Safeguarding health data with enhanced accountability and patient awareness

Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits. In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.PhDCommittee Chair: Mustaque Ahamad; Committee Member: Douglas M. Blough; Committee Member: Ling Liu; Committee Member: Mark Braunstein; Committee Member: Wenke Le

実験的に口腔StreptococcusおよびVeillonella種のバイオフィルムを産生させるワイヤー法(The wire method for generating experimental biofilms formed by oral Streptococcus and Veillonella species)

口腔細菌のバイオフィルムを効果的に形成させる方法の確立を目的として、歯列矯正に汎用されるワイヤーを足場とする培養装置を調製し、これを用いて口腔細菌を培養し、バイオフィルムの形成を調べた。ワイヤーは直径0.9mm、長さ15cmのものを用い、両端にゴム栓および軟質プラスチック菅で固定化し装置を調製し滅菌した。これをStreptococcusおよびVeillonella種の口腔細菌を培養した培地中に挿入し、37℃、4日間の嫌気培養をすると、ワイヤー上にバイオフィルムが形成されることが認められた。定量的実時間PCRを用いて、これらのバイオフィルムにおけるそれぞれの細菌を同定し、その細菌数を定量した。このワイヤー法はin vitro実験によるバイオフィルム産生に有用な方法であり、虫歯、歯周病および全身感染症のような口腔感染とバイオフィルム形成の関連性を調べるための有力な実験材料を提供するものである。口腔細菌のバイオフィルムを効果的に形成させる方法の確立を目的として、歯列矯正に汎用されるワイヤーを足場とする培養装置を調製し、これを用いて口腔細菌を培養し、バイオフィルムの形成を調べた。ワイヤーは直径0.9mm、長さ15cmのものを用い、両端にゴム栓および軟質プラスチック菅で固定化し装置を調製し滅菌した。これをStreptococcusおよびVeillonella種の口腔細菌を培養した培地中に挿入し、37℃、4日間の嫌気培養をすると、ワイヤー上にバイオフィルムが形成されることが認められた。定量的実時間PCRを用いて、これらのバイオフィルムにおけるそれぞれの細菌を同定し、その細菌数を定量した。このワイヤー法はin vitro実験によるバイオフィルム産生に有用な方法であり、虫歯、歯周病および全身感染症のような口腔感染とバイオフィルム形成の関連性を調べるための有力な実験材料を提供するものである

Vascular Adhesion Protein-1 Blockade Suppresses Ocular Inflammation After Retinal Laser Photocoagulation in Mice

PURPOSE. To investigate the effect of the vascular adhesion protein-1 (VAP-1) inhibitor RTU-1096 on retinal morphologic changes and ocular inflammation after retinal laser photocoagulation in mice. METHODS. C57BL/6JJcl mice were fed a diet containing RTU-1096, a specific inhibitor for VAP-1, or a control diet ad libitum for 7 days. Laser photocoagulation was performed on the peripheral retina of the animals. The semicarbazide sensitive amine oxidase (SSAO) activities in plasma and chorioretinal tissues were measured. Optical coherence tomography (OCT) images were acquired before and at 1, 3, and 7 days after laser photocoagulation, and thickness of the individual retinal layers was measured. Intravitreal leukocyte infiltration was assessed by histologic analysis. The expression level of intercellular adhesion molecule-1 (ICAM-1) in retinal tissues were examined by quantitative real-time PCR. RESULTS. One day after laser photocoagulation, the thickness of the outer nuclear layer (ONL) increased in the laser group compared with in the control group, and RTU-1096 administration abrogated the ONL thickening. Histologic analysis and OCT observation revealed that laser photocoagulation caused infiltration of inflammatory cells and the appearance of hyperreflective foci at the vitreoretinal surface, both of which were suppressed by RTU-1096 administration. In addition, systemic administration of RTU-1096 reduced upregulation of the leukocyte adhesion molecules ICAM-1 in the retina. CONCLUSIONS. The current data indicate that VAP-1/SSAO inhibition may be a potential therapeutic strategy for the prevention of macular edema secondary to scatter laser photocoagulation in patients with ischemic retinal diseases such as diabetic retinopathy

Low levels of plasma endothelin-1 in patients with retinitis pigmentosa

Hiroshi Ohguro1, Yukihiko Mashima2, Mitsuru Nakazawa31Department of Ophthalmology, Sapporo Medical University School of Medicine, 2Department of Ophthalmology, Keio University School of Medicine, 3Department of Ophthalmology, Hirosaki University School of Medicine, JapanPurpose: The aim of this study was to elucidate the role of endothelin-1 (ET-1) in the pathophysiology of retinitis pigmentosa (RP).Methods: Plasma ET-1 levels and ophthalmic features in 50 RP patients were compared with those in 20 healthy-eye control subjects. Plasma ET-1 concentrations were determined using a commercially available enzyme-linked immunosorbent assay kit.Results: Mean plasma ET-1 levels of RP patients (1.88 ± 0.56 pg/mL) were significantly lower than those of control subjects (2.30 ± 0.30 pg/mL, Mann-Whitney’s U test; P < 0.01). However, ET-1 concentrations varied markedly in each patient. Among RP patients, a significant correlation of ET-1 concentrations was not observed in terms of its hereditary forms or other clinical factors.Conclusion: ET-1 may be important in the pathogenesis of RP, and measurement of its plasma concentrations may also contribute to additional insights into the retinal hemodynamics of RP.Keywords: endothelin-1, retinitis pigmentosa, retinal hemodynamic