Multidimensional Perioperative Recovery Trajectories in a Mixed Surgical Cohort: A Longitudinal Cluster Analysis Utilizing National Institutes of Health Patient-Reported Outcome Measurement Information System Measures.

BACKGROUND: Pain trajectories have been described in numerous surgical settings where preoperative characteristics have been used to predict trajectory membership. Suboptimal pain intensity trajectories have been linked to poor longitudinal outcomes. However, numerous biopsychosocial modulators of postoperative pain may also have distinct longitudinal trajectories that may inform additional targets to improve postoperative recovery. METHODS: Patients undergoing total joint arthroplasty, thoracic surgery, spine surgery, major abdominal surgery, or mastectomy completed Patient Reported Outcome Measurement Information System (PROMIS) measures and additional scales preoperatively and at 1 week, 2 weeks, 1 month, 3 months, and 6 months postoperatively. A k-means clustering for longitudinal data was utilized to explore and describe distinct pain impact (PROMIS Pain Interference and Physical Function) trajectories and associated changes in additional biopsychosocial measures. Follow-up analyses examined participant demographics and clinical characteristics associated with trajectory memberships. RESULTS: Three postoperative biopsychosocial symptom clusters were identified across all patients (n = 402): low (35%), average (47%), and high (18%) performance cluster trajectories. Participants undergoing total knee arthroplasty (TKA), spinal surgery, reporting presurgical opioid use, and higher pain catastrophizing scale scores were found to be associated with the low performance trajectory. Patients within the low performance trajectory, while demonstrating small improvements by 6 months, remained mild to moderately impaired in both pain impact and physical health outcomes. Alternatively, participants in the average performance trajectory demonstrated improvement in pain impact to population norms compared to baseline and demonstrated continued improvement across physical and psychological outcomes. Patients within the high performance cluster started within population norms across all measures at baseline and returned to baseline or exceeded baseline values by 6 months postoperatively. Self-reported opioid utilization was significantly higher in the low performance cluster across all time points. While a larger proportion of average performance patients reported opioid utilization during the first postoperative month compared to the high performance cluster, no differences were detected at 6 months postoperatively between these 2 clusters. CONCLUSIONS: These pain impact trajectories build upon previous unidimensional pain intensity trajectories and suggest that additional distinct biopsychosocial measures may have unique trajectories related to cluster assignment. Additionally, these findings highlight the importance of continued pain impact surveillance through the perioperative recovery period to detect patients at risk of experiencing a poor trajectory and subsequently poor longitudinal health outcomes.

Adaptation of software with the nursing process for innovation units / Adaptación de software con el proceso de enfermería para unidades de internación / Adaptação de software com o processo de enfermagem para unidades de internação

ABSTRACT Objective: To adapt data collection of the Information System software with the nursing process in Intensive Therapy for use in medical and surgical clinic units. Methods: A descriptive study developed in three stages. The first consisted of team training; in the second, the software was applied in clinical practice with 100 patients; and in the third, we analyzed the modifications to be done. Results: There was inter-observer agreement of 91%, followed by application of the software in 100 patients. In the "patient registration" module, it was suggested the exclusion of one item, inclusion of six and modification of four of them. In the anamnesis screens, no items were flagged to be deleted; 26 inclusions and 7 changes were proposed. In the physical examination screens, it was suggested the exclusion of 31 items, inclusion of 26 and modification of 27. Conclusion: Modifying information systems and going through stages methodologically constructed and implemented was important.

RESUMEN Objetivo: adaptar la etapa de recolección de datos del software Sistema de Información con el Proceso de Enfermería en Terapia Intensiva para uso en unidades de clínica médica y quirúrgica. Métodos: estudio descriptivo desarrollado en tres etapas. La primera consistió en la capacitación del equipo; la segunda, en la aplicación del software a la práctica clínica con 100 pacientes y; la tercera, en el análisis de las modificaciones que se deben llevar a cabo. Resultados: se obtuvo concordancia interobservador del 91 %, seguida de aplicación del software a 100 pacientes. En el módulo de registro de los pacientes, se sugirió la exclusión de un ítem, la inclusión de seis ítems y la modificación de cuatro. En las pantallas de Anamnesis, no se señaló ningún ítem que excluir; se propusieron 26 inclusiones y siete modificaciones. En las pantallas del examen físico se sugirió la exclusión de 31 ítems, la inclusión de 26 y la modificación de 27. Conclusión: se observa la importancia de modificar sistemas de información, avanzando por etapas metodológicamente construidas e implementadas.

RESUMO Objetivo: adaptar a etapa de coleta de dados do software Sistema de Informação com o Processo de Enfermagem em Terapia Intensiva para uso em unidades de clínica médica e cirúrgica. Métodos: estudo descritivo desenvolvido em três etapas. A primeira consistiu na capacitação da equipe, na segunda o software foi aplicado na prática clínica com 100 pacientes e na terceira analisaram-se as modificações a serem realizadas. Resultados: obteve-se concordância inter-observador de 91%, seguido por aplicação do software em 100 pacientes. No módulo cadastro dos pacientes foi sugerida a exclusão de um item, incluídos seis e modificados quatro. Nas telas de Anamnese, nenhum item foi sinalizado para ser excluído; foram propostas 26 inclusões e sete alterações. Nas telas do exame físico foi sugerida a exclusão de 31 itens, a inclusão de 26 e 27 modificações. Conclusão: Observa-se a importância de modificar sistemas de informação, perpassando por etapas metodologicamente construídas e implementadas.

Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015 / Trend and inequality in the completeness of information on race/color in deaths of elderly in the Mortality Information System in Brazil, 2000 to 2015 / Tendencia y desigualdad en la cumplimentación de la información sobre raza/color de los óbitos de ancianos en el Sistema de Informacions sobre Mortalidad en Brasil, entre 2000 y 2015

A qualidade da informação sobre raça/cor é condição necessária para conhecer o impacto da desigualdade na mortalidade. O objetivo deste trabalho é analisar a tendência e a desigualdade na completude da raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade (SIM) entre 2000 e 2015 no Brasil. Analisa-se a completude dessa variável por diferentes abrangências geográficas, a raça/cor mais afetada pela má completude e a associação entre a excelência do preenchimento da raça/cor com a territorialidade e a condição socioeconômica dos municípios. Os dados dos óbitos de idosos provêm do SIM, e as informações de população, dos Censos e estimativas do Ministério da Saúde. Estima-se a variação percentual da proporção da incompletude. A variação percentual de pretos/pardos foi estimada entre 2000 e 2010 para o SIM e Censos. Estima-se regressão logística simples e ajustada (IC95%), tendo, como desfecho excelente, completude da raça/cor e, como resposta, variáveis territoriais e socioeconômicas. Encontrou-se acentuada melhora da qualidade do preenchimento no período, especialmente até 2006, sendo excelente a média nacional desde 2007. Nota-se desigualdade territorial em nível municipal. Municípios de IDH baixo/médio, com alta proporção de pobreza e desigualdade tiveram menor chance de ter excelente completude. O modelo ajustado mostra que a região e o tamanho do município são as características que explicam a excelente qualidade da variável raça/cor. Municípios do Nordeste e de pequeno porte têm menos chance de excelente completude. Conclui-se que raça/cor no SIM tem qualidade para ser utilizada nos estudos de desigualdade da mortalidade dos idosos, salvo exceções em nível municipal.

The quality of information on race/color is a necessary condition for knowing the impact of inequality on mortality. This study aims to analyze the trend and inequality in completeness of race/color in death records of elderly in Brazil's Mortality Information System (SIM in Portuguese) from 2000 to 2015. The study analyzes the completeness of this variable according to different geographic areas, the race or color most affected by poor completeness of records, and the association between excellent completion of race/color and the municipalities' territoriality and socioeconomic status. Data on deaths of elderly individuals were obtained from the SIM and information on the population from censuses and Ministry of Health estimates. The study estimates the percent variation in the proportion of incompleteness. The percent variation of black and brown individuals was estimated from 2000 to 2010 from the SIM and censuses. Crude and adjusted logistic regression (95%CI) were used to estimate completeness of race/color as the outcome and territorial and socioeconomic characteristics as independent variables. We found a sharp improvement in quality of completion during the period, especially up to 2006, with an excellent average since 2007. The findings showed territorial inequality at the municipal level. Municipalities with low/medium HDI (with a high proportion of poverty and inequality) showed lower odds of excellent completeness. The adjusted model shows that the region and size of the municipality are characteristics that explain the excellent quality of the race/color variable. Municipalities in Northeast Brazil and small municipalities have the lowest odds of excellent completeness. In conclusion, race/color in the SIM has sufficient quality to be used in studies on inequality of mortality in the elderly, with exceptions at the municipal level.

La calidad de la información sobre raza/color es una condición necesaria para conocer el impacto de la desigualdad en la mortalidad. El objetivo de este trabajo es analizar la tendencia y la desigualdad en la cumplimentación de la raza/color de los óbitos de ancianos en el Sistema de Informacions sobre Mortalidad (SIM) entre 2000 y 2015 en Brasil. Se analiza la cumplimentación de esta variable a través de diferentes ámbitos geográficos, la raza/color más afectada por la mala cumplimentación y la asociación entre la excelencia de la cumplimentación de la raza/color con la territorialidad y la condición socioeconómica de los municipios. Los datos de los óbitos de ancianos provienen del SIM y la información de población procede de los censos y estimativas del Ministerio de Salud. Se estima la variación del porcentaje a través de la proporción de la no cumplimentación. La variación del porcentaje de negros/mulatos se estimó entre 2000 y 2010 para el SIM y censos. Se estima regresión logística simple y ajustada (IC95%), teniendo como desenlace excelente la cumplimentación de la raza/color y como respuesta variables territoriales y socioeconómicas. Se encontró una acentuada mejora de la calidad de la cumplimentación durante el período, especialmente hasta 2006, siendo excelente la media nacional desde 2007. Se nota desigualdad territorial a nivel municipal. Municipios de IDH bajo/medio, con alta proporción de pobreza y desigualdad, tuvieron una menor oportunidad de contar con una excelente cumplimentación. El modelo ajustado muestra que la región y el tamaño del municipio son las características que explican la excelente calidad de la variable raza/color. Municipios del nordeste y de pequeño porte tienen menos oportunidad de excelente cumplimentación. Se concluye que raza/color en el SIM tiene calidad para ser utilizada en los estudios de desigualdad de la mortalidad de ancianos, salvo excepciones a nivel municipal.

Algunas reflexiones sobre los datos abiertos enlazados en Cuba / Some Reflections on Linked Open Data in Cuba

Cuba está realizando una introducción intensiva de las tecnologías de la información y la comunicación en la sociedad, con el desarrollo y el despliegue de sistemas de información para aumentar la eficiencia de varios sectores económicos y sociales. En este contexto, varias instituciones gubernamentales están publicando datos; sin embargo, estos datos se publican utilizando diversos formatos y estándares, sin relaciones explícitas entre ellos, con alta dispersión y baja capacidad de integración de datos. En este artículo presentamos algunas reflexiones sobre la necesidad del uso de los datos abiertos enlazados en Cuba y algunos desafíos que afectan la adopción masiva de ellos en el país. Señalamos que la apertura de los datos abiertos enlazados en Cuba requiere el uso de mecanismos adecuados relacionados con una infraestructura tecnológica actualizada, un marco legal adecuado y una sinergia adecuada entre los productores y los consumidores de los datos abiertos enlazados en el país(AU)

Cuba is carrying out an intensive introduction of the ICT in the society, developing and deploying information systems to increase the efficiency of several economic and social sectors. In this context, several government institutions are publishing open data; however, these data are published using diverse formats and standards, without explicit relations between them, with high dispersion and low data integration capabilities. In this paper, we state some reflections about the use of the linked open data in Cuba and some challenges affecting the massive adoption of them in the country. We point out that the openness of the linked open data in Cuba requires the use of adequate mechanisms related to an updated technological infrastructure, an adequate legal framework and an adequate synergy between the producers and consumers of the linked open data in the country(AU)

World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation.

OBJECTIVES: To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. STUDY DESIGN: An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. RESULTS: Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. CONCLUSIONS: The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed.

Caracterización del sistema de información del programa de salud bucal del Ministerio del Poder Popular para la Salud adscrito a la Dirección de Salud de Salud Estadal del Distrito Capital Venezuela: estudio realizado en el período marzo / octubre 2010 / Information system characterization of oral health progran of people for Ministry of Health assigned to address the health dept state authority capital Venezuela: study conducted in the period march 2009 / october 2010

La finalidad de un Sistema de Información en Salud (SIS)es articular adecuadamente la operación de los componentes internos y de los externos con los cuales está relacionado, para que se produzcan los datos necesarios, y al final generar la información para los usuarios responsables de la planificación, ejecución control y evaluación de los servicios de salud 1.El objetivo general de esta investigación fue la caracterización del Sistema de Información del Programa de Salud Bucal del Ministerio del Poder Popular para la Salud (MPPS) adscrito a la Dirección de Salud Estadal del Distrito Capital. La investigación, se inscribe en el método empírico analítico. Para operacionalizarla se construyó guiones de entrevistas estructuradas y semi-estructuradas, las cuales se aplicaron a los informantes siguientes: Un Coordinador Regional del Programa de Salud Bucal del Distrito Capital, cuatro Coordinadores Distritales, dos técnicos de soporte de la Coordinación del Sistema de Información de Salud de la Dirección Estadal de Salud, para un total de siete entrevistados, identificados como informantes claves, que representan el nivel de coordinación y técnico del SIS Regional y Distrital. También se abordó, con el mismo fin, el nivel operativo del SIS, constituido por una muestra no probabilística de tipo opinática de ochentaisiete personas entre odontólogos e higienistas dentales, que laboran en diferentes servicios en el Distrito Capital a quienes se les aplicó un cuestionario Entre las conclusiones más relevantes se distinguen las siguientes: No existe pertinencia del Sistema de Información actual del programa de Salud Bucal con las decisiones que se toman a nivel de la coordinación. Los usuarios, no procesan la información, se limitan solo a realizar un registro de datos, que en ningún momento constituyen una referencia para evaluar o reconsiderar las acciones que se ejecutan en un momento determinado

The purpose of a health information system is to articulate properly the operation of the internal components and external which is related to the occurrence of the data needed, and finally generate the information to the users responsible for planning, performance monitoring and evaluation of health services 1. the general objective of this research was the characterization of the Information System for Oral Health Program of the Ministry of Popular Power for Health (MPPS) attached to the health Directorate of the State Authority Capital district. The research is part of the empirical method of analysis. Built scripts to operationalize structured interviews and semi-structured interviews, which were applied to the following informants: One Regional Coordinator of the Oral Health Program of the Capital District, four District Coordinators, two technical coordination support System Health Information Management Health State Authority, for a total of seven interviewed key informants identified as representing the level of coordination and technical support from Regional and District SIS. Also addressed, with the same purpose, the operational level of the SIS, consisting of a non-probability sample of 87 opinática type people between dentists and dental hygienists, who work in various departments in the Capital District who have applied a questionnaire among the most important conclusions are distinguished as follows: There is no relevance of current Information System Oral Health program with the decisions taken at the level of coordination. Users, not process information is limited only to perform a data record that at no time constitute a reference to evaluate or review the actions that are executed at a given time

Management of cancer pain in the community: Perceptions of current UK information technology systems and implications for future development.

The objective of this study was to investigate perceptions of how information technology (IT) is currently utilised in the UK in the community management of cancer pain, perceived weaknesses in the current systems and expectations of future IT systems. Healthcare professionals and patient representatives (n = 46) attended two meetings that explored perceptions of current and future provision of managing cancer pain in the community and the potential role of informatics in supporting this. Discussion was captured and analysed using qualitative methods. Analysis revealed that complexities and barriers to the routine capture of data on pain and related distress focused on locations of care, circles of support, and management and sharing of data. In addition, analysis revealed IT was perceived to be peripheral to supporting delivery and organisation. Delegates shared a vision for an IT system that enabled patients to access healthcare provision by effective co-ordination and communication of patient-centred information. Gaps exist between the expectations of users and the ability of current IT systems to support care. While recognising the potential of tele-health solutions, supporting the complexity of multi-agency care delivery in rapidly evolving clinical circumstances was seen as the main challenge. There is, therefore, a need to position IT more flexibly within the delivery model of clinical care if technology is to address current limitations and enhance the community management of cancer pain.

The dangerous decade.

Over the next 10 years, more information and communication technology (ICT) will be deployed in the health system than in its entire previous history. Systems will be larger in scope, more complex, and move from regional to national and supranational scale. Yet we are at roughly the same place the aviation industry was in the 1950s with respect to system safety. Even if ICT harm rates do not increase, increased ICT use will increase the absolute number of ICT related harms. Factors that could diminish ICT harm include adoption of common standards, technology maturity, better system development, testing, implementation and end user training. Factors that will increase harm rates include complexity and heterogeneity of systems and their interfaces, rapid implementation and poor training of users. Mitigating these harms will not be easy, as organizational inertia is likely to generate a hysteresis-like lag, where the paths to increase and decrease harm are not identical.

Data liquidity in health information systems.

In 2001, the Institute of Medicine report Crossing the Quality Chasm and the National Committee on Vital and Health Statistics report Information for Health were released, and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data are provided to the right person at the right time, which is one definition of "data liquidity." This concept has had some traction in recent years as a shorthand way to express a system property for health information technology, but there is not a well-defined characterization of what properties of a system or of its components give it better or worse data liquidity. This article looks at some recent work that help to identify those properties and perhaps can help to ground the concept with metrics that are assessable.

O pensamento psicanalítico sobre o autismo a partir da análise da Revista Estilos da Clínica / The psychoanalitical thought about autism through the analysis of Periodical Estilos da Clínica / El pensamiento psicoanalítico sobre el autismo a partir de los análisis del Periódico Estilos da Clínica

Atualmente, observamos o surgimento de trabalhos clínicos e institucionais com crianças autistas no Brasil, cujos reflexos resultaram em publicações distribuídas em periódicos nacionais. Este artigo tem por objetivo discutir o tema do autismo a partir da análise de artigos publicados no periódico Estilos da Clínica, o qual é direcionado ao tema da infância e psicanálise. Para tal, fizemos um estudo qualitativo de artigos publicados nesta revista (de 1996 a 2007), congregando um total de trinta e cinco trabalhos. A discussão é apresentada por meio de eixos temáticos: a clínica e perspectivas de tratamento e a problemática da escolarização destinada a essas crianças.

Currently, we observe the emergence of clinical and institutional work with autistic children in Brazil, whose consequences have resulted in publications distributed in national periodicals. This article aims to discuss the topic of autism from the analysis of articles published in the "Estilos da Clínica" periodical, which is directed to the theme of childhood and psychoanalysis. For such, we made a qualitative study of articles published in this magazine (from 1996 to 2007), bringing together a total of thirty five works. The discussion is presented through thematic axes: the clinic and treatment perspectives and the problem of schooling meant to these children.

Actualmente, observamos el aparecimiento de trabajos clínicos e institucionales con niños autistas en Brasil, cuyos reflejos tuvieron como resultado publicaciones distribuidas en periódicos nacionales. Este artículo tiene por objetivo discutir el tema del autismo partiendo del análisis de artículos publicados en el periódico "Estilos da Clínica", el cual encamina para el tema de infancia y psicoanálisis. Para eso, hicimos un estudio cualitativo de artículos publicados en esta revista (de 1996 hasta 2007) llegando a un total de trenta y cinco trabajos. La discusión es presentada a través de ejes temáticos: la clínica y perspectivas de tratamiento y la problemática de la escolarización destinada a estos niños.

Micro-nano-biosystems: An overview of European research.

New developments in science, technologies and applications are blurring the boundaries between information and communications technology (ICT), micro-nano systems and life sciences, e.g. through miniaturisation and the ability to manipulate matter at the atomic scale and to interface live and man-made systems. Interdisciplinary research towards integrated systems and their applications based on emerging convergence of information & communication technologies, micro-nano and bio technologies is expected to have a direct influence on healthcare, ageing population and well being. Micro-Nano-Bio Systems (MNBS) research and development activities under the European Union's R&D Programs, Information & Communication Technologies priority address miniaturised, smart and integrated systems for in-vitro testing e.g. lab-on-chips and systems interacting with the human e.g. autonomous implants, endoscopic capsules and robotics for minimally invasive surgery. The MNBS group involves hundreds of key public and private international organisations working on system development and validation in diverse applications such as cancer detection and therapy follow-up, minimally invasive surgery, capsular endocsopy, wearable biochemical monitoring and repairing of vital functions with active implant devices. The paper presents MNBS rationale and activities, discusses key research and innovation challenges and proposes R&D directions to achieve the expected impact on healthcare and quality of life.

Information systems for cancer research.

The last decade has seen a massive growth in data for cancer research, with high-throughput technologies joining clinical trials as major drivers of informatics needs. These data provide opportunities for developing new cancer treatments, but also major challenges for informatics, and we summarize the systems needed and potential issues arising in addressing these challenges. Integrating these data into the research enterprise will require investments in (1) data capture and management, (2) data analysis, (3) data integration standards, (4) visualization tools, and (5) methods for integration with other enterprise systems.

Elaboração de um sistema informatizado de materiais cirúrgicos: relato de experiência / Developing a computer sustem of surgical materials: a case report

Estudo desenvolvido em um hospital de reabilitação para elaborar um sistema informatizado de materiais cirúrgicos. O sistema criado tem o objetivo de orientar e direcionar o preparo das cirurgias e possibilitar a troca de informações entre Centro Cirúrgico (CC), Central de Material e Esterilização (CME) e os cirurgiões e a equipe de enfermagem. Método: os materiais utilizados pelas equipes cirúrgicas foram revisados e listados pelos enfermeiros da CME e do CC e alimentaram um programa de software específico, denominado Sistema de Suporte para Procedimentos Cirúrgicos. Este trabalho contribuiu para organização de carrinhos cirúrgicos, salas de indução anestésica e operatória, planejamento e autonomia das condutas, educação continuada, treinamento e melhor operacionalização do serviço .

Databases applicable to quantitative hazard/risk assessment--towards a predictive systems toxicology.

The Workshop on The Power of Aggregated Toxicity Data addressed the requirement for distributed databases to support quantitative hazard and risk assessment. The authors have conceived and constructed with federal support several databases that have been used in hazard identification and risk assessment. The first of these databases, the EPA Gene-Tox Database was developed for the EPA Office of Toxic Substances by the Oak Ridge National Laboratory, and is currently hosted by the National Library of Medicine. This public resource is based on the collaborative evaluation, by government, academia, and industry, of short-term tests for the detection of mutagens and presumptive carcinogens. The two-phased evaluation process resulted in more than 50 peer-reviewed publications on test system performance and a qualitative database on thousands of chemicals. Subsequently, the graphic and quantitative EPA/IARC Genetic Activity Profile (GAP) Database was developed in collaboration with the International Agency for Research on Cancer (IARC). A chemical database driven by consideration of the lowest effective dose, GAP has served IARC for many years in support of hazard classification of potential human carcinogens. The Toxicological Activity Profile (TAP) prototype database was patterned after GAP and utilized acute, subchronic, and chronic data from the Office of Air Quality Planning and Standards. TAP demonstrated the flexibility of the GAP format for air toxics, water pollutants and other environmental agents. The GAP format was also applied to developmental toxicants and was modified to represent quantitative results from the rodent carcinogen bioassay. More recently, the authors have constructed: 1) the NIEHS Genetic Alterations in Cancer (GAC) Database which quantifies specific mutations found in cancers induced by environmental agents, and 2) the NIEHS Chemical Effects in Biological Systems (CEBS) Knowledgebase that integrates genomic and other biological data including dose-response studies in toxicology and pathology. Each of the public databases has been discussed in prior publications. They will be briefly described in the present report from the perspective of aggregating datasets to augment the data and information contained within them.