OMPUTERIZED CLINICAL DECIs i o n s u p p o r t s y s t e m s (CDSSs) are information systems designed to improve clinical decision making. Characteristics of individual patients are matched to a computerized knowledge base, and software algorithms generate patientspecific recommendations. Practitioners, health care staff, or patients can manually enter patient characteristics into the computer system; alternatively, electronic medical records can be queried for retrieval of patient characteristics. Computer-generated recommendations are delivered to the clinician through the electronic medical record, by pager, or through printouts placed in a patient's paper chart. Such systems have been developed for a myriad of clinical issues, including diagnosis of chest pain, treatment of infertility, and timely administration of immunizations. These systems provide several modes of decision support, including alerts of critical val-See also pp 1197 and 1261.

Xenograft studies indicate that some solid tumors and leukemias are organized as cellular hierarchies sustained by cancer stem cells (CSCs). Despite the promise of the CSC model, its relevance in humans remains uncertain. Here we show that acute myeloid leukemia (AML) follows a CSC model on the basis of sorting multiple populations from each of 16 primary human AML samples and identifying which contain leukemia stem cells (LSCs) using a sensitive xenograft assay. Analysis of gene expression from all functionally validated populations yielded an LSC-specific signature. Similarly, a hematopoietic stem cell (HSC) gene signature was established. Bioinformatic analysis identified a core transcriptional program shared by LSCs and HSCs, revealing the molecular machinery underlying 'stemness' properties. Both stem cell programs were highly significant independent predictors of patient survival and were found in existing prognostic signatures. Thus, determinants of stemness influence the clinical outcome of AML, establishing that LSCs are clinically relevant and not artifacts of xenotransplantation.

ObjeCtiveTo systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. DesignSystematic review and meta-analysis.