Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: An Observational Analysis (Preprint)

2021 ◽  
Author(s):  
Nhi Dinh ◽  
Smisha Agarwal ◽  
Lisa Avery ◽  
Priya Ponnappan ◽  
Judith Chelangat ◽  
...  
Keyword(s):  
Implementation Research ◽  
Completion Rate ◽  
Second Phase ◽  
Labor And Delivery ◽  
Intrapartum Care ◽  
Ministry Of Health ◽  
Data Completeness ◽  
Clinical Support ◽  
Data Completion ◽  
Over Time

BACKGROUND To support quality of care improvements, iDeliver, a digital clinical support system for maternal and neonatal care, was developed. OBJECTIVE Taking an implementation research lens, we evaluated the adoption and fidelity of iDeliver and assessed the feasibility of its use to provide routine Ministry of Health reports. METHODS We analyzed routinely collected data from the iDeliver implemented at Trans Mara West sub-county Hospital (Kenya), from December 2018 to October 2020. To evaluate its adoption, we assessed the proportion of total facility deliveries over time. To examine the fidelity of iDeliver usage, we studied data completion to assess the plausibility of data entry by care providers during each stage of the labor and delivery workflow and if the usage reflected iDeliver’s envisioned function. We also examined the data completeness of maternal and neonatal indicators prioritized by the Kenyan Ministry of Health. RESULTS 1164 deliveries were registered in iDeliver, capturing 47.3% of the facility’s deliveries over 22 months. Registration improved significantly from 32.3% in the first to 62.2% in the second phase of implementation (P=0.003). Across iDeliver’s workflow, the overall completion rate of all variables improved significantly from 34.1% to 48.0% in the second phase (P<0.001). Data completion was highest for the Discharge-Labor Summary (67.7%) and was lowest for Labor Signs (14.4%). The completion rate of the key Ministry of Health indicators also improved significantly (P<0.001). CONCLUSIONS iDeliver’s adoption and data completeness improved significantly over time. Assessment of iDeliver’ usage fidelity suggested that some features were more easily utilized because providers had time to enter data, versus lower utilization during active childbirth when providers are necessarily engaged with the woman and baby. These insights on the adoption and fidelity of iDeliver usage prompted the team to adapt the application to reflect the users’ culture of use and further improve the implementation of iDeliver. CLINICALTRIAL newborn; neonatal health; maternal health; intrapartum care; labor and delivery; Kenya; digital clinical decision support; health information systems; digital health; implementation research

Evolutionary Patterns in the History of Permo-Triassic and Cenozoic Synapsid Predators

2002 ◽  
Vol 8 ◽  
pp. 267-288 ◽  
Author(s):  
Blaire Van Valkenburgh ◽  
Ian Jenkins
Keyword(s):  
Fossil Record ◽  
Late Carboniferous ◽  
Second Phase ◽  
Evolutionary Patterns ◽  
Large Size ◽  
Jaw Mechanics ◽  
History Of ◽  
Trends Over Time ◽  
Energetic Constraints ◽  
Over Time

Synapsids include modern mammals and their fossil ancestors, the non-mammalian synapsids, or ‘mammal-like reptiles' of old classifications. The synapsid fossil record extends from the Late Carboniferous to the present, a span of nearly 300 million years. However, it can be broken into two distinct phases of diversification, separated by about 150 million years. The first phase extends from the Late Carboniferous to the mid-Triassic, includes the first large land predators on Earth, and is almost entirely non-mammalian. The second phase begins about 65 million years ago after the demise of the dinosaurs, includes only mammals, and extends to the present. In this overview of synapsid predators, we emphasize terrestrial species of large size, and their adaptations for killing and feeding, rather than locomotion. Despite fundamental differences in jaw mechanics and tooth morphology, there are significant parallels in the non-mammalian and mammalian radiations of synapsid predators. Both groups evolve sabertooth forms more than once, and both evolve short-snouted, powerful biting forms. In addition, both the Late Carboniferous—Triassic and Cenozoic phases are characterized by repeated patterns of clade replacement, in which one or a few clades evolve large size and seem to dominate the carnivore guild for several million years, but then decline and are replaced by new taxa. Moreover, within both ancient and Cenozoic predator clades, there are parallel trends over time toward increased body size and hypercarnivory that likely result from a combination of interspecific competition and energetic constraints.

scholarly journals A Reusable Perfused Human Cadaver Model for Surgical Training: An Initial Proof of Concept Study

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 43-47 ◽  
Author(s):  
Jenny M Held ◽  
Robert B McLendon ◽  
Christian S McEvoy ◽  
Travis M Polk
Keyword(s):  
Surgical Training ◽  
Tap Water ◽  
Regional Perfusion ◽  
Whole Body ◽  
Suture Repair ◽  
Second Phase ◽  
Proof Of Concept ◽  
Handling Characteristics ◽  
Surgical Trainees ◽  
Over Time

Abstract Objectives Today’s surgical trainees have less exposure to open vascular and trauma procedures. Lightly embalmed cadavers may allow a reusable model that maximizes resources and allows for repeat surgical training over time. Methods This was a three-phased study that was conducted over several months. Segments of soft-embalmed cadaver vessels were harvested and perfused with tap water. To test durability, vessels were clamped, then an incision was made and repaired with 5-0 polypropylene. Tolerance to suturing and clamping was graded. In a second phase, both an arterial-synthetic graft and an arterial-venous anastomosis were performed and tested at 90 mmHg perfusion. In the final phase, lower extremity regional perfusion was performed and vascular control of a simulated injury was achieved. Results Seven arteries and six veins from four cadavers were explanted. All vessels accommodated suture repair over 6 weeks. There was minor leaking at all previous clamp sites. In the anastomotic phase, vessels tolerated grafting, clamping, and perfusion without tearing or leaking. Regional perfusion provided a life-like training scenario. Conclusions Explanted vessels of soft-embalmed cadavers show adequate durability over time with realistic vascular surgery handling characteristics. This shows promise as initial proof of concept for a reusable perfused cadaver model. Further study with serial regional and whole-body perfusion is warranted.

Method and Description of the Aging in Manitoba Project: A 20-Year Longitudinal Study

1997 ◽  
Vol 16 (4) ◽  
pp. 606-625 ◽  
Author(s):  
Judith G. Chipperfield ◽  
Betty Havens ◽  
Wendy D. Doig
Keyword(s):  
Longitudinal Study ◽  
Longitudinal Data ◽  
Longitudinal Studies ◽  
Demographic Variables ◽  
Education Level ◽  
Completion Rate ◽  
Major Goal ◽  
Cross Sectional ◽  
Gender Education ◽  
Over Time

ABSTRACTThe Aging in Manitoba (AIM) project includes nearly 9,000 seniors who have been interviewed. Three independent cross-sectional samples (i.e. 1971, 1976, 1983) were subsequently followed (1983–1984, 1990), producing cross-sectional and longitudinal data. A major goal of this paper was to examine non-response over time and representativeness of the panel of AIM survivors. This involved analysis of non-response, calculations of completion/response rates, and comparisons of demographic variables across the AIM sample and the broader Manitoba and Canadian populations. Non-response was very low (4.6% in 1983–1984, 5.0% in 1990) and did not appear to be dependent on such factors as location, gender, education level, or nationality descent. The 95.0 per cent completion rate compares favourably with other longitudinal studies, demonstrating the value of employing rigorous tracking procedures. These findings suggest that attempts to minimize bias and selective attrition in the AIM study have been successful.

How Do Adolescents Get Their E-Cigarettes and Other Electronic Vaping Devices?

2018 ◽  
Vol 33 (3) ◽  
pp. 420-429 ◽  
Author(s):  
Jessica K. Pepper ◽  
Ellen M. Coats ◽  
James M. Nonnemaker ◽  
Brett R. Loomis
Keyword(s):  
Social Media ◽  
Logistic Regression ◽  
Social Experience ◽  
Completion Rate ◽  
Future Research ◽  
Social Situations ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Past ◽  
Over Time

Purpose: More adolescents “vape” (use e-cigarettes and similar devices) than smoke, but little is known about how underage users obtain vaping devices. This knowledge could inform efforts to prevent youth access. Design: Original cross-sectional survey with social media recruitment. Settings: Online. Participants: A total of 1729 adolescents (2809 qualified on screener; completion rate 61.6%) aged 15 to 17 years who vaped in the past 30 days. Measures: Adolescents’ vaping attitudes, ownership of vaping devices, how they obtain devices, and frequency of borrowing others’ devices. Analysis: Logistic regression. Results: Most adolescents (78.2%) owned a vaping device. The most common sources were purchasing from a store or online (31.1%), buying from another person (16.3%), or giving someone money to purchase for them (15.0%). The majority (72.8%) had used someone else’s vaping device in the past 30 days. Adolescents who vaped more often, did not own a vaping device, vaped in social situations, and had previously been refused purchase were more likely to frequently borrow others’ devices. Conclusions: Despite high rates of ownership, many adolescents borrowed devices, suggesting that borrowing is part of users’ social experience, not just a means of acquisition. Although better enforcement of age restrictions could lessen purchasing, future research is needed to understand why adolescents borrow and how their acquisition sources shift over time. That information could be harnessed for targeted, borrowing-related antivaping campaigns.

scholarly journals Understanding Resilience by relating Stimuli Optimality to Schema Constructs

2017 ◽  
Author(s):  
Karmela Arbanasić ◽  
Nicholas Hubert Kirk
Keyword(s):  
World View ◽  
The Self ◽  
Second Phase ◽  
The Novel ◽  
Cognitive Schemas ◽  
Autobiographical Memories ◽  
Two Phase ◽  
Heterogeneous Nature ◽  
Over Time

We hereby define a novel, two-phase framework which describes the process of elaborating input stimuli of heterogeneous nature into cognitive schemas. For our first phase (PI), we formalize the concept of stress as the deviation from the optimal stimuli level of an individual, described as either understimulation or overstimulation. As second phase (PII), we consider retrieval and rating of autobiographical memories on an importance-positivity scale, which provides an estimation of the individual’s self- and world-schema. The present paper also highlights the novel nonlinear transformation function between the mentioned first (PI) and second phase (PII), in terms of translating over- and under-stimulation to the self- and world-view over time. The described framework, in addition to proposing a novel classification of individuals based on their needs for stimuli, entails representation and potentially diagnosis of multiple psychopathological conditions we have analytically described herein.

scholarly journals Partnership Among Hospitals To Reduce Healthcare Associated Infections: A Quasi-Experimental Study In Brazilian ICUs

2021 ◽  
Author(s):  
Ladjane Santos Wolmer de Melo ◽  
Maria Verônica Monteiro de Abreu ◽  
Bernuarda Roberta de Oliveira Santos ◽  
Maria das Graças Washington Casimiro Carreteiro ◽  
Maria Carolina Andrade Lins de Albuquerque ◽  
...  
Keyword(s):  
Experimental Study ◽  
Length Of Stay ◽  
Public Hospitals ◽  
Healthcare Associated Infections ◽  
Ministry Of Health ◽  
Collaborative Project ◽  
Quasi Experimental ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Over Time

Abstract Background: Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. Methods: A quasi-experimental study in 5 public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI “Improvement Model”, during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals of excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project).Result: A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. Conclusions: Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.Trial registration: Promoted by Brazilian Ministry of Health. Approved by the Hospital das Clínicas – UFPE Ethics Committee (No. 3,307,293).

scholarly journals Real-Time Detection of Behavioural Anomalies for Older People, the 3-PEGASE Study: Methods of an Artificial Intelligence Real-life Prospective Trial. (Preprint)

2019 ◽  
Author(s):  
Antoine Piau ◽  
Benoit Lepage ◽  
Carole Bernon ◽  
Marie-Pierre Gleyzes ◽  
Fati Nourhashemi
Keyword(s):  
Artificial Intelligence ◽  
Older Adults ◽  
Health Care Professionals ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Real Life ◽  
Second Phase ◽  
Care Partners ◽  
Over Time

BACKGROUND Most frail older persons are living at home and we face difficulties in achieving seamless monitoring to detect adverse health changes. Even more important, this lack of follow-up could have a negative impact on the living choices made by older individuals and their care partners. People could give up their homes for the more reassuring environment of a medicalized living facility. We have developed a low-cost non-obtrusive sensor-based solution to trigger automatic alerts in case of an acute event or subtle changes over time. It could facilitate the follow-up of older adults in their own homes, and thus support independent living. OBJECTIVE The primary objective of our prospective open-label study is to evaluate the relevance of the automatic alerts generated by our artificial intelligence-driven monitoring solution as judged by the recipients: older adult, caregiver, and professional support worker. The secondary objective is to evaluate its ability to detect subtle functional and cognitive decline and major medical events. METHODS The primary outcome assessment will be performed for each successive 2-month follow-up period to estimate the progression of our learning algorithm performances over time. Twenty-five frail or disabled participants aged 75 and above and living alone in their own homes, will be enrolled for a 6-month follow-up period. RESULTS The first phase with five participants for a 4-month feasibility period has been completed and the expected completion date for the second phase of the study (20 participants for 6 months) is July 2020. CONCLUSIONS The originality of our 6-month real-life project lies in the choice of the primary outcome and in our user-centered design. We will evaluate the relevance of the alerts and the algorithm performances over time according to the end users. The first-line recipients of the information are the older adults and care partners rather than health-care professionals. Despite the fast pace of e-Health device development, no study addressed the specific everyday needs of older adults and their families using such a participatory design and ‘bottom-up’ approach. CLINICALTRIAL ClinicalTrials.gov NCT03484156

A feasibility study using a touchscreen tool in the AYA population.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9575-9575
Author(s):  
Jonathan R. Espenschied ◽  
Julie Anna Wolfson ◽  
Alicia Bogardus ◽  
Yanjun Chen ◽  
Jeanelle Folbrecht ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Feasibility Study ◽  
Negative Impact ◽  
Support Staff ◽  
Ease Of Use ◽  
Completion Rate ◽  
Care Team ◽  
Care Needs ◽  
Clinical Support

9575 Background: Adolescent and young adults (AYA) 15 to 39 years present unique health care needs; however, barriers to communication of treatment-related and psychosocial difficulties exist. We hypothesized that a tailored AYA Touchscreen Tool (AYATT) in cancer patients/survivors would facilitate patient-provider communication, toward the larger goal of timely intervention. As a first step, we evaluated the feasibility of such a tool, operationally defined as an 80% acceptance and completion rate. Methods: Eligible City of Hope AYA patients receiving treatment and follow up care for oncologic or hematologic disease were systematically approached for study participation. Target accrual to assess feasibility was set at 50 participants. Consented patients completed a concise AYATT battery, mostly standardized measures, assessing access to care (CHIS), needs, neurocognitive function (BRIEF-A, CogState), and other quality of life (PedsQL) issues. Patients and clinical/support staff completed satisfaction and ease-of-use surveys to further evaluate feasibility. Results: 54 participants were accrued over 8 weeks, with a 96% completion rate exceeding our primary feasibility criteria. At the time of participation: Mean age=26.2 years; Range 15.3 to 38.9 years. Acceptability was high with positive responses throughout the survey. Based on patient responses, the AYATT helped 52% remember issues they had, or have, with their care or treatment; 39% were encouraged to discuss medical issues with their care team that they might not have discussed; 92% found it a useful way to communicate with their health care team; and 98% would recommend that other patients use AYATT. A separate survey from 31/36 clinical/support staff reported AYATT had minimal negative impact in clinic or patient care, increased communication, and was useful in maintaining/improving care. Conclusions: The aggregate findings from this feasibility study support utilizing a tailored touchscreen device in the AYA oncology population. Predictably, high levels of computer knowledge in our AYA cohort may account for the success and acceptance of using such a tool. These results provide evidence for further exploration and continued use in the AYA clinic and patient care setting.

IncNSA: Detecting communities incrementally from time-evolving networks based on node similarity

2020 ◽  
Vol 31 (07) ◽  
pp. 2050094
Author(s):  
Xing Su ◽  
Jianjun Cheng ◽  
Haijuan Yang ◽  
Mingwei Leng ◽  
Wenbo Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Detection Method ◽  
Dynamic Networks ◽  
Second Phase ◽  
World Systems ◽  
Evolving Networks ◽  
The Third ◽  
Third Phase ◽  
Node Similarity ◽  
Over Time

Many real-world systems can be abstracted as networks. As those systems always change dynamically in nature, the corresponding networks also evolve over time in general, and detecting communities from such time-evolving networks has become a critical task. In this paper, we propose an incremental detection method, which can stably detect high-quality community structures from time-evolving networks. When the network evolves from the previous snapshot to the current one, the proposed method only considers the community affiliations of partial nodes efficiently, which are either newborn nodes or some active nodes from the previous snapshot. Thus, the first phase of our method is determining active nodes that should be reassigned due to the change of their community affiliations in the evolution. Then, we construct subgraphs for these nodes to obtain the preliminary communities in the second phase. Finally, the final result can be obtained through optimizing the primary communities in the third phase. To test its performance, extensive experiments are conducted on both some synthetic networks and some real-world dynamic networks, the results show that our method can detect satisfactory community structure from each of snapshot graphs efficiently and steadily, and outperforms the competitors significantly.

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