Evaluation of technical approaches for real-time data transfer from electronic health record systems.

BACKGROUND AND OBJECTIVE: Real-time data (RTD) are data that are delivered immediately after creation. The key feature of RTD is low delivery latency. Information systems in health care are extremely time-sensitive and their building block is the electronic health record (EHR). Real-time data from EHRs play an important role to support decision-making, analytics and coordination of care. This is well mentioned in the literature, but the process has not yet been described, providing reference implementations and testing. Real-time data delivery can technically be achieved using several methods. The objective of this work is to evaluate the performance of different transfer methods of RTD from EHRs by measuring delivery latency. METHODS: In our work we used four approaches to transfer RTD from EHRs: REST hooks, WebSocket notifications, reverse proxy and database triggers. We deployed a Fast Health Interoperability Resources (FHIR) server as it is one of the most widely used EHR standard. For the reference implementations we used Python and Golang. Delivery latency was selected as performance metric, derived by subtracting the timestamp of the EHR resource creation from the timestamp of the EHR resource receipt in millisecond. The data was analyzed using descriptive statistics, cumulative distribution function (CDF), Kruskal-Wallis and post-hoc tests. RESULTS: The database trigger approach had the best mean delivery latency 13.52±5.56 ms, followed by the reverse proxy 14.43±4.58 ms, REST hooks 19.26±5.76 ms and WebSocket 27.32±9.44 ms. The reverse proxy showed a tighter range of the values and lower variability. There were significant differences in the latencies between all pairs of approaches, except for reverse proxy and database trigger. CONCLUSION: Real-time data transfer is vital for the development of robust and innovative healthcare applications. Properties of current EHR systems as a data source predefine the approaches for transfer. In our work for the first time the performance of RTD transfer from the EHRs with reference implementations is measured and evaluated. We found that database triggers achieve lowest delivery latency. Reverse proxy performed slightly slower, but offered more stability, followed by REST hooks and WebSocket notifications.

Epidemiology of hip fractures in Bulgaria: development of a country-specific FRAX model.

A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model. OBJECTIVE: To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool. METHODS: We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models. RESULTS: The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece. CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.

Synergistic inhibition of influenza A virus replication by a plant polyphenol-rich extract and epsilon-aminocaproic acid in vitro and in vivo.

UNLABELLED: A combined antiviral effect of a polyphenol-rich extract of the medicinal plant Geranium sanguineum L. (PC) and a protease inhibitor, epsilon-aminocaproic acid (ACA) was examined in Influenza A virus (IAV)-infected MDCK cell cultures and mice. Synergistic, antagonistic, or indifferent antiviral effects were distinguished on the basis of virus yields, namely fractional yields of individual compounds and yields of both compounds in combination. Combinations of PC and ACA in particular concentrations proved synergistic in the inhibition of virus replication in MDCK cells and in protection of mice against virus infection as determined by virus titers, lung weight, mean survival time (MST), mortality rate, and protection rate (PR). Following the application of a combination of PC and ACA to the virus-infected mice, the levels of the lung protease and protease-inhibitory activity, which were increased due to the virus infection, were brought to normal. These results demonstrate the rationale for a combined application of viral inhibitors with different modes of action to the treatment of IAV infection, in particular PC as a natural inhibitor of early viral transcription and translation and ACA as a synthetic inhibitor of cellular proteases. KEYWORDS: Influenza A virus; antiviral effect; synergism; plant polyphenol extract; epsilon-aminocaproic acid; protease inhibitors.

A newly discovered bacteriocin produced by Enterococcus faecalis 3915.

Different Enterococci, isolated from starters for the production of the traditional Bulgarian yellow cheese 'Kashkaval' were screened for bacteriocin production, and one of them, Enterococcus faecalis 3915 demonstrated bacteriocin activity. In this study, we investigated the growth parameters of the producer strain as well as the production kinetics and preliminary characterisation of the produced bacteriocin named enterocin 3915. For the growth modelling, the logistic model was used, while bacteriocin production was monitored. Experiments on inducibility were conducted, and strain was checked for the presence of plasmids. The peptide was crudely purified by ammonium sulphate precipitation followed by preparative PAGE. The approximate molecular mass was determined electrophoretically, and the activity was visualised by electrophoresis and agar overlay technique. It was found that E. faecalis 3915 produces a bacteriocin with constitutive synthesis and chromosomal localisation of its genetic determinants. The peptide revealed to be relatively heat-stable with a molecular mass of about 6.5 kDa. As E. faecalis 3915 originates from cheese starter it can be classified as generally recognised as safe (GRAS). The inhibitory activity of enterocin 3915 comprises commensals or pathogens, so properties generally accepted as probiotic could be attributed to the producer, and potential application in the dairy industry is not to be excluded.

[Economic effect of using a comprehensive program for the control of Varroa infestation]. / Ikonomicheski efekt ot prilozhenieto na kompleksnata programa za borba s varoatozata.

The control of Varroa infestation in honeybees embraces a system of veterinary measures requiring an overall economic evaluation as a prerequisite for the wide use of a special programme. A comparative economic analysis of the dynamics of the process is made for two periods: a basic one, when no programmed control measures have been taken, and a planned one, when the programme has been put into practice and the results thereof by the end of the time are compared with those of the basic period. Employed has been the method of the index factorial analysis taking into consideration the complex and individual effects of definite factors, contributing to such effects. The increased absolute volume of material expenditures (chiefly therapeutic agents) is reflected in the absolute and the relative growth in the end-product economic results obtained with the two apiaries studied.

Attempts for replacement of asparagine in Sauton's medium by some organic acids in the production of PPD-tuberculins.

In the process of obtaining PPD-tuberculins we studied some carbonic acids thus replacing asparagine with them in the original medium of Sauton. The following carbonic acids were used: dibasic saturated carbonic acids--oxalic, malonic and succinic; dibasic non-satured carbonic acids--maleic and fumaric; the dibasic oxycarbonic acid--tartaric. Each of the above mentioned acids was in a concentration equivalent to that of the asparagine in the original Sauton's medium. The tuberculins were obtained through the precipitation of the filtrate of killed liquid cultures by trichloracetic acid. The bovine and avian PPD-tuberculins so obtained with the different carbonic acids were assayed on sensitized guinea pigs and hens together with standard tuberculins. The results obtained from the application of the PPD-tuberculins of carbonic acids are almost identical with the ones of the standard PPD-tuberculins. The experimental and standard bovine PPD-tuberculins used contain 50,000 ISU in 1 ml and the avian experimental and standard PPD-tuberculins contain 25,000 ISU in 1 ml. The results obtained give us reason to consider that some of the above mentioned carbonic acids could be used for the production of PPD-tuberculins.

[Experiments to replace asparagine in Sauton's medium with organic acids in producing PPD tuberculins]. / Opiti za zamiana na asparagina v sredata na Soton s niakoi organichni kiselini pri poluchavane na PPD-tuberkulini.

Studied were some carbonic acids to replace asparagine in Soton's original medium in the production of PPD-tuberculins. Used were the following carbonic acids: (a) dicarboxylic saturated--oxalic, malonic, and amber acid; (b) dicarboxylic unsaturated--maleic and fumaric; and (c) dibasic oxicarbonic acids--malic and tartaric. Each of these acids participated in an equal amount as that of asparagine in replacing it in Soton's medium. Two strains were used in the experiments--AN5 and D4. Tuberculins were obtained through precipitating a filtrated material of cultures killed with trichloracetic acid. The tuberculins produced (bovine and avian PPD types) with the use of the various carbonic acids were tested on sensibilized guinea pigs and chickens parallel to the testing of standard tuberculins. The results obtained with the use of carbonic PPD-tuberculins were almost identical to those obtained with the use of standard PPD-tuberculins. The positive results make it reasonable to believe that some of the carbonic acids mentioned above may well be used in the production of PPD-tuberculins.

[Micromethod of determining the complement-binding properties of commercial series of the foot-and-mouth disease virus]. / Mikrometod za opredeliane komplement-svurzvashtite svoistva na proizvodstveni serii shapen virus.

Investigations were carried out to establish the possibility of using a micromethod of the complement-fixation test to determine the complement-fixing properties of productional series of the foot-and-mouth disease virus. It was found that the micromethod referred to is an economically profitable and practically simple one. It is readily applicable requiring no particular apparatuses and equipment, is specific, and can successfully be used instead of the routinely employed CFT method. The micromethod suggested is economical, requiring minimal amounts (0.025 cu.c7) of the components taking part.