Increasing Human Papillomavirus Vaccination in a Federally Qualified Health Center Organization Using a Systems-Based Intervention Integrating EHR and Statewide Immunization Information System.

Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates.During the intervention, 8960 patients (11-16 yo) were followed, with 48.8% girls (n = 4370) and 51.2% boys (n = 4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.

The use of actigraphy to objectively define motion and function before and after shoulder arthroplasty.

Introduction: Actigraphy is a quantitative means of measuring activity data that has proven viable in post-surgery recovery analysis for arthroplasties in lower extremities, but scant literature has been published on the utilization actigraphy to evaluate shoulder motion and function before and after shoulder arthroplasty. The purpose of this prospective cohort study is to identify if actigraphy can serve as a valid means for objective evaluation of shoulder function and motion before and after shoulder arthroplasty. Secondarily, the data collected by the actigraphy can be analyzed with standard patient-reported outcomes to report correlations between the subjective and objective methods used in this study. Materials and methods: Sixty-four subjects wore an actigraphy device for one day at pre-op, six, twelve and twenty-four weeks. In addition, subjects completed three patient-reported outcome surveys at each time-point. Student t-tests were used to compare percent activity preoperatively with 24-weeks and to compare PROs preoperatively with 24-week results; categorical variables were compared with one-way ANOVAs. Results: All Patient reported outcome scores significantly improved following arthroplasty (p-value<0.001). The percent of physical activity was highly correlated with vector magnitude (p-value<0.001), but neither percent activity or the vector magnitude were correlated with any of the PROs: UCLA Pain p-value = 0.656, SANE p-value = 0.328, UCLA Function p-value = 0.532. Conclusions: Actigraphy results from this study mirror findings in previous literature utilizing the technology in similar manners and demonstrate its potential for motion and function analysis before and after total shoulder arthroplasties. Despite both being suitable methods independently for the evaluation of shoulder function, there was no significant correlation between standard actigraphy measurements and PROs at 24-weeks. Future research to determine clinical utility and an overall broader scope for actigraphy monitoring could benefit from improved technology, such as increased battery life for prolonged durations of data collection during observation periods.

Dry-EEG Manifestations of Acute and Insidious Hypoxia During Simulated Flight.

INTRODUCTION: Recently, portable dry electroencephalographs (dry-EEGs) have indexed cognitive workload, fatigue, and drowsiness in operational environments. Using this technology this project assessed whether significant changes in brainwave frequency power occurred in response to hypoxic exposures as experienced in military aviation.METHODS: There were 60 (30 women, 30 men) student Naval Aviators or Flight Officers who were exposed to an intense (acute) high-altitude (25,000 ft) normobaric hypoxic exposure, and 20 min later, more gradual (insidious) normobaric hypoxic exposure up to 20,000 ft while flying a fixed-wing flight simulation and monitored with a dry-EEG system. Using MATLAB, EEG frequencies and power were quantified and analyzed. Cognitive performance was also assessed with a cognitive task validated under hypoxia. Normobaric hypoxia and O2 saturation (Spo2) were produced and monitored using the Reduced Oxygen Breathing Device (ROBD2).RESULTS: Significant Spo2 decreases were recorded at acute 25K and insidious 20K simulated altitudes. Significant power decreases were recorded in all frequencies (alpha, beta, gamma, and theta) and all channels with acute 25K exposures. Gamma, beta, and theta frequency power were significantly decreased with insidious 20K exposures at most of the channels. The frequency power decreases corresponded to significant decreases in cognitive performance and flight performance. Most importantly, frequency power suppressions occurred despite 42% of the volunteers not perceiving they were hypoxic in the acute phase, nor 20% in the insidious phase.DISCUSSION: Results suggest EEG suppression during acute/insidious hypoxia can index performance decrements. These findings have promising implications in the development of biosensors that mitigate potential in-flight hypoxic physiological episodes.Rice GM, Snider D, Drollinger S, Greil C, Bogni F, Phillips J, Raj A, Marco K, Linnville S. Dry-EEG manifestations of acute and insidious hypoxia during simulated flight. Aerosp Med Hum Perform. 2019; 90(2):92-100.

Gender Differences in Dry-EEG Manifestations During Acute and Insidious Normobaric Hypoxia.

INTRODUCTION: Prior research suggests there may be gender differences with regards to hypoxia resilience. Our study was designed to determine whether there were differences between genders in neuronal electrical activity at simulated altitude and whether those changes correlated with cognitive and aviation performance decrements.METHODS: There were 60 student Naval Aviators or Flight Officers who completed this study (30 women, 30 men). Participants were exposed to increasing levels of normobaric hypoxia and monitored with dry EEG while flying a fixed-base flight simulation. Gender differences in brainwave frequency power were quantified using MATLAB. Changes in flight and cognitive performance were analyzed via simulation tasks and with a cognitive test validated under hypoxia.RESULTS: Significant decreases in theta and gamma frequency power occurred for women compared to men with insidious hypoxic exposures to 20K, with an average frequency power decrease for women of 19.4% compared to 9.3% for men in theta, and a 42.2% decrease in gamma for women compared to 21.7% for men. Beta frequency power correlated highest between genders, with an average correlation coefficient of r = 0.95 across seven channels.DISCUSSION: Results of this study suggest there is identifiable brain wave suppression for both men and women with hypoxic exposure and, moreover, there are significant differences in this suppression between genders. Beta frequency power was most sensitive for both genders and highly correlative compared to other brainwave frequencies. The implications of these findings are important considerations for next-generation aviation helmets, which may employ this technology as an early warning mechanism.Rice GM, Snider D, Drollinger S, Greil C, Bogni F, Phillips J, Raj A, Marco K, Linnville S. Gender differences in dry-EEG manifestations during acute and insidious normobaric hypoxia. Aerosp Med Hum Perform. 2019; 90(4):369-377.

Development of a Web-Based Registry to Support Diabetes Care in Free Medical Clinics.

The United States has more than 1,000 free medical clinics. Because these clinics do not bill Medicare or Medicaid, they are not eligible for federal reimbursement for electronic health record (EHR) adoption. As a result, most do not have EHRs or electronic disease registries. A web-based diabetes registry was created with all open-source components for use in an urban free clinic to manage patients with type 2 diabetes and comorbidities. The registry was modeled after the Chronic Disease Electronic Management System and recommendations of the American Diabetes Association. The software was enhanced to include multiple other features, such as progress notes, so that it can function as a simple EHR. The configuration permits other free clinics to join securely, and the software can be shared.

IBM Watson Analytics: Automating Visualization, Descriptive, and Predictive Statistics.

BACKGROUND: We live in an era of explosive data generation that will continue to grow and involve all industries. One of the results of this explosion is the need for newer and more efficient data analytics procedures. Traditionally, data analytics required a substantial background in statistics and computer science. In 2015, International Business Machines Corporation (IBM) released the IBM Watson Analytics (IBMWA) software that delivered advanced statistical procedures based on the Statistical Package for the Social Sciences (SPSS). The latest entry of Watson Analytics into the field of analytical software products provides users with enhanced functions that are not available in many existing programs. For example, Watson Analytics automatically analyzes datasets, examines data quality, and determines the optimal statistical approach. Users can request exploratory, predictive, and visual analytics. Using natural language processing (NLP), users are able to submit additional questions for analyses in a quick response format. This analytical package is available free to academic institutions (faculty and students) that plan to use the tools for noncommercial purposes. OBJECTIVE: To report the features of IBMWA and discuss how this software subjectively and objectively compares to other data mining programs. METHODS: The salient features of the IBMWA program were examined and compared with other common analytical platforms, using validated health datasets. RESULTS: Using a validated dataset, IBMWA delivered similar predictions compared with several commercial and open source data mining software applications. The visual analytics generated by IBMWA were similar to results from programs such as Microsoft Excel and Tableau Software. In addition, assistance with data preprocessing and data exploration was an inherent component of the IBMWA application. Sensitivity and specificity were not included in the IBMWA predictive analytics results, nor were odds ratios, confidence intervals, or a confusion matrix. CONCLUSIONS: IBMWA is a new alternative for data analytics software that automates descriptive, predictive, and visual analytics. This program is very user-friendly but requires data preprocessing, statistical conceptual understanding, and domain expertise.

Wearable Accelerometers in High Performance Jet Aircraft.

INTRODUCTION: Wearable accelerometers have become ubiquitous in the fields of exercise physiology and ambulatory hospital settings. However, these devices have yet to be validated in extreme operational environments. The objective of this study was to correlate the gravitational forces (G forces) detected by wearable accelerometers with the G forces detected by high performance aircraft. METHODS: We compared the in-flight G forces detected by the two commercially available portable accelerometers to the F/A-18 Carrier Aircraft Inertial Navigation System (CAINS-2) during 20 flights performed by the Navy's Flight Demonstration Squadron (Blue Angels). Postflight questionnaires were also used to assess the perception of distractibility during flight. RESULTS: Of the 20 flights analyzed, 10 complete in-flight comparisons were made, accounting for 25,700 s of correlation between the CAINS-2 and the two tested accelerometers. Both accelerometers had strong correlations with that of the F/A-18 Gz axis, averaging r = 0.92 and r = 0.93, respectively, over 10 flights. Comparison of both portable accelerometer's average vector magnitude to each other yielded an average correlation of r = 0.93. Both accelerometers were found to be minimally distracting. DISCUSSION: These results suggest the use of wearable accelerometers is a valid means of detecting G forces during high performance aircraft flight. Future studies using this surrogate method of detecting accelerative forces combined with physiological information may yield valuable in-flight normative data that heretofore has been technically difficult to obtain and hence holds the promise of opening the door for a new golden age of aeromedical research.

Evidence for -Gz Adaptation Observed with Wearable Biosensors During High Performance Jet Flight.

INTRODUCTION: Few studies have evaluated physiological responses to high acceleration forces during actual flight and to our knowledge no normative data has been acquired by technologies such as wearable biosensors during high performance jet aircraft operations. METHODS: In-flight physiological data from an FDA cleared portable triaxial accelerometer and bio-sensor were observed from five active duty F-18 pilots of the Naval Flight Demonstration Squadron (Blue Angels). Of the five pilots, three were formation pilots who flew lower G profiles and two were solo pilots who flew higher G profiles. Physiological parameters monitored were heart rate, respiratory rate, temperature, caloric expenditure, and duration of exposure to levels of acceleration. RESULTS: Evaluated were 25 practice demonstration flights; 9 flights were excluded secondary to incomplete or inaccurate physiological data. We observed no significant bradycardia during a total of 189 maneuvers which met inclusion criteria for push-pull events (PPE) or isolated -Gz exposures. Further analysis of 73 PPE revealed an overall significant rise in HR following the PPE, where mean heart rate was 106 (95% CI, 100:112) at the beginning of the push and 129 (95% CI, 123:135) following the pull. DISCUSSION: A majority of the flights monitored provided reliable physiological data. Initial data suggests, contrary to currently held aeromedical doctrine, maneuvers such as the "push-pull" do not evoke vasovagal based bradycardic responses in aerobatic pilots. Possible explanations for these findings are sympathetic nervous system activation through adaptation and/or sustained isometric resistance from control inputs, both of which are areas of future research for our team.Rice GM, Snider D, Moore JL, Lavan JT, Folga R, VanBrunt TB. Evidence for -Gz adaptation observed with wearable biosensors during high performance jet flight. Aerosp Med Hum Perform. 2016; 87(12):996-1003.