Martin Kulldorff

Bio: Martin Kulldorff is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Scan statistic & Population. The author has an hindex of 70, co-authored 244 publications receiving 19607 citations. Previous affiliations of Martin Kulldorff include Boston Children's Hospital & Harvard University.

A spatial scan statistic

Abstract: The scan statistic is commonly used to test if a one dimensional point process is purely random, or if any clusters can be detected. Here it is simultaneously extended in three directions:(i) a spatial scan statistic for the detection of clusters in a multi-dimensional point process is proposed, (ii) the area of the scanning window is allowed to vary, and (iii) the baseline process may be any inhomogeneous Poisson process or Bernoulli process with intensity pro-portional to some known function. The main interest is in detecting clusters not explained by the baseline process. These methods are illustrated on an epidemiological data set, but there are other potential areas of application as well.

Spatial disease clusters: detection and inference.

Abstract: We present a new method of detection and inference for spatial clusters of a disease. To avoid ad hoc procedures to test for clustering, we have a clearly defined alternative hypothesis and our test statistic is based on the likelihood ratio. The proposed test can detect clusters of any size, located anywhere in the study region. It is not restricted to clusters that conform to predefined administrative or political borders. The test can be used for spatially aggregated data as well as when exact geographic co-ordinates are known for each individual. We illustrate the method on a data set describing the occurrence of leukaemia in Upstate New York.

A space-time permutation scan statistic for disease outbreak detection.

Abstract: Background The ability to detect disease outbreaks early is important in order to minimize morbidity and mortality through timely implementation of disease prevention and control measures. Many national, state, and local health departments are launching disease surveillance systems with daily analyses of hospital emergency department visits, ambulance dispatch calls, or pharmacy sales for which population-at-risk information is unavailable or irrelevant. Methods and Findings We propose a prospective space–time permutation scan statistic for the early detection of disease outbreaks that uses only case numbers, with no need for population-at-risk data. It makes minimal assumptions about the time, geographical location, or size of the outbreak, and it adjusts for natural purely spatial and purely temporal variation. The new method was evaluated using daily analyses of hospital emergency department visits in New York City. Four of the five strongest signals were likely local precursors to citywide outbreaks due to rotavirus, norovirus, and influenza. The number of false signals was at most modest.

Prospective time periodic geographical disease surveillance using a scan statistic

Abstract: Most disease registries are updated at least yearly. If a geographically localized health hazard suddenly occurs, we would like to have a surveillance system in place that can pick up a new geographical disease cluster as quickly as possible, irrespective of its location and size. At the same time, we want to minimize the number of false alarms By using a space-time scan statistic, we propose and illustrate a system for regular time periodic disease surveillance to detect any currently active' geographical clusters of disease and which tests the statistical significance of such clusters adjusting for the multitude of possible geographical locations and sizes, time intervals and time periodic analyses. The method is illustrated on thyroid cancer among men in New Mexico 1973-1992.

Evaluating cluster alarms: a space-time scan statistic and brain cancer in Los Alamos, New Mexico.

Abstract: OBJECTIVES: This article presents a space-time scan statistic, useful for evaluating space-time cluster alarms, and illustrates the method on a recent brain cancer cluster alarms in Los Alamos, NM. METHODS: The space-time scan statistic accounts for the preselection bias and multiple testing inherent in a cluster alarm. Confounders and time trends can be adjusted for. RESULTS: The observed excess of brain cancer in Los Alamos was not statistically significant. CONCLUSIONS: The space-time scan statistic is useful as a screening tool for evaluating which cluster alarms merit further investigation and which clusters are probably chance occurrences.

sources and effects of ionizing radiation

Abstract: NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

A spatial scan statistic

Abstract: The scan statistic is commonly used to test if a one dimensional point process is purely random, or if any clusters can be detected. Here it is simultaneously extended in three directions:(i) a spatial scan statistic for the detection of clusters in a multi-dimensional point process is proposed, (ii) the area of the scanning window is allowed to vary, and (iii) the baseline process may be any inhomogeneous Poisson process or Bernoulli process with intensity pro-portional to some known function. The main interest is in detecting clusters not explained by the baseline process. These methods are illustrated on an epidemiological data set, but there are other potential areas of application as well.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Abstract: www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

[Guillain-Barré syndrome].

Abstract: L'incidence annuelle du syndrome de Guillain-Barre est de 1,5/100000 habitants La mortalite actuelle est estimee a environ 5 % d'apres des essais therapeutiques recents, bien conduits Dix pour cent des malades gardent des sequelles motrices tres invalidantes un an apres le debut des premiers signes neurologiques La prise en charge de ces malades necessite des equipes entrainees, multidisciplinaires, pouvant pratiquer l'ensemble des therapeutiques specifiques La corticotherapie per os'ou par voie intraveineuse est inefficace Les echanges plasmatiques sont le premier traitement dont l'efficacite a ete demontree par rapport a un groupe controle Les indications sont maintenant mieux connues Les formes benignes (marche possible) beneficient de 2 echanges plasmatiques; 2 echanges supplementaires sont realises en cas d'aggravation Dans les formes intermediaires (marche impossible) et les formes severes (recours a la ventilation mecanique), 4 echanges plasmatiques sont conseilles Il n'est pas utile d'augmenter leur nombre dans les formes severes ou en cas d'absence d'amelioration De fortes doses d'immunoglobulines donnees par voie intraveineuse (lq IV) [0,4 g/kg/j pendant 5 jours] sont aussi efficaces que les echanges plasmatiques dans les formes intermediaires et severes Dans ces formes, le choix entre Ig IV et echanges plasmatiques depend des contre-indications respectives de ces traitements et de leur faisabilite Les travaux en cours ont comme objectif de mieux preciser les indications respectives des echanges plasmatiques et des lq IV dans des formes de gravite differente, leur morbidite comparee, la dose optimale des lq IV