Assessing the Potential Risks of Digital Therapeutics (DTX): The DTX Risk Assessment Canvas

Motivation: Digital therapeutics (DTX), i.e., health interventions that are provided through digital means, are increasingly available for use; in some countries, physicians can even prescribe selected DTX following a reimbursement by health insurances. This results in an increasing need for methodologies to consider and monitor DTX’s negative consequences, their risks to patient safety, and possible adverse events. However, it is completely unknown which aspects should be subject to surveillance given the missing experiences with the tools and their negative impacts. Objective: Our aim is to develop a tool—the DTX Risk Assessment Canvas—that enables researchers, developers, and practitioners to reflect on the negative consequences of DTX in a participatory process. Method: Taking the well-established business model canvas as a starting point, we identified relevant aspects to be considered in a risk assessment of a DTX. The aspects or building blocks of the canvas were constructed in a two-way process: first, we defined the aspects relevant for discussing and reflecting on how a DTX might bring negative consequences and risks for its users by considering ISO/TS 82304-2, the scientific literature, and by reviewing existing DTX and their listed adverse effects. The resulting aspects were grouped into thematic blocks and the canvas was created. Second, six experts in health informatics and mental health provided feedback and tested the understandability of the initial canvas by individually applying it to a DTX of their choice. Based on their feedback, the canvas was modified. Results: The DTX Risk Assessment Canvas is organized into 15 thematic blocks which are in turn grouped into three thematic groups considering the DTX itself, the users of the DTX, and the effects of the DTX. For each thematic block, questions have been formulated to guide the user of the canvas in reflecting on the single aspects. Conclusions: The DTX Risk Assessment Canvas is a tool to reflect the negative consequences and risks of a DTX by discussing different thematic blocks that together constitute a comprehensive interpretation of a DTX regarding possible risks. Applied during the DTX design and development phase, it can help in implementing countermeasures for mitigation or means for their monitoring

Dialéctica 'entre las Fuerzas Productivas y las Relaciones de Producción en el Movimiento de Liberación Nanional en El Salvador

La presente investigación se propone, establece~ dialéc ticamente, la naturaleza y desarrollo del movimiento que impulsa \el pueblo salvadoreño y su vanguardia, en su lucha, por la liberación nacional. En la comprensión de éste fenómeno histórico social,que se asienta en el movimiento popular, se pone en práctica, el conocimiento acerca del colonialismo y del imperialismo, así corno también, sobre la historia de los movimientos de' libera, ción de otros países, en los que este proceso ha tenido diver sas repercusiones y resultados. La generalización de los resultados alcanzados por los movimientos de liberación nacional, son cuestionables en pri mer lugar, en lo que respecta a las posibilidades que culminaron, en la victoria o la derrota según sea el caso, de cada uno de ellos; y en segundo lugar i teniendo en cuenta el régimen social en el que se desenvuelven los países que ya se liberaro, lo cual se generaliza, con ejemplos de países capitalistas independientes (no hubo revolución social) por un lado y de otro, con los pueblos que ade~ás de liberarse de la opresión de clase, también,se liberaron de la opresión nacional, a que los somete el neo-colonialismo y el imperialismo; 'todo lo que nos plantea a más del pro~eso de liberación, el de la revolución social que conduce al cambio de la base económica y en consecuencia, el parecimiento de un nuevo régimen social

Patient-reported outcomes and therapeutic affordances of social media findings from a global online survey of people with chronic pain

BACKGROUND: Patient-reported outcomes (PROs) from social media use in chronic disease management continue to emerge. While many published articles suggest the potential for social media is positive, there is a lack of robust examination into mediating mechanisms that might help explain social media’s therapeutic value. This study presents findings from a global online survey of people with chronic pain (PWCP) to better understand how they use social media as part of self-management. OBJECTIVE: Our aim is to improve understanding of the various health outcomes reported by PWCP by paying close attention to therapeutic affordances of social media. We wish to examine if demographics of participants underpin health outcomes and whether the concept of therapeutic affordances explains links between social media use and PROs. The goal is for this to help tailor future recommendations for use of social media to meet individuals’ health needs and improve clinical practice of social media use. METHODS: A total of 231 PWCP took part in a global online survey investigating PROs from social media use. Recruited through various chronic disease entities and social networks, participants provided information on demographics, health/pain status, social media use, therapeutic affordances, and PROs from use. Quantitative analysis was performed on the data using descriptive statistics, cross-tabulation, and cluster analysis. RESULTS: The total dataset represented 218 completed surveys. The majority of participants were university educated (67.0%, 146/218) and female (83.9%, 183/218). More than half (58.7%, 128/218) were married/partnered and not working for pay (75.9%, 88/116 of these due to ill health). Fibromyalgia (46.6%, 55/118) and arthritis (27.1%, 32/118) were the most commonly reported conditions causing pain. Participants showed a clear affinity for social network site use (90.0%, 189/210), followed by discussion forums and blogs. PROs were consistent, suggesting that social media positively impact psychological, social, and cognitive health. Analysis also highlighted two strong correlations linking platform used and health outcomes (particularly psychological, social, and cognitive) to (1) the narrative affordance of social media and (2) frequency of use of the platforms. CONCLUSIONS: Results did not uncover definitive demographics or characteristics of PWCP for which health outcomes are impacted. However, findings corroborate literature within this domain suggesting that there is a typical profile of people who use social media for health and that social media are more suited to particular health outcomes. Exploration of the relationship between social media’s therapeutic affordances and health outcomes, in particular the narration affordance, warrants further attention by patients and clinicians

Why does ethics matter in participatory health?

Social media and participatory health has emerged as a promising tool for health, including developing diagnostic tools and therapeutic interventions. In the realm of online health care delivery, artificial intelligence based counseling apps now enable patients to consult with a chatbot instead of an actual therapist. However, several ethical issues and implications became relevant with this shift to digital interventions and healthcare delivery. This panel will describe ethical issues related to recent developments in participatory health and social media including the digital exposome, importance of involving patients in the design of AI-based applications and ethics of social media research in healthcare

Salivary gland entrance dose in dental radiology

Introduction: Soft tissues modify radiation absorption and increase dispersion. It can also influence the density and the contrast of the film, and therefore, the diagnosis accuracy. In order to estimate the relative risk of cancer associated with induction by radiation, it is important to measure radiation doses at organs and tissues. Objective: to evaluate salivary glands entrance dose, with two digital devices in a head and neck phantom. Methodology: Periapical incidences simulations of incisors were conducted and compared with two digital periapical radiological equipment (Kodak® 2200 Intraoral X-ray System) which have similar characteristics. A dry bone skull prototype and an equivalent human tissue material with wax were used. To measure the organ entrance dose: parotid gland and sublingual glands, it was used a solid-state sensor from Radcal®, Accu-Gold® for diagnostic radiology and an ionization chamber from Radcal®, Accu-Gold®, where effective doses were measured in the equipment and in the sensor and then compared. Results: in parotid glands were 0.033 mSv and in sublingual 0.388 mSv. Conclusion: It is important to highlight from the results the importance of using low doses of radiation and the appropriate equipment positioning in order to perform periapical radiological incidences in maxillary and mandibular regions. If the beam it is not corrected positioned, an increase in the radiation dose to organs can occur near to the area of study

Machine Learning Based Microbiome Signature to Predict Inflammatory Bowel Disease Subtypes

Crohn's disease; Microbiome; Ulcerative colitisEnfermedad de Crohn; Microbioma; Colitis ulcerosaMalaltia de Crohn; Microbioma; Colitis ulcerosaInflammatory bowel disease (IBD) is a chronic disease with unknown pathophysiological mechanisms. There is evidence of the role of microorganims in this disease development. Thanks to the open access to multiple omics data, it is possible to develop predictive models that are able to prognosticate the course and development of the disease. The interpretability of these models, and the study of the variables used, allows the identification of biological aspects of great importance in the development of the disease. In this work we generated a metagenomic signature with predictive capacity to identify IBD from fecal samples. Different Machine Learning models were trained, obtaining high performance measures. The predictive capacity of the identified signature was validated in two external cohorts. More precisely a cohort containing samples from patients suffering Ulcerative Colitis and another from patients suffering Crohn's Disease, the two major subtypes of IBD. The results obtained in this validation (AUC 0.74 and AUC = 0.76, respectively) show that our signature presents a generalization capacity in both subtypes. The study of the variables within the model, and a correlation study based on text mining, identified different genera that play an important and common role in the development of these two subtypes.CF-L's work was supported by the Collaborative Project in Genomic Data Integration (CICLOGEN) PI17/01826 funded by the Carlos III Health Institute from the Spanish National plan for Scientific and Technical Research and Innovation 2013-2016 and the European Regional Development Funds (FEDER)–A way to build Europe. JS's work was funded by the Ramón y Cajal grant (RYC2019-026576-I) funded by Ministry of Science and Innovation of the Spanish government. GL-C's work was supported by a grant from the Biotechnology and Biological Sciences Research Council (BBSRC grant BB/S006281/1) and open access publication fees were supported by Queen's University of Belfast UKRI block grant

Reproductibilidad de un cuestionario que valora la actividad física en adolescentes escolares

Introducción: Los cuestionarios de actividad física por lo general son los instrumentos más sencillos y fáciles de aplicar a grandes poblaciones, sin embargo, la capacidad de reproductibilidad varía entre las poblaciones. Objetivo: Analizar la fiabilidad de un cuestionario que valora la Actividad Física en una muestra de escolares adolescentes que viven a elevada altitud por medio de consistencia interna y test re-test. Diseño: Descriptivo-Transversal (Survey). Institución: Universidad Nacional del Altiplano, Puno, Perú. Participantes: Adolescentes escolares de 12 a 17 años. Intervenciones: Fueron seleccionados de forma sistemática 109 escolares de ambos sexos. Se valoró las medidas antropométricas de peso, estatura, estatura sentada y circunferencia del abdomen. Además se aplicó un cuestionario de actividad física con 11 preguntas (test y re-test) con un intervalo de 7 días. Principales medidas: Valoración de la capacidad de reproductibilidad por consistencia interna y estabilidad. Resultados: Los valores de alpha de Cronbach (Consistencia interna) mostraron valores de 0,73 a 0,77 para ambos sexos. El Error Técnico de Medida (ETM) fue de 0,50 a 1,61% y el coeficiente de correlación de Spearman  osciló entre 0,91 a 0,95. Conclusión: El cuestionario de actividad física muestra altos valores de confiabilidad, tanto en su consistencia interna como en la estabilidad de las medidas. Introduction: Physical activity questionnaires usually are the most simple and easy to apply to large populations, however, reproducibility capacity varies between populations. Objective: To analyze the reliability of a questionnaire to assess physical activity in a sample of school adolescents living at high altitude through internal consistency and test re-test. Design: Descriptive, transversal (Survey). Institution: Universidad Nacional del Altiplano, Puno, Peru. Participants: School Teens 12 to 17 years. Interventions: There were systematically selected 109 students of both sexes. We evaluated anthropometric measurements of weight, height, sitting height and circumference of the abdomen. In addition we applied a physical activity questionnaire with 11 questions (test and re-test) with an interval of 7 days. Main measures: capacity rating for internal consistency, reproducibility and stability. Results: Cronbach's alpha values ??(internal consistency) showed values ??from 0.73 to 0.77 for both sexes. Measuring technical error (SEM) was from 0.50 to 1.61% and the Spearman correlation coefficient ranges from 0.91 to 0.95. Conclusion: The physical activity questionnaire shows high values ??of reliability, consistency both internally and in the stability of the measures

A method for automatically extracting infectious disease-related primers and probes from the literature

BACKGROUND: Primer and probe sequences are the main components of nucleic acid-based detection systems. Biologists use primers and probes for different tasks, some related to the diagnosis and prescription of infectious diseases. The biological literature is the main information source for empirically validated primer and probe sequences. Therefore, it is becoming increasingly important for researchers to navigate this important information. In this paper, we present a four-phase method for extracting and annotating primer/probe sequences from the literature. These phases are: (1) convert each document into a tree of paper sections, (2) detect the candidate sequences using a set of finite state machine-based recognizers, (3) refine problem sequences using a rule-based expert system, and (4) annotate the extracted sequences with their related organism/gene information. RESULTS: We tested our approach using a test set composed of 297 manuscripts. The extracted sequences and their organism/gene annotations were manually evaluated by a panel of molecular biologists. The results of the evaluation show that our approach is suitable for automatically extracting DNA sequences, achieving precision/recall rates of 97.98% and 95.77%, respectively. In addition, 76.66% of the detected sequences were correctly annotated with their organism name. The system also provided correct gene-related information for 46.18% of the sequences assigned a correct organism name. CONCLUSIONS: We believe that the proposed method can facilitate routine tasks for biomedical researchers using molecular methods to diagnose and prescribe different infectious diseases. In addition, the proposed method can be expanded to detect and extract other biological sequences from the literature. The extracted information can also be used to readily update available primer/probe databases or to create new databases from scratch.The present work has been funded, in part, by the European Commission through the ACGT integrated project (FP6-2005-IST-026996) and the ACTION-Grid support action (FP7-ICT-2007-2-224176), the Spanish Ministry of Science and Innovation through the OntoMineBase project (ref. TSI2006-13021-C02-01), the ImGraSec project (ref. TIN2007-61768), FIS/AES PS09/00069 and COMBIOMED-RETICS, and the Comunidad de Madrid, Spain.S

Tripartite motif-containing 55 identified as functional candidate for spontaneous cardiac hypertrophy in the rat locus cardiac mass 22

Background:Left ventricular (LV) hypertrophy is a risk factor for cardiovascular death, but the genetic factors determining LV size and predisposition to hypertrophy are not well understood. We have previously linked the quantitative trait locus cardiac mass 22 (Cm22) on chromosome 2 with cardiac hypertrophy independent of blood pressure in the spontaneously hypertensive rat. From an original cross of spontaneously hypertensive rat with F344 rats, we derived a normotensive polygenic model of spontaneous cardiac hypertrophy, the hypertrophic heart rat (HHR) and its control strain, the normal heart rat (NHR).Methods and results:To identify the genes and molecular mechanisms underlying spontaneous LV hypertrophy we sequenced the HHR genome with special focus on quantitative trait locus Cm22. For correlative analyses of function, we measured global RNA transcripts in LV of neonatal HHR and NHR and 198 neonatal rats of an HHRxNHR F2 crossbred population. Only one gene within locus Cm22 was differentially expressed in the parental generation: tripartite motif-containing 55 (Trim55), with mRNA downregulation in HHR (P<0.05) and reduced protein expression. Trim55 mRNA levels were negatively correlated with LV mass in the F2 cross (r=-0.16, P=0.025). In exon nine of Trim55 in HHR, we found one missense mutation that functionally alters protein structure. This mutation was strongly associated with Trim55 mRNA expression in F2 rats (F=10.35, P<0.0001). Similarly, in humans, we found reduced Trim55 expression in hearts of subjects with idiopathic dilated cardiomyopathy.Conclusion:Our study suggests that the Trim55 gene, located in Cm22, is a novel candidate gene for polygenic LV hypertrophy independent of blood pressure

Nanoinformatics: developing new computing applications for nanomedicine

Nanoinformatics has recently emerged to address the need of computing applications at the nano level. In this regard, the authors have participated in various initiatives to identify its concepts, foundations and challenges. While nanomaterials open up the possibility for developing new devices in many industrial and scientific areas, they also offer breakthrough perspectives for the prevention, diagnosis and treatment of diseases. In this paper, we analyze the different aspects of nanoinformatics and suggest five research topics to help catalyze new research and development in the area, particularly focused on nanomedicine. We also encompass the use of informatics to further the biological and clinical applications of basic research in nanoscience and nanotechnology, and the related concept of an extended ?nanotype? to coalesce information related to nanoparticles. We suggest how nanoinformatics could accelerate developments in nanomedicine, similarly to what happened with the Human Genome and other -omics projects, on issues like exchanging modeling and simulation methods and tools, linking toxicity information to clinical and personal databases or developing new approaches for scientific ontologies, among many others