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Extracting Physician Group Intelligence from Electronic Health Records to Support Evidence Based Medicine
Griffin M. Weber, Isaac S. Kohane
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064933
Abstract: Evidence-based medicine employs expert opinion and clinical data to inform clinical decision making. The objective of this study is to determine whether it is possible to complement these sources of evidence with information about physician “group intelligence” that exists in electronic health records. Specifically, we measured laboratory test “repeat intervals”, defined as the amount of time it takes for a physician to repeat a test that was previously ordered for the same patient. Our assumption is that while the result of a test is a direct measure of one marker of a patient's health, the physician's decision to order the test is based on multiple factors including past experience, available treatment options, and information about the patient that might not be coded in the electronic health record. By examining repeat intervals in aggregate over large numbers of patients, we show that it is possible to 1) determine what laboratory test results physicians consider “normal”, 2) identify subpopulations of patients that deviate from the norm, and 3) identify situations where laboratory tests are over-ordered. We used laboratory tests as just one example of how physician group intelligence can be used to support evidence based medicine in a way that is automated and continually updated.
The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders
Isaac S. Kohane, Andrew McMurry, Griffin Weber, Douglas MacFadden, Leonard Rappaport, Louis Kunkel, Jonathan Bickel, Nich Wattanasin, Sarah Spence, Shawn Murphy, Susanne Churchill
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033224
Abstract: Objectives Use electronic health records Autism Spectrum Disorder (ASD) to assess the comorbidity burden of ASD in children and young adults. Study Design A retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these comorbidities was measured. The comorbidity prevalence of the younger (Age<18 years) and older (Age 18–34 years) individuals with ASD was compared. Results 19.44% of ASD patients had epilepsy as compared to 2.19% in the overall hospital population (95% confidence interval for difference in percentages 13.58–14.69%), 2.43% of ASD with schizophrenia vs. 0.24% in the hospital population (95% CI 1.89–2.39%), inflammatory bowel disease (IBD) 0.83% vs. 0.54% (95% CI 0.13–0.43%), bowel disorders (without IBD) 11.74% vs. 4.5% (95% CI 5.72–6.68%), CNS/cranial anomalies 12.45% vs. 1.19% (95% CI 9.41–10.38%), diabetes mellitus type I (DM1) 0.79% vs. 0.34% (95% CI 0.3–0.6%), muscular dystrophy 0.47% vs 0.05% (95% CI 0.26–0.49%), sleep disorders 1.12% vs. 0.14% (95% CI 0.79–1.14%). Autoimmune disorders (excluding DM1 and IBD) were not significantly different at 0.67% vs. 0.68% (95% CI ?0.14-0.13%). Three of the studied comorbidities increased significantly when comparing ages 0–17 vs 18–34 with p<0.001: Schizophrenia (1.43% vs. 8.76%), diabetes mellitus type I (0.67% vs. 2.08%), IBD (0.68% vs. 1.99%) whereas sleeping disorders, bowel disorders (without IBD) and epilepsy did not change significantly. Conclusions The comorbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of tertiary health centers. This burden of comorbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management that payors and providers will have to plan for.
SHRINE: Enabling Nationally Scalable Multi-Site Disease Studies
Andrew J. McMurry, Shawn N. Murphy, Douglas MacFadden, Griffin Weber, William W. Simons, John Orechia, Jonathan Bickel, Nich Wattanasin, Clint Gilbert, Philip Trevvett, Susanne Churchill, Isaac S. Kohane
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0055811
Abstract: Results of medical research studies are often contradictory or cannot be reproduced. One reason is that there may not be enough patient subjects available for observation for a long enough time period. Another reason is that patient populations may vary considerably with respect to geographic and demographic boundaries thus limiting how broadly the results apply. Even when similar patient populations are pooled together from multiple locations, differences in medical treatment and record systems can limit which outcome measures can be commonly analyzed. In total, these differences in medical research settings can lead to differing conclusions or can even prevent some studies from starting. We thus sought to create a patient research system that could aggregate as many patient observations as possible from a large number of hospitals in a uniform way. We call this system the ‘Shared Health Research Information Network’, with the following properties: (1) reuse electronic health data from everyday clinical care for research purposes, (2) respect patient privacy and hospital autonomy, (3) aggregate patient populations across many hospitals to achieve statistically significant sample sizes that can be validated independently of a single research setting, (4) harmonize the observation facts recorded at each institution such that queries can be made across many hospitals in parallel, (5) scale to regional and national collaborations. The purpose of this report is to provide open source software for multi-site clinical studies and to report on early uses of this application. At this time SHRINE implementations have been used for multi-site studies of autism co-morbidity, juvenile idiopathic arthritis, peripartum cardiomyopathy, colorectal cancer, diabetes, and others. The wide range of study objectives and growing adoption suggest that SHRINE may be applicable beyond the research uses and participating hospitals named in this report.
Powering Renewable Programs: The Utility Perspective  [PDF]
Nicole Griffin, Athens Gomes Silaban
Open Journal of Energy Efficiency (OJEE) , 2016, DOI: 10.4236/ojee.2016.54013
Abstract: In order to make renewable energy projects successful, there are many factors that utilities need to consider. These include policy drivers, assessing what renewable technologies it will employ, identifying the rates and pricing incentives that could be made available, and how customers can be better engaged. Utilities have created renewable programs with varying degrees of customer participation: some have taken the initiative to provide customers with 100% renewable generated power, others rely exclusively on customers to participate to meet renewable energy goals and the last alternative is a blend of both in which utilities offer customers the option to purchase renewable power matches or install and generate their own renewable power. Overall, the economics of solar and wind technologies are trending in the upward direction—the costs of the technologies are decreasing and the yields are getting higher. Better still, predictive modeling, energy storage and the plethora of research in this area will only make the prospects of integrating renewables more viable.
Industrialization: Different Approaches and Case Studies Industrialization: Different Approaches and Case Studies
Keith Griffin
Revista de Análisis Económico (RAE) , 1987,
Abstract: Industrialization: Different Approaches and Case Studies This paper enquires whether an industrialisation policy designed by the state might be successful in achieving industrialisation and development in the third world. Three common approaches to industrialisation are analysed in terms of their structural features and consequences: import substitution, capital goods sector promotion, and manufacturing export promotion. Associating these strategies to Brazil, India and South Korea, respectively, a detailed comparison of their characteristics and achievements is carried out. The paper concludes by ranking these country experiences, arguing that their relative achievements might be independent from their political regimes
An overview of the key changes in public administration in the United Kingfom from 1970 to 2002
Rosarii Griffin
Pyramides : Revue du Centre d'Etudes et de Recherches en Administration Publique , 2011,
Abstract: Cet article montre qu’il n’y a eu rien moins qu’une révolution dans l’administration publique au Royaume-Uni durant la période allant de 1970 à nos jours. Les quatre principaux secteurs des services publics abordés sont : la sécurité sociale, la santé, la sécurité et tout particulièrement, l’éducation. L’article aborde tout d’abord le r le des autorités locales qui furent instituées à la fin du dix-neuvième siècle pour assurer les services publics et virtuellement abolies sous les ères Thatcher et Major des années 80 et 90. Les conséquences de ces réformes drastiques sur l’administration publique y sont discutées, ainsi que le r le des nouveaux organes de contr le (Quangos et NDPBs). Ces derniers sont destinés à : a) maintenir et améliorer les normes des services publics ; b) assurer les r les traditionnels des autorités locales. Cet article s’achève par une brève discussion de la démarche du New Labour vis-à-vis du secteur public et les réalisations générales (ou autres) des différents gouvernements des années 1970 à nos jours.
Tradition and Imitation in Spenser’s The Faerie Queene
Jonathan Griffin
Journal of Arts and Humanities , 2013,
Abstract: The purpose of this paper is to discuss Spenser’s use of imitation as a literary device in his allegorical epic poem The Faerie Queene, originally published in 1590. The paper begins with a synopsis of Spenser’s general intent behind the poem, as well as his use of the theoretical models of literary excellence proposed by his contemporary Sir Phillip Sidney. The paper then follows Spenser’s reinterpretation of Ariosto, his treatment of Virgil and Ovid, and chronicles his attempts to parody these imperious influences to create an epic that would give synthesis to the poetic tradition to which he belonged with his religious ethic and fervent nationalism, while paying tribute to his monarch, Elizabeth I.
Nicholas Griffin
Journal for the History of Analytical Philosophy , 2013, DOI: 10.4148/jhap.v2i1.1709
Abstract: Russell’s rejection in 1898 of the doctrine of internal relations — the view that all relations are grounded in the intrinsic properties of the terms related — was a decisive part of his break with Hegelianism and opened the way for his turn to analytic philosophy. Before rejecting it, Russell had given the doctrine little thought, though it played an essential role in the most intractable of the problems facing his attempt to construct a Hegelian dialectic of the sciences. I argue that it was Russell’s early reading of Leibniz, in preparation for his lectures on Leibniz given at Cambridge in 1899, that most probably alerted him to the role the doctrine was playing in his own philosophy. Leibniz defended a similar doctrine and extricated it from difficulties like those faced by Russell by means of devices that were not open to Russell. Russell would have come across these views of Leibniz in writings by Leibniz that he read in the summer of 1898, just before he rejected the doctrine of internal relations.
Theory of excitations of the condensate and non-condensate at finite temperatures
Allan Griffin
Physics , 1999,
Abstract: We give an overview of the current theory of collective modes in trapped atomic gases at finite temperatures, when the dynamics of the condensate and non-condensate must both be considered. A simple introduction is given to the quantum field formulation of the dynamics of an interacting Bose-condensed system, based on equations of motion for the condensate wavefunction and single-particle Green's functions for the non-condensate atoms. We discuss the nature of excitations in the mean-field collisionless region, including the Beliaev second-order approximation for the self-energies. We also sketch the derivation of coupled two-fluid hydrodynamic equations using a simple kinetic equation which includes collisions between condensate and non-condensate atoms.
A Brief History of Our Understanding of BEC: From Bose to Beliaev
Allan Griffin
Physics , 1999,
Abstract: We review how our current ideas about BEC developed in the early period 1925-1965, which had the specific goal of understanding superfluid $^4$He. This history is presented by commenting on the key contributions made by Einstein, Fritz London, Tisza, Landau, Bogoliubov, Oliver Penrose and Feynman. We emphasize the emergence of the concept of a macroscopic wavefunction describing the condensate. Starting with the fundamental work of Beliaev in 1957, the period 1957-1965 was a golden era for theoretical studies of interacting Bose-condensed gases. This work provided a sound conceptual basis for understanding the properties of trapped atomic gases which were discovered thirty years later.
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