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After kidney transplantation graft rejection must be prevented. Therefore, a multitude of parameters of the patient is observed pre- and postoperatively. To support this process, the Screen Reject research project is developing a data warehouse optimized for kidney rejection diagnostics. In the course of this project it was discovered that important information are only available in form of free texts instead of structured data and can therefore not be processed by standard ETL tools, which is necessary to establish a digital expert system for rejection diagnostics. Due to this reason, data integration has been improved by a combination of methods from natural language processing and methods from image processing. Based on state-of-the-art data warehousing technologies (Microsoft SSIS), a generic data integration tool has been developed. The tool was evaluated by extracting Banff-classification from 218 pathology reports and extracting HLA mismatches from about 1700 PDF files, both written in german language.
Background:
Hereditary angioedema (HAE) is a rare genetic disease and characterized by clinical features such as paroxysmal, recurrent angioedema of the skin, the gastrointestinal tract, and the upper airways. Swelling of the skin occurs primarily in the face, extremities and genitals. Gastrointestinal attacks are accompanied by painful abdominal cramps, vomiting and diarrhea. Due to the low prevalence and the fact that HAE patients often present with rather unspecific symptoms such as abdominal cramps, the final diagnosis is often made after a long delay. The aim of this German-wide survey was to characterize the period between occurrence of first symptoms and final diagnosis regarding self-perceived health, symptom burden and false diagnoses for patients with HAE.
Results:
Overall, 81 patients with HAE were included and participated in the telephone-based survey. Of those, the majority reported their current health status as “good” (47.5%) or “very good” (13.8%), which was observed to be a clear improvement compared to the year before final diagnosis (“good” (16.3%), “very good” (11.3%)). Edema in the extremities (85.2%) and in the gastrointestinal tract (81.5%) were the most currently reported symptoms and occurred earlier than other reported symptoms (mean age at onset 18.1 and 17.8 years, respectively). Misdiagnoses were observed in 50.6% of participating HAE patients with appendicitis and allergy being the most frequently reported misdiagnoses (40.0 and 30.0% of those with misdiagnosis, respectively). Patients with misdiagnosis often received mistreatment (80.0%) with pharmaceuticals and surgical interventions as the most frequently carried out mistreatments (65.6 and 56.3% of those with mistreatment, respectively). The mean observed diagnostic delay was 18.1 years (median 15.0 years). The diagnostic delay was higher in older patients and index patients.
Conclusions:
This study showed that self-perceived status of health for patients is much better once the final correct diagnosis has been made and specific treatment was available. Further challenge in the future will still be to increase awareness for HAE especially in settings which are normally approached by patients at occurrence of first symptoms to assure early referral to specialists and therefore increase the likelihood of receiving an early diagnosis.
Aim:
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods:
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results:
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions:
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
Background:
Multiple Sclerosis (MS) is a chronic inflammatory, immune mediated disease of the central nervous system, with Relapsing Remitting MS (RRMS) being the most common type. Within the last years, the status of high disease activity (HDA) has become increasingly important for clinical decisions. Nevertheless, little is known about the incidence, the characteristics, and the current treatment of patients with RRMS and HDA in Germany. Therefore, this study aims to estimate the incidence of HDA in a German RRMS patient population, to characterize this population and to describe current drug treatment routines and further healthcare utilization of these patients.
Methods:
A claims data analyses has been conducted, using a sample of the InGef Research Database that comprises data of approximately four million insured persons from around 70 German statutory health insurances (SHI). The study was conducted in a retrospective cohort design, including the years 2012–2016. Identification of RRMS population based on ICD-10 code (ICD-10-GM: G35.1). For identification of HDA, criteria from other studies as well as expert opinions have been used. Information on incidence, characteristics and current treatment of patients with RRMS and HDA was considered.
Results:
The overall HDA incidence within the RRMS population was 8.5% for 2016. It was highest for the age group of 0–19 years (29.4% women, 33.3% men) and lowest for the age group of ≥ 50 years (4.3% women, 5.6% men). Mean age of patients with RRMS and incident HDA was 38.4 years (SD: 11.8) and women accounted for 67.8%.
Analyses of drug utilization showed that 82.4% received at least one disease-modifying drug (DMD) in 2016. A percentage of 49.8% of patients received drugs for relapse therapy. A share of 55% of RRMS patients with HDA had at least one hospitalization with a mean length of stay of 13.9 days (SD: 18.3 days) in 2016. The average number of outpatient physician contacts was 28.1 (SD: 14.0).
Conclusions:
This study based on representative Germany-wide claims data from the SHI showed a high incidence of HDA especially within the young RRMS population. Future research should consider HDA as an important criterion for the quality of care for MS patients.
Self-directed learning is an essential basis for lifelong learning and requires constantly changing, target groupspecific and personalized prerequisites in order to motivate people to deal with modern learning content, not to overburden them and yet to adequately convey complex contexts. Current challenges in dealing with digital resources such as information overload, reduction of complexity and focus, motivation to learn, self-control or psychological wellbeing are taken up in the conception of learning settings within our QpLuS IM project for the study program Information Management and Information Management extra-occupational (IM) at the University of Applied Sciences and Arts Hannover. We present an interactive video on the functionality of search engines as a practical example of a medially high-quality and focused self-learning format that has been methodically produced in line with our agile, media-didactic process and stage model of complexity levels.
Digital data on tangible and intangible cultural assets is an essential part of daily life, communication and experience. It has a lasting influence on the perception of cultural identity as well as on the interactions between research, the cultural economy and society. Throughout the last three decades, many cultural heritage institutions have contributed a wealth of digital representations of cultural assets (2D digital reproductions of paintings, sheet music, 3D digital models of sculptures, monuments, rooms, buildings), audio-visual data (music, film, stage performances), and procedural research data such as encoding and annotation formats. The long-term preservation and FAIR availability of research data from the cultural heritage domain is fundamentally important, not only for future academic success in the humanities but also for the cultural identity of individuals and society as a whole. Up to now, no coordinated effort for professional research data management on a national level exists in Germany. NFDI4Culture aims to fill this gap and create a usercentered, research-driven infrastructure that will cover a broad range of research domains from musicology, art history and architecture to performance, theatre, film, and media studies.
The research landscape addressed by the consortium is characterized by strong institutional differentiation. Research units in the consortium's community of interest comprise university institutes, art colleges, academies, galleries, libraries, archives and museums. This diverse landscape is also characterized by an abundance of research objects, methodologies and a great potential for data-driven research. In a unique effort carried out by the applicant and co-applicants of this proposal and ten academic societies, this community is interconnected for the first time through a federated approach that is ideally suited to the needs of the participating researchers. To promote collaboration within the NFDI, to share knowledge and technology and to provide extensive support for its users have been the guiding principles of the consortium from the beginning and will be at the heart of all workflows and decision-making processes. Thanks to these principles, NFDI4Culture has gathered strong support ranging from individual researchers to highlevel cultural heritage organizations such as the UNESCO, the International Council of Museums, the Open Knowledge Foundation and Wikimedia. On this basis, NFDI4Culture will take innovative measures that promote a cultural change towards a more reflective and sustainable handling of research data and at the same time boost qualification and professionalization in data-driven research in the domain of cultural heritage. This will create a long-lasting impact on science, cultural economy and society as a whole.
Microservices is an architectural style for complex application systems, promising some crucial benefits, e.g. better maintainability, flexible scalability, and fault tolerance. For this reason microservices has attracted attention in the software development departments of different industry sectors, such as ecommerce and streaming services. On the other hand, businesses have to face great challenges, which hamper the adoption of the architectural style. For instance, data are often persisted redundantly to provide fault tolerance. But the synchronization of those data for the sake of consistency is a major challenge. Our paper presents a case study from the insurance industry which focusses consistency issues when migrating a monolithic core application towards microservices. Based on the Domain Driven Design (DDD) methodology, we derive bounded contexts and a set of microservices assigned to these contexts. We discuss four different approaches to ensure consistency and propose a best practice to identify the most appropriate approach for a given scenario. Design and implementation details and compliance issues are presented as well.
Die Problematik der aktuell batteriebetriebenen Elektrofahrzeuge liegt in der geringen Reichweite, einem geringen Fahrtgastkomfort, sowie den langen Ladezeiten und einer nicht ausreichenden Ladeinfrastruktur. Diese Tatsachen stellen für die Nutzer eine Hürde für den Umstieg zu batteriebetriebenen Fahrzeugen dar. Eine schon heute verfügbare Brückentechnologie ist der Range Extender. Diese, meist im Fahrzeug integrierten Einheiten, liefern zusätzliche Reichweite, bei einer elektrischen Leistung von meist über 15 kWel und einem durchschnittlichen Anlagenwirkungsgrad von Ƞ RE ≈ 29 %. In dieser Arbeit wird ein modulares Konzept eines erweiterten Range Extenders untersucht, welches die Funktion der Kraft-Wärme-Kopplung und Kraft-Kälte-Kopplung nutzt. Diese Hilfseinheit soll zum einen den Nachteil der geringen Reichweite aufgrund der eingeschränkten Batteriekapazitäten, zum anderen den geringen thermischen Innenraumkomfort von batteriebetriebenen Fahrzeugen ausgleichen. Das Konzept einer Kraftwärme/-kältekopplung zur Klimatisierung von BEV wird in der vorliegenden Arbeit mit Hilfe eines Versuchsaufbaus messtechnisch und theoretisch mittels Simulation untersucht, sowie anhand der ermittelten Kennfelder beurteilt. Die Simulation basiert dabei auf empirisch ermittelten Daten. In den gewählten Fahrzeugklassen Kleinstwagen, Kompakt- und Mittelklasse wird der mittlere Gesamtwirkungsgrad der Anlagenkomponenten in Abhängigkeit von Klimadaten (Wetterdaten) bestimmt. Dieser ermittelte Wirkungsgrad ist abhängig von äußeren thermischen Anforderungen und der Ausnutzung der Anlagenkomponenten. Der modulierbare Leistungsbereich des mikro Blockheizkraftwerks mit Kraft-Kälte-Kopplung hat zum Heizen einen thermischen Leistungsbereich von 5,7 – 13,0 kWthh. Der mechanische Leistungsbereich von 2,0 - 14,5 kWme wird in zwei Bereiche aufgeteilt. Zur Kühlung wird ein thermischer Bereich von 1,0 – 7,0 kWthk und zur elektrischen Stromerzeugung ein Leistungsbereich von 1,0 – 6,0 kWel verwendet. Basierend auf den in dieser Arbeit experimentell ermittelten Kennfeldern, die unter Berücksichtigung der lokalen klimatischen Bedingungen in Deutschland berechnet wurden, kann der Anlagenwirkungsgrad für Kleinstwagen mit Ƞ Kl = 58,9 ± 3,5 %, für die Kompaktklasse mit Ƞ Ko = 62,2 ± 5,5 % und für die Mittelklasse mit durchschnittlich Ƞ Mk = 65,2 ± 4,8 % ermittelt werden. Die zusätzlich gewonnenen Reichweiten, die durch Einsparung von batterieelektrischer Energie für die Klimatisierung und durch Einspeisung von erzeugter elektrischer Energie erreicht werden, liegen bei den Kleinstwagen bei 246 ± 31 km, in der Kompaktklasse bei 296 ± 103 km und in der Mittelklasse bei 314 ± 104 km. Eine Abtrennung des Klimakompressors von der Verbrennungskraftmaschine führt dabei zusätzlich zu einer teilweisen Verbesserung der ermittelten Werte. Im Vergleich dazu, lässt sich ein durchschnittlicher Reichweitenzuwachs von 103 km, ohne den Einsatz eines Kraftstoffes, nur durch Nutzung eines effizienteren Systems erreichen, wenn eine Wärmepumpe eingesetzt wird. Zusammenfassend kann festgehalten werden, dass der Einsatz der Kraftwärme -Kältekopplung zur Klimatisierung von Elektrofahrzeugen nachhaltig und sinnvoller erscheint, als der Einsatz eines konventionellen Range Extender, denn der Einsatz eines zusätzlichen Kraftstoffes sollte so effizient wie möglich genutzt werden.
Background
In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention.
Methods
This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed.
Discussion
This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers.
A novel method has been implemented to prepare metal oxide nanopowders covered with known quantities of adsorbed water; we subsequently studied the γ-radiolysis of ZrO2 nanopowders covered with H2O layers. H2 yields from the adsorbed water radiolysis are of importance in multiple industrial contexts – the nuclear industry being a prime example. Measured H2 yields at water coverages of just below and above one monolayer are around 350 times greater than for neat water, but these yields decrease rapidly with increasing water loading of the ZrO2 nanoparticles, approaching the yield of bulk water at coverages of tens of water layers. The observed plateau of the yields at 0.5 to 2.0 monolayers coverage can be explained by the ease with which electronic excitations in the ZrO2 can be transferred across the interface to the first one or two adsorbed water layers. However, with increasing water loading, energy transfer to water layers further away from the interface becomes less efficient, and above ~30 water layers, most of the water is not affected by any exciton formation in the ZrO2.