RAMPVIS: Answering the challenges of building visualisation capabilities for large-scale emergency responses.

The effort for combating the COVID-19 pandemic around the world has resulted in a huge amount of data, e.g., from testing, contact tracing, modelling, treatment, vaccine trials, and more. In addition to numerous challenges in epidemiology, healthcare, biosciences, and social sciences, there has been an urgent need to develop and provide visualisation and visual analytics (VIS) capacities to support emergency responses under difficult operational conditions. In this paper, we report the experience of a group of VIS volunteers who have been working in a large research and development consortium and providing VIS support to various observational, analytical, model-developmental, and disseminative tasks. In particular, we describe our approaches to the challenges that we have encountered in requirements analysis, data acquisition, visual design, software design, system development, team organisation, and resource planning. By reflecting on our experience, we propose a set of recommendations as the first step towards a methodology for developing and providing rapid VIS capacities to support emergency responses.

Analysis of extracorporeal photopheresis within the frame of the WAA register.

The aim of the study was to investigate safety and if extracorporeal photopheresis (ECP) may change health criteria (HC) and quality of life (QoL). MATERIAL AND METHOD: 560 patients (33 % women) were treated with ECP for a total of 13,871 procedures during a 17-years period. Mean age was 48 years (±18, range 3-81 years). Self-estimation of QoL was graded: 0 (suicidal) up to 10 (best ever) and HC: 0 (Bed ridden, ICU condition) up to 10 (athletic). Adverse events were analyzed. ANOVA and paired comparisons were performed. RESULTS: Patients were treated due to graft versus host disease (GVHD, n = 317), skin lymphoma (n = 70), solid organ transplants (n = 47), skin diseases (n = 20) and other diseases (n = 106). Adverse events (AEs) were registered in 5.4 % of the first treatments and in 1.2 % of the subsequent procedures. Severe AEs were present in 0.04 % of all procedures. No patient died due to the procedure. Tingling and stitching were the most common AE. For those with GVHD an improvement was noticed within approximately 10 procedures of ECP in the severity stage, QoL (from a mean of 6.1 to 6.8, p < 0.002) and the HC (6.1 -> 6.4, p < 0.014) and improved further with added procedures. CONCLUSION: Photopheresis is an established therapy with few side effects. The present study of soft variables indicate that GVHD shows benefits upon ECP within approximately 10 procedures in regard to the severity of mainly skin GVHD, and lower baseline levels of HC and QoL.

Systemic ventricular assist device support in Fontan patients: A report by ACTION.

BACKGROUND: The size of the Fontan population with end-stage heart failure is growing. In this population, heart transplantation has been the only option. This study sought to investigate the efficacy of ventricular assist device (VAD) support in Fontan patients. METHODS: We conducted a retrospective study of Fontan patients in the Advanced Cardiac Therapies Improving Outcomes Network. We evaluated patient characteristics, and the clinical and physiologic outcomes after VAD implantation. RESULTS: We identified 45 Fontan patients implanted with VAD. The average age of patients was 10 years (interquartile range: 4.5-18) and 30% were female. The majority had a morphologic right ventricle (69%), moderate or greater ventricular dysfunction (83%), and moderate or greater atrioventricular valve regurgitation (65%). The majority of implants were as a bridge to transplantation (76%), and the majority of patients were Interagency Registry for Mechanically Assisted Circulatory Support Profile 2 (56%). The most commonly employed device was the Medtronic HeartWare HVAD (56%). A total of 13 patients were discharged on device support, and 67% of patients experienced adverse events, the most common of which were neurologic (25%). At 1 year after device implantation, the rate of transplantation was 69.5%, 9.2% of patients continued to be VAD supported, and 21.3% of patients had died. Hemodynamically, VAD was effective in decreasing both Fontan and ventricular end-diastolic pressures in some individuals. CONCLUSIONS: VAD is effective in supporting patients with end-stage Fontan failure awaiting heart transplantation. Future research should focus on identifying clinical and physiologic characteristics predictive of a favorable response to VAD support.

A and B antigen levels acquired by group O donor-derived erythrocytes following ABO-non-identical transfusion or minor ABO-incompatible haematopoietic stem cell transplantation.

BACKGROUND AND OBJECTIVES: ABO-incompatible haematopoietic stem cell transplantation (HSCT) presents a challenge to blood component transfusion. The aim of this study was to investigate the weak blood group A or B antigen expression by donor-derived group O red blood cells (RBC) observed following transfusion or minor ABO-incompatible HSCT. In addition, in vitro experiments were performed to elucidate possible mechanisms underlying this phenomenon. MATERIALS AND METHODS: A sensitive flow cytometry assay for the semi-quantification of RBC A/B antigen levels was used to assess patient samples and evaluate in vitro experiments. RESULTS: Analysis of blood samples from patients, originally typed as A, B and AB but recently transplanted or transfused with cells from group O donors, revealed the A antigen expression on donor-derived RBC, ranging from very low levels in non-secretor individuals to almost subgroup Ax -like profiles in group A secretors. The B antigen expression was less readily detectable. In vitro experiments, in which group O donor RBC were incubated with (i) group A/B secretor/non-secretor donor plasma or (ii) group A/B donor RBC in the absence of plasma, supported the proposed adsorption of A/B antigen-bearing glycolipids from secretor plasma but also indicated a secretor-independent mechanism for A/B antigen acquisition as well as direct cell-to-cell transfer of ABO antigens. CONCLUSION: The in vivo conversion of donor-derived blood group O RBC to ABO subgroup-like RBC after transfusion or minor ABO-incompatible HSCT raises the question of appropriate component selection. Based on these data, AB plasma should be transfused following ABO-incompatible HSCT.

Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry.

The WAA apheresis registry was established in 2003 and an increasing number of centers have since then included their experience and data of their procedures. The registry now contains data of more than 74,000 apheresis procedures in more than 10,000 patients. This report shows that the indications for apheresis procedures are changing towards more oncological diagnoses and stem cell collections from patients and donors and less therapeutic apheresis procedures. In centers that continue to register, the total extent of apheresis procedures and patients treated have expanded during the latest years.

Adverse events in apheresis: An update of the WAA registry data.

Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.

Sketchy Rendering for Information Visualization.

We present and evaluate a framework for constructing sketchy style information visualizations that mimic data graphics drawn by hand. We provide an alternative renderer for the Processing graphics environment that redefines core drawing primitives including line, polygon and ellipse rendering. These primitives allow higher-level graphical features such as bar charts, line charts, treemaps and node-link diagrams to be drawn in a sketchy style with a specified degree of sketchiness. The framework is designed to be easily integrated into existing visualization implementations with minimal programming modification or design effort. We show examples of use for statistical graphics, conveying spatial imprecision and for enhancing aesthetic and narrative qualities of visualization. We evaluate user perception of sketchiness of areal features through a series of stimulus-response tests in order to assess users' ability to place sketchiness on a ratio scale, and to estimate area. Results suggest relative area judgment is compromised by sketchy rendering and that its influence is dependent on the shape being rendered. They show that degree of sketchiness may be judged on an ordinal scale but that its judgement varies strongly between individuals. We evaluate higher-level impacts of sketchiness through user testing of scenarios that encourage user engagement with data visualization and willingness to critique visualization design. Results suggest that where a visualization is clearly sketchy, engagement may be increased and that attitudes to participating in visualization annotation are more positive. The results of our work have implications for effective information visualization design that go beyond the traditional role of sketching as a tool for prototyping or its use for an indication of general uncertainty.

SU-E-T-261: Determination of Initial Exposure Rates and Clearance Constants in a Sequence of 165 Consecutive Thyroid Cancer Patients Undergoing NaI-131 Therapy.

PURPOSE: Following surgery, papillary and follicular thyroid cancers are usually treated with oral administration of NaI-131. In order to estimate subsequent staff, family, and public exposures, it is important to measure both exposure rates as well as the time of clearance of residual activity from these individuals. There is the additional possibility that patient whole-body absorbed dose estimates may be made using the data. METHODS: During the historical interval 2006 - 2010, a total of 165 consecutive thyroid cancer patients were assayed at the time of activity administration and over the following several days. Using a calibrated radiation detector, exposure rates at one meter from the navel were measured between 2 and 5 times before release. By using these measurements and assuming a single-exponential clearance, we were able to evaluate initial exposure rates as well as the biological rate constant [k(biol)] for clearance of I-131 from the body. RESULTS: Regression analyses were used to fit the initial exposure [X(0)] results as a function of administered activity. By least-squares, the slope was determined to be 0.15 mR/h/mCi over a clinically determined activity range of 25 to 250 mCi. At a given activity, there was wide variation of X(0) due to individual factors such as amount of residual thyroid mass and body habitus. For example, at 150 mCi, X(0) varied from 15 to 35 mR/h at one meter with the average being 25 mR/h. For the 165 patients, the mean biological clearance constant was 0.049/h. CONCLUSION: Average initial exposure rates at one meter from 165 NaI-131 patients have been determined. The biological clearance was seen to be much more rapid than the physical decay constant for I-131 (0.0036/h). At a given activity level, variation of exposure rates was approximately +/- 40% over the corresponding patient population.

Autologous del(20q)-positive erythroid progenitor cells, re-emerging after DLI treatment of an MDS patient relapsing after allo-SCT, can provide a normal peripheral red blood cell count.

A 54-year-old RhD-negative male with del(20q)-positive myelodysplastic syndrome was transplanted with bone marrow from an HLA-identical RhD-positive sibling donor. Cytogenetic relapse was detected 21 months after stem cell transplantation (SCT), with reappearance of the original del(20q)-positive clone and reversion to recipient RhD-negative blood group. The patient received sequential donor lymphocyte infusions (DLIs), resulting in mild graft-versus-host disease and pure red cell aplasia. At 2 years post DLI, the patient remains in a stable condition, despite a dominance of recipient-derived erythro- and granulopoiesis originating in del(20q)-carrying progenitor cells. We conclude that reappearance of autologous erythropoiesis, upon relapse after allogeneic SCT, may be predictive of erythropenia after DLI and that re-emerging autologous del(20q)-positive erythropoiesis post DLI can provide a normal peripheral red blood cell count. Furthermore, in patients relapsing after blood-group-mismatched transplantation, a possible reversion to recipient blood group should be considered prior to blood transfusion or DLI.

Socioeconomic gradient in body size and obesity among women: the role of dietary restraint, disinhibition and hunger in the Whitehall II study.

OBJECTIVE: To examine the associations between three psychological eating behaviour variables--restraint, hunger and disinhibition--and body weight and size, and to assess their explanatory power for the employment grade gradients in body measurement. DESIGN: Cross-sectional analysis of self-report and clinical data. SUBJECTS: : In all, 1470 women (aged 45-68 y, mean 56.3, s.d. 6.0 y), body mass index (BMI) 26.3 (4.8) kg/m(2) at phase 5 (1997-98) of the Whitehall II study. MEASUREMENTS: Employment grade was measured in six bands ranging from clerical (lowest) to administrative (highest). Five measures of body size were examined: BMI, weight in kilograms, waist and hip measurement in centimetres and waist-hip ratio. The eating behaviour variables were measured using Stunkard and Messick's (1985) Three-Factor Eating Questionnaire (TFEQ). RESULTS: Disinhibition and hunger scores were strongly and directly associated with all measures of body weight and size. Restraint score was not directly associated with body size and weight. An interaction between restraint and disinhibition scores was found. The low-restraint-high-disinhibition group (based on median score splits) were the heaviest (BMI 28.5 kg/m(2)) and largest (waist 85.8 cm), while the low-restraint-low-disinhibition group were the lightest (BMI 24.2 kg/m(2)) and smallest (waist 76.3 cm). Employment grade gradients in body weight and size remained largely unchanged after adjustment for dietary restraint. Moderate attenuations were found for disinhibition scores (3.6-15.0%) and hunger (4.8-19.9%) on the five body-size measures. CONCLUSION: Among middle-aged women high scores on hunger and disinhibition, as measured by the TFEQ, are associated with greater body size. Restraint relates to body size through its interaction with disinhibition. Individuals with high disinhibition and any level of restraint are heavier and larger than those with low levels of disinhibition. High disinhibition coupled with low levels of restraint is associated with the greatest weight and size. Hunger and disinhibition explain a moderate amount of the gradient in body size across employment grade and may be useful concepts for future work on the socio-economic gradient in obesity and overweight.

Socio-economic and ethnic influences on infant feeding practices related to oral health.

OBJECTIVE: To assess the role of socio-economic factors in explaining ethnic differences in two infant feeding practices contra-indicated for dental health: adding sugary foods to a feeding bottle and bottle usage for any type of drink after one year. DESIGN: Secondary analysis of dietary and socio-demographic data from the Office of National Statistics (ONS) survey of infant feeding in Asian families. Regression models examining the impact of ethnicity on the two feeding practices were compared with models which also included eight socio-economic variables. SAMPLE: The ONS survey collected data from a representative sample of minority ethnic groups living in the UK. The sample consisted of 764 Indian, 593 Pakistani, and 477 Bangladeshi families and 548 White families by the final stage of the study. RESULTS: Significant socio-economic differences were identified between the different ethnic groups in the sample. The Bangladeshi group were the most disadvantaged and deprived group. Regression analyses showed that inclusion of socio-economic variables added significantly to models based solely on ethnicity for the two selected feeding practices. There was a considerable drop in the odds ratios for ethnicity when socioeconomic variables were included in models for adding sugary foods to the bottle. However, this effect was less evident in models predicting bottle usage at fifteen months. CONCLUSION: While ethnicity may influence infant feeding practices, when socio-economic factors are considered it appears to be a less important determinant for some of these behaviours.

A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use.

Data regarding the effects of oral contraceptive use on women's risk of melanoma have been difficult to resolve. We undertook a pooled analysis of all case-control studies of melanoma in women completed as of July 1994 for which electronic data were available on oral contraceptive use along with other melanoma risk factors such as hair colour, sun sensitivity, family history of melanoma and sun exposure. Using the original data from each investigation (a total of 2391 cases and 3199 controls), we combined the study-specific odds ratios and standard errors to obtain a pooled estimate that incorporates inter-study heterogeneity. Overall, we observed no excess risk associated with oral contraceptive use for 1 year or longer compared to never use or use for less than 1 year (pooled odds ratio (pOR)=0.86; 95% CI=0.74-1.01), and there was no evidence of heterogeneity between studies. We found no relation between melanoma incidence and duration of oral contraceptive use, age began, year of use, years since first use or last use, or specifically current oral contraceptive use. In aggregate, our findings do not suggest a major role of oral contraceptive use on women's risk of melanoma.

Exploratory visualization software for reporting environmental survey results.

Environmental surveys yield three principal products: maps, a set of data tables, and a textual report. The relationships between these three elements, however, are often cumbersome to present, making full use of all the information in an integrated and systematic sense difficult. The published paper report is only a partial solution. Modern developments in computing, particularly in cartography, GIS, and hypertext, mean that it is increasingly possible to conceive of an easier and more interactive approach to the presentation of such survey results. Here, we present such an approach which links map and tabular datasets arising from a vegetation survey, allowing users ready access to a complex dataset using dynamic mapping techniques. Multimedia datasets equipped with software like this provide an exciting means of quick and easy visual data exploration and comparison. These techniques are gaining popularity across the sciences as scientists and decision-makers are presented with increasing amounts of diverse digital data. We believe that the software environment actively encourages users to make complex interrogations of the survey information, providing a new vehicle for the reader of an environmental survey report.

Two-stage methods for the analysis of pooled data.

Epidemiologic studies of disease often produce inconclusive or contradictory results due to small sample sizes or regional variations in the disease incidence or the exposures. To clarify these issues, researchers occasionally pool and reanalyse original data from several large studies. In this paper we explore the use of a two-stage random-effects model for analysing pooled case-control studies and undertake a thorough examination of bias in the pooled estimator under various conditions. The two-stage model analyses each study using the model appropriate to the design with study-specific confounders, and combines the individual study-specific adjusted log-odds ratios using a linear mixed-effects model; it is computationally simple and can incorporate study-level covariates and random effects. Simulations indicate that when the individual studies are large, two-stage methods produce nearly unbiased exposure estimates and standard errors of the exposure estimates from a generalized linear mixed model. By contrast, joint fixed-effects logistic regression produces attenuated exposure estimates and underestimates the standard error when heterogeneity is present. While bias in the pooled regression coefficient increases with interstudy heterogeneity for both models, it is much smaller using the two-stage model. In pooled analyses, where covariates may not be uniformly defined and coded across studies, and occasionally not measured in all studies, a joint model is often not feasible. The two-stage method is shown to be a simple, valid and practical method for the analysis of pooled binary data. The results are applied to a study of reproductive history and cutaneous melanoma risk in women using data from ten large case-control studies.

Socio-economic determinants of selected dietary indicators in British pre-school children.

OBJECTIVES: To assess the proportion of pre-school children meeting reference nutrient intakes (RNIs) and recommendations for daily intakes of iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. To assess whether meeting these five dietary requirements was related to a series of socio-economic variables. DESIGN: Secondary analysis of data on daily consumption of foods and drinks from the National Diet and Nutrition Survey (NDNS) of children aged 1.5-4.5 years based on 4-day weighed intakes. SUBJECTS: One thousand six hundred and seventy-five British pre-school children aged 1.5-4.5 years in 1993. RESULTS: Only 1% of children met all five RNIs/recommendations examined; 76% met only two or fewer. Very few children met the recommendations for intakes of zinc (aged over four years) and non-milk extrinsic sugars (all ages). The number of RNIs/recommendations met was related to measures of socio-economic class. Children from families in Scotland and the North of England, who had a manual head of household and whose mothers had fewest qualifications, met the least number of RNIs/recommendations. CONCLUSIONS: Very few pre-school children have diets that meet all the RNIs and recommendations for iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. Dietary adequacy with respect to these five parameters is related to socio-economic factors. The findings emphasise the need for a range of public health policies that focus upon the social and economic determinants of food choice within families.

Preschool children's consumption of drinks: implications for dental health.

OBJECTIVE: To examine drinking patterns in pre-school children and their relationship to percentage of energy intake from non-milk extrinsic sugars. DESIGN: Secondary analysis of data from the national diet and nutrition survey (NDNS) relating to the dietary intakes of a representative sample of pre-school children in the UK. SUBJECTS: 1,675 children aged 1.5 to 4.5 years surveyed between July 1992 and June 1993. OUTCOME MEASURES: Proportion of consumers, average daily frequency of consumption and estimated seven day volume of consumption of different drinks. Percentage of average daily energy intake obtained from non-milk extrinsic sugars (NMES). RESULTS: Soft drinks were the most commonly consumed drinks followed by whole milk and diet or low sugar varieties of soft drinks. Half the sample were estimated to consume more than 1.5 litres of soft drinks and whole milk and over a litre of diet or low-sugar soft drinks per seven days. Fifty-six per cent of the children consumed soft drinks more than once a day. The youngest children (1.5-2.5 years) were more likely to consume whole milk and less likely to consume diet, soft drinks and skimmed milk than other age groups. Children from manual home backgrounds consumed more tea and coffee and were less likely to consume fruit juice than those from non-manual backgrounds. Drinks contributed 23% to total energy intake and 39% of NMES intake. Consumption of soft drinks, fruit juice and whole and semi-skimmed milk accounted for 59% of variance in percentage of energy from NMES. CONCLUSIONS: A large proportion of pre-school children consume considerable quantifies of soft drinks which have little or no nutritional value and are high in cariogenic non-milk extrinsic sugars. This has implications for children's dental and general health. Recommendations for drinks consumption should be included in food policy guidelines for pre-school children.

Competition among Streptococcus pneumoniae for intranasal colonization in a mouse model.

Widespread use of conjugate vaccines against Streptococcus pneumoniae, by reducing carriage of S. pneumoniae serotypes included in the vaccine, may result in an increase in nasopharyngeal carriage of - and disease from - nonvaccine serotypes of the same species. Mathematical models predict that the extent of such replacement will depend positively on the degree to which carriage of vaccine-type S. pneumoniae inhibits acquisition of nonvaccine-type pneumococci, and may depend negatively on the inhibition of vaccine-type pneumococci by nonvaccine-type pneumococci. We used a mouse model of intranasal carriage of pneumococci to test whether such inhibition occurs between different pneumococcal strains. Mice carrying a streptomycin-resistant derivative of S. pneumoniae BG9163 (serotype 6B) as a resident strain showed reduced levels of colonization when challenged intranasally by optochin-resistant derivatives of the same strain and of a serotype 23F pneumococcus, BG8826. Inhibition could be overcome by increasing the dose of the challenge strain. Carriage of optochin-resistant BG9163 did not inhibit acquisition of the streptomycin-resistant variant. Colonization by a challenge strain did not significantly affect the level of colonization with the resident strain. These results provide evidence that is consistent with several hitherto untested assumptions of mathematical models of serotype replacement and suggest that a biological mechanism exists that could account for serotype replacement that is observed in clinical trials. The findings provide a basis for further studies of in vivo interactions between strains of S. pneumoniae.

Association of silicofluoride treated water with elevated blood lead.

UNLABELLED: Previous epidemiological studies have associated silicofluoride-treated community water with enhanced child blood lead parameters. Chronic, low-level dosage of silicofluoride (SiF) has never been adequately tested for health effects in humans. We report here on a statistical study of 151,225 venous blood lead (VBL) tests taken from children ages 0-6 inclusive, living in 105 communities of populations from 15,000 to 75,000. The tests are part of a sample collected by the New York State Department of Children's Health, mostly from 1994-1998. Community fluoridation status was determined from the CDC 1992 Fluoridation Census. Covariates were assigned to each community using the 1990 U.S. Census. Blood lead measures were divided into groups based on race and age. Logistic regressions were carried out for each race/age group, as well as above and below the median of 7 covariates to test the relationship between known risk factors for lead uptake, exposure to SiF-treated water, and VBL >10 microg/dL. RESULTS: For every age/race group, there was a consistently significant association of SiF treated community water and elevated blood lead. Logistic regressions above and below the median value of seven covariates show an effect of silicofluoride on blood lead independent of those covariates. The highest likelihood of children having VBL> 10 microg/dL occurs when they are both exposed to SiF treated water and likely to be subject to another risk factor known to be associated with high blood lead (e.g., old housing). Results are consistent with prior analyses of surveys of children's blood lead in Massachusetts and NHANES III. These data contradict the null hypothesis that there is no difference between the toxic effects of SiF and sodium fluoride, pointing to the need for chemical studies and comprehensive animal testing of water treated with commercial grade silicofluorides.