Abstract
Background
Care-management tools are typically utilized for chronic disease management. Sonoma County government agencies employed advanced health information technologies, artificial ...intelligence (AI), and interagency process improvements to help transform health and health care for socially disadvantaged groups and other displaced individuals.
Objectives
The objective of this case report is to describe how an integrated data hub and care-management solution streamlined care coordination of government services during a time of community-wide crisis.
Methods
This innovative application of care-management tools created a bridge between social and clinical determinants of health and used a three-step approach—access, collaboration, and innovation. The program Accessing Coordinated Care to Empower Self Sufficiency Sonoma was established to identify and match the most vulnerable residents with services to improve their well-being. Sonoma County created an Interdepartmental Multidisciplinary Team to deploy coordinated cross-departmental services (e.g., health and human services, housing services, probation) to support individuals experiencing housing insecurity. Implementation of a data integration hub (DIH) and care management and coordination system (CMCS) enabled integration of siloed data and services into a unified view of citizen status, identification of clinical and social determinants of health from structured and unstructured sources, and algorithms to match clients across systems.
Results
The integrated toolset helped 77 at-risk individuals in crisis through coordinated care plans and access to services in a time of need. Two case examples illustrate the specific care and services provided individuals with complex needs after the 2017 Sonoma County wildfires.
Conclusion
Unique application of a care-management solution transformed health and health care for individuals fleeing from their homes and socially disadvantaged groups displaced by the Sonoma County wildfires. Future directions include expanding the DIH and CMCS to neighboring counties to coordinate care regionally. Such solutions might enable innovative care-management solutions across a variety of public, private, and nonprofit services.
To develop a conceptual model and novel, comprehensive framework that encompass the myriad ways informatics and technology can support public health response to a pandemic.
The conceptual model and ...framework categorize informatics solutions that could be used by stakeholders (e.g., government, academic institutions, healthcare providers and payers, life science companies, employers, citizens) to address public health challenges across the prepare, respond, and recover phases of a pandemic, building on existing models for public health operations and response.
Mapping existing solutions, technology assets, and ideas to the framework helped identify public health informatics solution requirements and gaps in responding to COVID-19 in areas such as applied science, epidemiology, communications, and business continuity. Two examples of technologies used in COVID-19 illustrate novel applications of informatics encompassed by the framework. First, we examine a hub from The Weather Channel, which provides COVID-19 data via interactive maps, trend graphs, and details on case data to individuals and businesses. Second, we examine IBM Watson Assistant for Citizens, an AI-powered virtual agent implemented by healthcare providers and payers, government agencies, and employers to provide information about COVID-19 via digital and telephone-based interaction.
Early results from these novel informatics solutions have been positive, showing high levels of engagement and added value across stakeholders.
The framework supports development, application, and evaluation of informatics approaches and technologies in support of public health preparedness, response, and recovery during a pandemic. Effective solutions are critical to success in recovery from COVID-19 and future pandemics.
Abstract
Aims
Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its ...safety and efficacy during a centre’s early experience are sparse.
Methods and results
Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32).
Conclusion
During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
Vascular Ultrasound for AFA
Introduction
The most frequent complications of AF ablation (AFA) are related to vascular access, but there is little evidence as to how these can be minimized.
Methods
...Consecutive patients undergoing AFA at a high‐volume center received either standard care (Group S) or routine ultrasound‐guided vascular access (Group U). Vascular complications were assessed before hospital discharge and by means of postal questionnaire 1 month later. Outcome measures were BARC 2+ bleeding complications, postprocedural pain, and prolonged bruising.
Results
Patients in Group S (n = 146) and U (n = 163) were well matched at baseline. Follow‐up questionnaires were received from 92.6%. Patients in Group U were significantly less likely to have a BARC 2+ bleed, 10.4% versus 19.9% P = 0.02, were less likely to suffer groin pain after discharge (27.1% vs. 42.8%; P = 0.006) and were less likely to experience prolonged local bruising (21.5% vs. 40.4%; P = 0.001). Multivariable logistic regression analysis revealed a significant association of vascular complications with nonultrasound guided access (OR 3.12 95%CI 1.54–5.34; P = 0.003) and increasing age (OR 1.05 95%CI 1.01–1.09; P = 0.02).
Conclusion
Routine use of ultrasound‐guided vascular access for AFA is associated with a significant reduction in bleeding complications, postprocedural pain, and prolonged bruising when compared to standard care.
Identify how novel datasets and digital health technology, including both analytics-based and artificial intelligence (AI)-based tools, can be used to assess non-clinical, social determinants of ...health (SDoH) for population health improvement.
A state-of-the-art literature review with systematic methods was performed on MEDLINE, Embase, and the Cochrane Library databases and the grey literature to identify recently published articles (2013-2018) for evidence-based qualitative synthesis. Following single review of titles and abstracts, two independent reviewers assessed eligibility of full-texts using predefined criteria and extracted data into predefined templates.
The search yielded 2,714 unique database records of which 65 met inclusion criteria. Most studies were conducted retrospectively in a United States community setting. Identity, behavioral, and economic factors were frequently identified social determinants, due to reliance on administrative data. Three main themes were identified: 1) improve access to data and technology with policy - advance the standardization and interoperability of data, and expand consumer access to digital health technologies; 2) leverage data aggregation - enrich SDoH insights using multiple data sources, and use analytics-based and AI-based methods to aggregate data; and 3) use analytics-based and AI-based methods to assess and address SDoH - retrieve SDoH in unstructured and structured data, and provide contextual care management sights and community-level interventions.
If multiple datasets and advanced analytical technologies can be effectively integrated, and consumers have access to and literacy of technology, more SDoH insights can be identified and targeted to improve public health. This study identified examples of AI-based use cases in public health informatics, and this literature is very limited.
Describe an augmented intelligence approach to facilitate the update of evidence for associations in knowledge graphs.
New publications are filtered through multiple machine learning study ...classifiers, and filtered publications are combined with articles already included as evidence in the knowledge graph. The corpus is then subjected to named entity recognition, semantic dictionary mapping, term vector space modeling, pairwise similarity, and focal entity match to identify highly related publications. Subject matter experts review recommended articles to assess inclusion in the knowledge graph; discrepancies are resolved by consensus.
Study classifiers achieved F-scores from 0.88 to 0.94, and similarity thresholds for each study type were determined by experimentation. Our approach reduces human literature review load by 99%, and over the past 12 months, 41% of recommendations were accepted to update the knowledge graph.
Integrated search and recommendation exploiting current evidence in a knowledge graph is useful for reducing human cognition load.
Ablation Effectiveness Quotient
Introduction
Inability to predict clinical outcome despite acutely successful pulmonary vein isolation (PVI) remains the Achilles’ heel of atrial fibrillation ablation ...(AFA). Arrhythmia recurrence is frequently due to recovery of radiofrequency (RF) ablation lesions believed to be complete at the original procedure.
Objectives
We hypothesized that a high ratio between post‐AFA levels of serum high sensitivity cardiac troponin T (HScTnT), a highly specific marker of acute myocardial injury, and duration of RF application (the ablation effectiveness quotient, AEQ) would indicate effective ablation and correlate with early clinical success.
Methods
We prospectively measured HScTnT levels in 60 patients (42 70% male, 22 37% with paroxysmal AF PAF, mean age 62.5 ± 10.6 years) 12–18 hours after AFA and calculated the AEQ for each. Patients were followed‐up with ECGs and Holter monitors for recurrence of atrial tachyarrhythmia (AT).
Results
Early recurrence of AT within 6 months occurred in 22 (37%). AT recurrence was not significantly related to left atrial size or comorbidities, nor to RF time or HScTnT level. Mean AEQ was significantly lower in those with recurrence than those without (0.35 ± 0.14 ng/L/s vs. 0.45 ± 0.18 ng/L/s), P = 0.02. Subgroup analysis showed this finding was due to patients with PAF in whom early significance was maintained to one year, with an AEQ >0.4 ng/L/s having 75% sensitivity and 90% specificity in predicting freedom from AT.
Conclusion
A high AEQ correlates well with freedom from AT in patients with PAF in both the short and medium term. If confirmed in further studies, AEQ may become a useful marker of risk of AT post‐AFA.
Molecular geochemical compositions of a suite of Middle Devonian sourced and reservoired oils from the Rainbow–Zama–Shekilie sub-basins in N.W. Alberta, Canada, reveal the presence of at least two ...oil families in the study area. The distribution of each oil family is geographically restricted to a single sub-basin, consistent with the oils being sourced locally within a series of closed generation/migration/trapping systems. The diversity in the biomarker distributions of the oils indicates the wide range of depositional environments and source materials existing in each sub-basin, rather than mixing of end member oils across different sub-basins. Clear maturity differences are observed between the oils from the Rainbow and Zama subbasins. Pre-Cretaceous thermal anomalies along the reactivated regional Precambrian basement faults are proposed as one of the major causes for the relatively high maturity levels for the Middle Devonian source rocks in the study area. We infer that depositional environment and thermal maturity have had a strong impact on the geochemical characteristics of the saturated and aromatic hydrocarbons in the Rainbow–Shekilie–Zama oils, but may not influence the pyrrolic nitrogen compounds to a significant extent. However, recognition of possible source and maturity effects on pyrrolic nitrogen compounds in other studies suggests that these factors should be considered before the pyrrolic nitrogen compounds are used to characterize petroleum migration.
Understanding the sources and pathways of pollutant transport to the Arctic is fundamental to our custody of this sensitive ecosystem. To achieve such an understanding, we need to go beyond a catalog ...of environmental concentrations. Sediments, which are a final sink for particle-active contaminants, can provide a valuable resource to assess fluxes and sources of contaminants. Here, we interpret PAH distributions from widely distributed Arctic marine sediments both as indicators of anthropogenic contribution and to illuminate transport pathways. We use principal components analysis (PCA) to reveal the potential sources of PAHs and their geochemistry in sediments from the Beaufort and Barents Seas. PCA distinguishes between natural and anthropogenic inputs and supports a direct linkage between anthropogenic emissions and Arctic contamination. In the Beaufort Sea, PAHs and triterpenes reflect strong Mackenzie River-dominated inputs of natural PAHs and petroleum which overwhelm anthropogenic sources. In the Barents Sea, PAH and triterpene concentrations are generally 2−20 times lower than in the Beaufort Sea while the anthropogenic contribution is greater. Samples from the NW Barents Sea and from deep in cores contain natural, predominantly petrogenic material. However, samples from the SE Barents and Novaya Zemlya have received greater amounts of combustion PAHs.
PDF
