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Recent Submissions

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    Economic evaluations of eHealth technologies: A systematic review
    (Public Library of Science, 2018-06-13) Sanyal, Chiranjeev; Stolee, Paul; Juzwishin, Don; Husereau, Don
    Background Innovations in eHealth technologies have the potential to help older adult live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults. Methods We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Results Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studied demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors. Conclusions This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.
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    Sentiment in nursing notes as an indicator of out-of-hospital mortality in intensive care patients
    (Public Library of Science, 2018-06-07) Waudby-Smith, Ian E. R.; Tran, Nam; Dubin, Joel A.; Lee, Joon
    Background Nursing notes have not been widely used in prediction models for clinical outcomes, despite containing rich information. Advances in natural language processing have made it possible to extract information from large scale unstructured data like nursing notes. This study extracted the sentiment - impressions and attitudes - of nurses, and examined how sentiment relates to 30-day mortality and survival. Methods This study applied a sentiment analysis algorithm to nursing notes extracted from MIMIC-III, a public intensive care unit (ICU) database. A multiple logistic regression model was fitted to the data to correlate measured sentiment with 30-day mortality while controlling for gender, type of ICU, and SAPS-II score. The association between measured sentiment and 30-day mortality was further examined in assessing the predictive performance of sentiment score as a feature in a classifier, and in a survival analysis for different levels of measured sentiment. Results Nursing notes from 27,477 ICU patients, with an overall 30-day mortality of 11.02%, were extracted. In the presence of known predictors of 30-day mortality, mean sentiment polarity was a highly significant predictor in a multiple logistic regression model (Adjusted OR = 0.4626, p < 0.001, 95% Cl: [o.4244, 0.5041]) and led to improved predictive accuracy (AUROC = 0.8189 versus 0.8092, 95% BCl of difference: [0.0070, 0.0126]). The Kaplan Meier survival curves showed that mean sentiment polarity quartiles are positively correlated with patient survival (log-rank test: p < 0.001). Conclusions This study showed that quantitative measures of unstructured clinical notes, such as sentiment of clinicians, correlate with 30-day mortality and survival, thus can also serve as a predictor of patient outcomes in the ICU. Therefore, further research is warranted to study and make use of the wealth of data that clinical notes have to offer.
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    Assessing trade-offs in large marine protected areas
    (Public Library of Science, 2018-04-18) Davies, Tammy E.; Epstein, Graham; Aguilera, Stacy E.; Brooks, Cassandra M.; Cox, Michael; Evans, Louisa S.; Maxwell, Sara M.; Nenadovic, Mateja; Ban, Natalie C.
    Large marine protected areas (LMPAs) are increasingly being established and have a high profile in marine conservation. LMPAs are expected to achieve multiple objectives, and because of their size are postulated to avoid trade-offs that are common in smaller MPAs. However, evaluations across multiple outcomes are lacking. We used a systematic approach to code several social and ecological outcomes of 12 LMPAs. We found evidence of three types of trade-offs: trade-offs between different ecological resources (supply trade-offs); trade-offs between ecological resource conditions and the well-being of resource users (supply-demand trade-offs); and trade-offs between the well-being outcomes of different resource users (demand trade-offs). We also found several divergent outcomes that were attributed to influences beyond the scope of the LMPA. We suggest that despite their size, trade-offs can develop in LMPAs and should be considered in planning and design. LMPAs may improve their performance across multiple social and ecological objectives if integrated with larger-scale conservation efforts.
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    Do payments for forest ecosystem services generate double dividends? An integrated impact assessment of Vietnam's PES program
    (Public Library of Science, 2018-08-01) Phan, Thu-Ha Dang; Brouwer, Roy; Hoang, Long Phi; Davidson, Marc David
    Payments for ecosystem services (PES) often serve multiple objectives, such as carbon emission reduction and poverty alleviation. However, the effectiveness of PES as an instrument to achieve these multiple objectives, in particular in a conservation-development context, is often questioned. This study adds to the very limited empirical evidence base and investigates to what extent Vietnam’s move to PES has helped protect forest ecosystems and improve local livelihoods and income inequality. We zoom in on Lam Dong province, where PES was first introduced in Vietnam in 2009. Changes in forest cover are analysed using satellite images over a period of 15 years (2000–2014). Socio-economic impacts are assessed based on rural household interviews with PES participants and non-participants as a control group over a period of 7 years (2008–2014). Our results show that PES contributes significantly to forest cover, the improvement of local livelihoods, and the reduction of income inequality.
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    Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis
    (Public Library of Science, 2018-07-10) Badawi, Alaa; Velummailum, Russanthy; Ryoo, Seung Gwan; Senthinathan, Arrani; Yaghoubi, Sahar; Vasileva, Denitsa; Ostermeier, Emma; Plishka, Mikayla; Soosaipillai, Marcel; Arora, Paul
    Background Flavivirius disease such as dengue fever (DENV), West Nile virus (WNV), Zike and yellow fever represent a substantial global public health concern. Preexisting chronic conditions such as cardiovascular diseases, diabetes, obesity, and asthma were thought to predict risk of progression to severe infections. Objective We aimed to quantify the frequency of chronic comorbidities in flavivirs diseases to provide an estimate for their prevalence in severe and non-severe infections and examine whether chronic diseases contribute to the increased risk of severe viral expression. Methods We conducted a comprehensive search in PudMed, Ovid MEDLINE(R), Embase and Embase Classic and grey literature databases to identify studies reporting prevalence estimates of comorbidities in flavivirus diseases. Study quality was assessed with the risk of bias tool. Age-adjusted odds ratios (ORs) were estimated for severe infection in the presence of chronic comorbidities. Results We identified 65 studies as eligible for inclusion for DENV (47 studies) and WNV (18 studies). Obesity and overweight (i.e., BMI> 25 kg/m2, prevalence: 24.5%, 95% CI: 18.6–31.6%), hypertension (17.1%, 13.3–21.8%) and diabetes (13.3%, 9.3–18.8%) were the most prevalent comorbidities in DENV. However, hypertension (45.0%, 39.1–51.0%), diabetes (24.7%, 20.2–29.8%) and heart diseases (25.6%, 19.5–32.7%) were the most prevalent in WNV. ORs of severe flavivirus diseases were about 2 to 4 in infected patients with comorbidities such as diabetes, hypertension and heart diseases. The small number of studies in JEV, YFV and Zika did not permit estimating the prevalence of comorbidities in these infections. Conclusion Higher prevalence of chronic comorbidities was found in severe cases of flavivirus diseases compared to non-severe cases. Findings of the present study may guide public health practitioners and clinicians to evaluate infection severity based on the presence of comorbidity, a critical public health measure that may avert severe disease outcome given the current dearth of clear prevention practices for some flavivirus diseases.