Use of attribute association error probability estimates to evaluate quality of medical record geocodes

BACKGROUND: The utility of patient attributes associated with the spatiotemporal analysis of medical records lies not just in their values but also the strength of association between them. Estimating the extent to which a hierarchy of conditional probability exists between patient attribute associations such as patient identifying fields, patient and date of diagnosis, and patient and address at diagnosis is fundamental to estimating the strength of association between patient and geocode, and patient and enumeration area. We propose a hierarchy for the attribute associations within medical records that enable spatiotemporal relationships. We also present a set of metrics that store attribute association error probability (AAEP), to estimate error probability for all attribute associations upon which certainty in a patient geocode depends. METHODS: A series of experiments were undertaken to understand how error estimation could be operationalized within health data and what levels of AAEP in real data reveal themselves using these methods. Specifically, the goals of this evaluation were to (1) assess if the concept of our error assessment techniques could be implemented by a population-based cancer registry; (2) apply the techniques to real data from a large health data agency and characterize the observed levels of AAEP; and (3) demonstrate how detected AAEP might impact spatiotemporal health research. RESULTS: We present an evaluation of AAEP metrics generated for cancer cases in a North Carolina county. We show examples of how we estimated AAEP for selected attribute associations and circumstances. We demonstrate the distribution of AAEP in our case sample across attribute associations, and demonstrate ways in which disease registry specific operations influence the prevalence of AAEP estimates for specific attribute associations. CONCLUSIONS: The effort to detect and store estimates of AAEP is worthwhile because of the increase in confidence fostered by the attribute association level approach to the assessment of uncertainty in patient geocodes, relative to existing geocoding related uncertainty metrics

Predicting the environmental suitability and population at risk of podoconiosis in Africa

Podoconiosis is a type of tropical lymphedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. The geographical distribution and burden of podoconiosis in Africa are uncertain. We applied statistical modelling to the most comprehensive database compiled to date to predict the environmental suitability of podoconiosis in the African continent. By combining climate and environmental data and overlaying population figures, we predicted the environmental suitability and human population at risk of podoconiosis in Africa. Environmental suitability for podoconiosis was predicted in 29 African countries. In the year 2020, the total population in areas suitable for podoconiosis is estimated at 114.5 million people, (95% uncertainty interval: 109.4–123.9) with 16.9 million in areas suitable for both lymphatic filariasis and podoconiosis. Of the total 5,712 implementation units (typically second administrative-level units, such as districts) defined by the World Health Organization in Africa, 1,655 (29.0%) were found to be environmentally suitable for podoconiosis. The majority of implementation units with high environmental suitability are located in Angola (80, 4.8%), Cameroon (170, 10.3%), the DRC (244, 14.7%), Ethiopia (495, 29.9%), Kenya (217, 13.1%), Uganda (116, 7.0%) and Tanzania (112, 6.8%). Of the 1,655 environmentally suitable implementation units, 960 (58.0%) require more detailed community-level mapping. Our estimates provide key evidence of the population at risk and geographical extent of podoconiosis in Africa, which will help decision-makers to better plan more integrated intervention programmes

Phylodynamic assessment of intervention strategies for the West African Ebola virus outbreak

Genetic analyses have provided important insights into Ebola virus spread during the recent West African outbreak, but their implications for specific intervention scenarios remain unclear. Here, we address this issue using a collection of phylodynamic approaches. We show that long-distance dispersal events were not crucial for epidemic expansion and that preventing viral lineage movement to any given administrative area would, in most cases, have had little impact. However, major urban areas were critical in attracting and disseminating the virus: preventing viral lineage movement to all three capitals simultaneously would have contained epidemic size to one-third. We also show that announcements of border closures were followed by a significant but transient effect on international virus dispersal. By quantifying the hypothetical impact of different intervention strategies, as well as the impact of barriers on dispersal frequency, our study illustrates how phylodynamic analyses can help to address specific epidemiological and outbreak control questions.info:eu-repo/semantics/publishe

Language experience impacts brain activation for spoken and signed language in infancy: Insights from unimodal and bimodal bilinguals

Recent neuroimaging studies suggest that monolingual infants activate a left lateralised fronto-temporal brain network in response to spoken language, which is similar to the network involved in processing spoken and signed language in adulthood. However, it is unclear how brain activation to language is influenced by early experience in infancy. To address this question, we present functional near infrared spectroscopy (fNIRS) data from 60 hearing infants (4-to-8 months): 19 monolingual infants exposed to English, 20 unimodal bilingual infants exposed to two spoken languages, and 21 bimodal bilingual infants exposed to English and British Sign Language (BSL). Across all infants, spoken language elicited activation in a bilateral brain network including the inferior frontal and posterior temporal areas, while sign language elicited activation in the right temporo-parietal area. A significant difference in brain lateralisation was observed between groups. Activation in the posterior temporal region was not lateralised in monolinguals and bimodal bilinguals, but right lateralised in response to both language modalities in unimodal bilinguals. This suggests that experience of two spoken languages influences brain activation for sign language when experienced for the first time. Multivariate pattern analyses (MVPA) could classify distributed patterns of activation within the left hemisphere for spoken and signed language in monolinguals (proportion correct = 0.68; p = 0.039) but not in unimodal or bimodal bilinguals. These results suggest that bilingual experience in infancy influences brain activation for language, and that unimodal bilingual experience has greater impact on early brain lateralisation than bimodal bilingual experience

Urban health and prevention and control of vector-borne diseases

Background: Over half the world's human populations are currently at risk from vector-borne diseases (VBDs), and the heaviest burden is borne by the world's poorest people, communities, and countries. The aim of this study was to conduct a review on VBD interventions relevant to housing and hygiene (including sanitation and waste management) in urban areas. Main body: We conducted a scoping review, which involved systematically searching peer-reviewed and grey literature published between 2000 and 2016 using five scientific databases and one database for grey literature. Different data extraction tools were used for data coding and extraction. We assessed the quality of each study using the Mixed Methods Appraisal Tool and extracted descriptive characteristics and data about implementation process and transferability from all studies using the Template for Intervention Description and Replication and ASTAIRE (a tool for analyzing the transferability of health promotion interventions) tools. We reviewed 44 studies. Overall, the studies were judged to be of high risk for bias. Our results suggest multifaceted interventions, particularly community-based interventions, have the potential to achieve wider and more sustained effects than do standard vertical single-component programs. The evaluations of multifaceted interventions tend to include integrated evaluations, using not only entomological indicators but also acceptability and sustainability indicators. Conclusions: This review highlighted the important need for higher quality research in VBDs and improved and standardized reporting of interventions. Significant research gaps were found regarding qualitative research and implementation research, and results highlighted the need for more interventions focus on sanitation and hygiene practices