Improving the accuracy and utility of harmful algal bloom forecasting systems

Author Posting. © The Author(s), 2006. This is the author's version of the work. It is posted here by permission of Geological Society for the Micropalaeontological Society for personal use, not for redistribution. The definitive version was published in Biological and Geological Perspectives of Dinoflagellates, edited by Jane Lewis, F. Marret, L.Bradley, :141-147. London: Geological Society for the Micropalaeontological Society, 2013. ISBN: 9781862393684.One of the goals of harmful algal bloom (HAB) research has been to develop predictive capabilities for blooms. Major steps have been made towards this goal, including the development of physical-biological models of HAB species that simulate bloom dynamics in specific regions. In the Gulf of Maine region of the northeastern U.S., models have been developed that have considerable skill in simulating blooms of Alexandrium fundyense, the causative organism for paralytic shellfish poisoning (PSP) outbreaks in the region. This model is now being used for both short-term and long-term forecasts. This paper describes several ongoing activities that will improve the accuracy and usefulness of the model and forecasts. These include efforts to streamline or minimize the sampling and analysis requirements of annual A. fundyense cyst surveys, efforts to quantitatively describe or characterize the severity of predicted outbreaks, and plans to obtain real-time data on Alexandrium cell abundance and toxicity that can be assimilated into the models. Together, these and other activities are moving us towards an operational forecasting system for Alexandrium blooms in the region.Woods Hole Center for Oceans and Human Health, National Science Foundation (NSF) Grants OCE-0430724, and OCE-0911031; and National Institute of Environmental Health Sciences (NIEHS) Grant 1-P50-ES012742-01, the ECOHAB Grant program through NOAA Grants NA06NOS4780245 and NA09NOS4780193, and the MERHAB Grant program through NOAA Grant NA11NOS4780025

Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square \u3c0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS (P \u3c .001) and S/F (P \u3c .001). The ROC analysis showed significant accuracy (area under the curve \u3e 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series

Validation and Generalizability of Preoperative PROMIS Scores to Predict Postoperative Success in Foot and Ankle Patients

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population. Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and ankle clinic were obtained between January 2014 and November 2016. Patients undergoing elective foot and ankle surgery were identified and PROMIS values obtained at initial and follow-up visits (average, 7.9 months). Analysis of variance was used to assess differences in PROMIS scores before and after surgery. The distributive method was used to estimate a minimal clinically important difference (MCID). Receiver operating characteristic curve analysis was used to determine thresholds for achieving and failing to achieve MCID. To assess the validity and generalizability of these threshold values, they were compared with previously published threshold values for accuracy using likelihood ratios and pre- and posttest probabilities, and the percentages of patients identified as achieving and failing to achieve MCID were evaluated using χ2 analysis. Results: There were significant improvements in PF (P \u3c .001) and PI (P \u3c .001) after surgery. The area under the curve for PF (0.77) was significant (P \u3c .01), and the thresholds for achieving MCID and not achieving MCID were similar to those in the prior study. A significant proportion of patients (88.9%) identified as not likely to achieve MCID failed to achieve MCID (P = .03). A significant proportion of patients (84.2%) identified as likely to achieve MCID did achieve MCID (P \u3c .01). The area under the curve for PROMIS PI was not significant. Conclusions: PROMIS PF threshold scores from published data were successful in classifying patients from a different patient and geographic population who would improve with surgery. If functional improvement is the goal, these thresholds could be used to help identify patients who will benefit from surgery and, most important, those who will not, adding value to foot and ankle health care. Level of evidence: Level II, Prospective Comparative Stud