ClinVar: improvements to accessing data Landrum, Melissa J; Chitipiralla, Shanmuga; Brown, Garth R ...
Nucleic acids research,
01/2020, Volume:
48, Issue:
D1
Journal Article
Peer reviewed
Open access
Abstract
ClinVar is a freely available, public archive of human genetic variants and interpretations of their relationships to diseases and other conditions, maintained at the National Institutes of ...Health (NIH). Submitted interpretations of variants are aggregated and made available on the ClinVar website (https://www.ncbi.nlm.nih.gov/clinvar/), and as downloadable files via FTP and through programmatic tools such as NCBI’s E-utilities. The default view on the ClinVar website, the Variation page, was recently redesigned. The new layout includes several new sections that make it easier to find submitted data as well as summary data such as all diseases and citations reported for the variant. The new design also better represents more complex data such as haplotypes and genotypes, as well as variants that are in ClinVar as part of a haplotype or genotype but have no interpretation for the single variant. ClinVar's variant-centric XML had its production release in April 2019. The ClinVar website and E-utilities both have been updated to support the VCV (variation in ClinVar) accession numbers found in the variant-centric XML file. ClinVar's search engine has been fine-tuned for improved retrieval of search results.
Although social media usage in business markets continues to grow, managers still struggle with designing popular brand message posts. This research investigates the key factors that contribute to ...Facebook brand content popularity metrics (i.e., number of likes and comments) for Fortune 500 companies' brand posts in business-to-business (B2B) versus business-to-consumer (B2C) markets. Building on psychological motivation theory, the authors examine key differences in B2B and B2C social media message strategies in terms of branding, message appeals, selling, and information search. Using Bayesian models, they find noteworthy differences in the propensity of viewers to popularize brand posts. Specifically, the results indicate that the inclusion of corporate brand names, functional and emotional appeals, and information search cues increases the popularity of B2B messages compared with B2C messages. Moreover, viewers of B2B content demonstrate a higher message liking rate but a lower message commenting rate than viewers of B2C content.
•The authors examine Facebook likes and comments as a measure of the popularity of B2B versus B2C content strategies.•Viewers of B2B content exhibit a higher liking rate than viewers of B2C content.•Both functional and emotional appeals increase the number of message likes in B2B messages more than in B2C messages.•Informational cues and links generate more likes and comments in B2B messages compared with in B2C messages.•Corporate brand names increase the number of message likes in B2B messages more than in B2C messages.
Business-to-business (B2B) marketers hesitate to embrace social media as a marketing tool, unlike their business-to-consumer (B2C) counterparts, and they struggle to implement successful social media ...strategies due to their limited understanding of the phenomenon. Drawing on communication and word-of-mouth theories, the authors investigate how marketers use Twitter differently across contexts and predict key factors likely to influence the message strategies used in each. A longitudinal content analysis and logistic regression support the assessment of a sample of more than 7000 tweets by Fortune 500 companies. Marketers in B2B and B2C settings exhibit significant differences in their branding and selling strategies; their use of message appeals; and the use of cues, links, and hashtags to support information searches. Whereas B2B marketers tend to use more emotional than functional appeals in their tweets, neither B2C nor B2B marketers have adopted “hard sell” message strategies.
•This paper analyzes Twitter communications for Fortune 500 companies.•B2B tweeting strategies are different than those for B2C.•B2B marketers use corporate brand names, functional appeals, and information search cues/links more frequently than B2C.•Emotional appeals are more frequent than functional appeals within B2B communications.
Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This ...information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5,135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received
>
1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100,000 patient-years of VHA treatment (95 % CI 9.6–36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.
Previous research has conceptualized and modeled customer orientation (CO) in one of two ways: as a psychological phenomenon antecedent to critical job states (i.e., stress and engagement) or as ...frontline employee behaviors that are caused by these same job states. Building on meta-analytic data, this study finds greater support for the causal relationships implied by a psychological construal of the construct and reveals that CO influences frontline employees'job outcomes through its effects on stress and engagement. Moderation analyses also indicate that CO's influence on model variables is stronger when frontline employees' customer workloads increase and is weaker as the need for customer persuasion increases. These findings contradict widely held assumptions rooted in a behavioral view of CO—namely, that CO is a consequence of job states, a proximate determinant of job outcomes, and most beneficial when ample opportunity for customer engagement exists. Overall, the results support a broadened perspective that recognizes that CO improves job outcomes because it enhances frontline employees' psychological welfare in addition to being good for business. These findings suggest that managers should consider CO an important criterion in frontline employee decisions, recognize CO as beneficial when limited opportunity for customer engagement exists, and avoid efforts to curtail CO's costs at the frontline employee level.
There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United ...States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.
Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population.
In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.
This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.
Coccidioidomycosis: epidemiology Brown, Jennifer; Benedict, Kaitlin; Park, Benjamin J ...
Clinical epidemiology,
2013, Volume:
5, Issue:
Issue 1
Journal Article
Peer reviewed
Open access
Coccidioidomycosis consists of a spectrum of disease, ranging from a mild, self-limited, febrile illness to severe, life-threatening infection. It is caused by the soil-dwelling fungi, Coccidioides ...immitis and C. posadasii, which are present in diverse endemic areas. Climate changes and environmental factors affect the Coccidioides lifecycle and influence infection rates. The incidence of coccidioidomycosis has risen substantially over the past two decades. The vast majority of Coccidioides infections occur in the endemic zones, such as California, Arizona, Mexico, and Central America. Infections occurring outside those zones appear to be increasingly common, and pose unique clinical and public health challenges. It has long been known that elderly persons, pregnant women, and members of certain ethnic groups are at risk for severe or disseminated coccidioidomycosis. In recent years, it has become evident that persons with immunodeficiency diseases, diabetics, transplant recipients, and prisoners are also particularly vulnerable.
Introduction Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial ...strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. Methods This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997–2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C. Results After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response–like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions. Conclusions Social determinants are prevalent factors in transgender patients’ lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals.
We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among ...veterans with a GID diagnosis.
We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk.
GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population.
The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.
Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized ...collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients' clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity.
Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients' clinician text notes were extracted and searched for transgender-related words and phrases.
Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22 072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate.
Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.
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