bluuebunny/crossref_metadata_2025 huggingface dataset:
A Web Service-based Grid Portal for Edgebreaker Compression
Authors: Barba M. C. , Blasi E. , Cafaro M. , Fiore S. , Mirto M. , Aloisio G.
Published: March 2018

Background:
In health applications, and elsewhere, 3D data sets are increasingly accessed through the Internet. To reduce the transfer time while maintaining an unaltered 3D model, adequate compression and decompression techniques are needed. Recently, Grid technologies have been integrated with Web Services technologies to provide a framework for interoperable application-to-application interaction.

Objectives:
The paper describes an implementation of the Edgebreaker compression technique exploiting web services technology and presents a novel approach for using such services in a Grid Portal. The Grid portal, developed at the CACT/ISUFI of the University of Lecce, allows the processing and delivery of biomedical images (CT – computerized tomography – and MRI – magnetic resonance images) in a distributed environment, using the power and security of computational Grids.

Methods:
The Edgebreaker Compression Web Service has been deployed on a Grid portal and allows compressing and decompressing 3D data sets using the Globus toolkit GSI (Globus Security Infrastructure) protocol. Moreover, the classical algorithm has been modified extending the compression to files containing more than one object.

Results and Conclusions:
An implementation of the Edgebreaker compression technique and related experimental results are presented. A novel approach for using the compression web service in a Grid portal allowing storing and preprocessing of huge 3D data sets, and subsequent efficient transmission of results for remote visualization is also described.
A Comparison of Organized and Traditional Health Care
Authors: Lawrence D. M.
Published: March 2018

Purpose:
To compare organized and traditional health care delivery systems and their ability to meet several major challenges facing health care in the next 25 years.

Approach:
Analysis of traditional and organized health care systems based on a career spent in organized health care systems.

Conclusions:
The traditional health care system based on independent autonomous physicians is not able to meet the challenges of current healthcare. Stronger integration and coordination, i.e., organized health care delivery systems are required.
Health Promotion in the Workplace – The Merging of the Paradigms
Authors: Yassi A.
Published: March 2018

Purpose:
To synthesize the lessons from both occupational health and health promotion, to improve workplace health.

Approach:
This article briefly outlines the evolution in defining and understanding health promotion as well as current thinking in occupational health and safety.

It also discusses an approach taken in the healthcare sector in British Columbia, Canada, where evidence-based practices and collaboration became the cornerstones to bringing about change and achieve impressive cost-beneficial results in healthcare workforce health.

Conclusion:
Traditionally, workplace health promotion and occupational health and safety have been two solitudes. Workplace health promotion is rooted in ‘wellness’ and healthy lifestyle choices, while occupational health is heavily dictated by workplace health and safety requirements and legislation. Recently however, there has been increasing recognition of the need for a more holistic approach that focusses on workplace culture, addressing both primary and secondary prevention [1], as well as interventions aimed both at the individual as well as the organisation [2].
Video Conferencing-based Telehealth
Authors: Anglin C. R. , Schaafsma J. P. , Pantazi S. V. , Anglin S. , Grimm N. A. , Moehr J. R.
Published: March 2018

Purpose:
To review the experience with a province-wide telehealth system in Canada, and its implications for health care and health promotion. To explore whether group support systems (GSS) based on networked computers can substitute for video conferencing technology.

Methods:
Key results of the evaluation of the BC Tele-health Program are summarized. The potential of extending the successful principles through use of GSS is explored based on literature review, demonstrations, and trial use for educational applications.

Results:
The BC Telehealth Program was designed to support health professionals at secondary care facilities, such as regional and district hospitals in two application domains: children’s and women’s health (C&W) and emergency room and trauma care (ER-Trauma). Successful applications extended beyond health professionals and focused on chronic conditions, the management of which is contingent on visual information, and involves established teams in regular scheduled visits or in sessions scheduled well in advance. Ad hoc applications, in particular applications under emergency conditions proved problematic.

Administrative applications in support of telehealth implementation, e.g., through facilitation of management and provider education, are essential for clinical success. Savings from support of administrative applications exceeded the substantial capital investment and made educational and clinical applications available at variable cost. Educational applications were shown to have significant clinical benefits.

Exploration of GSS technology showed that it may not be mature enough to substitute for video conferencing technology in support of sophisticated training and education aiming at clinical impact.

Conclusion:
The substantial clinical and efficiency gains provided by video conferencing-based telehealth may for now continue to depend on mature videoconferencing technology.
Clinical Guidelines as Plans
Authors: Smith B. , Pisanelli D. M. , Gangemi A. , Stefanelli M. , Kumar A.
Published: March 2018

Objective:
Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations.

Method:
The framework we propose allows us to represent, in formal terms, how clinical guidelines are realized through the actions of individuals or ganized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations.

Result:
Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons.

Conclusion:
The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation.
Evaluation of the Electronic Transmission of Medical Findings from Hospitals to Practitioners by Triangulation
Authors: Ammenwerth E. , Schabetsberger T. , Machan C.
Published: March 2018

Objectives:
The need for regional, cross-institutional electronic networks in health care is steadily growing to support seamless, cooperative health care. The aim of this study is to evaluate the impact of electronic transmission between hospitals and practitioners in a Tyrolean health care network, and to derive technical and organizational points for improvement.

Methods:
Between March and August 2004 we carried out a triangulation-based cross-sectional study, combining a qualitative study based on semi-structured, problem-centric interviews with selected practitioners, with a quantitative study based on a standardized questionnaire survey of all the Tyrolean practitioners that receive electronic messages. The survey was designed to confirm the hypotheses which have been systematically derived from the interviews.

Results and Conclusions:
The results show high satisfaction and positive impact of electronic communication. The triangulation of quantitative and qualitative methods was found to be useful in order to make the definition and confirmation of the hypotheses more transparent.
Analysis and Management of HIV Peptide Microarray Experiments
Authors: García-Albert L. , Martín-Sánchez F. , García-Sáiz A. , López-Campos G. H.
Published: March 2018

Objectives:
To develop a tool for then easy and user-friendly management of peptide microarray experiments and for the use of the results of these experiments for the study the immune response against HIV virus infection in clinical samples.

Methods:
Applying bioinformatics and statistics for the analysis of data coming from microarray experiments as well as implementing a MIAME (Minimum Information About a Microarray Experiment) compliant database for managing and annotating experiments, results and samples.

Results:
We present a new tool for managing not only nucleic acid microarray experiments but also protein microarray experiments. From the analysis of experimental data, we can detect different profiles in the reactivity of the sera with different genotypes.

Conclusions:
We have developed a new tool for managing microarray data including clinical annotations for the samples as well as the capability of annotating other microarray formats different to those based on nucleic acids. The use of peptide microarrays and bioinformatics analysis opens a new scope for the characterization of the immune response, and analyzing and identifying the humoral response of viruses with different genotypes.
Professional Competence and Computer Literacy in e-age, Focus on Healthcare
Authors: Engová D. , Štepánková O.
Published: March 2018

Objectives:
The healthcare sector is facing an enormous acceleration due to the emergence of new knowledge, drugs, devices and diseases. Professional competence, continuing education, service excellence and patient benefits can be facilitated by the developments in information and computer technology – computer literacy is becoming imperative for all who are involved in healthcare delivery. The paper attempts to identify solutions that can aid the process of ICT uptake for full benefit of patients and healthcare professionals.

Methods:
With the support of published literature, the article considers the importance of ICT skills in general and in healthcare and presents some advantages of generic vendor-independent methods of ICT certification.

Results:
Discussed are the preliminary results of the United Kingdom’s National Health Service information technology reform which addresses the need for intensified use of ICT and applies the ECDL concept.

Conclusions:
It is useful to complement the introduction of computer literacy as a qualification concept by a standardized accreditation of ICT skills. Solid level of computer literacy creates a reliable and efficient background for everyday activities of healthcare professionals, enables the application of further domain-specific training modules and prepares suitable environments for the introduction and acceptance of new technologies such as electronic health records and electronic transfer of prescriptions by positively transforming the attitudes of users towards them.
EGOOZ: Specifying the Components of Electronic Patient Record-related Education
Authors: Moorman P. , de Vries-Robbé P. F. , Bindels R. , Zandstra P. , van Ast W. , van der Lei J. , Hasman A.
Published: March 2018

Objective:
To determine whether educators consider electronic patient record (EPR)-related education necessary and if so, what subjects have to be taught more extensively in the future.

Methods:
A list of possibly relevant subjects was determined from the literature. A questionnaire was designed which contained those subjects and the respondents were asked to indicate, for each subject, its competency level and required competency level in current teaching. Since the response rate was low a second questionnaire was developed to have the results of the analysis of the first questionnaire validated by a larger group of educators.

Results:
In total 45 learning goals were identified from the literature. The questionnaire was sent to representatives of several disciplines: basic medical education, medical specializations, pharmacy, dentistry and nursing. The analysis of the first questionnaire resulted in nine subjects that needed more attention in the future. Because of the low response the needs could not be specified for the individual disciplines. This insight was obtained from a second questionnaire. The response to this questionnaire was high. From the analysis of the second questionnaire differences between views of educators involved in the training of GPs and educators involved in the training of other specializations were observed.

Conclusion:
Educators find EPR-related education important. There are different opinions about the phase in which EPR-related education should be given.
Assessing the State of Population Health by Age-adjusted Life Expectancies
Authors: Mehnert R. F. , Feldmann U.
Published: March 2018

Objectives:
A gain in life expectancy of a population is commonly interpreted as an effect of improved health care. After the reunion of Germany in 1990 life expectancy at birth grew extremely in the new federal states. Within one decade after reunion the new federal states had a gain in life expectancy of about five years while the gain in the old federal states was only about two years.

Methods:
It has been widely argued that this phenomenon is caused by an obviously improved public health service and environmental protection or even by an increased social status in the new federal states. On the other hand, the median population age grew rapidly in the new federal states, caused by a dramatic reduction of the birth rate as well as a high emigration rate of young people. Using real time series for three selected federal states and for the total Federal Republic of Germany, it is derived that most of the gain in life expectancy is explained by population ageing.

Results:
An elementary probabilistic procedure is proposed allowing for estimating the amount in life expectancy not attributable to population ageing.

Conclusions:
The age-adjusted life expectancy can be regarded as an unbiased measure of a populations’ state of health that stays comparable both over time and across countries.
A Framework for Characterizing Terminological Systems
Authors: de Keizer N. F. , Abu-Hanna A. , Cornet R.
Published: March 2018

Objectives:
The notion of a terminological system (TS) is complex due to the broad range of systems, applications, and clinical domains. A uniform approach to describe the characteristics of TSs is lacking. This impedes furthering understanding, applicability, mutual comparison and development of TSs. For these reasons we propose a terminological systems characterization framework.

Methods:
Relevant issues pertaining to TSs and terminology servers have been extracted from literature describing requirements and functionality of TSs. From these issues, features have been distilled and further refined. A categorization has been developed to provide a convenient arrangement of these features.

Results:
The framework distinguishes between application-dependent and application-independent features of TSs. Definitions are provided for measures of content coverage, which was identified as the only application-dependent feature. Application-independent features are categorized along two axes: their respective type of TS and the particular element within that system, i.e. the formalism, the content, or the functionality. For each feature we provide an explicit question, the answer to which yields a feature value. The framework has been applied to SNOMED CT and the CLUE browser.

Conclusions:
We present and apply a framework to support a feature-based characterization of terminological systems. Standardized methods for content coverage studies reduce the effort of assessing the applicability of a TS for a specific clinical setting. A two-axial categorization provides a convenient arrangement of the large number of application-independent features. Application of the framework increases comparability of terminological systems. This framework may also help TS developers determine how their system can be improved.
Assessing the Difficulty and Time Cost of De-identification in Clinical Narratives
Authors: Phillips W. F. , Phansalkar S. , Sims S. A. , Hurdle J. F. , Dorr D. A.
Published: March 2018

Objective:
To characterize the difficulty confronting investigators in removing protected health information (PHI) from cross-discipline, free-text clinical notes, an important challenge to clinical informatics research as recalibrated by the introduction of the US Health Insurance Portability and Accountability Act (HIPAA) and similar regulations.

Methods:
Randomized selection of clinical narratives from complete admissions written by diverse providers, reviewed using a two-tiered rater system and simple automated regular expression tools. For manual review, two independent reviewers used simple search and replace algorithms and visual scanning to find PHI as defined by HIPAA, followed by an independent second review to detect any missed PHI. Simple automated review was also performed for the “easy” PHI that are number- or date-based.

Results:
From 262 notes, 2074 PHI, or 7.9 ± 6.1 per note, were found. The average recall (or sensitivity) was 95.9% while precision was 99.6% for single reviewers. Agreement between individual reviewers was strong (ICC = 0.99), although some asymmetry in errors was seen between reviewers (p = 0.001). The automated technique had better recall (98.5%) but worse precision (88.4%) for its subset of identifiers. Manually de-identifying a note took 87.3 ± 61 seconds on average.

Conclusions:
Manual de-identification of free-text notes is tedious and time-consuming, but even simple PHI is difficult to automatically identify with the exactitude required under HIPAA.
Process Potential Screening
Authors: Ammenwerth E. , Haux R. , Ehlers F.
Published: March 2018

Objectives:
Hospitals are increasingly under pressure to optimize their processes. So far, an instrument to systematically identify the potentials for improvement of a given business process is missing. The aim of this project is to develop such an instrument.

Methods:
Initially, central aspects of the quality of a hospital process were identified on the basis of a systematic literature review. Secondary to that, criteria to measure quality aspects were defined: More than 300 criteria from medical and business informatics, economics and quality management publications were gathered and systematically aggregated.

Results:
As a result, the Process Potential Screening (PPS) instrument was developed. The PPS is a matrix containing two axes: Axis I comprises 30 quality aspects referring to results, execution and control of hospital processes. Axis II comprises 16 quality criteria (e.g., customer satisfaction, time). The PPS displays approximately 400 relevant combinations of those quality aspects and quality criteria that help to identify potentials for improvement of a given hospital process. It utilizes different methods for the measurement of the criteria and for application by way of individuals or groups.

Conclusions:
In using the PPS, relevant potentials for improvement were identified in ten typical hospital processes. The instrument’s practicability must now be examined in further studies by the final target group (e.g., quality or project managers, and the staff responsible for processes).
Estimates of the Number of Cancer Patients Hospitalized in a Geographic Area Using Claims Data without a Unique Personal Identifier
Authors: Couris C. M. , Gutknecht C. , Ecochard R. , Gelas-Dore B. , Hajri T. , Colin C. , Schott A.-M.
Published: March 2018

Objective:
In French national claims databases, claims are currently anonymous i.e. not linked to individual patients. In order to improve our estimate of the medical activity related to cancer in one French region, a statistical method was developed to use claims data to assess the number of cancer patients hospitalized in acute care.

Methods:
This method used the medical and administrative information available in the claims (i.e. age, primary site, length of stay) to predict an average number of stays per patient, followed by a number of patients. It was based on a two-phase study design using an internal dataset which contained personal identifiers to estimate the model parameters.

Results:
The predicted number of acute care patients hospitalized in one or several health care centers in one French region was 38,109 with a 95% predictive interval (37,990; 38,228) for the first six months of 2002. A prediction error of 24% was found.

Conclusion:
We provide a good estimate of the morbidity in acute care hospitals using claims data that is not linked to individual patients. This estimate reflects the medical activity and can be used to anticipate acute care needs.
Two Models for Outcome Prediction
Authors: Linder R. , Weimar C. , Diener H. C. , Pöppl S. J. , Ziegler A. , König I. R.
Published: March 2018

Objectives:
Accurately predicting disease progress from a set of predictive variables is an important aspect of clinical work. For binary outcomes, the classical approach is to develop prognostic logistic regression (LR) models. Alternatively, machine learning algorithms were proposed with artificial neural networks (ANN) having become popular over the last decades. Although some studies have compared predictive accuracies of LR and ANN models, some concerns regarding their methodological quality have been voiced. Our comparison has the advantage of being based on two large independent data sets allowing for elaborate model development and independent validation.

Methods:
From the German Stroke Database, a learning data set including 1754 prospectively recruited patients with acute ischemic stroke was used. Utilizing LR and ANN, two prognostic models were developed predicting restitution of functional independence and survival after 100 days. The resulting models were applied to classify 1470 patients with acute ischemic stroke; this test data set was collected independently from the learning data. Error fractions in the test data were determined, and differences in error fractions between the algorithms were calculated with 95% confidence intervals.

Results:
For most prognostic models, error fractions in the test data were below 40%. There was no difference between the algorithms except for the model predicting completely versus incompletely restituted or deceased patients (difference in error fractions = 4.01% [2.10-5.96%], p = 0.0001).

Conclusions:
The conscientiously applied LR remains the gold standard for prognostic modelling; however, ANN can be an alternative automated “quick and easy” multivariate analysis.
Measuring Agreement for Ordered Ratings in 3 x 3 Tables
Authors: Aubas P. , Seguret F. , Kramar A. , Dujols P. , Neveu D.
Published: March 2018

Objectives:
When two raters consider a qualitative variable ordered according to three categories, the qualitative agreement is commonly assessed with a symmetrically weighted kappa statistic. However, these statistics can present paradoxes, since they may be insensitive to variations of either complete agreements or disagreements.

Methods:
Agreement may be summarized by the relative amounts of complete agreements, partial and maximal disagreements beyond chance. Fixing the marginal totals and the trace, we computed symmetrically weighted kappa statistics and we developed a new statistic for qualitative agreements. Data sets from the literature were used to illustrate the methods.

Results:
We show that agreement may be better assessed with the unweighted kappa index, κc, and a new statistic ζ, which assesses the excess of maximal disagreements with respect to the partial ones, and does not depend on a particular weighting system. When ζis equal to zero, maximal and partial disagreements beyond chance are equal. With its estimated large sample variance, we compared the values of two contingency tables.

Conclusions:
The (κc, ζ) pair is sensitive to variations in agreements and/or disagreements and enables locating the difference between two qualitative agreements. The qualitative agreement is better with increasing values of κc and ζ.
Electrodynamic Heart Model Construction and ECG Simulation
Authors: Huo M. , Wei Q. , Liu F. , Crozier S. , Xia L.
Published: March 2018

Objectives:
In this paper, we present a unified electrodynamic heart model that permits simulations of the body surface potentials generated by the heart in motion. The inclusion of motion in the heart model significantly improves the accuracy of the simulated body surface potentials and therefore also the 12-lead ECG.

Methods:
The key step is to construct an electromechanical heart model. The cardiac excitation propagation is simulated by an electrical heart model, and the resulting cardiac active forces are used to calculate the ventricular wall motion based on a mechanical model. The source-field point relative position changes during heart systole and diastole. These can be obtained, and then used to calculate body surface ECG based on the electrical heart-torso model.

Results:
An electromechanical biventricular heart model is constructed and a standard 12-lead ECG is simulated. Compared with a simulated ECG based on the static electrical heart model, the simulated ECG based on the dynamic heart model is more accordant with a clinically recorded ECG, especially for the ST segment and T wave of a V1-V6 lead ECG. For slight-degree myocardial ischemia ECG simulation, the ST segment and T wave changes can be observed from the simulated ECG based on a dynamic heart model, while the ST segment and T wave of simulated ECG based on a static heart model is almost unchanged when compared with a normal ECG.

Conclusions:
This study confirms the importance of the mechanical factor in the ECG simulation. The dynamic heart model could provide more accurate ECG simulation, especially for myocardial ischemia or infarction simulation, since the main ECG changes occur at the ST segment and T wave, which correspond with cardiac systole and diastole phases.
The Impact of Rotary Blood Pump in Conjunction with Mechanical Ventilation on Ventricular Energetic Parameters
Authors: Darowski M. , Ferrari G. , Pisanelli D. M. , Tosti G. , De Lazzari C.
Published: March 2018

Objectives:
Aim of this work is to study the impact of left ventricular rotary blood pump assistance, on energetic variables, when mechanical ventilation (MV) of the lungs is applied.

Methods:
Computer simulation was used to perform this study. Lumped parameter models reproduce the circulatory system. Variable elastance models reproduce the Starling’s law of the heart for each ventricle. After the reproduction of ischemic heart disease left ventricular assistance was applied using a model of rotary blood pump. The pump speed was changed in steps and was assumed to be constant during each step. The influence of mechanical ventilation was introduced by different values of positive mean thoracic pressure.

Results:
The increase of the rotational speed has a significant influence on some ventricular energetic variables. In fact it decreased left ventricular external work, left and right ventricular pressure-volume area and the left ventricular efficiency. Finally, it increased the right ventricular efficiency but had no influence on the right ventricular external work. The increase of thoracic pressure from –2 to +5 mmHg caused a significant decrease of external work, pressure-volume area (right ventricular pressure-volume area dropped up to 50%) and an increase of right ventricular efficiency (by 40%) while left ventricular efficiency remained almost stable.

Conclusions:
Numerical simulation is a very suitable tool to predict changes of not easily measurable parameters such as energetic ventricular variables when mechanical assistance of heart and/or lungs is applied independently or simultaneously.
Bayesian Random-effect Model for Predicting Outcome Fraught with Heterogeneity
Authors: Yen A. M. -F. , Liou H.-H. , Lin H.-L. , Chen T. H.-H.
Published: March 2018

Objective:
The study aimed to develop a predictive model to deal with data fraught with heterogeneity that cannot be explained by sampling variation or measured covariates.

Methods:
The random-effect Poisson regression model was first proposed to deal with over-dispersion for data fraught with heterogeneity after making allowance for measured covariates. Bayesian acyclic graphic model in conjunction with Markov Chain Monte Carlo (MCMC) technique was then applied to estimate the parameters of both relevant covariates and random effect. Predictive distribution was then generated to compare the predicted with the observed for the Bayesian model with and without random effect. Data from repeated measurement of episodes among 44 patients with intractable epilepsy were used as an illustration.

Results:
The application of Poisson regression without taking heterogeneity into account to epilepsy data yielded a large value of heterogeneity (heterogeneity factor = 17.90, deviance = 1485, degree of freedom (df) = 83). After taking the random effect into account, the value of heterogeneity factor was greatly reduced (heterogeneity factor = 0.52, deviance = 42.5, df = 81). The Pearson χ2 for the comparison between the expected seizure frequencies and the observed ones at two and three months of the model with and without random effect were 34.27 (p = 1.00) and 1799.90 (p <0.0001), respectively.

Conclusion:
The Bayesian acyclic model using the MCMC method was demonstrated to have great potential for disease prediction while data show over-dispersion attributed either to correlated property or to subject-to-subject variability.
Modeling in Biomedical Informatics – An Exploratory Analysis (Part 1)
Authors: Hasman A. , Haux R.
Published: March 2018

Objectives:
Modeling is a significant part of research, education and practice in biomedical and health informatics. Our objective was to explore, which types of models of processes are used in current biomedical/ health informatics research, as reflected in publications of scientific journals in this field. Also the implications for medical informatics curricula were investigated.

Methods:
Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM).

Results:
384 publications have been analyzed, 190 of IJMI and 194 of MIM. In regular papers (69 in IJMI, 62 in MIM), analyzed here in part 1, all of these model types could be found. In many publications we observed a mixture of models, being used to solve the ‘core’ research questions and also to systematically evaluate the research done. Knowledge of (and models for) software engineering and project management are also often needed. IJMI seems to have a closer focus on research concerning health information systems and electronic patient records, with a strong emphasis on evaluation. MIM seems to have a broader range of research approaches, including also statistical modeling and computational intensive approaches. The aim to provide solutions for problems related to data, information and knowledge processing and to study the general principles of processing data, information and knowledge in medicine and health care in order to contribute to improve the quality of health care, and of research and education in medicine and the health sciences was given in all publications.

Conclusions:
Modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills concerning a broad range of model types is needed.
Integrating Genomics into Health Information Systems
Authors: Maojo V. , Lopez-Campos G. , Martin-Sanchez F.
Published: March 2018

Objective: To outline the main issues related to the impact of the data generated by the Human Genome Project on health information systems. A major challenge for medical informatics is identified, consisting of adapting traditional systems to new genetic-based diagnostic and therapeutic tools. Methods: Reviewing and analysing the different health information levels from an organisational complexity point of view. A model is proposed to explain the interactions between health informatics, bioinformatics and molecular medicine.

Results: We suggest a new framework that integrates genetic data into health information systems. Using this model, new topics for future research and development are identified.

Conclusions: We are witnessing the birth of a new era (post-genomics). In this era technological advancements in genomics offer new opportunities for clinical applications. Medical informaticians should play an important role in this new endeavour.
Theory, Abstraction and Design in Medical Informatics
Authors: Martín F. , Crespo J. , Billhardt H. , Maojo V.
Published: March 2018

Objective: To analyze the scientific and engineering components of Medical Informatics. A clear characterization of these components should be undertaken to categorize different areas of Medical Informatics and create a research agenda for the future. Methods: We have adapted a classical ACM and IEEE report on computing to analyze Medical Informatics from three different viewpoints: Theory, Abstraction, and Design.

Results: We suggest that Medical Informatics can be considered from these three perspectives: (1) Theory, from which medical informaticians formally characterize the properties of the objects of study, creating new theories or using and adapting existing theories (e.g., from mathematics), (2) Abstraction, from which medical informaticians deal with all aspects of medical information and create new abstractions, methods, and technology-independent models, which can be experimentally verified, and (3) Design, from which medical informaticians develop systems or act as information brokers or advisors between medical and technology professionals, to improve the quality of computer applications in medicine.

Conclusion: Based on this framework, we suggest that Medical Informatics has an independent scientific character, different from other applied informatics areas. Finally, we analyze these three perspectives using data mining in medicine.
Reflections on an Arranged Marriage between Bioinformatics and Health Informatics
Authors: Moshyk A. M. , Kushniruk A. , Moehr J. R. , Grant A. M.
Published: March 2018

Objective: To compare the discussions of two workshops held during 2001 by two Canadian organisations, HEALNet, a Network of Centres of Excellence for research in health information applications, and Genome Canada, a national research funding agency for genomics and proteomics, in collaboration with the Institute of Genetics of the Canadian Institutes of Health Research, to examine strategic research development in Health Informatics and Bioinformatics respectively.

Methods: Invited workshops with structured debate. Concept analysis of preparative material and debates. Results: A predominantly common set of concepts was discerned from both workshops. Analysis of published definitions showed an inability to distinguish a definition that would suggest that health informatics and bioinformatics are separate disciplines. In both workshops there was evidence of deep concerns of identity, the lack of clear structures to support research funding as well as uncertainty in distinguishing between service and research.

Conclusions: Many deep issues currently inhibit the recognition and funding of research in health and bioinformatics in Canada and elsewhere. Some of these issues are common to both health and bioinformatics. The overlap in prevailing definitions, research concerns and methodological content in the respective domains suggest that common research needs should be better identified and reinforced for the benefit of both.
Privacy Enhancing Techniques
Authors: Claerhout B. , De Meyer F. , De Moor G. J. E.
Published: March 2018

Objectives: To introduce some of the privacy protection problems related to genomics based medicine and to highlight the relevance of Trusted Third Parties (TTPs) and of Privacy Enhancing Techniques (PETs) in the restricted context of clinical research and statistics.

Methods: Practical approaches based on two different pseudonymisation models, both for batch and interactive data collection and exchange, are described and analysed.

Results and Conclusions: The growing need of managing both clinical and genetic data raises important legal and ethical challenges. Protecting human rights in the realm of privacy, while optimising research potential and other statistical activities is a challenge that can easily be overcome with the assistance of a trust service provider offering advanced privacy enabling/enhancing solutions. As such, the use of pseudonymisation and other innovative Privacy Enhancing Techniques can unlock valuable data sources.
Integr8: Enhanced Inter-Operability of European Molecular Biology Databases
Authors: Morris L. , Hermjakob H. , Apweiler R. , Kersey P. J.
Published: March 2018

Objectives: The increasing production of molecular biology data in the post-genomic era, and the proliferation of databases that store it, require the development of an integrative layer in database services to facilitate the synthesis of related information. The solution of this problem is made more difficult by the absence of universal identifiers for biological entities, and the breadth and variety of available data. Methods: Integr8 was modelled using UML (Universal Modelling Language). Integr8 is being implemented as an n-tier system using a modern object-oriented programming language (Java). An object-relational mapping tool, OJB, is being used to specify the interface between the upper layers and an underlying relational database.

Results: The European Bioinformatics Institute is launching the Integr8 project. Integr8 will be an automatically populated database in which we will maintain stable identifiers for biological entities, describe their relationships with each other (in accordance with the central dogma of biology), and store equivalences between identified entities in the source databases. Only core data will be stored in Integr8, with web links to the source databases providing further information.

Conclusions: Integr8 will provide the integrative layer of the next generation of bioinformatics services from the EBI. Web-based interfaces will be developed to offer gene-centric views of the integrated data, presenting (where known) the links between genome, proteome and phenotype.
Tele-Affiliation in Medical Education: Experience from the International Program at Yale Office of Telemedicine
Authors: Condos S. G. , Selles J. M. , Merrell R. C. , Stamkopoulos T.
Published: March 2018

Objectives: Telemedicine is developed in response to the needs of users that results in a more viable model. Yale has developed a process called tele-affiliation to combine services that are customized to the international client’s needs.

Methods: Several defined steps compose the tele-affiliation process. The Yale-Greece telemedicine program is used as an illustration of this process. Some of the programs developed in response to Greek needs include breast cancer clinics, women’s health clinics and tele-homecare monitoring for post-operative and chronically ill patients.

Results: Tele-affiliation creates an infrastructure that has the potential to change the method of health care delivery. By using the infrastructure created by the tele-affiliation process, templates for disease management, as well as health promotion and education can be delivered to a global audience.

Conclusions: A tele-affiliation education environment has been developed and tested between Yale University School of Medicine and Greece resulting in an improved infrastructure for health education and management.
Development of a Regional Health Care Network and the Effect of Knowledge Intensive Work on Personnel and Organisation
Authors: Itkonen P.
Published: March 2018

Objectives: a) To present a regional health care communication system developed in the North Karelia Hospital District with the help of two EU funded information technology projects namely the TERVE project (1) which was implemented at the national level financed by the regional subsidy 6 of the ERDF and the CHIN project (2) that was implemented at the European level. b) To present the questions and issues that arose when implementing new technologies in a regional health care environment.

Results: Transformations in information technology are usually parts of other organisational transformations in health care. As a result of these issues, implementation of great information technology transformations has failed because of too strong a technology emphasis, insufficent participative touch and underestimation of social factors. Another result is that there is a cultural shock for physicians working in organisations where there are networks rather than hierarchies and relationships are predominantly contractual rather than professional.

Conclusions: The effectiveness, productivity and profitability of the hospitals will be decisively dependent on information technology as well as its regional applications. Transformations in information technology are parts of other organisational transformations in health care, and can induce cultural shocks for physicians since the networked environment has a different philosophy than the hierarchy-based environment which was the case until recently. Finally, in a taxation based system, one key requirement is to understand that the network contacts and the time spent on networks must bring additional value to health care.
Extensions to the HISA Standard – the SynEx Computing Environment
Authors: Jung B. , van Mulligen E. M. , van Ginneken A. , Pardon S. , Sottile P. A. , Grimson W.
Published: March 2018

Objectives: This paper reports on the integration work required to support the delivery of healthcare. Specifically, four elements are included being: the DHE (a standards based distributed healthcare environment), Synapses which is a patient record server, XML as a technology to deliver records, and finally two client applications that facilitate structured data entry (SDE) and the remote booking of specialist services. Methods: A general motivation for the work is presented and augmented on hand of a clinical scenario. Additionally, the adoption of a middleware approach is reviewed. The role of computerised patient records is described followed by an account of a federated record server. The approach favoured by standards bodies in utilising XML is covered and the tailoring to suit the needs of the integration is explained. The main practical challenges in achieving integration are presented, one of these being the mapping between the DHE data model and the Synapses server record architecture.

Results: The described environment has been demonstrated to provide the functionality that is required and in addition it has been shown that the engineering challenges can be met in a controlled and orderly manner.

Conclusions: The role of the DHE middleware component acting as an ‘anchor’ has been shown to be a valid one onto which other specialised components can be added to provide a richer service environment. Additionally, it has been demonstrated that XML is a good candidate technology that facilitates connectivity to client applications over an extranet. The demands inherent in both the clinical scenario and the computerised patient record can be met by the computing environment described in the paper.
Automated Nasopharyngeal Carcinoma Detection with Dynamic Gadolinium-Enhanced MR Imaging
Authors: Hsu C.-C. , Lai P.-H. , Huang W.-C. , Lee C.
Published: March 2018

Objectives:
The purpose of this research is to develop an automatic medical diagnosis for segmenting nasopharyngeal carcinoma (NPC) with dynamic gadolinium-enhanced MR imaging.

Methods:
This system is a multistage process, involving motion correction, head mask generation, dynamic MR data quantitative evaluation, rough segmentation, and rough segmentation refinement. Two approaches, a relative signal increase method and a slope method, are proposed for the quantitative evaluation of dynamic MR data.

Results:
The NPC detection results obtained using the proposed methods had a rating of 85% in match percent compared with these lesions identified by an experienced radiologist. The match percent for the two proposed methods did not have significant differences. However, the computation cost for the slope method was about twelve times faster than the relative signal increase method.

Conclusions:
The proposed methods can identify the NPC regions quickly and effectively. This system can enhance the performance of clinical diagnosis.
Towards Cooperative Patient Management Through Organizational and Medical Ontologies
Authors: Dazzi L. , Lanzola G. , Quaglini S. , Saracco R. , Stefanelli M. , Falasconi S.
Published: March 2018

Within knowledge and data engineering a new research paradigm is emerging based on the Multi-Agent System (MAS) architectural framework, allowing human and software agents to interoperate and thus cooperate within common application areas. In such a framework, knowledgeable agents of heterogeneous nature, that possess diverse but at least partially compatible or inter-translatable conceptual views, or ontologies, modeling both their own expertise and the external environment, make somehow available their information resources or problem-solving abilities for cooperative processes addressing the construction of a new agent or the achievement of some common goal through a correlated execution of tasks.

In this paper, we restrict our analysis to the case of an organization of cognitive agents, illustrated with examples from a prototypical healthcare MAS, that is, a so-called Distributed Healthcare Information System (D-HIS). The prototype makes use of an ontological library written in the standard language Ontolingua. An ongoing application of the methodology to the main problem of Clinical Practice Guidelines (GLs) computer-based dissemination and enforcement is described.
Formal Classification of Medical Concept Descriptions: Graph-Oriented Operators
Authors: Schoop D. , Bernauer J.
Published: March 2018

A crucial component of a medical concept representation system is the classifier. It requires features that are not sufficiently supported by current logic based formalisms like description logics and conceptual graphs. Those features are, for instance, the representation of partitive and spatial relations and their impact on sUbsumption. This paper introduces graph oriented classification operators for a concept representation language with normal forms. Emphasis is on the separation of generic and partitive relations and on the mutual interdependence of sUbsumption and part-whole. For that purpose operators are given for formal subsumption, formal part-whole, subsumptive part-whole and part-sensitive subsumption. These operators are based on the formal structure of concept descriptions and on explicitly introduced generic and partitive relationships between their constituents.
How Groups Co-ordinate their Concepts and Terminology: Implications for Medical Informatics
Authors: Garrod S.
Published: March 2018

Conceptual and terminological systems are established and maintained by the communities who use them. This paper reports experiments which investigate the role of communication and interaction in the process. The experiments show that isolated pairs of communicators and virtual communities of interacting pairs naturally converge on their own conceptual and terminological systems when confronted with a common task. The results also indicate that the system converged on is optimal for that particular group engaged in that particular task. These findings are discussed in relation to the increasing use of tightly coordinated medical teams and its implications for getting them to adopt standardized medical terminologies.