Integration mobiler Informationswerkzeuge in heterogene Krankenhausinformationssysteme.

Der Einsatz mobiler Kleinstcomputer in der klinischen Routine besitzt großes Potential, die Kommunikations- und Informationsbedürfnisse von Ärzten und Pflegern zeitnah an deren unterschiedlichen Wirkungsstätten (z.B. am Patientenbett) zu erfüllen. Obwohl zahlreiche Arten von leistungsfähigen, tragbaren Kleinstcomputern zur Verfügung stehen, setzen sich diese nur langsam als Werkzeuge der Informationsverarbeitung in Krankenhäusern durch. Ziel dieser Arbeit ist es, die Gestaltung von mobilen Informations- und Kommunikationswerkzeugen in Bezug auf Funktionalität, Geräteeigenschaften und Integrationsmöglichkeiten in heterogene Krankenhausinformationssysteme (KIS) zu erarbeiten. Dabei werden die Wünsche der klinischen Anwender und die derzeitige Praktikabilität berücksichtigt. Zum Erreichen dieses Zieles wurden zwei praxisnahe Evaluationen am Universitätsklinikum Heidelberg durchgeführt. Anhand internationaler Literatur und aus diesen Ergebnissen werden wesentliche Integrationsaspekte abgeleitet und in einen Leitfaden für die Integration übertragen. Die Anwendbarkeit dieses Leitfadens wird anhand eines Realisierungsvorschlages für das Universitätsklinikum Heidelberg demonstriert. Insgesamt zeigt sich, daß das wichtigste mobil zu realisierende Verfahren die Unterstützung der interpersonellen Kommunikation ist. Weitere wichtige Verfahren sind z.B. die Einsicht in eine 'Elektronische Patientenakte', 'Klinische Dokumentation', 'Koordination mit Leistungserbringern', 'Anfordern von Essen, Material und Medikamenten' und der 'Zugriff auf Wissen'. Die funktionale Überschneidung zu festinstallierten Klinischen Arbeitsplatzsystemen (KLAPS) ist offensichtlich. Deutlich wird, daß mobile Kleinstcomputer die Benutzung von KLAPS räumlich ausweiten und die Anzahl der fest zu installierenden KLAPS verringern, jedoch diese nicht ersetzen können. Sie müssen vielmehr an die örtlichen Gegebenheiten, Organisationsstrukturen und Arbeitsweisen unterschiedlicher Personengruppen angepaßt ei

Heterogeneous Populations in B Cell Memory Responses and Glioblastoma Growth

Heterogeneity is a hallmark of biological systems at every conceivable scale. In this work, I develop computational methods for describing various interacting types of biological heterogeneity. I apply them to explore two scenarios of biomedical interest: the evocation of protective B cell responses by vaccination and the growth dynamics of an aggressive brain tumour. In the vast majority of currently licensed vaccines, antibody titres are strong correlates of vaccine-induced immunity. However, diseases like influenza, tuberculosis and malaria continue to escape efficient vaccination, and the mechanisms behind many established vaccines remain incompletely understood. In the first part of this work, I therefore develop a data-driven computational model of the B cell memory response to vaccination based on an ensemble of simulated germinal centres. This model can address immunisation problems of different difficulty levels by allowing both pathogen- and host-specific parameters to vary. Using this framework, I show that two distinct bottlenecks for successful vaccination exist: the availability of high-quality precursors for clonal selection and the efficiency of affinity maturation dependent on binding complexity. Together with experimental collaborators, we have used these results to interpret single-cell immunoglobulin sequencing data from a vaccination trial targeting the malaria parasite Plasmodium falciparum (Pf ). As predicted for a complex antigen, after repeated immunisation with Pf sporozoites, the clonal selection of potent germline and memory B cell precursors against a major surface protein outpaces affinity maturation because the majority of immunoglobulin gene mutations are affinity-neutral. These findings have implications for the design of potentially personalised vaccination strategies to induce potent B cell responses against structurally complex antigens. A quantitative understanding of functional cell heterogeneity in tumour growth promises insights into the fundamentals of cancer biology. In the second part of this work, I correspondingly develop mathematical models of glioblastoma growth. Employing a Bayesian approach to parameter estimation and incorporating a large body of experimental data from mouse models, I show that brain tumour stem cells drive exponential tumour growth while more differentiated tumour progenitor cells, although fast cycling, are unable to sustain expansion by themselves. Comparing a three-dimensional simulation of tumour growth to experimental growth curves, I derive that glioblastoma stem cells are highly migratory. Based on single-cell clonal tracing data and a combination of deterministic and stochastic modelling approaches, I identify their migration rate and explain experimentally observed clone size distributions. Finally, I employ the resulting fully quantified model of tumour growth to predict the response to two therapeutic interventions. These predictions were verified experimentally by our collaborators, suggesting that quantitative knowledge on the hierarchical subpopulation structure of a tumour may provide valuable guidance for treatment

Privacy matters : Welchen Wert hat der Schutz persönlicher Daten bei Online-Girokonten?

Finanztransaktionen werden zunehmend online abgewickelt, generell scheinen FinTechs das traditionelle Bankgeschäft zu verdrängen. Damit stellt sich vermehrt die Frage, inwiefern der Schutz personenbezogener Daten bei Online-Finanzdienstleistungen in der Wahrnehmung des Kunden als Differenzierungsmerkmal gesehen werden kann. Welchen Wert haben diese Daten aus Sicht der Bankkunden? Lassen sie sich durch Finanzdienstleister monetarisieren? Der vorliegende Artikel zeigt mithilfe der Präferenzmessmethode Choice-Based-Conjoint-Analyse, dass Studierende im Allgemeinen großen Wert auf den Schutz ihrer Privatsphäre legen und bereit sind, eine deutlich höhere monatliche Grundgebühr zu akzeptieren, wenn ihre Daten ausreichend von dem Zugriff Dritter geschützt sind. Schon wenige, besonders relevante Eigenschaften eines Girokontos (v. a. Datenschutz & Privatheit sowie Grundgebühr) tragen dazu bei, dass sich Studierende für ein bestimmtes Girokonto entscheiden. Der Wert, den Studierende der Privatsphäre beimessen, hängt dabei von verschiedenen Faktoren, wie der Vorerfahrung mit Online-Finanzdienstleistungen oder dem Geschlecht der jeweiligen Person, ab

Fully digital data processing during cardiovascular implantable electronic device follow-up in a high-volume tertiary center

Background Increasing numbers of patients with cardiovascular implantable electronic devices (CIEDs) and limited follow-up capacities highlight unmet challenges in clinical electrophysiology. Integrated software (MediConnect®) enabling fully digital processing of device interrogation data has been commercially developed to facilitate follow-up visits. We sought to assess feasibility of fully digital data processing (FDDP) during ambulatory device follow-up in a high-volume tertiary hospital to provide guidance for future users of FDDP software. Methods A total of 391 patients (mean age, 70 years) presenting to the outpatient department for routine device follow-up were analyzed (pacemaker, 44%; implantable cardioverter defibrillator, 39%; cardiac resynchronization therapy device, 16%). Results Quality of data transfer and follow-up duration were compared between digital (n = 265) and manual processing of device data (n = 126). Digital data import was successful, complete and correct in 82% of cases when early software versions were used. When using the most recent software version the rate of successful digital data import increased to 100%. Software-based import of interrogation data was complete and without failure in 97% of cases. The mean duration of a follow-up visit did not differ between the two groups (digital 18.7 min vs. manual data transfer 18.2 min). Conclusions FDDP software was successfully implemented into the ambulatory follow-up of patients with implanted pacemakers and defibrillators. Digital data import into electronic patient management software was feasible and supported the physician’s workflow. The total duration of follow-up visits comprising technical device interrogation and clinical actions was not affected in the present tertiary center outpatient cohort

Improving interinstitutional and intertechnology consistency of pulmonary SBRT by dose prescription to the mean internal target volume dose.

Dose, fractionation, normalization and the dose profile inside the target volume vary substantially in pulmonary stereotactic body radiotherapy (SBRT) between different institutions and SBRT technologies. Published planning studies have shown large variations of the mean dose in planning target volume (PTV) and gross tumor volume (GTV) or internal target volume (ITV) when dose prescription is performed to the PTV covering isodose. This planning study investigated whether dose prescription to the mean dose of the ITV improves consistency in pulmonary SBRT dose distributions. This was a multi-institutional planning study by the German Society of Radiation Oncology (DEGRO) working group Radiosurgery and Stereotactic Radiotherapy. CT images and structures of ITV, PTV and all relevant organs at risk (OAR) for two patients with early stage non-small cell lung cancer (NSCLC) were distributed to all participating institutions. Each institute created a treatment plan with the technique commonly used in the institute for lung SBRT. The specified dose fractionation was 3 × 21.5 Gy normalized to the mean ITV dose. Additional dose objectives for target volumes and OAR were provided. In all, 52 plans from 25 institutions were included in this analysis: 8 robotic radiosurgery (RRS), 34 intensity-modulated (MOD), and 10 3D-conformal (3D) radiation therapy plans. The distribution of the mean dose in the PTV did not differ significantly between the two patients (median 56.9 Gy vs 56.6 Gy). There was only a small difference between the techniques, with RRS having the lowest mean PTV dose with a median of 55.9 Gy followed by MOD plans with 56.7 Gy and 3D plans with 57.4 Gy having the highest. For the different organs at risk no significant difference between the techniques could be found. This planning study pointed out that multiparameter dose prescription including normalization on the mean ITV dose in combination with detailed objectives for the PTV and ITV achieve consistent dose distributions for peripheral lung tumors in combination with an ITV concept between different delivery techniques and across institutions

Evaluation of the uncertainty in an EBT3 film dosimetry system utilizing net optical density

Radiochromic film has become an important tool to verify dose distributions for intensity-modulated radiotherapy (IMRT) and quality assurance (QA) procedures. A new radiochromic film model, EBT3, has recently become available, whose composition and thickness of the sensitive layer are the same as those of previous EBT2 films. However, a matte polyester layer was added to EBT3 to prevent the formation of Newton’s rings. Furthermore, the symmetrical design of EBT3 allows the user to eliminate side-orientation dependence. This film and the flatbed scanner, Epson Perfection V750, form a dosimetry system whose intrinsic characteristics were studied in this work. In addition, uncertainties associated with these intrinsic characteristics and the total uncertainty of the dosimetry system were determined. The analysis of the response of the radiochromic film (net optical density) and the fitting of the experimental data to a potential function yielded an uncertainty of 2.6%, 4.3%, and 4.1% for the red, green, and blue channels, respectively. In this work, the dosimetry system presents an uncertainty in resolving the dose of 1.8% for doses greater than 0.8 Gy and less than 6 Gy for red channel. The films irradiated between 0 and 120 Gy show differences in the response when scanned in portrait or landscape mode; less uncertainty was found when using the portrait mode. The response of the film depended on the position on the bed of the scanner, contributing an uncertainty of 2% for the red, 3% for the green, and 4.5% for the blue when placing the film around the center of the bed of scanner. Furthermore, the uniformity and reproducibility radiochromic film and reproducibility of the response of the scanner contribute less than 1% to the overall uncertainty in dose. Finally, the total dose uncertainty was 3.2%, 4.9%, and 5.2% for red, green, and blue channels, respectively. The above uncertainty values were obtained by minimizing the contribution to the total dose uncertainty of the film orientation and film homogeneity