Pediatric Population Management Classification for Children with Medical Complexity.

Improving the overall care of children with medical complexity (CMC) is often beset by challenges in proactively identifying the population most in need of clinical management and quality improvement. The objective of the current study was to create a system to better capture longitudinal risk for sustained and elevated utilization across time using real-time electronic health record (EHR) data. A new Pediatric Population Management Classification (PPMC), drawn from visit diagnoses and continuity problem lists within the EHR of a tristate health system, was compared with an existing complex chronic conditions (CCC) system for agreement (with weighted κ) on identifying CCMC, as well as persistence of elevated charges and utilization from 2016 to 2019.

Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study.

Objectives: Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable.

Rapid prototyping of multi-compartment models for urea kinetics in hemodialysis: a System Dynamics approach.

Models of urea kinetics facilitate a mechanistic understanding of urea transfer and provide a tool for optimizing dialysis efficacy. Dual-compartment models have largely replaced single-compartment models as they are able to accommodate the urea rebound on the cessation of dialysis. Modeling the kinetics of urea and other molecular species is frequently regarded as a rarefied academic exercise with little relevance at the bedside.

Orbital and In-Situ Investigation of Periodic Bedrock Ridges in Glen Torridon, Gale Crater, Mars.

Gale crater, the field site for NASA's Mars Science Laboratory Curiosity rover, contains a diverse and extensive record of aeolian deposition and erosion. This study focuses on a series of regularly spaced, curvilinear, and sometimes branching bedrock ridges that occur within the Glen Torridon region on the lower northwest flank of Aeolis Mons, the central mound within Gale crater. During Curiosity's exploration of Glen Torridon between sols ∼2300-3080, the rover drove through this field of ridges, providing the opportunity for in situ observation of these features.

The Effectiveness Of Government Masking Mandates On COVID-19 County-Level Case Incidence Across The United States, 2020.

Evidence for the effectiveness of masking on SARS-CoV-2 transmission at the individual level has accumulated, but the additional benefit of community-level mandates is less certain. In this observational study of matched cohorts from 394 US counties between March 21 and October 20, 2020, we estimated the association between county-level public masking mandates and daily COVID-19 case incidence. On average, the daily case incidence per 100,000 people in masked counties compared with unmasked counties declined by 23 percent at four weeks, 33 percent at six weeks, and 16 percent across six weeks postintervention.

Evaluating the Clinical Realism of Synthetic Chest X-Rays Generated Using Progressively Growing GANs.

Chest X-rays are a vital diagnostic tool in the workup of many patients. Similar to most medical imaging modalities, they are profoundly multi-modal and are capable of visualising a variety of combinations of conditions. There is an ever pressing need for greater quantities of labelled images to drive forward the development of diagnostic tools; however, this is in direct opposition to concerns regarding patient confidentiality which constrains access through permission requests and ethics approvals.

Facilitating Understanding, Modeling and Simulation of Infectious Disease Epidemics in the Age of COVID-19.

Interest in the mathematical modeling of infectious diseases has increased due to the COVID-19 pandemic. However, many medical students do not have the required background in coding or mathematics to engage optimally in this approach. System dynamics is a methodology for implementing mathematical models as easy-to-understand stock-flow diagrams.

Gaze tracking dataset for comparison of smooth and saccadic eye tracking.

Pupil tracking data are collected through the use of an infrared camera, and a head-mounted system [1]. The head-mounted system detects the relative pupil position and adjusts the mouse cursor position accordingly. The data are available for comparison of eye tracking with saccadic movements (with the head fixed in space) versus those from smooth movements (with the head moving in space).

Toward Respiratory Support of Critically Ill COVID-19 Patients Using Repurposed Kidney Hollow Fiber Membrane Dialysers to Oxygenate the Blood.

The COVID-19 pandemic has highlighted resource constraints in respiratory support. The oxygen transfer characteristics of a specific hollow fiber membrane dialyser was investigated with a view to repurposing the device as a low-cost, readily available blood oxygenator. Oxygen transfer in a low-flux hollow fiber dialyser with a polysulfone membrane was studied by passing first water and then blood through the dialyser in countercurrent to high-purity oxygen.

An Asthma Population Health Improvement Initiative for Children With Frequent Hospitalizations.

Objectives: A relatively small proportion of children with asthma account for an outsized proportion of health care use. Our goal was to use quality improvement methodology to reduce repeat emergency department (ED) and inpatient care for patients with frequent asthma-related hospitalization.

Methods: Children ages 2 to 17 with ≥3 asthma-related hospitalizations in the previous year who received primary care at 3 in-network clinics were eligible to receive a bundle of 4 services including (1) a high-risk asthma screener and tailored education, (2) referral to a clinic-based asthma community health worker program, (3) facilitated discharge medication filling, and (4) expedited follow-up with an allergy or pulmonology specialist.

Association of State Medicaid Expansion With Hospital Community Benefit Spending.

Importance: Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.

Objective: To examine changes in nonprofit hospital spending on community benefit activities after Medicaid expansion.

Association of a Targeted Population Health Management Intervention with Hospital Admissions and Bed-Days for Medicaid-Enrolled Children.

Importance: As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources.

Objective: To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days.

Design, Setting, And Participants: This quality improvement study, using difference-in-differences analysis, deployed integrated team interventions in an academic pediatric health system with 31 in-network primary care practices among children enrolled in Medicaid who received care at the health system's hospital and primary care practices.

Data from wearable wireless instrumentation device taken during simulated CPR with and without intentional error toward a quality feedback device.

Data of Cardiopulmonary Resuscitation performed on a mannequin was collected via wearable instrumentation (using the MYO device). The data were collected for both "good" CPR and for performance of CPR with common errors introduced intentionally for this study. The data are labelled according to the error, and contain a variety of derived measurements.

Families With TRICARE Report Lower Health Care Quality And Access Compared To Other Insured And Uninsured Families.

Children in military families, who receive health insurance through the TRICARE program, face barriers to care such as frequent relocations, unique behavioral health needs, increased complex health care needs, and lack of accessible specialty care. How TRICARE-insured families perceive health care access and quality for their children compared to their civilian peers' perceptions remains unknown. Using data from the Medical Expenditure Panel Survey, we found that TRICARE-insured families were less likely to report accessible or responsive care compared to civilian peers, whether commercially or publicly insured or uninsured.

Growth Of Public Coverage Among Working Families In The Private Sector.

Working families have increasingly enrolled their children in Medicaid or the Children's Health Insurance Program in recent years. Parents' place of employment affects the availability and cost of family health insurance, making it a determinant of pediatric public insurance enrollment. We examined that enrollment in the period 2008-16 in families working full time and earning more than 100 percent of the federal poverty level at three types of employers.

Routine Cholesterol Tests and Subsequent Change in BMI Among Overweight and Obese Children.

Introduction: In 2011, the National Heart, Lung and Blood Institute and American Academy of Pediatrics concluded that both familial and obesity-associated dyslipidemias increase cardiovascular risk and recommended universal cholesterol testing at ages 9 to 11. It remains unknown whether testing influences body mass index (BMI) trajectory, a key modifiable cardiovascular outcome.

Methods: This quasi-experimental-matched cohort includes children aged 9 to 11 years completing well visits in a diverse primary care network from 2012 to 2014.