Enabling Personalized Decision Support with Patient-Generated Data and Attributable Components

Decision-making related to health is complex. Machine learning (ML) and patient generated data can identify patterns and insights at the individual level, where human cognition falls short, but not all ML-generated information is of equal utility for making health-related decisions. We develop and apply attributable components analysis (ACA), a method inspired by optimal transport theory, to type 2 diabetes self-monitoring data to identify patterns of association between nutrition and blood glucose control. In comparison with linear regression, we found that ACA offers a number of characteristics that make it promising for use in decision support applications. For example, ACA was able to identify non-linear relationships, was more robust to outliers, and offered broader and more expressive uncertainty estimates. In addition, our results highlight a tradeoff between model accuracy and interpretability, and we discuss implications for ML-driven decision support systems

Hamiltonian formalism and the Garrett-Munk spectrum of internal waves in the ocean

Wave turbulence formalism for long internal waves in a stratified fluid is developed, based on a natural Hamiltonian description. A kinetic equation appropriate for the description of spectral energy transfer is derived, and its self-similar stationary solution corresponding to a direct cascade of energy toward the short scales is found. This solution is very close to the high wavenumber limit of the Garrett-Munk spectrum of long internal waves in the ocean. In fact, a small modification of the Garrett-Munk formalism includes a spectrum consistent with the one predicted by wave turbulence.Comment: 4 pages latex fil

Influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens, 27 states, 2007-2009

INTRODUCTION: The objective of this study was to determine whether perceptions of the home and school food environments are related to food and beverage intakes of postpartum teens. METHODS: Our study was a baseline, cross-sectional analysis of 853 postpartum teens enrolled in a weight-loss intervention study across 27 states from 2007 through 2009. Eight-item scales assessed perceived accessibility and availability of foods and beverages in school and home environments. Associations between environments and intakes were assessed by using χ(2) and using logistic regression with generalized estimating equations (GEE), respectively. RESULTS: Overall, 52% of teens perceived their school food environment as positive, and 68% of teens perceived their home food environment as positive. A positive school environment was independently associated with fruit consumption and 100% fruit juice consumption. A positive home environment was independently associated with fruit, vegetable, and water consumption and infrequent consumption of soda and chips (χ(2) P < .05). Having only a positive school environment was associated with fruit consumption (GEE odds ratio [OR], 3.1; 95% confidence interval [CI], 1.5–6.5), and having only a positive home environment was associated with fruit (GEE OR, 2.9; 95% CI, 1.6–5.6), vegetable (GEE OR, 3.1; 95% CI, 1.5–6.2), and water (GEE OR, 2.6; 95% CI, 1.7–4.0) consumption and infrequent consumption of soda (GEE OR, 0.5; 95% CI, 0.3–0.7). Results for positive home and school environments were similar to those for positive home only. CONCLUSION: Home and school environments are related to dietary behaviors among postpartum teens, with a positive home environment more strongly associated with healthful behaviors

A case study of adapting a health insurance decision intervention from trial into routine cancer care

OBJECTIVE: This study adapted Improving Cancer Patients\u27 Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (\u3e 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact. RESULTS: Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise

Energy spectra of the ocean's internal wave field: theory and observations

The high-frequency limit of the Garrett and Munk spectrum of internal waves in the ocean and the observed deviations from it are shown to form a pattern consistent with the predictions of wave turbulence theory. In particular, the high frequency limit of the Garrett and Munk spectrum constitutes an {\it exact} steady state solution of the corresponding kinetic equation.Comment: 4 pages, one color figur

Overall Diet History and Reversibility of the Metabolic Syndrome Over 5 Years: The Whitehall II prospective cohort study

International audienceOur findings support the benefit of adherence to AHEI dietary guidelines for individuals with MetS, especially those with central obesity or high triglyceride levels

Needs, expectations and consequences for the child growing up in a family with a parent with mental illness

Parental mental illness is considered one of the strongest risk-factors for development of offspring psychopathology. The lack of pan-European guidelines for empowering children of parents with mental illness led to EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The first task in this project, was to analyse needs, expectations and consequences for children, with respect to living with a parent with mental illness. The aim this paper is to report results of these analyses. The qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland (N=96). There were 3 types of focus groups: (1) professionals (doctors, nurses, psychologists, social workers), (2) adult children and partners of a person with mental illness, (3) parents who have experienced mental illness during their parenthood. Framework analysis method was used. Results of the study highlighted that the main consequences for children of parental mental illness were role reversal, emotional and behavioural problems, lack of parent’s attention and stigma. The main needs of these children were emotional support, security and multidisciplinary help. Implications for practice are: (1) professionals working with parents with mental illness should be aware of the specific consequences for the children; (2) to empower children they should focus on them, but not excluding parents from the parental roles; (3) the multi-agency collaboration is necessary; (4) schools should provide counselling and teach staff and students about mental health problems to reduce stigm

A scoping review of de-implementation frameworks and models

BACKGROUND: Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research. METHODS: We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies. RESULTS: The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM. CONCLUSION: De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM. REGISTRATION: Not registered

Multi-filament structures in relativistic self-focusing

A simple model is derived to prove the multi-filament structure of relativistic self-focusing with ultra-intense lasers. Exact analytical solutions describing the transverse structure of waveguide channels with electron cavitation, for which both the relativistic and ponderomotive nonlinearities are taken into account, are presented.Comment: 21 pages, 12 figures, submitted to Physical Review