Classifying Emergency Department Data to Improve Syndromic Surveillance: From Mixed Data Types to ICD Codes and Syndromes

Syndromic surveillance systems are used to monitor public health and enable a timely outbreak detection. Emergency department (ED) data can serve as an important data source for syndromic surveillance, but a high amount of missing diagnosis codes can make analyses relying on this information impossible. This study aims at enhancing an ED dataset from a piloted syndromic surveillance system in Germany to enable the monitoring of an influenza-like illness (ILI) syndrome. Routinely collected data from one ED containing mixed-type variables are analysed and two different approaches are implemented to deal with the missing data. Within the first approach, the missing diagnosis codes are imputed by predicting them from the remaining variables, using a multi-class naive Bayes classifier and a deep learning imputation package. In the second approach, a logistic regression model and a binary naive Bayes classifier are used to predict the ILI syndrome from all variables except the diagnosis code. The resulting ILI cases are evaluated on time series level with regard to seasonal patterns. The diagnosis codes were predicted from mixed-type input variables with sufficient precision (34.37% F1-measure in the best model). By taking into account the hierarchical structure of the ICD-10 codes, the performance was improved. Predicting the ILI syndrome independent of the diagnosis code from the remaining variables worked well (39.63% F1-measure in the best model) and the predictions showed medical similarity with the ILI syndrome. The models differed in their sensitivity of including cases, which can be adjusted by changing the threshold of the classifiers. The resulting ILI cases from all models were positively correlated with the reference cases on a time series basis (r = 0.865 for best model) and were comparable with an external data source, a surveillance of severe acute respiratory infections (SARI) (r = 0.867 for best model). The present study showed that the ED dataset can be enhanced to enable the syndromic surveillance of an ILI syndrome based on the diagnosis codes, even if this variable is missing. Additionally, a flexible case definition for an ILI syndrome was developed that is independent of the diagnosis code and the underlying generic method can be applied to other syndromes as well

Interactive Hesitation Synthesis: Modelling and Evaluation

Betz S, Carlmeyer B, Wagner P, Wrede B. Interactive Hesitation Synthesis: Modelling and Evaluation. Multimodal Technologies and Interaction. 2018;2(1): 9

The Hesitating Robot - Implementation and First Impressions

Carlmeyer B, Betz S, Wagner P, Wrede B, Schlangen D. The Hesitating Robot - Implementation and First Impressions. In: Companion of the 2018 ACM/IEEE International Conference on Human-Robot Interaction - HRI '18. New York, NY, USA: ACM Press; 2018: 77-78

Priming effect of glucagon-like peptide-1 (7-36) amide, glucose-dependent insulinotropic polypeptide and cholecystokinin-8 at the isolated perfused rat pancreas

The priming effect of glucagon-like peptide-1 (7-36) amide (GLP-1 (7-36) amide), glucose-dependent insulin-releasing polypeptide (GIP) and cholecystokinin-8 (CCK-8) on glucose-induced insulin secretion from rat pancreas was investigated. The isolated pancreas was perfused in vitro with Krebs-Ringer bicarbonate buffer containing 2.8 mmol/l glucose. After 10 min this medium was supplemented with GLP-1 (7-36) amide, GIP or CCK-8 (10, 100, 1000 pmol/l) for 10 min. After an additional 10 min period with 2.8 mmol/l glucose alone, insulin secretion was stimulated with buffer containing 10 mmol/l glucose for 44 min. In control experiments the typical biphasic insulin response to 10 mmol/l glucose occurred. Pretreatment of the pancreas with GIP augmented insulin secretion: 10 pmol/l GIP enhanced only the first phase of the secretory response to 10 mmol/l glucose; 100 and 1000 pmol/l GIP stimulated both phases of hormone secretion. After exposure to CCK-8, enhanced insulin release during the first (at 10 and 1000 pmol/l CCK-8) and the second phase (at 1000 pmol/l) was observed. Priming with 100 pmol/l GLP-1 (7-36) amide significantly amplified the first and 1000 pmol/l GLP-1 (7-36) amide both secretion periods. 10 pmol/l GLP-1 (7-36) amide had no significant effect. All three peptide hormones influenced the first, quickly arising secretory response more than the second phase. Priming with forskolin (30 mM) enhanced the secretory response to 10 mM glucose plus 0.5 nM GLP-1 (7-36) amide 4-fold. With a glucose-responsive B-cell line (HIT cells), we investigated the hypothesis that the priming effect of GLP-1 (7-36) amide is mediated by the adenylate cyclase system. Priming with either IBMX (0.1 mM) or forskolin (2.5 [mu]M) enhanced the insulin release after a consecutive glucose stimulation (5 mM). This effect was pronounced when GLP-1 (7-36) amide (100 pM) was added during glucose stimulation. Priming capacities of intestinal peptide hormones may be involved in the regulation of postprandial insulin release. The incretin action of these hormones can probably, at least in part, be explained by these effects. The priming effect of GLP-1 (7-36) amide is most likely mediated by the adenylate cyclase system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29450/1/0000532.pd

Interferon beta-1a sc at 25 years: a mainstay in the treatment of multiple sclerosis over the period of one generation.

INTRODUCTION Interferon beta (IFN beta) preparations are an established group of drugs used for immunomodulation in patients with multiple sclerosis (MS). Subcutaneously (sc) applied interferon beta-1a (IFN beta-1a sc) has been in continuous clinical use for 25 years as a disease-modifying treatment. AREAS COVERED Based on data published since 2018, we discuss recent insights from analyses of the pivotal trial PRISMS and its long-term extension as well as from newer randomized studies with IFN beta-1a sc as the reference treatment, the use of IFN beta-1a sc across the patient life span and as a bridging therapy, recent data regarding the mechanisms of action, and potential benefits of IFN beta-1a sc regarding vaccine responses. EXPERT OPINION IFN beta-1a sc paved the way to effective immunomodulatory treatment of MS, enabled meaningful insights into the disease process, and remains a valid therapeutic option in selected vulnerable MS patient groups

Diretrizes da Federação Mundial das Sociedades de Psiquiatria Biológica para o tratamento biológico da esquizofrenia. Parte 2: tratamento de longo prazo

These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A/D). This second part of the guidelines covers the long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.Estas diretrizes para o tratamento biológico da esquizofrenia foram desenvolvidas pela Força-Tarefa da Federação Mundial das Sociedades de Psiquiatria Biológica (World Federation of Societies of Biological Psychiatry, WFSBP). As metas fixadas durante o desenvolvimento destas diretrizes foi a revisão sistemática de todas as evidências disponíveis referentes ao tratamento da esquizofrenia, tanto no âmbito clínico como no científico, e o estabelecimento de um consenso sobre as principais recomendações para a prática psiquiátrica. Estas diretrizes são destinadas a todos os médicos que atendem e tratam de pacientes portadores de esquizofrenia. Os dados usados para desenvolver estas diretrizes foram extraídos primariamente de vários painéis e diretrizes nacionais para o tratamento da esquizofrenia, assim como de metanálises, revisões e estudos clínicos randomizados sobre a eficácia do tratamento farmacológico e de outras intervenções terapêuticas biológicas, identificadas por uma busca nas bases de dados MedLine e na Biblioteca Cochrane. A literatura identificada foi avaliada quanto à solidez das evidências a favor da eficácia de determinada intervenção, sendo, então, categorizada em quatro níveis de evidência (de A a D). A segunda parte das diretrizes abrange o tratamento de longo prazo, bem como o controle dos efeitos colaterais relevantes. Essas diretrizes são primariamente relacionadas ao tratamento biológico de adultos esquizofrênicos, incluindo medicação antipsicótica, outras opções de tratamento farmacológico, eletroconvulsoterapia, estratégias terapêuticas recentes e complementares

Nährstoffbilanzen für Buchen-, Eichen-, Fichten- und Kiefernbestände bei verschiedenen Nutzungsintensitäten

Für 10 Waldstandorte in Niedersachsen mit Buche, Eiche, Fichte bzw. Kiefer wurden Bilanzen des Ein- und Austrags von Calcium, Kalium, Magnesium und Stickstoff unter Berücksichtigung von 3 Nutzungsintensitäten (ohne Nutzung, Derbholz-Nutzung, Vollbaum-Nutzung) berechnet. Bereits die konventionelle Derbholz-Nutzung kann erhebliche Nährstoffverluste verursachen. Der zusätzliche Entzug einer intensivierten Nutzung wäre bei nährstoffarmen Standorten und besonders für Calcium (Fichte > Buche > Kiefer > Eiche) und Magnesium (Fichte > Kiefer > Buche > Eiche) kritisch. Bei signifikant negativen Bilanzen würde er innerhalb von 100 Jahren bei Calcium > 90 % (Eiche > Fichte > Kiefer > Buche) und bei Magnesium > 110 % (Eiche > Fichte > Buche > Kiefer) des Umfangs einer Kalkung entsprechen. Eine Intensivierung der konventionellen Derbholz-Nutzung sollte deshalb nur auf solchen Standorten erfolgen, wo nachhaltige Nährstoffkreisläufe gesichert sind

Prognostic factors for relapse in patients with clinical stage I testicular non-seminoma: A nationwide, population-based cohort study

BACKGROUND: Approximately 30% of patients with clinical stage I non-seminoma (CSI-NS) relapse. Current risk stratification is based on lymphovascular invasion (LVI) alone. The extent to which additional tumor characteristics can improve risk prediction remains unclear.OBJECTIVE: To determine the most important prognostic factors for relapse in CSI-NS patients.DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study including all patients with CSI-NS diagnosed in Denmark between 2013 and 2018 with follow-up until 2022. Patients were identified in the prospective Danish Testicular Cancer database. By linkage to the Danish National Pathology Registry, histological slides from the orchiectomy specimens were retrieved.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Histological slides were reviewed blinded to the clinical outcome. Clinical data were obtained from medical records. The association between prespecified potential prognostic factors and relapse was assessed using Cox regression analysis. Model performance was evaluated by discrimination (Harrell's C-index) and calibration.RESULTS: Of 453 patients included, 139 patients (30.6%) relapsed during a median follow-up of 6.3 years. Tumor invasion into the hilar soft tissue of the testicular hilum, tumor size, LVI and embryonal carcinoma were independent predictors of relapse. The estimated 5-year risk of relapse ranged from &lt; 5% to &gt; 85%, depending on the number of risk factors. After internal model validation, the model had an overall concordance statistic of 0.75. Model calibration was excellent.CONCLUSION AND RELEVANCE: The identified prognostic factors provide a much more accurate risk stratification than current clinical practice, potentially aiding clinical decision-making.</p

Bodenvorräte & Bilanzen von Makronährstoffen als Indikatoren für die ökologische Bewertung intensiver Biomassenutzung im Wald

Die mögliche Nutzungsintensität von Waldbeständen wird häufig anhand einzelner Indikatoren wie den Nährstoffvorräten im effektiven Wurzelraum (AKe), dem Nährstoffentzugsindex oder der Stoffbilanz bewertet. Dabei ergeben sich für die hier untersuchten Flächen des Intensiven Umweltmonitorings für Kalium und Magnesium große Differenzen zwischen den betrachteten Indikatoren, dagegen für Calcium ein eher undifferenziertes Bild. Aufgrund der uneinheitlichen Ergebnisse ist es erforderlich, die Indikatoren hinsichtlich ihrer Aussage genau zu überprüfen. Gleichzeitig sollte die Ableitung von standortspezifischen Empfehlungen für eine angemessene Nutzungsintensität und den Bedarf an Kompensationsmaßnahmen (z. B. Kalkung) unbedingt unter Berücksichtigung aller potenziellen Indikatoren erfolgen

Routinedaten aus der medizinischen Versorgung für die Notaufnahme-Surveillance: 1,5 Jahre Notaufnahme-Situationsreport

SUMO ist ein am Robert Koch-Institut entwickeltes und betriebenes System, welches Gesundheitsdaten für Public Health-Surveillance verarbeitet und bereitstellt. Der Notaufnahme-Situationsreport enthält Daten der Routinedokumentation aus einer Auswahl deutscher Notaufnahmen und bildet die aktuelle Inanspruchnahme dieser Notaufnahmen ab.SUMO is a system that has been developed and implemented at the Robert Koch Institute. It processes and provides health data for surveillance and public health research. The Emergency Department Situation Report presents data from the routine documentation of selected emergency departments in Germany, and shows the current utilisation of those emergency departments