Development of Data Quality Indicators for Improving Hospital International Classification of Diseases-coded Health Data Quality Globally.

BACKGROUND: Hospital inpatient data, coded using the International Classification of Diseases (ICD), is widely used to monitor diseases, allocate resources and funding, and evaluate patient outcomes. As such, hospital data quality should be measured before use; however, currently, there is no standard and international approach to assess ICD-coded data quality. OBJECTIVE: To develop a standardized method for assessing hospital ICD-coded data quality that could be applied across countries: Data quality indicators (DQIs). RESEARCH DESIGN: To identify a set of candidate DQIs, we performed an environmental scan, reviewing gray and academic literature on data quality frameworks and existing methods to assess data quality. Indicators from the literature were then appraised and selected through a 3-round Delphi process. The first round involved face-to-face group and individual meetings for idea generation, while the second and third rounds were conducted remotely to collect online ratings. Final DQIs were selected based on the panelists' quantitative and qualitative feedback. SUBJECTS: Participants included international experts with expertise in administrative health data, data quality, and ICD coding. RESULTS: The resulting 24 DQIs encompass 5 dimensions of data quality: relevance, accuracy and reliability; comparability and coherence; timeliness; and Accessibility and clarity. These will help stakeholders (eg, World Health Organization) to assess hospital data quality using the same standard across countries and highlight areas in need of improvement. CONCLUSIONS: This novel area of research will facilitate international comparisons of ICD-coded data quality and be valuable to future studies and initiatives aimed at improving hospital administrative data quality.

Crop rotational diversity can mitigate climate-induced grain yield losses.

Diversified crop rotations have been suggested to reduce grain yield losses from the adverse climatic conditions increasingly common under climate change. Nevertheless, the potential for climate change adaptation of different crop rotational diversity (CRD) remains undetermined. We quantified how climatic conditions affect small grain and maize yields under different CRDs in 32 long-term (10-63 years) field experiments across Europe and North America. Species-diverse and functionally rich rotations more than compensated yield losses from anomalous warm conditions, long and warm dry spells, as well as from anomalous wet (for small grains) or dry (for maize) conditions. Adding a single functional group or crop species to monocultures counteracted yield losses from substantial changes in climatic conditions. The benefits of a further increase in CRD are comparable with those of improved climatic conditions. For instance, the maize yield benefits of adding three crop species to monocultures under detrimental climatic conditions exceeded the average yield of monocultures by up to 553 kg/ha under non-detrimental climatic conditions. Increased crop functional richness improved yields under high temperature, irrespective of precipitation. Conversely, yield benefits peaked at between two and four crop species in the rotation, depending on climatic conditions and crop, and declined at higher species diversity. Thus, crop species diversity could be adjusted to maximize yield benefits. Diversifying rotations with functionally distinct crops is an adaptation of cropping systems to global warming and changes in precipitation.

Evaluating the coding accuracy of type 2 diabetes mellitus among patients with non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) describes a spectrum of chronic fattening of liver that can lead to fibrosis and cirrhosis. Diabetes has been identified as a major comorbidity that contributes to NAFLD progression. Health systems around the world make use of administrative data to conduct population-based prevalence studies. To that end, we sought to assess the accuracy of diabetes International Classification of Diseases (ICD) coding in administrative databases among a cohort of confirmed NAFLD patients in Calgary, Alberta, Canada. METHODS: The Calgary NAFLD Pathway Database was linked to the following databases: Physician Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, Pharmaceutical Information Network database, Laboratory, and Electronic Medical Records. Hemoglobin A1c and diabetes medication details were used to classify diabetes groups into absent, prediabetes, meeting glycemic targets, and not meeting glycemic targets. The performance of ICD codes among these groups was compared to this standard. Within each group, the total numbers of true positives, false positives, false negatives, and true negatives were calculated. Descriptive statistics and bivariate analysis were conducted on identified covariates, including demographics and types of interacted physicians. RESULTS: A total of 12,012 NAFLD patients were registered through the Calgary NAFLD Pathway Database and 100% were successfully linked to the administrative databases. Overall, diabetes coding showed a sensitivity of 0.81 and a positive predictive value of 0.87. False negative rates in the absent and not meeting glycemic control groups were 4.5% and 6.4%, respectively, whereas the meeting glycemic control group had a 42.2% coding error. Visits to primary and outpatient services were associated with most encounters. CONCLUSION: Diabetes ICD coding in administrative databases can accurately detect true diabetic cases. However, patients with diabetes who meets glycemic control targets are less likely to be coded in administrative databases. A detailed understanding of the clinical context will require additional data linkage from primary care settings.

Methane-derived carbon flows into host-virus networks at different trophic levels in soil.

The concentration of atmospheric methane (CH4) continues to increase with microbial communities controlling soil-atmosphere fluxes. While there is substantial knowledge of the diversity and function of prokaryotes regulating CH4 production and consumption, their active interactions with viruses in soil have not been identified. Metagenomic sequencing of soil microbial communities enables identification of linkages between viruses and hosts. However, this does not determine if these represent current or historical interactions nor whether a virus or host are active. In this study, we identified active interactions between individual host and virus populations in situ by following the transfer of assimilated carbon. Using DNA stable-isotope probing combined with metagenomic analyses, we characterized CH4-fueled microbial networks in acidic and neutral pH soils, specifically primary and secondary utilizers, together with the recent transfer of CH4-derived carbon to viruses. A total of 63% of viral contigs from replicated soil incubations contained homologs of genes present in known methylotrophic bacteria. Genomic sequences of 13C-enriched viruses were represented in over one-third of spacers in CRISPR arrays of multiple closely related Methylocystis populations and revealed differences in their history of viral interaction. Viruses infecting nonmethanotrophic methylotrophs and heterotrophic predatory bacteria were also identified through the analysis of shared homologous genes, demonstrating that carbon is transferred to a diverse range of viruses associated with CH4-fueled microbial food networks.

Personalized prediction of incident hospitalization for cardiovascular disease in patients with hypertension using machine learning.

BACKGROUND: Prognostic information for patients with hypertension is largely based on population averages. The purpose of this study was to compare the performance of four machine learning approaches for personalized prediction of incident hospitalization for cardiovascular disease among newly diagnosed hypertensive patients. METHODS: Using province-wide linked administrative health data in Alberta, we analyzed a cohort of 259,873 newly-diagnosed hypertensive patients from 2009 to 2015 who collectively had 11,863 incident hospitalizations for heart failure, myocardial infarction, and stroke. Linear multi-task logistic regression, neural multi-task logistic regression, random survival forest and Cox proportional hazard models were used to determine the number of event-free survivors at each time-point and to construct individual event-free survival probability curves. The predictive performance was evaluated by root mean squared error, mean absolute error, concordance index, and the Brier score. RESULTS: The random survival forest model has the lowest root mean squared error value at 33.94 and lowest mean absolute error value at 28.37. Machine learning methods provide similar discrimination and calibration in the personalized survival prediction of hospitalizations for cardiovascular events in patients with hypertension. Neural multi-task logistic regression model has the highest concordance index at 0.8149 and lowest Brier score at 0.0242 for the personalized survival prediction. CONCLUSIONS: This is the first personalized survival prediction for cardiovascular diseases among hypertensive patients using administrative data. The four models tested in this analysis exhibited a similar discrimination and calibration ability in predicting personalized survival prediction of hypertension patients.

Supporting wild pollinators in agricultural landscapes through targeted legume mixtures.

Insect-pollinated legumes are rich in plant-based proteins making them a vital constituent of sustainable healthy diets for people and livestock. Furthermore, they deliver or support a range of ecosystem services that underpin agricultural production and their prevalence in agricultural landscapes is likely to increase. Under typical implementation and management, the value of legumes to pollinators has, however, been questioned. Through exploring a range of legume crops, grown as monocultures and mixtures, this study aims to identify multifunctional legume cropping systems that optimise forage availability for a diversity of wild pollinators whilst delivering a wide range of agronomic and environmental benefits. This study innovatively explores legume mixtures concurrently with monocultures of the component species using replicated small-plot field trials established in two geographical locations. Observational plots assessed the richness and abundance of floral resources, and wild pollinators (i.e. bumblebees and hoverflies) throughout the peak flowering period. Densely flowering, highly profitable legumes (e.g. Trifolium incarnatum and Trifolium mixes) supported abundant and rich pollinator assemblages. The functional makeup of floral visitors was strongly influenced by flower structure and hoverflies, with their shorter proboscises, were largely constrained to legumes with shallower corolla and open weed species. Floral richness was not a key driver of pollinator assemblages; however, clear intra-specific differences were observed in flowering phenology. Combining functionally distinct legumes with respect to flower structure and phenology, will support a wider suite of pollinating insects and help stabilise the temporal availability of forage. For highly competitive legumes (e.g. Vicia faba and Vicia sativa), planting in discrete patches is recommended to reduce the risk of less competitive species failing in mixtures. Legumes can provide valuable forage for pollinators; however, they fail to meet all resource requirements. They should therefore be used in combination with agri-environmental measures targeted to promote early-season forage (e.g. hedgerows and farm woodlands), open flowers for hoverflies, saprophytic hoverfly larval resources (e.g. ditches and ponds) and nesting habitats (e.g. undisturbed field margins).

A comparison of reading, in people with simulated and actual central vision loss, with static text, horizontally scrolling text, and rapid serial visual presentation.

Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or rapid serial visual presentation (RSVP). The rationale for these dynamic text formats is that they can be read while holding gaze away from the text, potentially supporting reading while using the eccentric viewing strategy. This study was designed to evaluate the practice of reading with CVL, with passages of text presented as static sentences, with horizontal scrolling sentences, or as single-word RSVP. In separate studies, normally sighted participants with a simulated (artificial) central scotoma, controlled by an eye-tracker, or participants with CVL resulting from macular degeneration read passages of text using the eccentric viewing technique. Comprehension was better overall with scrolling text when reading with a simulated CVL, whereas RSVP produced lower overall comprehension and high error rates. Analysis of eye movement behavior showed that participants consistently adopted a strategy of making multiple horizontal saccades on the text itself. Adherence to using eccentric viewing was better with RSVP, but this did not translate into better reading performance. Participants with macular degeneration and an actual CVL also showed the highest comprehension and lowest error rates with scrolling text and the lowest comprehension and highest errors with RSVP. We conclude that scrolling text can support effective reading in people with CVL and has potential as a reading aid.

Increased Word Spacing Improves Performance for Reading Scrolling Text with Central Vision Loss.

SIGNIFICANCE: Scrolling text can be an effective reading aid for those with central vision loss. Our results suggest that increased interword spacing with scrolling text may further improve the reading experience of this population. This conclusion may be of particular interest to low-vision aid developers and visual rehabilitation practitioners. PURPOSE: The dynamic, horizontally scrolling text format has been shown to improve reading performance in individuals with central visual loss. Here, we sought to determine whether reading performance with scrolling text can be further improved by modulating interword spacing to reduce the effects of visual crowding, a factor known to impact negatively on reading with peripheral vision. METHODS: The effects of interword spacing on reading performance (accuracy, memory recall, and speed) were assessed for eccentrically viewed single sentences of scrolling text. Separate experiments were used to determine whether performance measures were affected by any confound between interword spacing and text presentation rate in words per minute. Normally sighted participants were included, with a central vision loss implemented using a gaze-contingent scotoma of 8° diameter. In both experiments, participants read sentences that were presented with an interword spacing of one, two, or three characters. RESULTS: Reading accuracy and memory recall were significantly enhanced with triple-character interword spacing (both measures, P ≤ .01). These basic findings were independent of the text presentation rate (in words per minute). CONCLUSIONS: We attribute the improvements in reading performance with increased interword spacing to a reduction in the deleterious effects of visual crowding. We conclude that increased interword spacing may enhance reading experience and ability when using horizontally scrolling text with a central vision loss.

Informing Primary Care Changes in Alberta: Continuity and Potential Impacts on Acute Care.

Health systems across Canada are embarking on initiatives to enhance access to primary care services, with the intent of improving patient outcomes and mitigating escalating healthcare costs. However, it is important that such initiatives be carefully weighed with the evidence that the changes will indeed have the desired impact. In Alberta, part of the informative process involved an analysis to examine links between continuity with primary care and utilization of acute care services. The findings provide information regarding expectations for outcomes and potentially useful (and not so useful) measures for monitoring progress and performance.

Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care.

Spirituality has been shown to be important to many individuals dealing with a cancer diagnosis. While African-American breast cancer survivors have been reported to have higher levels of spirituality compared to White women, little is known about how levels of spirituality may vary among African-American breast cancer survivors. The aims of this study were to examine factors associated with spirituality among African-American survivors and test whether spirituality levels were associated with women's attitudes about treatment or health care. The primary outcome, spirituality, was nine-item scale (Cronbach's α = .99). Participants completed standardized telephone interviews that captured sociocultural, healthcare process, and treatment attitudes. Medical records were abstracted post-adjuvant therapy for treatment and clinical information. In bivariate analysis, age was not correlated with spirituality (p = .40). Married/living as married women had higher levels of spirituality (m = 32.1) than single women (m = 30.1). Contextual factors that were associated with higher levels spirituality were: collectivism (r = .44; p < 0.0001, Afrocentric worldview (r = .185; p = .01), and self-efficacy scale (r = .17; p = .02). In multivariable analysis, sociodemographic factors were not significant. Collectivism remained a robust predictor (p < 0.0001). Attitudes about the efficacy of cancer treatment were not associated with spirituality. The high levels of spirituality in African-American survivors suggest consideration of integrating spiritual care within the delivery of cancer treatment. Future studies should consider how spirituality may contribute to positive coping and/or behaviors in African-American women with high levels of spirituality.

ACSC Indicator: testing reliability for hypertension.

BACKGROUND: With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. METHODS: We applied the Canadian Institute for Health Information's case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. RESULTS: There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. CONCLUSIONS: This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.

The value of Tablets as reading aids for individuals with central visual field loss: an evaluation of eccentric reading with static and scrolling text.

PURPOSE: Technological devices such as smartphones and tablets are widely available and increasingly used as visual aids. This study evaluated the use of a novel app for tablets (MD_evReader) developed as a reading aid for individuals with a central field loss resulting from macular degeneration. The MD_evReader app scrolls text as single lines (similar to a news ticker) and is intended to enhance reading performance using the eccentric viewing technique by both reducing the demands on the eye movement system and minimising the deleterious effects of perceptual crowding. Reading performance with scrolling text was compared with reading static sentences, also presented on a tablet computer. METHODS: Twenty-six people with low vision (diagnosis of macular degeneration) read static or dynamic text (scrolled from right to left), presented as a single line at high contrast on a tablet device. Reading error rates and comprehension were recorded for both text formats, and the participant's subjective experience of reading with the app was assessed using a simple questionnaire. RESULTS: The average reading speed for static and dynamic text was not significantly different and equal to or greater than 85 words per minute. The comprehension scores for both text formats were also similar, equal to approximately 95% correct. However, reading error rates were significantly (p = 0.02) less for dynamic text than for static text. The participants' questionnaire ratings of their reading experience with the MD_evReader were highly positive and indicated a preference for reading with this app compared with their usual method. CONCLUSIONS: Our data show that reading performance with scrolling text is at least equal to that achieved with static text and in some respects (reading error rate) is better than static text. Bespoke apps informed by an understanding of the underlying sensorimotor processes involved in a cognitive task such as reading have excellent potential as aids for people with visual impairments.

Effects of longitudinal changes in Charlson comorbidity on prognostic survival model performance among newly diagnosed patients with hypertension.

BACKGROUND: To assess the use of updated comorbidity information over time on ability to predict mortality among adults with newly diagnosed hypertension. METHODS: We studied adults 18 years and older with an incident diagnosis of hypertension from Alberta, Canada. We compared the prognostic performance of Cox regression models using Charlson comorbidities as time-invariant covariates at baseline (TIC) versus models including Charlson comorbidities as time-varying covariates (TVC) using Akaike Information Criterion (AIC) for testing goodness of fit. RESULTS: The strength of the association between important prognostic clinical variables and mortality varied by modeling technique; for example, myocardial infarction was less strongly associated with mortality in the TIC model (Hazard Ratio 1.07; 95% Confidence Interval (CI): 1.05 to 1.1) than in the TVC model (HR 1.20; 95% CI: 1.18 to 1.22). All TVC models slightly outperformed TIC models, regardless of the method used to adjust for comorbid conditions (individual Charlson Comorbidities, count of comorbidities or indices). The TVC model including all 17 Charlson comorbidities as individual independent variables showed the best fit and performance. CONCLUSION: Accounting for changes in patient comorbidity status over time more accurately captures a patient's health risk and slightly improves predictive model fit and performance than traditional methods using TIC assessment.

Development and validation of method for defining conditions using Chinese electronic medical record.

BACKGROUND: The adoption of the electronic medical record (EMR) is rapidly growing in China. Constantly evolving, Chinese EMRs contain vast amounts of clinical and financial data, providing tremendous potential for research and policy use; however, they are only partially standardized and contain free text or unstructured data. To utilize the information contained in Chinese EMRs, the development of data extraction methodology is urgently needed. The purpose of this study is to develop and validate methods to extract clinical information from the Chinese EMR for research use. METHODS: Using 2010 to 2014 EMR data from YouAn Hospital, a large teaching hospital affiliated with Capital Medical University in Beijing, China, we developed extraction methods including 40 EMR definitions for defining 6 liver disease, 5 disease severity conditions, and 29 comorbidities and treatments. We conducted a chart review of 450 randomly selected EMRs. Using physician chart review results as a reference, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to validate each EMR definition. RESULTS: The sensitivity of the 6 EMR definitions for liver diseases ranged from 78.9 to 100.0 %, and PPV ranged from 82.1 to 100.0 %. The sensitivity of the 5 definitions on disease severity conditions ranged from 91.0 to 100.0 %, and PPV ranged from 79.2 to 100.0 %. Among the 29 EMR definitions for comorbidities and treatments, 23 had sensitivity over 90.0 % and 25 had PPV over 80.0 %. The specificity and NPV for all 40 EMR definitions were over 90.0 %. CONCLUSION: The extraction method developed is a valid way of extracting information on liver diseases, comorbidities and related treatments from YouAn hospital EMRs. Our method should be modified for application to other Chinese EMR systems, following our framework for extracting conditions.

Activity in the human superior colliculus relating to endogenous saccade preparation and execution.

In recent years a small number of studies have applied functional imaging techniques to investigate visual responses in the human superior colliculus (SC), but few have investigated its oculomotor functions. Here, in two experiments, we examined activity associated with endogenous saccade preparation. We used 3-T fMRI to record the hemodynamic activity in the SC while participants were either preparing or executing saccadic eye movements. Our results showed that not only executing a saccade (as previously shown) but also preparing a saccade produced an increase in the SC hemodynamic activity. The saccade-related activity was observed in the contralateral and to a lesser extent the ipsilateral SC. A second experiment further examined the contralateral mapping of saccade-related activity with a larger range of saccade amplitudes. Increased activity was again observed in both the contralateral and ipsilateral SC that was evident for large as well as small saccades. This suggests that the ipsilateral component of the increase in BOLD is not due simply to small-amplitude saccades producing bilateral activity in the foveal fixation zone. These studies provide the first evidence of presaccadic preparatory activity in the human SC and reveal that fMRI can detect activity consistent with that of buildup neurons found in the deeper layers of the SC in studies of nonhuman primates.

Linking ligand perception by PEPR pattern recognition receptors to cytosolic Ca2+ elevation and downstream immune signaling in plants.

Little is known about molecular steps linking perception of pathogen invasion by cell surface sentry proteins acting as pattern recognition receptors (PRRs) to downstream cytosolic Ca(2+) elevation, a critical step in plant immune signaling cascades. Some PRRs recognize molecules (such as flagellin) associated with microbial pathogens (pathogen-associated molecular patterns, PAMPs), whereas others bind endogenous plant compounds (damage-associated molecular patterns, DAMPs) such as peptides released from cells upon attack. This work focuses on the Arabidopsis DAMPs plant elicitor peptides (Peps) and their receptors, PEPR1 and PEPR2. Pep application causes in vivo cGMP generation and downstream signaling that is lost when the predicted PEPR receptor guanylyl cyclase (GC) active site is mutated. Pep-induced Ca(2+) elevation is attributable to cGMP activation of a Ca(2+) channel. Some differences were identified between Pep/PEPR signaling and the Ca(2+)-dependent immune signaling initiated by the flagellin peptide flg22 and its cognate receptor Flagellin-sensing 2 (FLS2). FLS2 signaling may have a greater requirement for intracellular Ca(2+) stores and inositol phosphate signaling, whereas Pep/PEPR signaling requires extracellular Ca(2+). Maximal FLS2 signaling requires a functional Pep/PEPR system. This dependence was evidenced as a requirement for functional PEPR receptors for maximal flg22-dependent Ca(2+) elevation, H(2)O(2) generation, defense gene [WRKY33 and Plant Defensin 1.2 (PDF1.2)] expression, and flg22/FLS2-dependent impairment of pathogen growth. In a corresponding fashion, FLS2 loss of function impaired Pep signaling. In addition, a role for PAMP and DAMP perception in bolstering effector-triggered immunity (ETI) is reported; loss of function of either FLS2 or PEPR receptors impaired the hypersensitive response (HR) to an avirulent pathogen.

Saccadic distractor effects: the remote distractor effect (RDE) and saccadic inhibition (SI): A response to McIntosh and Buonocore (2014).

We (Walker & Benson, 2013) reported studies in which the spatial effects of distractors on the remote distractor effect (RDE) and saccadic inhibition (SI) were examined. Distractors remote from the target increased mean latency and the skew of the distractor-related distributions, without the presence of dips that are regarded as the hallmark of SI. We further showed that early onset distractors had similar effects although these would not be consistent with existing estimates of the duration of SI (of around 60-70 ms). McIntosh and Buonocore (2014) report a simulation showing that skewed latency distributions can arise from the putative SI mechanism and they also highlighted a number of methodological considerations regarding the RDE and SI as measures of saccadic distractor effects (SDEs). Here we evaluate these claims and note that the measures of SI obtained by subtracting latency distributions (specifically the decrease in saccade frequency--or dip duration) are no more diagnostic of a single inhibitory process, or more sensitive indicators of it, than is median latency. Furthermore the evidence of inhibitory influences of small distractors presented close to the target is incompatible with the explanations of both the RDE and SI. We conclude that saccadic distractor effects may be a more inclusive term to encompass the different characteristics of behavioral effects of underlying saccade target selection.

Molecular steps in the immune signaling pathway evoked by plant elicitor peptides: Ca2+-dependent protein kinases, nitric oxide, and reactive oxygen species are downstream from the early Ca2+ signal.

Endogenous plant elicitor peptides (Peps) can act to facilitate immune signaling and pathogen defense responses. Binding of these peptides to the Arabidopsis (Arabidopsis thaliana) plasma membrane-localized Pep receptors (PEPRs) leads to cytosolic Ca(2+) elevation, an early event in a signaling cascade that activates immune responses. This immune response includes the amplification of signaling evoked by direct perception of pathogen-associated molecular patterns by plant cells under assault. Work included in this report further characterizes the Pep immune response and identifies new molecular steps in the signal transduction cascade. The PEPR coreceptor BRASSINOSTEROID-INSENSITIVE1 Associated Kinase1 contributes to generation of the Pep-activated Ca(2+) signal and leads to increased defense gene expression and resistance to a virulent bacterial pathogen. Ca(2+)-dependent protein kinases (CPKs) decode the Ca(2+) signal, also facilitating defense gene expression and enhanced resistance to the pathogen. Nitric oxide and reduced nicotinamide adenine dinucleotide phosphate oxidase-dependent reactive oxygen species generation (due to the function of Respiratory Burst Oxidase Homolog proteins D and F) are also involved downstream from the Ca(2+) signal in the Pep immune defense signal transduction cascade, as is the case with BRASSINOSTEROID-INSENSITIVE1 Associated Kinase1 and CPK5, CPK6, and CPK11. These steps of the pathogen defense response are required for maximal Pep immune activation that limits growth of a virulent bacterial pathogen in the plant. We find a synergism between function of the PEPR and Flagellin Sensing2 receptors in terms of both nitric oxide and reactive oxygen species generation. Presented results are also consistent with the involvement of the secondary messenger cyclic GMP and a cyclic GMP-activated Ca(2+)-conducting channel in the Pep immune signaling pathway.

Acute alcohol modulates cardiac function as PI3K/Akt regulates oxidative stress.

BACKGROUND: Clinical manifestations of alcohol abuse on the cardiac muscle include defective contractility with the development of heart failure. Interestingly, low alcohol consumption has been associated with reduced risk of cardiovascular disease. Although several hypotheses have been postulated for alcoholic cardiomyopathy and for the low-dose beneficial cardiovascular effects, the precise mechanisms and mediators remain largely undefined. We hypothesize that modulation of oxidative stress by PI3K/Akt plays a key role in the cardiac functional outcome to acute alcohol exposure. METHODS: Thus, acutely exposed rat cardiac tissue and cardiocytes to low (LA: 5 mM), moderate (MA: 25 mM), and high (HA: 100 mM) alcohol were assessed for markers of oxidative stress in the presence and absence of PI3K/Akt activators (IGF-1 0.1 µM or constitutively active PI3K: Ad.BD110 transfection) or inhibitor (LY294002 1 µM or Akt-negative construct Ad.Akt(K179M) transfection). RESULTS: Acute LA reduced Akt, superoxide dismutase (SOD-3) and NFκB, ERK1, and p38 MAPK gene expression. Acute HA only increased that of SOD-3 and NFκB. These effects were generally inhibited by Ad.Akt(K179M) and enhanced with Ad.BD110 transfection. In parallel, LA reduced but HA enhanced Akt activity, which was reversed by IGF-1 and inhibited by Ad.Akt(K179M), respectively. Also, LA reduced caspase 3/7 activity and oxidative stress, while HA increased both. The former was blocked, while the latter effect was enhanced by Ad.Akt(K179M). The reverse was true with PI3K/Akt activation. This translated into reduced viability with HA, with no effect with LA. On the functional level, acute LA improved cardiac output and ejection fraction, mainly through increased stroke volume. This was accompanied with enhanced end-systolic pressure-volume relationship and preload recruitable stroke work. Opposite effect was recorded for HA. LA and HA in vivo functional effects were alleviated by LY and enhanced by IGF-1 treatment. CONCLUSIONS: Acute LA and HA seem to oppositely affect cardiac function through modulation of oxidative stress where PI3K/Akt plays a pivotal role.

Automated extraction of weight, height, and obesity in electronic medical records are highly valid.

Objective: Coding of obesity using the International Classification of Diseases (ICD) in healthcare administrative databases is under-reported and thus unreliable for measuring prevalence or incidence. This study aimed to develop and test a rule-based algorithm for automating the detection and severity of obesity using height and weight collected in several sections of the Electronic Medical Records (EMRs). Methods: In this cross-sectional study, 1904 inpatient charts randomly selected in three hospitals in Calgary, Canada between January and June 2015 were reviewed and linked with AllScripts Sunrise Clinical Manager EMRs. A rule-based algorithm was created which looks for patients' height and weight values recorded in EMRs. Clinical notes were split into sentences and searched for height and weight, and BMI was computed. Results: The study cohort consisted of 1904 patients with 50.8% females and 43.3% > 64 years of age. The final model to identify obesity within EMRs resulted in a sensitivity of 92.9%, specificity of 98.4%, positive predictive value of 96.7%, negative predictive value of 96.6%, and F1 score of 94.8%. Conclusions: This study developed a highly valid rule-based EMR algorithm that detects height and weight. This could allow large-scale analyses using obesity that were previously not possible.