Big Data, Predictive Analytics, and Quality Improvement in Kidney Transplantation: A Proof of Concept.

We sought proof of concept of a Big Data Solution incorporating longitudinal structured and unstructured patient-level data from electronic health records (EHR) to predict graft loss (GL) and mortality. For a quality improvement initiative, GL and mortality prediction models were constructed using baseline and follow-up data (0-90 days posttransplant; structured and unstructured for 1-year models; data up to 1 year for 3-year models) on adult solitary kidney transplant recipients transplanted during 2007-2015 as follows: Model 1: United Network for Organ Sharing (UNOS) data; Model 2: UNOS & Transplant Database (Tx Database) data; Model 3: UNOS, Tx Database & EHR comorbidity data; and Model 4: UNOS, Tx Database, EHR data, Posttransplant trajectory data, and unstructured data. A 10% 3-year GL rate was observed among 891 patients (2007-2015). Layering of data sources improved model performance; Model 1: area under the curve (AUC), 0.66; (95% confidence interval [CI]: 0.60, 0.72); Model 2: AUC, 0.68; (95% CI: 0.61-0.74); Model 3: AUC, 0.72; (95% CI: 0.66-077); Model 4: AUC, 0.84, (95 % CI: 0.79-0.89). One-year GL (AUC, 0.87; Model 4) and 3-year mortality (AUC, 0.84; Model 4) models performed similarly. A Big Data approach significantly adds efficacy to GL and mortality prediction models and is EHR deployable to optimize outcomes.

Retrospective review of locally set tolerances for VMAT prostate patient specific QA using the COMPASS(®) system.

PURPOSE: This study retrospectively reviewed locally set pass rates/tolerances for COMPASS(®) pre-treatment quality assurance results for RapidArc prostate plans to determine if these are appropriate. This was performed via quantifying the agreement between treatment planning system calculations and measurements based on absolute dose comparisons (3% tolerance for all dose points) and global gamma index assessment (3%/3 mm criterion for 97% of points). METHOD: Seventy-three prostate one-arc RapidArc plans, delivered by four dosimetrically matched linacs, were measured using the MatriXX Evolution two-dimensional array and analysed using COMPASS(®) (v.3, IBA Dosimetry). For the planning target volumes (PTV) considered, the D99%, D50%, D1% and DMean differences were analysed. The percentage volume with gamma greater than 1, average gamma and DMean difference were investigated for all structures. Nine plans were also assessed across the linac fleet to investigate potential linac dependence of results. RESULTS AND CONCLUSIONS: Regarding PTV DMean differences, all plans fell within the 3% tolerance and mostly within 2%, although there was a relatively small systematic difference. The absolute percentage differences of average and median doses suggested a weak linac dependence of the results which was found to be clinically insignificant. New stricter tolerances were established both for dose comparisons and gamma evaluation. Correlation between the gamma pass rates and the differences in the D99%, D50% and D1% was found to be moderate suggesting that gamma analysis in isolation has questionable clinical meaning and should only be used to indicate outliers for further analysis.

Zebra mussels affect benthic predator foraging success and habitat choice on soft sediments.

The introduction of zebra mussels ( Dreissena spp.) to North America has resulted in dramatic changes to the complexity of benthic habitats. Changes in habitat complexity may have profound effects on predator-prey interactions in aquatic communities. Increased habitat complexity may affect prey and predator dynamics by reducing encounter rates and foraging success. Zebra mussels form thick contiguous colonies on both hard and soft substrates. While the colonization of substrata by zebra mussels has generally resulted in an increase in both the abundance and diversity of benthic invertebrate communities, it is not well known how these changes affect the foraging efficiencies of predators that prey on benthic invertebrates. We examined the effect of zebra mussels on the foraging success of four benthic predators with diverse prey-detection modalities that commonly forage in soft substrates: slimy sculpin ( Cottus cognatus), brown bullhead ( Ameirus nebulosus), log perch ( Percina caprodes), and crayfish ( Orconectes propinquus). We conducted laboratory experiments to assess the impact of zebra mussels on the foraging success of predators using a variety of prey species. We also examined habitat use by each predator over different time periods. Zebra mussel colonization of soft sediments significantly reduced the foraging efficiencies of all predators. However, the effect was dependent upon prey type. All four predators spent more time in zebra mussel habitat than in either gravel or bare sand. The overall effect of zebra mussels on benthic-feeding fishes is likely to involve a trade-off between the advantages of increased density of some prey types balanced against the reduction in foraging success resulting from potential refugia offered in the complex habitat created by zebra mussels.

Dissipation-induced instabilities in an optical cavity laser: a mechanical analog near the 1:1 resonance.

The 1:1 resonance for perturbed Hamiltonian systems with small dissipative and energy injection terms has been studied. These perturbations of the 1:1 resonance exhibit dissipation induced instabilities. This mechanism allows one to show that an optical cavity with small pumping is unstable when one takes into account the dissipative effects. The Maxwell-Bloch equations are the asymptotic normal form that describe this instability when energy is injected through forcing at zero frequency. A simple mechanical system close to the 1:1 resonance has been displayed, which is a mechanical analog of the laser.

Management of eye emergencies in the accident and emergency department by senior house officers: a national survey.

OBJECTIVE: To assess the training that accident and emergency (A&E) senior house officers (SHOs) receive in dealing with eye emergencies, their own perceived level of confidence and competence in managing such cases, and the availability of appropriate equipment in their departments. METHODS: Prospective telephone survey using a standardised structured questionnaire. One SHO from each United Kingdom A&E department listed in the BAEM directory of 1993 was chosen at random and interviewed. RESULTS: 226 A&E departments were contacted and 192 SHOs were successfully interviewed (response rate 84.9%); 26.0% received no training in the management of eye emergencies, 68.8% had only a little or no confidence in dealing with these cases, and 42.2% worked in A&E departments which had no slit lamp. CONCLUSIONS: There is a lack of adequate basic ophthalmic training for A&E SHOs, leading to a lack of confidence on their part in the management of eye emergencies. In just over 40% of A&E departments in the United Kingdom, the management of these cases may be less than optimal because of the absence of a slit lamp.

Single-Locus Inheritance in the Tetraploid Treefrog Hyla versicolor with an Analysis of Expected Progeny Ratios in Tetraploid Organisms.

The recently evolved autotetraploid frog, Hyla versicolor , was examined electrophoretically for evidence of genomic restructuring leading to diploidization. Loci were tested against the progeny ratios expected if inheritance was disomic vs. tetrasomic. Two loci (Mpi and Sod-2) appeared to be inherited tetrasomically, one (Mdh-2) appeared to be inherited disomically, and one (Tpi) appeared to be inherited disomically in one family and tetrasomically in another family, when tested conventionally against 1:2:1 and 1:4:1 segregation ratios. The minimum number of progeny required for this type of analysis for codominant alleles is shown to be 92. Progeny resulting from double reduction were observed, and the occurrence of a null allele class at Mpi was noted. A reexamination of expected progeny ratios in tetraploid organisms reveals that tetrasomic inheritance patterns cannot be predicted without adequate knowledge of the amount of crossing-over, the proportion of tetravalents vs. random bivalents that are formed, and the ratio and types of centromere segregation (alternate and adjacent) that occur from tetravalents in the species being studied. However, disomic inheritance can be unambiguously confirmed only by the production of all heteroallelic gametes from homobivalent, symmetrically heterozygous individuals. In addition, a method is described for estimating genecentromere distances using the ratio of progeny genotypes in certain crosses in tetraploid species.

Inheritance of duplicated fumarase and phosphoglucomutase loci in lake trout (Salvelinus namaycush).

Two polymorphic, duplicated loci (fumarase-1,2 and phosphoglucomutase-3,4), previously undescribed in salmonids, were examined in lake trout to determine their electrophoretic expression, mode of inheritance, and linkage associations. Both loci appear to be located on chromosomes which show residual tetrasomy. Neither locus pair shows joint segregation with other loci examined or with each other.

Diploid and tetraploid grey treefrogs (Hyla chrysoscelis and Hyla versicolor) have similar metabolic rates.

We measured oxygen consumption of the diploid frog Hyla chrysoscelis and its recently evolved tetraploid cryptic species Hyla versicolor at rest and during forced locomotory exercise. We also measured whole-body lactic acid concentrations of individuals of the two species at rest and following 4 min of exercise. Contrary to predictions based on tissue-culture experiments, rates of organismal metabolism are not different in this diploid/tetraploid species pair: the diploid and tetraploid species did not differ in rates of oxygen consumption at rest or during exercise. Furthermore, whole-body lactate concentrations of frogs at rest and following forced locomotion were the same in the diploid and tetraploid species. For these species, polyploidy does not appear to be associated with lower maintenance costs at the level of the organism. However, polyploidy also does not appear to have metabolic consequences that would limit the behavioral or ecological repertoire of an anuran.