Toward Automated Interpretation of LC-MS Data for Quality Assurance of a Screening Collection.

The AstraZeneca Compound Management group uses high-performance liquid chromatography-mass spectrometry for structure elucidation and purity determination of the AstraZeneca compound collection. These activities are conducted in a high-throughput environment where the rate-limiting step is the review and interpretation of analytical results, which is time-consuming and experience dependent. Despite the development of a semiautomated review system, manual interpretation of results remains a bottleneck. Data-mining techniques were applied to archived data to further automate the review process. Various classification models were evaluated using WEKA and Pipeline Pilot (Pipeline Pilot version 8.5.0.200, BIOVIA, San Diego, CA). Results were assessed using criteria including precision, recall, and receiver operating characteristic area. Each model was evaluated as a cost-insensitive classifier and again using MetaCost to apply cost sensitivity. Pruning and variable importance were also investigated. A 10-tree random forest generated with Pipeline Pilot reduced the number of analyses requiring manual review to 36.4% using a threshold of 90% confidence in predictions. This represents a 45% reduction in manual reviews compared with the previous system, delivering an annual savings of $45,000 or an increase in capacity from 25,000 analyses per month up to 45,000 with the same resource levels.

Data Exploration Toolkit for serial diffraction experiments.

Ultrafast diffraction at X-ray free-electron lasers (XFELs) has the potential to yield new insights into important biological systems that produce radiation-sensitive crystals. An unavoidable feature of the `diffraction before destruction' nature of these experiments is that images are obtained from many distinct crystals and/or different regions of the same crystal. Combined with other sources of XFEL shot-to-shot variation, this introduces significant heterogeneity into the diffraction data, complicating processing and interpretation. To enable researchers to get the most from their collected data, a toolkit is presented that provides insights into the quality of, and the variation present in, serial crystallography data sets. These tools operate on the unmerged, partial intensity integration results from many individual crystals, and can be used on two levels: firstly to guide the experimental strategy during data collection, and secondly to help users make informed choices during data processing.

Improving radiopharmaceutical supply chain safety by implementing bar code technology.

The aim of this study was to describe and evaluate an approach for improving radiopharmaceutical supply chain safety by implementing bar code technology. We first evaluated the current situation of our radiopharmaceutical supply chain and, by means of the ALARM protocol, analysed two dispensing errors that occurred in our department. Thereafter, we implemented a bar code system to secure selected key stages of the radiopharmaceutical supply chain. Finally, we evaluated the cost of this implementation, from overtime, to overheads, to additional radiation exposure to workers. An analysis of the events that occurred revealed a lack of identification of prepared or dispensed drugs. Moreover, the evaluation of the current radiopharmaceutical supply chain showed that the dispensation and injection steps needed to be further secured. The bar code system was used to reinforce product identification at three selected key stages: at usable stock entry; at preparation-dispensation; and during administration, allowing to check conformity between the labelling of the delivered product (identity and activity) and the prescription. The extra time needed for all these steps had no impact on the number and successful conduct of examinations. The investment cost was reduced (2600 euros for new material and 30 euros a year for additional supplies) because of pre-existing computing equipment. With regard to the radiation exposure to workers there was an insignificant overexposure for hands with this new organization because of the labelling and scanning processes of radiolabelled preparation vials. Implementation of bar code technology is now an essential part of a global securing approach towards optimum patient management.

A comparison of human and machine translation of health promotion materials for public health practice: time, costs, and quality.

CONTEXT: Most local public health departments serve limited English proficiency groups but lack sufficient resources to translate the health promotion materials that they produce into different languages. Machine translation (MT) with human postediting could fill this gap and work toward decreasing health disparities among non-English speakers. OBJECTIVES: (1) To identify the time and costs associated with human translation (HT) of public health documents, (2) determine the time necessary for human postediting of MT, and (3) compare the quality of postedited MT and HT. DESIGN: A quality comparison of 25 MT and HT documents was performed with public health translators. The public health professionals involved were queried about the workflow, costs, and time for HT of 11 English public health documents over a 20-month period. Three recently translated documents of similar size and topic were then machine translated, the time for human postediting was recorded, and a blind quality analysis was performed. SETTING: Seattle/King County, Washington. PARTICIPANTS: Public health professionals. MAIN OUTCOME MEASURES: (1) Estimated times for various HT tasks; (2) observed postediting times for MT documents; (3) actual costs for HT; and (4) comparison of quality ratings for HT and MT. RESULTS: Human translation via local health department methods took 17 hours to 6 days. While HT postediting words per minute ranged from 1.58 to 5.88, MT plus human postediting words per minute ranged from 10 to 30. The cost of HT ranged from $130 to $1220; MT required no additional costs. A quality comparison by bilingual public health professionals showed that MT and HT were equivalently preferred. CONCLUSIONS: MT with human postediting can reduce the time and costs of translating public health materials while maintaining quality similar to HT. In conjunction with postediting, MT could greatly improve the availability of multilingual public health materials.

Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project.

INTRODUCTION: Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. RESULTS: Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. CONCLUSION: Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets' capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff.

The impact of New York City's Health Bucks Program on electronic benefit transfer spending at farmers markets, 2006-2009.

INTRODUCTION: Increasing the accessibility and affordability of fresh produce is an important strategy for municipalities combatting obesity and related health conditions. Farmers markets offer a promising venue for intervention in urban settings, and in recent years, an increasing number of programs have provided financial incentives to Supplemental Nutrition Assistance Program (SNAP) recipients. However, few studies have explored the impact of these programs on use of SNAP benefits at farmers markets. METHODS: New York City's Health Bucks Program provides SNAP recipients with a $2 coupon for every $5 spent using SNAP benefits at participating farmers markets. We analyzed approximately 4 years of electronic benefit transfer (EBT) sales data, from July 2006 through November 2009, to develop a preliminary assessment of the effect of the Health Bucks Program on EBT spending at participating markets. RESULTS: Farmers markets that offered Health Bucks coupons to SNAP recipients averaged higher daily EBT sales than markets without the incentive ($383.07, 95% confidence interval [CI], 333.1-433.1, vs $273.97, 95% CI, 243.4-304.5, P < 0.001) following the introduction of a direct point-of-purchase incentive. Multivariate analysis indicated this difference remained after adjusting for the year the market was held and the neighborhood poverty level. CONCLUSION: When a $2 financial incentive was distributed with EBT, use of SNAP benefits increased at participating New York City farmers markets. We encourage other urban jurisdictions to consider adapting the Health Bucks Program to encourage low-income shoppers to purchase fresh produce as one potential strategy in a comprehensive approach to increasing healthful food access and affordability in low-income neighborhoods.

Tracking in anatomic pathology.

Bar code-based tracking solutions, long present in clinical pathology laboratories, have recently made an appearance in anatomic pathology (AP) laboratories. Tracking of AP "assets" (specimens, blocks, slides) can enhance laboratory efficiency, promote patient safety, and improve patient care. Routing of excess clinical material into research laboratories and biorepositories are other avenues that can benefit from tracking of AP assets. Implementing tracking is not as simple as installing software and turning it on. Not all tracking solutions are alike. Careful analysis of laboratory workflow is needed before implementing tracking to assure that this solution will meet the needs of the laboratory. Such analysis will likely uncover practices that may need to be modified before a tracking system can be deployed. Costs that go beyond simply that of purchasing software will be incurred and need to be considered in the budgeting process. Finally, people, not technology, are the key to assuring quality. Tracking will require significant changes in workflow and an overall change in the culture of the laboratory. Preparation, training, buy-in, and accountability of the people involved are crucial to the success of this process. This article reviews the benefits, available technology, underlying principles, and implementation of tracking solutions for the AP and research laboratory.

Prospective cost-benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking.

In the United States recording accurate vaccine lot numbers in immunization records is required by the National Childhood Vaccine Injury Act and is necessary for public health surveillance and implementation of vaccine product recalls. However, this information is often missing or inaccurate in records. The Food and Drug Administration (FDA) requires a linear barcode of the National Drug Code (NDC) on vaccine product labels as a medication verification measure, but lot number and expiration date must still be recorded by hand. Beginning in 2011, FDA permitted manufacturers to replace linear barcodes with two-dimensional (2D) barcodes on unit-of-use product labels. A 2D barcode can contain the NDC, expiration date, and lot number in a symbol small enough to fit on a unit-of-use label. All three data elements could be scanned into a patient record. To assess 2D barcodes' potential impacts, a mixed-methods approach of time-motion data analysis, interview and survey data collection, and cost-benefit analysis was employed. Analysis of a time-motion study conducted at 33 practices suggests scanning 2D-barcoded vaccines could reduce immunization documentation time by 36-39 s per dose. Data from an internet survey of primary care providers and local health officials indicate that 60% of pediatric practices, 54% of family medicine practices, and 39% of health departments would use the 2D barcode, with more indicating they would do so if they used electronic health records. Inclusive of manufacturer and immunization provider costs and benefits, we forecast lower-bound net benefits to be $310-334 million between 2011 and 2023 with a benefit-to-cost ratio of 3.1:1-3.2:1. Although we were unable to monetize benefits for expected improved immunization coverage, surveillance, or reduced medication errors, based on our findings, we expect that using 2D barcodes will lower vaccine documentation costs, facilitate data capture, and enhance immunization data quality.

The cost of implementing inpatient bar code medication administration.

OBJECTIVES: To calculate the costs associated with implementing and operating an inpatient bar-code medication administration (BCMA) system in the community hospital setting and to estimate the cost per harmful error prevented. STUDY DESIGN: This is a retrospective, observational study. Costs were calculated from the hospital perspective and a cost-consequence analysis was performed to estimate the cost per preventable adverse drug event averted. METHODS: Costs were collected from financial records and key informant interviews at 4 not-for profit community hospitals. Costs included direct expenditures on capital, infrastructure, additional personnel, and the opportunity costs of time for existing personnel working on the project. The number of adverse drug events prevented using BCMA was estimated by multiplying the number of doses administered using BCMA by the rate of harmful errors prevented by interventions in response to system warnings. Our previous work found that BCMA identified and intercepted medication errors in 1.1% of doses administered, 9% of which potentially could have resulted in lasting harm. RESULTS: The cost of implementing and operating BCMA including electronic pharmacy management and drug repackaging over 5 years is $40,000 (range: $35,600 to $54,600) per BCMA-enabled bed and $2000 (range: $1800 to $2600) per harmful error prevented. CONCLUSIONS: BCMA can be an effective and potentially cost-saving tool for preventing the harm and costs associated with medication errors.

Administrative simplification: adoption of operating rules for health care electronic funds transfers (EFT) and remittance advice transactions. Interim final rule with comment period.

This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of operating rules for the health care electronic funds transfers (EFT) and remittance advice transaction.

Increasing supplemental nutrition assistance program/electronic benefits transfer sales at farmers' markets with vendor-operated wireless point-of-sale terminals.

BACKGROUND: Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamp Program) participants can use their benefits at many farmers' markets. However, most markets have only one market-operated wireless point-of-sale (POS) card swipe terminal for electronic benefits transfer (EBT) transactions. It is not known whether providing each farmer/vendor with individual wireless POS terminals and subsidizing EBT fees will increase SNAP/EBT purchases at farmers' markets. OBJECTIVE: To evaluate the effects of multiple vendor-operated wireless POS terminals (vs a single market-operated terminal) on use of SNAP benefits at an urban farmers' market. DESIGN: Time-series analyses of SNAP/EBT sales. SETTING: The Clark Park farmers' market in West Philadelphia, PA, which accounts for one quarter of all SNAP/EBT sales at farmers' markets in Pennsylvania. INTERVENTION: Vendors were provided with individual wireless POS terminals for 9 months (June 2008-February 2009.) The pilot program covered all equipment and wireless service costs and transaction fees associated with SNAP/EBT, credit, and debit sales. MAIN OUTCOME MEASURE: Monthly SNAP/EBT sales at the Clark Park farmers' market. STATISTICAL ANALYSES: SNAP/EBT sales data were collected for 48 months (January 2007-December 2010). Time-series regression analysis was used to estimate the effect of the intervention period (June 2008-February 2009) on SNAP/EBT sales, controlling for seasonal effects and total SNAP benefits issued in Philadelphia. RESULTS: The intervention was associated with a 38% increase in monthly SNAP/EBT sales. Effects were greatest during the busy fall market seasons. SNAP/EBT sales did not remain significantly higher after the intervention period. CONCLUSIONS: Providing individual wireless POS terminals to farmers' market vendors leads to increased sales. However, market vendors indicated that subsidies for equipment costs and fees would be needed to break even. Currently, SNAP provides some support for these services for supermarket and other SNAP retailers with landline access, but not for farmers' markets.

Administrative simplification: adoption of standards for health care electronic funds transfers (EFTs) and remittance advice. Interim final rule with comment period.

This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of a standard for electronic funds transfers (EFT). It defines EFT and explains how the adopted standards support and facilitate health care EFT transmissions.