Visualizing Study Profiles Using the GMDS Competency Catalog for Medical Informatics Programs

BACKGROUND

Medical informatics programs cover a variety of topics.

OBJECTIVES

To test the utility of the GMDS medical informatics competency catalog in comparing programs by developing study profiles.

METHODS

Coverage of 234 competencies is recorded and visualized in a spider diagram.

RESULTS

Spider diagrams allow visualizing various study profiles.

CONCLUSION

The GMDS catalog seems useful for comparing medical informatics study programs, e.g., for interested students, employers, or accreditation reviewers.

Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany

Background

The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life.

In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”.

The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany.

The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system.

Methods

The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations.

Results

The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system.

Discussion

Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system.

Trial registration

The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.

Planning for Implementation Success of an Electronic Cross-Facility Health Record for Pediatric Palliative Care Using the Consolidated Framework for Implementation Research (CFIR)

Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.

FRI0456 EARLY IMPLEMENTATION OF TREATMENT WITH ETANERCEPT INCREASES THE LIKELIHOOD TO ACHIEVE REMISSION

Background:

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic disease in children and adolescents. A consistent therapy is required to avoid consequential damage and permanent loss of function. Biologic disease modifying anti-rheumatic drugs (bDMARDs) provide a well-accepted option for treatment of patients with a severe course of JIA. Etanercept (ETA) is still the most commonly prescribed bDMARD for JIA in Germany.

Objectives:

To analyze adherence to treatment with ETA with special attention on discontinuation after achieving an inactive disease and recurrence of active disease after ETA withdrawal.

Methods:

Data from two ongoing prospective, multicenter, non-interventional registries BiKeR and JuMBO were used for the analysis. JuMBO is the follow-up study to BiKeR and follows patients who have reached the age of 18. Both registers provide treatment data, individual trajectories of clinical data and outcomes from childhood into adulthood in JIA patients treated with bDMARDs and csDMARDs. Clinical disease characteristics, such as disease activity, were reported by the rheumatologists in addition to patient-reported outcomes at each six-months follow-up. Remission was defined as inactive disease defined by the Wallace Criteria (1).

Results:

Data from 2,500 patients who were included in BiKeR and had an age ≥18 at the time of analysis were considered. A subset of 1,535 were enrolled in JuMBO. The mean follow-up was 8.6 (SD 4.2) years for the JuMBO patients. The majority of them had polyarthritis (35%), followed by enthesitis-related arthritis (20%). A total of 1,779 (68.8% of 2,584) patients were ever treated with ETA, providing 2,178 ETA treatment courses. There were 1,724 (67%) patients with first, 338 patients with a second and 54 with a third course of ETA treatment course. 710 (41.2%) discontinued ETA by ineffectiveness in the first course with similar rates of discontinuation due to ineffectiveness in the first and second course. A total of 332 (+/-MTX, 19.3%) discontinued ETA after achieving remission in the first ETA course. Among those, 129 (38.9%) patients did not require treatment with any other bDMARD subsequently until last follow-up (3.9 years, SD 3.5), while 169 (50.9%) re-started treatment with ETA, 14 (4.2%) with adalimumab and 4 with other bDMARDs. The likelihood of discontinuing ETA due to an inactive disease was positively associated with a younger age (hazard ratio (HR) 1.08, p<0.001), persistent oligoarthritis (HR 1.89, p=0.004), a shorter duration between JIA onset and ETA start (HR 1.10, p<0.001) as well as a good response to therapy within the first six months of treatment (HR 1.11, p<0.001). 209 (of 332) had ETA monotherapy at withdrawal. Of those, 77% (n=161) experienced recurrence of disease with a mean time to flare of 12.1 (SD 13.7) months. 129 patients restarted bDMARD therapy (n=117 ETA). We could not identify any correlates for the risk of flare. 70% re-achieved remission and 20% again discontinued therapy thereafter.

Conclusion:

The study confirms the good effectiveness of ETA, even in the re-treatment of patients with JIA. Our data highlight the association of an early bDMARD treatment with a higher likelihood to achieve an inactive disease indicating a window of opportunity.

References:

[1]Wallace CA, Giannini EH, Huang B et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res 2011;63:929–36

Disclosure of Interests:

Jens Klotsche: None declared, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Peter Haas: None declared, Ivan Foeldvari Consultant of: Novartis, Martina Niewerth: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche

THU0500 PHYSICAL ACTIVITY AND SCREEN-BASED MEDIA USE IN ADOLESCENTS WITH JUVENILE IDIOPATHIC ARTHRITIS - DATA FROM A GERMAN INCEPTION COHORT

Background:

Insufficient physical activity (PA) and screen-based media use (SBM) are different aspects of sedentary behavior (SB), independently and inversely related to health and wellbeing. Recent research indicates that adolescents with chronic conditions are at least as likely at risk of being physically inactive or accumulating high levels of screen-based SB when compared with their healthy peers [1].

Objectives:

Since PA and SBM have not yet been (sufficiently) evaluated in young patients with juvenile idiopathic arthritis (JIA), our aim was to i) quantify the daily SBM use of adolescents with JIA, ii) measure the frequency of their weekly PA, and iii) compare both aspects of SB with those of age- and sex-matched controls from the general population during the course of the disease.

Methods:

Data from JIA patients and controls enrolled in the inception cohort study ICON were analyzed. Young people, such as friends and mates, served as the peer group. Patients and peers aged 13 and over were followed prospectively and questioned about their weekly PA frequency and SBM use at a two-year interval. Data from young people for whom at least two questionnaires were available were analyzed using linear mixed models.

Results:

Data from 209 patients with JIA (63% female, 28% rheumatoid factor negative polyarthritis) and 138 peers (55% female) were included in the analysis. At baseline (T1), 51% of the patients were treated with a DMARD, 58% at follow-up (T2). The proportion of adolescents being physically active at most twice a week was substantially higher in patients than in controls (T1: 59% vs. 43%; T2: 54% vs. 42%). In patients, the total daily screen time was 3.5±2.6 hours at T1 and 3.6±2.5h at T2, respectively. In comparison, a value about 0.5h less was found in the controls both at T1 and T2. Both groups increasingly spent time on mobile phones during the observation period. At T1 (66% vs. 45%) and T2 (60% vs. 45%), the proportion of physically inactive girls was significantly higher than that of boys. Conversely, boys reported higher levels of SBM than girls. Patients with high SBM consumption (>3h/day) showed a significantly lower PedsQLTM psychosocial functioning (OR 0.94; 95%CI: 0.89-0.99) and a significantly higher cJADAS-10 score (OR 1.34; 95%CI: 1.07-1.67) than those who did not exceed the national recommendations on SBM use.

Sedentary behaviorsBaseline2-year follow-upJIAN=209 (%)CGN=138 (%)JIAN=209 (%)CGN=138 (%)TV/videosAt most 2h/day85.489.086.293.4At least 3h/day14.611.013.76.6Computer/InternetAt most 2h/day76.983.172.174.6At least 3h/day23.016.927.825.4Gaming consolesAt most 2h/day93.598.592.596.2At least 3h/day6.51.57.53.8Total screen timeAt most 2h/day40.045.141.539.5At least 5h/day26.215.831.320.9Physical activity frequencyAt most 2 times/week58.943.454.442.3At least 3 times/week41.156.645.657.7

Conclusion:

Although adolescents with JIA tend to become more physically active during the course of disease, on average they remain more inactive and spend significantly more time on SBM than their peers. Given that high SBM use was associated with lower self-reported psychosocial quality of life and higher disease activity, it is important to develop sustainable and effective interventions to reduce sedentary behaviors in this population.

References:

[1]Elmesmari R et al. Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis. PLoS One 2017;12:e0179429.

Acknowledgments:

ICON is supported by a grant from the German Federal Ministry of Education and Research (FKZ 01 ER 1504A)

Disclosure of Interests: :

Florian Milatz: None declared, Ina Liedmann: None declared, Martina Niewerth: None declared, Jens Klotsche: None declared, Peter Haas: None declared, Frank Dressler: None declared, Rainer Berendes: None declared, Kirsten Moenkemoeller: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche

Evaluation of a complex integrated, cross-sectoral psycho-oncological care program (isPO): a mixed-methods study protocol

INTRODUCTION

International standards of care require the complete integration of psycho-oncological care into biomedical cancer treatment. The structured integrated, cross-sectoral psycho-oncological programme 'isPO' is aiming to ensure a provision of care in inpatient and outpatient settings according to a stepped-care approach. Up to now, psycho-oncological care is missing regulated and standardised processes to demonstrate the effectiveness. This study protocol describes the process and outcome evaluation that is conducted, along with the isPO study. The programme evaluation is aiming to proof effectiveness, explain potential discrepancies between expected and observed outcomes. Additionally, provide insight into the implementation process, as well as contextual factors that might promote or inhibit the dissemination and implementation of the stepped care programme will be gained. In addition to these measures, a cost-consequence analysis will provide further evidence aimed at integrating psycho-oncological care into primary healthcare.

METHODS AND ANALYSIS

The evaluation concept is based on a tripartite strategy consisting of a prospective, formative and summative evaluation. To capture all determinants, a concurrent mixed-method design is applied comprising qualitative (interviews and focus groups) and quantitative (standardised questionnaires) surveys of patients and healthcare providers. In addition, analysis of the psycho-oncological care data (isPO care data) and statutory health insurance claims data will be conducted. Primary and secondary data will complement one another (data linkage) to obtain a more comprehensive picture of the effectiveness and implementation of the complex intervention within the isPO study.

ETHICS AND DISSEMINATION

The study has been approved by the ethics committee of the Medical Faculty of the University of Cologne. For all collected data, the relevant national and European data protection regulations will be considered. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include annual reports as well as quality workshops for the organisations, the presentation of results in publications and on conferences, and public relations.

TRIAL REGISTRATION NUMBER

DRKS00015326; Pre-results.

Attenuation correction for confocal laser scanning microscopy and its application in chromatography

The applicability of confocal laser scanning microscopy is limited, e.g. by attenuation of the excitation and the fluorescence emission beam. As a prerequisite for further processing and analysis of the obtained microscopic images, a new method is presented for correcting this attenuation. The correction is based on beam modelling and on a differential form of the modified Beer-Lambert law. It turns out that the intensity decay can be modelled as a double convolution of the microscopic image with the intensities of the excitation semibeam and the emission beam. Under weak assumptions made for the intensities of the fluorescent radiation and the detected signal, formulas for the attenuation correction and the attenuation simulation are derived. The method traces back to that one published by Roerdink which is modified concerning a more realistic beam modelling, avoiding the so-called weak attenuation expansion and considering fluorescence excitation throughout the light cone of the excitation beam. The applicability of the method is demonstrated for synthetic examples as well as microscopic images of chromatographic beads. It is shown that the new method can be successfully applied for reconstructing the true fluorophore distribution in specimens even if the microscopic images are affected by strong attenuation. LAY DESCRIPTION: The applicability of confocal laser scanning microscopy is limited by attenuation of the excitation and the fluorescence emission beam. As a prerequisite for further processing and analysis of the obtained microscopic images, a new method is presented for correcting this attenuation. The correction is based on modeling the excitation as well as the emission beam and on a modified Beer-Lambert law for beam attenuation. The applicability of the method is demonstrated for synthetic examples as well as microscopic images of chromatographic beads. It is shown that the new method can be successfully applied for reconstructing the true fluorophore distribution in specimens even if the microscopic images are affected by strong attenuation.

Effectiveness of whole grain consumption in the prevention of colorectal cancer: meta-analysis of cohort studies

The present work aimed to evaluate the effectiveness of whole grain consumption in preventing colorectal cancer. A systematic review with meta-analysis of 11 cohort studies was carried out. The age group of the population studied (1,719,590 participants) was between 25 and 76 years of age. The review evaluated the relative risks with the Cox proportional hazard model. The period of study varied from 6 to 16 years, where 7,745 persons developed colorectal cancer during the follow-up period. In the multivariate analysis, the highest quintile relative risk was 0.94 (95% confidence interval, 0.85-1.03), whereas that for the lowest quintile was 0.96 (95% confidence interval, 0.88-1.04). The location of tumors was also evaluated, with tumors in the colon demonstrating a relative risk of 0.93 (95% confidence interval, 0.83-1.02) and tumors in the recto a relative risk equal to 0.89 (95% confidence interval, 0.79-1.00). In this multivariate analysis, consumption of whole grains was inversely associated with the risk of developing colorectal cancer.

A century of leishmaniasis in Alpes-Maritimes, France

A century of publications on leishmaniasis in Alpes-Maritimes, in southern France, is here reviewed. Autochtonous human and canine leishmaniasis were first recognised in this département, which lies by the Mediterranean Sea and near the Italian border, in 1918 and 1925, respectively. The parasite responsible for the leishmaniasis, Leishmania infantum, is transmitted by Phlebotomus perniciosus and P. ariasi. The human leishmaniasis is zoonotic, with domestic dogs acting as the main 'reservoir' hosts. In prospective surveys over the last two decades, a mean of 12% of the domestic dogs checked in Alpes-Maritimes have been found seropositive for L. infantum but only about 50% of the seropositive animals showed any clinical signs of infection at the time of the surveys. During the last 30 years, 178 cases of human visceral leishmaniasis have been recorded in the area. Such cases are sporadic and often opportunistic, occurring predominantly in children (29% of the 178 cases) or HIV-positive subjects (31%). Recently, it has been demonstrated that, in Alpes-Maritimes, approximately 20% of those found seropositive in leishmanin skin tests are asymptomatic carriers, with amastigotes in their peripheral blood.

Determination of Alcohol Ethoxylate Components in Sewage Sludge

An analytical method has been developed for the determination of alcohol ethoxylate (AE) components in sewage sludge. The method has been extensively ring tested in several industrial laboratories and concentrations in sludge samples from a number of EU countries have been obtained. The method is based on a methanol soxhlet extraction of centrifuged sludge, which is then cleaned up using an alumina column, followed by derivatisation with naphthoyl chloride and a further alumina column clean-up. The extract is analysed using high performance liquid chromatography (HPLC) with fluorescence detection. The method is capable of determining alcohol ethoxylate components in the range of C12–C18 alkyl chain lengths with an ethoxylate chain of EO4 up to approximately EO20 in sludge samples. The detection limit is approximately 20–30 mg kg−1 of total AEs in dry weight of sludge. Using the method, sludges from several European Sewage Treatment Plants (STP) were analysed. The concentration of the AEs, which are primarily linear, in digestor inlet averaged 1164 mg kg−1 (550–2947 mg kg−1) and in outlet sludges the mean value obtained was 167 mg kg−1 (<22–468 mg kg−1). At those plants in which concentrations were monitored in both inlet and outlet sludges, removal of the AEs by anaerobic digestion at the STP averaged 82% (range 61–93%). The interlaboratory relative standard deviation of the procedure was around 40% for the digester sludges analysed. The method developed provides a more accurate estimate of the environmental level of AE components compared to existing colorimetric approaches, but the method will over-estimate the concentration of alcohol ethoxylates in sludges due to the non-specific nature of the detection. However, it is sufficiently robust and accurate to estimate alcohol ethoxylates in sludges and hence concentrations that could be applied to soil.

Dedicated vertical wind tunnel for the study of sedimentation of non-spherical particles

A dedicated 4-m-high vertical wind tunnel has been designed and constructed at the University of Geneva in collaboration with the Groupe de compétence en mécanique des fluides et procédés énergétiques. With its diverging test section, the tunnel is designed to study the aero-dynamical behavior of non-spherical particles with terminal velocities between 5 and 27 ms(-1). A particle tracking velocimetry (PTV) code is developed to calculate drag coefficient of particles in standard conditions based on the real projected area of the particles. Results of our wind tunnel and PTV code are validated by comparing drag coefficient of smooth spherical particles and cylindrical particles to existing literature. Experiments are repeatable with average relative standard deviation of 1.7%. Our preliminary experiments on the effect of particle to fluid density ratio on drag coefficient of cylindrical particles show that the drag coefficient of freely suspended particles in air is lower than those measured in water or in horizontal wind tunnels. It is found that increasing aspect ratio of cylindrical particles reduces their secondary motions and they tend to be suspended with their maximum area normal to the airflow. The use of the vertical wind tunnel in combination with the PTV code provides a reliable and precise instrument for measuring drag coefficient of freely moving particles of various shapes. Our ultimate goal is the study of sedimentation and aggregation of volcanic particles (density between 500 and 2700 kgm(-3)) but the wind tunnel can be used in a wide range of applications.

Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome

Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e.g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/'fatigue' of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and impairments in activities of daily living, Karnofsky Index below 80%, quality of life/'fatigue' of 50 or over, are likely to have poor outcomes.

Effects of perfusion and cyclic compression on in vitro tissue engineered meniscus implants

PURPOSE

The purpose of this study was to investigate the influence of continuous perfusion and mechanical stimulation on bone marrow stromal cells seeded on a collagen meniscus implant.

METHODS

Bone marrow aspirates from 6 donors were amplified in vitro. 10(6) human BMSC were distributed on a collagen meniscus implant. Scaffolds were cultured under static conditions (control) or placed into a bioreactor system where continuous perfusion (10 ml/min) or perfusion and mechanical stimulation (8 h of 10% cyclic compression at 0.5 Hz) were administered daily. After 24 h, 7 and 14 days, cell proliferation, synthesis of procollagen I and III peptide (PIP, PIIIP), histology, and the equilibrium modulus of the constructs were analyzed.

RESULTS

Proliferation demonstrated a significant increase over time in all groups (p < 0.001). PIP synthesis was found to increase from 0.1 ± 0.0 U/ml/g protein after 24 h to 2.0 ± 0.5 (perfusion), 3.8 ± 0.3 (mechanical stimulation), and 1.8 ± 0.2 U/ml/g protein (static control, lower than perfusion and mechanical stimulation, p < 0.05). These differences were also evident after 2 weeks (2.7 ± 0.3, 4.0 ± 0.6, and 1.8 ± 0.2 U/ml/g protein, p < 0.01); PIIIP synthesis was found to increase from 0.1 ± 0.0 U/ml/g protein after 24 h to 2.9 ± 0.7 (perfusion), 3.1 ± 0.9 (mechanical stimulation), and 1.6 ± 0.3 U/ml/g protein (controls) after 1 week and remained significantly elevated under the influence of perfusion and mechanical stimulation (p < 0.01) after 2 weeks. Mechanical stimulation increased the equilibrium modulus more than static culture and perfusion after 2 weeks (24.7 ± 7.6; 12.3 ± 3.7; 15.4 ± 2.6 kPa; p < 0.02).

CONCLUSION

Biomechanical stimulation and perfusion have impact on collagen scaffolds seeded with BMSCs. Cell proliferation can be enhanced using continuous perfusion and differentiation is fostered by mechanical stimulation.

Semantic enrichment of medical forms - semi-automated coding of ODM-elements via web services

Semantic interoperability is an unsolved problem which occurs while working with medical forms from different information systems or institutions. Standards like ODM or CDA assure structural homogenization but in order to compare elements from different data models it is necessary to use semantic concepts and codes on an item level of those structures. We developed and implemented a web-based tool which enables a domain expert to perform semi-automated coding of ODM-files. For each item it is possible to inquire web services which result in unique concept codes without leaving the context of the document. Although it was not feasible to perform a totally automated coding we have implemented a dialog based method to perform an efficient coding of all data elements in the context of the whole document. The proportion of codable items was comparable to results from previous studies.

Assessing the impact of a downscaled climate change simulation on the fish fauna in an Inner-Alpine River

This study assesses the impact of a changing climate on fish fauna by comparing the past mean state of fish assemblage to a possible future mean state. It is based on (1) local scale observations along an Inner-Alpine river called Mur, (2) an IPCC emission scenario (IS92a), implemented by atmosphere-ocean global circulation model (AOGCM) ECHAM4/OPYC3, and (3) a model-chain that links climate research to hydrobiology. The Mur River is still in a near-natural condition and water temperature in summer is the most important aquatic ecological constraint for fish distribution. The methodological strategy is (1) to use downscaled air temperature and precipitation scenarios for the first half of the twenty-first century, (2) to establish a model that simulates water temperature by means of air temperature and flow rate in order to generate water temperature scenarios, and (3) to evaluate the impact on fish communities using an ecological model that is driven by water temperature. This methodology links the response of fish fauna to an IPCC emission scenario and is to our knowledge an unprecedented approach. The downscaled IS92a scenarios show increased mean air temperatures during the whole year and increased precipitation totals during summer, but reduced totals for the rest of the annual cycle. These changes result in scenarios of increased water temperatures, an altered annual cycle of flow rate, and, in turn, a 70 m displacement in elevation of fish communities towards the river's head. This would enhance stress on species that rely on low water temperatures and coerce cyprinid species into advancing against retreating salmonids. Hyporhithral river sectors would turn into epipotamal sectors. Grayling (Thymallus thymallus) and Danube salmon (Hucho hucho), presently characteristic for the Mur River, would be superceded by other species. Native brown trout (Salmo trutta), already now under pressure of competition, may be at risk of losing its habitat in favour of invaders like the exotic rainbow trout (Oncorhynchus mykiss), which are better adapted to higher water temperatures. Projected changes in fish communities suggest an adverse influence on salmonid sport fishing and a loss in its high economic value.

Activating KIR genes are associated with CMV reactivation and survival after non-T-cell depleted HLA-identical sibling bone marrow transplantation for malignant disorders

Combinations of HLA and killer immunoglobulin-like receptors (KIR) may affect outcome in T-cell depleted haematopoietic stem cell transplantation (HSCT). The KIR gene family includes inhibitory (KIR2DL and 3DL) and activating receptors (KIR2DS). Ligands are HLA-C (KIR2D) and HLA-Bw4 (KIR3DL1) for inhibitory KIR and are still unknown for activating KIR. The impact of activating KIR genotypes from donor and recipient is poorly documented in HSCT outcome. Here, HLA and KIR genotypes were determined in 131 pairs from non-T-cell depleted HLA-identical sibling HSCT. No effect of 'missing KIR ligand' was detected on acute graft-versus-host disease (GVHD), relapse, survival or infections even in myeloid malignancies. However, additional activating KIR genes in the donor compared to the recipient's genotype or an identity between donor and recipient activating KIR genotypes was associated with a lower transplant-related mortality (TRM) (P=0.005) and in a multivariate analysis with a better survival (P=0.02, HR=0.28; P=0.013, HR=0.29) and a lower incidence of cytomegalovirus (CMV) reactivation (P=0.009, HR=0.36). These data highlight the impact of donor-activating KIR genes on TRM, overall survival and CMV reactivation in HLA-identical sibling HSCT.