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FHIR PIT: a geospatial and spatiotemporal data integration pipeline to support subject-level clinical research
Get PDFBackground Environmental exposures such as airborne pollutant exposures and socio-economic indicators are increasingly recognized as important to consider when conducting clinical research using electronic health record (EHR) data or other sources of clinical data such as survey data. While numerous public sources of geospatial and spatiotemporal data are available to support such research, the data are challenging to work with due to inconsistencies in file formats and spatiotemporal resolutions, computational challenges with large file sizes, and a lack of tools for patient- or subject-level data integration. Results We developed FHIR PIT (HL7® Fast Healthcare Interoperability Resources Patient data Integration Tool) as an open-source, modular, data-integration software pipeline that consumes EHR data in FHIR® format and integrates the data at the level of the patient or subject with environmental exposures data of varying spatiotemporal resolutions and file formats. We applied FHIR PIT to generate “integrated feature tables” containing patient- or subject-level EHR data integrated with environmental exposures data on two cohorts: one on patients with asthma and related common pulmonary disorders; and a second on patients with primary ciliary dyskinesia and related rare pulmonary disorders. The data were then exposed via the open Integrated Clinical and Environmental Exposures Service, which was then queried to explore relationships between exposures to two representative airborne pollutants (particulate matter and ozone) and annual emergency department or inpatient visits for respiratory issues. We found that hospitalizations for respiratory issues were more common among patients exposed to relatively high levels of particulate matter and ozone and were higher overall among patients with primary ciliary dyskinesia than among patients with asthma. Conclusions Our manuscript describes a major release of FHIR PIT v1.0 and includes a technical demonstration use case and a clinical application on the use of FHIR PIT to support research on environmental exposures and health outcomes related to asthma and primary ciliary dyskinesia. For application of the tool to common data models (CDMs) other than FHIR, we offer open-source conversion tools to map from the PCORnet, i2b2, and OMOP CDMs to FHIR
Beyond stable alliances: uncertainty at the dawn of Trump’s second act
Get PDFDonald Trump’s successful bid for the White House in 2024, combined with the Republican Party’s unified control of Congress and a solid conservative majority on the Supreme Court, underscores a stark reality: the second coming of “Trumpism” may be more relentless than the first. While Trump’s initial presidency from 2017 to 2021 introduced a disruptive “America First” paradigm that already led to far-spread uncertainty in International Relations, his return now carries the force of unrestrained partisan alignment across all branches of the federal government. His return also buries any hopes in Europe for the US to pursue its traditional foreign policy role any time soon. This configuration has far-reaching implications for the global stage, sowing a profound sense of uncertainty among allies and partners, especially in Europe
Corrections to “CardioGPT: An ECG Interpretation Generation Model”
Get PDFPresents corrections to the paper, “CardioGPT: An ECG Interpretation Generation Model”
Dialogue on difference: Identity and political communication
Get PDFIdentity is a crucial force in every facet of contemporary politics, but political communication research has too often addressed it only superficially, excluded it from the subfield’s primary foci, and failed to acknowledge many dominant identities as forms of identity that circulate globally. Still, recent scholarly endeavors create space for deeper conversations about identity in communication research. This essay engages this conversation in the context of political communication research, arguing for the need to emphasize and more thoughtfully interrogate identity in its myriad forms. To make this case, we first review recent research in three domains (elite communication, journalistic norms/routines, and engagement) that productively engage with identity – or that would benefit from unraveling specific intersections and/or implications of identity. We then consider the path forward, providing strategies for scholars in political communication and beyond to productively center identity in their research
Trends in Respiratory Pathogen Testing at US Children’s Hospitals
Get PDFImportance: Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood. Objective: To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (aged <18 years) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends. Design, Setting, and Participants: This retrospective serial cross-sectional study included emergency department (ED) encounters and hospitalizations in US children's hospitals among children and adolescents with a primary acute infectious respiratory illness diagnosis. Data were ascertained from the Pediatric Health Information System database from January 1, 2016, to December 31, 2023. Exposure: Respiratory pathogen testing. Main Outcomes and Measures: The primary outcome was the percentage of encounters with respiratory testing over time. Interrupted time series models were created to assess the association of COVID-19 with testing patterns. The inflation-adjusted standardized unit cost associated with respiratory testing was also examined. Results: There were 5 090 923 eligible encounters among patients who were children or adolescents (mean [SD] age, 3.36 [4.06] years); 55.0% of the patients were male. Among these encounters, 87.5% were ED only, 77.9% involved children younger than 6 years, and 94.5% involved children without complex chronic conditions. Respiratory testing was performed in 37.2% of all encounters. The interrupted time series models demonstrated increasing prepandemic testing rates in both ED-only encounters (slope, 0.26 [95% CI, 0.21-0.30]; P < .001) and hospitalizations (slope, 0.12 [95% CI, 0.07-0.16]; P < .001). Increases in respiratory testing were seen at the onset of the COVID-19 pandemic in both ED-only encounters (level change, 33.78 [95% CI, 31.77-35.79]; P < .001) and hospitalizations (level change, 30.97 [95% CI, 29.21-32.73]; P < .001), associated initially with COVID-19-only testing. Postpandemic testing rates remained elevated relative to prepandemic levels. The percentage of encounters with respiratory testing increased from 13.6% [95% CI, 13.5%-13.7%] in 2016 to a peak of 62.2% [95% CI, 62.1%-62.3%] in 2022. While COVID-19-only testing decreased after 2020, other targeted testing and large-panel (>5 targets) testing increased. The inflation-adjusted standardized unit cost associated with respiratory testing increased from 33.9-128.2 [95% CI, 128.6] per encounter in 2022. Conclusions and Relevance: The findings of this cross-sectional study suggest that respiratory testing rates have increased over time, with large increases at the onset of the COVID-19 pandemic that have persisted. Respiratory testing rates and related costs increased significantly, supporting a need for future deimplementation efforts
