Report of the First ONTOX Stakeholder Network Meeting: Digging Under the Surface of ONTOX Together With the Stakeholders.

The first Stakeholder Network Meeting of the EU Horizon 2020-funded ONTOX project was held on 13-14 March 2023, in Brussels, Belgium. The discussion centred around identifying specific challenges, barriers and drivers in relation to the implementation of non-animal new approach methodologies (NAMs) and probabilistic risk assessment (PRA), in order to help address the issues and rank them according to their associated level of difficulty. ONTOX aims to advance the assessment of chemical risk to humans, without the use of animal testing, by developing non-animal NAMs and PRA in line with 21st century toxicity testing principles. Stakeholder groups (regulatory authorities, companies, academia, non-governmental organisations) were identified and invited to participate in a meeting and a survey, by which their current position in relation to the implementation of NAMs and PRA was ascertained, as well as specific challenges and drivers highlighted. The survey analysis revealed areas of agreement and disagreement among stakeholders on topics such as capacity building, sustainability, regulatory acceptance, validation of adverse outcome pathways, acceptance of artificial intelligence (AI) in risk assessment, and guaranteeing consumer safety. The stakeholder network meeting resulted in the identification of barriers, drivers and specific challenges that need to be addressed. Breakout groups discussed topics such as hazard versus risk assessment, future reliance on AI and machine learning, regulatory requirements for industry and sustainability of the ONTOX Hub platform. The outputs from these discussions provided insights for overcoming barriers and leveraging drivers for implementing NAMs and PRA. It was concluded that there is a continued need for stakeholder engagement, including the organisation of a 'hackathon' to tackle challenges, to ensure the successful implementation of NAMs and PRA in chemical risk assessment.

Expanding Predictive Capacities in Toxicology: Insights from Hackathon-Enhanced Data and Model Aggregation.

In the realm of predictive toxicology for small molecules, the applicability domain of QSAR models is often limited by the coverage of the chemical space in the training set. Consequently, classical models fail to provide reliable predictions for wide classes of molecules. However, the emergence of innovative data collection methods such as intensive hackathons have promise to quickly expand the available chemical space for model construction. Combined with algorithmic refinement methods, these tools can address the challenges of toxicity prediction, enhancing both the robustness and applicability of the corresponding models. This study aimed to investigate the roles of gradient boosting and strategic data aggregation in enhancing the predictivity ability of models for the toxicity of small organic molecules. We focused on evaluating the impact of incorporating fragment features and expanding the chemical space, facilitated by a comprehensive dataset procured in an open hackathon. We used gradient boosting techniques, accounting for critical features such as the structural fragments or functional groups often associated with manifestations of toxicity.

Innovate 4 Change: An interdisciplinary nursing student-led hackathon.

BACKGROUND: Health care challenges are increasingly complex. Nursing student involvement in hackathons can help create a sustainable culture of innovation and leadership within nursing. PURPOSE: To host and evaluate the inaugural Innovate 4 Change Hackathon. METHODS: Nursing student-led interdisciplinary teams worked together for 5 weeks to solve pressing health care problems, ultimately pitching ideas for prizes. FINDINGS: Seven teams with 33 students represented multiple disciplines. For nearly 70% of participants, hackathons were a new experience. Nursing students were on every team, representing 50% of the participants. DISCUSSION: Nurse-led hackathons help students gain experience in innovative problem-solving and elevate confidence. They provide a structured format to learn about nursing innovation, design thinking, and business models while also challenging students to address problems related to health equity, clinical care, health care delivery, and policy.

Nurses' confidence in starting a new venture, startup or project in the context of nurse-led hackathons: Results of prehackathon survey.

BACKGROUND: A hackathon framework has been successfully applied to solving health care challenges, including COVID-19, without much documented evidence of nurses' baseline or acquired confidence. PURPOSE: To understand differences in baseline confidence levels in starting a new venture, startup or project in the context of nurse-led hackathons. METHOD: A retrospective secondary analysis of a presurvey of hackathon participants from two NurseHack4Health (NH4H) events held in 2021. DISCUSSION: Male nurses and international nurses were more confident than the U.S.-based nurses. When comparing the 75% of participants who had not attended a hackathon previously to the 25% of participants who had, there was an increased confidence level among non-nurses and among participants with the previous hackathon, datathon, and ideation experience. CONCLUSION: If hackathons can help nurses identify strengths, add new expertise and boost confidence, it may empower nurses to pursue their ideas more effectively, aid professional growth, and provide affirmation of innovator self-identity.

Improving Patient-Centered Care for Veterans With Treatment-Resistant Depression Using Shared Decision-Making Tools.

INTRODUCTION: Treatment-resistant depression (TRD) exists when patient depression continues without remission or reduction despite treatment. There are no standardized guidelines for identifying TRD, but one failed antidepressant treatment at an adequate dose and duration can constitute TRD, especially in cases of severe depression or suicidality. TRD rates for depressed patients average approximately 50% to 60% of the general population. These numbers are higher in the military population and are often complicated by comorbidities. AIM: Chart audits revealed 68% of psychiatric clinic outpatient veterans met criteria for TRD. Only 25% of patients were being treated adequately for TRD, and 0% were offered other options for treatment. This project aimed to improve patient-centered TRD care at a veteran's hospital to 80% within 90 days. METHODS: This quality improvement project was implemented using plan-do-study-act (PDSA) cycles. Interventions were tested over four rapid-cycle phases with improvements for screening, handouts, surveys, and team meetings over 8 weeks. Four core interventions were followed throughout the project: screening for TRD, right-care case management tracking, patient engagement with shared decision-making (SDM), and team engagement. RESULTS: Starting from a baseline right-care score of 25%, the project attained an overall mean of 99.6% representing improved patient-centered TRD care and surpassing the 80% goal defined in the aim. CONCLUSION: Overall TRD care was improved using SDM options and inter-clinic teamwork and communication.

Fostering an Innovation Culture in the Education Sector: A Scoping Review and Bibliometric Analysis of Hackathon Research.

Despite originating in the tech industry, hackathons have now been adopted in a variety of domains. However, little is known about the status of hackathon literature within educational research. As the number of studies grows, it is essential to develop an understanding of the current state and identify prevalent topics and trends shaping the literature. Toward this goal, this study conducted a bibliometric analysis and scoping review on hackathon research in the field of education. A total of 249 documents written by 1,309 authors and published in 180 unique sources for the period 2014-2022 were identified. Collectively, the dataset amassed 1,312 citations with an average of 6.69 citations per document. The most prevalent subject areas were computer science, social sciences, engineering, medicine, and business. Word frequency analysis showed that "innovation" was the most occurring word, which represents the fundamental objective of hackathon events. The most influential work was the analysis of hackathons as an informal learning platform. Engineering education was the most trending topic while healthcare is an emerging research cluster. Overall, this study provides a better understanding of the hackathon literature and its research landscape in an educational setting.

One-off events? An empirical study of hackathon code creation and reuse.

Context: Hackathons have become popular events for teams to collaborate on projects and develop software prototypes. Most existing research focuses on activities during an event with limited attention to the evolution of the hackathon code. Objective: We aim to understand the evolution of code used in and created during hackathon events, with a particular focus on the code blobs, specifically, how frequently hackathon teams reuse pre-existing code, how much new code they develop, if that code gets reused afterwards, and what factors affect reuse. Method: We collected information about 22,183 hackathon projects from Devpost and obtained related code blobs, authors, project characteristics, original author, code creation time, language, and size information from World of Code. We tracked the reuse of code blobs by identifying all commits containing blobs created during hackathons and identifying all projects that contain those commits. We also conducted a series of surveys in order to gain a deeper understanding of hackathon code evolution that we sent out to hackathon participants whose code was reused, whose code was not reused, and developers who reused some hackathon code. Result: 9.14% of the code blobs in hackathon repositories and 8% of the lines of code (LOC) are created during hackathons and around a third of the hackathon code gets reused in other projects by both blob count and LOC. The number of associated technologies and the number of participants in hackathons increase reuse probability. Conclusion: The results of our study demonstrates hackathons are not always "one-off" events as the common knowledge dictates and it can serve as a starting point for further studies in this area.

Interdisciplinary Online Hackathons as an Approach to Combat the COVID-19 Pandemic: Case Study.

BACKGROUND: The COVID-19 outbreak has affected the lives of millions of people by causing a dramatic impact on many health care systems and the global economy. This devastating pandemic has brought together communities across the globe to work on this issue in an unprecedented manner. OBJECTIVE: This case study describes the steps and methods employed in the conduction of a remote online health hackathon centered on challenges posed by the COVID-19 pandemic. It aims to deliver a clear implementation road map for other organizations to follow. METHODS: This 4-day hackathon was conducted in April 2020, based on six COVID-19-related challenges defined by frontline clinicians and researchers from various disciplines. An online survey was structured to assess: (1) individual experience satisfaction, (2) level of interprofessional skills exchange, (3) maturity of the projects realized, and (4) overall quality of the event. At the end of the event, participants were invited to take part in an online survey with 17 (+5 optional) items, including multiple-choice and open-ended questions that assessed their experience regarding the remote nature of the event and their individual project, interprofessional skills exchange, and their confidence in working on a digital health project before and after the hackathon. Mentors, who guided the participants through the event, also provided feedback to the organizers through an online survey. RESULTS: A total of 48 participants and 52 mentors based in 8 different countries participated and developed 14 projects. A total of 75 mentorship video sessions were held. Participants reported increased confidence in starting a digital health venture or a research project after successfully participating in the hackathon, and stated that they were likely to continue working on their projects. Of the participants who provided feedback, 60% (n=18) would not have started their project without this particular hackathon and indicated that the hackathon encouraged and enabled them to progress faster, for example, by building interdisciplinary teams, gaining new insights and feedback provided by their mentors, and creating a functional prototype. CONCLUSIONS: This study provides insights into how online hackathons can contribute to solving the challenges and effects of a pandemic in several regions of the world. The online format fosters team diversity, increases cross-regional collaboration, and can be executed much faster and at lower costs compared to in-person events. Results on preparation, organization, and evaluation of this online hackathon are useful for other institutions and initiatives that are willing to introduce similar event formats in the fight against COVID-19.

Global Surgery Hackathons: A Case Study From Pakistan.

Background. Hackathons aim to solve problems in a selected field by bringing together people from multiple domains and combining their expertise. Global surgery is an emerging field with a huge burden of disease and massive implications for bettering health care. In this study, we describe the first Global Surgery Hackathon held in Pakistan and analyze the impacts of the hack and post-hack incubation. Methods. This research study used data collected from a Hackathon held at the Aga Khan University (AKU) in Karachi, Pakistan, and progress from the post-hack incubation teams. Data were collected from applications, from sign-in attendance, via evaluation forms, and milestone tracking of the incubation teams. A list of factors such as sectors addressed by winning projects and grants received was made. Results. The evaluations provided by the participants were positive, with mean scores of 4.00 (SD = .78) out of 5 on a Likert scale. Pitches made (n = 69, 68%) by the 109 participants were sorted into 5 categories: workplace, access, quality, safety, and design. Fifteen teams were formed, out of which 5 were accepted for incubation. All teams had a minimum viable product at the one-year mark. Conclusion. Hackathons are a reliable way to come up with effective solutions for targeted problems in various areas of health care and using the methodology of a Hackathon, a pool of low-cost, innovative solutions can be generated. These solutions can definitely impact health outcomes, especially for the field of global surgery. Further statistics should be collected to affirm the incubated solutions' impact.

Prototypes for automating product system model assembly.

INTRODUCTION: The flexibility of life cycle inventory (LCI) background data selection is increasing with the increasing availability of data, but this comes along with the challenge of using the background data with primary life cycle inventory data. To relieve the burden on the practitioner to create the linkages and reduce bias, this study aimed at applying automation to create foreground LCI from primary data and link it to background data to construct product system models (PSM). METHODS: Three experienced LCA software developers were commissioned to independently develop software prototypes to address the problem of how to generate an operable PSM from a complex product specification. The participants were given a confidential product specification in the form of a Bill of Materials (BOM) and were asked to develop and test prototype software under a limited time period that converted the BOM into a foreground model and linked it with one or more a background datasets, along with a list of other functional requirements. The resulting prototypes were compared and tested with additional product specifications. RESULTS: Each developer took a distinct approach to the problem. One approach used semantic similarity relations to identify best-fit background datasets. Another approach focused on producing a flexible description of the model structure that removed redundancy and permitted aggregation. Another approach provided an interactive web application for matching product components to standardized product classification systems to facilitate characterization and linking. DISCUSSION: Four distinct steps were identified in the broader problem of automating PSM construction: creating a foreground model from product data, determining the quantitative properties of foreground model flows, linking flows to background datasets, and expressing the linked model in a format that could be used by existing LCA software. The three prototypes are complementary in that they address different steps and demonstrate alternative approaches. Manual work was still required in each case, especially in the descriptions of the product flows that must be provided by background datasets. CONCLUSION: The study demonstrates the utility of a distributed, comparative software development, as applied to the problem of LCA software. The results demonstrate that the problem of automated PSM construction is tractable. The prototypes created advance the state of the art for LCA software.

Innovation in emergency medicine; a perspective from a low middle income country, Pakistan.

Creativity and innovation are essential life skills in the 21st century. These skills are even more important in the healthcare sector of a resource limited country like Pakistan. The acquisition and implementation of innovation is necessary in the field of emergency medicine in Pakistan to troubleshoot challenges like rising emergency room visits while facing lack of resources. This article highlights the need of innovation in the field of emergency medicine and some of the activities that took place in our local context to bring innovation to the surface.

Hackathons as Stepping Stones in Health Care Innovation: Case Study With Systematic Recommendations.

BACKGROUND: Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users' unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation. OBJECTIVE: This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care. METHODS: A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included. RESULTS: In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step. CONCLUSIONS: This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons.

Health hackathon as a venue for interprofessional education: a qualitative interview study.

A Health Hackathon provides an opportunity for healthcare professionals to collaborate with IT developers and designers to solve health issues using technology and thus serves as a potential venue for interprofessional education. The present paper reports the views and experiences of participants on how the KKU mHealth Hackathon 2017 served as a venue for interprofessional education. A phenomenological approach was used involving semi-structured in-depth interviews of three faculty members and three students who participated in the hackathon. Participants expressed their learning experiences during the event, as well as factors that promoted or hindered learning. Our findings suggest that a health hackathon can serve as a suitable venue for interprofessional education as interviewees reported how they had learnt to successfully collaborate in interprofessional teams, move beyond their prior views and appreciate complementary work from other professions, focus on solving problems practically, and create a collegial, collaborative atmosphere. There were also some potential downsides of the hackathon that could be solved with an improved design in future occasions. A Health Hackathon can be an important opportunity for interprofessional education. Further studies should focus on methods to reproduce these positive learning experiences, mitigate the negative aspects, and investigate their long-term effects.

Interprofessional, learner-driven collaboration for innovative solutions to healthcare delivery in student-run clinics.

Student-run clinics are settings in which learners are empowered to design service delivery. Despite shared challenges faced by these clinics in improving clinical and educational programming, information exchange and collaboration between clinics of different institutions and professions are inefficiently facilitated by existing platforms. An abridged, one-hour hackathon event was piloted at the Society of Student-Run Free Clinics' 2018 Annual Conference. During the event, interprofessional teams were guided through defining a problem, ideating and prototyping possible solutions, and sharing them with the larger group. There were 23 participants representing 16 institutions and 5 professions; most had never discussed their clinic's problems with members of other institutions before. Teams generated novel ideas that culminated from a combination of existing local best practices or focused on developing infrastructure between clinics. Feedback of the event was positive; participants felt confident to design and implement solutions and collaborate with other clinics after the event. The abridged hackathon shows promise to facilitate communication and innovation among diverse groups across institutions.

Sex, obesity, diabetes, and exposure to particulate matter among patients with severe asthma: Scientific insights from a comparative analysis of open clinical data sources during a five-day hackathon.

This special communication describes activities, products, and lessons learned from a recent hackathon that was funded by the National Center for Advancing Translational Sciences via the Biomedical Data Translator program ('Translator'). Specifically, Translator team members self-organized and worked together to conceptualize and execute, over a five-day period, a multi-institutional clinical research study that aimed to examine, using open clinical data sources, relationships between sex, obesity, diabetes, and exposure to airborne fine particulate matter among patients with severe asthma. The goal was to develop a proof of concept that this new model of collaboration and data sharing could effectively produce meaningful scientific results and generate new scientific hypotheses. Three Translator Clinical Knowledge Sources, each of which provides open access (via Application Programming Interfaces) to data derived from the electronic health record systems of major academic institutions, served as the source of study data. Jupyter Python notebooks, shared in GitHub repositories, were used to call the knowledge sources and analyze and integrate the results. The results replicated established or suspected relationships between sex, obesity, diabetes, exposure to airborne fine particulate matter, and severe asthma. In addition, the results demonstrated specific differences across the three Translator Clinical Knowledge Sources, suggesting cohort- and/or environment-specific factors related to the services themselves or the catchment area from which each service derives patient data. Collectively, this special communication demonstrates the power and utility of intense, team-oriented hackathons and offers general technical, organizational, and scientific lessons learned.

The Research Role of the Librarian at a Community Health Hackathon - A Technical Report.

A hackathon is a social event that is focused on building small and innovative technology projects. The 2018 Hackathon hosted by the Washington State University (WSU) Elson S. Floyd College of Medicine aimed to solve rural health problems in Washington state. One major modification to the regular format of a healthcare hackathon was the inclusion of research librarians. Librarians with health sciences and business expertise provided research and library services at a designated Research Station, which included literature, patent, and internet searches. Participant and hackathon librarian observations, verbal feedback, and librarian survey results demonstrate the positive value/outcome of library services to the health hackathon winners. The winning hackathon teams used the services by the Research Station extensively. Areas of strength for this event included collaboration between librarians, promotion of library services, and efficient information retrieval. Areas for improvement included making regular contact with hackathon teams during the event and clearer signage and marketing.

A Case for Global Surgery in Pakistan: Implementation Through Multi-Disciplinary Engagement.

The increasing disparity in healthcare access in Pakistan requires immediate intervention in the form of informed policy and appropriate implementation of such a policy. The implementation of a global surgery framework in Pakistan has the potential to improve healthcare access and parity in rural areas. Benefitting from the lessons learned through previous attempts at implementing centrally planned health programmes, This paper makes the case for a decentralised approach in facilitating the implementation of a Global Surgery framework in Pakistan. The Critical Creative Innovative Thinking (CCIT) forum, established at the Aga Khan University (AKU), Karachi, has an important role to play in this regard. The CCIT forum has demonstrated ability in developing and facilitating multi - disciplinary engagement around topics of biomedicine and healthcare, and in growing such engagements to their commercial value. Hence, the CCIT forum has immense potential in creating a highfunctioning ecosystem around Global Surgery, thereby formulating a dynamic implementation plan - outside of conventional, centrally implemented public policy frameworks.

Institutionalizing healthcare hackathons to promote diversity in collaboration in medicine.

BACKGROUND: Medical students and healthcare professionals can benefit from exposure to cross-disciplinary teamwork and core concepts of medical innovation. Indeed, to address complex challenges in patient care, diversity in collaboration across medicine, engineering, business, and design is critical. However, a limited number of academic institutions have established cross-disciplinary opportunities for students and young professionals within these domains to work collaboratively towards diverse healthcare needs. METHODS: Drawing upon best practices from computer science and engineering, healthcare hackathons bring together interdisciplinary teams of students and professionals to collaborate, brainstorm, and build solutions to unmet clinical needs. Over the course of six months, a committee of 20 undergraduates, medical students, and physician advisors organized Stanford University's first healthcare hackathon (November 2016). Demographic data from initial applications were supplemented with responses from a post-hackathon survey gauging themes of diversity in collaboration, professional development, interest in medical innovation, and educational value. In designing and evaluating the event, the committee focused on measurable outcomes of diversity across participants (skillset, age, gender, academic degree), ideas (clinical needs), and innovations (projects). RESULTS: Demographic data (n = 587 applicants, n = 257 participants) reveal participants across diverse academic backgrounds, age groups, and domains of expertise were in attendance. From 50 clinical needs presented representing 19 academic fields, 40 teams ultimately formed and submitted projects spanning web (n = 13) and mobile applications (n = 13), artificial intelligence-based tools (n = 6), and medical devices (n = 3), among others. In post-hackathon survey responses (n = 111), medical students and healthcare professionals alike noted a positive impact on their ability to work in multidisciplinary teams, learn from individuals of different backgrounds, and address complex healthcare challenges. CONCLUSIONS: Healthcare hackathons can encourage diversity across individuals, ideas, and projects to address clinical challenges. By providing an outline of Stanford's inaugural event, we hope more universities can adopt the healthcare hackathon model to promote diversity in collaboration in medicine.

Patient-Centered Radiology with FHIR: an Introduction to the Use of FHIR to Offer Radiology a Clinically Integrated Platform.

Fast Healthcare Interoperability Resources (FHIR) is an open interoperability standard that allows external software to quickly search for and access clinical information from the electronic medical record (EMR) in a method that is developer-friendly, using current internet technology standards. In this article, we highlight the new FHIR standard and illustrate how FHIR can be used to offer the field of radiology a more clinically integrated and patient-centered system, opening the EMR to external radiology software in ways unfeasible with traditional standards. We explain how to construct FHIR queries relevant to medical imaging using the Society for Imaging Informatics in Medicine (SIIM) Hackathon application programming interface (API), provide sample queries for use, and suggest solutions to offer a patient-centered, rather than an image-centered, workflow that remains clinically relevant.

Learning HL7 FHIR Using the HAPI FHIR Server and Its Use in Medical Imaging with the SIIM Dataset.

Health Level 7's (HL7's) new standard, FHIR (Fast Health Interoperability Resources), is setting healthcare information technology and medical imaging specifically ablaze with excitement. This paper aims to describe the protocol's advantages in some detail and explore an easy path for those unfamiliar with FHIR to begin learning the standard using free, open-source tools, namely the HL7 application programming interface (HAPI) FHIR server and the SIIM Hackathon Dataset.