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Article ; Online: Electronic Health Record Usability When Caring for Children With Medical Complexity.

Wilson, Averi E / Diaz, Marlon I / Lehmann, Christoph U / Maddox, Katherine

Hospital pediatrics

2024 Volume 14, Issue 3, Page(s) e156–e160

Abstract: Objectives: To evaluate usability of and clinician satisfaction with the electronic health record (EHR) in the context of caring for children with medical complexity (CMC) at a large academic pediatric hospital and to identify key areas for targeted ... ...

Abstract	Objectives: To evaluate usability of and clinician satisfaction with the electronic health record (EHR) in the context of caring for children with medical complexity (CMC) at a large academic pediatric hospital and to identify key areas for targeted improvements. Methods: Cross-sectional study of pediatric faculty and advanced practice providers across several pediatric specialties using an online Research Electronic Data Capture survey. EHR usability was measured with 6 validated questions from the National Usability-Focused Health Information System Scale, and satisfaction with common EHR functionalities was measured with 6 original Likert-scale questions and 3 free-text questions. Results were analyzed with bivariate testing. Results: More than half of providers completed the survey (n = 81, response rate 56%). When asked 6 positively-phrased, validated usability questions, a majority of respondents either agreed or were neutral. Respondents were most dissatisfied with information quality of the summary view and most satisfied with physician communication. Older respondents were less satisfied with EHR usability (P < .01). Focusing on functionalities needed for CMC, the majority of respondents were dissatisfied with the chart review process. More respondents were dissatisfied with order entry (P = .002) and documentation (P = .017) when caring for CMC compared with caring for other patients. The most cited challenges were locating recent patient data, performing an accurate medication reconciliation, and lack of specialized documentation templates. Conclusions: Clinicians are less satisfied with common EHR functionalities when caring for CMC compared with caring for all other patients. Targeted interventions to improve usability and common EHR functionalities for CMC are necessary to improve the user experience.
MeSH term(s)	Humans ; Child ; Cross-Sectional Studies ; Electronic Health Records ; Communication ; Documentation ; Faculty
Language	English
Publishing date	2024-02-21
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007471
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Article ; Online: Generalized cost-effectiveness analysis to assess treatment value in hepatitis C.

Chou, Jacquelyn W / Graf, Marlon / Díaz Espinosa, Oliver / Brewer, Iris / Heim, Zachary / Baumgardner, James

The American journal of managed care

2024 Volume 29, Issue 12, Page(s) 696–703

Abstract: Objectives: To estimate the comprehensive value of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) compared with peginterferon alfa and ribavirin (PEG/riba) employing a generalized cost-effectiveness analysis (GCEA).: ... ...

Abstract	Objectives: To estimate the comprehensive value of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) compared with peginterferon alfa and ribavirin (PEG/riba) employing a generalized cost-effectiveness analysis (GCEA). Study design: To assess the societal-level cost-effectiveness of DAA treatment for HCV, we extended a previously published discrete-time Markov simulation model of HCV transmission and progression to include market dynamics and broader elements of value. Methods: We followed a stepwise process to add novel value elements to a traditional CEA model for HCV treatments. For each additional element of value, we estimated incremental cost-effectiveness ratios (ICERs) of DAAs compared with PEG/riba. Results: The health technology assessment (HTA)-style model yielded an ICER value of $64,512 per quality-adjusted life-year (QALY). Adding transmission dynamics resulted in an ICER value of $52,971 per QALY, whereas accounting for transmission dynamics and dynamic price and efficacy further decreased ICER values by 90% to $6406 per QALY. Incorporating genericization, productivity loss, caregiver spillover, and differential valuations of LYs vs quality of life, disease severity, and insurance value further decreased the ICER value to $4487 per QALY, a 93% reduction from the baseline HTA-style CEA to the fully realized GCEA. Conclusions: Our GCEA study results confirm that DAAs are a cost-effective treatment for HCV compared with PEG/riba even when using conventional cost-effectiveness approaches. Incorporating broader elements of value resulted in more than a 10-fold improvement in cost-effectiveness, emphasizing the substantive impact of a generalized approach and the importance of incorporating GCEAs into decision-making.
MeSH term(s)	Humans ; Antiviral Agents/therapeutic use ; Hepacivirus ; Cost-Effectiveness Analysis ; Quality of Life ; Hepatitis C, Chronic/drug therapy ; Cost-Benefit Analysis ; Ribavirin/therapeutic use ; Quality-Adjusted Life Years ; Hepatitis C/drug therapy
Chemical Substances	Antiviral Agents ; Ribavirin (49717AWG6K)
Language	English
Publishing date	2024-01-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2023.89468
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Article ; Online: Twitter discussions on breastfeeding during the COVID-19 pandemic.

Jagarapu, Jawahar / Diaz, Marlon I / Lehmann, Christoph U / Medford, Richard J

International breastfeeding journal

2023 Volume 18, Issue 1, Page(s) 56

Abstract: Background: Breastfeeding is a critical health intervention in infants. Recent literature reported that the COVID-19 pandemic resulted in significant mental health issues in pregnant and breastfeeding women due to social isolation and lack of direct ... ...

Abstract	Background: Breastfeeding is a critical health intervention in infants. Recent literature reported that the COVID-19 pandemic resulted in significant mental health issues in pregnant and breastfeeding women due to social isolation and lack of direct professional support. These maternal mental health issues affected infant nutrition and decreased breastfeeding rates during COVID-19. Twitter, a popular social media platform, can provide insight into public perceptions and sentiment about various health-related topics. With evidence of significant mental health issues among women during the COVID-19 pandemic, the perception of infant nutrition, specifically breastfeeding, remains unknown. Methods: We aimed to understand public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic through Twitter analysis using natural language processing techniques. We collected and analyzed tweets related to breastfeeding and COVID-19 during the pandemic from January 2020 to May 2022. We used Python software (v3.9.0) for all data processing and analyses. We performed sentiment and emotion analysis of the tweets using natural language processing libraries and topic modeling using an unsupervised machine-learning algorithm. Results: We analyzed 40,628 tweets related to breastfeeding and COVID-19 generated by 28,216 users. Emotion analysis revealed predominantly "Positive emotions" regarding breastfeeding, comprising 72% of tweets. The overall tweet sentiment was positive, with a mean weekly sentiment of 0.25 throughout, and was affected by external events. Topic modeling revealed six significant themes related to breastfeeding and COVID-19. Passive immunity through breastfeeding after maternal vaccination had the highest mean positive sentiment score of 0.32. Conclusions: Our study provides insight into public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic. Contrary to other topics we explored in the context of COVID (e.g., ivermectin, disinformation), we found that breastfeeding had an overall positive sentiment during the pandemic despite the documented rise in mental health challenges in pregnant and breastfeeding mothers. The wide range of topics on Twitter related to breastfeeding provides an opportunity for active engagement by the medical community and timely dissemination of advice, support, and guidance. Future studies should leverage social media analysis to gain real-time insight into public health topics of importance in child health and apply targeted interventions.
MeSH term(s)	Child ; Humans ; Female ; COVID-19/epidemiology ; Pandemics ; Social Media ; Breast Feeding
Language	English
Publishing date	2023-11-04
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2227239-2
ISSN	1746-4358 ; 1746-4358
ISSN (online)	1746-4358
ISSN	1746-4358
DOI	10.1186/s13006-023-00593-x
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Article: The lived experience of people with disabilities during the COVID-19 pandemic on Twitter: Content analysis.

Diaz, Marlon I / Medford, Richard J / Lehmann, Christoph U / Petersen, Carolyn

Digital health

2023 Volume 9, Page(s) 20552076231182794

Abstract: Objective: People with disabilities (PWDs) are at greater risk of COVID-19 infection, complications, and death, and experience more difficulty accessing care. We analyzed Twitter tweets to identify important topics and investigate health policies' ... ...

Abstract	Objective: People with disabilities (PWDs) are at greater risk of COVID-19 infection, complications, and death, and experience more difficulty accessing care. We analyzed Twitter tweets to identify important topics and investigate health policies' effects on PWDs. Methods: Twitter's application programming interface was used to access its public COVID-19 stream. English-language tweets from January 2020 to January 2022 containing a combination of keywords related to COVID-19, disability, discrimination, and inequity were collected and refined to exclude duplicates, replies, and retweets. The remaining tweets were analyzed for user demographics, content, and long-term availability. Results: The collection yielded 94,814 tweets from 43,296 accounts. During the observation period, 1068 (2.5%) accounts were suspended and 1088 (2.5%) accounts were deleted. Account suspension and deletion among verified users tweeting about COVID-19 and disability were 0.13% and 0.3%, respectively. Emotions were similar among active, suspended, and deleted users, with general negative and positive emotions most common followed by sadness, trust, anticipation, and anger. The overall average sentiment for the tweets was negative. Ten of the 12 topics identified (96.8%) related to pandemic effects on PWDs; "politics that rejects and leaves the disabled, elderly, and children behind" (48.3%) and "efforts to support PWDs in the COVID crisis" (31.8%) were most common. The sample of tweets by organizations (43.9%) was higher for this topic than for other COVID-19-related topics the authors have investigated. Conclusions: The primary discussion addressed how pandemic politics and policies disadvantage PWDs, older adults, and children, and secondarily expressed support for these populations. The increased level of Twitter use by organizations suggests a higher level of organization and advocacy within the disability community than in other groups. Twitter may facilitate recognition of increased harm to or discrimination against specific populations such as people living with disability during national health events.
Language	English
Publishing date	2023-06-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819396-9
ISSN	2055-2076
ISSN	2055-2076
DOI	10.1177/20552076231182794
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Article ; Online: Identifying the Optimal Look-back Period for Prior Antimicrobial Resistance Clinical Decision Support.

Hanna, John J / Wakene, Abdi D / Cooper, Lauren N / Diaz, Marlon I / Chen, Catherine / Lehmann, Christoph U / Medford, Richard J

AMIA ... Annual Symposium proceedings. AMIA Symposium

2024 Volume 2023, Page(s) 969–976

Abstract: Background: Lack of consensus on the appropriate look-back period for multi-drug resistance (MDR) complicates antimicrobial clinical decision support. We compared the predictive performance of different MDR look-back periods for five common MDR ... ...

Abstract	Background: Lack of consensus on the appropriate look-back period for multi-drug resistance (MDR) complicates antimicrobial clinical decision support. We compared the predictive performance of different MDR look-back periods for five common MDR mechanisms (MRSA, VRE, ESBL, AmpC, CRE). Methods: We mapped microbiological cultures to MDR mechanisms and labeled them at different look-back periods. We compared predictive performance for each look-back period-MDR combination using precision, recall, F1 scores, and odds ratios. Results: Longer look-back periods resulted in lower odds ratios, lower precisions, higher recalls, and lower delta changes in precision and recall compared to shorter periods. We observed higher precision with more information available to clinicians. Conclusion: A previously positive MDR culture may have significant enough precision depending on the mechanism of resistance and varying information available. One year is a clinically relevant and statistically sound look-back period for empiric antimicrobial decision-making at varying points of care for the studied population.
MeSH term(s)	Humans ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Decision Support Systems, Clinical ; Drug Resistance, Bacterial
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Journal Article
ISSN	1942-597X
ISSN (online)	1942-597X
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Article ; Online: Twitter discussions on breastfeeding during the COVID-19 pandemic

Jawahar Jagarapu / Marlon I. Diaz / Christoph U. Lehmann / Richard J. Medford

International Breastfeeding Journal, Vol 18, Iss 1, Pp 1-

2023 Volume 8

Abstract: Abstract Background Breastfeeding is a critical health intervention in infants. Recent literature reported that the COVID-19 pandemic resulted in significant mental health issues in pregnant and breastfeeding women due to social isolation and lack of ... ...

Abstract	Abstract Background Breastfeeding is a critical health intervention in infants. Recent literature reported that the COVID-19 pandemic resulted in significant mental health issues in pregnant and breastfeeding women due to social isolation and lack of direct professional support. These maternal mental health issues affected infant nutrition and decreased breastfeeding rates during COVID-19. Twitter, a popular social media platform, can provide insight into public perceptions and sentiment about various health-related topics. With evidence of significant mental health issues among women during the COVID-19 pandemic, the perception of infant nutrition, specifically breastfeeding, remains unknown. Methods We aimed to understand public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic through Twitter analysis using natural language processing techniques. We collected and analyzed tweets related to breastfeeding and COVID-19 during the pandemic from January 2020 to May 2022. We used Python software (v3.9.0) for all data processing and analyses. We performed sentiment and emotion analysis of the tweets using natural language processing libraries and topic modeling using an unsupervised machine-learning algorithm. Results We analyzed 40,628 tweets related to breastfeeding and COVID-19 generated by 28,216 users. Emotion analysis revealed predominantly “Positive emotions” regarding breastfeeding, comprising 72% of tweets. The overall tweet sentiment was positive, with a mean weekly sentiment of 0.25 throughout, and was affected by external events. Topic modeling revealed six significant themes related to breastfeeding and COVID-19. Passive immunity through breastfeeding after maternal vaccination had the highest mean positive sentiment score of 0.32. Conclusions Our study provides insight into public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic. Contrary to other topics we explored in the context of COVID (e.g., ivermectin, disinformation), we found that ...
Keywords	Social media ; Twitter ; Breastfeeding ; COVID-19 ; Breast milk ; Lactation ; Pediatrics ; RJ1-570 ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The lived experience of people with disabilities during the COVID-19 pandemic on Twitter

Marlon I. Diaz / Richard J. Medford / Christoph U. Lehmann / Carolyn Petersen

Digital Health, Vol

Content analysis

2023 Volume 9

Abstract: Objective People with disabilities (PWDs) are at greater risk of COVID-19 infection, complications, and death, and experience more difficulty accessing care. We analyzed Twitter tweets to identify important topics and investigate health policies’ effects ...

Abstract	Objective People with disabilities (PWDs) are at greater risk of COVID-19 infection, complications, and death, and experience more difficulty accessing care. We analyzed Twitter tweets to identify important topics and investigate health policies’ effects on PWDs. Methods Twitter's application programming interface was used to access its public COVID-19 stream. English-language tweets from January 2020 to January 2022 containing a combination of keywords related to COVID-19, disability, discrimination, and inequity were collected and refined to exclude duplicates, replies, and retweets. The remaining tweets were analyzed for user demographics, content, and long-term availability. Results The collection yielded 94,814 tweets from 43,296 accounts. During the observation period, 1068 (2.5%) accounts were suspended and 1088 (2.5%) accounts were deleted. Account suspension and deletion among verified users tweeting about COVID-19 and disability were 0.13% and 0.3%, respectively. Emotions were similar among active, suspended, and deleted users, with general negative and positive emotions most common followed by sadness, trust, anticipation, and anger. The overall average sentiment for the tweets was negative. Ten of the 12 topics identified (96.8%) related to pandemic effects on PWDs; “politics that rejects and leaves the disabled, elderly, and children behind” (48.3%) and “efforts to support PWDs in the COVID crisis” (31.8%) were most common. The sample of tweets by organizations (43.9%) was higher for this topic than for other COVID-19-related topics the authors have investigated. Conclusions The primary discussion addressed how pandemic politics and policies disadvantage PWDs, older adults, and children, and secondarily expressed support for these populations. The increased level of Twitter use by organizations suggests a higher level of organization and advocacy within the disability community than in other groups. Twitter may facilitate recognition of increased harm to or discrimination against specific ...
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	360
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: The Politicization of Ivermectin Tweets During the COVID-19 Pandemic.

Diaz, Marlon I / Hanna, John J / Hughes, Amy E / Lehmann, Christoph U / Medford, Richard J

Open forum infectious diseases

2022 Volume 9, Issue 7, Page(s) ofac263

Abstract: Background: We explore the ivermectin discourse and sentiment in the United States with a special focus on political leaning through the social media blogging site Twitter.: Methods: We used sentiment analysis and topic modeling to geospatially ... ...

Abstract	Background: We explore the ivermectin discourse and sentiment in the United States with a special focus on political leaning through the social media blogging site Twitter. Methods: We used sentiment analysis and topic modeling to geospatially explore ivermectin Twitter discourse in the United States and compared it to the political leaning of a state based on the 2020 presidential election. Results: All modeled topics were associated with a negative sentiment. Tweets originating from democratic leaning states were more likely to be negative. Conclusions: Real-time analysis of social media content can identify public health concerns and guide timely public health interventions tackling disinformation.
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac263
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Article ; Online: Analyzing COVID-19 disinformation on Twitter using the hashtags #scamdemic and #plandemic: Retrospective study.

Lanier, Heather D / Diaz, Marlon I / Saleh, Sameh N / Lehmann, Christoph U / Medford, Richard J

PloS one

2022 Volume 17, Issue 6, Page(s) e0268409

Abstract: Introduction: The use of social media during the COVID-19 pandemic has led to an "infodemic" of mis- and disinformation with potentially grave consequences. To explore means of counteracting disinformation, we analyzed tweets containing the hashtags # ... ...

Abstract	Introduction: The use of social media during the COVID-19 pandemic has led to an "infodemic" of mis- and disinformation with potentially grave consequences. To explore means of counteracting disinformation, we analyzed tweets containing the hashtags #Scamdemic and #Plandemic. Methods: Using a Twitter scraping tool called twint, we collected 419,269 English-language tweets that contained "#Scamdemic" or "#Plandemic" posted in 2020. Using the Twitter application-programming interface, we extracted the same tweets (by tweet ID) with additional user metadata. We explored descriptive statistics of tweets including their content and user profiles, analyzed sentiments and emotions, performed topic modeling, and determined tweet availability in both datasets. Results: After removal of retweets, replies, non-English tweets, or duplicate tweets, 40,081 users tweeted 227,067 times using our selected hashtags. The mean weekly sentiment was overall negative for both hashtags. One in five users who used these hashtags were suspended by Twitter by January 2021. Suspended accounts had an average of 610 followers and an average of 6.7 tweets per user, while active users had an average of 472 followers and an average of 5.4 tweets per user. The most frequent tweet topic was "Complaints against mandates introduced during the pandemic" (79,670 tweets), which included complaints against masks, social distancing, and closures. Discussion: While social media has democratized speech, it also permits users to disseminate potentially unverified or misleading information that endangers people's lives and public health interventions. Characterizing tweets and users that use hashtags associated with COVID-19 pandemic denial allowed us to understand the extent of misinformation. With the preponderance of inaccessible original tweets, we concluded that posters were in denial of the COVID-19 pandemic and sought to disperse related mis- or disinformation resulting in suspension. Conclusion: Leveraging 227,067 tweets with the hashtags #scamdemic and #plandemic in 2020, we were able to elucidate important trends in public disinformation about the COVID-19 vaccine.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Disinformation ; Humans ; Pandemics/prevention & control ; Retrospective Studies ; Social Media
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0268409
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Article ; Online: The CONJUDOR pipeline for multiplexed knockdown of gene pairs identifies RBBP-5 as a germ cell reprogramming barrier in C. elegans.

Kazmierczak, Marlon / Farré I Díaz, Carlota / Ofenbauer, Andreas / Herzog, Sergej / Tursun, Baris

Nucleic acids research

2020 Volume 49, Issue 4, Page(s) e22

Abstract: Multiple gene activities control complex biological processes such as cell fate specification during development and cellular reprogramming. Investigating the manifold gene functions in biological systems requires also simultaneous depletion of two or ... ...

Abstract	Multiple gene activities control complex biological processes such as cell fate specification during development and cellular reprogramming. Investigating the manifold gene functions in biological systems requires also simultaneous depletion of two or more gene activities. RNA interference-mediated knockdown (RNAi) is commonly used in Caenorhabditis elegans to assess essential genes, which otherwise lead to lethality or developmental arrest upon full knockout. RNAi application is straightforward by feeding worms with RNAi plasmid-containing bacteria. However, the general approach of mixing bacterial RNAi clones to deplete two genes simultaneously often yields poor results. To address this issue, we developed a bacterial conjugation-mediated double RNAi technique 'CONJUDOR'. It allows combining RNAi bacteria for robust double RNAi with high-throughput. To demonstrate the power of CONJUDOR for large scale double RNAi screens we conjugated RNAi against the histone chaperone gene lin-53 with more than 700 other chromatin factor genes. Thereby, we identified the Set1/MLL methyltransferase complex member RBBP-5 as a novel germ cell reprogramming barrier. Our findings demonstrate that CONJUDOR increases efficiency and versatility of RNAi screens to examine interconnected biological processes in C. elegans with high-throughput.
MeSH term(s)	Animals ; Bacteria/genetics ; Caenorhabditis elegans/genetics ; Caenorhabditis elegans Proteins/genetics ; Cellular Reprogramming/genetics ; Conjugation, Genetic ; Epigenesis, Genetic ; Germ Cells/metabolism ; Luminescent Proteins/genetics ; Muscles/metabolism ; Neurons/metabolism ; Plasmids/genetics ; RNA Interference ; Repressor Proteins/genetics
Chemical Substances	Caenorhabditis elegans Proteins ; LIN-53 protein, C elegans ; Luminescent Proteins ; Repressor Proteins
Language	English
Publishing date	2020-12-08
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	186809-3
ISSN	1362-4962 ; 1362-4954 ; 0301-5610 ; 0305-1048
ISSN (online)	1362-4962 ; 1362-4954
ISSN	0301-5610 ; 0305-1048
DOI	10.1093/nar/gkaa1171
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