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The research project "Herbar Digital" was started in 2007 with the aim to digitize 3.5 million dried plants on paper sheets belonging to the Botanic Museum Berlin in Germany. Frequently the collector of the plant is unknown, so a procedure had to be developed in order to determine the writer of the handwriting on the sheet. In the present work the static character was transformed into a dynamic form. This was done with the model of an inert ball which was rolled along the written character. During this off-line writer recognition, different mathematical procedures were used such as the reproduction of the write line of individual characters by Legendre polynomials. When only one character was used, a recognition rate of about 40% was obtained. By combining multiple characters, the recognition rate rose considerably and reached 98.7% with 13 characters and 93 writers (chosen randomly from the international IAM-database [3]). A global statistical approach using the whole handwritten text resulted in a similar recognition rate. By combining local and global methods, a recognition rate of 99.5% was achieved.
The methods developed in the research project "Herbar Digital" are to help plant taxonomists to master the great amount of material of about 3.5 million dried plants on paper sheets belonging to the Botanic Museum Berlin in Germany. Frequently the collector of the plant is unknown. So a procedure had to be developed in order to determine the writer of the handwriting on the sheet. In the present work the static character is transformed into a dynamic form. This is done with the model of an inert ball which is rolled through the written character. During this off-line writer recognition, different mathematical procedures are used such as the reproduction of the write line of individual characters by Legendre polynomials. When only one character is used, a recognition rate of about 40% is obtained. By combining multiple characters, the recognition rate rises considerably and reaches 98.7% with 13 characters and 93 writers (chosen randomly from the international IAM-database [3]). Another approach tries to identify the writer by handwritten words. The word is cut out and transformed into a 6-dimensional time series and compared e.g. by means of DTW-methods. A global statistical approach using the whole handwritten sentences results in a similar recognition rate of more than 98%. By combining the methods, a recognition rate of 99.5% is achieved.
Objectives:
The aim was to identify theoretically expected as well as actually reported benefits from drug development and the importance of individual patient benefits compared to the collective benefits to society in general.
Background:
Ethical guidelines require that clinical research involving humans offer the potential for benefit. A number of characteristics can be applied to define research benefit. Often benefit is categorized as being either direct or indirect. Indirect benefits can involve collective benefits for society rather than any benefits to the trial patient or subject. The purpose of this review was to examine which potential individual and societal benefits were mentioned as being expected in publications from government experts and which were mentioned in publications describing completed drug development trial results.
Methods:
Literature on research benefit was first identified by searching the PubMed database using several combinations of the key words benefit and clinical research. The search was limited to articles published in English. A Google search with the same combinations of key words but without any language limitation was then performed. Additionally, the reference lists of promising articles were screened for further thematically related articles. Finally, a narrative review was performed of relevant English- and German-language articles published between 1996 and 2016 to identify which of several potential benefits were either theoretically expected or which were mentioned in publications on clinical drug development trial results.
Results:
The principal benefits from drug development discussed included 2 main types of benefit, namely individual benefits for the patients and collective benefits for society. Twenty-one of an overall total of 26 articles discussing theoretically expected benefits focused on individual patient benefits, whereas 17 out of 26 articles mentioned collective benefits to society. In these publications, the most commonly mentioned theoretically expected individual patient benefit was the chance to receive up-to-date care (38.1%). A general increase in knowledge about health care, treatments, or drugs (70.6%) was the most commonly mentioned theoretically expected benefit for society. In contrast, all 13 publications reporting actual benefits of clinical drug development trials focused on personal benefits and only 1 of these publications also mentioned a societal benefit. The most commonly mentioned individual benefit was an increased quality of life (53.9%), whereas the only mentioned collective benefit to society was a general gain of knowledge (100.0%).
Conclusions:
Both theoretically expected and actually reported benefits in the majority of the included publications emphasized the importance of individual patient benefits from drug development rather than the collective benefits to society in general. The authors of these publications emphasized the right of each individual patient or subject to look for and expect some personal benefit from participating in a clinical trial rather than considering societal benefit as a top priority. From an ethical point of view, the benefits each individual patient receives from his or her participation in a clinical trial might also be seen as a societal benefit, especially when the drug or device tested, if approved for marketing, would eventually be made available for other similar patients from the country in which the clinical trial was conducted.
Wearable sensors in healthcare and sensor-enhanced health information systems: all our tomorrows?
(2012)
Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuro-psychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health
care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.
Background: Depletion of ovarian hormone in postmenopausal women has been associated with changes in the locomotor apparatus that may compromise walking function including muscle atrophy/weakness, weight gain, and bone demineralization. Therefore, handgrip strength (HGS), bone mineral density (BMD) and body composition [percentage body fat mass (%BFM), fat mass (FM), Fat-free mass (FFM) and body mass index (BMI)], may significantly vary and predict WB in postmenopausal women. Consequently, the study sought to 1. Explore body composition, BMD and muscle strength differences between premenopausal and postmenopausal women and 2. Explore how these variables [I.e., body composition, BMD and muscle strength] relate to WB in postmenopausal women.
Method: Fifty-one pre-menopausal (35.74 + 1.52) and 50 postmenopausal (53.32 + 2.28) women were selected by convenience sampling and studied. Six explanatory variables (HGS, BMD, %BFM, FFM, BMI and FM) were explored to predict WB in postmenopausal women: Data collected were analyzed using multiple linear regression, ANCOVA, independent t-test and Pearson correlation coefficient at p < 0.05.
Result: Postmenopausal women had higher BMI(t = + 1.72; p = 0.04), %BFM(t = + 2.77; p = .003), FM(t = + 1.77; p = 0.04) and lower HGS(t = − 3.05; p = 0.001),compared to the premenopausal women. The predicted main effect of age on HGS was not significant, F(1, 197) = 0.03, p = 0.06, likewise the interaction between age and %BFM, F(1, 197) = 0.02, p = 0.89; unlike the predicted main effect of %BFM, F(1, 197) = 10.34, p = .002, on HGS. HGS was the highest predictor of WB (t = 2.203; β=0.3046) in postmenopausal women and combined with T-score right big toe (Tscorert) to produce R2 = 0.11;F (2, 47)=4.11;p = 0.02 as the best fit for the predictive model. The variance (R2) change was significant from HGS model (R2 = 0.09;p = 0.03) to HGS + Tscorert model (R2 = 0.11;p = 0.02). The regression model equation was therefore given as: WB =5.4805 + 0.1578(HGS) + (− 1.3532) Tscorert.
Conclusion: There are differences in body composition suggesting re-compartmentalization of the body, which may adversely impact the (HGS) muscle strength in postmenopausal women. Muscle strength and BMD areassociated with WB, although, only contribute to a marginal amount of the variance for WB. Therefore, other factors in addition to musculoskeletal health are necessary to mitigate fall risk in postmenopausal women.
Scientific papers from all disciplines contain many abbreviations and acronyms. In many cases these acronyms are ambiguous. We present a method to choose the contextual correct definition of an acronym that does not require training for each acronym and thus can be applied to a large number of different acronyms with only few instances. We constructed a set of 19,954 examples of 4,365 ambiguous acronyms from image captions in scientific papers along with their contextually correct definition from different domains. We learn word embeddings for all words in the corpus and compare the averaged context vector of the words in the expansion of an acronym with the weighted average vector of the words in the context of the acronym. We show that this method clearly outperforms (classical) cosine similarity. Furthermore, we show that word embeddings learned from a 1 billion word corpus of scientific exts outperform word embeddings learned from much larger general corpora.
Using openEHR Archetypes for Automated Extraction of Numerical Information from Clinical Narratives
(2019)
Up to 80% of medical information is documented by unstructured data such as clinical reports written in natural language. Such data is called unstructured because the information it contains cannot be retrieved automatically as straightforward as from structured data. However, we assume that the use of this flexible kind of documentation will remain a substantial part of a patient’s medical record, so that clinical information systems have to deal appropriately with this type of information description. On the other hand, there are efforts to achieve semantic interoperability between clinical application systems through information modelling concepts like HL7 FHIR or openEHR. Considering this, we propose an approach to transform unstructured documented information into openEHR archetypes. Furthermore, we aim to support the field of clinical text mining by recognizing and publishing the connections between openEHR archetypes and heterogeneous phrasings. We have evaluated our method by extracting the values to three openEHR archetypes from unstructured documents in English and German language.
In huge warehouses or stockrooms, it is often very difficult to find a certain item, because it has been misplaced and is therefore not at its assumed position. This position paper presents an approach on how to coordinate mobile RFID agents using a blackboard architecture based on Complex Event Processing.
The network security framework VisITMeta allows the visual evaluation and management of security event detection policies. By means of a "what-if" simulation the sensitivity of policies to specific events can be tested and adjusted. This paper presents the results of a user study for testing the usability of the approach by measuring the correct completion of given tasks as well as the user satisfaction by means of the system usability scale.
Type 2 Diabetes Mellitus: Risk Evaluation and Advice in Undergraduate Students in Ashrafieh, Lebanon
(2016)
Type 2 diabetes mellitus (T2DM) is a chronic lifestyle disease. It has become evident that T2DM occurs even among the younger age groups.1 In Lebanon, T2DM has a major public health impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities.2
The paper sheds light on the change in the concept of obedience within the Society of Jesus since the 1960s. In the aftermath of the Second Vatican Council, a so-called crisis of authority and obedience took place in the Catholic Church and the religious orders. As a consequence, the notions of responsibility and conscience came to the fore in the Jesuit definition of obedience. The religious concept of obedience, that is the obedience towards God, was reassessed as a service to humanity. The paper analyzes how the change in the concept of obedience gave rise to the promotion of social justice, which the Society of Jesus proclaimed at General Congregation 32 in 1974/75. By including the promotion of social justice into their central mission, Jesuits not only fundamentally transformed their self-conception, but also their ethical values. The paper argues that the pursuit of social justice became a form of religious obedience.
Objectives: Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery.
Methods: We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery.
Results: In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia.
Conclusions: Tractography of language pathways can help to determine the individual aphasia risk profile presurgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.
Toward a service-based workflow for automated information extraction from herbarium specimens
(2018)
Over the past years, herbarium collections worldwide have started to digitize millions of specimens on an industrial scale. Although the imaging costs are steadily falling, capturing the accompanying label information is still predominantly done manually and develops into the principal cost factor. In order to streamline the process of capturing herbarium specimen metadata, we specified a formal extensible workflow integrating a wide range of automated specimen image analysis services. We implemented the workflow on the basis of OpenRefine together with a plugin for handling service calls and responses. The evolving system presently covers the generation of optical character recognition (OCR) from specimen images, the identification of regions of interest in images and the extraction of meaningful information items from OCR. These implementations were developed as part of the Deutsche Forschungsgemeinschaft funded a standardised and optimised process for data acquisition from digital images of herbarium specimens (StanDAP-Herb) Project.
Research information, i.e., data about research projects, organisations, researchers or research outputs such as publications or patents, is spread across the web, usually residing in institutional and personal web pages or in semi-open databases and information systems. While there exists a wealth of unstructured information, structured data is limited and often exposed following proprietary or less-established schemas and interfaces. Therefore, a holistic and consistent view on research information across organisational and national boundaries is not feasible. On the other hand, web crawling and information extraction techniques have matured throughout the last decade, allowing for automated approaches of harvesting, extracting and consolidating research information into a more coherent knowledge graph. In this work, we give an overview of the current state of the art in research information sharing on the web and present initial ideas towards a more holistic approach for boot-strapping research information from available web sources.
From an ethical perspective, clinical research involving humans is only acceptable if it involves the potential for benefit. Various characteristics can be applied to differentiate research benefit. Often benefit is categorized in direct or indirect benefit, whereby indirect benefit might be further differentiated in collective or benefit for the society, excluding or including the trial patient in the long term. Ethical guidelines, such as the Declaration of Helsinki in its latest version, do not precisely favor a particular type of benefit.
Background: The topographical correlations between certain extracranial and intracranial osseous points of interest (POIs), and their age-related changes, are indispensable to know for a diagnostical or surgical access to intracranial structures; however, they are difficult to assess with conventional devices.
Materials and methods: In this pilot study, the 3-dimensional coordinates of extra-/intracranial POIs were determined, thus avoiding perspective distortions that used to be intrinsic problems in 2-dimensional morphometry. The data sets were then analysed by creating virtual triangles. The sizes, shapes, and positions of these triangles described the extent and the directions of the age-related shifts of the POIs. A selection of extracranial and intracranial POIs were marked on half skulls of four warmblood horses in two age groups (young: 6 weeks, n = 2; old: 14 and 17 years, n = 2). The x-, y-, and z-coordinates of these POIs were determined with a measurement arm (FaroArm Fusion, FARO Europe®). Direct distances between the POIs as well as their indirect distances on the x-, y-, and z-axis, and angles were calculated.
Results: The analysed virtual triangles revealed that some parts of the skull grew in size, but did not change in shape/relative proportions (proportional type of growth, as displayed by POI A and POI B at the Arcus zygomaticus). The same POIs (A and B) remained in a very stable relationship to their closest intracranial POI at the Basis cranii on the longitudinal axis, however, shifted markedly in the dorso-lateral direction. In contrast, a disproportional growth of other parts of the cranium was, for example, related to POI C at the Crista nuchae, which shifted strongly in the caudal direction with age. A topographically stable reference point (so-called anchor point) at the Basis cranii was difficult to determine.
Conclusions: Two candidates (one at the Synchondrosis intersphenoidalis, another one at the Synchondrosis sphenooccipitalis) were relatively stable in their positions. However, the epicentre of (neuro-)cranial growth could only be pinpointed to an area between them.
BACKGROUND:
Safety climate research suggests that a corresponding climate in work units is crucial for patient safety. Intensive care units are usually co-led by a nurse and a physician, who are responsible for aligning an interprofessional workforce and warrant a high level of safety. Yet, little is known about whether and how these interprofessional co-leaders jointly affect their unit's safety climate.
PURPOSE:
This empirical study aims to explain differences in the units' safety climate as an outcome of the nurse and physician leaders' degree of shared goals. Specifically, we examine whether the degree to which co-leaders share goals in general fosters a safety climate by pronouncing norms of interprofessional cooperation as a behavioral standard for the team members' interactions.
METHODOLOGY/APPROACH:
A cross-sectional design was used to gather data from 70 neonatal intensive care units (NICUs) in Germany. Survey data for our variables were collected from the unit's leading nurse and the leading physician, as well as from the unit's nursing and physician team members. Hypotheses testing at unit level was conducted using multivariate linear regression.
RESULTS:
Our analyses show that the extent to which nurse-physician co-leaders share goals covaries with safety climate in NICUs. This relationship is partially mediated by norms of interprofessional cooperation among NICU team members. Our final model accounts for 54% of the variability in safety climate of NICUs.
CONCLUSION:
Increasing the extent to which co-leaders share goals is an effective lever to strengthen interprofessional cooperation and foster a safety climate among nursing and physician team members of hospital units.
The reuse of scientific raw data is a key demand of Open Science. In the project NOA we foster reuse of scientific images by collecting and uploading them to Wikimedia Commons. In this paper we present a text-based annotation method that proposes Wikipedia categories for open access images. The assigned categories can be used for image retrieval or to upload images to Wikimedia Commons. The annotation basically consists of two phases: extracting salient keywords and mapping these keywords to categories. The results are evaluated on a small record of open access images that were manually annotated.
A German university has developed a learning information system to improve information literacy among German students. An online tutorial based on this Lerninformationssystem has been developed. The structure of this learning information system is described, an online tutorial based on it is illustrated, and the different learning styles that it supports are indicated.
Targeted panel sequencing in pediatric primary cardiomyopathy supports a critical role of TNNI3
(2019)
The underlying genetic mechanisms and early pathological events of children with primary cardiomyopathy (CMP) are insufficiently characterized. In this study, we aimed to characterize the mutational spectrum of primary CMP in a large cohort of patients ≤18 years referred to a tertiary center. Eighty unrelated index patients with pediatric primary CMP underwent genetic testing with a panel-based next-generation sequencing approach of 89 genes. At least one pathogenic or probably pathogenic variant was identified in 30/80 (38%) index patients. In all CMP subgroups, patients carried most frequently variants of interest in sarcomere genes suggesting them as a major contributor in pediatric primary CMP. In MYH7, MYBPC3, and TNNI3, we identified 18 pathogenic/probably pathogenic variants (MYH7 n = 7, MYBPC3 n = 6, TNNI3 n = 5, including one homozygous (TNNI3 c.24+2T>A) truncating variant. Protein and transcript level analysis on heart biopsies from individuals with homozygous mutation of TNNI3 revealed that the TNNI3 protein is absent and associated with upregulation of the fetal isoform TNNI1. The present study further supports the clinical importance of sarcomeric mutation-not only in adult-but also in pediatric primary CMP. TNNI3 is the third most important disease gene in this cohort and complete loss of TNNI3 leads to severe pediatric CMP.
This paper deals with new job profiles in libraries, mainly systems librarians (German: Systembibliothekare), IT librarians (German: IT-Bibliothekare) and data librarians (German: Datenbibliothekare). It investigates the vacancies and requirements of these positions in the German-speaking countries by analyzing one hundred and fifty published job advertisements of OpenBiblioJobs between 2012-2016. In addition, the distribution of positions, institutional bearers, different job titles as well as time limits, scope of work and remuneration of the positions are evaluated. The analysis of the remuneration in the public sector in Germany also provides information on demands for a bachelor's or master's degree.
The average annual increase in job vacancies between 2012 and 2016 is 14.19%, confirming the need and necessity of these professional library profiles.
The higher remuneration of the positions in data management, in comparison to the systems librarian, proves the prerequisite of the master's degree and thus indicates a desideratum due to missing or few master's degree courses. Accordingly, the range of bachelor's degree courses (or IT-oriented major areas of study with optional compulsory modules in existing bachelor's degree courses) for systems and IT librarians must be further expanded. An alternative could also be modular education programs for librarians and information scientists with professional experience, as it is already the case for music librarians.
Systematizing IT Risks
(2019)
IT risks — risks associated with the operation or use of information technology — have taken on great importance in business, and IT risk management is accordingly important in the science and practice of information management. Therefore, it is necessary to systematize IT risks in order to plan, manage and control for different risk-specific measures. In order to choose and implement suitable measures for managing IT risks, effect-based and causebased procedures are necessary. These procedures are explained in detail for IT security risks because of their special importance.
Purpose. To identify stroke survivors with symptoms of poststroke depression and the extent of psychiatry needs and care they have received while on physiotherapy rehabilitation. Participants. Fifty stroke survivors (22 females and 28 males) at the outpatient unit of Physiotherapy Department, University of Nigeria Teaching Hospital, Enugu, who gave their informed consent, were randomly selected. Their age range and mean age were 26–66 years and 54.76 ± 8.79 years, respectively. Method. A multiple case study of 50 stroke survivors for symptoms of poststroke depression was done with Beck’s Depression Inventory, mini mental status examination tool, and Modified Motor Assessment Scale. The tests were performed independently by the participants except otherwise stated and scored on a scale of 0–6. Data were analyzed using -test for proportional significance and chi-square test for determining relationship between variables, at p < 0.05. Results. Twenty-one (42.0%) stroke survivors had symptoms of PSD, which was significantly dependent on duration of stroke ( = 21.680, df = 6, and p = 0.001), yet none of the participants had a psychiatry review. Conclusions. Symptoms of PSD may be common in cold compared to new cases of stroke and may need psychiatry care while on physiotherapy rehabilitation.
In the present paper we sketch an automated procedure to compare different versions of a contract. The contract texts used for this purpose are structurally differently composed PDF files that are converted into structured XML files by identifying and classifying text boxes. A classifier trained on manually annotated contracts achieves an accuracy of 87% on this task. We align contract versions and classify aligned text fragments into different similarity classes that enhance the manual comparison of changes in document versions. The main challenges are to deal with OCR errors and different layout of identical or similar texts. We demonstrate the procedure using some freely available contracts from the City of Hamburg written in German. The methods, however, are language agnostic and can be applied to other contracts as well.
Streptococcus dysgalactiae is among the most important pathogens causing bovine mastitis. Unfortunately, there is presently a lack of clear knowledge about the mode of transmission — contagious or environmental — of this pathogen. To obtain more information on this, knowledge of the genetic diversity of the isolated microorganisms at the farm level can be useful. To observe the strain variety in different herds of cattle, isolates of Strep. dysgalactiae were collected from clinical mastitis samples at different farms, and the strains were typed using the pulsed-field gel electrophoresis (PFGE) method. Overall, we performed strain typing on 93 isolates from 16 farms in Germany and used an index to describe the degree of contagiosity of Strep. dysgalactiae at each farm. This index (CI) represents the number of isolates divided by the number of strains found in mastitis milk of clinical cases within a period of 14 months. The results differed between the farms. In one farm, all six Strep. dysgalactiae cases that occurred during the study period were caused by a single strain (CI = 6), while in another farm the six cases that occurred were caused by five different strains (CI = 1.2). All other farms fell between these two extremes. This indicates that Strep. dysgalactiae infections can occur via several routes of transmission. At the farm level, strain comparisons are necessary to determine the routes of transmission. Two strains were able to survive on the farm for a minimum of 14 months.
Staphylococcus aureus is recognized worldwide as one of the major agents of dairy cow intra-mammary infections. This microorganism can express a wide spectrum of pathogenic factors used to attach, colonize, invade and infect the host. The present study evaluated 120 isolates from eight different countries that were genotyped by RS-PCR and investigated for 26 different virulence factors to increase the knowledge on the circulating genetic lineages among the cow population with mastitis. New genotypes were observed for South African strains while for all the other countries new variants of existing genotypes were detected. For each country, a specific genotypic pattern was found. Among the virulence factors, fmtB, cna, clfA and leucocidins genes were the most frequent. The sea and sei genes were present in seven out of eight countries; seh showed high frequency in South American countries (Brazil, Colombia, Argentina), while sel was harboured especially in one Mediterranean country (Tunisia). The etb, seb and see genes were not detected in any of the isolates, while only two isolates were MRSA (Germany and Italy) confirming the low diffusion of methicillin resistance microorganism among bovine mastitis isolates. This work demonstrated the wide variety of S. aureus genotypes found in dairy cattle worldwide. This condition suggests that considering the region of interest might help to formulate strategies for reducing the infection spreading.
In recent years, multiple efforts for reducing energy usage have been proposed. Especially buildings offer high potentials for energy savings. In this paper, we present a novel approach for intelligent energy control that combines a simple infrastructure using low cost sensors with the reasoning capabilities of Complex Event Processing. The key issues of the approach are a sophisticated semantic domain model and a multi-staged event processing architecture leading to an intelligent, situation-aware energy management system.
Background: Fall events contribute significantly to mortality, morbidity and costs in our ageing population. In order to identify persons at risk and to target preventive measures, many scores and assessment tools have been developed. These often require expertise and are costly to implement. Recent research investigates the use of wearable inertial sensors to provide objective data on motion features which can be used to assess individual fall risk automatically. So far it is unknown how well this new method performs in comparison with conventional fall risk assessment tools. The aim of our research is to compare the predictive performance of our new sensor-based method with conventional and established methods, based on prospective data.
Methods: In a first study phase, 119 inpatients of a geriatric clinic took part in motion measurements using a wireless triaxial accelerometer during a Timed Up&Go (TUG) test and a 20 m walk. Furthermore, the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) was performed, and the multidisciplinary geriatric care team estimated the patients’ fall risk. In a second follow-up phase of the study, 46 of the participants were interviewed after one year, including a fall and activity assessment. The predictive performances of the TUG, the STRATIFY and team scores are compared. Furthermore, two automatically induced logistic regression models based on conventional clinical and assessment data (CONV) as well as sensor data (SENSOR) are matched.
Results: Among the risk assessment scores, the geriatric team score (sensitivity 56%, specificity 80%) outperforms STRATIFY and TUG. The induced logistic regression models CONV and SENSOR achieve similar performance values (sensitivity 68%/58%, specificity 74%/78%, AUC 0.74/0.72, +LR 2.64/2.61). Both models are able to identify more persons at risk than the simple scores.
Conclusions: Sensor-based objective measurements of motion parameters in geriatric patients can be used to assess individual fall risk, and our prediction model’s performance matches that of a model based on conventional clinical and assessment data. Sensor-based measurements using a small wearable device may contribute significant information to conventional methods and are feasible in an unsupervised setting. More prospective research is needed to assess the cost-benefit relation of our approach.
Fall events and their severe consequences represent not only a threatening problem for the affected individual, but also cause a significant burden for health care systems. Our research work aims to elucidate some of the prospects and problems of current sensor-based fall risk assessment approaches. Selected results of a questionnaire-based survey given to experts during topical workshops at international conferences are presented. The majority of domain experts confirmed that fall risk assessment could potentially be valuable for the community and that prediction is deemed possible, though limited. We conclude with a discussion of practical issues concerning adequate outcome parameters for clinical studies and data sharing within the research community. All participants agreed that sensor-based fall risk assessment is a promising and valuable approach, but that more prospective clinical studies with clearly defined outcome measures are necessary.
Background: Concerns about practice of self-medication (SM) world across are based on associated risks such as adverse reactions, disease masking, increased morbidity, wastage of resources and antibiotic resistance. SM is likely to differ between rural and urban areas of India. Systematically retrieved evidence on these differences are required in order to design targeted measures for improvement. Methods: We conducted a cross sectional study among the general population in urban (Matunga) and rural (Tala) areas of Maharashtra, India to explore SM practices and its associated factors. Face to face interviews were conducted using the validated study questionnaire. Data was analyzed by using descriptive and analytical statistical methods. Results: A total of 1523 inhabitants from 462 households were interviewed between [June/2015] and [August /2015], 778 (51%) of them in rural and 745 (49%) in urban areas. Overall self-medication prevalence was 29.1% (urban; 51.5%, rural; 7.7%, OR 12.7, CI 9.4-17.2) in the study participants. Participants having chronic disease (OR: 3.15, CI: 2.07-4.79) and from urban areas (OR:15.38, CI:8.49-27.85) were more likely to self-medicate. Self-medication practices were characterized by having old prescription (41.6%) as the main reason, fever (39.4%) as top indication and NSAIDs (Non-Steroidal Anti Inflammatory Agents) as the most self-medicated category of drugs (40.7%). Conclusions: The present study documented that the prevalence of self-medication is associated with place of residence, and health status of the study participants. Self-medication is still a major issue in western Maharashtra, India and is majorly an urban phenomenon. Status of implementation of existing regulations should be reconsidered.
Background: Self-medication, practiced globally is an important public health problem. Research studies have indicated inappropriate self‐medication results in adverse drug reactions, disease masking, antibiotic resistance and wastage of healthcare resources. The objectives of the study were to explore overall self-medication and antibiotic self-medication prevalence among students of university students in Karachi, Pakistan along with probable reasons, indications, and sources of advice for self-medication. Methods: A descriptive, cross-sectional, questionnaire-based study was carried out among students from university of Karachi, Pakistan during the time period of September to November 2016. Pretested questionnaire was distributed to 320 students, collected data was analyzed using IBM SPSS version 24. Results: From 320 students, 311 (83 male and 228 female) students participated in the study giving a response rate of 97%. Prevalence of self-medication was 66%. Belonging to higher monthly family income group was associated with likelihood of self-medication. Antibiotic self-medication prevalence was 39%. Lack of time (39%), and old prescription (35%) were the main reasons for self-medication. Pharmacy shop (75%) was the main source for self-medication. In case of antibiotics, 44% students changed the dosage of antibiotic and 50% students stopped antibiotics after the disappearance of the symptoms. Conclusions: Antibiotic self-medication (39%) and self-medication with other drugs among university students of Karachi is a worrisome problem. Our findings highlight the need for planning interventions to promote the judicious use of general medicines as well as that of antibiotics.
We compare the effect of different segmentation strategies for passage retrieval of user generated internet video. We consider retrieval of passages for rather abstract and complex queries that go beyond finding a certain object or constellation of objects in the visual channel. Hence the retrieval methods have to rely heavily on the recognized speech. Passage retrieval has mainly been studied to improve document retrieval and to enable question answering. In these domains best results were obtained using passages defined by the paragraph structure of the source documents or by using arbitrary overlapping passages. For the retrieval of relevant passages in a video no author defined paragraph structure is available. We compare retrieval results from 5 different types of segments: segments defined by shot boundaries, prosodic segments, fixed length segments, a sliding window and semantically coherent segments based on speech transcripts. We evaluated the methods on the corpus of the MediaEval 2011 Rich Speech Retrieval task. Our main conclusions are (1) that fixed length and coherent segments are clearly superior to segments based on speaker turns or shot boundaries; (2) that the retrieval results highly depend on the right choice for the segment length; and (3) that results using the segmentation into semantically coherent parts depend much less on the segment length. Especially, the quality of fixed length and sliding window segmentation drops fast when the segment length increases, while quality of the semantically coherent segments is much more stable. Thus, if coherent segments are defined, longer segments can be used and consequently fewer segments have to be considered at retrieval time.
This document describes the work done during the Research Semester in Summer 2006 of Prof. Dr. Stefan Wohlfeil. It is about Security Management tasks and how these tasks might be supported by Open Source software tools. I begin with a short discussion of general management tasks and describe some additional, security related management tasks. These security related tasks should then be added to a software tool which already provides the general tasks. Nagios is such a tool. It is extended to also perform some of the security related management tasks, too. I describe the new checking scripts and how Nagios needs to be configured to use these scripts. The work has been done in cooperation with colleagues from the Polytech- nic of Namibia in Windhoek, Namibia. This opportunity was used to also establish a partnership between the Department of Computer Science at FH Hannover and the Department of Information Technology at the Polytechnic. A first Memorandum of Agreement lays the groundwork for future staff or student exchange.
Enterprise apps on mobile devices typically need to communicate with other system components by consuming web services. Since most of the current mobile device platforms (such as Android) do not provide built-in features for consuming SOAP services, extensions have to be designed. Additionally in order to accommodate the typical enhanced security requirements of enterprise apps, it is important to be able to deal with SOAP web service security extensions on client side. In this article we show that neither the built-in SOAP capabilities for Android web service clients are sufficient for enterprise apps nor are the necessary security features supported by the platform as is. After discussing different existing extensions making Android devices SOAP capable we explain why none of them is really satisfactory in an enterprise context. Then we present our own solution which accommodates not only SOAP but also the WS-Security features on top of SOAP. Our solution heavily relies on code generation in order to keep the flexibility benefits of SOAP on one hand while still keeping the development effort manageable for software development. Our approach provides a good foundation for the implementation of other SOAP extensions apart from security on the Android platform as well. In addition our solution based on the gSOAP framework may be used for other mobile platforms in a similar manner.
Subject of this work is the investigation of universal scaling laws which are observed in coupled chaotic systems. Progress is made by replacing the chaotic fluctuations in the perturbation dynamics by stochastic processes.
First, a continuous-time stochastic model for weakly coupled chaotic systems is introduced to study the scaling of the Lyapunov exponents with the coupling strength (coupling sensitivity of chaos). By means of the the Fokker-Planck equation scaling relations are derived, which are confirmed by results of numerical simulations.
Next, the new effect of avoided crossing of Lyapunov exponents of weakly coupled disordered chaotic systems is described, which is qualitatively similar to the energy level repulsion in quantum systems. Using the scaling relations obtained for the coupling sensitivity of chaos, an asymptotic expression for the distribution function of small spacings between Lyapunov exponents is derived and compared with results of numerical simulations.
Finally, the synchronization transition in strongly coupled spatially extended chaotic systems is shown to resemble a continuous phase transition, with the coupling strength and the synchronization error as control and order parameter, respectively. Using results of numerical simulations and theoretical considerations in terms of a multiplicative noise partial differential equation, the universality classes of the observed two types of transition are determined (Kardar-Parisi-Zhang equation with saturating term, directed percolation).
The most important attribute for which we all aspire as human beings is good health because it enables us to undertake different forms of activities of daily living. The emergence of scientific knowledge in Western societies has enabled us to explore and define several parameters of “health” by drawing boundaries around factors that are known to impact the achievement of good health. For example, the World Health Organization defined health by taking physical and psychological factors into consideration.
Roads to Health in Developing Countries: Understanding the Intersection of Culture and Healing
(2017)
Background:
The most important attribute to which all human beings aspire is good health because it enables us to undertake different forms of activities of daily living. The emergence of scientific knowledge in Western societies has enabled scientists to explore and define several parameters of health by drawing boundaries around factors that are known to influence the attainment of good health. For example, the World Health Organization defined health by taking physical and psychological factors into consideration. Their definition of health also included a caveat that says, “not merely the absence of sickness.”
This definition has guided scientists and health care providers in the Western world in the development of health care programs in non-Western societies.
Objective:
However, ethnomedical beliefs about the cause(s) of illness have given rise to alternative theories of health, sickness, and treatment approaches in the developing world. Thus, there is another side to the story.
Method:
Much of the population in developing countries lives in rural settings where the knowledge of health, sickness, and care has evolved over centuries of practice and experience. The definition of health in these settings tends to orient toward cultural beliefs, traditional practices, and social relationships. Invariably, whereas biomedicine is the dominant medical system in Western societies, traditional medicine — or ethno-medicine — is often the first port of call for patients in developing countries.
Results:
The 2 medical systems represent, and are influenced by, the cultural environment in which they exist. On one hand, biomedicine is very effective in the treatment of objective, measurable disease conditions. On the other hand, ethnomedicine is effective in the management of illness conditions or the experience of disease states. Nevertheless, an attempt to supplant 1 system of care with another from a different cultural environment could pose enormous challenges in non-Western societies.
Conclusion:
In general, we, as human beings, are guided in our health care decisions by past experiences, family and friends, social networks, cultural beliefs, customs, tradition, professional knowledge, and intuition. No medical system has been shown to address all of these elements; hence, the need for collaboration, acceptance, and partnership between all systems of care in cultural communities. In developing countries, the roads to health are incomplete without an examination of the intersection of culture and healing. Perhaps mutual exclusiveness rather inclusiveness of these 2 dominant health systems is the greatest obstacle to health in developing countries.
Medical devices are health care products distinguished from drugs for regulatory purposes in most countries based on mechanism of action. Unlike drugs, medical devices operate via physical or mechanical means and are not dependent on metabolism to accomplish their primary intended effect. Developing new medical devices requires clinical investigations and approval process goes through similar process like drugs. Medical device approvals in the period of 2010 to 2014 were searched from USFDA website. Disease burden data in the similar period was searched from centers for disease control and prevention website. Collected data was analyzed to know number of approved devices, top therapy areas, and mechanism of action of these devices. Out of a total of 200 medical devices approvals in the time period of 2010 to 2014, maximum number of devices (51; 25.5%) were approved in the year 2011, cardiovascular (78; 39%) was the top therapy area. Highest number (180; 90%) of approved medical devices belonged to the category III and maximum number (73; 36.5%) of approved medical devices had ―mechanical‖ mechanism of action. The top 3 causes of deaths in USA during 2010 to 2014 were heart disease, cancer and followed by respiratory infection. There was a match between the top diseases and the medical device approvals for top 2 diseases in USA i.e. heart disease, and cancer. With respect to respiratory infections and ailments which was the 3rd leading cause of death only one device was approved out of 200 approvals in total.
Background: The mission of the pharmacy profession is to improve public health through ensuring safe, effective, and appropriate use of medications. Population health management (PHP) is a process wherein opportunities are identified to improve the quality of health care delivered and thereby, promote better health outcomes for patients.
Rationale: As concept of PHP is extremely important in today’s context, it is helpful to integrate data related to pharmacist in population health management practices. Authors conducted a systematic review of the literature on role of pharmacist in population health management practices. Method: We conducted a systematic review of the literature on literature on role of pharmacist in population health management practices by searching, PubMed Medline database using the following combination of keywords – pharmacist, population health. Truncation was used to ensure retrieval of all possible variations of search terms. The search was limited to articles published between 1st January 2015 and 31st December 2019, human studies and English language.
Results: Initial search resulted in a total of 281 studies, title abstract review to remove irrelevant studies resulted in 256 studies. Yearly trend showed that number of publications are decreasing. Highest number of publications were from Europe (47; 18%) and 29 publications (11%) discussed role of pharmacist in population health management of subjects in the age group of 10 to 20 years. Twenty five publications mentioned health management was done in the community settings. Advice on the lifestyle was mentioned in 242 (96%) and 10 (4%) publications offered advice about drugs during the health management. Pharmacists played important roles in population health management for e.g. as care provider in exploring the challenges faced in clinics for management of Type 2 DM. Pharmacists played an important role in increasing the quality of life of patients.
Discussion: Population health management concept has evolved steadily over the past few decades and is now contributing to the ‘patient care journey’ at all stages. There were 24 (9%) publications from India. Specially designed and implemented Pharm D program would play a major role in Indian health care system in future. This will give an opportunity to pharmacists to work more prominently in Indian health care system.
Conclusion: Authors are of the opinion that this is the first review encompassing the topic of pharmacist and population health management in the global context. It is clear that there is a global trend of moving towards involvement of pharmacist in healthcare management. This enables pharmacists to assume an expanded role and at same time it necessitates reforms in pharmacy education and practice
Objective
We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.
Methods
Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994–2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time.
Results
We included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.
Conclusions
NRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.
Due to demographic change the number of serious kidney diseases and thus required transplantations will increase. The increased demand for donor organs and a decreasing supply of these organs underline the necessity for effective early rejection diagnostic measures to improve the lifetime of transplants. Expert systems might improve rejection diagnostics but for the development of such systems data models are needed that encompass the relevant information to enable optimal data aggregation and evaluation. Results of a literature review concerning published data models and information systems concerned with kidney transplant rejection diagnostic lead to a set of data elements even if no papers could be identified that publish data models explicitly.
Background: Available preliminary data on menopause does not relate changes in body fat mass (BFM) and handgrip strength (HGS) (an indicator of body/muscle strength) to gait parameters.
Objective: To determine the relationship between BFM, HGS and gait parameters, namely, stride length (SL) (an indicator of walking balance/postural stability), stride frequency (SF), and velocity (V) (gait out- put), to guide gait training.
Methods: Ninety consenting (45 postmenopausal and 45 premenopausal) female staffof the University of Nigeria Teaching Hospital, Enugu, were randomly selected and assessed for BFM and HGS with a hydration monitor and dynamometer, respectively, in an observational study. The mean of 2 trials of the number of steps and time taken to cover a 10-m distance at normal speed was used to calculate SF, SL, and V. Data were analyzed using an independent t test and a Pearson correlation coefficient at P < 0.05.
Results: Premenopausal (BFM = 42.93% [12.61%], HGS = 27.89 [7.52] kg, stride ratio = 1.43, and velocity = 1.04 [0.01] m/sec) and postmenopausal (BFM = 41.55% [12.71%], HGS = 30.91 [7.07] kg, stride ratio = 1.44, and velocity = 1.06 [0.01] m/sec) women showed no significant differences in gait output/velocity ( t = 0.138; P = 0.89; d = 0.029). At postmenopause, BFM was significantly and negatively ( r = –0.369; r 2 = 0.1362; P = 0.013) correlated with SL, whereas HGS was positively and significantly ( r = 0.323; r 2 = 0.104; P = 0.030) correlated with gait output at premenopause.
Conclusions: BFM may adversely influence walking balance at postmenopause, whereas HGS may enhance gait output at premenopause but not postmenopause. Therefore, muscle strengthening alone may not enhance gait output in postmenopausal women without balance training.
In this study, we investigated injection molded wood-polypropylene composites based on various wood sources and their decay resistance against white rot (Trametes versicolor) and brown rot (Coniophora puteana) in a laboratory test according to EN 15534-1:2014. The manufactured composites consisted of poplar (Populus spp.), willow (Salix spp.), European beech (Fagus sylvatica L.), Norway spruce (Picea abies (L.) H. Karst.), and a commercial wood source (Arbocel® C100), respectively. All formulations were compounded on a co-rotating twin screw extruder and subsequently injection molded to wood–PP specimens with a wood content of 60% or 70% by weight. It was found that the test procedure had a significant effect on the mechanical properties. Loss in mechanical properties was primarily caused by moisture and less by fungal decay. Moisture caused a loss in the modulus of rupture and modulus of elasticity of 34 to 45% and 29 to 73%, respectively. Mean mass and wood mass losses were up to a maximum of 3.7% and 5.3%, respectively. The high resistance against fungal decay was generally attributed to the encapsulation of wood by the polymer matrix caused by sample preparation, and enhanced by reduced moisture uptake during the preconditioning procedure. Notable differences with respect to the wood particle source and decay fungi were also observed. Structural characterization confirmed the decay pattern of the fungi such as void cavities close the surface and the deposition of calcium oxalates.
Nanotechnology is emerging as one of the key technologies of the 21st century and is expected to enable developments across a wide range of sectors that can benefit citizens. Nanomedicine is an application of nanotechnology in the areas of healthcare, disease diagnosis, treatment and prevention of disease. Nanomedicines pose problem of nanotoxicity related to factors like size, shape, specific surface area, surface morphology, and crystallinity. Currently, nanomedicines are regulated as medicinal products or as medical devices and there is no specific regulatory framework for nanotechnology-based products neither in the EU nor in the USA. This review presents a scheme for classification and regulatory approval process for nanotechnology based medicines.
Regional knowledge map is a tool recently demanded by some actors in an institutional level to help regional policy and innovation in a territory. Besides, knowledge maps facilitate the interaction between the actors of a territory and the collective learning. This paper reports the work in progress of a research project which objective is to define a methodology to efficiently design territorial knowledge maps, by extracting information of big volumes of data contained in diverse sources of information related to a region. Knowledge maps facilitate management of the intellectual capital in organisations. This paper investigates the value to apply this tool to a territorial region to manage the structures, infrastructures and the resources to enable regional innovation and regional development. Their design involves the identification of information sources that are required to find which knowledge is located in a territory, which actors are involved in innovation, and which is the context to develop this innovation (structures, infrastructures, resources and social capital). This paper summarizes the theoretical background and framework for the design of a methodology for the construction of knowledge maps, and gives an overview of the main challenges for the design of regional knowledge maps.
The objective was to establish and standardise a broth microdilution susceptibility testing method for porcine Bordetella (B.) bronchiseptica. B. bronchiseptica isolates from different geographical regions and farms were genotyped by macrorestriction analysis and subsequent pulsed-field gel electrophoresis. One reference and one type strain plus two field isolates of B. bronchiseptica were chosen to analyse growth curves in four different media: cation-adjusted Mueller-Hinton broth (CAMHB) with and without 2% lysed horse blood, Brain-Heart-Infusion (BHI), and Caso broth. The growth rate of each test strain in each medium was determined by culture enumeration and the suitability of CAMHB was confirmed by comparative statistical analysis. Thereafter, reference and type strain and eight epidemiologically unrelated field isolates of B. bronchiseptica were used to test the suitability of a broth microdilution susceptibility testing method following CLSI-approved performance standards given in document VET01-A4. Susceptibility tests, using 20 antimicrobial agents, were performed in five replicates, and data were collected after 20 and 24 hours incubation and statistically analysed. Due to the low growth rate of B. bronchiseptica, an incubation time of 24 hours resulted in significantly more homogeneous minimum inhibitory concentrations after five replications compared to a 20-hour incubation. An interlaboratory comparison trial including susceptibility testing of 24 antimicrobial agents revealed a high mean level of reproducibility (97.9%) of the modified method. Hence, in a harmonization for broth microdilution susceptibility testing of B. bronchiseptica, an incubation time of 24 hours in CAMHB medium with an incubation temperature of 35°C and an inoculum concentration of approximately 5 x 105 cfu/ml was proposed.
Background: Often preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German “Reaching the Elderly” study (2008–2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs.
Methods: Four focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65–75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants’ knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.
Results: A gender-specific approach profile was observed. Men were more likely to favor competitive and exerciseoriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The “older seniors” (76+) were ambivalent towards
certain wordings referring to aging.
Conclusions: Our results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of
the potential participants.
Publication Bias
(2016)
According to the Declaration of Helsinki, as well as the Statement on Public Disclosure of Clinical Trial Results of the World Health Organization, every researcher has the ethical obligation to publish research results on all trials with human participants in a complete and accurate way within 12 months after the end of the trial.1,2 Nevertheless, for several reasons, not all research results are published in an accurate way in case they are released at all. This phenomenon of publication bias may not only create a false impression on the reliability of clinical research business, but it may also affect the evidence of clinical conclusions about the best treatments, which are mostly based on published data and results.
Objective: To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring
physicians’ perspective. <br>
Data sources/Study setting: Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03–06/2016). <br>
Study design: Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass
media channels (Mass Media, npr MM=132, nph MM=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, npr MSM=117; nph MSM=130). <br> Principal findings: Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16–8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72–4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information. <br>
Conclusions: Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.