Developing HL7 CDA-Based Data Warehouse for the Use of Electronic Health Record Data for Secondary Purposes

Background The growing availability of clinical and administrative data collected in electronic health records (EHRs) have led researchers and policy makers to implement data warehouses to improve the reuse of EHR data for secondary purposes. This approach can take advantages from a unique source of information that collects data from providers across multiple organizations. Moreover, the development of a data warehouse benefits from the standards adopted to exchange data provided by heterogeneous systems. Objective This article aims to design and implement a conceptual framework that semiautomatically extracts information collected in Health Level 7 Clinical Document Architecture (CDA) documents stored in an EHR and transforms them to be loaded in a target data warehouse. Results The solution adopted in this article supports the integration of the EHR as an operational data store in a data warehouse infrastructure. Moreover, data structure of EHR clinical documents and the data warehouse modeling schemas are analyzed to define a semiautomatic framework that maps the primitives of the CDA with the concepts of the dimensional model. The case study successfully tests this approach. Conclusion The proposed solution guarantees data quality using structured documents already integrated in a large-scale infrastructure, with a timely updated information flow. It ensures data integrity and consistency and has the advantage to be based on a sample size that covers a broad target population. Moreover, the use of CDAs simplifies the definition of extract, transform, and load tools through the adoption of a conceptual framework that load the information stored in the CDA in the data warehouse

An interesting cause of syncope

Patient with a history of repeated episodes of syncope over the preceding week

Continuous-Variable Entangled States of Light carrying Orbital Angular Momentum

The orbital angular momentum of light, unlike spin, is an infinite-dimensional discrete variable and may hence offer enhanced performances for encoding, transmitting, and processing information in the quantum regime. Hitherto, this degree of freedom of light has been studied mainly in the context of quantum states with definite number of photons. On the other hand, field-quadrature continuous-variable quantum states of light allow implementing many important quantum protocols not accessible with photon-number states. Here, we present the first generation and complete experimental characterization of a bipartite continuous-variable Gaussian entangled state endowed with non-zero orbital angular momentum. A q-plate is used to transfer the continuous-variable entanglement initially generated in polarization into orbital angular momentum. We then apply a reconfigurable homodyne detector to various combinations of orbital angular momentum modes in order to reconstruct the entire quantum-state covariance matrix, by directly measuring the fluctuations of quadrature operators. Our work is a step towards generating multipartite continuous-variable entanglement in a single optical beam.Comment: To appear in Phys. Rev.

How Outer Coordination Sphere Modifications Can Impact Metal Structures in Proteins: A Crystallographic Evaluation

A challenging objective of de novo metalloprotein design is to control of the outer coordination spheres of an active site to fine tune metal properties. The well‐defined three stranded coiled coils, TRI and CoilSer peptides, are used to address this question. Substitution of Cys for Leu yields a thiophilic site within the core. Metals such as HgII, PbII, and AsIII result in trigonal planar or trigonal pyramidal geometries; however, spectroscopic studies have shown that CdII forms three‐, four‐ or five‐coordinate CdIIS3(OH2)x (in which x=0–2) when the outer coordination spheres are perturbed. Unfortunately, there has been little crystallographic examination of these proteins to explain the observations. Here, the high‐resolution X‐ray structures of apo‐ and mercurated proteins are compared to explain the modifications that lead to metal coordination number and geometry variation. It reveals that Ala substitution for Leu opens a cavity above the Cys site allowing for water excess, facilitating CdIIS3(OH2). Replacement of Cys by Pen restricts thiol rotation, causing a shift in the metal‐binding plane, which displaces water, forming CdIIS3. Residue d‐Leu, above the Cys site, reorients the side chain towards the Cys layer, diminishing the space for water accommodation yielding CdIIS3, whereas d‐Leu below opens more space, allowing for equal CdIIS3(OH2) and CdIIS3(OH2)2. These studies provide insights into how to control desired metal geometries in metalloproteins by using coded and non‐coded amino acids.Controlling coordination geometries: The high‐resolution X‐ray structures of apo‐ and mercurated proteins were compared to explain the modifications that lead to metal coordination number and geometry variation. These studies provide insights into how to control desired metal geometries in metalloproteins by using coded and noncoded amino acids.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149308/1/chem201806040-sup-0001-misc_information.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149308/2/chem201806040.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149308/3/chem201806040_am.pd

A system of concepts to support the integration of Health and social care and assistive domotics services: the Health@Home project.

The main objective of this work is to define a common shared conceptual model that describes the health care environment using the ContSys standard, harmonizing it with the social care and assistive domotics concepts. The development of this model supports the integration of services, the interoperability among systems and the continuity of care across domains.Starting from the identification and extraction of the portion of the ContSys model suitable for the healthcare part, the article provides the methodology adopted to extend it with social and home automation concepts and to integrate them in a unique framework that supports the continuity of care.The integrated model defined in this paper has been adopted in the design phase of an interoperable open platform, called Health@Home, that organizes the provision of a set of health, social and home automation integrated services provided at home.Our model is a starting point to analyze the various determinants of wellbeing able to guarantee a high-level individual's quality of life. At the moment the Health@Home system is at the implementation phase

Cambiamento climatico, inquinamento atmosferico e aumento delle allergie respiratorie: solo una coincidenza o qualcosa di più? [Climate change, air pollution, and increase of respiratory allergies: just a coincidence or something more?].

It is well known that the prevalence of respiratory allergies has increased over time. At the same time, climate change has become part of our everyday life. The resulting question is whether this 'allergic epidemic' is linked to this aspect. It is assumed that the causes of the increase of respiratory allergies are mainly related to environmental factors and lifestyle: first, the improvement of social and health conditions and related hygiene hypothesis; secondly, lifestyle change and anthropogenic activities, which have caused an alteration in the balance normally existing between soil, water, and atmosphere, giving rise to the phenomena of climate change. In fact, it has been demonstrated that they can influence beginning, duration, and intensity of the pollen season, as well as the allergenicity of pollen. The consequence is both an increase in frequency and intensity of allergic symptomatology in subjects previously affected by allergy, and a promotion of the sensitization of the airways to allergens present in the atmosphere in predisposed subjects. Several intervention strategies aiming to mitigate climate change and reduce anthropogenic emissions and, consequently, respiratory allergies are possible and can be implemented on an individual and social level. It follows that the allergist cannot solve the problem of the progressive increase of respiratory allergies on his own. Anyway, his role can have both clinical and educational purposes with a special commitment to reduce health impact due to environmental risk factors. KEYWORDS: respiratory allergies; allergenic potential of pollen; climate change; pollution

Structural characterization of [VO(salicylhydroximate)(CH3OH)]3: Applications to the biological chemistry of vanadium(V)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28085/1/0000531.pd

The Importance of Stereochemically Active Lone Pairs For Influencing Pb II and As III Protein Binding

The toxicity of heavy metals, which is associated with the high affinity of the metals for thiolate rich proteins, constitutes a problem worldwide. However, despite this tremendous toxicity concern, the binding mode of As III and Pb II to proteins is poorly understood. To clarify the requirements for toxic metal binding to metalloregulatory sensor proteins such as As III in ArsR/ArsD and Pb II in PbrR or replacing Zn II in δ‐aminolevulinc acid dehydratase (ALAD), we have employed computational and experimental methods examining the binding of these heavy metals to designed peptide models. The computational results show that the mode of coordination of As III and Pb II is greatly influenced by the steric bulk within the second coordination environment of the metal. The proposed basis of this selectivity is the large size of the ion and, most important, the influence of the stereochemically active lone pair in hemidirected complexes of the metal ion as being crucial. The experimental data show that switching a bulky leucine layer above the metal binding site by a smaller alanine residue enhances the Pb II  binding affinity by a factor of five, thus supporting experimentally the hypothesis of lone pair steric hindrance. These complementary approaches demonstrate the potential importance of a stereochemically active lone pair as a metal recognition mode in proteins and, specifically, how the second coordination sphere environment affects the affinity and selectivity of protein targets by certain toxic ions. Experimental and computational methods have been employed to study the influence of the lone pair of As III and Pb II for the binding of these ions in proteins using designed peptide models. The results show that the mode of coordination of As III and Pb II is greatly influenced by the steric bulk within the second coordination environment of the metals (see figure).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90414/1/chem_201102786_sm_miscellaneous_information.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/90414/2/2040_ftp.pd

The Friendly Health Issue Network to Support Computer-Assisted Education for Clinical Reasoning in Multimorbidity Patients

Clinical reasoning in multimorbidity conditions asks for the ability to anticipate the possible evolutions of the overall health state of a patient and to identify the interactions among the concurrent health issues and their treatments. The HIN (Health Issue Network) approach, as Petri Nets-based formal language, is introduced as capable of providing a novel perspective to facilitate the acquisition of such competencies, graphically representing the network among a set of health issues (HIs) that affect a person throughout their life, and describing how HIs evolve over time. The need to provide a more immediate user-oriented interface has led to the development of f-HIN (friendly HIN), a lighter version based on the same mathematical properties as HIN, from which stems in turn the f-HINe (friendly HIN extracted) model, used to represent networks related to either real patients’ clinical experiences extracted from electronic health records, or from teacher-designed realistic clinical histories. Such models have also been designed to be embedded in a software learning environment that allows drawing a f-HIN diagram, checking for its format correctness, as well as designing clinical exercises for the learners, including their computer-assisted assessment. The present paper aims at introducing and discussing the f-HIN/f-HINe models and their educational use. It also introduces the main features of the software learning environment it was built upon, pointing out its importance to: (i) help medical teachers in designing and representing the context of a learning outcome; and (ii) handle the complex history of a multimorbidity patient, to be conveyed in Case-Based Learning (CBL) exercises