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Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti 2016 University of Southern Maine

Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti

eGEMs (Generating Evidence & Methods to improve patient outcomes)

Introduction: As the number of clinical decision support systems incorporated into electronic medical records increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. Here we use machine learning and natural language processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an electronic medical record system and compare it against manual evaluation.

Methods: Modeled after the electronic medical record system EPIC at Maine Medical Center, we developed a dummy dataset containing physician notes in free text for 3621 artificial patients ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Tiffany A. Moore Simas

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Jeroan J. Allison

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Nancy Byatt

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. McManus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. Mcmanus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg

Molly E. Waring

Background: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome (ACS).

Methods: We studied 2,174 patients discharged from the hospital after an ACS at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments ...


Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones 2016 Harvard Medical School

Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones

Catarina I. Kiefe

BACKGROUND: Cross-sectional clustering of metabolic risk factors for cardiovascular disease in middle-aged adults is well described, but less is known regarding the order in which risk factors develop through young adulthood and their relation to subclinical atherosclerosis.

METHOD AND RESULTS: A total of 3178 black and white women and men in the Coronary Artery Risk Development in Young Adults study were assessed to identify the order in which cardiovascular disease risk factors including diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol or high triglyceride levels), hypercholesterolemia (high total or low-density lipoprotein cholesterol), and obesity develop. Observed patterns of risk factor development ...


Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg 2016 University of Colorado

Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND: Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized.

METHODS AND RESULTS: We studied 2954 patients with left ventricular ejection fraction < /=0.35 undergoing first-time implantable cardioverter-defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged > 65 years. In a median follow-up of 2.4 years, outcome rates per 1000 patient-years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure-related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ...


Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg 2016 University of Massachusetts Medical School

Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg

Jeroan J. Allison

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and ...


Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar 2016 University of Massachusetts Medical School

Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar

Jeroan J. Allison

Introduction: In 2013, approximately 2.8 million children worldwide died within the neonatal period. India is at the epicenter of this tragedy, accounting for one-third of all neonatal mortalities. Prematurity and/or with low birth weight are the leading cause of neonatal mortality and India has the highest number of neonates born preterm and weighing less than 2,500 grams worldwide. It is estimated that Kangaroo Care can avert up to 48% of all neonatal deaths among premature babies by 2025. However, the promise of Kangaroo Care as a low-cost, safe, and efficacious intervention to reduce neonatal mortality in India ...


The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore 2016 University of Massachusetts Medical School

The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore

Open Access Articles

BACKGROUND: A lack of advanced healthcare information systems and validated scientific cohorts in Nicaragua makes it difficult to estimate disease prevalences and other public health statistics. Although there is concern of an "epidemic" of chronic kidney disease (CKD) in this country, statistics regarding its magnitude are derived from only a small number of non-representative studies. Budgetary constraints and the logistical problems of maintaining a study cohort make longitudinal studies difficult. The Rivas Cohort was created to measure disease burden of CKD and other public health priorities in the Department of Rivas, Nicaragua. Using primarily volunteer research students and technologic innovation ...


Inequalities In Social Determinants Of Health In The Ontario Transgender Population, Rachel E. Giblon 2016 The University of Western Ontario

Inequalities In Social Determinants Of Health In The Ontario Transgender Population, Rachel E. Giblon

Electronic Thesis and Dissertation Repository

This study examined how everyday living conditions known to influence health outcomes – social determinants of health – differ between transgender Ontarians and the general Ontario population. Previously collected data on social determinants, demographics, health, and health care from trans (n=433) and non-trans individuals (n=39980) living in Ontario were used. Standardized risk differences showed that significantly more trans individuals were underpaid and underemployed, unable to complete their post-secondary education, and had experienced food insecurity, social exclusion and unmet health care needs. Differences were largest comparing trans men to cisgender men of the same age distribution. Findings from this study identified ...


Implementation And Reporting Of Causal Mediation Analysis In 2015: A Systematic Review In Epidemiological Studies, Shao-Hsien Liu, Christine M. Ulbricht, Stavroula A. Chrysanthopoulou, Kate L. Lapane 2016 University of Massachusetts Medical School

Implementation And Reporting Of Causal Mediation Analysis In 2015: A Systematic Review In Epidemiological Studies, Shao-Hsien Liu, Christine M. Ulbricht, Stavroula A. Chrysanthopoulou, Kate L. Lapane

Open Access Articles

BACKGROUND: Causal mediation analysis is often used to understand the impact of variables along the causal pathway of an occurrence relation. How well studies apply and report the elements of causal mediation analysis remains unknown.

METHODS: We systematically reviewed epidemiological studies published in 2015 that employed causal mediation analysis to estimate direct and indirect effects of observed associations between an exposure on an outcome. We identified potential epidemiological studies through conducting a citation search within Web of Science and a keyword search within PubMed. Two reviewers independently screened studies for eligibility. For eligible studies, one reviewer performed data extraction, and ...


Retention Of Mothers And Infants In The Prevention Of Mother-To-Child Transmission Of Hiv Programme Is Associated With Individual And Facility-Level Factors In Rwanda., Godfrey B Woelk, Dieudonne Ndatimana, Sally Behan, Martha Mukaminega, Epiphanie Nyirabahizi, Heather J. Hoffman, Placidie Mugwaneza, Muhayimpundu Ribakare, Anouk Amzel, B Ryan Phelps 2016 George Washington University

Retention Of Mothers And Infants In The Prevention Of Mother-To-Child Transmission Of Hiv Programme Is Associated With Individual And Facility-Level Factors In Rwanda., Godfrey B Woelk, Dieudonne Ndatimana, Sally Behan, Martha Mukaminega, Epiphanie Nyirabahizi, Heather J. Hoffman, Placidie Mugwaneza, Muhayimpundu Ribakare, Anouk Amzel, B Ryan Phelps

Epidemiology and Biostatistics Faculty Publications

OBJECTIVES: Investigate levels of retention at specified time periods along the prevention of mother-to-child transmission (PMTCT) cascade among mother-infant pairs as well as individual- and facility-level factors associated with retention.

METHODS: A retrospective cohort of HIV-positive pregnant women and their infants attending five health centres from November 2010 to February 2012 in the Option B programme in Rwanda was established. Data were collected from several health registers and patient follow-up files. Additionally, informant interviews were conducted to ascertain health facility characteristics. Generalized estimating equation methods and modelling were utilized to estimate the number of mothers attending each antenatal care visit ...


The Significance Of Alternative Techniques In Biomedical Research: An Analysis Of Nobel Prize Awards, Martin Stephens 2016 The Humane Society of the United States

The Significance Of Alternative Techniques In Biomedical Research: An Analysis Of Nobel Prize Awards, Martin Stephens

Martin Stephens, Ph.D.

The "alternatives approach" consists of developing and employing methods specifically designed as alternatives. The aim of the approach is to determine the extent to which alternatives can replace traditional uses of animals. This aim has an ethical and compassionate appeal that is being bolstered by recent scientific advances in developing alternatives (Stephens 1986b).

The importance of alternative methods in the history of biomedical research can be inferred from Nobel Prize awards in medicine or physiology. These awards are generally believed to recognize research "of the highest caliber, the most enduring influence, and the most importance to biomedical science" according to ...


Estimation Of Long-Term Area-Average Pm2.5 Concentrations For Area-Level Health Analyses, Sun-Young Kim, Casey Olives, Neal Fann, Joel Kaufman, Sverre Vedal, Lianne Sheppard 2016 University of Washington - Seattle Campus

Estimation Of Long-Term Area-Average Pm2.5 Concentrations For Area-Level Health Analyses, Sun-Young Kim, Casey Olives, Neal Fann, Joel Kaufman, Sverre Vedal, Lianne Sheppard

UW Biostatistics Working Paper Series

Introduction: There is increasing evidence of an association between individual long-term PM2.5 exposure and human health. Mortality and morbidity data collected at the area-level are valuable resources for investigating corresponding population-level health effects. However, PM2.5 monitoring data are available for limited periods of time and locations, and are not adequate for estimating area-level concentrations. We developed a general approach to estimate county-average concentrations representative of population exposures for 1980-2010 in the continental U.S.

Methods: We predicted annual average PM2.5 concentrations at about 70,000 census tract centroids, using a point prediction model previously ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

UMass Center for Clinical and Translational Science Supported Publications

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Self-Care And Mobility Disability At Mid-Life In Lucky Few, Early-, And Late-Baby Boom Birth-Cohorts, Carlos Siordia 2016 University of Pittsburgh - Main Campus

Self-Care And Mobility Disability At Mid-Life In Lucky Few, Early-, And Late-Baby Boom Birth-Cohorts, Carlos Siordia

Journal of Health Disparities Research and Practice

Disability is related in definite ways with makers of social stratum, as it can be influenced by and has the potential to contribute to the production and reproduction of social stratification. Intersectional markers of social stratification processes are ignored determinants of health. The Class, Race, Sex (CRS) hypothesis presented here argues that a low-education, racial-minority, and female disadvantage will compound to affect the prevalence and risks of disability. The evidence presented validates the CRS hypothesis by showing that disability prevalence and risk clusters first by class, race, and then sex. The cross-sectional study of community-dwelling adults in the Unites States ...


Q-Fever In A Refugee After Exposure To A Central New York State Livestock Farm, Mustafa Qazi, Anita C. Weimer, Brenden Bedard, Byron S. Kennedy 2016 University of Rochester

Q-Fever In A Refugee After Exposure To A Central New York State Livestock Farm, Mustafa Qazi, Anita C. Weimer, Brenden Bedard, Byron S. Kennedy

Health Science Faculty Publications

Q-fever is a zoonotic disease caused by Coxiella burnetii that can create an acute or chronic form of the illness. In March 2014, Q-fever was identified by serology and Real-time Polymerase Chain Reaction (RT-PCR), in a 62 year-old male that was a Nepalese refugee. The male visited a livestock farm with a slaughterhouse in rural Central New York State, twenty-two days prior to onset of symptoms. He had direct handling of goats on this farm prior to slaughter. We describe the case presentation of his illness and the public health epidemiological investigation.


The Association Between Social Cohesion And Physical Activity In Communities Across Canada: A Multilevel Analysis, Calvin Yip 2016 The University of Western Ontario

The Association Between Social Cohesion And Physical Activity In Communities Across Canada: A Multilevel Analysis, Calvin Yip

Electronic Thesis and Dissertation Repository

Background: In Canada, only 15% of adults meet physical activity guidelines for optimal health. Previous research has suggested that social cohesion may promote physical activity.

Objective: To assess the association between social cohesion and physical activity among adults aged 18 to 64 years in Canada.

Methods: Data from the 2009-2010, 2011-2012, and 2013-2014 cycles (N=245,150) of the Canadian Community Health Survey were used. Physical activity level was operationalized using average daily energy expenditure, social cohesion was determined by self-rated sense of belonging to the local community, and communities were represented by Canada’s Forward Sortation Areas. Multilevel regression ...


Survival Rates In Trauma Patients Following Health Care Reform In Massachusetts, Turner Osler, Laurent G. Glance, Wenjun Li, Jeffery S. Buzas, David W. Hosmer 2016 University of Vermont Medical Center

Survival Rates In Trauma Patients Following Health Care Reform In Massachusetts, Turner Osler, Laurent G. Glance, Wenjun Li, Jeffery S. Buzas, David W. Hosmer

Wenjun Li

IMPORTANCE: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate. OBJECTIVE: To examine the effect of Massachusetts HCR on survival rates of injured patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient ...


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