Toward a Digital Triage Platform for the German Healthcare System

While Germany’s healthcare system seems to have abundant resources compared to other countries, it also has a very high level of utilization (OECD 2019). Due to a high degree of patient choice, a lack of coordination has frequently been diagnosed, in particular with respect to the rising use of emergency care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen 2018). This critique peaked in legislation trying to curb the use of emergency care by non-urgent patients. While the legislative process has not yet been finalized, a unified demand management system was implemented by the Associations of Statutory Health Insurance Physicians as of January 1, 2020. This comprised a telephone-triage system based on software supported decision making on the urgency of need and the appropriate level of care, and a telephone appointment service. The triage software named Strukturierte medizinische Ersteinschätzung in Deutschland (SmED) is based on a Swiss development which has been adapted for implementation in Germany. By way of a progress report, initial experiences with its implementation are being reported and options for further development are being explored. Early data suggests that 3 out of 4 patients are being directed to the ambulatory sector, while more than half of those require attention within 24 hours. To increase availability of the service and to address the increasing share of patients who begin their contact with the health system digitally, implementation of a self-triage version of the software is being prepared for 2020. While an evaluation of the software and its implementation is still underway, it is obvious that it will only foster effective demand management if patients and practices perceive this as a benefit.Im Vergleich zu anderen Ländern scheint das deutsche Gesundheitssystem zwar über reichliche Ressourcen zu verfügen, ist aber auch sehr stark ausgelastet (OECD 2019). Weil Patienten eine hohe Wahlmöglichkeit haben, verzeichnet sich häufig ein Mangel an Koordination, insbesondere im Hinblick auf die steigende Inanspruchnahme der Notfallversorgung (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen 2018). Diese Kritik gipfelte in einer Gesetzgebung, die versucht, die Inanspruchnahme der Notfallversorgung durch Patienten, die keine Notversorgung benötigen, einzuschränken. Obwohl das Gesetzgebungsverfahren noch nicht abgeschlossen ist, haben die Kassenärztlichen Vereinigungen zum 1. Januar 2020 ein einheitliches System zur Nachfragesteuerung eingeführt. Dies besteht aus einem telefonischen Termindienst sowie einem telefonischen Triage-System, das mithilfe einer Software die Entscheidungsfindung auf der Grundlage der Dringlichkeit und des angemessenen Niveaus der Versorgung unterstützt. Die Triage-Software mit dem Namen Strukturierte medizinische Ersteinschätzung in Deutschland (SmED) beruht auf einer Schweizer Entwicklung, die für eine Implementierung in Deutschland angepasst wurde. In einem Zwischenbericht wird über erste Erfahrungen bei der Umsetzung berichtet und Optionen für die weitere Entwicklung ausgelotet. Erste Daten deuten darauf hin, dass 3 von 4 Patienten in die ambulante Behandlung geleitet werden, wobei mehr als die Hälfte dieser Patienten innerhalb von 24 Stunden behandelt werden müssen. Im Jahr 2020 wird die Implementierung einer Selbsttriage-Version der Software vorbereitet, damit diese Dienstleistung öfters zur Verfügung steht und die steigende Anzahl von Patienten, deren Kontakt mit dem Gesundheitssystem digital beginnt, angesprochen wird. Obwohl die Bewertung und Implementierung der Software noch im vollen Gange sind, wird ein effektives Nachfragemanagement nur dann erreicht werden, wenn Patienten und Arztpraxen dies als Vorteil wahrnehmen

Visualization and Quantification of the Laser-Induced Art of TiO2 by Photoexcitation of Adsorbed Dyes

Dye-pretreated anatase TiO2 films, commonly used as photoanodes in dye sensitized solar cells (DSSC), were utilized as a model system to investigate the laser-induced anatase to rutile phase transformation (ART), using N719 dye, N749 dye, D149 dye, and MC540 dye as photo-sensitizers. The visible lasers (532 and 785 nm) used for Raman spectroscopy were able to transform pure anatase into rutile at the laser spot when excitation of the dye sensitizer caused an electron injection from the excited state of the dye molecule into the conduction band of the TiO2. The three dyes with carboxylic acid anchor groups (N719, N749 and D149 dyes) experienced ART upon dye excitation; diffuse reflectance infrared Fourier transform (DRIFTS) and Raman spectra validated that these dyes were chemisorbed to the semiconductor surface. The MC540 dye with a sulfonic acid anchor group did not experience ART and the DRIFTS and Raman spectra were inconclusive about the chemisorption of this dye to the TiO2. A TiO2 calibration curve and percent rutile contour plots developed for this project are able to quantify the amount of rutile created at the surface of the samples. These improved chemical images which map rutile concentration help to visualize how ART propagates from the center of the laser spot to the surroundings. Factors such as visible light absorption and anchor groups that covalently bind to the semiconductor play a key role in effective laser induced ART

Context Matters: Accounting for Item Features in the Assessment of Citizen Scientists’ Scientific Reasoning Skills

Citizen science (CS) projects engage citizens for research purposes and promote individual learning outcomes such as scientific reasoning (SR) skills. SR refers to participants’ skills to solve problems scientifically. However, the evaluation of CS projects’ effects on learning outcomes has suffered from a lack of assessment instruments and resources. Assessments of SR have most often been validated in the context of formal education. They do not contextualize items to be authentic or to represent a wide variety of disciplines and contexts in CS research. Here, we describe the development of an assessment instrument that can be flexibly adapted to different CS research contexts. Furthermore, we show that this assessment instrument, the SR questionnaire, provides valid conclusions about participants’ SR skills. We found that the deep-structure and surface features of the items in the SR questionnaire represent the thinking processes associated with SR to a substantial extent. We suggest that practitioners and researchers consider these item features in future adaptations of the SR questionnaire. This will most likely enable them to draw valid conclusions about participants’ SR skills and to gain a deeper understanding of participants’ SR skills in CS project evaluation

Emergence of qualia from brain activity or from an interaction of proto-consciousness with the brain: which one is the weirder? Available evidence and a research agenda

This contribution to the science of consciousness aims at comparing how two different theories can explain the emergence of different qualia experiences, meta-awareness, meta-cognition, the placebo effect, out-of-body experiences, cognitive therapy and meditation-induced brain changes, etc. The first theory postulates that qualia experiences derive from specific neural patterns, the second one, that qualia experiences derive from the interaction of a proto-consciousness with the brain\u2019s neural activity. From this comparison it will be possible to judge which one seems to better explain the different qualia experiences and to offer a more promising research agenda

Spirituality: The Legacy of Parapsychology

Spirituality is a topic of recent interest. Mindfulness, for example, a concept derived from the Buddhist tradition, has captivated the imagination of clinicians who package it in convenient intervention programs for patients. Spirituality and religion have been researched with reference to potential health benefi ts. Spirituality can be conceptualised as the alignment of the individual with the whole, experientially, motivationally and in action. For spirituality to unfold its true potential it is necessary to align this new movement with the mainstream of science, and vice versa. Hence, both a historical review, and a systematic attempt at integration is called for, which we are trying to give here. It is useful to go back to one of the roots: parapsychology. Parapsychology was founded as a counter movement to the rising materialist paradigm in the 19th century. Adopting the methods of the natural sciences, it tried to prove the direct infl uence of consciousness on matter. After 125 years this mission must be declared unaccomplished. Surveying the database of parapsychological research it is obvious that it will not convince sceptics: Although there are enough exceptional fi ndings, it has in general not been possible to reproduce them in replication experiments. Th is is, however, a characteristic signature of a category of eff ects which we call eff ects of generalised entanglement, predicted by a theoretical model analogous to quantum theory. Using this perspective, parapsychological eff ects can be understood, and the original aim of the founding fathers can be recovered, as well as a new, systematic understanding of spirituality be gained. Generalised entanglement is a formal and scientifi c way of explaining spirituality as alignment of an individual with a whole, which, according to the model, inevitably leads to non-local correlations

A synergy-based hand control is encoded in human motor cortical areas

How the human brain controls hand movements to carry out different tasks is still debated. The concept of synergy has been proposed to indicate functional modules that may simplify the control of hand postures by simultaneously recruiting sets of muscles and joints. However, whether and to what extent synergic hand postures are encoded as such at a cortical level remains unknown. Here, we combined kinematic, electromyography, and brain activity measures obtained by functional magnetic resonance imaging while subjects performed a variety of movements towards virtual objects. Hand postural information, encoded through kinematic synergies, were represented in cortical areas devoted to hand motor control and successfully discriminated individual grasping movements, significantly outperforming alternative somatotopic or muscle-based models. Importantly, hand postural synergies were predicted by neural activation patterns within primary motor cortex. These findings support a novel cortical organization for hand movement control and open potential applications for brain-computer interfaces and neuroprostheses

I’m fine with collecting data: Engagement profiles differ depending on scientific activities in an online community of a citizen science project

Digital technologies facilitate collaboration between citizens and scientists in citizen science (CS) projects. Besides the facilitation of data transmission and access, digital technologies promote novel formats for education in CS by including citizens in the process of collecting, analyzing, and discussing data. It is usually assumed that citizens profit more from CS the more they participate in the different steps of the scientific process. However, it has so far not been analyzed whether citizens actually engage in these steps. Therefore, we investigated citizens’ actual engagement in different scientific steps online (i.e., data collection and data analysis) in two field studies of a CS project. We then compared them with other CS projects. We analyzed behavioral engagement patterns of N = 273 participants with activity logs and cluster analyses. Opportunities to engage in different steps of the scientific process increased participants’ overall commitment compared to contributory CS projects. Yet, despite their increased commitment, participants’ engagement was only more active for data collection but not for data analysis. We discuss how participants’ perceived role as data collectors influenced their actual engagement in the scientific steps. To conclude, citizens may need support to change their role from data collectors to data inquirers

First report from the German COVID-19 autopsy registry

BACKGROUND: Autopsies are an important tool in medicine, dissecting disease pathophysiology and causes of death. In COVID-19, autopsies revealed e.g., the effects on pulmonary (micro)vasculature or the nervous system, systemic viral spread, or the interplay with the immune system. To facilitate multicentre autopsy-based studies and provide a central hub supporting autopsy centres, researchers, and data analyses and reporting, in April 2020 the German COVID-19 Autopsy Registry (DeRegCOVID) was launched. METHODS: The electronic registry uses a web-based electronic case report form. Participation is voluntary and biomaterial remains at the respective site (decentralized biobanking). As of October 2021, the registry included N=1129 autopsy cases, with 69271 single data points including information on 18674 available biospecimens gathered from 29 German sites. FINDINGS: In the N=1095 eligible records, the male-to-female ratio was 1·8:1, with peaks at 65-69 and 80-84 years in males and >85 years in females. The analysis of the chain of events directly leading to death revealed COVID-19 as the underlying cause of death in 86% of the autopsy cases, whereas in 14% COVID-19 was a concomitant disease. The most common immediate cause of death was diffuse alveolar damage, followed by multi-organ failure. The registry supports several scientific projects, public outreach and provides reports to the federal health authorities, leading to legislative adaptation of the German Infection Protection Act, facilitating the performance of autopsies during pandemics. INTERPRETATION: A national autopsy registry can provide multicentre quantitative information on COVID-19 deaths on a national level, supporting medical research, political decision-making and public discussion. FUNDING: German Federal Ministries of Education and Research and Health. Hintergrund: Obduktionen sind ein wichtiges Instrument in der Medizin, um die Pathophysiologie von Krankheiten und Todesursachen zu untersuchen. Im Rahmen von COVID-19 wurden durch Obduktionen z.B. die Auswirkungen auf die pulmonale Mikrovaskulatur, das Nervensystem, die systemische Virusausbreitung, und das Zusammenspiel mit dem Immunsystem untersucht. Um multizentrische, auf Obduktionen basierende Studien zu erleichtern und eine zentrale Anlaufstelle zu schaffen, die Obduktionszentren, Forscher sowie Datenanalysen und -berichte unterstützt, wurde im April 2020 das deutsche COVID-19-Autopsieregister (DeRegCOVID) ins Leben gerufen. Methoden: Das elektronische Register verwendet ein webbasiertes elektronisches Fallberichtsformular. Die Teilnahme ist freiwillig und das Biomaterial verbleibt am jeweiligen Standort (dezentrales Biobanking). Im Oktober 2021 umfasste das Register N=1129 Obduktionsfälle mit 69271 einzelnen Datenpunkten, die Informationen über 18674 verfügbare Bioproben enthielten, die von 29 deutschen Standorten gesammelt wurden. Ergebnisse: In den N=1095 ausgewerteten Datensätzen betrug das Verhältnis von Männern zu Frauen 1,8:1 mit Spitzenwerten bei 65-69 und 80-84 Jahren bei Männern und >85 Jahren bei Frauen. Die Analyse der Sequenz der unmittelbar zum Tod führenden Ereignisse ergab, dass in 86 % der Obduktionsfälle COVID-19 die zugrunde liegende Todesursache war, während in 14 % der Fälle COVID-19 eine Begleiterkrankung war. Die häufigste unmittelbare Todesursache war der diffuse Alveolarschaden, gefolgt von Multiorganversagen. Das Register unterstützt mehrere wissenschaftliche Projekte, die Öffentlichkeitsarbeit und liefert Berichte an die Bundesgesundheitsbehörden, was zu einer Anpassung des deutschen Infektionsschutzgesetzes führte und die Durchführung von Obduktionen in Pandemien erleichtert. Interpretation: Ein nationales Obduktionsregister kann multizentrische quantitative Informationen über COVID-19-Todesfälle auf nationaler Ebene liefern und damit die medizinische Forschung, die politische Entscheidungsfindung und die öffentliche Diskussion unterstützen. Finanzierung: Bundesministerien für Bildung und Forschung und für Gesundheit