Precision or “Personalized Medicine” and “Big Data” are growing trends in the biomedical research community and highlight an increased focus on access to larger datasets to effectively explore disease processes at the molecular level versus the previously common one-size-fits all approach. This focus necessitated a local transition from independent lab and siloed projects to a single software application utilizing a common ontology to create access to data from multiple repositories. Use of a common system has allowed for increased ease of collaboration and access to quality biospecimens that are extensively annotated with clinical, molecular, and patient associated data. The software needed to function at an enterprise level while continuing to allow investigators the autonomy and security access they desire. To identify a solution, a working group comprised of representation from independent repositories and areas of research focus across departments was established and responsible for review and implementation of an enterprise-wide biospecimen management system. Central to this process was the creation of a unified vocabulary across all repositories, including consensus around source of truth, standardized field definitions, and shared terminology.

Assessing the impacts of invasive predators on the demography and distribution of native species is critical for understanding mechanisms of species persistence and informing the design of recovery programmes. On the oceanic island of Guam, the introduction of the predatory brown treesnake Boiga irregularis after World War II caused the near-total loss of the native forest avifauna. Localised snake control measures have been implemented since the early 1990s, yet it remains poorly understood how they have impacted Guam’s remaining native bird populations. To address this question, we combined intensive area searches of Andersen Air Force Base (AAFB) with island-wide transect surveys and opportunistic sightings to provide a comprehensive update on the distribution and abundance of Såli (Micronesian Starling, Aplonis opaca) – one of Guam’s last extant native bird species. Area searches of AAFB, where the largest remnant of the Såli population persists, revealed a 15-fold population increase since the last survey in the early 1990s, and transect surveys and opportunistic sightings indicate incipient recolonisation of other urbanised areas of northern and central Guam. We estimate the current island-wide population size at ~1,400 individuals. The population increase can likely be attributed to a combination of snake control measures and the Såli’s ability to exploit urban refugia for nesting and roosting. Although these trends demonstrate some population recovery, a skewed age ratio (>90% adults and subadults) at AAFB and a highly urbanised distribution and low abundance outside AAFB indicate that snake predation continues to strongly impact the population. More intensive snake suppression efforts, particularly in forested areas, may allow for the Såli population to attain its former distribution and abundance on Guam. More broadly, our findings reinforce the importance of urban areas as refugia for some threatened species.

Strengthening health systems and maintaining essential service delivery during health emergencies response is critical for early detection and diagnosis, prompt treatment, and effective control of pandemics, including the novel coronavirus disease 2019 (COVID-19). Health information systems (HIS) developed during recent Ebola outbreaks in West Africa and the Democratic Republic of the Congo (DRC) provided opportunities to collect, analyze, and distribute data to inform both day-to-day and long-term policy decisions on outbreak preparedness. As COVID-19 continues to sweep across the globe, HIS and related technological advancements remain vital for effective and sustained data sharing, contact tracing, mapping and monitoring, community risk sensitization and engagement, preventive education, and timely preparedness and response activities. In reviewing literature of how HIS could have further supported mitigation of these Ebola outbreaks and the ongoing COVID-19 pandemic, 3 key areas were identified: governance and coordination, health systems infrastructure and resources, and community engagement. In this concept study, we outline scalable HIS lessons from recent Ebola outbreaks and early COVID-19 responses along these 3 domains, synthesizing recommendations to offer clear, evidence-based approaches on how to leverage HIS to strengthen the current pandemic response and foster community health systems resilience moving forward.

Hypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012–August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0–24, 24–48, 48–72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1–2.8) in neonates versus 4 g/dl (IQR, 3.5–4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01–13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08–1.82). Lower 0–24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12–1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Hurricane Sandy hit the East Coast of the United States on 29 October 2012, flooding hundreds of thousands of homes and costing over $50 billion in property damage. After Hurricane Sandy residents and communities required food, water and clothing, and in the weeks and months following, there was demand for cleaning supplies, building materials and contracting services. Polycentric orders, because of their flexibility and access to local knowledge, are well suited to respond to the challenges of disaster. We highlight the importance of privately provided social services within polycentric orders and illustrate that the private provision of these services was important to post-disaster recovery in the Orthodox Jewish community in the Rockaway Peninsula in New York.

Background: Most people with dementia in Western societies will eventually be placed in a nursing home. This can be stressful to those with dementia and to their families. The adjustment to this new caring environment by both residents and their family caregivers and the factors that influence this are the focus of this review.

Methods: A literature search of Embase, Scopus, and Medline databases of articles published in English between 1990 and 2011 using specified search terms was performed to examine this transition. The 174 titles located were screened and reference lists hand searched resulting in the 49 relevant articles included in this review.

Results: This decision and the subsequent adjustment period is a difficult time for people with dementia and their family caregivers. Admission has been linked to increased behavioral symptoms and in particular depression and agitation, decreasing cognition, frailty, and falls in people with dementia. For caregivers, guilt, depression, feelings of failure, and continuing burden but also improvement in quality of life have been variously reported. Research to determine what influences the trajectory of these different outcomes and the prevalence of positive outcomes for people with dementia is lacking. Successful transitions may be assisted by ensuring that the person with dementia has input into decision making, orientation procedures for the person with dementia and family member prior to and on admission, a “buddy” system for new arrivals, and a person-centered approach.

Conclusions: Adjustment to admission to residential care can be difficult for people with dementia and their family caregivers. Longitudinal research examining factors influencing the adjustment can provide a basis for intervention trials to improve this transition.