Towards an interoperable healthcare information infrastructure - working from the bottom up

Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers' needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry

Prevention of ulcer disease in goldfish by means of vaccination

A vaccine comprising cells of Aeromonas bestiarum grown in tryptic soy broth and atypical A. salmonicida cells produced in iron-limited and iron-supplemented media protected goldfish Carassius auratus when administered by immersion (dosage ≈ 5 × 107 cells/mL for 60 s) followed after 28 d by an oral booster (dosage = 5 × 107 cells/g of feed), which was fed for 7 d so that each fish received about 1 g of vaccine-containing feed. After challenge by intramuscular injection of a virulent culture of atypical A. salmonicida, the relative percent survival (RPS) was more than 90%. The approach was more successful than using a commercial furunculosis vaccine with or without supplementation with A. bestiarum or atypical A. salmonicida cells. Moreover, a smooth derivative of the virulent rough culture of atypical A. salmonicida was less effective as a vaccine candidate, yielding an RPS of only 65%. Low antibody titers of 1:39–1:396 were found in the vaccinated fish. The vaccinated fish had a significantly higher proportion of dead head kidney macrophages (10.9 ± 3.5%; P = 0.0149) than did the controls (6.8 ± 3.1%). However, differences in the number of erythrocytes and leukocytes, the level of phagocytic and lysozyme activities, and the proportion of lymphocytes, monocytes, and polymorphonuclear cells were not statistically significant between the two groups

Copper(I) Chloride Carbonyl Polymers

Addition of bridging diamine ligands to methanolic solutions of CuCl under a CO purge produces the polymeric complexes [(CuCl)2(CO)2(biL)] (biL = diazabicyclo[2.2.2]octane (DABCO), piperazine (Pip), N,N‘-dimethylpiperazine (DMP)). X-ray crystal structures of the three complexes reveal rhombic OC−Cu(μ-Cl)2Cu−CO bridged by biL. Unsaturated bridging ligands fail to produce carbonyl-bearing products

Recent Extreme Ultraviolet Solar Spectra and Spectroheliograms

Extreme ultraviolet solar spectra and spectroheliogram analyse

The Effect of Laminar Flow on Rotor Hover Performance

The topic of laminar flow effects on hover performance is introduced with respect to some historical efforts where laminar flow was either measured or attempted. An analysis method is outlined using combined blade element, momentum method coupled to an airfoil analysis method, which includes the full e(sup N) transition model. The analysis results compared well with the measured hover performance including the measured location of transition on both the upper and lower blade surfaces. The analysis method is then used to understand the upper limits of hover efficiency as a function of disk loading. The impact of laminar flow is higher at low disk loading, but significant improvement in terms of power loading appears possible even up to high disk loading approaching 20 ps f. A optimum planform design equation is derived for cases of zero profile drag and finite drag levels. These results are intended to be a guide for design studies and as a benchmark to compare higher fidelity analysis results. The details of the analysis method are given to enable other researchers to use the same approach for comparison to other approaches

Absorption of Energy at a Metallic Surface due to a Normal Electric Field

The effect of an oscillating electric field normal to a metallic surface may be described by an effective potential. This induced potential is calculated using semiclassical variants of the random phase approximation (RPA). Results are obtained for both ballistic and diffusive electron motion, and for two and three dimensional systems. The potential induced within the surface causes absorption of energy. The results are applied to the absorption of radiation by small metal spheres and discs. They improve upon an earlier treatment which used the Thomas-Fermi approximation for the effective potential.Comment: 19 pages (Plain TeX), 2 figures, 1 table (Postscript

Towards practical classical processing for the surface code

The surface code is unarguably the leading quantum error correction code for 2-D nearest neighbor architectures, featuring a high threshold error rate of approximately 1%, low overhead implementations of the entire Clifford group, and flexible, arbitrarily long-range logical gates. These highly desirable features come at the cost of significant classical processing complexity. We show how to perform the processing associated with an nxn lattice of qubits, each being manipulated in a realistic, fault-tolerant manner, in O(n^2) average time per round of error correction. We also describe how to parallelize the algorithm to achieve O(1) average processing per round, using only constant computing resources per unit area and local communication. Both of these complexities are optimal.Comment: 5 pages, 6 figures, published version with some additional tex