A stimulus to define informatics and health information technology

<p>Abstract</p> <p>Background</p> <p>Despite the growing interest by leaders, policy makers, and others, the terminology of health information technology as well as biomedical and health informatics is poorly understood and not even agreed upon by academics and professionals in the field.</p> <p>Discussion</p> <p>The paper, presented as a Debate to encourage further discussion and disagreement, provides definitions of the major terminology used in biomedical and health informatics and health information technology. For informatics, it focuses on the words that modify the term as well as individuals who practice the discipline. Other categories of related terms are covered as well, from the associated disciplines of computer science, information technolog and health information management to the major application categories of applications used. The discussion closes with a classification of individuals who work in the largest segment of the field, namely clinical informatics.</p> <p>Summary</p> <p>The goal of presenting in Debate format is to provide a starting point for discussion to reach a documented consensus on the definition and use of these terms.</p

Fresh Perspectives on Motivation, Engagement, and Identity : A Conclusion

Peer reviewe

Ecological Effects of Major Storms on Coastal Watersheds and Coastal Waters: Hurricane Bob on Cape Cod

Hurricane Bob, a category 3 storm, made landfall on Cape Cod in August 1991, and its effects on watersheds and adjoining estuaries were detected in the ongoing studies being caried out as part of the Waquoit Bay Land Margin Ecosystems Research project. On land, Bob had only minor overall effects on forests; localized wind bursts did snap and break trees in small and widely scattered forest parcels. Wind stripped up to half the leaves of deciduous trees and many herbaceous plants on the watershed, and most remaining leaves were damaged by salt, so that by the end of Aug, Cape Cod forests were defoliated. Damaged growing tips of exposed trees were evident for several growing seasons. The salt exposure was followed by a burst of growth and bloom in some plants during Sep-Oct. Forest invertebrates were disturbed by the storm. Nests of hornets and wasps, for example, were apparently destroyed and the survivors became a serious pest problem: hospital records show a ten-fold increase in cases of wasp stings just after Bob. Populations of these insects did not return to earlier abundance for several years. Birds and mammals did not appear to have suffered much damage. Leaching of salt to soils released previously-adsorbed soil ammonium. Such loss of critical nitrogen may be in part responsible for the characteristically dwarfed near-shore coastal forests, as well as adds nitrogen to groundwater that in turn transports the nitrogen to receiving waters. On the Bay, Bob thoroughly mixed the water column, but the stratification was restored within 1-2 days after passage of the storm. Short recovery times might be characteristic of shallow bays with short (2-3 d) water residence times. Bob opened a new inlet to Waquoit Bay, which remains open. The new inlet exerts only minor effects on circulation within the Bay, but did create localized damage to dune and eelgrass habitats near the new inlet. The mixing of the water column released major amounts of nutrients that were held within the macroalgal canopy and upper sediments, into the upper layers, and prompted a short-lived (2-3 d) phytoplankton bloom. Biomass of unattached macroalgae was not affected by Bob. Respiration and nitrogen content of the dominant macroalgal species were elevated after passage of the storm, but returned to normal rates after several days. Nearly all above-sediment eelgrass biomass was removed, but returned to previous biomass during the next growing season. There was no visible damage to fringing salt marsh habitats. Damage to aquatic animals appears to have been minimal. A small decrease in water temperature and increased respiration by macroalgae led to decreased total net ecosystem production and increased net ecosystem respiration, but the decreases disappeared after 2 d. The effects of Hurricane Bob seemed more intense and protracted on land than on aquatic ecosystems. Recovery from the various disturbances took hours to days in the aquatic system, but months to decades in terrestrial components. Rigid, larger organisms attached or rooted to substrates seem most subject to storm-related disturbances

Immunization of Alpacas (\u3cem\u3eLama pacos\u3c/em\u3e) with Protein Antigens and Production of Antigen-Specific Single Domain Antibodies

In this manuscript, a method for the immunization of alpaca and the use of molecular biology methods to produce antigen-specific single domain antibodies is described and demonstrated. Camelids, such as alpacas and llamas, have become a valuable resource for biomedical research since they produce a novel type of heavy chain-only antibody which can be used to produce single domain antibodies. Because the immune system is highly flexible, single domain antibodies can be made to many different protein antigens, and even different conformations of the antigen, with a very high degree of specificity. These features, among others, make single domain antibodies an invaluable tool for biomedical research. A method for the production of single domain antibodies from alpacas is reported. A protocol for immunization, blood collection, and B-cell isolation is described. The B-cells are used for the construction of an immunized library, which is used in the selection of specific single domain antibodies via panning. Putative specific single domain antibodies obtained via panning are confirmed by pull-down, ELISA, or gel-shift assays. The resulting single domain antibodies can then be used either directly or as a part of an engineered reagent. The uses of single domain antibody and single domain antibody-based regents include structural, biochemical, cellular, in vivo, and therapeutic applications. Single domain antibodies can be produced in large quantities as recombinant proteins in prokaryotic expression systems, purified, and used directly or can be engineered to contain specific markers or tags that can be used as reporters in cellular studies or in diagnostics

Performance evaluation of unified medical language system®'s synonyms expansion to query PubMed

<p>Abstract</p> <p>Background</p> <p>PubMed is the main access to medical literature on the Internet. In order to enhance the performance of its information retrieval tools, primarily non-indexed citations, the authors propose a method: expanding users' queries using Unified Medical Language System' (UMLS) synonyms i.e. all the terms gathered under one unique Concept Unique Identifier.</p> <p>Methods</p> <p>This method was evaluated using queries constructed to emphasize the differences between this new method and the current PubMed automatic term mapping. Four experts assessed citation relevance.</p> <p>Results</p> <p>Using UMLS, we were able to retrieve new citations in 45.5% of queries, which implies a small increase in recall. The new strategy led to a heterogeneous 23.7% mean increase in non-indexed citation retrieved. Of these, 82% have been published less than 4 months earlier. The overall mean precision was 48.4% but differed according to the evaluators, ranging from 36.7% to 88.1% (Inter rater agreement was poor: kappa = 0.34).</p> <p>Conclusions</p> <p>This study highlights the need for specific search tools for each type of user and use-cases. The proposed strategy may be useful to retrieve recent scientific advancement.</p

Open source challenges for hospital information system (HIS) in developing countries: a pilot project in Mali

<p>Abstract</p> <p>Background</p> <p>We are currently witnessing a significant increase in use of Open Source tools in the field of health. Our study aims to research the potential of these software packages for developing countries. Our experiment was conducted at the Centre Hospitalier Mere Enfant in Mali.</p> <p>Methods</p> <p>After reviewing several Open Source tools in the field of hospital information systems, Mediboard software was chosen for our study. To ensure the completeness of Mediboard in relation to the functionality required for a hospital information system, its features were compared to those of a well-defined comprehensive record management tool set up at the University Hospital "La Timone" of Marseilles in France. It was then installed on two Linux servers: a first server for testing and validation of different modules, and a second one for the deployed full implementation. After several months of use, we have evaluated the usability aspects of the system including feedback from end-users through a questionnaire.</p> <p>Results</p> <p>Initial results showed the potential of Open Source in the field of health IT for developing countries like Mali.</p> <p>Five main modules have been fully implemented: patient administrative and medical records management of hospital activities, tracking of practitioners' activities, infrastructure management and the billing system. This last component of the system has been fully developed by the local Mali team.</p> <p>The evaluation showed that the system is broadly accepted by all the users who participated in the study. 77% of the participants found the system useful; 85% found it easy; 100% of them believe the system increases the reliability of data. The same proportion encourages the continuation of the experiment and its expansion throughout the hospital.</p> <p>Conclusions</p> <p>In light of the results, we can conclude that the objective of our study was reached. However, it is important to take into account the recommendations and the challenges discussed here to avoid several potential pitfalls specific to the context of Africa.</p> <p>Our future work will target the full integration of the billing module in Mediboard and an expanded implementation throughout the hospital.</p

Protecting healing relationships in the age of electronic health records: report from an international conference

We present findings of an international conference of diverse participants exploring the influence of electronic health records (EHRs) on the patient-practitioner relationship. Attendees united around a belief in the primacy of this relationship and the importance of undistracted attention. They explored administrative, regulatory, and financial requirements that have guided United States (US) EHR design and challenged patient-care documentation, usability, user satisfaction, interconnectivity, and data sharing. The United States experience was contrasted with those of other nations, many of which have prioritized patient-care documentation rather than billing requirements and experienced high user satisfaction. Conference participants examined educational methods to teach diverse learners effective patient-centered EHR use, including alternative models of care delivery and documentation, and explored novel ways to involve patients as healthcare partners like health-data uploading, chart co-creation, shared practitioner notes, applications, and telehealth. Future best practices must preserve human relationships, while building an effective patient-practitioner (or team)-EHR triad

From Euclidean Geometry to Knots and Nets

This document is the Accepted Manuscript of an article accepted for publication in Synthese. Under embargo until 19 September 2018. The final publication is available at Springer via https://doi.org/10.1007/s11229-017-1558-x.This paper assumes the success of arguments against the view that informal mathematical proofs secure rational conviction in virtue of their relations with corresponding formal derivations. This assumption entails a need for an alternative account of the logic of informal mathematical proofs. Following examination of case studies by Manders, De Toffoli and Giardino, Leitgeb, Feferman and others, this paper proposes a framework for analysing those informal proofs that appeal to the perception or modification of diagrams or to the inspection or imaginative manipulation of mental models of mathematical phenomena. Proofs relying on diagrams can be rigorous if (a) it is easy to draw a diagram that shares or otherwise indicates the structure of the mathematical object, (b) the information thus displayed is not metrical and (c) it is possible to put the inferences into systematic mathematical relation with other mathematical inferential practices. Proofs that appeal to mental models can be rigorous if the mental models can be externalised as diagrammatic practice that satisfies these three conditions.Peer reviewe

Clinical outcomes resulting from telemedicine interventions: a systematic review

BACKGROUND: The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. METHODS: Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence. RESULTS: A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. CONCLUSIONS: Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective