Presented by Farrokh Alemi, Ph.D. Sequence of Disabilities Network Analysis Research conducted by Cari Levy M.D., Manaf Zargoush Ph.D., Raya E. Kheirbek.

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Presentation transcript:

Presented by Farrokh Alemi, Ph.D. Sequence of Disabilities Network Analysis Research conducted by Cari Levy M.D., Manaf Zargoush Ph.D., Raya E. Kheirbek M.D., Allison E. Williams Ph.D., Arthur R. Williams Ph.D., Janusz Wojtusiak Ph.D., Bryce Sutton Ph.D., Etienne Pracht Ph.D., Bruce Citron Ph.D., Lisa Argyros and Phan Giang Ph.D.

I Know, You Know We All Know We Agree

Causal Network Models: Association, Sequence, Counterfactual, Mechanism

Causal Network Models: Association, Sequence, Counterfactual, Mechanism

Sequence of disabilities has been the focus of cultural and scientific inquiries

“His acts being seven ages … The sixth age shifts into the lean and slippered pantaloon, with spectacles on nose and pouch on side; his youthful hose, well saved, a world too wide for his shrunk shank; and his big manly voice, turning again toward childish treble, pipes and whistles in his sound. Last scene of all, that ends this strange eventful history, is second childishness and mere oblivion, sans teeth, sans eyes, sans taste, sans everything.” Shakespeare: As You Like It: Act 2, Scene 7, Page

Katz, Ford, Moskowitz, Jackson, & Jaffe 1963 Bathing Walking Dressing Transfer Toileting Feeding 50

Dunlop, Hughes, & Manheim 1997 Bathing Walking Dressing Transfer Toileting Feeding

Spector & Fleishman 1998 Bathing Walking Dressing Transfer Toileting Feeding

Ferrucci, Guralnik, Cecchi et al 1998 Bathing Walking Dressing Transfer Toileting Feeding We excluded from this list cutting toenails, shopping, use of steps, heavy housework, cooking hot meal, moving around outside, washing arms/face and light housework which were not studied across studies. Bathing includes showering or full wash and not simply face wash.

Jagger, Arthur, Spiers, Clarke 2001 Bathing Walking Dressing Transfer Toileting Feeding Transferring refers to transfer from bed and not simply transfer from chair or toilet

Kingston, Collerton, Davies et al Bathing Walking Dressing Transfer Toileting Feeding Transferring refers to transfer from bed and not simply transfer from chair or toilet. Toileting includes transfer from toilet.

Gill & Kurland 2003

A Multiple Path Network Model Is Needed

Admissions 79.88% White, 96.34% Men, years (SD=11.44) Old at 1st Assessment

25 Combinations 84% of All Cases All DataToo Much

B=Bathe, W=Walk, G=Groom, D=Dress, T=Toilet

B=Bathe, W=Walk, G=Groom, D=Dress, T=Toilet, L=Bowel Continence, S=Transfer, U=Urinary Continence and F=Feeding disabilities

Trimmed Mean Days to Partial Recovery of One Disability Insurance

Still Too Confusing Statistical Summary

Learn New Network Model Relationship of 9 Disabilities

Nodes Are Connected Based on Associations

Direction is Set Based on Independence Structure

Cross Section Analysis Longitudinal Analysis Algorithms for Learning Network Models Algorithms for Dynamic Modeling: Confusing

Network Model

Cross Section Analysis Longitudinal Analysis Learn Network Model Subject to Longitudinal Constraints Do as Humans Do

Probabilistic Contrast Do as Humans Do

Numbers show the correlation between two disabilities. Dashed red arrows show the maximum likelihood path.

Same Many Pathways from Start to End

Analytical Progress Use Longitudinal Constraints

Clinical Relevance Experience of Majority

Policy Implications Don’t Give Up at 100 Days