XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Data Mining - Concepts and Techniques.

/pdf/research-design-qualitative-quantitative-and-mixed-methods-1m92m1x5gg.pdf

Research Design: Qualitative, Quantitative, and Mixed Methods Approaches

ToppGene Suite (http://toppgene.cchmc.org; this web site is free and open to all users and does not require a login to access) is a one-stop portal for (i) gene list functional enrichment, (ii) candidate gene prioritization using either functional annotations or network analysis and (iii) identification and prioritization of novel disease candidate genes in the interactome. Functional annotation-based disease candidate gene prioritization uses a fuzzy-based similarity measure to compute the similarity between any two genes based on semantic annotations. The similarity scores from individual features are combined into an overall score using statistical meta-analysis. A P-value of each annotation of a test gene is derived by random sampling of the whole genome. The protein-protein interaction network (PPIN)-based disease candidate gene prioritization uses social and Web networks analysis algorithms (extended versions of the PageRank and HITS algorithms, and the K-Step Markov method). We demonstrate the utility of ToppGene Suite using 20 recently reported GWAS-based gene-disease associations (including novel disease genes) representing five diseases. ToppGene ranked 19 of 20 (95%) candidate genes within the top 20%, while ToppNet ranked 12 of 16 (75%) candidate genes among the top 20%.

ToppGene Suite for gene list enrichment analysis and candidate gene prioritization

国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

We present a method utilizing Healthcare Cost and Utilization Project (HCUP) dataset for predicting disease risk of individuals based on their medical diagnosis history. The presented methodology may be incorporated in a variety of applications such as risk management, tailored health communication and decision support systems in healthcare. We employed the National Inpatient Sample (NIS) data, which is publicly available through Healthcare Cost and Utilization Project (HCUP), to train random forest classifiers for disease prediction. Since the HCUP data is highly imbalanced, we employed an ensemble learning approach based on repeated random sub-sampling. This technique divides the training data into multiple sub-samples, while ensuring that each sub-sample is fully balanced. We compared the performance of support vector machine (SVM), bagging, boosting and RF to predict the risk of eight chronic diseases. We predicted eight disease categories. Overall, the RF ensemble learning method outperformed SVM, bagging and boosting in terms of the area under the receiver operating characteristic (ROC) curve (AUC). In addition, RF has the advantage of computing the importance of each variable in the classification process. In combining repeated random sub-sampling with RF, we were able to overcome the class imbalance problem and achieve promising results. Using the national HCUP data set, we predicted eight disease categories with an average AUC of 88.79%.

https://link.springer.com/content/pdf/10.1186%2F1472-6947-11-51.pdf

Predicting disease risks from highly imbalanced data using random forest

More than a third of elderly fall each year in the United States. It has been shown that the longer the lie on the floor, the poorer is the outcome of the medical intervention. To reduce delay of the medical intervention, we have developed an acoustic fall detection system (acoustic-FADE) that automatically detects a fall and reports it promptly to the caregiver. Acoustic-FADE consists of a circular microphone array that captures the sounds in a room. When a sound is detected, acoustic-FADE locates the source, enhances the signal, and classifies it as “fall” or “nonfall.” The sound source is located using the steered response power with phase transform technique, which has been shown to be robust under noisy environments and resilient to reverberation effects. Signal enhancement is performed by the beamforming technique based on the estimated sound source location. Height information is used to increase the specificity. The mel-frequency cepstral coefficient features computed from the enhanced signal are utilized in the classification process. We have evaluated the performance of acoustic-FADE using simulated fall and nonfall sounds performed by three stunt actors trained to behave like elderly under different environmental conditions. Using a dataset consisting of 120 falls and 120 nonfalls, the acoustic-FADE achieves 100% sensitivity at a specificity of 97%.

A Microphone Array System for Automatic Fall Detection

To address an aging population, we have been investigating sensor networks for monitoring older adults in their homes. In this paper, we report ongoing work in which passive sensor networks have been installed in 17 apartments in an aging in place eldercare facility. The network under development includes simple motion sensors, video sensors, and a bed sensor that captures sleep restlessness and pulse and respiration levels. Data collection has been ongoing for over two years in some apartments. This longevity in sensor data collection is allowing us to study the data and develop algorithms for identifying alert conditions such as falls, as well as extracting typical daily activity patterns for an individual. The goal is to capture patterns representing physical and cognitive health conditions and then recognize when activity patterns begin to deviate from the norm. In doing so, we strive to provide early detection of potential problems which may lead to serious health events if left unattended. We describe the components of the network and show examples of logged sensor data with correlated references to health events. A summary is also included on the challenges encountered and the lessons learned as a result of our experiences in monitoring aging adults in their homes.

A smart home application to eldercare: Current status and lessons learned

More than one third of about 38 million adults 65 and older fall each year in the United States. To address the above problem we propose to develop an acoustic fall detection system (FADE) that will automatically signal a fall to the monitoring caregiver. As opposed to many existent fall detection systems that require the monitored person to wear devices such as accelerometers or gyroscopes at all times, our system is completely unobtrusive by not requiring any wearable devices. To reduce the false alarm rate we employ an array of acoustic sensors to obtain sound source height information. The sound is considered a false alarm if it comes from a source located at a height higher than 2 feet. We tested our system in a pilot study that consisted of a set of 23 falls performed by a stunt actor during six sessions of about 15 minutes each (1.3 hours in total). The actor was previously trained by our nursing collaborators to fall like an elderly person. The use of height information reduced the false alarm hourly rate from 32 to 5 at a 100% fall detection rate.

An acoustic fall detector system that uses sound height information to reduce the false alarm rate

Falling is a common health problem for elderly. It is reported that more than one third of adults 65 and older fall each year in the United States. To address the problem, we are currently developing a Doppler radar-based fall detection system. Doppler radar sensors provide an inexpensive way to recognize human activity. In this paper, we employed mel-frequency cepstral coefficients (MFCC) to represent the Doppler signatures of various human activities such as walking, bending down, falling, etc. Then we used two different classifiers, SVM and kNN, to automatically detect falls based on the extracted MFCC features. We obtained encouraging classification results on a pilot dataset that contained 109 falls and 341 non-fall human activities.

Mihail Popescu

Papers

Predicting disease risks from highly imbalanced data using random forest

A Microphone Array System for Automatic Fall Detection

A smart home application to eldercare: Current status and lessons learned

An acoustic fall detector system that uses sound height information to reduce the false alarm rate

Automatic fall detection based on Doppler radar motion signature