The Population Health Management PolicyMap Project (PHM/PMP)

The Population Health Management/ PolicyMap Project links together the academic focus on population health management and the adoption of the PolicyMap technology to develop essential analytical skills applicable to real-time health industry decision-making. This Project helps prepare students to identify populations at risk, develop risk segmentation characteristics and criteria and to complete risk stratification in order to complete integrated care plans and management. The map representation will help students further engage in determining risk factors and treatment options/availabilities that will be crucial in planning, preventing and managing any of the at-risk health conditions. The PolicyMap learning assignment will be integrated within a designated unit of the HCAD 7518 – Managing Community and Population Health course offered during the Fall 2016 semester to two separate sections (online and on-campus). Within each course, students will be divided into task forces focusing on a specific population health topic. These topics will be based on immediate health issues that have major impacts on quality of life and health costs. Potential topics will be very diverse from focusing on emerging contagious diseases (Zika) to substance abuse (Opoid epidemic), HIV/AIDs persistence in rural populations and behavioral health management for at-risk populations. The actual assignment will require the students to identify the population health issues, research the characteristics and criteria of the condition and to define the population at-risk. The key skill development revolves around the student\u27s capacity to find the most appropriate data sources and to select those data indicators that best represent the needs of the population at-risk. The PolicyMap tool will allow the student to link together not only clinical conditions, but social determinants as well. The summary reports and presentations will allow students to demonstrate critical thinking as they design their management responses to the various healthcare challenges

Teaching Population Health: Innovations in the integration of the healthcare and public health systems

Population health is a critical concept in healthcare delivery today. Many healthcare administrators are struggling to adapt their organization from fee-for-service to value delivery. Payers and patients expect healthcare leaders to understand how to deliver care under this new model. Health administration programs play a critical role in training future leaders of healthcare organizations to be adaptable and effective in this dynamic environment. The purpose of this research was to: (a) engage current educators of health administration students in a dialogue about the best practices of integrating the healthcare and public health systems; (b) identify the content and pedagogy for population health in the undergraduate and graduate curricula; and (c) discuss exemplar population health curriculum models, available course materials, and curriculum integration options. Authors conducted focus groups of participants attending this educational session at the 2017 annual AUPHA meeting. Qualitative analysis of the focus group discussions was performed and themes identified by a consensus process. Study findings provide validated recommendations for population health in the health administration curriculum. The identification of key content areas and pedagogical approaches serves to inform health educators as they prepare future health administrators to practice in this new era of population health

Pedagogy: How to best teach population health to future healthcare leaders

Our healthcare system is moving from a fee-for-service reimbursement model to one that provides payment for improvements in three areas related to care: quality, coordination, and cost. Healthcare organizations must use a population health approach when delivering care under this new paradigm. Health administration programs play a critical role in training future leaders of healthcare organizations to be adaptable and effective in this dynamic environment. The purpose of this research was to: (1) engage health administration educators in a dialogue about population health and its relevance to healthcare administration education; (2) describe pedagogical methods appropriate for teaching population health skills and abilities needed for successful careers in our healthcare environment; and (3) identify current student learning outcomes that participants can tailor to utilize in their undergraduate and graduate health management courses. Authors conducted focus groups of participants attending this educational session at the 2018 annual AUPHA meeting. Qualitative analysis of the focus group discussions identified themes by a consensus process. Study findings provide validated recommendations for population health in the health administration curriculum. The identification of pedagogical approaches serves to inform educators as they prepare future health administrators to practice in this new era of healthcare delivery

Remarkable resilience of forest structure and biodiversity following fire in the peri-urban bushland of Sydney, Australia

In rapidly urbanizing areas, natural vegetation becomes fragmented, making conservation planning challenging, particularly as climate change accelerates fire risk. We studied urban forest fragments in two threatened eucalypt‐dominated (scribbly gum woodland, SGW, and ironbark forest, IF) communities across ~2000 ha near Sydney, Australia, to evaluate effects of fire frequency (0– 4 in last 25 years) and time since fire (0.5 to >25 years) on canopy structure, habitat quality and biodiversity (e.g., species richness). Airborne lidar was used to assess canopy height and density, and ground‐based surveys of 148 (400 m2) plots measured leaf area index (LAI), plant species com‐ position and habitat metrics such as litter cover and hollow‐bearing trees. LAI, canopy density, litter, and microbiotic soil crust increased with time since fire in both communities, while tree and mistletoe cover increased in IF. Unexpectedly, plant species richness increased with fire frequency, owing to increased shrub richness which offset decreased tree richness in both communities. These findings indicate biodiversity and canopy structure are generally resilient to a range of times since fire and fire frequencies across this study area. Nevertheless, reduced arboreal habitat quality and subtle shifts in community composition of resprouters and obligate seeders signal early concern for a scenario of increasing fire frequency under climate change. Ongoing assessment of fire responses is needed to ensure that biodiversity, canopy structure and ecosystem function are maintained in the remaining fragments of urban forests under future climate change which will likely drive hotter and more frequent fires

A first constraint on basal melt-water production of the Greenland ice sheet

PROMICE is funded by the Geological Survey of Denmark and Greenland (GEUS) and the Danish Ministry of Climate, Energy and Utilities under the Danish Cooperation for Environment in the Arctic (DANCEA), and is conducted in collaboration with DTU Space (Technical University of Denmark) and Asiaq, Greenland.The Greenland ice sheet has been one of the largest sources of sea-level rise since the early 2000s. However, basal melt has not been included explicitly in assessments of ice-sheet mass loss so far. Here, we present the first estimate of the total and regional basal melt produced by the ice sheet and the recent change in basal melt through time. We find that the ice sheet’s present basal melt production is 21.4 +4.4/−4.0 Gt per year, and that melt generated by basal friction is responsible for about half of this volume. We estimate that basal melting has increased by 2.9 ± 5.2 Gt during the first decade of the 2000s. As the Arctic warms, we anticipate that basal melt will continue to increase due to faster ice flow and more surface melting thus compounding current mass loss trends, enhancing solid ice discharge, and modifying fjord circulation.Publisher PDFPeer reviewe

Genotype-free demultiplexing of pooled single-cell RNA-seq.

A variety of methods have been developed to demultiplex pooled samples in a single cell RNA sequencing (scRNA-seq) experiment which either require hashtag barcodes or sample genotypes prior to pooling. We introduce scSplit which utilizes genetic differences inferred from scRNA-seq data alone to demultiplex pooled samples. scSplit also enables mapping clusters to original samples. Using simulated, merged, and pooled multi-individual datasets, we show that scSplit prediction is highly concordant with demuxlet predictions and is highly consistent with the known truth in cell-hashing dataset. scSplit is ideally suited to samples without external genotype information and is available at: https://github.com/jon-xu/scSplit

Inter-laboratory automation of the in vitro micronucleus assay using imaging flow cytometry and deep learning.

The in vitro micronucleus assay is a globally significant method for DNA damage quantification used for regulatory compound safety testing in addition to inter-individual monitoring of environmental, lifestyle and occupational factors. However, it relies on time-consuming and user-subjective manual scoring. Here we show that imaging flow cytometry and deep learning image classification represents a capable platform for automated, inter-laboratory operation. Images were captured for the cytokinesis-block micronucleus (CBMN) assay across three laboratories using methyl methanesulphonate (1.25-5.0 μg/mL) and/or carbendazim (0.8-1.6 μg/mL) exposures to TK6 cells. Human-scored image sets were assembled and used to train and test the classification abilities of the "DeepFlow" neural network in both intra- and inter-laboratory contexts. Harnessing image diversity across laboratories yielded a network able to score unseen data from an entirely new laboratory without any user configuration. Image classification accuracies of 98%, 95%, 82% and 85% were achieved for 'mononucleates', 'binucleates', 'mononucleates with MN' and 'binucleates with MN', respectively. Successful classifications of 'trinucleates' (90%) and 'tetranucleates' (88%) in addition to 'other or unscorable' phenotypes (96%) were also achieved. Attempts to classify extremely rare, tri- and tetranucleated cells with micronuclei into their own categories were less successful (≤ 57%). Benchmark dose analyses of human or automatically scored micronucleus frequency data yielded quantitation of the same equipotent concentration regardless of scoring method. We conclude that this automated approach offers significant potential to broaden the practical utility of the CBMN method across industry, research and clinical domains. We share our strategy using openly-accessible frameworks

Avoiding the danger that stop smoking services may exacerbate health inequalities: building equity into performance assessment

<p>Abstract</p> <p>Background</p> <p>The UK is the only developed country to have established a nation-wide stop smoking treatment service. Apart from addressing tobacco dependence, which is the leading preventable cause of ill health and premature death, smoking cessation has been identified by the UK department of health as a service priority for reducing gaps in health between disadvantaged groups and the country as a whole. However smoking cessation tends to be more successful among affluent than disadvantaged groups. This means that for stop smoking services there is a trade-off to be had in terms of maximising the number of quitters and reducing socioeconomic inequalities in smoking prevalence. Current performance targets for the national stop smoking services in the UK are set only in terms of numbers of quitters, which does not encourage the adoption of strategies to reduce socioeconomic inequalities in smoking prevalence.</p> <p>Discussion</p> <p>This paper proposes an assessment framework, which allows the two dimensions of overall reduction in smoking prevalence and reductions of inequalities in smoking prevalence to be assessed together. The framework is used to assess the performance over time of a stop smoking service in Derwentside, a former Primary Care Trust in the North East of England, both in terms of meeting targets for the overall number of quitters and in terms of reducing socioeconomic inequalities in smoking prevalence.</p> <p>The example demonstrates how the proposed assessment framework can be applied in practice given existing records kept by stop smoking services in England and the available information on smoking prevalence at small area level. For Derwentside it is shown that although service expansion was successful in increasing the overall number of quitters, the service continued to exacerbate inequality in smoking prevalence between deprived and affluent wards.</p> <p>Summary</p> <p>The Secretary of State for Health in the UK has warned about the dangers of health promotion services and messages being taken up more readily by the better-off, thus exacerbating health inequalities. Because smokers from affluent backgrounds are more successful at quitting than those living in deprived circumstances, it is important to build an equity element into the monitoring of individual stop smoking services. Otherwise the danger highlighted by the Secretary of State for Health will go undetected and unaddressed.</p