Identifying facilitators of and barriers to the adoption of dynamic consent in digital health ecosystems: a scoping review.

BACKGROUND: Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. METHODS: This scoping review, conducted in December 2022, adhered to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. RESULTS: The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. CONCLUSIONS: Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape.

Compound-level identification of sasang constitution type-specific personalized herbal medicine using data science approach.

Introduction: Sasang Constitutional Medicine (SCM) is a type of traditional Korean medicine where patients are classified as one of four Sasang constitution types (Sasang type) and medications consisting of medicinal herbs are prescribed according to the Sasang type. Despite the importance of personalized medicine, the operation mechanism is largely unknown. To gain a better understanding, we investigated the compound information that composes Sasang type-specific personalized herbal medicines on both multivariate and univariate levels. Methods: Five machine learning classifiers including extremely randomized trees (ERT) were trained to investigate whether the Sasang type can be explained by compound information at the multivariate level. Hierarchical clustering was conducted to determine whether compounds are processed distributedly or specifically. Taxonomic and biosynthetic analyses were conducted on these compounds. A univariate level statistical test was conducted to provide more robust Sasang type-specific compound information. Results: Using the trained ERT classifier, sixty important compounds were extracted. The sixty compounds were clustered into three groups, corresponding to each Sasang type-prominent compounds, suggesting that most compounds have specific preference for the Sasang type. Structural and biosynthetic characteristics of these Sasang type-prominent compounds were determined based on taxonomy and pathway analyses. Fourteen compounds showed statistically significant relevance with the Sasang type. Additionally, we predicted the Sasang type of unknown herbs, which were confirmed by their biological effects in functional assays. Conclusion: This study investigated the personalized herbal medicines of the SCM using compound information. This study provided information on the chemical characteristics of the compounds that are essential for classifying the Sasang type of medicinal herbs, as well as predictions regarding the Sasang type of the commonly used but unidentified medicinal herbs.

Development of a Frailty Detection Model Using Machine Learning with the Korean Frailty and Aging Cohort Study Data.

OBJECTIVES: This paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results. METHODS: This study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried's frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization. RESULTS: During the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm. CONCLUSIONS: The results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants' health conditions and alert them regarding potential risks in advance.

Developing a Transnational Health Record Framework with Level-Specific Interoperability Guidelines Based on a Related Literature Review.

With the advent of digital healthcare without borders, enormous amounts of health information are captured and computerized. As healthcare quality largely depends on the reliability of given health information, personal health records should be accessible according to patients' mobility, even as they travel or migrate to other countries. However, since all the health information is scattered in multiple places, it is an onerous task to carry it whenever people move to other countries. To effectively and efficiently utilize health information, interoperability, which is the ability of various healthcare information technologies to exchange, to interpret, and to use data, is needed. Hence, building a robust transnational health information infrastructure with clear interoperability guidelines considering heterogeneous aspects is necessary. For this purpose, this study proposes a Transnational Health Record framework, which enables access to personal health records anywhere. We review related literature and define level-specific interoperability guidelines, business processes, and requirements for the Transnational Health Record system framework.

CHDC: Common Hospital Data Connector for exchanging medical information.

With the advance of technology, smart healthcare is emerging, and the amount of medical data is exploding. Currently, these large-scale medical data is scattered and stored in a variety of institutions. The data format is also different. These make medical data exchange difficult. Although there are many attempts to integrate EMR systems into a standardized structure, a high rate of EMR adoption in Korea using a standardized model such as HL7 RIM (Reference Information Model), attempts to replace systems that are already in use have largely failed due to a variety of causes, including time, cost and implementation manpower, and so on. In this paper, we propose a Common Hospital Data Connector model that has a way to integrate medical data without replacing the systems. This model defines what data should be extracted from the system with a variety of interfaces. These data profiles are based on statutory document and are able to be accepted in other medical institution. To ensure interoperability, the document is based on the international standard of Fast Healthcare Interoperability Resources and can be created in the form of a statutory document that can be printed. We applied this model to the hospital and verified that it can be used in actual services.

Fucoxanthin, the constituent of Laminaria japonica, triggers AMPK-mediated cytoprotection and autophagy in hepatocytes under oxidative stress.

BACKGROUND: Laminaria japonica has frequently been used as a food supplement and drug in traditional oriental medicine. Among the major active constituents responsible for the bioactivities of L. japonica, fucoxanthin (FX) has been considered as a potential antioxidant. This study was conducted to examine the effects of L. japonica extract (LJE) or FX against oxidative stress on hepatocytes and to elucidate the overall their cellular mechanisms of the effects. METHODS: We constructed an in vitro model with the treatment of arachidonic acid (AA) + iron in HepG2 cells to stimulate the oxidative damage. The cells were pre-treated with LJE or FX for 1 h, and incubated with AA + iron. The effect on oxidative damage and cellular mechanisms of LJE or FX were assessed by cytological examination and several biochemical assays under conditions with or without kinase inhibitiors. RESULTS: LJE or FX pretreatment effectively blocked the pathological changes caused by AA + iron treatment, such as cell death, altered expression of apoptosis-related proteins such as procaspase-3 and poly (ADP-ribose) polymerase, and mitochondria dysfunction. Moreover, FX induced AMPK activation and AMPK inhibitor, compound C, partially reduced the protective effect of FX on mitochondria dysfunction. Consistent with AMPK activation, FX increased the protein levels of autophagic markers (LC3II and beclin-1) and the number of acridine orange stained cells, and decreased the phosphorylation of mTOR and simultaneously increased the phosphorylation of ULK1. And the inhibition of autophagy by 3-methylanine or bafilomycin A1 partially inhibited the protective effect of FX on mitochondria dysfunction. CONCLUSION: These findings suggest that FX have the function of being a hepatic protectant against oxidative damages through the AMPK pathway for the control of autophagy.

Promotion of Adequate Exercise for Chronic Disorders' Elderly Through Paced Music.

South Korean population has been aging at an accelerated rate in recent years and the country will be a hyper-aging nation at 2020. One important issue in an aged society is higher rates of chronic disorders among the population. One of the best means to prevent an increase in severity of chronic disease is making patients exercise regularly. In this paper, we present a mobile app for senior citizens that provides daily exercise recommendations an receive tailored service related to a chronic disorder. In this app, pace (BPM) of played music is regulated to encourage patients to fulfill their daily exercise goal. The combination was constructed by using suggestions of World Health Organization and Korea Sports Promotion Foundation. Through our app, users are guided to exercise daily and regularly with appropriate exercise intensity. Patients can deal with their chronic disorders via our mobile application with increased physical activities.

Development of Parkinson Patient Generated Data Collection Platform Using FHIR and IoT Devices.

Internet of Things (IoT) devices can be effectively used in cases where continuous observation of patients is required, such as Parkinson's disease. This is due to the characteristics of the IoT (Internet of Things), which allows data to be measured and transmitted at any time, anywhere. In this study, we developed a health data collection platform that stores and transmits the foot pressure data of Parkinson patients using FHIR (Fast Healthcare Interoperability Resources). The platform can be used to collect the foot pressure of a large number of Parkinson's patients. Based on the accumulated data, it is possible to identify abnormal behaviors such as walking pattern, tilt and instability of stride length in patients with Parkinson's disease. Based on the results of this study, accurate diagnosis and treatment of Parkinson's disease can be made.

The Educational and Supportive Mobile Application for Caregivers of Dementia People.

This paper presents a healthcare mobile app for caregivers of dementia patients. The app had been implemented to run on wearable and mobile devices, and it helps caregivers to take dementia test, review dementia test history, and search location of public health centers in the vicinity. The collective purpose of these features is to provide meaningful healthcare services to elderly at risk of dementia. The app uses the time and change (T&C) test for screening for dementia. The app was tried for its validity and usability for the intended purpose, and participating users were surveyed to evaluate its usefulness.

Clinical Document Architecture integration system to support patient referral and reply letters.

Many Clinical Document Architecture (CDA) referrals and reply documents have been accumulated for patients since the deployment of the Health Information Exchange System (HIES) in Korea. Clinical data were scattered in many CDA documents and this took too much time for physicians to read. Physicians in Korea spend only limited time per patient as insurances in Korea follow a fee-for-service model. Therefore, physicians were not allowed sufficient time for making medical decisions, and follow-up care service was hindered. To address this, we developed CDA Integration Template (CIT) and CDA Integration System (CIS) for the HIES. The clinical items included in CIT were defined reflecting the Korean Standard for CDA Referral and Reply Letters and requests by physicians. CIS integrates CDA documents of a specified patient into a single CDA document following the format of CIT. Finally, physicians were surveyed after CIT/CIS adoption, and they indicated overall satisfaction.

Embedding the shapes of regions of interest into a Clinical Document Architecture document.

Sharing a medical image visually annotated by a region of interest with a remotely located specialist for consultation is a good practice. It may, however, require a special-purpose (and most likely expensive) system to send and view them, which is an unfeasible solution in developing countries such as Vietnam. In this study, we design and implement interoperable methods based on the HL7 Clinical Document Architecture and the eXtensible Markup Language Stylesheet Language for Transformation standards to seamlessly exchange and visually present the shapes of regions of interest using web browsers. We also propose a new integration architecture for a Clinical Document Architecture generator that enables embedding of regions of interest and simultaneous auto-generation of corresponding style sheets. Using the Clinical Document Architecture document and style sheet, a sender can transmit clinical documents and medical images together with coordinate values of regions of interest to recipients. Recipients can easily view the documents and display embedded regions of interest by rendering them in their web browser of choice.

Improving chronic disease management with mobile health platform.

In modern society, aging and chronic disease is becoming common phenomenon due to the increasing numbers of elderly patients. To best treat this growing segment of the population, medical care should be based on constant vital sign monitoring. In this study, we propose a mobile vital sign measurement and data collection system for chronic disease management.. And we implemented a middle ware using Multi-Agent platform in SOS (Self-Organizing System) platform that transmits patient clinical data for services. We also implemented a HL7 messaging interface for interoperability of clinical data exchange. We propose health services on a self-organized software platform.

Preliminary comparison of mHealth architectures based on MU2 criteria.

Mobile Health (MH) is a hot topic in the health IT industry because it can make a big difference in healthcare services. Before adopting Mobile Health technology, however, we must ensure that it provides safe and reliable services to users and it should be evaluated by authoritative criteria. In US, Electronic Health Record (EHR) systems are evaluated through Meaningful Use (MU). Although MU focuses on EHR systems, it can't be thought of without MH. So in this paper we derive proper evaluation criteria for MH from MU criteria and evaluate existing MH architectures that are currently being surveyed in ISO/AWI TR 17522 - Provisions for Health Applications on Mobile/Smart Devices.

Health management system with smart TV using zero-configuration.

The health services using mobile devices are available in the world. But mobile services with mobile devices still have Zero configuration problem. If the problem is solved, various services are available. Smart TV has input problem. The service using Smart TV is not yet activated. So In this Study, we propose new health management service using Smart TV using Zero-configuration.

The synergic effect of regular exercise and resveratrol on kainate-induced oxidative stress and seizure activity in mice.

The synergic effect of regular exercise and resveratrol, a polyphenolic compound with potent antioxidant activity, was investigated against kainate-induced seizures and oxidative stress in mice. After 6 weeks of swimming training, the total body weight decreased and the blood concentration of lactate stabilized statistically in comparison with the sedentary mice, indicate that the training program increased the aerobic resistance of mice. Kainate (30 mg/kg) evoked seizure activity 5 min after injection, and seizure activity was measured seizure rating scores every 5 min up to 2 h. As previously well known experiments, regular exercise and resveratrol (40 mg/kg, daily supplementation for 6 weeks) have an inhibitory effect on kainate-induced seizure activity and oxidative stress. In particularly, a synergistic cooperation of regular exercise and resveratrol was observed in seizure activity, mortality and oxidative stress especially in SOD activity. These results suggest that regular exercise along with an anti-convulsant agent such as resveratrol could be a more efficient method for the prevention of seizure development than exercise alone.