Cloud Services for Patient Cohort Identification Using the Informatics for Integrating Biology and the Bedside Platform.

Despite the widespread use of the "Informatics for Integrating Biology and the Bedside" (i2b2) platform, there are substantial challenges for loading electronic health records (EHR) into i2b2 and for querying i2b2. We have previously presented a simplified framework for semantic abstraction of EHR records into i2b2. Building on our previous work, we have created a proof-of-concept implementation of cloud services on an i2b2 data store for cohort identification. Specifically, we have implemented a graphical user interface (GUI) that declares the key components for data import, transformation, and query of EHR data. The GUI integrates with Azure cloud services to create data pipelines for importing EHR data into i2b2, creation of derived facts, and querying for generating Sankey-like flow diagrams that characterize the patient cohorts. We have evaluated the implementation using the real-world MIMIC-III dataset. We discuss the key features of this implementation and direction for future work, which will advance the efforts of the research community for patient cohort identification.

Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals.

OBJECTIVES: To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market. METHODS: A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported. RESULTS: 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption. CONCLUSIONS: EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research.

Rapid Integration of Tactile and Visual Information by a Newly Sighted Child.

How we learn to interact with and understand our environment for the first time is an age-old philosophical question. Scientists have long sought to understand what is the origin of egocentric spatial localization and the perceptual integration of touch and visual information. It is difficult to study the beginnings of intermodal visual-motor and visual-tactile linkages in early infancy since infants' muscular strength and control cannot accurately guide visual-motor behavior and they do not concentrate well [1-6]. Alternatively, one can examine young children who have a restored congenital sensory modality loss. They are the best infant substitute if they are old enough for good muscle control and young enough to be within the classic critical period for neuroplasticity [7, 8]. Recovery studies after removal of dense congenital cataracts are examples of this, but most are performed on older subjects [9-14]. We report here the results of video-recorded experiments on a congenitally blind child, beginning immediately after surgical restoration of vision. Her remarkably rapid development of accurate reaching and grasping showed that egocentric spatial localization requires neural circuitry needing less than a half hour of spatially informative experience to be calibrated. 32 hr after first sight, she visually recognized an object that she had simultaneously looked at and held, even though she could not use single senses alone (vision to vision; touch to touch) to perform this recognition until the following day. Then she also performed intersensory transfer of tactile object experience to visual object recognition, demonstrating that the two senses are prearranged to immediately become calibrated to one another.

Early and Midterm Results of No-Touch Aorta Multivessel Small Thoracotomy Coronary Artery Bypass Grafting: A Propensity Score-Matched Study.

OBJECTIVE: To carry out the comparative analysis of early and midterm results of no-touch aorta multivessel small thoracotomy coronary artery bypass grafting (MVST CABG), conventional off-pump (OPCABG) and on-pump CABG (ONCABG). METHODS: From 2007 to 2014, 537 consecutive patients underwent CABG by the same surgeon. Propensity score computer matching was performed, and a total of 453 patients were successfully matched in 3 groups of 151 patients. RESULTS: Significant differences were found in the intraoperative blood loss: 220 (180; 300) mL in MVST CABG versus 400 (300; 550) mL in OPCABG vs 350 (250; 435) mL in ONCABG group; first 24-hour postoperative blood loss: 170 (100; 280), 320 (200; 470), and 380 (200; 500) mL, respectively; operation time: 352.4 ± 74.4, 289.3 ± 55.0, and 280.4 ± 56.4 minutes, respectively; median time to return to full physical activity: 14, 56, and 56 days, respectively (P < 0.05); rate of deep wound infection: 0.0%, 2.0%, and 2.0%, respectively; and postoperative length of stay (surgical department): 4.5, 7.0, and 7.5 days, respectively (P < 0.1). No significant differences were observed in rates of severe in-hospital events (P > 0.05), cumulative midterm survival, and freedom from major adverse cardiac and cerebrovascular events (P > 0.05). CONCLUSIONS: The MVST CABG seems as safe as OPCABG and ONCABG and is associated with less wound infections, perioperative blood loss, shorter hospital length of stay and time to return to full physical activity. Multivessel small thoracotomy CABG can be applied to most patients with coronary heart disease saving the effectiveness during midterm follow-up. The MVST CABG can be introduced avoiding a prolonged learning curve.

Vision after 53 years of blindness.

Several studies have shown that visual recovery after blindness that occurs early in life is never complete. The current study investigated whether an extremely long period of blindness might also cause a permanent impairment of visual performance, even in a case of adult-onset blindness. We examined KP, a 71-year-old man who underwent a successful sight-restoring operation after 53 years of blindness. A set of psychophysical tests designed to assess KP's face perception, object recognition, and visual space perception abilities were conducted six months and eight months after the surgery. The results demonstrate that regardless of a lengthy period of normal vision and rich pre-accident perceptual experience, KP did not fully integrate this experience, and his visual performance remained greatly compromised. This was particularly evident when the tasks targeted finer levels of perceptual processing. In addition to the decreased robustness of his memory representations, which was hypothesized as the main factor determining visual impairment, other factors that may have affected KP's performance were considered, including compromised visual functions, problems with perceptual organization, deficits in the simultaneous processing of visual information, and reduced cognitive abilities.

The newly sighted fail to match seen with felt.

Would a blind subject, on regaining sight, be able to immediately visually recognize an object previously known only by touch? We addressed this question, first formulated by Molyneux three centuries ago, by working with treatable, congenitally blind individuals. We tested their ability to visually match an object to a haptically sensed sample after sight restoration. We found a lack of immediate transfer, but such cross-modal mappings developed rapidly.

A prospective randomised multicentre clinical comparison of a minimised perfusion circuit versus conventional cardiopulmonary bypass.

OBJECTIVE: Minimised perfusion circuits (MPCs) are expected to reduce the side effects of conventional cardiopulmonary bypass (CCPB); however, conclusive data from sufficiently powered clinical trials are lacking. The purpose of this study was to evaluate the safety and efficacy of the ROCsafeRX minimised perfusion circuit. METHODS: A randomised, controlled, multicentre clinical trial comparing both perfusion circuits in patients subjected to elective coronary artery bypass and/or aortic valve replacement is described. The primary end points of safety, defined as procedure success without device-related complications, and secondary end point of efficacy, including reduction of transfusion requirement and incidence of atrial fibrillation, are analysed. RESULTS: To date, 291 patients have been enrolled and randomised (146 MPC vs 145 CCPB). With the exception of a significantly higher male population in the MPC group (83.6% vs 71.0%, p=0.01), both groups were well matched for demographic data and type of surgery. There were no device-related complications but a hard-shell reservoir had to be integrated in one MPC because of a tear in the right atrium that was managed uneventfully. Total transfusion requirement (329+/-599 ml vs 783+/-1638 ml, p < or = 0.001) and erythrocyte transfusion (181+/-341 ml vs 434+/-798 ml, p < or = 0.001) were significantly reduced in the MPC group. The incidence of atrial fibrillation was significantly lower in the MPC group (7.1% vs 19.5%, p < or = 0.01), while freedom of major adverse events showed no significant difference. CONCLUSIONS: Lack of device-related complications combined with a significant reduction in postoperative atrial fibrillation and transfusion requirements have shown the ROCsafeRX MPC to be both safe and efficient for large-scale use in cardiac patients. Additional data are expected to confirm these initial findings.

Visual parsing after recovery from blindness.

How the visual system comes to bind diverse image regions into whole objects is not well understood. We recently had a unique opportunity to investigate this issue when we met three congenitally blind individuals in India. After providing them treatment, we studied the early stages of their visual skills. We found that prominent figural cues of grouping, such as good continuation and junction structure, were largely ineffective for image parsing. By contrast, motion cues were of profound significance in that they enabled intraobject integration and facilitated the development of object representations that permitted recognition in static images. Following 10 to 18 months of visual experience, the individuals' performance improved, and they were able to use the previously ineffective static figural cues to correctly parse many static scenes. These results suggest that motion information plays a fundamental role in organizing early visual experience and that parsing skills can be acquired even late in life.

Vision following extended congenital blindness.

Animal studies suggest that early visual deprivation can cause permanent functional blindness. However, few human data on this issue exist. Given enough time for recovery, can a person gain visual skills after several years of congenital blindness? In India, we recently had an unusual opportunity to work with an individual whose case history sheds light on this question. S.R.D. was born blind, and remained so until age 12. She then underwent surgery for the removal of dense congenital cataracts. We evaluated her performance on an extensive battery of visual tasks 20 years after surgery. We found that although S.R.D.'s acuity is compromised, she is proficient on mid- and high-level visual tasks. These results suggest that the human brain retains an impressive capacity for visual learning well into late childhood. They have implications for current conceptions of cortical plasticity and provide an argument for treating congenital blindness even in older children.

Perceiving illumination inconsistencies in scenes.

The human visual system is adept at detecting and encoding statistical regularities in its spatiotemporal environment. Here, we report an unexpected failure of this ability in the context of perceiving inconsistencies in illumination distributions across a scene. Prior work with arrays of objects all having uniform reflectance has shown that one inconsistently illuminated target can 'pop out' among a field of consistently illuminated objects (eg Enns and Rensink, 1990 Science 247 721 723; Sun and Perona, 1997 Perception 26 519-529). In these studies, the luminance pattern of the odd target could be interpreted as arising from either an inconsistent illumination or inconsistent pigmentation of the target. Either cue might explain the rapid detection. In contrast, we find that once the geometrical regularity of the previous displays is removed, the visual system is remarkably insensitive to illumination inconsistencies, both in experimental stimuli and in altered images of real scenes. Whether the target is interpreted as oddly illuminated or oddly pigmented, it is very difficult to find if the only cue is deviation from the regularity of illumination or reflectance. Our results allow us to draw inferences about how the visual system encodes illumination distributions across scenes. Specifically, they suggest that the visual system does not verify the global consistency of locally derived estimates of illumination direction.

Life cycle theory and the residential mobility of older Canadians.

This paper outlines a debate in the economics literature about the role of housing wealth in post-retirement consumption choices and provides a description of the patterns of the residential mobility, tenure, and dwelling-type transitions of older Canadians, using the newly available Statistics Canada Survey of Labour and Income Dynamics (SLID). The paper also presents estimation results for a panel data model that accounts for individual heterogeneity. The patterns of residential mobility of older adults in Canada appear to be similar to those in the United States and some European countries and do not seem to be motivated by the desire to use housing wealth for general consumption.