Data quality in trauma transfusion studies and the impact of missing data on predicting massive transfusion

Maximizing data quality may be especially difficult in trauma-related clinical research. Strategies are needed to improve data quality and assess the impact of data quality on clinical predictive models. This study had two objectives. The first was to compare missing data between two multi-center trauma transfusion studies: a retrospective study (RS) using medical chart data with minimal data quality review and the PRospective Observational Multi-center Major Trauma Transfusion (PROMMTT) study with standardized quality assurance. The second objective was to assess the impact of missing data on clinical prediction algorithms by evaluating blood transfusion prediction models using PROMMTT data. RS (2005-06) and PROMMTT (2009-10) investigated trauma patients receiving ≥ 1 unit of red blood cells (RBC) from ten Level I trauma centers. Missing data were compared for 33 variables collected in both studies using mixed effects logistic regression (including random intercepts for study site). Massive transfusion (MT) patients received ≥ 10 RBC units within 24h of admission. Correct classification percentages for three MT prediction models were evaluated using complete case analysis and multiple imputation based on the multivariate normal distribution. A sensitivity analysis for missing data was conducted to estimate the upper and lower bounds of correct classification using assumptions about missing data under best and worst case scenarios. Most variables (17/33=52%) had <1% missing data in RS and PROMMTT. Of the remaining variables, 50% demonstrated less missingness in PROMMTT, 25% had less missingness in RS, and 25% were similar between studies. Missing percentages for MT prediction variables in PROMMTT ranged from 2.2% (heart rate) to 45% (respiratory rate). For variables missing >1%, study site was associated with missingness (all p≤0.021). Survival time predicted missingness for 50% of RS and 60% of PROMMTT variables. MT models complete case proportions ranged from 41% to 88%. Complete case analysis and multiple imputation demonstrated similar correct classification results. Sensitivity analysis upper-lower bound ranges for the three MT models were 59-63%, 36-46%, and 46-58%. Prospective collection of ten-fold more variables with data quality assurance reduced overall missing data. Study site and patient survival were associated with missingness, suggesting that data were not missing completely at random, and complete case analysis may lead to biased results. Evaluating clinical prediction model accuracy may be misleading in the presence of missing data, especially with many predictor variables. The proposed sensitivity analysis estimating correct classification under upper (best case scenario)/lower (worst case scenario) bounds may be more informative than multiple imputation, which provided results similar to complete case analysis.^

Molecular analysis of a neurovirulent murine leukemia virus, {\it ts\/}1

ts1 is a neurovirulent spontaneous temperature-sensitive mutant of Moloney murine leukemia virus TB (MoMuLV-TB). MoMuLV-TB causes T-cell lymphoma or lymphoid leukemia in mice after a long latency period whereas ts1 causes a progressive hindlimb paralytic disease after a much shorter latency period. In previous studies, it had been shown that the temperature-sensitive defect resided in the $env$ gene. At the restrictive temperature, the envelope precursor polyprotein, gPr80$\sp{env}$, is inefficiently processed intracellularly into a heterodimer consisting of two cleavage products, gp70 and Prp15E. This inefficient processing is correlated with neurovirulence. In this study, the nucleotide sequences of the env genes for both ts1 and MoMuLV-TB were determined, and the encoded amino acid sequences were deduced from the DNA sequences. There were four unique amino acid substitutions in the gPr80$\sp{env}$ of ts1. In order to determine which unique amino acid was responsible for the phenotypic characteristics of ts1, a set of hybrid genomes was constructed by exchanging restriction fragments between ts1 and MoMuLV-TB. NIH 3T3 cells were transfected with the hybrid genomes to obtain infectious hybrid viruses. Assays of the hybrid viruses showed that a Val-25$\to$Ile substitution in gPr80$\sp{env}$ was responsible for the temperature sensitivity, inefficient processing, and neurovirulence of ts1. In further studies, the Ile-25 in gPr80$\sp{env}$ was substituted with Thr, Ala, Leu, Gly, and Glu by site-directed mutagenesis to generate a new set of mutant viruses, i.e., ts1-T, -A, -L, -G, and -E, respectively. The rank order of the mutants for temperature sensitivity was: ts1-E $>$ ts1-G $>$ ts1-L $>$ ts1-A $>$ ts1 $>$ ts1-T. The degree of temperature sensitivity of each of the mutants also correlated with the degree of inefficient processing of gPr80$\sp{env}$. The mutant viruses were assayed for neurovirulence. ts1-T caused whole body tremor, ts1-A caused hindlimb paralysis, ts1-L caused paraparesis, but ts1-G and -E were not neurovirulent. These results show that inefficient processing of gPr80$\sp{env}$ is correlated with neurovirulence, but if processing of gPr80$\sp{env}$ is too inefficient there is no neurovirulence. Furthermore, the disease profile of each of the neurovirulent viruses depends on the degree of inefficient processing of gPr80$\sp{env}$. ^

Case studies of the effects of a total solar eclipse on weather with varying degrees of cloud cover using a local numerical weather prediction model

The importance of renewable energies for the European electricity market is growing rapidly. This presents transmission grids and the power market in general with new challenges which stem from the higher spatiotemporal variability of power generation. This uncertainty is due to the fact that renewable power production results from weather phenomena, thus making it difficult to plan and control. We present a sensitivity study of a total solar eclipse in central Europe in March. The weather in Germany and Europe was modeled using the German Weather Service's local area models COSMO-DE and COSMO-EU, respectively (http://www.cosmo-model.org/). The simulations were performed with and without considering a solar eclipse for the following 3 situations: 1. An idealized, clear-sky situation for the entire model area (Europe, COSMO-EU) 2. A real weather situation with mostly cloudy skies (Germany, COSMO-DE) 3. A real weather situation with mostly clear skies (Germany, COSMO-DE) The data should help to evaluate the effects of a total solar eclipse on the weather in the planetary boundary layer. The results show that a total solar eclipse has significant effects particularly on the main variables for renewable energy production, such as solar irradiation and temperature near the ground.

Benthic foraminiferal d18O and Mg/Ca studies of sediment cores off tropical NW Africa

Benthic foraminiferal d18O and Mg/Ca of sediment cores off tropical NW Africa are used to study the properties of Atlantic central waters during the Last Glacial Maximum (LGM) and Heinrich Stadial 1 (HS1). We combined our core top data with published results to develop a new Mg/Ca-temperature calibration for Planulina ariminensis, which shows a Mg/Ca-temperature sensitivity of 0.19 mmol/mol per °C. Estimates of the LGM and HS1 thermocline temperatures are comparable to the present-day values between 200 and 400 m water depth, but were 1.2-1.5°C warmer at 550-570 m depth. The HS1 thermocline waters (200-570 m depth) did not show any warming relative to the LGM. This is in contrast to previous climate model studies, which concluded that tropical Atlantic thermocline waters warmed significantly when Atlantic meridional overturning circulation was reduced. However, our results suggest that thermocline temperatures of the northeastern tropical Atlantic show no pronounced sensitivity to changes in the thermohaline circulation during glacial periods. In contrast, we find a significant increase in thermocline-water salinity during the LGM (200-550 m depth) and HS1 (200-400 m depth) with respect to the present-day, which we relate to changes in the wind-driven circulation. We infer that the LGM thermocline (200-550 m depth) and the HS1 upper thermocline (200-400 m depth) in the northeastern tropical Atlantic was ventilated by surface waters from the North Atlantic rather than the southern-sourced waters. This suggests that the frontal zone between the modern South Atlantic and North Atlantic Central Waters was probably shifted southward during the LGM and HS1.

(Table 1) Ice thickness at lake Nam Co, Tibet, during 2008-2009

Lake ice change is one of the sensitive indicators of regional and global climate change. Different sources of data are used in monitoring lake ice phenology nowadays. Visible and Near Infrared bands of imagery (VNIR) are well suited for the observation of freshwater ice change, for example data from AVHRR and MODIS. Active and passive microwave data are also used for the observation of lake ice, e.g., from satellite altimetry and radiometry, backscattering coefficient from QuickSCAT, brightness temperature (Tb) from SSM/I, SMMR, and AMSR-E. Most of the studies are about lake ice cover phenology, while few studies focus on lake ice thickness. For example, Hall et al. using 5 GHz (6 cm) radiometer data showed a good relationship between Tb and ice thickness. Kang et al. found the seasonal evolution of Tb at 10.65 GHz and 18.7 GHz from AMSR-E to be strongly influenced by ice thickness. Many studies on lake ice phenology have been carried out since the 1970s in cold regions, especially in Canada, the USA, Europe, the Arctic, and Antarctica. However, on the Tibetan Plateau, very little research has focused on lake ice-cover change; only a small number of published papers on Qinghai Lake ice observations. The main goal of this study is to investigate the change in lake ice phenology at Nam Co on the Tibetan Plateau using MODIS and AMSR-E data (monitoring the date of freeze onset, the formation of stable ice cover, first appearance of water, and the complete disappearance of ice) during the period 2000-2009.

Relative sensitivity of soft-bottom intertidal macrofauna to increased CO2 and experimental stress

We used a controlled CO2 perturbation experiment to test hypotheses about changes in diversity, composition and structure of soft-bottom intertidal macrobenthic assemblages, under realistic and locally relevant scenarios of seawater acidification. Patches of undisturbed sediment were collected from 2 types of intertidal sedimentary habitat in the Ria Formosa coastal lagoon (South Portugal) and exposed to 2 levels of seawater acidification (pH reduced by 0.3 and 0.6 units) and 1 unmanipulated (control) level. After 75 d the assemblages differed significantly between the 2 types of sediment and between field controls and the ex situ treatments, but not among the 3 pH levels tested. The naturally high values of total alkalinity buffered seawater from the changes imposed on carbonate chemistry and may have contributed to offsetting acidification at the local scale. Observed differences on biota were strongly related to the organic matter content and grain-size of the sediments, particularly to the fractions of medium and coarse sand. Soft-bottom intertidal macrofauna was significantly affected by the stress of being held in an artificial environment, but not by CO2-induced seawater acidification. Given the previously observed variations in the sensitivities of marine organisms to seawater acidification, direct extrapolations of the present findings to different regions or other types of assemblages do not seem advisable. However, the contribution of ex situ studies to the assessment of ecosystem-level responses to environmental disturbances could generally be improved by incorporating adequate field controls in the experimental design.

(Table 1) Elemental composition of benthic foraminifera from South Atlantic core top samples

The ocean plays a major role in the global carbon cycle, and attempts to reconstruct past changes in the marine carbonate system are increasing. The speciation of dissolved uranium is sensitive to variations in carbonate system parameters, and previous studies have shown that this is recorded in the uranium-to-calcium ratio (U/Ca) of the calcite shells of planktonic foraminifera. Here we test whether U/Ca ratios of deep-sea benthic foraminifera are equally suited as an indicator of the carbonate system. We compare U/Ca in two common benthic foraminifer species (Planulina wuellerstorfi and Cibicidoides mundulus) from South Atlantic core top samples with the calcite saturation state (Delta [CO3**2-] = [CO3**2-]in situ - [CO3**2-]sat) of the ambient seawater and find significant negative correlations for both species. Compared with planktonic foraminifera, the sensitivity of U/Ca in benthic foraminifera to changes in Delta [CO3**2-] is about 1 order of magnitude higher. Although Delta [CO3**2-] exerts the dominant control on the average foraminiferal U/Ca, the intertest and intratest variability indicates the presence of additional factors forcing U/Ca.