ResearchPad - proceedings https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Promoting healthy aging: intervening with diet, drugs, or exercise]]> https://www.researchpad.co/article/elastic_article_14072 <![CDATA[Proceedings of the 2015 AASOG conference: Reducing disparities in sarcoidosis through personalized care and increased detection]]> https://www.researchpad.co/article/elastic_article_13771 The 2015 annual meeting of the Americas Association of Sarcoidosis and Other Granulomatous Disorders (AASOG) was held on September 25th and 26th at the University of Colorado Anschutz Medical Campus in Aurora, CO, U.S.A. The meeting was hosted by National Jewish Health and the theme of the meeting was “Reducing Disparities in Sarcoidosis through Personalized Care and Increased Detection”. The meeting was endorsed by the American Thoracic Society (ATS) and the Foundation for Sarcoidosis Research (FSR), and was conducted through support provided by the National Institutes of Health (NIH), particularly the National Heart Lung and Blood Institute (NHLBI), and an unrestricted educational grant from Mallinckrodt, Inc. The meeting participants were predominantly from North America, and included preeminent experts and emerging clinical scientists engaged in sarcoidosis research. The AASOG meeting was held in parallel with a sarcoidosis patient conference that was organized and funded by the Foundation of Sarcoidosis Research (FSR). The AASOG talks covered various state-of-the-arts topics related to sarcoidosis research and care; most notable were talks focusing on preliminary and emerging data from the Genomic Research in Alpha-1 antitrypsin Deficiency and Sarcoidosis (GRADS) study, recent novel immunological and genomic discoveries that further our understanding of sarcoidosis disease pathogenesis, results from clinical trials in sarcoidosis and proposals of novel therapeutic targets for the treatment of sarcoidosis, the introduction of the FSR sponsored clinical studies network, insights from other granulomatous diseases, and a focus on extra-pulmonary sarcoidosis, particularly cardiac disease, small fiber neuropathy, and fatigue. A session dedicated to scientific abstracts from predominantly junior investigators and five oral abstract presentations brought the conference to a conclusion. A brief overview and selected excerpts of the 2015 AASOG meeting proceedings are provided herein. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 264-268)

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<![CDATA[The Impact of Responsive Feeding Practice Training on Teacher Feeding Behaviors in Tribal Early Care and Education: The Food Resource Equity and Sustainability for Health (FRESH) Study]]> https://www.researchpad.co/article/Nfa546802-6431-4b7d-aece-c3e5105b2919

ABSTRACT

Background

Establishing healthy eating habits early affects lifelong dietary intake, which has implications for many health outcomes. With children spending time in early care and education (ECE) programs, teachers establish the daytime meal environment through their feeding practices.

Objective

We aimed to determine the effect of a teacher-focused intervention to increase responsive feeding practices in 2 interventions, 1 focused exclusively on the teacher's feeding practices and the other focused on both the teacher's feeding practices and a nutrition classroom curriculum, in ECE teachers in a Native American (NA) community in Oklahoma.

Methods

Nine tribally affiliated ECE programs were randomly assigned to 1 of 2 interventions: 1) a 1.5-h teacher-focused responsive feeding practice training (TEACHER; n = 4) and 2) TEACHER plus an additional 3-h training to implement a 15-wk classroom nutrition curriculum (TEACHER + CLASS; n = 5). Feeding practice observations were conducted during lunch at 1 table in 1 classroom for 2- to 5-y-olds at each program before and 1 mo after the intervention. The Mealtime Observation in Child Care (MOCC) organizes teacher behaviors into 8 subsections. Descriptive statistics and the Shapiro–Wilk test for normality were calculated. Paired t tests were calculated to determine change in each group.

Results

A mean ± SD of 5.2 ± 2.0 (total n = 47) children and 1.7 ± 0.5 (total n = 14) teachers/center were observed at baseline, and 5.6 ± 1.7 (total n = 50) children and 1.7 ± 0.7 teachers (total n = 14) were observed/center postintervention. Total MOCC scores (max possible = 10) improved for TEACHER (6.1 ± 0.9 compared with 7.5 ± 0.3, t = 4.12, P = 0.026) but not for TEACHER + CLASS (6.5 ± 0.8 compared with 6.4 ± 1.0, t = −0.11, P = 0.915). No other changes were observed.

Conclusions

Teacher intervention–only programs demonstrated improvements in responsive feeding practices, whereas the programs receiving teacher and classroom training did not. Greater burden likely decreased capacity to make changes in multiple domains. We demonstrated the ability to implement interventions in NA ECE. Further research with larger communities is necessary. This trial was registered at clinicaltrials.gov as NCT03251950.

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<![CDATA[Process Evaluation Tool Development and Fidelity of Healthy Retail Interventions in American Indian Tribally Owned Convenience Stores: the Tribal Health Resilience in Vulnerable Environments (THRIVE) Study]]> https://www.researchpad.co/article/N6d7ebce9-71a7-4fd8-b805-8ce5d2a8cc6a

ABSTRACT

Background

The Tribal Health Resilience in Vulnerable Environments (THRIVE) study aimed to increase healthy food access in 2 rural American Indian communities. The intervention sought to increase fruit and vegetable availability, variety, and convenience through placement, promotion, and pricing of healthy foods and beverages in tribal convenience stores.

Objective

The aim of this study was to describe the development and implementation of the study process evaluation tool to assess intervention fidelity as part of this cluster-controlled trial.

Methods

Eight stores (2 intervention and 2 control stores per Nation) participated in the study, implemented from May 2016 to May 2017. A web-based survey tailored to store layouts and intervention components assessed how often intervention items were available, approximate quantity available, and whether placement of healthier food items and promotional materials were implemented as designed. After pilot testing the survey, tribal staff members implemented it to collect process evaluation data in the 8 stores during a period of 9–12 mo, assessing study implementation and potential changes in control stores.

Results

Promotional materials were available ≥75% of the time for most intervention locations. Fruit availability was similar in Nation A and Nation B intervention stores (79–100% compared with 70–100%), whereas fresh vegetable availability was higher in Nation B compared with Nation A (95–96% compared with 55–75%). Both control stores in Nation A and 1 control store in Nation B had moderate fruit and vegetable availability, ranging from 45% to 52%. No control stores in either Nation used intervention promotional materials.

Conclusions

Process evaluation data indicate that the study was implemented with moderate to high fidelity. The development and implementation of the tool can inform future healthy retail interventions that aim to improve rural and tribal food environments.

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<![CDATA[Sex Differences in Diabetes Prevalence, Comorbidities, and Health Care Utilization among American Indians Living in the Northern Plains]]> https://www.researchpad.co/article/N8e8beaf2-21b5-49d4-a370-e160c614ed91

ABSTRACT

Background

The American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease (CVD). Owing to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the NHANES. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions.

Objective

We examined the sex differences in diabetes prevalence, comorbidity experience, health care utilization, and treatment costs among AIs within a Northern Plains Indian Health Service (IHS) service unit.

Methods

We assessed data from a sample of 11,144 persons using an IHS service unit in the Northern Plains region of the United States. Detailed analyses were conducted for adults (n = 7299) on prevalence of diabetes by age and sex. We described sex differences in comorbidities, health care utilization, and treatment costs among the adults with diabetes.

Results

In our sample, adult men and women had a similar prevalence of diabetes (10.0% and 11.0%, respectively). The prevalence of CVD among men and women with diabetes was 45.7% and 34.0%, respectively. Among adults with diabetes, men had a statistically higher prevalence of hypertension and substance use disorders than women. The men were statistically less likely to have a non–substance use mental health disorder. Although men had higher utilization and costs for hospital inpatient services than women, the differences were not statistically significant.

Conclusions

In this AI population, there were differences in comorbidity profiles between adult men and women with diabetes, which have differential mortality and cost consequences. Appropriate diabetes management addressing gender-specific comorbidities, such as substance use disorders for men and non–substance use mental health disorders for women, may help reduce additional comorbidities or complications to diabetes.

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<![CDATA[Food Diversity and Indigenous Food Systems to Combat Diet-Linked Chronic Diseases]]> https://www.researchpad.co/article/N34b53313-19ea-4fe4-93a5-23a69314d60a

ABSTRACT

Improving food and nutritional diversity based on the diversity of traditional plant-based foods is an important dietary strategy to address the challenges of rapidly emerging diet- and lifestyle-linked noncommunicable chronic diseases (NCDs) of indigenous communities worldwide. Restoration of native ecosystems, revival of traditional food crop cultivation, and revival of traditional knowledge of food preparation, processing, and preservation are important steps to build dietary support strategies against an NCD epidemic of contemporary indigenous communities. Recent studies have indicated that many traditional plant-based foods of Native Americans provide a rich source of human health–relevant bioactive compounds with diverse health benefits. Based on this rationale of health benefits of traditional plant-based foods, the objective of this review is to present a state-of-the-art comprehensive framework for ecologically and culturally relevant sustainable strategies to restore and integrate the traditional plant food diversity of Native Americans to address the NCD challenges of indigenous and wider nonindigenous communities worldwide.

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<![CDATA[Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study]]> https://www.researchpad.co/article/Nd553dd41-e360-4342-9f4e-a7ae190276db

ABSTRACT

Background

Native American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements.

Objective

This study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements.

Methods

This longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950.

Results

Total grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred.

Conclusions

This study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.

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<![CDATA[“Think Tank on the Future of Public Health in Canada”]]> https://www.researchpad.co/article/Na79e5bde-3c5d-4329-a247-d4174e87b3d4 ]]> <![CDATA[Description and comparison of Philippine hornbill (Bucerotidae) vocalizations]]> https://www.researchpad.co/article/Na2911893-5497-47a4-969e-8c488d46e958
Abstract

The role of vocalisation for the Philippine hornbills' ecology and speciation and their implication in understanding speciation is not well understood. We described and compared recorded calls of seven hornbill taxa in captivity namely Mindanao Wrinkled hornbill (Rhabdotorrhinus leucocephalus), Rufous-headed hornbill (Rhabdotorrhinus waldeni), Luzon Rufous hornbill (Buceros hydrocorax hydrocorax), Samar Rufous hornbill (Buceros hydrocorax semigaleatus), Mindanao Rufous hornbill (Buceros hydrocorax mindanensis), Mindanao Tarictic hornbill (Penelopides affinis), Samar Tarictic hornbill (Penelopides samarensis), Visayan Tarictic hornbill (Penelopides panini) and Luzon Tarictic hornbill (Penelopides manillae), as well as comparison with the non-native Papuan hornbill (Rhyticeros plicatus). Vocalisation analysis included call duration, minimum frequency, maximum frequency, bandwidth and peak frequency. For each species in the sample, the mean and standard deviation were used to calculate the Cohen’s d statistic by using an effect size calculator. Results showed that the effect size for minimum frequency was small for P. panini vs. P. samarensis and B. hydrocorax vs. B. h. mindanensis. However, bandwidth, duration, minimum frequency, maximum frequency and peak frequency have large effect sizes for the rest of the allopatric species pairs. Hornbills' conspicuous resonating calls are sufficiently quantifiable for bioacoustic analysis and may provide new insights for their taxonomic review.

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<![CDATA[Outcomes After Metal-on-metal Hip Revision Surgery Depend on the Reason for Failure: A Propensity Score-matched Study]]> https://www.researchpad.co/article/5c636efbd5eed0c484b28281

Abstract

Background

Metal-on-metal hip replacement (MoMHR) revision surgery for adverse reactions to metal debris (ARMD) has been associated with an increased risk of early complications and reoperation and inferior patient-reported outcome scores compared with non-ARMD revisions. As a result, early revision specifically for ARMD with adoption of a lower surgical threshold has been widely recommended with the goal of improving the subsequent prognosis after ARMD revisions. However, no large cohorts have compared the risk of complications and reoperation after MoMHR revision surgery for ARMD (an unanticipated revision indication) with those after non-ARMD revisions (which represent conventional modes of arthroplasty revision).

Questions/purposes

(1) Does the risk of intraoperative complications differ between MoMHRs revised for ARMD compared with non-ARMD indications? (2) Do mortality rates differ after MoMHRs revised for ARMD compared with non-ARMD indications? (3) Do rerevision rates differ after MoMHRs revised for ARMD compared with non-ARMD indications? (4) How do implant survival rates differ after MoMHR revision when performed for specific non-ARMD indications compared with ARMD?

Methods

This retrospective observational study involved all patients undergoing MoMHR from the National Joint Registry (NJR) for England and Wales subsequently revised for any indication between 2008 and 2014. The NJR achieves high levels of patient consent (93%) and linked procedures (ability to link serial procedures performed on the same patient and hip; 95%). Furthermore, recent validation studies have demonstrated that when revision procedures have been captured within the NJR, the data completion and accuracy were excellent. Revisions for ARMD and non-ARMD indications were matched one to one for multiple potential confounding factors using propensity scores. The propensity score summarizes the many patient and surgical factors that were used in the matching process (including sex, age, type of primary arthroplasty, time to revision surgery, and details about the revision procedure performed such as the approach, specific components revised, femoral head size, bearing surface, and use of bone graft) using one single score for each revised hip. The patient and surgical factors within the ARMD and non-ARMD groups subsequently became much more balanced once the groups had been matched based on the propensity scores. The matched cohort included 2576 MoMHR revisions with each study group including 1288 revisions (mean followup of 3 years for both groups; range, 1-7 years). Intraoperative complications, mortality, and rerevision surgery were compared between matched groups using univariable regression analyses. Implant survival rates in the non-ARMD group were calculated for each specific revision indication with each individual non-ARMD indication subsequently compared with the implant survival rate in the ARMD group using Cox regression analyses.

Results

There was no difference between the ARMD and non-ARMD MoMHR revisions in terms of intraoperative complications (odds ratio, 0.97; 95% confidence interval [CI], 0.59-1.59; p = 0.900). Mortality rates were lower after ARMD revision compared with non-ARMD revision (hazard ratio [HR], 0.43; CI, 0.21-0.87; p = 0.019); however, there was no difference when revisions performed for infection were excluded from the non-ARMD indication group (HR, 0.69; CI, 0.35-1.37; p = 0.287). Rerevision rates were lower after ARMD revision compared with non-ARMD revision (HR, 0.52; CI, 0.36-0.75; p < 0.001); this difference persisted even after removing revisions performed for infection (HR, 0.59; CI, 0.40-0.89; p = 0.011). Revisions for infection (5-year survivorship = 81%; CI, 55%-93%; p = 0.003) and dislocation/subluxation (5-year survivorship = 82%; CI, 69%-90%; p < 0.001) had the lowest implant survival rates when compared with revisions for ARMD (5-year survivorship = 94%; CI, 92%-96%).

Conclusions

Contrary to previous observations, MoMHRs revised for ARMD have approximately half the risk of rerevision compared with non-ARMD revisions. We suspect worldwide regulatory authorities have positively influenced rerevision rates after ARMD revision by recommending that surgeons exercise a lower revision threshold and that such revisions are now being performed at an earlier stage. The high risk of rerevision after MoMHR revision for infection and dislocation is concerning. Infected MoMHR revisions were responsible for the increased mortality risk observed after non-ARMD revision, which parallels findings in non-MoMHR revisions for infection.

Level of Evidence

Level III, therapeutic study.

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<![CDATA[Proceedings of JOMFP panel discussion on publication, ethics and research, held in XVII National IAOMP PG Convention 2018]]> https://www.researchpad.co/article/5c48f837d5eed0c4841f790d ]]> <![CDATA[Time to Huddle: Initiating the Bedside Sepsis Huddle on an Acute Care Pediatric Unit]]> https://www.researchpad.co/article/5c0e35f5d5eed0c484e1328c

Background:

Rapid recognition and prompt treatment of sepsis within 1 hour may improve sepsis outcomes in children.

Objectives:

To develop and implement a sepsis screening tool and huddle process to improve early recognition and treatment of sepsis on an inpatient pediatric unit.

Methods:

Sepsis huddle implementation entailed house-wide education on early recognition of sepsis, antibiotic administration, and fluid bolus delivery methods. We used rapid Plan Do Study Act (PDSA) cycles to enhance documentation and communication among care providers during sepsis huddles. The team developed pocket cards for all team members to screen patients for sepsis based on Systemic Inflammatory Response Syndrome (SIRS) criteria (Goldstein, 2005). A paper huddle form was developed and adapted to ensure all the bundle elements were implemented within the 1 hour goal. We added a sepsis huddle section to the vital sign band of the electronic medical record. Standardized sepsis order sets ensured consistent care between the ED, inpatient units, and PICU.

Results:

Between April 24 and December 1, there were 112 huddles, 28 rapid response activations, and 14 immediate transfers to a higher level of care. The pediatric department met the goal of 70% of first dose STAT antibiotics administered within 1 hour. Our Vizient observed to expected sepsis mortality has dropped from 1.37 (FY 2016) to 0.99 (FY 2017, preliminary data). (Table 1)

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<![CDATA[De-escalation of Care Through Pediatric Intensive Care Unit Liberation Rounds and a Daily Checklist]]> https://www.researchpad.co/article/5c0e35f0d5eed0c484e13204

Introduction:

Pediatric intensive care unit (PICU) Liberation Bundle1 was implemented to standardize weaning of ICU support after clinical stabilization and to prevent iatrogenicity by timely assessment of pain, extubation readiness, sedation, delirium, withdrawal, early mobilization, and family engagement. By implementing a PICU Liberation bedside rounding process and a de-escalation daily rounding checklist, we hypothesized that the PICU Liberation Bundle compliance will improve and the risk for iatrogenic conditions can be minimized.

Methods:

The “old” rounding process used a nursing script organized by organ systems while the “new” process (Fig. 1) focused on PICU Liberation Bundle elements and the addition of a physician-completed checklist (Fig. 2). Independent observers collected data during rounds. All checklists completed over the first 50 days after deployment were analyzed.

Results:

There was an increase in frequency of PICU Liberation Bundle elements discussed during the “new” process with similar rounding time compared with the “old” process (Table 1). The overall compliance with the checklist was 90.4% (322 of 356 total patient-days). The medical plan was modified 62 times in 14.0% (45 of 322) of the checklists completed. The 5 most frequently modified tasks were converting intravenous to per os meds (13), initiating bowel regimen (11), initiating GI prophylaxis (9), consulting physical therapy/occupational therapy/physical medicine and rehabilitation services (9), and initiating sleep enhancement protocol (6) accounting for 77.4% (48/62) of all amendments made.

Conclusions:

PICU Liberation rounding process improved adherence with the PICU Liberation Bundle elements, and the checklist caught numerous missed opportunities, thereby increasing the frequency of timely de-escalation of care and minimizing the risk of iatrogenic conditions without lengthening rounding time.

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<![CDATA[Escalation Huddles: Facilitating Sepsis Activations Using Hospital-wide Escalation Processes]]> https://www.researchpad.co/article/5c0e35f4d5eed0c484e1325d

Background:

Bedside huddles can be valuable parts of hospital sepsis responses. These huddles, however, risk duplication of effort with existing care escalation systems, and they may also be of value in settings other than sepsis. Streamlining care escalation processes may present an opportunity to improve sepsis responses.

Objectives:

To facilitate team-based discussion of patients with suspected sepsis as a step toward reducing time to first antibiotic administration.

Methods:

Existing care escalation frameworks were amended (Figs. 1, 2) and incorporated into rapid cycle process improvement initiatives on non-ICU units. New sepsis response resources were created to facilitate team communication, intravenous (IV) access, and timely antibiotic delivery (Fig. 3).

Results:

An Escalation Huddle system was created to bring local care teams together early during clinical deterioration, including cases of suspected sepsis. Rapid Response Team activation is available but not mandated. An Urgent IV & Blood Draw algorithm was created to facilitate IV access using a protocolized progression through existing hospital resources. An Inpatient Suspected Sepsis order set was created with antibiotic decision support and recommendations for evaluation of organ dysfunction. These processes have been improved through 3 “Plan, Do, Study, Act” cycles.

Conclusions:

Rather than create a separate sepsis response system, we chose to enhance existing hospital-wide escalation processes by formalizing an Escalation Huddle system and developing new tools to enhance sepsis responses within that system. We anticipate this approach will facilitate discussion of suspected sepsis cases and improve sepsis responses while avoiding inefficient or duplicative escalation actions by care team members.

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<![CDATA[Electronic Screening Tool and Shock Huddle Process for Children at Risk for Sepsis]]> https://www.researchpad.co/article/5c0e35f7d5eed0c484e132c4

Background:

Nemours created an electronic screening tool for severe sepsis/septic shock (SS/SS) called the Shock Score (Table 1). At a threshold score, a Shock Huddle (SH) is initiated, and the patient is assessed by the Shock RN (pediatric intensive care unit nurse with enhanced training on sepsis) with the primary team (Fig. 1).

Objectives:

We sought to describe the characteristics of the score and the demographics of patients who underwent an SH.

Methods:

One thousand seven hundred forty-eight admissions were screened over 109 days. Cases of SS/SS were identified by chart review of patients with an elevated score, transfers to the intensive care unit via the medical emergency team, and patients with International Classification of Disease-10 codes of R65.20/R65.21. A subset (1,323 admissions) was used to evaluate the score characteristics.

Results:

There were 58 cases of SS/SS. Five cases were missed by the score due to a missed high risk condition or delay in documentation. One hundred twenty SH were completed on 51 unique patients. Seventy-three percent had a high risk condition. Nearly 40% of SHs involved diagnostic or therapeutic intervention (Table 2). The score had an area under the receiver operating characteristic curve (AUROC) 0.8, sensitivity 0.9 (0.72–0.97), specificity 0.44 (0.35–0.54), negative predictive value 0.95 (0.84–0.99), and positive predictive value 0.28 (0.19–0.38).

Conclusions/Implications:

The score demonstrates acceptable characteristics as a screening tool to identify children at risk for sepsis. Nearly 40% of SHs included a diagnostic or therapeutic intervention. Misses of the score were related to high risk conditions that were not scored by the electronic medical record and delays in documentation.

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<![CDATA[Decision Tree Model for Hematology/Oncology Patients with Severe and Nonsevere Sepsis]]> https://www.researchpad.co/article/5c0e35f9d5eed0c484e132d4

Background:

Hematology/oncology (H/O) patients have been screened for sepsis since 2013 at a pediatric hospital. Using sepsis screening (Ss) tool, results, and addition of organ dysfunction screening (ODs), decision tree (DT) was designed (Fig. 1) for nurses to identify sepsis and intervene.

Objectives:

Positive Ss require multiple assessments by nurses and H/O physicians creating sepsis alert fatigue. By implementing DT, calls to H/O physicians for sepsis alerts could be reduced 24% without increasing misses of patients with sepsis.

Methods:

Patients with Ss < 4 considered negative; Ss > 4 positive. ODs < 2 considered negative, = 2 at risk, > 2 positive for sepsis. In 2016, Ss were performed on H/O patients upon admission, status change, or nurse concern. May 2017, DT was implemented on H/O. From 5/5/17 to 8/30/17 Ss and ODs were conducted every 12 hours or with status change (Fig. 2).

Results:

Design period: 1,457 Ss (n = 1,393); 200 Ss positive (n = 180); 8 Ss, ODs < 2 (n = 44); 152 Ss, ODs = 2 (n = 139); and 0 Ss, ODs > 2. Implementation period: 6,502 Ss (n = 512); 1,647 Ss positive (n = 292); 293 Ss, ODs < 2 (n = 72); 1,351 Ss, ODs = 2 (n = 265); and 30 Ss, ODs > 2 (n = 14). See Figure 3 for pediatric intensive care unit (PICU) transfers during design/implementation periods.

Conclusions/Implications:

During implementation, calls were reduced to H/O physicians by 17.5% (ODs < 2). Most patients were ODs = 2. Recommendations included calling physician only if nurse was concerned of patient’s status with OD = 2. DT with addition of ODs has increased awareness of sepsis and communication between transferring providers. We have not found an increase in sepsis misses requiring transfer to PICU.

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<![CDATA[Recognition of Sepsis Triggers in a Mixed EMR Community Hospital]]> https://www.researchpad.co/article/5c0e35fbd5eed0c484e132e4

Background:

Early recognition of sepsis and rapid intervention has been proven to decrease both morbidity and mortality. However, early recognition continues to be a problem across all pediatric settings including our hospital.

Objectives:

Having no capable EMR system, our institution has implemented a manual trigger tool (Fig. 1) to help earlier identify those at risk and prevent progression to severe sepsis.

Methods:

All patients admitted to the pediatric floor at Goryeb Children’s Hospital, a community hospital, with 1,900 inpatient admissions annually, were monitored for abnormal vitals meeting criteria as defined by our trigger tool. With our key driver being prevention, we instituted a manual trigger tool as the secondary driver to help us achieve our goal. We retrospectively collected data on the number of patients who were identified and documented versus those who met criteria that were not documented. After the first month of data collection, further sepsis education was provided to the resident house staff and nursing staff. Additionally, vital sign criteria for our trigger were placed on all monitors (Fig. 2).

Results:

Over the first 4 months, from July to October, after instituting our manual trigger tool, 55%, 45%, 50%, and 43% of vital signs were appropriately identified and documented (Table 1).

Conclusions:

Our ability to recognize abnormal vitals in a potentially septic patient continues to be below our goal of 80% at 6 months with a manual trigger process. Areas for possible improvement include further education to the staff and integration of EMR with automated trigger tools.

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<![CDATA[Implementation of the CHA IPSO Collaborative at a Pediatric Academic Center]]> https://www.researchpad.co/article/5c0e35ffd5eed0c484e13304

Supplemental Digital Content is available in the text.

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<![CDATA[Unsupervised embedding of single-cell Hi-C data]]> https://www.researchpad.co/article/5b5bb1ff463d7e2238d2d917

Abstract

Motivation

Single-cell Hi-C (scHi-C) data promises to enable scientists to interrogate the 3D architecture of DNA in the nucleus of the cell, studying how this structure varies stochastically or along developmental or cell-cycle axes. However, Hi-C data analysis requires methods that take into account the unique characteristics of this type of data. In this work, we explore whether methods that have been developed previously for the analysis of bulk Hi-C data can be applied to scHi-C data. We apply methods designed for analysis of bulk Hi-C data to scHi-C data in conjunction with unsupervised embedding.

Results

We find that one of these methods, HiCRep, when used in conjunction with multidimensional scaling (MDS), strongly outperforms three other methods, including a technique that has been used previously for scHi-C analysis. We also provide evidence that the HiCRep/MDS method is robust to extremely low per-cell sequencing depth, that this robustness is improved even further when high-coverage and low-coverage cells are projected together, and that the method can be used to jointly embed cells from multiple published datasets.

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<![CDATA[Deep neural networks and distant supervision for geographic location mention extraction]]> https://www.researchpad.co/article/5b5bb238463d7e2238d2d918

Abstract

Motivation

Virus phylogeographers rely on DNA sequences of viruses and the locations of the infected hosts found in public sequence databases like GenBank for modeling virus spread. However, the locations in GenBank records are often only at the country or state level, and may require phylogeographers to scan the journal articles associated with the records to identify more localized geographic areas. To automate this process, we present a named entity recognizer (NER) for detecting locations in biomedical literature. We built the NER using a deep feedforward neural network to determine whether a given token is a toponym or not. To overcome the limited human annotated data available for training, we use distant supervision techniques to generate additional samples to train our NER.

Results

Our NER achieves an F1-score of 0.910 and significantly outperforms the previous state-of-the-art system. Using the additional data generated through distant supervision further boosts the performance of the NER achieving an F1-score of 0.927. The NER presented in this research improves over previous systems significantly. Our experiments also demonstrate the NER’s capability to embed external features to further boost the system’s performance. We believe that the same methodology can be applied for recognizing similar biomedical entities in scientific literature.

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