Marc Nyssen

Gene Expression Profiling of Early Hepatic Stellate Cell Activation Reveals a Role for Igfbp3 in Cell Migration

Background Scarring of the liver is the result of prolonged exposure to exogenous or endogenous stimuli. At the onset of fibrosis, quiescent hepatic stellate cells (HSCs) activate and transdifferentiate into matrix producing, myofibroblast-like cells. Aim and methods To identify key players during early HSC activation, gene expression profiling was performed on primary mouse HSCs cultured for 4, 16 and 64 hours. Since valproic acid (VPA) can partly inhibit HSC activation, we included VPA-treated cells in the profiling experiments to facilitate this search. Results Gene expression profiling confirmed early changes for known genes related to HSC activation such as alpha smooth muscle actin (Acta2), lysyl oxidase (Lox) and collagen, type I, alpha 1 (Col1a1). In addition we noticed that, although genes which are related to fibrosis change between 4 and 16 hours in culture, most gene expression changes occur between 16 and 64 hours. Insulin-like growth factor binding protein 3 (Igfbp3) was identified as a gene strongly affected by VPA treatment. During normal HSC activation Igfbp3 is up regulated and this can thus be prevented by VPA treatment in vitro and in vivo. siRNA-mediated silencing of Igfbp3 in primary mouse HSCs induced matrix metalloproteinase (Mmp) 9 mRNA expression and strongly reduced cell migration. The reduced cell migration after Igfbp3 knock-down could be overcome by tissue inhibitor of metalloproteinase (TIMP) 1 treatment. Conclusion Igfbp3 is a marker for culture-activated HSCs and plays a role in HSC migration. VPA treatment prevents Igfbp3 transcription during activation of HSCs in vitro and in vivo.

A Method for Detecting Behavior-Based User Profiles in Collaborative Ontology Engineering

Ontology engineering is far from trivial and most collaborative methods and tools start from a predefined set of rules, stakeholders can have in the ontology engineering process. We, however, believe that the different types of user behavior are not known a priori and depend on the ontology engineering project. The detection of such user profiles based on unsupervised learning allows finding roles and responsibilities along peers in a collaborative setting. In this paper, we present a method for automatic detection of user profiles in a collaborative ontology engineering environment by means of the K-means clustering algorithm only by looking at the type of interactions a user makes. In this paper we use the GOSPL ontology engineering tool and method to demonstrate this method. The data used to demonstrate the method stems from two ontology engineering projects involving respectively 42 and 36 users.

Using Togaf for Building a National Implementation Strategy for E-Health Services and Technologies in Burundi

In order to better align existing and future ICT implementations in the health domain with the strategic options defined by the National Plan for Health Development, the Ministry of Health (MoH) of Burundi initiated in 2014 the development of a national e-health enterprise architecture based on the TOGAF methodology. A first part of the development cycle consisted of a detailed analysis of regulatory documents and strategic plans related to the Burundian health system. In a second part, semi-structured interviews were organized with a representative sample of relevant MoH health structures. The study demonstrated the donor driven unequal distribution of hardware equipment over health administration components and health facilities. Internet connectivity remains problematic and few health oriented business applications found their way to the Burundian health system. Paper based instruments remain predominant in Burundi’s health administration. The study also identified a series of problems introduced by the uncoordinated development of health ICT in Burundi such as the lack of standardization, data security risks, varying data quality, inadequate ICT infrastructures, an unregulated e-health sector and insufficient human capacity. The results confirm the challenging situation of the Burundian health information system but they also expose a number of bright spots that provide hope for the future: a political will to reclaim MoH leadership in the health information management domain, the readiness to develop e-health education and training programs and the opportunity to capitalize the experiences with DHIS2 deployment, results based financing monitoring and hospital information management systems implementation.

A Photographic Method For The Tridimensional Reconstruction Of The Human Thorax

A method is presented for easy spatial reconstruction of the complete human thorax. Eight cameras are used to photograph the subject simultaneously. Position and orientation of the cameras is not critical and no alignment tool is needed as the use of a reference frame allows easy computerized determination of these parameters a posteriori. The eight photographs are digitized. Processing of the digitized data by computer results in the determination of the spatial coordinates of any arbitrary point on the thorax (such as characteristic bodymarks, electrodes, etc...). After axistransformation and representation in cylindrical coordinates, smoothing of these coordinates is realized with a special computer program using bicubic B-spline functions. Mathematical constraints for this program are provided by a set of anthropometrical measurements. In this way the complete thorax is reconstructed and an analytical function of the thorax surface is obtained. The model of the thorax, obtained with this cinematographical technique is validated by the results of axial tomography.

Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Background Worldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events. Objective The aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review. Results Of the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently. Conclusions Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also, the effect on patient outcomes and cost-effectiveness should be evaluated.

Detecting User Profiles in Collaborative Ontology Engineering Using a User’s Interactions

Collaborative ontology-engineering methods usually prescribe a set of processes, activities, stakeholders, and the roles each stakeholder plays in these activities. We, however, believe that (a) the stakeholder community of each ontology-engineering project is different, and (b) one can observe different types of user behavior. It may thus very well be that the prescribed set of stakeholder types and roles do not suffice. If one were able to identify these user behavior types, which we will call user profiles, one can compliment or revisit those predefined roles. For instance, those user profiles can be used to provide customized interfaces for optimizing activities in certain ontology-engineering projects. We present a method for discovering different user profiles based on the interactions users have with each other on a collaborative ontology-engineering environment. Our approach clusters users based on the types of interactions they perform, which are retrieved from datasets that were annotated with an interaction ontology—built on top of SIOC—that we have developed. We demonstrate our method using the database of two instances of the GOSPL ontology-engineering tool. The databases contain the interactions of two distinct ontology-engineering projects involving, respectively, 42 and 36 users. For each dataset, we discuss the findings by analyzing the different clusters. We found that we are able to discover different user profiles, indicating that the approach we have taken is viable, though more experiments are needed to validate the results and to discover patterns across ontology-engineering projects.

ICT-Enabled Universal Health Coverage Monitoring and Evaluation in Sub-Saharan Health Facilities: Study in 8 Reference Hospitals of Rwanda, Burundi, the Democratic Republic of Congo and Mali

UHC (Universal Health Coverage) is at the center of the Sustainable Development Agenda. In this study, the authors made an evaluation of the indicators allowing quantification of the impact of health coverage schemes on patients, applied in 4 sub-Saharan Africa countries: Rwanda, Burundi, the DRC (Democratic Republic of Congo) and Mali. After an analysis of potential health coverage indicators, the most relevant ones were calculated on the basis of patient administrative and health insurance data, collected via OpenClinic GA, an HIMS (health information management system) used in 8 sub-Saharan hospitals during the period 2010-2016. The results show that the PHSC (patient health services coverage) rate is highest (81.5%-92.7%) in the 2 hospitals of Rwanda and in 2 hospitals of Burundi (37.7%-77.7%). The PHSP (patient health service payment) rate as the proportion of costs paid by the patient versus total health service costs is below the 25% threshold recommended by WHO only for the 2 hospitals in Rwanda. The POOP (patient out-of-pocket) payment is below the threshold of 180USD per patient per year for all hospitals. The HIEXs (health insurance expenditures) are funded by the university private insurance (86% of expenses covered) in 2 university teaching hospitals in DRC, by CBHI (community based health insurance) (69%) in 2 hospitals in Rwanda, by the free care policy (77%) in 2 hospitals in Burundi and by the SHI (social health insurance) (100%) in the 2 hospitals in Mali. PHSC in the 8 reference hospitals reflects the national trend towards UHC in each country. With this study, we demonstrate the possibility to assess the degree of UHC in developing countries, by a methodology based on indicators calculated via information extraction from routine data in electronic health records.

An Architecture for Electronic Prescribing in Physiotherapy in Belgium

This paper describes the architecture designed for the introduction of the electronic physiotherapy prescription in Belgium. Based on the model for the ambulatory medication prescription, which is currently in a national roll-out phase, we constructed a model that takes into account the particularities of the physiotherapy domain as well as all legal regulations. We focus on key components of the project: the technical building blocks and the prescription content. We illustrate the data-flow and use-case with two specific examples comprising both the normal physiotherapy prescribing situation as well as more complex situations where missing information are dealt with. Furthermore, we elaborate on the implementation and patient involvement.

Building а National Clinical Data Warehouse

Turkey has created an e-health vision along with the Health Transformation Program. In this framework, standard coding systems such as standard definitions of the institutions, databank of healthcare providers, standard disease, drug and medical supplies classifications have been developed and a national clinical data warehouse (Health-NET) was established. Health-NET is an integrated, safe, fast and expandable health information system which aims to improve efficiency and quality of health services by collecting all kinds of data produced in the health institutions in line with the standards and generating information adequate for all stakeholders of the collected data.

The Application of PEST Analysis to the Creation of the Profile of na IT Product Designed to Activate and Support Senior Citizens in Poland

The purpose of the paper is to create a profile of an IT product, using IT tools to collect and to analyse information and enable communication between elderly people to support and activate them. PEST Analysis method was used to determine different factors of influence on the domain of elderly people activation and support Having evaluated the factors and defined the product characteristics, the Authors focused on defining the profile of the IT product by referring the aforementioned characteristics to the structure of the product in the marketing understanding thereof.