ObjectiveTo develop and validate a phenotyping algorithm for the identification of patients with type 1 and type 2 diabetes mellitus (DM) preoperatively using routinely available clinical data from electronic health records.Patients and MethodsWe used first-order logic rules (if-then-else rules) to imply the presence or absence of DM types 1 and 2. The “if” clause of each rule is a conjunction of logical and, or predicates that provides evidence toward or against the presence of DM. The rule includes International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes, outpatient prescription information, laboratory values, and positive annotation of DM in patients’ clinical notes. This study was conducted from March 2, 2015, through February 10, 2016. The performance of our rule-based approach and similar approaches proposed by other institutions was evaluated with a reference standard created by an expert reviewer and implemented for routine clinical care at an academic medical center.ResultsA total of 4208 surgical patients (mean age, 52 years; males, 48%) were analyzed to develop the phenotyping algorithm. Expert review identified 685 patients (16.28% of the full cohort) as having DM. Our proposed method identified 684 patients (16.25%) as having DM. The algorithm performed well—99.70% sensitivity, 99.97% specificity—and compared favorably with previous approaches.ConclusionAmong patients undergoing surgery, determination of DM can be made with high accuracy using simple, computationally efficient rules. Knowledge of patients’ DM status before surgery may alter physicians’ care plan and reduce postsurgical complications. Nevertheless, future efforts are necessary to determine the effect of first-order logic rules on clinical processes and patient outcomes.
Institute for the Law and the Web, University of Southampton, UK Keywords: Digital identity Identity crime Identity management Big data Profiling Mobile identity Automated identification Identity surveillance Biometrics a b s t r a c t Modern identity is valuable, multi-functional and complex. Today we typically manage multiple versions of self, made visible in digital trails distributed widely across offline and online spaces. Yet, technology-mediated identity leads us into crisis. Enduring accessibility to greater and growing personal details online, alongside increases in both computing power and data linkage techniques, fuel fears of identity exploitation. Will it be stolen?Who controls it? Are others aggregating or analysing our identities to infer new data about us without our knowledge or consent? New challenges present themselves globally around these fears, as manifested by concerns over massive online data breaches and automated identification technologies, which also highlight the conundrum faced by governments about how to safeguard individuals' interests on the Web while striking a fair balance with wider public interests. This paper reflects upon some of these problems as part of the interdisciplinary, transatlantic 'SuperIdentity' project investigating links between cyber and real-world identifiers. To meet the crisis, we explore the relationship between identity and digitisation from the perspective of policy and law. We conclude that traditional models of identity protection need supplementing with new ways of thinking, including pioneering 'technical-legal' initiatives that are sensitive to the different risks that threaten our digital identity integrity. Only by re-conceiving identity dynamically to appreciate the increasing capabilities for connectivity between different aspects of our identity across the cyber and the physical domains, will policy and law be able to keep up with and address the challenges that lie ahead in our progressively networked world.
Alison M. Knight received her bachelor's degree in Industrial Engineering from Tennessee Technological University. She worked for three years for TranSystems as a simulation analyst. She then received her MSE in Systems Engineering at the University of Alabama in Huntsville. During her graduate studies, she was a teaching assistant and later instructor for undergraduate Engineering Economy courses. She is currently working as a Health Systems Engineering Analyst at Mayo Clinic in Rochester, MN.
The Introduction explores the primary grounds on which textual difficulties in scripture were formulated in early modern England, charting early modern theories of and approaches to interpretive difficulty. It explores how Catholic–Protestant and intra-Protestant polemic framed biblical difficulty in English culture. Such polemic sets the stage for English literary encounters with scripture’s textual concerns and highlights key textual and hermeneutic arguments. In their seminal debate during the early years of the Reformation, Martin Luther and Erasmus discussed not whether scripture or the Church was the authoritative basis of faith, nor scripture’s inerrancy, but whether it was difficult. The Dark Bible opens with this polemic and its English offspring, in particular that of William Tyndale and Sir Thomas More, and William Fulke and Gregory Martin.
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