Architecture of a consent management suite and integration into IHE-based regional health information networks

<p>Abstract</p> <p>Background</p> <p>The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment.</p> <p>Methods</p> <p>Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR.</p> <p>Results</p> <p>The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents.</p> <p>Conclusions</p> <p>Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general.</p

Recommendations for the Use of Programmable Logic Controllers (PLCs) at CERN

Programmable Logic Controllers (PLCs) have been increasingly used at CERN for several years. In future control solutions, PLCs will initially be considered for the rejuvenation of old and obsolete systems, and then for the control of new equipment to be installed in technical services, accelerators and experiments. Many industrial systems will be installed for the control of equipment during the next 5 to 10 years, particularly for the construction of the LHC project. In order to increase efficiency, to reduce the initial investment and to minimise the long term maintenance costs in terms of money and human resources the Working Group recommends that all CERN equipment control projects, based on PLCs, select or specify PLCs from the product lines of the recommended PLC manufacturers

Implementing an Insect Brain Computational Circuit Using III–V Nanowire Components in a Single Shared Waveguide Optical Network

Recent developments in photonics include efficient nanoscale optoelectronic components and novel methods for sub-wavelength light manipulation. Here, we explore the potential offered by such devices as a substrate for neuromorphic computing. We propose an artificial neural network in which the weighted connectivity between nodes is achieved by emitting and receiving overlapping light signals inside a shared quasi 2D waveguide. This decreases the circuit footprint by at least an order of magnitude compared to existing optical solutions. The reception, evaluation and emission of the optical signals are performed by a neuron-like node constructed from known, highly efficient III-V nanowire optoelectronics. This minimizes power consumption of the network. To demonstrate the concept, we build a computational model based on an anatomically correct, functioning model of the central-complex navigation circuit of the insect brain. We simulate in detail the optical and electronic parts required to reproduce the connectivity of the central part of this network, using experimentally derived parameters. The results are used as input in the full model and we demonstrate that the functionality is preserved. Our approach points to a general method for drastically reducing the footprint and improving power efficiency of optoelectronic neural networks, leveraging the superior speed and energy efficiency of light as a carrier of information.Comment: 28 pages, 6 figures; supplementary information 15 pages, 8 figure

Magnetic Scanning Tunneling Microscopy with a Two-Terminal Non-Magnetic Tip: Quantitative Results

We report numerical simulation result of a recently proposed \{P. Bruno, Phys. Rev. Lett {\bf 79}, 4593, (1997)\} approach to perform magnetic scanning tunneling microscopy with a two terminal non-magnetic tip. It is based upon the spin asymmetry effect of the tunneling current between a ferromagnetic surface and a two-terminal non-magnetic tip. The spin asymmetry effect is due to the spin-orbit scattering in the tip. The effect can be viewed as a Mott scattering of tunneling electrons within the tip. To obtain quantitative results we perform numerical simulation within the single band tight binding model, using recursive Green function method and Landauer-B\"uttiker formula for conductance. A new model has been developed to take into account the spin-orbit scattering off the impurities within the single-band tight-binding model. We show that the spin-asymmetry effect is most prominent when the device is in quasi-ballistic regime and the typical value of spin asymmetry is about 5%.Comment: 5 pages, Late

Higher education and unemployment in Europe : an analysis of the academic subject and national effects

This paper examines the impact of an academic degree and field of study on short and long-term unemployment across Europe (EU15). Labour Force Survey (LFS) data on over half a million individuals are utilised for that purpose. The harmonized LFS classification of level of education and field of study overcomes past problems of comparability across Europe. The study analyses (i) the effect of an academic degree at a European level, (ii) the specific effect of 14 academic subjects and (iii) country specific effects. The results indicate that an academic degree is more effective on reducing the likelihood of short-term than long-term unemployment. This general pattern even though it is observed for most of the academic subjects its levels show significant variation across disciplines and countries

Insulin autoantibodies as determined by competitive radiobinding assay are positively correlated with impaired beta-cell function — The Ulm-Frankfurt population study

Out of a random population of 4208 non-diabetic pupils without a family history of Type I diabetes 44 (1.05%) individuals had islet cell antibody (ICA) levels greater or equal to 5 Juvenile Diabetes Foundation (JDF) units. 39 of these ICA-positives could be repeatedly tested for circulating insulin autoantibodies (CIAA) using a competitive radiobinding assay. The results were compared with the insulin responses in the intravenous glucose tolerance tests (IVGTT) and with HLA types. Six pupils were positive for CIAA. All of them had complement-fixing ICA, and 5 of them were HLA-DR4 positive. Three of the 6 showed a first-phase insulin response below the first percentile of normal controls. Our data indicate that in population-based studies CIAA can be considered as a high risk marker for impaired beta-cell function in non-diabetic ICA-positive individuals

Inconsistent strategies to spin up models in CMIP5: Implications for ocean biogeochemical model performance assessment

This is the final version of the article. Available from EGU via the DOI in this record.During the fifth phase of the Coupled Model Intercomparison Project (CMIP5) substantial efforts were made to systematically assess the skill of Earth system models. One goal was to check how realistically representative marine biogeochemical tracer distributions could be reproduced by models. In routine assessments model historical hindcasts were compared with available modern biogeochemical observations. However, these assessments considered neither how close modeled biogeochemical reservoirs were to equilibrium nor the sensitivity of model performance to initial conditions or to the spin-up protocols. Here, we explore how the large diversity in spin-up protocols used for marine biogeochemistry in CMIP5 Earth system models (ESMs) contributes to model-to-model differences in the simulated fields. We take advantage of a 500-year spin-up simulation of IPSL-CM5A-LR to quantify the influence of the spin-up protocol on model ability to reproduce relevant data fields. Amplification of biases in selected biogeochemical fields (O2, NO3, Alk-DIC) is assessed as a function of spin-up duration. We demonstrate that a relationship between spin-up duration and assessment metrics emerges from our model results and holds when confronted with a larger ensemble of CMIP5 models. This shows that drift has implications for performance assessment in addition to possibly aliasing estimates of climate change impact. Our study suggests that differences in spin-up protocols could explain a substantial part of model disparities, constituting a source of model-to-model uncertainty. This requires more attention in future model intercomparison exercises in order to provide quantitatively more correct ESM results on marine biogeochemistry and carbon cycle feedbacks.We sincerely thank I. Kriest, F. Joos, the anonymous reviewer and A. Yool for their useful comments on this paper. This work was supported by H2020 project CRESCENDO “Coordinated Research in Earth Systems and Climate: Experiments, kNowledge, Dissemination and Outreach”, which received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 641816 and by the EU FP7 project CARBOCHANGE “Changes in carbon uptake and emissions by oceans in a changing climate” which received funding from the European community’s Seventh Framework Programme under grant agreement no. 264879. Supercomputing time was provided by GENCI (Grand Equipement National de Calcul Intensif) at CCRT (Centre de Calcul Recherche et Technologie), allocation 016178. Finally, we are grateful to the ESGF project which makes data available for all the community. Roland Séférian is grateful to Aurélien Ribes for his kind advices on statistics. Jerry Tjiputra acknowledges ORGANIC project (239965/F20) funded by the Research Council of Norway. Christoph Heinze and Jerry Tjiputra are grateful for support through project EVA – Earth system modelling of climate variations in the Anthropocene (229771/E10) funded by the Research Council of Norway, as well as CPU-time and mass storage provided through NOTUR project NN2345K as well as NorStore project NS2345K. Keith Lindsay and Scott C. Doney acknowledge support from the National Science Foundation

Effect of interface bonding on spin-dependent tunneling from the oxidized Co surface

We demonstrate that the factorization of the tunneling transmission into the product of two surface transmission functions and a vacuum decay factor allows one to generalize Julliere's formula and explain the meaning of the ``tunneling density of states'' in some limiting cases. Using this factorization we calculate spin-dependent tunneling from clean and oxidized fcc Co surfaces through vacuum into Al using the principal-layer Green's function approach. We demonstrate that a monolayer of oxygen on the Co (111) surface creates a spin-filter effect due to the Co-O bonding which produces an additional tunneling barrier in the minority-spin channel. This changes the minority-spin dominated conductance for the clean Co surface into a majority spin dominated conductance for the oxidized Co surface.Comment: 7 pages, revtex4, 4 embedded eps figure

Globally, plant-soil feedbacks are weak predictors of plant abundance

Plant-soil feedbacks (PSFs) have been shown to strongly affect plant performance under controlled conditions, and PSFs are thought to have far reaching consequences for plant population dynamics and the structuring of plant communities. However, thus far the relationship between PSF and plant species abundance in the field is not consistent. Here, we synthesize PSF experiments from tropical forests to semiarid grasslands, and test for a positive relationship between plant abundance in the field and PSFs estimated from controlled bioassays. We meta-analyzed results from 22 PSF experiments and found an overall positive correlation (0.12 <= r over bar <= 0.32) between plant abundance in the field and PSFs across plant functional types (herbaceous and woody plants) but also variation by plant functional type. Thus, our analysis provides quantitative support that plant abundance has a general albeit weak positive relationship with PSFs across ecosystems. Overall, our results suggest that harmful soil biota tend to accumulate around and disproportionately impact species that are rare. However, data for the herbaceous species, which are most common in the literature, had no significant abundance-PSFs relationship. Therefore, we conclude that further work is needed within and across biomes, succession stages and plant types, both under controlled and field conditions, while separating PSF effects from other drivers (e.g., herbivory, competition, disturbance) of plant abundance to tease apart the role of soil biota in causing patterns of plant rarity versus commonness