UMMS Biomedical Data Assets & D3Health

As part of the mini-symposium entitled “Research on Digital Health for Designing Scalable Pervasive Healthcare Monitoring, Rehabilitation, and Home-based Healthcare Systems,” Dr. Mathew discusses the research and clinical data ecosystem at UMass Medical School and the D3Health system integrating biomedical big data, analytics, and decision support

Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit

Background and study aims: Video capsule endoscopy (VCE) is a minimally invasive tool that helps visualize the gastrointestinal tract from the esophagus to the right colon without the need for sedation or preparation. VCE is safe with very few contraindications. However, its role and safety profile in the intensive care unit (ICU) population have not been reported. The aim of this study is to evaluate the safety, efficacy, and feasibility of VCE use in ICU patients. Patients and methods: We conducted a single-center retrospective observational study of patients who underwent VCE for evaluation of obscure overt gastrointestinal bleeding in the ICU between 2008 and 2016. Results: This study included 48 patients who were admitted to the UMass Memorial Medical Center ICUs for gastrointestinal bleeding. VCE was successfully completed in 43/48 (90 %) patients. The entire length of small bowel could be evaluated in 75 % and the source of bleeding was identified in 44 % of the patients. The most commonly identified source of bleeding included small bowel angioectasias, duodenal erosions/ulcers, and small bowel polyps. No major complications could be attributed to the VCE. Only 1 capsule was retained after 2 wk; however, there was no incidence of bowel obstruction, perforation, or capsule aspiration. Conclusions: This observational retrospective study demonstrates that VCE may be a safe, feasible, and effective diagnostic tool in evaluation of gastrointestinal bleeding in the ICU population with few complications. VCE may be a safe diagnostic prelude and be a guide to the correct therapeutic procedure if needed, in the context of patients who are seriously ill

Proton pump inhibitors increase the severity of hepatic encephalopathy in cirrhotic patients

BACKGROUND: Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites, esophageal/gastric varices or encephalopathy. The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy (HE). Well established triggers for HE include infection, gastrointestinal bleeding, constipation, and medications. Alterations to the gut microbiome is one of the leading ammonia producers in the body, and therefore may make patients more susceptible to HE. AIM: To investigate the relationship between the use of proton pump inhibitors (PPIs) and HE in patients with cirrhosis. METHODS: This is a single center, retrospective analysis. Patients were included in the study with an admitting diagnosis of HE. The degree of HE was determined from subjective and objective portions of hospital admission notes using the West Haven Criteria. The primary outcome of the study was to evaluate the grade of HE in PPI users versus non-users at admission to the hospital and throughout their hospital course. Secondary outcomes included rate of infection, gastrointestinal bleeding within the last 12 mo, mean ammonia level, and model for end-stage liver disease scores at admission. RESULTS: The HE grade at admission using the West Haven Criteria was 2.3 in the PPI group compared to 1.7 in the PPI nonuser group (P = 0.001). The average length of hospital stay in PPI group was 8.3 d compared to 6.5 d in PPI nonusers (P = 0.046). Twenty-seven (31.8%) patients in the PPI user group required an Intensive Care Unit admission during their hospital course compared to 6 in the PPI nonuser group (16.7%) (P = 0.138). Finally, 10 (11.8%) patients in the PPI group expired during their hospital stay compared to 1 in the PPI nonuser group (2.8%) (P = 0.220). CONCLUSION: Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs

SUPPORT-AF: Piloting a Multi-Faceted, Electronic Medical Record-Based Intervention to Improve Prescription of Anticoagulation

Background: Only 50% of eligible atrial fibrillation ( AF ) patients receive anticoagulation ( AC ). Feasibility and effectiveness of electronic medical record (EMR)-based interventions to profile and raise provider AC percentage is poorly understood. The SUPPORT-AF (Supporting Use of AC Through Provider Profiling of Oral AC Therapy for AF) study aims to improve rates of adherence to AC guidelines by developing and delivering supportive tools based on the EMR to providers treating patients with AF. Methods and Results: We emailed cardiologists and community-based primary care providers affiliated with our institution reports of their AC percentage relative to peers. We also sent an electronic medical record-based message to these providers the day before an appointment with an atrial fibrillation patient who was eligible but not receiving AC . The electronic medical record message asked the provider to discuss AC with the patient if he or she deemed it appropriate. To assess feasibility, we tracked provider review of our correspondence. We also tracked the change in AC for intervention providers relative to alternate primary care providers not receiving our intervention. We identified 3786, 1054, and 566 patients cared for by 49 cardiology providers, 90 community-based primary care providers, and 88 control providers, respectively. At baseline, the percentage of AC was 71.3%, 63.5%, and 58.3% for these 3 respective groups. Intervention providers reviewed our e-mails and electronic medical record messages 45% and 96% of the time, respectively. For providers responding, patient refusal was the most common reason for patients not being on AC (21%) followed by high bleeding risk (19%). At follow-up 10 weeks later, change in AC was no different for either cardiology or community-based primary care providers relative to controls (0.2% lower and 0.01% higher, respectively). Conclusions: Our intervention profiling AC was feasible, but not sufficient to increase AC in our population

The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems

Main objective There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04506528 (https://clinicaltrials.gov/ct2/show/NCT04506528)

Modeling ‘yield-population’ relationships in soybean

Our objectives were to evaluate the seed yield of soybean, and Duncan\u27s model with respect to relationship between seed yield and plant population, and analyze the response of soybean seed yield components to light enrichment initiated at different growth stages. Duncan coined the term crowding to include the effects of density and planting pattern. Duncan\u27s model states that there is a linear relationship between natural logarithm of yield plant−1 and crowding. Results of the studies fitting Duncan\u27s model to the data obtained from different soybean cultivars planted at different densities and planting patterns indicated that the model can predict the changes in yield with changing densities and planting pattern especially if the variability in the data is low. In order to analyze the response of soybean seed yield components to non-destructive light enrichment initiated at different growth stages, light enrichment was imposed on the indeterminate soybean cultivar Evans by installing wire mesh fencing on either side of the center row to push the adjacent rows aside at different growth stages. Fences prevented plants in the neighboring rows from encroaching on the growing space of the center row plants. Pod number per plant and to a lesser extent seed size accounted for variation in seed yield. Light enrichment initiated at late vegetative or early flowering stages increased seed yield 217%, mainly by increasing pod number, while light enrichment beginning at early pod formation increased seed size 23%, resulting in a 115% increase in seed yield. Responses to light enrichment occurred proportionately across all node positions despite the differences in the time (15 to 20 days) of development of yield components at the different node positions. Although maximum seed size may be under genetic control in soybean plants, our results suggested seed size can still be modified by the environment with some internal control moderating the final size of most seeds in all pods. It indicates that plants are able to redistribute the available resources to components not yet determined, in an attempt to maintain or improve yield

Prevalence and risk factors associated with underweight among under-five children in a rural area of Puducherry

Background: Nutrition has been recognized as a basic pillar for social and economic development. One in every three malnourished children in the world lives in India. The objective of this study was to measure the prevalence and to study the selected factors associated with underweight among the under-five children in a rural area of Puducherry. Aims: This study aims to study the prevalence of underweight among children under-five years of age and to study the associated risk factors. Methodology: This was a cross-sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments were taken and plotted on the Indian Academy of Pediatrics growth charts.Results: The prevalence of underweight was found to be 23.8%. The age of the child, gender, socioeconomic status, duration of exclusive breast feeds, birth order, and birth weight were found to have statistical significance in underweight. However, the maternal education did not show any significance in underweight. Conclusion: Nutritional status of under-five years children is one of the important indicators of overall development of community and thus country. Intervention to reduce the burden of underweight should be directed toward the education of the mothers regarding the importance of nutrition by community health workers

A Review of Secure and Privacy-Preserving Medical Data Sharing

In the digital healthcare era, it is of the utmost importance to harness medical information scattered across healthcare institutions to support in-depth data analysis and achieve personalized healthcare. However, the cyberinfrastructure boundaries of healthcare organizations and privacy leakage threats place obstacles on the sharing of medical records. Blockchain, as a public ledger characterized by its transparency, tamper-evidence, trustlessness, and decentralization, can help build a secure medical data exchange network. This paper surveys the state-of-the-art schemes on secure and privacy-preserving medical data sharing of the past decade with a focus on blockchain-based approaches. We classify them into permissionlessblockchain-based approaches and permissioned blockchain-based approaches and analyze their advantagesand disadvantages. We also discuss potential research topics on blockchain-based medical data sharing

Toward secure, privacy-preserving, and interoperable medical data sharing via blockchain

In the era of cloud computing and big data analysis, how to efficiently share and utilize medical information scattered across various care providers has become a critical problem. This paper proposes a new framework for sharing medical data in a secure and privacy-preserving way. This framework holistically integrates multi-Authority attribute based encryption, blockchain and smart contract, as well as software defined networking to define and enforce sharing policies. Specifically in our framework, patients\u27 medical records are encrypted and stored in hospital databases, where strict access controls are enforced with attribute based encryption coupled with privacy level classification. Our framework leverages blockchain technology to connect scattered private databases from participating hospitals for efficient and secure data provision, smart contracts to enable the business logic of clinical data usage, and software defined networking to revoke sharing privileges. The performance evaluation of our prototype demonstrates that the associated computation costs are reasonable in practice