Trusted interoperability and the patient safety issues of parasitic health care software

With the proliferation of software systems and products in the healthcare environment, it is increasingly common for such software products to be constructed in a modular design. However, for modular software to be securely interoperable with other software products requires agreed consistent and accountable interfaces. This agreement may take the form of bilateral vendor to vendor arrangements or via a trusted external third-party who coordinates agreed interaction methods, such as a jurisdiction. Standards are a particular form of mutually trusted third party. Unfortunately, this agreed method of interoperability is not always present in vendor software. Where one software product or module interacts with another, in the absence of any agreement, it is referred to as ―bolt-on‖. It is perhaps more descriptive to refer to such software in terms of its potential to cause harm and refer to it using the biological analogy of ―parasitic‖ software and associated ―host‖ software. Analogous to biological systems, parasitic software can operate by data injection into or data extraction from, the associated host database. Both forms of parasitic software exploit access mechanisms or security flaws in the host software independent of the host vendor and in ways not intended or supported by the host vendor. This paper discusses the mechanics of this security vulnerability and more importantly, the potential adverse consequences to patient safety of such susceptibilities. As Australia moves to a national connected e-health system these issues are causes for grave concern. This paper provides a case study of this insecurity to highlight the problem, promote discussion and encourage potential change

Trusted interoperability and the patient safety issues of parasitic health care software

With the proliferation of software systems and products in the healthcare environment, it is increasingly common for such software products to be constructed in a modular design. However, for modular software to be securely interoperable with other software products requires agreed consistent and accountable interfaces. This agreement may take the form of bilateral vendor to vendor arrangements or via a trusted external third-party who coordinates agreed interaction methods, such as a jurisdiction. Standards are a particular form of mutually trusted third party. Unfortunately, this agreed method of interoperability is not always present in vendor software. Where one software product or module interacts with another, in the absence of any agreement, it is referred to as “bolt-on”. It is perhaps more descriptive to refer to such software in terms of its potential to cause harm and refer to it using the biological analogy of “parasitic” software and associated “host” software. Analogous to biological systems, parasitic software can operate by data injection into or data extraction from, the associated host database. Both forms of parasitic software exploit access mechanisms or security flaws in the host software independent of the host vendor and in ways not intended or supported by the host vendor. This paper discusses the mechanics of this security vulnerability and more importantly, the potential adverse consequences to patient safety of such susceptibilities. As Australia moves to a national connected e-health system these issues are causes for grave concern. This paper provides a case study of this insecurity to highlight the problem, promote discussion and encourage potential change

Avoiding epic fails: software and standards directions to increase clinical safety

The safety issues related to IT and software are gaining more exposure within the Healthcare industry. While software and computing was seen as a panacea to a range of preventable clinical errors, the introduction of healthcare IT has of itself presented patient safety issues. It is the inherently complex nature of healthcare, and its delivery, that creates increasing patient safety concerns in the application of IT and software. This position paper provides a collation of current work in international standards and highlights the drivers for the necessary change required to address patient safety in the use of healthcare IT software and systems. Software development and deployment has already altered and standards to oversee these are only just catching up. The need to revise such standards has been recognised and is underway, however a clash of cultures is delaying the emergence of Standards traditionally developed and governed by Standards Development Organisations (SDOs). The impact of this is that whilst standards are being informed by current software trends, the standards developers themselves are struggling to assimilate the rapid changes in the market. Whilst SDOs are cooperating more closely, there is an increased need for the involvement of the healthcare software development community and e-health informaticians in the standards process to narrow the gap in standards relevance. Such involvement would expand the currently narrow field of experts with the appropriate skills, background, knowledge, and experience in healthcare software risk analysis, security, privacy, and standards development

The oral microbiome and adverse pregnancy outcomes.

Significant evidence supports an association between periodontal pathogenic bacteria and preterm birth and preeclampsia. The virulence properties assigned to specific oral pathogenic bacteria, for example, Fusobacterium nucleatum, Porphyromonas gingivalis, Filifactor alocis, Campylobacter rectus, and others, render them as potential collaborators in adverse outcomes of pregnancy. Several pathways have been suggested for this association: 1) hematogenous spread (bacteremia) of periodontal pathogens; 2) hematogenous spread of multiple mediators of inflammation that are generated by the host and/or fetal immune response to pathogenic bacteria; and 3) the possibility of oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. As periodontal disease is, for the most part, preventable, the medical and dental public health communities can address intervention strategies to control oral inflammatory disease, lessen the systemic inflammatory burden, and ultimately reduce the potential for adverse pregnancy outcomes. This article reviews the oral, vaginal, and placental microbiomes, considers their potential impact on preterm labor, and the future research needed to confirm or refute this relationship

Azelastine hydrochloride, a dual-acting anti-inflammatory ophthalmic solution, for treatment of allergic conjunctivitis

Over 50% of patients who seek treatment for allergies present with ocular symptoms. Our current ability to control ocular allergic symptoms is greater than ever before. Newer dual-acting topical eyedrops attack multiple facets of the allergic cascade. Azelastine has antihistaminic effects providing immediate relief, mast cell stabilization providing early-phase intervention, and inhibition of expression and activation of anti-inflammatory mediators which characterize the late phase of the immune reaction. The ophthalmic eyedrop formulation is approved for treatment of allergic conjunctivitis in adults and children aged over 3 years. In clinical trials comparing azelastine with other dual-acting eyedrops, such as levocabastine and olopatadine, azelastine was reported to be slightly less efficacious and to sting briefly upon administration. Even so, many patients experienced the full benefit of symptom relief, and preferred azelastine. As a broad-spectrum drug, azelastine offers many desirable properties for management of ocular allergies. Because it can often produce maximal effect with just twice-daily dosing, azelastine is a particularly good choice for the allergic population in whom minimizing exposure to topical products and preservatives is a key concern

Synthesis of a new vanadyl(IV) complex with trehalose (TreVO): insulin-mimetic activities in osteoblast-like cells in culture

Vanadium compounds show interesting biological and pharmacological properties. Some of them display insulin-mimetic effects and others produce antitumor actions. The bioactivity of vanadium is present in inorganic species like the vanadyl(IV) cation or vanadate( V) anion. Nevertheless, the development of new vanadium derivatives with organic ligands which improve the beneficial actions and decrease the toxic effects is of great interest. On the other hand, the mechanisms involved in vanadium bioactivity are still poorly understood. A new vanadium complex of the vanadyl(IV) cation with the disaccharide trehalose (TreVO), Na6 [VO(Tre)2].4H2O, here reported, shows interesting insulin- mimetic properties in two osteoblast cell lines, a normal one (MC3T3E1) and a tumoral one (UMR106). The complex affected the proliferation of both cell lines in a different manner. On tumoral cells, TreVO caused a weak stimulation of growth at 5 lM but it inhibited cell proliferation in a dose-response manner between 50 and 100 lM. TreVO significantly inhibited UMR106 differentiation (15–25% of basal) in the range 5–100 lM. On normal osteoblasts, TreVO behaved as a mitogen at 5–25 lM. Different inhibitors of the MAPK pathway blocked this effect. At higher concentrations (75–100 lM), the complex was a weak inhibitor of the MC3T3E1 proliferation. Besides, TreVO enhanced glucose consumption by a mechanism independent of the PI3-kinase activation. In both cell lines, TreVO stimulated the ERK phosphorylation in a dose- and time-dependent manner. Different inhibitors (PD98059, wortmannin, vitamins C and E) partially decreased this effect, which was totally inhibited by their combination. These results suggest that TreVO could be a potential candidate for therapeutic treatments

Synthesis of a new vanadyl(IV) complex with trehalose (TreVO): insulin-mimetic activities in osteoblast-like cells in culture

Vanadium compounds show interesting biological and pharmacological properties. Some of them display insulin-mimetic effects and others produce antitumor actions. The bioactivity of vanadium is present in inorganic species like the vanadyl(IV) cation or vanadate( V) anion. Nevertheless, the development of new vanadium derivatives with organic ligands which improve the beneficial actions and decrease the toxic effects is of great interest. On the other hand, the mechanisms involved in vanadium bioactivity are still poorly understood. A new vanadium complex of the vanadyl(IV) cation with the disaccharide trehalose (TreVO), Na6 [VO(Tre)2].4H2O, here reported, shows interesting insulin- mimetic properties in two osteoblast cell lines, a normal one (MC3T3E1) and a tumoral one (UMR106). The complex affected the proliferation of both cell lines in a different manner. On tumoral cells, TreVO caused a weak stimulation of growth at 5 lM but it inhibited cell proliferation in a dose-response manner between 50 and 100 lM. TreVO significantly inhibited UMR106 differentiation (15–25% of basal) in the range 5–100 lM. On normal osteoblasts, TreVO behaved as a mitogen at 5–25 lM. Different inhibitors of the MAPK pathway blocked this effect. At higher concentrations (75–100 lM), the complex was a weak inhibitor of the MC3T3E1 proliferation. Besides, TreVO enhanced glucose consumption by a mechanism independent of the PI3-kinase activation. In both cell lines, TreVO stimulated the ERK phosphorylation in a dose- and time-dependent manner. Different inhibitors (PD98059, wortmannin, vitamins C and E) partially decreased this effect, which was totally inhibited by their combination. These results suggest that TreVO could be a potential candidate for therapeutic treatments.Facultad de Ciencias Exacta

Synthesis of a new vanadyl(IV) complex with trehalose (TreVO): insulin-mimetic activities in osteoblast-like cells in culture

Vanadium compounds show interesting biological and pharmacological properties. Some of them display insulin-mimetic effects and others produce antitumor actions. The bioactivity of vanadium is present in inorganic species like the vanadyl(IV) cation or vanadate( V) anion. Nevertheless, the development of new vanadium derivatives with organic ligands which improve the beneficial actions and decrease the toxic effects is of great interest. On the other hand, the mechanisms involved in vanadium bioactivity are still poorly understood. A new vanadium complex of the vanadyl(IV) cation with the disaccharide trehalose (TreVO), Na6 [VO(Tre)2].4H2O, here reported, shows interesting insulin- mimetic properties in two osteoblast cell lines, a normal one (MC3T3E1) and a tumoral one (UMR106). The complex affected the proliferation of both cell lines in a different manner. On tumoral cells, TreVO caused a weak stimulation of growth at 5 lM but it inhibited cell proliferation in a dose-response manner between 50 and 100 lM. TreVO significantly inhibited UMR106 differentiation (15–25% of basal) in the range 5–100 lM. On normal osteoblasts, TreVO behaved as a mitogen at 5–25 lM. Different inhibitors of the MAPK pathway blocked this effect. At higher concentrations (75–100 lM), the complex was a weak inhibitor of the MC3T3E1 proliferation. Besides, TreVO enhanced glucose consumption by a mechanism independent of the PI3-kinase activation. In both cell lines, TreVO stimulated the ERK phosphorylation in a dose- and time-dependent manner. Different inhibitors (PD98059, wortmannin, vitamins C and E) partially decreased this effect, which was totally inhibited by their combination. These results suggest that TreVO could be a potential candidate for therapeutic treatments.Facultad de Ciencias Exacta

Three new vanadyl(IV) complexes with non-steroidal anti-inflammatory drugs (Ibuprofen, Naproxen and Tolmetin) : Bioactivity on osteoblast-like cells in culture

The synthesis and spectral and magnetic characterization of VO(2+) complexes with Ibuprofen (2-(4-isobutylphenyl)propionic acid), Naproxen (6-methoxy-alpha-methyl-2-naphthalene acetic acid) and Tolmetin (1-methyl-5-(4-methylbenzoyl)-1H-pyrrole-2-acetic acid) were studied. The complexes [VO(Ibu)(2)] x 5CH(3)OH, [VO(Nap)(2)] x 5CH(3)OH and [VO(Tol)(2)] were obtained from methanolic solutions under nitrogen atmosphere. The biological activities of these complexes on the proliferation of two osteoblast-like cells in culture (MC3T3E1 and UMR106) were compared with that of the vanadyl(IV) cation. The complexes exhibited different effects depending on the concentration and the cellular type, while no effect was observed for their parent drugs.Facultad de Ciencias Exacta

Promoting medical students’ reflection on competencies to advance a global health equities curriculum

Abstract Background The move to frame medical education in terms of competencies – the extent to which trainees “can do” a professional responsibility - is congruent with calls for accountability in medical education. However, the focus on competencies might be a poor fit with curricula intended to prepare students for responsibilities not emphasized in traditional medical education. This study examines an innovative approach to the use of potential competency expectations related to advancing global health equity to promote students’ reflections and to inform curriculum development. Methods In 2012, 32 medical students were admitted into a newly developed Global Health and Disparities (GHD) Path of Excellence. The GHD program takes the form of mentored co-curricular activities built around defined competencies related to professional development and leadership skills intended to ameliorate health disparities in medically underserved settings, both domestically and globally. Students reviewed the GHD competencies from two perspectives: a) their ability to perform the identified competencies that they perceived themselves as holding as they began the GHD program and b) the extent to which they perceived that their future career would require these responsibilities. For both sets of assessments the response scale ranged from “Strongly Disagree” to “Strongly Agree.” Wilcoxon’s paired T-tests compared individual students’ ordinal rating of their current level of ability to their perceived need for competence that they anticipated their careers would require. Statistical significance was set at p < .01. Results Students’ ratings ranged from “strongly disagree” to “strongly agree” that they could perform the defined GHD-related competencies. However, on most competencies, at least 50 % of students indicated that the stated competencies were beyond their present ability level. For each competency, the results of Wilcoxon paired T-tests indicate – at statistically significant levels - that students perceive more need in their careers for GHD-program defined competencies than they currently possess. Conclusion This study suggests congruence between student and program perceptions of the scope of practice required for GHD. Students report the need for enhanced skill levels in the careers they anticipate. This approach to formulating and reflecting on competencies will guide the program’s design of learning experiences aligned with students’ career goals.http://deepblue.lib.umich.edu/bitstream/2027.42/109541/1/12909_2013_Article_919.pd