Approach: The Aadhaar identification system provides each resident in India with a 12-digit unique identification number, linked to demographic and biometric data. Identification by Aadhaar in welfare programmes has the important advantage of ensuring targeted benefits reach the intended recipients.
Local setting: Some of the major issues faced by the public health sector in India are inadequate funding and inefficient utilization of the funds allocated. The enhancement of currently available digital health records will greatly increase the efficiency of the health care services.
Relevant changes: The Aadhaar identification system has been linked to several health programmes since 2013. Success was achieved in a programme encouraging pregnant women to undergo delivery at a health facility, as use of Aadhaar number ensured that cash incentives reached the correct recipient. However, interruptions in the treatment of patients with tuberculosis and acquired immunodeficiency syndrome have been reported in other health programmes, due to patients fearing a breach of their confidentiality.
Lessons learnt: Although the proposed merging of the Aadhaar identification system with digital health care records could enable greater efficiency in monitoring public health and welfare programmes, important ethical issues of privacy and data ownership and use must be considered. In joining the digital revolution, low- and middle-income countries must also develop strict legal regulation to protect data and avoid information technology companies exploiting such databases for profit.
METHODS: Using multi-region sampled RNA-seq data of 90 patients, we performed patient-specific differential expression testing, together with the patients' matched adjacent normal samples.
RESULTS: Comparing the results from conventional DE analysis and patient-specific DE analyses, we show that the conventional DE analysis omits some genes due to high inter-individual variability present in both tumour and normal tissues. Dysregulated genes shared in small subgroup of patients were useful in stratifying patients, and presented differential prognosis. We also showed that the target genes of some of the current targeted agents used in HCC exhibited highly individualistic dysregulation pattern, which may explain the poor response rate.
DISCUSSION/CONCLUSION: Our results highlight the importance of identifying patient-specific DE genes, with its potential to provide clinically valuable insights into patient subgroups for applications in precision medicine.