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An encyclopedia of human enhancer-gene regulatory interactions.

Identifying transcriptional enhancers and their target genes is essential for understanding gene regulation and the effect of human genetic variation on disease1-6. Here we create and evaluate a resource of more than 92 million enhancer-gene regulatory interactions across 1,458 biosamples covering 369 cell types and tissues, by integrating predictive models, chromatin states, three-dimensional contacts and large-scale genetic perturbations generated by the ENCODE Consortium7. We first create a systematic benchmarking pipeline to compare predictive models, assembling a dataset of 10,356 element-gene pairs measured in CRISPR perturbation experiments, more than 30,000 fine-mapped expression quantitative trait loci and 569 fine-mapped genome-wide association study (GWAS) variants linked to a probable causal gene. Using this framework, we develop ENCODE-rE2G, a predictive model achieving state-of-the-art performance across several prediction tasks, demonstrating that iterative perturbations and supervised machine learning can build increasingly accurate predictive models of enhancer regulation. Using ENCODE-rE2G, we build an encyclopedia of enhancer-gene regulatory interactions in the human genome, revealing global properties of enhancer networks, identifying differences in regulatory complexity across genes and improving analyses linking noncoding variants to target genes and cell types for common complex diseases. By interpreting the model, we find that beyond enhancer activity and three-dimensional enhancer-promoter contacts, additional features that guide enhancer-promoter communication include promoter class and enhancer-enhancer synergy. These genome-wide maps of enhancer-gene regulatory interactions, benchmarking software, predictive models and insights about enhancer function provide a valuable resource for future studies of gene regulation and human genetics.

Humans↗

transAlign: using amino acids to facilitate the multiple alignment of protein-coding DNA sequences.

BACKGROUND: Alignments of homologous DNA sequences are crucial for comparative genomics and phylogenetic analysis. However, multiple alignment represents a computationally difficult problem. For protein-coding DNA sequences, it is more advantageous in terms of both speed and accuracy to align the amino-acid sequences specified by the DNA sequences rather than the DNA sequences themselves. Many implementations making use of this concept of "translated alignments" are incomplete in the sense that they require the user to manually translate the DNA sequences and to perform the amino-acid alignment. As such, they are not well suited to large-scale automated alignments of large and/or numerous DNA data sets. RESULTS: transAlign is an open-source Perl script that aligns protein-coding DNA sequences via their amino-acid translations to take advantage of the superior multiple-alignment capabilities and speed of an amino-acid alignment. It operates by translating each DNA sequence into its corresponding amino-acid sequence, passing the entire matrix to ClustalW for alignment, and then back-translating the resulting amino-acid alignment to derive the aligned DNA sequences. In the translation step, transAlign determines the optimal orientation and reading frame for each DNA sequence according to the desired genetic code. It also checks for apparent frame shifts in the DNA sequences and can handle frame-shifted sequences in one of three ways (delete, align as amino acids regardless, or profile align as DNA). As a set of comparative benchmarks derived from six protein-coding genes for mammals shows, the strategy implemented in transAlign always improves the speed and usually the apparent accuracy of the alignment of protein-coding DNA sequences. CONCLUSION: transAlign represents one of few full and cross-platform implementations of the concept of translated alignments. Both the advantages accruing from performing a translated alignment and the suite of user-definable options available in the program mean that transAlign is ideally suited for large-scale automated alignments of very large and/or very numerous protein-coding DNA data sets. However, the good performance offered by the program also translates to the alignment of any set of protein-coding sequences. transAlign, including the source code, is freely available at http://www.tierzucht.tum.de/Bininda-Emonds/ (under "Programs").

Algorithms↗

New products: benchmarking the critical success factors.

New-product development is emerging as the key strategic endeavour of companies in fields such as medical devices. Drawing on the findings of a recent study, the author suggests that the critical factors that influence the success of new products are process, strategy and resources. Process was found to have the strongest impact on the performance of a new product. This article describes a stage-gate process that provides companies with a template for driving new-product projects from idea through to launch.

Commerce↗

Integrative missing value estimation for microarray data.

BACKGROUND: Missing value estimation is an important preprocessing step in microarray analysis. Although several methods have been developed to solve this problem, their performance is unsatisfactory for datasets with high rates of missing data, high measurement noise, or limited numbers of samples. In fact, more than 80% of the time-series datasets in Stanford Microarray Database contain less than eight samples. RESULTS: We present the integrative Missing Value Estimation method (iMISS) by incorporating information from multiple reference microarray datasets to improve missing value estimation. For each gene with missing data, we derive a consistent neighbor-gene list by taking reference data sets into consideration. To determine whether the given reference data sets are sufficiently informative for integration, we use a submatrix imputation approach. Our experiments showed that iMISS can significantly and consistently improve the accuracy of the state-of-the-art Local Least Square (LLS) imputation algorithm by up to 15% improvement in our benchmark tests. CONCLUSION: We demonstrated that the order-statistics-based integrative imputation algorithms can achieve significant improvements over the state-of-the-art missing value estimation approaches such as LLS and is especially good for imputing microarray datasets with a limited number of samples, high rates of missing data, or very noisy measurements. With the rapid accumulation of microarray datasets, the performance of our approach can be further improved by incorporating larger and more appropriate reference datasets.

Algorithms↗

Apparent truth about congenital diaphragmatic hernia: a population-based database is needed to establish benchmarking for clinical outcomes for CDH.

BACKGROUND: The authors hypothesize that recent single or multiinstitution-based reports of improved survival of congenital diaphragmatic hernia (CDH) patients are biased by patient selection, practice, and referral patterns. Here the authors report a population-based analysis of the clinical outcomes of CDH in the province of Ontario for 1996. METHODS: A retrospective analysis of cross-sectional data from the Bureau of Vital Statistics of Ontario and all 5 pediatric surgical institutions in Ontario for 1996 was performed. RESULTS: Twenty-four CDH-associated deaths were registered in Canada in 1996. Fourteen of 24 occurred in Ontario (58.3%). Of 30 institutionally identified CDH in Ontario, 8 patients died (26.7%). CDH-associated infant mortality rate was 6.6 of 100,000 live births in Canada compared with 10 of 100,000 live births for Ontario (Relative risk, 1.4; confidence interval, 0.5, 3.7; P >.01). Neonatal death (<28 postnatal days) accounted for the majority, 13 of 14 (92.8%) of deaths. Six of 14 (42.9%) CDH-associated deaths, however, were not accounted by the institutional-based reporting. In addition, institutional-based survival rates for CDH varied from 62.5% to 100%. CONCLUSIONS: Our results indicate the existing bias associated with institution-based reporting and database of CDH. The "hidden mortality" associated with CDH is still present. A population-based database is needed to establish the benchmarking for management of CDH.

Bias↗

Validation of the EuroSCORE model in Australia.

OBJECTIVE: There is an important role for accurate risk prediction models in current cardiac surgical practice. Such models enable benchmarking and allow surgeons and institutions to compare outcomes in a meaningful way. They can also be useful in the areas of surgical decision-making, preoperative informed consent, quality assurance and healthcare management. The aim of this study was to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model on the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) patient database. METHODS: The additive and logistic EuroSCORE models were applied to all patients undergoing cardiac surgery at six institutions in the state of Victoria between 1st July 2001 and 4th July 2005 within the ASCTS database who have complete data. The entire cohort and a subgroup of patients undergoing coronary artery bypass grafting (CABG) only were analysed. Observed and predicted mortalities were compared. Model discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. Model calibration was tested by the Hosmer-Lemeshow chi-square test. RESULTS: Eight thousand three hundred and thirty-one patients with complete data were analysed. There were significant differences in the prevalence of risk factors between the ASCTS and European cardiac surgical populations. Observed mortality was 3.20% overall and 2.00% for the CABG only group. The EuroSCORE models over estimated mortality (entire cohort: additive predicted 5.31%, logistic predicted 8.76%; CABG only: additive predicted 4.25%, logistic predicted 6.19%). Discriminative power of both models was very good. Area under ROC curve was 0.83 overall and 0.82 for the CABG only group. Calibration of both models was poor as mortality was over predicted at nearly all risk deciles. Hosmer-Lemeshow chi-square test returned P-values less than 0.05. CONCLUSIONS: The additive and logistic EuroSCORE does not accurately predict outcomes in this group of cardiac surgery patients from six Australian institutions. Hence, the use of the EuroSCORE models for risk prediction may not be appropriate in Australia. A model, which accurately predicts outcomes in Australian cardiac surgical patients, is required.

Adult↗

Unveiling the power of TIIC: A prognostic tool for esophageal adenocarcinoma.

BACKGROUND: Esophageal adenocarcinoma (EAC) remains a lethal malignancy with limited prognostic tools for guiding immunotherapy. Tumor-infiltrating immune cells (TIICs) play a critical role in EAC prognosis and treatment response. METHODS: We integrated single-cell RNA sequencing and bulk transcriptome data from TCGA and GEO databases. TIIC-specific RNAs were identified via tissue specificity index calculation combined with machine learning feature selection. Twenty machine learning algorithms were benchmarked to construct an optimal TIIC signature score (TIIC-Score) based on the comprehensive C-index. Immunotherapy response, genomic mutation, and copy number variation were analyzed. Summary-data-based Mendelian randomization (SMR) and two-sample Mendelian randomization (MR) were performed to explore genetic associations. Core prognostic TIIC-related genes were functionally validated in esophageal cancer cell lines through loss-of-function assays. RESULTS: The TIIC-Score demonstrated robust prognostic value for 1-, 2-, and 3-year overall survival across multiple cohorts, outperforming 22 published models. High TIIC-Score was associated with poor survival and increased chromosomal instability. Mutation profiling revealed high frequencies of TP53 (78.2%), TTN (48.7%), and SYNE1 (30.8%). MR analysis identified a significant association between gastro-oesophageal reflux and EAC risk at SNP rs8130507. Functionally, CCNI was upregulated in esophageal cancer cells, and its knockdown suppressed malignant phenotypes while promoting apoptosis, supporting its pro-tumorigenic role. CONCLUSION: The TIIC-Score provides a novel prognostic framework for EAC that effectively stratifies patient risk and may help identify individuals most likely to benefit from immunotherapy.

Esophageal adenocarcinoma↗

Joint thresholding and quantizer selection for compression of medical ultrasound images in the wavelet domain.

This paper introduces a simple and efficient technique for compression of medical ultrasound (US) images in the wavelet domain. The statistics of subband wavelet coefficients are modelled using the generalized Gaussian distribution (GGD). By exploiting these statistics, a uniform scalar quantizer is designed which adapts very well to the changing statistics of the signal across various subbands and scales. To increase the quantization performance, a threshold is chosen adaptively to zero-out the insignificant wavelet coefficients in the detail subbands before quantization. A distinctive feature of the proposed technique is that it unifies the two approaches to image adaptive coding: rate-distortion (R-D) optimized quantizer selection and R-D optimal thresholding, in order to increase the compression performance of the coder. The operational R-D criterion used for joint optimization is derived in the minimum description length (MDL) framework. The experimental results show that the joint R-D optimization leads to significant improvement in the compression performance of the proposed coder, named JTQ-WV, over the best state-of-the-art image coder, SPIHT. For example, the coding of US images at 0.25 bpp by JTQ-WV yields a PSNR gain of 1.0 dB over the benchmark SPIHT.

Algorithms↗

Quality benchmark for trans-tibial prostheses in low-income countries.

Based on four series of patients (N=141) participating in clinical field testing of prosthetic feet and all provided with trans-tibial prostheses in accordance with the polypropylene component and assembly system developed by the International Committee of the Red Cross (ICRC) a series of quality benchmarks was developed and tested against historical data. The patient compliance demands were set for walking >1 km at 90 +/- 10%, non-users at 5 +/- 5%, discomfort at 10 +/- 10%, pain at 10 +/- 10%, and patient satisfaction at 90 +/- 10%. The technical performance demands were set for good socket fit at 60 +/- 10%, misalignment at 15 +/- 10%, insufficient craftsmanship at 10 +/- 10%, and requirements for socket change at 10 +/- 10%.

Adolescent↗

A doubly robust framework for addressing outcome-dependent selection bias in multi-cohort EHR studies.

Selection bias can hinder accurate estimation of association parameters in binary disease risk models using non-probability samples like electronic health records (EHRs). The issue is compounded when participants are recruited from multiple clinics/centers with varying selection mechanisms that may depend on the disease/outcome of interest. Traditional inverse-probability-weighted (IPW) methods, based on constructed parametric selection models, often struggle with misspecifications when selection mechanisms vary across cohorts. This paper introduces a new Joint Augmented Inverse Probability Weighted (JAIPW) method, which integrates individual-level data from multiple cohorts collected under potentially outcome-dependent selection mechanisms, with data from an external probability sample. JAIPW offers double robustness by incorporating a flexible auxiliary score model to address potential misspecifications in the selection models. We outline the asymptotic properties of the JAIPW estimator, and our simulations reveal that JAIPW achieves up to 6 times lower relative bias and 5 times lower root mean square error (RMSE) compared to the best performing joint IPW methods under scenarios with misspecified selection models. Applying JAIPW to the Michigan Genomics Initiative (MGI), a multi-clinic EHR-linked biobank, combined with external national probability samples, resulted in cancer-sex association estimates closely aligned with national benchmark estimates. We also analyzed the association between cancer and polygenic risk scores (PRS) in MGI to illustrate a situation where the exposure variable is not measured in the external probability sample.

Selection Bias↗

A 28-day oral dose toxicity study enhanced to detect endocrine effects of hexabromocyclododecane in Wistar rats.

A 28-day repeated dose study in rats (OECD407) enhanced for endocrine and immune parameters was performed with hexabromocyclododecane (HBCD). Rats were exposed by daily gavage to HBCD dissolved in corn oil in 8 dose groups with doses ranging between 0 and 200 mg/kg bw per day (mkd). Evaluation consisted of dose-response analysis with calculation of a benchmark dose at the lower 95% one-sided confidence bound (BMDL) at predefined critical effect sizes (CESs) of 10-20%. The most remarkable findings were dose-related effects on the thyroid hormone axis, that is, decreased total thyroxin (TT4, BMDL 55.5 mkd at CES--10%), increased pituitary weight (29 mkd at 10%) and increased immunostaining of TSH in the pituitary, increased thyroid weight (1.6 mkd at 10%), and thyroid follicle cell activation. These effects were restricted to females. Female rats also showed increased absolute liver weights (22.9 mkd at 20%) and induction of T4-glucuronyl transferase (4.1 mkd at 10%), suggesting that aberrant metabolization of T4 triggers feedback activation of the thyroid hormone system. These effects were accompanied by possibly secondary effects, including increased cholesterol (7.4 mkd at 10%), increased tibial bone mineral density (> 49 mkd at 10%), both in females, and decreased splenocyte counts (0.3-6.3 mkd at 20%; only evaluated in males). Overall, female rats appeared to be more sensitive to HBCD than male rats, and an overall BMDL is proposed at 1.6 mkd, based on a 10% increase of the thyroid weight, which was the most sensitive parameter in the sequence of events.

Administration, Oral↗

Strategies for quality management in clinical microbiology.

Quality assessment and performance improvement are important management functions that add value to information and services produced by the clinical microbiology laboratory. Analytical quality control procedures are well standardized, and in many cases regulated. Whereas preanalytical and postanalytical factors have considerable impact on quality, performance assessment and improvement in this area have received less consideration. This article describes an approach to quality management of the total testing process in clinical microbiology, including interdisciplinary participation, specimen quality, test use, result use, turnaround time, information quality, user perceptions, and benchmarking.

Humans↗

Red cell or serum folate? Results from the National Pathology Alliance benchmarking review.

AIMS: The National Pathology Alliance benchmarking review has completed five years of data collection and analysis of the workload and organisation of haematology laboratories in the UK. This study analyses variation in practice in how laboratories respond to a request to determine whether or not a patient has folate deficiency. METHODS: A three year analysis of workload data on the number of serum/plasma folate and red cell folate assays performed on an annual basis for the period 1 April 1999 to 31 March 2002. RESULTS: Three diagnostic testing strategies were found, namely: serum/plasma folate only, red cell folate only, and both serum/plasma folate and red cell folate. CONCLUSION: Evidence from the literature indicates that serum folate measurements provide equivalent information to red cell folate measurements when attempting to determine whether folate deficiency is present. There seems to be no basis for the routine testing of all samples for serum/plasma folate and a red cell folate.

Benchmarking↗

Critical analysis of performance of medical students.

BACKGROUND: Admission to B. P. Koirala Institute of Health Sciences (BPKIHS), a health sciences university, depends upon a candidate's academic score in prior education and performance in entrance examination. This study analyzes the performance of the first three classes of MBBS (Bachelor's Degree in Medicine and Surgery) students at different levels, who graduated between 1999 and 2001. OBJECTIVE: To determine whether the premedical performance at different levels has any role in medical performance, and to determine the extent to which the factors predict achievement in the medical program. METHODOLOGY: The scores of students at different levels in premedical and medical education, gender and the medium of schooling of 86 medical students were compiled and analyzed. RESULTS: Annual medical performance scores were found to be significantly correlated with each other, but the average MBBS score was not dependent on either high school or entrance examination scores. However, it correlated with intermediate level in science score. Thus, the selection procedure needs to be developed in such a way that the candidates selected by the entrance examination are most likely to perform well in medical school and beyond. IMPLICATIONS: There is a strong need to standardize the entrance selection procedure of MBBS at BPKIHS.

Benchmarking↗

Co-bedding versus traditional bedding of multiple-gestation infants in the NICU.

This study was part of a large departmental performance improvement initiative to implement and evaluate developmental and family-centered care as "best practice" in the neonatal intensive care unit (NICU). The goal was to evaluate the safety, effect on infant clinical and developmental outcomes, and maternal satisfaction of co-bedding of multiple-gestation infants compared to traditionally bedded infants/mothers. A secondary purpose was to evaluate co-bedding and American Academy of Pediatrics-recommended "back to sleep" behaviors in the same infants/mothers after discharge. A retrospective, comparative, descriptive design was used. Chart reviews and mailed written surveys were used to collect study data. Findings showed no significant differences in demographic variables or clinical and developmental outcomes between the total traditionally bedded and co-bedded groups. All mothers reported positive experiences with the NICU. Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes. Once policies and education are in place, parents should be offered the option to co-bed multiple-gestation infants in the NICU. There is a performance improvement opportunity regarding the education provided to parents of multiple-gestation infants before discharge on the "back to sleep" recommendations.

Benchmarking↗

ORYX PLUS: what you must know about JCAHO's 'accelerated option'.

Even though the deadline for participation in the Joint Commission's ORYX initiative has finally arrived, your hospital still has the option of participating in ORYX PLUS, the initiative's "accelerated option." But should it? Critics contend that the potential benefits of participation in ORYX PLUS are outweighed by its cost, labor requirements, disclosure requirements, and lack of relevance to smaller hospitals. The Joint Commission counters that because ORYX PLUS' performance measures and risk-adjusted methods are standard for all participating measurement systems, hospitals can be assured that they're participating in a valid and reliable database.

Accreditation↗

Balancing the perfect scorecard. Inquiry as intervention in physician practice management.

We describe how inquiry into several operational aspects of health care delivery in the Division of Medicine at the Cleveland Clinic Foundation improved clinical and administrative functions, demonstrating the principle that inquiry is intervention. The process of inquiry displays data on a "performance wheel" that summarizes several indicators, allowing easy comprehension of performance in various operational aspects and a visual appreciation of the interaction among these operational aspects.

Appointments and Schedules↗

Wall Street's assessment of plastic surgery--related technology: a clinical and financial analysis.

Many plastic surgeons develop technologies that are manufactured by Wall Street-financed companies. Others participate in the stock market as investors. This study examines the bioengineered skin industry to determine whether it integrates clinical and financial information as Wall Street tenets would predict, and to see whether the financial performance of these companies provides any lessons for practicing plastic surgeons. In efficient markets, the assumptions on which independent financial analysts base their company sales and earnings projections are clinically reasonable, the volatility of a company's stock price does not irrationally differ from that of its industry sector, and the buy/sell recommendations of analysts are roughly congruent. For the companies in this study, these key financial parameters were compared with a benchmark index of 69 biotech companies of similar age and annual revenues (Student's t test). Five bioengineered skin companies were included in the study. Analysts estimated that each company would sell its product to between 24 and 45 percent of its target clinical population. The average stock price volatility was significantly higher for study companies than for those in the benchmark index (p < 0.05). Similarly, buy/sell recommendations of analysts for the study companies were significantly less congruent than those for the benchmark companies (p < 0.05). These results indicate clinically unrealistic projections for market penetration, significantly high price volatility, and significantly high discordance among professional analysts. In all cases, the market is inefficient-an unusual finding on Wall Street. A likely explanation for this market failure is a cycle of poor clinical correlation when assigning sales projections, which in turn leads to price volatility and discordance of buy/sell recommendations. This study's findings have implications for plastic surgeons who develop new technology or who participate in the equities markets as investors. Plastic surgeons who develop new medical devices or technology cannot universally depend on the market to drive clinically reasonable financial performance. Although inflated sales estimates have benefits in the short term, failure to meet projections exacts severe financial penalties. Plastic surgeons who invest in the stock market, because of their unique clinical experience, may sometimes be in the position to evaluate new technologies and companies better than Wall Street experts. Well-timed trades that use this expertise can result in opportunities for profit.

Biomedical Engineering↗