Mining High Impact Combinations of Conditions from the Medical Expenditure Panel Survey

The condition of multimorbidity — the presence of two or more medical conditions in an individual — is a growing phenomenon worldwide. In the United States, multimorbid patients represent more than a third of the population and the trend is steadily increasing in an already aging population. There is thus a pressing need to understand the patterns in which multimorbidity occurs, and to better understand the nature of the care that is required to be provided to such patients. In this thesis, we use data from the Medical Expenditure Panel Survey (MEPS) from the years 2011 to 2015 to identify combinations of multiple chronic conditions (MCCs). We first quantify the significant heterogeneity observed in these combinations and how often they are observed across the five years. Next, using two criteria associated with each combination -- (a) the annual prevalence and (b) the annual median expenditure -- along with the concept of non-dominated Pareto fronts, we determine the degree of impact each combination has on the healthcare system. Our analysis reveals that combinations of four or more conditions are often mixtures of diseases that belong to different clinically meaningful groupings such as the metabolic disorders (diabetes, hypertension, hyperlipidemia); musculoskeletal conditions (osteoarthritis, spondylosis, back problems etc.); respiratory disorders (asthma, COPD etc.); heart conditions (atherosclerosis, myocardial infarction); and mental health conditions (anxiety disorders, depression etc.). Next, we use unsupervised learning techniques such as association rule mining and hierarchical clustering to visually explore the strength of the relationships/associations between different conditions and condition groupings. This interactive framework allows epidemiologists and clinicians (in particular primary care physicians) to have a systematic approach to understand the relationships between conditions and build a strategy with regards to screening, diagnosis and treatment over a longer term, especially for individuals at risk for more complications. The findings from this study aim to create a foundation for future work where a more holistic view of multimorbidity is possible

Customer-Base Analysis in an Online Search Setting

Consider a major online travel site that presents users with a wide selection of search results when a user enters a query into their system. From October 1st through October 15th 2009, the behavior of all users searching for hotels in four major destinations were collected and compiled. This information included details including the links users were presented, the order in which they were shown, the number of links users were shown, and most importantly, which links users actually clicked. Given this data, management would like to know more about their users to determine how best to display the search results

Regulate or Not? Retelling Kerala’s Experience to Review the Neoliberal Agenda behind Agricultural Reforms in India

This paper is an analysis of the controversial reforms introduced in the agricultural market of India in 2020. The researcher does a comprehensive review of these reforms using data obtained from Kerala and interlinks the components in the existing literature to proceed for a macro-level examination. This is to critically understand the policy dimensions of the laws introduced and their subsequent repeal. The background and evolution of market-mediated reforms in the agricultural sector, the immediate drive for a new set of laws, the question of middlemen in the market, the structural inequalities, and the resultant power asymmetry in Indian rural society are addressed. There are also informed suggestions for possible ways to guarantee a Minimum Support Price (MSP). More than a systemic critique of the newly introduced (and later repealed) farm laws, the real problems in the agricultural market are placed to check the changing direction and agenda in market reforms

Unveiling the silent nemesis: periprosthetic joint infection-the burden and road to recovery

Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery that poses significant challenges for patients and healthcare systems. It is associated with increased morbidity, financial burdens, and emotional distress for patients. Understanding the risk factors for PJI and implementing preventive strategies are crucial to reducing its incidence and mitigating its impact on both individuals and healthcare institutions

‘Beyond broken bones’: the hidden impact of depression on orthopaedic patients-the silent struggle

The recognition of the interplay between physical and mental health is of increasing importance in the management of orthopaedic patients. Orthopaedic patients not only encounter physical impairments but also mental health complications such as anxiety and depression. While orthopaedic surgeons traditionally focus on the physical aspects of patients' recovery, recent studies have highlighted the significant impact of psychological factors on functional outcomes and quality of life; thus, necessitating a comprehensive treatment approach

Advancing patient care: unleashing the potential of artificial intelligence in orthopaedics

I am writing to highlight the remarkable strides that artificial intelligence (AI) has taken in the field of orthopaedics, paving the way for transformative changes in patient care and clinical outcomes. As the realm of medical science evolves, integrating AI into orthopaedics has the potential to revolutionize diagnosis, treatment, and management strategies, enhancing both the precision and efficiency of orthopaedic care

Orthopaedic residency in the time of COVID-19: navigating a new normal

The pandemic had affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialties of orthopaedics

Orthopaedic surgeons and the legal tightrope: safeguarding patient welfare amidst rising litigation

Medicolegal litigation is a critical aspect of orthopaedic practice. These disputes can arise due to a variety of reasons, including medical negligence, malpractice, and breach of duty. Orthopaedic surgeons are at risk of being involved in medicolegal cases due to the nature of their work, which involves complex surgical procedures and postoperative care. They are required to manage a wide range of cases, from minor fractures to complex spinal and joint surgeries. As with any medical field, orthopaedic surgery being a complex and dynamic medical specialty; carries with it a certain amount of legal responsibility, with litigation rates on the rise globally. This article aims to provide an overview of the areas in orthopaedics where medicolegal litigation is highest and highlight some of the strategies that can be employed to reduce the risk of litigation

‘From bones to burnout, delving beyond the scalpel’: prioritizing surgeon wellness for optimal patient outcomes

Orthopaedic surgeons face significant challenges in balancing their demanding professional responsibilities with their personal lives, which can often lead to burnout and poor well-being. Orthopaedic surgeons face a variety of multifaceted stressors which lead to burnout and have significant impacts on their well-being and the quality of patient care. Here, we present an overview of relevant literature and provide evidence-based recommendations for a comprehensive multidisciplinary approach to implement strategies to mitigate their effects