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1.
Genome Med ; 13(1): 6, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441150

RESUMO

BACKGROUND: Clinical laboratory (lab) tests are used in clinical practice to diagnose, treat, and monitor disease conditions. Test results are stored in electronic health records (EHRs), and a growing number of EHRs are linked to patient DNA, offering unprecedented opportunities to query relationships between genetic risk for complex disease and quantitative physiological measurements collected on large populations. METHODS: A total of 3075 quantitative lab tests were extracted from Vanderbilt University Medical Center's (VUMC) EHR system and cleaned for population-level analysis according to our QualityLab protocol. Lab values extracted from BioVU were compared with previous population studies using heritability and genetic correlation analyses. We then tested the hypothesis that polygenic risk scores for biomarkers and complex disease are associated with biomarkers of disease extracted from the EHR. In a proof of concept analyses, we focused on lipids and coronary artery disease (CAD). We cleaned lab traits extracted from the EHR performed lab-wide association scans (LabWAS) of the lipids and CAD polygenic risk scores across 315 heritable lab tests then replicated the pipeline and analyses in the Massachusetts General Brigham Biobank. RESULTS: Heritability estimates of lipid values (after cleaning with QualityLab) were comparable to previous reports and polygenic scores for lipids were strongly associated with their referent lipid in a LabWAS. LabWAS of the polygenic score for CAD recapitulated canonical heart disease biomarker profiles including decreased HDL, increased pre-medication LDL, triglycerides, blood glucose, and glycated hemoglobin (HgbA1C) in European and African descent populations. Notably, many of these associations remained even after adjusting for the presence of cardiovascular disease and were replicated in the MGBB. CONCLUSIONS: Polygenic risk scores can be used to identify biomarkers of complex disease in large-scale EHR-based genomic analyses, providing new avenues for discovery of novel biomarkers and deeper understanding of disease trajectories in pre-symptomatic individuals. We present two methods and associated software, QualityLab and LabWAS, to clean and analyze EHR labs at scale and perform a Lab-Wide Association Scan.

2.
PLoS One ; 16(1): e0244978, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406133

RESUMO

The location-based services can provide users with the requested location information. But users also need to disclose their current location to the location-based service provider. Therefore, how to protect user's location privacy is a major concern. In this paper, we propose a heterogeneous deniable authenticated encryption scheme called HDAE for location-based services. The proposed scheme permits a sender in a public key infrastructure environment to transmit a message to a receiver in an identity-based environment. Our design utilizes a hybrid encryption method combing the tag-key encapsulation mechanism (tag-KEM) and the data encapsulation mechanism (DEM), which is well adopted for location-based services applications. We give how to design an HDAE scheme utilizing a heterogeneous deniable authenticated tag-KEM (HDATK) and a DEM. We also construct an HDATK scheme and provide security proof in the random oracle model. Comprehensive analysis shows that our scheme is efficient and secure. In addition, we give an application of the HDAE to a location-based services system.

3.
Glob Health Sci Pract ; 8(4): 699-720, 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361237

RESUMO

BACKGROUND: The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS: We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS: Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION: Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.

4.
Ann Appl Stat ; 14(2): 1045-1061, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32999698

RESUMO

Data from electronic health records (EHR) are prone to errors, which are often correlated across multiple variables. The error structure is further complicated when analysis variables are derived as functions of two or more error-prone variables. Such errors can substantially impact estimates, yet we are unaware of methods that simultaneously account for errors in covariates and time-to-event outcomes. Using EHR data from 4217 patients, the hazard ratio for an AIDS-defining event associated with a 100 cell/mm3 increase in CD4 count at ART initiation was 0.74 (95%CI: 0.68-0.80) using unvalidated data and 0.60 (95%CI: 0.53-0.68) using fully validated data. Our goal is to obtain unbiased and efficient estimates after validating a random subset of records. We propose fitting discrete failure time models to the validated subsample and then multiply imputing values for unvalidated records. We demonstrate how this approach simultaneously addresses dependent errors in predictors, time-to-event outcomes, and inclusion criteria. Using the fully validated dataset as a gold standard, we compare the mean squared error of our estimates with those from the unvalidated dataset and the corresponding subsample-only dataset for various subsample sizes. By incorporating reasonably sized validated subsamples and appropriate imputation models, our approach had improved estimation over both the naive analysis and the analysis using only the validation subsample.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33014110

RESUMO

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, which will eventually lead to joints deformity and functional damage. The aim of this research is to evaluate the effect of moxibustion on the serum indicators related to bone and cartilage metabolism, matrix metalloproteinase 1 (MMP-1), matrix metalloproteinase 3 (MMP-3), and vascular endothelial growth factor (VEGF) in patients with RA and to explore the mechanism of moxibustion in the treatment of RA. Methods: We recruited 70 RA patients who met the inclusion criteria, and they were randomly divided into two groups, a treatment group and a control group in equal ratio. The control group took methotrexate, folate, or leflunomide orally, while the treatment group received methotrexate, folate, or leflunomide orally and moxibustion at ST36 (Zusanli), BL23 (Shen shu), and Ashi points. We compared the clinical symptoms, RA serological disease markers and serum contents of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), MMP-1, MMP-3, and VEGF of RA patients before and after treatment. Results: (1) The clinical symptoms and RA serological disease markers of the two groups improved after treatment (P < 0.05), while the clinical symptoms of the treatment group were significantly improved in comparison with the control group (P < 0.05). (2) The levels of IL-1ß, TNF-α, and VEGF decreased in both groups after treatment (P < 0.05), but the treatment group was significantly decreased compared with the control group (P < 0.05). (3) There were significant differences in MMP-1 and MMP-3 contents after treatment in the treatment group (P < 0.05, P < 0.05), while there were no significant differences in the control group (P > 0.05, P > 0.05). Above all, the contents of IL-1ß, TNF-α, MMP-1, MMP-3, and VEGF in the treatment group decreased more significantly than those in the control group (P < 0.05). Conclusion: The improvement effect of moxibustion on the clinical symptoms of RA patients may be related to influence on the contents of IL-1ß, TNF-α, MMP-1, MMP-3, and VEGF, and moxibustion may play a potential role in bone protection.

6.
Biomed Res Int ; 2020: 7647181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33015178

RESUMO

Background: CD147/basigin (Bsg), a transmembrane glycoprotein, activates matrix metalloproteinases and promotes inflammation. Objective: The aim of this study is to explore the clinical significance of CD147 in the pathogenesis of inflammatory bowel disease (IBD). Results: In addition to monocytes, the clinical analysis showed that there is no significance obtained in leucocyte, neutrophil, eosinophil, basophil, and erythrocyte between IBD and controls. Immunohistochemistry analysis showed that CD147 was increased in intestinal tissue of patients with active IBD compared to that in the control group. What is more, CD147 is involved in intestinal barrier function and intestinal inflammation, which was attributed to the fact that it has an influence on MCT4 expression, a regulator of intestinal barrier function and intestinal inflammation, in HT-29 and CaCO2 cells. Most importantly, serum level of CD147 content is higher in active IBD than that in inactive IBD or healthy control, which could be a biomarker of IBD. Conclusion: The data suggested that increased CD147 level could be a biomarker of IBD in children.

7.
Genome Biol ; 21(1): 217, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847609

RESUMO

Germline disease-causing variants are generally more spatially clustered in protein 3-dimensional structures than benign variants. Motivated by this tendency, we develop a fast and powerful protein-structure-based scan (PSCAN) approach for evaluating gene-level associations with complex disease and detecting signal variants. We validate PSCAN's performance on synthetic data and two real data sets for lipid traits and Alzheimer's disease. Our results demonstrate that PSCAN performs competitively with existing gene-level tests while increasing power and identifying more specific signal variant sets. Furthermore, PSCAN enables generation of hypotheses about the molecular basis for the associations in the context of protein structures and functional domains.

8.
Nutr Metab Cardiovasc Dis ; 30(9): 1500-1511, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32620337

RESUMO

BACKGROUND AND AIMS: Consumption of soy foods has been associated with protection against cardiometabolic disease, but the mechanisms are incompletely understood. We hypothesized that habitual soy food consumption associates with gut microbiome composition, metabolite production, and the interaction between diet, microbiota and metabolites. METHODS AND RESULTS: We analyzed dietary soy intake, plasma and stool metabolites, and gut microbiome data from two independent cross-sectional samples of healthy US individuals (N = 75 lean or overweight, and N = 29 obese). Habitual soy intake associated with several circulating metabolites. There was a significant interaction between soy intake and gut microbiome composition, as defined by gut enterotype, on metabolites in plasma and stool. Soy consumption associated with reduced systolic blood pressure, but only in a subset of individuals defined by their gut microbiome enterotype, suggesting that responsiveness to soy may be dependent on microbiome composition. Soy intake was associated with differences in specific microbial taxa, including two taxa mapping to genus Dialister and Prevotella which appeared to be suppressed by high soy intake We identified context-dependent effects of these taxa, where presence of Prevotella was associated with higher blood pressure and a worse cardiometabolic profile, but only in the absence of Dialister. CONCLUSIONS: The gut microbiome is an important intermediate in the interplay between dietary soy intake and systemic metabolism. Consumption of soy foods may shape the microbiome by suppressing specific taxa, and may protect against hypertension only in individuals with soy-responsive microbiota. CLINICAL TRIALS REGISTRY: NCT02010359 at clinicaltrials.gov.


Assuntos
Pressão Sanguínea , Metabolismo Energético , Microbioma Gastrointestinal , Intestinos/microbiologia , Obesidade/dietoterapia , Alimentos de Soja , Adolescente , Adulto , Biomarcadores/sangue , Estudos Transversais , Fezes/química , Fezes/microbiologia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Masculino , Metabolômica , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/microbiologia , Obesidade/fisiopatologia , Pennsylvania , Ribotipagem , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
9.
Heart Rhythm ; 17(11): 1909-1916, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32512178

RESUMO

BACKGROUND: No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been published. OBJECTIVES: Determine outcomes (major complications [MC]; death, extended hospitalization, or rehospitalization within 60 days [RH]; lead malfunction) of LE, LA, and GC for recalled leads. METHODS: Retrospective, multicenter, comparative study. RESULTS: A total of 298 LE, 85 LA, and 310 GC were performed. In the clinical setting of a lead intervention, there was no difference in a composite of MC, death, RH, lead revision, inappropriate shocks, or device infection between LE and LA groups (15% vs 22%, P = .140). In the clinical setting of a device at elective replacement interval (ERI), there were significantly more acute events at 60 days (MC, death, and RH) in the LE and LA groups at 15.4% (4) and 15.4% (4), and this was significantly (P = .017) higher than the GC group at 5.1% (16). There was no difference (P = 1.000) in the composite of MC, death, RH, lead malfunction, lead revisions, device infections, or inappropriate shocks between LE, LA, and GC groups at 15.4% (4), 15.4% (4), and 17.4% (54), respectively. Following generator change, 14 of 175 Fidelis leads and 3 of 135 Riata leads failed over a total of 12,714 months of follow-up. CONCLUSIONS: The failure rate of recalled leads was substantially lower compared to previous reports. It may be prudent to perform generator change only when the device is at ERI, especially when the recalled lead has historical performance that likely outweighs the risks of extraction/abandonment.

10.
Mayo Clin Proc Innov Qual Outcomes ; 4(3): 259-265, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32542217

RESUMO

Objective: To determine whether there is an association between dehydration and falls in adults 65 years and older. Patients and Methods: We used University of Wisconsin Health electronic health records from October 1, 2011 to September 30, 2015 to conduct a retrospective cohort study of Midwestern patients 65 years and older and examined the association between dehydration at baseline (defined as serum urea nitrogen to creatinine ratio > 20, sodium level > 145 mg/dL, urine specific gravity > 1.030, or serum osmolality > 295 mOsm/kg) and falls within 3 years after baseline while accounting for prescriptions of loop diuretic, antidepression, anticholinergic, antipsychotic, and benzodiazepine/hypnotic medications and demographic characteristics, using logistic regression. Results: Of 30,634 patients, 37.9% (n=11,622) were dehydrated, 11.4% (n=3483) had a fall during follow-up, and 11.7% (n=3572) died during the follow-up period. We found a positive association of dehydration with falls alone (odds ratio [OR], 1.13; P=.002). For the outcome of falls or death, dehydration was positively associated (OR, 1.13; P=.001), along with loop diuretics (OR, 1.26; P<.001) and antipsychotic medications (OR, 1.52; P<.001). Conclusion: More than one-third of older adults in this cohort were dehydrated, with a strong association between dehydration and falls. Understanding and addressing the risks associated with dehydration, including falls, has potential for improving quality of life for patients as they age.

11.
Pain Res Manag ; 2020: 5165682, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32318129

RESUMO

Objectives: This research describes the prevalence and covariates associated with opioid-induced constipation (OIC) in an observational cohort study utilizing a national veteran cohort and integrated data from the Center for Medicare and Medicaid Services (CMS). Methods: A cohort of 152,904 veterans with encounters between 1 January 2008 and 30 November 2010, an exposure to opioids of 30 days or more, and no exposure in the prior year was developed to establish existing conditions and medications at the start of the opioid exposure and determining outcomes through the end of exposure. OIC was identified through additions/changes in laxative prescriptions, all-cause constipation identification through diagnosis, or constipation related procedures in the presence of opioid exposure. The association of time to constipation with opioid use was analyzed using Cox proportional hazard regression adjusted for patient characteristics, concomitant medications, laboratory tests, and comorbidities. Results: The prevalence of OIC was 12.6%. Twelve positively associated covariates were identified with the largest associations for prior constipation and prevalent laxative (any laxative that continued into the first day of opioid exposure). Among the 17 negatively associated covariates, the largest associations were for erythromycins, androgens/anabolics, and unknown race. Conclusions: There were several novel covariates found that are seen in the all-cause chronic constipation literature but have not been reported for opioid-induced constipation. Some are modifiable covariates, particularly medication coadministration, which may assist clinicians and researchers in risk stratification efforts when initiating opioid medications. The integration of CMS data supports the robustness of the analysis and may be of interest in the elderly population warranting future examination.


Assuntos
Analgésicos Opioides/efeitos adversos , Constipação Induzida por Opioides/epidemiologia , Idoso , Estudos de Coortes , Feminino , Humanos , Laxantes/uso terapêutico , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estados Unidos , Veteranos
12.
WMJ ; 119(1): 26-32, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32348068

RESUMO

PURPOSE: To examine the association between patients' use of online health portal-based secure messaging and the likelihood of traditional encounters (office visits and telephone calls) and to identify patient characteristics associated with use of the messaging feature of health portals. METHODS: This retrospective cohort study used EHR data from 80,801 patients aged 18 and older to determine traditional encounter rates among portal users who sent at least 1 message compared to those who sent none. Association between the number of messages sent and number of traditional encounters, while accounting for other covariates (including number of traditional encounters the year before account activation and other patient characteristics) was examined using a hurdle negative-binomial (NB) model. RESULTS: In the year after their portal account activation, 22,789 (28%) patients sent at least 1 message (median = 3, mean = 5.38). Patients who sent messages were more likely to be female (63.9% vs 58.0%, P <0.001), white (92.2% vs 90.0%, P <0.001), and have depression (27.0% vs 24.2%, P <0.001) than those who sent none. We observed a positive association between sending messages and number of traditional encounters. Patients who sent messages were more likely to have a traditional encounter and have more traditional encounters in the year after account activation than those who sent none (mean 17.6 vs 11.4, P <0.001); they also had more in-person office visits (7.6 vs 5.0, P <0.001) and telephone calls (9.9 vs 6.4, P <0.001)) when examined separately. CONCLUSIONS: Our study adds to the growing literature that EHR messaging is associated with increased traditional resource utilization. This has the potential to add to workload while diminishing productivity and increasing the risk of staff and physician burnout. Health systems should prepare for the increased visits and calls expected as more patients use secure messaging.

13.
Infect Dis Model ; 5: 282-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32292868

RESUMO

Based on the official data modeling, this paper studies the transmission process of the Corona Virus Disease 2019 (COVID-19). The error between the model and the official data curve is quite small. At the same time, it realized forward prediction and backward inference of the epidemic situation, and the relevant analysis help relevant countries to make decisions.

14.
Biol Res ; 53(1): 12, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209121

RESUMO

BACKGROUND: Mast cells (MCs) have been found to play a critical role during development of inflammatory bowel disease (IBD) that characterized by dysregulation of inflammation and impaired intestinal barrier function. However, the function of MCs in IBD remains to be fully elucidated. RESULTS: In our study, we used exosomes isolated from human mast cells-1 (HMCs-1) to culture with NCM460, HT-29 or CaCO2 of intestinal epithelial cells (IECs) to investigate the communication between MCs and IECs. We found that MCs-derived exosomes significantly increased intestinal epithelial permeability and destroyed intestinal barrier function, which is attributed to exosome-mediated functional miRNAs were transferred from HMCs-1 into IECs, leading to inhibit tight junction-related proteins expression, including tight junction proteins 1 (TJP1, ZO-1), Occludin (OCLN), Claudin 8 (CLDN8). Microarray and bioinformatic analysis have further revealed that a panel of miRNAs target different tight junction-related proteins. Interestingly, miR-223 is enriched in mast cell-derived exosome, which inhibit CLDN8 expression in IECs, while treatment with miR-223 inhibitor in HT-29 cells significantly reversed the inhibitory effect of HMCs-1-derived exosomes on CLDN 8 expression. Most importantly, enrichment of MCs accumulation in intestinal mucosa of patients with IBD compared with those healthy control. CONCLUSIONS: These results indicated that enrichment of exosomal miR-223 from HMCs-1 inhibited CLDN8 expression, leading to destroy intestinal barrier function. These finding provided a novel insight of MCs as a new target for therapeutic treatment of IBD.


Assuntos
Células Epiteliais/metabolismo , Mucosa Intestinal/metabolismo , Mastócitos/metabolismo , MicroRNAs/metabolismo , Animais , Células CACO-2/citologia , Bovinos , Células Cultivadas , Claudinas/metabolismo , Biologia Computacional , Exossomos/metabolismo , Humanos , Doenças Inflamatórias Intestinais/metabolismo , Ocludina/metabolismo , Permeabilidade , Análise Serial de Tecidos , Proteína da Zônula de Oclusão-1/metabolismo
15.
Sci Total Environ ; 711: 134539, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32000307

RESUMO

In the present study, the UVC-assisted electrochemical degradation ofthree novel bisphenol analogues (BPs; including bisphenol F, S, and B, i.e., BPF, BPS and BPB, respectively), along with bisphenol A (BPA), was investigated using boron-doped diamond (BDD) electrode. At first, this study demonstrated a significant influence ofcurrent density on the degradation rates of BPF by the BDD anode. The pseudo-first order rate constants for BPF were calculated as 0.012, 0.028 and 0.029 min-1 at the applied current densities of 10, 20 and 30 mA/cm2, respectively. UVC irradiation significantly enhanced the electrochemical degradation of BPF in the concentration range from 5 to 30 mg/L, with synergistic effects in the range of 32.0%-40.9%. The UVC-BDD electrolysisshowed comparable or even lower electric energy per order (EEO) than single BDD electrolysis. The UVC-assisted degradation of the investigated BPs showed decreased pseudo-first order rate constants in the following order: BPF > BPA > BPB > BPS. Based on the identifiedtransformation products, UVC-assisted electrochemical degradation pathways of the novel BPs were proposed to be mainly hydroxylation and bond-cleavage. UVC irradiation has been proved to promote the formation of hydroxyl radicals by BDD electrode to facilitate the degradation process. For these BPs, nearly 100% mineralization can be achieved by a modified strategy using a short-time UVC-assisted BDD electrolysis (120 min) that is followed by UVC photolysis (360 min). Finally, the eco-toxicity of the BPs solutions towardsVibrio Fischeri was significantly removed after 120 min of the electrochemical degradation period. Based on these results, the UVC-assisted electrochemical treatment using a BDD electrode can be considered a promising technology for the removal of novel BPs and the reduction of their hazardous effects to aqueous environments.


Assuntos
Diamante , Compostos Benzidrílicos , Boro , Eletrodos , Cinética , Oxirredução , Fenóis , Poluentes Químicos da Água
16.
Stat Med ; 39(9): 1250-1263, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31951041

RESUMO

Dynamic treatment regimes are sequential decision rules that adapt throughout disease progression according to a patient's evolving characteristics. In many clinical applications, it is desirable that the format of the decision rules remains consistent over time. Unlike the estimation of dynamic treatment regimes in regular settings, where decision rules are formed without shared parameters, the derivation of the shared decision rules requires estimating shared parameters indexing the decision rules across different decision points. Estimation of such rules becomes more complicated when the clinical outcome of interest is a survival time subject to censoring. To address these challenges, we propose two novel methods: censored shared-Q-learning and censored shared-O-learning. Both methods incorporate clinical preferences into a qualitative rule, where the parameters indexing the decision rules are shared across different decision points and estimated simultaneously. We use simulation studies to demonstrate the superior performance of the proposed methods. The methods are further applied to the Framingham Heart Study to derive treatment rules for cardiovascular disease.

17.
Vaccine ; 38(6): 1565-1571, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-31776028

RESUMO

INTRODUCTION: Seasonal influenza imposes a significant clinical and economic burden. Despite the availability of an annual vaccine to prevent influenza infection and reduce disease severity, influenza vaccination rates remain suboptimal. Research suggests personal experience, perceived effectiveness, and concerns regarding vaccine safety and side effects are the most influential factors in predicting a parent's decision to vaccinate. However, current literature is primarily focused on the vaccine decision-making of healthcare workers and those at high risk for influenza complications. METHODS: To assess parental attitudes and beliefs regarding the influenza vaccine, a brief mixed-methods survey was developed and optimized for an electronic platform. The Health Belief Model informed survey design and data analysis. Questions were classified into five core concepts: knowledge, barriers, benefits, experience, and severity. Participants were solicited from a population of parents whose children had participated in a school-based influenza surveillance study (n = 244, 73% response rate). We tested associations between responses and children's influenza vaccination status the prior season. Categorical questions were tested using Pearson's chi-squared tests and numerical or ordered questions using Mann-Whitney tests. P-values were corrected using the Bonferroni method. RESULTS: Doubting effectiveness, concerns about side effects, inconvenience, and believing the vaccine is unnecessary were barriers negatively associated with parents' decision to vaccinate their children during the 2017-18 flu season (p < 0.001). Knowledge that the vaccine is effective in lowering risk, duration, and severity of influenza; receiving the influenza vaccine as an adult; and recognizing the importance of vaccination to prevent influenza transmission in high-risk populations were positively associated with parents' decision to vaccinate (p < 0.001). CONCLUSION: Understanding barriers and motivators behind parents' decision to vaccinate provides valuable insight that has the potential to shape vaccine messaging, recommendations, and policy. The motivation to vaccinate to prevent influenza transmission in high-risk populations is a novel finding that warrants further investigation.

18.
Biometrics ; 76(1): 348-358, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31424089

RESUMO

In identifying subgroups of a heterogeneous disease or condition, it is often desirable to identify both the observations and the features which differ between subgroups. For instance, it may be that there is a subgroup of individuals with a certain disease who differ from the rest of the population based on the expression profile for only a subset of genes. Identifying the subgroup of patients and subset of genes could lead to better-targeted therapy. We can represent the subgroup of individuals and genes as a bicluster, a submatrix, U , of a larger data matrix, X , such that the features and observations in U differ from those not contained in U . We present a novel two-step method, SC-Biclust, for identifying U . In the first step, the observations in the bicluster are identified to maximize the sum of the weighted between-cluster feature differences. In the second step, features in the bicluster are identified based on their contribution to the clustering of the observations. This versatile method can be used to identify biclusters that differ on the basis of feature means, feature variances, or more general differences. The bicluster identification accuracy of SC-Biclust is illustrated through several simulated studies. Application of SC-Biclust to pain research illustrates its ability to identify biologically meaningful subgroups.

19.
Dig Dis Sci ; 65(4): 1003-1031, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31531817

RESUMO

BACKGROUND: Early hospital readmission for patients with cirrhosis continues to challenge the healthcare system. Risk stratification may help tailor resources, but existing models were designed using small, single-institution cohorts or had modest performance. AIMS: We leveraged a large clinical database from the Department of Veterans Affairs (VA) to design a readmission risk model for patients hospitalized with cirrhosis. Additionally, we analyzed potentially modifiable or unexplored readmission risk factors. METHODS: A national VA retrospective cohort of patients with a history of cirrhosis hospitalized for any reason from January 1, 2006, to November 30, 2013, was developed from 123 centers. Using 174 candidate variables within demographics, laboratory results, vital signs, medications, diagnoses and procedures, and healthcare utilization, we built a 47-variable penalized logistic regression model with the outcome of all-cause 30-day readmission. We excluded patients who left against medical advice, transferred to a non-VA facility, or if the hospital length of stay was greater than 30 days. We evaluated calibration and discrimination across variable volume and compared the performance to recalibrated preexisting risk models for readmission. RESULTS: We analyzed 67,749 patients and 179,298 index hospitalizations. The 30-day readmission rate was 23%. Ascites was the most common cirrhosis-related cause of index hospitalization and readmission. The AUC of the model was 0.670 compared to existing models (0.649, 0.566, 0.577). The Brier score of 0.165 showed good calibration. CONCLUSION: Our model achieved better discrimination and calibration compared to existing models, even after local recalibration. Assessment of calibration by variable parsimony revealed performance improvements for increasing variable inclusion well beyond those detectable for discrimination.


Assuntos
Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Readmissão do Paciente/tendências , Idoso , Estudos de Coortes , Feminino , Previsões , Humanos , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
20.
Med Care ; 58(3): 265-272, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31876663

RESUMO

BACKGROUND: Numerous studies have reported that losing as little as 5% of one's total body weight (TBW) can improve health, but no studies have used electronic health record data to examine long-term changes in weight, particularly for adults with severe obesity [body mass index (BMI) ≥35 kg/m]. OBJECTIVE: To measure long-term weight changes and examine their predictors for adults in a large academic health care system. RESEARCH DESIGN: Observational study. SUBJECTS: We included 59,816 patients aged 18-70 years who had at least 2 BMI measurements 5 years apart. Patients who were underweight, pregnant, diagnosed with cancer, or had undergone bariatric surgery were excluded. MEASURES: Over a 5-year period: (1) ≥5% TBW loss; (2) weight loss into a nonobese BMI category (BMI <30 kg/m); and (3) predictors of %TBW change via quantile regression. RESULTS: Of those with class 2 or 3 obesity, 24.2% and 27.8%, respectively, lost at least 5% TBW. Only 3.2% and 0.2% of patients with class 2 and 3 obesity, respectively, lost enough weight to attain a BMI <30 kg/m. In quantile regression, the median weight change for the population was a net gain of 2.5% TBW. CONCLUSIONS: Although adults with severe obesity were more likely to lose at least 5% TBW compared with overweight patients and patients with class 1 obesity, sufficient weight loss to attain a nonobese weight class was very uncommon. The pattern of ongoing weight gain found in our study population requires solutions at societal and health systems levels.


Assuntos
Interpretação Estatística de Dados , Registros Eletrônicos de Saúde/estatística & dados numéricos , Obesidade/terapia , Perda de Peso/fisiologia , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
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