区域医疗信息平台

为进一步提高医疗卫生资源利用率,提升医疗服务质量,降低医疗成本和风险,构建完善合理分级诊疗模式,需要以医疗服务机构为主体,以医疗资源和信息共享为目标,集成共性技术及医疗服务关键技术,建立区域医疗信息平台,实现区域医疗信息、资源、服务共享协同．针对区域医疗信息共享与协同服务需求,提出了平台的总体架构,并对患者主索引、跨区域文档共享、临床文档构建、术语服务、数据采集和传输、院内前置服务和文档存储等关键问题提出了解决方案．     

New Media and the ‘Anchor Baby’ Boom

The term ‘anchor baby’ refers to children born in the U.S. to undocumented migrant parents who are thought to have been conceived in order to improve their parents' chances of attaining citizenship. Though the term is considered racist and dehumanizing by many, it has recently entered into common usage. This study investigates the process by which this has occurred. We test hypotheses derived from theories of mass and new media using multiple data sources and methods of analysis, and find that the main sources of the anchor baby boom are partisan news websites. The findings suggest that new media may be influencing mass media by creating unique and unprecedented opportunities for medium‐sized partisan news organizations.     

Ageing and Care Giving in the United States: Policy Contexts and the Immigrant Workforce

The ageing population of the United States is generating an increasing demand for care and foreign-born workers will supply an important part of that demand. This article discusses the ways in which U.S. healthcare and immigration policies affect the supply of the foreign born to professional and lesser skilled, direct care jobs. The U.S. market for long term care is shifting away from hospitals and institutionalised facilities to the direct provision of private services and long term care in homes. A well designed immigration policy would complement the demand generated by the healthcare system. Yet, there are few dedicated avenues of legal admission that select for professional care workers and none at all that target direct care workers. There is concern over shortages of professional workers and a substantial number of unauthorized workers in direct care work that flag deficiencies in immigration policies. Our examination of data, nevertheless, finds that the foreign born play an important role in the supply of workers. In the provision of direct care they are roughly one-quarter of the workforce that provides 80% of all long term care. Among professional care workers they are highly concentrated in the home care industry. These national-level concentrations, however, do not fully reveal the remarkable concentration of immigrants in just a few metropolitan areas.     

Inside Cyber Warfare,Mapping the Cyber Underworld,by Carr,Jeffrey

ABSTRACT

We're all aware of the external threats that face organizations today, but have we properly considered the internal threats? Given the string of high profile data breaches in the healthcare industry, specifically clinician's unauthorized access to celebrities' medical information, healthcare facilities of all types are taking a serious look at their security. This article talks about the current state of the market and the tools available to help implement stronger security policy to remedy these embarrassing situations. With the use of strong authentication, coupled with single sign-on, hospitals can make sure that every “front door” in the hospital is as secure as possible.     

Reflections on the Nature of Multi-Agent Coordination and Its Implications for an Agent Architecture

The development of enabling infrastructure for the next generation of multi-agent systems consisting of large numbers of agents and operating in open environments is one of the key challenges for the multi-agent community.Current infrastructure support does not materially assist in the development of sophisticated agent coordination strategies. It is the need for and the development of such a high-level support structure that will be the focus of this paper. A domain-independent (generic) agent architecture is proposed that wraps around an agent's problem-solving component in order to make problem solving responsive to real-time constraints, available network resources, and the need to coordinate—both in the large and small—with problem-solving activities of other agents. This architecture contains five components, local agent scheduling, multi-agent coordination, organizational design, detection and diagnosis, and on-line learning, that are designed to interact so that a range of different situation-specific coordination strategies can be implemented and adapted as the situation evolves. The presentation of this architecture is followed by a more detailed discussion on the interaction among these components and the research questions that need to be answered to understand the appropriateness of this architecture for the next generation of multi-agent systems.     

三网融合环境区域云数字图书馆构建研究

为了使区域云数字图书馆尽快适应三网融合的环境,增加服务的渠道,一定程度上打破时空限制,扩大读者群,为用户带来海量、多样化的信息资源,对三网融合环境区域云数字图书馆的构建进行了研究。首先介绍了区域云数字图书馆的定义和研究现状、三网融合的定义和特征;然后指出三网融合环境下区域云数字图书馆的内涵和应用模式;最后重点阐述一种适用于三网融合环境的区域云数字图书馆的体系结构,并对构建所使用的关键技术进行了分析和探索。     

A new approach for component’s port modeling in software architecture

The component’s interaction points with the external world play a fundamental role in the specification of an application’s architecture. Current software architecture approaches consider an interaction point as an atomic element in the specification of interconnections, despite the complexity of its structure and the attached behavior. It is not possible in current component models to deal separately with an element of an interaction point when such an element is needed alone for specifying a specific logic. To support such logic and the specification of a wide range of early ideas in the process of elaborating a software system, the Integrated Approach to Software Architecture (IASA) uses an interaction point model which provides facilities to manipulate any structural or behavioral element defining an interaction point. In addition, such facilities represent the fundamental foundation of the native support by IASA of Aspect Oriented Software Architectures (AOSA) specifications.     

Architectural requirements for rapid development of agile manufacturing systems

As product life cycle becomes shortened, high product quality becomes necessary for survival, and continuous and unexpected change becomes key obstacles in success, the need for a method of rapidly and cost-effectively developing products, production facilities and supporting software including design, process planning, shop floor control systems becomes urgent. The essence of this concept of manufacturing would be characterized by adopting a new term “agility”. Agile manufacturing can be successfully accomplished using various well-defined system architecture. This paper provides a primary sketch of architectural requirements for rapid development of agile manufacturing systems.There are several aspects of system architecture : control, function, process, information, communication, distribution, development, and implementation.In the past, the confusion of those architectures prohibited the successful construction of the automated CIM systems.     

Extending Design Environments to Software Architecture Design

Designing a complex software system is a cognitively challenging task; thus, designers need cognitive support to create good designs. Domain-oriented design environments are cooperative problem-solving systems that support designers in complex design tasks. In this paper we present the architecture and facilities of Argo, a domain-oriented design environment for software architecture. Argo's own architecture is motivated by the desire to achieve reuse and extensibility of the design environment. It separates domain-neutral code from domain-oriented code, which is distributed among active design materials as opposed to being centralized in the design environment. Argo's facilities are motivated by the observed cognitive needs of designers. These facilities extend previous work in design environments by enhancing support for reflection-in-action, and adding new support for opportunistic design and comprehension and problem solving.     

Audibility and identification of auditory alarms in the operating room and intensive care unit

Abstract

The audibility and the identification of 23 auditory alarms in the intensive care unit (ICU) and 26 auditory alarms in the operating rooms (ORs) of a 214-bed Canadian teaching hospital were investigated. Digital tape recordings of the alarms were made and analysed using masked-threshold software developed at the Université de Montréal. The digital recordings were also presented to the hospital personnel responsible for monitoring these alarms on an individual basis in order to determine how many of the alarms they would be able to identify when they heard them. Several of the alarms in both areas of the hospital could mask other alarms in the same area, and many of the alarms in the operating rooms could be masked by the sound of a surgical saw or a surgical drill. The staff in the OR (anaesthetists, anaesthesia residents, and OR technologists) were able to identify a mean of between 10 and 15 of the 26 alarms found in their operating theatres. The ICU nurses were able to identify a mean of between 9 and 14 of the 23 alarms found in their ICU. Alarm importance was positively correlated with the frequency of alarm identification in the case of the OR, rho=0·411, but was not significantly correlated in the case of the ICU, rho=0·155. This study demonstrates the poor design of auditory warning signals in hospitals and the need for standardization of alarms on medical equipment.     

A decision system using fuzzy cognitive map and multi-group data envelopment analysis to estimate hospitals’ outputs level

Due to its vital role in healthcare system, performance evaluation of hospitals is indispensable. In addition, hospitals try to achieve desired and efficient conditions by careful planning based on their present facilities. Several studies have been conducted on hospital evaluation, but nearly none of them has taken into consideration the difference in the nature of performance in respect of hospitals’ managerial construction, funding, and type of services provided by them. Furthermore, hospitals’ outputs have not been estimated in respect of cause and effect relationships between inputs and outputs for achieving efficient conditions. In the present study, first, a new approach for hospital evaluation is presented according to the differences in the nature of their performances while categorized in groups. Then, optimal outputs for each hospital in its own group are dealt with using results obtained from multi-group data envelopment analysis and the method of fuzzy cognitive map. The activation Hebbian learning (AHL) algorithm is adapted to the concept of efficiency and is conducted to estimate the outputs of inefficient hospitals. In the present study, 27 hospitals located in the provincial capitals in northwest of Iran are categorized in four groups including general governmental hospitals, specialty governmental hospitals, private hospitals, and social security hospitals. Afterward, optimal outputs are estimated for the inefficient hospitals by using the proposed modified AHL algorithm. The results indicate that when the hospitals have been evaluated in groups, efficiency scores of hospitals have changed. Also, given the cause and effect relationships between inputs and outputs in each group can help to decision and policy makers to estimate the optimal outputs that have caused inefficient hospitals become efficient.

     

Next Generation GRIDs for environmental science

GRIDs technology has developed from first generation, supplier-specific and configuration-specific systems through second generation systems providing metacomputing facilities over various underlying platforms. The 2.5 generation added facilities for fast data transfer (GRIDFTP) and directories (LDAP). The third generation embraced from the W3C (World Wide Web Consortium) community the idea of services, leading to OGSA (Open Grid Services Architecture). Under GGF (Global Grid Forum) auspices, a team from UK has developed OGSA/DAI (data access interface) which starts to make 3G GRIDs usable. However, others consider the existing architecture unsuitable for widespread acceptance beyond the metacomputing/supercomputing community. A small group of ERCIM experts was invited to give keynote presentations at an EC-sponsored workshop in January 2003 which had well over 200 participants. This led to a call from the community for documentation of NGG (Next Generation GRIDs). The three experts with the EC pulled together a team of 14 (including three more from ERCIM) which produced the ‘NGG Report’ in June 2003; the report is provided as an adjunct document to FP6 Calls for proposals. The key point is that the proposed NGG architecture is more suitable for environmental applications than the conventional 3G GRID. The characteristics and implications are discussed.     

对象技术在分布式系统中的作用

对象管理集团公司（ＯｂｊｅｃｔＭａｎａｇｍｅｎｔＧｒｏｕｐ－ＯＭＧ）是一个致力于解决分布式环境中互操作问题的非盈利性协作组织，它遵循一个新的技术途径，即对象技术，产生了公认的基于可商用对象技术的事实标准。它的一套面向对象的标准化语言、接口和协议的基础是一种称作通用对象请求代理结构（ＣｏｍｍｏｎＯｂｊｅｃｔＲｅｑｕｅｓｔＢｒｏｋｅｒＡｒｃｈｉ－ｔｅｃｔｕｒｅ—ＣＯＲＢＡ）的通信约定。ＣＯＲＢＡ在具有不同的操作系统、语言、网络协议和硬件结构的系统间提供了应用层的互操作性。ＯＭＧ未来的计划是运用这些有力的服务和功能支持应用程序员的设计开发。     

Microcomputer-aided studies of cry jitter uttered by newborn children based upon high-resolution analysis of fundamental frequencies

The metrological and computational problems of detecting very weak variations in the frequencies of the fundamental tone are discussed from a signal processing point of view. An appropriate computer method of high-resolution analysis of the fundamental frequency is proposed. When applying high-resolution fundamental frequency analysis to cry signals, a jitter was found to exist in the fundamental frequency curve of both healthy babies and those suffering from cerebral disorders. A method is given to separate the jitter from the fundamental frequency curve. The separated jitter curve depends on the degree of slope of the fundamental frequency curve and shows differences between healthy and ill babies. For an objective evaluation of the jitter abnormities, an integral parameter--the so-called cry-jitter index--is proposed.     

基于“军卫一号”的病员就诊排队管理系统

该文从硬件、软件接口及功能上阐述了在军卫一号架构上实现病员就诊排队管理的系统,其目标是面向和服务医院的一线门诊工作,改善就医流程和净化医院工作环境,提高医院信息化管理水平。     

Scheduling operating rooms: achievements,challenges and pitfalls

In hospitals, the operating room (OR) is a particularly expensive facility and thus efficient scheduling is imperative. This can be greatly supported by using advanced methods that are discussed in the academic literature. In order to help researchers and practitioners to select new relevant articles, we classify the recent OR planning and scheduling literature into tables regarding patient type, used performance measures, decisions made, OR up- and downstream facilities, uncertainty, research methodology and testing phase. Based on these classifications, we identify trends and promising topics. Additionally, we recognize three common pitfalls that hamper the adoption of research results by stakeholders: the lack of a clear choice of authors on whether to target researchers (contributing advanced methods) or practitioners (providing managerial insights), the use of ill-fitted performance measures in models and the failure to understandably report on the hospital setting and method-related assumptions. We provide specific guidelines that help to avoid these pitfalls. First, we show how to build up an article based on the choice of the target group (i.e., researchers or practitioners). Making a clear distinction between target groups impacts the problem setting, the research task, the reported findings, and the conclusions. Second, we discuss points that need to be considered by researchers when deciding on the used performance measures. Third, we list the assumptions that need to be included in articles in order to enable readers to decide whether the presented research is relevant to them.     

医院网络管理技术和经验谈

随着信息技术的飞速发展和网络规模的不断扩大,计算机网络渗透到社会各个领域,医院信息系统是现代化医院建设中不可缺少的基础设施和支撑环境。只有保护医院的计算机数据以及网络系统的正常运行,才能使医院的正常医疗活动等得以持续不断地开展。本文在简单介绍医院网络管理技术的基础上阐述了笔者在医院网络管理的工作中遇到的一些问题及其处理方法和经验。     

Current Status of Ambulatory Health Care Computer Applications

Much of the present consumer concern with American health care starts with the discrepancy most people experience between the office visit to a doctor and the focus of most medical research and its results. Medical progress has affected public health and the acutely ill or disabled, but has had comparatively minor impact on the average doctor-patient encounter outside the hospital, university medical center, or other specialized setting. In 1970, 72% of the population consulted a physician at least once, but only 10.3% reported one or more hospital episodes; American Hospital Association statistics showed community hospitals averaging 4.6 outpatient visit every one inpatient admission.1     

A field trial using Artificial Neural Networks to predict psychiatric in-patient Length-of-stay

Demands for health care reform will increase service utilization, much of which will fall on a system of expanded primary care providers, many of whom will not be specialists in psychiatry. These providers will need tools to augment their decision-making process. In this paper, we explore the use of Artificial Neural Networks (ANNs) in three different field sites to predict inpatient psychiatric Length-Of-Stay (LOS). This study describes the development and implementation of a runtime system in three different psychiatric facilities. Data was collected at these respective sites using the runtime system, and then this data was used to retrain the networks to determine if site-specific data would improve accuracy of prediction of LOS. The results indicate that ANNs trained with state hospital data could accurately predict LOS in two different community hospital psychiatric units. When the respective ANNs were retrained with approximately 10% new data from these specific hospitals, rates of improvement ranged from 3% to 15%. Our findings demonstrate that an ANN can adapt to different treatment settings and, when retrained, significantly improve prediction of LOS. Prediction rates by the ANN after retraining are comparable to results of a clinical team.