Doodle Health: A Crowdsourcing Game for the Co-design and Testing of Pictographs to Reduce Disparities in Healthcare Communication

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming. We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs. We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, informatics researchers, clinicians, and community members participated in two Design Box meetings. The results of the meetings were used to create the Doodle Health crowdsourcing game. The game was presented and tested at two public fairs. Initial testing indicates crowdsourcing is a promising approach to pictograph development and testing for relevancy and comprehension. Over 596 drawings were collected and 1,758 guesses were performed to date with 70-90% accuracies, which are satisfactorily high

Healthy Lifestyle and Mood: A Biomedical Informatics Citizen Science Project in a High School Classroom

Mental health is an increasing concern in adolescents. Mental health disorders can affect academic performance, affect the cultivation of healthy relationships, and even lead to suicide. Healthy lifestyle can improve mental health, though there are gaps in the research, partly resulted from the lack of detailed longitudinal datasets on lifestyle and mental health. To inform and engage students in the research on adolescent lifestyle and mood, the George Washington University and the T.C. Williams High School in Alexandria, Virginia teamed up in a citizen science project. Students generated questions, collected data on themselves, analyzed the data, and produced research reports relating to their mental health and lifestyle. Student feedbacks suggest that the students find the project to be generally interesting and some students (46%) reported that the participation in the project may influence their college and career plans. The anonymized dataset resulted from the project provides another contribution to science

v3NLP Framework: Tools to Build Applications for Extracting Concepts from Clinical Text.

Introduction: Substantial amounts of clinically significant information are contained only within the narrative of the clinical notes in electronic medical records. v3NLP Framework is a set of best of breed functionalities developed to transform this information into structured data for use in quality improvement, research, population health surveillance, and decision support. Background: MetaMap, cTAKES and similar well known NLP tools do not have sufficient scalability out of the box. v3NLP Framework evolved out of the necessity to scale these tools up and provide a framework to customize and tune techniques to fit a variety of tasks, including document classification, tuned concept extraction for specific conditions, patient classification, and information retrieval. Innovation: Beyond scalability, several v3NLP Framework developed projects have been efficacy tested and benchmarked. While v3NLP Framework includes annotators, pipelines and applications, the functionalities enable developers to create novel annotators, put annotators into pipelines and scaled applications. Discussion: v3NLP Framework has been successfully utilized in many projects including general concept extraction, risk factors for homelessness among veterans, and identification of mentions of the presence of an indwelling urinary catheter. Projects as diverse as predicting colonization with methicillin resistant Staphylococcus aureus and extracting references to military sexual trauma are being built using v3NLP Framework components. Conclusion: v3NLP Framework is a set of functionalities and components that provide Java developers the ability to create novel annotators, place annotators into pipelines, and applications to extract concepts from clinical text. There are scale-up and scale-out functionalities to process large numbers of records

Joint longitudinal trajectories of pain intensity and opioid prescription in Veterans with back pain

PURPOSE: We describe pain intensity and opioid prescription jointly over time in Veterans with back pain to better understand their relationship. METHODS: We performed a retrospective cohort study on electronic health record data from 117126 Veterans (mean age 49.2 years) diagnosed with back pain in 2015. We used latent class growth analysis to jointly model pain intensity (0-10 scores) and opioid prescriptions over two years to identify classes of individuals similar in their trajectory of pain and opioid over time. Multivariable multinomial logit models assessed sociodemographic and clinical predictors of class membership. RESULTS: We identified six trajectory classes: a no pain/no opioid class (22.2%), a mild pain/no opioid class (45.0%), a moderate pain/no opioid class (24.6%), a moderate, decreasing pain/decreasing opioid class (3.3%), a moderate pain/high opioid class (2.6%), and a moderate, increasing pain/increasing opioid class (2.3%). Among those in moderate pain classes, being white (vs. non-white) and older were associated with higher odds of being prescribed opioids. Veterans with mental health diagnoses had increased odds of being in the painful classes vs. no pain/no opioid class. CONCLUSION: We found distinct patterns in the long-term joint course of pain and opioid prescription in Veterans with back pain. Understanding these patterns and associated predictors may help with development of targeted interventions for patients with back pain. This article is protected by copyright. All rights reserved

Allogeneic bone marrow transplantation with post-transplant cyclophosphamide for patients with HIV and haematological malignancies: a feasibility study.

BACKGROUND: Allogeneic blood or marrow transplantation (alloBMT) is potentially life-saving treatment for individuals with HIV and hematologic malignancies; challenges include identifying donors and maintaining antiretroviral therapy (ART). The objectives of our study were to investigate interventions to expand donor options and to prevent ART interruptions for patients with HIV in need of alloBMT. METHODS: We conducted a single-center, single-arm interventional trial of alloBMT in patients with HIV and high-risk hematologic malignancy in which we used post-transplantation cyclophosphamide (PTCy) as graft-versus-host-disease (GvHD) prophylaxis to expand donor options and an optimized ART strategy of avoiding pharmacoenhancers and adding subcutaneous enfuvirtide during PTCy and during oral medication intolerance. Our primary outcome was the proportion of participants who maintained ART through day 60. We measured the HIV latent reservoir (LR) using a quantitative viral outgrowth assay. ClinicalTrials.gov, NCT01836068. FINDINGS: Between June 1, 2013 and August 27, 2015, nine patients who were referred for transplant provided consent. Two patients had relapsed malignancy before donor searches were initiated. Seven patients had suitable donors identified (two matched sibling, two matched unrelated, two haploidentical, and one single-antigen mismatched unrelated) and proceeded to alloBMT. All patients maintained ART through day 60 and required ART changes (median 1, range 1-3) in the first 90 days. One patient stopped ART and developed HIV rebound with grade 4 meningoencephalitis at day 146. Among six alloBMT patients with measurements, the HIV LR was not detected post-alloBMT in four patients with >95% donor chimerism, consistent with a 2·06- to 2·54 log(10) reduction in the HIV LR. In two patients, with <95% donor chimerism, the HIV LR remained relatively stable. INTERPRETATION: By using PTCy as GvHD prophylaxis, we successfully expanded alloBMT donor options for patients with HIV. Continuing ART with a regimen that includes enfuvirtide post-alloBMT was safe, but life-threatening viral rebound can occur with ART interruption. FUNDING: amfAR The Foundation for AIDS Research, the Johns Hopkins University Center for AIDS Research and National Cancer Institute. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0183606