Towards Open Information Management in Health Care

The utilization of information technology as tool in health care is increasing. The main benefits stem from the fact that information in electronic form can be transferred to different locations rapidly and from the possibility to automate certain information management tasks. The current technological approach for this automation relies on structured, formally coded representation of information. We discuss the limitations of the current technological approach and present a viewpoint, grounded on previous research and the authors’ own experiences, on how to progress. We present that a bottleneck in the automation of the management of constantly evolving clinical information is caused by the fact that the current technological approach requires the formal coding of information to be static in nature. This inherently hinders the expandability of the information case space to be managed. We present a new paradigm entitled open information management targeting unlimited case spaces. We also present a conceptual example from clinical medicine demonstrating open information management principles and mechanisms

Lymphatic endothelium stimulates melanoma metastasis and invasion via MMP14-dependent Notch3 and b1-integrin activation

Lymphatic invasion and lymph node metastasis correlate with poor clinical outcome in melanoma. However, the mechanisms of lymphatic dissemination in distant metastasis remain incompletely understood. We show here that exposure of expansively growing human WM852 melanoma cells, but not singly invasive Bowes cells, to lymphatic endothelial cells (LEC) in 3D co-culture facilitates melanoma distant organ metastasis in mice. To dissect the underlying molecular mechanisms, we established LEC co-cultures with different melanoma cells originating from primary tumors or metastases. Notably, the expansively growing metastatic melanoma cells adopted an invasively sprouting phenotype in 3D matrix that was dependent on MMP14, Notch3 and β1-integrin. Unexpectedly, MMP14 was necessary for LEC-induced Notch3 induction and coincident β1-integrin activation. Moreover, MMP14 and Notch3 were required for LEC-mediated metastasis of zebrafish xenografts. This study uncovers a unique mechanism whereby LEC contact promotes melanoma metastasis by inducing a reversible switch from 3D growth to invasively sprouting cell phenotype

Is Diversity the Missing Link in Coastal Fisheries Management?

Fisheries management has historically focused on the population elasticity of target fish based primarily on demographic modeling, with the key assumptions of stability in environmental conditions and static trophic relationships. The predictive capacity of this fisheries framework is poor, especially in closed systems where the benthic diversity and boundary effects are important and the stock levels are low. Here, we present a probabilistic model that couples key fish populations with a complex suite of trophic, environmental, and geomorphological factors. Using 41 years of observations we model the changes in eastern Baltic cod (Gadus morhua), herring (Clupea harengus), and Baltic sprat (Sprattus sprattus balticus) for the Baltic Sea within a Bayesian network. The model predictions are spatially explicit and show the changes of the central Baltic Sea from cod-to sprat-dominated ecology over the 41 years. This also highlights how the years 2004 to 2014 deviate in terms of the typical cod–environment relationship, with environmental factors such as salinity being less influential on cod population abundance than in previous periods. The role of macrozoobenthos abundance, biotopic rugosity, and flatfish biomass showed an increased influence in predicting cod biomass in the last decade of the study. Fisheries management that is able to accommodate shifting ecological and environmental conditions relevant to biotopic information will be more effective and realistic. Non-stationary modelling for all of the homogeneous biotope regions, while acknowledging that each has a specific ecology relevant to understanding the fish population dynamics, is essential for fisheries science and sustainable management of fish stocks

Modelling spatial patterns in host-associated microbial communities

Microbial communities exhibit spatial structure at different scales, due to constant interactions with their environment and dispersal limitation. While this spatial structure is often considered in studies focusing on free-living environmental communities, it has received less attention in the context of host-associated microbial communities or microbiota. The wider adoption of methods accounting for spatial variation in these communities will help to address open questions in basic microbial ecology as well as realize the full potential of microbiome-aided medicine. Here, we first overview known factors affecting the composition of microbiota across diverse host types and at different scales, with a focus on the human gut as one of the most actively studied microbiota. We outline a number of topical open questions in the field related to spatial variation and patterns. We then review the existing methodology for the spatial modelling of microbiota. We suggest that methodology from related fields, such as systems biology and macro-organismal ecology, could be adapted to obtain more accurate models of spatial structure. We further posit that methodological developments in the spatial modelling and analysis of microbiota could in turn broadly benefit theoretical and applied ecology and contribute to the development of novel industrial and clinical applications.Peer reviewe

A Single Visualization Technique for Displaying Multiple Metabolite-Phenotype Associations.

To assist with management and interpretation of human metabolomics data, which are rapidly increasing in quantity and complexity, we need better visualization tools. Using a dataset of several hundred metabolite measures profiled in a cohort of ~1500 individuals sampled from a population-based community study, we performed association analyses with eight demographic and clinical traits and outcomes. We compared frequently used existing graphical approaches with a novel 'rain plot' approach to display the results of these analyses. The 'rain plot' combines features of a raindrop plot and a conventional heatmap to convey results of multiple association analyses. A rain plot can simultaneously indicate effect size, directionality, and statistical significance of associations between metabolites and several traits. This approach enables visual comparison features of all metabolites examined with a given trait. The rain plot extends prior approaches and offers complementary information for data interpretation. Additional work is needed in data visualizations for metabolomics to assist investigators in the process of understanding and convey large-scale analysis results effectively, feasibly, and practically

Polygenic Risk Scores Predict Hypertension Onset and Cardiovascular Risk

Although genetic risk scores have been used to predict hypertension, their utility in the clinical setting remains uncertain. Our study comprised N=218 792 FinnGen participants (mean age 58 years, 56% women) and N=22 624 well-phenotyped FINRISK participants (mean age 50 years, 53% women). We used public genome-wide association data to compute polygenic risk scores (PRSs) for systolic and diastolic blood pressure (BP). Using time-to-event analysis, we then assessed (1) the association of BP PRSs with hypertension and cardiovascular disease (CVD) in FinnGen and (2) the improvement in model discrimination when combining BP PRSs with the validated 4- and 10-year clinical risk scores for hypertension and CVD in FINRISK. In FinnGen, compared with having a 20 to 80 percentile range PRS, a PRS in the highest 2.5% conferred 2.3-fold (95% CI, 2.2-2.4) risk of hypertension and 10.6 years (95% CI, 9.9-11.4) earlier hypertension onset. In subgroup analyses, this risk was only 1.6-fold (95% CI, 1.5-1.7) for late-onset hypertension (age >= 55 years) but 2.8-fold (95% CI, 2.6-2.9) for early-onset hypertension (agePeer reviewe

Työttömän työelämävalmiuksien tukeminen viranomaisverkostossa

Artikkelissa kuvataan työttömän hyvinvointiin liittyvää moninaista viranomaisverkostoa sekä viranomaisyhteistyön tilaa työttömän terveyden ja työ- ja toimintakyvyn edistämisessä. Artikkeli perustuu Kuopiossa vuosina 2008–2010 toteutetun Työterveysneuvontahankkeen alkukartoitukseen ja siihen liittyvän teemahaastatteluaineiston sekä verkostoanalyysin tuloksiin. Tulosten perusteella verkostoituminen työttömän työelämävalmiuksia tukevassa viranomaistoiminnassa on vielä alkuvaiheessa, mutta verkostotyön kehittämistä pidetään tärkeänä. Perusterveydenhuollon vastaanottotoimintaa ja työterveyshuoltoa pidetään merkittävinä mutta verkoston ulkopuolisina yhteistyökumppaneina. Terveydenhuolto on työttömän työelämävalmiuksia tukevan verkoston kehittämisessä jäljessä muita sidosryhmiä. Kehittämiskohteiksi mainittiin eri organisaatioiden toimintaan tutustuminen, tiedottamisen lisääminen sekä niukat aikaresurssit. Työterveyshuollon rooli työttömän työelämävalmiuksia tukevassa verkostossa ei ole vakiintunut, vaikka työterveyshuollon erikoisosaaminen on eduksi työkyvyn arvioinnissa, ylläpidossa ja edistämisessä, varhaisessa puuttumisessa työn riskitekijöihin ja kuntoutukseen ohjaamisessa. Perusterveydenhuollon ja työterveyshuollon välillä tehtiin yhteistyötä monissa asiakkaiden asioissa, mutta kehittämisen tarvetta nähdään edelleen

Review of the research knowledge and gaps on fish populations, fisheries and linked ecosystems in the Central Arctic Ocean (CAO)

This report presents a review of the research knowledge and gaps on fish populations, fisheries and linked ecosystems in the Central Arctic Ocean (CAO). The CAO comprises the deep basins of the Arctic Ocean beyond the shelf break, which largely overlap with the High Seas of the Arctic Ocean, i.e. the marine areas outside the Exclusive Economic Zones (EEZs) of the Arctic coastal nations. The authors of the report are members of the European Fisheries Inventory in the Central Arctic Ocean (EFICA) Consortium. This study was funded by the European Commission as an EU contribution to the international cooperation within the Agreement to Prevent Unregulated High Seas Fisheries in the Central Arctic Ocean. The report contains desk-based research, using scientific research data bases as well as any available research performed by the EFICA Consortium partners and EU institutions or others. In Chapters 2-8 the authors review the literature and identify specific knowledge gaps. The gap analyses involve comparisons of actual knowledge with desired knowledge on the fish stocks of the CAO to be able to evaluate possibilities for future sustainable fisheries in the area. Chapter 1 is an introductory chapter, and Chapter 9 presents a holistic gap analysis based on Chapters 2-8 and recommendations for research priorities and the next steps. The critical gap analysis highlights that the knowledge gaps for the CAO are enormous and obstruct any quantitative analyses of its fish stocks. This agrees with the conclusions from the Fifth FiSCAO Report (FiSCAO 2018). While data for the physical environment in the CAO (oceanography, bottom topography and ice-cover dynamics) would be sufficient for fish stock modelling and assessment, there is a massive lack of biological and ecological data. The CAO is not a closed system and some aspects of the shelf seas are of high relevance for the CAO, notably connectivity of fish stocks and fish species moving north with climate warming. Scientific research and monitoring programs are established in the shelf seas, and new data are constantly being produced. Fish stock data are available from scientific projects and monitoring programs for some of the shelf seas (Barents Sea, Bering Sea, and to a lesser extent for the Beaufort Sea and the Chukchi Sea). Data exist also for the Russian shelf seas (Kara Sea, Laptev Sea, East Siberian Sea), but these data are not internationally available, while for the areas north of Canada/Greenland data are missing; they do not exist because of the severe ice conditions there. More data from all shelf seas may be hidden in reports that are not publicly accessible. We recommend to make current knowledge generally available by translating key publications and identification of valuable data reports. Research priorities comprise the collection and analysis of primary data in the CAO, and – to a limited extent – from adjacent waters through collaborations with other Signatories of the Agreement (e.g. on population genetics). Further research priorities include an evaluation of ecosystem vulnerability, social-ecological analyses, i.e. recognizing the close and often complex interactions between humans and nature, and recommendations for governance of the CAO. Fulfilling the 14 specific research priorities mentioned in Chapter 9 to “sufficient knowledge available” could enable the potential, future application of an Ecosystem Approach to Management for the CAO

Quantum biology on the edge of quantum chaos

We give a new explanation for why some biological systems can stay quantum coherent for long times at room temperatures, one of the fundamental puzzles of quantum biology. We show that systems with the right level of complexity between chaos and regularity can increase their coherence time by orders of magnitude. Systems near Critical Quantum Chaos or Metal-Insulator Transition (MIT) can have long coherence times and coherent transport at the same time. The new theory tested in a realistic light harvesting system model can reproduce the scaling of critical fluctuations reported in recent experiments. Scaling of return probability in the FMO light harvesting complex shows the signs of universal return probability decay observed at critical MIT. The results may open up new possibilities to design low loss energy and information transport systems in this Poised Realm hovering reversibly between quantum coherence and classicality

Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

IMPORTANCE: Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. OBJECTIVE: To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. INTERVENTIONS: Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). MAIN OUTCOMES AND MEASURES: The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. RESULTS: Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053). CONCLUSIONS AND RELEVANCE: Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879892