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Faecal incontinence (FI) is a debilitating condition which reduces quality of life (QOL). Conservative management with education, pelvic floor exercise and pharmacological agents are first-line treatment. Following which, biofeedback therapy (BFT) is recommended. Although well described in the West, existing literature on its efficacy in Asian populations remains sparse. The primary aim of our study is to evaluate the efficacy of BFT in improvement of symptoms, QOL and overall satisfaction in our Asian population.Patients with moderate FI in Singapore General Hospital between 2012 and 2016 were enrolled. Rockwood FI quality of life scale (FIQL) and Wexner scale were used to evaluate QOL across four domains, and symptom severity respectively. They were scored at baseline and again after four sessions of BFT, with an additional overall satisfaction score (OSS).A total of 137 patients were included. Mean age was 62 years and 72.3% were female. Majority demonstrated improvement in Wexner score (68.6%) and FIQL (65%). Sixty-five patients (47.4%) reported improvement in both. Positive correlation was found between Wexner score and OSS (r = 0.206), and Wexner score and FIQL across all four domains. Only one FIQL domain-coping/behaviour, showed statistically significant correlation with OSS (r = 0.263).BFT is effective in our Asian population in both symptom reduction and improving QOL. Wexner score demonstrated low correlation with FIQL and OSS-suggesting that FI requires a multi-dimensional approach beyond symptom treatment, of which ability to cope appears crucial. BFT, consistent with the biopsychosocial model, shows benefit in this regard.

OBJECTIVES To determine the all-cause health care resource utilization and costs among long-term nursing home (LTNH) residents with and without overactive bladder (OAB). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Minimum Data Set (MDS)-linked Medicare Part A, B, and D claims data from 2013 to 2015 were analyzed. LTNH residents aged 65 years or older with a diagnosis of OAB (n = 216,731) were propensity score matched with LTNH residents without OAB (n = 300,327) (non-OAB cohort). METHODS We measured health care resource utilization and costs associated with OAB by setting (inpatient, outpatient, emergency department, or prescription) during the 6 months following nursing home admission. Descriptive and multivariate (negative binomial for health care resource utilization and 2-part model for costs) analyses were performed to examine the health care resource utilization and costs among LTNH residents with and without OAB. The annual cost attributed to OAB was calculated as the difference between total annual OAB costs and total annual non-OAB costs. RESULTS A total of 214,505 patients were included in each matched cohort. Across all health care resource categories, LTNH residents with OAB had higher health care resource utilization and costs compared to the non-OAB cohort (all P

Background Immune checkpoint inhibitors are effective therapies for a wide range of malignancies. Their increased use has led to a wide range of immune-related adverse effects including skin, gastrointestinal, pulmonary, endocrine, cardiac, and neurologic complications. Case presentation We present the case of a 72-year-old Caucasian man with non-small cell lung cancer who was admitted for dyspnea after two cycles of durvalumab. He was found to have significantly elevated levels of serum creatinine kinase and troponin with a negative cardiac catheterization. During his hospitalization, he developed progressive dyspnea and new-onset axial weakness, ultimately leading to the diagnosis of durvalumab-induced myocarditis, myasthenia gravis, and myositis. Conclusion This is, to our knowledge, the first reported case of anti-programmed cell death ligand 1-induced combination of myocarditis, myasthenia gravis, and myositis. While the use of immunologic agents has resulted in overall improved cancer outcomes, their increased use has led to a vast spectrum of immune-related adverse effects. We review the diagnostic workup and management of patients with these immune-related adverse effects, underscoring the importance of early identification given the potential for rapid deterioration.

Introduction This study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB). Methods This retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset. Results The study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p

Methyl CpG binding protein 2 (MECP2) duplication syndrome is a rare X-linked genetic disease. Core phenotypes include infantile hypotonia, developmental delay, and minimal speech with mild dysmorphic features. Many have refractory epilepsy and recurrent infections, which are the leading causes of mortality. This article presents a case of a patient with MECP2 duplication syndrome who required general anesthesia for respiratory workup and reviews the anesthetic management for these patients, which includes induction technique, choice of drugs, and other major anesthetic concerns.

Many important scientific discoveries require lengthy experimental processes of trial and error and could benefit from intelligent prioritization based on deep domain understanding. While exponential growth in the scientific literature makes it difficult to keep current in even a single domain, that same rapid growth in literature also presents an opportunity for automated extraction of knowledge via text mining. We have developed a web application implementation of the KinderMiner algorithm for proposing ranked associations between a list of target terms and a key phrase. Any key phrase and target term list can be used for biomedical inquiry. We built the web application around a text index derived from PubMed. It is the first publicly available implementation of the algorithm, is fast and easy to use, and includes an interactive analysis tool. The KinderMiner web application is a public resource offering scientists a cohesive summary of what is currently known about a particular topic within the literature, and helping them to prioritize experiments around that topic. It performs comparably or better to similar state-of-the-art text mining tools, is more flexible, and can be applied to any biomedical topic of interest. It is also continually improving with quarterly updates to the underlying text index and through response to suggestions from the community. The web application is available at https://www.kinderminer.org.

Within the brewing industry, malted barley is being increasingly replaced by raw barley supplemented with exogenous enzymes to lessen reliance on the time-consuming, high water and energy cost of malting. Regardless of the initial grain of choice, malted or raw, the resultant bulk spent grains are rich in proteins (up to 25% dry weight). Efficient enzymatic solubilization of these proteins requires knowledge of the protein composition within the spent grains. Therefore, a comprehensive proteomic profiling was performed on spent grains derived from (i) malted barley (spent grain A, SGA) and (ii) enzymatically treated raw barley (spent grain B, SGB); data are available via ProteomeXchange with identifier PXD008090. Results from complementary shotgun proteomics and 2D gel electrophoresis showed that the most abundant proteins in both spent grains were storage proteins (hordeins and embryo globulins); these were present at an average of two fold higher in spent grain B. Quantities of other major proteins were generally consistent in both spent grains A and B. Subsequent in silico protein sequence analysis of the predominant proteins facilitated knowledge-based protease selection to enhance spent grain solubilization. Among tested proteases, Alcalase 2.4 L digestion resulted in the highest remaining protein solubilization with 9.2 and 11.7% net dry weight loss in SGA and SGB respectively within 2 h. Thus, Alcalase alone can significantly reduce spent grain side stream, which makes it a possible solution to increase the value of this low-value side stream from the brewing and malt extract beverage manufacturing industry.

Aims Nodular fasciitis is known to be a benign mimic of sarcoma, both clinically and histologically. Accurate diagnosis, particularly on small biopsies, remains a challenge, as the morphology can be varied and the immunophenotype is essentially non-specific. Recently, rearrangement of the ubiquitin-specific protease 6 (USP6) gene has been reported as a recurrent and specific finding in nodular fasciitis. The aim of this this study was to evaluate the diagnostic utility of USP6 fluorescence in-situ hybridization (FISH) analysis in a subset of spindle-cell proliferations in which nodular fasciitis enters into the differential diagnosis. Methods and results A database search was performed at the Middlemore Hospital Histopathology Department. All in-house cases diagnosed between 2002 and March 2014 in which nodular fasciitis was considered as a differential diagnosis were retrospectively identified. Twenty cases were retrieved, reviewed and categorized as ‘definite’, ‘possible’ or ‘definitely not’ nodular fasciitis by consensus morphological opinion of three experienced pathologists. FISH analysis for USP6 rearrangement was performed in each case, with a commercially available break-apart probe. Of seven cases that were morphologically categorized as ‘definite’ nodular fasciitis, six were FISH-positive and one was FISH-negative. Of four cases categorized as ‘possible’ nodular fasciitis, one was FISH-positive and three were FISH-negative. Nine cases categorized as ‘definitely not’ nodular fasciitis were all FISH-negative. In the morphologically definitive cases, FISH analysis for USP6 had a sensitivity of 86% and specificity of 100% for a diagnosis of nodular fasciitis. The positive predictive value was 100%, and the negative predictive value 90%. Conclusions USP6 FISH is a useful ancillary test in cases where nodular fasciitis is a potential diagnostic consideration.

Hospital admissions (inpatient and emergency room) are a major source of medical costs for community-acquired pneumonia (CAP) initially treated in the outpatient setting. Current CAP treatment guidelines do not differentiate between outpatient treatment with levofloxacin and moxifloxacin.Compare health care resource use and medical costs to payers for CAP outpatients initiating treatment with levofloxacin or moxifloxacin.CAP episodes were identified in the PharMetrics database between 2Q04 and 2Q07 based on: pneumonia diagnosis, chest X-ray and treatment with levofloxacin or moxifloxacin. Subsequent 30-day risk of pneumonia-related hospital visits and 30-day health care costs to payers for levofloxacin vs. moxifloxacin treatment were estimated after adjusting for pre-treatment demographics, health care resource use and pneumonia-specific risk factors using propensity score and exact factor matching.A total of 15,472 levofloxacin- and 6474 moxifloxacin-initiated CAP patients were identified. Among 6352 matched pairs, levofloxacin treatment was associated with a 35% reduction in the odds of pneumonia-related hospital visits (odds ratio = 0.65, P = 0.004), lower per-patient costs for pneumonia-related hospital visits (102 dollars vs. 210 dollars, P = 0.001), lower pneumonia-related total costs (medical services and prescription drugs, 363 dollars vs. 491 dollars, P0.001) and lower total costs (1308 dollars vs. 1446 dollars, P0.001) vs. moxifloxacin over the 30-day observation period.Although observational analyses of claims data provide large sample sizes and reflect routine care, they do have several inherent limitations. Since randomization of subjects is not possible, adequate statistical techniques must be used to ensure that patient characteristics are well-balanced between treatment groups. In addition, data may be missing or miscoded.CAP outpatients initiated with levofloxacin generated substantially lower costs to payers compared to matched patients initiated with moxifloxacin. The cost savings for patients initiated with levofloxacin were largely attributable to reduced rates of pneumonia-related hospitalization or ER visits.

The implementation of effective screening programs has decreased the incidence and mortality of cervical carcinoma. However, single screening tests are subjective and carry a significant false-negative rate. Therefore, supplementary tests to support the Papanicolaou (PAP) smear are being developed. Human papillomavirus (HPV) testing has increased the specificity of the PAP smear, but has high sensitivity rate. This has proven unhelpful in low-grade lesions and in young women. Cervical carcinogenesis is a multifactorial disorder. In addition to exposure to oncogenic HPV, which is regarded as the initiator, there must be a promoter to eventuate in invasive disease. The promoter factor appears to be the acquisition of extra copies of chromosome 3q and has been shown to be a constant recurrence in cervical carcinoma (squamous and adenocarcinomas). The 3q region contains the RNA sequence of the human telomerase gene TERC. Recent studies have shown a strong correlation between high-grade cervical lesions and abnormalities of TERC. This study supports the previous studies and examines the status of the TERC gene in low and high-grade cervical intraepithelial lesions, diagnosed on cytology. ASC-H smears are also examined in an attempt to categorize lesions that are more likely to progress. Potentially this may help identify women in need of close clinical follow-up and early treatment.

O-linked-N-acetylglucosamine (O-GlcNAc) post-translationally modifies and regulates thousands of proteins involved in various cellular mechanisms. Recently, O-GlcNAc has been linked to human embryonic stem cells (hESC) differentiation, however the identity and function of O-GlcNAc proteins regulating hESC remain unknown. Here, we firstly identified O-GlcNAc modified human stem cell regulators such as hnRNP K, HP1γ, and especially RING1B/RNF2. Thereafter, we focused our work on RING1B which is the catalytic subunit of the polycomb repressive complex 1 (PRC1) a major epigenetic repressor essential for pluripotency maintenance and differentiation. By point-mutation, we show that T(250)/S(251) and S(278) RING1B residues are bearing O-GlcNAc, and that T(250)/S(251) O-GlcNAcylation decreases during differentiation. O-GlcNAc seems to regulate RING1B-DNA binding as suggested by our ChIP-sequencing results. Non-O-GlcNAcylated RING1B is found to be enriched near cell cycle genes whereas O-GlcNAcylated RING1B seems preferentially enriched near neuronal genes. Our data suggest that during hESC differentiation, the decrease of RING1B O-GlcNAcylation might enable PRC1 to switch its target to induce neuron differentiation. Overall, we demonstrate that O-GlcNAc modifies and regulates an essential epigenetic tool, RING1B, which may contribute to hESC pluripotency maintenance and differentiation.

Status asthmaticus is both a common and dangerous cause of acute dyspnea in the emergency department (ED) setting. Although most cases respond favorably to standard treatment, there are rare cases in which therapy beyond traditional treatment is needed. One of these treatment modalities includes inhalational anesthesia. We present a case in which inhaled sevoflurane was initiated out of the ED for a life-threatening asthma exacerbation refractory to conventional treatment. To our knowledge, this is only the second case to report the use of inhaled anesthetics initiated out of the ED for status asthmaticus and is the first report of its kind to thoroughly detail the respiratory response noted while inhalation anesthesia was being implemented. A brief review of other case reports involving the use of sevoflurane for asthma is included. This case, as well as the others reviewed, illustrates the significant beneficial effect inhaled anesthetics can have on asthma, making this a treatment modality that must be recognized and appreciated by all emergency medicine providers.

Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America. [West J Emerg Med. 2015;16(1):165–168.]

Background/Aims This session will provide investigators, project teams, and organizational administrators with a basic understanding of the HMO Research Network’s (HMORN) structure and organization, as well as several key processes the HMORN has developed to streamline collaboration across sites. Those new to the Network, to multi-center research, or just needing a refresher will benefit from an overview of HMORN governance, the Virtual Data Warehouse (VDW), multi-site grant writing tools and resources, and the IRB ceding process.

Background/Aims Patient mortality data is a critical component of health research data, especially where death is a clinical outcome of interest. Mortality data is also important for cohort selection and to avoid communications with families of deceased patients. The HMORN Virtual Data Warehouse (VDW) has a DEATH file and a CAUSE OF DEATH file that contain data on whether a patient is dead or alive, date of death, confidence of death status, and causes of death. VDW mortality data is synthesized from multiple sources, such as state death certificates, federal data, and health plan utilization and membership data. These sources are combined using complex, probabilistic algorithms. There is variation in both source data and the transformation logic used by sites. This poses potential challenges for researchers to derive accurate results from multi-site studies. Our aim is to measure the quality of VDW mortality data across HMORN sites, highlight areas of consistency and variation, report issues for remediation, and identify opportunities to improve data specifications and guidelines.

BackgroundThe mortality status of an HMO?s members, whether a person is alive or dead, is critically important to health care research. The uses of mortality status include determination of causes of death, death rates, and for selection of study cohorts. Unlike other clinical activity and health statuses, mortality status cannot be determined solely with a health plan?s internal data, even for well-defined populations, because health plan members often die outside of the plan?s care delivery and claims payment systems. For such members, determination of mortality status and date of death requires linkage of health plan data to external sources of mortality data, such as state death certificate or federal Social Security data. This person-level statistical linkage is a complex, multi-step process that involves many decisions, assumptions, and choosing of priorities. Even when death data from internal systems is available, internal data sources can disagree, likewise requiring complex decisions to determine a member?s ?true? mortality status.MethodsThis presentation highlights key challenges and decisions points in the development of death data logic at Kaiser Permanente Northern California (KPNC).ResultsKey decisions in KPNC?s death data logic include: handling internal membership data with conflicting personal identifiers, e.g., multiple Social Security Numbers associated with a single Medical Record Number; ranking, grading, and selecting from multiple matches between internal and external data; finding members with multiple MRNs; using utilization contact dates and membership activity dates to evaluate death records, judging reliability of internal health plan data, setting thresholds and criteria for confidence scoring, selecting between multiple possible dates of death, chart validation of final death data.ConclusionsThe development of death data logic at KPNC is a complex process that requires intricate decisions, careful analysis, and a higher degree of discretionary judgment than is typical of building other data areas. The quality of final results depends upon validation and iterative improvements to the process.

Background and Aims HIPAA policies define values derived from PHI as also being PHI. Consequently, applying algorithmic functions to PHI has been viewed as having little benefit to research data. However, short of full de-identification, the use of transformed PHI may reduce compliance risk and increase security of routine data handling. Our aim is to: present a general framework for evaluating methods of de-identifying/protecting PHI, and evaluate how well selected mathematical functions, including common cryptographic functions, can enhance protection of PHI in the HMORN Virtual Data Warehouse (VDW). Methods The methods used include a review of technical literature/material, from both within and outside traditional research disciplines, followed by analysis and application of findings to the issues addressed here, including: reviewing both the regulatory and practical context for protecting PHI in research data; developing a set of criteria to evaluate the benefits and costs of methods for PHI protection/de-identification; reviewing the basic uses of general cryptography; comparing/contrasting the needs of general cryptography with those of PHI protection in research data; evaluating selected methods of protecting PHI against the proposed criteria. Results The proposed framework for evaluating PHI protection methods includes five criteria: effect on usefulness of data; effect on ease of use or analytical efficiency; net impact on data security; system implementation costs; negative effect on data quality. There are several methods for protecting PHI that can be easily implemented in the VDW, including: the creation of linking variables that eliminate the need to routinely query PHI variables, such as service dates; the MD5 cryptographic hash function, which can be used to obscure any PHI data and is relatively easy to implement in SAS, the standard analysis software platform used in the HMORN. Conclusions Stewards of research data, like the VDW, should adopt the use mathematical functions, including cryptographic hash functions, to transform PHI into derived values. Such methods do not replace the need for full de-identification, but can enhance security and reduce compliance risk during routine data handling.

Background/Aims The aim is to educate programmers on how to pull chemotherapy infusion data from Clarity. The data are complex, and it can be take a while to learn the Clarity Data model, which can be difficult to understand. At Kaiser Permanente Northern California (KPNC), we developed a smaller model and an easy-to-understand workflow of the data. We would like to share our learnings, including how to link treatment plans, orders, dispensing, and administration together; and our knowledge of how to find completed treatment plans, days and cycles.

Background Muir–Torre syndrome is a variant of Lynch syndrome, characterised by sebaceous neoplasia and/or keratoacan-thomas associated with visceral malignancies. Muir–Torre syndrome is caused by germline mutations of one of the mismatch repair genes, frequently MSH2 and less frequently MLH1 and MSH6. Visceral malignancies associated with Muir–Torre syndrome and Lynch syndrome include colorectal, endometrial and other gastrointestinal, urological and gynaecological malignancies. Small numbers of Lynch syndrome-associated soft tissue sarcomas have been reported but there are no reported cases of soft tissue sarcomas in Muir–Torre syndrome. Aim and Methods In this study, we report a 74-year-old man with known Muir–Torre syndrome with confirmed MSH2 germ-line mutation, diagnosed with pleomorphic liposarcoma of the right buttock in a previous radiation field. The tumour showed loss of expression of MSH2 and MSH6 on immunohistochemistry. Results Immunohistochemistry on another pleomorphic liposar-coma in a different patient with no previous history of Muir–Torre syndrome or Lynch syndrome showed no loss of expression of mismatch repair proteins. Discussion This is the first report of Muir–Torre syndrome-associated sarcoma and the first case of post-radiation sarcoma in Lynch syndrome.

This study was undertaken to identify genetic polymorphisms that are associated with the risk of an elevated fasting glucose (FG) level using genome-wide analyses. We explored a quantitative trait locus (QTL) for FG level in a genome-wide study from a Korean twin-family cohort (the Healthy Twin Study) using a combined linkage and family-based association analysis approach. We investigated 1,754 individuals, which included 432 families and 219 pairs of monozygotic twins. Regions of chromosomes 2q23.3-2q31.1, 15q26.1-15q26.3, 16p12.1, and 20p13-20p12.2, were found to show evidence of linkage with FG level, and several markers in these regions were found to be significantly associated with FG level using family-based or general association tests. In particular, a single-nucleotide polymorphism (rs6138953) on the PTPRA gene in the 20p13 region (combined P = 1.8 × 10(-6)) was found to be associated with FG level, and the PRKCB1 gene (in 16p12.1) to be possibly associated with FG level. In conclusion, multiple regions of chromosomes 2q23.3-2q31.1, 15q26.1-15q26.3, 16p12.1, and 20p13-20p12.2 are associated with FG level in our Korean twin-family cohort. The combined approach of genome-wide linkage and family-based association analysis is useful to identify novel or known genetic regions concerning FG level in a family cohort study.

Background The Virtual Data Warehouse (VDW) was created as a mechanism for producing comparable data across sites for purposes of proposing and conducting research. It is “virtual” in the sense that the data remain at the local sites; there is no shared multi-site physical database at a centralized data coordinating center. At the core of the VDW are a series of standardized file definitions. Content areas and data elements that are commonly required for research studies are identified, and data dictionaries are created for each of the content areas, specifying a common format for each of the elements—variable name, label, description, code values, and value labels. Local site programmers have mapped the data elements from their HMO’s data systems into this standardized set of variable definitions, names, and codes, as well as into standardized SAS file formats. This common structure of the VDW files enables a SAS analyst at one site to write one program to extract and/or analyze data at all participating sites.

Background/AimsThe HMO Research Network (HMORN) Virtual Data Warehouse (VDW) is a series of dataset standards and automated processes that aim to streamline the process of multi-site research. The Pharmacy file contains data on all outpatient dispensings captured within the HMORN. The objective was to assess the overall quality and completeness of the Pharmacy file.MethodsThe VDW Pharmacy Working Group created a data verification protocol to assess the overall quality and completeness of Pharmacy file data (e.g., to identify missing data or out-of-range values). A distributed SAS program was run at each HMORN site that maintains a VDW Pharmacy file (n=14 of 19 HMORN sites), and de-identified summary data were returned for analysis. Pharmacy file variables that were assessed included National Drug Code (NDC), days supplied, amount dispensed, and prescribing physician (which joins to the VDW Provider Specialty file). An ?invalid? NDC was defined as any value not having exactly 11 digits or containing a non-numeric character. The days supplied variable was considered out-of-range if the value was 20 years of data. There were 93.4 million dispensings in 2009, with an average of 7.8 million dispensings per month among 3.1 million monthly users (average per user: 2.6 dispensings per month; range across sites 2.3?5.8). Across all sites from 2000?2009, 0.082% (712,131/870,182,026) and 0.072% (629,656/870,182,026) of dispensings had missing or ?invalid? NDCs, respectively; and 0.083% (724,210/870,182,026) and 0.315% (2,736,756/870,182,026) had out-of-range days supplied and amount supplied, respectively. The prescribing physician was identified in 96% (1,038,725,660/1,079,370,265) of all dispensings. The prescriber?s specialty was identified in 62% (539,944,688/870,182,078) of dispensings overall and improved from 61% (46,678,731/77,078,104) in 2000 to 63% (60,160,629/95,867,812) in 2009.DiscussionThe VDW Pharmacy file has excellent overall data quality results, and has improved in identification of prescriber specialty. It has measurably comprehensive and consistent outpatient dispensing data across 14 HMORN sites.

Background and Aim: VDW system architecture varies from one institution to another. This provides an opportunity for the development of best practice in system architecture design. The word architecture describes the underlying structure of networks, computer hardware and software. Well-designed systems-level architectures are critical to the success of large-scale projects. The explosion of technological opportunities and customer demands has driven up the size, complexity, cost, and investment risks of projects. Without solid architectures, these projects lack the firm foundation and robust structure on which to build. Solid systems architecture and design is a required phase following data gathering and analysis which should precede any design prior to any implementation. With functional requirements established, the system architect can design a system to perform in an optimized environment, ultimately producing robust data and customer satisfaction. Architecture choices Hardware platform DBMS –Relational Database Management System (RDBMS)Query/analysis tools Maintenance/ service strategy. For bioinformatics research, the most important qualities of system architecture are: extensibility for new functions/features; interoperability for cross-site collaboration; security due to regulatory and ethical requirements; serviceability/maintainability to support independence from enterprise/business computing; and performance for analysis of large datasets. Aim of this study was to determine best practice architecture choices resulting in performance improvements per institutions data volume. Methods: Performance benchmarking analysis was gathered from KPNC and S&W comparing the effect on VDW performance of different design choices and implementations of database software and hardware. Our performance measurement focused on the delivery speed of data return. Measurements were made on various data areas at both peak and off-peak times. Results: KPNC has measured via benchmarking on VDW tables that Oracle DBMS can increase performance compared to SAS datasets. KPNC was able to measure separately the performance improvement from migration to a more powerful hardware platform. Conclusions: A proactive, best practice approach to systems architecture can create benefits for research databases, particularly in performance speed. Improvements in performance can be achieved through software, by adopting a relational database management system such as Oracle, that allows table indexing and partitioning, and through investment in high-performance hardware. The two strategies can be implemented alone or in conjunction for maximum benefits.

Synthese de m-terphenyle, diaryl-, dimethoxy-, tetramethoxy-m-terphenyles, de m-quinquephenyle et de m-phenylene bis-naphtalenes par reaction de trihalogeno benzenes avec des bromures d'aryl-magnesium