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AimsThe association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes.Methods and resultsA total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina.ConclusionLocal low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.

The availability of massive amounts of biological data, distributed in various data sources, in conjunction with the need to understand the underlying biological processes of life, has prompted the development of a wide range of data analysis tools, most of which are publicly available through the Internet. However, due to the heterogeneity and complexity of the domain, performing a specific analysis by combining tools is complicated. In this paper, we argue that the software agent metaphor constitutes a flexible approach that efficiently addresses integration of bioinformatics analysis tools and dynamic composition-execution of data analysis workflows. To substantiate this assertion, a scalable engineering methodology is presented, aiming to address horizontal and/or vertical integration, through functionally related multiagent systems. The proposed approach is mediator-oriented, relying primarily on agent coordination strategies and semantic domain descriptions. The applicability and virtue of the proposed systems are illustrated through test cases addressing integration of computational gene finders. [ABSTRACT FROM AUTHOR]

In this paper, a multiagent system (MAS) is presented, aiming to enhance monitoring, surveillance, and educational services of a generic medical contact center (MCC) for chronic disease management. In such a home-care scenario, a persistent need arises for efficiently monitoring the patient contacts and the MCC's functionality, in order to effectively manage and interpret the large volume of medical data collected during the patient sessions with the system, and to assess the use of MCC resources. Software agents were adopted to provide the means to accomplish such real-time information-processing tasks, due to their autonomous, reactive and/or proactive nature, and their effectiveness in dynamic environments by incorporating coordination strategies. Specifically, the objective of the MAS is to monitor the MCC environment, detect important cases, and inform the healthcare and administrative personnel via alert messages, notifications, recommendations, and reports, prompting them for actions. The main aim of this paper is to present the overall design and implementation of a proposed MAS, emphasizing its functional model and architecture, as well as on the agent interactions and the knowledge-sharing mechanism incorporated, in the context of a generic MCC. [ABSTRACT FROM AUTHOR]

In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system. [ABSTRACT FROM AUTHOR]

Aims: The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes., Methods and Results: A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina., Conclusion: Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Although a plethora of remote health monitoring systems have been proposed for chronic conditions, the challenge posed by the changing patient needs and the requirement for personalization in health monitoring to move beyond proprietary, difficult to extend, and unsustainable solutions still pertains. In this direction, we describe a mobile health system based on a smartphone, portable/wearable sensors for measuring the patient's physiological parameters, and back-end platforms for the health professionals to monitor the patient condition and configure monitoring plans in an individualized manner. A prototype system was developed based on a Service-oriented Architecture and integrating commercially available sensing devices. An experimental study has been conducted with 53 patients in order to investigate the usability of the proposed system. The patients were able to perform the majority of the target tasks successfully (Success Rate = 77%), while the perceived usability using the System Usability Scale (SUS) was found to be above average (SUS score = 73%), indicating that the patients overall perceived the system as both easy to use and useful.