Predictive analytics and tailored interventions improve clinical outcomes in older adults: a randomized controlled trial.

This study explored the potential to improve clinical outcomes in patients at risk of moving to the top segment of the cost acuity pyramid. This randomized controlled trial evaluated the impact of a Stepped-Care approach (predictive analytics + tailored nurse-driven interventions) on healthcare utilization among 370 older adult patients enrolled in a homecare management program and using a Personal Emergency Response System. The Control group (CG) received care as usual, while the Intervention group (IG) received Stepped-Care during a 180-day intervention period.

A randomized trial examining the effect of predictive analytics and tailored interventions on the cost of care.

This two-arm randomized controlled trial evaluated the impact of a Stepped-Care intervention (predictive analytics combined with tailored interventions) on the healthcare costs of older adults using a Personal Emergency Response System (PERS). A total of 370 patients aged 65 and over with healthcare costs in the middle segment of the cost pyramid for the fiscal year prior to their enrollment were enrolled for the study. During a 180-day intervention period, control group (CG) received standard care, while intervention group (IG) received the Stepped-Care intervention.

Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States.

Background: Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting.

Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls.

Background: With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible.

Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study.

Background: Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years.

Predictive Modeling of 30-Day Emergency Hospital Transport of Patients Using a Personal Emergency Response System: Prognostic Retrospective Study.

Background: Telehealth programs have been successful in reducing 30-day readmissions and emergency department visits. However, such programs often focus on the costliest patients with multiple morbidities and last for only 30 to 60 days postdischarge. Inexpensive monitoring of elderly patients via a personal emergency response system (PERS) to identify those at high risk for emergency hospital transport could be used to target interventions and prevent avoidable use of costly readmissions and emergency department visits after 30 to 60 days of telehealth use.

Evaluating the Impact of a Web-Based Risk Assessment System (CareSage) and Tailored Interventions on Health Care Utilization: Protocol for a Randomized Controlled Trial.

Background: Soaring health care costs and a rapidly aging population, with multiple comorbidities, necessitates the development of innovative strategies to deliver high-quality, value-based care.

Objective: The goal of this study is to evaluate the impact of a risk assessment system (CareSage) and targeted interventions on health care utilization.

Methods: This is a two-arm randomized controlled trial recruiting 370 participants from a pool of high-risk patients receiving care at a home health agency.

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015.

Background: Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization.

Target motion predictions for pre-operative planning during needle-based interventions.

During biopsies, breast tissue is subjected to displacement upon needle indentation, puncture, and penetration. Thus, accurate needle placement requires pre-operative predictions of the target motions. In this paper, we used ultrasound elastography measurements to non-invasively predict elastic properties of breast tissue phantoms.

Predicting target displacements using ultrasound elastography and finite element modeling.

Soft tissue displacements during minimally invasive surgical procedures may cause target motion and subsequent misplacement of the surgical tool. A technique is presented to predict target displacements using a combination of ultrasound elastography and finite element (FE) modeling. A cubic gelatin/agar phantom with stiff targets was manufactured to obtain pre- and post-loading ultrasound radio frequency (RF) data from a linear array transducer.

Validated finite element models of the proximal femur using two-dimensional projected geometry and bone density.

Two-dimensional finite element models of cadaveric femoral stiffness were developed to study their suitability as surrogates of bone stiffness and strength, using two-dimensional representations of femoral geometry and bone mineral density distributions. If successfully validated, such methods could be clinically applied to estimate patient bone stiffness and strength using simpler and less costly radiographs. Two-dimensional femur images were derived by projection of quantitative computed tomography scans of 22 human cadaveric femurs.

Robust QCT/FEA models of proximal femur stiffness and fracture load during a sideways fall on the hip.

Clinical implementation of quantitative computed tomography-based finite element analysis (QCT/FEA) of proximal femur stiffness and strength to assess the likelihood of proximal femur (hip) fractures requires a unified modeling procedure, consistency in predicting bone mechanical properties, and validation with realistic test data that represent typical hip fractures, specifically, a sideways fall on the hip. We, therefore, used two sets (n = 9, each) of cadaveric femora with bone densities varying from normal to osteoporotic to build, refine, and validate a new class of QCT/FEA models for hip fracture under loading conditions that simulate a sideways fall on the hip. Convergence requirements of finite element models of the first set of femora led to the creation of a new meshing strategy and a robust process to model proximal femur geometry and material properties from QCT images.

In situ parameter identification of optimal density-elastic modulus relationships in subject-specific finite element models of the proximal femur.

Quantitative computed tomography based finite element analysis of the femur is currently being investigated as a method for non-invasive stiffness and strength predictions of the proximal femur. The specific objective of this study was to determine better conversion relationships from QCT-derived bone density to elastic modulus, in order to achieve accurate predictions of the overall femoral stiffness in a fall-on-the-hip loading configuration. Twenty-two femurs were scanned, segmented and meshed for finite element analysis.

Validation of a fluid-structure interaction model of solute transport in pores of cyclically deformed tissue scaffolds.

Convection induced by repetitive compression of porous tissue scaffolds enhances solute transport inside the scaffold. Our previous experiments have shown that pore size, shape, and orientation with respect to strain direction greatly influence loading-induced solute transport. The objective of this study was to develop a computational model of deformation-induced solute transport in porous tissue scaffolds, which included the pore geometry of the scaffold.

Cyclic deformation-induced solute transport in tissue scaffolds with computer designed, interconnected, pore networks: experiments and simulations.

Nutrient supply and waste removal in porous tissue engineering scaffolds decrease from the periphery to the center, leading to limited depth of ingrowth of new tissue into the scaffold. However, as many tissues experience cyclic physiological strains, this may provide a mechanism to enhance solute transport in vivo before vascularization of the scaffold. The hypothesis of this study was that pore cross-sectional geometry and interconnectivity are of major importance for the effectiveness of cyclic deformation-induced solute transport.

Solute transport in cyclically deformed porous tissue scaffolds with controlled pore cross-sectional geometries.

The objective of this study was to investigate the influence of pore geometry on the transport rate and depth after repetitive mechanical deformation of porous scaffolds for tissue engineering applications. Flexible cubic imaging phantoms with pores in the shape of a circular cylinder, elliptic cylinder, and spheroid were fabricated from a biodegradable polymer blend using a combined 3D printing and injection molding technique. The specimens were immersed in fluid and loaded with a solution of a radiopaque solute.

Bayesian tracking of a nonlinear model of the capnogram.

Capnography, the monitoring of expired carbon dioxide (CO2) has been employed clinically as a non-invasive measure for the adequacy of ventilation of the alveoli of the lung. In combination with air flow measurements, the capnogram can be used to estimate the partial pressure of CO2 in the alveolar sacs. In addition, physiologically relevant parameters, such as the extent of CO2 rebreathing, the airway dead space, and the metabolic CO2 production can be predicted.

Branching morphology of the rat hepatic portal vein tree: a micro-CT study.

In contrast to the lung and the myocardium, the liver is a relatively homogeneous organ with fewer anatomic constraints on vascular branching. Hence, we hypothesize that the hepatic vasculature could more closely follow optimization of branching geometry than is the case in other organs. The geometrical and fractal properties of the rat hepatic portal vein tree were investigated, with the aid of three-dimensional micro-computed tomography data.

Altered calcium handling is an early sign of streptozotocin-induced diabetic cardiomyopathy.

The main objective of the present study was to determine alterations of calcium handling in the diabetic rat heart during the transition from adaptive to maladaptive phase of cardiomyopathy. By inhibiting the nuclear enzyme poly(ADP-ribose) polymerase (PARP), we also investigated the possible role of this enzyme in the sequence of pathological events. Six weeks after induction of type I diabetes by injection of streptozotocin in rats, the hearts were perfused according to Langendorff.

beta-Adrenergic activation reveals impaired cardiac calcium handling at early stage of diabetes.

Cardiac function is known to be impaired in diabetes. Alterations in intracellular calcium handling have been suggested to play a pivotal role. This study aimed to test the hypothesis that beta-adrenergic activation can reveal the functional derangements of intracellular calcium handling of the 4-week diabetic heart.

In vivo heat shock preconditioning mitigates calcium overload during ischaemia/reperfusion in the isolated, perfused rat heart.

Heat shock (HS) pretreatment of the heart is effective in mitigating the deleterious effects of ischaemia/reperfusion. The main objective of this study was to determine whether the beneficial effect of HS is associated with the preservation of intracellular Ca2+ handling in the ischaemic/reperfused, isolated rat heart. Twenty-four hours after raising body core temperature to 42 degrees C for 15 min, rat hearts were perfused according to Langendorff and subjected to 30 min ischaemia followed by 20 min reperfusion.

Mathematical modeling of vascular endothelial layer maintenance: the role of endothelial cell division, progenitor cell homing, and telomere shortening.

Maintenance of the endothelial cell (EC) layer of the vessel wall is essential for proper functioning of the vessel and prevention of vascular disorders. Replacement of damaged ECs could occur through division of surrounding ECs. Furthermore, EC progenitor cells (EPCs), derived from the bone marrow and circulating in the bloodstream, can differentiate into ECs.

Mathematical modeling confirms the length-dependency of telomere shortening.

Telomeres, the ends of chromosomes, shorten with each cell division in human somatic cells, because of the end-replication problem, C-strand processing and oxidative damage. On the other hand, the reverse transcriptase telomerase can add back telomeric repeats at the telomere ends. It has been suggested that once telomeres have reached a critical length, cells cease proliferation, also known as senescence.