AUTOMATED IDENTIFICATION OF TYPE 2 DIABETES MELLITUS: CODE VERSUS TEXT

Background: A growing emphasis in the healthcare industry today is being placed on demonstrating meaningful use of one’s Electronic Health Record (EHR) system. As rates of chronic disease, including diabetes mellitus (DM) rise, it has become clear that accurate and timely disease surveillance could be greatly improved utilizing the technologies available to clinicians today. As the Centers for Medicare and Medicaid Services (CMS) meaningful use incentive program deadlines fast approach, it remains unclear if their limited attestation criteria clearly reflect their end goal of improving patient care. The objective of this research was to determine the diagnostic accuracy of an automated text- based algorithm for identifying patients with diabetes mellitus from the longitudinal PPRNet Database. Methods: The longitudinal PPRNet database is comprised of McKesson’s Practice Partner, Lytec or Medisoft EHR system users nationwide. The analysis included data from the 115 PPRNet practices that submitted their 4th quarter data extract in January 2014. An unstructured free-text algorithm was used to determine the number of type 2 diabetics among all active adult patients. This algorithm which examines unstructured free-text data documented within the EHR title lines was compared to a previously established protocol which used a combination of ICD-9 diagnostic codes and/or active DM prescriptions Results: Between all algorithm comparisons, the patients identified as having diabetes varied considerably. Using the combination of ICD-9 diagnostic codes and/or active DM prescriptions as comparison method, the resulting sensitivity was 77.8% and specificity was 97.2% for the free-text definition. Using diagnostic codes alone as the standard for comparison resulted in a much higher sensitivity (99.3%), and lower specificity (91.9%). However, when we compared the free-text definition to the ICD-9 diagnostic codes alone, 70% of free-text identified cases were found to be un-coded. Conclusions: As EHR use continues to rise, it is crucial that we continue to develop ways to accurately translate patient data out of these systems in order to meaningfully utilize these powerful technologies. This thesis has helped clarify the need for further development of accurate data translation platforms in order to capture each patient’s full and unique health story as well as for monitoring treatment and outcomes all while minimizing physician burden

2011 ADEA Annual Session: Poster Abstracts

Poster session abstracts from the 2011 American Dental Education Association (ADEA) Conference

Phenotypic plasticity of nest timing in a post‐glacial landscape: how do reptiles adapt to seasonal time constraints?

Life histories evolve in response to constraints on the time available for growth and development. Nesting date and its plasticity in response to spring temperature may therefore be important components of fitness in oviparous ectotherms near their northern range limit, as reproducing early provides more time for embryos to complete development before winter. We used data collected over several decades to compare air temperature and nest date plasticity in populations of painted turtles and snapping turtles from a relatively warm environment (southeastern Michigan) near the southern extent of the last glacial maximum to a relatively cool environment (central Ontario) near the northern extent of post‐glacial recolonization. For painted turtles, population‐level differences in reaction norm elevation for two phenological traits were consistent with adaptation to time constraints, but no differences in reaction norm slopes were observed. For snapping turtle populations, the difference in reaction norm elevation for a single phenological trait was in the opposite direction of what was expected under adaptation to time constraints, and no difference in reaction norm slope was observed. Finally, among‐individual variation in individual plasticity for nesting date was detected only in the northern population of snapping turtles, suggesting that reaction norms are less canalized in this northern population. Overall, we observed evidence of phenological adaptation, and possibly maladaptation, to time constraints in long‐lived reptiles. Where present, (mal)adaptation occurred by virtue of differences in reaction norm elevation, not reaction norm slope. Glacial history, generation time, and genetic constraint may all play an important role in the evolution of phenological timing and its plasticity in long‐lived reptiles

Semimicro exercises and experiments in organic chemistry

Thesis (M.A.)--Boston UniversityThis thesis consitutes a laboratory manual, with experiments on a semimicro scale, for a course in elementary organic chemistry and includes both a student's manual and an instructor's manual. The content of the student manual may be grouped into three classes, scattered throughout the manual. The first is primarily informational, dealing at some length with common laboratory techniques as an orientation to subsequent work. The second class is concerned mostly with the chemistry of aliphatic compounds, while the third is devoted largely to aromatic reactions. [TRUNCATED

Ectomycorrhizal fungal communities are dominated by mammalian dispersed truffle-like taxa in north-east Australian woodlands

Mycorrhizal fungi are very diverse, including those that produce truffle-like fruiting bodies. Truffle-like fungi are hypogeous and sequestrate (produced below-ground, with an enclosed hymenophore) and rely on animal consumption, mainly by mammals, for spore dispersal. This dependence links mycophagous mammals to mycorrhizal diversity and, assuming truffle-like fungi are important components of mycorrhizal communities, to plant nutrient cycling and ecosystem health. These links are largely untested as currently little is known about mycorrhizal fungal community structure and its dependence on mycophagous mammals. We quantified the mycorrhizal fungal community in the north-east Australian woodland, including the portion interacting with ten species of mycophagous mammals. The study area is core habitat of an endangered fungal specialist marsupial, Bettongia tropica, and as such provides baseline data on mycorrhizal fungi-mammal interactions in an area with no known mammal declines. We examined the mycorrhizal fungi in root and soil samples via high-throughput sequencing and compared the observed taxa to those dispersed by mycophagous mammals at the same locations. We found that the dominant root-associating ectomycorrhizal fungal taxa (> 90% sequence abundance) included the truffle-like taxa Mesophellia, Hysterangium and Chondrogaster. These same taxa were also present in mycophagous mammalian diets, with Mesophellia often dominating. Altogether, 88% of truffle-like taxa from root samples were shared with the fungal specialist diet and 52% with diets from generalist mammals. Our data suggest that changes in mammal communities, particularly the loss of fungal specialists, could, over time, induce reductions to truffle-like fungal diversity, causing ectomycorrhizal fungal communities to shift with unknown impacts on plant and ecosystem health

Closing the Gap: Raising Medical Professionals\u27 Transgender Awareness and Medical Proficiency through Pharmacist-led Education

Introduction: Patients who are transgender have unique population-specific needs and risk factors. Nationwide surveys of health profession school administrators indicate a gap in coverage of lesbian, gay, bisexual, and transgender health content in their curricula. To address this gap, a pharmacist-developed transgender–health care focused seminar was presented to medical professionals, trainees, and students accompanied by a novel education assessment scale. Methods: The seminar was presented by a psychiatric pharmacy resident to health care professionals and trainees in various settings. Subjects covered during the seminar included terminology, diagnostic criteria and prevalence of gender dysphoria, nonhormonal treatment, gender-affirming hormone therapy, and other considerations. The Trans* Health Education Evaluation Scale (THEES) was developed to assess participants’ self-perceived proficiency regarding care of patients who are transgender immediately before and after attending a seminar. Total scale scores were compared preseminar and postseminar using a repeated- measures t-test, and sign tests with Bonferroni correction were used for individual scale items. Psychometric properties of this scale were examined. Results: Five seminars were given, and a total of 100 scales were completed by health care–associated workers and students. The majority of participants were in the pharmacy or medical professions. Attending 1 seminar significantly improved THEES total and individual item scores (P,.001). Additionally, 90% of participants felt the seminar was directly applicable to their practice, and 84% felt more confident in providing care to patients who are transgender. Discussion: A single, pharmacist-led, trans health–focused education session significantly improved the confidence level and self-perceived proficiency of health care–associated personnel as measured by THEES

Quality of seed produced by tropical forage legumes on low fertility soils

This study compared seed yields, seed and seedling characteristics of 8 forage legumes including Stylosanthes spp, Centrosema spp, Desmanthus spp, and Macroptilium spp grown on red and yellow kandosol soils of low fertility

Recognising and defining a new crown clade within Stromboidea Rafinesque, 1815 (Mollusca, Gastropoda)

This paper defines a new crown clade Neostromboidea to separate the Strombidae, Rostellariidae, and Seraphsidae from their sister families Struthiolariidae and Aporrhaidae. There is significant value to understanding evolutionary processes within Stromboidea to recognise the universal similarity in the position of the eye on the end of peduncles and a diminished cephalic tentacle that arises from the middle to the end on that peduncle. This is in contrast to other members of the Stromboidea where the eye is located at the base of the cephalic tentacle. These physiological differences represent two set of organisms with divergent and independent evolutionary life histories and therefore these differences need to be identifiable within the nomenclature to bring meaning to the way we name things

There is More to Gesture Than Meets the Eye: Visual Attention to Gesture’s Referents Cannot Account for Its Facilitative Effects During Math Instruction

Teaching a new concept with gestures – hand movements that accompany speech – facilitates learning above-and-beyond instruction through speech alone (e.g., Singer & GoldinMeadow, 2005). However, the mechanisms underlying this phenomenon are still being explored. Here, we use eye tracking to explore one mechanism – gesture’s ability to direct visual attention. We examine how children allocate their visual attention during a mathematical equivalence lesson that either contains gesture or does not. We show that gesture instruction improves posttest performance, and additionally that gesture does change how children visually attend to instruction: children look more to the problem being explained, and less to the instructor. However looking patterns alone cannot explain gesture’s effect, as posttest performance is not predicted by any of our looking-time measures. These findings suggest that gesture does guide visual attention, but that attention alone cannot account for its facilitative learning effects