EHRs Connect Research and Practice: Where Predictive Modeling, Artificial Intelligence, and Clinical Decision Support Intersect

Objectives: Electronic health records (EHRs) are only a first step in capturing and utilizing health-related data - the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients' health conditions and responses to treatment over time. Methods: We describe a case study of 423 patients treated by Centerstone within Tennessee and Indiana in which we utilized electronic health record data to generate predictive algorithms of individual patient treatment response. Multiple models were constructed using predictor variables derived from clinical, financial and geographic data. Results: For the 423 patients, 101 deteriorated, 223 improved and in 99 there was no change in clinical condition. Based on modeling of various clinical indicators at baseline, the highest accuracy in predicting individual patient response ranged from 70-72% within the models tested. In terms of individual predictors, the Centerstone Assessment of Recovery Level - Adult (CARLA) baseline score was most significant in predicting outcome over time (odds ratio 4.1 + 2.27). Other variables with consistently significant impact on outcome included payer, diagnostic category, location and provision of case management services. Conclusions: This approach represents a promising avenue toward reducing the current gap between research and practice across healthcare, developing data-driven clinical decision support based on real-world populations, and serving as a component of embedded clinical artificial intelligences that "learn" over time.Comment: Keywords: Data Mining; Decision Support Systems, Clinical; Electronic Health Records; Implementation; Evidence-Based Medicine; Data Warehouse; (2012). EHRs Connect Research and Practice: Where Predictive Modeling, Artificial Intelligence, and Clinical Decision Support Intersect. Health Policy and Technology. arXiv admin note: substantial text overlap with arXiv:1112.166

Barefoot Training: Effects on EMG Activity of Gluteus Medius and Tensor Fascia Latae in Habitually Shod Runners

Purpose/Hypothesis: Running has been a common practice in humans since the species’ dawn. Due to its relative ease and low cost, running continues to be one of the most popular forms of exercise today. Although running provides many benefits such as disease prevention, injury prevalence in running is high. The trend of minimalist shoes and barefoot training has gained popularity over the decade as a return to a more natural form of running. Some researcher hypothesize that barefoot running can reduce injury rate by changing the biomechanics of the runner. In this study we propose a different hypothesis: barefoot running changes activity of musculature of the hip, increasing activation in muscles that are commonly weak in injured runners. Research investigating the hip muscle activity and movement with barefoot running is lacking in literature; thus, giving rise to the purpose of this study. This multifactorial study was performed to explore the effect of barefoot training on the muscular activity of the gluteus medius (GM) and tensor fascia latae (TFL). The hypothesis being tested was that barefoot training period would increase the muscle activity of GM and decrease the muscle activity of TFL. Materials/Methods: Twenty-two subjects, 14 females and 8 males, with a mean age of 22.8 completed the pre-testing electromyography (EMG) analyses. EMG muscle activity of TFL and GM was recorded during a maximal isometric contraction, a barefoot running and walking trial and a shod running and walking trial. Subjects were randomly assigned to a barefoot running group (N=13) and shod running group (N=9). Participants completed a 6-week training program consisting of running twice a week. The first week of training consisted of 10 minutes of running (either barefoot or shod) with a 2- minute increase each week, reaching a maximum running period of 20 minutes during the final week. Following the training program, post-test EMG was performed and analyzed. Results: No significant differences in change of EMG activity of the GM and TFL was found between the barefoot and shod training groups from pre-testing to post-testing data collection. Conclusions: Due to no statistically significant differences in change of EMG activity of the GM and TFL between the training groups from pre- to post-test trials, further research is recommended to explore the impact of a barefoot training protocol on GM and TFL muscle activity. Clinical Relevance: This study provides insight to the muscle activity occurring at the hip when foot attire is altered during training. No statistically significant change was found between barefoot or shod training groups in regard to change in muscle activity from pre-test to post-test. This lack of statistical significance may have been due to lack of statistical power, as the number of subjects was low. The training period also may have not provided enough volume to create a stimulus to significantly change muscle activity. While there were no statistically significant findings, trends in the data pointed towards a greater change in GM activity for the barefoot group from pre-test to post-test. Replicating the study with a higher number of subjects or a larger training volume may yield significant results in future research. In addition, collecting other data such as V02 max, running economy or foot strike pattern also may reveal other physiological changes that can occur with barefoot training

An exploratory study investigating the experience of a group of Irish social workers undertaking an applied training in mentalization-based thinking and practice.

This qualitative study explored the potential relevance of mentalization-based theory (MBT) and its corollary reflective functioning (RF) within social work practice. A bespoke MBT-informed psychoeducational programme emphasizing a novel tripartite model, comprising MBT, Attachment Theory and Regulation Theory was delivered in two hourly groups over twelve weeks. In addition to the provision of psychoeducational information, the groups incorporated a Tavistock style Work Discussion Group to support the participants’ applied use of MBT to one of their own cases. The study aimed to explore the participants’ own experience of engaging with and acquiring a working knowledge of mentalization, its relevance, both personally and professionally, as well as garnering any learnings from this first attempt to research the provision of introductory MBT training to a group of social worker practitioners. Nine of the eleven social workers, recruited from a large metropolitan area in Ireland completed the programme. Utilizing a thematic analysis in conjunction with a psychoanalytic lens, the transcriptions of the groups were analyzed within a critical realist world view, using Braun and Clarke’s six-stage model. The case studies were subjected to close scrutiny and reflexive considerations from which three central themes emerged for further analysis. The study advances our knowledge by indicating a strong consensus amongst the participants that MBT was a relevant and beneficial theoretical and practice gyroscope to support the social work task. Participants warmly welcomed the new language and ‘Thinking Tools’ of MBT which supported their ability to conceptualize and articulate a level of complexity of their clients and their own intersubjective process which they had previously struggled to enunciate. This novel tripartite model offers significant potential as a centralizing theoretical and practice framework; as such, it warrants further development and research. Future social work practice development could be beneficially advanced in light of these findings

An exploratory study investigating the experience of a group of Irish social workers undertaking an applied training in mentalization-based thinking and practice

This qualitative study explored the potential relevance of mentalization-based theory (MBT) and its corollary reflective functioning (RF) within social work practice. A bespoke MBT-informed psychoeducational programme emphasizing a novel tripartite model, comprising MBT, Attachment Theory and Regulation Theory was delivered in two hourly groups over twelve weeks. In addition to the provision of psychoeducational information, the groups incorporated a Tavistock style Work Discussion Group to support the participants’ applied use of MBT to one of their own cases. The study aimed to explore the participants’ own experience of engaging with and acquiring a working knowledge of mentalization, its relevance, both personally and professionally, as well as garnering any learnings from this first attempt to research the provision of introductory MBT training to a group of social worker practitioners. Nine of the eleven social workers, recruited from a large metropolitan area in Ireland completed the programme. Utilizing a thematic analysis in conjunction with a psychoanalytic lens, the transcriptions of the groups were analyzed within a critical realist world view, using Braun and Clarke’s six-stage model. The case studies were subjected to close scrutiny and reflexive considerations from which three central themes emerged for further analysis. The study advances our knowledge by indicating a strong consensus amongst the participants that MBT was a relevant and beneficial theoretical and practice gyroscope to support the social work task. Participants warmly welcomed the new language and ‘Thinking Tools’ of MBT which supported their ability to conceptualize and articulate a level of complexity of their clients and their own intersubjective process which they had previously struggled to enunciate. This novel tripartite model offers significant potential as a centralizing theoretical and practice framework; as such, it warrants further development and research. Future social work practice development could be beneficially advanced in light of these findings

Emotion regulation in psychopathy

Emotion processing is known to be impaired in psychopathy, but less is known about the cognitive mechanisms that drive this. Our study examined experiencing and suppression of emotion processing in psychopathy. Participants, violent offenders with varying levels of psychopathy, viewed positive and negative images under conditions of passive viewing, experiencing and suppressing. Higher scoring psychopathics were more cardiovascularly responsive when processing negative information than positive, possibly reflecting an anomalously rewarding aspect of processing normally unpleasant material. When required to experience emotional response, by ‘getting into the feeling’ of the emotion conveyed by a negative image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting that they were less able to do this. These data, together with the absence of corresponding differences in subjective self-report might be used to inform clinical strategies for normalising emotion processing in psychopathic offenders to improve treatment outcome, and reduce risk amongst this client group

Using Data-Informed Instruction to Drive Education: Keeping Catholic Education a Viable and Educationally Sound Option in Challenging Times

This study was conducted to obtain an understanding of the perceptions that Catholic schoolteachers possessed regarding data informed instructional (DII) practices, specifically curriculum based measurement (CBM). The researchers investigated changes in teacher’s perceptions from pretest to posttest to determine the impact of the 90-minute professional development on teacher’s perceptions of DII. Results showed that Catholic schoolteachers did perceive that they lacked sufficient knowledge to effectively implement curriculum-based measures prior to the training. Significant growth was noted with regard to their perceptions of their knowledge in some areas. According to the results of the paired samples t-test, a meaningful change in educators’ perceptions of DII was observed for three of the nine pairs of questionnaire items from pre to post-test. The findings support previous research and pave the way for future research on the impact of short, one-day professional development sessions