Ability of Anthropometric Measurements to Predict Metabolic Health among Patients in Alberta: A Cross-sectional Study in Primary Care.

Purpose: This study compared anthropometric and body fat percent (BF%) equations in relation to measures of metabolic health.Methods: BF% calculations (Bergman, Fels, and Woolcott) and anthropometric measurements were used to determine obesity among a sample of patients attending primary care in Alberta, Canada. Anthropometric variables included body mass index (BMI), waist circumference, waist:hip ratio, waist:height ratio, and calculated BF%. Metabolic Z-score was computed as the average of the individual Z-scores of triglycerides, total cholesterol, and fasting glucose and the number of standard deviations from the sample mean.Results: Five hundred and fourteen individuals were included (41.2% male, age: 53 ± 16y, BMI: 27.4 ± 5.7 kg/m2). BMI ≥ 30 kg/m2 detected the smallest number of participants (n = 137) as having obesity, while Woolcott BF% equation categorized the largest number of participants as having obesity (n = 369). No anthropometric or BF% calculation predicted metabolic Z-score in males (all p ≥ 0.05). In females, age-adjusted waist:height ratio had the highest prediction power (R2 = 0.204, p < 0.001), followed by age-adjusted waist circumference (R2 = 0.200, p < 0.001) and age-adjusted BMI (R2 = 0.178, p < 0.001).Conclusions: This study did not find evidence that BF% equations more strongly predicted metabolic Z-scores than other anthropometric values. In fact, all anthropometric and BF% variables were weakly related to metabolic health parameters, with apparent sex differences.

Safety and clinical activity of elosulfase alfa in pediatric patients with Morquio A syndrome (mucopolysaccharidosis IVA) less than 5 y.

BACKGROUND: Previous studies have shown that elosulfase alfa has a favorable efficacy/safety profile in Morquio A patients aged ≥5 y. This study evaluated safety and impact on urine keratan sulfate (uKS) levels and growth velocity in younger patients. METHODS: Fifteen Morquio A patients aged <5 y received elosulfase alfa 2.0 mg/kg/week for 52 wk during the primary treatment phase of a phase II, open-label, multinational study. Primary endpoint was safety and tolerability; secondary endpoints were change in uKS and growth velocity over 52 wk. RESULTS: All 15 patients completed the primary treatment phase. Six of 743 infusions (0.8%) administered led to adverse events (AEs) requiring infusion interruption and medical intervention. Eleven patients (73.3%) had ≥1 study drug-related AE, mostly infusion-associated reactions. Mean z-score growth rate per year numerically improved from -0.6 at baseline to -0.4 at week 52. Comparison to untreated subjects of similar age in the Morquio A Clinical Assessment Program study showed a smaller decrease in height z-scores for treated than for untreated patients. Mean percent change from baseline in uKS was -30.2% at 2 wk and -43.5% at 52 wk. CONCLUSION: Early intervention with elosulfase alfa is well-tolerated and produces a decrease in uKS and a trend toward improvement in growth.

Interactive, in-browser cinematic volume rendering of medical images.

The diversity and utility of cinematic volume rendering (CVR) for medical image visualization have grown rapidly in recent years. At the same time, volume rendering on augmented and virtual reality systems is attracting greater interest with the advance of the WebXR standard. This paper introduces CVR extensions to the open-source visualization toolkit (vtk.js) that supports WebXR. This paper also summarizes two studies that were conducted to evaluate the speed and quality of various CVR techniques on a variety of medical data. This work is intended to provide the first open-source solution for CVR that can be used for in-browser rendering as well as for WebXR research and applications. This paper aims to help medical imaging researchers and developers make more informed decision when selecting CVR algorithms for their applications. Our software and this paper also provide a foundation for new research and product development at the intersection of medical imaging, web visualization, XR, and CVR.

Design and testing of an architecture for a national primary care chronic disease surveillance network in Canada.

Chronic diseases are a growing concern around the globe. In Canada, chronic disease care is taking an increasing share of health care budgets, and with an aging population, is threatening to overwhelm Provincial budgets where most health care is paid for. A chronic disease surveillance network fills an important gap in current public health surveillance systems. This paper describes the design and feasibility testing of an information technology and privacy architecture to extract, transform and transfer data from 7 electronic medical record systems used by 100 primary care providers in 6 province to a central data repository at the High Performance Computing Virtual Laboratory at Queen's University in Canada.

Data quality in healthcare: A report of practical experience with the Canadian Primary Care Sentinel Surveillance Network data.

Data quality (DQ) is the degree to which a given dataset meets a user's requirements. In the primary healthcare setting, poor quality data can lead to poor patient care, negatively affect the validity and reproducibility of research results and limit the value that such data may have for public health surveillance. To extract reliable and useful information from a large quantity of data and to make more effective and informed decisions, data should be as clean and free of errors as possible. Moreover, because DQ is defined within the context of different user requirements that often change, DQ should be considered to be an emergent construct. As such, we cannot expect that a sufficient level of DQ will last forever. Therefore, the quality of clinical data should be constantly assessed and reassessed in an iterative fashion to ensure that appropriate levels of quality are sustained in an acceptable and transparent manner. This document is based on our hands-on experiences dealing with DQ improvement for the Canadian Primary Care Sentinel Surveillance Network database. The DQ dimensions that are discussed here are accuracy and precision, completeness and comprehensiveness, consistency, timeliness, uniqueness, data cleaning and coherence.

SlicerVR for Medical Intervention Training and Planning in Immersive Virtual Reality.

Virtual reality (VR) provides immersive visualization that has proved to be useful in a variety of medical applications. Currently, however, no free open-source software platform exists that would provide comprehensive support for translational clinical researchers in prototyping experimental VR scenarios in training, planning or guiding medical interventions. By integrating VR functions in 3D Slicer, an established medical image analysis and visualization platform, SlicerVR enables virtual reality experience by a single click. It provides functions to navigate and manipulate the virtual scene, as well as various settings to abate the feeling of motion sickness. SlicerVR allows for shared collaborative VR experience both locally and remotely. We present illustrative scenarios created with SlicerVR in a wide spectrum of applications, including echocardiography, neurosurgery, spine surgery, brachytherapy, intervention training and personalized patient education. SlicerVR is freely available under BSD type license as an extension to 3D Slicer and it has been downloaded over 7,800 times at the time of writing this article.

Time dependent processing in a parallel pipeline architecture.

Pipeline architectures provide a versatile and efficient mechanism for constructing visualizations, and they have been implemented in numerous libraries and applications over the past two decades. In addition to allowing developers and users to freely combine algorithms, visualization pipelines have proven to work well when streaming data and scale well on parallel distributed-memory computers. However, current pipeline visualization frameworks have a critical flaw: they are unable to manage time varying data. As data flows through the pipeline, each algorithm has access to only a single snapshot in time of the data. This prevents the implementation of algorithms that do any temporal processing such as particle tracing; plotting over time; or interpolation, fitting, or smoothing of time series data. As data acquisition technology improves, as simulation time-integration techniques become more complex, and as simulations save less frequently and regularly, the ability to analyze the time-behavior of data becomes more important. This paper describes a modification to the traditional pipeline architecture that allows it to accommodate temporal algorithms. Furthermore, the architecture allows temporal algorithms to be used in conjunction with algorithms expecting a single time snapshot, thus simplifying software design and allowing adoption into existing pipeline frameworks. Our architecture also continues to work well in parallel distributed-memory environments. We demonstrate our architecture by modifying the popular VTK framework and exposing the functionality to the ParaView application. We use this framework to apply time-dependent algorithms on large data with a parallel cluster computer and thereby exercise a functionality that previously did not exist.

Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study.

BACKGROUND: Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions. METHODS: Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada. RESULTS: Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%-9.5%, p < 0.01). CONCLUSIONS: Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

Integrating segmentation methods from the Insight Toolkit into a visualization application.

The Insight Toolkit (ITK) initiative from the National Library of Medicine has provided a suite of state-of-the-art segmentation and registration algorithms ideally suited to volume visualization and analysis. A volume visualization application that effectively utilizes these algorithms provides many benefits: it allows access to ITK functionality for non-programmers, it creates a vehicle for sharing and comparing segmentation techniques, and it serves as a visual debugger for algorithm developers. This paper describes the integration of image processing functionalities provided by the ITK into VolView, a visualization application for high performance volume rendering. A free version of this visualization application is publicly available and is available in the online version of this paper. The process for developing ITK plugins for VolView according to the publicly available API is described in detail, and an application of ITK VolView plugins to the segmentation of Abdominal Aortic Aneurysms (AAAs) is presented. The source code of the ITK plugins is also publicly available and it is included in the online version.

The Next Generation EMR.

Electronic medical/health record (EMR) usage in North America has increased significantly in the last half decade. But there is widespread dissatisfaction with the technologies that are currently available in the market place. Our hypothesis is that EMR vendors and the market place alone cannot solve the issue of poor technology. We propose an architecture for the next generation of electronic records that solves current concerns of end users and addresses the needs of additional stakeholders, including health system funders, patients, researchers and guideline implementers. By including additional stakeholders, we believe that additional resources, competencies and functionality can be unleashed to solve the larger problems of the current generation of EMRs. The architecture also addresses future requirements that are likely to arise from technological developments such as mobile apps and PHRs and from innovations in medicine, including genomics, artificial intelligence and personalized medicine. The paper makes a call to action for informatics researchers to play a greater role in R&D on EMRs.

Are We Asking Patients if They Smoke?: Missing Information on Tobacco Use in Canadian Electronic Medical Records.

INTRODUCTION: All adolescent and adult patients should be asked if they smoke. Data entered in electronic medical records offer new opportunities to study tobacco-related clinical activities. The purpose of this study is to examine the recording of tobacco use in Canadian electronic medical records. METHODS: Data were collected on September 30, 2013, and analyzed in 2014. Data on 249,223 patients that were aged ≥16 years as of September 30, 2013 and had at least one primary care encounter in the previous 2 years were included. The proportion of patients with information on tobacco use entered in a summative health profile was calculated. Associations between data gaps and patient or physician factors were examined. RESULTS: Information on tobacco use was available for 64.4% of patients. Physicians using an electronic medical record for ≥4 years were more likely to have data (AOR=4.57, 95% CI=1.84, 7.29, p<0.0001). Patients aged ≥30 years were more likely to have tobacco information present (AOR=2.92, 95% CI=2.82, 3.02, p<0.0001, for patients aged 30-59 compared to those aged <30 years), as were patients with any comorbidities (AOR=1.41, 95% CI=1.36, 1.45, p<0.0001, for patients with one or two comorbidities compared with none) or more visits. CONCLUSIONS: A third of Canadians in this sample lacked data on tobacco in their electronic medical record. Younger, healthier people were less likely to have information about their smoking status. Efforts to improve the recording of tobacco-related information in electronic medical records, especially for younger patients, are needed.

Crime scene investigations using portable, non-destructive space exploration technology.

The National Institute of Justice (NIJ) and the National Aeronautics and Space Administration's (NASAs) Goddard Space Flight Center (GSFC) have teamed up to explore the use of NASA developed technologies to help criminal justice agencies and professionals solve crimes. The objective of the program is to produce instruments and communication networks that have application within both NASA's space program and NIJ programs with state and local forensic laboratories. A working group of NASA scientists and law enforcement professionals has been established to develop and implement a feasibility demonstration program. Specifically, the group has focused its efforts on identifying gunpowder and primer residue, blood, and semen at crime scenes. Non-destructive elemental composition identification methods are carried out using portable X-ray fluorescence (XRF) systems. These systems are similar to those being developed for planetary exploration programs. A breadboard model of a portable XRF system has been constructed for these tests using room temperature silicon and cadmium-zinc telluride (CZT) detectors. Preliminary tests have been completed with gunshot residue (GSR), blood-spatter and semen samples. Many of the element composition lines have been identified. Studies to determine the minimum detectable limits needed for the analyses of GSR, blood and semen in the crime scene environment have been initiated and preliminary results obtained. Furthermore, a database made up of the inorganic composition of GSR is being developed. Using data obtained from the open literature of the elemental composition of barium (Ba) and antimony (Sb) in handswipes of GSR, we believe that there may be a unique GSR signature based on the Sb to Ba ratio.

Understanding the Early Presentation of Mucopolysaccharidoses Disorders: Results of a Systematic Literature Review and Physician Survey

Abstract As therapies are developed for rare disorders, challenges of early diagnosis become particularly relevant. This article focuses on clinical recognition of mucopolysaccharidoses (MPS), a group of rare genetic diseases related to abnormalities in lysosomal function. As quality of outcomes with current therapies is impacted by timing of intervention, minimizing time to diagnosis is critical. The objective of this study was to characterize how, when, and to whom patients with MPS first present and develop tools to stimulate earlier recognition of MPS. A tripartite approach was used, including a systematic literature review yielding 194 studies, an online physician survey completed by 209 physicians who described