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Seleznjev, Oleg, and Bernhard Thalheim. "Random Databases with Approximate Record Matching." Methodology and Computing in Applied Probability 12, no. 1 (July 31, 2008): 63–89. http://dx.doi.org/10.1007/s11009-008-9092-4.
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Verykios, Vassilios S., Ahmed K. Elmagarmid, and Elias N. Houstis. "Automating the approximate record-matching process." Information Sciences 126, no. 1-4 (July 2000): 83–98. http://dx.doi.org/10.1016/s0020-0255(00)00013-x.
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Essex, Aleksander. "Secure Approximate String Matching for Privacy-Preserving Record Linkage." IEEE Transactions on Information Forensics and Security 14, no. 10 (October 2019): 2623–32. http://dx.doi.org/10.1109/tifs.2019.2903651.
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Hanrath, Scott, and Erik Radio. "User search terms and controlled subject vocabularies in an institutional repository." Library Hi Tech 35, no. 3 (September 18, 2017): 360–67. http://dx.doi.org/10.1108/lht-11-2016-0133.
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Purpose The purpose of this paper is to investigate the search behavior of institutional repository (IR) users in regard to subjects as a means of estimating the potential impact of applying a controlled subject vocabulary to an IR. Design/methodology/approach Google Analytics data were used to record cases where users arrived at an IR item page from an external web search and subsequently downloaded content. Search queries were compared against the Faceted Application of Subject Terminology (FAST) schema to determine the topical nature of the queries. Queries were also compared against the item’s metadata values for title and subject using approximate string matching to determine the alignment of the queries with current metadata values. Findings A substantial portion of successful user search queries to an IR appear to be topical in nature. User search queries matched values from FAST at a higher rate than existing subject metadata. Increased attention to subject description in IR records may provide an opportunity to improve the search visibility of the content. Research limitations/implications The study is limited to a particular IR. Data from Google Analytics does not provide comprehensive search query data. Originality/value The study presents a novel method for analyzing user search behavior to assist IR managers in determining whether to invest in applying controlled subject vocabularies to IR content.
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Bianchi Santiago, Josie D., Héctor Colón Jordán, and Didier Valdés. "Record Linkage of Crashes with Injuries and Medical Cost in Puerto Rico." Transportation Research Record: Journal of the Transportation Research Board 2674, no. 10 (July 31, 2020): 739–48. http://dx.doi.org/10.1177/0361198120935439.
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Cost considerations are critical in the analysis and prevention of traffic crashes. Integration of cost data into crash datasets facilitates the crash-cost analyses with all their related attributes. It is, however, a challenging task because of the lack of availability of unique identifiers across the databases and because of privacy and confidentiality regulations. This study performed a record linkage comparison between the deterministic and probabilistic approaches using attributes matching techniques with numerical distance and weight patterns under the Fellegi–Sunter approach. As a result, the deterministic algorithm developed using the exact match of the 14-digit police accident record number had an overall matching performance of 52.38% of real matched records, while the probabilistic algorithm had an overall matching performance of 70.41% with a quality measurement of the sensitivity of 99.99%. The deterministic approach was thus outperformed by the probabilistic approach by approximately 20% of records matched. The probabilistic matching with numerical variables seems to be a good matching strategy supported by quality variables. On record matching, a multivariable regression model was developed to model medical costs and identify factors that increase the costs of treating injured claimants in Puerto Rico.
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Douglas, M. M., D. Gardner, D. Hucker, and S. W. Kendrick. "Best-Link Matching of Scottish Health Data Sets." Methods of Information in Medicine 37, no. 01 (1998): 64–68. http://dx.doi.org/10.1055/s-0038-1634494.
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Abstract:Methods are described used to link the Community Health Index and the National Health Service Central Register (NHSCR) in Scotland to provide a basis for a national patient index. The linkage used a combination of deterministic and probability matching techniques. A best-link principle was used by which each Community Health Index record was allowed to link only to the NHSCR record with which it achieved the highest match weight. This strategy, applied in the context of two files which each covered virtually the entire population of Scotland, increased the accuracy of linkage approximately a thousand-fold compared with the likely results of a less structured probability matching approach. By this means, 98.8% of linkable records were linked automatically with a sufficient degree of confidence for administrative purposes.
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Wang, Shan, Huiling Shan, Chi Zhang, Yuexing Wang, and Chunxiang Shi. "Bias Correction in Monthly Records of Satellite Soil Moisture Using Nonuniform CDFs." Advances in Meteorology 2018 (July 16, 2018): 1–11. http://dx.doi.org/10.1155/2018/1908570.
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It is important to eliminate systematic biases in the field of soil moisture data assimilation. One simple method for bias removal is to match cumulative distribution functions (CDFs) of modeled soil moisture data to satellite soil moisture data. Traditional methods approximate numerical CDFs using 12 or 20 uniformly spaced samples. In this paper, we applied the Douglas–Peucker curve approximation algorithm to approximate the CDFs and found that three nonuniformly spaced samples can achieve the same reduction in standard deviation. Meanwhile, the matching results are always closely related to the temporal and spatial availability of soil moisture observed by automatic soil moisture station (ASM). We also applied the new nonuniformly spaced sampling method to a shorter time series. Instead of processing a whole year of data at once, we divided it into 12 datasets and used three nonuniformly spaced samples to approximate the model data’s CDF for each month. The matching results demonstrate that NU-CDF3 reduced the SD, improved R, and reduced the RMSD in over 70% of the stations, when compared with U-CDF12. Additionally, the SD and RMSD have been reduced by over 4% with R improved by more than 9%.
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Grannis, Shaun J., Huiping Xu, Joshua R. Vest, Suranga Kasthurirathne, Na Bo, Ben Moscovitch, Rita Torkzadeh, and Josh Rising. "Evaluating the effect of data standardization and validation on patient matching accuracy." Journal of the American Medical Informatics Association 26, no. 5 (March 8, 2019): 447–56. http://dx.doi.org/10.1093/jamia/ocy191.
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Abstract Objective This study evaluated the degree to which recommendations for demographic data standardization improve patient matching accuracy using real-world datasets. Materials and Methods We used 4 manually reviewed datasets, containing a random selection of matches and nonmatches. Matching datasets included health information exchange (HIE) records, public health registry records, Social Security Death Master File records, and newborn screening records. Standardized fields including last name, telephone number, social security number, date of birth, and address. Matching performance was evaluated using 4 metrics: sensitivity, specificity, positive predictive value, and accuracy. Results Standardizing address was independently associated with improved matching sensitivities for both the public health and HIE datasets of approximately 0.6% and 4.5%. Overall accuracy was unchanged for both datasets due to reduced match specificity. We observed no similar impact for address standardization in the death master file dataset. Standardizing last name yielded improved matching sensitivity of 0.6% for the HIE dataset, while overall accuracy remained the same due to a decrease in match specificity. We noted no similar impact for other datasets. Standardizing other individual fields (telephone, date of birth, or social security number) showed no matching improvements. As standardizing address and last name improved matching sensitivity, we examined the combined effect of address and last name standardization, which showed that standardization improved sensitivity from 81.3% to 91.6% for the HIE dataset. Conclusions Data standardization can improve match rates, thus ensuring that patients and clinicians have better data on which to make decisions to enhance care quality and safety.
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Zhang, Yifan, Erin E. Holsinger, Lea Prince, Jonathan A. Rodden, Sonja A. Swanson, Matthew M. Miller, Garen J. Wintemute, and David M. Studdert. "Assembly of the LongSHOT cohort: public record linkage on a grand scale." Injury Prevention 26, no. 2 (October 29, 2019): 153–58. http://dx.doi.org/10.1136/injuryprev-2019-043385.
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BackgroundVirtually all existing evidence linking access to firearms to elevated risks of mortality and morbidity comes from ecological and case–control studies. To improve understanding of the health risks and benefits of firearm ownership, we launched a cohort study: the Longitudinal Study of Handgun Ownership and Transfer (LongSHOT).MethodsUsing probabilistic matching techniques we linked three sources of individual-level, state-wide data in California: official voter registration records, an archive of lawful handgun transactions and all-cause mortality data. There were nearly 28.8 million unique voter registrants, 5.5 million handgun transfers and 3.1 million deaths during the study period (18 October 2004 to 31 December 2016). The linkage relied on several identifying variables (first, middle and last names; date of birth; sex; residential address) that were available in all three data sets, deploying them in a series of bespoke algorithms.ResultsAssembly of the LongSHOT cohort commenced in January 2016 and was completed in March 2019. Approximately three-quarters of matches identified were exact matches on all link variables. The cohort consists of 28.8 million adult residents of California followed for up to 12.2 years. A total of 1.2 million cohort members purchased at least one handgun during the study period, and 1.6 million died.ConclusionsThree steps taken early may be particularly useful in enhancing the efficiency of large-scale data linkage: thorough data cleaning; assessment of the suitability of off-the-shelf data linkage packages relative to bespoke coding; and careful consideration of the minimum sample size and matching precision needed to support rigorous investigation of the study questions.
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Greer, Melody Lynn. "4294 Patient Matching Errors and Associated Safety Events." Journal of Clinical and Translational Science 4, s1 (June 2020): 42. http://dx.doi.org/10.1017/cts.2020.160.
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OBJECTIVES/GOALS: Errors in patient matching could result in serious adverse safety events. Unlike publicized mix-ups by healthcare providers these errors are insidious and with increased data sharing, this is a growing concern in healthcare. The following project will examine patient matching errors and quantify their association with safety. METHODS/STUDY POPULATION: EHR systems perform matching out-of-the-box with unknown quality. Using matching processes outside the EMR, the rate at which matching errors are present was quantified and the erroneous records were flagged providing both comparative measures and data necessary to evaluate patient safety. To understand the relationship between matching and safety we will establish a percent of voluntarily reported safety events in our institution where a matching error existed during an encounter. Any safety events occurring for a flagged patient will be reviewed to determine if matching errors contributed to the safety problem. Not all safety events are reported so we will perform full chart review of a filtered list of medical records that have a higher likelihood of safety events. RESULTS/ANTICIPATED RESULTS: We were able to quantify matching errors, and the preliminary matching error rate is approximately 1%, representing over 700 patients. The work is in progress and we are beginning to determine the association between safety events and incorrect matching. Together these results will provide an incentive to identify errors, make corrections, and develop methods to achieve these objectives. The number of matching errors impacts patient care as well as business operations and is likely to have a negative financial impact on institutions with high error rates regardless of its relationship to safety. DISCUSSION/SIGNIFICANCE OF IMPACT: Patient matching is bundled with EHR software and institutions have little control over error rates, yet bear the liability for resulting clinical error. Institutions need to be able to identify undetected matching errors and any associated safety events and this project will provide that solution.
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Conway, Rebecca B. N., Matthew G. Armistead, Michael J. Denney, and Gordon S. Smith. "Validating the Matching of Patients in the Linkage of a Large Hospital System's EHR with State and National Death Databases." Applied Clinical Informatics 12, no. 01 (January 2021): 082–89. http://dx.doi.org/10.1055/s-0040-1722220.
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Abstract Background Though electronic health record (EHR) data have been linked to national and state death registries, such linkages have rarely been validated for an entire hospital system's EHR. Objectives The aim of the study is to validate West Virginia University Medicine's (WVU Medicine) linkage of its EHR to three external death registries: the Social Security Death Masterfile (SSDMF), the national death index (NDI), the West Virginia Department of Health and Human Resources (DHHR). Methods Probabilistic matching was used to link patients to NDI and deterministic matching for the SSDMF and DHHR vital statistics records (WVDMF). In subanalysis, we used deaths recorded in Epic (n = 30,217) to further validate a subset of deaths captured by the SSDMF, NDI, and WVDMF. Results Of the deaths captured by the SSDMF, 59.8 and 68.5% were captured by NDI and WVDMF, respectively; for deaths captured by NDI this co-capture rate was 80 and 78%, respectively, for the SSDMF and WVDMF. Kappa statistics were strongest for NDI and WVDMF (61.2%) and NDI and SSDMF (60.6%) and weakest for SSDMF and WVDMF (27.9%). Of deaths recorded in Epic, 84.3, 85.5, and 84.4% were captured by SSDMF, NDI, and WVDMF, respectively. Less than 2% of patients' deaths recorded in Epic were not found in any of the death registries. Finally, approximately 0.2% of “decedents” in any death registry re-emerged in Epic at least 6 months after their death date, a very small percentage and thus further validating the linkages. Conclusion NDI had greatest validity in capturing deaths in our EHR. As a similar, though slightly less capture and agreement rate in identifying deaths is observed for SSDMF and state vital statistics records, these registries may be reasonable alternatives to NDI for research and quality assurance studies utilizing entire EHRs from large hospital systems. Investigators should also be aware that there will be a very tiny fraction of “dead” patients re-emerging in the EHR.
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Eichstaedt, Johannes C., Robert J. Smith, Raina M. Merchant, Lyle H. Ungar, Patrick Crutchley, Daniel Preoţiuc-Pietro, David A. Asch, and H. Andrew Schwartz. "Facebook language predicts depression in medical records." Proceedings of the National Academy of Sciences 115, no. 44 (October 15, 2018): 11203–8. http://dx.doi.org/10.1073/pnas.1802331115.
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Depression, the most prevalent mental illness, is underdiagnosed and undertreated, highlighting the need to extend the scope of current screening methods. Here, we use language from Facebook posts of consenting individuals to predict depression recorded in electronic medical records. We accessed the history of Facebook statuses posted by 683 patients visiting a large urban academic emergency department, 114 of whom had a diagnosis of depression in their medical records. Using only the language preceding their first documentation of a diagnosis of depression, we could identify depressed patients with fair accuracy [area under the curve (AUC) = 0.69], approximately matching the accuracy of screening surveys benchmarked against medical records. Restricting Facebook data to only the 6 months immediately preceding the first documented diagnosis of depression yielded a higher prediction accuracy (AUC = 0.72) for those users who had sufficient Facebook data. Significant prediction of future depression status was possible as far as 3 months before its first documentation. We found that language predictors of depression include emotional (sadness), interpersonal (loneliness, hostility), and cognitive (preoccupation with the self, rumination) processes. Unobtrusive depression assessment through social media of consenting individuals may become feasible as a scalable complement to existing screening and monitoring procedures.
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Oliveira, Mariana S., Adriano Mourthe, and Maria Clara Duque. "Extracting events from Daily Drilling Reports using Fuzzy String Matching." APPEA Journal 62, no. 2 (May 13, 2022): S158—S161. http://dx.doi.org/10.1071/aj21118.
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Continuous monitoring of oil drilling operations reduces process interruptions and equipment failure. It also contributes to the development of Key Performance Indicators, which leads to more efficient resource management. Daily Drilling Reports (DDRs) have long been the primary way of recording noticeable events, such as stuck pipe. DDRs came to constitute a valuable information base for most oil drilling companies. However, the task of extracting knowledge from DDRs can be costly and time-consuming. This work proposes an approach to recognise drilling events in DDRs using a rule-based language processing method called Fuzzy String Matching (FSM). We applied the FSM algorithm to search for a set of predefined keywords and key phrases to extract possible Invisible Lost Time (ILT) events from DDRs that may indicate risks or low operational efficiency. The fuzzy part of the algorithm allows the identification of terms or expressions that match the pre-established ones approximately rather than exactly, accounting for typos and different suffixes or prefixes. The proposed solution was applied on a data set of 392 real-world DDR records from a drilling company using a set of six ILT event’s key phrases annotated by Subject Matter Specialists. This process can be readily replicated to other events. The results show that in 116 reports tagged as normal, 92 records were identified as possible ILT events, which represents, in hours, 56% of the total drill normal time. Such promising results can lead to very significant improvements in identifying and extracting drilling events within DDRs.
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Liu, Qingwei, and Aihua Xia. "On moderate deviations in Poisson approximation." Journal of Applied Probability 57, no. 3 (September 2020): 1005–27. http://dx.doi.org/10.1017/jpr.2020.47.
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AbstractIn this paper we first use the distribution of the number of records to demonstrate that the right tail probabilities of counts of rare events are generally better approximated by the right tail probabilities of a Poisson distribution than those of the normal distribution. We then show that the moderate deviations in Poisson approximation generally require an adjustment and, with suitable adjustment, we establish better error estimates of the moderate deviations in Poisson approximation than those in [18]. Our estimates contain no unspecified constants and are easy to apply. We illustrate the use of the theorems via six applications: Poisson-binomial distribution, the matching problem, the occupancy problem, the birthday problem, random graphs, and 2-runs. The paper complements the works [16], [8], and [18].
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Foukal, Peter. "Solar Irradiance Variability and Luminosity Changes." Highlights of Astronomy 10 (1995): 294–95. http://dx.doi.org/10.1017/s1539299600011242.
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This review presents a discussion of radiometrie measurements of solar total irradiance variation, ΔS, on time scales of days, to the 15-year extent of present measurements. It does not cover variations in spectral irradiance, particularly the relatively large solar UV and EUV flux variations of great importance in studies of trends in stratospheric ozone, and of upper atmospheric heating variations.Analysis of the pyrheliometry of ΔS carried out from the Solar Maximum Mission, Nimbus-7 and ERB S satellites has shown that a) the sun brightens by 0.05 - 0.1% around activity maximum and; b) it dims by up to approximately 0.2% when large sunspot groups cross the disc. Empirical models of ΔS based on areas and photometric contrasts of sunspots, and on proxies of facular area, are remarkably successful in matching the observed record of ΔS, on time scales between days and the full 15- year record available since 1978. These models indicate that the opposite contributions of sunspots and faculae in active regions roughly balance over time scales of years, and the net solar brightening observed around peak activity is caused by increased emission from the photospheric magnetic network.
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Amiri-Kordestani, Laleh, Xin Gao, Shrujal Baxi, Erik Bloomquist, Jonathan Bryan, Lynn Howie, Catherine Keane, et al. "Abstract P2-11-05: Generating real-world external comparators for randomized clinical trials (RCTs) in metastatic breast cancer (mBC) using electronic health records (EHRs)." Cancer Research 82, no. 4_Supplement (February 15, 2022): P2–11–05—P2–11–05. http://dx.doi.org/10.1158/1538-7445.sabcs21-p2-11-05.
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Abstract Objectives: Real-world data (RWD) from the routine care of patients with cancer captured through EHRs is a valuable resource for research. Understanding the relationship between characteristics and outcomes of patients treated in the real world and those treated in clinical trials is essential to produce evaluable trial-like populations using RWD in oncology for research and regulatory purposes. Methods: This study used: a) RWD from the Flatiron Health EHR-derived, de-identified, longitudinal database (comprising patient-level structured and unstructured data, curated via technology-enabled abstraction selected from approximately 280 US cancer clinics [~800 sites of care]) and b) patient-level data from three completed RCTs (PALOMA-2, MONALEESA-2, and MONARCH-3) including patients with previously untreated hormone receptor positive (HR+), HER2/neu negative (HER2-) mBC, then separately pooled across the trials into two treatment groups, patients who received aromatase inhibitor monotherapy (AI) or a CDK4/6 inhibitor + AI. Key eligibility criteria were similar across the RCTs and were used to select a real world external cohort (rwEC) initiating AI monotherapy on or prior to 11 Nov 2015 (end of MONARCH-3 enrollment period). Patients from the rwEC were matched separately to the control arm and experimental arm patients from the pooled RCT using propensity score method (PSM). The propensity score was estimated by a logistic regression using baseline covariates of age, race, site of disease (visceral, non-visceral), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0, 1), and metastatic disease (recurrent, new). The matching ratio was 1:1 without replacement with calipers. Covariate balance was measured by the absolute standardized mean difference (ASMD). Due to the high percentage of missing ECOG PS data, matching was repeated 100 times with imputed ECOG PS. The impact of including additional key covariates for propensity matching such as number of disease sites, bone-only disease, and prior endocrine therapy was assessed. Results: There were 1326 patients with HR+, HER2- mBC selected from the EHR-derived database who received first-line AI therapy and 1827 patients randomized in the RCTs (1106 and 721 patients for experimental and control arms, respectively). With 100 matching iterations, 563 rwEC patients on average (range, 547-572) were matched to the RCTs control arm, and 753 rwEC patients on average (range: 741-761) were matched to the RCTs experimental arm. Prior to matching, the ASMD varied widely across all prespecified baseline covariates (4.3 for the rwEC vs. RCTs control arm, 2.6 for the rwEC vs. RCTs experimental arm). After matching was performed, across all baseline covariates used in the PSM, the ASMD was reduced to be under 0.12 for the rwEC vs. RCTs control arm, and under 0.2 for the rwEC vs. RCTs experimental arm in more than 90% of the matching iterations. Analyses looking at the additional baseline covariates to the propensity matching resulted in similar ASMDs. Conclusions: EHR-derived RWD can be used to generate a cohort of patients with similar baseline characteristics to those treated on RCT. The next step in our trial emulation framework is to analyze the comparability of outcomes between these two matched cohorts. Citation Format: Laleh Amiri-Kordestani, Xin Gao, Shrujal Baxi, Erik Bloomquist, Jonathan Bryan, Lynn Howie, Catherine Keane, Paul G. Kluetz, Christy Osgood, Prashni Paliwal, Donna R. Rivera, James Roose, Julie Schneider, Harpreet Singh, Shenghui Tang, Lijun Zhang, Julia A. Beaver. Generating real-world external comparators for randomized clinical trials (RCTs) in metastatic breast cancer (mBC) using electronic health records (EHRs) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-05.
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Liu, Yuchen, Jianhong (Cecilia) Xia, and Aloke Phatak. "Evaluating the Accuracy of Bluetooth-Based Travel Time on Arterial Roads: A Case Study of Perth, Western Australia." Journal of Advanced Transportation 2020 (February 21, 2020): 1–19. http://dx.doi.org/10.1155/2020/9541234.
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Bluetooth (BT) time-stamped media access control (MAC) address data have been used for traffic studies worldwide. Although Bluetooth (BT) technology has been widely recognised as an effective, low-cost traffic data source in freeway traffic contexts, it is still unclear whether BT technology can provide accurate travel time (TT) information in complex urban traffic environments. Therefore, this empirical study aims to systematically evaluate the accuracy of BT travel time estimates in urban arterial contexts. There are two major hurdles to deriving accurate TT information for arterial roads: the multiple detection problem and noise in BT estimates. To date, they have not been fully investigated, nor have well-accepted solutions been found. Using approximately two million records of BT time-stamped MAC address data from twenty weekdays, this study uses five different BT TT-matching methods to investigate and quantify the impact of multiple detection problems and the noise in BT TT estimates on the accuracy of average BT travel times. Our work shows that accurate Bluetooth-based travel time information on signalised arterial roads can be derived if an appropriate matching method can be selected to smooth out the remaining noise in the filtered travel time estimates. Overall, average-to-average and last-to-last matching methods are best for long (>1 km) and short (≤1 km) signalised arterial road segments, respectively. Furthermore, our results show that the differences between BT and ground truth average TTs or speeds are systematic, and adding a calibration is a pragmatic method to correct inaccurate BT average TTs or speeds. The results of this research can help researchers and road operators to better understand BT technology for TT analysis and consequently to optimise the deployment location and configuration of BT MAC address scanners.
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Kwak, Jaewon. "An Assessment of Dam Operation Considering Flood and Low-Flow Control in the Han River Basin." Water 13, no. 5 (March 8, 2021): 733. http://dx.doi.org/10.3390/w13050733.
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An assessment of dam operation is essential in dam management; however, there is a lack of a simple method that could be used in actual practice. This study aims for an actual dam operation evaluation method for flood and low-flow control of the three multi-purpose dams of Soyanggang, Chungju, and Hoengseong in the Han River basin, South Korea. Frequency matching method was applied to make a pair of cumulative distribution function (CDF) using daily dam inflow and outflow records. Runoff increasing and flood reduction rates are derived using CDFs of total and annual records. As a result, the average flood mitigation rates of the Chungju dam is approximately 35% annually and is relatively disadvantaged than the Soyanggang dam, which is 67.7% annually, due to small flood control capacity. The Hoengseong dam appeared to have a small flood reduction rate, but its runoff increasing rate is 94.7% annually because of the 209 km2 upper basin area. The suggested method in this study could be used as a simple and intuitive field method to evaluate dam operations. Also, according to the annual evaluation, the Soyanggang and Chunju dam need more aggressive and anticipative operations for flood control such as pre-discharge before flooding or modify the Restricted Water Level (RWL) for flood seasons. On the other hand, Hoengseong dam need further data and studies.
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Seppä, Heikki, and K. D. Bennett. "Quaternary pollen analysis: recent progress in palaeoecology and palaeoclimatology." Progress in Physical Geography: Earth and Environment 27, no. 4 (December 2003): 548–79. http://dx.doi.org/10.1191/0309133303pp394oa.
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During the last decade Quaternary pollen analysis has developed towards improved pollen-taxonomical precision, automated pollen identification and more rigorous definition of pollen assemblage zones. There have been significant efforts to model the spatial representation of pollen records in lake sediments which is important for more precise interpretation of the pollen records in terms of past vegetation patterns. We review the difficulties in matching modelled post-glacial plant migration patterns with pollen-based palaeorecords and discuss the potential of DNA analysis of pollen to investigate the ancestry and past migration pathways of the plants. In population ecology there has been an acceleration of the widely advocated conceptual advance of pollen-analytical research from vaguely defined ‘environmental reconstructions’ towards investigating more precisely defined ecological problems aligned with the current ecological theories. Examples of such research have included an increasing number of investigations about the ecological impacts of past disturbances, often integrating pollen records with other palaeoecological data. Such an approach has also been applied to incorporate a time perspective to the questions of ecosystem restoration, nature conservation and forest management. New lines of research are the use of pollen analysis to study long-term patterns of vegetation diversity, such as the role of glacial-age vegetation fragmentation as a cause of Amazonian rain forest diversity, and to investigate links between pollen richness and past plant diversity. Palaeoclimatological use of pollen records has become more quantitative and has included more precise and rigorous testing of pollen-climate calibration models with modern climate data. These tests show the approximate nature of the models and warn against a too straightforward climatic interpretation of the small-scale variation in reconstructions. Pollen-based climate reconstructions over the Late Glacial-early Holocene boundary have indicated that pollen-stratigraphical changes have been rapid with no evidence for response lags. This does not rule out the possibility of migrational disequilibrium, however, as the rapid changes may be mostly due to nonmigrational responses of existing vegetation. It is therefore difficult to assess whether the amplitude of reconstructed climate change reflects real climate change. Other outstanding problems remain the obscure relationship of pollen production and climate, the role of human impact and other nonclimatic factors, and nonanalogue situations.
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Juluri, Ravichandra, Maria Moran, Jon B. Suzuki, and Ahmed Khocht. "A Comparison of Computed Tomography Scans and Digital Periapical Radiographs Ridge Height Measurements." Journal of Oral Implantology 41, no. 2 (April 1, 2015): 125–31. http://dx.doi.org/10.1563/aaid-joi-d-12-00169.
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To investigate the agreement between computerized tomography scans (CT) and intraoral periapical digital radiographs (PA) alveolar ridge height measurements in maxillary and mandibular posterior regions. We reviewed 100 implant patient radiographic records and identified 27 mandibular sites in 19 patients and 23 maxillary sites in 13 patients with available CT scans and matching PA radiographs. The distance from the crest of the ridge to the floor of the maxillary sinus or to the superior border of the inferior alveolar canal was measured. PAs were measured with Dexis software v. 8.0 and CTs were measured with Simplant software v. 11.02. Two examiners (RJ and MM) recorded the measurements separately; each examiner recorded two readings. The average of the 4 readings was used for data analysis. Absolute agreement: Paired t test comparing ridge-height measurements between the two imaging methods showed no differences for maxillary sites (P > 0.2) and significant differences for the mandibular sites (CT > PA, P = 0.0009). Relative agreement: Kendall rank correlation analysis of ridge-height measurements between the 2 imaging methods showed a high positive correlation for maxillary sites (Kendall's tau = 0.76, P = 0.0001) and moderate correlation for the mandibular sites (Kendall's tau = 0.46, P = 0.001). Maxillary PAs tend to approximate CT ridge-height measurements. By contrast mandibular PAs tend to underestimate the distance from the crest of the ridge to the inferior alveolar canal.
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Ronquillo, Jay G., and William T. Lester. "Practical Aspects of Implementing and Applying Health Care Cloud Computing Services and Informatics to Cancer Clinical Trial Data." JCO Clinical Cancer Informatics, no. 5 (August 2021): 826–32. http://dx.doi.org/10.1200/cci.21.00018.
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PURPOSE Cloud computing has led to dramatic growth in the volume, variety, and velocity of cancer data. However, cloud platforms and services present new challenges for cancer research, particularly in understanding the practical tradeoffs between cloud performance, cost, and complexity. The goal of this study was to describe the practical challenges when using a cloud-based service to improve the cancer clinical trial matching process. METHODS We collected information for all interventional cancer clinical trials from ClinicalTrials.gov and used the Google Cloud Healthcare Natural Language Application Programming Interface (API) to analyze clinical trial Title and Eligibility Criteria text. An informatics pipeline leveraging interoperability standards summarized the distribution of cancer clinical trials, genes, laboratory tests, and medications extracted from cloud-based entity analysis. RESULTS There were a total of 38,851 cancer-related clinical trials found in this study, with the distribution of cancer categories extracted from Title text significantly different than in ClinicalTrials.gov ( P < .001). Cloud-based entity analysis of clinical trial criteria identified a total of 949 genes, 1,782 laboratory tests, 2,086 medications, and 4,902 National Cancer Institute Thesaurus terms, with estimated detection accuracies ranging from 12.8% to 89.9%. A total of 77,702 API calls processed an estimated 167,179 text records, which took a total of 1,979 processing-minutes (33.0 processing-hours), or approximately 1.5 seconds per API call. CONCLUSION Current general-purpose cloud health care tools—like the Google service in this study—should not be used for automated clinical trial matching unless they can perform effective extraction and classification of the clinical, genetic, and medication concepts central to precision oncology research. A strong understanding of the practical aspects of cloud computing will help researchers effectively navigate the vast data ecosystems in cancer research.
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Brokešová, Johana, and Jiří Málek. "Comparative Measurements of Local Seismic Rotations by Three Independent Methods." Sensors 20, no. 19 (October 5, 2020): 5679. http://dx.doi.org/10.3390/s20195679.
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A comparative active experiment that is aimed at collocated measurement of seismic rotation rates along three orthogonal axes by means of three different methods is described. The rotation rates in a short-period range of 6–20 Hz were obtained using three different methods: the 6C Rotaphone sensor system developed by the authors, the commercial R-1 rotational sensor by Eentec, and a small-aperture array of twelve standard velocigraphs in a rectangular arrangement. Those three methods are compared and discussed in detail. A medium-size quarry blast was used as a seismic source. At a distance of approximately 240 m, the rotation rates reached an amplitude of the order of magnitude of 10−4–10−5 rad/s. The array derived rotation rates displayed serious limitations, as clearly documented. The R-1 instruments have shown certain technical problems that partly limit their applicability. The measured rotation rates were compared to the relevant acceleration components according to rotation-to-translation relations. Out of all the three methods, the records best matching the acceleration components were made by Rotaphone. The experiment also revealed that rotation rates in the given short-period range noticeably changed over a distance as short as 2 m.
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Tweet, Justin, Karen Chin, and A. A. Ekdale. "Trace fossils of possible parasites inside the gut contents of a hadrosaurid dinosaur, Upper Cretaceous Judith River Formation, Montana." Journal of Paleontology 90, no. 2 (March 2016): 279–87. http://dx.doi.org/10.1017/jpa.2016.43.
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AbstractTiny sinuous trace fossils have been found within probable gut contents of an exceptionally preserved specimen of a hadrosaurid dinosaur,Brachylophosaurus canadensis, from the Judith River Formation of Montana. Approximately 280 examples of the trace fossils were observed in 19 samples of gut region material. The tubular structures typically are about 0.3 mm across. Many have thin calcareous linings or layers, and some exhibit fine surficial striae. At least two dozen of these trace fossils share walls with adjacent tubular traces, and this association can extend for several millimeters. While the trace fossils share some characteristics with fine rhizoliths, these features are most consistent with tiny burrows, or possibly body impressions, of worms (vermiform organisms) of uncertain biologic affinity. Such trace fossils have not been reported previously, and herein described asParvitubulites striatusn. gen. n. sp. Either autochthonous (parasites) or allochthonous (scavengers) worms may have created the trace fossils, but taphonomic factors suggest that autochthonous burrowers are more likely. Several lines of evidence, such as constant diameters and matching directional changes, suggest that the paired trace fossils were made by two individuals moving at the same time, which implies sustained intraspecific contact.Parvitubulites striatusprovides a rare record of interactions between terrestrial, meiofaunal-sized, soft-bodied invertebrates and a dinosaur carcass. The evidence that the worms may have parasitized a living hadrosaur and subsequently left traces of intraspecific behavior between individual worms adds unique information to our understanding of Mesozoic trophic interactions.
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Machado, Gabriel L., Garrett J. Hickman, Maulin P. Gogri, Kurt J. Marfurt, Matthew J. Pranter, and Zulfiquar A. Reza. "Characterization of Arbuckle-basement wastewater disposal system, Payne County, Northern Oklahoma." Interpretation 7, no. 4 (November 1, 2019): SL19—SL36. http://dx.doi.org/10.1190/int-2019-0025.1.
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Over the past eight years, north-central Oklahoma has experienced a significant increase in seismicity. Although the disposal of large volumes of wastewater into the Arbuckle Group basement system has been statistically correlated to this increased seismicity, our understanding of the actual mechanisms involved is somewhat superficial. To address this shortcoming, we initiated an integrated study to characterize and model the Arbuckle-basement system to increase our understanding of the subsurface dynamics during the wastewater-disposal process. We constructed a 3D geologic model that integrates 3D seismic data, well logs, core measurements, and injection data. Poststack-data conditioning and seismic attributes provided images of faults and the rugose top of the basement, whereas a modified-Hall analysis provided insights into the injection behavior of the wells. Using a Pareto-based history-matching technique, we calibrated the 3D models using the injection rate and pressure data. The history-matching process showed the dominant parameters to be formation-water properties, permeability, porosity, and horizontal anisotropy of the Arbuckle Group. Based on the pressure buildup responses from the calibrated models, we identified sealing and conductive characteristics of the key faults. Our analysis indicates the average porosity and permeability of Arbuckle Group to be approximately 7% and 10 mD, respectively. The simulation models also showed pockets of nonuniform and large pressure buildups in these formations, indicating that faults play an important role in fluid movement within the Arbuckle Group basement system. As one of the first integrated investigations conducted to understand the potential hydraulic coupling between the Arbuckle Group and the underlying basement, we evaluate the need for improved data recording and additional data collection. In particular, we recommend that operators wishing to pursue this type of analysis record their injection data on a daily rather than on an averaged basis. A more quantitative estimation of reservoir properties requires the acquisition of P-wave and dipole sonic logs in addition to the commonly acquired triple-combo logs. Finally, to better quantify flow units with the disposal reservoir, we recommend that operators acquire sufficient core to characterize the reservoir heterogeneity.
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Qiu, Junlan, Haifeng Zhang, Dongkui Xu, Lin Li, Lingkai Xu, Yiqing Jiang, Tao Wen, et al. "Comparing Long-Term Survival Outcomes for Muscle-Invasive Bladder Cancer Patients Who Underwent with Radical Cystectomy and Bladder-Sparing Trimodality Therapy: A Multicentre Cohort Analysis." Journal of Oncology 2022 (May 14, 2022): 1–11. http://dx.doi.org/10.1155/2022/7306198.
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Background. Although radical cystectomy (RC) is the clinical practice guideline-recommended treatment of muscle-invasive bladder cancer (MIBC), bladder-sparing trimodality therapy (TMT) has emerged as a valid treatment option. Findings comparing the survival outcomes for MIBC patients who underwent RC and TMT are inconclusive. Objective. We designed a large hospital-based multicohort study to compare the effectiveness of TMT with RC. Methods. Information on deaths was jointly retrieved from EMR (electronic medical record), cause of death registry, and chronic disease surveillance as well as study-specific questionnaire. To avoid the systematical difference between patients who received two modalities, RC-MIBC cohort was propensity score-matched to TMT-MIBC cohort, and the Cox proportional hazard regression was used to calculate the overall survival (OS) and disease-specific survival (DSS). Results. There were 891 MIBC patients treated with RC and another 891 MIBC patients who underwent with TMT in the propensity score matching. Comparable effectiveness between two modalities was observed for DSS (HR, 1.20; 95% confidence interval (CI), 0.94 to 1.49) and OS (HR, 1.17; 95% CI, 0.91 to 1.43) according to multiple adjustment after a median follow-up of approximately 9.3 years. However, a relatively higher mortality rate around 5 years after TMT treatment was found compared to RC (HR, 1.26; 95% CI, 1.01 to 1.53). The respective 5-year OS rates were 69% and 73% for TMT cohort and RC cohort, respectively. Conclusions. Our findings supported that MIBC patients with TMT yielded survival outcomes comparable to MIBC patients who underwent RC overall. Treatment options should be suggested considering patients’ age and willingness.
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Saskin, Aliza, Yulia Lin, Richard A. Wells, Martha Lenis, Alex Mamedov, Jeannie Callum, and Rena Buckstein. "Prophylactic Rh and Kell Antigen Matching Significantly Decreases Rates of Alloimmunization in Transfusion Dependent MDS Patients." Blood 124, no. 21 (December 6, 2014): 4297. http://dx.doi.org/10.1182/blood.v124.21.4297.4297.
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Abstract Background: 40-80 % of patients with myelodysplastic syndrome (MDS) become transfusion dependent during their disease course and are at risk for the development of alloimmunization. Red blood cell (RBC) alloantibodies can make finding compatible blood for transfusion more difficult, expensive and time consuming. Allommunization rates of approximately 30-47% have been reported in patients with sickle cell disease and the transfusion of RBCs prophylactically matched for Rh antigens E and C, and K antigens reduced the rate of alloimmunization from 3% to 0.5% per unit (Vichinsky et al, 2001). In 2007, our hospital instituted a policy of transfusing prophylactic Rh and K matched blood to MDS patients. The objectives of this study were to compare the rates of alloimmunization in MDS patients who received prophylactic Rh and K matched blood compared to those that did not and identify potential risk factors for alloimmunization. Methods: 193 Transfusion dependent MDS patients were identified out of 387 patients registered and prospectively followed in a local MDS registry. Transfusion dependence was defined as the receipt of at least 1 unit of PRBC every 8 weeks for a minimum of 16 weeks. Records of transfusions received up to May 1, 2014 were collected from blood bank databases of the hospitals at which patients were transfused. Patients were classified according to whether phenotyping had been performed, the location of transfusions (transfused only at our institution, transfused only at an outside institution or transfused at both sites) and whether prophylactic Rh (E, C antigens) and K matched blood was transfused. Data were descriptively analyzed and we conducted univariate and multivariate logistic regression using p< 0.05 as statistically significant to identify risk factors for alloimmunization. Results: 176 MDS patients with complete transfusion records are included, 73 transfused at Sunnybrook, 92 transfused in community hospitals and 11 at both. The median age was 72 yrs (range 22-89), 60% were male, and 8%, 43% and 27% had very low, low and intermediate risk R-IPSS scores respectively. Median follow up was 2.9 years (IQR 1.6-5) 3.49 SD). Blood groups O, A, B, AB and O were 45%, 38%, 15% and 2% respectively, while 85% were RhD+. The median time from diagnosis until first transfusion was 4 months (IQR: 0.2-14), with 51 patients having received at least 1 transfusion prior to diagnosis at a median time of 0.9 months. 4.5% had a pre-existing allo-antibody at time of MDS diagnosis. With a median follow up from diagnosis of 3 years (IQR:1.6-5)), the median number of RBC units transfused was 38 (IQR: 15-98)) and 36 (20%) patients developed new alloantibodies (median 2 (IQR (1-2.5) alloantibodies). The median number of RBC units until first allo antibody was 13.5 units (range 0-121) and 1.25 years from diagnosis (95% CI:0.4-2.1). The majority of the alloantibodies were in the Rh (n=28) and K (n=14) groups (80%) and co-existed 27% of the time. More patients transfused at our hospital received prophylactic Rh K matched blood sometimes or always (60% versus 26%) and rates of allo-immunization were decreased by 65% (absolute rate of alloimmunization 10% versus 29%). By multivariate analysis analysis, number of rbc transfused (p<.0001), receiving prophylactic phenotype matched blood (p=.0008) and location of transfusions (Sunnybrook versus elsewhere (p=.03)) were independent risk factors for alloimmunization. Conclusions: 20-30% of RBC transfusion dependent MDS patients will become allo-immunized to clinically significant blood group antigens, the majority being Rh and K antigens. The practice of phenotyping at baseline and prophylactically transfusing Rh and Kell matched blood decreases rates of alloimmunization up to 65% and should be strongly considered for routine transfusion practice in centres that treat MDS. Table 1. All Patients (n=176) Sunnybrook (n=73) Community(n=92) Ever phenotyped 45% 64% 28% Phenotyped before 1st transfusion 20% 38% 8% Developed allo-antibodies 20% 10% 29% Received prophylactic Rh K matched blood (developed alloantibodies) Never Sometimes Always 58% (16%) 24% (42%) 18% (6%) 40% (3%) 23% (23%) 37% (7%) 74% (22%) 22% (60%) 4% (0%) Figure 1. Allo Antibody free survival according to number of red cell units transfused in patients that developed an allo-antibody Figure 1. Allo Antibody free survival according to number of red cell units transfused in patients that developed an allo-antibody Disclosures Wells: Celgene: Honoraria, Other, Research Funding; Novartis: Honoraria, Research Funding; Alexion: Honoraria, Research Funding. Buckstein:Celgene: Research Funding.
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Hashibe, Mia, Yuji Chen, Brenna Blackburn, Yuan Wan, Kerry G. Rowe, John Snyder, Vikrant Deshmukh, et al. "Genitourinary disease risks among 5-year ovarian cancer survivors in a population-based cohort study." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10073. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10073.
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10073 Background: In the US, there are approximately 235,200 ovarian cancer survivors today. Five-year survival for ovarian cancer has increased from 36% for women who were diagnosed in 1975-1977 to 46% for women diagnosed between 2005-2011. Long term follow-up studies among ovarian cancer survivors are uncommon and late effects have not been well characterized in a population-based cohort. Although genitourinary complications during treatment are well known, long term impacts need to be investigated. Methods: A total of 602 first primary invasive ovarian cancer cases diagnosed between 1996-2012 who survived for > 5 years were identified in the Utah Population Database and compared to a general population cohort of women. Genitourinary disease diagnoses were identified through ICD codes from hospital electronic medical records and statewide ambulatory surgery and inpatient data. Cox regression models were used to estimate hazard ratios for disease risks by time since cancer diagnosis with adjustments on matching factors, baseline BMI, baseline Charlson Comorbidity Index (CCI), and race. Results: The overall risk of genitourinary diseases for ovarian cancer patients in comparison to the general population cohort was 1.51 (95%CI = 1.30-1.74) 5-10 years after cancer diagnosis. Approximately 54.6% of ovarian cancer survivors were diagnosed with a genitourinary disease 5-10 years after cancer diagnosis. The most common genitourinary diseases among the ovarian cancer survivors were urinary tract infections (10.1%), acute renal failure (5.5%), and chronic kidney disease (4.4%). The greatest risks were observed for hydronephrosis (HR = 10.65, 95%CI = 3.68-30.80), pelvic peritoneal adhesions (HR = 5.81, 95%CI = 1.11-30.39), cystitis and urethritis (HR = 2.67, 95%CI = 1.21-6.38), and acute renal failure (HR = 2.30, 95%CI = 1.36-3.88). Conclusions: Ovarian cancer survivors experience increased risks of various genitourinary diseases in the 5-10 year period following cancer diagnosis. Understanding the multimorbidity trajectory among ovarian cancer survivors is of vital importance to improve their clinical care after cancer diagnosis and allow for increased attention to these potential late effects.
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Welch, Brian C., Kieran Dwyer, Michael Helgen, Christopher F. Waythomas, and Robert W. Jacobel. "Geophysical survey of the intra-caldera icefield of Mt Veniaminof, Alaska." Annals of Glaciology 45 (2007): 58–65. http://dx.doi.org/10.3189/172756407782282381.
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AbstractMt Veniaminof is a large active stratovolcano located on the Alaska Peninsula (56.2° N, 159° W). We present results of the first geophysical survey of the icefield that fills much of the 10 km×8 km caldera that was most recently modified during the last major eruption roughly 3700 BP. The subglacial topography and ice volume are derived from an 8MHz radio-echo sounding survey conducted in July 2005. Prominent internal reflectors are assumed to be isochronal ash/acid deposits related to local eruptions. Accumulation rates and basal melt rates are calculated using a Nye one-dimensional steady-state accumulation model applied at a location that approximates an ice divide and calibrated by matching internal reflectors with published records of recent local volcanic eruptions. The model yields order of magnitude estimates of the accumulation rate of 4ma–1 water equivalent and 2 ma–1 of basal melt. The subsequent geothermal flux of ∽19Wm–2 is similar to active hydrothermal vents in volcanic lakes. We suggest that these values represent an upper limit for the geothermal flux within the ice-covered regions of the main caldera. We also analyze likely subglacial meltwater flow paths to examine the implications of recent eruption activity at an active intra-caldera cinder cone. Two lava-producing eruptions from the cinder cone in 1983–84 and 1993–94 melted roughly 0.17km3 of ice. The lack of significant deformation of the internal stratigraphy to the south and east of the melt hole suggests that any subglacial drainage in those directions was entirely within subglacial deposits. We suggest that the more likely drainage route was northwest into a large outlet glacier.
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Emms, Richard. "The scribe of the Paris Psalter." Anglo-Saxon England 28 (December 1999): 179–83. http://dx.doi.org/10.1017/s0263675100002301.
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The Paris Psalter (Bibliothèque Nationale de France, lat. 8824) has attracted much interest because of its long, thin format, its illustrations in the Utrecht Psalter tradition and its Old English prose translation of the first fifty psalms, which has been convincingly attributed to King Alfred himself. It is a bilingual psalter, with Latin (Roman version) on the left and Old English on the right. The first fifty psalms are in the prose translation connected with King Alfred, the remainder in a metrical version made by an author whose work has not been identified elsewhere. The leaves are approximately 526 × 186 mm, with a writing space of about 420 × 95 mm. It has been estimated that there were originally 200 leaves in twenty-five quires, but fourteen leaves, including those carrying all the major decoration, have been removed. There remain thirteen outline drawings integrated into the text on the first six folios. Some drawings may have functioned as ‘fillers’ where the Latin text was shorter than the Old English. Further on in the manuscript, in order to solve this problem, the scribe either left gaps or made the columns of Latin thinner than the corresponding Old English ones. The Old English introductions were set out across both columns, suggesting that the book was made for someone who read English more easily than Latin. The manuscript was written around the middle of the eleventh century, and it is clearly the work of a single skilled scribe who used a neat Anglo-Caroline minuscule for the Latin texts, and matching English vernacular minuscule with many Caroline letter forms for the Old English. Unfortunately, his hand has not been identified in any other books or charters; however, he did record in a colophon (186r; see pl.V) that he was called Wulfwinus cognomento Cada.
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Ding, Dan, Anna Stachel, Eduardo Iturrate, and Michael Phillips. "1184. Making Pneumonia Surveillance Easy: Automation of Pneumonia Case Detection." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S424—S425. http://dx.doi.org/10.1093/ofid/ofz360.1047.
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Abstract Background Pneumonia (PNU) is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. While definitions from CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety - the algorithm is still laborious. We propose an implementation of a refined algorithm script which combines two CDC definitions with the use of natural language processing (NLP), a tool which relies on pattern matching to determine whether a condition of interest is reported as present or absent in a report, to automate PNU surveillance. Methods Using SAS v9.4 to write a query, we used a combination of National Healthcare Safety Network’s (NHSN) PNU and ventilator-associated event (VAE) definitions that use discrete fields found in electronic medical records (EMR) and trained an NLP tool to determine whether chest x-ray report was indicative of PNU (Fig1). To validate, we assessed sensitivity/specificity of NLP tool results compared with clinicians’ interpretations. Results The NLP tool was highly accurate in classifying the presence of PNU in chest x-rays. After training the NLP tool, there were only 4% discrepancies between NLP tool and clinicians interpretations of 223 x-ray reports - sensitivity 92.2% (81.1–97.8), specificity 97.1% (93.4–99.1), PPV 90.4% (79.0–96.8), NPV 97.7% (94.1–99.4). Combining the automated use of discrete EMR fields with NLP tool significantly reduces the time spent manually reviewing EMRs. A manual review for PNU without automation requires approximately 10 minutes each day per admission. With a monthly average of 2,350 adult admissions at our hospital and 16,170 patient-days for admissions with at least 2 days, the algorithm saves approximately 2,695 review hours. Conclusion The use of discrete EMR fields with an NLP tool proves to be a timelier, cost-effective yet accurate alternative to manual PNU surveillance review. By allowing an automated algorithm to review PNU, timely reports can be sent to units about individual cases. Compared with traditional CDC surveillance definitions, an automated tool allows real-time critical review for infection and prevention activities. Disclosures All authors: No reported disclosures.
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Wegener, Maximilian D., Ralph P. Brooks, Suzanne Speers, and Merceditas Villanueva. "932. Creating a Statewide HCV Treatment Cascade for HIV/HCV Co-Infected Persons Using a Partnership with DPH." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S499—S500. http://dx.doi.org/10.1093/ofid/ofaa439.1118.
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Abstract Background Treatment cascade models focused on persons with HCV mono-infection have been created based on estimates from multiple data sources. Approximately 25% of persons with HIV are coinfected with HCV; no comparable treatment cascade has been reliably generated due to inadequate HCV surveillance data. Using expanded surveillance capacity and validated HIV matching algorithms, we created an HCV treatment cascade for HIV/HCV coinfected persons in Connecticut. Methods Surveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). eHARS data timeline includes all surveillance entries with labs from 1/1/2015-10/1/2019. Two CTEDSS timelines analyzed: One, all surveillance entries (1/1/1994-1/1/2020); Two, all surveillance entries with labs from 1/1/2016-1/1/2020. Matching CTEDSS and eHARS, coinfected lists were generated and patient HCV labs (AB & PCR) were assessed to determine HCV care status on the treatment cascade. Inclusions and Exclusions for All HCV surveillance entries (1/1/1994 to 1/1/2020) Inclusions and Exclusions for All HCV Surveillance Entries with Labs from 1/1/2016 to 1/1/2020 Results All surveillance entries (1/1/1994 to 1/1/2020): The coinfected list had 3,689 entries; 1,938 had positive HCV screenings (AB+ and/or PCR+) and were eligible for further analysis based on lab dispositions: 567 HCV AB+ only; 721 HCV AB+ and PCR+; 149 PCR+ only; 453 AB+ then PCR+ then PCR-; 48 PCR+ then PCR-. Of 1,371 with evidence for chronic HCV, 501 had presumed sustained virologic response (SVR) (36.5%). All surveillance entries with HCV labs from 1/1/2016 to 1/1/2020: The coinfected list had 912 entries; 665 met inclusion criteria for positive HCV screenings with lab dispositions: 17 HCV AB+ only; 197 HCV AB+ and PCR+; 6 PCR+ only; 407 AB+ then PCR+ then PCR-; 38 PCR+ then PCR-. Of the 648 chronically infected, 445 had presumed SVR (68.6%). Treatment cascade for all surveillance entries (1/1/1994 to 1/1/2020) Treatment cascade for all surveillance entries with labs from 1/1/2016 to 1/1/2020 Conclusion It is feasible to create statewide treatment cascades for HIV/HCV coinfected individuals. SVR rates improved from 36.5% to 68.6% with the use a of more recent HCV surveillance timeline. Contributing factors include: 2016 HCV case definition change (increased HCV PCR testing); electronic lab interface with CTEDSS being able to record negative PCRs in 2018; enhanced DAA availability and implementation. Future studies should adopt this approach which more accurately represents the HCV care status of the current co-infected population. Disclosures All Authors: No reported disclosures
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Huang, Jing, Yong Chen, J. Richard Landis, and Kevin B. Mahoney. "Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study." Journal of Medical Internet Research 21, no. 10 (October 7, 2019): e13146. http://dx.doi.org/10.2196/13146.
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Background Patient portals are frequently used in modern health care systems as an engagement and communication tool. An increased focus on the potential value of these communication channels to improve health outcomes is warranted. Objective This paper aimed to quantify the impact of portal use on patients’ preventive health behavior and chronic health outcomes. Methods We conducted a retrospective, observational cohort study of 10,000 patients aged 50 years or older who were treated at the University of Pennsylvania Health System (UPHS) from September 1, 2014, to October 31, 2016. The data were sourced from the UPHS electronic health records. We investigated the association between patient portal use and patients’ preventive health behaviors or chronic health outcomes, controlling for confounders using a novel cardinality matching approach based on propensity scoring and a subsequent bootstrapping method to estimate the variance of association estimates. Results Patient-level characteristics differed substantially between portal users, comprising approximately 59.32% (5932/10000) of the cohort, and nonusers. On average, users were more likely to be younger (63.46 years for users vs 66.08 years for nonusers), white (72.77% [4317/5932] for users vs 52.58% [2139/4068] for nonusers), have commercial insurance (60.99% [3618/5932] for users vs 40.12% [1632/4068] for nonusers), and have higher annual incomes (US $74,172/year for users vs US $62,940/year for nonusers). Even after adjusting for these potential confounders, patient portal use had a positive and clinically meaningful impact on patients’ preventive health behaviors but not on chronic health outcomes. Conclusions This paper contributes to the understanding of the impact of patient portal use on health outcomes and is the first study to identify a meaningful subgroup of patients’ health behaviors that improved with portal use. These findings may encourage providers to promote portal use to improve patients’ preventive health behaviors.
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Zambotti, G., W. Guan, and J. Gest. "VISUALIZING HUMAN MIGRATION TRHOUGH SPACE AND TIME." ISPRS Annals of Photogrammetry, Remote Sensing and Spatial Information Sciences II-4/W2 (July 10, 2015): 155–61. http://dx.doi.org/10.5194/isprsannals-ii-4-w2-155-2015.
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Human migration has been an important activity in human societies since antiquity. Since 1890, approximately three percent of the world’s population has lived outside of their country of origin. As globalization intensifies in the modern era, human migration persists even as governments seek to more stringently regulate flows. Understanding this phenomenon, its causes, processes and impacts often starts from measuring and visualizing its spatiotemporal patterns. This study builds a generic online platform for users to interactively visualize human migration through space and time. This entails quickly ingesting human migration data in plain text or tabular format; matching the records with pre-established geographic features such as administrative polygons; symbolizing the migration flow by circular arcs of varying color and weight based on the flow attributes; connecting the centroids of the origin and destination polygons; and allowing the user to select either an origin or a destination feature to display all flows in or out of that feature through time. The method was first developed using ArcGIS Server for world-wide cross-country migration, and later applied to visualizing domestic migration patterns within China between provinces, and between states in the United States, all through multiple years. The technical challenges of this study include simplifying the shapes of features to enhance user interaction, rendering performance and application scalability; enabling the temporal renderers to provide time-based rendering of features and the flow among them; and developing a responsive web design (RWD) application to provide an optimal viewing experience. The platform is available online for the public to use, and the methodology is easily adoptable to visualizing any flow, not only human migration but also the flow of goods, capital, disease, ideology, etc., between multiple origins and destinations across space and time.
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Ogdie, A., T. Love, J. Takeshita, J. Gelfand, J. Scher, H. Choi, R. Fitzsimmons, C. T. Ritchlin, and J. F. Merola. "FRI0355 IMPACT OF BIOLOGIC THERAPY ON THE INCIDENCE OF PSA AMONG PATIENTS WITH PSORIASIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 773.1–774. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3337.
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Background:One of the strongest known risk factors for the development of psoriatic arthritis (PsA) is psoriasis. A key question is whether treatment of psoriasis may prevent or delay onset of PsA.Objectives:To compare the incidence of PsA among patients with psoriasis treated with a biologic compared to those treated with a non-biologic therapy for psoriasisMethods:We performed a retrospective cohort study in the Optum de-identified Electronic Health Record dataset between 2006-2017. Patients with two or more ICD codes for psoriasis between the ages of 16 and 90, who were initiating an oral medication, a biologic therapy, or phototherapy (defined as no preceding codes for the therapy in the prior 12 months) were identified. Covariates at baseline were determined in the 12 months prior to therapy initiation. The outcome of interest was PsA as defined by one ICD code. The incidence of PsA was described overall and within each therapy group. We analyzed the data in two ways: a) a multivariable Cox model using a time varying exposure (once the patient was exposed to a biologic, they were considered always exposed) derived from automated stepwise regression and b) propensity score matching (greedy matching, caliper 0.1) between biologic-exposed patients and oral/phototherapy exposed patients.Results:Among 215,386 patients with psoriasis without PsA at baseline, 9,848 were excluded for prior biologic exposure, and among the remaining, 60,258 initiated phototherapy, oral or biologic therapy during follow up. Among 22,461 new biologic initiations, 29,121 oral therapy and 8,676 phototherapy initiations, the mean age was lower in the biologics group compared to the non-biologic groups (46.9 vs 50.8), with a similar proportion of females and Caucasians. Observational time was also similar. A total of 1,643, 1,813, and 122 new PsA cases occurred over 60,739, 85,670, and 28,528 person/years (PY) of follow up, respectively (incidence 27.1, 21.2 and 4.2 per 1,000 person years respectively). Using a traditional multivariable adjustment approach with time varying exposure, the age and sex adjusted and fully adjusted HR (95% CI) for biologic users were 1.01 (0.99-1.04) and 0.93 (0.91-0.95), respectively. However, after propensity score matching, the HR (95% CI) was 1.64 (1.51-1.77). Survival curves cross, however, at approximately 8 years (Figure 1) and most of the new diagnoses of PsA occurred shortly after therapy initiation (Figure 2).Conclusion:Confounding by indication or protopathic bias may explain the observed association of biologic therapy with the development of PsA among patients with psoriasis. Some patients may be receiving therapy because they have both psoriasis and early symptoms of PsA or their PsA diagnosis is not recorded appropriately. Given the directional discrepancy in the results between traditional modeling and propensity score analysis, further work is needed to understand the nature of this relationship.FigureFigure 3.Directed Acyclic Graphdescribing potential confounders in relationship between therapy prescription and diagnosis of PsADisclosure of Interests:Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Thorvardur Love: None declared, Junko Takeshita: None declared, Joel Gelfand Grant/research support from: grants (to the Trustees of the University of Pennsylvania) from Abbvie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc., Consultant of: BMS, Boehringer Ingelheim, Janssen Biologics, Novartis Corp, UCB (DSMB), Neuroderm (DSMB), Dr. Reddy’s Labs, Pfizer Inc., and Sun Pharma, Paid instructor for: received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologics and Novartis., Jose Scher Consultant of: Novartis, Janssen, UCB, Sanofi., Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood, Robert Fitzsimmons: None declared, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Joseph F. Merola Consultant of: Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB Pharma, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and LEO Pharma
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Meyer, Anne-Marie, David Barkhurst, Adrian Meyer, Saray Shai, Justin G. Trogdon, and Peter Mucha. "Creating a multi-payer provider database for cancer outcomes research." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 138. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.138.
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138 Background: Cancer care is multi-disciplinary in nature and relationships between healthcare providers may potentially influence outcomes. Yet understanding how patient care or outcomes are affected by these relationships has been hindered by the paucity of temporal and multi-relational data on physicians. We demonstrate a method for uniquely identifying and linking providers across multiple databases longitudinally. Methods: We identified unique, individual healthcare providers in Medicare, Medicaid, and private payer data in North Carolina (NC) from 2003-2014. In order to link the providers between the different identifiers (e.g., NPI, UPIN, etc.), five provider data sets were obtained. These databases included the National Plan and Provider Enumeration System (NPPES), the Medicare Physician Identification and Eligibility Records (MPIER), the NC State Medicaid provider file, private payer provider files and the NC medical license file. Identification and linking was performed using a novel approach leveraging relational database tools in Oracle and then verified via a second approach applying network analysis in Python. Sub-set validation was performed using claims from cancer cohorts in NC with continuous enrollment in multiple payers. Results: There was significant variation in data quality as well as temporal and geographic overlap between datasets. Linking across all data resulted in a Cartesian product of over 50 billion combinations. This was overcome by aligning provider identifiers under unique combinations of matching variables (given name, last name, zip code and specialty). From all five datasets, approximately 158,000 unique physicians were identified. In subset validation, the NPI and UPIN matches agreed 99-100% with the 2008 Medicare professional claims in a cohort of NC cancer patients. The NPI and private provider ID matches agreed between 73-79% of the time for those cancer patients with claims aligned in both payers. However, only about 30% of the Medicaid provider IDs were individually attributable and matched. Conclusions: Providers can be uniquely identified and matched across disparate databases enabling us to measure and contrast provider networks and their variation across payers and systems.
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Poon, Kean. "Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 11, no. 1 (January 17, 2022): e34915. http://dx.doi.org/10.2196/34915.
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Background The increasing rate of mental health issues among adolescents has recently been a considerable concern in Hong Kong. In particular, adolescents with low socioeconomic status (SES) are likely to experience poor mental health, including low self-esteem and high levels of anxiety, anger, and depression. Previous research has found that physical activities have a positive impact on improving mental health outcomes among adolescents. However, approximately 96% of adolescents in Hong Kong do not engage in regular exercise, which potentially increases the risk of poor mental health. Objective In this study, we aim to examine whether changes in the 3 indicators (reduced ill-being, enhanced well-being, and cognitive functions) of mental health among adolescents with low SES are evident before and after exercise. In addition, this study compares the effectiveness of aerobic exercise and high-intensity interval training on these indicators among adolescents with low SES. Methods A total of 78 participants from low-income families aged between 12 and 15 years from 3 to 4 secondary schools will be recruited for this study. They will be randomly assigned to either an aerobic exercise group (26/78, 33%), a high-intensity interval training group (26/78, 33%), or a control group (26/78, 33%). Participants in the first 2 groups will take part in a 10-week training program period. Participants in the control group will participate in other physical activities during the same intervention period. The training sessions will be conducted 3 times per week on nonconsecutive days. A range of neuropsychological tests and psychometric scales will be used to measure the executive functions and indicators of psychological well-being and ill-being, including enjoyment, self-efficacy, mood, depression, anxiety, and stress at pretest, posttest, and follow-up assessments. Results The project was funded in 2021 by the Research Matching Grant Scheme, through the University Grants Committee of the Hong Kong Special Administrative Region Government. Ethical approval has been obtained from the author’s institution. Participant recruitment will begin in January 2022 and continue through to April 2022. Data collection and follow-up are expected to be completed by the end of 2022. The results are expected to be submitted for publication in 2023. Conclusions The findings will help inform policy makers and practitioners in promoting the importance of physical exercise to enhance mental health. Trial Registration ClinicalTrials.gov NCT050293888; https://clinicaltrials.gov/ct2/show/record/NCT05029388 International Registered Report Identifier (IRRID) PRR1-10.2196/34915
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Cepeda, Santiago, Ana María Castaño-León, Pablo M. Munarriz, Igor Paredes, Irene Panero, Carla Eiriz, Pedro A. Gómez, and Alfonso Lagares. "Effect of decompressive craniectomy in the postoperative expansion of traumatic intracerebral hemorrhage: a propensity score–based analysis." Journal of Neurosurgery 132, no. 5 (May 2020): 1623–35. http://dx.doi.org/10.3171/2019.2.jns182025.
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OBJECTIVETraumatic intracerebral hemorrhage (TICH) represents approximately 13%–48% of the lesions after a traumatic brain injury (TBI), and hemorrhagic progression (HP) occurs in 38%–63% of cases. In previous studies, decompressive craniectomy (DC) has been characterized as a risk factor in the HP of TICH; however, few studies have focused exclusively on this relationship. The object of the present study was to analyze the relationship between DC and the growth of TICH and to reveal any correlation with the size of the craniectomy, degree of cerebral parenchymal herniation (CPH), or volumetric expansion of the TICH.METHODSThe authors retrospectively analyzed the records of 497 adult patients who had been consecutively admitted after suffering a severe or moderate closed TBI. An inclusion criterion was presentation with one or more TICHs on the initial or control CT. Demographic, clinical, radiological, and treatment variables were assessed for associations.RESULTSTwo hundred three patients presenting with 401 individual TICHs met the selection criteria. TICH growth was observed in 281 cases (70.1%). Eighty-two cases (20.4%) underwent craniectomy without TICH evacuation. In the craniectomy group, HP was observed in 71 cases (86.6%); in the noncraniectomy group (319 cases), HP occurred in 210 cases (65.8%). The difference in the incidence of HP between the two groups was statistically significant (OR 3.41, p < 0.01). The mean area of the craniectomy was 104.94 ± 27.5 cm2, and the mean CPH distance through the craniectomy was 17.85 ± 11.1 mm. The mean increase in the TICH volume was greater in the groups with a craniectomy area > 115 cm2 and CPH > 25 mm (16.12 and 14.47 cm3, respectively, p = 0.01 and 0.02). After calculating the propensity score (PS), the authors followed three statistical methods—matching, stratification, and inverse probability treatment weighting (IPTW)—thereby obtaining an adequate balance of the covariates. A statistically significant relationship was found between HP and craniectomy (OR 2.77, p = 0.004). This correlation was confirmed with the three methodologies based on the PS with odds greater than 2.CONCLUSIONSDC is a risk factor for the growth of TICH, and there is also an association between the size of the DC and the magnitude of the volume increase in the TICH.
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Bowen, TJ, Laura Stephens, Mark Vance, Yancui Huang, Deborah Fridman, and Chadi Nabhan. "Novel artificial intelligence (AI)-based technology to improve oncology clinical trial fulfillment." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2052. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2052.
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2052 Background: Less than 5% of US adult cancer pts are enrolled on clinical trials. Challenges in clinical trial fulfillment limit available treatment options, slow enrollment and ultimately delay new therapies from reaching market. Pt screening requires multiple clinical team members to find pts that meet strict inclusion/exclusion criteria. We evaluated the impact of new technology, Deep Lens VIPER, in identifying more qualified pts for clinical studies, and reduction of staff burden. Methods: We implemented Deep Lens VIPER at Hoag Hospital (Newport Beach, California), accessing the electronic medical records and pathology systems (EMR/LIS) to effectively identify pts who are candidates for 20 ongoing recruiting clinical studies. VIPER was fed pt data from 5,706 surgical pathology pts over a 4-month period (October 1, 2019 - January 31, 2020). Proprietary AI identification and matching technology was configured to align cancer pts with those 20 clinical studies, each with unique study criteria. Following an initial machine-assisted triage step, a research coordinator was alerted when pts who met protocol criteria were ready for final approval steps. Results were analyzed and a qualitative assessment of usability was also performed. Results: VIPER was able to triage all 5,706 surgical pathology cases (100%), identifying 1,045 pts (18.3%) with malignant neoplasms that would qualify for further analysis for clinical trials enrollment. Further triage based on inclusion and exclusion criteria led to the identification of 150 previously unidentified pts for 16 of the 20 studies. The 16 different studies for which potential pts were identified, included 11 tumor types, 12 biomarkers and 3 basket studies. Working with the VIPER system, 1 novice care team member performed initial identification of all 150 previously unidentified pts. The VIPER system increased monthly candidate pt catchment for 16 of the 20 studies under investigation, which is approximately 600 patients annually added for final triage for studies being conducted. Conclusions: We demonstrate the use of an AI-based platform to identify pts for clinical trial enrollment who would be missed using traditional recruiting methods. One staff member effectively triaged participants from 20 different studies with unique inclusion/exclusion criteria. These studies were previously managed by 6 different care team members with limited time for recruitment. Scaling this platform to additional institutions and more studies is ongoing to validate these findings.
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Chang, Sydney, Alan Copperman, and Andrea Elizabeth Dunaif. "Anti-Mullerian Hormone Protein-Altering Variants Are Associated With Hypertriglyceridemia in the General Population." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A737—A738. http://dx.doi.org/10.1210/jendso/bvab048.1500.
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Abstract We found 17 rare PCOS-specific functional protein-altering variants (PAVs) or mutations in the gene, AMH, that decrease the biologic activity of the encoded protein, anti-Müllerian hormone (AMH), in the heterozygous state. Approximately 3% of European ancestry PCOS cases in our cohort of ~700 were affected. Our preliminary studies found evidence for a metabolic phenotype in both PCOS as well as their male first-degree relatives who were heterozygous carriers of these AMH PAVs. We performed this study to test the hypothesis that AMH mutations are associated with metabolic abnormalities in the general population. The Mount Sinai BioMe Biobank is an electronic health record (EHR)-linked biobank, containing anonymized whole exome sequences from 30,813 participants of diverse ancestries. We interrogated the sequence data to identify individuals with PCOS-related AMH PAVs. IRB-approval was obtained to review the linked EHR. Outcomes were the presence of obesity (BMI ≥ 30 kg/m2), type 2 diabetes (hemoglobin A1C ≥ 6.5%), prediabetes (hemoglobin A1C 5.7% - 6.4%), elevated cholesterol (total cholesterol ≥ 200 mg/dL), hypertriglyceridemia (TG ≥ 150 mg/dL), and hypertension (≥2 blood pressure values ≥140/90, or administration of antihypertensive medications). Control subjects were obtained from the National Health and Nutrition Examination Survey using propensity score matching (for sex, age, and BMI) with a 1:4 case:control ratio. A total of 292 individuals with AMH PAVs were identified, resulting in a combined 0.95% prevalence of AMH PAVs in an unselected population (1.07% in Europeans, 0.28% in African Americans, 0.54% in Hispanics, and 0.07% in Asians). After adjusting for age, BMI, and race/ethnicity, there was a statistically significant increased prevalence of hypertriglyceridemia in both women (OR 7.29, 95% CI 3.77-14.00) and men (OR 10.15, 95% CI 4.68-22.00) with AMH PAVs compared to sex-, age- and BMI-matched controls. There was also a statistically significant increased prevalence of elevated cholesterol in men with AMH PAVs compared to controls (OR 2.48, 95% CI 1.15-5.34). There were no significant differences between individuals with AMH PAVs and matched controls with respect to the other outcomes. These findings suggest that decreased bioactivity of AMH is causally related to dyslipidemia in the general population. TG levels are elevated in both sexes, whereas increases in cholesterol are only seen in men. The mechanisms by which decreases in AMH bioactivity alter circulating lipid levels are of considerable interest since AMH has no known metabolic actions. It is possible that the putative metabolic effects of AMH are mediated by increases in circulating testosterone (T) levels that in turn alter lipid metabolism. Since T levels are not commonly available in EHR, future studies will be needed to investigate this hypothesis as well as to explore metabolic actions of AMH.
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Law, Ernest H., Elena Galve-Calvo, Achim Wöckel, Rohan Parikh, Samantha K. Kurosky, Valerie Derrien Ansquer, Gaelle Frugier, Keith L. Davis, Elizabeth J. Esterberg, and Olga Oikonomidou. "Abstract OT2-19-04: European treatment patterns and outcomes associated with first-line CDK4/6 inhibition and hormonal therapies assessed in a real-world non-interventional study (EUCHARIS)." Cancer Research 82, no. 4_Supplement (February 15, 2022): OT2–19–04—OT2–19–04. http://dx.doi.org/10.1158/1538-7445.sabcs21-ot2-19-04.
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Abstract Background: Palbociclib is currently the most commonly used cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) for patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) in Europe since its approval in 2017. However, large-scale assessments of palbociclib utilization and subsequent clinical outcomes in real-world settings are limited. Documentation of longitudinal treatment patterns and effectiveness following initiation of first-line (1L) palbociclib + aromatase inhibitor (AI) in more heterogeneous, real-world patient populations are needed to complement clinical trial findings. Trial Design: This is an observational cohort study using retrospective data abstracted from the medical records of patients with HR+/HER2- ABC who initiated 1L treatment (index date) with palbociclib + AI (September 2016-July 2020) or AI monotherapy (January 2010 to July 2020) as 1L therapy for ABC. Patients' study index dates will be at least 12 months before the data abstraction date to allow a minimum potential follow-up of at least 12 months. Patients who died within < 12 months after the index date will remain eligible. Eligibility Criteria: Adult patients who received a de novo or a recurrent diagnosis of locally advanced BC (i.e., not amenable to curative therapy) or metastatic BC will be included. Patients who participated in a clinical trial for ABC, had evidence of prior other malignant neoplasm, received any CDK4/6i for early stage disease, and received other CDK4/6i for ABC will be excluded. Study Aims: This study aims to describe patient characteristics, treatment patterns, and clinical outcomes among patients with HR+/HER2- ABC in Europe who received 1L CDK4/6i treatment. Key outcomes of interest include real-world tumor response, real-world progression-free survival, and overall survival. An exploratory objective will be to compare clinical outcomes between patients treated with 1L palbociclib + AI versus AI monotherapy. Statistical Methods: All study measures will be summarized descriptively. Time-to-event outcomes will be estimated using the Kaplan-Meier method. Direct covariate matching at the site-level and inverse probability weighting using propensity scores is planned to account for differences in baseline patient and clinical characteristics between treatment groups in the exploratory comparative analysis. Target Accrual: Data abstraction is anticipated to begin in September 2021. Data will be abstracted for up to 2,400 eligible patients. Approximately 60 total sites from across Germany, Spain, and the United Kingdom and, if feasible, from other European countries will be recruited. Citation Format: Ernest H. Law, Elena Galve-Calvo, Achim Wöckel, Rohan Parikh, Samantha K. Kurosky, Valerie Derrien Ansquer, Gaelle Frugier, Keith L. Davis, Elizabeth J. Esterberg, Olga Oikonomidou. European treatment patterns and outcomes associated with first-line CDK4/6 inhibition and hormonal therapies assessed in a real-world non-interventional study (EUCHARIS) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-19-04.
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Gunasinghe, N., M. P. You, V. Lanoiselet, N. Eyres, and M. J. Barbetti. "First Report of Powdery Mildew Caused by Erysiphe cruciferarum on Brassica campestris var. pekinensis, B. carinata, Eruca sativa, E. vesicaria in Australia and on B. rapa and B. oleracea var. capitata in Western Australia." Plant Disease 97, no. 9 (September 2013): 1256. http://dx.doi.org/10.1094/pdis-03-13-0299-pdn.
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Inspection of field plantings of diverse cruciferous species, mainly oilseed varieties sown for agronomic assessment at Crawley, (31.99°S, 115.82°E), Western Australia, in September 2012, indicated the occurrence of extensive leaf and stem colonization by powdery mildew at the late flowering stage, with whitish patches 3 to 4 cm in length on stems of Brassica campestris var. pekinensis, B. carinata, B. oleracea var. capitata, B. rapa, Eruca sativa, and E. vesicaria. These patches coalesced to form a dense, white, powdery layer. Infected leaves showed signs of early senescence. Pathogenicity was demonstrated from transferring field inoculum from the most susceptible variety by pressing diseased leaves onto leaves of the six potted plant species, and incubating plants in a moist chamber for 48 hours post-inoculation (hpi) in an air-conditioned glasshouse approximating 25°C. Signs of powdery mildew were evident by 7 days post-inoculation (dpi), and well developed symptoms by 10 dpi and as observed in the field. Uninoculated control plants did not develop powdery mildew. On all inoculated species, abundant conidia typical of those produced by Erysiphe cruciferarum were observed, matching the descriptions of conidia given by Purnell and Sivanesan (3), with cylindrical conidia typically borne singly or in short chains. Mycelia were amphigenous, in patches, often spreading to become effused. Conidiophores were 3 to 4 cells, unbranched, and foot cells cylindrical. Across all host species, conidia were mostly produced singly with overall mean measured lengths 19.7 to 35.4 μm (mean 26.9 μm), and measured widths 7.1 to 12.9 μm (mean 9.7 μm), from measurements taken on 200 conidia for each of the six different species. Spore sizes measured approximated those found for E. cruciferarum by Kaur et al. (1) on B. juncea in Western Australia (viz. 21.2 to 35.4 × 8.8 to 15.9 μm), but were smaller than those reported by Purnell and Sivanesan (3) (viz. 30 to 40 × 12 to 16 μm) or by Koike and Saenz (1) (viz. 35 to 50 × 12 to 21 μm). We confirmed a length-to-width ratio >2 (mean range 2.7 to 2.8 across all six species) as found by both Purnell and Sivanesan (3) and Koike and Saenz (2). Amplification of the internal transcribed spacer (ITS)1 and (ITS)2 regions flanking the 5.8S rRNA gene was carried out with universal primers ITS1 and ITS4 and PCR products from E. cruciferarum from B. oleracea var. capitata and B. rapa sequenced. BLAST analyses to compare sequences with those in GenBank showed a >99% nucleotide identity for E. cruciferarum. In Western Australia, E. cruciferarum has been recorded on B. napus var. napobrassica since 1971 (4), B. napus since 1986 (4), and on B. juncea since 2008 (1). In other regions of Australia, E. cruciferarum has been recorded on B. campestris, B. oleracea var. capitata, B. oleracea var. acephala, B. napus, B. napus var. naprobrassica, and B. rapa var. rapa. To the best of our knowledge, this is the first record of E. cruciferarum on B. campestris var. pekinensis, B. carinata, E. sativa, and E. vesicaria in Australia and on B. rapa and B. oleracea var. capitata in Western Australia. Powdery mildew epidemics on other brassicas in Western Australia are generally sporadic and it remains to be seen what the impact of this disease will be on these new host species. References: (1) P. Kaur et al. Plant Dis. 92:650, 2008. (2) S. T. Koike and G. S. Saenz. Plant Dis. 81:1093, 1997. (3) T. J. Purnell and A. Sivanesan. No. 251 in IMI Descriptions of Fungi and Bacteria, 1970. (4) R. G. Shivas. J. Royal Soc. West. Aust. 72:1, 1989.
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Lee, Y. H., J. F. Lamarque, M. G. Flanner, C. Jiao, D. T. Shindell, T. Berntsen, M. M. Bisiaux, et al. "Evaluation of preindustrial to present-day black carbon and its albedo forcing from ACCMIP (Atmospheric Chemistry and Climate Model Intercomparison Project)." Atmospheric Chemistry and Physics Discussions 12, no. 8 (August 23, 2012): 21713–78. http://dx.doi.org/10.5194/acpd-12-21713-2012.
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Abstract. As part of the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP), we evaluate the historical black carbon (BC) aerosols simulated by 8 ACCMIP models against observations including 12 ice core records, long-term surface mass concentrations and recent Arctic BC snowpack measurements. We also estimate BC albedo forcing by performing additional simulations using offline models with prescribed meteorology from 1996–2000. We evaluated the vertical profile of BC snow concentrations from these offline simulations using the recent BC snowpack measurements. Despite using the same BC emissions, the global BC burden differs by approximately a factor of 3 among models due to differences in aerosol removal parameterizations and simulated meteorology: 34 Gg to 103 Gg in 1850 and 82 Gg to 315 Gg in 2000. However, the global BC burden from preindustrial to present-day increases by 2.5–3 times with little variation among models, roughly matching the 2.5-fold increase in total BC emissions during the same period. We find a large divergence among models at both Northern Hemisphere (NH) and Southern Hemisphere (SH) high latitude regions for BC burden and at SH high latitude regions for deposition fluxes. The ACCMIP simulations match the observed BC surface mass concentrations well in Europe and North America except at Jungfraujoch and Ispra. However, the models fail to predict the Arctic BC seasonality due to severe underestimations during winter and spring. The simulated vertically resolved BC snow concentrations are, on average, within a factor of 2–3 of the BC snowpack measurements except for Greenland and the Arctic Ocean. For the ice core evaluation, models tend to capture both the observed temporal trends and the magnitudes well at Greenland sites. However, models fail to predict the decreasing trend of BC depositions/ice-core concentrations from the 1950s to the 1970s in most Tibetan Plateau ice cores. The distinct temporal trend at the Tibetan Plateau ice cores indicates a strong influence from Western Europe, but the modeled BC increases in that period are consistent with the emission changes in Eastern Europe, the Middle East, South and East Asia. At the Alps site, the simulated BCsuggests a strong influence from Europe, which agrees with the Alps ice core observations. Models successfully simulate higher BC concentrations observed at Zuoqiupu during the non-monsoon season than monsoon season, but models underpredict BC in both seasons. Despite a large divergence in BC deposition at two Antarctic ice core sites, models are able to capture the relative increase from preindustrial to present-day seen in the ice cores. In 2000 relative to 1850, globally annually averaged BC surface albedo forcing from the offline simulations ranges from 0.014 to 0.019 W m−2 among the ACCMIP models. Comparing offline and online BC albedo forcings computed by some of the same models, we find that the global annual mean can vary by up to a factor of two because of different aerosol models or different BC-snow parameterizations and snow cover. The spatial distributions of the offline BC albedo forcing in 2000 show especially high BC forcing (i.e. over 0.1 W m−2) over Manchuria, Karakoram, and most of the Former USSR. Models predict the highest global annual mean BC forcing in 1980 rather than 2000, mostly driven by the high fossil fuel and biofuel emissions in the Former USSR in 1980.
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Lee, Y. H., J. F. Lamarque, M. G. Flanner, C. Jiao, D. T. Shindell, T. Berntsen, M. M. Bisiaux, et al. "Evaluation of preindustrial to present-day black carbon and its albedo forcing from Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP)." Atmospheric Chemistry and Physics 13, no. 5 (March 5, 2013): 2607–34. http://dx.doi.org/10.5194/acp-13-2607-2013.
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Abstract. As part of the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP), we evaluate the historical black carbon (BC) aerosols simulated by 8 ACCMIP models against observations including 12 ice core records, long-term surface mass concentrations, and recent Arctic BC snowpack measurements. We also estimate BC albedo forcing by performing additional simulations using offline models with prescribed meteorology from 1996–2000. We evaluate the vertical profile of BC snow concentrations from these offline simulations using the recent BC snowpack measurements. Despite using the same BC emissions, the global BC burden differs by approximately a factor of 3 among models due to differences in aerosol removal parameterizations and simulated meteorology: 34 Gg to 103 Gg in 1850 and 82 Gg to 315 Gg in 2000. However, the global BC burden from preindustrial to present-day increases by 2.5–3 times with little variation among models, roughly matching the 2.5-fold increase in total BC emissions during the same period. We find a large divergence among models at both Northern Hemisphere (NH) and Southern Hemisphere (SH) high latitude regions for BC burden and at SH high latitude regions for deposition fluxes. The ACCMIP simulations match the observed BC surface mass concentrations well in Europe and North America except at Ispra. However, the models fail to predict the Arctic BC seasonality due to severe underestimations during winter and spring. The simulated vertically resolved BC snow concentrations are, on average, within a factor of 2–3 of the BC snowpack measurements except for Greenland and the Arctic Ocean. For the ice core evaluation, models tend to adequately capture both the observed temporal trends and the magnitudes at Greenland sites. However, models fail to predict the decreasing trend of BC depositions/ice core concentrations from the 1950s to the 1970s in most Tibetan Plateau ice cores. The distinct temporal trend at the Tibetan Plateau ice cores indicates a strong influence from Western Europe, but the modeled BC increases in that period are consistent with the emission changes in Eastern Europe, the Middle East, South and East Asia. At the Alps site, the simulated BC suggests a strong influence from Europe, which agrees with the Alps ice core observations. At Zuoqiupu on the Tibetan Plateau, models successfully simulate the higher BC concentrations observed during the non-monsoon season compared to the monsoon season but overpredict BC in both seasons. Despite a large divergence in BC deposition at two Antarctic ice core sites, some models with a BC lifetime of less than 7 days are able to capture the observed concentrations. In 2000 relative to 1850, globally and annually averaged BC surface albedo forcing from the offline simulations ranges from 0.014 to 0.019 W m−2 among the ACCMIP models. Comparing offline and online BC albedo forcings computed by some of the same models, we find that the global annual mean can vary by up to a factor of two because of different aerosol models or different BC-snow parameterizations and snow cover. The spatial distributions of the offline BC albedo forcing in 2000 show especially high BC forcing (i.e., over 0.1 W m−2) over Manchuria, Karakoram, and most of the Former USSR. Models predict the highest global annual mean BC forcing in 1980 rather than 2000, mostly driven by the high fossil fuel and biofuel emissions in the Former USSR in 1980.
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Zeidan, Amer M., Daniel A. Pollyea, Uma Borate, Alberto Vasconcelos, Ravi Potluri, David Rotter, Zephirin Kiendrebeogo, Lona Gaugler, Gaetano Bonifacio, and Clara Chen. "Venetoclax Plus Azacitidine (VEN-AZA) Vs. Intensive Chemotherapy (IC) As Induction for Patients with Acute Myeloid Leukemia (AML): Retrospective Analysis of an Electronic Medical Records (EMR) Database in the United States." Blood 138, Supplement 1 (November 5, 2021): 277. http://dx.doi.org/10.1182/blood-2021-147926.
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Abstract INTRODUCTION : Many patients (pts) with newly diagnosed (ND) AML achieve remission with IC regimens, typically comprising cytarabine and an anthracycline, with the eventual goal of therapy being cure. On 21 Nov 2018, the FDA approved venetoclax (VEN), a BCL2 inhibitor, in combination with azacitidine (AZA), a hypomethylating agent, for treatment (Tx) of pts with ND AML aged ≥ 75 years or with comorbidities that preclude use of IC. The efficacy of the VEN-AZA regimen in ND AML was established based on a complete remission (CR) rate of 37%, and a composite CR + CR with incomplete hematologic recovery (CRh) rate of 66% (DiNardo, 2020). Subsequent randomized phase 3 trial data showed improvement in overall survival (OS) with VEN-AZA compared with AZA alone among older pts with AML unfit for IC, but a cure cannot currently be achieved with this regimen. It is important to understand the patterns of use of this combination relative to IC in adult pts with ND AML treated in real-world clinical practice, particularly when induction decisions for some pts can be challenging. OBJECTIVE: To describe real-world CR rates, OS, and relapse-free survival (RFS) achieved with IC (induction ± consolidation) and VEN-AZA as first-line therapy for ND AML. METHODS: This retrospective cohort from the US-based Flatiron Health electronic medical records (EMR) database included pts with ND AML who received induction with VEN-AZA or IC between 21 Nov 2018 and 30 Nov 2020 and had ≥ 2 months of follow-up. Pts were separated into 3 age-based subgroups: 18-59, 60-75, and > 75 years. Assessments included the CR rate; RFS, defined as the time from start of therapy to relapse or death; and OS, the time from start of therapy until death. Both OS and RFS were estimated by Kaplan-Meier Methods. RESULTS: In all, 888 pts met the selection criteria, including 547 pts (61.6%) who received IC and 341 (38.4%) who received VEN-AZA. Baseline characteristics were generally comparable between cohorts with respect to sex (57.7% male overall) and practice type (74.9% treated at a community practice), but as expected, pts in the VEN-AZA cohort were significantly older than those in the IC cohort (mean [SD] age 58.1 [13.9] vs. 73.8 [9.1] years, respectively; P < 0.001). The age-based subgroups comprised 283 pts (31.9%) aged 18-59 years (IC, n = 261;VEN-AZA, n = 22), 393 pts (44.3%) aged 60-75 y (IC, n = 252; VEN-AZA, n = 141), and 212 pts (23.8%) aged > 75 years (IC, n = 34; VEN-AZA, n = 178) (Table). Thus, the 60-75 years pt subgroup comprised the most pts; few pts in the 18-59 years subgroup received VEN-AZA and few pts in the > 75 years subgroup received IC. Overall, the CR rate was 76.2% (417/547) in the IC cohort and 48.1% (164/341) in the VEN-AZA cohort (Table). Remission rate in the age 60-75 years subgroup was 75.0% (189/252) in pts who received IC and 53.9% (76/141) in pts who received VEN-AZA. The proportions of pts aged 60-75 who underwent transplant were 32.4% in the IC cohort and 12.8% in the VEN-AZA cohort. Median follow-up from diagnosis was 365 days in the IC cohort and 292 days in the VEN-AZA cohort. During the follow-up periods, the overall mortality rates for patients aged 60-75 years treated with IC and VEN-AZA were 35.3% (89/252) and 45.4% (64/141), respectively. Among all pts, estimated OS in IC-treated pts was not reached (NR) and in the VEN-AZA cohort was 392 days, and was NR and 531 days, respectively, in the subgroup of pts aged 60-75 years (Table). Among all pts, estimated median RFS was 544 days in the IC cohort and was 316 days in the VEN-AZA cohort; within the subgroup of pts aged 60-75 years, median RFS was 522 days and 342 days, respectively. CONCLUSIONS: As expected, use of IC was more common than VEN-AZA in pts aged ≤ 75 years, but approximately one-third of pts aged 60-75 years received VEN-AZA. IC was associated with nominally better remission rate and survival compared with VEN-AZA among pts aged ≤ 75 years. An ongoing analysis will use propensity score matching (or other appropriate method) to adjust for baseline covariates to identify predictors of VEN-AZA use, and to compare the impact of IC vs. VEN-AZA on OS. Data from that analysis will be presented at the congress. Figure 1 Figure 1. Disclosures Zeidan: Loxo Oncology: Consultancy, Other: Clinical Trial Committees; Novartis: Consultancy, Other: Clinical Trial Committees, Travel support, Research Funding; Geron: Other: Clinical Trial Committees; Jazz: Consultancy; BMS: Consultancy, Other: Clinical Trial Committees, Research Funding; Epizyme: Consultancy; Ionis: Consultancy; Boehringer Ingelheim: Consultancy, Research Funding; Astellas: Consultancy; Janssen: Consultancy; Gilead: Consultancy, Other: Clinical Trial Committees; Aprea: Consultancy, Research Funding; Genentech: Consultancy; AbbVie: Consultancy, Other: Clinical Trial Committees, Research Funding; Pfizer: Other: Travel support, Research Funding; Acceleron: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; ADC Therapeutics: Research Funding; AstraZeneca: Consultancy; Agios: Consultancy; BioCryst: Other: Clinical Trial Committees; BeyondSpring: Consultancy; Astex: Research Funding; Daiichi Sankyo: Consultancy; Incyte: Consultancy, Research Funding; Jasper: Consultancy; Kura: Consultancy, Other: Clinical Trial Committees; Cardiff Oncology: Consultancy, Other: Travel support, Research Funding. Pollyea: Syndax: Honoraria, Membership on an entity's Board of Directors or advisory committees; Foghorn: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other; Syros: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: advisory board; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria; Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Aprea: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Other: advisory board; Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Kiadis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Other: advisory board; Bristol Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Teva: Research Funding; Curis, Servier: Other; Pfizer: Research Funding; Agios: Other, Research Funding. Borate: Blueprint Medicine: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Genentech: Membership on an entity's Board of Directors or advisory committees, Other: Advisory Board; AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding; Jazz Pharma: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Astellas: Membership on an entity's Board of Directors or advisory committees; incyte: Membership on an entity's Board of Directors or advisory committees, Research Funding; Rampal: Membership on an entity's Board of Directors or advisory committees; Galecto, Inc.: Consultancy; Promedior: Consultancy. Vasconcelos: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Potluri: Bristol Myers Squibb: Consultancy. Rotter: SmartAnalyst Inc.: Current Employment. Gaugler: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Bonifacio: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Chen: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.
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Beswick, Jennifer M., Elizabeth Shin, Jieun Uhm, Fotios V. Michelis, Auro Viswabandya, Jeffrey H. Lipton, Hans A. Messner, Theodore Marras, and Dennis Dong Hwan Kim. "Incidence and Risk Factors for Nontuberculous Mycobacteria Infection after Allogeneic Hematopoietic Cell Transplantation." Blood 126, no. 23 (December 3, 2015): 1917. http://dx.doi.org/10.1182/blood.v126.23.1917.1917.
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Abstract Introduction: Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms that are increasingly recognized as clinically significant pathogens in the allogenic hematopoietic cell transplanted (alloHCT) population. The incidence of NTM infection post alloHCT has increased from 0.49-1.0% in early studies to 2.8-8.7% in more recent investigations, possibly due to improvements in NTM detection, varying pre-transplant conditioning regimens and regional epidemiology of different NTM species. We investigated incidence and risk factors of NTM infection after alloHCT. Methods & Patients: Medical records for 1097 consecutive patients who underwent alloHCT at Princess Margaret Cancer Centre from 2000 to 2013 were reviewed to determine the frequency, risk factors and outcomes associated with NTM infections. Clinically significant NTM infection was differentiated from colonization according to the American Thoracic Society guidelines, and was classified as pulmonary, non-pulmonary, or disseminated. Acute and chronic graft versus host disease (aGVHD and cGVHD) were diagnosed and graded using established and NIH consensus criteria respectively. The cumulative incidence of NTM was calculated considering competing risks of death. Multivariate analysis comprised Cox proportional hazards regression, modeling NTM risk. Statistical analyses were performed using EZR software (Saitama, Japan). Results: Of 1097 patients, NTM were isolated in 45 (4.1%) and judged clinically significant in 30 (2.7%). The incidence of NTM infection by competing risk analysis was 2.8% at 5 years (95% CI, 1.9-4.0%). The median (range) time to diagnosis was 343 (19-1967) days, and in 83% of patients, was diagnosed within 2 years of alloHCT. Of the 30 clinically significant NTM infections, 28 (93.3%) were pulmonary and 2 (6.7%) were disseminated. With respect to the latter group, one patient had NTM isolated from blood, while the second case was presumed disseminated based on characteristic skin findings, but with no confirmed microbiologic diagnosis. The most common species/groups isolated were Mycobacterium avium complex (n=11, 36.7%), M. xenopi (n=5, 16.7%), and M. fortuitum (n=5, 16.7%). 22/30 patients (73.3%) were on systemic immunosuppression at the time of diagnosis, and 95.7% had concurrent infections (30.4% pulmonary, 17.3% extra-pulmonary, and 47.8% both), with fungal infections occurring most frequently (53.3%). Significant risk factors (HR 95% CI) for NTM included aGVHD grades 2-4 (3.25 [1.33-7.96] p=0.036), cGVHD (3.20 [1.06-9.68] p=0.010), age (1.05 [1.02-1.07], p <0.001), and CMV viremia (4.64 [1.90-11.37] p=0.001). 76.7% of patients with clinically significant NTM had a diagnosis of cGVHD (23/30), in comparison to 47.4% (520/1097) of patients without a diagnosis of NTM infection (p=0.003), and cGVHD severity by NIH global score correlated with NTM risk. Among all patients with cGVHD, severe cGVHD was present in 39% (9/23) of NTM patients, versus 17% (89/520) of non-NTM patients (p=0.012). Pre-alloHCT diagnosis (p=0.34), conditioning regimen (p=0.81), T-cell depletion (p=0.66), HLA matching (p=0.62), or donor type (p=0.63), did not reach statistical significance. Median survival duration after a diagnosis of clinically significant NTM was 398 (range, 20-764) days, with a survival rate of 40.8±10.8% at 2 years. Conclusion: Clinically significant NTM infection after alloHCT was relatively common in our study population. GVHD (acute and chronic), age, and CMV bacteremia were significant risk factors. Given a median survival of approximately 1 year following diagnosis, NTM infection may be of greater clinical significance than previously thought. A high index of suspicion for NTM infection in patients with pulmonary symptoms, particularly within 2 years after HCT and in the presence of cGVHD, may lead to prompt diagnosis and treatment, and potentially better outcomes. Disclosures Lipton: Pfizer: Consultancy, Research Funding; Ariad: Consultancy, Research Funding; Teva: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Novartis Pharmaceuticals: Consultancy, Research Funding. Kim:Novartis Pharmaceuticals: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding.
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Cahen, Viviane C., Yimei Li, Caitlin W. Elgarten, Amanda M. DiNofia, Jennifer J. Wilkes, Lena E. Winestone, Yuan-Shung V. Huang, et al. "Using Administrative Data to Identify Relapse and Hematopoietic Stem Cell Transplantation (HSCT) in Children with Acute Lymphoblastic Leukemia (ALL): Validation at Two Centers and Incidence Estimation in a National Cohort." Blood 132, Supplement 1 (November 29, 2018): 624. http://dx.doi.org/10.1182/blood-2018-99-114228.
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Abstract Administrative databases can be used to study outcomes including patients outside of clinical trials and have been used to identify relapse and HSCT in adult and adolescent/young adult leukemia populations. However, there are no published studies using validated billing and diagnostic codes to identify timing of relapse or HSCT in children with ALL. Published approaches are limited to relapses occurring after cessation of therapy, but a substantial proportion of pediatric ALL relapses occur on therapy. We hypothesized HSCT and early and late relapses could be detected accurately in a previously assembled cohort of children with ALL (Fisher 2014 Med Care), using pharmacy billing and ICD-9 diagnosis and procedure codes. We present our methods, validated at two large freestanding children's hospitals, and incidence estimates of relapse or HSCT as first events in a national cohort. The Pediatric Health Information System (PHIS) cohort included patients aged 0-21 admitted between 1/1/2004 and 12/13/2013, previously identified with de novo ALL. We reviewed daily inpatient pharmacy, diagnosis, and procedure codes for patients in the PHIS ALL cohort from the Children's Hospital of Philadelphia (CHOP; 2004-2013) and Texas Children's Hospital (TCH; 2007-2013). Events were captured until the first of 5 years from diagnosis or last day of PHIS data. Relapses were identified using ICD-9 diagnosis/procedure codes and PHIS pharmacy codes (Figure 1A) correlating with relapse regimens. Manual review of daily PHIS data was performed for second-line chemotherapy at any time, reinduction-style chemotherapy365 days after diagnosis, or a relapsed ALL ICD-9 diagnosis code (204.02). HSCTs were identified using ICD-9 procedure and PHIS pharmacy code patterns consistent with conditioning (Figure 1B). We reviewed electronic medical records (EMR) for patients with do novo ALL from CHOP and TCH for all relapses and HSCTs as the gold standard. Demographics were evaluated by hospital and data source using chi-square tests. We calculated sensitivity and positive-predictive value (PPV) of PHIS-defined events compared to the EMR gold standard at the patient level and only considered the first relapse and HSCT per patient. PHIS events were considered valid if the date was within ±14 days of the EMR. We estimated 5-year incidences of relapse and HSCT as first events for the entire PHIS cohort, infants (<1 year at diagnosis), and high-risk ALL (receipt of daunorubicin in Induction). Of 395 patients in the CHOP EMR cohort, 362 matched with the PHIS ALL cohort. The TCH EMR cohort had 410 patients, matching 329 from PHIS. Age, sex, and Down syndrome were similar (Table 1). CHOP patients were more likely to be Black, and race distribution within each hospital was similar by data source. Fewer CHOP patients were Hispanic, and more had missing ethnicity. Fewer TCH patients were missing ethnicity regardless of data source, though PHIS had a higher proportion of missing data. Proportions of children with high- and low-risk B-ALL, T-ALL, infant ALL, and Induction daunorubicin were similar. Government primary insurance in the first admission was more common at TCH. At CHOP, 39 relapses were identified in PHIS, and 45 by EMR (sensitivity 85.7%, PPV 100%). At TCH, 30/31 relapses were correctly identified in PHIS (sensitivity 96.6%, PPV 100%). Our PHIS algorithm identified 38 CHOP patients who underwent HSCT during the study period and 34 at TCH. All matched the EMR, with 100% sensitivity and PPV for both hospitals. Table 2 shows five-year incidences of relapse and HSCT in the entire PHIS ALL cohort (N=10,162), including relapse estimates adjusted for sensitivity. Relapses and HSCTs were higher in infants and in children receiving daunorubicin. We present novel approaches to identify relapse and HSCT events using administrative data, validated at two children's hospitals. Timing of events are matched within ±14 days. Relapse estimates are slightly lower than clinical trial data, but this approach has higher sensitivity than published administrative data reports, and sensitivity-adjusted rates approximate clinical trial data. Detected events are likely to be true based on the 100% PPV. Our relapse identification approach is complex and requires disease-specific clinical expertise to identify relapse-style chemotherapy patterns in children on therapy; however, this approach can capture early relapses in children outside of clinical trials. Disclosures Fisher: Merck: Research Funding; Pfizer: Research Funding.
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Preddie, Martha Ingrid. "The Utilization of Wireless Handheld Computers with MEDLINE is an Effective Mechanism for Answering Clinical Questions at the Point of Care." Evidence Based Library and Information Practice 3, no. 3 (September 3, 2008): 64. http://dx.doi.org/10.18438/b8t31m.
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A Review of:
Hauser, Susan E., Dina Demner-Fushman, Joshua L. Jacobs, Susanne M. Humphrey, Glenn Ford, and George R. Thoma. “Using Wireless Handheld Computers to Seek Information at the Point of Care: An Evaluation by Clinicians.” Journal of the American Medical Informatics Association 14.6 (Nov./Dec. 2007): 807-15.
Abstract
Objective – To assess the effectiveness of wireless handheld computers (HHCs) for information retrieval in clinical environments and the role of MEDLINE in answering clinical questions at the point of care.
Design – A prospective single-cohort study.
Setting – Teaching rounds in the intensive care units and general medicine wards in two hospitals associated with a university’s school of medicine in the United States.
Subjects – Five internal medicine residents with training in evidence-based practice.
Methods – While accompanying medical teams on teaching rounds for approximately four consecutive weeks, each resident used MD on Tap (an application for handheld computers) on a TreoTM 650 PDA/cell phone to find answers in real time, to questions that were raised by members of the medical teams. Using a special version of MD on Tap, each resident initialized a UserID. Serving as evaluators, the residents described and categorized clinical scenarios and recognized questions. They also formulated search terms, searched MEDLINE and identified citations determined to be useful for answering the questions. An intermediate server collected details of all MEDLINE search query transactions, including system response time, the user (based on UserIDs), citations selected for viewing, the saving of citations to HHC memory, as well as use of the Linkout and Notes features. In addition evaluators submitted daily summaries. These summaries included information on the scenarios, clinical questions, evidence-based methodology (EBM) category, the team member who was the source of the question, the PubMed Identifiers (PMIDs) of relevant citations, and comments. At the end of the data collection period, each evaluator submitted a summary report consisting of a qualitative and quantitative evaluation of his experience using MEDLINE via the handheld device to find relevant evidence based information at the point of care. The report also focused on the usefulness of MD on Tap features, along with suggestions for additional features.
Data analysis encompassed matching the text of daily summaries to transaction records in order to identify sessions (containing a scenario, clinical question, one or more search queries, citation fetches and selected PMIDs). A senior medical librarian/expert indexer reviewed all the citations selected by evaluators and graded each citation as A (useful for answering the question), B (provided a partial answer) or C (not useful for answering the question). Only those graded A were regarded as “relevant.” For the purpose of analysis a session was deemed to be successful “if at least one of the citations selected by the evaluator as relevant was also classified as Relevant” (810) by the expert indexer. Similarly, an individual query was successful “if at least one of the citations among the results of the query was Relevant, that citation was viewed by the evaluator during rounds, and it addressed the clinical question as recorded in the daily summary” (810). Various types of relationships were analyzed including the characteristics of clinical questions vis-a-vis successful sessions, search strategies in relation to successful queries, and the association between MD on Tap features and successful queries. SAS/SUDAAN version 9.1 was used for statistical analysis.
Main Results – Evaluators answered 68% (246 of 363) clinical questions during rounding sessions. They identified 478 “relevant” citations, an average of 1.9 per successful session and 1.3 for each successful question. Session lengths averaged 3 minutes and 41 seconds. Characteristics of the evaluator (training, interest, experience and expertise) were a significant predictor of a session’s success. The significant determinants of query success were “the number of search terms that could be mapped to Medical Subject Headings (MeSH)” (812), the number of citations that were found for a query, and the use of MD on Tap’s auto-spellcheck feature. Narrative comments from the evaluators indicated that using MEDLINE on a HHC at the point of care contributed positively to the practice of evidence -based medicine.
Conclusion – Wireless handheld computers are useful for retrieving information in clinical environments. The application of several MeSH terms in a query facilitates the retrieval of MEDLINE citations that provide answers to clinical questions. The MD on Tap program is a valuable interface to MEDLINE at the point of care.
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Sauleau, Erik A., Jean-Philippe Paumier, and Antoine Buemi. "Medical record linkage in health information systems by approximate string matching and clustering." BMC Medical Informatics and Decision Making 5, no. 1 (October 11, 2005). http://dx.doi.org/10.1186/1472-6947-5-32.
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Brown, Adrian P., Sean M. Randall, James H. Boyd, and Anna M. Ferrante. "Evaluation of approximate comparison methods on Bloom filters for probabilistic linkage." International Journal of Population Data Science 4, no. 1 (May 23, 2019). http://dx.doi.org/10.23889/ijpds.v4i1.1095.
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Introduction The need for increased privacy protection in data linkage has driven the development of privacy-preserving record linkage (PPRL) techniques. A popular technique using Bloom filters with cryptographic analyses, modifications, and hashing variations to optimise privacy has been the focus of much research in this area. With few applications of Bloom filters within a probabilistic framework, there is limited information on whether approximate matches between Bloom filtered fields can improve linkage quality.
Objectives In this study, we evaluate the effectiveness of three approximate comparison methods for Bloom filters within the context of the Fellegi-Sunter model of recording linkage: Sørensen–Dice coefficient, Jaccard similarity and Hamming distance.
Methods Using synthetic datasets with introduced errors to simulate datasets with a range of data quality and a large real-world administrative health dataset, the research estimated partial weight curves for converting similarity scores (for each approximate comparison method) to partial weights at both field and dataset level. Deduplication linkages were run on each dataset using these partial weight curves. This was to compare the resulting quality of the approximate comparison techniques with linkages using simple cut-off similarity values and only exact matching.
Results Linkages using approximate comparisons produced significantly better quality results than those using exact comparisons only. Field level partial weight curves for a specific dataset produced the best quality results. The Sørensen-Dice coefficient and Jaccard similarity produced the most consistent results across a spectrum of synthetic and real-world datasets.
Conclusion The use of Bloom filter similarity comparisons for probabilistic record linkage can produce linkage quality results which are comparable to Jaro-Winkler string similarities with unencrypted linkages. Probabilistic linkages using Bloom filters benefit significantly from the use of similarity comparisons, with partial weight curves producing the best results, even when not optimised for that particular dataset.
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Garanin, S. M., I. N. Danilov, A. V. Kashin, and A. Yu Sedakov. "Application of the method of integral equations based on the Lorentz lemma for calculation of matching transitions between rectangular waveguides with offset axes." Antennas, 2021. http://dx.doi.org/10.18127/j03209601-202102-03.
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This work presents a brief description of the method of integral equations. Integral equations are obtained on the basis of the integral form of Lorentz's lemma using a non-standard physical approach. This method allows one to calculate the characteristics of various three-dimensional irregularities of the waveguide path. As an example of such irregularity, the considered transition between straight shielded waveguides with offset axes and with different transverse sizes. The main attention is paid to the description of the developed numerical-analytical algorithm for calculating the transmission characteristics of the matching transition. A procedure for obtaining an approximate record of the field components on the surface of an irregular region is presented, which makes it possible to take into account the curvature of the wave surface of an electromagnetic wave propagating in the guiding structure. In this case, the profile of the longitudinal section of the guiding structure can be described by any analytical functions. The concept of a 4W-fold comparison waveguide is introduced. In addition, this paper presents the results of calculating the frequency dependences of the transmission characteristics of the fundamental wave of waveguide transition at displacements of the axis of the second waveguide relative to the axis of the first waveguide by different values. The indicated transmission characteristics are found for single-mode and multimode modes of operation of the waveguide transition. In order to verify the results obtained, they have been compared with the results obtained using a modern licensed computer-aided design tool CST Microwave Studio. To demonstrate the possibility of solving the problem of “functional” optimization using the developed algorithm, the results of calculating the transmission characteristics of a waveguide transition between rectangular waveguides with cosine functions describing the profile of the longitudinal section of an irregular region have been presented. In order to indirectly substantiate the equivalence of the initial integral equations underlying the constructed algorithm and the problem of diffraction of an electromagnetic wave in a waveguide transition, a test problem of calculating the transmission characteristics of a stepped transition of two rectangular regular waveguides with different sizes has been solved. The calculation results have been compared with the results obtained on the basis of the electrodynamic substantiated method of half-inversion of the operator of the original boundary value problem. In addition to all the above, in order to assess the validity of the proposed method and the numerical-analytical algorithm built on its basis, a study of the convergence of the calculated results against the approximation number has been made.