Plasma proteins elevated in severe asthma despite oral steroid use and unrelated to Type-2 inflammation

Rationale Asthma phenotyping requires novel biomarker discovery. Objectives To identify plasma biomarkers associated with asthma phenotypes by application of a new proteomic panel to samples from two well-characterised cohorts of severe (SA) and mild-to-moderate (MMA) asthmatics, COPD subjects and healthy controls (HCs). Methods An antibody-based array targeting 177 proteins predominantly involved in pathways relevant to inflammation, lipid metabolism, signal transduction and extracellular matrix was applied to plasma from 525 asthmatics and HCs in the U-BIOPRED cohort, and 142 subjects with asthma and COPD from the validation cohort BIOAIR. Effects of oral corticosteroids (OCS) were determined by a 2-week, placebo-controlled OCS trial in BIOAIR, and confirmed by relation to objective OCS measures in U-BIOPRED. Results In U-BIOPRED, 110 proteins were significantly different, mostly elevated, in SA compared to MMA and HCs. 10 proteins were elevated in SA versus MMA in both U-BIOPRED and BIOAIR (alpha-1-antichymotrypsin, apolipoprotein-E, complement component 9, complement factor I, macrophage inflammatory protein-3, interleukin-6, sphingomyelin phosphodiesterase 3, TNF receptor superfamily member 11a, transforming growth factor-β and glutathione S-transferase). OCS treatment decreased most proteins, yet differences between SA and MMA remained following correction for OCS use. Consensus clustering of U-BIOPRED protein data yielded six clusters associated with asthma control, quality of life, blood neutrophils, high-sensitivity C-reactive protein and body mass index, but not Type-2 inflammatory biomarkers. The mast cell specific enzyme carboxypeptidase A3 was one major contributor to cluster differentiation. Conclusions The plasma proteomic panel revealed previously unexplored yet potentially useful Type-2independent biomarkers and validated several proteins with established involvement in the pathophysiology of SA

Analysis of Barriers to the Deployment of Health Information Systems: a Stakeholder Perspective

© 2018 The Author(s). This paper argues that the cross-analysis of barriers with stakeholders provides a richer picture than analyzing the barriers on their own, as most of the literature in this area does. To test this hypothesis, we used the data from 33 interviews across 19 different types of stakeholders that were involved in a telemedicine system for the Chronically-ill Patient. Our findings show encouraging results. For instance, it was found that the group of stakeholders who are directly related to the governance and policy-making identified most of the barriers. This finding may imply that this group is more aware of the challenges when implementing HIS, or it may suggest that this group poses more resistance due to the current economic and Organizational models in health care. It was also found that some barriers are cited by all stakeholders whereas others not, suggesting that some barriers may be more relevant than others

International perspectives and initiatives

This article introduces a new column which will explore the way different regions and nation states are dealing with the challenges of managing health information. The intention is to draw together trends which are relevant to both health science librarians and health informatics professionals. This inaugural piece maps out the territory. It provides a rationale for the column, along with evidence of current initiatives to articulate a global perspective on the application of communication and information technologies to health information

Contrasting ERP infusion and absorption capacities between transition and developed economies from the CEE region

This paper investigates IT value creation in transition and developed economies in Central and Eastern Europe. Using absorptive capacity theory and data envelopment analysis, we view business process transformation in ERP adoption as an economic production process. Data analysis suggests that the "sum of history" shapes adoption performance of firms, meaning that transition economies may suffer from less developed absorptive capacities in regard to IT and therefore face a greater challenge in ERP utilisation

Frequent exacerbators - a distinct phenotype of severe asthma

Background: Exacerbations represent a major source of morbidity and mortality in asthma and are a prominent feature of poorly controlled, difficult-to-treat disease. Objective: The goal of our study was to provide a detailed characterization of the frequent exacerbator phenotype and to identify risk factors associated with frequent and seasonal exacerbations. Methods: Ninety-three severe asthmatics (SA) and 76 mild-to-moderate patients (MA) were screened and prospectively followed up for 1 year (NCT00555607). Medical history, baseline clinical data and biomarkers were used to assess risk factors for frequent exacerbations. Results: During the study, 104 exacerbations were recorded in the SA group and 18 in the MA. Frequent exacerbators were characterized by use of higher doses of inhaled (1700 vs. 800 μg) and oral (6.7 vs. 1.7 mg) glucocorticosteroids, worse asthma control (ACQ score 2.3 vs. 1.4), lower quality of life (SGRQ score 48.5 vs. 33.3), higher sputum eosinophils (25.7% vs. 8.2%) and a more rapid decline in FEV1/FVC ratio (-0.07 vs. -0.01 ΔFEV1/FVC, frequent vs. non-frequent, respectively, P < 0.05). Exhaled NO > 45 p.p.b. and a history of smoking were associated with an increased risk of frequent exacerbations (odds ratios: 4.32 and 2.90 respectively). Conclusion and Clinical Relevance: We were able to distinguish and characterize a subphenotype of asthma subjects - frequent exacerbators - who are significantly more prone to exacerbations. Patients with FeNO > 45 p.p.b. and a history of smoking are at increased risk of frequent exacerbations and require careful monitoring in clinical practice. © 2013 John Wiley & Sons Ltd