Big Data: More than Just Big and More than Just Data.

According to an report, 90 percent of the data in the world today were created in the past two years. This statistic is not surprising given the explosion of mobile phones and other devices that generate data, the Internet of Things (e.g., smart refrigerators), and metadata (data about data). While it might be a stretch to figure out how a healthcare organization can use data generated from an ice maker, data from a plethora of rich and useful sources, when combined with an organization's own data, can produce improved results. How can healthcare organizations leverage these rich and diverse data sources to improve patients' health and make their businesses more competitive? The authors of the two feature articles in this issue of Frontiers provide tangible examples of how their organizations are using big data to meaningfully improve healthcare. Sentara Healthcare and Carolinas HealthCare System both use big data in creative ways that differ because of different business situations, yet are also similar in certain respects.

Making the move to an ACO.

Crystal Run Healthcare, a multispecialty physician group practice, needed to enhance workflows, change its culture, and establish partnerships with hospitals to succeed as an accountable care organization (ACO). An embedded care manager program at one local hospital decreased the 30-day all-cause readmission rate for Crystal Run patients at the hospital by 8 percent. Through the ACO, Crystal Run also has reduced the cost of care for its diabetic population by 15 percent while improving quality metrics for other at-risk populations.

Forcing family involvement in patient care: legislative and clinical issues.

OBJECTIVE: Families have an important role in the recognition and treatment of mental illness in their family members. However, the extent to which families are consulted during compulsory assessment processes has received little attention. In 2000, mandatory family/whanau consultation was introduced in New Zealand. This paper reviews the extent of family consultation during compulsory assessment and surveys clinicians' views and experience. METHOD: All applications for compulsory assessment in a representative sample of districts were audited over a 2-month period. An email survey of clinicians investigated changes in their practice since the introduction of mandatory family consultation, their views and training experiences. RESULTS: A total of 283 compulsory assessments were audited; 187 (66.1%) family/whanau consultations occurred and were completed by the assessing doctor 82.1% of the time. Of the remaining assessments, 12 did not appear consistent with the legally permitted exceptions to mandatory consultation. Some 88.6% of clinicians were aware of the legislative requirements about consultation. A significant percentage (54.7%) believed their practices had altered following legislative change. CONCLUSION: Family/whanau consultation occurred in the majority of compulsory assessments. The introduction of mandatory consultation with family/whanau may have improved clinical practice in this regard, although training and guidelines issued at a similar time are also likely to have contributed to the change in practice.

Macular microholes.

PURPOSE: To describe the clinical features and natural course of microholes of the macula. METHODS: We reviewed the charts of 31 patients (35 eyes) with punctate foveal defects, or "microholes," of the macula. Patients were seen between 1980 and 2005 at a tertiary referral center. Clinical, photographic, and optical coherence tomography findings were reviewed. RESULTS: All eyes had one or more well defined, punctate foveal lesions 35 microm to 150 microm in size. There was no gender predilection, and patient ages ranged from 6 years to 69 years. Visual acuity was > or =20/40 in 29 of 35 eyes. None of the eyes had foveal transmission defects shown by fluorescein angiography. A defect in the outer retina was demonstrated in five of seven patients who underwent optical coherence tomography. The lesions were nonprogressive, with no patients developing stage 3 or 4 macular holes. CONCLUSION: Macular microholes are small lamellar defects in the outer retina or retinal pigment epithelium that occur through a variety of mechanisms, including spontaneous vitreoretinal interface changes, trauma, phototoxicity, and other unrecognized causes. The condition is nonprogressive, occurs in patients of all ages, and is compatible with good visual acuity.

Effect of reduced impulse activity on the development of identified motor terminals in Drosophila larvae.

In Drosophila larvae, motoneurons show distinctive differences in the size of their synaptic boutons; that is, axon 1 has type Ib ("big" boutons) terminals and axon 2 has type Is ("small" boutons) terminals on muscle fibers 6 and 7. To determine whether axon 1 develops large boutons due to its high impulse activity, we reduced impulse activity and examined the motor terminals formed by axon 1. The number of functional Na(+) channels was reduced either with the nap(ts) mutation or by adding tetrodotoxin (TTX) to the media (0.1 microg/g). In both cases, the rate of locomotion was decreased by approximately 40%, presumably reflecting a decrease in impulse activity. Locomotor activity was restored to above wild-type (Canton-S) levels when nap(ts) was combined with a duplication of para, the Na(+)-channel gene. Lucifer yellow was injected into the axon 1 motor terminals, and we measured motor terminal area, length, the number of branches, and the number and width of synaptic boutons. Although all parameters were smaller in nap(ts) and TTX-treated larvae compared to wild-type, most of these differences were not significant when the differences in muscle fiber size were factored out. Only bouton width was significantly smaller in both different nap(ts) and TTX-treated larvae: boutons were about 20% smaller in nap(ts) and TTX-treated larvae, and 20% larger in nap(ts); Dp para(+) compared to wild-type. In addition, terminal area was significantly smaller in nap(ts) compared to wild-type. Bouton size at Ib terminals with reduced impulse activity was similar to that normally seen at Is terminals. Thus, differences in impulse activity play a major role in the differentiation of bouton size at Drosophila motor terminals.