Running head:RESEARCH PROPOSAL 1 RESEARCH PROPOSAL 5 Research Proposal on Security and Privacy of Health Data Name Institutional Affiliation Research Proposal on Security and Privacy of Health Data Summary of the Research The health sector is important because it ensures the health of the populace. Over the years, there has been digitization of health data with the aim of enabling faster efficient and effective delivery of healthcare services. Digitization of health care enables faster retrieval of health records hence facilitates faster and informed healthcare decisions (Nass, Levit & Gostin, 2009). Due to the importance of digitization of healthcare data, big healthcare data emerged; it changed the way data was previously managed (Abouelmehdi, Beni-Hessane & Khaloufi, 2018). The availability of big healthcare data comes with privacy and security challenges that must be solved. In cognizance of the challenges, the research focuses on identifying mechanisms used in ensuring the security and the limitations of available solutions and how they can be improved amidst increasing amount of healthcare data. Outline of the Research The Introduction to the Research · Overview of healthcare data · Justification of the research · Research objectives · Research questions Review of Literature · The differences between privacy and security of health data · Data protection laws in relation to health · Privacy and security concerns of health data · Technologies use in privacy and security of health data i. Authentication ii. De-identification iii. Encryption iv. Data masking v. Access control vi. Monitoring and auditing · Challenges of existing technologies Methodology · Sample selection · Methods of data collection, i. Online surveys ii. Oral interviews · Data analysis i. Thematic analysis Research Findings and Discussion Recommendations · Ways of improving the limitations of existing technologies Conclusion · The available opportunities for preserving the privacy and the security of health data Limitations of the Study · Considerations for future research References Abouelmehdi, K ., Beni-Hessane, A and Khaloufi, H (2018). Big Healthcare Data: Preserving Security and Privacy. Journal of Big Data, 5(1), pp. 15-28. Nass, S. J., Levit, L.A and Gostin, L. O (eds.) (2009). Beyond The HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. Washington DC: National Academies Press. DQ-1 Non-alcoholic fatty liver diseases (NAFLD). NAFLD is a spectrum of hepatic disorders not associated with excessive alcohol intake, ranging from steatosis to cirrhosis and hepatocellular carcinoma, with hepatic cell inflammation and injury thought to result from the accumulation of triglycerides in the liver (Ball.

1. Running head:RESEARCH PROPOSAL
1
RESEARCH PROPOSAL
5
Research Proposal on Security and Privacy of Health Data
Name
Institutional Affiliation
Research Proposal on Security and Privacy of Health Data
Summary of the Research
The health sector is important because it ensures the health
of the populace. Over the years, there has been digitization of
health data with the aim of enabling faster efficient and
effective delivery of healthcare services. Digitization of health
care enables faster retrieval of health records hence facilitates
faster and informed healthcare decisions (Nass, Levit & Gostin,
2009). Due to the importance of digitization of healthcare data,
big healthcare data emerged; it changed the way data was
previously managed (Abouelmehdi, Beni-Hessane & Khaloufi,
2018). The availability of big healthcare data comes with
privacy and security challenges that must be solved. In
cognizance of the challenges, the research focuses on
identifying mechanisms used in ensuring the security and the
limitations of available solutions and how they can be improved
amidst increasing amount of healthcare data.
Outline of the Research
The Introduction to the Research
· Overview of healthcare data
· Justification of the research

2. · Research objectives
· Research questions
Review of Literature
· The differences between privacy and security of health data
· Data protection laws in relation to health
· Privacy and security concerns of health data
· Technologies use in privacy and security of health data
i. Authentication
ii. De-identification
iii. Encryption
iv. Data masking
v. Access control
vi. Monitoring and auditing
· Challenges of existing technologies
Methodology
· Sample selection
· Methods of data collection,
i. Online surveys
ii. Oral interviews
· Data analysis
i. Thematic analysis
Research Findings and Discussion
Recommendations
· Ways of improving the limitations of existing technologies
Conclusion
· The available opportunities for preserving the privacy and the
security of health data
Limitations of the Study
· Considerations for future research

3. References
Abouelmehdi, K ., Beni-Hessane, A and Khaloufi, H (2018).
Big Healthcare Data: Preserving Security and Privacy.
Journal of Big Data, 5(1), pp. 15-28.
Nass, S. J., Levit, L.A and Gostin, L. O (eds.) (2009). Beyond
The HIPAA Privacy Rule: Enhancing Privacy, Improving
Health Through Research. Washington DC: National
Academies Press.
DQ-1
Non-alcoholic fatty liver diseases (NAFLD).
NAFLD is a spectrum of hepatic disorders not associated with
excessive alcohol intake, ranging from steatosis to cirrhosis and
hepatocellular carcinoma, with hepatic cell inflammation and
injury thought to result from the accumulation of triglycerides
in the liver (Ball, Daines, Flynn, Solomon, & Stewart, 2015).
Genetic and environmental factors are likely to contribute to
disease development and insulin resistance is an important
factor and associated with metabolic syndromes such as obesity,
hypertriglyceridemia, and diabetes (Ball, Daines, Flynn,
Solomon, & Stewart, 2015). Chronic liver disease in the United
States occurs fairly equal in males and females and ethnically
high prevalence in Hispanic individuals, most patients are

4. asymptomatic, but some describe right upper quadrant pain,
fatigue, malaise, and jaundice (Ball, Daines, Flynn, Solomon, &
Stewart, 2015).
In history, patients may present with a history of metabolic
syndromes such as diabetes, hyperlipidemia, and obesity
(weight gain). On physical examination other than elevated
body mass index (BMI), overweight or obese by criteria, may
have a typical unremarkable finding, about half of the patient
may have hepatomegaly and in severe disease, the patient may
have jaundice and ascites (Ball, Daines, Flynn, Solomon, &
Stewart, 2015). Lab findings show abnormal liver function tests,
most patients will have elevated transaminase with aspartate
aminotransferase (AST) and alanine aminotransferase (ALT)
being two to three times the upper limit of the normal (Ball,
Daines, Flynn, Solomon, & Stewart, 2015). Another diagnostic
tool that could be in use will be magnetic resonance
spectroscopy (MRS) and liver biopsy are most sensitive (Ball,
Daines, Flynn, Solomon, & Stewart, 2015).
Hepatocellular carcinoma screening in NAFLD patients with
cirrhosis is mandatory and low incidence is NAFLD patients
without cirrhosis (Reig, Gambato, Man, Roberts, Victor, Orci,
& Toso, 2019). According to Mcpherson et al, (2017), Fibrosis
progression rates are variable in NAFLD and the severity of
steatosis is an important histological factor in predicting
fibrosis progression, irrespective of baseline fibrosis stage.
High prevalence of chronic kidney diseases and hypertension
had been reported among NAFLD patients and a C-reactive
protein (CRP) and expression of intercellular adhesion molecule
1 (ICAM-1) and vascular cell adhesion molecule -1 (VCAM-1)
are strong independent predictors of hypertension risk (Tsai et
al 2020). A population-based cohort study among 4,629
participants that non-overweight individuals with NAFLD had a
high risk of incident type 2 diabetes mellitus (González-
Moreno, García-Compean, González-González, & Maldonado-
Garza, 2017).
Summary and plan.

5. Based On these study findings I will screen them for diabetes by
doing an HbA1C, baseline liver function panel, cholesterol
panel, and screen patient for high blood pressure and will do
CRP, ICAM-1, VCAM-1to rule out hypertension risk. If the
liver enzymes such as AST, ALT were high, then An MRS and a
liver biopsy will be done if lab findings are positive. The
recommendations will be mainly lifestyle changes including,
weight reduction with dietary modification, regular exercises,
and cessation of smoking and drinking if the patients have a
history of them with the patient involvement. I would suggest a
cholesterol-lowering agent such as atorvastatin 20 mg daily and
omega-3-fatty acids twice a day to reduce triglycerides will be
started, and depends on the level of HbAIC, if its above > 7 will
add an agent such as metformin and management of
hypertension with a beta-blocker (metoprolol tartrate50 mg bid)
in addition to the above lifestyle modifications.
Reference.
Ball, J.W., Daines, J.E., Flynn, J.A. Solomon, B.S., & Stewart,
R.W. (2015). Seidel’s guide to physical examination (8th. Eds.,
pp. 406.) St. Luis, Missouri: Elsevier.
Mcpherson, S., Pais, R., Valenti, L., Schattenberg, J. M.,
Dufour, J. F., Tsochatzis, E., ... & Ratziu, V. (2017). Further
delineation of fibrosis progression in NAFLD: evidence from a
large cohort of patients with sequential biopsies. Journal of
Hepatology, 66(1), S593-S593.
Reig, M., Gambato, M., Man, N. K., Roberts, J. P., Victor, D.,
Orci, L. A., & Toso, C. (2019). Should patients with
NAFLD/NASH be surveyed for HCC?. Transplantation, 103(1),
39-44. Retrieved
from https://journals.lww.com/transplantjournal/Abstract/2019/
01000/Should_Patients_With_NAFLD_NASH_Be_Surveyed_for
.13.aspx
Tsai, Y. L., Liu, C. W., Huang, S. F., Yang, Y. Y., Lin, M. W.,
Huang, C. C., ... & Lin, H. C. (2020). Urinary fatty acid and
retinol binding protein-4 predict CKD progression in severe

6. NAFLD patients with hypertension: a 4-year study with clinical
and experimental approaches. Medicine, 99(2). Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959901/
González-Moreno, E. I., García-Compean, D., González-
González, J. A., & Maldonado-Garza, H. J. (2017). How to
screen NAFLD patients for diabetes? Annals of hepatology,
15(5), 801-802. Retrieved
from https://www.medigraphic.com/cgi-
bin/new/resumenI.cgi?IDARTICULO=69581
DQ-2
Cyclic vomiting syndrome (CVS) is a disorder is characterized
by sudden and violent periods of vomiting with no apparent
cause, lasting a few hours to a few days. The vomiting is
typically projectile and contains bile, mucus, and, occasionally,
blood. Patients can experience between six and 12 episodes a
year, with the additional symptoms of headache, motion
sickness, sweating, agitation, photophobia, and abdominal pain
which is mostly located to the periumbilical or epigastric
region. It occurs in a variety of age groups and is more
prevalent in Caucasians and slightly more in males. Individuals
with CVS make repeated trips to Emergency Departments
seeking relief of the vomiting and the often-accompanying
abdominal pain and dehydration. Episodes of vomiting can be
triggered by infection, psychosocial stress, diet, and
menstruation. It is also commonly associated with cannabinoid
hyperemesis syndrome (CHS), which presents similarily and is
associated with heavy, chronic marijuana use(Hayes, VanGilder,
Berendse, Lemon, & Kappes, 2018).
Diagnosis of CVS based on history and clinical symptoms, and
remains largely one of exclusion. Tests that are routinely done
during the work-up include both blood and imaging. Serum
electrolytes, liver function tests, and lipase are often assessed in
the acute setting, prior to starting intravenous fluid therapy.
Esophageal pH testing may dismiss vomiting as an atypical
presentation of GERD. Some individuals may also be screened

7. for alcohol or drug use (Tan, Liwanag, & Quak, 2014). Upper
endoscopy, small bowel radiography, computed tomography, or
magnetic resonance enterography can assess for gastroduodenal
disease and small bowel obstruction. Peptic esophagitis and
hemorrhagic lesions of the gastric mucosa can be found as a
result of the vomiting episodes. If these tests are unremarkable,
brain imaging is often done to rule out tumors of the central
nervous system, especially if there are early morning emesis
and neurological findings on examination (Hayes et al., 2018).
Hayes, W. J., VanGilder, D., Berendse, J., Lemon, M. D., &
Kappes, J. A. (2018). Cyclic vomiting syndrome: diagnostic
approach and current management strategies. Clinical and
experimental gastroenterology, 11, 77–84.
https://doi.org/10.2147/CEG.S136420
Tan, M. L., Liwanag, M. J., & Quak, S. H. (2014). Cyclical
vomiting syndrome: Recognition, assessment and management.
World journal of clinical pediatrics, 3(3), 54–58.
https://doi.org/10.5409/wjcp.v3.i3.54
DQ-3
Irritable bowel syndrome (IBS) is a chronic gastrointestinal
(GI) disorder that causes cramping, abdominal pain, and
bloating with altered changes in bowel habits including
constipation, diarrhea, or both; also defined as a disorder of the
gut-brain interaction (Berens et al., 2019). IBS can result from
biological factors, in which altering bacterial flora and
increasing gut permeability, environmental factors including
intestinal infections and food allergies or intolerances, and
psychological factors, such as depression and stress (Berens et
al., 2019). Clinical manifestations of IBS include pain in the
lower abdominal quadrants, bloating, abdominal distention, and
constipation and/or diarrhea. Though, alarming symptoms may
include rectal bleeding, nocturnal pain, and weight loss (Soncini
et al., 2018).

8. Labs including CBC to screen for anemia or infection,
sedimentation rate to detect inflammation, and CMP to evaluate
for electrolyte and fluid abnormalities. Additionally, a tissue
transglutaminase antibody (tTG-IgA) test can be done for celiac
disease (Soncini et al., 2018). A stool examination can rule out
ova and parasites, C. difficile, and occult blood. A CT scan can
be helpful to determine fecal impaction, enteritis, or evidence of
a tumor. For constipation, an anorectal manometry can be done
to measure how well the rectum and anal sphincter are working
(Soncini et al., 2018). A colonoscopy would be essential to rule
out other GI disorders.
References
Berens, S., Rainer, S., Baumeister, D., Gauss, A., Eich, W., &
Tesarz, J. (2019). Does symptom activity explain psychological
differences in patients with irritable bowel syndrome and
inflammatory bowel disease? Results from a multi-center cross-
sectional study. Journal of Psychosomatic Research, 126,
109836. doi:10.1016/j.jpsychores.2019.109836
Soncini, M., Stasi, C., Satta, P. U., Milazzo, G., Bianco, M.,
Leandro, G., … Bellini, M. (2018). IBS clinical management in
Italy: The AIGO survey. Digestive and Liver Disease, 51(6),
782-789. doi:10.1016/j.dld.2018.10.006
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