Managing Patient Health Across Diverse Spaces: Using Activity Theory to Model Pervasive Decision Support

Clinical decision support (CDS) systems can offer health care providers and patient data that is intelligently filtered and presented in ways to enhance diagnosis and long-term health care management, both within and outside clinical spaces. Challenges to this information management include diagnostic error and inefficiencies from conflicting, incomplete, or suboptimal clinical systems [3] as well as extending care outside the traditional clinical environment. We propose a Clinical Activity Model (CAM) to understand pervasive CDS system design and use across multiple health care spaces as patients move between critical care, recovery, and long-term home care. We discuss CAM in the context of research findings comparing a novel CDS system with traditional modes of data delivery and by describing use of that system as a mobile diagnostic tool to bridge clinical care and home care

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Automated Coastal Ice Mapping with SAR Can Inform Winter Fish Ecology in the Laurentian Great Lakes

Many freshwater lakes in the temperate zone undergo annual freeze-thaw cycles. Climate change has disrupted these patterns and altered habitat for many species including ecologically, economically, and culturally valuable fish species. To understand the relationship between ice cover and aquatic species, suitable data can be derived from remote sensing. We developed a novel ice classification method with minimal user input using freely available Sentinel-1 data and an adjacent and time-coincident validation dataset. Using image object segmentation and a random forest classifier, ice conditions were classified correctly with >85% overall accuracy. Our ice mapping efforts coincided with a telemetry dataset of tagged Walleye (Sander vitreus) and Northern Pike (Esox lucius) in Hamilton Harbor in western Lake Ontario. Between years with low and high ice covers (2017 and 2019, respectively), we found Walleye appeared to reduce their area of movement when the harbor was covered in ice. Our ice mapping tool can provide a quick and consistent method for agencies to adopt for freshwater resource management as well as provide ice cover information in coastal areas that are important overwintering habitat for many fishes

Fish community indices of ecosystem health: How does Toronto Harbour compare to other Lake Ontario nearshore areas?

<p>We assessed fish community status for 16 nearshore areas in Lake Ontario and the upper St. Lawrence River, from 2006 to 2016, using complementary fish sampling gear types and protocols, boat electrofishing and trap nets, and the published aquatic ecosystem health indicators associated with them. Factors influencing Indices of Biotic Integrity scores included degree of exposure to the open-waters of Lake Ontario, effective fetch, and land cover and use in surrounding watersheds. Focusing on Toronto Harbour, we determined that Indices of Biotic Integrity scores were lower (45.1 and 45.6 for electrofishing and trap net gear types, respectively) than predicted (55.5 and 59.6) based on other Lake Ontario nearshore areas with similar physical/environmental conditions but seemed reasonable given the significant influence of Canada’s largest urban area, the City of Toronto. The proportion of fish community biomass comprised of piscivores (0.21 and 0.18 for electrofishing and trap nets, respectively) approached target levels (0.20) set for the Toronto Harbour fish community, and indicated a balanced trophic structure. On-going aquatic habitat remediation and creation projects on the Leslie Street Spit (including Tommy Thompson Park) and the Toronto Islands, should ensure maintenance or improvement in Indices of Biotic Integrity scores and aquatic ecosystem health generally.</p

Calpain-10 interacts with plasma saturated fatty acid concentrations to influence insulin resistance in individuals with the metabolic syndrome

Background: Calpain-10 protein (intracellular Ca2+-dependent cysteine protease) may play a role in glucose metabolism, pancreatic β cell function, and regulation of thermogenesis. Several CAPN10 polymorphic sites have been studied for their potential use as risk markers for type 2 diabetes and the metabolic syndrome (MetS). Fatty acids are key metabolic regulators that may interact with genetic factors and influence glucose metabolism. Objective: The objective was to examine whether the genetic variability at the CAPN10 gene locus is associated with the degree of insulin resistance and plasma fatty acid concentrations in subjects with MetS. Design: The insulin sensitivity index, glucose effectiveness, insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], insulin secretion (disposition index, acute insulin response, and HOMA of β cell function), plasma fatty acid composition, and 5 CAPN10 single nucleotide polymorphisms (SNPs) were determined in a cross-sectional analysis of 452 subjects with MetS participating in the LIPGENE dietary intervention cohort. Results: The rs2953171 SNP interacted with plasma total saturated fatty acid (SFA) concentrations, which were significantly associated with insulin sensitivity (P < 0.031 for fasting insulin, P < 0.028 for HOMA-IR, and P < 0.012 for glucose effectiveness). The G/G genotype was associated with lower fasting insulin concentrations, lower HOMA-IR, and higher glucose effectiveness in subjects with low SFA concentrations (below the median) than in subjects with the minor A allele (G/A and A/A). In contrast, subjects with the G/G allele with the highest SFA concentrations (above the median) had higher fasting insulin and HOMA-IR values and lower glucose effectiveness than did subjects with the A allele. Conclusion: The rs2953171 polymorphism at the CAPN10 gene locus may influence insulin sensitivity by interacting with the plasma fatty acid composition in subjects with MetS. This trial was registered at clinicaltrials.gov as NCT00429195