Emergency Data Management - Overcoming (Information) Borders.

BACKGROUND: In order to improve access to critical patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In Germany, the German Medical Association developed a medical emergency dataset (MED), which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information on the German Electronic Health Card. OBJECTIVES: The aim of the study is to evaluate how the MED can be used internationally. METHODS: A total of 64 paper-based emergency data sets were completed by primary care physicians in Germany, and were then evaluated by German clinicians, emergency physicians, and paramedics on the basis of fictitious emergency scenarios. Thirty randomly selected MEDs were then translated into English and will be evaluated by international emergency physicians and paramedics. RESULTS: In Germany, clinicians, emergency physicians and paramedics rated the emergency data set as very useful or useful in more than 70% of the reviewed cases. The international evaluation will start in September 2016, so these results are pending at this time. CONCLUSION: The first study results from Germany indicate high potential benefits of the emergency data set in real patient care situations. The subsequent tests will show whether the MED is also suitable for international use.

The emergency data set for the German Electronic Health Card--which benefits can be expected?

BACKGROUND: In order to improve access to pre-existing patient information in case of emergency, the German Electronic Health Card (EHC) is supposed to hold emergency data. As a basis, the German Medical Association developed an emergency data set, which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information. OBJECTIVES: One main objective of the study is to evaluate the usefulness of the emergency data in specific emergency situations. METHODS: Within a two-phase exploratory study, a total of 64 paper-based emergency data sets were completed by primary care physicians, and then were evaluated by clinicians, emergency physicians, and paramedics. RESULTS: Clinicians, emergency physicians as well as paramedics rated the emergency data set in more than 70% of the reviewed cases as very useful or useful. The greatest benefit was attributed to the information on diagnoses and medication. CONCLUSION: The implementation of an emergency data on the EHC has the potential to improve safety, quality and efficiency of emergency care.

In Case of Emergency - Are ICD-10 Codes Enough?

In an acute emergency, the knowledge of the patient's medical history, allergies, implants, and medication can be crucial. ICD-10 code to document medical diagnoses alone often does not contain enough information. Our comparison of 388 documented diagnoses (ICD-10 codes as well as free text) showed that almost 20% of all coded ICD-10 codes contained less information than the documented free text. Thus, if using ICD-10 codes, free text diagnoses must be a necessary item in the upcoming German Medical Emergency DataSet.

Large neutral barrier at grain boundaries in chalcopyrite thin films.

The electronic structure of grain boundaries in polycrystalline Cu(In,Ga)Se2 thin films and their role on solar cell device efficiency is currently under intense investigation. A neutral barrier of about 0.5 eV has been suggested as the reason for the benign behavior of grain boundaries in chalcopyrites. Previous experimental investigations have in fact shown a neutral barrier but only a few 10 meV high, which cannot be expected to have a significant influence on the solar cell efficiency. Here we show that a full investigation of the electrical behavior of charged and neutral grain boundaries shows the existence of an additional narrow neutral barrier, several 100 meV high, which is tunneled through by the majority carriers but is sufficiently high to explain the benign behavior of the grain boundaries.

EpiScanGIS: an online geographic surveillance system for meningococcal disease.

BACKGROUND: Surveillance of infectious diseases increasingly relies on Geographic Information Systems (GIS). The integration of pathogen fine typing data in dynamic systems and visualization of spatio-temporal clusters are a technical challenge for system development. RESULTS: An online geographic information system (EpiScanGIS) based on open source components has been launched in Germany in May 2006 for real time provision of meningococcal typing data in conjunction with demographic information (age, incidence, population density). Spatio-temporal clusters of disease detected by computer assisted cluster analysis (SaTScan) are visualized on maps. EpiScanGIS enables dynamic generation of animated maps. The system is based on open source components; its architecture is open for other infectious agents and geographic regions. EpiScanGIS is available at http://www.episcangis.org, and currently has 80 registered users, mostly from the public health service in Germany. At present more than 2,900 cases of invasive meningococcal disease are stored in the database (data as of June 3, 2008). CONCLUSION: EpiScanGIS exemplifies GIS applications and early-warning systems in laboratory surveillance of infectious diseases.

Integrating color constancy into JPEG2000.

The human visual system is able to perceive colors as approximately constant. This ability is known as color constancy. In contrast, the colors measured by a sensor vary with the type of illuminant used. Color constancy is very important for digital photography and automatic color-based object recognition. In digital photography, this ability is known under the name automatic white balance. A number of algorithms have been developed for color constancy. We review two well-known color constancy algorithms, the gray world assumption and the Retinex algorithm and show how a color constancy algorithm may be integrated into the JPEG2000 framework. Since computer images are usually stored in compressed form anyway, little overhead is required to add color constancy into the processing pipeline.

RIDOM: comprehensive and public sequence database for identification of Mycobacterium species.

BACKGROUND: Molecular identification of Mycobacterium species has two primary advantages when compared to phenotypic identification: rapid turn-around time and improved accuracy. The information content of the 5' end of the 16S ribosomal RNA gene (16S rDNA) is sufficient for identification of most bacterial species. However, reliable sequence-based identification is hampered by many faulty and some missing sequence entries in publicly accessible databases. METHODS: In order to establish an improved 16S rDNA sequence database for the identification of clinical and environmental isolates, we sequenced both strands of the 5' end of 16S rDNA (Escherichia coli positions 54 to 510) from 199 mycobacterial culture collection isolates. All validly described species (n = 89; up to March 21, 2000) and nearly all published sequevar variants were included. If the 16S rDNA sequences were not discriminatory, the internal transcribed spacer (ITS) region sequences (n = 84) were also determined. RESULTS: Using 5'-16S rDNA sequencing a total of 64 different mycobacterial species (71.9%) could be identified. With the additional input of the ITS sequence, a further 16 species or subspecies could be differentiated. Only Mycobacterium tuberculosis complex species, M. marinum/M. ulcerans and the M. avium subspecies could not be differentiated using 5'-16S rDNA or ITS sequencing. A total of 77 culture collection strain sequences, exhibiting an overlap of at least 80% and identical by strain number to the isolates used in this study, were found in the GenBank. Comparing these with our sequences revealed that an average of 4.31 nucleotide differences (SD +/- 0.57) were present. CONCLUSIONS: The data from this analysis show that it is possible to differentiate most mycobacterial species by sequence analysis of partial 16S rDNA. The high-quality sequences reported here, together with ancillary information (e.g., taxonomic, medical), are available in a public database, which is currently being expanded in the RIDOM project http://www.ridom-rdna.de), for similarity searches.

RIDOM: Ribosomal Differentiation of Medical Micro-organisms Database.

The ribosomal differentiation of medical micro-organisms (RIDOM) web server, first described by Harmsen et al. [Harmsden,D., Rothganger,J., Singer,C., Albert,J. and Frosch,M. (1999) Lancet, 353, 291], is an evolving electronic resource designed to provide micro-organism differentiation services for medical identification needs. The diagnostic procedure begins with a specimen partial small subunit ribosomal DNA (16S rDNA) sequence. Resulting from a similarity search, a species or genus name for the specimen in question will be returned. Where the first results are ambiguous or do not define to species level, hints for further molecular, i.e. internal transcribed spacer, and conventional phenotypic differentiation will be offered ('sequential and polyphasic approach'). Additionally, each entry in RIDOM contains detailed medical and taxonomic information linked, context-sensitive, to external World Wide Web services. Nearly all sequences are newly determined and the sequence chromatograms are available for intersubjective quality control. Similarity searches are now also possible by direct submission of trace files (ABI or SCF format). Based on the PHRED/PHRAP software, error probability measures are attached to each predicted nucleotide base and visualised with a new 'Trace Editor'. The RIDOM web site is directly accessible on the World Wide Web at http://www.ridom.de/. The email address for questions and comments is webmaster@ridom.de.