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Hall K, Kafashzadeh D, Chen L, Dudovitz R, Ross MK. Trends in telemedicine visits among pediatric asthma patients during COVID-19. J Allergy Clin Immunol Glob 2024; 3:100239. [PMID: 38577483 PMCID: PMC10992722 DOI: 10.1016/j.jacig.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/07/2024] [Indexed: 04/06/2024]
Abstract
Background Environmental and social factors, including lack of access to asthma care, contribute to persistent inequities in asthma outcomes among children from historically marginalized ethnoracial groups. Telemedicine, which expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, may be an approach to augment access to pediatric asthma care. Objectives We sought to describe characteristics of pediatric (0-17 years) telemedicine users with asthma and characterize use trends throughout the COVID-19 pandemic. Methods We conducted a retrospective analysis using electronic health record data of pediatric patients with asthma seen at University of California, Los Angeles, Medical Center between March 2019 to March 2022 describing telemedicine user characteristics, trends of asthma-related telemedicine use, and associations between user characteristics and having a telemedicine visit. Results Among 6,777 patients with asthma, the percentage of asthma-related telemedicine visits peaked early in the pandemic, comprising 74.3% of visits, before decreasing to 13.6% in 2022. Compared to White patients, Black patients had lower odds of an asthma telemedicine visit (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26, 0.94). Those with public insurance (OR, 1.7; 95% CI, 1.19, 2.43), severe persistent asthma (OR, 3.03; 95% CI, 1.70, 5.42), or comorbidities (OR, 1.59; 95% CI, 1.08, 2.33) had higher odds. Time to first emergency department visit and hospitalization comparing those with at least one telemedicine visit to those with none were similar. Conclusions More pediatric asthma patients are using telemedicine since the COVID-19 pandemic, particularly those with medical complexity and comorbidities, and outcomes appear similar. However, Black patients at our institution have lower odds of using telemedicine.
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Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Dariush Kafashzadeh
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Lucia Chen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Mindy K. Ross
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
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2
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Gao E, Radpavar I, Clark EJ, Ryan GW, Ross MK. Application of a user experience design approach for an EHR-based clinical decision support system. JAMIA Open 2024; 7:ooae019. [PMID: 38646110 PMCID: PMC11032728 DOI: 10.1093/jamiaopen/ooae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/17/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objective We applied a user experience (UX) design approach to clinical decision support (CDS) tool development for the specific use case of pediatric asthma. Our objective was to understand physicians' workflows, decision-making processes, barriers (ie, pain points), and facilitators to increase usability of the tool. Materials and methods We used a mixed-methods approach with semi-structured interviews and surveys. The coded interviews were synthesized into physician-user journey maps (ie, visualization of a process to accomplish goals) and personas (ie, user types). Interviews were conducted via video. We developed physician journey maps and user personas informed by their goals, systems interactions, and experiences with pediatric asthma management. Results The physician end-user personas identified were: efficiency, relationship, and learning. Features of a potential asthma CDS tool sought varied by physician practice type and persona. It was important to the physician end-user that the asthma CDS tool demonstrate value by lowering workflow friction (ie, difficulty or obstacles), improving the environment surrounding physicians and patients, and using it as a teaching tool. Customizability versus standardization were important considerations for uptake. Discussion Different values and motivations of physicians influence their use and interaction with the EHR and CDS tools. These different perspectives can be captured by applying a UX design approach to the development process. For example, with the importance of customizability, one approach may be to build a core module with variations depending on end-user preference. Conclusion A UX approach can drive design to help understand physician-users and meet their needs; ultimately with the goal of increased uptake.
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Affiliation(s)
- Emily Gao
- College of Letters and Sciences, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Ilana Radpavar
- College of Letters and Sciences, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Emma J Clark
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Gery W Ryan
- Department of Health Systems Science, Kaiser Permanente, Bernard J. Tyson School of Medicine, Pasadena, CA 91101, United States
| | - Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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3
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Szilagyi PG, Duru OK, Casillas A, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Clark E, Ross MK, Evans SA, Sloyan M, Fox CR, Lerner C. Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial. JAMA Intern Med 2024:2816427. [PMID: 38497955 PMCID: PMC10949147 DOI: 10.1001/jamainternmed.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 03/19/2024]
Abstract
Importance Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated. Objective To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system. Design, Setting, and Participants This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system. Interventions Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated. Main Outcomes and Measures The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources. Results A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders. Conclusions and Relevance At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels. Trial Registration ClinicalTrials.gov Identifier: NCT05525494.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael K. Ong
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | | | - Emma Clark
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Mindy K. Ross
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Sharon A. Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Anderson School of Management, University of California, Los Angeles
- Department of Psychology, University of California, Los Angeles
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
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4
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Llada IM, Mote RS, Hill NS, Lourenco JM, Jones DP, Suen G, Ross MK, Filipov NM. Ruminal ergovaline and volatile fatty acid dynamics: Association with poor performance and a key growth regulator in steers grazing toxic tall fescue. Environ Toxicol Pharmacol 2024; 105:104354. [PMID: 38151218 DOI: 10.1016/j.etap.2023.104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
Fescue toxicosis (FT) is produced by an ergot alkaloid (i.e., ergovaline [EV])-producing fungus residing in toxic fescue plants. Associations between EV, decreased weight gain and ruminal volatile fatty acids are unclear. Feces, rumen fluid, and blood were collected from 12 steers that grazed non-toxic (NT) or toxic (E +) fescue for 28 days. The E + group exhibited decreased propionate (P), increased acetate (A), and increased ruminal A:P ratio, with similar trends in feces. Plasma GASP-1 (G-Protein-Coupled-Receptor-Associated-Sorting-Protein), a myostatin inhibitor, decreased (day 14) only in E + steers. Ergovaline was present only in E + ruminal fluid and peaked on day 14. The lower ruminal propionate and higher A:P ratio might contribute to FT while reduced GASP-1 might be a new mechanism linked to E + -related weight gain reduction. Day 14 ergovaline zenith likely reflects ruminal adaptations favoring EV breakdown and its presence only in rumen points to local, rather than systemic effects.
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Affiliation(s)
- I M Llada
- Interdisciplinary Toxicology Program, United States; Department of Physiology and Pharmacology, United States
| | - R S Mote
- Interdisciplinary Toxicology Program, United States; Department of Physiology and Pharmacology, United States
| | - N S Hill
- Department of Crop and Soil Sciences, United States
| | - J M Lourenco
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, United States
| | - D P Jones
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA, United States
| | - G Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States
| | - M K Ross
- Center for Environmental Health Sciences, Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, United States
| | - N M Filipov
- Interdisciplinary Toxicology Program, United States; Department of Physiology and Pharmacology, United States.
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5
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Banerjee I, Syed K, Potturu A, Pragada VS, Sharma RS, Murcko A, Chern D, Todd M, Aking P, Al-Yaqoobi A, Bayless P, Belmonte W, Cuadra T, Dockins T, Eldredge C, El-Kareh R, Gale G, Gentile E, Kalpas E, Morris M, Mueller L, Piekut D, Ross MK, Sarris J, Singh G, Tharani S, Wallace M, Grando MA. Physicians differ in their perceptions of sensitive medical records: Survey and interview study. Health Informatics J 2023; 29:14604582231193519. [PMID: 37544770 DOI: 10.1177/14604582231193519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Physician categorizations of electronic health record (EHR) data (e.g., depression) into sensitive data categories (e.g., Mental Health) and their perspectives on the adequacy of the categories to classify medical record data were assessed. One thousand data items from patient EHR were classified by 20 physicians (10 psychiatrists paired with ten non-psychiatrist physicians) into data categories via a survey. Cluster-adjusted chi square tests and mixed models were used for analysis. 10 items were selected per each physician pair (100 items in total) for discussion during 20 follow-up interviews. Interviews were thematically analyzed. Survey item categorization yielded 500 (50.0%) agreements, 175 (17.5%) disagreements, 325 (32.5%) partial agreements. Categorization disagreements were associated with physician specialty and implied patient history. Non-psychiatrists selected significantly (p = .016) more data categories than psychiatrists when classifying data items. The endorsement of Mental Health and Substance Use categories were significantly (p = .001) related for both provider types. During thematic analysis, Encounter Diagnosis (100%), Problems (95%), Health Concerns (90%), and Medications (85%) were discussed the most when deciding the sensitivity of medical information. Most (90.0%) interview participants suggested adding additional data categories. Study findings may guide the evolution of digital patient-controlled granular data sharing technology and processes.
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Affiliation(s)
| | - Kazi Syed
- Arizona State University, Scottsdale, AZ, US
| | | | | | | | | | | | | | - Padma Aking
- Trinity Integrated Medicine, Phoenix, AZ, US
| | | | | | | | - Teresa Cuadra
- New York City Zen Center for Contemplative Care, New York, NY, US
| | | | | | | | | | | | - Edward Kalpas
- Arizona State University, Scottsdale, AZ, US
- HonorHealth, Scottsdale, AZ, US
| | - Meghan Morris
- Arizona State University, Scottsdale, AZ, US
- HonorHealth, Scottsdale, AZ, US
| | - Laurel Mueller
- Arizona Osteopathic Medical Association, Phoenix, AZ, US
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6
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Kafashzadeh D, Hall K, Pirani C, Szilagyi PG, Chen L, Ross MK. Electronic patient portal activation and outcomes among pediatric patients with asthma. J Allergy Clin Immunol Pract 2023; 11:1950-1953.e2. [PMID: 36948490 PMCID: PMC10752757 DOI: 10.1016/j.jaip.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Dariush Kafashzadeh
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Kaitlin Hall
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Cenan Pirani
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Lucia Chen
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Mindy K Ross
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
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7
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Szilagyi PG, Casillas A, Duru OK, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Ross MK, Friedman SR, Evans S, Sloyan M, Bogard JE, Fox CR, Lerner C. Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial. Prev Med 2023; 170:107474. [PMID: 36870572 PMCID: PMC11064058 DOI: 10.1016/j.ypmed.2023.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020-2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested: pre-commitment messages (sent September 2020, asking patients to commit to a vaccination); monthly portal reminders (October - December 2020), direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); and pre-appointment reminder messages (sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020-03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%); p > 0.017 for all comparisons (p value cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Michael K Ong
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America; VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America.
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | | | - Mindy K Ross
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Sarah R Friedman
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Sharon Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA, United States of America.
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA, United States of America.
| | - Jonathan E Bogard
- Olin Business School Washington University in Saint Louis, United States of America.
| | - Craig R Fox
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America; Anderson School of Management, University of California at Los Angeles, CA, United States of America; Department of Psychology, University of California at Los Angeles, CA, United States of America.
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
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8
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Radparvar I, Ross MK. Barriers and facilitators of electronic patient portal uptake for asthma management. J Asthma 2023; 60:635-646. [PMID: 35726134 PMCID: PMC9763543 DOI: 10.1080/02770903.2022.2087190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/28/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An active patient-practitioner partnership is a key aspect of asthma management and patient-reported data helps with shared decision making. Technological advances such as the electronic patient portal can facilitate partnership, with the goal of improved asthma outcomes. However, uptake of portals by end-users for asthma management has been low. We studied portal-based asthma interventions to understand barriers and facilitators to its use. DATA SOURCES We searched within the PubMed, Web of Science, Scopus, MEDLINE, and Google Scholar databases. STUDY SELECTIONS We used the PRISMA extension for scoping reviews to guide our analysis of studies related to asthma and patient portals. We summarized relevant studies in terms of barriers and facilitators as well as study characteristics. RESULTS Sixteen studies were included in our final analysis. Common barriers to patient portal use for asthma management were lack of perceived value by the end-user, low end-user technological literacy, and limited resources. Facilitators of portal use included ease of use, personalization, and adequate technical support. Patient portals in these studies were used for a variety of applications related to core asthma management concepts of assessment and monitoring, education for a partnership in asthma care, environmental factors, co-morbidities, and medications. CONCLUSIONS Patient portal use for asthma management can be encouraged by ensuring the portal is easy to access and navigate, demonstrates values, as well as has readily available technical support. Involving end-users closely in the design process and implementation may help address barriers. Special attention is needed for groups with technological resource limitations.
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Affiliation(s)
- Ilana Radparvar
- College of Letters and Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Mindy K. Ross
- University Of California Los Angeles, David Geffen School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
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9
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Ning E, Cladek A, Ross MK, Kabir S, Barve A, Kennelly E, Hussain F, Duffecy J, Langenecker SL, Nguyen T, Tulabandhula T, Zulueta J, Ajilore O, Demos AP, Leow A. Smartphone-derived Virtual Keyboard Dynamics Coupled with Accelerometer Data as a Window into Understanding Brain Health: Smartphone Keyboard and Accelerometer as Window into Brain Health. Proc SIGCHI Conf Hum Factor Comput Syst 2023; 2023:326. [PMID: 38115842 PMCID: PMC10729731 DOI: 10.1145/3544548.3580906] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
We examine the feasibility of using accelerometer data exclusively collected during typing on a custom smartphone keyboard to study whether typing dynamics are associated with daily variations in mood and cognition. As part of an ongoing digital mental health study involving mood disorders, we collected data from a well-characterized clinical sample (N = 85) and classified accelerometer data per typing session into orientation (upright vs. not) and motion (active vs. not). The mood disorder group showed lower cognitive performance despite mild symptoms (depression/mania). There were also diurnal pattern differences with respect to cognitive performance: individuals with higher cognitive performance typed faster and were less sensitive to time of day. They also exhibited more well-defined diurnal patterns in smartphone keyboard usage: they engaged with the keyboard more during the day and tapered their usage more at night compared to those with lower cognitive performance, suggesting a healthier usage of their phone.
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Affiliation(s)
- Emma Ning
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrea Cladek
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Mindy K Ross
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Sarah Kabir
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Amruta Barve
- University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Faraz Hussain
- University of Illinois Chicago, Chicago, Illinois, USA
| | | | | | | | | | - John Zulueta
- University of Illinois Chicago, Chicago, Illinois, USA
| | | | | | - Alex Leow
- University of Illinois Chicago, Chicago, Illinois, USA
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10
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Ross MK, Tulabandhula T, Bennett CC, Baek E, Kim D, Hussain F, Demos AP, Ning E, Langenecker SA, Ajilore O, Leow AD. A Novel Approach to Clustering Accelerometer Data for Application in Passive Predictions of Changes in Depression Severity. Sensors (Basel) 2023; 23:1585. [PMID: 36772625 PMCID: PMC9920816 DOI: 10.3390/s23031585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/11/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
The treatment of mood disorders, which can become a lifelong process, varies widely in efficacy between individuals. Most options to monitor mood rely on subjective self-reports and clinical visits, which can be burdensome and may not portray an accurate representation of what the individual is experiencing. A passive method to monitor mood could be a useful tool for those with these disorders. Some previously proposed models utilized sensors from smartphones and wearables, such as the accelerometer. This study examined a novel approach of processing accelerometer data collected from smartphones only while participants of the open-science branch of the BiAffect study were typing. The data were modeled by von Mises-Fisher distributions and weighted networks to identify clusters relating to different typing positions unique for each participant. Longitudinal features were derived from the clustered data and used in machine learning models to predict clinically relevant changes in depression from clinical and typing measures. Model accuracy was approximately 95%, with 97% area under the ROC curve (AUC). The accelerometer features outperformed the vast majority of clinical and typing features, which suggested that this new approach to analyzing accelerometer data could contribute towards unobtrusive detection of changes in depression severity without the need for clinical input.
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Affiliation(s)
- Mindy K. Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Theja Tulabandhula
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Casey C. Bennett
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
- Department of Computing, DePaul University, Chicago, IL 60604, USA
| | - EuGene Baek
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
| | - Dohyeon Kim
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
| | - Faraz Hussain
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alexander P. Demos
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Emma Ning
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alex D. Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60612, USA
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11
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Chen MH, Cherian C, Elenjickal K, Rafizadeh CM, Ross MK, Leow A, DeLuca J. Real-time associations among MS symptoms and cognitive dysfunction using ecological momentary assessment. Front Med (Lausanne) 2023; 9:1049686. [PMID: 36714150 PMCID: PMC9877417 DOI: 10.3389/fmed.2022.1049686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is characterized by a wide range of disabling symptoms, including cognitive dysfunction, fatigue, depression, anxiety, pain, and sleep difficulties. The current study aimed to examine real-time associations between non-cognitive and cognitive symptoms (latter measured both objectively and subjectively in real-time) using smartphone-administered ecological momentary assessment (EMA). Methods Forty-five persons with MS completed EMA four times per day for 3 weeks. For each EMA, participants completed mobile versions of the Trail-Making Test part B (mTMT-B) and a finger tapping task, as well as surveys about symptom severity. Multilevel models were conducted to account for within-person and within-day clustering. Results A total of 3,174 EMA sessions were collected; compliance rate was 84%. There was significant intra-day variability in mTMT-B performance (p < 0.001) and levels of self-reported fatigue (p < 0.001). When participants reported depressive symptoms that were worse than their usual levels, they also performed worse on the mTMT-B (p < 0.001), independent of upper extremity motor functioning. Other self-reported non-cognitive symptoms were not associated with real-time performance on the mTMT-B [p > 0.009 (Bonferroni-corrected)]. In contrast, when self-reported fatigue (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), and pain (p < 0.001) were worse than the individual's typical levels, they also reported more severe cognitive dysfunction at the same time. Further, there was a statistical trend that self-reported cognitive dysfunction (not mTMT-B performance) predicted one's self-reported sense of accomplishment in real-time. Discussion The current study was the first to identify divergent factors that influence subjectively and objectively measured cognitive functioning in real time among persons with MS. Notably, it is when symptom severity was worse than the individual's usual levels (and not absolute levels) that led to cognitive fluctuations, which supports the use of EMA in MS symptom monitoring.
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Affiliation(s)
- Michelle H. Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States,Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States,*Correspondence: Michelle H. Chen,
| | - Christine Cherian
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Karen Elenjickal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Caroline M. Rafizadeh
- Kessler Foundation, East Hanover, NJ, United States,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Mindy K. Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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12
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Bennett CC, Ross MK, Baek E, Kim D, Leow AD. Smartphone accelerometer data as a proxy for clinical data in modeling of bipolar disorder symptom trajectory. NPJ Digit Med 2022; 5:181. [PMID: 36517582 PMCID: PMC9751066 DOI: 10.1038/s41746-022-00741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Being able to track and predict fluctuations in symptoms of mental health disorders such as bipolar disorder outside the clinic walls is critical for expanding access to care for the global population. To that end, we analyze a dataset of 291 individuals from a smartphone app targeted at bipolar disorder, which contains rich details about their smartphone interactions (including typing dynamics and accelerometer motion) collected everyday over several months, along with more traditional clinical features. The aim is to evaluate whether smartphone accelerometer data could serve as a proxy for traditional clinical data, either by itself or in combination with typing dynamics. Results show that accelerometer data improves the predictive performance of machine learning models by nearly 5% over those previously reported in the literature based only on clinical data and typing dynamics. This suggests it is possible to elicit essentially the same "information" about bipolar symptomology using different data sources, in a variety of settings.
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Affiliation(s)
- Casey C. Bennett
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea ,grid.254920.80000 0001 0707 2013Department of Computing, DePaul University, Chicago, IL USA
| | - Mindy K. Ross
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA
| | - EuGene Baek
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Dohyeon Kim
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Alex D. Leow
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Dept. of Biomedical Engineering, University of Illinois–Chicago, Chicago, IL USA
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13
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Chen MH, Leow A, Ross MK, DeLuca J, Chiaravalloti N, Costa SL, Genova HM, Weber E, Hussain F, Demos AP. Associations between smartphone keystroke dynamics and cognition in MS. Digit Health 2022; 8:20552076221143234. [PMID: 36506490 PMCID: PMC9730018 DOI: 10.1177/20552076221143234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Examine the associations between smartphone keystroke dynamics and cognitive functioning among persons with multiple sclerosis (MS). Methods Sixteen persons with MS with no self-reported upper extremity or typing difficulties and 10 healthy controls (HCs) completed six weeks of remote monitoring of their keystroke dynamics (i.e., how they typed on their smartphone keyboards). They also completed a comprehensive neuropsychological assessment and symptom ratings about fatigue, depression, and anxiety at baseline. Results A total of 1,335,787 keystrokes were collected, which were part of 30,968 typing sessions. The MS group typed slower (P < .001) and more variably (P = .032) than the HC group. Faster typing speed was associated with better performance on measures of processing speed (P = .016), attention (P = .022), and executive functioning (cognitive flexibility: P = .029; behavioral inhibition: P = .002; verbal fluency: P = .039), as well as less severe impact from fatigue (P < .001) and less severe anxiety symptoms (P = .007). Those with better cognitive functioning and less severe symptoms showed a stronger correlation between the use of backspace and autocorrection events (P < .001). Conclusion Typing speed may be sensitive to cognitive functions subserved by the frontal-subcortical brain circuits. Individuals with better cognitive functioning and less severe symptoms may be better at monitoring their typing errors. Keystroke dynamics have the potential to be used as an unobtrusive remote monitoring method for real-life cognitive functioning among persons with MS, which may improve the detection of relapses, evaluate treatment efficacy, and track disability progression.
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Affiliation(s)
- Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA,Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA,Michelle H Chen, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick,
NJ 08901, USA.
Alex Leow, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., SPHPI MC 912, Chicago, IL 60612, USA.
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mindy K Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Silvana L Costa
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Helen M Genova
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Erica Weber
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Faraz Hussain
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexander P Demos
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Gao E, Radparvar I, Dieu H, Ross MK. User Experience Design for Adoption of Asthma Clinical Decision Support Tools. Appl Clin Inform 2022; 13:971-982. [PMID: 36223869 PMCID: PMC9556170 DOI: 10.1055/s-0042-1757292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emily Gao
- University of California Los Angeles, Los Angeles, California, United States
| | - Ilana Radparvar
- University of California Los Angeles, Los Angeles, California, United States
| | - Holly Dieu
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States
| | - Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States
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15
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Zarrabi M, Li-Fossum L, Tseng B, Lockett K, Shamsian A, Sim MS, Kozman DM, Ross MK. An Electronic Communication Workflow Optimization for Inpatient Specialist Consultation at an Academic Health Care System. Appl Clin Inform 2022; 13:677-680. [PMID: 35793699 DOI: 10.1055/s-0042-1750356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Maiah Zarrabi
- Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Leesa Li-Fossum
- Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Betty Tseng
- Information Services and Solutions, University of California Los Angeles, Los Angeles, California, United States
| | - Kelly Lockett
- Information Services and Solutions, University of California Los Angeles, Los Angeles, California, United States
| | - Arash Shamsian
- Information Services and Solutions, University of California Los Angeles, Los Angeles, California, United States
| | - Myung Shin Sim
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Daniel M Kozman
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Mindy K Ross
- Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
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16
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Hao H, Eckel SP, Hosseini A, Van Vliet EDS, Dzubur E, Dunton G, Chang SY, Craig K, Rocchio R, Bastain T, Gilliland F, Okelo S, Ross MK, Sarrafzadeh M, Bui AAT, Habre R. Daily Associations of Air Pollution and Pediatric Asthma Risk Using the Biomedical REAI-Time Health Evaluation (BREATHE) Kit. Int J Environ Res Public Health 2022; 19:ijerph19063578. [PMID: 35329265 PMCID: PMC8950308 DOI: 10.3390/ijerph19063578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
Abstract
Background: Exposure to air pollution is associated with acute pediatric asthma exacerbations, including reduced lung function, rescue medication usage, and increased symptoms; however, most studies are limited in investigating longitudinal changes in these acute effects. This study aims to investigate the effects of daily air pollution exposure on acute pediatric asthma exacerbation risk using a repeated-measures design. Methods: We conducted a panel study of 40 children aged 8−16 years with moderate-to-severe asthma. We deployed the Biomedical REAI-Time Health Evaluation (BREATHE) Kit developed in the Los Angeles PRISMS Center to continuously monitor personal exposure to particulate matter of aerodynamic diameter < 2.5 µm (PM2.5), relative humidity and temperature, geolocation (GPS), and asthma outcomes including lung function, medication use, and symptoms for 14 days. Hourly ambient (PM2.5, nitrogen dioxide (NO2), ozone (O3)) and traffic-related (nitrogen oxides (NOx) and PM2.5) air pollution exposures were modeled based on location. We used mixed-effects models to examine the association of same day and lagged (up to 2 days) exposures with daily changes in % predicted forced expiratory volume in 1 s (FEV1) and % predicted peak expiratory flow (PEF), count of rescue inhaler puffs, and symptoms. Results: Participants were on average 12.0 years old (range: 8.4−16.8) with mean (SD) morning %predicted FEV1 of 67.9% (17.3%) and PEF of 69.1% (18.4%) and 1.4 (3.5) puffs per day of rescue inhaler use. Participants reported chest tightness, wheeze, trouble breathing, and cough symptoms on 36.4%, 17.5%, 32.3%, and 42.9%, respectively (n = 217 person-days). One SD increase in previous day O3 exposure was associated with reduced morning (beta [95% CI]: −4.11 [−6.86, −1.36]), evening (−2.65 [−5.19, −0.10]) and daily average %predicted FEV1 (−3.45 [−6.42, −0.47]). Daily (lag 0) exposure to traffic-related PM2.5 exposure was associated with reduced morning %predicted PEF (−3.97 [−7.69, −0.26]) and greater odds of “feeling scared of trouble breathing” symptom (odds ratio [95% CI]: 1.83 [1.03, 3.24]). Exposure to ambient O3, NOx, and NO was significantly associated with increased rescue inhaler use (rate ratio [95% CI]: O3 1.52 [1.02, 2.27], NOx 1.61 [1.23, 2.11], NO 1.80 [1.37, 2.35]). Conclusions: We found significant associations of air pollution exposure with lung function, rescue inhaler use, and “feeling scared of trouble breathing.” Our study demonstrates the potential of informatics and wearable sensor technologies at collecting highly resolved, contextual, and personal exposure data for understanding acute pediatric asthma triggers.
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Affiliation(s)
- Hua Hao
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Anahita Hosseini
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095, USA; (A.H.); (M.S.)
| | | | - Eldin Dzubur
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Genevieve Dunton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Shih Ying Chang
- Sonoma Technology, Inc., Petaluma, CA 94954, USA; (S.Y.C.); (K.C.)
| | - Kenneth Craig
- Sonoma Technology, Inc., Petaluma, CA 94954, USA; (S.Y.C.); (K.C.)
| | - Rose Rocchio
- Mobilize Labs, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Theresa Bastain
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Frank Gilliland
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
| | - Sande Okelo
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA; (S.O.); (M.K.R.)
| | - Mindy K. Ross
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA; (S.O.); (M.K.R.)
| | - Majid Sarrafzadeh
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095, USA; (A.H.); (M.S.)
| | - Alex A. T. Bui
- Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Rima Habre
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA; (H.H.); (S.P.E.); (E.D.); (G.D.); (T.B.); (F.G.)
- Correspondence:
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Bradford L, Ross MK, Minso J, Cernelc-Kohan M, Shayan K, Wong SS, Li X, Rivier L, Jegga AG, Deutsch GH, Vece TJ, Loughlin CE, Gower WA, Hurley C, Furman W, Stokes D, Hagood JS. Interstitial lung disease in children with Rubinstein-Taybi syndrome. Pediatr Pulmonol 2022; 57:264-272. [PMID: 34585851 DOI: 10.1002/ppul.25709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rubinstein-Taybi syndrome (RSTS) is a rare genetic syndrome caused primarily by a mutation in the CREBBP gene found on chromosome 16. Patients with RSTS are at greater risk for a variety of medical problems, including upper airway obstruction and aspiration. Childhood interstitial lung disease (ILD) thus far has not been definitively linked to RSTS. Here we present three patients with RSTS who developed ILD and discuss possible mechanisms by which a mutation in CREBBP may be involved in the development of ILD. METHODS Routine hematoxylin and eosin staining was performed on lung biopsy tissue for histological analysis. Immunofluorescent staining was performed on lung biopsy tissue for markers of fibrosis, surfactant deficiency and histone acetylation. Cases 1 and 2 had standard clinical microarray analysis. Case 3 had whole exome sequencing. Bioinformatics analyses were performed to identify possible causative genes using ToppGene. RESULTS Computed tomography images in all cases showed consolidated densities overlying ground glass opacities. Lung histopathology revealed accumulation of proteinaceous material within alveolar spaces, evidence of fibrosis, and increased alveolar macrophages. Immunofluorescent staining showed increase in surfactant protein C staining, patchy areas of increased anti-smooth muscle antibody staining, and increased staining for acetylated histone 2 and histone 3 lysine 9. DISCUSSION Clinical characteristics, radiographic imaging, lung histopathology, and immunofluorescent staining results shared by all cases demonstrated findings consistent with ILD. Immunofluorescent staining suggests two possible mechanisms for the development of ILD: abnormal surfactant metabolism and/or persistent activation of myofibroblasts. These two pathways could be related to dysfunctional CREBBP protein.
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Affiliation(s)
- Lauren Bradford
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mindy K Ross
- Division of Pediatric Pulmonology, University of California-Los Angeles, Los Angeles, California, USA
| | - Jagila Minso
- Division of Pediatric Critical Care, Sanford Health, Fargo, North Dakota, USA
| | - Mateja Cernelc-Kohan
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA.,Division of Pediatric Respiratory Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Katayoon Shayan
- Division of Pediatric Respiratory Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Simon S Wong
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA
| | - Xiaoping Li
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA
| | - Lauraine Rivier
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anil G Jegga
- Department of Pediatrics, Division of Biomedical Informatics, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, Division of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gail H Deutsch
- Department of Pathology and Laboratory Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Gower
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Hurley
- Critical Care Medicine Division, Departments of Pediatric Medicine and Bone Marrow Transplant, St. Jude Children's Hospital, Memphis, Tennessee, USA.,Department of Oncology, Division of Solid Tumor, St. Jude Children's Hospital, Memphis, Tennessee, USA
| | - Wayne Furman
- Critical Care Medicine Division, Departments of Pediatric Medicine and Bone Marrow Transplant, St. Jude Children's Hospital, Memphis, Tennessee, USA.,Department of Oncology, Division of Solid Tumor, St. Jude Children's Hospital, Memphis, Tennessee, USA
| | - Dennis Stokes
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Hagood
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ross MK, Friedman S, Radparvar I, Ryan G. Partnered decision support: Parental perspectives of completing a pre-visit pediatric asthma questionnaire via the patient portal. Pediatr Pulmonol 2022; 57:100-108. [PMID: 34672435 PMCID: PMC8665051 DOI: 10.1002/ppul.25735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Collection of patient-reported data has been demonstrated to improve asthma outcomes. One method to collect information is through the electronic patient portal. In practice, patient portal use in pediatrics and, specifically for asthma management, has had low uptake. OBJECTIVE To understand parental/caregiver experience of pediatric asthma care management, and perceptions of the use of patient portal questionnaires before the clinic visit. METHODS We conducted semi-structured interviews with caregivers of children 5-11 years old with asthma in the University of California, Los Angeles (UCLA) Health System. We included patient portal "users" (n = 20) and "non-users" (n = 5). Interview questions were developed based on clinic visit workflow with a focus on perceived usefulness and ease of use to complete pediatric asthma questionnaires in the patient portal before the visit. Interviews were audio-recorded, transcribed, and codes were generated from themes using constant comparative analysis. RESULTS We identified eight themes related to caregiver-physician communication, perception of portal questionnaires, facilitators, and barriers to portal questionnaire use. A salient finding was that caregivers considered the portal questionnaire as a tool to be integrated into the visit to facilitate a conversation about their child's asthma. Caregiver portal-based questionnaire use was more likely if the ongoing data entered was accessible to caregivers to track and update, and if caregivers were reassured the clinicians would use questionnaire responses during the visit. CONCLUSION Caregivers of children with asthma are more likely to complete a patient portal intake questionnaire before the visit if they trust their responses will be used during the visit to inform care.
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Affiliation(s)
- Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Sarah Friedman
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Ilana Radparvar
- Department of Undergraduate Education, University of California Los Angeles, Los Angeles, California, USA
| | - Gery Ryan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Ross MK, Demos AP, Zulueta J, Piscitello A, Langenecker SA, McInnis M, Ajilore O, Nelson PC, Ryan KA, Leow A. Naturalistic smartphone keyboard typing reflects processing speed and executive function. Brain Behav 2021; 11:e2363. [PMID: 34612605 PMCID: PMC8613429 DOI: 10.1002/brb3.2363] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The increase in smartphone usage has enabled the possibility of more accessible ways to conduct neuropsychological evaluations. The objective of this study was to determine the feasibility of using smartphone typing dynamics with mood scores to supplement cognitive assessment through trail making tests. METHODS Using a custom-built keyboard, naturalistic keypress dynamics were unobtrusively recorded in individuals with bipolar disorder (n = 11) and nonbipolar controls (n = 8) on an Android smartphone. Keypresses were matched to digital trail making tests part B (dTMT-B) administered daily in two periods and weekly mood assessments. Following comparison of dTMT-Bs to the pencil-and-paper equivalent, longitudinal mixed-effects models were used to analyze daily dTMT-B performance as a function of typing and mood. RESULTS Comparison of the first dTMT-B to paper TMT-B showed adequate reliability (intraclass correlations = 0.74). In our model, we observed that participants who typed slower took longer to complete dTMT-B (b = 0.189, p < .001). This trend was also seen in individual fluctuations in typing speed and dTMT-B performance (b = 0.032, p = .004). Moreover, participants who were more depressed completed the dTMT-B slower than less depressed participants (b = 0.189, p < .001). A practice effect was observed for the dTMT-Bs. CONCLUSION Typing speed in combination with depression scores has the potential to infer aspects of cognition (visual attention, processing speed, and task switching) in people's natural environment to complement formal in-person neuropsychological assessments that commonly include the trail making test.
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Affiliation(s)
- Mindy K Ross
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - John Zulueta
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | | | | | - Peter C Nelson
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kelly A Ryan
- University of Michigan, Ann Arbor, Michigan, USA
| | - Alex Leow
- University of Illinois at Chicago, Chicago, Illinois, USA
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Ross MK, Romero T, Szilagyi PG. Adverse Childhood Experiences and Association With Pediatric Asthma Severity in the 2016-2017 National Survey of Children's Health. Acad Pediatr 2021; 21:1025-1030. [PMID: 33940207 PMCID: PMC8947844 DOI: 10.1016/j.acap.2021.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Prior studies have found that adverse childhood experiences (ACEs) are associated with asthma prevalence and onset, presumably related to stress and increased inflammation. We hypothesized that ACEs may be associated with asthma severity as well. We studied the 2016-2017 US National Survey of Children's Health dataset to explore the relationship between ACEs and pediatric asthma severity. METHODS We analyzed children ages 0 to 17 years old who had current caregiver-reported asthma diagnosed by a healthcare provider. We reported descriptive characteristics using chi-square analysis of variance (ANOVA) and used multivariable regression analysis to assess the relationship of cumulative and individual ACEs with asthma severity. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results. RESULTS Our analysis included 3691 children, representing a population of 5,465,926. Unadjusted analysis demonstrated that ACEs - particularly household economic hardship, parent/guardian served time in jail, witnessed household violence, or victim/witness of neighborhood violence - were each associated with higher odds of moderate/severe caregiver-reported asthma. After controlling for confounders possibly associated with both exposure (ACEs) and outcome (asthma severity), children who witnessed parent/adult violence had higher adjusted odds of caregiver-reported moderate/severe asthma. (1.67, confidence interval 1.05-2.64, P = .03) CONCLUSIONS: Intrafamilial witnessed household violence is significantly associated with caregiver-reported moderate/severe asthma.
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Affiliation(s)
- Mindy K. Ross
- University of California Los Angeles, Department of Pediatrics, Pediatric Pulmonology and Sleep Medicine, Los Angeles, Calif
| | - Tahmineh Romero
- University of California Los Angeles, Department of Medicine, Statistical Core, Los Angeles, Calif
| | - Peter G Szilagyi
- University of California Los Angeles, Department of Pediatrics, General Pediatrics, Los Angeles, Calif
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21
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Ross MK, Zheng H, Zhu B, Lao A, Hong H, Natesan A, Radparvar M, Bui AAT. Accuracy of Asthma Computable Phenotypes to Identify Pediatric Asthma at an Academic Institution. Methods Inf Med 2021; 59:219-226. [PMID: 34261147 DOI: 10.1055/s-0041-1729951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Asthma is a heterogenous condition with significant diagnostic complexity, including variations in symptoms and temporal criteria. The disease can be difficult for clinicians to diagnose accurately. Properly identifying asthma patients from the electronic health record is consequently challenging as current algorithms (computable phenotypes) rely on diagnostic codes (e.g., International Classification of Disease, ICD) in addition to other criteria (e.g., inhaler medications)-but presume an accurate diagnosis. As such, there is no universally accepted or rigorously tested computable phenotype for asthma. METHODS We compared two established asthma computable phenotypes: the Chicago Area Patient-Outcomes Research Network (CAPriCORN) and Phenotype KnowledgeBase (PheKB). We established a large-scale, consensus gold standard (n = 1,365) from the University of California, Los Angeles Health System's clinical data warehouse for patients 5 to 17 years old. Results were manually reviewed and predictive performance (positive predictive value [PPV], sensitivity/specificity, F1-score) determined. We then examined the classification errors to gain insight for future algorithm optimizations. RESULTS As applied to our final cohort of 1,365 expert-defined gold standard patients, the CAPriCORN algorithms performed with a balanced PPV = 95.8% (95% CI: 94.4-97.2%), sensitivity = 85.7% (95% CI: 83.9-87.5%), and harmonized F1 = 90.4% (95% CI: 89.2-91.7%). The PheKB algorithm was performed with a balanced PPV = 83.1% (95% CI: 80.5-85.7%), sensitivity = 69.4% (95% CI: 66.3-72.5%), and F1 = 75.4% (95% CI: 73.1-77.8%). Four categories of errors were identified related to method limitations, disease definition, human error, and design implementation. CONCLUSION The performance of the CAPriCORN and PheKB algorithms was lower than previously reported as applied to pediatric data (PPV = 97.7 and 96%, respectively). There is room to improve the performance of current methods, including targeted use of natural language processing and clinical feature engineering.
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Affiliation(s)
- Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, United States
| | - Henry Zheng
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
| | - Bing Zhu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
| | - Ailina Lao
- University of California Los Angeles, Los Angeles, California, United States
| | - Hyejin Hong
- University of California Los Angeles, Los Angeles, California, United States
| | - Alamelu Natesan
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, United States
| | - Melina Radparvar
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, United States
| | - Alex A T Bui
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States
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22
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Ross MK, Eckel SP, Bui AAT, Gilliland FD. Asthma clustering methods: a literature-informed application to the children's health study data. J Asthma 2021; 59:1305-1318. [PMID: 33926348 DOI: 10.1080/02770903.2021.1923738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The heterogeneity of asthma has inspired widespread application of statistical clustering algorithms to a variety of datasets for identification of potentially clinically meaningful phenotypes. There has not been a standardized data analysis approach for asthma clustering, which can affect reproducibility and clinical translation of results. Our objective was to identify common and effective data analysis practices in the asthma clustering literature and apply them to data from a Southern California population-based cohort of schoolchildren with asthma. METHODS As of January 1, 2020, we reviewed key statistical elements of 77 asthma clustering studies. Guided by the literature, we used 12 input variables and three clustering methods (hierarchical clustering, k-medoids, and latent class analysis) to identify clusters in 598 schoolchildren with asthma from the Southern California Children's Health Study (CHS). RESULTS Clusters of children identified by latent class analysis were characterized by exhaled nitric oxide, FEV1/FVC, FEV1 percent predicted, asthma control and allergy score; and were predictive of control at two year follow up. Clusters from the other two methods were less clinically remarkable, primarily differentiated by sex and race/ethnicity and less predictive of asthma control over time. CONCLUSION Upon review of the asthma phenotyping literature, common approaches of data clustering emerged. When applying these elements to the Children's Health Study data, latent class analysis clusters-represented by exhaled nitric oxide and spirometry measures-had clinical relevance over time.
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Affiliation(s)
- Mindy K Ross
- Pediatrics, Pediatric Pulmonology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alex A T Bui
- Radiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Frank D Gilliland
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ross MK, Sanz J, Tep B, Follett R, Soohoo SL, Bell DS. Accuracy of an Electronic Health Record Patient Linkage Module Evaluated between Neighboring Academic Health Care Centers. Appl Clin Inform 2020; 11:725-732. [PMID: 33147645 DOI: 10.1055/s-0040-1718374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Patients often seek medical treatment among different health care organizations, which can lead to redundant tests and treatments. One electronic health record (EHR) platform, Epic Systems, uses a patient linkage tool called Care Everywhere (CE), to match patients across institutions. To the extent that such linkages accurately identify shared patients across organizations, they would hold potential for improving care. OBJECTIVE This study aimed to understand how accurate the CE tool with default settings is to identify identical patients between two neighboring academic health care systems in Southern California, The University of California Los Angeles (UCLA) and Cedars-Sinai Medical Center. METHODS We studied CE patient linkage queries received at UCLA from Cedars-Sinai between November 1, 2016, and April 30, 2017. We constructed datasets comprised of linkages ("successful" queries), as well as nonlinkages ("unsuccessful" queries) during this time period. To identify false positive linkages, we screened the "successful" linkages for potential errors and then manually reviewed all that screened positive. To identify false-negative linkages, we applied our own patient matching algorithm to the "unsuccessful" queries and then manually reviewed a sample to identify missed patient linkages. RESULTS During the 6-month study period, Cedars-Sinai attempted to link 181,567 unique patient identities to records at UCLA. CE made 22,923 "successful" linkages and returned 158,644 "unsuccessful" queries among these patients. Manual review of the screened "successful" linkages between the two institutions determined there were no false positives. Manual review of a sample of the "unsuccessful" queries (n = 623), demonstrated an extrapolated false-negative rate of 2.97% (95% confidence interval [CI]: 1.6-4.4%). CONCLUSION We found that CE provided very reliable patient matching across institutions. The system missed a few linkages, but the false-negative rate was low and there were no false-positive matches over 6 months of use between two nearby institutions.
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Affiliation(s)
- Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, Los Angeles, United States
| | - Javier Sanz
- Department of Medicine, Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, United States
| | - Brian Tep
- Department of Enterprise Information Services, Advanced Analytic Services, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Rob Follett
- Department of Medicine, Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, United States
| | - Spencer L Soohoo
- Department of Biomedical Sciences, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Douglas S Bell
- Department of Medicine, University of California Los Angeles, Los Angeles, United States
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Petersen JD, Lozovatsky M, Markovic D, Duncan R, Zheng S, Shamsian A, Kagele S, Ross MK. Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record. Acad Pediatr 2020; 20:857-862. [PMID: 32058105 PMCID: PMC8221402 DOI: 10.1016/j.acap.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/20/2020] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physiologic neonatal hyperbilirubinemia (jaundice) is common and affects most newborn infants. However, there is a risk for permanent neurological damage if the bilirubin levels rise above a certain threshold. The management of neonatal jaundice includes the assessment of bilirubin laboratory values, consideration of patient-specific risk factors, and plotting on a bilirubin nomogram reference to determine risk and guide therapy. When performed manually, the process can be time consuming and error-prone. Therefore, web-based calculators such as BiliTool have been developed to assist in risk assessment. METHODS To streamline the risk assessment calculation process further within our electronic health record (EHR), we created a "BiliReport" to display patient bilirubin-related data and automate transmission of deidentified patient data to the BiliTool website (https://bilitool.org). After implementation, we evaluated usage data, provider satisfaction, and accuracy of documentation. RESULTS We demonstrated high provider use of the BiliReport and satisfaction with the workflow. We found a significant improvement in the accuracy of bilirubin risk level documentation, with a reduction in erroneous risk stratification from 4% (15/232) to 0.4% (1/243), P < 0.001. We did not find significant a difference in erroneous documentation of the bilirubin lab value (P = 0.07). CONCLUSIONS Integrating the neonatal hyperbilirubinemia risk assessment process into the EHR may reduce errors and improve provider documentation and adherence to recommended guidelines.
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Affiliation(s)
| | | | - Daniela Markovic
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ray Duncan
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Zheng
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Arash Shamsian
- University of California Los Angeles, Los Angeles, California
| | - Sonya Kagele
- University of California Los Angeles, Los Angeles, California
| | - Mindy K. Ross
- University of California Los Angeles, Los Angeles, California
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Bui AAT, Hosseini A, Rocchio R, Jacobs N, Ross MK, Okelo S, Lurmann F, Eckel S, Dzubur E, Dunton G, Gilliland F, Sarrafzadeh M, Habre R. Biomedical REAl-Time Health Evaluation (BREATHE): toward an mHealth informatics platform. JAMIA Open 2020; 3:190-200. [PMID: 32734159 PMCID: PMC7382637 DOI: 10.1093/jamiaopen/ooaa011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe a configurable mobile health (mHealth) framework for integration of physiologic and environmental sensors to be used in studies focusing on the domain of pediatric asthma. MATERIALS AND METHODS The Biomedical REAl-Time Health Evaluation (BREATHE) platform connects different sensors and data streams, contextualizing an individual's symptoms and daily activities over time to understand pediatric asthma's presentation and its management. A smartwatch/smartphone combination serves as a hub for personal/wearable sensing devices collecting data on health (eg, heart rate, spirometry, medications), motion, and personal exposures (eg, particulate matter, ozone); securely transmitting information to BREATHE's servers; and interacting with the user (eg, ecological momentary assessments). Server-side integration of electronic health record data and spatiotemporally correlated information (eg, weather, traffic) elaborates on these observations. An initial panel study involving pediatric asthma patients was conducted to assess BREATHE. RESULTS Twenty subjects were enrolled, during which BREATHE accrued seven consecutive days of continuous data per individual. The data were used to confirm knowledge about asthma (use of controller inhalers, time-activity behaviors, personal air pollution exposure), and additional analyses provided insights into within-day associations of environmental triggers and asthma exacerbations. Exit surveys focusing on mHealth usability, while positive, noted several translational challenges. DISCUSSION Based on these promising results, a longitudinal panel study to evaluate individual microenvironments and exposures is ongoing. Lessons learned thus far reflect the need to address various usability aspects, including convenience and ongoing engagement. CONCLUSION BREATHE enables multi-sensor mHealth studies, capturing new types of information alongside an evolving understanding of personal exposomes.
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Affiliation(s)
- Alex A T Bui
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, USA
| | | | - Rose Rocchio
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Nate Jacobs
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Mindy K Ross
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Sande Okelo
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Fred Lurmann
- Sonoma Technologies, Inc., Petaluma, California, USA
| | - Sandrah Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Eldin Dzubur
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Rima Habre
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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Nelson TS, Nepiyushchikh Z, Hooks JST, Razavi MS, Lewis T, Clement CC, Thoresen M, Cribb MT, Ross MK, Gleason RL, Santambrogio L, Peroni JF, Dixon JB. Lymphatic remodelling in response to lymphatic injury in the hind limbs of sheep. Nat Biomed Eng 2019; 4:649-661. [PMID: 31873209 DOI: 10.1038/s41551-019-0493-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Contractile activity in the lymphatic vasculature is essential for maintaining fluid balance within organs and tissues. However, the mechanisms by which collecting lymphatics adapt to changes in fluid load and how these adaptations influence lymphatic contractile activity are unknown. Here we report a model of lymphatic injury based on the ligation of one of two parallel lymphatic vessels in the hind limb of sheep and the evaluation of structural and functional changes in the intact, remodelling lymphatic vessel over a 42-day period. We show that the remodelled lymphatic vessel displayed increasing intrinsic contractile frequency, force generation and vessel compliance, as well as decreasing flow-mediated contractile inhibition via the enzyme endothelial nitric oxide synthase. A computational model of a chain of lymphatic contractile segments incorporating these adaptations predicted increases in the flow-generation capacity of the remodelled vessel at the expense of normal mitochondrial function and elevated oxidative stress within the lymphatic muscle. Our findings may inform interventions for mitigating lymphatic muscle fatigue in patients with dysfunctional lymphatics.
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Affiliation(s)
- Tyler S Nelson
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Zhanna Nepiyushchikh
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joshua S T Hooks
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Mohammad S Razavi
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tristan Lewis
- College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Cristina C Clement
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merrilee Thoresen
- College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Matthew T Cribb
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Mindy K Ross
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Rudolph L Gleason
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Laura Santambrogio
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John F Peroni
- College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - J Brandon Dixon
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA. .,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. .,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
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Ross MK, Okelo SO, Bui AAT. Towards Personalized and Comprehensive Pediatric Asthma Management: Understanding the Role of Social Determinants and Environmental Factors. Acad Pediatr 2019; 19:599-601. [PMID: 31207363 DOI: 10.1016/j.acap.2019.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mindy K Ross
- Department of Pediatrics, Division of Pediatric Pulmonology (MK Ross and SO Okelo), David Geffen School of Medicine at University of California Los Angeles.
| | - Sande O Okelo
- Department of Pediatrics, Division of Pediatric Pulmonology (MK Ross and SO Okelo), David Geffen School of Medicine at University of California Los Angeles
| | - Alex A T Bui
- Department of Radiological Sciences (AAT Bui), University of California Los Angeles
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Ross MK, Romero T, Sim MS, Szilagyi PG. Obese- and allergic-related asthma phenotypes among children across the United States. J Asthma 2019; 56:512-521. [PMID: 29672178 PMCID: PMC6195487 DOI: 10.1080/02770903.2018.1466317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Pediatric asthma is heterogeneous with phenotypes that reflect differing underlying inflammation and pathophysiology. Little is known about the national prevalence of certain obesity- and allergy-related asthma phenotypes or associated characteristics. We therefore assessed the national prevalence, risk factors, and caregiver-reported severity of four asthma phenotypes: not-allergic-not-obese, allergic-not-obese, obese-not-allergic, and allergic-and-obese. METHODS We analyzed data from the 2007-2008 National Survey of Children's Health (NSCH) of 10-17 year-olds with caregiver-reported asthma. We described sociodemographic and health risk factors of each phenotype and then applied logistic and ordinal regression models to identify associated risk factors and level of severity of the phenotypes. RESULTS Among 4427 children with asthma in this NSCH cohort, the association between race and phenotype was statistically significant (p < 0.0001); white children with asthma were most likely to have allergic-not-obese asthma while black and Hispanic children with asthma were most likely to have the obese-nonallergic phenotype (p < 0.001). Attention-deficit disorder/attention-deficit hyperactivity disorder was more likely to be present in allergic-not-obese children (odds ratio (OR) 1.50, confidence interval (CI) 1.14-1.98, p = 0.004). The phenotype with the highest risk for more severe compared to mild asthma was the obese-and-allergic asthma phenotype (OR 3.34, CI 2.23-5.01, p < 0.001). CONCLUSIONS Allergic-not-obese asthma comprised half of our studied asthma phenotypes, while obesity-related asthma (with or without allergic components) comprised one-fifth of asthma phenotypes in this cohort representative of the US population. Children with both obese and allergic asthma are most likely to have severe asthma. Future management of childhood asthma might consider more tailoring of treatment and management plans based upon different childhood asthma phenotypes.
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Affiliation(s)
- Mindy K Ross
- a University of California, Pediatrics, Pediatric Pulmonology , Los Angeles , California , United States
| | - Tahmineh Romero
- b University of California , Department of Medicine, Statistics Core , Los Angeles , California , United States
| | - Myung S Sim
- b University of California , Department of Medicine, Statistics Core , Los Angeles , California , United States
| | - Peter G Szilagyi
- a University of California, Pediatrics, Pediatric Pulmonology , Los Angeles , California , United States
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Stutz M, Kao RL, Huard L, Grotts J, Sanz J, Ross MK. Associations Between Pediatric Palliative Care Consultation and End-of-Life Preparation at an Academic Medical Center: A Retrospective EHR Analysis. Hosp Pediatr 2018; 8:162-167. [PMID: 29436391 PMCID: PMC7098707 DOI: 10.1542/hpeds.2017-0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Our aim in this study was to understand usage patterns of pediatric palliative care (PPC) consultation and associations with end-of-life preparation among pediatric patients who are deceased. METHODS We reviewed 233 pediatric mortalities. Data extraction from the electronic health record included determination of PPC consultation by using Current Procedural Terminology codes. Diagnoses were identified by International Classification of Disease codes and were classified into categories of life-threatening complex chronic conditions (LT-CCCs). Data analysis included Student's t test, Wilcoxon rank test, Fisher's exact test, χ2 test, and multivariable logistic regression. RESULTS The overall PPC consultation rate for pediatric patients who subsequently died was 24%. A PPC consultation for patients admitted to the pediatric ward and PICU was more likely than for patients cared for in the NICU (31% vs 12%, P < .01) and was more likely for those with an LT-CCC (40% vs 10%, P < .01), particularly malignancy (65% vs 35%, P < .01). Also noted were increased completion of Physician Orders for Life-Sustaining Treatment forms (8 vs 0, P < .01) and increased documentation of mental health disorders (60% vs 40%, P = .02). CONCLUSIONS Our findings suggest that PPC consultation for patients in the pediatric ward and PICU is more likely among patients with a greater number of LT-CCCs, and is associated with increased Physician Orders for Life-Sustaining Treatment preparation and documentation of mental health disorders. Patients at risk to not receive PPC consultation are those with acute illness and patients in the NICU.
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Affiliation(s)
- Matthew Stutz
- Department of Medicine and Pediatrics Residency Program, University of California Los Angeles, Los Angeles, California;
| | - Roy L Kao
- Pediatric Pain and Palliative Care Program
- Divisions of Pediatric Hematology-Oncology
| | | | - Jonathan Grotts
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Javier Sanz
- Biomedical Informatics Program, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
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Ross MK, Doshi A, Carrasca L, Pian P, Auger J, Baker A, Proudfoot JA, Pian MS. Interactive Palliative and End-of-Life Care Modules for Pediatric Residents. Int J Pediatr 2017; 2017:7568091. [PMID: 28286527 PMCID: PMC5329665 DOI: 10.1155/2017/7568091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/21/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022] Open
Abstract
Background. There is a need for increased palliative care training during pediatric residency. Objective. In this pilot study, we created a comprehensive experiential model to teach palliative care skills to pediatric residents. Our Comfort Care Modules (CCMs) address pediatric palliative care (PPC) topics of breaking bad news, dyspnea, anxiety, pain management, and the dying child. We also evaluated a scoring system and gathered qualitative data. Methods. The CCMs are part of the University of California San Diego pediatric residency's second-year curriculum. Comparisons were made for statistical trends between residents exposed to the modules (n = 15) and those not exposed (n = 4). Results. Nineteen of 36 residents (52%) completed surveys to self-rate their preparedness, knowledge, and confidence about PPC before and after the intervention. Resident scores increased in all areas. All improvements reached statistical significance except confidence when breaking bad news. Overall, the resident feedback about the CCMs was positive. Conclusions. This study demonstrates that the CCMs can be performed effectively in an academic setting and can benefit residents' self-perception of preparedness, confidence, and knowledge about pediatric palliative care. In the future, we plan to implement the modules on a larger scale. We encourage their use in interprofessional settings and across institutions.
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Affiliation(s)
- Mindy K. Ross
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ami Doshi
- Division of Hospitalist Medicine, UCSD, Rady Children's Hospital, San Diego, CA, USA
| | | | | | | | - Amira Baker
- Division of Pediatric Infectious Disease, UCLA, Los Angeles, CA, USA
- Department of Pediatrics, UCSD, Rady Children's Hospital, San Diego, CA, USA
| | | | - Mark S. Pian
- Pediatrics, UCSD School of Medicine, San Diego, CA, USA
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Muro SM, Lee JH, Stokes JV, Ross MK, Archer TM, Wills RW, Mackin AJ, Thomason JM. Effects of Leukoreduction and Storage on Erythrocyte Phosphatidylserine Expression and Eicosanoid Concentrations in Units of Canine Packed Red Blood Cells. J Vet Intern Med 2017; 31:410-418. [PMID: 28140476 PMCID: PMC5354049 DOI: 10.1111/jvim.14664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/14/2016] [Accepted: 01/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Storage of canine packed red blood cells (pRBCs) can increase erythrocyte phosphatidylserine (PS) expression and eicosanoid concentrations. Hypothesis/Objectives To determine the effects of leukoreduction on erythrocyte PS expression and eicosanoid concentrations in stored units of canine pRBCs. Our hypothesis was that leukoreduction would decrease PS expression and eicosanoid concentrations. Animals Eight healthy dogs. Methods In a cross‐over study, units of whole blood were leukoreduced (LR) or non‐LR and stored (10 and 21 days) as pRBCs. Samples were collected at donation, and before and after a simulated transfusion. PS expression was measured by flow cytometry, and concentrations of arachidonic acid (AA), prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), prostaglandin D2 (PGD2), thromboxane B2 (TXB2), 6‐keto‐prostaglandin F1α (6‐keto‐PGF1α), and leukotriene B4 (LTB4) were quantified by liquid chromatography–mass spectrometry. Results There was no change in PS expression during leukoreduction, storage, and simulated transfusion for non‐LR and LR units. Immediately after leukoreduction, there was a significant increase in TXB2 and PGF2α concentrations, but during storage, these eicosanoids decreased to non‐LR concentrations. In both LR and non‐LR units, 6‐keto‐PGF1α concentrations increased during storage and simulated transfusion, but there was no difference between unit type. There was no difference in AA, LTB4, PGE2, and PGD2 concentrations between unit types. Conclusions and Clinical Importance Leukoreduction, storage, and simulated transfusion do not alter erythrocyte PS expression. Leukoreduction causes an immediate increase in concentrations of TXB2 and PGF2α, but concentrations decrease to non‐LR concentrations with storage. Leukoreduction does not decrease the accumulation of 6‐keto‐PGF1α during storage.
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Affiliation(s)
- S M Muro
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - J H Lee
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - J V Stokes
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - M K Ross
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - T M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - R W Wills
- Department of Pathobiology and Population Medicine (Wills), College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - A J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - J M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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Abstract
OBJECTIVES Implementation of Electronic Health Record (EHR) systems continues to expand. The massive number of patient encounters results in high amounts of stored data. Transforming clinical data into knowledge to improve patient care has been the goal of biomedical informatics professionals for many decades, and this work is now increasingly recognized outside our field. In reviewing the literature for the past three years, we focus on "big data" in the context of EHR systems and we report on some examples of how secondary use of data has been put into practice. METHODS We searched PubMed database for articles from January 1, 2011 to November 1, 2013. We initiated the search with keywords related to "big data" and EHR. We identified relevant articles and additional keywords from the retrieved articles were added. Based on the new keywords, more articles were retrieved and we manually narrowed down the set utilizing predefined inclusion and exclusion criteria. RESULTS Our final review includes articles categorized into the themes of data mining (pharmacovigilance, phenotyping, natural language processing), data application and integration (clinical decision support, personal monitoring, social media), and privacy and security. CONCLUSION The increasing adoption of EHR systems worldwide makes it possible to capture large amounts of clinical data. There is an increasing number of articles addressing the theme of "big data", and the concepts associated with these articles vary. The next step is to transform healthcare big data into actionable knowledge.
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Affiliation(s)
- M K Ross
- Lucila Ohno-Machado, Division of Biomedical Informatics, 9500 Gilman Drive, MC 0505, La Jolla, California, 92037-0505, USA, Tel: +1 858 822 4931, E-mail:
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Ross MK, Ellis LS, Bird LM, Hagood JS. Pulmonary interstitial glycogenosis in a patient ultimately diagnosed with Noonan syndrome. Pediatr Pulmonol 2014; 49:508-11. [PMID: 24039098 DOI: 10.1002/ppul.22871] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/29/2013] [Indexed: 11/10/2022]
Abstract
We describe an infant prenatally diagnosed with hydrops fetalis ultimately found to have Noonan syndrome (NS). Prior to genetic confirmation of diagnosis, lung biopsy was performed which revealed widespread pulmonary interstitial glycogenosis (PIG), abnormal alveolarization, and mild inflammation. Although genetic alterations have been identified in NS, the mutations are heterogeneous and the diagnosis remains one of clinical suspicion. The combination of PIG and NS has not yet been documented in the literature. While the underlying pathophysiologic mechanism of PIG is unclear, we suggest that the mitogen-activated protein kinase signal transduction pathway members (PTPN11, KRAS, SOS1, RAF1, SHOC2, NRAS) involved in cellular growth factor signaling, which are affected in NS, can provide clues. In addition, this case demonstrates that empiric corticosteroids can be considered in complicated cases since biopsy did reveal an inflammatory component, not typically noted in PIG.
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Affiliation(s)
- Mindy K Ross
- Division of Pediatric Respiratory Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California
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Haraschak JL, Langston VC, Wang R, Riggs C, Fellman C, Ross MK, Bulla C, Lunsford K, Mackin A, Archer T. Pharmacokinetic evaluation of oral dantrolene in the dog. J Vet Pharmacol Ther 2013; 37:286-94. [PMID: 24219828 DOI: 10.1111/jvp.12089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022]
Abstract
The pharmacokinetics of dantrolene and its active metabolite, 5-hydroxydantrolene, after a single oral dose of either 5 or 10 mg/kg of dantrolene was determined. The effects of exposure to dantrolene and 5-hydroxydantrolene on activated whole-blood gene expression of the cytokines interleukin-2 (IL-2) and interferon-γ (IFN-γ) were also investigated. When dantrolene was administered at a 5 mg/kg dose, peak plasma concentration (Cmax ) was 0.43 μg/mL, terminal half-life (t1/2 ) was 1.26 h, and area under the time-concentration curve (AUC) was 3.87 μg·h/mL. For the 10 mg/kg dose, Cmax was 0.65 μg/mL, t1/2 was 1.21 h, and AUC was 5.94 μg·h/mL. For all calculated parameters, however, there were large standard deviations and wide ranges noted between and within individual dogs: t1/2 , for example, ranged from 0.43 to 6.93 h, Cmax ratios ranged from 1.05 to 3.39, and relative bioavailability (rF) values ranged from 0.02 to 1.56. While activated whole-blood expression of IL-2 and IFN-γ as measured by qRT-PCR was markedly suppressed following exposure to very high concentrations (30 and 50 μg/mL, respectively) of both dantrolene and 5-hydroxydantrolene, biologically and therapeutically relevant suppression of cytokine expression did not occur at the much lower drug concentrations achieved with oral dantrolene dosing.
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Affiliation(s)
- J L Haraschak
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
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Doan S, Lin KW, Conway M, Ohno-Machado L, Hsieh A, Feupe SF, Garland A, Ross MK, Jiang X, Farzaneh S, Walker R, Alipanah N, Zhang J, Xu H, Kim HE. PhenDisco: phenotype discovery system for the database of genotypes and phenotypes. J Am Med Inform Assoc 2013; 21:31-6. [PMID: 23989082 PMCID: PMC3912702 DOI: 10.1136/amiajnl-2013-001882] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The database of genotypes and phenotypes (dbGaP) developed by the National Center for Biotechnology Information (NCBI) is a resource that contains information on various genome-wide association studies (GWAS) and is currently available via NCBI's dbGaP Entrez interface. The database is an important resource, providing GWAS data that can be used for new exploratory research or cross-study validation by authorized users. However, finding studies relevant to a particular phenotype of interest is challenging, as phenotype information is presented in a non-standardized way. To address this issue, we developed PhenDisco (phenotype discoverer), a new information retrieval system for dbGaP. PhenDisco consists of two main components: (1) text processing tools that standardize phenotype variables and study metadata, and (2) information retrieval tools that support queries from users and return ranked results. In a preliminary comparison involving 18 search scenarios, PhenDisco showed promising performance for both unranked and ranked search comparisons with dbGaP's search engine Entrez. The system can be accessed at http://pfindr.net.
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Affiliation(s)
- Son Doan
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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Ross MK, Lin KW, Truong K, Kumar A, Conway M. Text Categorization of Heart, Lung, and Blood Studies in the Database of Genotypes and Phenotypes (dbGaP) Utilizing n-grams and Metadata Features. Biomed Inform Insights 2013; 6:35-45. [PMID: 23926434 PMCID: PMC3728208 DOI: 10.4137/bii.s11987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The database of Genotypes and Phenotypes (dbGaP) allows researchers to understand phenotypic contribution to genetic conditions, generate new hypotheses, confirm previous study results, and identify control populations. However, effective use of the database is hindered by suboptimal study retrieval. Our objective is to evaluate text classification techniques to improve study retrieval in the context of the dbGaP database. We utilized standard machine learning algorithms (naive Bayes, support vector machines, and the C4.5 decision tree) trained on dbGaP study text and incorporated n-gram features and study metadata to identify heart, lung, and blood studies. We used the χ(2) feature selection algorithm to identify features that contributed most to classification performance and experimented with dbGaP associated PubMed papers as a proxy for topicality. Classifier performance was favorable in comparison to keyword-based search results. It was determined that text categorization is a useful complement to document retrieval techniques in the dbGaP.
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Affiliation(s)
- Mindy K Ross
- Department of Pediatrics, Division of Respiratory Medicine, University of California, San Diego, USA. ; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, USA
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Ross MK, Turner S, Ibbetson RJ. The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (2) dental technicians. Br Dent J 2012; 213:E13. [PMID: 23099723 DOI: 10.1038/sj.bdj.2012.958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the impact of General Dental Council (GDC) registration and mandatory CPD on dental technicians' views, job satisfaction and intention to leave the profession. DESIGN Postal/online survey, conducted in parallel with a survey of dental nurses. SETTING UK private and NHS practices, community services, dental hospitals. SUBJECTS AND METHODS Representative sample of GDC registrants. MAIN OUTCOME MEASURES job satisfaction; intention to leave profession (dependent variable in regression analysis). RESULTS 605 were sampled: 40 were ineligible (left the register in July 2011, re-qualified in another dental care profession, shared a practice address with another selected DT); 193 responded (response rate 34%). 22% were female (mean age 38.2 years) and 78% male (mean age 49.4 years). The general principle of registration was endorsed by 52%, and compulsory registration by 54%, but the fee level by only 13%. Most technicians felt that registration had had either no effect or a negative effect on their view of their career (80%), role (78%) or status within the dental team (85%), and 66% did not agree that training helped them to do their job better. Fifty-one percent were not satisfied with their job and 20% intended to leave the profession. Intention to leave was predicted by greater dissatisfaction with remuneration. CONCLUSIONS Criticisms regarding the cost and relevance of registration and the cost, relevance and accessibility of CPD, coupled with potentially high level of attrition from the profession, suggest a review of the fee and salary structure and greater support for CPD is warranted.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, University of Edinburgh, 4th Floor, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK.
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Arnold JC, Cannavino CR, Ross MK, Westley B, Miller TC, Riffenburgh RH, Bradley J. Acute bacterial osteoarticular infections: eight-year analysis of C-reactive protein for oral step-down therapy. Pediatrics 2012; 130:e821-8. [PMID: 22966033 DOI: 10.1542/peds.2012-0220] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND One of the most important decisions in the treatment of osteoarticular infections is the time at which parenteral therapy can be changed to oral therapy. C-reactive protein (CRP) is an acute inflammatory indicator with a half-life of 19 hours and thus can be helpful in assessing the adequacy of therapy for bacterial infections. At our institution, a combination of CRP and clinical findings is used to determine the transition to oral therapy. METHODS A search of 8 years of electronic records identified children with osteoarticular infections. Only children with culture-positive acute bacterial arthritis (ABA) or acute bacterial osteomyelitis (ABO) were studied further. A primary chart review of demographic and clinical data was conducted, and a secondary chart review of complicated outcomes was performed. RESULTS Of 194 total patients, complicated outcomes occurred in 40, of which 35 were prolonged therapy. Only 1 microbiologic failure occurred, presumably due to a retained intra-articular fragment of infected bone. CRP was highest initially among patients with simultaneous ABO + ABA and among those with complicated outcomes, and was lower at the transition to oral therapy in the complicated outcome group (1.5 vs 2.1 mg/dL; P = .012). CONCLUSIONS The combination of clinical findings and CRP is a useful tool to transition children with osteoarticular infections to oral therapy. Complicated outcomes were associated with higher early CRP at diagnosis and lower CRP at the end of parenteral therapy, suggesting that clinicians were more conservative with prolonged initial parenteral therapy in this group.
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Affiliation(s)
- John C Arnold
- Department of Pediatrics, Division of Infectious Diseases, Naval Medical Center, San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
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Abstract
BACKGROUND UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. DESIGN A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. SETTING Starting Well project, Glasgow, UK. PREDICTORS Health visitor rating of family needs. MAIN OUTCOME MEASURES Families receiving high visiting rates or referred to social work services. RESULTS Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. CONCLUSIONS Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.
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Affiliation(s)
- C M Wright
- PEACH Unit, Faculty of Medicine, University of Glasgow, Glasgow, UK.
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Ross MK, Ibbetson RJ, Turner S. The acceptability of dually-qualified dental hygienist-therapists to general dental practitioners in South-East Scotland. Br Dent J 2007; 202:E8; discussion 146-7. [PMID: 17256012 DOI: 10.1038/bdj.2007.45] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 11/09/2022]
Abstract
AIMS Recent UK legislation allows dental therapists or jointly-qualified dental hygienist-therapists to work in the general dental service. This study aimed to investigate the extent of dentists' knowledge of the clinical remit of jointly qualified hygienist-therapists, their willingness to consider employing such a professional, and factors associated with these two measures. MATERIALS AND METHODS A postal questionnaire was sent to 616 NHS-registered dentists in South-East Scotland. Analysis and classification of responses to open-ended questions used standard non-parametric statistical tests and quantitative techniques. RESULTS Following two mailings, a 50% (n = 310) response rate was obtained. A total of 65% of dentists worked in a practice employing a dental hygienist, while only 2% employed a dental therapist. Hygienists tended to work in larger practices. Dentists' knowledge of the clinical remit of the dually-qualified hygienist-therapist was found to be limited, reflecting a restricted and inaccurate view of the professional remit of a hygienist-therapist. The majority (64%) said they would consider employing a hygienist-therapist in their practice, rising to 72% amongst dentists already working with a hygienist. Reasons given by dentists who were negative about this prospect were sought. Those who worked with a hygienist tended to refer to lack of physical space, whilst those who did not tended to cite reservations on clinical skills, competence and responsibilities, or on the costs involved. CONCLUSIONS This study identified considerable ignorance and negativity among dentists about the nature and clinical remit of this group of professionals. Dually-qualified hygienist-therapists will be in a position to treat much of the routine disease that exists within the population, and dentists may benefit from education in relation to the substantial contribution these individuals could potentially make to patient care.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, The University of Edinburgh, Lauriston Place, Edinburgh, UK.
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Abstract
OBJECTIVE To investigate the educational needs and employment status of dental nurses in Scotland. SUBJECTS One thousand, seven hundred and thirty dental nurses with postal addresses in Scotland. DESIGN Structured questionnaire. RESULTS A 65% response rate was achieved following three mailings. The majority of respondents were employed in the central belt of Scotland although comparatively, substantial numbers were also recorded as being employed in Highland and Grampian regions. A total of 70% of dental nurses stated they were in full-time employment, with 74% of all participants reporting they were qualified. Of those who were unqualified, 17% (n = 191) were not in the process of formal training which may mean they are unable to work in the future, unless they conform to the GDC 'grandparenting' requirements. Induction training had only been received by 34% (n = 377) of this group, and a mere 21% (n = 234) reported regular CPD involvement. Of the 75% (n = 832) who responded to a question on funding for CPD, only 50% (412) received financial assistance. Geographical location for many nurses generated a number of difficulties in accessing education, and the possibility of distance or e-learning was requested by 65% of the sample. CONCLUSIONS This study demonstrates clearly that there are many well-qualified dental nurses in employment in Scotland. However, unless structured career pathways are developed, access to education is simplified, and the problem of poor remuneration is addressed, then foreseeable problems may arise where there is insufficient enticement to encourage people to join what is an already underpopulated profession.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, The University of Edinburgh, 4th Floor, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK.
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Abstract
OBJECTIVE To investigate the educational needs and employment status of dental technicians in Scotland. SUBJECTS Two hundred and fifty dental technicians with postal addresses in Scotland. DESIGN Structured questionnaire. RESULTS An 83% response rate was achieved following three mailings. The majority of respondents were employed in commercial dental laboratories largely within the 'central belt' of Scotland, with 96% stating they were in full-time employment. Only 33% of these essential health-care workers were voluntarily registered with the Dental Technicians' Association, suggesting that a significant number had not felt it necessary or beneficial to do so. A lack of educational structure was identified, as was poor remuneration and an absence of opportunity for career progression. Although the prospect of continuing professional development was desirable, many respondents reported that they would be penalised financially for undertaking this and, in addition, may not be given the opportunity to pursue education because of lack of co-operation from their employer. Only 47% had attended an educational event within the preceding year, and of those who had not done this, a period of two-32 years had elapsed since any CPD involvement. Of the respondents, only 34% stated that any financial assistance had been available for educational purposes, with access to education being highlighted as problematic by 68%. A total of 64% of subjects felt they were out-of-date with professional education. CONCLUSIONS This study highlights a number of real and potential problems in the field of education in dental technology. It is apparent that change within the structure of education and professional status, although largely welcomed, may be difficult to implement. The profession, as a whole, must realise that these changes in education and employment are not optional, and should be embraced as a positive step which will hopefully raise the profile and status of dental technicians throughout the UK.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, The University of Edinburgh, Edinburgh.
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Holtzapple MT, Davison RR, Ross MK, Albrett-Lee S, Nagwani M, Lee CM, Lee C, Adelson S, Kaar W, Gaskin D, Shirage H, Chang NS, Chang VS, Loescher ME. Biomass conversion to mixed alcohol fuels using the MixAlco process. Appl Biochem Biotechnol 2005; 77-79:609-31. [PMID: 15304682 DOI: 10.1385/abab:79:1-3:609] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The MixAlco process is a patented technology that converts any biodegradable material (e.g., sorted municipal solid waste, sewage sludge, industrial biosludge, manure, agricultural residues, energy crops) into mixed alcohol fuels containing predominantly 2-propanol, but also higher alcohols up to 7-tridecanol. The feedstock is treated with lime to increase its digestibility. Then, it is fed to a fermentor in which a mixed culture of acid-forming microorganisms produces carboxylic acids. Calcium carbonate is added to the fermentor to neutralize the acids to their corresponding carboxylate salt. The dilute (approximately 3%) carboxylate salts are concentrated to 19% using an amine solvent that selectively extracts water. Drying is completed using multi-effect evaporators. Finally, the dry salts are thermally converted to ketones which subsequently are hydrogenated to alcohols. All the steps in the MixAlco process have been proven at the laboratory scale. A techno-economic model of the process indicates that with the tipping fees available in New York (126 dollars/dry tonne), mixed alcohol fuels may be sold for 0.04 dollars/L (0.16 dollars/gal) with a 60% return on investment (ROI). With the average tipping fee in the United States rates (63 dollars/dry tonne), mixed alcohol fuels may be sold for 0.18 dollars/L (0.69 dollars/gal) with a 15% ROI. In the case of sugarcane bagasse, which may be obtained for about 26 dollars/dry ton, mixed alcohol fuels may be sold for 0.29 dollars/L (1.09 dollars/gal) with a 15% ROI.
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Affiliation(s)
- M T Holtzapple
- Department of Chemical Engineering, Texas A&M University, College Station, TX 77843-3122, USA.
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Ross MK, Ibbetson RJ, Rennie JS. Educational needs and employment status of Scottish dental hygienists. Br Dent J 2005; 198:105-9. [PMID: 15702110 DOI: 10.1038/sj.bdj.4811981] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 01/15/2004] [Indexed: 11/08/2022]
Abstract
AIMS AND OBJECTIVES To investigate the educational needs and employment status of registered dental hygienists in Scotland. SUBJECTS Three hundred and eighty one registered dental hygienists with postal addresses in Scotland. DESIGN Structured questionnaire. RESULTS A 76% response rate was achieved following two mailings. Of the respondents, 43% were in full-time employment albeit in more than one setting, mostly in the 'central belt' of Scotland. It was reported that 41% were employed in general dental practice with both NHS and private lists and 39% worked in a purely private setting. The introduction of extended clinical duties had been well received and 59% of subjects were interested in additional training in dental therapy, should this become available. Absence of funding for CPD was raised repeatedly, with only 41% reporting a degree of financial assistance. Greater accessibility to continuing education via distance learning, particularly in remote and rural settings, was requested by 73% of hygienists. CONCLUSIONS This study identifies a number of issues in relation to this increasingly important group of healthcare professionals, which will inform the providers of oral healthcare. Although hygienists' involvement in CPD was commendable, results indicated that despite commitment to their profession, respondents did not always feel respected in terms of their employment status or support for continuing professional development.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, The University of Edinburgh, 4th Floor, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA.
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Abstract
The role of professionals complementary to dentistry (PCDs) has changed radically in recent times and further changes are likely in the foreseeable future. The modernisation of dentistry throughout the UK dictates that the existing workforce takes into account the substantial contribution which can be made by PCDs in addressing the unacceptable levels of disease which exist in many parts of the country.
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Affiliation(s)
- M K Ross
- Edinburgh Postgraduate Dental Institute, 4th Floor Lauriston Building, Lauriston Place, Edinburgh EH3 9HA.
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McVea J, Ross MK, de Caestecker L, Milne D, McEwen A, Rees N, Wilkie L, Morton C. The national health demonstration projects. Health Bull (Edinb) 2001; 59:268-75. [PMID: 12664738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The White Paper Towards a Healthier Scotland pledged 15 million Pounds to support four national health demonstration projects to lead the way in achieving sustained improvement in child health, young people's sexual health, coronary heart disease and cancer. The Starting Well project aims to demonstrate that child health in Glasgow can be improved by a programme of activities which both supports families and provides them with access to enhanced community-based resources. The Healthy Respect project aims to help young people in Lothian develop a positive attitude to their own sexuality and that of others, and a healthy respect for their partners, in order to reduce unplanned teenage pregnancies and sexually transmitted infections. The Have a Heart Paisley project is targeting coronary heart disease among the population of Scotland's largest town. The Cancer Challenge project is piloting a screening programme in the North East of Scotland for the detection of colorectal cancer. Though each project has specific objectives, appropriate to its own topic, all share underlying principles. The projects will act as test beds for action and a learning resource for the rest of Scotland.
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Affiliation(s)
- J McVea
- Scottish Executive Health Department, Greater Glasgow Health Board
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Abstract
Equipment and procedures were developed to study the conversion of lignocellulosic biomass to carboxylic acids using high-solids countercurrent fermentations. Countercurrent fermentations of cattle manure yielded a rapid fermentation (maximum 2.98 g of total acid/[L x d]) with high acid concentrations (maximum of 32.5 g of total acid/L), but the acid yield tended to be low (maximum of 0.24 g of total acid/g of volatile solids). Countercurrent fermentations of a mixture of 80% municipal solid waste/20% sewage sludge fermented more slowly (maximum of 1.98 g of total acid/[L x d]) with a lower acid concentration (maximum of 26.5 g of total acids/L), but higher acid yields were achieved (maximum of 0.34 g of total acid/g of volatile solids).
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Affiliation(s)
- M K Ross
- Department of Chemical Engineering, Texas A&M University, College Station 77843-3122, USA
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48
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Abstract
Modulation of DNA adduct formation by pre-existing adducts was examined in synthetic oligonucleotides and genomic DNA (calf thymus); genotoxins studied were N-acetoxy-acetylaminofluorene (N-AcO-AAF), aminofluorene (AF), aflatoxin B1-8,9-epoxide (AFB1-8,9-epoxide), and dimethylsulfate (DMS). Oligodeoxynucleotides containing either guanine-C8-AAF (Gua-C8-AAF) or Gua-C8-AF adducts and a neighboring unadducted guanine (G) (target G), located 1, 2, or 4 nucleotides from the adduct, were reacted, as single- (ss) or double-stranded (ds) substrates, with dimethylsulfate (DMS) or AFB1-8,9-epoxide. A modified Maxam-Gilbert technique showed that the presence of the AAF adduct lowered the extent to which AFB1-8,9-epoxide, but not DMS, reacted with target G. Binding of AFB1-8,9-epoxide to the target G was attenuated (> or =5-fold) when the target was located immediately adjacent to an AAF, but not AF, adduct in ds-DNA. Reaction with AFB1-8,9-epoxide increased when the target G was located 2 or 4 nucleotides from the AAF adduct. Pretreatment of calf thymus DNA with AAF (0-1.8% nucleotides modified) reduced levels of Gua-N7-AFB1 adducts formed after subsequent treatment with AFB1-8,9-epoxide. Pretreatment of calf thymus DNA with AFB1 did not alter levels of adducts formed after subsequent treatment with N-AcO-AAF. The supposition that aflatoxin B1-binding to DNA may be altered by conformational changes in the helix, due to the presence of a pre-existing AAF adduct, is supported by the absence of an effect by AF and confirmation of local denaturation of the oligomer helix by use of chemical probes hydroxylamine and diethylpyrocarbonate. Nonetheless, the importance of changes in the nucleophilicity of neighboring nucleotides and local steric effects cannot be ruled out.
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Affiliation(s)
- M K Ross
- Department of Community and Environmental Medicine, University of California at Irvine, 92697-1820, USA
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Said B, Ross MK, Hamade AK, Matsumoto DC, Shank RC. DNA-damaging effects of genotoxins in mixture: nonadditive effects of aflatoxin B1 and N-acetylaminofluorene on their mutagenicity in Salmonella typhimurium. Toxicol Sci 1999; 52:226-31. [PMID: 10630575 DOI: 10.1093/toxsci/52.2.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Most animal genotoxicity studies have used exposures to single chemicals; humans, however, are potentially exposed to mixtures of genotoxins. Cancer and developmental toxicity risks associated with genotoxins in mixture are generally estimated by assuming additivity of the components. Two or more genotoxins acting sequentially or simultaneously may present a greater or lesser hazard than that predicted by simple addition of their potencies. Previously, we studied the effect of one genotoxin on the binding of a second genotoxin to DNA in an in vitro system and demonstrated that consecutive binding of the two toxins was not additive. In the present study, the effect of one genotoxin on the mutagenicity of another was evaluated for two well-known genotoxins using the Salmonella assay. Pretreatment of frameshift strains TA98 and TA1538 with AFB1-8,9-epoxide (17.3 ng/plate) enhanced the mutagenicity induced by subsequent exposure to N-acetoxy-acetylaminofluorene (N-AcO-AAF) approximately 2-3 times above theoretical values for additivity. Pretreatment of base-substitution strain TA100 with N-AcO-AAF (0.1 microg/plate) inhibited the mutagenicity following subsequent exposure to AFB1-8,9-epoxide by 3 times below the theoretical additive value. Concentration-response relationships for these enhancing or inhibitory effects were demonstrated using increasing concentrations of the first genotoxin during pretreatment. These results demonstrate effects, other than additive, of sequential exposures to two genotoxins on the induction of mutations in a bacterial system.
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Affiliation(s)
- B Said
- Department of Community and Environmental Medicine, College of Medicine, University of California at Irvine, 92697-1820, USA
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Ross MK, Mathison BH, Said B, Shank RC. 5-Methylcytosine in CpG sites and the reactivity of nearest neighboring guanines toward the carcinogen aflatoxin B1-8,9-epoxide. Biochem Biophys Res Commun 1999; 254:114-9. [PMID: 9920742 DOI: 10.1006/bbrc.1998.9895] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The reactivity of guanines in an oligonucleotide containing mutational hot spots within the p53 gene (codons 248 and 249), 5'-CCG1G2AG3G4CCCA-3', toward dimethyl sulfate (DMS) and aflatoxin B1-8,9-epoxide (AFB1-8,9-epoxide) was investigated by a modified Maxam-Gilbert technique. 5-Methylcytosine in the CpG site of codon 248 did not appear to modulate the reactivity of target guanines G1, G2, G3, and G4 toward either genotoxin when compared to the sequence containing a nonmethylated CpG site. A similar experiment was conducted in which a 0.5-kb fragment of the human HPRT gene containing exon 1 and several CpG sites was treated with UV-activated aflatoxin B1. Results showed that guanine adduct formation was independent of the methylation status of the CpG site. These findings are discussed in relation to other studies that have shown that cytosine methylation has an inhibiting effect, an enhancing effect, or no effect on adduct formation with nearby guanine nucleotides.
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Affiliation(s)
- M K Ross
- Department of Community and Environmental Medicine, University of California, Irvine, Irvine, California, 92697-1825, USA
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