Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.

Introduction: Cloud-based solutions are a modern-day necessity for data intense computing. This case report describes in detail the development and implementation of Amazon Web Services (AWS) at Emory-a secure, reliable, and scalable platform to store and analyze identifiable research data from the Centers for Medicare and Medicaid Services (CMS).

Materials And Methods: Interdisciplinary teams from CMS, MBL Technologies, and Emory University collaborated to ensure compliance with CMS policy that consolidates laws, regulations, and other drivers of information security and privacy.

Medication reconciliation: comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2).

Background: Medication history forms completed by patients are an essential part of the medication reconciliation process.

Objective: In a crossover prospective study, investigators compared the accuracy and acceptability of a "fill-in-the blank" medication history form (USUAL) to a customized form (CUSTOM) that contained a checklist of the 44 most frequently prescribed diabetes clinic medications.

Methods: The content of both forms was compared to a "gold-standard" medication list compiled by a clinical pharmacist who conducted a medication history and reviewed pharmacy profiles and medical chart.

A Temporal Abstraction-based Extract, Transform and Load Process for Creating Registry Databases for Research.

In the CTSA era there is great interest in aggregating and comparing populations across institutions. These sites likely represent data differently in their clinical data warehouses and other databases. Clinical data warehouses frequently are structured in a generalized way that supports many constituencies.

The "metabolic syndrome" is less useful than random plasma glucose to screen for glucose intolerance.

Aims: To compare the utility of metabolic syndrome (MetS) to random plasma glucose (RPG) in identifying people with diabetes or prediabetes.

Methods: RPG was measured and an OGTT was performed in 1155 adults. Test performance was measured by area under the receiver-operating-characteristic curve (AROC).

Random plasma glucose in serendipitous screening for glucose intolerance: screening for impaired glucose tolerance study 2.

Background: With positive results from diabetes prevention studies, there is interest in convenient ways to incorporate screening for glucose intolerance into routine care and to limit the need for fasting diagnostic tests.

Objective: The aim of this study is to determine whether random plasma glucose (RPG) could be used to screen for glucose intolerance.

Design: This is a cross-sectional study.

Relationship of diabetes with cardiovascular disease-related hospitalization rates, length of stay, and charges: analysis by race/ethnicity, age, and sex.

Objective: Determine relationship of diabetes with risk of cardiovascular disease hospitalizations and the effect on hospital length of stay and charges.

Design: A cross-sectional analysis of Georgia hospital discharge data for 1998 through 2001.

Patients: Patients hospitalized principally with one of six cardiovascular disease (CVD) conditions (myocardial infarction, ischemic heart disease, cardiac dysrhythmia, heart failure, cerebrovascular events, peripheral vascular disease) were identified in the hospital discharge data.

Common reasons for hospitalization in urban diabetes patients.

Objectives: Determine principal reasons for hospitalization in a predominantly urban, African American diabetes patient population.

Design: Data for outpatients with a diagnosis of diabetes were abstracted from electronic records. The number of hospitalizations from 1998 through 2001 was determined after linking our dataset with a statewide discharge dataset.

An informatics-supported intervention improves diabetes control in a primary care setting.

Although research has shown that proper management of diabetes can improve outcomes, glucose control is worsening. This partly reflects the failure of providers to intensify diabetes therapy when indicated, termed clinical inertia. Our intervention used (a) decision support reminders which provided patient specific recommendations for management at each visit, and (b) computer generated provider specific feedback on performance.

An informatics model for clinical research--screening for impaired glucose tolerance study.

A major challenge for large scale, multi-site research studies is the time-sensitive tracking of numerous subjects, samples and results through multiple encounters and processes, by many team members in several different locations. This may be compounded by collaborations with other studies to share samples, data collection and subjects. The Screening for Impaired Glucose Tolerance (SIGT) study has met this challenge by developing a secure, informatics system with web and client server interfaces.

Increasing patient empowerment and improving diabetes care by utilizing a computer-based patient "roadmap".

The 20.8 million Americans with diabetes are at risk of amputation, kidney failure, blindness, and death which could be decreased if glucose control were better. Patients need motivation and empowerment to perform the daily management of diabetes.

Poor glycemic control increases risk of hospitalization in urban African Americans with diabetes.

Objective: Hospitalizations due to diabetes are more frequent among African Americans, but risk factors are not known. We analyzed data from an urban African American patient population to identify variables associated with hospitalizations attributable principally to diabetes.

Design: Demographic, disease, and metabolic characteristics on patients seen in an outpatient diabetes clinic during 1991 to 1997 were extracted from an electronic patient tracking system.

Potentially modifiable metabolic factors and the risk of cardiovascular disease hospitalizations in urban African Americans with diabetes.

Objective: Diabetes and cardiovascular disease (CVD) are frequent causes of hospitalization in African Americans but have rarely been studied as coexisting diagnoses. We analyzed data from an urban African American diabetes patient population to identify variables associated with CVD hospitalizations.

Design: Demographic, disease, and metabolic characteristics of patients seen from 1991 to 1997 were extracted from an electronic patient tracking system.

Common reasons for hospitalization among adult patients with diabetes.

Objective: To determine reasons for hospitalization among adult patients with diabetes.

Methods: A cross-sectional analysis was conducted of hospital discharges in the state of Georgia for the years 1998 through 2001 that contained either a primary or a coexisting diagnosis of diabetes. With use of the Clinical Classification Software of the Agency for Healthcare Research and Quality, the principal diagnoses among diabetes-related hospital discharges were organized into diagnostic categories.

An initial map of insertion and deletion (INDEL) variation in the human genome.

Although many studies have been conducted to identify single nucleotide polymorphisms (SNPs) in humans, few studies have been conducted to identify alternative forms of natural genetic variation, such as insertion and deletion (INDEL) polymorphisms. In this report, we describe an initial map of human INDEL variation that contains 415,436 unique INDEL polymorphisms. These INDELs were identified with a computational approach using DNA re-sequencing traces that originally were generated for SNP discovery projects.

Disparities in diabetes-related hospitalizations: relationship of age, sex, and race/ethnicity with hospital discharges, lengths of stay, and direct inpatient charges.

Objective: To identify any differences in hospitalization rates of diabetes patients by age, sex, or race/ethnicity.

Design: A cross-sectional study of Georgia hospital discharge data between 1998 and 2001.

Patients/participants: Patients with a principal discharge diagnosis of diabetes.

Recently mobilized transposons in the human and chimpanzee genomes.

Transposable genetic elements are abundant in the genomes of most organisms, including humans. These endogenous mutagens can alter genes, promote genomic rearrangements, and may help to drive the speciation of organisms. In this study, we identified almost 11,000 transposon copies that are differentially present in the human and chimpanzee genomes.

Natural genetic variation caused by transposable elements in humans.

Transposons and transposon-like repetitive elements collectively occupy 44% of the human genome sequence. In an effort to measure the levels of genetic variation that are caused by human transposons, we have developed a new method to broadly detect transposon insertion polymorphisms of all kinds in humans. We began by identifying 606,093 insertion and deletion (indel) polymorphisms in the genomes of diverse humans.

Management of insulin therapy in urban diabetes patients is facilitated by use of an intelligent dosing system.

The Intelligent Dosing System (IDS, Dimensional Dosing Systems, Inc., Wexford, PA) is a software suite that incorporates patient-specific, dose-response data in a mathematical model, and then calculates the new dose of agent needed to achieve the next desired therapeutic goal. We evaluated use of the IDS for titrating insulin therapy.

Single nucleotide polymorphisms (SNPs) that map to gaps in the human SNP map.

An international effort is underway to generate a comprehensive haplotype map (HapMap) of the human genome represented by an estimated 300,000 to 1 million 'tag' single nucleotide polymorphisms (SNPs). Our analysis indicates that the current human SNP map is not sufficiently dense to support the HapMap project. For example, 24.

Functional genomics reveals relationships between the retrovirus-like Ty1 element and its host Saccharomyces cerevisiae.

Retroviruses and their relatives, the long terminal repeat (LTR) retrotransposons, carry out complex life cycles within the cells of their hosts. We have exploited a collection of gene deletion mutants developed by the Saccharomyces Genome Deletion Project to perform a functional genomics screen for host factors that influence the retrovirus-like Ty1 element in yeast. A total of 101 genes that presumably influence many different aspects of the Ty1 retrotransposition cycle were identified from our analysis of 4483 homozygous diploid deletion strains.