Early Prediction of Alzheimers Disease Leveraging Symptom Occurrences from Longitudinal Electronic Health Records of US Military Veterans

Early prediction of Alzheimer's disease (AD) is crucial for timely intervention and treatment. This study aims to use machine learning approaches to analyze longitudinal electronic health records (EHRs) of patients with AD and identify signs and symptoms that can predict AD onset earlier. We used a case-control design with longitudinal EHRs from the U.S. Department of Veterans Affairs Veterans Health Administration (VHA) from 2004 to 2021. Cases were VHA patients with AD diagnosed after 1/1/2016 based on ICD-10-CM codes, matched 1:9 with controls by age, sex and clinical utilization with replacement. We used a panel of AD-related keywords and their occurrences over time in a patient's longitudinal EHRs as predictors for AD prediction with four machine learning models. We performed subgroup analyses by age, sex, and race/ethnicity, and validated the model in a hold-out and "unseen" VHA stations group. Model discrimination, calibration, and other relevant metrics were reported for predictions up to ten years before ICD-based diagnosis. The study population included 16,701 cases and 39,097 matched controls. The average number of AD-related keywords (e.g., "concentration", "speaking") per year increased rapidly for cases as diagnosis approached, from around 10 to over 40, while remaining flat at 10 for controls. The best model achieved high discriminative accuracy (ROCAUC 0.997) for predictions using data from at least ten years before ICD-based diagnoses. The model was well-calibrated (Hosmer-Lemeshow goodness-of-fit p-value = 0.99) and consistent across subgroups of age, sex and race/ethnicity, except for patients younger than 65 (ROCAUC 0.746). Machine learning models using AD-related keywords identified from EHR notes can predict future AD diagnoses, suggesting its potential use for identifying AD risk using EHR notes, offering an affordable way for early screening on large population.Comment: 24 page

Unfitness to Plead. Volume 1: Report.

This has been produced along with Volume 2: Draft Legislation as a combined document Presented to Parliament pursuant to section 3(2) of the Law Commissions Act 1965 Ordered by the House of Commons to be printed on 12 January 201

word~river literary review (2009)

wordriver is a literary journal dedicated to the poetry, short fiction and creative nonfiction of adjuncts and part-time instructors teaching in our universities, colleges, and community colleges. Our premier issue was published in Spring 2009. We are always looking for work that demonstrates the creativity and craft of adjunct/part-time instructors in English and other disciplines. We reserve first publication rights and onetime anthology publication rights for all work published. We define adjunct instructors as anyone teaching part-time or full-time under a semester or yearly contract, nationwide and in any discipline. Graduate students teaching under part-time contracts during the summer or who have used up their teaching assistant time and are teaching with adjunct contracts for the remainder of their graduate program also are eligible.https://digitalscholarship.unlv.edu/word_river/1002/thumbnail.jp

Global Health Partnerships During the COVID-19 Pandemic: Perspectives and Insights from International Partners

Global health partnerships (GHPs) have encountered many challenges during the coronavirus disease 2019 (COVID-19) pandemic. New perspectives and insights are needed to guide GHPs when navigating current and future collaborations. This study aimed to understand perspectives and insights of international partners regarding how the COVID-19 pandemic impacted their GHPs with institutions in the United States. We performed a cross-sectional qualitative study conducted through virtual semi-structured interviews performed between June 12, 2020 and July 22, 2020. We queried academic institutions based in the United States to refer individuals from their corresponding international GHP organizations. We invited these individuals to participate in virtual interviews that were audio-recorded and transcribed. We analyzed data qualitatively to identify themes. Eighty-four United States partners provided e-mail addresses for international partners. Ten individuals from these GHPs completed the interview. Participants reported overall positive experiences with their United States-based partners during the pandemic. The following themes emerged: imbalanced decision-making; worry about partnership continuity; opportunity to optimize communication within partnerships; interest in incorporating technology to facilitate engagement; and a desire for increased bilateral exchanges. Several challenges appeared to exist before COVID-19 and were highlighted by the pandemic. Most respondents were optimistic regarding the future of their GHPs. However, concerns were expressed regarding the implications of fewer in-person international experiences with United States trainees and the desire for stronger communication. Although our results do not represent the perspectives and insights of all GHPs, they provide considerations for the future. We urge institutions in the United States to re-examine and strive for equitable relationships with their international partners

Reciprocity? International Preceptors’ Perceptions of Global Health Elective Learners at African Sites

Background: Short-term global health electives (STGHEs) have become increasingly common, with evidence showing educational and clinical benefits for short-term learners (STLs). Despite increased recognition that STGHEs should be mutually beneficial for host sites and STLs, evidence demonstrating the impact on international host preceptors is lacking. Objectives: To understand international host preceptors’ perceptions regarding benefits and burdens of hosting STLs. Methods: Focus group discussions with a convenience sample of 10 of 18 eligible preceptors were conducted at pediatric STGHE sites in Malawi and Lesotho. Qualitative content analysis was performed to identify themes using a deductive-inductive approach. Findings: Common themes regarding benefits to preceptors included increased knowledge and resources for learning from STLs, broadened differential diagnoses, and the satisfaction of teaching. Regarding burdens, preceptors perceived that supervising STLs decreases efficiency. Preceptors identified the burden of having to intervene in instances that could lead to patient harm. Some preceptors perceived that STLs under-valued preceptors’ clinical decision-making in resource-limited contexts. Conclusions: Our findings emphasize the need for institutions to identify mutuality of benefits between STLs and host sites when developing STGHEs. Host preceptors identified robust pre-departure training for STLs, lengthened duration of STGHEs, and formal preceptor orientation as ways to enhance mutuality of benefits

Reliability of a smartphone goniometer app compared with traditional goniometer for measuring passive motion at the first metatarsophalangeal joint

BACKGROUND: Adequate sagittal plane motion of the first metatarsalphalangeal joint (1st MTPJ) is important during normal gait and goniometric measurement is commonly used as a diagnostic and outcome assessment tool. We aimed to determine the intra and inter-rater reliability together with the concurrent validity of a universal plastic goniometer (UG) and a smartphone applicationlication (Dr G) for the measurement of dorsiflexion at the 1st MTPJ. METHODS: Measurement of joint position and passive range of motion of the 1st MTPJ dorsiflexion was compared using a UG and DrG goniometer. A double-blind repeated measures design was utilized, with intraclass correlation coefficient (ICC) used to determine levels of reliability. RESULTS: For joint position good intra-rater reliability (ICC >0.861) and good inter-rater reliability (ICC >0.823) was noted. However, the Dr G application consistently measured lower angles (mean 27.8° (SD 8.37)) than the UG (mean 32° (SD 11.7)) and these associations were significant (r = 0.399, p < 0.001). For passive range of motion, the mean total range of dorsiflexion motion (from maximum plantarflexed position to maximum dorsiflexed position) was 82.8° (SD 12.2) for the UG and 82.9° (SD 11.3) for the Dr G application. Both instruments demonstrated high levels of intra-rater reliability (ICC >0.809). Inter-rater reliability was moderate to good for the UG (ICC 0.693 (95 % CI 0.580 to 0.788)) and good for the Dr G application (ICC 0.708 (95 % CI 0.597 to 0.799)). CONCLUSIONS: Moderate to high intra and inter-rater reliability of joint position and passive 1st MTPJ motion can be achieved with traditional and smartphone-based goniometric measurement. The Dr G application may provide a slightly higher reliability, but devices should not be used inter-changeably as significant variation in measurement between devices may occur. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13047-015-0088-3) contains supplementary material, which is available to authorized users

The Simons Observatory: Galactic Science Goals and Forecasts

Observing in six frequency bands from 27 to 280 GHz over a large sky area, the Simons Observatory (SO) is poised to address many questions in Galactic astrophysics in addition to its principal cosmological goals. In this work, we provide quantitative forecasts on astrophysical parameters of interest for a range of Galactic science cases. We find that SO can: constrain the frequency spectrum of polarized dust emission at a level of $\Delta\beta_d \lesssim 0.01$ and thus test models of dust composition that predict that $\beta_d$ in polarization differs from that measured in total intensity; measure the correlation coefficient between polarized dust and synchrotron emission with a factor of two greater precision than current constraints; exclude the non-existence of exo-Oort clouds at roughly 2.9$\sigma$ if the true fraction is similar to the detection rate of giant planets; map more than 850 molecular clouds with at least 50 independent polarization measurements at 1 pc resolution; detect or place upper limits on the polarization fractions of CO(2-1) emission and anomalous microwave emission at the 0.1% level in select regions; and measure the correlation coefficient between optical starlight polarization and microwave polarized dust emission in $1^\circ$ patches for all lines of sight with $N_{\rm H} \gtrsim 2\times10^{20}$ cm$^{-2}$. The goals and forecasts outlined here provide a roadmap for other microwave polarization experiments to expand their scientific scope via Milky Way astrophysics.Comment: Submitted to AAS journals. 33 pages, 10 figure