Image Data Sharing for Biomedical Research—Meeting HIPAA Requirements for De-identification

Data sharing is increasingly recognized as critical to cross-disciplinary research and to assuring scientific validity. Despite National Institutes of Health and National Science Foundation policies encouraging data sharing by grantees, little data sharing of clinical data has in fact occurred. A principal reason often given is the potential of inadvertent violation of the Health Insurance Portability and Accountability Act privacy regulations. While regulations specify the components of private health information that should be protected, there are no commonly accepted methods to de-identify clinical data objects such as images. This leads institutions to take conservative risk-averse positions on data sharing. In imaging trials, where images are coded according to the Digital Imaging and Communications in Medicine (DICOM) standard, the complexity of the data objects and the flexibility of the DICOM standard have made it especially difficult to meet privacy protection objectives. The recent release of DICOM Supplement 142 on image de-identification has removed much of this impediment. This article describes the development of an open-source software suite that implements DICOM Supplement 142 as part of the National Biomedical Imaging Archive (NBIA). It also describes the lessons learned by the authors as NBIA has acquired more than 20 image collections encompassing over 30 million images.     

The susceptibility of the kidney to alternative pathway activation—A hypothesis

The glomerulus is often the prime target of dysregulated alternative pathway (AP) activation. In particular, AP activation is the key driver of two severe kidney diseases: atypical hemolytic uremic syndrome and C3 glomerulopathy. Both conditions are associated with a variety of predisposing molecular defects in AP regulation, such as genetic variants in complement regulators, autoantibodies targeting AP proteins, or autoantibodies that stabilize the AP convertases (C3- and C5-activating enzymes). It is noteworthy that these are systemic AP defects, yet in both diseases pathologic complement activation primarily affects the kidneys. In particular, AP activation is often limited to the glomerular capillaries. This tropism of AP-mediated inflammation for the glomerulus points to a unique interaction between AP proteins in plasma and this particular anatomic structure. In this review, we discuss the pre-clinical and clinical data linking the molecular causes of aberrant control of the AP with activation in the glomerulus, and the possible causes of this tropism. Based on these data, we propose a model for why the kidney is so uniquely and frequently targeted in patients with AP defects. Finally, we discuss possible strategies for preventing pathologic AP activation in the kidney.     

Image panels for the special issue related to the meeting “The Nervous System of Drosophila melanogaster: From Development to Function”

These images were composed for the special issue related to the meeting “The Nervous System of Drosophila melanogaster: From Development to Function” that was held in Freiburg (Germany) from 26-29 Sept 2013.     

A Generalized Defries–Fulker Regression Framework for the Analysis of Twin Data

Twin studies compare the similarity between monozygotic twins to that between dizygotic twins in order to investigate the relative contributions of latent genetic and environmental factors influencing a phenotype. Statistical methods for twin data include likelihood estimation and Defries–Fulker regression. We propose a new generalization of the Defries–Fulker model that fully incorporates the effects of observed covariates on both members of a twin pair and is robust to violations of the Normality assumption. A simulation study demonstrates that the method is competitive with likelihood analysis. The Defries–Fulker strategy yields new insight into the parameter space of the twin model and provides a novel, prediction-based interpretation of twin study results that unifies continuous and binary traits. Due to the simplicity of its structure, extensions of the model have the potential to encompass generalized linear models, censored and truncated data; and gene by environment interactions.     

A EPC Approach to the Residual Water in Erythrocytes

A novel approach has been developed to determine the amount of residual water in human erythrocyte at room temperature by electronic particle counter. Nacl solutions of 13 osmolalities were prepared and the equilibrium cell volumes in which were measured one by one. The isotonic volume, Vo, was obtained under the isotonic condition. The mean RBC volumes of 5 donors at each osmolality were fitted according to Boyle van‘t Hoff relationship, and the osmotically inactive volume, Vb, of erythrocyte was then determined. The results show that Vb＝50% Vo. More importantly, the final cell volume with regard to the solution of the highest concentration found to be kept at about 0. 5 V0. The difference between these two volumes is unconspicuous. According to the published data that non-water volume of human erythrocyte is about 28.3% of its isotonic volume, residual water of human erythrocyte can be gained by subtracting Vdry from Vf, that is Vrw----21.7% Vo Then it was concluded that the residual water of human lays in 2 states, one is bound water, and the other is free water.     

Patients’ Continuing Use of an Online Health Record: A Quantitative Evaluation of 14,000 Patient Years of Access Data

Background

Online access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use.

Objective

Our aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups.

Methods

We analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view.

Results

At the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users.

Conclusions

In this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.     

Non-invasive markers in the management of pediatric neurogenic bladder over the last two decades – A review

Neurogenic bladder (NB) is one of the most challenging problems in nephro-urological management in pediatrics. It is an important risk factor of secondary upper urinary tract damage. A complete clinical evaluation is necessary and requires life-long extensive medical attention including invasive procedures that affect patients’ quality of life. Potential non-invasive biomarkers would be desirable, especially in the pediatric population. The aim of this review was to analyze two decades of data regarding potential non-invasive biomarkers in the assessment and follow-up of children with NB. This paper summarizes and appraises the knowledge about both biochemical and imaging-based markers in 3 aspects: markers of urinary tract infections (UTIs), bladder and renal function, and this paper looks at their prospective application in everyday clinical care.     

A Study on the Temperature Correlation of B-mode Ultrasonic Image Gray for Noninvasive Temperature Monitoring in Hyperthermia

INTRODUCTIONThe microwave hyperthermia(MH)has become an important tumor treatment method in recentyears.The basic technical principle of MHis to heat tumor tissues up to therapeutic temperature(over42-43℃)to kill cancer cells withoutoverheatingthe surroundingnormal tissue.For an effective MHitisimportant to monitor temperature changes in treated tissue.Atpresentthe invasive thermometers are clin-ically used for MHpurpose.However the invasive method for temperature measurement is relat…