Chapter 19: Public Health Informatics
Brian Dixon PhD
Saurabh Rahurkar DrPH
Learning Objectives
After reviewing the presentation, viewers should be able to:
Define public health informatics (PHI)
Explain the importance of informatics to the practice of public
health and the role of informatics within a public health agency
Define and distinguish the various forms of public health surveillance systems used in practice
List several common data sources used in the field of public health for surveillance
Public health: “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Public health informatics: “systematic application of information and computer science and technology to public health practice, research and learning”
Whereas physicians and care delivery organizations focus on the health of individuals, public health focuses on the health of populations and communities.
Definitions
Definitions
Public health surveillance: ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data for prevention and control
Syndromic surveillance: surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response
Introduction
The overarching goal of public health has been to monitor a variety of medical diseases and conditions rapidly and accurately so as to intervene as early as possible to detect, prevent, and mitigate the spread of epidemics, the effects of natural disasters, and bioterrorism
To address these challenges, public health organizations conduct a range of activities across three, broad core functions – assessment, policy development and assurance.
Assessment – Public health agencies spend most of their time and resources on investigations of potential threats to the public’s health. Activities include testing and monitoring of water quality, laboratory examination of diseases carried by mosquitoes, tracking food-borne illnesses, testing for environmental hazards (e.g. soil lead levels), monitoring for potential bioterrorism threats, and tracing the contacts for individuals exposed to diseases as well as hazardous chemicals.
Public Health 3 Core Functions
Policy Development – Public health agencies also create policies and regulations to protect the health of populations. For example, children may be required to have certain immunizations before they can attend school to prevent disease outbreaks that would harm children and disrupt family life. Agencies use the evidence they gather from their investigations as well as the scientific literature to advocate for p.
Unit-IV Health Surveillance ANP m.sc I year.pptxanjalatchi
Nurses modify patient risk factors through surveillance and intervention (often carried out simultaneously), with direct oversight and surveillance for groups of patients, enabling early detection and timely intervention (Dresser, 2012) .
Unit-IV Health Surveillance ANP m.sc I year.pptxanjalatchi
Nurses modify patient risk factors through surveillance and intervention (often carried out simultaneously), with direct oversight and surveillance for groups of patients, enabling early detection and timely intervention (Dresser, 2012) .
Epidemiology slides by Kuya Kabalo.pptxKUYA KABALO
this presentation gives an overview of epidemiology , concepts ,definition , types of epidemiological studies , uses of epidemiology , scope and application of epidemiology
advantages and disadvantages of each epidemiological study
aims of epidemiology is also covered in this presentation
Chapter 10 Check PointAnswer the following questions. Please.docxzebadiahsummers
Chapter 10 Check Point
Answer the following questions. Please ensure to use the Author, YYYY APA citations with any content brought into the assignment.
What are Anomalies/Outliers? And what are some variants of Anomaly/Outlier Detection Problems?
What are some Challenges and Work Assumptions of Anomaly Detection?
Explain the Nearest-Neighbor Based Approach and the different ways to Define Outliers.
Explain the Density-based: LOF Approach.
Provide the General Steps and Types of Anomaly Detection Schemes.
.
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What are some Challenges and Work Assumptions of Anomaly Detection?
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Chapter 10 Case Project 10-2 two page report double spaceCas.docxzebadiahsummers
Chapter 10: Case Project 10-2: two page report double space
Case Project 10-2: Discovering Web Application Attack Tools
After discovering that Alexander Rocco Corporation has multiple Web servers running on different platforms, you wonder whether your security tools can asses Web applications vulnerabilities throughly. You have only two tools for conducting Web security tests: Wapiti and Wfetch. Based on the information write a two page report on other tools for security testers conducting Web applications vulnerability testing. Use the skills you have gained to search the Internet and explore the Kali DVD to find tools for Windows and *nix platforms. The report should state the tool's name, describe the installation method, and include a brief description of what the tool does.
Chapter 11: Case Project 11-1- one-page report
Case Project: Determining Vulnerabilities of Wireless Networks
After conducting a security test on the Alexander Rocco network, you discover that the company has a wireless router configured to issue IP addresses to connecting stations. Vistumbler indicates that channel 6 is active, the SSID is linksys, and WEP is enabled. Based on this information, write a one-page report listing possible vulnerabilities of the WLAN’s current configuration. Your report should include recommendations for improving wireless security.
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Chapter 1 provided a high-level overview of the Information Syst.docxzebadiahsummers
Chapter 1 provided a high-level overview of the Information Systems Security Policy Management:
Information Systems Security (ISS). What is it? The act of protecting information and the systems that store, process and transmit
Why is ISS needed? ISS provides a foundation for establishing protection of systems and data against risks such as: Unauthorized access and Use, Disclosure, System Disruption, Modification or Corruption
Destruction
After reading chapter 1 and looking at the ISS Management Life Cycle.
Let’s look at a real-world scenario and discuss what C-I-A Triad is all about.
You must do the following:
1) Create a new thread. As indicated above,
please explain how DHS should handle the situation described in the preceding paragraph.
.
Chapter 1 Intro to Policy Making in a The Digital Age.docxzebadiahsummers
Chapter 1: Intro to Policy Making in a The Digital Age
CHAPTER SUMMARY: Summarize chapter presented during the week. Identify the main point (as in "What's your point?"), thesis, or conclusion of the key ideas presented in the chapter.
SUPPORT: Do research outside of the book and demonstrate that you have in a very obvious way. This refers to research beyond the material presented in the textbook. Show something you have discovered from your own research. Be sure this is obvious and adds value beyond what is contained in the chapter itself.
EVALUATION: Apply the concepts from the appropriate chapter. Hint: Be sure to use specific terms and models directly from the textbook in analyzing the material presented and include the page in the citation.
SOURCES: Include citations with your sources.
Use APA style citations and references.
.
Chapter 1 discussed the expansion of the European intermodal rai.docxzebadiahsummers
Chapter 1 discussed the expansion of the European intermodal rail-road freight transport (EIT) under the European Union. Chapter 2 explores the development of intermodal transportation in the United States.
Instructions:
In 2-3 pages maximum, discuss the impact (negative and positive) that regulation/deregulation has had on the growth and/or continued growth of intermodal transportation in both countries. Ensure you site specific examples in your paper. You are encouraged to use the internet and other sources to support your discussion.
Submission Instructions:
Please attach the assignment in Word Format. Format your paper consistent with APA guidelines.
.
Change is an activity and mindset that many resists. Kotter proposed.docxzebadiahsummers
Change is an activity and mindset that many resists. Kotter proposed a “dual operating system” for accelerating change.
1. What are the main reasons why people resist change? (support response with academic sources).
2. Then, give an example when YOU were resistant to change. Explain what the change was about, why you resisted, and what was the outcome.
3. Describe Kotter’s idea of a dual operating system for making change happen in an accelerating world. (and support your answer). Then provide a critical assessment.
.
Chapter 1 Government Boss, financial partner, regulator – Entrepre.docxzebadiahsummers
Chapter 1: Government: Boss, financial partner, regulator – Entrepreneurs in mixed economies
Chapter 3: Electronic innovation and the government: David Sarnoff creates the RCA empire
Chapter 5: Speeding voice and data traffic worldwide: Network microprocessors from RMI
Chapter 7: Implementing information technology across the globe
Ives, B., & Jarvenpaa, S.L. (1991). Applications of Global Information Technology: Key Issues for Management. MIS Quarterly, 15(1), 33. https://doi.org/10.2307/249433
Chapter 9: Kressel, H., & Lento, T. V. (2012).
Entrepreneurship in the Global Economy : Engine for Economic Growth
. Cambridge, UK: Cambridge University Press.
7
.
Chapter 1 Combating terrorism has entailed restrictions on civil li.docxzebadiahsummers
Chapter 1: Combating terrorism has entailed restrictions on civil liberties. How can we reconcile civil liberty and national security? Are we better off opting for more liberty or more security? Are the two goals mutually exclusive? Have Americans become less supportive of the limitations on liberty put into place after the terror attacks in 2001, or do they still perceive that it makes sense to give up some liberties in order to feel more secure?
.
Chapter 1 Evaluation and Social Work Making the ConnectionP.docxzebadiahsummers
Chapter 1 Evaluation and Social Work: Making the Connection
Page 4
Let’s begin by considering three important questions: 1. Is evaluation an important area of social work? 2. Is the evaluator role an important one for social workers? 3. How can evaluations help improve or enhance social work interventions? These questions may be your questions as you begin to read this book. They are questions that many social work students and practitioners have pondered. This book is about evaluation so the responses to the first two questions, in brief, will be no surprise to you. Yes, evaluation is an important area of social work. Further, the evaluator role is an important role for every social worker to prepare to assume. Some social workers will be evaluators of programs, and virtually every social worker will be an evaluator of their own practice. It’s like asking whether social workers need to know whether they are doing a good job, or asking them if they know whether their interventions are effective in helping their clients. The third question, asking how evaluation can help improve social work interventions, is the focus of this text.
The underlying theme driving the book is that evaluation is a vital element of any social work approach and is critical for ensuring that social work actually does work! A reassuring theme is that evaluation is a practice area that BSW and MSW students and practitioners alike can learn. Social workers and students wanting to maximize their impact in their jobs will find that the perspective, knowledge, ethics, and skills of evaluations covered in this book are a central component of practice and ensure that you will have a much greater impact on your clients’ well-being. This book provides the needed preparation for evaluation in both a comprehensive and a readable format. The primary emphasis is on the various kinds of small and mid-range formative evaluations that are often implemented at the local agency level; less emphasis is placed on the large, com-plex national and regional studies that may draw the most coverage under the title evaluation. These smaller formative evaluations are also the critical ones that social work students and graduates either are assigned or should consider taking on in their field placements and employment agencies. Such
Page 5
evaluations often are instrumental in determining whether the programs in which you are working will continue and possibly expand. Example of a Small, Formative Evaluation An agency that provides an anger management program to perpetrators of domestic violence offers a series of ten psychoeducational group sessions to help them manage their anger. The agency also conducts an evaluation of this program that is integral to it. An anger management scale is used to measure changes that occur in the participants’ anger after they have completed all ten sessions of a group program. Throughout the series, the specific items of the anger management scale (e.g., be.
Changes in the Human Figure in ArtYou likely noticed that during.docxzebadiahsummers
Changes in the Human Figure in Art
You likely noticed that during the two hundred years covered in this week’s study there were radical changes in how the human figure is depicted in Italy, from something that was highly stylized to an idealized form that looked more real yet was strongly influenced by the Classical Age of ancient Greece and Rome. In Northern Europe, however, depiction of the human form remained somewhat stylized.
Use the textbook and/or online sources to locate and capture three works of art.
one from the Early Renaissance (fourteenth century, 1300–1399)
one from the Northern European Renaissance (fifteenth century, 1400–1499)
one from the Italian Renaissance (fifteenth century, 1400–1499)
Your works of art must either be all paintings or all sculptures.
First, place images of your selected works in a Word document. Then do the following:
For each work identify:
The artist
Title of the work of art
The date(s) it was created
The medium or materials used to create the work of art, such as oil paint, marble, etc.
Where the work is located now.
In a
well-developed
paragraph, provide at least two important historical facts about each work.
In another well-developed paragraph, describe how each artist depicted the human figure, supporting your observation using art historical vocabulary from this week's reading.
Then, In a 6–10-sentence concluding paragraph:
Compare and contrast how the depiction of the human figure has changed. Be sure to note such things as general appearance of the figures; their body types; whether the figures have been stylized, elongated, or idealized; and whether their clothing, colors, and other visual details have changed.
Based on your reading and what you learned from the historic facts you have for each work of art discuss what may have been influencing factors behind these changes.
Offer a citation of your sources for each image and the information provided as appropriate.
.
Chapter #131. Explain the terms Computationalism and Culturalism.docxzebadiahsummers
Chapter #13
1. Explain the terms Computationalism and Culturalism and their effects on Learning
2. Explain the implications of Pedagogy and Social practices in the development of adult learners
Chapter #15
3. According to Ziehe (2018), what are some normal Learning problems in youth. Name and explain at least 3
Chapters #16 and #17
4. Describe the four components of the Social Theory of Learning
5.Explain the Psychological theories:
a. Behaviorist
b. Cognitive
d. Social Learning
.
chapter 8 notes – Asian Americans model minoritieschapter b.docxzebadiahsummers
chapter 8 notes – Asian Americans: model minorities?
chapter begins with a story of a sociologist, riding in a taxi
- he was born in the US of Japanese heritage (grandfather came to US in 1880s)
- taxi drive asks him how long he was in the US (the answer is since birth)
- brings up the perception of ‘other’ around Asian Americans
focus of this chapter: Chinese Americans and Japanese Americans (oldest Asian groups in the US; often considered to be ‘model minorities’)
- model minorities stereotype: successful, affluent, highly educated, not suffer from minority group status (remember this is a stereotype)
why an increase in immigration from the Philippines and India into the US?
- both colonized
— India by Britain
— Philippines 1st by Spain, then the US
current demographics
- Asian Americans are about 5.6% of the total population (2012) – see table 8.1 above
— contrasted with African Americans (13%) and Hispanic Americans (16%)
- overall, rapid growth in numbers of Asian Americans in US recently
— one reason: immigration changes in 1965
— one of the largest growing groups – Asian Indians
— rapid growth is expected to continue
- 10 largest Asian groups in fig 8.1 below
- high percentage of foreign born in Asian American population
— 88% of Asian Americans are either 1st generation (foreign born) or 2nd generation (their children)
— — see figure 8.2 below
- similar to Hispanic Americans, Asian Americans are
+ likely to identify with country of origin 1st
origins and cultures
great diversity in languages, cultures, religions
- Asian cultures are much older than the founding of the US
- these cultures are quite different from each other, but there are some similarities
similarities:
- group membership is more important than the individual
— some of above from Confucianism which emphasizes a person is one part of the larger social system, one part of the status hierarchy
— — therefore loyalty to group, conformity to societal expections and respect for superiors are important
- it is important to be sensitive to the opinions and judgements of others; avoid public embarrassment, giving offence
— guilt / shame dichotomy
— — Asian cultures: emphasis on not bringing shame to the family / group from others (if someone goes against societal expectations, they are bringing shame onto their family / group)
— — — emphasis on proper behavior, conformity to convention and how others judge one, avoid embarressment (to self or to others), avoid personal confrontations
— — — overall desire to seek harmony
— — Western culture emphasizes individuals develop personal consciences and we need to avoid guilt (if someone goes against societal expectations, they are guilty of ... — Westerners guided by personal sense of guilt)
- generally (but not always) traditionally patriarchal
— in China foot binding was practiced for many generations
the above tendencies are more likely for individuals new to the US, but not as likely for individuals / families in the U.
CHAPTER 1 This list below indicated various audits, attestation,.docxzebadiahsummers
CHAPTER 1: This list below indicated various audits, attestation, and other engagements involving auditors.
1. A report on the effectiveness of internal control over financial reporting as required by Section 404 of the Sarbanes-Oxley Act.
2. An auditor’s report on whether the financial statements are fairly presented in accordance with International Financial Reporting Standards.
3. An engagement to help a company structure a merger transaction to minimize the taxes of the combined entities.
4. A report stating whether the company has complied with restrictive covenants related to officer compensation and payment of dividends contained in a bank loan agreement.
5. A report on the effectiveness of internal controls at a company that provides payroll processing for other companies.
6. An examination report stating whether a company’s statement of greenhouse gas emissions is presented in conformity with standards issued by the World Business Council for Sustainable Development and the World Resources Institute.
7. Evaluating the voting process and certifying the outcome for Rolling Stones Magazine’s “Greatest Singer of All Time” poll.
8. A report indicating whether a governmental entity has compiled with certain government regulations.
9. A review report that provides limited assurance about whether financial statements are fairly stated in accordance with U.S. GAAP.
10. A report about management’s assertion on the effectiveness of controls over the availability, reliability, integrity, and maintainability of its accounting information system.
11. An evaluation of the effectiveness of key measures used to assess an entity’s success in achieving specific targets linked to an entity’s strategic plan and vision.
Required
a. Explain the relationships among audit services, attestation services, and other assurance and no assurance services provided by CPA’s.
b. For each of the services listed above, indicate the type of service from the list that follows.
(1) An audit of historical financial statements.
(2) An attestation service other than an audit service.
(3) An assurance or no assurance service that is not an attestation service.
1-21. Dave Czarnecki is the managing partner of Czarnecki and Hogan, a medium-sized local CPA firm located outside of Chicago. Over lunch, he is surprised when his friend James Foley asks, him, “Doesn’t it bother you that your clients don’t look forward to seeing their auditors each year?” Dave responds, “Well auditing is only one of several services we provide. Most of our work for clients does not involve financial statement audits, and our audit clients seem to like interacting with us.”
a. Identify ways in which a financial statement audit adds value for clients.
b. List other services other than audits that Czarnecki and Hogan likely provides.
c. Assume Czarnecki and Hogan has hired you as a consultant to identify ways in which they can expand their practice. Identify at least one additional service that .
Challenges and Resources for Nurses Participating in a Hurrica.docxzebadiahsummers
Challenges and Resources for Nurses Participating in a Hurricane
Sandy Hospital Evacuation
Nancy VanDevanter, RN, DrPH1, Victoria H. Raveis, PhD2, Christine T. Kovner, RN, PhD3, Meriel McCollum,
BSN, RN4, & Ronald Keller, PhD, MPA, RN, NE-BC5
1 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
2 Professor, New York University, College of Dentistry, New York, NY, USA
3 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
4 PhD Candidate, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
5 Senior Director of Nursing NYU Hospitals Center, New York University, Langone Medical Center, New York, NY, USA
Key words
Nurse’s disaster experience, nurses’ disaster
preparedness education, Superstorm Sandy
Correspondence
Dr. Nancy VanDevanter, New York University,
College of Nursing, 433 1st Ave., New York, NY
10010. E-mail: [email protected]
Accepted May 13, 2017
doi: 10.1111/jnu.12329
Abstract
Purpose: Weather-related disasters have increased dramatically in recent
years. In 2012, severe flooding as a result of Hurricane Sandy necessitated
the mid-storm patient evacuation of New York University Langone Medical
Center. The purpose of this study was to explore, from the nurses’ perspec-
tive, what the challenges and resources were to carrying out their responsibil-
ities, and what the implications are for nursing education and preparation for
disaster.
Design: This mixed-methods study included qualitative interviews with a
purposive sample of nurses and an online survey of nurses who participated in
the evacuation.
Methods: The interviews explored prior disaster experience and train-
ing, communication, personal experience during the evacuation, and lessons
learned. The cross-sectional survey assessed social demographic factors, nurs-
ing education and experience, as well as potential challenges and resources in
carrying out their disaster roles.
Findings: Qualitative interviews provided important contextual information
about the specific challenges nurses experienced and their ability to respond
effectively. Survey data identified important resources that helped nurses to
carry out their roles, including support from coworkers, providing support to
others, personal resourcefulness, and leadership. Nurses experienced consid-
erable challenges in responding to this disaster due to limited prior disaster
experience, training, and education, but drew on their personal resourceful-
ness, support from colleagues, and leadership to adapt to those challenges.
Conclusions: Disaster preparedness education in schools of nursing and
practice settings should include more hands-on disaster preparation exercises,
more “low-tech” options to address power loss, and specific policies on nurses’
disaster roles.
Clinical Relevance: Nurses play a critical role in responding to disasters.
Learning from their disaster experience can inform approaches to nursing ed-
ucation and preparation.
Weath.
Chamberlain College of NursingNR631 Nurse Executive Track—CGE I.docxzebadiahsummers
Chamberlain College of Nursing NR631 Nurse Executive Track—CGE I
Learning Agreement
Student name:
Student D#:
Student e-mail, phone:
Mentor name and credentials:
Mentor contact information (work phone, cell phone, e-mail and work address):
Directions:
For Week 1, complete the Learning Agreement with self-identified goals to meet Course Outcomes (COs) and initial plans to meet those self-identified goals; review the TIPS document to help you and discuss your goals and plans with your mentor. Your mentor must sign the Learning Agreement for your Week 1 submission.
The agreement should be revised each week to reflect completed goals, additional goals, and changes to the plan dictated by the actual experience or revisions suggested by faculty or the mentor. At the end of the practicum experience, evaluate success with your mentor and obtain the mentor’s signature at the bottom of agreement. Save this form as a Word document and enter required information directly onto it; submit the completed Learning Agreement, signed by your mentor, on the Saturday of Week 8. See the Learning Agreement Grading Rubric for grading details.
The Learning Agreement consists of three sections.
I. Student Learning Outcomes table (Week 1)
II. Signatures approving plan (Week 1)
III. Signatures and mentor verification (Week 8)
Due Dates:
1. Initial signed Learning Agreement is submitted by 11:59 p.m. MT, Sunday at the end of Week 1
2. Completed signed Learning Agreement is submitted by 11:59 p.m. MT, Saturday of Week 8
A minimum of 144 hours practicum experience is required by the end of NR632.
If the 144 hours are not completed by end of term, you will receive a grade of “I” and not be able to graduate until completed.
I. Student Learning Outcomes
Course Outcomes
Student Identified Practicum Goals to Meet COs
Plan to Meet Student Identified Practicum Goals
Narrative Description of Attainment of Student-Identified Goals Through the End of CGE 1
CO 1: Apply leadership skills concepts of project management as a nurse executive in an organizational setting to develop, implement and evaluate successful project plans. (POs 4 and 5)
CO 2: Using current knowledge, standards of practice, and research from evidence-based literature, synthesize a foundation for the nurse executive role. (POs 3 and 4)
CO 3: Exemplify professional values and scholarship that support the role of a student in a practicum setting. (PO 4)
CO 4: Contribute to the body of nursing leadership and management knowledge through research, planning, evaluation and dissemination of findings. (PO 4)
CO 5: Apply professional values characteristic of the competent and caring nurse executive that promote holistic care principles and an appreciation of cultural humility ( POs 1, 3, and 4)
CO 6: Apply evidence-based fiscal principles that contribute to the creation of a caring environment characterized by high quality, safe, patient-centered care (PO.
Chamberlain College of NursingNR449 Evidence-Based PracticeEvide.docxzebadiahsummers
Chamberlain College of Nursing NR449 Evidence-Based PracticeEvidence Matrix Table
Article
Reference
Purpose
Hypothesis
Study Question
Variables
Independent(I)
Dependent(D)
Study Design
Sample
Size and Selection
Data Collection
Methods
Major Findings
1
(sample not a real article)
Smith, Lewis (2013),
What should I eat? A focus for those living with diabetes. Journal of Nursing Education, 1 (4) 111-112.
How do educational support groups effect dietary modifications in patients with diabetes?
D-Dietary modifications
I-Education
Qualitative
N- 18
Convenience sample-selected from local support group in Pittsburgh, PA
Focus Groups
Support and education improved compliance with dietary modifications.
1
2
3
4
5
NR449 Evidence Matric Table.docx Revised10/20/14 ns/cs
1
.
Centralized System for Strategic ResourcesIntroductionAttentio.docxzebadiahsummers
Centralized System for Strategic Resources
Introduction
Attention: According to recent news reports, US states are competing with each other to shop for medical supplies such as masks, PPE (personal protective equipment), and ventilators. Sometimes, states are even battling with the federal government for bidding, which pushed the prices for such supplies even higher and caused a lot of chaos.
Reveal Topic: A centralized system for strategic resources means that the federal government would represent all individual states and make purchases globally as a single outward-facing entity. Then resources will be coordinated and allocated to individual states.
Credibility: New York State Governor Cuomo states that it is very problematic to keep the current chaotic and unorganized systems. It costs more for taxpayers and could be life-threatening.
Central Idea: US federal government should establish a centralized system for buying, coordinating, and allocating strategic resources such as medical supplies.
Preview: Today, I will talk about why the lack of a centralized system for strategic resources could be costly and even deadly and the benefits of a centralized system.
Transition: Now let's first have a look at the harmful impacts of the current unorganized situation.
Body
I. Main Point #1 (statement of the need for action): Since the unorganized bidding for medical supplies is causing chaos and uncertainty, there should be a way to organize the bidding efforts so that all states can be allocated sufficient supplies.
A. (Description of the problem) The demand for medical supplies is high across all states in the United States amid the COVID-19 pandemic.
1. (signs, symptoms, effects of problem) Due to an increase in coronavirus cases, the low supply of medical resources, and the existence of numerous bidders in the market, States are experiencing a surge in the need for medical supplies (Lara, Rand, and Bartley).
2. (example, narrative, or testimony) The current situation in the country has slowed down the capacity of states to procure PPEs and has also augmented the costs (Triggle).
B. (Importance of problem) There is no efficient way to facilitate the process as everyone is trying to purchase the same thing.
1. (extent of problem) In the past, states in the U.S have worked closely with regional officials when faced with emergencies such as hurricanes, but the current unprecedented situation has affected all states simultaneously and has made the process murkier.
a. (facts/statistics) There is a bidding war between the various states and local governments as all states in the U.S are desperate to find a solution to meet the needs of their healthcare professionals in their fight against the spread of COVID-19 (Lara, Rand, and Bartley).
b. (expert/narrative) According to Casey Tingle, deputy director of the Louisiana Governor’s Office of Homeland Security and Emergency Preparedness, it is not clear whether the federal administration can p.
Challenge your thinking.10) After completing the WebQuest, has y.docxzebadiahsummers
Challenge your thinking.
10) After completing the WebQuest, has your opinion about the homeless individuals changed?
11) If so, how did it change? If not, provide rationale.
12) Suggest at least two community interventions relating to homelessness.
13) Are there examples of these interventions in our area? Identify and describe the services they offer.
FS 1513 Observation Project Details
Time Involved
Students enrolled in FS 1513 are expected to complete at least 15 hours of observations related to human development. This work will involve creating a journal entry for each of their observational sessions. There should be entries for at least 15 hours of observations by the end of the semester.
There should be 1 journal entry for each time you observe—whether it is for 1 hour or more—there should only be 1 entry. So, if you observed 3 times in 1 week for 1 hour each time then you would need 3 journal entries. Alternately, if you observed 1 time for 3 hours then you would need 1 journal entry. However, this means that there will be less information to assess your work (i.e., 1 mistake can cost more points).
Observations: Who and Where
Part of the purpose of this project is to observe differences in development across the life span. So, observations should involve people from different age ranges over the course of the semester. Some entries should focus on development observed during childhood (i.e., observing children from infancy through grade-school), others should involve observing development during adolescence (i.e., observing pubescent and adolescent children), and others should involve should involve observing development during adulthood (i.e., observing adults from early to later in life). The important point is that observations should be completed for at least three age groups for the entire semester.
Observations should take place in naturalistic settings. Naturalistic means that people should be observed in place where they would normally be present (i.e., not in a lab). Ideally, this would mean that they are able to behave as they normally would. The goal, however, is to have enough time to observe a person so that they can demonstrate what they have developed. This means that you will need to be able to watch them behaving naturally for the duration of your observation (i.e., at least 1 hour). Observations that are less than 1 hour will not be counted as complete.
Formatting
Journal entries using the appropriate templates should be completed for each observation session. The templates (available on the course website and below) should contain all of the identifying information. Journal entries that do not use the template will not be graded.
First, each journal entry must contain documentary information. This should cover (1) who did the observations and who was observed, (2) where and when did the observations happen, (3) what were the people being observed generally like, (4) what was the setting like, and (5) keep tr.
Ch.10 Discussion - Jingles
33 unread replies.33 replies.
Discussion - Ch.10: Jingles
Instructions:
Jingles are a popular creative form in radio advertising. Even so, there may be as many jingles that you don't want to hear again as there are ones that you do. Identify one jingle that you really dislike and another one that you like.
Analyze why these jingles either work or don't work and present your critique to the class. Explain your thoughts.
Give thoughtful responses to at least two other students’ postings. Make your reply specific to their comments. Go beyond simple agreement and add something new to the discussion with your reply. A response posting should be a minimum of one short paragraph.
Grading Rubric for Discussion Post:
Criteria
D:
Below
Standard
C:
Meeting Standard
B:
Above
Standard
A:
Exceeding Standard
Weight
Criteria Definitions
Incomplete and/or missing work; in need of major revisions, additions and edits
Submission appears as first-draft quality needing edits and improvements; limited supporting data
Submission contains all elements and includes supporting data; analysis, vision and/or strategy are still developing
Submission has compelling analysis, vision and strategy; well-supported with strong data
Discussion Assignment
Professionalism: Proper grammar, spelling, citations, sources, good organization, readability, clear articulation of ideas, correct use of templates, etc.
40%
Thoroughness: Follows instructions; response is well-researched and articulate; appropriate length; addresses all prompts and assignment criteria; thoughtful analysis
40%
Progression: Incorporates feedback and suggestions from instructor and peers; demonstrates continuous improvement
20%
.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdf
Chapter 19 Public Health InformaticsBrian Dixon PhDSaurabh .docx
1. Chapter 19: Public Health Informatics
Brian Dixon PhD
Saurabh Rahurkar DrPH
Learning Objectives
After reviewing the presentation, viewers should be able to:
Define public health informatics (PHI)
Explain the importance of informatics to the practice of public
health and the role of informatics within a public health agency
Define and distinguish the various forms of public health
surveillance systems used in practice
List several common data sources used in the field of public
health for surveillance
2. Public health: “the science and art of preventing disease,
prolonging life, and promoting health through the organized
efforts and informed choices of society, organizations, public
and private communities, and individuals.”
Public health informatics: “systematic application of
information and computer science and technology to public
health practice, research and learning”
Whereas physicians and care delivery organizations focus on the
health of individuals, public health focuses on the health of
populations and communities.
Definitions
Definitions
Public health surveillance: ongoing systematic collection,
analysis, and interpretation of health-related data essential to
planning, implementation and evaluation of public health
practice, closely integrated with the timely dissemination of
these data for prevention and control
3. Syndromic surveillance: surveillance using health-related data
that precede diagnosis and signal a sufficient probability of a
case or an outbreak to warrant further public health response
Introduction
The overarching goal of public health has been to monitor a
variety of medical diseases and conditions rapidly and
accurately so as to intervene as early as possible to detect,
prevent, and mitigate the spread of epidemics, the effects of
natural disasters, and bioterrorism
To address these challenges, public health organizations
conduct a range of activities across three, broad core functions
– assessment, policy development and assurance.
Assessment – Public health agencies spend most of their time
and resources on investigations of potential threats to the
public’s health. Activities include testing and monitoring of
water quality, laboratory examination of diseases carried by
4. mosquitoes, tracking food-borne illnesses, testing for
environmental hazards (e.g. soil lead levels), monitoring for
potential bioterrorism threats, and tracing the contacts for
individuals exposed to diseases as well as hazardous chemicals.
Public Health 3 Core Functions
Policy Development – Public health agencies also create
policies and regulations to protect the health of populations. For
example, children may be required to have certain
immunizations before they can attend school to prevent disease
outbreaks that would harm children and disrupt family life.
Agencies use the evidence they gather from their investigations
as well as the scientific literature to advocate for policies that
state and federal legislative bodies ultimately adopt for the
health of populations and communities.
Public Health 3 Core Functions
5. Assurance – Once laws and regulations are passed to protect
health, public health agencies are tasked with assuring
compliance with them. Local health departments may perform
housing inspections to assure that landlords comply with rules
concerning pest control. Restaurant inspectors typically work
for local health authorities, and they assure that those who
prepare food wash their hands, wear gloves, and take other
precautions to prevent the spread of disease.
Public Health 3 Core Functions
Public Health Surveillance
Public health surveillance (PHS): the systematic collection,
analysis, interpretation and dissemination of health-related data,
is the bedrock of public health practice.
This is because the surveillance systems capture and manage the
volumes of data and information necessary to support the three
core functions of public health.
The notion of PHS can be traced as far back as the Renaissance.
6. Public Health Surveillance Goals
Estimate significance of the problem
Determine distribution of illness
Outline natural history of a disease
Detect epidemics
Identify epidemiological and laboratory research needs
Evaluate programs and control measures
Detect changes in infectious diseases
Monitor changes in health practices and behaviors
Assess the quality and safety of health care, drugs, devices,
diagnostics and procedures
Support public health planning
Indicator-based surveillance refers to the monitoring of a
specific disease/health condition, or a class of diseases/health
conditions that are of interest to public health.
Event-based surveillance monitors data from specific events
where a large number of people gather in one place
PHS Types
7. Case
Syndromic
Sentinel
Behavioral
Integrated disease
Clinical outcomes
Types of Surveillance Systems
Case Surveillance Systems
Collect data on individual cases of a health event or disease
with previously determined case definitions in respect to
criteria for person, time, place, clinical & laboratory diagnosis
Analyze case counts and rates, trends over time and geographic
clustering patterns
Historically, case surveillance has been the focus of most public
health surveillance
The NEDSS Base System is an example of a case management
system
8. Syndromic Surveillance Systems
Collect data on clusters of symptoms and clinical features of an
undiagnosed disease or health event in near real time allowing
for early detection and rapid response mobilization
Data can be obtained through specific surveillance systems as
well as existing epidemiologic data such as insurance claims,
school and work absenteeism reports, over the counter (OTC)
medication sales, consumer driven health inquiries on the
Internet, mortality reports and animal illnesses or deaths for
syndromic surveillance
Geographic and temporal aberration and geographic clustering
analyses are performed with real-time syndromic surveillance
data
Syndromic surveillance systems can also be used to track
longitudinal data and monitor disease trends
Eight syndromes are monitored:
Botulism-like illnesses
Febrile (fever) illnesses (influenza-like illnesses)
Gastrointestinal (stomach) symptoms
9. Hemorrhagic (bleeding) illnesses
Neurological syndromes
Rash associated illnesses
Respiratory syndromes
Shock or coma
Syndromic Surveillance
Syndromic data is based on symptoms and not hard evidence
such as cultures. Experts try to predict epidemics and
bioterrorism based on this early data
Syndromic surveillance is part of Meaningful Use with the goal
of submitting reports to public health
ESSENCE is a syndromic surveillance system that is not real
time
RODS is similar and being used by a limited number of hospital
systems and approaches real time reporting
Distribute is an “influenza-like” syndrome surveillance system
Syndromic Surveillance
10. This is a CDC web-based program to improve disease detection,
monitoring and situational awareness for healthcare
organizations by reporting emergency room, pharmacy and
laboratory data. Participants include DOD, Veterans Affairs
and civilian hospitals
BioSense 2.0 allowed state and local health departments to
access data that would support syndromic surveillance systems
under meaningful use. A search engine can conduct a query by
syndrome, location and date
The goal is to provide a web based clearinghouse where data
can be stored, searched and analyzed from and by multiple
parties
Biosense
Sentinel Surveillance Systems
Collect and analyze data from designated agencies selected for
their geographic location, medical specialty, and ability to
accurately diagnose and report high quality data. They include
health facilities or laboratories in selected locations that report
all cases of a certain health event or disease to analyze trends in
the entire population
Pros: Useful to monitor and identify suspected health events or
diseases
Cons: Less reliable in assessing the magnitude of health events
on a national level as well as rare events since data collection is
11. limited to specific geographic locations
Behavioral Surveillance Systems
Collect data on health-risk behaviors, preventative health
behaviors, and health care access in relation to chronic disease
and injury
Analyze the prevalence of behaviors as well as the trends in the
prevalence of behaviors over time
Information is most commonly collected by personal interview
or examination
Inferential and descriptive analysis methods such as age
adjusted rates, linear regression, and weighted analyses are used
Most acute when conducted regularly, every 3 to 5 years
Integrated Disease Surveillance
and Response (IDSR)
Incorporates epidemiologic and laboratory data in systems
designed to monitor communicable diseases at all levels of the
12. public health jurisdiction, particularly in Africa
Useful for: detecting, registering and confirming individual
cases of disease; reporting, analysis, use, and feedback of data;
and preparing for and responding to epidemics
Clinical Outcomes Surveillance
Monitors clinical outcomes to study disease progression or
regression in a population
Analyzes the rates of and factors associated with clinical
outcomes using descriptive and inferential methods such as
incidence rates from probability samples
Laboratory Based Surveillance
Collects data from public health laboratories, which routinely
conduct tests for viruses, bacteria, and other pathogens
Used to detect and monitor infectious and food-borne diseases
based on standard methods for identifying and reporting the
genetic makeup of specific disease-causing agents
13. Commonly used in case surveillance and sentinel surveillance
Strategic vision for how informatics and information technology
should support the practice of public health
Everyone in a public health agency needs to know something
about informatics and information systems
Information systems should deliver value to the public health
agency by supporting the work done by its professional staff.
Public Health Informatics Core Elements
The CDC would like a robust interoperable web based system to
integrate all aspects of public health
This will require data standards, security measures and high
level funding to succeed
The PHIN Strategic Plan for 2011-2016 can be found on the
CDC web site
Public Health Information Network
14. The capability to electronically transmit immunization data to
immunization registries or immunization information systems
The capability to electronically transmit reportable lab results
The capability to electronically transmit syndromic surveillance
data from an EHR
The capability to report cancer cases to a state registry from a
certified EHR
The capability to report specific cases to a non-cancer state
registry from a certified EHR
Meaningful Use and Public Health
Health Information Exchange and Public Health Use Cases
Mandated reporting of lab diagnoses
Non-mandated reporting of lab data
Mandated reporting of physician-based diagnoses
Non-mandated reporting of clinical data:
Public health investigation
Clinical care in public health clinics
15. Population-level quality monitoring
Mass-casualty events
Disaster medical response
Public health alerting - patient level
Public health alerting - population level
Geographic Information Systems (GIS)
Epidemiologists often characterize data by place, time and
person
In 1855, Dr. John Snow created a simple map to show where
patients with cholera lived in London in relation to the drinking
water source in the Soho District of London
Modern GIS uses digitized maps from satellites or aerial
photography
A GIS is a system of hardware, software and data used for the
16. mapping and analysis of geographic data
GIS provides access to large volumes of data; the ability to
select, query, merge and spatially analyze data; and visually
display data through maps
Using GPS and mobile technology, field workers can enter
epidemiologic data to populate a GIS
Geographic Information Systems (GISs)
GIS Map
HealthMap
global avian influenza outbreaks
17. Partners in Information Access for the Public Health Workforce
Resource
County and Local Health Data
State Health Data
Individual State Data
National Health Data
Global Health Data
Statistical Reports
Demographic Data
Geographic Information Systems (GIS)
Training and Education
Health Information Technology and Standards
Tools for Data Collection and Planning
Public Health Data Tools and Statistics
The National Health Interview Survey (NHIS)
The National Health and Nutrition Examination Survey
18. (NHANES)
The National Survey of Family Growth (NSFG)
National Health Care Surveys
Project Tycho
Public Health Data Tools and Statistics
The Association of Schools of Public Health (ASPH) estimates
that the field of public health will require 250,000 more workers
by 2020 to avert a national public health crisis
University of Washington’s Center for Public Health
Informatics developed a list of informatics competencies for
public health workers to meet the needs of the evolving public
health field as well as for the Public Health Informatician
A Public Health Informatician is “a public health professional
who works in practice, research, or academia and whose
primary work function is to use informatics to improve
population health
PHI Workforce
19. All of the goals of the US Public Health system also pertain to
the international community
The World Health Organization represents world public health
with the following goals:
Foster health security
Promote health development
Strengthen health systems
Global Public Health Informatics
WHO Programs
Global Alert and Response (GAR): the integrated infectious
disease surveillance program within WHO
International Health Regulations
Early Warning Surveillance: surveillance mechanism to
effectively identify disease outbreaks and other health issues
immediately following acute emergencies
Global Public Health Intelligence Network: to electronically
monitor infectious disease outbreaks
Global Outbreak Alert and Response Network: provide a rapid
identification and response to outbreaks and alert the
international community
20. Systems need to integrate diseases that affect animals with
human data
Enhance the global response to outbreaks
Improve communication between health entities e.g. the Ebola
virus crisis
Better diagnostic tools for earlier detection
PHI Challenges
Public Health Informatics is an important part of Health
Informatics
Public Health reporting is part of Meaningful Use
Public Health surveillance is the backbone of public health to
detect and track epidemics, natural disasters and bioterrorism
Geographical Information Systems can provide maps with
important health data overlays
New public health programs will continue to evolve that will
require informaticists to analyze, disseminate and store data
21. Conclusions
Chapter 17: Telemedicine
Robert Hoyt MD
Thomas Martin PhD
Learning Objectives
After reviewing the presentation, viewers should be able to:
State the difference between telehealth and telemedicine
List the various types of telemedicine consultations, such as
22. teleradiology and teleneurology
List the potential benefits of telemedicine to patients and
clinicians
Identify the different means of transferring information with
telemedicine, such as store and forward
Discuss the most significant ongoing telemedicine projects
Definitions
Telehealth: The use of electronic information and
telecommunications technologies to support long-distance
clinical health care, patient and professional health-related
education, public health and health administration
Telemedicine: “the use of medical information exchanged from
one site to another via electronic communications to improve
patients' health status” or simply the remote delivery of
healthcare
Popularity of Telemedicine
23. Rising cost of healthcare worldwide
new strategies (telemedicine) to prevent readmissions
Shortage of specialists in rural areas
Rise in chronic diseases and aging of population
Improved collaboration among physicians and disparate
healthcare organizations
Raises patient satisfaction when it results in better access to
specialty care
Electronic Telemedicine Modes
Radio Doctor—predicted in 1924
TV
Telephone
Internet
Telemedicine Communication ModesCommunication
ModeProsConsPatient-Portal
24. Secure messagingAsynchronous. Able to attach photos.
Response can be formatted with
template. Could use VoIP. Audit trail is availableNot as
personal as live visit. Usually not connected to EHR or other
enterprise information but may be in
the futureTelephoneWidely available, simple and inexpensive.
Real-timeNot asynchronous. Unstructured.
No audit trail. Only real-timeAudio-VideoMaximal input to
clinician. Can include review of x-rays, etc. Perhaps more
personal than just messagingCurrently, most expensive in terms
of networks and hardware, but that is
changing
Telemedicine Transmission Modes
Store-and-forward
Images or videos are saved and sent later
Asynchronous communication
Real time
A specialist views video images transmitted from a remote site
and discusses the case with another physician
Requires more sophisticated equipment: two way interactive
telemonitors permit the specialist to see and talk to the patient
Remote monitoring
Monitor patients at home or in a nursing home; usually part of
disease management
25. Telemedicine Categories
(Author’s classification)
Televisits:
Teleconsultations:
Teleradiology, teledermatology, teleneurology, telepharmacy
Telemonitoring
Telerounding: hospital inpatients
Telerobots
eICUs
Telehomecare: monitoring physiological parameters, activity,
diet, etc. at home
Teleconsultation is a worldwide phenomenon because
specialists tend to practice in large metropolitan areas, and not
in rural areas
Most programs consist of a central medical hub and several
rural spokes
Programs attempt to improve access to services in rural and
26. underserved areas, to include prisons. This reduces travel time
and lowers the cost for specialists and patients alike
The most commonly delivered services are mental health,
dermatology, cardiology, radiology and orthopedics
Teleconsultations
Teleradiology: with new digital imaging, EHRs and other
technologies, this teleconsultation makes sense
Radiologists can be home at night, read an image, dictate a
report via voice recognition and host it all in the cloud for
others to view and link to the local EHR
vRad is a service that reads images, usually during the night,
when there may be a shortage of radiologists in some areas
In 2013 The American College of Radiologists published
Teleradiology Practice Guidelines. The Task Force outlined
benefits as well as challenges to the practice
Teleconsultations
27. Teleneurology: there is a shortage of neurologists in rural areas
and a shortage covering ERs due to liability issues
This is very significant given the fact that many stroke patients
may benefit from receiving “clot busters” in the first 3 hours of
a stroke
Teleradiology permits a remote neurologist to read the CAT
scan of the brain and see the neurological exam being conducted
on the patient
There are now several commercial teleneurology groups that
contract to cover emergency rooms remotely
Concussions are another medical problem that potentially could
benefit from teleneurology
Teleconsultations
Telemental Health (Telepsychiatry): There is a national
shortage of mental health workers in the US
There is evidence that a remote session with a therapist has the
same outcome as a face to face visit
This approach is particularly valuable for ERs, prisons and
post-deployed active duty military personnel
Some use Skype to accomplish a visit, while others use more
elaborate audio-visual technology
This is an international effort
Teleconsultations
28. Teledermatology: Very logical specialty because there are very
few emergencies in this specialty and an image of a skin lesion
is frequently diagnostic
Store and forward most common mode
Digital cameras/camera phones have only made the process that
much easier
There are several international initiatives that support
teledermatology, mentioned in the textbook
Artificial intelligence can interpret the images
Teleconsultations
Retinal images can now be obtained, even without dilating the
pupil.
A primary care doc can image a diabetic while in the office and
forward it to an ophthalmologist for a reading (store and
forward)
There is go evidence that this increases screening in patients
with diabetes
Teleophthalmology
29. Telerounding
Robot rounds: expensive robots can be placed at the bedside to
collect and store information and then communicate to the
responsible physician, preventing a second set of rounds
Virtual ICU or eICU: Due to a nationwide shortage of ICU
experts (intensivists) eICUs have appeared that have a central
hub at a larger medical center covering small remote ICUs
It includes not just an ICU nurse and physician covering remote
patients but care is based on the best possible evidence
Particularly valuable at night or weekends when coverage may
be light
Families can converse with remote staff
eICUs have great potential to improve morbidity/mortality and
length of stay but articles have tended to show conflicting
results
Telemonitoring
30. Telehomecare: the concept is that monitoring patients at home
may prevent unnecessary ER visits and hospital admissions
Multiple sensor now exist to measure a myriad of physiological
markers (see next slide)
This approach is embraced by the medical home model and
accountable care organizations
Unfortunately, thus far most telehomecare studies have not
shown a significant impact on medical quality, cost, etc.
Telemonitoring
Available Sensors and Devices
Measure:
Weight
Blood Pressure
Glucose: blood sugar
Oximeter: oxygen level
Spirometry : breathing capacity
Temperature
Medication tracker
PT/INR: how thin the blood is on blood thinners
Motion detectors/chair and bed sensors: can detect falls
Fitness
31. Health Buddy Telemonitoring Example
Telemedicine Initiatives
Informatics for Diabetes Education and Telemedicine
(IDEATel)
Georgia Partnership for Telehealth (GPT)
Middle East Society of Telemedicine (MESOTEL)
University of Texas Medical Branch at Galveston
Teleburn at the Ottawa Telemedicine Network
California Central Valley Teleretinal Program
Northwest Telehealth
More examples in the textbook
32. Barriers to Telemedicine
Limited reimbursement
Limited research showing reasonable benefit and return on
investment
High initial cost
Limited availability of high speed telecommunications
Bandwidth issues
Need for high resolution images or video for some specialties
Licensure laws
Lack of standards
Lack of evaluation by a certifying organization
Fear of malpractice as a result of telemedicine
Ethical and legal challenges
Sustainability due to inadequate long term business
Lack of sophistication on the part of the patient
Barriers to Telemedicine
33. 21
Telehealth is a broad term that means remote delivery of
medical care, administration and education
Telemedicine is the remote delivery of medical care using
technology
Almost all specialties are testing telemedicine
In spite of no reimbursement eICUs are expanding
Telehomecare is popular but too new to know its actual impact
Multiple barriers to telemedicine exist
Conclusions
Chapter 20: eResearch
John Sharp
34. Learning Objectives
After reviewing the presentation, viewers should be able to:
Describe the scope of eResearch and Clinical Research
Informatics within the clinical research workflow
Describe the use of EHR data in various phases of research
including research originating from EHR data
Conceptualize how informatics tools can be utilized in
recruiting subjects for clinical research
Detail how informatics supports the ongoing management of
clinical trials
Review the new trends in big data, real-time analytics and data
mining
Definition
eResearch: use of information technology to support research
In the past few years we have witnessed the shift from paper-
based research to almost completely electronic
Major contributing factors: adoption of electronic medical
records and electronic research platforms
35. There is no doubt that health informatics and specifically
eResearch will have a major impact on evidence based medicine
in the future
The new field to study eResearch is Clinical Research
Informatics
Preparatory to Research
Electronic retrieval of information:
PubMed
National Library of Medicine
Google Scholar
Google Books
ClinicalTrials.gov (WHO for international)
Research collaboration networks have seen significant growth in
recent years. Research networks are typically web-based
applications which include features such as a personal profile,
opportunities to connect with others with similar interests and
the ability to post status updates
36. Preparatory to Research
Research Collaborative Networks Tools
Vivo: An open source tool developed at Cornell University
Harvard Profiles Catalyst: An open source community of over
130 member institutions with built-in network analysis and data
visualization tool
SciVal Experts: Commercial solution to find research funding
and measure benchmarks
EHR Recruiting: ability to evaluate adequate pools of patients
to be recruited into the study. This requires a clinical data
repository from EHR data with a query tool to search de-
identified clinical information. By modifying inclusion and
exclusion criteria, a researcher can find the appropriate cohort
for recruitment based on a reasonable recruitment rate
Electronic grant process: researchers can search for grant
opportunities and grant submission is now common for
government and civilian agencies
Preparatory to Research
37. Study Initiation
Volunteer recruitment on the Internet
ResearchMatch: matches patients seeking clinical trials and
researchers seeking volunteers
TrialX: permits volunteer to search clinical trials from
ClinicalTrials.gov
Social network: example, ArmyOfWomen
EHR can be used to find cohorts of eligible patients and create
patient contact lists (alerts) for recruitment. Clinical trial alerts
can be embedded within EHR based on diagnoses, lab tests or
other patient characteristics. Alert would typically remind
provider that patient may be eligible for a clinical trial and who
to contact
ResearchMatch Program
38. Study Management
and Data Management
Clinical trial management systems (CTMS)
Manage the planning, preparation, performance, and reporting
of clinical trials
Budget management, study calendar of patient visits, and
creating electronic case report forms (eCRFs)
Examples of CTMSs
Research Electronic Data Capture (REDCap) by Vanderbilt
OpenClinica
REDCap Program
39. EHRs and Clinical Trials
Integration is rarely available within commercial EHRs
Data from EHRs can be exported and then imported into study
data management systems
Design a variety of study types: epidemiologic research
Identification of risk factors
Comparative effectiveness research
Challenges with EHR Data
Data that is not routinely collected in EHRs can be collected
with “smart forms”
Collection of research data using medical devices (e.g. EKG).
Many organizations are integrating device data with EHRs
Patient Reported Outcomes (PROs): is the term used to denote
health data that is provided by the patient through a system of
reporting. This data might be collected with a tablet and
inputted into the EHR
40. Data Management Systems
for FDA Regulated Studies
Regulation 21 CFR Part 11
Selecting a system compatible with regulatory requirements
Significant validation tests must be developed and executed
Commercial programs may assist: PhaseForward and Oracle
Clinical
Open source programs such as OpenClinica can help
Interfaces and Query Tools
Clinical data repositories to support research are commonplace
and based on EHR data:
i2b2: Informatics for Integrating Biology and the Bedside
TrialViz (UK)
STRIDE (Stanford University)
Challenges: gain regular access to source clinical systems and
preservation of semantics across systems during aggregation
process
Natural language processing of unstructured EHR data is
critical
41. Health Information Organizations are also a rich resource for
research
Big data means big research tools such as Hadoop. The Apache
Hadoop software library “is a framework that allows for the
distributed processing of large data sets across clusters of
computers using a simple programming model”
Research can come from voluminous image data
Research can also arise from genomic information integrated
with EHR data
Interfaces and Query Tools
Data Analysis
With tools like The R Project for Statistical Computing, an open
source statistical package, there is the potential for integration
of the statistical package with the data repository
REDCap provides access to their API (Application
Programming Interface) to connect directly to statistical
programs. SAS also provides for integration of patient data
from a variety of sources with tools for data cleaning,
standardization and exploration
Data visualization is a new and evolving field to assist research
Real time analytics is the provision of analyzed data relatively
42. instantly to support decision making. IBM’s Watson is the best
example we have today
eResearch has become an almost paperless process
There is a need for Clinical Research Informaticists
EHR data is the largest source of research data today
There are obstacles in using all EHR data for research because
much of it is unstructured
Informatics tools can be used for patient recruiting and
management of research
Big data is the results of EHRs, imaging and genomics so that
researchers must have tools to analyze these huge data sets
Conclusions
Chapter 18: Bioinformatics
Robert E. Hoyt MD
William R. Hersh
43. Indra Neil Sarkar MD
Learning Objectives
After viewing the presentation, viewers should be able to:
Define bioinformatics, translational bioinformatics and other
bioinformatics-related terms
State the importance of bioinformatics in future medical
treatments and prevention
Describe the Human Genome Project and its important
implications
List major private and governmental bioinformatics initiatives
List several bioinformatics projects that involve EHRs
Describe the application of bioinformatics in genetic profiling
of individuals and large populations
44. Definitions
Bioinformatics = Computational Biology or the field of science
in which biology, computer science and information technology
merge to form a single discipline
Bioinformatics makes use of fundamental aspects of computer
science (such as databases and artificial intelligence) to develop
algorithms for facilitating the development and testing of
biological hypotheses
Finding genes of various organisms
Predicting structure or function of newly developed proteins
Developing protein models and examining evolutionary
relationships
Transformational Bioinformatics: Simply put, is the
specialization of bioinformatics for human health
Genomics is the field that analyzes genetic material from a
species
Proteomics is the study at the level of proteins (e.g., through
gene expression)
Pharmacogenomics is the study of genetic material in
relationship with drug targets
Metabolomics is the study of genes, proteins or metabolites
45. Definitions
Biologists
collect molecular data:
DNA & Protein sequences,
gene expression, etc.
Computer scientists
(+Mathematicians, Statisticians, etc.)
Develop tools, softwares, algorithms
to store and analyze the data.
Bioinformaticians
Study biological questions by analyzing molecular data
The field of science in which biology, computer science and
information technology merge into a single discipline
46. 5
Translational Bioinformatics
Metagenomics is the analysis of genetic material derived from
complete microbial communities harvested from natural
environments
A phenotype is the observable characteristic, structure, function
and behavior of a living organism. Size and hair color could be
examples. Phenotype is strongly guided by the genotype. The
Phenome refers to total phenotypic traits
Genotype is based on the raw genetic information that is
associated with a phenotype or regulation of biological
function. The genome is the total of genotypic traits
Definitions
47. The human body has about 100 trillion cells and each one
contains a complete set of genetic information (chromosomes)
in the nucleus; exceptions are eggs, sperm and red blood cells
Humans have a pair of 23 chromosomes in each cell that
includes an X and Y chromosome for males and two Xs for
females
Offspring inherit one pair from each parent
Chromosomes are listed approximately by size with
chromosome 1 being the largest and chromosome 23 the
smallest
Genomic Primer
Chromosomes consist of double twisted helices of
deoxyribonucleic acid (DNA)
DNA is composed of four sugar-based building blocks
(“nucleotides”: adenine [A], thymine [T], cytosine [C], and
guanine [G]) that are generally found in pairs (“Watson-Crick”
pairing: A-T, C-G)
An organism’s DNA encodes its full complement of proteins
48. essential for cellular function
Genes are regions on chromosomes that encode instructions,
which may result in proteins that then enable biological
functions
Genomic Primer
The process of decoding genes involves transcribing the DNA
into ribonucleic acid (RNA) and then translation into amino
acids that form the building blocks for proteins
Collectively, the complete set of genes is referred to as a
“genome” (combination of “gene” and “chromosome”)
It is estimated that humans have between 20,000 and 30,000
genes and genomes are about 99.9% the same between
individuals
Variations in genomes between individuals are known as single
nucleotide polymorphisms (SNPs) (pronounced “snips”)
Genomic Primer
49. Genome-wide associations studies (GWASs) are being
conducted where two groups of participants are studied; those
with a disease of interest, compared with those without the
disease. The variations or SNPs discovered are said to be
associated with the disease, but true cause and effect is often
unclear
Similarly, phenome-wide association studies (PheWAS) are
being carried out comparing genes to disease associations, most
recently using the electronic health record for phenotypical
information
Genomic Primer
Genes
Importance of Bioinformatics
Diagnosing hereditary diseases
50. Discovering future drugs targets
Developing personalized drugs based on genetic profiles
(personalized medicine)
Developing gene therapies to treat diseases with a strong
genomic component (e.g. cancer)
Discover:
New indications for an old drug (drug repurposing)
New targets for existing drugs (e.g., treatment of tongue cancer
using RET inhibitors)
Drugs to work better in certain patient groups (gender, age,
race, ethnicity, etc.) with possible genetic variants
What drugs to avoid due to higher incidence of side effects that
are genetically modulated
Improve clinical decision support for electronic health records
Importance of Pharmacogenomics
The Human Genome Project
51. International collaborative project started in 1990 and finished
in 2003
3 million SNPs discovered
Ethical, legal and social issues also discussed
Huge relational databases are necessary to store and retrieve
this massive information
New technologies such as DNA arrays (gene chips) speed up
analysis
Significant drop in cost along the way
Other Projects
National Human Genome Research Institute (NHGRI)
Encyclopedia of DNA Elements (ENCODE) Project
Human Microbiome Project (HMP)
Humans have more bacteria on and in their body than cells =
microbiome
Project will determine whether individuals share a core human
microbiome and try to understand whether changes in the human
microbiome can be correlated with changes in human health
Studies are already suggesting the intestinal bacteria function
like a new organ system
52. Other Projects
Human Variome Project
The PhenX Project
1000 Genomes Project
Pediatric Cancer Genome Project
National Center for Biotechnology Information (NCBI)
Hosts thousands of databases associated with biomedicine,
Including MEDLINE and GenBank databases
The NCBI provides access to sequences from over 285,000
organisms
Others noted in the textbook
Personal Genomics
The goal is to have “tailor made” medications and treatments
that target the individual and not a group having little in
common with the patient
Also to offer bio-surveillance for future outbreaks of infectious
diseases
All of Us Project will collect biological data to further precision
or personalized medicine
53. Cost of Human Genome Determination Decreasing
Personal Genetics Testing
Available commercially without a doctor’s order:
Often less than $100
DNA Direct
AncestryDNA
23andMe
Myriad™ specializes in cancer-genetic links but they found they
could not patent BRAC gene testing
54. Ethical Questions Related to Genetic Testing
Testing is not regulated, lacks external standards for accuracy,
has not demonstrated economic viability or clinical benefits and
has the potential to mislead customers, according to Varmus
Patients must be sure of accuracy before undergoing e.g. a
prophylactic mastectomy
Patients will need genetic counseling as most physicians have
not had this training
Genetic Information Nondiscrimination Act of 2008 protects
patients against discrimination by employers and healthcare
insurers based on genetic information
Genomic Information Integrated with Electronic Health Records
Genetic profiles will likely be part of many electronic health
records in the future
Cost will become less of a factor but adding the genetic
information will raise multiple other questions and data storage
must be increased due to large data files
The Electronic Medical Records and Genomics (eMERGE)
Network is a consortium of nine healthcare organizations with
significant investments in both EHR and genomic analytics
across the United States that have already started the process
55. In order for EHRs to incorporate genomic data:
They must store data in structured format
Data must be standards based
Phenotypic information must also be stored as structured data
Data must be available for use by rules engines
EHRs must be able to display information needed by the
clinician based on phenotypic and genotypic data
SNOMED CT will be modified to incorporate genomic data
Data standards and clinical decision support will need to be
enhanced
Genomic Information Integrated with Electronic Health Records
Digital family histories are now a reality with pervasive EHRs
and meaningful use
It will likely be at least a decade before we can intelligently
integrate genomic information into EHRs, so in the mean time
we can expect some use of the family history to alert clinicians
of genetic risk of e.g. cancer
The US government is interested in better family history
56. integration and hence their creation of the web site My Family
Health Portrait
Digital Family Histories
Translational bioinformatics will blend traditional
bioinformatics with health informatics
We are experiencing huge advances in bioinformatics but we are
still a ways off in terms of incorporating this information into
the average medical practice
It is logical that eventually genomic information will be part of
every EHR; in the meantime we will use family histories
Direct to consumer genomic testing is very interesting but not
always evidence based
Conclusions