Neighborhood Variability in Obesity in Children in Omaha, Nebraska

BACKGROUND: The prevalence of childhood obesity is a serious public health concern in the United States. Although several individual-level factors have been found to be associated with obesity in children, neighborhood environmental and social factors likely play an important role. The main goal of this study was to describe the prevalence of child obesity in Omaha, Nebraska by various demographic subgroups, determine if obesity prevalence varies by neighborhood operationalized as zip code, and examine the association between neighborhood-level child obesity prevalence and neighborhood-level socioeconomic status. It was hypothesized that child obesity prevalence varies by demographic subgroup and by zip code and that neighborhood SES is significantly associated with child obesity prevalence. METHOD: Electronic health record data from Children’s Hospital & Medical Center’s primary care network was utilized to examine child obesity based on objectively measured heights and weights from a sample of 40,303 children aged two to 20 years in 34 zip codes in Omaha, Nebraska. Chi-square test of independence assessed the association between individual-level demographic variables and obesity. Child obesity was mapped by zip code. Pearson correlation assessed the relationship between neighborhood-level obesity and neighborhood-level median household income and percent of individuals below poverty in a subsample. RESULTS: Chi-square analyses revealed that obesity is significantly associated with gender (Χ2(1) = 26.42, p \u3c .0001), age (Χ2(3) = 300.69, p \u3c .0001), race (Χ2(7) = 951.40, p \u3c .0001), ethnicity (Χ2(1) = 593.75, p \u3c .0001), and medical insurance provider (Χ2(1) = 629.50, p \u3c .0001). Demographic subgroups more likely to be obese were males, children 12 to 17 years old, Native Hawaiian and Other Pacific Islanders, Hispanics, and those on Medicaid. Obesity prevalence by zip code ranged from 6.7% to 26.7%. Neighborhood-level child obesity, defined by percent obese in each neighborhood, was significantly associated with both neighborhood-level median household income (r=-0.69406, p\u3c.0001) and percent of individuals below poverty (0.72843, p\u3c.0001). CONCLUSION: This study provides a preliminary cross-sectional analysis of current child obesity prevalence in Omaha, Nebraska. Child obesity prevalence varied by zip code, and significant associations were found between each individual-level variable and child obesity and between both neighborhood-level variables and neighborhood-level child obesity. Future studies should utilize a multi-unit statistical model approach to data analysis, examine obesity trends longitudinally to examine the underlying factors causing obesity, and examine neighborhood variation in child obesity at multiple geographic scales. Future community interventions should include a focus on geospatial areas and use of multi-setting, multi-strategy approaches in order to impact the neighborhood factors influencing child obesity

Reducing Disease Exacerbation in Women with Confirmed COPD: A Systematic Literature Review

Abstract A systematic literature review was conducted to establish whether gender specific treatment exists for patients with Chronic Obstructive Pulmonary Disease (COPD), specifically, women with (COPD). The PICO question developed for this review is as follows: In women with confirmed diagnoses of COPD, does gender-specific treatment, compared to standard treatment, impact the frequency of exacerbations? Could the number of COPD exacerbations in women be reduced by incorporating interventions designed with (female) gender in mind? Four databases were included in the search: CINAHL, Pubmed, Medline, and Nursing and Allied Health. Articles included addressed gender differences in relation to the disease process, medication(s), or overall treatment. There were 16 articles selected for this review. This analysis found gender differences with regards to lung development, disease presentation, diagnosis, exacerbations, and prognosis. A definitive answer to the PICO question was not found from this systematic review, yet future research is warranted to determine whether gender differences to exist with regards to treatments/interventions in patients with COPD. Recommendations for practice, research, education, and policy are based on articles included within the review

The Connected Intensive Care Unit Patient: Exploratory Analyses and Cohort Discovery From a Critical Care Telemedicine Database.

Background: Many intensive care units (ICUs) utilize telemedicine in response to an expanding critical care patient population, off-hours coverage, and intensivist shortages, particularly in rural facilities. Advances in digital health technologies, among other reasons, have led to the integration of active, well-networked critical care telemedicine (tele-ICU) systems across the United States, which in turn, provide the ability to generate large-scale remote monitoring data from critically ill patients. Objective: The objective of this study was to explore opportunities and challenges of utilizing multisite, multimodal data acquired through critical care telemedicine. Using a publicly available tele-ICU, or electronic ICU (eICU), database, we illustrated the quality and potential uses of remote monitoring data, including cohort discovery for secondary research. Methods: Exploratory analyses were performed on the eICU Collaborative Research Database that includes deidentified clinical data collected from adult patients admitted to ICUs between 2014 and 2015. Patient and ICU characteristics, top admission diagnoses, and predictions from clinical scoring systems were extracted and analyzed. Additionally, a case study on respiratory failure patients was conducted to demonstrate research prospects using tele-ICU data. Results: The eICU database spans more than 200 hospitals and over 139,000 ICU patients across the United States with wide-ranging clinical data and diagnoses. Although mixed medical-surgical ICU was the most common critical care setting, patients with cardiovascular conditions accounted for more than 20% of ICU stays, and those with neurological or respiratory illness accounted for nearly 15% of ICU unit stays. The case study on respiratory failure patients showed that cohort discovery using the eICU database can be highly specific, albeit potentially limiting in terms of data provenance and sparsity for certain types of clinical questions. Conclusions: Large-scale remote monitoring data sources, such as the eICU database, have a strong potential to advance the role of critical care telemedicine by serving as a testbed for secondary research as well as for developing and testing tools, including predictive and prescriptive analytical solutions and decision support systems. The resulting tools will also inform coordination of care for critically ill patients, intensivist coverage, and the overall process of critical care telemedicine.Office of Research, Discovery, Innovation at the University of Arizona; National Science Foundation [1838745]; National Heart, Lung, and Blood Institute of the National Institutes of Health [5T32HL007955]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Acute complications after stroke and mortality

Introduction:Medical complications are common among patients with stroke. In our country, there is a limited information about the morbidity and mortality after an acute stroke in hospitalised patients. Aim:To study the frequency, type and timing of acute complications of stroke and the risk factors associated with these complications and the mortality rate. Materials and Methods:This is a prospective study, it was done at Al Assad and Tishreen University Hospitals, Lattakia, Syria, during the period between April 2016 –April 2017. 100 patientswith acute stroke were included and followed  up with assessment of complications until discharge or death in the hospital. Results:61 patients(61%) experienced 1 or more complications. The most common complications were  pneumonia in 19 patients (19%), urinary tract infection (UTI) in 12 patients (12%), seizures in 8 patients (8%), pressure sores in 6 patients (6%), depression in 6 patients (6%), constipation in 5 patients (5%). Complications developed more in older patients, and in patients with MCA involvement, with no important difference between males and females. No relation was found between risk factors of stroke and the development of complications after stroke. Most complications occurred early, the mean Length of stay (LOS) was 14 days, complications associated with longer LOS. Mortality rate in this study was 10% (10 patients), and 8 patients (80%) experienced 1 complication at least. The severity of stroke on admission was the most important risk factor for developing complications and associated with more mortality rate. Conclusion:Complications rate is 61% , they develop early, and associate with longer LOS. Mortality rate during hospitalization is 10% The severity of stroke on admission is the most important risk factor for developing complications and associated with more mortality rate. الاختلاطات الحادة في الحوادث الوعائية الدماغية ومعدل الوفيات. مقدمة: الاختلاطات المرضية شائعة عند مرضى النشبة, وهنالك محدودية في المعلومات المتعلقة بالمراضة والوفيات بعد النشبة الحادة عند المرضى المقبولين في المشفى في بلدنا. الهدف: دراسة تواتر, نمط, وتوقيت حدوث الاختلاطات الحادة في الحوادث الوعائية الدماغية وعوامل الخطر المرافقة لهذه الاختلاطات ومعدل الوفيات. المواد والطرق: دراسة مستقبلية, أجريت في مشفيي الأسد وتشرين الجامعيين في الفترة الممتدة من نيسان 2016 حتى نيسان 2017. شملت هذه الدراسة 100 مريض بتشخيص نشبة حادة, وتمت متابعتهم وتقييم  حدوث الاختلاطات حتى التخريج من المشفى أو الوفاة ضمن المشفى. النتائج: 61 مريض (61%) عانى من اختلاط واحد على الأقل. كانت أكثر الاختلاطات شيوعاً:  ذات الرئة عند 19 مريض (19%), الإنتان البولي عند 12 مريض (12%), الاختلاجات عند 8 مرضى (8%), قرحات الاضطجاع عند 6 مرضى (6%) , والإمساك عند 5 مرضى (5%). حدثت الاختلاطات أكثر عند المرضى الأكبر عمراً وعند إصابة الشريان المخي المتوسط(MCA), دون فرق في الحدوث بين الذكور والإناث. لم تشاهد علاقة بين عوامل الخطر لحدوث النشبة وتطور اختلاطات بعد النشبة. حدثت معظم الاختلاطات بشكلٍ مبكرٍ. بلغ متوسط مدة البقاء في المشفى(LOS) في مرضى هذه الدراسة 14 يوم, وترافقت الاختلاطات الحادة مع LOS أطول. بلغ معدل الوفيات في الفترة الحادة 10 مرضى (10%), و8 مرضى (80%) أظهروا وجود اختلاط  واحد على الأقل. إن شدة النشبة عند القبول هي أهم عامل خطر لحدوث الاختلاطات عند مرضى النشبة, وتترافق مع حدوث الوفيات بشكل أكبر. الخلاصة: معدل حدوث الاختلاطات الحادة بعد النشبة 61%, وتحدث بشكل مبكر بعد الاستشفاء, وتترافق مع LOS أطول. معدل الوفيات خلال فترة الاستشفاء هو10%, شدة النشبة عند القبول هي عامل الخطر الأهم لحدوث الاختلاطات وتترافق مع معدل وفيات أعلى

A rubric based approach towards Automated Essay Grading : focusing on high level content issues and ideas

Assessment of a student’s work is by no means an easy task. Even if the student response is in the form of multiple choice answers, manually marking those answer sheets is a task that most teachers regard as rather tedious. The development of an automated method to grade these essays was thus an inevitable step.This thesis proposes a novel approach towards Automated Essay Grading through the use of various concepts found within the field of Narratology. Through a review of the literature, several methods in which essays are graded were identified together with some of the problems. Mainly, the issues and challenges that plague AEG systems were that those following the statistical approach needed a way to deal with more implicit features of free text, while other systems which did manage that were highly dependent on the type of student response, the systems having pre-knowledge pertaining to the subject domain in addition to requiring more computational power. It was also found that while narrative essays are one of the main methods in which a student might be able to showcase his/her mastery over the English language, no system thus far has attempted to incorporate narrative concepts into analysing these type of free text responses.It was decided that the proposed solution would be centred on the detection of Events, which was in turn used to determine the score an essay receives under the criteria of Audience, Ideas, Character and Setting and Cohesion, as defined by the NAPLAN rubric. From the results gathered from experiments conducted on the four criteria mentioned above, it was concluded that the concept of detecting Events as they were within a narrative type story when applied to essay grading, does have a relation towards the score the essay receives. All experiments achieved an average F-measure score of 0.65 and above while exact agreement rates were no lower than 70%. Chi-squared and paired T-test values all indicated that there was insufficient evidence to show that there was any significant difference between the scores generated by the computer and those of the human markers

いまなぜレイチェル・カーソンか? : 「べつの道」を実践する

1. はじめに 2. いまなぜレイチェル・カーソンか?　3. レイチェル・カーソンの人となり　4. レイチェルの5つの作品　5. 問題提起の書 : 『沈黙の春』　6. 「べつの道」　7. おわりに