Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically ...requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patient's record. We propose a representation of patients' entire raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two US academic medical centers with 216,221 adult patients hospitalized for at least 24 h. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting: in-hospital mortality (area under the receiver operator curve AUROC across sites 0.93-0.94), 30-day unplanned readmission (AUROC 0.75-0.76), prolonged length of stay (AUROC 0.85-0.86), and all of a patient's final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed traditional, clinically-used predictive models in all cases. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios. In a case study of a particular prediction, we demonstrate that neural networks can be used to identify relevant information from the patient's chart.
Despite COVID-19 vaccination programs, the threat of new SARS-CoV-2 strains and continuing pockets of transmission persists. While many U.S. universities replaced their traditional nine-day spring ...2021 break with multiple breaks of shorter duration, the effects these schedules have on reducing COVID-19 incidence remains unclear. The main objective of this study is to quantify the impact of alternative break schedules on cumulative COVID-19 incidence on university campuses. Using student mobility data and Monte Carlo simulations of returning infectious student size, we developed a compartmental susceptible-exposed-infectious-asymptomatic-recovered (SEIAR) model to simulate transmission dynamics among university students. As a case study, four alternative spring break schedules were derived from a sample of universities and evaluated. Across alternative multi-break schedules, the median percent reduction of total semester COVID-19 incidence, relative to a traditional nine-day break, ranged from 2 to 4% (for 2% travel destination prevalence) and 8-16% (for 10% travel destination prevalence). The maximum percent reduction from an alternate break schedule was estimated to be 37.6%. Simulation results show that adjusting academic calendars to limit student travel can reduce disease burden. Insights gleaned from our simulations could inform policies regarding appropriate planning of schedules for upcoming semesters upon returning to in-person teaching modalities.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background Treatments for Churg-Strauss syndrome (CSS), a rare eosinophilic vasculitis characterized by asthma, sinusitis, peripheral eosinophilia, pulmonary infiltrates, and tissue infiltration, are ...limited by toxicity or poor efficacy. Levels of IL-5, a cytokine regulating eosinophils, can be increased in patients with CSS. Mepolizumab, a humanized monoclonal anti–IL-5 antibody, decreases steroid requirements in patients with non-CSS hypereosinophilic syndromes. Objective The purpose of this study was to assess whether mepolizumab would safely allow corticosteroid tapering in patients with steroid-dependent CSS while decreasing serum markers of disease activity. Methods This open-label pilot study treated 7 patients with 4 monthly doses of mepolizumab to assess whether it safely decreased CSS disease activity and permitted tapering of systemic corticosteroids. Results Mepolizumab was safe and well tolerated in patients with CSS. Mepolizumab reduced eosinophil counts and allowed for safe corticosteroid reduction in all 7 subjects. On cessation of mepolizumab, CSS manifestations recurred, necessitating corticosteroid bursts. Conclusion Mepolizumab is a safe and well-tolerated therapy in patients with CSS, offering clinical benefit by enabling corticosteroid tapering while maintaining clinical stability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in children less than 1 year of age in the United States. Internet search engine queries may provide high resolution temporal ...and spatial data to estimate and predict disease activity.
After filtering an initial list of 613 symptoms using high-resolution Bing search logs, we used Google Trends data between 2004 and 2016 for a smaller list of 50 terms to build predictive models of RSV incidence for five states where long-term surveillance data was available. We then used domain adaptation to model RSV incidence for the 45 remaining US states.
Surveillance data sources (hospitalization and laboratory reports) were highly correlated, as were laboratory reports with search engine data. The four terms which were most often statistically significantly correlated as time series with the surveillance data in the five state models were RSV, flu, pneumonia, and bronchiolitis. Using our models, we tracked the spread of RSV by observing the time of peak use of the search term in different states. In general, the RSV peak moved from south-east (Florida) to the north-west US.
Our study represents the first time that RSV has been tracked using Internet data results and highlights successful use of search filters and domain adaptation techniques, using data at multiple resolutions. Our approach may assist in identifying spread of both local and more widespread RSV transmission and may be applicable to other seasonal conditions where comprehensive epidemiological data is difficult to collect or obtain.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Evidence suggests that Hispanic and non-Hispanic White men (NHW) have comparable prevalence rates of alcohol use. However, Hispanic men consistently have higher prevalence rates of alcohol misuse ...compared with NHW men. Consequently, Hispanic men experience disproportionate levels of adverse health consequences of alcohol misuse when compared with NHW men. The aim of this study was to explore Hispanic male perspectives and opinions regarding alcohol use patterns that may lead to disparate rates of alcohol misuse in Hispanic males. Demographic data were collected with questionnaires. Twenty semistructured one-on-one interviews were completed in English and Spanish with Mexican-origin Hispanic men (age: 44.6 ± 11.3 years). A thematic analysis was conducted using a hybrid deductive–inductive strategy with an a priori codebook supplemented with iterative analysis of transcripts. Results suggest that alcohol misuse patterns in Hispanic males are influenced by an interaction between alcohol-related social norms and learned expressions of masculinity; a lack of knowledge of the alcohol-related health risks that further perpetuate the normalization of alcohol misuse; and expressions of masculinity and adaptive coping that lead to alcohol misuse as an escape from life stressors. Given the rapid expansion of the Hispanic population in the United States, and the disparate consequences of alcohol misuse in this population, it is imperative to consider the complex and often compounded impact of sociocultural norms and the social context on misuserelated behaviors. Viable prevention and treatment strategies should be addressed thought multicomponent, communitylevel strategies that more comprehensively address the complexities of alcohol misuse in this population.
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BFBNIB, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Abstract Background and aims We sought to determine current knowledge and practices among gastroenterology physicians and assess adherence to current guidelines for H. pylori management. Methods ...Online surveys were distributed in 2014 to practicing gastroenterology physicians for information related to the diagnosis and treatment of H. pylori infection. Results A total of 582 completed surveys were reviewed. The H. pylori screening test used “almost always” was gastric biopsy obtained during endoscopy (histology) (59%) followed by stool antigen test (20%). Standard triple therapy for 14 days was commonly prescribed by 53% of respondents. The stool antigen test was most frequently chosen to confirm H. pylori eradication (51%), although only 58% of physicians checked for eradication in patients who underwent treatment. Conclusions Adherence to current American College of Gastroenterology guidelines is low. Although more physicians treat patients with a positive H. pylori test, only half ensure eradication after treatment. Improving knowledge of the resistance patterns of H. pylori may be critical to ensure successful eradication.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Hispanic men have poor access to alcohol abuse treatment, low treatment engagement, and low treatment completion rates despite the contrasting burden of alcohol-related consequences they face. The ...purpose of this study was to examine Hispanic male perspectives regarding alcohol abuse treatment-seeking behaviors and the structural, sociocultural, and individual factors that may influence initiation and continued engagement in treatment in this population. Individual interviews were conducted with a sample of 20 Hispanic men (age: 44.6 ± 11.3 years). Thematic analysis was completed using a hybrid deductive–inductive approach centered in an a priori codebook that was further supplemented with iterative exploration of transcripts. Results suggested treatment-seeking behaviors were highly influenced by (a) structural factors related to poor treatment access, as well as lack of linguistic- and cultural-responsiveness of available treatment; (b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of community awareness, societal normalization of consumption, and stigmatization of alcohol abuse treatment; and (c) individual factors related to lack of individual knowledge. This work highlights the perceived lack of congruency between available treatment and the linguistic, cultural, and gender norms of Hispanic men. There is need for responsive treatment strategies that comprehensively consider the gendered- and sociocultural-factors that govern treatment seeking and engagement behaviors. Findings also suggest a need for targeted alcohol abuse awareness building efforts in the Hispanic community. Specifically, the detrimental effects of alcohol-related problems and potential benefits of treatment should be addressed in order to diminish social stigma of abuse and of treatment.
We address the problem of scalable distributed reasoning, proposing a technique for materialising the closure of an RDF graph based on MapReduce. We have implemented our approach on top of Hadoop and ...deployed it on a compute cluster of up to 64 commodity machines. We show that a naive implementation on top of MapReduce is straightforward but performs badly and we present several non-trivial optimisations. Our algorithm is scalable and allows us to compute the RDFS closure of 865M triples from the Web (producing 30B triples) in less than two hours, faster than any other published approach.
The early stages of the COVID-19 pandemic required a dramatic change in social practices, including distancing from social settings, to limit its spread. While social capital has considerable ...potential in facilitating the adoption of these norms, it also comes with considerable limitations that potentially undermine its effectiveness. We draw upon recently released mobility data from Google, network data from Facebook, and demographic data from the 2018 American Community Survey to determine how both organizational and networked measures of social capital relate to different forms of distancing. In addition, we employ geographically weighted regression to identify how these relationships vary across the nation. Findings indicate that while both forms of social capital can positively relate to distancing, the impacts are spatially inconsistent and, in some locations, social capital can discourage distancing. In sum, more policy efforts are needed to address not only low-social capital, but also unhelpful social capital.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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