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1. The impact of multimorbidity on severe COVID-19 outcomes in community and congregate settings

Author

Anna Pefoyo Kone, Lynn Martin, Deborah Scharf, Helen Gabriel, Tamara Dean, Idevania Costa, Refik Saskin, Luis Palma, and Walter P. Wodchis

Subjects
COVID-19, Mortality, Hospital, Multimorbidity, Risk factors, Chronic conditions, Public aspects of medicine, RA1-1270
Abstract

Purpose: This study examined the impact of multimorbidity on severe COVID-19 outcomes in community and long-term care (LTC) settings, alone and in interaction with age and sex. Methods: We conducted a retrospective cohort study of all Ontarians who tested positive for COVID-19 between January-2020 and May-2021 with follow-up until June 2021. We used cox regression to evaluate the adjusted impact of multimorbidity, individual characteristics, and interactions on time to hospitalization and death (any cause). Results: 24.5% of the cohort had 2 or more pre-existing conditions. Multimorbidity was associated with 28% to 170% shorter time to hospitalization and death, respectively. However, predictors of hospitalization and death differed for people living in community and LTC. In community, increasing multimorbidity and age predicted shortened time to hospitalization and death. In LTC, we found none of the predictors examined were associated with time to hospitalization, except for increasing age that predicted reduced time to death up to 40.6 times. Sex was a predictor across all settings and outcomes: among male the risk of hospitalization or death was higher shortly after infection (e.g. HR for males at 14 days = 30.3) while among female risk was higher for both outcome in the longer term (e.g. HR for males at 150 days = 0.16). Age and sex modified the impact of multimorbidity in the community. Conclusion: Community-focused public health measures should be targeted and consider sociodemographic and clinical characteristics such as multimorbidity. In LTC settings, further research is needed to identify factors that may contribute to improved outcomes.

Published
2023
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3. Understanding the Extent of Polypharmacy and its Association With Health Service Utilization Among Persons With Cancer and Multimorbidity: A Population-Based Retrospective Cohort Study in Ontario, Canada

Author

Tamara Dean, Anna Koné, Lynn Martin, Joshua Armstrong, and Caroline Sirois

Subjects
Pharmacology (medical)
Abstract

Background Cancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization. Objectives This study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer. Methods This retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy. Results The prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively. Conclusion Polypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity

Published
2022

4. Network+ Guide to Networks

Author

Jill West, Tamara Dean, Jean Andrews, Jill West, Tamara Dean, and Jean Andrews

Subjects
Telecommunications engineers--Certification--Study guides, Computer networks--Examinations--Study guides
Abstract

Master the technical skills and industry knowledge you need to begin an exciting career installing, configuring and troubleshooting computer networks with West/Dean/Andrews'NETWORK+ GUIDE TO NETWORKS, 8th edition. It thoroughly prepares you for success on CompTIA's Network+ N10-007 certification exam with fully mapped coverage of all objectives, including protocols, topologies, hardware, network design, security and troubleshooting. Virtualization-based projects give you experience working with a wide variety of hardware, software, operating systems and device interactions, while'On the Job'stories, Applying Concepts activities, and Hands-On and Capstone Projects let you explore concepts in more depth. MindTap Networking offers additional practice and certification prep. The text's emphasis on real-world problem solving provides the tools for success in any computing environment.

Published
2019

5. Network+ Guide to Networks

Author

Jill West, Tamara Dean, Jean Andrews, Jill West, Tamara Dean, and Jean Andrews

Subjects
Study guides, Computer networks--Examinations--Study guides, Telecommunications engineers--Certification--S, Computer networks--Examinations, Telecommunications engineers--Certification
Abstract

Master the technical skills and industry knowledge you need to begin an exciting career installing, configuring and troubleshooting computer networks with West/Dean/Andrews'NETWORK+ GUIDE TO NETWORKS, 8th edition. It thoroughly prepares you for success on CompTIA's Network+ N10-007 certification exam with fully mapped coverage of all objectives, including protocols, topologies, hardware, network design, security and troubleshooting. Virtualization-based projects give you experience working with a wide variety of hardware, software, operating systems and device interactions, while'On the Job'stories, Applying Concepts activities, and Hands-On and Capstone Projects let you explore concepts in more depth. MindTap Networking offers additional practice and certification prep. The text's emphasis on real-world problem solving provides the tools for success in any computing environment.

Published
2018

6. CompTIA Network+ 2009 In Depth

Author

Tamara Dean and Tamara Dean

Subjects
Electronic data processing personnel--Certification, Computer networks--Examinations--Study guides
Abstract

'CompTIA Network+ 2009 In Depth gives you all the skills necessary to pass the CompTIA 2009 Network+ exam and provides everything you need to know to install, configure, and troubleshoot a computer network. This book begins by introducing the fundamental building blocks that form a modern network, such as protocols, topologies, hardware, and network operating systems. It then provides in-depth coverage of the most important concepts in contemporary networking, such as TCP/IP, Ethernet, wireless transmission, and security. Because some technical topics can be difficult to grasp, this book explains concepts logically and in a clear, approachable style. In addition, concepts are reinforced by real-world examples of networking issues from a professional's standpoint. Each chapter opens with an'On the Job'story from a network engineer. These real-world examples help make this book a more practical learning tool. Additionally, the numerous tables and illustrations, along with the glossary, appendixes, and review questions, make the book a valuable reference for any networking professional. After reading this book and completing the end-of-chapter review questions, you will be prepared to select the best network design, hardware, and software for your environment. You will also have the skills to build a network from scratch and maintain, upgrade, and troubleshoot an existing network. Most importantly, you will be well prepared to pass CompTIA's Network+ 2009 certification exam!'--Resource description page.

Published
2009

7. The Human-Powered Home : Choosing Muscles Over Motors

Author

Tamara Dean and Tamara Dean

Subjects
Household appliances--Design and construction, Household appliances
Abstract

A complete guide to modern pedaled-powered, treadled, and hand-cranked devices for the home.What if I could harness this energy? An unusual question for anyone putting in a long stint on a treadmill perhaps, and yet human power is a very old, practical and empowering alternative to fossil fuels. Replacing motors with muscles can be considered a political act -- an act of self-sufficiency that gains you independence.The Human-Powered Home is a one-of-a-kind compendium of human-powered devices gathered from a unique collection of experts. Enthusiasts point to the advantages of human power:Portable and available on-demandClose connection to the process or product offers more controlImproved health and fitnessThe satisfaction of being able to make do with what is availableThis book discusses the science and history of human power and examines the common elements of human-powered devices. It offers plans for making specific devices, grouped by area of use, and features dozens of individuals who share technical details and photos of their inventions.For those who want to apply their own ingenuity, or for those who have never heard of human-powered machines, this book is a fine reference. For those who are beginning to understand the importance of a life of reduced dependency on fossil fuels, this book could be a catalyst for change.

Published
2008

8. The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial

Author

Meng Ni, Lorna G. Brown, Danielle Lawler, Terry D. Ellis, Tamara Deangelis, Nancy K. Latham, Jennifer Perloff, Steve J. Atlas, Sanja Percac-Lima, and Jonathan F. Bean

Subjects
Physical therapy, Mobility, Geriatrics, Healthcare model, RC952-954.6
Abstract

Abstract Background Mobility limitations among older adults increase the risk for disability and healthcare utilization. Rehabilitative care is identified as the most efficacious treatment for maintaining physical function. However, there is insufficient evidence identifying a healthcare model that targets prevention of mobility decline among older adults. The objective of this study is to evaluate the preliminary effectiveness of a physical therapy program, augmented with mobile tele-health technology, on mobility function and healthcare utilization among older adults. Methods This is a quasi-experimental 12-month clinical trial conducted within a metropolitan-based healthcare system in the northeastern United States. It is in parallel with an existing longitudinal cohort study evaluating mobility decline among community-dwelling older adult primary care patients over one year. Seventy-five older adults (≥ 65–95 years) are being recruited using identical inclusion/exclusion criteria to the cohort study. Three aims will be evaluated: the effect of our program on 1) physical function, 2) healthcare utilization, and 3) healthcare costs. Changes in patient-reported function over 1 year in those receiving the intervention (aim 1) will be compared to propensity score matched controls (N = 150) from the cohort study. For aims 2 and 3, propensity scores, derived from logistic regression model that includes demographic and diagnostic information available through claims and enrollment information, will be used to match treatment and control patients in a ratio of 1:2 or 1:3 from a Medicare Claims Registry derived from the same geographic region. The intervention consists of a one-year physical therapy program that is divided between a combination of outpatient and home visits (6–10 total visits) and is augmented on a computerized tablet using of a commercially available application to deliver a progressive home-based exercise program emphasizing lower-extremity function and a walking program. Discussion Incorporating mobile health into current healthcare models of rehabilitative care has the potential to decrease hospital visits and provide a longer duration of care. If the hypotheses are supported and demonstrate improved mobility and reduced healthcare utilization, this innovative care model would be applicable for optimizing the maintenance of functional independence among community-dwelling older adults. Trial registration ClinicalTrial.gov Identifier: NCT02580409 (Date of registration October 14, 2015).

Published
2017
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