Secure e-mailing between physicians and patients: transformational change in ambulatory care.

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization.

Improving population care with an integrated electronic panel support tool.

This study measured the impact of an electronic Panel Support Tool (PST) on primary care teams' performance on preventive, monitoring, and therapeutic evidence-based recommendations. The PST, tightly integrated with a comprehensive electronic health record, is a dynamic report that identifies gaps in 32 evidence-based care recommendations for individual patients, groups of patients selected by a provider, or all patients on a primary care provider's panel. It combines point-of-care recommendations, disease registry capabilities, and continuous performance feedback for providers. A serial cross-sectional study of the PST's impact on care performance was conducted, retrospectively using monthly summary data for 207 teams caring for 263,509 adult members in Kaiser Permanente's Northwest region. Baseline care performance was assessed 3 months before first PST use and at 4-month intervals over 20 months of follow-up. The main outcome measure was a monthly care performance percentage for each provider, calculated as the number of selected care recommendations that were completed for all patients divided by the number of clinical indications for care recommendations among them. Statistical analysis was performed using the t test and multiple regression. Average baseline care performance on the 13 measures was 72.9% (95% confidence interval [CI], 71.8%-74.0%). During the first 12 months of tool use, performance improved to a statistically significant degree every 4 months. After 20 months of follow-up, it increased to an average of 80.0% (95% CI, 79.3%-80.7%).

Geographical, meteorological and vectorial factors related to malaria re-emergence in Huang-Huai River of central China.

BACKGROUND: Malaria still represents a significant public health problem in China, and the cases dramatically increased in the areas along the Huang-Huai River of central China after 2001. Considering spatial aggregation of malaria cases and specific vectors, the geographical, meteorological and vectorial factors were analysed to determine the key factors related to malaria re-emergence in these particular areas. METHODS: The geographic information of 357 malaria cases and 603 water bodies in 113 villages were collected to analyse the relationship between the residence of malaria cases and water body. Spearman rank correlation, multiple regression, curve fitting and trend analysis were used to explain the relationship between the meteorological factors and malaria incidence. Entomological investigation was conducted in two sites to get the vectorial capacity and the basic reproductive rate to determine whether the effect of vector lead to malaria re-emergence. RESULTS: The distances from household of cases to the nearest water-body was positive-skew distributed, the median was 60.9 m and 74% malaria cases were inhabited in the extent of 60 m near the water body, and the risk rate of people live there attacked by malaria was higher than others(OR = 1.6, 95%CI (1.042, 2.463), P < 0.05). The annual average temperature and rainfall may have close relationship with annual incidence. The average monthly temperature and rainfall were the key factors, and the correlation coefficients are 0.501 and 0.304(P < 0.01), respectively. Moreover, 75.3% changes of monthly malaria incidence contributed to the average monthly temperature (T(mean)), the average temperature of last two months(T(mean01)) and the average rainfall of current month (R(mean)) and the regression equation was Y = -2.085 + 0.839I1 + 0.998T(mean0) - 0.86T(mean01) + 0.16R(mean0). All the collected mosquitoes were Anopheles sinensis. The vectorial capacity and the basic reproductive rate of An. sinensis in two sites were 0.6969, 0.4983 and 2.1604, 1.5447, respectively. CONCLUSION: The spatial distribution between malaria cases and water-body, the changing of meteorological factors, and increasing vectorial capacity and basic reproductive rate of An. sinensis leaded to malaria re-emergence in these areas.

Improved quality at Kaiser Permanente through e-mail between physicians and patients.

The American Recovery and Reinvestment Act identified secure patient-physician e-mail messaging as an objective of the meaningful use of electronic health records. In our study of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail within a two-month period was associated with a statistically significant improvement in effectiveness of care as measured by the Healthcare Effectiveness Data and Information Set (HEDIS). In addition, the use of e-mail was associated with an improvement of 2.0-6.5 percentage points in performance on other HEDIS measures such as glycemic (HbA1c), cholesterol, and blood pressure screening and control.

Wideband antireflective polarizers based on integrated diffractive multilayer microstructures.

Microstructures of composite materials can exhibit properties significantly different from their individual constitution. By utilizing these unique characteristics, we design diffractive optical elements to demonstrate transmission-only polarizers for telecommunications. The transmittance and the extinction ratio of the proposed structure are >95% and >40 dB at 1470-1910 nm wavelengths, respectively. The average reflectance for random polarization is less than 1% at 1350-1580 nm. The methods are applicable to diffractive optics, e.g., in the ultraviolet and visible spectrum.

Achromatic wave plates for optical pickup units fabricated by use of imprint lithography.

We report achromatic form-birefringence wave plates for optical pickup units. Material dispersion and structure dispersion are balanced in a rigorous multilayer design. A trilayer grating using SiN(x)/SiO(y)N(z)/SiO2 provides easily accessible process control points and relaxed fabrication tolerance. We demonstrate precise patterning by using nanoimprint lithography on UV-curable polymers, alleviating a major fabrication challenge. The achromatic wave plates exhibit 90+/-3 degrees retardance and >95% transmittance as measured by a Mueller matrix method at wavelengths of 640-800 nm.