Stimulant medications restore simple alertness during sleep loss, but it is not clear how they affect complex executive functions, particularly in light of sex differences in cerebral organization. The effectiveness of caffeine, modafinil, dextroamphetamine, or placebo for sustaining performance on the Biber Cognitive Estimation Test (BCET) was compared in 29 men and 25 women following 46 hr of sleep deprivation. Stimulants had differential effects on BCET performance as a function of the sex of the subjects. Women receiving placebo or caffeine scored significantly worse than males, while modafinil and dextroamphetamine were effective at sustaining BCET performance of men and women.

The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC.

Objective To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). Methods and materials The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Results Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Discussion Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. Conclusions An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness.