Early detection of at-risk patients of re-presentation to emergency department using a recurrent neural network (Preprint)

BACKGROUND Re-presentations to emergency departments (EDs) have been directly associated with increased healthcare cost and length of stay, poorer quality of care and increased morbidity and mortality. Early detection of at-risk patients to EDs can reduce unnecessary re-presentations and provide provision of better quality of care and healthcare planning. Conventional risk predictive models, however, have difficulties when the at-risk patients have diverse and complex disease states or demographic profiles. These models also ignore related temporal patient information such as changes in their disease state and personal circumstance which can be used to model the progression of risks. OBJECTIVE Our aim is to develop a temporal risk predictive model based on recurrent neural network (RNN) can understand temporal relationships between different times of patient presentations to EDs and improve the predictive modelling. METHODS We used the data extracted from Health Information Exchange (HIE) system, which included all available ED records from the Nepean hospital in Australia from the period 1 January 2009 to 30 June 2016. A total of 343,014 ED presentations were identified from 170,134 individual patients. We used the variables including age, marital status, indigenous status, mode of arrival, mode of separations, referred to on departure and diagnosis code which have shown to be correlated to frequent presenters to EDs. We evaluated our RNN model by comparing it to other conventional predictive models using the area under to receiver operating characteristics curve (AUROC). All models were trained using the ED data extracted from the 6 to 12-months period by setting an interval that is divided into an observation window and a prediction window. We further proposed a context-based patient representation learning (CPRL) framework to better characterise the feature representation of patient data and discussed the general extension of our CPRL framework as an optimisation algorithm to improve the feature representation of patient data. RESULTS Using a 9-month observation with 1-month prediction window (i.e., prediction of at-risk patients of re-presentation to ED in next 1-month), the AUROC for the RNN model was 71.60% compared to AUROCs for logistic regression (57.18%), Naves Bayes (56.35%) and random forest (56.02%). The at-risk patients presented to the ED more frequently (i.e., time (day) differences between presentations become shorter) when their marital status was changed (e.g., from ‘Married’ to ‘Separated’ or ‘Separated’ to ‘Divorced’). These patients also consistently had similar diagnoses during the observation period, indicating that these groups of patients may be the focus of certain integrated cares / interventions to improve the quality of care and reduce the unnecessary re-presentations. CONCLUSIONS Our findings indicate that our RNN improves the predictive modelling, is robust and can effectively understand the disease state and personal circumstance changes within patients over time. We suggest that our model highlights the gaps in ED interventions and can be used to develop tailored integrated cares / interventions.

Dynamic Dataset of Global Population Mental Wellbeing

Mental wellbeing changes dynamically with life circumstance and is a barometer of current societal healthand productivity. Using an online assessment tool called the MHQ, the Mental Health Million project collectsreal-time global data on population mental wellbeing that can be used to guide public health campaigns andpolicy making, as well as provides a large-scale dynamic dataset for investigative research. Here we describethis dataset which includes 47 individual indicators of mental wellbeing, 30 life context metrics that placepeople within their personal circumstance, as well as aggregate scores of mental wellbeing overall, andacross 6 dimensions. We provide a detailed summary of the MHQ assessment methodology and recruitmentoutreach strategy that capitalizes on the opportunity afforded by the global growth in internet connectivity.The dataset automatically updates over time and is available for researchers to download for non-commercialuse. As of May 2021, there were 104,000 responses in the dataset, spanning 10 English-speaking countries.By the end of 2021, the MHQ will be launched in Spanish and Arabic, facilitating the expansion of the datasetto cover an additional 20 countries. A summary of key trends from 2020 are provided in the Annual MentalState of the World Report 2020.

Experiences of individuals with various sexual orientations with healthcare professionals

Introduction: Individuals may belong to different sexual minorities. Such a personal circumstance should not influence the quality of healthcare. Yet, many face discrimination due to their sexual orientation, while the healthcare system is typically heteronormative. The objective of this integrative review was to provide a synthesis of research evidence on the experiences of lesbian, gay, bisexual and transgender (LGBT) individuals with healthcare professionals.Methods: An integrative literature review was employed, and codes and categories were identified. A literature search was performed in the databases Springer Link, SAGE, CINAHL, Academic Search Elite and MEDLINE. The key words used were: "experiences", "healthcare", "gay patient experiences", "gay", "lesbian", "homosexual", "bisexual" and "transgender". Primary sources were selected according to inclusion and exclusion criteria. Thematic analysis was conducted with an open coding of the results of selected sources. Results: A total of 6,839 studies were screened from June to August 2018 and 14 (published between 2009 and 2017) were selected for the final analysis. The results yielded 41 codes, combined into two categories termed: 'Positive experiences of LGBT individuals with healthcare professionals' and 'Negative experiences of LGBT individuals with healthcare professionals'.Discussion and conclusion: The experiences of LGBT individuals with healthcare professionals are ambivalent. Although positive experiences prevail, negative ones should not be overlooked as they are derived from heteronormativity and sometimes even prejudice and homophobia. Healthcare professionals need cultural competences which reflect the developments in a society and the needs of its individuals.

Birth of the New Afrikan Independence Movement

Chapter 1 provides a historical overview of the NAIM from its inception into the 1980s. It explains how two brothers from South Philadelphia helped organize a Black Government Convention in 1968. Tracing the birth and early development of the NAIM clarifies how political geography, historical context, and personal circumstance helped shape activism. After relocating to the Detroit metropolitan area in the 1950s, brothers Milton and Richard Henry became community activists and political leaders. Working through the Group on Advanced Leadership and the Freedom Now Party, political struggle taught them the limits of seeking full entry into a nation that circumscribed their political power. At the same time, the Henry brothers witnessed decolonization in Africa, especially Ghana, which challenged them to reconsider the meaning of black liberation. Under the tutelage of people like Malcolm X and “Queen Mother” Audley Moore, they shifted their politics from reform and inclusion to revolution and self-determination. Changing their names to Gaidi and Imari Abubakari Obadele, they called for the 1968 convention. Convention participants declared black people’s right to independence from the United States of America, formed a provisional government with Robert F. Williams as the nominal president, and demanded reparations.

Uncertainty as opportunity: the challenge of project based careers

Purpose Current literature acknowledges the growth of careers in project management. The purpose of this paper is to provide a better understanding of the characteristics of those who choose and continue in project-based careers. Design/methodology/approach Using social cognitive career theory as the lens to explore project management career journeys, 74 project practitioners were interviewed from across three broad industry sectors. A qualitative research approach was utilized and Atlas.ti was used to analyze and categorize the interview data collected. Findings Those who choose to continue in project-based roles demonstrate high levels of self-efficacy and coping efficacy and see uncertainty as opportunity. They value challenge, flexibility and variety and take responsibility for their own career progression. Desire for employment security may vary according to personal circumstance. These findings are of value to employers in guiding selection and retention of people for project roles. Research limitations/implications This is a qualitative and exploratory study covering only three industry sectors and results are not generalizable. SCCT was found useful as a lens for understanding the nature of project-based careers. Practical implications Findings of this research provide valuable guidance for employers and HR practitioners in project-based organizations. For practitioners the study provides a useful framework for reflecting upon their own careers in projects. Social implications The nature of careers is changing. Project-based careers are indicative of this change. This study therefore provides insight into an evolving phenomenon. Originality/value This study expands our understanding of careers in projects, going beyond technical skill development to gain a deeper understanding of personal attributes that contribute to selection into and retention in project-based careers.

Disabled Persons in Slovenian Archives Reading Rooms: the Problem of Accessibility

Article 14 of the Constitution of the Republic of Slovenia (1991) quotes: “In the Republic of Slovenia everyone is granted the same human and universal rights regardless of nationality, race, gender, language, religion, political beliefs, education, social status, disability or any other personal circumstance”. Reality isn’t always like that and with my paper I would like to point out a group of people that encounters various problems when executing their right of free movement (access to public spaces) and their right to retrieve, receive and spread information (access to- and usage of archives). When building or reconstructing Archives we shouldn’t think only about how to protect archival material but also about how to enable people with disabilities to move freely inside of premises and access archives.

Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence

BackgroundStudies of cognitive behavioural therapy delivered by computer (cCBT) show clinical efficacy for treating anxiety and depression, but have not focused on barriers to uptake. Potential barriers include adverse consequences, accessibility and acceptability.MethodAn integrated systematic review was conducted of quantitative and qualitative studies and surveys from multiple electronic databases where computers delivered cCBT for anxiety or depression.ResultsSubstantial numbers of potential participants are lost prior to trials commencing with little explanation. Among trial participants, drop-outs may be higher in the cCBT groups (odds ratio 2.03, 95% confidence interval 0.81–5.09). Only a median of 56% completed a full course of cCBT and personal circumstance was a more common cause of drop-out than difficulties with the technology or social background. Risk was rarely assessed in the majority of programs. Significant staff time was needed to support clients. Therapists were more negative about cCBT than clients.ConclusionsWhile cCBT is likely to be an effective and acceptable intervention for some people, there are barriers to its uptake that will substantially limit its impact if not addressed. These included investigating the outcome and attitudes of those who do not make it as far as cCBT trials and why so few finish a full course of cCBT.

Matching the Self: The Paradoxical Case and Life History of a Late Career Teacher/Coach

This case study focuses on a late career, male teacher/coach and reveals the multidimensionality of his life and career. It demonstrates the influence of significant career and life events, as well as the social context in which the teacher/coach works. Overall, a life history approach describes the paradox of the employment/accommodation of a veteran elementary teacher as a physical educator at the secondary school in which he coaches. This study reveals the marginality of physical education and its teachers at the secondary school level in contrast to the importance of interscholastic athletics and those who serve in varsity coaching roles. The study shows how the teacher studied is both a good-fit and a weak-fit stayer (Yee, 1990). Equally, it demonstrates how one’s conception of self (Nias, 1985) relates to professional and personal circumstance. Finally, the research demonstrates the value of and need for biographical research in sport pedagogy.

The Diary of an Old New England Minister

The morbid emotional self-consciousness of such a journal as David Brainerd's was not likely to find imitation in the active seaport society of Salem. But journals were kept there. Hawthorne began one at the tender age of twelve with the motive of self-improvement in expression, and the practised ease he gained appears in the later note-books, which are cherished illustrations of his grave and graceful style as well as of the artist's propensity to transmute experience into symbol and dream. The Salem boy doubtless did not know that his most eminent elder townsman was an indefatigable diarist, jotting down in careless, awkward language matter not meant for an imaginative version of life. Certainly too the older Salem diarist was not recording his spiritual condition. The Reverend William Bentley, a short and portly clergyman, living an unhampered celibate life, was wont to close days of phenomenal industry by hasty and incisive records of event and comment. After his vigorous walk in the early morning he had stood at a desk all the forenoon working on sermons and correspondence, on manuscript text-books in science or languages, on scripture commentaries, local history, critical reviews of books read, on bi-weekly summaries of home and foreign news to be printed in the newspapers, on parochial records minutely exact as to family occupation and personal circumstance.