Diabetes case finding based on structured medical records does not fully identify diabetic patients whose medical histories related to diabetes are available in the form of free text. Manual chart ...reviews have been used but involve high labor costs and long latency.
This study developed and tested a Web-based diabetes case finding algorithm using both structured and unstructured electronic medical records (EMRs).
This study was based on the health information exchange (HIE) EMR database that covers almost all health facilities in the state of Maine, United States. Using narrative clinical notes, a Web-based natural language processing (NLP) case finding algorithm was retrospectively (July 1, 2012, to June 30, 2013) developed with a random subset of HIE-associated facilities, which was then blind tested with the remaining facilities. The NLP-based algorithm was subsequently integrated into the HIE database and validated prospectively (July 1, 2013, to June 30, 2014).
Of the 935,891 patients in the prospective cohort, 64,168 diabetes cases were identified using diagnosis codes alone. Our NLP-based case finding algorithm prospectively found an additional 5756 uncodified cases (5756/64,168, 8.97% increase) with a positive predictive value of .90. Of the 21,720 diabetic patients identified by both methods, 6616 patients (6616/21,720, 30.46%) were identified by the NLP-based algorithm before a diabetes diagnosis was noted in the structured EMR (mean time difference = 48 days).
The online NLP algorithm was effective in identifying uncodified diabetes cases in real time, leading to a significant improvement in diabetes case finding. The successful integration of the NLP-based case finding algorithm into the Maine HIE database indicates a strong potential for application of this novel method to achieve a more complete ascertainment of diagnoses of diabetes mellitus.
Estimating patient risk of future emergency department (ED) revisits can guide the allocation of resources, e.g. local primary care and/or specialty, to better manage ED high utilization patient ...populations and thereby improve patient life qualities.
We set to develop and validate a method to estimate patient ED revisit risk in the subsequent 6 months from an ED discharge date. An ensemble decision-tree-based model with Electronic Medical Record (EMR) encounter data from HealthInfoNet (HIN), Maine's Health Information Exchange (HIE), was developed and validated, assessing patient risk for a subsequent 6 month return ED visit based on the ED encounter-associated demographic and EMR clinical history data. A retrospective cohort of 293,461 ED encounters that occurred between January 1, 2012 and December 31, 2012, was assembled with the associated patients' 1-year clinical histories before the ED discharge date, for model training and calibration purposes. To validate, a prospective cohort of 193,886 ED encounters that occurred between January 1, 2013 and June 30, 2013 was constructed.
Statistical learning that was utilized to construct the prediction model identified 152 variables that included the following data domains: demographics groups (12), different encounter history (104), care facilities (12), primary and secondary diagnoses (10), primary and secondary procedures (2), chronic disease condition (1), laboratory test results (2), and outpatient prescription medications (9). The c-statistics for the retrospective and prospective cohorts were 0.742 and 0.730 respectively. Total medical expense and ED utilization by risk score 6 months after the discharge were analyzed. Cluster analysis identified discrete subpopulations of high-risk patients with distinctive resource utilization patterns, suggesting the need for diversified care management strategies.
Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. It promises to provide increased opportunity for high ED utilization identification, and optimized resource and population management.
Aquaculture of the giant keyhole limpet,
Megathura crenulata, may provide a reliable long-term supply of keyhole limpet hemocyanin (KLH) for many promising biomedical applications. However, previous ...studies have reported a complete loss of the KLH1 isoform under certain cultivation conditions. We examined whether captivity per se and diet caused a significant change in the isoform profile of
M.
crenulata. Although there was a trend toward a decreasing percentage of KLH1 in some animals, in general isoform profiles were not significantly affected by captivity or dietary limitations. Further, the percentage of KLH1 significantly increased for limpets with previously low levels of KLH1 when fed a supplemental mixed diet. Our results indicate that normal isoform profiles can be maintained in limpets held in captivity even when fed insufficient diets, and that these conditions do not cause a complete loss of either KLH isoform. Notably, the enhancement of abnormally low levels of KLH1 suggests that variability in isoform profiles could potentially be minimized through diet. While there is a need for further research on the factors responsible for the variability of KLH, overall, these results support the premise that culture of
M. crenulata may provide a sustainable source of this biomedically important product.
Fisheries management, including the development of fishery management plans (FMPs), requires the best available scientific information. To address this need, we piloted a collaborative at‐sea ...sampling program (CASP) among California commercial lobster fishermen, scientists, and fishery managers to develop scientifically rigorous protocols and collect, analyze, and interpret essential fisheries information (EFI). Significant differences in catch characteristics among three regions (South, North Coast, and Northwest Islands) were documented. Legal CPUE was generally similar among regions, whereas sublegal CPUE was consistently highest in the South, followed by the North Coast and Northwest Islands. Evaluation of size structure revealed that legal lobsters were significantly smaller, just larger than legal size, in the South than in the other two regions, suggesting a higher exploitation rate there. Despite this, the South had significantly more prerecruits than the northern regions, a fact not considered in present fishery models. We also found a female bias in the legal sex ratios in the north regions and in the sublegal sex ratios in all regions that could affect model parameters for trap vulnerability and reproductive capacity. A discrepancy in the average weight of legal lobster for the Northwest Islands was identified which has implications for the spawning potential ratio, a reference point that elicits management action. The regional variations in catch characteristics suggest that the California lobster fishery would benefit from using more sophisticated models that incorporate area‐based EFI to better inform the harvest control rules. This finding supports the recommendations of the lobster FMP scientific review panel and the interests of resource managers, with the CASP data illustrating the value of the additional EFI and a mechanism for obtaining it. The demonstrated utility of the CASP for both cross‐checking and providing additional data supports its ongoing use to inform management of the lobster fishery and as a model for other fisheries.
Foraminiferal communities in the Cenozoic shelf deposits of the North American Atlantic Coastal Plain exhibit little unity during almost 55 million years of successive transgressions and regressions. ...Transgression communities are composed of a dynamic mixture of immigrants and newly evolved species. During regressions, species within these communities either became extinct or emigrated. Some emigrants returned during subsequent transgressions, but many did not. The neritic species of the Atlantic and Gulf continental margins constitute a species pool. Immigrants and emigrants transferred into and out of the species pool, while extinctions and originations repeatedly altered its species composition. While the results indicate a lack of local community unity, at the same time they demonstrate the necessity of a species pool to sustain species diversity.
This paper describes a set of design parameters for manipulating the branch length, branch direction, and overall size of gold nanostars (AuNS) synthesized by a seedless process. We controlled the ...structure of AuNS by varying four different synthetic factors: mechanical agitation, type of Good’s buffer, concentration ratio of precursors, and pH of growth solution. We found that stirring the precursors increased the yield of branched particles. Additionally, the AuNS morphology could be controlled by changing the buffer type and concentration ratio of precursors, which tuned the localized plasmon resonances from the visible to the near-infrared. We determined that performing the synthesis at a pH less than the pK a of the buffer was critical for the stability of the AuNS; when the pH was greater than the pK a, the nanoparticles aggregated in solution. We expanded the library of Good’s buffers able to form AuNS and optimized the mechanical and chemical synthesis conditions, which improved the structural homogeneity and overall colloidal stability of the particles.
We described the distributions of foraminifera from ten physiographically distinct salt marshes in the Albemarle–Pamlico estuarine system, North Carolina using 193 surface samples. We defined ...elevation-dependent ecological zones at individual sites using cluster analysis and detrended correspondence analysis. Additionally, seven principal biozones of salt-marsh foraminifera were identified that have distinctive spatial distributions reflecting a pattern of salinity regimes caused by the current configuration of barrier-island inlets. High salinity sites along the southern Outer Banks are associated with sub-tidal calcareous assemblages, low marshes dominated by
Miliammina fusca and high marsh environments defined by
Haplophragmoides wilberti,
Trochammina inflata and
Arenoparrella mexicana. In contrast, lower salinity marshes have
Ammobaculites spp. in sub-tidal settings,
Miliammina fusca-dominated low marshes and high marsh settings characterized by
Jadammina macrescens. Spatial variation of foraminiferal populations and the potential for biozones to migrate in response to changing inlet configuration and salinity, suggests that datasets of modern salt-marsh foraminifera from multiple environments would be appropriate for reconstructing Holocene relative sea level in North Carolina.
After several years of treatment with levodopa and other drugs,
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motor fluctuations ranging from bradykinesia to hyperkinesia develop in many patients with Parkinson's disease. No drug therapy has ...eliminated these fluctuations. However, the implantation of embryonic dopamine neurons into the brain may improve motor control. We and others have reported that transplanted dopamine neurons survive and that patients may have progressive clinical improvement over a period of three to four years.
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All these studies were unblinded, and the number of patients in each was small. Even with standardized scoring with the use of the Unified Parkinson's Disease Rating Scale . . .
We examined service representation patterns of four racial/ethnic groups (African Americans, Asian/ Pacific Islander Americans, Caucasian Americans, and Latinos) across five public youth service ...sectors (alcohol/drug treatment, child welfare, juvenile justice, mental health, and public school services for children with serious emotional disturbance) in San Diego County. A full enumeration of children ages 0 to 18 served by those sectors during a 6-month period was analyzed to determine representation of each racial/ethnic group. Comparison groups of San Diego children were culled from three sources: 1996 census estimates, 1996 census estimates at or below 200% of poverty level, and the 1997 San Diego County school enrollment census. Results varied by racial/ethnic group and comparison group used, indicating that race/ethnicity affects service use patterns and that socioeconomic status should be taken into consideration when examining racial/ethnic representation. When socioeconomic status was taken into account, African Americans and Caucasian Americans were overrepresented across most sectors, Latinos were underrepresented across all sectors, and Asian/ Pacific Islander Americans demonstrated a mixed pattern. Results are discussed in terms of methodological and policy implications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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