Identifying Young Adults at High Risk for Weight Gain Using Machine Learning.

Introduction: Weight gain among young adults continues to increase. Identifying adults at high risk for weight gain and intervening before they gain weight could have a major public health impact. Our objective was to develop and test electronic health record-based machine learning models to predict weight gain in young adults with overweight/class 1 obesity.

Association between neighborhood food environments and bariatric surgery outcomes.

Background: Individual characteristics associated with weight loss after bariatric surgery are well established, but the neighborhood characteristics that influence outcomes are unknown.

Objectives: The objective of this study was to determine if neighborhood characteristics, including social determinants and lifestyle characteristics, were associated with weight loss after bariatric surgery.

Setting: Single university healthcare system, United States.

Obesity and "obesity-related" cancers: are there body mass index cut-points?

Background: Despite compelling links between excess body weight and cancer, body mass index (BMI) cut-points, or thresholds above which cancer incidence increased, have not been identified. The objective of this study was to determine if BMI cut-points exist for 14 obesity-related cancers.

Subjects/methods: In this retrospective cohort study, patients 18-75 years old were included if they had ≥2 clinical encounters with BMI measurements in the electronic health record (EHR) at a single academic medical center from 2008 to 2018.

Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study.

Background: Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown.

Objective: The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities.

Patient Experiences, Satisfaction, and Expectations with Current Systemic Lupus Erythematosus Treatment: Results of the SLE-UPDATE Survey.

Objectives: To provide information on systemic lupus erythematosus (SLE) patients' experiences, satisfaction, and expectations with treatments and examine the association between treatment satisfaction and patient-reported outcomes (PRO).

Methods: A cross-sectional, non-interventional, online survey of US adult patients with SLE was conducted in 2019. The survey consisted of 104 questions about SLE and the following PRO instruments: LupusPRO™, Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue, Work Productivity and Activity Impairment (WPAI), an 11-point Worst Pain Numerical Rating scale (NRS), and an 11-point Worst Joint Pain NRS.

Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes.

Objective: To compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss.

Background: The literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes.

Small area estimation and childhood obesity surveillance using electronic health records.

There is an urgent need for childhood surveillance systems to design, implement, and evaluate interventions at the local level. We estimated obesity prevalence for individuals aged 5-17 years using a southcentral Wisconsin EHR data repository, Public Health Information Exchange (PHINEX, 2007-2012). The prevalence estimates were calculated by aggregating the estimated probability of each individual being obese, which was obtained via a generalized linear mixed model.

The ALPHA Project: Establishing consensus and prioritisation of global community recommendations to address major challenges in lupus diagnosis, care, treatment and research.

The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus effort to identify, prioritise and address top barriers in lupus impacting diagnosis, care, treatment and research. To conduct this process, the ALPHA Project convened a multistakeholder Global Advisory Committee (GAC) of lupus experts and collected input from global audiences, including patients. In phase I, the ALPHA Project used expert interviews and a global survey of lupus experts to identify and categorise barriers into three overarching pillars: drug development, clinical care and access to care.

Simultaneous spatial smoothing and outlier detection using penalized regression, with application to childhood obesity surveillance from electronic health records.

Electronic health records (EHRs) have become a platform for data-driven granular-level surveillance in recent years. In this paper, we make use of EHRs for early prevention of childhood obesity. The proposed method simultaneously provides smooth disease mapping and outlier information for obesity prevalence that are useful for raising public awareness and facilitating targeted intervention.

Establishing Consensus Understanding of the Barriers to Drug Development in Lupus.

Objective: Due to the extreme heterogeneity of lupus and the lack of consensus among stakeholders, pharmaceutical and biotechnology companies have had limited success in developing treatments for lupus. For this reason, the Lupus Foundation of America (LFA), researchers at the Center for the Study of Drug Development at Tufts University School of Medicine (Tufts CSDD) and an advisory committee of 13 international lupus experts collaborated to launch the Addressing Lupus Pillars for Health Advancement (ALPHA) project.

Methods: To inform the ALPHA project, 17 in-depth interviews among lupus experts and a global survey among lupus drug development and clinical care professionals was conducted to identify, characterize, and prioritize fundamental barriers and validate findings.

Association Between Dehydration and Falls.

Objective: To determine whether there is an association between dehydration and falls in adults 65 years and older.

Patients And Methods: We used University of Wisconsin Health electronic health records from October 1, 2011 to September 30, 2015 to conduct a retrospective cohort study of Midwestern patients 65 years and older and examined the association between dehydration at baseline (defined as serum urea nitrogen to creatinine ratio > 20, sodium level > 145 mg/dL, urine specific gravity > 1.030, or serum osmolality > 295 mOsm/kg) and falls within 3 years after baseline while accounting for prescriptions of loop diuretic, antidepression, anticholinergic, antipsychotic, and benzodiazepine/hypnotic medications and demographic characteristics, using logistic regression.

Modeling Asthma Exacerbations from Electronic Health Records.

Asthma is a prevalent chronic respiratory condition, and acute exacerbations represent a significant fraction of the economic and health-related costs associated with asthma. We present results from a novel study that is focused on modeling asthma exacerbations from data contained in patients' electronic health records. This work makes the following contributions: (i) we develop an algorithm for phenotyping asthma exacerbations from EHRs, (ii) we determine that models learned via supervised learning approaches can predict asthma exacerbations in the near future (AUC ≈ 0.

Resource Utilization Among Portal Users Who Send Messages: A Retrospective Cohort Study.

Purpose: To examine the association between patients' use of online health portal-based secure messaging and the likelihood of traditional encounters (office visits and telephone calls) and to identify patient characteristics associated with use of the messaging feature of health portals.

Methods: This retrospective cohort study used EHR data from 80,801 patients aged 18 and older to determine traditional encounter rates among portal users who sent at least 1 message compared to those who sent none. Association between the number of messages sent and number of traditional encounters, while accounting for other covariates (including number of traditional encounters the year before account activation and other patient characteristics) was examined using a hurdle negative-binomial (NB) model.

Weight Loss for Patients With Obesity: An Analysis of Long-Term Electronic Health Record Data.

Background: Numerous studies have reported that losing as little as 5% of one's total body weight (TBW) can improve health, but no studies have used electronic health record data to examine long-term changes in weight, particularly for adults with severe obesity [body mass index (BMI) ≥35 kg/m].

Objective: To measure long-term weight changes and examine their predictors for adults in a large academic health care system.

Research Design: Observational study.

SLE clinical trials: impact of missing data on estimating treatment effects.

Objective: A common problem in clinical trials is missing data due to participant dropout and loss to follow-up, an issue which continues to receive considerable attention in the clinical research community. Our objective was to examine and compare current and alternative methods for handling missing data in SLE trials with a particular focus on multiple imputation, a flexible technique that has been applied in different disease settings but not to address missing data in the primary outcome of an SLE trial.

Methods: Data on 279 patients with SLE randomised to standard of care (SoC) and also receiving mycophenolate mofetil (MMF), azathioprine or methotrexate were obtained from the Lupus Foundation of America-Collective Data Analysis Initiative Database.

Circannual growth in Wisconsin children and adolescents: Identifying optimal periods of obesity prevention.

Background: Recent studies suggest kids tend to gain the most weight in summer, but schools are chastised for supporting obesogenic environments. Conclusions on circannual weight gain are hampered by infrequent body mass index (BMI) measurements, and guidance is limited on the optimal timeframe for paediatric weight interventions.

Objectives: This study characterized circannual trends in BMI in Wisconsin children and adolescents and identified sociodemographic differences in excess weight gain.

Global consensus building and prioritisation of fundamental lupus challenges: the ALPHA project.

Objective: Lupus is a complex, heterogeneous autoimmune disease that has yet to see significant progress towards more timely diagnosis, improved treatment options for short-term and long-term outcomes, and appropriate access to care. The Addressing Lupus Pillars for Health Advancement (ALPHA) project is the first step in establishing global consensus and developing concrete strategies to address the challenges limiting progress.

Methods: A Global Advisory Committee of 13 individuals guided the project and began barrier identification.

Development and content validity of the Lupus Foundation of America rapid evaluation of activity in lupus (LFA-REAL™): a patient-reported outcome measure for lupus disease activity.

Background/purpose: The LFA REAL™ is a measurement system for evaluating lupus disease activity from both clinician and patient perspectives. Patients' viewpoints are captured using a patient-reported outcome (PRO) questionnaire. A series of visual analog scales are designed to rate disease severity and progress over the past 4 weeks.

Hydroxychloroquine usage in US patients, their experiences of tolerability and adherence, and implications for treatment: survey results from 3127 patients with SLE conducted by the Lupus Foundation of America.

The majority of patients with SLE in the USA have been prescribed hydroxychloroquine (HCQ). Given more recent guidelines, the availability of only one strength (200 mg tablets) may limit the flexibility and ability to accurately dose patients with lupus. The Lupus Foundation of America undertook a survey to assess the current landscape of HCQ tolerability and adherence.

The Spectrum of Health Domains Important to Lupus Patients Early Development of a Disease Activity Patient Reported Outcome.

Introduction: Patients with systemic lupus erythematosus (SLE) face lifelong challenges from chronic and disabling symptoms. The toolkit for assessing patient progress lacks a simple, scalable index that includes both physician assessments and patient experiences. Clinician and patient reported outcomes (ClinROs and PROs) were developed in isolation and discrepancies in their results promote confusion.

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

Background: Treatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.

Methods And Findings: In a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization.

Patient Engagement and Attitudes Toward Using the Electronic Medical Record for Medical Research: The 2015 Greater Plains Collaborative Health and Medical Research Family Survey.

Background: Electronic health records (EHRs) are ubiquitous. Yet little is known about the use of EHRs for prospective research purposes, and even less is known about patient perspectives regarding the use of their EHR for research.

Objective: This paper reports results from the initial obesity project from the Greater Plains Collaborative that is part of the Patient-Centered Outcomes Research Institute's National Patient-Centered Clinical Research Network (PCORNet).

Effectiveness of a Best Practice Alerts at Improving Hypertension Control.

Background: Inadequately treated hypertension (HTN) leads to considerable morbidity and mortality. Despite many treatment options, blood pressure (BP) control is suboptimal. Missed opportunities due to the growing complexity of primary care office visits contribute.

Evaluating duration of response to treatment in systemic lupus erythematosus clinical trials.

Objective: To evaluate response duration and identify predictors of transitioning into and out of the response state in patients with SLE receiving standard of care (SoC) in 52-week clinical trials.

Methods: A multistate model (MSM) allowing for bidirectional transitions between response and non-response states was fit to data on 759 patients with SLE with active disease randomised to SoC. The probability of being in response at 52 weeks, average duration of response (sojourn time) and mean total time in response for SLE Responder Index (SRI-4, SRI-5, SRI-6) and BILAG-based Composite Lupus Assessment (BICLA) were estimated.