The Deterioration Risk Index: Developing and Piloting a Machine Learning Algorithm to Reduce Pediatric Inpatient Deterioration.

Objectives: Develop and deploy a disease cohort-based machine learning algorithm for timely identification of hospitalized pediatric patients at risk for clinical deterioration that outperforms our existing situational awareness program.

Design: Retrospective cohort study.

Setting: Nationwide Children's Hospital, a freestanding, quaternary-care, academic children's hospital in Columbus, OH.

The Diagnostic Error Index: A Quality Improvement Initiative to Identify and Measure Diagnostic Errors.

Objective: To develop a diagnostic error index (DEI) aimed at providing a practical method to identify and measure serious diagnostic errors.

Study Design: A quality improvement (QI) study at a quaternary pediatric medical center. Five well-defined domains identified cases of potential diagnostic errors.

Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons Learned.

Introduction: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial.

Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma.

Objective: To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma.

Materials And Methods: We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments.

IT in the ED: past, present, and future.

Over the past 40 years, information technology in the emergency department (ED) has evolved from primitive tracking, order entry, and laboratory reporting systems to complex multifunctional applications that permeate all aspects of patient care and ED operations. Spurred by incentive programs and technological improvements, both ED physicians and administrators view these systems as a way to increase staff efficiency, to improve patient care quality and safety, to satisfy compliance and reporting obligations, and to reduce costs. As organizations implement and optimize systems, it is helpful to look back at how these technologies were developed, to review the current impacts and effects of their use, and to glimpse the future of information technology in the ED.

IT in the ED: a new section of Pediatric Emergency Care.

Information technology (IT) has profoundly changed the delivery of health care during the past decade. The pediatric emergency department (ED) represents a specific challenge for applying IT systems to the patient bedside. The rapid pace and unscheduled nature of the ED, the breadth of care delivered, and the range of medical, ethical, cultural, and process issues presented by pediatric patients make this a setting in particular need of thoughtfully designed and usable IT systems.

Biogeographic partitioning of Southern Ocean microorganisms revealed by metagenomics.

We performed a metagenomic survey (6.6 Gbp of 454 sequence data) of Southern Ocean (SO) microorganisms during the austral summer of 2007-2008, examining the genomic signatures of communities across a latitudinal transect from Hobart (44°S) to the Mertz Glacier, Antarctica (67°S). Operational taxonomic units (OTUs) of the SAR11 and SAR116 clades and the cyanobacterial genera Prochlorococcus and Synechococcus were strongly overrepresented north of the Polar Front (PF).

Global biogeography of SAR11 marine bacteria.

The ubiquitous SAR11 bacterial clade is the most abundant type of organism in the world's oceans, but the reasons for its success are not fully elucidated. We analysed 128 surface marine metagenomes, including 37 new Antarctic metagenomes. The large size of the data set enabled internal transcribed spacer (ITS) regions to be obtained from the Southern polar region, enabling the first global characterization of the distribution of SAR11, from waters spanning temperatures -2 to 30°C.

Virophage control of antarctic algal host-virus dynamics.

Viruses are abundant ubiquitous members of microbial communities and in the marine environment affect population structure and nutrient cycling by infecting and lysing primary producers. Antarctic lakes are microbially dominated ecosystems supporting truncated food webs in which viruses exert a major influence on the microbial loop. Here we report the discovery of a virophage (relative of the recently described Sputnik virophage) that preys on phycodnaviruses that infect prasinophytes (phototrophic algae).

An integrative study of a meromictic lake ecosystem in Antarctica.

In nature, the complexity and structure of microbial communities varies widely, ranging from a few species to thousands of species, and from highly structured to highly unstructured communities. Here, we describe the identity and functional capacity of microbial populations within distinct layers of a pristine, marine-derived, meromictic (stratified) lake (Ace Lake) in Antarctica. Nine million open reading frames were analyzed, representing microbial samples taken from six depths of the lake size fractionated on sequential 3.

Metaproteogenomic analysis of a dominant green sulfur bacterium from Ace Lake, Antarctica.

Green sulfur bacteria (GSB) (Chlorobiaceae) are primary producers that are important in global carbon and sulfur cycling in natural environments. An almost complete genome sequence for a single, dominant GSB species ('C-Ace') was assembled from shotgun sequence data of an environmental sample taken from the O(2)-H(2)S interface of the water column of Ace Lake, Antarctica. Approximately 34 Mb of DNA sequence data were assembled into nine scaffolds totaling 1.

High-energy response of passive dosemeters in use at LANL.

The high-energy neutron response of three passive dosemeters in use at the Los Alamos National Laboratory (LANL) has been investigated using metrology-grade fields. The dosemeters include the LANL Model 8823 TLD badge and the LANL PN3 track etch device. Both are dosemeters of record at LANL.