist at the time of admission. The findings of this study suggest that implementing electronic health record systems with decision support for identifying inaccurate doses and frequencies of prescribed medicines will increase the accuracy of patients' medication histories.

Adoption and utilization of electronic health record systems by long-term care facilities in Texas.

Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities.

Running the numbers on an EHR. Applying cost-benefit analysis in EHR adoption.

Even with federal incentive payments, providers will be hesitant to adopt EHRs without understanding the return on investment. A cost-benefit analysis helps determine EHR profitability over time.