Why digital medicine depends on interoperability

Digital data are anticipated to transform medicine. However, most of today's medical data lack interoperability: hidden in isolated databases, incompatible systems and proprietary software, the data are difficult to exchange, analyze, and interpret. This slows down medical progress, as technologies that rely on these data - artificial intelligence, big data or mobile applications - cannot be used to their full potential. In this article, we argue that interoperability is a prerequisite for the digital innovations envisioned for future medicine. We focus on four areas where interoperable data and IT systems are particularly important: (1) artificial intelligence and big data; (2) medical communication; (3) research; and (4) international cooperation. We discuss how interoperability can facilitate digital transformation in these areas to improve the health and well-being of patients worldwide

German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs

Aim: Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment. Subject and methods: In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany. Results: PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001). Conclusion: Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results

The German Corona Consensus Dataset (GECCO): a standardized dataset for COVID-19 research in university medicine and beyond

Background: The current COVID-19 pandemic has led to a surge of research activity. While this research provides important insights, the multitude of studies results in an increasing fragmentation of information. To ensure comparability across projects and institutions, standard datasets are needed. Here, we introduce the “German Corona Consensus Dataset” (GECCO), a uniform dataset that uses international terminologies and health IT standards to improve interoperability of COVID-19 data, in particular for university medicine. Methods: Based on previous work (e.g., the ISARIC-WHO COVID-19 case report form) and in coordination with experts from university hospitals, professional associations and research initiatives, data elements relevant for COVID-19 research were collected, prioritized and consolidated into a compact core dataset. The dataset was mapped to international terminologies, and the Fast Healthcare Interoperability Resources (FHIR) standard was used to define interoperable, machine-readable data formats. Results: A core dataset consisting of 81 data elements with 281 response options was defined, including information about, for example, demography, medical history, symptoms, therapy, medications or laboratory values of COVID-19 patients. Data elements and response options were mapped to SNOMED CT, LOINC, UCUM, ICD-10-GM and ATC, and FHIR profiles for interoperable data exchange were defined. Conclusion: GECCO provides a compact, interoperable dataset that can help to make COVID-19 research data more comparable across studies and institutions. The dataset will be further refined in the future by adding domain-specific extension modules for more specialized use cases

Psychologische Mechanismen und neuronale Korrelate

Tension and suspense are ubiquitous emotional phenomena that are experienced in a multitude of contexts (e.g., in music, literature, film, sports, or everyday life). However, the psychological and neuronal mechanisms underlying tension experiences remain largely unclear. This dissertation aims to advance the understanding of tension and suspense by presenting theoretical and empirical work that investigates the psychological underpinnings and neural correlates of tension phenomena. The empirical studies focus on the special cases of musical tension (i.e., tension experiences evoked by music) and suspense evoked by a literary text. First, a behavioral study explored the role of different tonal and expressive structural features of a musical piece (harmony, melody, outer voices, dynamics, and expressive timing) as a mediator of musical tension. Results of this study indicate that musical tension largely depends on tonal features and their relative importance in the musical piece but can be enhanced by expressive features (such as dynamics). A subsequent study using functional magnetic resonance imaging (fMRI) investigated neural correlates of tension experiences during music listening. The subjective experience of felt musical tension was found to be related to neural activations in areas associated with affective processing in the orbitofrontal cortex and the amygdala, underlining the close connection between musical tension and music-evoked emotion. A methodologically similar fMRI study investigating neural correlates of suspense evoked by a literary text found suspenseful text segments to be associated with activity in medial prefrontal, inferior frontal, as well as posterior temporal and temporo- parietal brain areas, suggesting an involvement of processes of theory of mind and predictive inference. In addition to these empirical studies, two articles explore tension phenomena from more theoretical perspectives. The first article discusses patterns of tension and resolution and their contribution to aesthetic emotions evoked by works of art. Building on this, the second article reviews general, domain-independent cognitive processes underlying tension experiences and proposes a general psychological model of tension and suspense. According to this model, tension experiences result from states of conflict, instability, dissonance, or uncertainty that trigger processes of expectation and anticipation directed at future events of emotional significance. In sum, the work presented in this dissertation explores both domain-specific (i.e., music and literature) as well as general, domain- independent aspects of emotional experiences of tension from empirical and theoretical perspectives. It includes the first neuroimaging studies of tension and suspense in music and literature, which—together with the theoretical articles—provide a foundation for subsequent research on tension phenomena which might be useful to researchers from a variety of disciplines including cognitive and affective neuroscience, psychological emotion research, media psychology, film and literature studies, as well as empirical aesthetics.Das Erleben von Spannung ist ein allgegenwärtiges emotionales Phänomen, das durch eine Vielzahl unterschiedlicher Kontexte ausgelöst werden kann (z.B. durch Musik, Literatur, Film, Sport oder diverse Alltagssituationen). Die psychologischen und neuronalen Mechanismen, die der emotionalen Erfahrung von Spannung zu Grunde liegen, sind jedoch weitgehend ungeklärt. Ziel der vorliegenden Dissertation ist es, die psychologischen Grundlagen und neuronalen Korrelate von Spannungsphänomenen empirisch und theoretisch zu untersuchen und auf diese Weise zum besseren Verständnis dieses Aspekts menschlicher Emotion beizutragen. Die empirischen Studien befassen sich mit den Spezialfällen musikalischer Spannung (d.h. mit durch Musik hervorgerufenen Spannungserfahrungen) und mit Spannungsempfindungen beim Lesen eines literarischen Texts. Zunächst wurde in einer Verhaltensstudie der Einfluss verschiedener struktureller und expressiver Merkmale (Harmonie, Melodie, Außenstimmen, Dynamik, expressives Timing) zweier Musikstücke auf die Erfahrung musikalischer Spannung untersucht. Die Ergebnisse zeigen, dass musikalische Spannung in erster Linie von tonalen Merkmalen und deren relativer Bedeutung im jeweiligen Musikstück abhängt, jedoch durch expressive Merkmale (wie z.B. der Dynamik) verstärkt werden kann. In einer Folgestudie wurden die neuronalen Korrelate musikalischer Spannung mittels funktioneller Magnetresonanztomographie (fMRT) untersucht. Die Ergebnisse dieser Studie zeigen, dass das subjektive Erleben musikalischer Spannung mit neuronalen Aktivierungen des orbitofrontalen Kortex und der Amygdala einhergehen, d.h. Arealen, die mit der Verarbeitung von Emotionen zusammenhängen. In einer methodisch ähnlichen fMRT-Studie, die die neuronalen Korrelate von Spannung (Suspense) beim Lesen eines literarischen Texts untersuchte, wurde ein Zusammenhang zwischen empfundener Spannung und Aktivierungen in medial- präfrontalen, inferior-frontalen, und posterior-temporalen Hirnarealen gefunden. Diese Aktivierungen legen einen Einfluss von Prozessen der sogenannten „Theory of Mind“ (d.h. der Fähigkeit, anderen Personen geistige Zustände zuzuschreiben) und Prädiktionsprozessen während des Lesens spannender Textabschnitte nahe. Zusätzlich zu diesen empirischen Studien, wurden Spannungsphänomene in zwei Artikeln aus theoretischer Perspektive genauer beleuchtet. Der erste Theorieartikel diskutiert Spannungs- und Auflösungsstrukturen und deren Zusammenhang mit durch Kunstformen wie Musik, Literatur oder Film hervorgerufenen Emotionen. Darauf aufbauend untersucht der zweite Theorieartikel allgemeine, domänenübergreifende kognitive Prozesse, die Spannungserfahrungen zu Grunde liegen, und entwickelt ein psychologisches Spannungsmodell. Diesem Modell zufolge resultieren Spannungserfahrungen aus Zuständen, die mit Konflikt, Instabilität, Dissonanz und Unsicherheit assoziiert sind, welche Erwartungs- und Antizipationsprozesse hervorrufen, die sich auf zukünftige Ereignisse emotionaler Bedeutung richten. Die im Rahmen dieses Dissertationsprojekts durchgeführten Arbeiten untersuchen sowohl domänenspezifische (in Musik und Literatur) als auch domänenenunabhängige Aspekte von Spannungserlebnissen. Die Dissertation beschreibt die ersten fMRT- Studien zu Spannungserfahrungen in Musik und Literatur, und schafft so, zusammen mit den Theorieartikeln, eine Grundlage für zukünftige neurowissenschaftliche und psychologische Forschung zu Spannungsphänomenen

Tension-related activity in the orbitofrontal cortex and amygdala:an fMRI study with music

Tonal music is characterized by a continuous flow of tension and resolution. This flow of tension and resolution is closely related to processes of expectancy and prediction and is a key mediator of music-evoked emotions. However, the neural correlates of subjectively experienced tension and resolution have not yet been investigated. We acquired continuous ratings of musical tension for four piano pieces. In a subsequent functional magnetic resonance imaging experiment, we identified blood oxygen level-dependent signal increases related to musical tension in the left lateral orbitofrontal cortex (pars orbitalis of the inferior frontal gyrus). In addition, a region of interest analysis in bilateral amygdala showed activation in the right superficial amygdala during periods of increasing tension (compared with decreasing tension). This is the first neuroimaging study investigating the time-varying changes of the emotional experience of musical tension, revealing brain activity in key areas of affective processing

Reading a suspenseful literary text activates brain areas related to social cognition and predictive inference

Stories can elicit powerful emotions. A key emotional response to narrative plots (e.g., novels, movies, etc.) is suspense. Suspense appears to build on basic aspects of human cognition such as processes of expectation, anticipation, and prediction. However, the neural processes underlying emotional experiences of suspense have not been previously investigated. We acquired functional magnetic resonance imaging (fMRI) data while participants read a suspenseful literary text (E.T.A. Hoffmann's "The Sandman") subdivided into short text passages. Individual ratings of experienced suspense obtained after each text passage were found to be related to activation in the medial frontal cortex, bilateral frontal regions (along the inferior frontal sulcus), lateral premotor cortex, as well as posterior temporal and temporo-parietal areas. The results indicate that the emotional experience of suspense depends on brain areas associated with social cognition and predictive inference

One trial of the experiment: a segment of the text was presented, followed by a rating screen on which the suspense experienced while reading the text segment was selected on a 10-point scale using two buttons (for moving the selected point on the rating scale to the left or right).

<p>Timing was self-paced, i.e., participants pressed a button in order to proceed to the next text segment / rating screen. A total of 65 text segments was presented during the experiment.</p

Statistical parametric maps (<i>p</i> <. 05, cluster-level FWE-corrected, shown in neurological convention) for (A) the contrast <i>reading > rating</i> and (B) the parametric <i>suspense</i> regressor capturing participants' experience of suspense during reading.

<p>Statistical parametric maps (<i>p</i> <. 05, cluster-level FWE-corrected, shown in neurological convention) for (A) the contrast <i>reading > rating</i> and (B) the parametric <i>suspense</i> regressor capturing participants' experience of suspense during reading.</p

PPI analysis: anatomical locations, peak MNI coordinates, T-values, and cluster sizes (number of voxels) of brain areas in which suspense (high vs. low) significantly modulated the functional connectivity to the seed region.

<p>(<i>p</i> <.05, cluster-level FWE-corrected; indented regions are part of one continuous cluster)</p><p>IFG: inferior frontal gyrus; ITG: inferior temporal gyrus; MFC: medial frontal cortex; PMC: premotor cortex.</p><p>PPI analysis: anatomical locations, peak MNI coordinates, T-values, and cluster sizes (number of voxels) of brain areas in which suspense (high vs. low) significantly modulated the functional connectivity to the seed region.</p