Introduction: Clinical decision support (CDS) alerts have shown promise in improving health care quality and patient outcomes. Although repeated exposure to alerts may lead to declined responses by physicians, known as “alert fatigue,” little is known about how the introduction of competing alerts may affect uptake over time.

Methods: We examined alert responses over time and identified factors associated with decreased alert effectiveness. We analyzed the audit data from all occurrences of a CDS alert at a single, large academic health system. For patients screening positive for depression during ambulatory visits, a non-interruptive CDS alert is presented to the physician, offering a number of appropriate documentation actions. Alert uptake was defined as the selection of any option offered within the alert during the patient encounter. We assessed the effect of (1) the number of competing clinical guidance alerts presented during the same encounter and (2) the total number of all clinical guidance alerts that the same provider had seen in the prior 90 days, on the probability of depression screen alert uptake, adjusting for physician and patient characteristics.

Results: A total of 55,649 office visits involving 418 physicians and 40,474 patients between September 1, 2017, and February 28, 2021, were included. After adjustment for potential confounders, physicians who had seen the most CDS alerts in the prior 90 days were less likely to utilize the depression alert than those who had seen it the least (adjusted uptake rate, 19.8% at the highest quartile versus 39.3% at the lowest quartile; adjusted odds ratio, 0.38; 95% CI 0.35 to 0.42; p<0.001). The negative impact of competing alerts in the same visit on depression alert uptake was only seen among physicians in the middle two quartiles of alert exposure in the prior 90 days.

Conclusion: Among physicians at a single large academic health care system, the declining use of a non-interruptive depression alert was strongly associated with the provider’s 90-day prior exposure to alerts. Health systems should monitor providers’ recent alert exposure as a measure of potential alert fatigue.

This technical supplement provides the tables and maps upon which the analysis included in the report for the Economic Development Administration of the U.S. Department of Commerce, "Economic Needs of Asian Americans and Pacific Islander in Distressed Areas” was based. contains detailed neighborhood profiles and maps of low-income APA areas in the following MSAs: Chicago, Long Beach (Little Phnom Pen), Los Angeles (Koreatown), Lowell, New Orleans, New York City (Chinatown), New York City (Jackson Heights), Orange County (Little Saigon), Sacramento, Saint Paul, San Francisco (Chinatown), Seattle, Stockton (Cambodian), Stockton (Filipino), Hawaii Study Area, Oahu, Hawaii Study Area, Molokai and San Francisco (Samoan).

This technical supplement provides the tables and maps upon which the analysis included in the report for the Economic Development Administration of the U.S. Department of Commerce, "Economic Needs of Asian Americans and Pacific Islander in Distressed Areas” was based. contains detailed neighborhood profiles and maps of low-income APA areas in the following MSAs: Chicago, Long Beach (Little Phnom Pen), Los Angeles (Koreatown), Lowell, New Orleans, New York City (Chinatown), New York City (Jackson Heights), Orange County (Little Saigon), Sacramento, Saint Paul, San Francisco (Chinatown), Seattle, Stockton (Cambodian), Stockton (Filipino), Hawaii Study Area, Oahu, Hawaii Study Area, Molokai and San Francisco (Samoan).

In developed countries, most workers depend on government-based social security systems and private company-based pensions to smooth their consumption. In the developing world, the mechanisms are quite different. In the absence of significant formal institutional support, older individuals rely on their own labor income and on family support in the form of transfer payments, coresidence, and participation in family businesses. However, the dramatic gains in life expectancy and declines in family size and coresidence that accompany development suggest that these traditional forms of support may break down. In this paper I build and estimate a structural dynamic model of labor supply for older men in Indonesia that incorporates these mechanisms. I use this model to simulate the effects of demographic change on labor supply and to evaluate two possible public pension reforms, which may be necessary to address the growing needs of an aging population in a developing setting. The results show that families and health play a key role in labor supply choices in old age. When faced with declining family support, simulations show that older men stay in the labor force at ages when they would otherwise exit. Moreover, when pension benefits are extended to private sector workers, people switch from unemployment and self-employment into the private sector even when wages are taxed to pay for the pension program. These results highlight the complexities of old age labor supply and pension reform in the context of rapidly developing societies.

This handbook, by a professional musician rather than a professional classicist, presents the basic facts about Greek pronunciation, rhythm, melody, and tunings and offers musical reconstructions of selected passages of ancient Greek poetry intended for modern performers.

About the author: A resident of his native Oregon, Douglas Leedy (b. 1938) is a composer, as well as a conductor specializing in early Western music; he has written extensively on tuning and intonation in musical theory and practice. He studied classical Indian singing with K. V. Narayanaswamy and Pandit Pran Nath; his Greek studies began at the University of California, Berkeley, under Elroy Bundy and Gerson Rabinowitz.

About this publication: the Department of Classics is pleased to host this suggestive work by a UC Berkeley alumnus. It has not proved practical to typeset the work, but it has been judged to be a useful addition to the literature on reconstructing Greek musical performance, presenting the unique perspective of a practicing musician and musicologist and thus complementing the efforts of classical scholars. It is therefore offered here as is, scanned from the typescript and manuscript pages.

Abstract The federal Americans with Disabilities Act (ADA), which took effect in 1992, was adopted to provide a comprehensive national mandate to eliminate discrimination against people with disabilities. The ADA may be used to protect people with asthma and others whose daily activities are substantially limited by secondhand smoke exposure in private and public workplaces with fifteen or more employees (Title I); while accessing the services of, or participating in, state and local government (Title II); and in places of public accommodation (Title III). This law synopsis outlines when exposure to secondhand smoke qualifies as a disability under the ADA, summarizes what constitutes a “reasonable accommodation” by an employer or public place, describes the scope and constitutionality of the ADA as defined by recent Supreme Court and other cases, and identifies the remedies under the ADA for smoking-related discrimination. The author also provides information on who to contact for assistance in bringing ADA legal actions.