Automated Detection of HONcode Website Conformity Compared to Manual Detection: An Evaluation

Background

To earn HONcode certification, a website must conform to the 8 principles of the HONcode of Conduct In the current manual process of certification, a HONcode expert assesses the candidate website using precise guidelines for each principle. In the scope of the European project KHRESMOI, the Health on the Net (HON) Foundation has developed an automated system to assist in detecting a website’s HONcode conformity. Automated assistance in conducting HONcode reviews can expedite the current time-consuming tasks of HONcode certification and ongoing surveillance. Additionally, an automated tool used as a plugin to a general search engine might help to detect health websites that respect HONcode principles but have not yet been certified.

Objective

The goal of this study was to determine whether the automated system is capable of performing as good as human experts for the task of identifying HONcode principles on health websites.

Methods

Using manual evaluation by HONcode senior experts as a baseline, this study compared the capability of the automated HONcode detection system to that of the HONcode senior experts. A set of 27 health-related websites were manually assessed for compliance to each of the 8 HONcode principles by senior HONcode experts. The same set of websites were processed by the automated system for HONcode compliance detection based on supervised machine learning. The results obtained by these two methods were then compared.

Results

For the privacy criterion, the automated system obtained the same results as the human expert for 17 of 27 sites (14 true positives and 3 true negatives) without noise (0 false positives). The remaining 10 false negative instances for the privacy criterion represented tolerable behavior because it is important that all automatically detected principle conformities are accurate (ie, specificity [100%] is preferred over sensitivity [58%] for the privacy criterion). In addition, the automated system had precision of at least 75%, with a recall of more than 50% for contact details (100% precision, 69% recall), authority (85% precision, 52% recall), and reference (75% precision, 56% recall). The results also revealed issues for some criteria such as date. Changing the “document” definition (ie, using the sentence instead of whole document as a unit of classification) within the automated system resolved some but not all of them.

Conclusions

Study results indicate concordance between automated and expert manual compliance detection for authority, privacy, reference, and contact details. Results also indicate that using the same general parameters for automated detection of each criterion produces suboptimal results. Future work to configure optimal system parameters for each HONcode principle would improve results. The potential utility of integrating automated detection of HONcode conformity into future search engines is also discussed.     

A data recipient centered de-identification method to retain statistical attributes

Privacy has always been a great concern of patients and medical service providers. As a result of the recent advances in information technology and the government’s push for the use of Electronic Health Record (EHR) systems, a large amount of medical data is collected and stored electronically. This data needs to be made available for analysis but at the same time patient privacy has to be protected through de-identification. Although biomedical researchers often describe their research plans when they request anonymized data, most existing anonymization methods do not use this information when de-identifying the data. As a result, the anonymized data may not be useful for the planned research project. This paper proposes a data recipient centered approach to tailor the de-identification method based on input from the recipient of the data. We demonstrate our approach through an anonymization project for biomedical researchers with specific goals to improve the utility of the anonymized data for statistical models used for their research project. The selected algorithm improves a privacy protection method called Condensation by Aggarwal et al. Our methods were tested and validated on real cancer surveillance data provided by the Kentucky Cancer Registry.     

A conceptual framework and principles for trusted pervasive health

Background

Ubiquitous computing technology, sensor networks, wireless communication and the latest developments of the Internet have enabled the rise of a new concept—pervasive health—which takes place in an open, unsecure, and highly dynamic environment (ie, in the information space). To be successful, pervasive health requires implementable principles for privacy and trustworthiness.

Objective

This research has two interconnected objectives. The first is to define pervasive health as a system and to understand its trust and privacy challenges. The second goal is to build a conceptual model for pervasive health and use it to develop principles and polices which can make pervasive health trustworthy.

Methods

In this study, a five-step system analysis method is used. Pervasive health is defined using a metaphor of digital bubbles. A conceptual framework model focused on trustworthiness and privacy is then developed for pervasive health. On that model, principles and rules for trusted information management in pervasive health are defined.

Results

In the first phase of this study, a new definition of pervasive health was created. Using this model, differences between pervasive health and health care are stated. Reviewed publications demonstrate that the widely used principles of predefined and static trust cannot guarantee trustworthiness and privacy in pervasive health. Instead, such an environment requires personal dynamic and context-aware policies, awareness, and transparency. A conceptual framework model focused on information processing in pervasive health is developed. Using features of pervasive health and relations from the framework model, new principles for trusted pervasive health have been developed. The principles propose that personal health data should be under control of the data subject. The person shall have the right to verify the level of trust of any system which collects or processes his or her health information. Principles require that any stakeholder or system collecting or processing health data must support transparency and shall publish its trust and privacy attributes and even its domain specific policies.

Conclusions

The developed principles enable trustworthiness and guarantee privacy in pervasive health. The implementation of principles requires new infrastructural services such as trust verification and policy conflict resolution. After implementation, the accuracy and usability of principles should be analyzed.     

Towards pervasive computing in health care – A literature review

Background

The evolving concepts of pervasive computing, ubiquitous computing and ambient intelligence are increasingly influencing health care and medicine. Summarizing published research, this literature review provides an overview of recent developments and implementations of pervasive computing systems in health care. It also highlights some of the experiences reported in deployment processes.

Methods

There is no clear definition of pervasive computing in the current literature. Thus specific inclusion criteria for selecting articles about relevant systems were developed. Searches were conducted in four scientific databases alongside manual journal searches for the period of 2002 to 2006. Articles included present prototypes, case studies and pilot studies, clinical trials and systems that are already in routine use.

Results

The searches identified 69 articles describing 67 different systems. In a quantitative analysis, these systems were categorized into project status, health care settings, user groups, improvement aims, and systems features (i.e., component types, data gathering, data transmission, systems functions). The focus is on the types of systems implemented, their frequency of occurrence and their characteristics. Qualitative analyses were performed of deployment issues, such as organizational and personnel issues, privacy and security issues, and financial issues. This paper provides a comprehensive access to the literature of the emerging field by addressing specific topics of application settings, systems features, and deployment experiences.

Conclusion

Both an overview and an analysis of the literature on a broad and heterogeneous range of systems are provided. Most systems are described in their prototype stages. Deployment issues, such as implications on organization or personnel, privacy concerns, or financial issues are mentioned rarely, though their solution is regarded as decisive in transferring promising systems to a stage of regular operation. There is a need for further research on the deployment of pervasive computing systems, including clinical studies, economic and social analyses, user studies, etc.     

Evaluation of the histologic criteria for the diagnosis of Sj?gren's syndrome]

OBJECTIVE: The most important diagnostic criterion in Sj?gren's syndrome (SS) is considered to be the histologic focus score of the labial salivary glands. The focus score is defined as the number of lymphocytic foci per 4 mm2 of the salivary gland according to the criterion of Chisholm & Mason. On the other hand, in the criteria of the Sj?gren's Disease Research Committee of the Ministry of Health and Welfare in Japan it is defined as the number of lymphocytic foci per a lobule of the salivary gland. By setting the limited criteria for SS on the basis of objective signs of both dry eyes and dry mouth, we compared the usefulness of these two diagnostic criteria for the diagnosis of SS in terms of the sensitivity, the specificity and laboratory data. METHODS: The biopsy of labial salivary glands was performed in 245 patients (230 females and 15 males, with a mean age of 54.9 years) who were suspected of SS in our hospital during the time between 1975 and 1996. Labial salivary glands were histologically assessed and the focus score was calculated according to the criterion of Chisholm & Mason and to that of the Sj?gren's Disease Research Committee, respectively. RESULTS: The average area per a lobule of the salivary gland was 0.70 mm2. According to the limited criteria for SS, the Japanese histologic diagnostic criteria showed a higher specificity (93.3%) and a lower sensitivity (23.5%). The sensitivity of the criterion of Chisholm & Mason was 72.1%, and the specificity was 80.0%. The margin of the lobule was sometimes difficult to be identified because of the fatty change and fibrosis in some salivary glands. CONCLUSIONS: By comparing the two different histologic criteria using our limited criteria, it was better to use the histologic criterion of Chisholm & Mason as a criterion for the diagnosis of SS than that of the Sjogren's Disease Research Committee of the Ministry of Health and Welfare in Japan in terms of the sensitivity, the specificity and laboratory data.     

Perspectives of Australian adults about protecting the privacy of their health information in statistical databases

ObjectivesThe aim of this study was to discover the public's attitude and views towards privacy in health care. This is a part of a larger project which aims to gain an insight into what kind of privacy is needed and develop technical measures to provide such privacy.MethodsThe study was a two-stage process which combined qualitative and quantitative research. Stage One of the study comprised arranging and facilitating focus groups while in Stage Two we conducted a social survey.MeasurementsWe measured attitudes towards privacy, medical research and consent; privacy concern about sharing one's health information for research; privacy concern about the possibility that some specific information from medical records could be linked to the patient's name in a situation that was not related to medical treatment.ResultsThe results of the study revealed both great support for medical research (98%), and concern about privacy of health information (66%). Participants prefer to be asked for their permission before their health information is used for any purpose other than medical treatment (92%), and they would like to know the organisation and details of the research before allowing the use of their health records (83%). Age, level of education, place of birth and employment status are most strongly associated with privacy concerns. The study showed that there are some particularly sensitive issues and there is a concern (42–60%) about any possibility of linking these kinds of data to the patient's name in a situation that is not related to medical treatment. Such issues include sexually transmitted diseases, abortions and infertility, family medical history/genetic disorders, mental illness, drug/alcohol related incidents, lists of previous operations/procedures/dates and current medications.ConclusionsParticipants believe they should be asked for permission before their health information is used for any purpose other than medical treatment. However, consent and privacy concerns are not necessary related.Assuring individuals that their personal health information is de-identified reduces their concern about the necessity of consent for releasing health information for research purposes, but many people are not aware that removing their names and other direct identifiers from medical records does not guarantee full privacy protection for their health information. Privacy concerns decrease as extra security measures are introduced to protect privacy. Therefore, instead of “tailoring concern” as proposed by Willison [1] we suggest improving privacy protection of personal information by introducing additional security measures in data publishing.     

Examining individuals’ adoption of healthcare wearable devices: An empirical study from privacy calculus perspective

BackgroundWearable technology has shown the potential of improving healthcare efficiency and reducing healthcare cost. Different from pioneering studies on healthcare wearable devices from technical perspective, this paper explores the predictors of individuals’ adoption of healthcare wearable devices. Considering the importance of individuals’ privacy perceptions in healthcare wearable devices adoption, this study proposes a model based on the privacy calculus theory to investigate how individuals adopt healthcare wearable devices.MethodThe proposed conceptual model was empirically tested by using data collected from a survey. The sample covers 333 actual users of healthcare wearable devices. Structural equation modeling (SEM) method was employed to estimate the significance of the path coefficients.ResultsThis study reveals several main findings: (1) individuals’ decisions to adopt healthcare wearable devices are determined by their risk–benefit analyses (refer to privacy calculus). In short, if an individual’s perceived benefit is higher than perceived privacy risk, s/he is more likely to adopt the device. Otherwise, the device would not be adopted; (2) individuals’ perceived privacy risk is formed by health information sensitivity, personal innovativeness, legislative protection, and perceived prestige; and (3) individuals’ perceived benefit is determined by perceived informativeness and functional congruence. The theoretical and practical implications, limitations, and future research directions are then discussed.     

An innovative privacy preserving technique for incremental datasets on cloud computing

Cloud computing (CC) is a magnificent service-based delivery with gigantic computer processing power and data storage across connected communications channels. It imparted overwhelming technological impetus in the internet (web) mediated IT industry, where users can easily share private data for further analysis and mining. Furthermore, user affable CC services enable to deploy sundry applications economically. Meanwhile, simple data sharing impelled various phishing attacks and malware assisted security threats. Some privacy sensitive applications like health services on cloud that are built with several economic and operational benefits necessitate enhanced security. Thus, absolute cyberspace security and mitigation against phishing blitz became mandatory to protect overall data privacy. Typically, diverse applications datasets are anonymized with better privacy to owners without providing all secrecy requirements to the newly added records. Some proposed techniques emphasized this issue by re-anonymizing the datasets from the scratch. The utmost privacy protection over incremental datasets on CC is far from being achieved. Certainly, the distribution of huge datasets volume across multiple storage nodes limits the privacy preservation. In this view, we propose a new anonymization technique to attain better privacy protection with high data utility over distributed and incremental datasets on CC. The proficiency of data privacy preservation and improved confidentiality requirements is demonstrated through performance evaluation.     

The reliability of assigning individuals to cognitive states using the Mini Mental-State Examination: a population-based prospective cohort study

The recently published "COSMIN" guidelines aim to rate properties of outcome instruments and state two issues with regard to responsiveness which is the instrument's ability to detect change over time. These issues are comparison of score changes with change of an external criterion using correlations and the judgement of traditional methods as inappropriate. The latter are the "transition" concept, a global rating of change, and parametric measures of responsiveness, for example, effect sizes. It can be shown that the methodology proposed by the guidelines has important weaknesses and that denunciation of traditional methods is not appropriate. Some claims of the guidelines about responsiveness do not match the demands of clinical reality and confront findings of numerous epidemiological studies.     

Contingency Theory and Classical Autonomic Excitatory and Inhibitory Conditioning: Some Problems of Assessment and Interpretation

The primary aims are to elaborate on and clarify two general issues which are raised in the context of assessing contingency theory: (a) the operational requirements and the psychophysical considerations for assessing autonomic excitatory and inhibitory factors in Pavlovian conditioning, and (b) the topic of the appropriate CR specification in the autonomic electrodermal system. Our substantive conclusion, based on an evaluation of the methodology of available human autonomic studies, is that there is no empirical support for the contingency truly random control procedure. In addition, contrary to the suggestion of striking analogies with the skeletal eyelid system, a latency criterion should not be used to deny associative status to first-interval electrodermal responses, provided that these do satisfy conventional behavioral criteria for associative conditioning, e.g., discrimination.     

Automatic identification of heart failure diagnostic criteria,using text analysis of clinical notes from electronic health records

ObjectiveEarly detection of Heart Failure (HF) could mitigate the enormous individual and societal burden from this disease. Clinical detection is based, in part, on recognition of the multiple signs and symptoms comprising the Framingham HF diagnostic criteria that are typically documented, but not necessarily synthesized, by primary care physicians well before more specific diagnostic studies are done. We developed a natural language processing (NLP) procedure to identify Framingham HF signs and symptoms among primary care patients, using electronic health record (EHR) clinical notes, as a prelude to pattern analysis and clinical decision support for early detection of HF.DesignWe developed a hybrid NLP pipeline that performs two levels of analysis: (1) At the criteria mention level, a rule-based NLP system is constructed to annotate all affirmative and negative mentions of Framingham criteria. (2) At the encounter level, we construct a system to label encounters according to whether any Framingham criterion is asserted, denied, or unknown.MeasurementsPrecision, recall, and F-score are used as performance metrics for criteria mention extraction and for encounter labeling.ResultsOur criteria mention extractions achieve a precision of 0.925, a recall of 0.896, and an F-score of 0.910. Encounter labeling achieves an F-score of 0.932.ConclusionOur system accurately identifies and labels affirmations and denials of Framingham diagnostic criteria in primary care clinical notes and may help in the attempt to improve the early detection of HF. With adaptation and tooling, our development methodology can be repeated in new problem settings.     

Evaluation of criteria for classical dissociations in single-case studies by Monte Carlo simulation

The conventional criteria for a classical dissociation in single-case studies require that a patient be impaired on one task and within normal limits on another. J. R. Crawford and P. H. Garthwaite (2005) proposed an additional criterion, namely, that the patient's (standardized) difference on the two tasks should differ from the distribution of differences in controls. Monte Carlo simulation was used to evaluate these criteria. When Type I errors were defined as falsely concluding that a control case exhibited a dissociation, error rates were high for the conventional criteria but low for Crawford and Garthwaite's criteria. When Type I error rates were defined as falsely concluding that a patient with equivalent deficits on the two tasks exhibited a dissociation, error rates were very high for the conventional criteria but acceptable for the latter criteria. These latter criteria were robust in the face of nonnormal control data. The power to detect classical dissociations was studied.     

基于人工神经网络的心脏功能评定研究

作者应用人工神经网络的方法,利用心脏收缩时间间期指标评定心脏功能。采用21个输入、3个输出和单个隐层的前馈网络,用反向传播算法进行训练。所用7个指标,将其进行编码后作为输入矢量,心脏功能分为3级,在人工神经网络学习由专家评定的结果后,对200位受试者的心脏功能进行评定。人工神经网络评定的正确率达93.5％,且具有自学习、容量扩充和较强的容错能力。     

Responses of human elbow flexor muscles to electrically stimulated forced lengthening exercise

This study developed an electrical stimulation model for human elbow flexors to examine eccentric exercise-induced muscle damage and adaptation. Male students (n=17) were randomly placed into one of two groups; isometric (ES-ISO, n=8) and eccentric (ES-ECC, n=9). The elbow joint was fixed at 90 degrees (1.57 rad) and the elbow flexors stimulated percutaneously by an electronic muscle stimulator for 5 s through two electrodes placed over the muscles for ES-ISO. In ES-ECC, the muscles were stimulated similarly to the ES-ISO, but the elbow joint was forcibly extended from an elbow flexed (90 degrees 1.57 rad) to a full-extended position (180 degrees, 3.14 rad) in 3 s. Maximal voluntary isometric force, range of motion, upper arm circumference, muscle thickness by ultrasonography, muscle soreness, plasma creatine kinase and aspartate aminotransferase activities were assessed before and for 4 days after exercise. ES-ECC produced significantly larger changes in all criterion measures compared with ES-ISO (P < 0.01). These findings confirmed that eccentric muscle actions induced muscle damage, but isometric contractions resulted in little or no damage. Six subjects from the ES-ECC group repeated the same eccentric exercise (ECC2) 2 weeks after the first bout (ECC1), and changes in the criterion measures were compared between the bouts. Changes in all criterion measures after ECC2 were significantly smaller than ECC1 (P < 0.01). These results suggest that the first eccentric exercise produced a protective effect against muscle damage in the subsequent eccentric exercise bout, which does not involve adaptations in the central nervous system.     

Cardiac Transplantation: A Quarter Century of Progress

This article provides a review of the current status of cardiac transplantation, which offers the only viable alternative for the management of patients with refractory congestive heart failure. The criteria for recipient evaluation and selection are discussed. The major limitation to the number of potential recipients of cardiac transplantation is the availability of donors, numbering about 2000 per year. The current one-year survival rate is approximately 80%, while the 5-year survival rate is in excess of 70%. These numbers confirm the therapeutic benefit derived from cardiac transplantation, and are in marked contrast to the one-year mortality rate of 30–60% experienced by patients with New York Heart Association class IV congestive heart failure. The long-term complications of cardiac transplantation include acute and chronic rejection, infection, the side effects of immunosuppressive agents (including nephrotoxicity and hypertension), the development of neoplasms, and accelerated transplant coronary arteriopathy.
This paper also emphasizes the areas in which investigation into the behavioral aspects of cardiac transplantation may be directed, including: (a) study of the individual and group attitudes toward organ donation; (b) psychologic implications of mechanical circulatory support as an alternative to cardiac transplantation; (c) in the transplanted patient with a denervated heart there is the opportunity to study the interaction between the autonomic nervous system and behavioral stimuli; (d) the psychologic adaptation of the recipient to organ transplantation; (e) the role of educational programs designed to influence favorably the attitude of the general population toward organ transplantation; and (f) in the future, the psychologic aspects of xenograft transplantation as an alternative to homograft transplantation.     

Considerations for uniform and accurate biospecimen labelling in a biorepository and research environment

Correct labelling of specimens in a biorepository or research laboratory is vital, especially for translational or clinical studies linking clinical data with biospecimens. While patient privacy must be carefully protected, confusing or inadequate labelling can potentially result in the study of the wrong biospecimens with detrimental effects to the accuracy of published findings or a requirement for invaluable biospecimens to be discarded. Labelling guidelines are described in the biorepository of the University of California-Los Angeles Brain Tumour Translational Resource, and in recipient neuro-oncology laboratories to which biospecimens and derivatives are provided. This approach includes specifying identifier types, types of dates and institutions on the biospecimen labels; using multiple identifiers on each specimen when feasible; and developing a three to four-letter alphanumeric code to aid in label recognition. In addition, steps are being taken to educate recipient laboratories on best practices in labelling.