-
Journal of Law and the Biosciences 2022The distribution of crucial medical goods and services in conditions of scarcity is among the most important, albeit contested, areas of public policy development....
The distribution of crucial medical goods and services in conditions of scarcity is among the most important, albeit contested, areas of public policy development. Policymakers must strike a balance between multiple efficiency and fairness objectives, while reconciling disparate value judgments from a diverse set of stakeholders. We present a general framework for combining ethical theory, data modeling, and stakeholder input in this process and illustrate through a case study on designing organ transplant allocation policies. We develop a novel analytical tool, based on machine learning and optimization, designed to facilitate efficient and wide-ranging exploration of policy outcomes across multiple objectives. Such a tool enables all stakeholders, regardless of their technical expertise, to more effectively engage in the policymaking process by developing evidence-based value judgments based on relevant tradeoffs.
PubMed: 35496981
DOI: 10.1093/jlb/lsac012 -
Applied Clinical Informatics May 2021To examine pediatricians' perspectives on administrative tasks including electronic health record (EHR) documentation burden and their effect on work-life balance and...
OBJECTIVES
To examine pediatricians' perspectives on administrative tasks including electronic health record (EHR) documentation burden and their effect on work-life balance and life and career satisfaction.
METHODS
We analyzed 2018 survey data from the American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES), a longitudinal cohort study of early and midcareer pediatricians. Cohorts graduated from residency between 2002 and 2004 or 2009 and 2011. Participants were randomly selected from an AAP database (included all pediatricians who completed U.S. pediatric residency programs). Four in 10 pediatricians (1,796 out of 4,677) were enrolled in PLACES in 2012 and considered participants in 2018. Data were weighted to adjust for differences between study participants and the overall population of pediatricians. Chi-square and multivariable logistic regression examined the association of EHR burden on work-life balance (three measures) and satisfaction with work, career, and life (three measures). Responses to an open-ended question on experiences with administrative tasks were reviewed.
RESULTS
A total of 66% of pediatrician participants completed the 2018 surveys (1,192 of 1,796; analytic sample = 1,069). Three-fourths reported EHR documentation as a major or moderate burden. Half reported such burden for billing and insurance and 42.7% for quality and performance measurement. Most pediatricians reported satisfaction with their jobs (86.7%), careers (84.5%), and lives (66.2%). Many reported work-life balance challenges (52.5% reported stress balancing work and personal responsibilities). In multivariable analysis, higher reported EHR burden was associated with lower scores on career and life satisfaction measures and on all three measures of work-life balance. Open-ended responses ( = 467) revealed several themes. Two predominant themes especially supported the quantitative findings-poor EHR functionality and lack of support for administrative burdens.
CONCLUSION
Most early to midcareer pediatricians experience administrative burdens with EHRs. These experiences are associated with worse work-life balance including more stress in balancing responsibilities and less career and life satisfaction.
Topics: Child; Electronic Health Records; Humans; Job Satisfaction; Longitudinal Studies; Pediatricians; Personal Satisfaction; Surveys and Questionnaires; United States; Work-Life Balance
PubMed: 34341980
DOI: 10.1055/s-0041-1732402 -
Digital Health 2021Asia has been at the forefront of leveraging big data and digital technologies to strengthen measures against SARS-CoV-2 spread. Understanding strengths and challenges... (Review)
Review
BACKGROUND
Asia has been at the forefront of leveraging big data and digital technologies to strengthen measures against SARS-CoV-2 spread. Understanding strengths and challenges of these new approaches is important to inform improvements and implementation. In this review, we aimed to explore how these tools were utilized in four countries in Asia to facilitate COVID-19 preventative control measures.
METHODS
We conducted a pragmatic review of English-language literature and web-based information in Pubmed, MedRxiv, national and international public health institution websites and media sources between 1st January-3rd August 2020 to identify examples of big data and digital technologies to facilitate COVID-19 preventative control measures in Taiwan, South Korea, Hong Kong, and Singapore. Results were summarized narratively by common technological themes, and examples of integration highlighted.
RESULTS
Digital tools implemented included real-time epidemiological dashboards, interactive maps of case location, mobile apps for tracing patients' contacts and geofencing to monitor quarantine compliance. Examples of integration of tools included linkage of national health and immigration databases to identify high-risk individuals in Taiwan, and the use of multiple digital surveillance sources to map patients' movements in South Korea. Challenges in balancing privacy and public good were identified.
CONCLUSIONS
Digital technologies have facilitated and strengthened traditional public health measures for prevention of SARS-CoV-2 spread in Asia. Resolving issues around privacy concerns would improve future preparedness, implementation speed and uptake of digital measures. The significant technological advances and lessons learned can be adopted or adapted by other countries to ensure public health preparedness for future waves of COVID-19 and other pandemics.
PubMed: 33815815
DOI: 10.1177/20552076211002953 -
Journal of Medical Ethics Jun 1991In this paper we argue that the human form should be seen to exist, in a longitudinal way, throughout the continuum of human growth and development. This entails that...
In this paper we argue that the human form should be seen to exist, in a longitudinal way, throughout the continuum of human growth and development. This entails that the moral value of that form, which we link analytically to the adult, interacting, social and rational being, attaches to all phases of human life to some extent. Having established this we discuss the consequences it has for the moral status of the human embryo. We then apply this argument, and the resulting moral status, to the area of reproductive technology. In doing this we show that there are certain regulations and controls which ought to apply to the use of these infertility treatments.
Topics: Abortion, Induced; Attitude to Death; Attitude to Health; Beginning of Human Life; Embryo, Mammalian; Ethical Theory; Ethics, Medical; Female; Human Rights; Humans; Insemination, Artificial; Life; Moral Obligations; Morals; Personhood; Pregnancy; Pregnancy, Multiple; Pregnant Women; Social Values; Value of Life
PubMed: 1870084
DOI: 10.1136/jme.17.2.62 -
The Journals of Gerontology. Series B,... Aug 2020Integration into social networks reduces stress during adverse life events and improves coping with disability in late life. The aim was to investigate whether social...
OBJECTIVES
Integration into social networks reduces stress during adverse life events and improves coping with disability in late life. The aim was to investigate whether social network closure (frequent contact among ties) and balance (positive contact among ties) are associated with perceived stress. We expect lowest stress for older adults with highly closed and balanced networks.
METHOD
Panel data on self-reported egocentric networks stem from the population-based Chicago Health, Aging, and Social Relations Study. Five waves were collected between 2002 and 2006, with 708 observations from 160 participants aged 50-68 years at baseline. Data include information on the participants' social relationships, that is, interaction frequency and relationship quality, for ego-alter ties and alter-alter ties, and participants' perceived stress. The analytical strategy used fixed- and random-effects models.
RESULTS
Participants reporting the highest number of balanced relationships (positive ties among alters) experience least stress. This effect holds independently of sociodemographic confounders, loneliness, and network size.
DISCUSSION
The absence of a stress-reducing effect from network closure suggests that balance matters more. Future research would benefit from considering balance when examining the characteristics of social networks that impinge on mental health outcomes in older adults.
Topics: Aged; Chicago; Female; Humans; Interpersonal Relations; Longitudinal Studies; Male; Middle Aged; Social Integration; Social Networking; Social Support; Socioeconomic Factors; Stress, Psychological
PubMed: 30888040
DOI: 10.1093/geronb/gbz035 -
Analytical and Bioanalytical Chemistry Jan 2021Hybrid material surfaces on microparticles are emerging as vehicles for many biomedical multiplexing applications. Functionalization of these hybrid surface...
Hybrid material surfaces on microparticles are emerging as vehicles for many biomedical multiplexing applications. Functionalization of these hybrid surface microparticles to biomolecules presents unique challenges related to optimization of surface chemistries including uniformity, repeatability, and sample sparring. Hybrid interfaces between microlevel surfaces and individual biomolecules will provide different microenvironments impacting the surface functionalization optimization and efficiency. Here, we propose and validate the first demonstration of streptavidin adsorption-based antibody functionalization on unmodified, hybrid surface microparticles for in vitro analysis. We test this analytical technique and fabricate hybrid surface microparticles with a polystyrene core and aluminum oxide semi-coating. Additionally, we optimize the streptavidin-biotin functionalization chemistry in both assay implementation and sample sparring via analytical mass balances for these microparticles and subsequently conjugate anti-human CD11b antibodies. Result confirmation and characterization occurs from ultraviolet protein absorbance and ImageJ processing of fluorescence microscopy images. Additionally, we design and implement the multi-sectional imaging (MSI) approach to support functionalization uniformity on the hybrid surface microparticles. Finally, as a proof-of-concept performance, we validate anti-CD11b antibodies functionalization by visualizing hybrid surface microparticles conjugate to human neutrophils isolated from blood samples collected from potentially septic patients. Our study introduces and defines a category of functionalization for hybrid surface microparticles with the intent of minuscule sample volumes, low cost, and low environmental impact to be used for many cellular or proteomic in vitro multiplexing applications in the future. Graphical abstract.
Topics: Adsorption; Aluminum Oxide; Biotin; CD11b Antigen; Humans; In Vitro Techniques; Microscopy, Fluorescence; Microspheres; Neutrophils; Particle Size; Polystyrenes; Streptavidin; Surface Properties
PubMed: 33156401
DOI: 10.1007/s00216-020-03026-4 -
Kidney Medicine Apr 2023Patients with kidney failure who have used multiple treatment modalities are a unique source of information for how different options may best fit values. We aimed to...
RATIONALE & OBJECTIVE
Patients with kidney failure who have used multiple treatment modalities are a unique source of information for how different options may best fit values. We aimed to understand how people interpret their health and kidney failure treatment experience to inform providers who facilitate shared decision-making conversations.
STUDY DESIGN
This qualitative, interpretive phenomenological study explores how patients with kidney failure interpret health throughout their treatment trajectory.
SETTING & PARTICIPANTS
We recruited a purposive sample of patients who had used 3 or more kidney failure treatment options, including transplant and dialysis from transplant clinics and online support groups, for semi-structured interviews. Eligible participants were over 18 and spoke English for a total of 7 current transplant, 10 current home dialysis, and 1 current in-center patient.
ANALYTICAL APPROACH
A 6-step iterative process of data analysis occurred concurrently with data collection.
RESULTS
Half of the 18 participants were Black; 67% were women. Three interrelated themes emerged from interviews: ability to engage in meaningful activities; working for balance; and living in context. Participants evaluated health according to their ability to engage in meaningful activities while balancing their emotional and physical needs with their life goals. When their social and treatment environments supported their autonomy, participants also considered themselves healthy.
LIMITATIONS
The inclusion of only English-speaking patients limits the transferability of findings. A longitudinal design, repeated interviews, observation, and dyadic interviews would increase the health care providers' understanding and interpretation of health.
CONCLUSIONS
The themes demonstrated patients evaluated health based on ability to engage in meaningful activities while maintaining balance. The treatment context, particularly how health care providers responded to patients' physiological experience, autonomy, and power, influenced interpretation of patient treatment experiences. Integrating patient interpretations of health with quantitative measures of treatment effectiveness can help health care providers better partner with patients to provide effective care for kidney failure.
PubMed: 36925662
DOI: 10.1016/j.xkme.2023.100603 -
Neural Computing & Applications 2022This study is conducted to build a multi-criteria text mining model for COVID-19 testing reasons and symptoms. The model is integrated with a temporal predictive...
This study is conducted to build a multi-criteria text mining model for COVID-19 testing reasons and symptoms. The model is integrated with a temporal predictive classification model for COVID-19 test results in rural underserved areas. A dataset of 6895 testing appointments and 14 features is used in this study. The text mining model classifies the notes related to the testing reasons and reported symptoms into one or more categories using look-up wordlists and a multi-criteria mapping process. The model converts an unstructured feature to a categorical feature that is used in building the temporal predictive classification model for COVID-19 test results and conducting some population analytics. The classification model is a temporal model (ordered and indexed by testing date) that uses machine learning classifiers to predict test results that are either positive or negative. Two types of classifiers and performance measures that include balanced and regular methods are used: (1) balanced random forest and (2) balanced bagged decision tree. The balanced or weighted methods are used to address and account for the biased and imbalanced dataset and to ensure correct detection of patients with COVID-19 (minority class). The model is tested in two stages using validation and testing sets to ensure robustness and reliability. The balanced classifiers outperformed regular classifiers using the balanced performance measures (balanced accuracy and G-score), which means the balanced classifiers are better at detecting patients with positive COVID-19 results. The balanced random forest achieved the best average balanced accuracy (86.1%) and G-score (86.1%) using the validation set. The balanced bagged decision tree achieved the best average balanced accuracy (83.0%) and G-score (82.8%) using the testing set. Also, it was found that the patient history, age, testing reasons, and time are the key features to classify the testing results.
PubMed: 35013649
DOI: 10.1007/s00521-021-06884-w -
ESC Heart Failure Mar 2016The proliferation of cardiac-related biomarkers and advocacy for their use has often come without adequate discussion of limitations in the interpretation of values and... (Review)
Review
The proliferation of cardiac-related biomarkers and advocacy for their use has often come without adequate discussion of limitations in the interpretation of values and their best use in heart failure (HF) patients to provide a balanced assessment of how cardiac biomarkers are advocated for use in HF and areas where we would argue there are no gaps in knowledge. We include suggestions to address these issues. We have focused on peer-reviewed publications over the period 2000 to present. Most studies have used samples at one or at most two points in time to define risk. Although biomarkers might add to the magnitude of risk, it is unclear how often they lead to changes in treatment. We suggest that defining the use of serial biomarker testing over time would be more helpful. To do this, it is necessary to take into account the biomarker's analytical and biological variability in addition to its ability to define and monitor therapy. These factors are often overlooked leading to conclusions that may be statistically significant but not clinically or analytically robust. An appreciation of the value and limitations of biomarker use is important to all clinicians who manage HF patients. If the proper studies are done so that biomarkers are used optimally, they will likely be helpful in defining when and how to intervene. If we continue as we have, we will continue to have ambiguity about the use of these valuable probes in the assessment and management of HF.
PubMed: 27774262
DOI: 10.1002/ehf2.12071 -
Statistics in Medicine Aug 2013Propensity score methods are being increasingly used as a less parametric alternative to traditional regression to balance observed differences across groups in both... (Comparative Study)
Comparative Study
Propensity score methods are being increasingly used as a less parametric alternative to traditional regression to balance observed differences across groups in both descriptive and causal comparisons. Data collected in many disciplines often have analytically relevant multilevel or clustered structure. The propensity score, however, was developed and has been used primarily with unstructured data. We present and compare several propensity-score-weighted estimators for clustered data, including marginal, cluster-weighted, and doubly robust estimators. Using both analytical derivations and Monte Carlo simulations, we illustrate bias arising when the usual assumptions of propensity score analysis do not hold for multilevel data. We show that exploiting the multilevel structure, either parametrically or nonparametrically, in at least one stage of the propensity score analysis can greatly reduce these biases. We applied these methods to a study of racial disparities in breast cancer screening among beneficiaries of Medicare health plans.
Topics: Aged; Aged, 80 and over; Bias; Black People; Breast Neoplasms; Cluster Analysis; Computer Simulation; Early Detection of Cancer; Female; Healthcare Disparities; Humans; Medicare; Monte Carlo Method; Propensity Score; United States; White People
PubMed: 23526267
DOI: 10.1002/sim.5786