Northeast Ohio Research Articles

The “full species list” fallacy in Floristic Quality Assessment

AbstractBiological assessments typically involve field surveys that are time‐consuming and require taxonomic expertise. Floristic Quality Assessment, a popular bioassessment method for wetlands and other ecosystems, generally assumes a comprehensive or representative species list for accurate implementation. We explored this long‐held belief by analyzing an essential floristic quality metric (mean conservatism) across real and simulated gradients of species representation in two disparate case studies. In one study, we incrementally removed species at random from an exhaustive floristic survey of a suburban wetland complex in northeast Ohio. Bootstrapping mean conservatism at each removal step, precision scarcely decreased with 10%–30% species loss, becoming noticeable only when about 50% or fewer species remained. For the other study, we exploited varying percentages of dominant species available from hundreds of single‐visit wetland determination surveys throughout Illinois. Comparing dominants‐only mean conservatism with total species mean conservatism, the relationship steadily improved as dominants covered progressively larger fractions of native richness, ranging from r2 = 0.12 at ≤10% dominants to 0.74 at >40% dominants. Both exercises suggest that community size is more important than taxonomic representation or inventory completeness per se in determining accuracy. Our results indicate that full or representative checklists are not a prerequisite for reliable Floristic Quality Assessment, supporting the investigation and potential use of taxonomic shortcuts and empowering a wide range of users beyond expert field botanists.

ASCVD risk scores versus a novel cancer-specific Machine Learning-based calculator among patients with breast, colorectal, lung or prostate cancer

Abstract Background Patients with cancer have up to a 3-fold higher risk for cardiovascular disease (CVD) than the general population. Consequently, traditional risk scores developed to predict CVD in the general population (i.e., Pooled Cohort Equations (PCE), Predicting Risk of cardiovascular disease EVENTs [PREVENT]) may provide less accurate risk prediction for this population. Purpose Compare cancer-specific Machine Learning (ML)-based score to PCE and PREVENT to predict 10-year CVD risk in patients with breast cancer (BC), colorectal cancer (CRC), lung cancer (LC), or prostate cancer (PC). Methods Patients aged ≥18 years, diagnosed with BC, CRC, LC, or PC between 2005-2012 at a large hybrid academic-community practice in Northeast Ohio, United States, were included. An ML Extreme Gradient Boosting (XGBoost) algorithm, adapted for survival modeling, was developed using a training subset of the cohort (55% train + 20% test) and ranked 40 to 50 covariates (including social determinants of health, cancer treatment) for predicting 10-year CVD risk for each cancer type using SHAP (SHapley Additive exPlanations) values. The top 10 ML predictors were utilized to create a predictive equation using logistic regression models. This equation was then tested in the cohort validation subset (25%) and subsequently compared to the PCE and PREVENT (both simple and enhanced versions) using the area under the curve (AUC) of the time-dependent receiver operating characteristic curve. The CVD events were identified using ICD codes corresponding to Acute Coronary Syndrome, Ischemic Stroke, and Heart Failure. CVD risk was assessed through Kaplan-Meier. Results We included 10,240 patients (Table 1). The actual 10-year CVD events were: BC 21% (95% CI 19-23), CRC 10% (95% CI 8-12), LC 27% (95% CI 24-30), and PC 20% (95% CI 17-23). The ACC/AHA PCE predicted mean 10-year CVD risks of 16% (95% CI 15-18) for BC, 19% (95% CI 17-21) for CRC, 28% (95% CI 25-32) for LC, and 19% (95% CI 19-20) for PC, with corresponding AUCs of 0.75, 0.65, 0.76, and 0.61, respectively. The PREVENT simple version predicted mean 10-year CVD risks of 13% (95% CI 13-14) for BC, 13% (95% CI 12-13) for CRC, 15% (95% CI 14-15) for LC, and 16% (95% CI 12-19) for PC, with AUCs of 0.55, 0.55, 0.55, and 0.53, respectively. The PREVENT enhanced equation predicted mean 10-year CVD risks of 17% (95% CI 17-18) for BC, 15% (95% CI 14-15) for CRC, 15% (95% CI 15-16) for LC, and 17% (95% 16-19) for PC, with AUCs of 0.75, 0.62, 0.79, and 0.63, respectively. The predictive equation derived from the top 10 ML predictors (Table 2) achieved AUCs of 0.84 for BC, 0.76 for CRC, 0.83 for LC, and 0.71 for PC. Conclusion(s) Conventional CVD equations inadequately assess the risk in patients with BC, CRC, LC, or PC, often resulting in underestimation or overestimation. Cancer-specific ML-derived equations show good performance and emphasize the importance of integrating cancer-related covariates for precise prediction.Table 1Table 2

ECR Spotlight – Grégoire Boulinguez-Ambroise

ECR Spotlight is a series of interviews with early-career authors from a selection of papers published in Journal of Experimental Biology and aims to promote not only the diversity of early-career researchers (ECRs) working in experimental biology but also the huge variety of animals and physiological systems that are essential for the ‘comparative’ approach. Grégoire Boulinguez-Ambroise is an author on ‘ Biomechanical and morphological determinants of maximal jumping performance in callitrichine monkeys’, published in JEB. Grégoire conducted the research described in this article while a postdoc in Jesse W. Young's lab at the Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA. He is now a postdoc in the lab of Daniel Schmitt at the Department of Evolutionary Anthropology, Duke University, Durham, NC, USA, investigating the use of integrative approaches, combining morphology, behavior and performance, to further understand the origins of primate locomotion.

Variability in Antimicrobial Prescribing Across Five Ambulatory Settings Within a Large Integrated Health System.

Background: Lack of access to timely, detailed antibiotic use data has limited ambulatory antibiotic stewardship efforts. Antibiotic utilization is tracked across ambulatory care sites and emergency departments (ED) within a large integrated health system. Methods: This is a retrospective cohort analysis from June 1, 2019 to May 31, 2020 comparing antibiotic prescribing for all patients with ICD-10 diagnosis codes for cystitis, otitis media, pharyngitis, sinusitis, and upper respiratory tract infections (URTIs) among five ambulatory care departments across northeast Ohio and southeast Florida locations: ED, Urgent Care (UC), On-Demand Telehealth (TEL), Pediatrics (PED), and Primary Care (PC). Results: A total of 261,947 encounters were included (ED:56,766, UC:92,749, TEL:8,783, PED:29,151, PC:74,498) for the treatment of cystitis (30,932), otitis media (22,094), pharyngitis (59,964), sinusitis (53,693), or URTI (95,264). The population was 63% female with a median age of 34.2 years [12.8-56.3]. A total of 17% of patients had documented penicillin allergies and 18% of patients with pharyngitis received Group A Streptococcus (GAS) testing. Antibiotics were prescribed in 44% of encounters (ED:21,746 [38%], UC:45,652 [49%], TEL:4,622 [53%], PED:10,909 [37%], PC:33,547 [45%]; P < 0.001). Guideline concordant antibiotics were prescribed in 65% of encounters (ED:14,338 [66%], UC:31,532 [69%], TEL:3,869 [84%], PED:8,212 [75%], PC:17,263 [51%]; P < 0.001). Conclusions: Observed rates of antibiotic and guideline concordant antibiotic prescribing were similar to national published rates of antibiotic prescribing in the ambulatory setting. The variability in antibiotic prescribing demonstrates opportunities for targeted outpatient stewardship efforts. Timely antibiotic tracking tools can facilitate ambulatory antimicrobial stewardship activities.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

Evolution of serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed: an observational study of mortality to 60 days after admission to a 15-hospital US health system

ObjectiveIn order to predict at hospital admission the prognosis of patients with serious and life-threatening COVID-19 pneumonia, we sought to understand the clinical characteristics of hospitalised patients at admission as...

Disparities in diagnosis and access to care in patients with young-onset rectal cancers in northeast Ohio.

e15521 Background: The rising incidence of young-onset colorectal cancers (YO-CRC) in individuals &lt; 50 years old is alarming. Despite the updated USPSTF recommended age for CRC screening ( &lt; 45) in 2021, disparities in receiving proper care for YO-CRC remained largely under addressed. We sought to identify modifiable disparities to be addressed with future interventions for patients with YO-rectal cancer (YO-RC). Methods: We analyzed a cohort of patients with newly diagnosed YO-RC from 2001 to 2023 at a large academic center in Northeast Ohio. Demographic data included sex, race, age, smoking status, and poverty index. A retrospective chart review was completed to assess diagnosis date and time from symptom onset to diagnosis. Access to guideline-concordant care was assessed via clinic visits with specialty providers in medical oncology, radiation oncology, colorectal surgery, genetics, and onco-fertility. Chi-square testing and Cox regression modeling was used for statistical analyses. Results: We identified 83 patients with YO-RC, 52% female (n = 43) and 48% male (n = 40), of which 76% were White (n = 63), 21% Black (n = 17), 2% Hispanic (n = 2), and 1% Asian (n = 1). Median age at diagnosis was 44 years (IQR[39-49]). Non-White (NW) patients had a greater delay from symptom onset to diagnosis compared to White (W) patients, with an average time of 6.9mo vs 1.3mo (p &lt; 0.00001). Colonoscopy completion rates after symptom onset for NW and W patients at 2-months was 11% vs 81% and 33% vs 98% at 4-months (p &lt; 0.0001, respectively). Rate of access to specialty care once diagnosed was not statistically significant for either groups, but there is a lower percentage of all YO-RC patients who accessed onco-fertility (13%, n = 11) or genetics services (46%, n = 38). The median 1-year overall survival was 50% for NW patients vs 85.7% for W patients, which was statically significant on univariate analysis (p = 0.04), but not on multivariate analysis. Conclusions: We found significant disparities for YO-RC from symptom onset to diagnosis with longer delays noted in NW patients. Such delays in diagnosis may lead to higher staging upon presentation and impact survival. Once a diagnosis was made, access to specialty oncology care rates was similar across groups. This study encourages further evaluation and consideration of socioeconomic factors and care access patterns to address disparities in diagnosis, access, and treatment of YO-CRC. [Table: see text]

Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic.

We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p = .019) on the Hamilton Depression Rating Scale and improved global health (p = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p < .001) and crowded living space (p = .001, p = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p = .001) and improved global health (p = .029). Increasing access to medicine (p < .01) and satisfaction with telehealth appointments (p < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.

Rates of Female Sterilization, Vasectomy, and LARC Placement Before and After the Dobbs Decision: A Retrospective Cohort Study [ID 2683404

INTRODUCTION: Immediately after the Dobbs decision in Ohio, abortion was restricted after detection of a fetal heartbeat. The objective of this study was to characterize changes in utilization of long-acting reversible contraception (LARC) and permanent sterilization (PS) after the abrupt enactment of restrictive abortion legislation. METHODS: We conducted a retrospective cohort study of female and male patients aged 15–55 who underwent permanent sterilization (tubal ligation, salpingectomy, vasectomy) or LARC placement (IUD, contraceptive implant) at a large Northeast Ohio hospital system from January 1, 2022 to December 31, 2022; 6 months before and after Dobbs. Contraception procedure volumes were compared, and patient characteristics were assessed. RESULTS: Pre-Dobbs, 4,247 procedures were identified among females, including 725 (17.1%) PS and 7,449 (81.3%) LARC. Post-Dobbs, the total number of female procedures increased by 15.5% (4,916) and there was a significant increase in the proportion of PS procedures, representing 20.1% of all female procedures (P&lt;.001). Males showed a similar trend, with vasectomies rising from 1,193 to 1,590 procedures. Post-Dobbs, patients undergoing procedures were younger (women, 30.9 years [24.5, 36.8] versus 31.5 [25.2, 36.9]; P=.011; men, 36.6 years [32.9, 39.6] versus 37.2 [34.2, 40.4]; P&lt;.001). Among patients undergoing procedures post-Dobbs, the proportion that reported single relationship status significantly increased for women (57.4% versus 55.9%; P=.028) and men (23.0% versus 18.1%; P=.002). CONCLUSION: This study demonstrates increased utilization of LARC and PS following the Dobbs decision. This rise in PS and demographic changes implies concerns about abortion access, especially among younger reproductive-aged patients. Further research is warranted to understand the driving factors behind these trends.

Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio.

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework. This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child-parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization. Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization. Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.

Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs

ObjectivesImmediately following the Dobbs decision, Ohio prohibited abortion after the detection of fetal cardiac activity. We aimed to characterize changes in the uptake of long-acting reversible contraception (LARC) and permanent contraception following the abrupt enactment of restrictive abortion legislation. Study designWe conducted a retrospective cohort study using electronic medical record data of patients aged 15 to 55 who underwent permanent contraception (tubal ligation, vasectomy) or LARC placement (intrauterine device, contraceptive implant) at a multihospital system in northeast Ohio from January 1, 2022 to Decemeber 31, 2022, 6 months before and after Dobbs. We compared procedure volumes and patient characteristics. ResultsWe identified 4247 tubal ligation and LARC procedures pre-Dobbs, including 725 (17.1%) permanent contraception and 3522 (82.9%) LARC. Post-Dobbs, the total number of tubal ligation and LARC procedures increased by 15.8% (4916), and there was a significant increase in the proportion of permanent contraception, (p < 0.001). Vasectomy volume increased by 33.3% post-Dobbs, from 1193 to 1590 procedures. Compared to pre-Dobbs, patients undergoing contraceptive procedures post-Dobbs were younger (tubal ligation and LARC, 30.9 median years [24.5, 36.8] vs 31.5 [25.2, 36.9], p = 0.011; vasectomy, median 36.6 years [32.9, 39.6] vs 37.2 [34.2, 40.4], p < 0.001) and more likely to report single relationship status (57.4% vs 55.9% for tubal ligation and LARC, p = 0.028% and 23.0% vs 18.1% for vasectomy, p = 0.002). ConclusionsThis study demonstrates increased uptake of contraceptive procedures following the Dobbs decision. This rise in permanent contraception suggests a relationship between abortion policy and contraceptive decision-making, especially among younger patients. ImplicationsIncreased permanent and long-acting reversible contraception procedures following Dobbs reveal shifting contraceptive choices, particularly among younger individuals, indicating a connection between abortion policy and reproductive decisions.

Collaborative Planning in the Context of Deindustrialization: A Qualitative Evaluation of Comparative Cases in Northeast Ohio

This article investigates whether and how the contexts of the Rust Belt decline extend collaborative planning theory. We evaluate two collaborative planning projects in Northeast Ohio: (1) the Cuyahoga Greenways (CG), a regional trails project and (2) the Mahoning River Corridor Initiative (MRCI), a postindustrial river restoration project. Based on participant interviews and document analysis, we find that the projects are distinct in their contextual conditions and collaborative processes, with CG better aligning with common expectations found in the literature. MRCI deviates from normative theory pertaining to collaborative planning; we discuss how this might relate to processes of institutional change. Our results suggest that the collaborative planning literature is insufficiently tailored to assess collaborative projects in the context of decline—particularly where there is controversy around the project and where collaborative institutions and networks are weak.

Nutrition to Enhance Metabolic-Bariatric Surgery Outcomes.

Gender-specific post-surgical goals for 12-month percent body fat (%BF) based on World Health Organization (WHO) obesity thresholds and for lean mass-sparing were published as preliminary body composition (BC) guidelines to address a knowledge gap in metabolic-bariatric surgery (MBS). Other studies' %BF outcomes inconsistently fell below obesity thresholds; none described nutrition practices. To help practitioners positively influence patients' BC and weight changes, this study describes the team-supported process of conducting serial body composition analysis (sBCA) concomitantly with the evidence-based nutrition practices applied to generate the preliminary guidelines. Guidelines were generated using the cumulative outcomes of separate, original research board-approved Roux-en-Y Gastric Bypass and Sleeve Gastrectomy studies. One dietitian assessed BC using the same bioimpedance machine, educated patients, and collected data from patients aged 18 and older in a 532-bed nonprofit acute-care institution in Northeast Ohio, USA, from May, 2007, through November, 2016. Essential to pre- and postoperative education was the "Nutrition Goal Checklist," an evidence-based synopsis of imperative practices. Body composition was assessed on initial visit, presurgically, and postoperative months 3, 6, and 12, generating individual patient handouts of progressive weight and BC changes with coordinating %BF graphs. Serial assessment enabled intervention toward meeting BC goals. For genders in both surgeries, the described process influenced highly significant fat mass reduction, transitioning %BF below obesity thresholds. Lean mass-sparing outcomes supported the suggested preliminary guidelines. Utilizing sBCA with evidence-based nutrition practices consistently generated outcomes to formulate preliminary BC guidelines following MBS. Further research is needed to solidify formal guidelines.

Spatial Patterns of Nonprofit Founding: Toward a Local Ecology

Nonprofit organizations are vital to the implementation of social policy and provide myriad benefits to those nearby, yet few studies consider founding patterns in small areas. Conceptualizing ecological processes at the local level and in the context of developmental regimes, this article investigates nonprofit founding events among neighborhoods with a unique data set aggregated by census tract from 2010 to 2016 in one northeast Ohio county (United States) using a hierarchical Bayesian model. The results broadly support the density dependence hypothesis, however, suggest high density is required to reduce founding rates in small areas. The results indicate nonprofit founding rates are lower in tracts with higher levels of economic disadvantage and higher shares of Latino residents. The paper calls for further research into nonprofit population dynamics among small areas and for policymakers to closely consider nonprofit founding events, as founding determines the future of a region’s nonprofit infrastructure.

The Rise and Fall of " The Clevelander ": The Voice of Northeast Ohio's Optimism

The Rise and Fall of " The Clevelander ": The Voice of Northeast Ohio's Optimism

Effect of ultra‐early, early, and normal soybean planting dates and rye cover crop on soybean grain yield

AbstractWith changes to climate and crop insurance, earlier soybean [Glycine max (L.) Merr.] planting dates need to be investigated. Additionally, the use of a cover crop prior to soybean is promoted as a sustainable practice though little is known about cover crop and ultra‐early soybean planting (prior to April 15). The objective was to evaluate soybean planting date and cereal rye (Secale cereale L.) cover crop termination timing on cover crop biomass, soybean plant population, and yield. The study was conducted in Northeast and West Central Ohio in 2021 and 2022. Treatments included three soybean planting dates (early April, late April, and late May) and three cover crop treatments (termination 1–2 weeks prior to planting or “early,” termination at or after planting or “late,” and no cover crop). Cover crop biomass increased as termination was delayed. Soybean planted in early April resulted in a yield reduction of 1.8 Mg ha−1 when planted into a cover crop compared to the no cover crop control. However, when soybean was planted in late April, grain yield was not different among cover crop treatments. Yield reduction associated with early April planting with a cover crop was likely due to low soybean plant population, especially in Northeast Ohio, where plant population was &lt;55,000 plants ha−1 with a cover crop and &gt;120,000 plants ha−1 without a cover crop. To maximize yield, soybean should be planted by the end of April in Northeast Ohio. In West Central Ohio, soybean can be planted in early April without a cover crop.

Comparison of machine learning approaches for positive airway pressure adherence prediction in a veteran cohort

BackgroundAdherence to positive airway pressure (PAP) therapy for sleep apnea is suboptimal, particularly in the veteran population. Accurately identifying those best suited for other therapy or additional interventions may improve adherence. We evaluated various machine learning algorithms to predict 90-day adherence.MethodsThe cohort of VA Northeast Ohio Health Care system patients who were issued a PAP machine (January 1, 2010–June 30, 2015) had demographics, comorbidities, and medications at the time of polysomnography obtained from the electronic health record. The data were split 60:20:20 into training, calibration, and validation data sets, with no use of validation data for model development. We constructed models for the first 90-day adherence period (% nights ≥4 h use) using the following algorithms: linear regression, least absolute shrinkage and selection operator, elastic net, ridge regression, gradient boosted machines, support vector machine regression, Bayes-based models, and neural nets. Prediction performance was evaluated in the validation data set using root mean square error (RMSE).ResultsThe 5,047 participants were 38.3 ± 11.9 years old, and 96.1% male, with 36.8% having coronary artery disease and 52.6% with depression. The median adherence was 36.7% (interquartile range: 0%, 86.7%). The gradient boosted machine was superior to other machine learning techniques (RMSE 37.2). However, the performance was similar and not clinically useful for all models without 30-day data. The 30-day PAP data and using raw diagnoses and medications (vs. grouping by type) improved the RMSE to 24.27.ConclusionComparing multiple prediction algorithms using electronic medical record information, we found that none has clinically meaningful performance. Better adherence predictive measures may offer opportunities for personalized tailoring of interventions.

Impact of Sedation Practices on Mortality in COVID-19-Associated Adult Respiratory Distress Syndrome Patients: A Multicenter Retrospective Descriptive Study.

Background: Reduction in sedation exposure is an important metric in intensive care unit (ICU) patients. However, challenges arose during the coronavirus disease-2019 (COVID-19) pandemic in adhering to this practice, driven by concerns on transmission and disease severity issues. Accordingly, diverse sedation approaches emerged, although the effect on mortality has not been studied thoroughly. Methods: Retrospective cohort study in the medical ICU of seven hospitals within a major Health System in Northeast Ohio. We included all adult patients admitted with COVID-19 requiring invasive mechanical ventilation (IMV) from March 2020 to December 2021. Results: Study included 2394 COVID-19 patients requiring IMV. Across waves, sample included 55-63% male subjects, with an average age of 61-68 years (P < 0.001), Acute Physiologic and Chronic Health Evaluation (APACHE)-III score 65.8-68.9 (P = 0.37), median IMV duration 8-10 days (P = 0.14), and median ICU duration 9.8-11.6 days (P = 0.084). Propofol remained the primary sedative (84-92%; P = 0.089). Ketamine use increased from the first (9.7%) to fourth (19%) wave (P = 0.002). Midazolam use decreased from the first (27.4%) to third (9.4%) wave (P = 0.001). Dexmedetomidine use declined from 35% to 27-28% (P = 0.002) after the first wave. A multivariable regression analysis indicated clinical variables explained 34% of the variation in hospital mortality (R2). Factors associated with higher mortality included age [aOR = 1.059 (95% CI 1.049-1.069); P < 0.001], COVID-19 wave, especially fourth wave [aOR = 2.147, (95% CI 1.370-3.365); P = 0.001], and higher number of vasopressors [aOR = 31.636, (95% CI 17.603-56.856); P < 0.001]. Addition of sedative medications to a second model led to an increase in the R2 by only 1.6% to 35.6% [aOR = 1 (95% CI 1-1); P > 0.05] for propofol, ketamine, and midazolam. Dexmedetomidine demonstrated a decrease in the odds of mortality [aOR = 0.96 (95% CI 0.94-0.97); P < 0.001]. Conclusion: Mortality in critical COVID-19 patients was mostly driven by illness severity, and the choice of sedation might have minimal impact when other factors are controlled.

Patient factors associated with survival after critical care interhospital transfer

ObjectiveTo identify the factors that predict mortality post-transfer and develop a comprehensive mortality prediction model capable of supporting pre-transfer decision making.Materials and methodsElectronic health record data from the Medical Transport Data Repository of a large health system hospital in Northeast Ohio that consists of a main campus and 11 affiliated medical centers. We retrospectively analyzed patient data from the referring hospital encounter prior to interhospital transfer. All patient data including diagnoses, laboratory results, medication, and medical and social history were analyzed to predict in-hospital mortality post-transfer. We employed a multi-method approach including logistic regression, gradient boosting, and multiple correspondence analysis to identify significant predictors of mortality as well as variables that are clinically useful to inform clinical decision support development. We identified all patients aged 21 and older that underwent critical care transfer in the health system between 2010 and 2017.ResultsWe found that age, laboratory results (albumin, INR, platelets, BUN, leukocyte, hemoglobin, glucose), vital signs (temperature, respirations, pulse, systolic blood pressure, pulse oximetry), and ventilator usage are the most predictive variables of post-interhospital transfer mortality. Using structured data from the EHR we achieved the same performance as APACHE IV within our health system (0.85 vs. 0.85). Lastly, mode of transport alone was not a significant predictor for the general population in any of the outcome models.ConclusionsOur findings provide a foundation for the development of decision support tools to guide transport referrals and identified the need for further inquiry to discern the role of mode of transport to enable future inclusion in decision support approaches. Further inquiry is needed to identify factors that differentiate patients not triaged as time-sensitive transfers but still require helicopter intervention to maintain or improve post-interhospital transfer morbidity and mortality.

Nurse Reports of Moral Distress During the COVID-19 Pandemic.

COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.