A Data Quality Framework for Process Mining of Electronic Health Record Data

Reliable research demands data of known quality. This can be very challenging for electronic health record (EHR) based research where data quality issues can be complex and often unknown. Emerging technologies such as process mining can reveal insights into how to improve care pathways but only if technological advances are matched by strategies and methods to improve data quality. The aim of this work was to develop a care pathway data quality framework (CP-DQF) to identify, manage and mitigate EHR data quality in the context of process mining, using dental EHRs as an example. Objectives: To: 1) Design a framework implementable within our e-health record research environments; 2) Scale it to further dimensions and sources; 3) Run code to mark the data; 4) Mitigate issues and provide an audit trail. Methods: We reviewed the existing literature covering data quality frameworks for process mining and for data mining of EHRs and constructed a unified data quality framework that met the requirements of both. We applied the framework to a practical case study mining primary care dental pathways from an EHR covering 41 dental clinics and 231,760 patients in the Republic of Ireland. Results: Applying the framework helped identify many potential data quality issues and mark-up every data point affected. This enabled systematic assessment of the data quality issues relevant to mining care pathways. Conclusion: The complexity of data quality in an EHR-data research environment was addressed through a re-usable and comprehensible framework that met the needs of our case study. This structured approach saved time and brought rigor to the management and mitigation of data quality issues. The resulting metadata is being used within cohort selection, experiment and process mining software so that our research with this data is based on data of known quality. Our framework is a useful starting point for process mining researchers to address EHR data quality concerns

Marine microphytobenthic assemblage shift along a natural shallow-water CO<inf>2</inf> gradient subjected to multiple environmental stressors

Predicting the effects of anthropogenic CO2 emissions on coastal ecosystems requires an understanding of the responses of algae, since these are a vital functional component of shallow-water habitats. We investigated microphytobenthic assemblages on rock and sandy habitats along a shallow subtidal pCO2 gradient near volcanic seeps in the Mediterranean Sea. Field studies of natural pCO2 gradients help us understand the likely effects of ocean acidification because entire communities are subjected to a realistic suite of environmental stressors such as over-fishing and coastal pollution. Temperature, total alkalinity, salinity, light levels and sediment properties were similar at our study sites. On sand and on rock, benthic diatom abundance and the photosynthetic standing crop of biofilms increased significantly with increasing pCO2. There were also marked shifts in diatom community composition as pCO2 levels increased. Cyanobacterial abundance was only elevated at extremely high levels of pCO2 (>1400 μatm). This is the first demonstration of the tolerance of natural marine benthic microalgae assemblages to elevated CO2 in an ecosystem subjected to multiple environmental stressors. Our observations indicate that Mediterranean coastal systems will alter as pCO2 levels continue to rise, with increased photosynthetic standing crop and taxonomic shifts in microalgal assemblages

The use of metabonomics to uncover differences between the small molecule profiles of eggs from cage and barn housing systems

Metabonomic techniques have been used to observe differences in the small molecule profiles of chicken eggs, to work towards the detection, and thus prevention, of fraud regarding the misrepresentation of egg farming systems. High Performance Liquid Chromatography-Quadrupole-Time-of-Flight-Mass Spectrometry (HPLC-Q-ToF-MS) was used to obtain profiles of the small molecules found in the yolks of eggs that were laid by hens in enriched cage systems, and in barn systems. Statistical analysis of these small molecule profiles, including the use of XCMS Online and multivariate statistics, was able to uncover differences between the yolks of cage and barn eggs. Several unidentified compounds were found to be present in significantly different abundances between cage and barn egg yolks and one of these compounds was tentatively identified, through the use of METLIN, as 1,2-dipalmitoyl-glycero-3-phosphocholine

Squirrelpox virus: assessing prevalence, transmission and environmental degradation

Red squirrels (Sciurus vulgaris) declined in Great Britain and Ireland during the last century, due to habitat loss and the introduction of grey squirrels (Sciurus carolinensis), which competitively exclude the red squirrel and act as a reservoir for squirrelpox virus (SQPV). The disease is generally fatal to red squirrels and their ecological replacement by grey squirrels is up to 25 times faster where the virus is present. We aimed to determine: (1) the seropositivity and prevalence of SQPV DNA in the invasive and native species at a regional scale; (2) possible SQPV transmission routes; and, (3) virus degradation rates under differing environmental conditions. Grey (n = 208) and red (n = 40) squirrel blood and tissues were sampled. Enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qPCR) techniques established seropositivity and viral DNA presence, respectively. Overall 8% of squirrels sampled (both species combined) had evidence of SQPV DNA in their tissues and 22% were in possession of antibodies. SQPV prevalence in sampled red squirrels was 2.5%. Viral loads were typically low in grey squirrels by comparison to red squirrels. There was a trend for a greater number of positive samples in spring and summer than in winter. Possible transmission routes were identified through the presence of viral DNA in faeces (red squirrels only), urine and ectoparasites (both species). Virus degradation analyses suggested that, after 30 days of exposure to six combinations of environments, there were more intact virus particles in scabs kept in warm (25°C) and dry conditions than in cooler (5 and 15°C) or wet conditions. We conclude that SQPV is present at low prevalence in invasive grey squirrel populations with a lower prevalence in native red squirrels. Virus transmission could occur through urine especially during warm dry summer conditions but, more notably, via ectoparasites, which are shared by both species

Prevalence of Oral Pain and Barriers to use of Emergency Oral Care Facilities Among Adult Tanzanians.

Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations.\ud Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07-1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09-13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25-5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25-12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended

Low pH immobilizes and kills human leukocytes and prevents transmission of cell-associated HIV in a mouse model

BACKGROUND: Both cell-associated and cell-free HIV virions are present in semen and cervical secretions of HIV-infected individuals. Thus, topical microbicides may need to inactivate both cell-associated and cell-free HIV to prevent sexual transmission of HIV/AIDS. To determine if the mild acidity of the healthy vagina and acid buffering microbicides would prevent transmission by HIV-infected leukocytes, we measured the effect of pH on leukocyte motility, viability and intracellular pH and tested the ability of an acidic buffering microbicide (BufferGel(®)) to prevent the transmission of cell-associated HIV in a HuPBL-SCID mouse model. METHODS: Human lymphocyte, monocyte, and macrophage motilities were measured as a function of time and pH using various acidifying agents. Lymphocyte and macrophage motilities were measured using video microscopy. Monocyte motility was measured using video microscopy and chemotactic chambers. Peripheral blood mononuclear cell (PBMC) viability and intracellular pH were determined as a function of time and pH using fluorescent dyes. HuPBL-SCID mice were pretreated with BufferGel, saline, or a control gel and challenged with HIV-1-infected human PBMCs. RESULTS: Progressive motility was completely abolished in all cell types between pH 5.5 and 6.0. Concomitantly, at and below pH 5.5, the intracellular pH of PBMCs dropped precipitously to match the extracellular medium and did not recover. After acidification with hydrochloric acid to pH 4.5 for 60 min, although completely immotile, 58% of PBMCs excluded ethidium homodimer-1 (dead-cell dye). In contrast, when acidified to this pH with BufferGel, a microbicide designed to maintain vaginal acidity in the presence of semen, only 4% excluded dye at 10 min and none excluded dye after 30 min. BufferGel significantly reduced transmission of HIV-1 in HuPBL-SCID mice (1 of 12 infected) compared to saline (12 of 12 infected) and a control gel (5 of 7 infected). CONCLUSION: These results suggest that physiologic or microbicide-induced acid immobilization and killing of infected white blood cells may be effective in preventing sexual transmission of cell-associated HIV

Derivations and automorphisms of free nilpotent Lie algebras and their quotiens

Let \n_{d,t} be the free nilpotent Lie algebra of type $d$ and nilindex $t$. Starting out with the derivation algebra and the automorphism group of \n_{d,t}, we get a natural description of derivations and automorphisms of any generic nilpotent Lie algebra of the same type and nilindex. Moreover, along the paper we discuss several examples to illustrate the obtained results.Comment: 13 page

Lymph node infarction – a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever

BACKGROUND: Lymph node infarction is known to occur in association with many non-neoplastic and neoplastic conditions however its occurrence in association with DIC is not reported hitherto in the literature. CASE PRESENTATION: We describe an unusual case of lymph node infarction in a twenty seven year old male following disseminated intravascular coagulation (DIC) in a case of dengue fever. Multiple sections of the infarcted and the surrounding non-infarcted lymph nodes failed to reveal any predisposing condition. How ever the parahilar vessels showed thrombotic occlusion, which must have been responsible for the infarction. CONCLUSION: Global infarction of the lymph node may mask the underlying pathology. Any malignancy especially lymphoma may coexist or follow lymph node infarction, therefore the patient needs constant surveillance

Mouse Acetylcholinesterase Enhances Neurite Outgrowth of Rat R28 Cells Through Interaction With Laminin-1

The enzyme acetylcholinesterase (AChE) terminates synaptic transmission at cholinergic synapses by hydrolyzing the neurotransmitter acetylcholine, but can also exert ‘non-classical’, morpho-regulatory effects on developing neurons such as stimulation of neurite outgrowth. Here, we investigated the role of AChE binding to laminin-1 on the regulation of neurite outgrowth by using cell culture, immunocytochemistry, and molecular biological approaches. To explore the role of AChE, we examined fiber growth of cells overexpressing different forms of AChE, and/or during their growth on laminin-1. A significant increase of neuritic growth as compared with controls was observed for neurons over-expressing AChE. Accordingly, addition of globular AChE to the medium increased total length of neurites. Co-transfection with PRIMA, a membrane anchor of AChE, led to an increase in fiber length similar to AChE overexpressing cells. Transfection with an AChE mutant that leads to the retention of AChE within cells had no stimulatory effect on neurite length. Noticeably, the longest neurites were produced by neurons overexpressing AChE and growing on laminin-1, suggesting that the AChE/laminin interaction is involved in regulating neurite outgrowth. Our findings demonstrate that binding of AChE to laminin-1 alters AChE activity and leads to increased neurite growth in culture. A possible mechanism of the AChE effect on neurite outgrowth is proposed due to the interaction of AChE with laminin-1