66 results on '"Mirhaji P"'
Search Results
52. Clinical characteristics of the first and second COVID-19 waves in the Bronx, New York: A retrospective cohort study.
- Author
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Hoogenboom WS, Pham A, Anand H, Fleysher R, Buczek A, Soby S, Mirhaji P, Yee J, and Duong TQ
- Abstract
Background: There is limited clinical patient data comparing the first and second waves of the coronavirus disease 2019 (COVID-19) in the United States and the effects of a COVID-19 resurgence on different age, racial and ethnic groups. We compared the first and second COVID-19 waves in the Bronx, New York, among a racially and ethnically diverse population., Methods: Patients in this retrospective cohort study were included if they had a laboratory-confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab specimen detected between March 11, 2020, and January 21, 2021. Main outcome measures were critical care, in-hospital acquired disease and death. Patient demographics, comorbidities, vitals, and laboratory values were also collected., Findings: A total of 122,983 individuals were tested for SARS-CoV-2 infection, of which 12,659 tested positive. The second wave was characterized by a younger demographic, fewer comorbidities, less extreme laboratory values at presentation, and lower risk of adverse outcomes, including in-hospital mortality (adj. OR = 0·23, 99·5% CI = 0·17 to 0·30), hospitalization (adj. OR = 0·65, 99·5% CI = 0·58 to 0·74), invasive mechanical ventilation (adj. OR = 0·70, 99·5% CI = 0·56 to 0·89), acute kidney injury (adj. OR = 0·62, 99·5% CI = 0·54 to 0·71), and length of stay (adj. OR = 0·71, 99·5% CI = 0·60 to 0·85), with Black and Hispanic patients demonstrating most improvement in clinical outcomes., Interpretation: The second COVID-19 wave in the Bronx exhibits improved clinical outcomes compared to the first wave across all age, racial, and ethnic groups, with minority groups showing more improvement, which is encouraging news in the battle against health disparities., Competing Interests: None., (© 2021 The Author(s). Published by Elsevier Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
53. Pediatric Ambulatory Central Line-Associated Bloodstream Infections.
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Rinke ML, Heo M, Saiman L, Bundy DG, Rosenberg RE, DeLaMora P, Rabin B, Zachariah P, Mirhaji P, Ford WJH, Obaro-Best O, Drasher M, Klein E, Peshansky A, and Oyeku SO
- Subjects
- Academic Medical Centers, Antibiotic Prophylaxis adverse effects, Case-Control Studies, Child, Cohort Studies, Hospitalization statistics & numerical data, Humans, Incidence, Respiration, Artificial statistics & numerical data, Retrospective Studies, Risk Factors, Serum Albumin analysis, United States epidemiology, Urban Population, Ambulatory Care, Catheter-Related Infections epidemiology, Catheterization, Central Venous adverse effects, Central Venous Catheters adverse effects, Sepsis epidemiology
- Abstract
Background: Inpatient pediatric central line-associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes., Methods: Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors., Results: Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively ( P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4-5.5) and low albumin (OR 2.3; 95% CI: 1.2-4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12-0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16-0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5-13)., Conclusions: Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)
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- 2021
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- View/download PDF
54. Preserving temporal relations in clinical data while maintaining privacy.
- Author
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Hripcsak G, Mirhaji P, Low AF, and Malin BA
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- Health Insurance Portability and Accountability Act, Humans, Methods, Observational Studies as Topic, Time, United States, Confidentiality, Data Anonymization, Electronic Health Records
- Abstract
Objective: Maintaining patient privacy is a challenge in large-scale observational research. To assist in reducing the risk of identifying study subjects through publicly available data, we introduce a method for obscuring date information for clinical events and patient characteristics., Methods: The method, which we call Shift and Truncate (SANT), obscures date information to any desired granularity. Shift and Truncate first assigns each patient a random shift value, such that all dates in that patient's record are shifted by that amount. Data are then truncated from the beginning and end of the data set., Results: The data set can be proven to not disclose temporal information finer than the chosen granularity. Unlike previous strategies such as a simple shift, it remains robust to frequent - even daily - updates and robust to inferring dates at the beginning and end of date-shifted data sets. Time-of-day may be retained or obscured, depending on the goal and anticipated knowledge of the data recipient., Conclusions: The method can be useful as a scientific approach for reducing re-identification risk under the Privacy Rule of the Health Insurance Portability and Accountability Act and may contribute to qualification for the Safe Harbor implementation., (© The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2016
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55. Changing the research landscape: the New York City Clinical Data Research Network.
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Kaushal R, Hripcsak G, Ascheim DD, Bloom T, Campion TR Jr, Caplan AL, Currie BP, Check T, Deland EL, Gourevitch MN, Hart R, Horowitz CR, Kastenbaum I, Levin AA, Low AF, Meissner P, Mirhaji P, Pincus HA, Scaglione C, Shelley D, and Tobin JN
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- Humans, Information Dissemination, New York City, Computer Communication Networks organization & administration, Electronic Health Records organization & administration, Outcome Assessment, Health Care organization & administration, Patient-Centered Care
- Abstract
The New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants' experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
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56. Coordination and management of multicenter clinical studies in trauma: Experience from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study.
- Author
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Rahbar MH, Fox EE, del Junco DJ, Cotton BA, Podbielski JM, Matijevic N, Cohen MJ, Schreiber MA, Zhang J, Mirhaji P, Duran SJ, Reynolds RJ, Benjamin-Garner R, and Holcomb JB
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- Cardiopulmonary Resuscitation methods, Cohort Studies, Critical Illness mortality, Critical Illness therapy, Databases, Factual, Emergency Service, Hospital organization & administration, Female, Hospital Mortality trends, Humans, Injury Severity Score, Male, Organizational Innovation, Outcome Assessment, Health Care, Prospective Studies, Risk Assessment, Safety Management, Shock, Hemorrhagic diagnosis, Shock, Hemorrhagic mortality, Survival Analysis, Transfusion Reaction, Trauma Centers organization & administration, United States, Wounds and Injuries diagnosis, Wounds and Injuries mortality, Blood Transfusion methods, Emergency Medicine organization & administration, Registries, Shock, Hemorrhagic therapy, Wounds and Injuries therapy
- Abstract
Aim: Early death due to hemorrhage is a major consequence of traumatic injury. Transfusion practices differ among hospitals and it is unknown which transfusion practices improve survival. This report describes the experience of the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study Data Coordination Center in designing and coordinating a study to examine transfusion practices at ten Level 1 trauma centers in the US., Methods: PROMMTT was a multisite prospective observational study of severely injured transfused trauma patients. The clinical sites collected real-time information on the timing and amounts of blood product infusions as well as colloids and crystalloids, vital signs, initial diagnostic and clinical laboratory tests, life saving interventions and other clinical care data., Results: Between July 2009 and October 2010, PROMMTT screened 12,561 trauma admissions and enrolled 1245 patients who received one or more blood transfusions within 6h of Emergency Department (ED) admission. A total of 297 massive transfusions were observed over the course of the study at a combined rate of 5.0 massive transfusion patients/week., Conclusion: PROMMTT is the first multisite study to collect real-time prospective data on trauma patients requiring transfusion. Support from the Department of Defense and collaborative expertise from the ten participating centers helped to demonstrate the feasibility of prospective trauma transfusion studies. The observational data collected from this study will be an invaluable resource for research in trauma surgery and it will guide the design and conduct of future randomized trials., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
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57. Ontology driven integration platform for clinical and translational research.
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Mirhaji P, Zhu M, Vagnoni M, Bernstam EV, Zhang J, and Smith JW
- Subjects
- Database Management Systems, Internet, Medical Informatics, Software, Systems Integration, User-Computer Interface, Biomedical Research, Computational Biology methods, Information Storage and Retrieval methods, Vocabulary, Controlled
- Abstract
Semantic Web technologies offer a promising framework for integration of disparate biomedical data. In this paper we present the semantic information integration platform under development at the Center for Clinical and Translational Sciences (CCTS) at the University of Texas Health Science Center at Houston (UTHSC-H) as part of our Clinical and Translational Science Award (CTSA) program. We utilize the Semantic Web technologies not only for integrating, repurposing and classification of multi-source clinical data, but also to construct a distributed environment for information sharing, and collaboration online. Service Oriented Architecture (SOA) is used to modularize and distribute reusable services in a dynamic and distributed environment. Components of the semantic solution and its overall architecture are described.
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- 2009
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58. Semantic representation of CDC-PHIN vocabulary using Simple Knowledge Organization System.
- Author
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Zhu M and Mirhaji P
- Subjects
- Artificial Intelligence, Subject Headings, Texas, Medical History Taking methods, Medical Records Systems, Computerized, Natural Language Processing, Pattern Recognition, Automated methods, Semantics, Terminology as Topic, Vocabulary, Controlled
- Abstract
PHIN Vocabulary Access and Distribution System (VADS) promotes the use of standards based vocabulary within CDC information systems. However, the current PHIN vocabulary representation hinders its wide adoption. Simple Knowledge Organization System (SKOS) is a W3C draft specification to support the formal representation of Knowledge Organization Systems (KOS) within the framework of the Semantic Web. We present a method of adopting SKOS to represent PHIN vocabulary in order to enable automated information sharing and integration.
- Published
- 2008
59. Information integration from heterogeneous data sources: a Semantic Web approach.
- Author
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Kunapareddy N, Mirhaji P, Richards D, and Casscells SW
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- Information Storage and Retrieval, Internet, Programming Languages, Semantics, Databases as Topic, Systems Integration
- Abstract
Although the decentralized and autonomous implementation of health information systems has made it possible to extend the reach of surveillance systems to a variety of contextually disparate domains, public health use of data from these systems is not primarily anticipated. The Semantic Web has been proposed to address both representational and semantic heterogeneity in distributed and collaborative environments. We introduce a semantic approach for the integration of health data using the Resource Definition Framework (RDF) and the Simple Knowledge Organization System (SKOS) developed by the Semantic Web community.
- Published
- 2006
60. Services oriented architectures and rapid deployment of ad-hoc health surveillance systems: lessons from Katrina relief efforts.
- Author
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Mirhaji P, Casscells SW, Srinivasan A, Kunapareddy N, Byrne S, Richards DM, and Arafat R
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- Computer Systems, Delivery of Health Care organization & administration, Disease Outbreaks prevention & control, Humans, Medical Records Systems, Computerized, Texas, Computer Communication Networks, Disasters, Internet, Population Surveillance methods, Relief Work organization & administration, Software
- Abstract
During the Hurricane Katrina relief efforts, a new city was born overnight within the City of Houston to provide accommodation and health services for thousands of evacuees deprived of food, rest, medical attention, and sanitation. The hurricane victims had been exposed to flood water, toxic materials, physical injury, and mental stress. This scenario was an invitation for a variety of public health hazards, primarily infectious disease outbreaks. Early detection and monitoring of morbidity and mortality among evacuees due to unattended health conditions was an urgent priority and called for deployment of real-time surveillance to collect and analyze data at the scene, and to enable and guide appropriate response and planning activities. The University of Texas Health Science Center at Houston (UTHSC) and the Houston Department of Health and Human Services (HDHHS) deployed an ad hoc surveillance system overnight by leveraging Internet-based technologies and Services Oriented Architecture (SOA). The system was post-coordinated through the orchestration of Web Services such as information integration, natural language processing, syndromic case finding, and online analytical processing (OLAP). Here we will report the use of Internet-based and distributed architectures in providing timely, novel, and customizable solutions on demand for unprecedented events such as natural disasters.
- Published
- 2006
61. Semantic web representation of LOINC: an ontological perspective.
- Author
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Srinivasan A, Kunapareddy N, Mirhaji P, and Casscells SW
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- Semantics, Unified Medical Language System, Clinical Laboratory Techniques classification, Logical Observation Identifiers Names and Codes
- Abstract
The Logical Observation Identifiers Names and Codes terminology (LOINC) has been proposed as a nomenclature for clinical laboratory tests. We present a formal representation of LOINC using a Semantic Web-based ontology that defines LOINC concepts in terms of the six main LOINC axes and their relationships with UMLS Semantic Types and the UMLS Metathesarus. This representation may enable automated information integration and decision support in public health surveillance.
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- 2006
62. Semantic approach for text understanding of chief complaints data.
- Author
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Mirhaji P, Byrne S, Kunapareddy N, and Casscells SW
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- Internet, Semantics, Vocabulary, Controlled, Natural Language Processing, Unified Medical Language System
- Abstract
We propose a semantic approach to processing free form text information such as chief complaints using formal knowledge representation and Description Logic reasoning. Our method extracts concepts and as much contextual information as is available in the text. Output is a computationally interpretable representation of this information using the Resource Definition Framework (RDF) and UMLS Metathesaurus.
- Published
- 2006
63. A Web Services architecture for UMLS Knowledge Sources.
- Author
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Mirhaji P, Kunapareddy N, Michea Y, and Srinivasan A
- Subjects
- Internet, Software, Unified Medical Language System
- Abstract
A web service is a collection of industry standards to enable reusability of services and interoperability of heterogeneous applications. The UMLS Knowledge Source (UMLSKS) Server provides remote access to the UMLSKS and related resources. We propose a Web Services Architecture that encapsulates UMLSKS-API and makes it available in distributed and heterogeneous environments. This is the first step towards intelligent and automatic UMLS services discovery and invocation by computer systems in distributed environments such as web.
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- 2005
64. Information visualization for quality control in health data exchange platforms.
- Author
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Kunapareddy N, Mirhaji P, Zhang J, Michea Y, and Srinivasan A
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- Bioterrorism, Computer Systems standards, Databases as Topic standards, Disease Outbreaks, Humans, Quality Control, Computer Communication Networks standards, Databases as Topic organization & administration, Population Surveillance
- Abstract
Policy Makers, System Administrators and Designers in health care are often deluged by the complexity of maintaining a reliable information exchange platform involving multiple systems. Often two factors are taken for granted in such health data exchange settings: that the communication between systems is reliable and that the messages transmitted between systems contain quality data. We are presenting an approach to meaningfully analyzing and visualizing information exchange to provide situational awareness in data exchange platforms.
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- 2005
65. Houston biosecurity: building a national model.
- Author
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Casscells W, Mirhaji P, Lillibridge S, and Madjid M
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- Government Agencies, Humans, Terrorism prevention & control, Texas, United States, Bioterrorism prevention & control, Security Measures legislation & jurisprudence
- Abstract
On September 11, 2001, Al Qaeda terrorists committed an atrocity when they used domestic jetliners to crash into buildings in New York City and Washington, DC, killing thousands of people. In October 2001, another act of savagery occurred, this time using anthrax, not airplanes, to take innocent lives. Each incident demonstrates the vulnerability of an open society, and Americans are left to wonder how such acts can be prevented. Two years later, Al Qaeda operatives are reportedly regrouping, recruiting, and changing their tactics to distribute money and messages to operatives around the world. Many experts believe that terrorist attacks are inevitable. Every city is vulnerable to an attack, and none are fully prepared to handle the residual impact of a biological or chemical attack. A survey conducted by the Cable News Network (CNN) in January 2002, studied 30 major US cities, ranking them based on 6 statistical indices of vulnerability. Thirteen cities were deemed better prepared than Houston, 10 were in a similar state of preparedness, and only 6 were less prepared than Houston. We will discuss the protective measures that have been put in place in Houston, and future steps to take. Other cities can model Houston's experience to develop similar plans nation-wide.
- Published
- 2004
66. Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction.
- Author
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Oraii S, Maleki M, Tavakolian AA, Eftekharzadeh M, Kamangar F, and Mirhaji P
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- Case-Control Studies, Female, Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Risk Factors, Electrocardiography, Myocardial Infarction diagnosis
- Abstract
The prevalence and clinical significance of ST-segment elevation (STE) in posterior electrocardiographic (ECG) leads during acute myocardial infarction (AMI) is largely unknown. We obtained posterior ECG leads (V7, V8, and V9), as well as standard 12-lead and right precordial leads (V4R-V6R), immediately upon admission in 210 consecutive patients with AMI. Nineteen patients (9% of 210 cases) had STE of > or =1 mm in 2 or more posterior leads, either as an isolated finding (7 cases, 3.3% of 210) or in association with STE at inferior or lateral sites (12 cases, 5.7% of 210). STE in posterior leads was detected in 10.9% (7 of 64) of patients without STE in standard ECG leads. Tall R waves in V1-V2 developed in 5 cases (26.3% of 19). Patients with STE in posterior leads were significantly older (64.4+/-7.3 years vs 58.9+/-8.9 years) with more frequent cardiovascular risk factors (3.4+/-1.1 vs 2.9+/-1.2) than those without. In-hospital complications were significantly more frequent in these patients compared with matched controls (Mantel-Haenszel odds ratio = 7, confidence interval = 1.28-28.43). There was also a trend toward lower ejection fraction and increased in-hospital mortality that did not reach statistical significance. We conclude that STE in posterior ECG leads is not uncommon among patients with AMI and no STE in standard leads and may portend a worse in-hospital course.
- Published
- 1999
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