Phybrata Sensors and Machine Learning for Enhanced Neurophysiological Diagnosis and Treatment.

Concussion injuries remain a significant public health challenge. A significant unmet clinical need remains for tools that allow related physiological impairments and longer-term health risks to be identified earlier, better quantified, and more easily monitored over time. We address this challenge by combining a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration ("phybrata") sensor and several candidate machine learning (ML) models. The performance of this solution is assessed for both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments. Results are compared with previously reported approaches to ML-based concussion diagnostics. Using phybrata data from a previously reported concussion study population, four different machine learning models (Support Vector Machine, Random Forest Classifier, Extreme Gradient Boost, and Convolutional Neural Network) are first investigated for binary classification of the test population as healthy vs. concussion (Use Case 1). Results are compared for two different data preprocessing pipelines, Time-Series Averaging (TSA) and Non-Time-Series Feature Extraction (NTS). Next, the three best-performing NTS models are compared in terms of their multiclass prediction performance for specific concussion-related impairments: vestibular, neurological, both (Use Case 2). For Use Case 1, the NTS model approach outperformed the TSA approach, with the two best algorithms achieving an F1 score of 0.94. For Use Case 2, the NTS Random Forest model achieved the best performance in the testing set, with an F1 score of 0.90, and identified a wider range of relevant phybrata signal features that contributed to impairment classification compared with manual feature inspection and statistical data analysis. The overall classification performance achieved in the present work exceeds previously reported approaches to ML-based concussion diagnostics using other data sources and ML models. This study also demonstrates the first combination of a wearable IMU-based sensor and ML model that enables both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments.

Cost of best-practice primary care management of chronic disease in a remote Aboriginal community.

OBJECTIVE: To estimate the cost of completing all chronic care tasks recommended by the Central Australian Rural Practitioners Association Standard Treatment Manual (CARPA STM) for patients with type 2 diabetes and chronic kidney disease (CKD). DESIGN AND SETTING: The study was conducted at a health service in a remote Central Australian Aboriginal community between July 2010 and May 2011. The chronic care tasks required were ascertained from the CARPA STM. The clinic database was reviewed for data on disease prevalence and adherence to CARPA STM guidelines. Recommended tasks were observed in a time-and-motion study of clinicians' work. Clinicians were interviewed about systematic management and its barriers. Expenditure records were analysed for salary and administrative costs. MAIN OUTCOME MEASURES: Diabetes and CKD prevalence; time spent on chronic disease care tasks; completion of tasks recommended by the CARPA STM; barriers to systematic care identified by clinicians; and estimated costs of optimal primary care management of all residents with diabetes or CKD. RESULTS: Projected annual costs of best-practice care for diabetes and CKD for this community of 542 people were $900 792, of which $645 313 would be met directly by the local primary care service. Estimated actual expenditure for these conditions in 2009-10 was $446 585, giving a projected funding gap of $198 728 per annum, or $1733 per patient. High staff turnover, acute care workload and low health literacy also hindered optimal chronic disease care. CONCLUSION: Barriers to optimal care included inadequate funding and workforce issues. Reduction of avoidable hospital admissions and overall costs necessitates adequate funding of primary care of chronic disease in remote communities.

Evidence for improved patient management through electronic patient records at a Central Australian Aboriginal Health Service.

AIM: To examine chronic disease (CD)-related clinical activity and outcomes associated with introduction of a more systematic approach to chronic disease care in a remote Aboriginal community, using data from Communicare patient record management system. METHODS: We examined CD process measures, outcomes and clinical profiles in adults age 15+ years from Communicare data and compared results for two intervals. Process measures were clinic visits and proportions of eligible patients with recorded CD-related procedures or diagnostic tests. Outcome measures were results of CD care items and CD morbidities. Data in the interval 2007-2009 were compared with data from 2009 to 2011, in which an intensified CD program was conducted in the clinic by its own staff. RESULTS: About one-third of adult visits were related to CD care; CD-cycle of care encounters increased significantly in the second interval, from 3.2% to 9.1%, and proportions of adults having CD-related procedures or tests were also higher. For already commonly performed items, like blood pressure, weight and lipids, proportions of adults tested were 30-50% higher in the second interval, while proportions tested for more recently emphasised items, like waist, HbA1C, urine ACR, rose by more than 200%. Levels of SBP, DBP, HbA1c and HDL-C significantly improved in the second interval. Proportions of adults with clinical values outside normal ranges decreased for at least half of observations. CONCLUSIONS: Parameters of CD care activities and outcomes have increased significantly over the last four years in this setting, accompanied by stabilisation of or improvement in outcomes.

Aboriginal women's stories of sexually transmissible infection transmission and condom use in remote central Australia.

BACKGROUND: Sexually transmissible infection (STI) rates are persistently high in central Australia, creating conditions for a potential HIV pandemic in the area. There is a shortage of qualitative research examining the underlying factors affecting STI transmission in this region. The present study investigates Aboriginal women's current levels of knowledge regarding STI and their transmission, perception of risk for STI, patterns of condom use, access to condoms and experiences of condom negotiation with their partners. It also explores the sociocultural context of their sexual health. METHODS: The present study used qualitative methods with a semistructured questionnaire. Twenty-four women aged 18-35 years from one remote central-Australian Aboriginal community were recruited. RESULTS: The results revealed poor understandings of STI transmission, limited access to condoms and low levels of condom use despite a high perception of risk to STI. They also identified specific issues facing these women regarding the sociocultural context of their condom use, their access to condoms and the transmission of STI. The perceived effects of alcohol abuse, infidelity, sexual assault and shame on the acquisition of STI were significant issues for the women. CONCLUSION: This research has identified an urgent need for further qualitative research into the sociocultural factors that facilitate the spread of STI among Aboriginal people of remote central Australia. Implications include the need to increase their knowledge regarding STI and STI transmission, to increase women's access to condoms and to incorporate the teaching of skills to deal with sexual assault and violence into sexual-health education.

Apparent contrasting rates of pharyngitis and pyoderma in regions where rheumatic heart disease is highly prevalent.

BACKGROUND: The aim of the study was to describe the epidemiology of pharyngitis and pyoderma in a Central Australian Aboriginal community with a high prevalence of rheumatic heart disease (RHD) and compare it to communities in the Top End of the Northern Territory. METHODS: Following ethics approval and community consultation, selected households were enrolled and visited over a 13-month period. People were asked if they had a sore throat and/or skin sores and asked about current or recent use of antibiotics; all throats and any pyoderma lesions were swabbed for bacterial culture. Beta-haemolytic streptococci (BHS), including group A streptococcus (GAS), were identified in the central laboratory using standard methods. Household crowding was also assessed. Results were then compared to those from the Top End study. RESULTS: Sore throat was relatively common (480 episodes per 100 person years), although there was only one case of GAS pharyngitis in 326 consultations. Only 5.5% of children <15 years had pyoderma during the course of the study. This is the opposite picture to that reported in the Top End where symptomatic pharyngitis is rare and pyoderma is common. CONCLUSIONS: Although the data are limited, the epidemiology of pharyngitis and pyoderma in this Central Australian Aboriginal community appears to be more akin to that seen in temperate climates rather than tropical Top End communities. In this community, RHD preventative measure should continue to include aggressive treatment of pharyngitis according to recommendations.

Barriers and enablers for implementing general practice training.

BACKGROUND: The Australian College of Rural and Remote Medicine (ACRRM) curriculum is designed for rural and remote general practice in Australia. We explored the potential for its implementation in the Northern Territory (NT). METHODS: Forty-two doctors who might teach or study the ACRRM curriculum were interviewed on the predicted barriers to the curriculum, strategies to overcome these barriers and a model for curriculum delivery. RESULTS: The themes that emerged were: recognition of the ACRRM fellowship, the structure and content of the curriculum, using the curriculum, and delivery of the curriculum. The current curriculum seemed peripheral to the daily activity of general practice registrars and general practice supervisors. Other barriers to registrar learning in the NT were identified. DISCUSSION: The project outcomes were ways to achieve a better balance of service provision and educational opportunity for general practitioners in training, as well as strategies specific to delivery of the ACRRM curriculum.