Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

A fuzzy approach to risk analysis in information systems

Assets are interrelated in risk analysis methodologies for information systems promoted by international standards. This means that an attack on one asset can be propagated through the network and threaten an organization's most valuable assets. It is necessary to valuate all assets, the direct and indirect asset dependencies, as well as the probability of threats and the resulting asset degradation. These methodologies do not, however, consider uncertain valuations and use precise values on different scales, usually percentages. Linguistic terms are used by the experts to represent assets values, dependencies and frequency and asset degradation associated with possible threats. Computations are based on the trapezoidal fuzzy numbers associated with these linguistic terms.

21st National Information Systems Security Conference : building the information security bridge to the 21st century : October 5-8, 1998, Hyatt Regency Crystal City, Arlington, Va.

Cover title.

LUMIS : Land use management and information systems : coordinate oriented program documentation /

"JPL SP 43-33."

18th National Information Systems Security Conference : October 10-13, 1995, Baltimore Convention Center, Baltimore, Maryland, proceedings, making security real /

Mode of access: Internet.

Clinical laboratory science/biotechnology cluster /

Project staff: Joseph A. Bonefeste, Kathryn Torricelli, Jane Adrian. Cf. p. [2] of cover.

Designing multiple user perspectives and functionality for clinical decision support systems

Clinical Decision Support Systems (CDSSs) need to disseminate expertise in formats that suit different end users and with functionality tuned to the context of assessment. This paper reports research into a method for designing and implementing knowledge structures that facilitate the required flexibility. A psychological model of expertise is represented using a series of formally specified and linked XML trees that capture increasing elements of the model, starting with hierarchical structuring, incorporating reasoning with uncertainty, and ending with delivering the final CDSS. The method was applied to the Galatean Risk and Safety Tool, GRiST, which is a web-based clinical decision support system (www.egrist.org) for assessing mental-health risks. Results of its clinical implementation demonstrate that the method can produce a system that is able to deliver expertise targetted and formatted for specific patient groups, different clinical disciplines, and alternative assessment settings. The approach may be useful for developing other real-world systems using human expertise and is currently being applied to a logistics domain. © 2013 Polish Information Processing Society.

Web-Based Information Systems in the Stock Market Financial Information Domain

The information domain is a recognised sphere for the influence, ownership, and control of information and it's specifications, format, exploitation and explanation (Thompson, 1967). The article presents a description of the financial information domain issues related to the organisation and operation of a stock market. We review the strategic, institutional and standards dimensions of the stock market information domain in relation to the current semantic web knowledge and how and whether this could be used in modern web based stock market information systems to provide the quality of information that their stakeholders want. The analysis is based on the FINE model (Blanas, 2003). The analysis leads to a number of research questions for future research.

Geographic Information Systems (GIS) in Assessing Dental Health

The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.

AMBIVALENT IMPLICATIONS OF HEALTH CARE INFORMATION SYSTEMS: A STUDY IN THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM

This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

Information from managing information systems as a fundamental element to support decision-making in hospitals

This article deals with the activity of defining information of hospital systems as fundamental for choosing the type of information systems to be used and also the organizational level to be supported. The use of hospital managing information systems improves the user`s decision -making process by allowing control report generation and following up the procedures made in the hospital as well.

Logistics information systems adoption: an empirical investigation in Brazil

Purpose - The purpose of this paper is to examine whether the level of logistics information systems (LIS) adoption in manufacturing companies is influenced by organizational profile variables, such as the company`s size, the nature of its operations and their subsectors. Design/methodology/approach - A review of the mainstream literature on US was carried out to identify the factors influencing the adoption of such information systems and also some research gaps. The empirical study`s strategy is based on a survey research in Brazilian manufacturing firms from the capital goods industry. Data collected were analyzed through Kruskall-Wallis and Mann Whitney`s non-parametric tests. Findings - The analysis indicates that characteristics such as the size of companies and the nature of their operations influence the levels of LIS adoption, whilst comparisons regarding the subsectors appeared to be of little influence. Originality/value - This is the first known study to examine the influence of organizational profiles such as size, nature of operations and subsector on the level of US adoption in manufacturing companies. Moreover, it is unique in portraying the Brazilian scenario on this topic and addressing the adoption of seven types of LIS in a single study.