Creating Change at Scale: Quality Improvement Strategies used by the California Maternal Quality Care Collaborative.

Creating change at scale within a short time frame poses multiple challenges. Using the experience of the California Maternal Quality Care Collaborative, the authors illustrate how state perinatal quality collaboratives have been able to achieve this goal using a series of key steps: engage as many disciplines and partner organizations as possible; mobilize low-burden data to create a rapid-cycle data center to support the quality improvement efforts; provide up-to-date guidance for implementation using safety bundles and tool kits; and make available coaching and peer learning to support implementation through multihospital quality collaboratives. There are now multiple national resources available to support these efforts.

Weakly supervised natural language processing for assessing patient-centered outcome following prostate cancer treatment.

Background: The population-based assessment of patient-centered outcomes (PCOs) has been limited by the efficient and accurate collection of these data. Natural language processing (NLP) pipelines can determine whether a clinical note within an electronic medical record contains evidence on these data. We present and demonstrate the accuracy of an NLP pipeline that targets to assess the presence, absence, or risk discussion of two important PCOs following prostate cancer treatment: urinary incontinence (UI) and bowel dysfunction (BD).

Reproducible pharmacokinetics.

Reproducibility is a highly desired feature of scientific investigation in general, and it has special connotations for research in pharmacokinetics, a vibrant field with over 500,000 publications to-date. It is important to be able to differentiate between genuine heterogeneity in pharmacokinetic parameters from heterogeneity that is due to errors and biases. This overview discusses efforts and opportunities to diminish the latter type of undesirable heterogeneity.

A Scalable Machine Learning Approach for Inferring Probabilistic US-LI-RADS Categorization.

We propose a scalable computerized approach for large-scale inference of Liver Imaging Reporting and Data System (LI-RADS) final assessment categories in narrative ultrasound (US) reports. Although our model was trained on reports created using a LI-RADS template, it was also able to infer LI-RADS scoring for unstructured reports that were created before the LI-RADS guidelines were established. No human-labelled data was required in any step of this study; for training, LI-RADS scores were automatically extracted from those reports that contained structured LI-RADS scores, and it translated the derived knowledge to reasoning on unstructured radiology reports.

Advancing Semantic Interoperability of Image Annotations: Automated Conversion of Non-standard Image Annotations in a Commercial PACS to the Annotation and Image Markup.

Sharing radiologic image annotations among multiple institutions is important in many clinical scenarios; however, interoperability is prevented because different vendors' PACS store annotations in non-standardized formats that lack semantic interoperability. Our goal was to develop software to automate the conversion of image annotations in a commercial PACS to the Annotation and Image Markup (AIM) standardized format and demonstrate the utility of this conversion for automated matching of lesion measurements across time points for cancer lesion tracking. We created a software module in Java to parse the DICOM presentation state (DICOM-PS) objects (that contain the image annotations) for imaging studies exported from a commercial PACS (GE Centricity v3.

Microstructural properties of white matter pathways in relation to subsequent reading abilities in children: a longitudinal analysis.

Microstructural properties of white matter pathways are associated with concurrent reading abilities in children. In this longitudinal study, we asked whether properties of white matter pathways at the onset of learning to read would be associated with reading abilities at older ages. Children (N = 37) with a wide range of reading abilities completed standardized measures of language and phonological awareness and diffusion MRI at age 6 years.

You're worth what you eat: Adolescent beliefs about healthy eating, morality and socioeconomic status.

Amidst growing concern about adolescents' diets and dietary health in the United States, this article asks: what does healthy eating mean to adolescents? Using data from in-depth interviews conducted with 74 adolescents across socioeconomic status (SES) in California in 2015-2016, I show how adolescents view healthy eating as a moral, affluent practice and use discussions of healthy eating to assert their own morality and socioeconomic position. Adolescents associate healthy eating with 1) financial privilege and 2) moral superiority. Adolescents differ, however, in how they view their own families' healthy eating habits, and accordingly, their own moral worth.

Automated dendritic spine detection using convolutional neural networks on maximum intensity projected microscopic volumes.

Background: Dendritic spines are structural correlates of excitatory synapses in the brain. Their density and structure are shaped by experience, pointing to their role in memory encoding. Dendritic spine imaging, followed by manual analysis, is a primary way to study spines.

Preventing false discovery of heterogeneous treatment effect subgroups in randomized trials.

Background: Heterogeneous treatment effects (HTEs), or systematic differences in treatment effectiveness among participants with different observable features, may be important when applying trial results to clinical practice. Current methods suffer from a potential for false detection of HTEs due to imbalances in covariates between candidate subgroups.

Methods: We introduce a new method, matching plus classification and regression trees (mCART), that yields balance in covariates in identified HTE subgroups.

Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.

Background: When used judiciously, cesarean sections can save lives; but in the United States, prior research indicates that cesarean birth rates have risen beyond the threshold to help women and infants and become a contributor to increased maternal mortality and rising healthcare costs. Healthy People 2020 has set the goal for nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at no more than 23.9% of births.

Proposing New RadLex Terms by Analyzing Free-Text Mammography Reports.

After years of development, the RadLex terminology contains a large set of controlled terms for the radiology domain, but gaps still exist. We developed a data-driven approach to discover new terms for RadLex by mining a large corpus of radiology reports using natural language processing (NLP) methods. Our system, developed for mammography, discovers new candidate terms by analyzing noun phrases in free-text reports to extend the mammography part of RadLex.

U-Index, a dataset and an impact metric for informatics tools and databases.

Measuring the usage of informatics resources such as software tools and databases is essential to quantifying their impact, value and return on investment. We have developed a publicly available dataset of informatics resource publications and their citation network, along with an associated metric (u-Index) to measure informatics resources' impact over time. Our dataset differentiates the context in which citations occur to distinguish between 'awareness' and 'usage', and uses a citing universe of open access publications to derive citation counts for quantifying impact.

Novel patterns of physical activity in a large sample of preschool-aged children.

Background: Moderate-to-vigorous physical activity (MVPA), shown to be associated with health benefits, is not well-characterized in preschool-aged children. MVPA is commonly described as a threshold amount to achieve. We examined a novel way to characterize MVPA patterns in preschool-aged children by gender and age.

Effect of Maternal Body Mass Index on Postpartum Hemorrhage.

Background: It is unclear whether obesity is a risk factor for postpartum hemorrhage. The authors hypothesized that obese women are at greater risk of hemorrhage than women with a normal body mass index.

Methods: The authors conducted a cohort study of women who underwent delivery hospitalization in California between 2008 and 2012.

Gender differences in limited duty time for lower limb injury.

Background: Among active-duty military personnel, lower limb musculoskeletal injuries and related conditions (injuries) frequently arise as unintended consequences of physical training. These injuries are particularly common among women. The practical impact of such injuries on temporary military occupational disability has not been estimated with precision on a large scale.

A genome-wide association study meta-analysis of clinical fracture in 10,012 African American women.

Background: Osteoporosis is a major public health problem associated with excess disability and mortality. It is estimated that 50-70% of the variation in osteoporotic fracture risk is attributable to genetic factors. The purpose of this hypothesis-generating study was to identify possible genetic determinants of fracture among African American (AA) women in a GWAS meta-analysis.

A meta-analysis but not a systematic review: an evaluation of the Global BMI Mortality Collaboration.

Meta-analyses of individual participant data (MIPDs) offer many advantages and are considered the highest level of evidence. However, MIPDs can be seriously compromised when they are not solidly founded upon a systematic review. These data-intensive collaborative projects may be led by experts who already have deep knowledge of the literature in the field and of the results of published studies and how these results vary based on different analytical approaches.

Targeting LDL Cholesterol: Beyond Absolute Goals Toward Personalized Risk.

Purpose Of Review: The aim of this study was to review and assess the evidence for low-density lipoprotein cholesterol (LDL-C) treatment goals as presented in current guidelines for primary and secondary prevention of cardiovascular disease.

Recent Findings: Different sets of guidelines and clinical studies for secondary prevention have centered on lower absolute LDL-C targets [<70 mg/dL (<1.8 mmol/L)], greater percent reductions of LDL-C (≥50%), or more intense treatment to achieve greater reductions in cardiovascular risk.

Is Accessibility to Dental Care Facilities in Rural Areas Associated with Number of Teeth in Elderly Residents?

Given that public transportation networks are less developed in rural than in urban areas, a lack of accessibility to dental care facilities could be a barrier to routine dental checkups. Thus, we hypothesized that the distance to the dental care facilities is a risk factor for tooth loss. The aim of this study was to test whether there is an association between the distance to dental care facilities, estimated by geographic information systems, and number of teeth, assessed by an oral examination, among elderly residents of a rural area in Japan.

Prevalence of Chronic Disease and Their Risk Factors Among Iranian, Ukrainian, Vietnamese Refugees in California, 2002-2011.

Little is known about how the health status of incoming refugees to the United States compares to that of the general population. We used logistic regression to assess whether country of origin is associated with prevalence of hypertension, obesity, type-II diabetes, and tobacco-use among Iranian, Ukrainian and Vietnamese refugees arriving in California from 2002 to 2011 (N = 21,968). We then compared the prevalence among refugees to that of the Californian general population (CGP).

The weaker sex? Vulnerable men and women's resilience to socio-economic disadvantage.

Sex differences in mortality vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. Drawing on a wide swath of mortality data across countries and over time, we develop a set of empiric observations with which any theory about excess male mortality and its correlates will have to contend.