The 4emedicine: Emergency, Environmental, Electronics and Extreme medicine. Overview of the available and on‐going related controlled trials with a survey on the overlap areas and on the use of bioinformatics
Authors: Trovato Guglielmo 
Published: April 2020

4eMedicine refers to the current digital revolution in medicine facing harmful scenarios for individuals’ and community health. Priorities of general concern are Emergency, Extreme and Environmental medicine issues, needing careful digital risk analysis and management. Limited information deriving by controlled clinical investigations and by bioinformatics approaches to big‐data management are available.4e Electronic, Emergency, Extreme and Environmental medicine (Figure
) shares the objective of a more effective, sustainable and comprehensive approach to practice, innovation and research in many health domains. Actually, extreme medicine shares with emergency and environment medicine challenges on Earth and beyond Earth, to health and well‐being (hot, cool, sun and ice exposure, starvation, sea, deserts and mountains, different gravity, endurance and extreme sports, war and catastrophic scenarios). In many subsets, with advanced or limited resources and facilities, the study of extreme physiology and psychology, also by models, is still a neglected or concealed component of medical research and best practice evidences. Challenges to human body and mind in extreme situations were, are and will be sources of information on unsuspected coping, reactions and solutions.The aim is to display a research profile of this multidisciplinary approach using the 321,599 research studies recorded at October 2019 in the ClinicalTrials.gov, detailing the areas of overlap by five main keywords: Electronics, Environment, Extreme, Emergency, Bioinformatics (Table
1). Also Pubmed was searched concurrently (Table
2).Results256 Pubmed articles claim the use of bioinformatics approaches in areas of binary overlap of the 4eMedicine components. Nonetheless, completed or ongoing investigations in ClinicalTrials.gov are fewer, only 91.ConclusionEmergency Medicine and complementary, but equally relevant Extreme Medicine, are the fields of experience and of the challenges to understanding mechanisms of disease and survival in different environments. New answers may still derive from ongoing or future comprehensive clinical practice and investigations, better if conducted by clinical trials and bioinformatics tools: this is needed for managing numerous and different data. Such awareness warrants greater cross‐disciplinary working and a quest for more supportive management of big data‐bases. Enhancing research, increasing literacy, competences and skills in research methods and bioinformatics, promoting international harmonization of emergency service facilities, also by reliable and sustainable e‐learning courses, are realistic goals and ongoing actions.Support or Funding InformationThis abstract is also an information tool of the EU iProcure Security Project,
https://project.iprocuresecurity.eu/, Strategic Partnership of Emergency Medical Service, and of the BioS Project
https://bios‐project.eu/site/. The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflect the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.The Four Pillars of 21st Century 4eMedicine, within the current digital revolution, are Electronic, Emergency, Extreme and Enviromental Medicine. All should be managed by appropriate scientific approaches which include accurate and reliable project planning and bioinformatics.Figure 1
Absolute number of completed and on‐going investigations in ClinicalTiials.gov

Overlapping

Electronics

Environment

Emergency

Extreme

Bioinformatics

Electronics

–

30

67

24

13

Environment

30

–

26

29

15

Emergency

67

26

‐‐

82

50

Extreme

24

29

82

‐‐

13

Bioinformatics

13

15

50

13

‐‐
Absolute number of published investigations in PUBMED

Overlapping
Research Trials

Electronics

Environment

Emergency

Extreme

Bioinformatics & computational

Electronics

–

18

4

17

Environment

108

‐‐

1806

159

263

Emergency

18

1806

‐‐

58

50

Extreme

4

159

58

‐‐

26

Bioinformatics & computational

17

263

50

26

‐‐

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world, here detailing the areas of overlap of five general fields of medical and scientific work: Electronics, Environment, Extreme, Emergency, Bioinformatics (Table
1). Pubmed database was searched concurrently for finding by the same criteria areas of overlap of the same issues (Table
2).