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Ab initio correlation functionals from second-order perturbation theory.

Orbital-dependent exchange-correlation functionals are not limited by the explicit dependence on the density and present an attractive alternative to conventional functionals. With the successful implementation of the exact orbital-dependent exchange functional, the challenge lies in developing orbital-dependent approximations for the correlation functional. Ab initio many-body methods can provide such approximations. In particular, perturbation theory with the Kohn-Sham model as the reference [Görling and Levy, Phys. Rev. A 50, 196 (1994)] defines the exact correlation functional via an infinite perturbation series. The second-order term of these series gives the lowest-order approximation to the correlation functional. However, it has been suggested [Bartlett et al., J. Chem. Phys. 122, 034104 (2005)] that the Kohn-Sham Hamiltonian is not the optimal choice for the perturbation expansion and a different reference Hamiltonian may lead to an improved perturbation series and more accurate second-order approximation. Here, we demonstrate explicitly that the modified series can be used to define superior functional and potential. We present results of atomic and molecular calculations with both second-order functionals. Our results demonstrate that the modified functional offers a significantly improved description of the correlation effects as it does not suffer from convergence problems and results in energies and densities that are more accurate than those obtained with second-order Møller-Plesset perturbation theory or generalized-gradient approximation functionals.

Journal Article↗

Booking systems for elective services: the New Zealand experience.

This article provides a brief overview of New Zealand's experience in implementing booking systems for elective services in public hospitals. It identifies the basic features of the booking systems policy and explores the rationale and objectives for these policy settings. Progress with implementation of booking systems is explored and some of the challenges and recent developments are also outlined. The authors argue that booking systems represent a major improvement on waiting lists for patients, providers, purchasers and policy-makers.

Appointments and Schedules↗

The ACT heroin trial: intellectual, practical and political challenges.

An array of intellectual, practical and political challenges will be faced both if the Australian Capital Territory "heroin trial" does or does not eventuate. The intellectual challenges include the development of new methodologies and analytical tools for some of the outcome measures; the further development of a research process which involves all the relevant disciplines and interest groups; and capitalizing on an unprecedented opportunity to investigate the pharmacokinetics of heroin. The practicalities of setting up a trial also present a number of challenges, as does incorporating a health development approach. Political challenges include getting a sensible decision made about the trial, avoiding capture of the debate by supporters or opponents of drug law reform and avoiding unrealistic expectations. The major challenge if the trial does not go ahead is to implement other well-considered proposals which can be carefully evaluated.

Journal Article↗

Clinical trial design considerations in assessing long-term functional impacts of tiotropium in COPD: the UPLIFT trial.

An accelerated loss of lung function is one of the defining characteristics of chronic obstructive pulmonary disease (COPD). To date, the only successful intervention shown to conclusively attenuate the loss of lung function over time is smoking cessation. Pharmacological interventions including inhaled corticosteroids and ipratropium bromide have not altered the rate of decline of lung function. Tiotropium is an inhaled anticholinergic that provides 24-hour bronchodilation with once-daily dosing due to prolonged muscarinic M3 receptor blockade. Controlled clinical trials have suggested sustained efficacy for periods of up to one year. We therefore initiated a four-year, controlled clinical trial (UPLIFT, Understanding the Potential Long-Term Impacts on Function with Tiotropium) in patients with COPD to evaluate the long-term effects of tiotropium on the rate of decline in lung function and health status as well as the frequency of exacerbations. The design of such large, long-term clinical trials presents unique methodological challenges including the definition of endpoints, the quality and variability of spirometric measurements and premature patient discontinuations from the trial. The present manuscript outlines the rationale for the UPLIFT study, and reviews the study design and the steps taken to address methodological challenges experienced in other long term studies. Careful design and implementation of the UPLIFT trial is anticipated to yield high quality results that will help in increasing our understanding of the long term natural history of COPD in a global population as well as to elucidate the role that tiotropium can play in affecting the course of this debilitating disease.

Administration, Inhalation↗

Developing policies and guidelines.

Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines of infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.

Cost Control↗

ALPAR: automated learning pipeline for antimicrobial resistance.

SUMMARY: The field of machine learning in antimicrobial resistance (AMR) research has experienced rapid growth, fueled by advancements in high-throughput genome sequencing and the growing capacity of computational resources. However, the complexity and lack of standardized data preparation and bioinformatic analyses present significant challenges, especially for newcomers to the domain. In response to these challenges, we introduce ALPAR (Automated Learning Pipeline for Antimicrobial Resistance), a comprehensive AMR data analysis tool covering the entire process from processing of raw genomic data to training machine learning models to interpretation of results. Our method relies on a reproducible pipeline that integrates widely used bioinformatics tools, presenting a simplified, automatic workflow specifically tailored for single-reference AMR analysis. Accepting genomic data in the form of FASTA files as input, ALPAR facilitates the generation of machine learning-ready data tables and both the training of machine learning and the execution of genome-wide association studies (GWAS) experiments. Additionally, our tool offers supplementary functionalities such as phylogeny-based analysis of the distribution of mutations, enhancing its utility for researchers. The tool has also proven its performance in competitive benchmarks, winning the 2024 CAMDA Anti-Microbial Resistance Prediction Challenge and placing third in the 2025 edition. AVAILABILITY AND IMPLEMENTATION: ALPAR is open-source and freely accessible via GitHub (https://github.com/kalininalab/ALPAR). The pipeline is fully reproducible and can be easily installed as a Conda package (https://anaconda.org/kalininalab/ALPAR).

Machine Learning↗

Accuracy of MSI testing in predicting germline mutations of MSH2 and MLH1: a case study in Bayesian meta-analysis of diagnostic tests without a gold standard.

Microsatellite instability (MSI) testing is a common screening procedure used to identify families that may harbor mutations of a mismatch repair (MMR) gene and therefore may be at high risk for hereditary colorectal cancer. A reliable estimate of sensitivity and specificity of MSI for detecting germline mutations of MMR genes is critical in genetic counseling and colorectal cancer prevention. Several studies published results of both MSI and mutation analysis on the same subjects. In this article we perform a meta-analysis of these studies and obtain estimates that can be directly used in counseling and screening. In particular, we estimate the sensitivity of MSI for detecting mutations of MSH2 and MLH1 to be 0.81 (0.73-0.89). Statistically, challenges arise from the following: (a) traditional mutation analysis methods used in these studies cannot be considered a gold standard for the identification of mutations; (b) studies are heterogeneous in both the design and the populations considered; and (c) studies may include different patterns of missing data resulting from partial testing of the populations sampled. We address these challenges in the context of a Bayesian meta-analytic implementation of the Hui-Walter design, tailored to account for various forms of incomplete data. Posterior inference is handled via a Gibbs sampler.

Adaptor Proteins, Signal Transducing↗

The Medical Education Evaluation Program of the state of Ohio.

In October 1988, seven foreign medical graduates participated in the first administration of the examination devised by the Medical Education Evaluation Program (MEEP) mandated by the State Medical Board of Ohio. The MEEP was established to provide an objective evaluation of an applicant's clinical competencies; passing the MEEP examination was intended to certify that the applicant's clinical skills were comparable to those of a medical student graduating from a school accredited by the Liaison Committee on Medical Education. An applicant who successfully passed the MEEP examination and fulfilled the other Ohio licensure requirements would be eligible to take the Federation Licensing Examination (FLEX) and apply for an unrestricted license to practice medicine in Ohio. The paper describes the origin and development of the MEEP examination and the testing modalities selected (multiple-choice examinations and the use of standardized patients). Four fundamental areas were tested; these are named and described, along with the method for calculating scores for each area and the criteria for passing the different components of the examination. Although the small sample size prohibited meaningful data analysis for the performance of the first group of MEEP candidates, the MEEP examination appears to meet psychometric standards of certifying and licensing examinations, based on data from comparable tests taken by beginning fourth-year medical students in New England and NBME Part III examination examinees. Some potential pitfalls of the MEEP examination are mentioned, as well as the fact that it presents a challenge to boards of medical examiners of other states to implement performance-based assessments of physicians who graduate from non-accredited medical schools.

Clinical Competence↗

Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program.

Junior faculty wishing to achieve successful careers in academic medicine face many challenges. To facilitate faculty in their career development, the authors implemented and evaluated an innovative collaborative, or peer-group, mentoring program at their medical school. Based on Rogerian and adult learning principles, the program incorporated development of skills in key areas for career development, a structured values-based approach to career planning, and instruction in scholarly writing. The 80-hour program has so far been conducted twice over two academic years (1999-2001) with 18 faculty (50% women). Quantitative and qualitative methods were used in the evaluation. Program attendance was 89%. All participants completed a written academic development plan, an exercise they rated as valuable. They also completed an average of one to three manuscripts for publication. Evaluation data highlighted the critical nature of a supportive learning environment and the reasons participants chose to attend the program consistently. Key meaningful outcomes for most participants were: (1) identification of their core values; (2) a structured process of short- and long-term career planning based on these core values; (3) the development of close, collaborative relationships; (4) development of skills in such areas as gender and power issues, negotiation and conflict management, scholarly writing, and oral presentation, and (5) improved satisfaction linked to participants' decisions to remain in academic medicine. Participants developed a sense of personal transformation and empowerment. The authors conclude that collaborative mentoring offers a new approach to faculty development that addresses limitations of traditional approaches in a satisfying and cost-effective way.

Faculty, Medical↗

An algorithm to optimize perioperative blood management in surgery.

Innovation in surgical blood management has been fueled by patients' perceptions of the risks associated with allogeneic blood transfusions and by surgeons' attitudes toward the use of allogeneic blood. The challenge is to determine the best blood management strategy to implement in the individual patient, particularly in patients with anemia who are at high risk of allogeneic blood transfusion. An algorithm to estimate safe blood loss based on individual patient parameters has been developed. The algorithm uses patient weight, gender, and preoperative hematocrit level to derive the volume of blood loss that can be tolerated while maintaining a target postoperative hematocrit level. Because the margin of safe blood loss can be anticipated, the most appropriate blood conservation option(s) can be implemented and perioperative blood management can be optimized.

Algorithms↗

Recruiting the brightest and best for nursing--an honors program can help.

The severe shortage in nursing and significant decline in enrollments in schools of nursing present unique challenges. One way the University of Minnesota School of Nursing responded to this challenge was by initiating an honors program. The development and implementation throughout the first year are described. Funding, admission and graduation requirements, faculty work load, and the difficulties of introducing flexibility into typically highly structured undergraduate professional degree programs are addressed. Implications for the future are presented.

Curriculum↗

Beam me up, nurse! Educational technology supports distance education.

The Intercollegiate Center for Nursing Education (ICNE) has recently added a second technology to its earlier distance education program. Orientation of nursing faculty to effectively use the new two-way video and audio interactive microwave system has been a challenge, and the reward for meeting that challenge is satisfied distant learners. The author discusses the planning, implementation, and evaluation of this new technology.

Education, Nursing, Baccalaureate↗

Implementation strategy: one-stop recovery for cardiac surgical patients.

"Fast-track" or "rapid recovery" for cardiac surgical patients is enjoying widespread use due to its benefits of increased patient comfort, enhanced quality of care, and cost-savings. Successful implementation of a fast-track program, however, may be challenged by physicians, the institution, or patients and their families. One-Stop Recovery is a fast-track program that emphasizes the benefits of traditional rapid recovery programs while addressing potential challenges.

Cardiac Surgical Procedures↗

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Centers for Disease Control and Prevention, U.S.↗

Development of a Vascular Access Team in an acute care setting.

In today's ever-changing acute care setting, justifying the allocation of resources for development and implementation of a Vascular Access Team (VAT) can often be challenging. The Infusion Nurses Society (2000), which establishes standards of practice for the infusion nursing profession, states that "the profession itself must seek control of its practice to assure the quality of its services to the public. A profession's concerns for quality services reflects its commitment to serving the community." This article discusses the steps that were taken in the development of a VAT in the acute care setting of Froedtert Memorial Lutheran Hospital, a teaching hospital affiliated with the Medical College of Wisconsin.

Acute Disease↗

Brain injury after adult cardiac surgery.

Despite remarkable progress in surgical, cardiopulmonary bypass and anaesthetic techniques during the last three decades, brain damage remains an important complication of adult cardiac surgery. Effective brain protection strategies are already implemented today, but ongoing research is needed to meet the challenges faced in operating on increasingly old and disabled patients. The incidence of brain injury may be reduced by modifying the surgical procedure according to carotid duplex scanning and epiaortic echocardiography, by using techniques to reduce microembolization during cardiopulmonary bypass and by optimizing patient temperature during and after surgery. Increased knowledge will aid in choosing the best procedure or combination of procedures in each case to ensure that risks do not outweigh benefits.

Adult↗

Journeying to professionalism: the case of Irish nursing and midwifery research.

This paper gives a 'discursive' account of the contemporary development of nursing and midwifery research in the Republic of Ireland in the context of advancing professionalism. Initially, the paper views the landscape by placing research in the current framework of Irish nursing and midwifery. It then examines the map of our present location by documenting a baseline. It ascertains the signposts that are in place by exploring the strategic direction for development. Finally, it uses the compass to orienteer the route through the various obstacles by examining the challenges of the role of the joint appointee leading the implementation of the national Research Strategy for Nursing and Midwifery in Ireland.

Documentation↗

Home haemodialysis in remote Australia.

The Royal Perth Hospital provides access to dialysis treatment to Indigenous Australians living in remote areas of Western Australia who are suffering from end-stage renal disease (ESRD). The Remote Area Dialysis Programme (RADP), established in 1989, relocated traditional hospital services to remote communities and introduced home or community-based therapy. This unique state-wide programme was developed in cooperation with tribal elders in Aboriginal communities, and regional medical, nursing and community health staff. Prior to RADP's establishment, these patients faced the choice of permanent relocation to Perth for dialysis treatment or death from renal failure. Development of the RADP allowed Indigenous patients with ESRD to receive dialysis treatment in their own home/community. Requirements for home haemodialysis include establishing the suitability and capability of patients, the availability of carers and an appropriate home or community environment for dialysis machine installation. This has required novel strategies to address cultural and language impediments to home therapy. The remoteness of some isolated communities has been a technical challenge for the dialysis technicians due to the uncertainty of power supply, climatic extremes and inadequate supply or poor quality of water. A specific training program has been developed to adapt to the needs of Aboriginal patients. Patients undertaking home haemodialysis face many challenges and a number of initiatives will need to be implemented to ensure the ongoing success of the programme.

Caregivers↗