Brett Trusko

De Minimis Risk: A Proposal for a New Category of Research Risk

De Minimis Risk: A Proposal for a New Category of Research Risk Rosamond Rhodes a , Jody Azzouni b , Stefan Bernard Baumrin c , Keith Benkov a , Martin J. Blaser d , Barbara Brenner a , Joseph W. Dauben c , William J. Earle c , Lily Frank c , Nada Gligorov a , Joseph Goldfarb a , Kurt Hirschhorn a , Rochelle Hirschhorn d , Ian Holzman a , Debbie Indyk a , Ethylin Wang Jabs a , Douglas P. Lackey c , Daniel A. Moros a , Sean Philpott e , Matthew E. Rhodes f , Lynne D. Richardson a , Henry S. Sacks a , Abraham Schwab g , Rhoda Sperling a , Brett Trusko a & Arnulf Zweig h a Mount Sinai School of Medicine b Tufts University c The Graduate Center, CUNY d New York University Medical School, CUNY e Union Graduate College f Pennsylvania State University g Indiana University, Purdue h University of Oregon (Emeritus)

BioProspecting: novel marker discovery obtained by mining the bibleome.

BioProspecting is a novel approach that enabled our team to mine data related to genetic markers from the New England Journal of Medicine (NEJM) utilizing SNOMED CT and the Human Gene Onotology (HUGO). The Biomedical Informatics Research Collaborative was able to link genes and disorders using the Multi-threaded Clinical Vocabulary Server (MCVS) and natural language processing engine, whose output creates an ontology-network using the semantic encodings of the literature that is organized by these two terminologies. We identified relationships between (genes or proteins) and (diseases or drugs) as linked by metabolic functions and identified potentially novel functional relationships between, for example, genes and diseases (e.g. Article #1 ([Gene - IL27] = > {Enzyme - Dipeptidyl Carboxypeptidase 1}) and Article #2 ({Enzyme - Dipeptidyl Carboxypeptidase 1} < = [Disorder - Type II DM]) showing a metabolic link between IL27 and Type II DM). In this manuscript we describe our method for developing the database and its content as well as its potential to assist in the discovery of novel markers and drugs.

Automated quality measurement in Department of the Veterans Affairs discharge instructions for patients with congestive heart failure.

&NA; Quality measurement is an important issue for the United States Department of Veterans Affairs (VA). In this study, we piloted the use of an informatics tool, the Multithreaded Clinical Vocabulary Server (MCVS), which extracted automatically whether the VA Office of Quality and Performance measures of quality of care were met for the completion of discharge instructions for inpatients with congestive heart failure. We used a single document, the discharge instructions, from one section of the medical records for 152 patients and developed a reference standard using two independent reviewers to assess performance. When evaluated against the reference standard, MCVS achieved a sensitivity of 0.87, a specificity of 0.86, and a positive predictive value of 0.90. The automated process using the discharge instruction document worked effectively. The use of the MCVS tool for concept‐based indexing resulted in mostly accurate data capture regarding quality measurement, but improvements are needed to further increase the accuracy of data extraction.

Are posttraumatic stress disorder mental health terms found in SNOMED‐CT medical terminology

The authors sought to evaluate how well the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) controlled vocabulary represents terms commonly used clinically when documenting posttraumatic stress disorder (PTSD). A list was constructed based on the PTSD criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), symptom assessment instruments, and publications. Although two teams mapping the terms to SNOMED-CT differed in their approach, the consensus mapping accounted for 91% of the 153 PTSD terms. They found that the words used by clinicians in describing PTSD symptoms are represented in SNOMED-CT. These results can be used to codify mental health text reports for health information technology applications such as automated chart abstraction, algorithms for identifying documentation of symptoms representing PTSD in clinical notes, and clinical decision support.

Standardization and simplification of vaccination records

The majority of vaccines are administered during childhood. Vaccination records are important documents to be kept for a lifetime, but the documentation of immunization events is poorly standardized. At the point of care, paper records are often unavailable, making it impossible to obtain accurate vaccination histories. Vaccination records should include batch specifications to allow the tracking of licensed vaccines in cases of recall. The WHO have generated the International Certificate of Vaccination or Prophylaxis for the documentation of childhood and travel vaccinations as well as seasonal and booster immunizations. When moving vaccination records into the digital age, data standards and interoperability need to be considered. The ideal vaccination record should facilitate the interpretation of safety reports and promote a data continuum from pre-licensure trials to post-marketing surveillance. The current article describes which data elements are essential, and how vaccination documentation could be streamlined and simplified.

The Health Archetype Language (HAL-42): Interface considerations

In this manuscript we report an evaluation of the reliability of clinical research rules creation by multiple clinicians using the Health Archetype Language (HAL-42) and user interface. HAL-42 is a language which allows real time epidemiological inquiry using automatically derived clinical encodings with any health Ontology. This evaluation used SNOMED CT as the underlying Ontology. The inquiries were performed on a population of 17,731 patients whose 50,000 clinical records have all been fully encoded in SNOMED CT. Four subject matter experts (SMEs) were asked independently to encode and run 10 rules/studies. The inter-rater agreement was 74.8% (p=0.6526) with a Kappa statistic of 0.49217 (p=0.5722). The ten rules were divided into three easy rules, four moderate and three complex rules. There was no significant difference in the SMEs agreement when representing easy and complex rules (p=0.6243). We conclude that although the usability of the HAL-42 language is usable enough to achieve reasonable inter-rater reliability, some training will be necessary to reach high levels of reliability for ad hoc queries. We also conclude that SMEs are just as competent to perform complex queries as easy queries of ontologically indexed clinical data.

The Innovation Iteration Grid

A common misconception about innovation is that the innovation process lacks pragmatism. Innovation professionals use soft concepts applied in fuzzy ways with too much emphasis on unproven approaches to solving problems. Perhaps because of the unconventional approaches taken by practitioners of innovation, business executives have generally segregated innovators from main stream operations, recognizing the importance of innovation, but not comfortable with the approach that innovation professionals often employ in getting to their ends. This paper discusses an approach to innovation that has the ability to firmly tie the strategy, mission or vision of the organization to the innovation process. An approach that allows you to take the “Universal Intentions” (mission, vision, goals objectives or strategies) to an iterative process that allows innovation iteration to optimization of a process.

Another new year in a strange new world

Another new year in a strange new world Another new year in a strange new world. Although the title for this editorial may sound odd, even grammatically incorrect, it personifies the way many of us throughout the world are feeling as profound change appears to be occurring everywhere. We have new leaders who utilize the technology we thought would save the world to seemingly destabilize it. We have changes in the way we live looming over the horizon as I contemplate not having to worry about ever losing my driver’s license due to old age and infirmity as self-driving cars become a reality. The climate is changing, and the world, while becoming smaller through communication and travel advances, is simultaneously becoming bigger as the same technologies seem to be driving us apart. What does all this actually mean? Well, for most of us (I am a young 50-something), it means that things are happening that we have never seen before. We are seeing demonstrations driven by social media throughout the world. If you turn on the news, it appears that the world is truly ending – it is stressful, distressing, and in some cases, downright scary. But the reality is that while most of us are too young to remember, the world has always been in a state of disruption, and when we are in the midst of it, I am sure it always seems like the end of the world. This is a fundamental of innovation. Before you condemn me and give up reading the Journal forever, hear me out. I still have a land line. Why I have a landline, I have no idea. Perhaps it is just comfortable to know I can just pick up any phone in the house and talk all I want. The only thing about this landline is that the only calls I ever receive are from marketing or polling companies, and usually during dinner or while I am in the shower. Yes, there is some comfort to be had in the landline, but it is from a bygone era so my mind tells me I need to give it up, but my heart has a hard time letting go. About six months ago, I purchased a fully-automated, Wi-Fi-enabled sprinkler controller for my home. It connects to the local weather station and only waters my yard when it needs it. My best guess is that I have already in six months saved over 50,000 gallons of water because this device only waters when it is needed and doesn’t even turn on if it is expected to rain, or it has been unusually wet. It took some time to resist the urge to force it to water every other day (my previous setting), but the company that builds the product insists that they have a team of experts with advanced college degrees that developed algorithms to water the right amount at the right time of day for the optimal times per week (my sprinkler didn’t turn on for two months this winter). After the initial four or five months of wanting to override the system regularly, I realized the lawn was healthier than ever. The problem now is that my gardener needs my looking over his shoulder, as there are no more manual on–off valves. I have to take out my phone and turn things on and off as he adjusts the sprinkler heads. Mind you, the application will allow me to invite my gardener as a guest to the system, but with all due respect to my gardener, I don’t believe this will ever happen. More resistance to change. The world of today is changing very quickly and many citizens are terrified of the changes that are coming. However, much like Elisabeth Kübler-Ross’s 1969 book On Death and Dying, we can apply the stages of death to the land line and sprinkler controller and countless other material, social and economic models under which we have grown comfortable. My father talked me out of applying for cell tower rights back in the 80s by convincing me that no one would ever want to carry around a phone IJIS 9,2

Biosphere of the Sea: An Interview With Jamie Sweeting

INTRODUCTION With such a large number of guests, Celebrity can reasonably be compared to many large hotel chains. Unlike hotel chains, however, a cruise ship must be self-sustaining while at sea. Additionally, just as in the airline business, weight leads to energy consumption and energy consumption leads to costs. In addition, since the tourism industry relies on pristine ports, the company must be a steward of the environment, as well as work with local official in their efforts to minimize harm to the environment so that their business continues to thrive.