Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.

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Purpose -The Navy Nurse Corps is part of a team of professionals that provides high quality, economical health care to approximately 700,000 active duty Navy and Marine Corps members, as well as 2.6 million retired and family members. Navy Nurse Corps manpower management efficiency is critical to providing this care. This paper aims to focus on manpower planning in the Navy Nurse Corps. Design/methodology/approach -The Nurse Corps manages personnel primarily through the recruitment process, drawing on multiple hiring sources. Promotion rates at the lowest two ranks are mandated, but not at the higher ranks. Retention rates vary across pay grades. Using these promotion and attrition rates, a Markov model was constructed to model the personnel flow of junior nurse corps officers. Findings -Hiring sources were shown to have a statistically significant effect on promotion and retention rates. However, these effects were not found to be practically significant in the Markov model. Only small improvements in rank imbalances are possible given current recruiting guidelines. Allowing greater flexibility in recruiting practices, fewer recruits would generate a 25 percent reduction in rank imbalances, but result in understaffing. Recruiting different ranks at entry would generate a 65 percent reduction in rank imbalances without understaffing issues. Practical implications -Policies adjusting promotion and retention rates are more powerful in controlling personnel flows than adjusting hiring sources. These policies are the only means for addressing the fundamental sources of rank imbalances in the Navy Nurse Corps arising from current manpower guidelines. Originality/value -The paper shows that modeling to improve manpower management may enable the Navy Nurse Corps to more efficiently fulfill its mandate for high-quality healthcare.

Special care must be applied to the proper planning and design of public school facilities. Student populations for this age group are prone toward high levels of inner ear deficiencies, and they struggle in difficult acoustical environments. Additionally, students with asthma conditions must contend daily in building environments with marginal ventilation systems. What can be done? Schools must be free from unnecessary ambient noise and indoor air pollutants. The design professional must provide extraordinary design leadership through the use of natural day lighting and daylight modeling. Qualified acousticians should be engaged to evaluate designs for better learning environments. Operations and maintenance staff can be trained in the benefits of good indoor air quality. Pesticides and herbicide use can be reduced or eliminated. Town constituency, school board members, parents, staff and students should be educated on the benefits of the LEED initiatives and the certification process. Since children spend vast amounts of time in these facilities during critical physical growth periods, they need to be afforded the protection of such building design and construction.Accordingly, in Radnor, Pennsylvania, such an initiative is underway -the construction of a LEED driven middle school with a different twist. For this project, the school district, the engineer, and the architect have all completed "green" projects in the last few years. Armed with the experience of lessons learned, the project team is endeavoring to provide a high performance school for the township. A school that is not only energy efficient, but also healthy, comfortable, well lit, and providing all the amenities needed for a quality education.

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