- Particulate Air Pollutants and Trajectories of Depressive Symptoms in Older Women. [Journal Article]
- AJAm J Geriatr Psychiatry 2019 May 09
- CONCLUSIONS: Long-term exposure to ambient fine particles was associated with increased depressive symptoms among older women without prior depression or cognitive impairment.
- Prospective Associations of Waist-to-Height Ratio With Cardiovascular Events in Postmenopausal Women: Results From the Women's Health Initiative. [Letter]
- DCDiabetes Care 2019 Jul 15
- Beyond "implementation": digital health innovation and service design. [Review]
- NDNPJ Digit Med 2018; 1:48
- Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs)…
Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs), but their actual impact remains variable. In this commentary, we suggest that shifting from a perspective focused on "implementing" new digital tools in health care settings toward one focused on "service design" will help teams execute more successful digital technology adoption projects. We present value proposition design (VPD) as a service design strategy requiring that stakeholders are brutally honest in determining the value of a new digital tool for their everyday work. Incorporating a perspective focused on how the value proposition of a technology is understood by each team member, and implications for their work routines, will help project teams to better understand how services can be reinvented during technology adoption initiatives. We present the simple heuristic [Tool+Team+Routine] as a reminder of the central considerations that make up a service design initiative, and present an illustrative case scenario of designing the use of a digital care coordination platform in an actual digital technology adoption project. We conclude by outlining two important challenges that need to be addressed to advance service design approaches to technology adoption in health care.
- Accelerometer-based predictive models of fall risk in older women: a pilot study. [Journal Article]
- NDNPJ Digit Med 2018; 1:25
- Current clinical methods of screening older adults for fall risk have difficulties. We analyzed data on 67 women (mean age = 77.5 years) who participated in the Objective Physical Activity and Cardio…
Current clinical methods of screening older adults for fall risk have difficulties. We analyzed data on 67 women (mean age = 77.5 years) who participated in the Objective Physical Activity and Cardiovascular Health (OPACH) study within the Women's Health Initiative and in an accelerometer calibration substudy. Participants completed the short physical performance battery (SPPB), questions about falls in the past year, and a timed 400-m walk while wearing a hip triaxial accelerometer (30 Hz). Women with SPPB ≤ 9 and 1+reported falls (n = 19) were grouped as high fall risk; women with SPPB = 10-12 and 0 reported falls (n = 48) were grouped as low fall risk. Random Forests were trained to classify women into these groups, based upon traditional measures of gait and/or signal-based features extracted from accelerometer data. Eleven models investigated combined feature effects on classification accuracy, using 10-fold cross-validation. The models had an average 73.7% accuracy, 81.1% precision, and 0.706 AUC. The best performing model including triaxial data, cross-correlations, and traditional measures of gait had 78.9% accuracy, 84.4% precision, and 0.846 AUC. Mediolateral signal-based measures-coefficient of variance, cross-correlation with anteroposterior accelerations, and mean acceleration-ranked as the top 3 features. The classification accuracy is promising, given research on probabilistic models of falls indicates accuracies ≥80% are challenging to achieve. The results suggest accelerometer-based measures captured during walking are potentially useful in screening older women for fall risk. We are applying algorithms developed in this paper on an OPACH dataset of 5000 women with a 1-year prospective falls log and week-long, free-living accelerometer data.
- Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial. [Journal Article]
- BQBMJ Qual Saf 2019 Jul 13
- CONCLUSIONS: PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively.
- Health-Related Quality of Life in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial. [Journal Article]
- JHJACC Heart Fail 2019 Jul 03
- CONCLUSIONS: HRQL was largely worse in women and was similar in HFpEF and HFrEF after accounting for variation in demographics, functional status, and symptom burden. Prospective Comparison of ARNI with ARB Global Outcomes in HFpEF [PARAGON-HF] NCT01920711; Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255).
- Family physicians and health advocacy: Is it really a difficult fit? [Journal Article]
- CFCan Fam Physician 2019; 65(7):491-496
- CONCLUSIONS: Team-based care was seen as one of the most important enablers for becoming involved in the full spectrum of advocacy, as was time for personal reflection.
- Cross Sector Data Sharing: Necessity, Challenge, and Hope. [Journal Article]
- JLJ Law Med Ethics 2019; 47(2_suppl):83-86
- Existing data sources have tremendous potential to inform public health activities. However, a patchwork of data protection laws impede data sharing efforts. Nevertheless, a data-sharing initiative i…
Existing data sources have tremendous potential to inform public health activities. However, a patchwork of data protection laws impede data sharing efforts. Nevertheless, a data-sharing initiative in Peoria, IL was able to overcome challenges to set up a cross-sectoral data system to coordinate mental health, law enforcement, and healthcare services.
- The Role of Magnetic Resonance Imaging in Classifying Individuals Who Will Develop Accelerated Radiographic Knee Osteoarthritis. [Journal Article]
- JOJ Orthop Res 2019 Jul 12
- We assessed whether adding magnetic resonance (MR)-based features to a base model of clinically accessible participant characteristics (i.e., serological, radiographic, demographic, symptoms, and phy…
We assessed whether adding magnetic resonance (MR)-based features to a base model of clinically accessible participant characteristics (i.e., serological, radiographic, demographic, symptoms, and physical function) improved classification of adults who developed accelerated radiographic knee osteoarthritis (AKOA) or not over the subsequent 4 years. We conducted a case-control study using radiographs from baseline and the first four annual visits of the Osteoarthritis Initiative to define groups. Eligible individuals had no radiographic KOA in either knee at baseline (Kellgren-Lawrence grade (KL) <2). We classified 2 groups matched on sex: 1) AKOA: at least one knee developed advanced-stage KOA (KL=3 or 4) within 48 months and 2) did not develop AKOA within 48 months. The MR-based features were assessments of bone, effusion/synovitis, tendons, ligaments, cartilage, and menisci. All characteristics and MR-based features were from the baseline visit. Classification and regression tree analyses were performed to determine classification rules and identify statistically important variables. The CART models with and without MR features each explained approximately 40% of the variability. Adding MR-based features to the model yielded modest improvements in specificity (0.90 versus 0.82) but lower sensitivity (0.62 versus and 0.70) than the base model. There was consistent evidence that serum glucose, effusion-synovitis volume, and cruciate ligament degeneration are statistically important variables in classifying individuals who will develop AKOA. We found common MR-based measures failed to dramatically improve classification. These findings also show a complex interplay among participant characteristics and a need to identify novel characteristics to improve classification. This article is protected by copyright. All rights reserved.
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- Paternal-age-related de novo mutations and risk for five disorders. [Journal Article]
- NCNat Commun 2019 Jul 10; 10(1):3043
- There are established associations between advanced paternal age and offspring risk for psychiatric and developmental disorders. These are commonly attributed to genetic mutations, especially de novo…
There are established associations between advanced paternal age and offspring risk for psychiatric and developmental disorders. These are commonly attributed to genetic mutations, especially de novo single nucleotide variants (dnSNVs), that accumulate with increasing paternal age. However, the actual magnitude of risk from such mutations in the male germline is unknown. Quantifying this risk would clarify the clinical significance of delayed paternity. Using parent-child trio whole-exome-sequencing data, we estimate the relationship between paternal-age-related dnSNVs and risk for five disorders: autism spectrum disorder (ASD), congenital heart disease, neurodevelopmental disorders with epilepsy, intellectual disability and schizophrenia (SCZ). Using Danish registry data, we investigate whether epidemiologic associations between each disorder and older fatherhood are consistent with the estimated role of dnSNVs. We find that paternal-age-related dnSNVs confer a small amount of risk for these disorders. For ASD and SCZ, epidemiologic associations with delayed paternity reflect factors that may not increase with age.