Transinstitutional information management in health care networks: requirements and methods

Die koordinierte Zusammenarbeit zwischen medizinischen Leistungserbringern, Organisationen des Gesundheitswesens und Systemsektoren ist ein wichtiger Faktor für die Qualität und Effizienz der Versorgung insgesamt. In Deutschland, wie auch in anderen Ländern nehmen daher die Bestrebungen zu, die organisatorischen Grundlagen für die die einrichtungsübergreifende Zusammenarbeit durch die Bildung von Gesundheitsnetzwerken zu verbessern. Transinstitutionelle Informationssystemarchitekturen werden als eine zentrale Voraussetzung für die Realisierung eines patientenzentrierten Versorgungsparadigmas betrachtet. Es ist unklar, wie transinstitutionelle Systeme angesichts der teilweise divergierenden Interessen von Gesundheitsnetzwerkmitgliedern systematisch geplant, gesteuert und überwacht werden können. Eine Ursache hierfür liegt in fehlenden Ansätzen der systematischen Ermittlung von Faktoren, die das Informationsmanagement in Gesundheitsnetzwerken beeinflussen sowie in der Schwierigkeit, diese Einflüsse strukturiert zu beschreiben. In dieser Arbeit werden daher zunächst die relevanten Forschungsergebnisse der Netzwerkforschung aufgearbeitet. Hierbei wird der Fokus auf die Probleme gelegt, die sich aus der Koexistenz von Eigenständigkeit und Kooperation ergeben, gelegt. Darauf aufbauend wird eine Studie konzipiert, durchgeführt und ausgewertet, deren Ziel in der Ermittlung von Umsetzungsbarrieren des einrichtungsübergreifenden Informationsmanagements liegt. Es wird das integrierte Ordnungssystem für Gesundheitsnetzwerke (DIOGEN) vorgestellt. Dies ist ein Ordnungssystem, welches ermöglicht, Gesundheitsnetzwerke anhand der Hauptmerkmale Netzwerkstruktur, Netzwerkmanagementsystem, Versorgungssystem, transinstitutionelles Informationssystem sowie Netzwerkphase, zu charakterisieren. Die Bedeutung der Zentralität des transinstitutionellen Informationsmanagements sowie daraus resultierender einrichtungsübergreifender Abhängigkeiten ist ein weiterer Schwerpunkt dieser Arbeit.The rapid advancement of medical knowledge and technologies for preventive, diagnostic and therapeutic interventions are leading to increasing functional und organizational differentiation in modern health care systems. Appropriate coordination of health care activities between professionals, health organizations and system sectors is conceived as a key requirement for efficient and effective health care. In Germany, as well as in other countries, efforts have emerged to improve transinstitutional cooperation by the means of health care networks. Transinstitutional information system architectures are playing a vital role in implementing the patient-centered care paradigm. It is not clear how can transinstitutional information systems be planned, steered and controlled systematically against the background of the legal autonomy and potentially conflicting interests of participating actors. In order to develop adequate methods of transinstitutional information management, factors that influence information management in health care networks have to be identified and described systematically. Hence, the first goal of this thesis is to review relevant literature from the field of network research, in particular with respect to the complexity that arises from the coexistence of autonomy and cooperation in health care networks. A study is presented that aims at identifying barriers of transinstitutional information management in health care networks. An integrated description framework for health care networks (DIOGEN) is presented. It characterizes health care networks by the dimensions network structure, network management system, care system, transinstitutional information system and network phase. One important focus of this thesis lies on interorganizational dependencies that arise from centralized transinstitutional information management. An approach for modeling and quantifying centrality is developed

TXS 0506+056 with Updated IceCube Data

Past results from the IceCube Collaboration have suggested that the blazar TXS 0506+056 is a potential source of astrophysical neutrinos. However, in the years since there have been numerous updates to event processing and reconstruction, as well as improvements to the statistical methods used to search for astrophysical neutrino sources. These improvements in combination with additional years of data have resulted in the identification of NGC 1068 as a second neutrino source candidate. This talk will re-examine time-dependent neutrino emission from TXS 0506+056 using the most recent northern-sky data sample that was used in the analysis of NGC 1068. The results of using this updated data sample to obtain a significance and flux fit for the 2014 TXS 0506+056 "untriggered" neutrino flare are reported

Galactic Core-Collapse Supernovae at IceCube: “Fire Drill” Data Challenges and follow-up

The next Galactic core-collapse supernova (CCSN) presents a once-in-a-lifetime opportunity to make astrophysical measurements using neutrinos, gravitational waves, and electromagnetic radiation. CCSNe local to the Milky Way are extremely rare, so it is paramount that detectors are prepared to observe the signal when it arrives. The IceCube Neutrino Observatory, a gigaton water Cherenkov detector below the South Pole, is sensitive to the burst of neutrinos released by a Galactic CCSN at a level >10σ. This burst of neutrinos precedes optical emission by hours to days, enabling neutrinos to serve as an early warning for follow-up observation. IceCube\u27s detection capabilities make it a cornerstone of the global network of neutrino detectors monitoring for Galactic CCSNe, the SuperNova Early Warning System (SNEWS 2.0). In this contribution, we describe IceCube\u27s sensitivity to Galactic CCSNe and strategies for operational readiness, including "fire drill" data challenges. We also discuss coordination with SNEWS 2.0

All-Energy Search for Solar Atmospheric Neutrinos with IceCube

The interaction of cosmic rays with the solar atmosphere generates a secondary flux of mesons that decay into photons and neutrinos – the so-called solar atmospheric flux. Although the gamma-ray component of this flux has been observed in Fermi-LAT and HAWC Observatory data, the neutrino component remains undetected. The energy distribution of those neutrinos follows a soft spectrum that extends from the GeV to the multi-TeV range, making large Cherenkov neutrino telescopes a suitable for probing this flux. In this contribution, we will discuss current progress of a search for the solar neutrino flux by the IceCube Neutrino Observatory using all available data since 2011. Compared to the previous analysis which considered only high-energy muon neutrino tracks, we will additionally consider events produced by all flavors of neutrinos down to GeV-scale energies. These new events should improve our analysis sensitivity since the flux falls quickly with energy. Determining the magnitude of the neutrino flux is essential, since it is an irreducible background to indirect solar dark matter searches

Recent neutrino oscillation results with the IceCube experiment

The IceCube South Pole Neutrino Observatory is a Cherenkov detector instrumented in a cubic kilometer of ice at the South Pole. IceCube’s primary scientific goal is the detection of TeV neutrino emissions from astrophysical sources. At the lower center of the IceCube array, there is a subdetector called DeepCore, which has a denser configuration that makes it possible to lower the energy threshold of IceCube and observe GeV-scale neutrinos, opening the window to atmospheric neutrino oscillations studies. Advances in physics sensitivity have recently been achieved by employing Convolutional Neural Networks to reconstruct neutrino interactions in the DeepCore detector. In this contribution, the recent IceCube result from the atmospheric muon neutrino disappearance analysis using the CNN-reconstructed neutrino sample are presented and compared to the existing worldwide measurements

Angular dependence of the atmospheric neutrino flux with IceCube data

IceCube Neutrino Observatory, the cubic kilometer detector embedded in ice of the geographic South Pole, is capable of detecting particles from several GeV up to PeV energies enabling precise neutrino spectrum measurement. The diffuse neutrino flux can be subdivided into three components: astrophysical, from extraterrestrial sources; conventional, from pion and kaon decays in atmospheric Cosmic Ray cascades; and the yet undetected prompt component from the decay of charmed hadrons. A particular focus of this work is to test the predicted angular dependence of the atmospheric neutrino flux using an unfolding method. Unfolding is a set of methods aimed at determining a value from related quantities in a model-independent way, eliminating the influence of several assumptions made in the process. In this work, we unfold the muon neutrino energy spectrum and employ a novel technique for rebinning the observable space to ensure sufficient event numbers within the low statistic region at the highest energies. We present the unfolded energy and zenith angle spectrum reconstructed from IceCube data and compare the result with model expectations and previous measurements