bluuebunny/crossref_metadata_2025 huggingface dataset:
Resolving Clinicians’ Queries Across a Grid’s Infrastructure
Authors: Estrella F. , del Frate C. , Hauer T. , Odeh M. , Rogulin D. , Amendolia S. R. , Schottlander D. , Solomonides T. , Warren R. , McClatchey R.
Published: March 2018

Objectives:
The past decade has witnessed order of magnitude increases in computing power, data storage capacity and network speed, giving birth to applications which may handle large data volumes of increased complexity, distributed over the internet.

Methods:
Medical image analysis is one of the areas for which this unique opportunity likely brings revolutionary advances both for the scientist’s research study and the clinician’s everyday work. Grids [1] computing promises to resolve many of the difficulties in facilitating medical image analysis to allow radiologists to collaborate without having to co-locate.

Results:
The EU-funded MammoGrid project [2] aims to investigate the feasibility of developing a Grid-enabled European database of mammograms and provide an information infrastructure which federates multiple mammogram databases. This will enable clinicians to develop new common, collaborative and co-operative approaches to the analysis of mammographic data.

Conclusion:
This paper focuses on one of the key requirements for large-scale distributed mammogram analysis: resolving queries across a grid-connected federation of images.
Partitioning Medical Image Databases for Content-based Queries on a Grid
Authors: Breton V. , Magnin I. E. , Montagnat J.
Published: March 2018

Objectives:
In this paper we study the impact of executing a medical image database query application on the grid. For lowering the total computation time, the image database is partitioned into subsets to be processed on different grid nodes.

Methods:
A theoretical model of the application complexity and estimates of the grid execution overhead are used to efficiently partition the database.

Results:
We show results demonstrating that smart partitioning of the database can lead to significant improvements in terms of total computation time.

Conclusions:
Grids are promising for content-based image retrieval in medical databases.
GEMSS: Grid-infrastructure for Medical Service Provision
Authors: Berti G. , Engelbrecht G. , Fingberg J. , Kohring G. , Middleton S. E. , Schmidt R. , Benkner S.
Published: March 2018

Objectives:
The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, flexible support for business models, and security at all levels in order to ensure privacy of patient data as well as compliance to EU law.

Methods:
The GEMSS Grid infrastructure is based on a service-oriented architecture and is being built on top of existing standard Grid and Web technologies. The GEMSS infrastructure offers a generic Grid service provision framework that hides the complexity of transforming existing applications into Grid services. For the development of client-side applications or portals, a pluggable component framework has been developed, providing developers with full control over business processes, service discovery, QoS negotiation, and workflow, while keeping their underlying implementation hidden from view.

Results:
A first version of the GEMSS Grid infrastructure is operational and has been used for the set-up of a Grid test-bed deploying six medical Grid service prototypes including maxillofacial surgery simulation, neuro-surgery support, radio-surgery planning, inhaled drug-delivery simulation, cardiovascular simulation and advanced image reconstruction.

Conclusions:
The GEMSS Grid infrastructure is based on standard Web Services technology with an anticipated future transition path towards the OGSA standard proposed by the Global Grid Forum. GEMSS demonstrates that the Grid can be used to provide medical practitioners and researchers with access to advanced simulation and image processing services for improved preoperative planning and near real-time surgical support.
Security Architecture for Health Grid Using Ambient Intelligence
Authors: Riguidel M. , Demeure I. , Naqvi S.
Published: March 2018

Objectives:
To propose a novel approach of incorporating ambient intelligence in the health grid security architecture.

Methods:
Security concerns are severely impeding the grid community effort in spreading its wings in health applications. In this paper, we have proposed a high level approach to incorporate ambient intelligence for health grid security architecture and have argued that this will significantly improve the current state of the grid security paradigm with an enhanced user-friendly environment. We believe that the time is right to shift the onus of traditional security mechanisms onto the new technologies. The incorporation of ambient intelligence in the security architecture of a grid will not only render a security paradigm robust but also provide an attractive vision for the future of computing by bringing the two worlds together.

Results:
In this article we propose an evolutionary approach of utilizing smart devices for grid security architecture. We argue that such an infrastructure will impart unique features to the existing grid security paradigms by offering fortified and relentless monitoring. This new security architecture will be comprehensive in nature but will not be cumbersome for the users due to its typical characteristics of not prying into their lives and adapting to their needs.

Conclusions:
We have identified a new paradigm of the security architecture for a health grid that will not only render a security mechanism robust but will also provide the high levels of user-friendliness. As our approach is a first contribution to this problem, a number of other issues for future research remain open. However, the prospects are fascinating.
Security Aspects of Grid-based Digital Mammography
Authors: Slaymaker M. A. , Politou E. , Power D. J. , Lloyd S. , Simpson A. C.
Published: March 2018

Objectives:
The principal aim of the eDiaMoND project is to develop a prototype Grid infrastructure to support the needs of the breast care community. The prototype system is but one major deliverable of the project; the other is a blueprint document that describes how a system such as eDiaMoND might be deployed throughout the United Kingdom to support the NHS Breast Screening Programme. A key consideration of both the prototype and the blueprint is security. In this paper we address some of the generic security issues faced by projects such as eDiaMoND. We also indicate how these problems are being overcome within our project.

Methods:
In order to fully understand the security issues faced by the project a review of current initiatives within the NHS was performed. The work of the NHS Information Authority was found to be particularly significant. Also reviewed was BS7799, the British Standard for the deployment of security systems and processes. Finally, modelling of the proposed prototype was performed using methods proposed by the e-Science Security Task Force, in particular the method proposed by Flechais and Sasse.

Results and Conclusions:
It is felt that the issues of security surrounding the eDiaMoND project are sufficiently generic that the eHealth community can consider and criticise the work described. It is hoped that this will enable the eHealth community to move forwards with a common agenda.
A Grid Service for the Interactive Use of a Parallel Non-rigid Registration Algorithm of Medical Images
Authors: Pennec X. , Ayache N. , Stefanescu R.
Published: March 2018

Objective:
The goal of this work is to improve the usability of a non-rigid registration software for medical images.

Method:
We have built a registration grid service in order to use the interactivity of a visualization workstation and the computing power of a cluster.

On the user side, the system is composed of a graphical interface that interacts in a complex and fluid manner with the registration software running on a remote cluster.

Conclusion:
Although the transmission of images back and forth between the computer running the user interface and the cluster running the registration service adds to the total registration time, it provides a user-friendly way of using the registration software without heavy infrastructure investments in hospitals. The system exhibits good performances even if the user is connected to the grid service through a low throughput network such as a wireless network interface or ADSL.
Health Promotion in Occupational Health
Authors: Kaijser C. F. O.
Published: March 2018

Objectives:
To describe a Swedish approach to occupational health and its implications for health promotion.

Methods:
We start business with a new customer by creating a health policy for the whole company. Every year a follow-up is presented to top management where decisions are taken on what to do for the coming period.

Results:
The result from a paper mill is presented where cost savings were five times more than expected. We have found that close follow-up and the use of personalized reminders is very useful for individuals. We have also found the importance of working more with “the softer side” i.e. looking into a person’s total life situation. Management training activities are essential. This training includes for instance personality, communication and conflict handling seminars and every manager has to go through those seminars. The focus is moved from sick care to health improvement. The result is measured in long-term health for individuals. To reach that level you have to be healthy and have no absences for at least two years.

Conclusion:
The Swedish occupational health system is a unique system for creating health. With a specially trained staff including MDs, nurses, physiotherapists, psychologists, management consultants and engineers, and working from prevention to treatment, they can create a total view of both individual health and customer company wealth. Working closely together in teams and in close cooperation with customers, they can initiate great changes in both these dimensions.
HIV/AIDS Health Literacy in Zimbabwe
Authors: Masvaure T. B. , Gavin L. , Terry P. E.
Published: March 2018

Objective:
This qualitative study was designed to assess program needs and evaluate and improve HIV/AIDS prevention efforts at the University of Zimbabwe.

Methods:
We conducted eight focus group discussions with 70 students and conducted key informant interviews with formal and informal opinion leaders. Four mixed-sex focus group discussions, two all-female, and two all-male sessions were held.

Results:
We found a pervasive sense of despondency and powerlessness among students. Consistent across focus groups, but particularly within the women’s groups, respondents revealed that financial and accommodation needs and peer pressure were causing many male and female students to engage in prostitution. Focus group discussions also revealed condom use with regular partners is low and that students dating partners who are employed find it hard to insist on condom use in the relationship.

Conclusions:
Participants stated programs had positively influenced their reduction in the number of sexual partners and intentions to get tested for HIV.
The SARS Epidemic in Hong Kong – A Human Calamity in the 21st Century
Authors: Lee S. H.
Published: March 2018

Purpose:
This paper reviews the epidemiology and control measures of the SARS epidemic in Hong Kong. It sets out proposals for better preparedness to tackle the disease in future.

Background:
Severe Acute Respiratory Syndrome (SARS) started to strike Hong Kong in March 2003. A total of 1,755 SARS cases with 298 deaths were reported. Prior to the occurrence of the disease in Hong Kong, an intense outbreak of atypical pneumonia was reported in the nearby Guangdong Province in Mainland China.

Results:
There were three phases in the epidemic. The first phase in March 2003 involved a teaching hospital. The infection originated from a visiting professor from Guangdong, He developed SARS in Hong Kong and died in a Hong Kong hospital. The second phase in April was the spread of the infection from the hospital to the community. The third phase in May was the declining period which ended in June following the removal of Hong Kong from the list of infected areas by WHO.

Conclusion:
Hong Kong was ill prepared at the early stage of the epidemic. The epidemic produced not only health but also social, economic and humanitarian problems. The epidemic, however, created a strong sense of unity among all sectors of the population in the fight against the disease.
The Future Profile of Health Promotion and Disease Prevention in Japan
Authors: Doba N. , Hinohara S.
Published: March 2018

Objectives:
One of the serious challenges for Japanese healthcare is the aging population. Analysis of health evaluation data, especially of the elderly over 75 years, is considered very important. In view of this prolonged life expectancy in Japan, our government started the new campaign of Healthy Japan 21, of which details are described, and also we will demonstrate the general profile of our perspective cohort study program concerning the new elder citizens in Japan.

Methods and Results:
Our group has started a health evaluation program for those apparently healthy new elder citizens over the age of 75. A ten-year cohort study is in progress, which is designed to accumulate health check-up data annually. The study collects information on physical well being, as well as information on the individual’s lifestyle, and social, emotional and spiritual environment. Such health appraisal is of primary importance. Preliminary results will be demonstrated with their special implications in clinical and epidemiological significance. The degree of frailty of the individual was also carefully evaluated, so that we can learn about the QOL of the seniors in Japan.

Conclusions:
At the present stage, we can only report a part of our study including the mental and spiritual environments of the individual. This kind of outcome study will give us some insights concerning the natural progress of frailty in the apparently healthy elderly.
On Genetic Information, Diversity and Distance
Authors: Vajda I. , Zvárová J.
Published: March 2018

Objectives:
General information-theoretic concepts such as f-divergence, f-information and f-entropy are applied to the genetic models where genes are characterized by randomly distributed alleles. The paper thus presents an information-theoretic background for measuring genetic distances between populations, genetic information in various observations on individuals about their alleles and, finally, genetic diversities in various populations.

Methods:
Genetic distances were derived as divergences between frequencies of alleles representing a gene in two different populations. Genetic information was derived as a measure of statistical association between the observations taken on individuals and the alleles of these individuals. Genetic diversities were derived from divergences and information.

Results:
The concept of genetic f-information introduced in the paper seems to be new. We show that the measures of genetic distance and diversity used in the previous literature are special cases of the genetic f-divergence and f-diversity introduced in the paper and illustrated by examples. We also display intimate connections between the genetic f-information and the genetic f-divergence on one side and genetic f-diversity on the other side. The examples at the same time also illustrate practical computations and applications of the important concepts of quantitative genetics introduced in the paper.

Conclusions:
We discussed a general class of f-divergence measures that are suitable measures of genetic distance between populations characterized by concrete frequencies of alleles. We have shown that a wide class of genetic information, called f-information, can be obtained from f-divergences and that a wide class of measures of genetic diversity, called f-diversities, can be obtained from the f-divergences and f-information.
Shape and Size of Dental Arch
Authors: Tauferová E. , Teuberová Z. , Seydlová M. , Smutný V. , Racek J. , Bartonova M. , Dostálová T.
Published: March 2018

Objectives:
The diagnostic procedure commences with the initial examination, during which a number of individual findings of the occlusion or malocclusion are clarified [1]. The objective is to describe the morphological and functional characteristics on each patient using specific guidelines, and then to provide a prognosis of the therapy. Upper and lower arch compression in first premolars and molars area was visible before treatment.

Methods:
A special device (Czech technical university research prototype) was prepared for this purpose. The optical head contains a digital color camera. The front of the optical head consists of a removable prism which is put into the mouth. The findings can display live images from the camera, which can be archived on a PC. The device captured and geometrically calibrated images permitting comparison of several different dental casts.

Results:
In the first part of this study 792 sets of study plaster casts were screened. Measurements of dental arch width between reference points of canines, first premolars and first molars were made: upper jaw: men: 3-3 – 35.1 mm (SE 0.13); 4-4 – 37.5 mm (SE 0.13); 6-6 – 48.1 mm (SE 0.19); women: 3-3 – 33.4 mm (SE 0.13); 4-4 – 35.6 mm (SE 0.15); 6-6 – 46.7 mm (SE 0.19). The second part concerns the group of 36 patients which is different from the 792 controls. There were studied changes between initial, post-treatment and post-retention alignment of upper and lower dental arch.

Conclusions:
Geometrically calibrated images help compare several different steps of the treatment and show a significant difference between patients before and after treatment.
Characterizing Decision Support Telemedicine Systems
Authors: Abu-Hanna A. , Nannings B.
Published: March 2018

Objectives:
Decision Support Telemedicine Systems (DSTS) are at the intersection of two disciplines: telemedicine and clinical decision support systems (CDSS). The objective of this paper is to provide a set of characterizing properties for DSTSs. This characterizing property set (CPS) can be used for typing, classifying and clustering DSTSs.

Methods:
We performed a systematic keyword-based literature search to identify candidate-characterizing properties. We selected a subset of candidates and refined them by assessing their potential in order to obtain the CPS.

Results:
The CPS consists of 14 properties, which can be used for the uniform description and typing of applications of DSTSs. The properties are grouped in three categories that we refer to as the problem dimension, process dimension, and system dimension. We provide CPS instantiations for three prototypical applications.

Conclusions:
The CPS includes important properties for typing DSTSs, focusing on aspects of communication for the telemedicine part and on aspects of decisionmaking for the CDSS part. The CPS provides users with tools for uniformly describing DSTSs.
Association between Split Selection Instability and Predictive Error in Survival Trees
Authors: Gefeller O. , Rabenstein T. , Hothorn T. , Radespiel-Tröger M.
Published: March 2018

Objectives:
To evaluate split selection instability in six survival tree algorithms and its relationship with predictive error by means of a bootstrap study.

Methods:
We study the following algorithms: logrank statistic with multivariate p-value adjustment without pruning (LR), Kaplan-Meier distance of survival curves (KM), martingale residuals (MR), Poisson regression for censored data (PR), within-node impurity (WI), and exponential log-likelihood loss (XL). With the exception of LR, initial trees are pruned by using split-complexity, and final trees are selected by means of cross-validation. We employ a real dataset from a clinical study of patients with gallbladder stones. The predictive error is evaluated using the integrated Brier score for censored data. The relationship between split selection instability and predictive error is evaluated by means of box-percentile plots, covariate and cutpoint selection entropy, and cutpoint selection coefficients of variation, respectively, in the root node.

Results:
We found a positive association between covariate selection instability and predictive error in the root node. LR yields the lowest predictive error, while KM and MR yield the highest predictive error.

Conclusions:
The predictive error of survival trees is related to split selection instability. Based on the low predictive error of LR, we recommend the use of this algorithm for the construction of survival trees. Unpruned survival trees with multivariate p-value adjustment can perform equally well compared to pruned trees. The analysis of split selection instability can be used to communicate the results of tree-based analyses to clinicians and to support the application of survival trees.
Deconfounding Microarray Analysis
Authors: Jacobsen M. , Repsilber D. , Gutschmidt A. , Neher A. , Feldmann K. , Mollenkopf H. J. , Kaufmann S. H. E. , Ziegler A.
Published: March 2018

Objectives:
Microarray analysis requires standardized specimens and evaluation procedures to achieve acceptable results. A major limitation of this method is caused by heterogeneity in the cellular composition of tissue specimens, which frequently confounds data analysis. We introduce a linear model to deconfound gene expression data from tissue heterogeneity for genes exclusively expressed by a single cell type.

Methods:
Gene expression data are deconfounded from tissue heterogeneity effects by analyzing them using an appropriate linear regression model. In our illustrating data set tissue heterogeneity is being measured using flow cytometry. Gene expression data are determined in parallel by real time quantitative polymerase chain reaction (qPCR) and microarray analyses. Verification of deconfounding is enabled using protein quantification for the respective marker genes.

Results:
For our illustrating dataset, quantification of cell type proportions for peripheral blood mononuclear cells (PBMC) from tuberculosis patients and controls revealed differences in B cell and monocyte proportions between both study groups, and thus heterogeneity for the tissue under investigation. Gene expression analyses reflected these differences in celltype distribution. Fitting an appropriate linear model allowed us to deconfound measured transcriptome levels from tissue heterogeneity effects. In the case of monocytes, additional differential expression on the single cell level could be proposed. Protein quantification verified these deconfounded results.

Conclusions:
Deconfounding of transcriptome analyses for cellular heterogeneity greatly improves interpretability, and hence the validity of transcriptome profiling results.
Impact of CPOE on Mortality Rates – Contradictory Findings, Important Messages
Authors: Talmon J. , Ash J. S. , Bates D. W. , Beuscart-Zéphir M.-C. , Duhamel A. , Elkin P. L. , Gardner R. M. , Geissbuhler A. , Ammenwerth E.
Published: March 2018

Objective:
To analyze the seemingly contradictory results of the Han study (Pediatrics 2005) and the Del Beccaro study (Pediatrics 2006), both analyzing the effect of CPOE systems on mortality rates in pediatric intensive care settings.

Methods:
Seven CPOE system experts from the United States and Europe comment on these papers.

Results:
The two studies are not contradictory, but almost non-comparable due to differences in design and implementation. They demonstrate the range of outcomes that can be obtained from introducing informatics applications in complex health care settings. Implementing informatics applications is a socio-technical activity, which often depends more on the organizational context than on a specific technology. As health informaticians, we must not only learn from failures, but also avoid both uncritical scepticism that may arise from drawing overly general conclusions from one negative trial, as much as uncritical optimism from limited successful ones.

Conclusion:
The commentaries emphasize the need to promote systematic studies for assessing the socio-technical factors that influence the introduction of increasingly sophisticated informatics applications within complex organizations. The emergence of evidence-based health informatics will be based both on evaluation guidelines and implementation guidelines, both of which increase the chances of successful implementation. In addition, well-educated health informaticians are needed to manage and guide the implementation processes.
Romanian Medical Informatics and Professor Jan H. van Bemmel’s Support
Authors: Mihalas G. I.
Published: March 2018

Objective:
The development of medical informatics education in Romania, starting from Timisoara, was strongly influenced by the support offered generously by Professor Jan H. van Bemmel, in a period when the imposed political conditions limited contacts between Western and Eastern countries. We tried to present here some of the most significant actions and events related to this long lasting collaboration.

Methods:
The evolution of the relations between the Departments of Medical Informatics from Medical University in Timisoara and Erasmus University in Rotterdam is described in chronological order.

Results:
Professor van Bemmel found appropriate ways to offer his support, adapted to each historical period. He started by sending books, journals and software, continued with support for attending conferences and then extended to more active collaborations.

Conclusion:
In 2006 professor van Bemmel was the keynote speaker of the EFMI Special Topic Conference held in Timisoara and was awarded the title of “Doctor Honoris Causa” of the Victor Babes University of Medicine and Pharmacy.
The Young Person’s Guide to Biomedical Informatics
Authors: van Bemmel J. H.
Published: March 2018

Objective:
To draw a parallel between the challenges by which a research department in biomedical informatics is confronted and those of a symphony orchestra; in both areas different disciplines and various groups of instruments can be discerned.

Method:
Retrospective, personal review of how to conduct biomedical research.

Results:
The importance of mastering one’s instrument and the harmony between the team members is stressed. The conductor has to motivate all players so that they can have a successful career. Competition between orchestras and performance assessments determine survival and success. A record of refereed publications is crucial for continued existence.

Conclusions:
Biomedical informatics is typically multidisciplinary. Hypotheses underlying research should be carefully formulated. The time from research to application may easily take 20 years or more. Mutual trust and knowing each other’s competences is essential for success. A good leader gives enough room to all team members to develop their careers. The outcomes of assessment studies are directly related to the quality of publications.
From Hospital Information Systems to Health Information Systems
Authors: Giuse D. A. , Kuhn K. A.
Published: March 2018

Objectives:
Hospital information systems are evolving towards health information systems. This article aims at identifying both proven benefits and critical issues, and at discussing problems and possible solutions.

Methods:
Reports on HIS successes and failures were analyzed, and core challenges were identified. These challenges are discussed against state of the art solutions.

Results:
In spite of demonstrated benefits, there are more severe problems than reports on successes suggest. Among today’s core problems are integration, human-computer interaction, socio-technical issues, and support of processes.

Conclusions:
Significant efforts of all parties involved in the health care process are needed to improve, implement, and evaluate the concepts described.
Determining the Effects of Patient Casemix on Length of Hospital Stay: A Proportional Hazards Frailty Model Approach
Authors: Yau K. K. W. , Lee A. H.
Published: March 2018

Objectives:
To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs).

Methods:
A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs.

Results:
Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients.

Conclusions:
The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.
Induction of Hypotheses Concerning Hip Arthroplasty: A Modified Methodology for Medical Research
Authors: Bratko I. , Demšar J. , Smrke D. , Stankovski V.
Published: March 2018

Objectives:
The objective of this study is to advocate a methodology for medical research that, in contrast to traditional medical methodology, exploits the flexibility of machine learning and retains the kind of statistical tests that are generally accepted in the medical field for the confirmation of hypotheses.

Methods:
First, the medical problem is defined and data for an observed population are collected; then a machine learning tool is used to generate hypotheses regarding the problem; finally, statistical methods are used to determine the validity of the generated hypotheses.

Results:
To illustrate this approach, the problem of defining indications for hip arthroplasty after an acute medial femoral neck fracture is investigated as a case study.

Conclusions:
The methodology is similar to the usual style of applying machine learning, but insists on a link to the techniques of statistical tests that are normally used in medicine. It aims at a more flexible and economical use of experimental data than in the usual medical research, which is enabled by techniques of machine learning. At the same time, by reference to traditional statistical tests, it is hoped that this approach will lead to improved acceptance of machine learning in the medical field.
Prediction in Medicine by Integrating Regression Trees into Regression Analysis with Optimal Scaling
Authors: Meulman J. J. , Dusseldorp E.
Published: March 2018

Objectives:
A new data-analysis strategy is proposed to solve the problems of selecting interaction terms in linear regression on the one hand, and of statistically testing the significance of regression trees on the other hand.

Methods:
The proposed strategy combines two data mining techniques: regression trees and regression analysis with optimal scaling (CATREG). The method traces small regression trees using the bootstrap and integrates the results as interaction variables (called “trunk variables”) into CATREG.

Results:
An application to data from cardiac patients shows a relative increase of 19% variance accounted for (16% cross-validated variance), by the CATREG model including the trunk variables compared to the model excluding these variables.

Conclusions:
This study indicates that trunk variables can be useful to model interaction effects in prediction problems.
Experiences with a Generator Tool for Building Clinical Application Modules
Authors: Lenz R. , Elstner T. , Siegele H. , Moll R. , Kuhn K.A.
Published: March 2018

Objectives: To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis®/ OpenMed, which is in widespread use in Germany, Austria, and Switzerland.

Methods: In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system’s functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool.

Results: The system’s functionality is comparable to other commercial products’ functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users’ work practice.

Conclusions: We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.
Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions
Authors: Trivedi M. H. , Kern J. K. , Marcee A. , Grannemann B. , Kleiber B. , Bettinger T. , Altshuler K. Z. , McClelland A.
Published: March 2018

Next, the article discusses the need to incorporate the use of surveys, questionnaires, or rating instruments for the collection of end-user feedback during and after the implementation process. A description of the types of rating instruments that will facilitate the assessment of user satisfaction is provided. Initial results from physician feedback during the implementation of our prototype are discussed. Research indicates that computerized decision support systems (CDSSs) can improve clinical performance and patient outcomes, and yet CDSSs are not in widespread use. Physician guidelines, in general, face barriers in implementation. Guidelines in a computerized format can overcome some of the barriers to conventional text-form guidelines; however, computerized programs have novel aspects that have to be considered, aspects such as technical problems/support and user interface issues that can act as barriers. Though the literature points out that human, organizational, and technical issues can act as barriers in the implementation of CDSSs, studies clearly indicate that there are methods that can overcome these barriers and improve CDSS acceptance and use. These methods come from lessons learned from a variety of CDSS implementation ventures. Notably, most of the methods that improve acceptance and use of a CDSS require feedback and involvement of end-users. Measuring and addressing physician or user attitudes toward the computerized support system has been shown to be important in the successful implementation of a CDSS. This article discusses: 1) the barriers of implementation of guidelines in general and of CDSSs; 2) the importance of the physician’s role in development, implementation, and adherence; 3) methods that can improve CDSS acceptance and use; and 4) the types of tools needed to obtain end-user feedback.
Cortical Source Estimate of Combined High Resolution EEG and fMRI Data Related to Voluntary Movements
Authors: Babiloni C. , Carducci F. , Gratta Del , Romani G. L. , Rossini P. M. , Cincotti F. , Babiloni F.
Published: March 2018

Objectives: In this paper, we employed advanced methods for the modeling of human cortical activity related to voluntary right one-digit movements from combined high-resolution electroencephalography (EEG) and functional magnetic resonance imaging (fMRI).

Methods: Multimodal integration between EEG and fMRI data was performed by using realistic head models, a large number of scalp electrodes (128) and the estimation of current density strengths by linear inverse estimation.

Results: Increasing of spatial details of the estimated cortical density distributions has been detected by using the proposed integration method with respect to the estimation using EEG data alone.

Conclusion: The proposed method of multimodal EEG-fMRI data is useful to increase spatial resolution of movement-related potentials and can also be applied to other kinds of event-related potentials.
Medical Informatics: Between Science and Engineering, Between Academia and Industry
Authors: Shahar Y.
Published: March 2018

Objective: To analyze the nature and appropriate role of the Medical Informatics research and practice area in the 21st Century, and to determine its links to academic environments versus industrial companies and health-care organizations.

Methods: A qualitative analysis of the state of the art of Medical Informatics, based on observation of current medical informatics programs and research in academic and industrial sites.

Results and Conclusions: Medical Informatics is definitely a scientific and technological area of endeavor, although somewhat ill-defined in scope. It is situated between science and engineering, but much closer to the engineering world, and its multidisciplinary nature fits well the engineering paradigm. It is better viewed as a specialization of the informatics field rather than as a basic medical science. However, there are good arguments as to why Medicine should be the first among equals to have its own informatics domain. Medical Informatics must have extensions to both academia and industry to survive. Medical informaticians, whether implicitly or explicitly, exist in three different environments: academic, clinical (user), and industrial (informatics developer); all three environments must be considered when trying to predict the future of this new multi-disciplinary area.
Knowledge Management to Support Performance-based Medicine
Authors: Stefanelli M.
Published: March 2018

Objectives: To discuss research issues for medical informatics in order to support the further development of health information systems, exploiting knowledge management and information and communication technology to increase the performance of Health Care Organizations (HCOs).

Methods: Analyze the potential of exploiting knowledge management technology in medicine.

Results and conclusions: The increasing pressure on HCOs to ensure efficiency and cost-effectiveness, balance the quality of care, and contain costs will drive them towards more effective management of medical knowledge derived from biomedical research. Knowledge management technology may provide effective methods and tools in speeding up the diffusion of innovative medical procedures. Reviews of the effectiveness of various methods of best practice dissemination show that the greatest impact is achieved when such knowledge is made accessible through the health information system at the moment it is required by care providers at their work sites. There is a need to take a more clinical process view of health care delivery and to identify the appropriate organizational and information infrastructures to support medical work. Thus, the great challenge for medical informatics is represented by the effective exploitation of the astonishing capabilities of new technologies to assure the conditions of knowledge management and organizational learning within HCOs.
Person Identification from the EEG using Nonlinear Signal Classification
Authors: Rangoussi M. , Alexandris N. , Evangelou A. , Poulos M.
Published: March 2018

Objectives: This paper focusses on the person identification problem based on features extracted from the ElectroEncephaloGram (EEG). A bilinear rather than a purely linear model is fitted on the EEG signal, prompted by the existence of non-linear components in the EEG signal – a conjecture already investigated in previous research works. The novelty of the present work lies in the comparison between the linear and the bilinear results, obtained from real field EEG data, aiming towards identification of healthy subjects rather than classification of pathological cases for diagnosis.

Methods: The EEG signal of a, in principle, healthy individual is processed via (non)linear (AR, bilinear) methods and classified by an artificial neural network classifier.

Results: Experiments performed on real field data show that utilization of the bilinear model parameters as features improves correct classification scores at the cost of increased complexity and computations. Results are seen to be statistically significant at the 99.5% level of significance, via the χ2 test for contingency.

Conclusions: The results obtained in the present study further corroborate existing research, which shows evidence that the EEG carries individual-specific information, and that it can be successfully exploited for purposes of person identification and authentication.
Medical Informatics as a Discipline at the Beginning of the 21st Century
Authors: Talmon J. L. , Hasman A.
Published: March 2018

Objectives: To analyse the present situation of the discipline medical informatics and to propose actions for change.

Methods: Evaluation of the current situation mainly based on anecdotal evidence.

Results: The difference between the scientific and the engineering aspects of medical informatics get blurred. Because of the requirements of European funding medical informatics focuses more on engineering than on science. Too many manuscripts are submitted that describe engineered artefacts without a scientific purpose. Some of the subjects (like security issues) that are studied in medical informatics are not considered important by medical faculties thus impeding support.

Conclusions: The methodological underpinnings of our research should be strengthened, impact studies should be more frequently performed; the quality of results reporting should be increased.
Combining Medical Informatics and Bioinformatics toward Tools for Personalized Medicine
Authors: Simmons M. K. , Subramanian P. , Temkin J. M. , Sarachan B. D.
Published: March 2018

Objectives: Key bioinformatics and medical informatics research areas need to be identified to advance knowledge and understanding of disease risk factors and molecular disease pathology in the 21st century toward new diagnoses, prognoses, and treatments. Methods: Three high-impact informatics areas are identified: predictive medicine (to identify significant correlations within clinical data using statistical and artificial intelligence methods), along with pathway informatics and cellular simulations (that combine biological knowledge with advanced informatics to elucidate molecular disease pathology).

Results: Initial predictive models have been developed for a pilot study in Huntington’s disease. An initial bioinformatics platform has been developed for the reconstruction and analysis of pathways, and work has begun on pathway simulation.

Conclusions: A bioinformatics research program has been established at GE Global Research Center as an important technology toward next generation medical diagnostics. We anticipate that 21st century medical research will be a combination of informatics tools with traditional biology wet lab research, and that this will translate to increased use of informatics techniques in the clinic.
Probabilistic Graphical Models for Computational Biomedicine
Authors: Antal P. , Fannes G. , De Moor B. , Moreau Y.
Published: March 2018

Background: As genomics becomes increasingly relevant to medicine, medical informatics and bioinformatics are gradually converging into a larger field that we call computational biomedicine.

Objectives: Developing a computational framework that is common to the different disciplines that compose computational biomedicine will be a major enabler of the further development and integration of this research domain.

Methods: Probabilistic graphical models such as Hidden Markov Models, belief networks, and missing-data models together with computational methods such as dynamic programming, Expectation-Maximization, data-augmentation Gibbs sampling, and the Metropolis-Hastings algorithm provide the tools for an integrated probabilistic approach to computational biomedicine.

Results and Conclusions: We show how graphical models have already found a broad application in different fields composing computational biomedicine. We also indicate several challenges that lie at the interface between medical informatics, statistical genomics, and bioinformatics. We also argue that graphical models offer a unified framework making it possible to integrate in a statistically meaningful way multiple models ranging from the molecular level to cellular and to clinical levels. Because of their versatility and firm statistical underpinning, we assert that probabilistic graphical models can serve as the lingua franca for many computationally intensive approaches to biology and medicine. As such, graphical models should be a foundation of the curriculum of students in these fields. From such a foundation, students could then build towards specific computational methods in medical informatics, medical image analysis, statistical genetics, or bioinformatics while keeping the communication open between these areas.
Computational Integrative Physiology: At the Convergence of the Life and Computational Sciences
Authors: Julen N. , Sinteff J.-P. , Siregar P.
Published: March 2018

Objective: In this paper we outline how Computational Integrative Physiology (CIP) can help unravel the mechanisms of normal and pathological biological processes. Our objective is to illustrate how CIP is firmly grounded on the life and computational sciences.

Method: After describing a general theoretical framework for CIP, we will center our discussion on cardiac rhythmic disorders with a particular focus on the Long QT syndrome that will serve as a case example. Within this context, we will describe multi-scale processes in biological, medical and in general mathematical terms, starting from the control of gene expression to the electrical activity of the entire heart. We will therefore proceed from the smaller microscopic scales to the larger macroscopic ones. In doing so, we will illustrate, at least in a qualitative sense, how CIP can be accomplished by showing some of the relations that can exist between mathematical variables characterizing models of different space-scales.

Conclusion: We will conclude by putting forth how CIP and the related fields of bioinformatics and medical informatics are necessary to derive meaningful knowledge from the huge and exponentially growing biological and medical data.