Browsing by Author "Enders, Felicity T."

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    Collaborative biostatistics and epidemiology in academic medical centres: A survey to assess relationships with health researchers and ethical implications
    (Wiley, 2022-06-14) Devick, Katrina L.; Gunn, Heather J.; Price, Lori Lyn; Meinzen-Derr, Jareen K.; Enders, Felicity T.; Perkins, Susan M.; Schulte, Phillip J.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    The role of collaborative biostatisticians and epidemiologists in academic medical centres and how their degree type, supervisor type and sex influences recognition and feelings of respect is poorly understood. We conducted a cross-sectional survey of self-identified biostatisticians and epidemiologists working in academic medical centres in the United States or Canada. The survey was sent to 341 contacts at 125 institutions who were asked to forward the survey invitation to faculty and staff at their institution and posted on Community sections of the American Statistical Association website. Participants were asked a variety of questions including if they felt pressured to produce specific results, whether they had intellectual and ethical freedom to pursue appropriate use of statistical methods in collaborative research and if they felt their contributions were appropriately recognized by collaborators. We received responses from 314 biostatisticians or related methodologists. A majority were female (59%), had a doctorate degree (52%) and reported to a statistician or biostatistician supervisor (69%). Overall, most participants felt valued by their collaborators, but that they did not have sufficient calendar time to meet deadlines. Doctoral-level participants reported more autonomy in their collaborations than master's level participants. Females were less likely to feel recognized and respected compared with males. The survey results suggest that while most respondents felt valued by their collaborators, they have too many projects and need more time to critically review research. Further research is needed to understand why response differs by sex and how these responses fluctuate over time.
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    Health equity engineering: Optimizing hope for a new generation of healthcare
    (Cambridge University Press, 2024-05-23) Enders, Felicity T.; Golembiewski, Elizabeth H.; Balls-Berry, Joyce E.; Brooks, Tayla R.; Carr, Allison R.; Cullen, John P.; DiazGranados, Deborah; Gaba, Ayorkor; Johnson, Leigh; Menser, Terri; Messinger, Shari; Milam, Adam J.; Orellana, Minerva A.; Perkins, Susan M.; Chisholm Pineda, Tiffany D.; Thurston, Sally W.; Periyakoil, Vyjeyanthi S.; Hanlon, Alexandra L.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.
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    Quantitative prediction of stone fragility from routine single and dual energy CT: proof of feasibility
    (Elsevier, 2016-12) Ferrero, Andrea; Montoya, Juan C.; Vaughan, Lisa E.; Huang, Alice E.; McKeag, Ian O.; Enders, Felicity T.; Williams, James C.; McCollough, Cynthia H.; Anatomy and Cell Biology, School of Medicine
    Rationale and Objectives Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphological features from dual-energy CT images and assess their relationship to stone fragility. Materials and Methods Thirty-three calcified urinary stones were scanned with micro CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low-and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. Results The average stone volume was 300 mm3 (range 134–674 mm3). The average comminution time measured ex vivo was 32 s (range 7–115 s). Stone volume, dual-energy CT number ratio and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2= 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. Conclusion Dual-energy CT number ratios, volume, and morphological metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy.
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    Training the next generation of learning health system scientists
    (Wiley, 2022-09-10) Lozano, Paula M.; Lane-Fall, Meghan; Franklin, Patricia D.; Rothman, Russell L.; Gonzales, Ralph; Ong, Michael K.; Gould, Michael K.; Beebe, Timothy J.; Roumie, Christianne L.; Guise, Jeanne-Marie; Enders, Felicity T.; Forrest, Christopher B.; Mendonca, Eneida A.; Starrels, Joanna L.; Sarkar, Urmimala; Savitz, Lucy A.; Moon, JeanHee; Linzer, Mark; Ralston, James D.; Chelsey, Francis D., Jr.; Pediatrics, School of Medicine
    Introduction: The learning health system (LHS) aligns science, informatics, incentives, stakeholders, and culture for continuous improvement and innovation. The Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute designed a K12 initiative to grow the number of LHS scientists. We describe approaches developed by 11 funded centers of excellence (COEs) to promote partnerships between scholars and health system leaders and to provide mentored research training. Methods: Since 2018, the COEs have enlisted faculty, secured institutional resources, partnered with health systems, developed and implemented curricula, recruited scholars, and provided mentored training. Program directors for each COE provided descriptive data on program context, scholar characteristics, stakeholder engagement, scholar experiences with health system partnerships, roles following program completion, and key training challenges. Results: To date, the 11 COEs have partnered with health systems to train 110 scholars. Nine (82%) programs partner with a Veterans Affairs health system and 9 (82%) partner with safety net providers. Clinically trained scholars (n = 87; 79%) include 70 physicians and 17 scholars in other clinical disciplines. Non-clinicians (n = 29; 26%) represent diverse fields, dominated by population health sciences. Stakeholder engagement helps scholars understand health system and patient/family needs and priorities, enabling opportunities to conduct embedded research, improve outcomes, and grow skills in translating research methods and findings into practice. Challenges include supporting scholars through roadblocks that threaten to derail projects during their limited program time, ranging from delays in access to data to COVID-19-related impediments and shifts in organizational priorities. Conclusions: Four years into this novel training program, there is evidence of scholars' accomplishments, both in traditional academic terms and in terms of moving along career trajectories that hold the potential to lead and accelerate transformational health system change. Future LHS training efforts should focus on sustainability, including organizational support for scholar activities.