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Electronic health record (EHR) data have emerged as an important resource for population health and clinical research. There have been significant efforts to leverage EHR data for research; however, given data security concerns and the complexity of the data, EHR data are frequently difficult to access and use for clinical studies. We describe the development of a Clinical Research Datamart (CRDM) that was developed to provide well-curated and easily accessible EHR data to Duke University investigators.
The CRDM was designed to (1) contain most of the patient-level data elements needed for research studies; (2) be directly accessible by individuals conducting statistical analyses (including Biostatistics, Epidemiology, and Research Design (BERD) core members); (3) be queried via a code-based system to promote reproducibility and consistency across studies; and (4) utilize a secure protected analytic workspace in which sensitive EHR data can be stored and analyzed. The CRDM utilizes data transformed for the PCORnet data network, and was augmented with additional data tables containing site-specific data elements to provide additional contextual information.
We provide descriptions of ideal use cases and discuss dissemination and evaluation methods, including future work to expand the user base and track the use and impact of this data resource.
The CRDM utilizes resources developed as part of the Clinical and Translational Science Awards (CTSAs) program and could be replicated by other institutions with CTSAs.
Sexually transmitted infections (STIs) can be found in a range of hosts. Their epidemiology is predicted to vary with mean and variance in number of mating partners and, in more refined models, contact and social structure. Weak dependence of mating rate on host density leads to a prediction of density-independent dynamics, including the possibility that sterilising infections could drive their hosts extinct. Infection’s impact on the host is predicted to select for mate choice against infected partners and reduced mating rates. We examine these predictions against STIs in nature, with a particular focus on studies of beetle–ectoparasitic mite interactions. The Adalia bipunctata–Coccipolipus interaction has given rich insights, with ease of scoring infection and mating activity in natural populations enabling detailed documentation of dynamics. Laboratory study has allowed precise estimation of transmission parameters to inform models and focused analysis of behaviour. These studies have confirmed the core impact of mating rate on STI dynamics, but revealed unexpected drivers such as food supply (positively driving mating rate) and sex ratio (enhancing spread and producing male-biased prevalence), alongside constraints on spread from host phenology.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
Decreases in Fe status have been reported in military women during initial training periods of 8–10 weeks. The present study aimed to characterise Fe status and associations with physical performance in female New Zealand Army recruits during a 16-week basic combat training (BCT) course. Fe status indicators – Hb, serum ferritin (sFer), soluble transferrin receptor (sTfR), transferrin saturation (TS) and erythrocyte distribution width (RDW) – were assessed at the beginning (baseline) and end of BCT in seventy-six volunteers without Fe-deficiency non-anaemia (sFer <12 µg/l; Hb ≥120 g/l) or Fe-deficiency anaemia (sFer <12 µg/l; Hb <120 g/l) at baseline or a C-reactive protein >10 mg/l at baseline or end. A timed 2·4 km run followed by maximum press-ups were performed at baseline and midpoint (week 8) to assess physical performance. Changes in Fe status were investigated using paired t tests and associations between Fe status and physical performance evaluated using Pearson correlation coefficients. sFer (56·6 (sd 33·7) v. 38·4 (sd 23·8) µg/l) and TS (38·8 (sd 13·9) v. 34·4 (sd 11·5) %) decreased (P<0·001 and P=0·014, respectively), while sTfR (1·21 (sd 0·27) v. 1·39 (sd 0·35) mg/l) and RDW (12·8 (sd 0·6) v. 13·2 (sd 0·7) %) increased (P<0·001) from baseline to end. Hb (140·6 (sd 7·5) v. 142·9 (sd 7·9) g/l) increased (P=0·009) during BCT. At end, sTfR was positively (r 0·29, P=0·012) and TS inversely associated (r –0·32, P=0·005) with midpoint run time. There were no significant correlations between Fe status and press-ups. Storage and functional Fe parameters indicated a decline in Fe status in female recruits during BCT. Correlations between tissue-Fe indicators and run times suggest impaired aerobic fitness. Optimal Fe status appears paramount for enabling success in female recruits during military training.
Investigations into an outbreak of foodborne disease attempt to identify the source of illness as quickly as possible. Population-based reference values for food consumption can assist in investigation by providing comparison data for hypothesis generation and also strengthening the evidence associated with a food product through hypothesis testing. In 2014–2015 a national phone survey was conducted in Canada to collect data on food consumption patterns using a 3- or 7-day recall period. The resulting food consumption values over the two recall periods were compared. The majority of food products did not show a significant difference in the consumption over 3 days and 7 days. However, comparison of reference values from the 3-day recall period to data from an investigation into a Salmonella Infantis outbreak was shown to support the conclusion that chicken was the source of the outbreak whereas the reference values from a 7-day recall did not support this finding. Reference values from multiple recall periods can assist in the hypothesis generation and hypothesis testing phase of foodborne outbreak investigations.
OBJECTIVES/SPECIFIC AIMS: 1.Identify barriers to pursuing research for physician trainees 2.Develop a sustainable pipeline of physician-scientists at Duke 3.Coordinate physician-scientist development programs across the School of Medicine under one central Office 4.Provide infrastructure and resources for all physician-scientists 5.Increase the number of MDs and MD/PhDs who pursue, succeed, and are retained in research METHODS/STUDY POPULATION: To establish a baseline understanding of the needs and concerns of physician-scientist trainees at Duke, we conducted focus groups using a standardized interview guide and thematic analysis. Findings from these focus groups were used to develop a framework for support, leading to the creation of the Office of Physician-Scientist Development (OPSD) housed centrally within the Duke School of Medicine. The OPSD integrates programs and resources for multiple populations including medical students, residents, fellows, junior faculty, and faculty mentors. Pipeline programs will also be developed to enhance research engagement in targeted student populations prior to medical school. RESULTS/ANTICIPATED RESULTS: A total of 45 students and faculty participated in the focus groups and structured interviews (1st year medical student, n=11; 4th year medical students, n=11; residents/fellows, n=13; junior faculty, n=11). While participants raised a number of specific issues, one key message emerged: non-PhD MDs in basic research felt they lacked opportunities for directed training. Moreover, they felt the need to teach themselves many critical skills through trial and error. This has led to perceptions that they cannot compete effectively with PhDs and MD-PhD scientists for research funding and positions. Consensus recommendations included: better guidance in choosing mentors, labs, and projects; central resource for information relevant to physician scientists; training specifically tailored to physician scientists conducting laboratory-based research; improved infrastructure and well-defined training pathways; and assistance with grant preparation. To-date, over 90 students, residents, and fellows have been identified who identify as laboratory-based physician scientists. Additional efforts are underway to identify and characterize the broader range of physician-scientist students and trainees at Duke. DISCUSSION/SIGNIFICANCE OF IMPACT: Our planning study revealed specific steps forward toward developing a robust community of physician-scientists at Duke. As a first step, the Dean of the School of Medicine has appointed an Associate Dean of Physician-Scientist Development to oversee a new Office of Physician-Scientist Development (OPSD) being launched in December of 2018. The OPSD will offer four primary programs. 1) A concierge mentoring program will assist new trainees in identifying research areas of interest and mentors. Trainees will receive periodic contact to provide additional support as needed and promote success. 2) A physician-scientist training program is being created to provide training specific to laboratory research skills as well as career and professional development training to complement existing clinical and translational research programs. 3) Integrated training pathways will provide additional mentored research training for those pursuing research careers. Pathways will capitalize on existing resources from R38 programs, while pursuing additional R38 and R25 support. 4) An MD-Scientist funding program has been developed to provide additional research funding and protected time for students pursuing a second research year. Through the support and programming offered by the OPSD, we anticipate decreased perceptions of barriers to pursuing a physician-scientist career and increased satisfaction with training opportunities. Over time, we expect such support to increase the number of MD students pursuing research as a career and the number of residents, fellows, and MD junior faculty remaining in research careers.
The dynamics of two-dimensional (2-D) ideal fluid vortices is studied experimentally in the presence of an irrotational strain flow. Laboratory experiments are conducted using strongly magnetized pure electron plasmas, a technique which is made possible by the isomorphism between the drift–Poisson equations describing plasma dynamics transverse to the field and the 2-D Euler equations describing an ideal fluid. The electron plasma system provides an excellent opportunity to study the dynamics of a 2-D Euler fluid due to weak dissipation and weak 3-D effects, simple diagnosis and precise control. The plasma confinement apparatus used here was designed specifically to study vortex dynamics under the influence of external flow by applying boundary conditions in two dimensions. Additionally, vortex-in-cell simulations are carried out to complement the experimental results and to extend the parameter range of the studies. It is shown that the global dynamics of a quasi-flat vorticity profile is in good quantitative agreement with the theory of a piecewise-constant elliptical patch of vorticity, including the equilibria, dynamical orbits and stability properties. Deviations from the elliptical patch theory are observed for non-flat vorticity profiles; they include inviscid damping of the orbits and modified stability limits. The dependence of these phenomena on the flatness of the initial profile is discussed. The relationship of these results to other theoretical, numerical and experimental studies is also discussed.
Performance evaluation systems fundamentally shape the behaviour of Chinese judges, but scholarship on the concrete implementation of these institutions is scarce. Relying on nearly 15 months of fieldwork in six cities in China, we explain how the judicial cadre evaluation system, as unified by the 2011 “Guiding opinion of the Supreme People's Court,” has been implemented. Over 30 indices quantitatively measure Chinese courts’ “fairness” (gongzheng 公正), “efficiency” (xiaolü 效率) and “impact” (xiaoguo 效果), incentivizing court leaders to pressure their subordinate judges to resolve disputes as quickly as possible without unduly angering litigants or other actors. Under the hyper-quantified conditions of cadre evaluation, systemic praising and shaming bring about what we call “intra-state legibility,” which leads to a variety of informal worker reactions to these tactics. This study not only uses interviews and new documentary evidence to add necessary detail to our understanding of cadre evaluation systems, it also engages debates in comparative law and politics regarding bureaucratic influence on authoritarian judicial behaviour.
The mouse whipworm Trichuris muris has long been used as a tractable model of human Trichuriasis. Here we look back at the history of T. muris research; from the definition of the species and determination of its life cycle, through to the complex immune responses that we study today. We highlight the key research papers that have developed our understanding of immune responses to this parasite, and reflect on how original concepts have been transformed, as our knowledge of immunology has grown. Although we have a good understanding of host–parasite interactions in the context of the underlying cellular immunology, there are still many aspects of the biology of the Trichuris parasite that remain undefined. We predict that advances in parasite biology will be key in the future development of new and improved treatments for Trichuriasis.
In this study, we have developed and characterized two previously unstudied alkoxysilane surface chemistries for use with superparamagnetic iron oxide (SPIO) nanoparticles as a magnetic resonance imaging contrast agent. We modified superparamagnetic iron oxide nanoparticles (SPIO) using aminopropyl triethoxysilane and two analogous alkoxysilanes, aminopropyl dimethylethoxysilane and aminopropyl methyldiethoxysilane, to compare a mono- and dialkoxysilane, respectively, to a more commonly used trialkoxysilane as two new SPIO surface chemistries capable of forming ultrathin functional surface coatings. The ligand densities of the mono- and dialkoxysilane-modified SPIO produced in this study are consistent with near monolayers of ligands on the SPIO surface. We studied the chemical stability of the mono-, di-, and trialkoxysilane-modified SPIO in neutral and acidic media to evaluate the viability of these surface chemistries for use in long-term intracellular applications. The mono- and dialkoxysilane-modified SPIO demonstrate comparable chemical stability to the trialkoxysilane-modified SPIO, indicating that the mono- and dialkoxysilane are both viable new SPIO surface chemistries for future applications requiring minimally thick alkoxysilane surface coatings.
Collaboration is used by the US National Security Council as a means to integrate inter-federal government agencies during planning and execution of common goals towards unified, national security. The concept of collaboration has benefits in the healthcare system by building trust, sharing resources, and reducing costs. The current terrorist threats have made collaborative medical training between military and civilian agencies crucial.
This review summarizes the long and rich history of collaboration between civilians and the military in various countries and provides support for the continuation and improvement of collaborative efforts. Through collaboration, advances in the treatment of injuries have been realized, deaths have been reduced, and significant strides in the betterment of the Emergency Medical System have been achieved. This review promotes collaborative medical training between military and civilian medical professionals and provides recommendations for the future based on medical collaboration.
Groups of pigs were brought to an abattoir by truck and approximately 25 were killed on each of the next 3 days.
While the pigs were in lairage they were given water but were not fed. After slaughter the caecal contents of all pigs were cultured to detect Salmonella spp. The organism was isolated from 70% of 145 pigs killed after 1 day in lairage, 49% of 143 pigs that had been in lairage for 2 days and 41% of 135 pigs that had been held for 3 days.
Treatment of serum with the insoluble polysaccharide residue of yeast cells (zymosan) has been shown (a) to decrease the bactericidal power of serum for certain bacteria; (b) to remove from some sera a factor essential to the interaction of zymosan with the third component of complement. The adsorbed protein (properdin) was eluted from zymosan and found to contain α2, β and some γ globulins. It was shown to restore partially the normal characteristics to treated serum (RP).
Properdin levels have been estimated in the sera of eighteen burned patients and in twelve normal subjects. There was evidence of a reduced level in the patients' sera. The limitations of the assay method are discussed.
Bactericidal activity of normal serum containing properdin was tested against nineteen Gram-negative bacilli isolated from burns. Ps. pyocyanea, Proteus and Klebsiella, which are commonly found in burns, were with one exception resistant or slightly sensitive to the bactericidal action of this serum. Bact. coli, which is uncommon in burns, was usually highly sensitive.
From our preliminary studies reported here it would seem that the properdin system cannot be expected to kill the flora in established infections of burns, and properdin is therefore unlikely to prove useful as a therapeutic agent. However, it probably has an important role as one of the defence mechanisms of uninfected tissues.
We wish to thank Dr Derrick Rowley and Dr A. C. Wardlaw for helpful discussions, and Dr W. Weiner for his advice and co-operation. We are grateful to Miss Stella Baar, F.R.I.C., for N and P analyses.
Six strains of Str. pyogenes and four strains of Staph. aureus were found to grow well from large or small inocula in fresh human serum; four strains of E. coli failed to grow from large inocula and were killed when the inocula were small. Ps. pyocyanea, Proteus and Str. viridans sometimes grew and sometimes failed to grow in fresh serum.
In serum which had been treated with trypsin or heated at 56° C. for 1 hr. the Gram-negative bacilli grew readily, and growth was still better in serum which had been heated and then trypsinized. Heating at 56° C. and treatment with proteolytic enzymes were shown to destroy complement and to inactivate the bactericidal activity of fresh serum against a Shigella highly sensitive to the properdin system. It is suggested that these changes might be enough to explain the conversion of serum by proteolytic enzymes into a suitable medium for the growth of coliform bacilli. This change might be brought about by bacterial or leucocytic enzymes. Fibrinolytic serum from a cadaver was found to retain at least a part of its complement and bactericidal activity.
Strains of E. coli, Ps. pyocyanea, Proteus, Staph. aureus and Str. pyogenes were tested for growth in burn slough suspension and blister fluid. In slough suspension all strains grew well, but the Gram-negative bacilli grew rather more vigorously than the Gram-positive cocci. In blister fluid E. coli was killed and other strains grew.
These findings are discussed in relation to wound sepsis.
We have been developing noble metal nanoparticles and nanocomposites for large scale application to glass surfaces. The novel functionality of the nanocomposites is attributed to the properties of both the metal nanoparticles and host matrix. Here a single-process route to nanocomposite thin films by spray deposition technique has been investigated. Preformed gold nanoparticles have been incorporated into several different transition metal oxides (TiO2, SnO2, ZnO). The nanocomposite films showed intense coloration due to the surface plasmon resonance effects of gold nanoparticles embedded in the host matrix. The gold nanoparticles were found well embedded into the host metal oxides homogeneously. This film deposition method can easily be scaled up and is compatible with current industrial on-line processes.