Luciana Tricai Cavalini

Use of XML Schema Definition for the Development of Semantically Interoperable Healthcare Applications

Multilevel modeling has been proven in software as a viable solution for semantic interoperability, without imposing any specific programming languages or persistence models. The Multilevel Healthcare Information Modeling MLHIM specifications have adopted the XML Schema Definition 1.1 as the basis for its reference implementation, since XML technologies are consistent across all platforms and operating systems, with tools available for all mainstream programming languages. In MLHIM, the healthcare knowledge representation is defined by the Domain Model, expressed as Concept Constraint Definitions CCDs, which provide the semantic interpretation of the objects persisted according to the generic Reference Model classes. This paper reports the implementation of the MLHIM Reference Model in XML Schema Definition language version 1.1 as well as a set of examples of CCDs generated from the National Cancer Institute --- Common Data Elements NCI CDE repository. The set of CCDs was the base for the simulation of semantically coherent data instances, according to independent XML validators, persisted on an eXistDB database. This paper shows the feasibility of adopting XML technologies for the achievement of semantic interoperability in real healthcare scenarios, by providing application developers with a significant amount of industry experience and a wide array of tools through XML technologies.

Knowledge engineering of healthcare applications based on minimalist multilevel models

The long-term maintenance of electronic health records within their original context of information is an ethical requirement that conflicts with the constant need to migrate the information into new systems as they are developed and improved. The specifics of every particular healthcare setting preclude the feasibility of a monolithic health record, and the achievement of interoperability between systems is the primary challenge faced by health informatics researchers. Different multilevel modeling approaches have been studied to deal with this complexity. Nevertheless, the original multilevel modeling specifications are targeted to the development of hospital-based electronic medical records, which adds complexity to the development of simpler purpose-specific applications for extra-hospital healthcare situations. This paper presents the knowledge engineering of a minimalist multilevel model that can be implemented by developers across the broader spectrum of healthcare applications. By using industry standard technologies, this approach enables the wider adoption of interoperable technology for healthcare.

Risk of urinary retention after nerve‐sparing surgery for deep infiltrating endometriosis: A systematic review and meta‐analysis

Recently, nerve‐sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta‐analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non‐NS) techniques.

Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro

BackgroundBrazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses.MethodsAnalysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews.ResultsIn the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak.ConclusionsBoth cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.

Providing Full Semantic Interoperability for the Fast Healthcare Interoperability Resources Schemas with Resource Description Framework

The Fast Healthcare Interoperability Resources (FHIR) is an open suite of specifications and software implementations of the Health Level 7 version 3 (HL7v3) standard. It has been proposed to provide a consistent API for the HL7v3 CDA. However, the core issues of HL7v3 are not solved at the API level. The community around the project are proposing the adoption of RDF technologies to overcome the current challenges in interoperating with linked data. However, RDF triples nor ontologies provide semantic interoperability by themselves, a more robust information infrastructure, such as the Multilevel Model-Driven (MMD) approach, is required. An XML implementation of the MMD was used to model the FHIR Schemas as Domain Models (DMs) against a generic Reference Model (RM) to provide syntactic validation. RDF triples were included in the domain models to provide missing semantics. The XML data instances were validated against their Domain Models. The DMs do not create any new types, they only express constraints of the RM types, this provides consistent query and data analysis capability across all DMs. RDF triples were extracted from the DMs and added to a triple store graph with the RM ontology. The XML data is also expressed as Literals in the graph. This study shows the feasibility of using MMD solutions to provide full operational semantic interoperability for the FHIR ecosystem.

Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations

Abstract. Objective To evaluate, using ultrasound, the distribution of abdominal fat in obese prepubertal children, as well as its possible correlation with metabolic changes due to obesity. Materials and Methods This was a cross-sectional study of prepubescent children: 77 obese children (33 girls and 44 boys), with a mean age of 7.31 years; and 31 normal-weight children (17 girls and 14 boys), with a mean age of 7.32 years. In all of the children, abdominal wall thickness (AWT) and abdominal fat thickness (AFT) were measured by ultrasound. For the evaluation of the associated metabolic alterations, serum levels of glycemia, HDL cholesterol, triglycerides, and insulin were determined. Results The obese children presented with greater abdominal fat, predominantly greater AWT, without a significant gender-related difference in AWT or AFT. The homeostasis model assessment of insulin resistance (HOMA-IR) showed a significant direct correlation with AWT and AFT. Conclusion In obese prepubertal children, the AWT, as measured by ultrasound, was shown to be more closely related to the HOMA-IR than to the lipid metabolism or glycemia.

Clinical Decision Support Systems and Advanced Diagnostic Imaging

Second, a longer time to graduation is an imperfect measure of academic performance. Often, students take longer to graduate for personal reasons, such as family events, health problems, or the birth of a child. The climate of support for students with disabilities is markedly different today than during the period studied by Searcy and colleagues. Some students with disabilities work deliberately with their advisors to plan for an extension of the academic program as a way of managing the health implications of their disabilities. The “right” time to graduation can vary across students for anticipated reasons and should be grounded in developing competency rather than meeting prescribed benchmarks. In light of these limitations, we hope that medical schools do not allow the results of this study to cloud the evaluation of otherwise qualified applicants with disabilities, but rather commit to providing appropriate accommodations and support. The study by Searcy and colleagues highlighted an important and rarely studied issue in medical education but fell short in addressing whether adequately accommodated medical students with disabilities can achieve the same success as their peers.