Impact of Terminology Mapping on Population Health Cohorts IMPaCt

Background and Objectives: The population health care delivery model uses phenotype algorithms in the electronic health record (EHR) system to identify patient cohorts targeted for clinical interventions such as laboratory tests, and procedures. The standard terminology used to identify disease cohorts may contribute to significant variation in error rates for patient inclusion or exclusion. The United States requires EHR systems to support two diagnosis terminologies, the International Classification of Disease (ICD) and the Systematized Nomenclature of Medicine (SNOMED). Terminology mapping enables the retrieval of diagnosis data using either terminology. There are no standards of practice by which to evaluate and report the operational characteristics of ICD and SNOMED value sets used to select patient groups for population health interventions. Establishing a best practice for terminology selection is a step forward in ensuring that the right patients receive the right intervention at the right time. The research question is, “How does the diagnosis retrieval terminology (ICD vs SNOMED) and terminology map maintenance impact population health cohorts?” Aim 1 and 2 explore this question, and Aim 3 informs practice and policy for population health programs. Methods Aim 1: Quantify impact of terminology choice (ICD vs SNOMED) ICD and SNOMED phenotype algorithms for diabetes, chronic kidney disease (CKD), and heart failure were developed using matched sets of codes from the Value Set Authority Center. The performance of the diagnosis-only phenotypes was compared to published reference standard that included diagnosis codes, laboratory results, procedures, and medications. Aim 2: Measure terminology maintenance impact on SNOMED cohorts For each disease state, the performance of a single SNOMED algorithm before and after terminology updates was evaluated in comparison to a reference standard to identify and quantify cohort changes introduced by terminology maintenance. Aim 3: Recommend methods for improving population health interventions The socio-technical model for studying health information technology was used to inform best practice for the use of population health interventions. Results Aim 1: ICD-10 value sets had better sensitivity than SNOMED for diabetes (.829, .662) and CKD (.242, .225) (N=201,713, p Aim 2: Following terminology maintenance the SNOMED algorithm for diabetes increased in sensitivity from (.662 to .683 (p Aim 3: Based on observed social and technical challenges to population health programs, including and in addition to the development and measurement of phenotypes, a practical method was proposed for population health intervention development and reporting

Advisory Committee on Immunization Practices (ACIP) summary report : October 22-23, 2008, Atlanta, Georgia

min-oct08-508.pdf2008607

Determining if Development Capacity Leads to the Attainment of Redevelopment Goals for Six Communities Affected by Base Realignment and Closure (1988, 1991, and 1993)

The McGuire et al. model (1994) showed that development of a strategic plan led to higher development capacity, but did not address the relationship between development capacity and redevelopment success. This study examined the link between development capacity and redevelopment success. This study examined six base realignment and closure communities. Following the Yin Multiple Case Study Method, each community was evaluated on its own merits before being compared with other communities. In this study the McGuire et al. model was expanded to fourteen variables in three categories; citizen participation, community structure, and development instruments. Redevelopment success was measured by attainment of the communities\u27 redevelopment goals and indices used by other development agencies. The results show that higher development capacity leads to higher redevelopment success when measured by indices used by other agencies and attainment of community redevelopment goals. The most significant category is development instruments. The most significant variables are lead agency, an appropriate development focus, and investing in institutional infrastructure

Texas Register

A weekly publication, the Texas Register serves as the journal of state agency rulemaking for Texas. Information published in the Texas Register includes proposed, adopted, withdrawn and emergency rule actions, notices of state agency review of agency rules, governor's appointments, attorney general opinions, and miscellaneous documents such as requests for proposals. After adoption, these rulemaking actions are codified into the Texas Administrative Code

Revelation of Yin-Yang Balance in Microbial Cell Factories by Data Mining, Flux Modeling, and Metabolic Engineering

The long-held assumption of never-ending rapid growth in biotechnology and especially in synthetic biology has been recently questioned, due to lack of substantial return of investment. One of the main reasons for failures in synthetic biology and metabolic engineering is the metabolic burdens that result in resource losses. Metabolic burden is defined as the portion of a host cells resources either energy molecules (e.g., NADH, NADPH and ATP) or carbon building blocks (e.g., amino acids) that is used to maintain the engineered components (e.g., pathways). As a result, the effectiveness of synthetic biology tools heavily dependents on cell capability to carry on the metabolic burden. Although genetic modifications can effectively engineer cells and redirect carbon fluxes toward diverse products, insufficient cell ATP powerhouse is limited to support diverse microbial activities including product synthesis. Here, I employ an ancient Chinese philosophy (Yin-Yang) to describe two contrary forces that are interconnected and interdependent, where Yin represents energy metabolism in the form of ATP, and Yang represents carbon metabolism. To decipher Yin-Yang balance and its implication to microbial cell factories, this dissertation applied metabolic engineering, flux analysis, data mining tools to reveal cell physiological responses under different genetic and environmental conditions. Firstly, a combined approach of FBA and 13C-MFA was employed to investigate several engineered isobutanol-producing strains and examine their carbon and energy metabolism. The result indicated isobutanol overproduction strongly competed for biomass building blocks and thus the addition of nutrients (yeast extract) to support cell growth is essential for high yield of isobutanol. Based on the analysis of isobutanol production, \u27Yin-Yang\u27 theory has been proposed to illustrate the importance of carbon and energy balance in engineered strains. The effects of metabolic burden and respiration efficiency (P/O ratio) on biofuel product were determined by FBA simulation. The discovery of energy cliff explained failures in bioprocess scale-ups. The simulation also predicted that fatty acid production is more sensitive to P/O ratio change than alcohol production. Based on that prediction, fatty acid producing strains have been engineered with the insertion of Vitreoscilla hemoglobin (VHb), to overcome the intracellular energy limitation by improving its oxygen uptake and respiration efficiency. The result confirmed our hypothesis and different level of trade-off between the burden and the benefit from various introduced genetic components. On the other side, a series of computational tools have been developed to accelerate the application of fluxomics research. Microbesflux has been rebuilt, upgraded, and moved to a commercial server. A platform for fluxomics study as well as an open source 13C-MFA tool (WUFlux) has been developed. Further, a computational platform that integrates machine learning, logic programming, and constrained programming together has been developed. This platform gives fast predictions of microbial central metabolism with decent accuracy. Lastly, a framework has been built to integrate Big Data technology and text mining to interpret concepts and technology trends based on the literature survey. Case studies have been performed, and informative results have been obtained through this Big Data framework within five minutes. In summary, 13C-MFA and flux balance analysis are only tools to quantify cell energy and carbon metabolism (i.e., Yin-Yang Balance), leading to the rational design of robust high-producing microbial cell factories. Developing advanced computational tools will facilitate the application of fluxomics research and literature analysis

Junos Pulse Secure Access Service Administration Guide

This guide describes basic configuration procedures for Juniper Networks Secure Access Secure Access Service. This document was formerly titled Secure Access Administration Guide. This document is now part of the Junos Pulse documentation set. This guide is designed for network administrators who are configuring and maintaining a Juniper Networks Secure Access Service device. To use this guide, you need a broad understanding of networks in general and the Internet in particular, networking principles, and network configuration. Any detailed discussion of these concepts is beyond the scope of this guide.The Juniper Networks Secure Access Service enable you to give employees, partners, and customers secure and controlled access to your corporate data and applications including file servers, Web servers, native messaging and e-mail clients, hosted servers, and more from outside your trusted network using just a Web browser. Secure Access Service provide robust security by intermediating the data that flows between external users and your company’s internal resources. Users gain authenticated access to authorized resources through an extranet session hosted by the appliance. During intermediation, Secure Access Service receives secure requests from the external, authenticated users and then makes requests to the internal resources on behalf of those users. By intermediating content in this way, Secure Access Service eliminates the need to deploy extranet toolkits in a traditional DMZ or provision a remote access VPN for employees. To access the intuitive Secure Access Service home page, your employees, partners, and customers need only a Web browser that supports SSL and an Internet connection. This page provides the window from which your users can securely browse Web or file servers, use HTML-enabled enterprise applications, start the client/server application proxy, begin a Windows, Citrix, or Telnet/SSH terminal session, access corporate e-mail servers, start a secured layer 3 tunnel, or schedule or attend a secure online meeting

Laboratory directed research development annual report. Fiscal year 1996

This document comprises Pacific Northwest National Laboratory`s report for Fiscal Year 1996 on research and development programs. The document contains 161 project summaries in 16 areas of research and development. The 16 areas of research and development reported on are: atmospheric sciences, biotechnology, chemical instrumentation and analysis, computer and information science, ecological science, electronics and sensors, health protection and dosimetry, hydrological and geologic sciences, marine sciences, materials science and engineering, molecular science, process science and engineering, risk and safety analysis, socio-technical systems analysis, statistics and applied mathematics, and thermal and energy systems. In addition, this report provides an overview of the research and development program, program management, program funding, and Fiscal Year 1997 projects