Supporting patient screening to identify suitable clinical trials.

To support the efficient execution of post-genomic multi-centric clinical trials in breast cancer we propose a solution that streamlines the assessment of the eligibility of patients for available trials. The assessment of the eligibility of a patient for a trial requires evaluating whether each eligibility criterion is satisfied and is often a time consuming and manual task. The main focus in the literature has been on proposing different methods for modelling and formalizing the eligibility criteria. However the current adoption of these approaches in clinical care is limited. Less effort has been dedicated to the automatic matching of criteria to the patient data managed in clinical care. We address both aspects and propose a scalable, efficient and pragmatic patient screening solution enabling automatic evaluation of eligibility of patients for a relevant set of trials. This covers the flexible formalization of criteria and of other relevant trial metadata and the efficient management of these representations

Context matters: Explaining how and why mobilizing context influences motivational dynamics

The emphasis in the social-psychological collective action literature is on why individuals take part in collective action; however, it does not elaborate on how different mobilizing contexts may appeal to distinct motivational dynamics to participate. The present study connects the microlevel of motivational dynamics of individual protesters with the mesolevel of social movement characteristics. To do so a field study was conducted. Protesters were surveyed in the act of protesting in two different demonstrations in two different town squares simultaneously organized by two social movements at exactly the same time against the same budget cuts proposed by the same government. But with one fundamental difference, the movements emphasized different aspects of the policies proposed by the government. This most similar systems design created a unique natural experiment, which enabled the authors to examine whether the motivational dynamics of individual protesters are moderated by the social movement context. Previous research suggested an instrumental path to collective action, and the authors added an ideology path. The authors expected and found that power-oriented collective action appeals to instrumental motives and efficacy and that value-oriented collective action appeals to ideological motives, and, finally, that efficacy mediates on instrumental motives and motivational strength, but only so in power-oriented action. © 2009 The Society for the Psychological Study of Social Issues

iManageMyHealth and iSupportMyPatients: mobile decision support and health management apps for cancer patients and their doctors

Clinical decision support systems can play a crucial role in healthcare delivery as they promise to improve health outcomes and patient safety, reduce medical errors and costs and contribute to patient satisfaction. Used in an optimal way, they increase the quality of healthcare by proposing the right information and intervention to the right person at the right time in the healthcare delivery process. This paper reports on a specific approach to integrated clinical decision support and patient guidance in the cancer domain as proposed by the H2020 iManageCancer project. This project aims at facilitating efficient self-management and management of cancer according to the latest available clinical knowledge and the local healthcare delivery model, supporting patients and their healthcare providers in making informed decisions on treatment choices and in managing the side effects of their therapy. The iManageCancer platform is a comprehensive platform of interconnected mobile tools to empower cancer patients and to support them in the management of their disease in collaboration with their doctors. The backbone of the iManageCancer platform comprises a personal health record and the central decision support unit (CDSU). The latter offers dedicated services to the end users in combination with the apps iManageMyHealth and iSupportMyPatients. The CDSU itself is composed of the so-called Care Flow Engine (CFE) and the model repository framework (MRF). The CFE executes personalised and workflow oriented formal disease management diagrams (Care Flows). In decision points of such a Care Flow, rules that operate on actual health information of the patient decide on the treatment path that the system follows. Alternatively, the system can also invoke a predictive model of the MRF to proceed with the best treatment path in the diagram. Care Flow diagrams are designed by clinical experts with a specific graphical tool that also deploys these diagrams as executable workflows in the CFE following the Business Process Model and Notation (BPMN) standard. They are exposed as services that patients or their doctors can use in their apps in order to manage certain aspects of the cancer disease like pain, fatigue or the monitoring of chemotherapies at home. The mHealth platform for cancer patients is currently being assessed in clinical pilots in Italy and Germany and in several end-user workshops

Improved imputation quality of low-frequency and rare variants in European samples using the ‘Genome of The Netherlands'

Although genome-wide association studies (GWAS) have identified many common variants associated with complex traits, low-frequency and rare variants have not been interrogated in a comprehensive manner. Imputation from dense reference panels, such as the 1000 Genomes Project (1000G), enables testing of ungenotyped variants for association. Here we present the results of imputation using a large, new population-specific panel: the Genome of The Netherlands (GoNL). We benchmarked the performance of the 1000G and GoNL reference sets by comparing imputation genotypes with ‘true' genotypes typed on ImmunoChip in three European populations (Dutch, British, and Italian). GoNL showed significant improvement in the imputation quality for rare variants (MAF 0.05–0.5%) compared with 1000G. In Dutch samples, the mean observed Pearson correlation, r2, increased from 0.61 to 0.71. We also saw improved imputation accuracy for other European populations (in the British samples, r2 improved from 0.58 to 0.65, and in the Italians from 0.43 to 0.47). A combined reference set comprising 1000G and GoNL improved the imputation of rare variants even further. The Italian samples benefitted the most from this combined reference (the mean r2 increased from 0.47 to 0.50). We conclude that the creation of a large population-specific reference is advantageous for imputing rare variants and that a combined reference panel across multiple populations yields the best imputation results

Marketing, art and voices of dissent: promotional methods of protest art by the 2014 Hong Kong’s Umbrella Movement

Limited research exists around the interrelationships between protest camps and marketing practices. In this paper, we focus on the 2014 Hong Kong protest camps as a context where artistic work was innovatively developed and imaginatively promoted to draw global attention. Collecting and analyzing empirical data from the Umbrella Movement, our findings explore the interrelationships between arts marketing technologies and the creativity and artistic expression of the protest camps so as to inform, update and rethink arts marketing theory itself. We discuss how protesters used public space to employ inventive methods of audience engagement, participation and co-creation of artwork, together with media art projects which aimed not only to promote their collective aims but also to educate and inform citizens. While some studies have already examined the function of arts marketing beyond traditional and established artistic institutions, our findings offer novel insights into the promotional techniques of protest art within the occupied space of a social movement. Finally, we suggest avenues for future research around the artwork of social movements that could highlight creative and political aspects of (arts) marketing theory

Clinicopathological and molecular characterization of inflammatory breast cancer, the prospective INFLAME registry study

Inflammatory breast cancer (IBC) is rare, with challenging diagnostics and unfavorable outcomes. Therefore, more molecular insight into IBC is needed. The comprehensive Dutch prospective INFLAME registry related IBC follow-up and treatment to histopathology and molecular analysis. Of consecutive patients, nationwide identified with newly diagnosed IBC, clinicopathological, treatment and outcome data were collected. Histopathology and RNA-sequencing were related to outcome. 125 IBC patients were enrolled. Forty-one (34%) patients had HER2 +, and 31 (25%) had triple-negative IBC. The estimated 3-year OS was 78% in M0 IBC and 29% in M1. PFS was worst in triple-negative IBC (median 7.9 vs 16.3 and 15.8 months in M1 HER2+ and HR + /HER2- IBC). DFS and OS in M0 IBC were better with guideline-concordant trimodal therapy than without (HR 0.15 and 0.15; p = 0.000005 and 0.00038). The unique prospective INFLAME confirms unfavorable IBC characteristics and outcomes. International efforts may support guideline adherence and identify IBC-specific targets.</p

Increasing cardio-thoracic productivity at Erasmus MC

The Thoraxcenter of Erasmus MC started an improvement project in 2015 in order to increase the number of open-heart surgeries by 150 for three consecutive years (450 in total, +46%), and to decrease the access time from 12–14 to 2–3 weeks by the end of 2016. This was required to attain economy of scale in a highly competitive market. In this paper we describe the first year of the project, focusing on its structure and interventions taken, resulting in 165 additional open-heart surgeries carried out in 2016 and a significantly shorter access time of 2–3 weeks

Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care

BACKGROUND: Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). METHODS AND RESULTS: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between-hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between-hospital variation in outcomes was assessed using the variance of random hospital effects (tau2). In addition, we estimated the correlation between hospitals’ EVT-patient volume and (case-mix– adjusted) outcomes. Both early outcomes and case-mix characteristics varied significantly across hospitals. Between-hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case-mix adjustment (tau2=0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case-mix adjustment led to a decrease in variation between hospitals (tau2 decreases from 0.19 to 0.17). Hospitals’ EVT-patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores (r=0.48) and weakly with lower NIHSS score at 24 to 48 hours (r=0.15). CONCLUSIONS: Between-hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case-mix but not by patient volume. In contrast, between-hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT-patient volume but not by case-mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case-mix is applied for NIHSS score

A high-quality human reference panel reveals the complexity and distribution of genomic structural variants

Structural variation (SV) represents a major source of differences between individual human genomes and has been linked to disease phenotypes. However, the majority of studies provide neither a global view of the full spectrum of these variants nor integrate them into reference panels of genetic variation. Here, we analyse whole genome sequencing data of 769 individuals from 250 Dutch families, and provide a haplotype-resolved map of 1.9 million genome variants across 9 different variant classes, including novel forms of complex indels, and retrotransposition-mediated insertions of mobile elements and processed RNAs. A large proportion are previously under reported variants sized between 21 and 100 bp. We detect 4 megabases of novel sequence, encoding 11 new transcripts. Finally, we show 191 known, trait-associated SNPs to be in strong linkage disequilibrium with SVs and demonstrate that our panel facilitates accurate imputation of SVs in unrelated individuals