Data policy and availability supporting global change research, development, and decision-making: An information perspective

An explosion of information has created a crisis for today's information age. It has to be determined how to use the best available information sources, tools, and technology. To do this it is necessary to have leadership at the interagency level to promote a coherent information policy. It is also important to find ways to educate the users of information regarding the tools available to them. Advances in technology resulted in efforts to shift from Disciplinary and Mission-oriented Systems to Decision Support Systems and Personalized Information Systems. One such effort is being made by the Interagency Working Group on Data Management for Global Change (IAWGDMGC). Five federal agencies - the Department of Commerce (DOC), Department of Energy (DOE), National Aeronautics and Space Administration (NASA), National Library of Medicine (NLM), and Department of Defense (DOD) - have an on-going cooperative information management group, CENDI (Commerce, Energy, NASA, NLM, and Defense Information), that is meeting the challenge of coordinating and integrating their information management systems. Although it is beginning to be technically feasible to have a system with text, bibliographic, and numeric data online for the user to manipulate at the user's own workstation, it will require national recognition that the resource investment in such a system is worthwhile, in order to promote its full development. It also requires close cooperation between the producers and users of the information - that is, the research and policy community, and the information community. National resources need to be mobilized in a coordinated manner to move people into the next generation of information support systems

Implementing a Clinical Practice Guideline for Pediatric Appendicitis Safely Reduced Health Care Use and Improved Antimicrobial Stewardship

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration. Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap. Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P \u3c .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P \u3c .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P \u3c .01). Discussion: Through implementing the CPG we were able to understand our practice patterns and identify opportunities for improvement. Patients with perforated appendicitis were selected for study because they were affected by all components of the CPG and allowed for total adherence to be our primary outcome. Total adherence was set as the primary outcome knowing it would be difficult to achieve, but would also better identify opportunity for improvement and provide comprehensive assessment of the guideline. Conclusions: Implementing a multidisciplinary CPG reduced health care use and improved antimicrobial stewardship without increasing complications in pediatric acute appendicitis

The Use of Cognitive Screening in Pharmacotherapy Trials for Cognitive Impairment Associated With Schizophrenia.

There are currently no regulatory approved pharmacological treatments for cognitive impairment associated with schizophrenia (CIAS). One possibility is that trial methodology itself is hindering their development. Emerging evidence suggests that patients with schizophrenia may show limited benefit from pro-cognitive interventions if they already exhibit intact cognitive performance, relative to normative thresholds. The aim of this report was to examine the extent to which objectively assessed cognitive performance has been used as an eligibility and/or stratification criterion in CIAS pharmacotherapy trials. On 16th January 2019, we conducted a systematic search of studies listed on ClinicalTrials.gov to identify randomized, double-blind, placebo-controlled, add-on pharmacotherapy trials conducted in patients with a diagnosis of schizophrenia, in which a paper-and-pencil or computerized cognitive task (or battery) was specified as a primary outcome measure. Of the 87 trials that met our inclusion criteria, 10 (11.5%) required the presence of an objectively assessed cognitive deficit as part of their patient eligibility criteria. No studies reported stratifying patients according to the presence or degree of cognitive impairment they exhibited. These results suggest that the vast majority of CIAS trials may have been underpowered due to the inclusion of cognitively "normal" patients. Purposive screening for cognitive impairment could increase CIAS trial success

Social cognition in multiple sclerosis:A systematic review and meta-analysis

Objective: To quantify the magnitude of deficits in theory of mind (ToM) and facial emotion recognition among patients with multiple sclerosis (MS) relative to healthy controls. Methods: An electronic database search of Ovid MEDLINE, PsycINFO, and Embase was conducted from inception to April 1, 2016. Eligible studies were original research articles published in peer-reviewed journals that examined ToM or facial emotion recognition among patients with a diagnosis of MS and a healthy control comparison group. Data were independently extracted by 2 authors. Effect sizes were calculated using Hedges g. Results: Twenty-one eligible studies were identified assessing ToM (12 studies) and/or facial emotion recognition (13 studies) among 722 patients with MS and 635 controls. Deficits in both ToM (g -0.71, 95% confidence interval [CI] -0.88 to -0.55, p < 0.001) and facial emotion recognition (g -0.64, 95% CI -0.81 to -0.47, p < 0.001) were identified among patients with MS relative to healthy controls. The largest deficits were observed for visual ToM tasks and for the recognition of negative facial emotional expressions. Older age predicted larger emotion recognition deficits. Other cognitive domains were inconsistently associated with social cognitive performance. Conclusions: Social cognitive deficits are an overlooked but potentially important aspect of cognitive impairment in MS with potential prognostic significance for social functioning and quality of life. Further research is required to clarify the longitudinal course of social cognitive dysfunction, its association with MS disease characteristics and neurocognitive impairment, and the MS-specific neurologic damage underlying these deficits

Hybridised multigrid preconditioners for a compatible finite element dynamical core

Compatible finite element discretisations for the atmospheric equations of motion have recently attracted considerable interest. Semi-implicit timestepping methods require the repeated solution of a large saddle-point system of linear equations. Preconditioning this system is challenging since the velocity mass matrix is non-diagonal, leading to a dense Schur complement. Hybridisable discretisations overcome this issue: weakly enforcing continuity of the velocity field with Lagrange multipliers leads to a sparse system of equations, which has a similar structure to the pressure Schur complement in traditional approaches. We describe how the hybridised sparse system can be preconditioned with a non-nested two-level preconditioner. To solve the coarse system, we use the multigrid pressure solver that is employed in the approximate Schur complement method previously proposed by the some of the authors. Our approach significantly reduces the number of solver iterations. The method shows excellent performance and scales to large numbers of cores in the Met Office next-generation climate- and weather prediction model LFRic.Comment: 24 pages, 13 figures, 5 tables; accepted for publication in Quarterly Journal of the Royal Meteorological Societ