BACKGROUND: The ongoing evolution of the Next Generation Sequencing (NGS) technologies has led to the production of genomic data on a massive scale. While tools for genomic data integration and analysis are becoming increasingly available, the conceptual and analytical complexities still represent a great challenge in many biological contexts.
RESULTS: To address this issue, we describe a six-steps tutorial for the best practices in genomic data integration, consisting of (1) designing a data matrix; (2) formulating a specific biological question toward data description, selection and prediction; (3) selecting a tool adapted to the targeted questions; (4) preprocessing of the data; (5) conducting preliminary analysis, and finally (6) executing genomic data integration.
CONCLUSIONS: The tutorial has been tested and demonstrated on publicly available genomic data generated from poplar (Populus L.), a woody plant model. We also developed a new graphical output for the unsupervised multi-block analysis, cimDiablo_v2, available at https://forgemia.inra.fr/umr-gdec/omics-integration-on-poplar , and allowing the selection of master drivers in genomic data variation and interplay.

The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its causality is multifactorial and extremely complex. Its actual rate and its real impact are unknown. In medical practice, failure depends not only on the human factor but also on the medical system and has at its center a very important variable-the patient. To combat errors, capturing, tracking, and analyzing them at an institutional level are important. Barriers such as the fear of consequences or a specific work climate or culture can affect this process. Although important data regarding medical errors and their consequences can be extracted by analyzing patient outcomes or using quality indicators, patient stories (clinical cases) seem to have the greatest impact on our subconscious as medical doctors and nurses and these may generate the corresponding and necessary reactions. Every clinical case has its own story. In this study, three different cases are presented to illustrate how human error, the limits of the system, and the particularities of the patient\'s condition (severity of the disease), alone or in combination, may lead to tragic outcomes There is a need to talk openly and in a balanced way about failure, regardless of its cause, to look at things as they are, without hiding the inconvenient truth. The common goal is not to find culprits but to find solutions and create a culture of safety.

The accumulation of plastic waste in the marine environment has increased the global risk of marine pollution due to its negative impact on land, ecosystems, and especially the food chain and marine organisms. Ineffective plastic waste management has reduced the quality of the coastal environment including community sanitation and health, landscapes, and coastal views, and influenced economic sectors such as tourism, fisheries, and shipping. The economic and public activities within coastal areas have consistently as the source of plastic waste leakage either directly or indirectly. Various variables involved and connected each other, some influential and other existing variables were not working effectively and do not support each other optimally in the system. The policy without limitation on the plastic production and certain type of plastic such as packaging or single-use, bags, and a lack of management capacity have led to the establishment of a burden on current plastic waste management within the coastal and marine of Jakarta Bay. Therefore, the study aims to analyze the roles and interrelation of variables that influence plastic waste management in Jakarta Bay. Public participation through group discussion, interview, and Micmac analysis method was used to identify, map, and analyze their interrelationships, roles, and hierarchy in the plastic waste management system. The results showed that the dynamics of variables\' interaction affect their level of performance and contribution. The variables with strong influence have the potential to strengthen others, while some had a high dependence which was vulnerable to have ineffective performance in the waste management system as their stability relied on other variables\' performance. A group of variables were greatly affected by others and indicates that they had lower influence and higher dependence, while the rest of the variables were relatively disconnected from the system. The key to better waste management is to improve the performance and the quality of relationships of variables that were found in the influential and intermediate quadrants. Furthermore, the indirect influence variables also need to be considered as they have the potential to contribute to the future system strategy or scenario planning.

Introduction: Despite availability of selection criteria, different interpretations can lead to variability in the appreciation of donor eligibility with possible viable organs missed. Our primary objective was to test the perception of feasibility of potential organ donors through the survey of a small sample of external evaluators. Methods: Clinical scenarios summarizing 66 potential donors managed in the first year of our Organ Recovery Center were sent to four critical care physicians to evaluate the feasibility of the potential donors and the probability of organ procurement. Results: Potential donors procuring at least one organ were identified in 55 of the 66 cases (83%). Unanimity was reached in 38 cases, encompassing 35 out of the 55 converted and 3 of the non-converted donors. The overall agreement was moderate (kappa = 0.60, 95% CI: 0.37-0.82). For the organs finally procured for transplantation, organ donation was predicted for the majority of the cases, but high discrepancy was present with the final outcome of organs not procured (particularly liver and kidney). Conclusion: The assessment of a potential donor is a complex dynamic process. In order to increase organ availability, standardized electronically clinical data, as well a \"donor board\" structure of decision might inform future systems.

Local case reports highlighted safety issues arising from the delays for inpatient blood tests. A multidisciplinary team used systems engineering techniques to understand the dynamics of the end-to-end process and how policies, which benefited the efficiency of individuals and departments, compromised the safety and effectiveness of the whole hospital system. Upstream services were synchronised so that samples arrived in the lab earlier in the day. The laboratory process was then redesigned to meet the variations in hourly workload. Average laboratory lead-times for inpatients reduced from 1 h 58 min to 1 h 29 min with less variation predictability of lead-times. Most results were available by 10.30am rather than 12.00pm and clinical decisions were based on today\'s test. Removing the batching and prioritisation policies did not compromise the service for accident and emergency, general practice or outpatient and freed resources to address further delays up and downstream.

BACKGROUND: Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described.
METHODS: A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved.
RESULTS: The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure access for citizens in rural and remote regions. Challenges encountered are explored as are the process enablers and facilitators. The paper views the development and implementation process from the perspectives of several frameworks and models related to change management.
CONCLUSIONS: Following on several initial achievements, the long term success of the Regional Program will depend on consolidating the early gains and demonstrating changes based on key measurable outcomes.