Overcoming challenges to data quality in the ASPREE clinical trial

© 2019 The Author(s). Background: Large-scale studies risk generating inaccurate and missing data due to the complexity of data collection. Technology has the potential to improve data quality by providing operational support to data collectors. However, this potential is under-explored in community-based trials. The Aspirin in reducing events in the elderly (ASPREE) trial developed a data suite that was specifically designed to support data collectors: the ASPREE Web Accessible Relational Database (AWARD). This paper describes AWARD and the impact of system design on data quality. Methods: AWARD's operational requirements, conceptual design, key challenges and design solutions for data quality are presented. Impact of design features is assessed through comparison of baseline data collected prior to implementation of key functionality (n = 1000) with data collected post implementation (n = 18,114). Overall data quality is assessed according to data category. Results: At baseline, implementation of user-driven functionality reduced staff error (from 0.3% to 0.01%), out-of-range data entry (from 0.14% to 0.04%) and protocol deviations (from 0.4% to 0.08%). In the longitudinal data set, which contained more than 39 million data values collected within AWARD, 96.6% of data values were entered within specified query range or found to be accurate upon querying. The remaining data were missing (3.4%). Participant non-attendance at scheduled study activity was the most common cause of missing data. Costs associated with cleaning data in ASPREE were lower than expected compared with reports from other trials. Conclusions: Clinical trials undertake complex operational activity in order to collect data, but technology rarely provides sufficient support. We find the AWARD suite provides proof of principle that designing technology to support data collectors can mitigate known causes of poor data quality and produce higher-quality data. Health information technology (IT) products that support the conduct of scheduled activity in addition to traditional data entry will enhance community-based clinical trials. A standardised framework for reporting data quality would aid comparisons across clinical trials

Designing a broad-spectrum integrative approach for cancer prevention and treatment

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notablesuccesses in some cancers; however, significant problems remain with this approach. Many targetedtherapies are highly toxic, costs are extremely high, and most patients experience relapse after a fewdisease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistantimmortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are notreliant upon the same mechanisms as those which have been targeted). To address these limitations, aninternational task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspectsof relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a widerange of high-priority targets (74 in total) that could be modified to improve patient outcomes. For thesetargets, corresponding low-toxicity therapeutic approaches were then suggested, many of which werephytochemicals. Proposed actions on each target and all of the approaches were further reviewed forknown effects on other hallmark areas and the tumor microenvironment. Potential contrary or procar-cinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixedevidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of therelationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. Thisnovel approach has potential to be relatively inexpensive, it should help us address stages and types ofcancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for futureresearch is offered

Incidência de Colletotrichum graminicola em colmos de genótipos de milho

A podridão do colmo, causada por Colletotrichum graminicola, é uma das mais severas doenças da cultura do milho no Brasil, principalmente se ocorrer após a fase de florescimento, por causar perdas significativas na produtividade. A melhor alternativa para o controle da doença é a utilização de cultivares geneticamente resistentes. O objetivo deste trabalho foi avaliar a incidência da podridão de colmo em híbridos comerciais de milho, tendo em vista a pouca disponibilidade de informações que permitam a utilização da resistência genética como estratégia para o controle desta doença. Foram avaliados 18 híbridos comerciais de milho, em três ensaios conduzidos nos anos de 2005, 2006 e 2007 na área experimental da Embrapa Milho e Sorgo, sob condições de inóculo natural. Em cada parcela foram coletados fragmentos do colmo de três plantas, sendo: o segundo entrenó acima do solo, o entrenó de inserção da espiga e o entrenó localizado abaixo do pendão. Quatro fragmentos de cada parte foram desinfestados e transferidos para placas de Petri contendo meio de farinha de aveia - ágar (FAA). As placas foram mantidas em câmara de incubação sob luz fluorescente contínua à temperatura de 25 ºC, seguindo-se a identificação e quantificação do patógeno após três a quatro dias de incubação. As menores incidências (abaixo de 30%) foram observadas nos híbridos BR201 e BR206 e a maior incidência (acima de 60%) detectada no híbrido BRS1010. O patógeno foi detectado em todos os segmentos do colmo analisados, predominando, entretanto, no terço médio superior para a maioria dos híbridos avaliados. Apesar da variação observada entre os genótipos quanto à incidência da antracnose no colmo, nenhum híbrido pôde ser considerado como de altamente resistente ao patógeno.Stalk rot (Colletotrichum graminicola) is one of the most serious disease affecting maize crop in Brazil, especially after the flowering phase, when yield losses can reach significant levels. The use of genetically resistant cultivars is the most efficient strategy to control the disease. The aim of this work was to evaluate the incidence of stalk rot in maize commercial hybrids sinde there is scarce information to allow the use of genetic resistance as a strategy to control this disease. Eighteen maize commercial hybrids were evaluated in 2005, 2006, and 2007 in the experimental area of EMBRAPA Maize and Sorghum Research Center Sete Lagoas, Minas Gerais State, Brazil, under conditions of natural infection. From each plot, three stalk segments of three plants were sampled: the second internode above the soil line, the internode of ear insertion, and the internode right bellow the tassel. Four tissue fragments of each stalk segment were surface sterilized and transferred to oatmeal agar plates, which were incubated under continuous fluorescent light at 25ºC. Pathogen identification and quantification were performed after three to four days of incubation. The hybrids BR201 and BR206 showed the lowest infection level (below 30%) whereas the highest incidence (above 60%) was observed for the hybrid BRS1010. The pathogen was observed in all analyzed stalk segments, but was most frequently isolated from the internode right below the tassel. No evaluated hybrid could be considered to have high resistance to the pathogen

Prediction of disability-free survival in healthy older people

Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6–77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people. Trial registration Clinicaltrials.gov (NCT01038583)