Persuasive Explanation of Reasoning Inferences on Dietary Data

Explainable AI aims at building intelligent systems that are able to provide a clear, and human understandable, justification of their decisions. This holds for both rule-based and data-driven methods. In management of chronic diseases, the users of such systems are patients that follow strict dietary rules to manage such diseases. After receiving the input of the intake food, the system performs reasoning to understand whether the users follow an unhealthy behaviour. Successively, the system has to communicate the results in a clear and effective way, that is, the output message has to persuade users to follow the right dietary rules. In this paper, we address the main challenges to build such systems: i) the natural language generation of messages that explain the reasoner inconsistency; ii) the effectiveness of such messages at persuading the users. Results prove that the persuasive explanations are able to reduce the unhealthy users’ behaviours

Digital Pathology and Telepathology in Transplantation: Feasibility With the EHR

Digital pathology and telepathology play an emerging role conveying anatomical pathology diagnostic images in the Electronic Health Record. We sought to focus our attention to an innovative project, while identifying standards and practices between clinicians and the EHR (Electronic Health Record). The project aims at developing a second opinion network, based on telepathology, between two major transplantation centres over two years. The health authorities involved are the Hospital Trust of Verona and of Padua (Italy). In 2015 there were 376 renal and liver transplantations for both centres. We expect to significantly improve the transplantation workflow after combining the digital pathology platform with its proper and timely application in the telepathology network. Firstly it will allow the real time second opinion between pathologists in order to assess the suitability of the donor organs, avoiding the glass-slide transfer, with potential damage or loss. The technical partners delivered two slide scanners and software solutions to enable virtual microscopy and web-based digital slide sharing with storage resources. In addition, the project comprises an online survey which focuses on the accountability of the system, the user perception, and a concordance study for the project outcomes evaluation. The technical transactions between all the main actors and digital slides will be reviewed and updated in order to meet the integration standards and guideline according to IHE (Integrating the Healthcare Enterprise) initiative, Digital Imaging and COmmunications in Medicine (DICOM) and Health Level 7 (HL7). According to the first comparisons, we believe that the efforts to provide this new diagnostic imaging area to the actual EHR developments, will be rewarding and effective for the saving-life transplantation processes

Towards a rule-based support system for the coding of health conditions in the patient summary

In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient’s EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law

Programação por Restrições no Problema da Divisão Equânime de Conjuntos

Neste artigo, a Programação por Restrições é aplicada ao problema da divisão equânime de conjuntos. A solução aplicada no problema consiste em encontrar a melhor solução disponível, baseado em todas as possibilidades existentes. Problema de complexidade NP, teve como característica nestaimplementação, o uso da biblioteca fd sets, que possibilita criar variáaveis do tipo conjuntos (Sets). Na solução exibida neste artigo, os resultados levantados, bem como o tempo de execução, são compatíveis com a complexidade doproblema. Também, uma modelagem matemática sobre o problema foi criada. Esta, define regras e especifica fórmulas a serem utilizadas na solução do problema. Este resultado fortalece a PR como uma teoria atrativa a problema combinatoriais a serem aplicados a problemas reais, como o exemplo que é apresentado neste artigo

Over Expressed TKTL1, CIP-2A, and B-MYB Proteins in Uterine Cervix Epithelium Scrapings as Potential Risk Predictive Biomarkers in HR-HPV-Infected LSIL/ASCUS Patients

High oncogenic risk human papillomaviruses (HR-HPVs) promote cervical carcinoma development, the fourth most common feminine cancer. A slow oncodevelopmental phase—defined histopathologically as Cervical Intraepithelial Neoplasia (CIN) grades 1–3, or cytologically as Low- or High-grade Squamous Intraepithelial Lesions (LSIL or HSIL)—precedes the malignancy. Cervical carcinoma screenings through HR-HPV genotyping and Pap smears are regularly performed in Western countries. Faulty cytology screening or genotyping or patients' non-compliance with follow-ups can let slip an oncoprogression diagnosis. Novel biomarker tests flanking HR-HPV genotyping and cytology could objectively predict the risk of disease progression thus helping triage LSIL/ASCUS patients. Here, anonymized leftovers of fresh cervical epithelium scrapings from twice (LSIL/ASCUS and HR-HPV DNA)-positive and twice (Pap smear- and HR-HPV DNA)-negative (control) patients in a proteome-preserving solution served to assess the biomarker worth of three cervical carcinoma-related proteins, i.e., B-MYB (or MYBL2), Cancerous Inhibitor of PP2A (CIP-2a), and transketolase-like1 (TKTL1). Leftovers anonymity was strictly kept and storage at −80°C, protein extraction, immunoblotting, and band densitometry were blindly performed. Only after tests completion, the anonymous yet code-corresponding HR-HPV-genotyping and cytology data allowed to assign each sample to the twice-positive or twice-negative group. Descriptive statistics showed that the three proteins levels significantly increased in the twice-positive vs. twice-negative scrapings. Diagnostic ROC curve analysis identified each protein's Optimal Decision Threshold (OTD) showing that TKTL1 and CIP-2a are stronger risk predictive biomarkers (Sensitivity, 0.91–0.93; Specificity, 0.77–0.83) than B-MYB. Logistic Regression coupled with Likelihood-Ratio Tests confirmed that a highly significant relation links increasing TKTL1/CIP-2a/B-MYB protein levels in twice-positive cervical scrapings to the risk of HR-HPV-driven oncoprogression. Finally, a 3 year clinical follow-up showed that 13 patients (50% of total) of the twice-positive group with biomarker values over OTDs compliantly underwent scheduled colposcopy and biopsy. Of these, 11 (i.e., 84.7%) received a positive histological diagnosis, i.e., CIN1 (n = 5; 38.5%) or CIN2/CIN2+ (n = 6; 46,2%). Therefore, TKTL1/CIP-2a/B-MYB protein levels could objectively predict oncoprogression risk in twice (HR-HPV- and Pap smear)-positive women. Further studies will assess the translatability of these findings into clinical settings

Towards a rule-based support system for the coding of health conditions in the Patient Summary

Abstract. In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient's EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law

A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training-Validation Trial

Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved

Use of the ONCO-TreC electronic diary compared with a standard paper diary to improve adherence to oral cancer therapy in patients with solid and haematological tumours: protocol for a randomised controlled trial

Introduction ONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours. Methods and analysis This is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher’s exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs. Ethics and dissemination Ethical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations

LC3B and ph-S6K are both expressed in epithelioid and classic renal angiomyolipoma: a rationale tissue-based evidence for combining use of autophagic and mTOR targeted drugs

Background: Targeted drugs to the autophagy processes are emerging in clinical trials. The aim of this work is to assess the magnitude of autophagic expression in renal angiomyolipoma. Methods: Fourteen cases of renal angiomyolipoma were recruited. Anti-LC3B-II and anti-phospho-S6K were detected by Western blot analysis. For immunohistochemical staining, sections were stained with the antibodies LC3B-II and cathepsin-K. LC3B-II was also analyzed by immunofluorescence. We have also carried out electron microscopy analysis on tumor cells. Results: 13 classic and 1 epithelioid renal angiomyolipoma were recruited. The Western-blot LC3B-II analysis shows increasing in protein expression in all cases, however quantitative protein expression ranged from 1 to 15 (mean 5). The autophagosome protein LC3B-I also significantly increased in all tumor extraction. The expression of LC3B-II protein was confirmed in tumoral samples by immunofluorescence. The lysosomal marker cathepsin-K was observed by immunohistochemistry on all tumours. The Western-blot ph-S6K analysis showed significant protein overexpression along all cases after evaluation of the quantitative S6K/Ponceaus ratio. In 6/14 (52%) the expression was high, with a quantitative increase of 653 fold induction in 4 angiomyolipoma compared to normal tissue. At electron microscopy, cancer cells evidenced round or oval electron-dense granules associated with membranes and granules with double membrane. Conclusion: Both autophagic LC3B-II and ph-S6K molecules are over-represented in both epithelioid and classic renal angiomyolipoma and a combined use of inhibitors to the autophagic and mTOR processes may be designed in clinical trials, when enrolling patients affected by tumours in tuberous sclerosis or angiomyolipoma at risk of bledding

An implementation of a Security Infrastructure compliant with the Italian Personal Data Protection Code in a Web-based Cooperative Work System

In this poster we describe the security solutions implemented in a web-based cooperative work framework for managing heart failure patients among different health care professionals involved in the care process. The solution, developed in close collaboration with the Law Department of the University of Trento, is compliant with the new Italian Personal Data Protection Code, issued in 2003, that regulates also the storing and processing of health data