Faculty Bibliography

The era of applied genomic medicine is quickly approaching accompanied by the increasing availability of detailed genetic information. Understanding the genetic etiology behind complex, multi-gene diseases remains an important challenge. In order to uncover the putative genetic etiology of complex diseases, we designed a method that explores the relationships between two major terminological and ontological resources: the Unified Medical Language System (UMLS) and the Gene Ontology (GO). The UMLS has a mainly clinical emphasis; Gene Ontology has become the standard for biological annotations of genes and gene products. Using statistical and semantic relationships within and between the two resources, we are able to infer relationships between disease concepts in the UMLS and gene products annotated using GO and its associated databases. We validated our inferences by comparing them to the known gene-disease relationships, as defined in the Online Mendelian Inheritance in Man's morbidmap (OMIM). The proof-of-concept methods presented here are unique in that they bypass the ambiguity of the direct extraction of gene or disease term from MEDLINE. Additionally, our methods provide direct links to clinically significant diseases through established terminologies or ontologies. The preliminary results presented here indicate the potential utility of exploiting the existing, manually curated relationships in biomedical resources as a tool for the discovery of potentially valuable new gene-disease relationships

Medical diagnostic decision support systems are some of the most visible applications of medical informatics. Many of these systems, however, were created in the pre-WWW era, when access to clinical knowledge was much more limited than it is currently. Using the Google(tm) Java API1, we created a simple program to extract potential diagnoses from a general web search. Our system performed at a level comparable to other medical expert systems

To measure user expectations and knowledge of the issues involved in the transition from a paper-based system to an EHR, we created an on-line questionnaire, and invited physicians from several specialties at Beth Israel Medical Center (BIMC) to respond to it. As expected, most participants had positive expectations for the EHR and its features, but respondents were more skeptical of electronic clinical decision support systems (CDSS) than we had expected. The responses of this 'EHR-naive' group of physicians underscore the importance of managing expectations with the implementation of the EHR and of the delicate balance involved in preserving physician independence when proposing a clinical decision support system

The online population is becoming increasingly diverse. Cancer information websites are a popular destination. However, culturally-appropriate cancer information websites are lacking. METHODS: An Internet behavior and preference study was conducted in Caribbean immigrant women. 60 English-speaking Caribbean immigrant women in New York City participated in website review sessions. RESULTS: Three-quarters of the participants used computers regularly. Over 80% accessed the Internet from home. Over 50% felt confident using the Internet. However, only 6% used the Internet to search for health information. CONCLUSION: A 'cultural digital divide' exists. The Internet should be tailored to immigrants to facilitate web-based cancer education

This article examines whether differences in parental occupational prestige mediate or moderate race differences in four indicators of child development-reading scores, math scores, Behavior problems Index, and health status-using data front the Panel Stud v of Income Dynamics Child Development Supplement. The authors find that although for behavioral problems there is no impact of parental occupational prestige, for reading, math, and health there are significant academic returns to parental occupational prestige, but only for White families. The authors hypothesize that this racially, distinct dynamic may be a result of ongoing discrimination in the labor market, thereby, reducing the association between ability, (job and parenting) and prestige; or it may be a result of the difficulty of Blacks to translate occupational prestige gains into other benefits as a result of discrimination outside the labor market; or finally, it may, be the result of a generational lag between occupational status and parenting practices.

OBJECTIVE: The Minimizing Errors Maximizing Outcomes Study is designed to examine the effect of workplace conditions on quality of care and medical errors. In the first phase of the study, patients were asked to 'tell their stories' via focus groups. DESIGN: Moderators used a standard question guide. Researchers read the transcripts independently and reached consensus on major themes. Two coders independently assigned transcript statement to themes. SETTING: Three focus groups were conducted in three cities, including 21 patients from three clinics. PATIENTS: Patients with previously scheduled appointments at participating clinics were invited to join the focus groups. MEASUREMENTS AND MAIN RESULTS: Agreement between the two coders was 77.5% (kappa value 0.66). All but 2% of 187 distinct comments could be grouped into four categories: (1) Systems Issues (44% of comments). Long waits for providers and lack of access were the most common frustrations. Understaffing, underfunding and lack of health insurance were perceived as contributing to poor quality of care; (2) Interpersonal Skills (37%). Physician listening skills were valued. Participants felt patient attitudes affected care. (3) Knowledge and Technical Skills (9%). (4) Errors (7%). Medication errors, errors of inattention and technical errors were discussed. CONCLUSIONS: Patients provide important insights into complex systems issues, which can guide planners in improving quality and reducing errors. According to focus group participants, healthcare could be improved and made safer by increasing timely access to patients' own physicians, decreasing the time patients spend in waiting rooms, and adding staff to double-check prescriptions

OBJECIVES: To examine the number, type (menthol vs non-menthol), brand (Black, White, Women's, Other), and size of cigarette ads in Black, Latino, and White magazines. METHOD: Analysis of digital photographs of 274 cigarette ads appearing in Ebony (Black), People (White), and People in Spanish (Latino) for the 4.5-year period of January 1998 to August 2002. RESULTS: Black magazines were 9.8 times and Latino magazines 2.6 times more likely than White magazines to contain ads for menthol cigarettes. Black and Latino magazines also contained significantly more ads for brands (Virginia Slims) that target women. CONCLUSIONS: The tobacco industry continues to target Blacks with menthol cigarette ads, appears now to be targeting Latinos similarly, and targets Black and Latino women with additional, tailored cigarette ads