Improving the Timeliness, Accuracy, and Completeness of Mortality Reporting Using FHIR Apps and Machine Learning

There are approximately 56 million deaths per year world-wide, with millions happening in the United States. Accurate and timely mortality reporting is essential for gathering this important public health data in order to formulate emergency response to epidemics and new disease threats, to prevent communicable diseases such as flu, and to determine vital statistics such as life expectancy, mortality trends, etc. However, accurate collection and aggregation of high-quality mortality data remains an ongoing challenge due to issues such as the average low frequency with which physicians perform death certification, inconsistent training in determining the causes of death, complex data flow between the funeral home, the certifying physician and the registrar, and non-standard practices of data acquisition and transmission. We propose a smart application for medical providers at the point-of-care which will use \glsfirst{fhir} to integrate directly with the medical record, provide the practitioner with context for the death, and use machine learning techniques to enable the reporting of an accurate and complete causal chain of events leading to the death.Ph.D

Gender and Historiography

The chapters in this volume celebrate the work of Pauline Stafford, highlighting the ways in which it has advanced research in the fields of both Anglo-Saxon history and the history of medieval women and gender. Ranging across the period, and over much of the old Carolingian world as well as Anglo-Saxon England, they deal with such questions as the nature of kingship and queenship, fatherhood, elite gender relations, the transmission of property, the participation of women in lordship, slavery and warfare, and the nature of assemblies. Gender and historiography presents the fruits of groundbreaking research, inspired by Pauline Stafford

Évaluation de la qualité des soins et des services préventifs cardiovasculaires en première ligne

Les maladies cardiovasculaires (MCV) représentent l'une des principales causes de décès à travers le monde. Plusieurs études ont démontré que les pratiques préventives cardiovasculaires sont sous-optimales en première ligne. Des changements cliniques, législatifs et organisationnels ont donc été mis en place pour améliorer la qualité des soins et des services dispensés en première ligne. Toutefois, l’évaluation de la qualité des pratiques cliniques est impossible sans indicateurs de qualité fiables et valides. Dans le cadre d’une recherche participative en trois phases, dont le but était de soutenir l’amélioration continue des soins préventifs cardiovasculaires en première ligne (étude TRANSIT), 81 indicateurs de qualité (indicateurs TRANSIT) ont été développés. Pour optimiser l’utilisation des indicateurs de qualité dans des stratégies d’amélioration de la qualité, l’évaluation des propriétés psychométriques des indicateurs TRANSIT est essentielle. Ainsi, l’objectif du premier volet de ce programme de recherche consiste à évaluer la fiabilité et la validité des indicateurs TRANSIT. Puisque la principale source de données pour évaluer la qualité des soins et des services de première ligne est le dossier médical, l’objectif du second volet de ce programme de recherche est d’évaluer, à l’aide des indicateurs TRANSIT, la qualité de la documentation des processus de soins dans les dossiers médicaux. Dans le cadre du premier volet, une analyse psychométrique a d’abord été menée en utilisant les données collectées durant la Phase III de l’étude TRANSIT. D’abord, la fiabilité du test–retest, la fiabilité inter-évaluateurs ainsi que la validité conceptuelle convergente des indicateurs ont été évaluées dans un sous échantillon de patients participant à l’étude TRANSIT (projet 1). Par la suite, trois méthodes statistiques ont été utilisées pour évaluer la validité prédictive des indicateurs chez tous les participants à l’étude TRANSIT (projet 2). Dans le cadre du second volet, pour évaluer la qualité de la documentation des processus de soins, les résultats de conformité aux indicateurs TRANSIT obtenus à l’aide des dossiers médicaux ont été comparés à ceux obtenus à l’aide des questionnaires auto-administrés par les patients (projet 3). Les résultats du projet 1 ont démontrés que la fiabilité du test–retest et la fiabilité inter-évaluateurs étaient excellentes sauf pour 11 indicateurs alors que la validité conceptuelle convergente était élevée à l'exception des domaines en lien avec la gestion des facteurs de risque de MCV. Les résultats du projet 2 ont permis de constater qu’une méthode hybride combinant la régression logistique multivariée et la régression Least Absolute Shrinkage and Selection Operator était plus efficace que les méthodes statistiques classiques pour identifier des indicateurs de processus ayant une bonne validité prédictive. Finalement, les résultats du projet 3 ont démontrés que la qualité des soins préventifs cardiovasculaires, telle qu’évaluée par les indicateurs TRANSIT, était généralement supérieure lorsque l’information était recueillie auprès des patients à l’aide des questionnaires auto-administrés. En conclusion, ce programme de recherche propose une série d’indicateurs de processus fiables et valides qui pourront être utilisés pour évaluer la qualité des soins préventifs cardiovasculaires en première ligne. Malgré les nombreux enjeux relatifs à l’implantation d’instrument de mesure dans la pratique courante, le développement d’indicateurs de qualité tels que les indicateurs TRANSIT est un premier pas vers la mise en place d'une culture d’amélioration de la qualité et le développement d’une infrastructure adéquate qui soutient les activités d’évaluation de la qualité dans notre société.Although cardiovascular diseases (CVD) are one of the leading causes of death worldwide, several studies have shown that cardiovascular prevention is suboptimal in primary care. Changes at clinical, organizational, and legislative levels are currently underway to improve health care quality. However, monitoring quality of care is impossible without reliable and valid indicators. As part of a participatory research program (TRANSIT study) dedicated to improving cardiovascular prevention in primary care, 81 quality indicators (TRANSIT indicators) were developed. To optimize the use of quality indicators in quality improvement strategies, the psychometric properties of the TRANSIT indicators need to be evaluated. Consequently, the objective of the first part of this research program is to assess the reliability and the validity of the TRANSIT indicators. Since medical records are a key source of information to evaluate quality of care, the objective of the second part of this research program is to assess the quality of the documentation of care processes in medical records using the TRANSIT indicators. A psychometric analysis was first conducted using data collected during Phase III of the TRANSIT study. In the first component of the psychometric analysis, the test–retest and inter-rater reliabilities as well as the convergent validity of the indicators were evaluated in a subsample of patients participating in the TRANSIT study (project 1). In the second component of the psychometric analysis, three statistical methods were used to assess the predictive validity of the indicators in the entire population participating in the TRANSIT study (project 2). To assess the quality of the documentation of care processes, levels of compliance to the TRANSIT indicators assessed using medical records were compared with those assessed using patient self-administered questionnaires (project 3). The first research project showed that test–retest and inter-rater reliabilities were excellent except for ten indicators while convergent validity was strong except for domains related to the management of CVD risk factors. Results obtained in the second project suggested that a hybrid method combining multivariate logistic regression and Least Absolute Shrinkage and Selection Operator regression was more efficient than classic statistical methods in identifying process indicators with good predictive validity. Finally, the third research project showed that the quality of cardiovascular disease prevention, as assessed by the TRANSIT indicators, was generally higher when the information was collected using self-administered questionnaires. In conclusion, this research program proposes a series of reliable and valid process indicators that can be used to assess the quality of cardiovascular disease prevention in primary care. Despite the many challenges related to the implementation of measuring instruments in current practice, the development of quality indicators such as the TRANSIT indicators is a first step towards the establishment of a culture of quality improvement and the development of an adequate infrastructure that supports quality assessment activities in our society

Gender and Historiography

The chapters in this volume celebrate the work of Pauline Stafford, highlighting the ways in which it has advanced research in the fields of both Anglo-Saxon history and the history of medieval women and gender. Ranging across the period, and over much of the old Carolingian world as well as Anglo-Saxon England, they deal with such questions as the nature of kingship and queenship, fatherhood, elite gender relations, the transmission of property, the participation of women in lordship, slavery and warfare, and the nature of assemblies. Gender and historiography presents the fruits of groundbreaking research, inspired by Pauline Stafford

Diagnostic Significance of Exosomal miRNAs in the Plasma of Breast Cancer Patients

Poster Session AbstractsBackground and Aims: Emerging evidence that microRNAs (miRNAs) play an important role in cancer development has opened up new opportunities for cancer diagnosis. Recent studies demonstrated that released exosomes which contain a subset of both cellular mRNA and miRNA could be a useful source of biomarkers for cancer detection. Here, we aim to develop a novel biomarker for breast cancer diagnosis using exosomal miRNAs in plasma. Methods: We have developed a rapid and novel isolation protocol to enrich tumor-associated exosomes from plasma samples by capturing tumor specific surface markers containing exosomes. After enrichment, we performed miRNA profiling on four sample sets; (1) Ep-CAM marker enriched plasma exosomes of breast cancer patients; (2) breast tumors of the same patients; (3) adjacent non-cancerous tissues of the same patients; (4) Ep-CAM marker enriched plasma exosomes of normal control subjects. Profiling is performed using PCR-based array with human microRNA panels that contain more than 700 miRNAs. Results: Our profiling data showed that 15 miRNAs are concordantly up-regulated and 13 miRNAs are concordantly down-regulated in both plasma exosomes and corresponding tumors. These account for 25% (up-regulation) and 15% (down-regulation) of all miRNAs detectable in plasma exosomes. Our findings demonstrate that miRNA profile in EpCAM-enriched plasma exosomes from breast cancer patients exhibit certain similar pattern to that in the corresponding tumors. Based on our profiling results, plasma signatures that differentiated breast cancer from control are generated and some of the well-known breast cancer related miRNAs such as miR-10b, miR-21, miR-155 and miR-145 are included in our panel list. The putative miRNA biomarkers are validated on plasma samples from an independent cohort from more than 100 cancer patients. Further validation of the selected markers is likely to offer an accurate, noninvasive and specific diagnostic assay for breast cancer. Conclusions: These results suggest that exosomal miRNAs in plasma may be a novel biomarker for breast cancer diagnosis.link_to_OA_fulltex

Gender and historiography: Studies in the earlier middle ages in honour of Pauline Stafford

The chapters in this volume celebrate the work of Pauline Stafford, highlighting the ways in which it has advanced research in the fields of both Anglo-Saxon history and the history of medieval women and gender. Ranging across the period, and over much of the old Carolingian world as well as Anglo-Saxon England, they deal with such questions as the nature of kingship and queenship, fatherhood, elite gender relations, the transmission of property, the participation of women in lordship, slavery and warfare, and the nature of assemblies. Gender and historiography presents the fruits of groundbreaking research, inspired by Pauline Stafford's own interests over a long and influential career