Publications by authors named "E W Wilkins"

491 Publications

Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation.

Health Promot Pract 2021 May 10:15248399211009789. Epub 2021 May 10.

Johns Hopkins University, Baltimore, MD, USA.

System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.
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http://dx.doi.org/10.1177/15248399211009789DOI Listing
May 2021

Towards Patient-Centered Decision-Making in Breast Cancer Surgery: Machine Learning to Predict Individual Patient-Reported Outcomes at 1-Year Follow-up.

Ann Surg 2021 Mar 18. Epub 2021 Mar 18.

*PROVE Center, Harvard Medical School & Brigham and Women's Hospital, Boston, MA †Department of Plastic & Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY ‡Department of Surgery, University of Michigan, Ann Arbor, MI §Department of Symptom Research, The University of Texas MD Anderson Cancer Center.

Objective: We developed, tested, and validated machine learning algorithms to predict individual patient-reported outcomes at 1-year follow-up to facilitate individualized, patient-centered decision-making for women with breast cancer.

Summary Background Data: Satisfaction with breasts is a key outcome for women undergoing cancer-related mastectomy and reconstruction. Current decision-making relies on group-level evidence which may lead to sub-optimal treatment recommendations for individuals.

Methods: We trained, tested, and validated three machine learning algorithms using data from 1921 women undergoing cancer-related mastectomy and reconstruction conducted at eleven study sites in North America from 2011 to 2016. Data from 1921 women undergoing cancer-related mastectomy and reconstruction were collected prior to surgery and at 1-year follow-up. Data from 10 of the 11 sites was randomly split into training and test samples (2:1 ratio) to develop and test three algorithms (logistic regression with elastic net penalty, Extreme Gradient Boosting tree, and neural network) which were further validated using the additional site's data.Accuracy and area-under-the-receiver-operating-characteristics-curve (AUC) to predict clinically-significant changes in satisfaction with breasts at 1-year follow-up using the validated BREAST-Q were the outcome measures.

Results: The three algorithms performed equally well when predicting both improved or decreased satisfaction with breasts in both testing and validation datasets: For the testing dataset median accuracy= 0.81 (range 0.73-0.83), median AUC= 0.84 (range 0.78-0.85). For the validation dataset median accuracy= 0.83 (range 0.81-0.84), median AUC= 0.86 (range 0.83-0.89).

Conclusion: Individual patient-reported outcomes can be accurately predicted using machine learning algorithms, which may facilitate individualized, patient-centered decision-making for women undergoing breast cancer treatment.
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http://dx.doi.org/10.1097/SLA.0000000000004862DOI Listing
March 2021

Maternal nutrition and its intergenerational links to non-communicable disease metabolic risk factors: a systematic review and narrative synthesis.

J Health Popul Nutr 2021 04 26;40(1):20. Epub 2021 Apr 26.

Department for Health, University of Bath, Bath, BA2 7AY, UK.

Background: Non-communicable diseases (NCDs) are the leading cause of death and disability globally, while malnutrition presents a major global burden. An increasing body of evidence suggests that poor maternal nutrition is related to the development of NCDs and their risk factors in adult offspring. However, there has been no systematic evaluation of this evidence.

Methods: We searched eight electronic databases and reference lists for primary research published between 1 January 1996 and 31 May 2016 for studies presenting data on various dimensions of maternal nutritional status (including maternal exposure to famine, maternal gestational weight gain (GWG), maternal weight and/or body mass index (BMI), and maternal dietary intake) during pregnancy or lactation, and measures of at least one of three NCD metabolic risk factors (blood pressure, blood lipids and blood glucose) in the study population of offspring aged 18 years or over. Owing to high heterogeneity across exposures and outcomes, we employed a narrative approach for data synthesis (PROSPERO= CRD42016039244, CRD42016039247).

Results: Twenty-seven studies from 10 countries with 62,607 participants in total met our inclusion criteria. The review revealed considerable heterogeneity in findings across studies. There was evidence of a link between maternal exposure to famine during pregnancy with adverse blood pressure, blood lipid, and glucose metabolism outcomes in adult offspring in some contexts, with some tentative support for an influence of adult offspring adiposity in this relationship. However, the evidence base for maternal BMI, GWG, and dietary intake of specific nutrients during pregnancy was more limited and revealed no consistent support for a link between these exposures and adult offspring NCD metabolic risk factors.

Conclusion: The links identified between maternal exposure to famine and offspring NCD risk factors in some contexts, and the tentative support for the role of adult offspring adiposity in influencing this relationship, suggest the need for increased collaboration between maternal nutrition and NCD sectors. However, in view of the current scant evidence base for other aspects of maternal nutrition, and the overall heterogeneity of findings, ongoing monitoring and evaluation using large prospective studies and linked data sets is a major priority.
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http://dx.doi.org/10.1186/s41043-021-00241-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077952PMC
April 2021

Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar.

BMC Infect Dis 2021 Apr 21;21(1):375. Epub 2021 Apr 21.

Medical Action Myanmar, Yangon, Myanmar.

Background: Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon.

Method: This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7-1.0 mg/kg) and oral fluconazole (800 mg orally/day).

Results: Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies.

Conclusion: Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.
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http://dx.doi.org/10.1186/s12879-021-06049-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059000PMC
April 2021

Social media reveal ecoregional variation in how weather influences visitor behavior in U.S. National Park Service units.

Sci Rep 2021 Jan 28;11(1):2403. Epub 2021 Jan 28.

Department of Environment and Society, Utah State University, Logan, UT, USA.

Daily weather affects total visitation to parks and protected areas, as well as visitors' experiences. However, it is unknown if and how visitors change their spatial behavior within a park due to daily weather conditions. We investigated the impact of daily maximum temperature and precipitation on summer visitation patterns within 110 U.S. National Park Service units. We connected 489,061 geotagged Flickr photos to daily weather, as well as visitors' elevation and distance to amenities (i.e., roads, waterbodies, parking areas, and buildings). We compared visitor behavior on cold, average, and hot days, and on days with precipitation compared to days without precipitation, across fourteen ecoregions within the continental U.S. Our results suggest daily weather impacts where visitors go within parks, and the effect of weather differs substantially by ecoregion. In most ecoregions, visitors stayed closer to infrastructure on rainy days. Temperature also affects visitors' spatial behavior within parks, but there was not a consistent trend across ecoregions. Importantly, parks in some ecoregions contain more microclimates than others, which may allow visitors to adapt to unfavorable conditions. These findings suggest visitors' spatial behavior in parks may change in the future due to the increasing frequency of hot summer days.
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http://dx.doi.org/10.1038/s41598-021-82145-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843642PMC
January 2021