A novel personal health system with integrated decision support and guidance for the management of chronic liver disease

A personal health system platform for the management of patients with chronic liver disease that incorporates a novel approach to integrate decision support and guidance through care pathways for patients and their doctors is presented in this paper. The personal health system incorporates an integrated decision support engine that guides patients and doctors through the management of the disease by issuing tasks and providing recommendations to both the care team and the patient and by controlling the execution of a Care Flow Plan based on the results of tasks and the monitored health status of the patient. This Care Flow Plan represents a formal, business process based model of disease management designed off-line by domain experts on the basis of clinical guidelines, knowledge of care pathways and an organisational model for integrated, patient-centred care. In this way, remote monitoring and treatment are dynamically adapted to the patient's actual condition and clinical symptoms and allow flexible delivery of care with close integration of specialists, therapists and care-givers.

A prospective study evaluating the clinical relevance of a chemoresponse assay for treatment of patients with persistent or recurrent ovarian cancer

OBJECTIVE

Use of in vitro chemoresponse assays for informing effective treatment selection is a compelling clinical question and a topic of debate among oncologists. A prospective study was conducted evaluating the use of a chemoresponse assay in recurrent ovarian cancer patients.

METHODS

Women with persistent or recurrent ovarian cancer were enrolled under an IRB-approved protocol, and fresh tissue samples were collected for chemoresponse testing. Patients were treated with one of 15 protocol-designated treatments empirically selected by the oncologist, blinded to the assay results. Each treatment was classified by the assay as: sensitive (S), intermediate (I), or resistant (R). Patients were prospectively monitored for progression-free survival (PFS) and overall survival (OS). Associations of assay response for the physician-selected treatment with PFS and OS were analyzed.

RESULTS

A total of 262 evaluable patients were enrolled. Patients treated with an assay-sensitive regimen demonstrated significantly improved PFS and OS while there was no difference in clinical outcomes between I and R groups. Median PFS was 8.8 months for S vs. 5.9 months for I+R (hazard ratio [HR]=0.67, p=0.009). The association with assay response was consistent in both platinum-sensitive and platinum-resistant tumors (HR: 0.71 vs. 0.66) and was independent of other covariates in multivariate analysis (HR=0.66, p=0.020). A statistically significant14-month improvement in mean OS (37.5 months for S vs. 23.9 months for I+R, HR=0.61, p=0.010) was demonstrated.

CONCLUSIONS

This prospective study demonstrated improved PFS and OS for patients with either platinum-sensitive or platinum-resistant recurrent ovarian cancer treated with assay-sensitive agents.

Towards improved socio-economic assessments of ocean acidification's impacts

Ocean acidification is increasingly recognized as a component of global change that could have a wide range of impacts on marine organisms, the ecosystems they live in, and the goods and services they provide humankind. Assessment of these potential socio-economic impacts requires integrated efforts between biologists, chemists, oceanographers, economists and social scientists. But because ocean acidification is a new research area, significant knowledge gaps are preventing economists from estimating its welfare impacts. For instance, economic data on the impact of ocean acidification on significant markets such as fisheries, aquaculture and tourism are very limited (if not non-existent), and non-market valuation studies on this topic are not yet available. Our paper summarizes the current understanding of future OA impacts and sets out what further information is required for economists to assess socio-economic impacts of ocean acidification. Our aim is to provide clear directions for multidisciplinary collaborative research.

Impact of aragonite saturation state changes on migratory pteropods

Thecosome pteropods play a key role in the food web of various marine ecosystems and they calcify, secreting the unstable CaCO(3) mineral aragonite to form their shell material. Here, we have estimated the effect of ocean acidification on pteropod calcification by exploiting empirical relationships between their gross calcification rates (CaCO(3) precipitation) and aragonite saturation state Ω(a), combined with model projections of future Ω(a). These were corrected for modern model-data bias and taken over the depth range where pteropods are observed to migrate vertically. Results indicate large reductions in gross calcification at temperate and high latitudes. Over much of the Arctic, the pteropod Limacina helicina will become unable to precipitate CaCO(3) by the end of the century under the IPCC SRES A2 scenario. These results emphasize concerns over the future of shelled pteropods, particularly L. helicina in high latitudes. Shell-less L. helicina are not known to have ever existed nor would we expect them to survive. Declines of pteropod populations could drive dramatic ecological changes in the various pelagic ecosystems in which they play a critical role.

Segregation of Beaufort Sea beluga whales during the open-water season

Population segregation by habitat use occurs because energy requirements and survival strategies vary with age, sex, size, and reproductive stage. From late summer to early fall in 1993, 1995, and 1997, relative length (age), sex, and reproductive status of satellite-tagged beluga whales ( Delphinapterus leucas (Pallas, 1776)) in the eastern Beaufort Sea were tested for habitat segregation. We used (i) resource selection function models to evaluate how belugas used areas of varying sea ice concentration and shelf habitat and (ii) distance analysis to measure the selection of areas varying in distance to mainland and island coastlines. Resource selection functions and distance analysis established that habitat selection differed with length, sex, and reproductive status of whales: (i) females with calves and smaller males selected open-water habitats near the mainland; (ii) large males selected closed sea ice cover in and near the Arctic Archipelago; and (iii) smaller males and two females with calves (not newborn) selected habitat near the ice edge. The segregation of habitat use according to sex, age, and reproductive status relates to the different resources required at different life stages and may represent characteristics of beluga social structure. We discuss our results in the context of two common sexual segregation hypotheses and conclude that summer habitat segregation of belugas reflects differences in foraging ecology, risk of predation, and reproduction.