Quantifying data quality for clinical trials using electronic data capture.

BACKGROUND: Historically, only partial assessments of data quality have been performed in clinical trials, for which the most common method of measuring database error rates has been to compare the case report form (CRF) to database entries and count discrepancies. Importantly, errors arising from medical record abstraction and transcription are rarely evaluated as part of such quality assessments. Electronic Data Capture (EDC) technology has had a further impact, as paper CRFs typically leveraged for quality measurement are not used in EDC processes. METHODS AND PRINCIPAL FINDINGS: The National Institute on Drug Abuse Treatment Clinical Trials Network has developed, implemented, and evaluated methodology for holistically assessing data quality on EDC trials. We characterize the average source-to-database error rate (14.3 errors per 10,000 fields) for the first year of use of the new evaluation method. This error rate was significantly lower than the average of published error rates for source-to-database audits, and was similar to CRF-to-database error rates reported in the published literature. We attribute this largely to an absence of medical record abstraction on the trials we examined, and to an outpatient setting characterized by less acute patient conditions. CONCLUSIONS: Historically, medical record abstraction is the most significant source of error by an order of magnitude, and should be measured and managed during the course of clinical trials. Source-to-database error rates are highly dependent on the amount of structured data collection in the clinical setting and on the complexity of the medical record, dependencies that should be considered when developing data quality benchmarks.

Electronic Techtonics: Thinking at the Interface

This volume originated in HASTAC’s first international conference, “Electronic Techtonics: Thinking at the Interface,” held at Duke University during April 19-21, 2007. “Electronic Techtonics” was the site of truly unforgettable conversations and encounters that traversed domains, disciplines, and media – conversations that explored the fluidity of technology both as interface as well as at the interface. This hardcopy version of the conference proceedings is published in conjunction with its electronic counterpart (found at www.hastac.org). Both versions exist as records of the range and depth of conversations that took place at the conference. Some of the papers in this volume are almost exact records of talks given at the conference, while others are versions that were revised and reworked some time after the conference. These papers are drawn from a variety of fields and we have not made an effort to homogenize them in any way, but have instead retained the individual format and style of each author.

Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

Role of DNA binding sites and slow unbinding kinetics in titration-based oscillators.

Genetic oscillators, such as circadian clocks, are constantly perturbed by molecular noise arising from the small number of molecules involved in gene regulation. One of the strongest sources of stochasticity is the binary noise that arises from the binding of a regulatory protein to a promoter in the chromosomal DNA. In this study, we focus on two minimal oscillators based on activator titration and repressor titration to understand the key parameters that are important for oscillations and for overcoming binary noise. We show that the rate of unbinding from the DNA, despite traditionally being considered a fast parameter, needs to be slow to broaden the space of oscillatory solutions. The addition of multiple, independent DNA binding sites further expands the oscillatory parameter space for the repressor-titration oscillator and lengthens the period of both oscillators. This effect is a combination of increased effective delay of the unbinding kinetics due to multiple binding sites and increased promoter ultrasensitivity that is specific for repression. We then use stochastic simulation to show that multiple binding sites increase the coherence of oscillations by mitigating the binary noise. Slow values of DNA unbinding rate are also effective in alleviating molecular noise due to the increased distance from the bifurcation point. Our work demonstrates how the number of DNA binding sites and slow unbinding kinetics, which are often omitted in biophysical models of gene circuits, can have a significant impact on the temporal and stochastic dynamics of genetic oscillators.

Reducing Electronic Information Overload

College students receive a wealth of information through electronic communications that they are unable to process efficiently. This information overload negatively impacts their affect, which is officially defined in the field of psychology as the experience of feeling or emotion. To address this problem, we postulated that we could create an application that organizes and presents incoming content in a manner that optimizes users’ ability to process information. First, we conducted surveys that quantitatively measured each participant’s psychological affect while handling electronic communications, which was used to tailor the features of the application to what the user’s desire. After designing and implementing the application, we again measured the user's affect using this product. Our goal was to find that the program promoted a positive change in affect. Our application, Brevitus, was able to match Gmail on affect reduction profiles, while succeeding in implementing certain user interface specifications.

Localization in systems of non-identical oscillators

A singular perturbation method is applied to a non-conservative system of two weakly coupled strongly nonlinear non-identical oscillators. For certain parameters, localized solutions exist for which the amplitude of one oscillator is an order of magnitude smaller than the other. It is shown that these solutions are described by coupled equations for the phase difference and scaled amplitudes. Three types of localized solutions are obtained as solutions to these equations which correspond to phase locking, phase drift, and phase entrainment. Quantitative results for the phases and amplitudes of the oscillators and the stability of these phenomena are expressed in terms of the parameters of the model.

Development of a GEM Electronic Board (GEB) for triple-GEM detectors

Developed for use with triple GEM detectors, the GEM Electronic Board (GEB) forms a crucial part of the electronics readout system being developed as part of the CMS muon upgrade program. The objective of the GEB is threefold; to provide stable powering and ground for the VFAT3 front ends, to enable high-speed communication between 24 VFAT3 front ends and an optohybrid, and to shield the GEM detector from electromagnetic interference. The paper describes the concept and design of a large-size GEB in detail, highlighting the challenges in terms of design and feasibility of this deceptively difficult system component.

Flo/Stress: an integrated software module to predict stress in electronic products

Software technology that predicts stress in electronic systems and packages, developed as part of TCS Programme, is described. The software is closely integrated within a thermal design tool providing the ability to simulate the coupled effects of airflow, temperature and stress on product performance. This integrated approach to analysis will help decrease the number of design cycles.

Optimization and finite element analysis for reliable electronic packaging

This paper demonstrates a modeling and design approach that couples computational mechanics techniques with numerical optimisation and statistical models for virtual prototyping and testing in different application areas concerning reliability of eletronic packages. The integrated software modules provide a design engineer in the electronic manufacturing sector with fast design and process solutions by optimizing key parameters and taking into account complexity of certain operational conditions. The integrated modeling framework is obtained by coupling the multi-phsyics finite element framework - PHYSICA - with the numerical optimisation tool - VisualDOC into a fully automated design tool for solutions of electronic packaging problems. Response Surface Modeling Methodolgy and Design of Experiments statistical tools plus numerical optimisaiton techniques are demonstrated as a part of the modeling framework. Two different problems are discussed and solved using the integrated numerical FEM-Optimisation tool. First, an example of thermal management of an electronic package on a board is illustrated. Location of the device is optimized to ensure reduced junction temperature and stress in the die subject to certain cooling air profile and other heat dissipating active components. In the second example thermo-mechanical simulations of solder creep deformations are presented to predict flip-chip reliability and subsequently used to optimise the life-time of solder interconnects under thermal cycling.

Turbulence modelling and its effects on electronic systems

This paper presents simulated computational fluid dynamics (CFD) results for comparison against experimental data. The performance of four turbulence models has been assessed for electronic application areas considering both fluid flow and heat transfer phenomenon. CFD is vast becoming a powerful and almost essential tool for design, development and optimization in engineering problems. However turbulence models remain to be the key problem issue when tackling such flow phenomena. The reliability of CFD analysis depends heavily on the performance of the turbulence model employed together with the wall functions implemented. To be able to resolve the abrupt changes in the turbulent energy and other parameters near the wall a particularly fine mesh is necessary which unfortunately increases the computer storage capacity requirements. The objective of turbulence modelling is to enhance computational procdures of sufficient acccuracy and generality for engineers to anticipate the Reynolds stresses and the scalar transport terms.

Turbulence modelling for thermal management of electronic systems

The electronics industry is developing rapidly together with the increasingly complex problem of microelectronic equipment cooling. It has now become necessary for thermal design engineers to consider the problem of equipment cooling at some level. The use of Computational Fluid Dynamics (CFD) for such investigations is fast becoming a powerful and almost essential tool for the design, development and optimisation of engineering applications. However turbulence models remain a key issue when tackling such flow phenomena. The reliability of CFD analysis depends heavily on the turbulence model employed together with the wall functions implemented. In order to resolve the abrupt fluctuations experienced by the turbulent energy and other parameters located at near wall regions and shear layers a particularly fine computational mesh is necessary which inevitably increases the computer storage and run-time requirements. This paper will discuss results from an investigation into the accuract of currently used turbulence models. Also a newly formulated transitional hybrid turbulence model will be introduced with comparisonsaagainst experimental data.

Collaborating components in mesh-based electronic packaging

From the model geometry creation to the model analysis, the stages in between such as mesh generation are the most manpower intensive phase in a mesh-based computational mechanics simulation process. On the other hand the model analysis is the most computing intensive phase. Advanced computational hardware and software have significantly reduced the computing time - and more importantly the trend is downward. With the kind of models envisaged coming, which are larger, more complex in geometry and modelling, and multiphysics, there is no clear trend that the manpower intensive phase is to decrease significantly in time - in the present way of operation it is more likely to increase with model complexity. In this paper we address this dilemma in collaborating components for models in electronic packaging application.

Computational modeling techniques for reliability of electronic components on printed circuit boards

This paper describes modeling technology and its use in providing data governing the assembly and subsequent reliability of electronic chip components on printed circuit boards (PCBs). Products, such as mobile phones, camcorders, intelligent displays, etc., are changing at a tremendous rate where newer technologies are being applied to satisfy the demands for smaller products with increased functionality. At ever decreasing dimensions, and increasing number of input/output connections, the design of these components, in terms of dimensions and materials used, is playing a key role in determining the reliability of the final assembly. Multiphysics modeling techniques are being adopted to predict a range of interacting physics-based phenomena associated with the manufacturing process. For example, heat transfer, solidification, marangoni fluid flow, void movement, and thermal-stress. The modeling techniques used are based on finite volume methods that are conservative and take advantage of being able to represent the physical domain using an unstructured mesh. These techniques are also used to provide data on thermal induced fatigue which is then mapped into product lifetime predictions.

Low Reynolds number turbulence models for accurate thermal simulations of electronic components

The electronics industry and the problems associated with the cooling of microelectronic equipment are developing rapidly. Thermal engineers now find it necessary to consider the complex area of equipment cooling at some level. This continually growing industry also faces heightened pressure from consumers to provide electronic product miniaturization, which in itself increases the demand for accurate thermal management predictions to assure product reliability. Computational fluid dynamics (CFD) is considered a powerful and almost essential tool for the design, development and optimization of engineering applications. CFD is now widely used within the electronics packaging design community to thermally characterize the performance of both the electronic component and system environment. This paper discusses CFD results for a large variety of investigated turbulence models. Comparison against experimental data illustrates the predictive accuracy of currently used models and highlights the growing demand for greater mathematical modelling accuracy with regards to thermal characterization. Also a newly formulated low Reynolds number (i.e. transitional) turbulence model is proposed with emphasis on hybrid techniques.