Forming Aggregations using Virtual Sharding: Lessons Learned from Simple Scalable Storage (S3)

Data aggregation is the ability to combine separate datasets to form a single new logical dataset provides users with a powerful abstraction. The advantage of an aggregate dataset is that the users are freed from having to understand, and incorporate into their workflow, knowledge about the (ad hoc) organization of the constituent datasets. However, aggregating large numbers of files can be computationally complex with data server systems performing many repetitive operations. As part of the authors work on subsetting data stored on Amazon Web Service (AWS) Simple Storage Service (S3), we developed technology to read portions of otherwise monolithic data files. This enables the formation of virtual shards for user in subsetting data stored in HDF5 (hierarchical data format, version 5) files. This same tool can be used to form aggregations that combine data stored in many HDF5 files when those files are stored on S3. The nature of the virtual sharding and the algorithm that exploits it for subsetting is such that it can also be used for aggregation with the need for many of the repetitive operations required by the per file aggregation techniques. We will present timing information that demonstrates the flexibility of this approach. However, the lessons learned is that while this is a useful result in and of itself, these very same techniques can be applied in other contexts where data are stored in services and on media other than S3. For example, this same technique can be applied to data stored on spinning disk. Pushing the envelope for S3 forced a reexamination of our data access techniques which lead to unexpected positive benefits

Therapeutic Considerations for Antihyperglycemic Agents in Diabetic Kidney Disease.

Diabetic kidney disease is among the most frequent complications of diabetes, with approximately 50% of patients with ESRD attributed to diabetes in developed countries. Although intensive glycemic management has been shown to delay the onset and progression of increased urinary albumin excretion and reduced GFR in patients with diabetes, conservative dose selection and adjustment of antihyperglycemic medications are necessary to balance glycemic control with safety. A growing body of literature is providing valuable insight into the cardiovascular and renal safety and efficacy of newer antihyperglycemic medications in the dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, and sodium-glucose cotransporter 2 inhibitor classes of medications. Ongoing studies will continue to inform future use of these agents in patients with diabetic kidney disease

A clinical method for predicting the success of orthokeratology treatment phase II

Orthokeratology is a method of fitting rigid contact lenses in a progression in order to change the cornea\u27s radius of curvature, resulting in an improvement in uncorrected visual acuity. The usefulness of orthokeratology for most patients will depend on both the magnitude of myopia reduction and the amount of time he or she must wear a retainer lens to maintain that change. This study is an attempt to create a simple and clinically practical procedure to predict which patients will require the least amount of retainer lens wear while maintaining optimal visual acuity, and is divided into two phases. Phase I of this study revealed a significant difference between subjects\u27 refractive error changes after undergoing short-term orthokeratology lens wear. In Phase II, ten patients from Phase I were selected to receive the orthokeratology treatment. After patients achieved minimal wear time of their orthokeratology retainer lenses, a comparison of visual acuity retention time and the initial changes in refractive condition found in Phase I was statistically correlated. Statistical analysis revealed no significant difference between visual acuity retention time and the changes in refractive condition found in Phase I. However, the results of this study might be more promising if a larger and more controlled subject pool was incorporated

Can Blood Flow Restriction Therapy Augment Rotator Cuff Strength?

Blood flow restriction (BFR) is an occlusion training program that utilizes a inflatable or mechanical tourniquet that limits blood flow in the arterial and venous system

Medication use, renin-angiotensin system inhibitors, and acute care utilization after hospitalization in patients with chronic kidney disease.

OBJECTIVES: The aims of this secondary analysis were to: (a) characterize medication use following hospital discharge for patients with chronic kidney disease (CKD), and (b) investigate relationships of medication use with the primary composite outcome of acute care utilization 90 days after hospitalization. METHODS: The CKD-Medication Intervention Trial (CKD-MIT) enrolled acutely ill hospitalized patients with CKD stages 3-5 not dialyzed (CKD 3-5 ND). In this post hoc analysis, data for medication use were characterized, and the relationship of medication use with the primary outcome was evaluated using Cox proportional hazards models. RESULTS: Participants were taking a mean of 12.6 (standard deviation=5.1) medications, including medications from a wide variety of medication classes. Nearly half of study participants were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). ACE inhibitor/ARB use was associated with decreased risk of the primary outcome (hazard ratio=0.51; 95% confidence interval 0.28-0.95; CONCLUSIONS: A large number, variety, and complexity of medications were used by hospitalized patients with CKD 3-5 ND. ACE inhibitor or ARB use at hospital discharge was associated with a decreased risk of 90-day acute care utilization

Evidence supports prediabetes treatment

In his News Feature on prediabetes (“Dubious diagnosis,” 8 March, p. 1026), C. Piller asserts that prediabetes diagnoses and treatment may be ineffective and sullied by conflicts of interest. As current and former chairs of the American Diabetes Association’s (ADA’s) Professional Practice Committee [the group that reviews and updates the Standards of Medical Care in Diabetes (Standards) each year], we disagree. Prediabetes is a useful term to convey future risk of diabetes, and recommendations for diabetes prevention are based on best current evidence

Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS: We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS: The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION: CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD