Big Data: Medical Claims Data for Translational Research: Medicaid

Medical claims can be a primary data source for translational research. This presentation provides information on Medicaid as a source of claims data, including a description of Medicaid datasets, the most commonly used variables on each dataset, and examples of translational analyses using Medicaid

Data Acquisition, Management and Tracking

As part of the mini-symposium entitled Data Acquisition, Data Management, and Subject Tracking in Clinical and Translational Research: Seeking Solutions to Persistent Challenges, Drs. Barton and Costanza introduce the symposium with a presentation explaining the importance of data acquisition, management, and tracking of clinical research data

Differential role of MLKL in alcohol-associated and non-alcohol-associated fatty liver diseases in mice and humans

Hepatocellular death contributes to progression of alcohol-associated (ALD-associated) and non-alcohol-associated (NAFL/NASH) liver diseases. However, receptor-interaction protein kinase 3 (RIP3), an intermediate in necroptotic cell death, contributes to injury in murine models of ALD but not NAFL/NASH. We show here that a differential role for mixed-lineage kinase domain-like protein (MLKL), the downstream effector of RIP3, in murine models of ALD versus NAFL/NASH and that RIP1-RIP3-MLKL can be used as biomarkers to distinguish alcohol-associated hepatitis (AH) from NASH. Phospho-MLKL was higher in livers of patients with NASH compared with AH or healthy controls (HCs). MLKL expression, phosphorylation, oligomerization, and translocation to plasma membrane were induced in WT mice fed diets high in fat, fructose, and cholesterol but not in response to Gao-binge (acute on chronic) ethanol exposure. Mlkl-/- mice were not protected from ethanol-induced hepatocellular injury, which was associated with increased expression of chemokines and neutrophil recruitment. Circulating concentrations of RIP1 and RIP3, but not MLKL, distinguished patients with AH from HCs or patients with NASH. Taken together, these data indicate that MLKL is differentially activated in ALD/AH compared with NAFL/NASH in both murine models and patients. Furthermore, plasma RIP1 and RIP3 may be promising biomarkers for distinguishing AH and NASH

Outcome of Hyperkalemia in the Emergency Department: Impact of Hyperkalemic Severity, Renal Function and CHF on Survival

Background: Hyperkalemia is common and lethal electrolyte disorder with little known long-term consequences. This was retrospective, observational study of hospitalized patients with initial serum K \u3e 5.3 mEq/L. 143 consecutive episodes of hyperkalemia were analyzed in 133 patients. Survival was analyzed by parameters of renal dysfunction (admit eGFR), CHF, admit K and EKG abnormalities. Methods: Hazard ratios (HR) for mortality were computed by Cox proportional hazards multivariate regression. Primary end point, all-cause mortality determined by Social Security Death Index and medical record review. Results: Admit eGFR was the most powerful predictor of mortality. The effect of renal function was nonlinear(figure 1). Highest mortality is eGFR group of 15-59 HR 6.92. More severe renal impairment with eGFR(HD) HR 3.67. ESRD had lower mortality HR 1.33(table 1). Hyperkalemic severity had a modest effect(figure 2). Compared to patients Admit K 5.3-5.9 mEq/L, patients with K 6-7, HR 2.21 (p=0.0210) and K \u3e7.0, HR 2.62 (p=0.0521). History of CHF, increased mortality by univariate analysis (p Conclusions: Survival in hyperkalemic patients is predicted by lower admit eGFR in a non-linear fashion. ESRD patients exhibited lower mortality perhaps reflecting adaptation to chronic hyperkalemia. CHF has an additive effect on mortality in non HD patients. We emphasize that 86% of the mortality was after discharge. This extraordinary mortality necessitates the need to develop risk stratification strategies in the long-term care of the hyperkalemic patients

Response of sea bream to handling

Understanding how gilthead sea bream, Sparus aurata L., an important Mediterranean Sea species for aquaculture, respond physiologically to stressors commonly encountered in intensive rearing is important for eiective production, as managing for stress is a major factor in maintaining healthy ¢sh stocks. Our objective was to determine whether holding juvenile gilthead sea bream at a high density (HD), as a chronic stressor, would aiect their physiological responses to a subsequent acute handling stressor. After acclimation at a low density (LD) of 6k g m 3 in 200-L circular tanks containing 33^ 36 g L 1 recirculating seawater at 191C under a normal photoperiod, juvenile 37-g gilthead sea bream were con¢ned for 14 days at a HD of 26 kg m 3 an

Biostatistics, Epidemiology & Research Design (BERD)

This seminar describes the Biostatistics, Epidemiology, and Research Design component of the UMCCTS, including the Quantitative Methods Core (QMC). An overview of the new Department of Quantitative Health Sciences is also presented

Cognitive testing for dementia is adversely affected by administration in a foreign location

BACKGROUND: It is colloquially considered that cognitive tests can be adversely affected by administration in a foreign location. However, a definitive demonstration of this is lacking in the literature. To determine whether or not this is the case, we compared the results of cognitive testing in a familiar versus foreign environment by single test administrator of individuals diagnosed with Alzheimer\u27s disease randomized to placebo in a multi-site clinical study. FINDINGS: Cognitive tests were administered to 6 long-term residents of an assisted living facility at their residence (the Familiar cohort). The identical tests were administered to a newly admitted resident and to 2 community-dwelling individuals who drove to the administrator\u27s office for the first time (the Foreign cohort). Secondary testing was administered 3 months later at the same respective locations. Caregivers of participants completed reports of mood, behavior and activities of daily living. The Familiar cohort performed equally well at both visits. The Foreign cohort performed significantly worse than the Familiar cohort at baseline. They improved statistically, and matched Familiar cohort performance, by their second visit. Caregiver reports for both cohorts were unchanged between visits. CONCLUSIONS: These findings support the notion that a foreign location can adversely affect performance on cognitive tests, and therefore support cognitive testing in a familiar location

A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System

Background. The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods. A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results. In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P \u3c .001); in addition, the ratio of hand hygiene to room entry/exit events also increased from 26.1% to 36.6% (40% increase, P \u3c .001). The performance returned to baseline (1473 hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions. In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity