Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Background The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies. Methods Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated. Results Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily. Conclusion Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue

Names, addresses and identities in ambient networks

Ambient Networks interconnect independent realms that may use different local network technologies and may belong to different administrative or legal entities. At the core of these advanced internetworking concepts is a flexible naming architecture based on dynamic indirections between names, addresses and identities. This paper gives an overview of the connectivity abstractions of Ambient Networks and then describes its naming architecture in detail, comparing and contrasting them to other related next-generation network architectures

The effects of inorganic nitrogen and phosphorus enrichment on herbaceous species growth of the Kimages Creek wetland (VA)

Dissolved inorganic nitrogen (DIN) and dissolved inorganic phosphorus (DIP) infiltrate waterways through fertilizer application, urban stormwater runoff, and sewer infrastructure leaks. As surrounding waterbodies experience increased DIN and DIP inputs, wetlands can experience corresponding nutrient enrichment. Vegetation uses DIN and DIP for structural growth, color, and seed production. Changes in DIN and DIP availability can influence species distribution due to differences in photosynthetic rates, root morphology and structure, and tissue type. DIP and DIN inputs are projected to increase 15-30% and 30-60% in the next fifty years¹. It is of interest to examine plant growth characteristics within this nutrient enrichment projection as well as nutrient enrichment from a potential 100-year projection to analyze future species composition responses within a freshwater tidal marsh

Soil inorganic N leaching in edges of different forest types subject to high N deposition loads

We report on soil leaching of dissolved inorganic nitrogen (DIN) along transects across exposed edges of four coniferous and four deciduous forest stands. In a 64-m edge zone, DIN leaching below the main rooting zone was enhanced relative to the interior (at 128 m from the edge) by 21 and 14 kg N ha-1 y-1 in the coniferous and deciduous forest stands, respectively. However, the patterns of DIN leaching did not univocally reflect those of DIN throughfall deposition. DIN leaching in the first 20 m of the edges was lower than at 32–64 m from the edge (17 vs. 36 kg N ha-1 y-1 and 15 vs. 24 kg N ha-1 y-1 in the coniferous and deciduous forests, respectively). Nitrogen stocks in the mineral topsoil (0–30 cm) were, on average, 943 kg N ha-1 higher at the outer edges than in the interior, indicating that N retention in the soil is probably one of the processes involved in the relatively low DIN leaching in the outer edges. We suggest that a complex of edge effects on biogeochemical processes occurs at the forest edges as a result of the interaction between microclimate, tree dynamics (growth and litterfall), and atmospheric deposition of N and base cations

A dynamic modelling of safety nets

The nonlinear dynamic modelling of safety net systems is approached at different scales. For this purpose, the fundamental rope dynamic tests are the reference for two basic tools. One hand an anaytical bidimensional model with explicit geometrical nonlinearity and bilnear material law is proposed for preliminary design. On the other hand, a nonlinear explicit finite element is defined for numerical modelling of net systems. Semi-scale and full scale dynamic tests are performed to validate complete finite element models, suitable for global qualification of safety systems. The direct applications of these tools deal with explicit certification of safety systems for high-speed sport, such as downhill competitions

Applying formal methods to standard development: the open distributed processing experience

Since their introduction, formal methods have been applied in various ways to different standards. This paper gives an account of these applications, focusing on one application in particular: the development of a framework for creating standards for Open Distributed Processing (ODP). Following an introduction to ODP, the paper gives an insight into the current work on formalising the architecture of the Reference Model of ODP (RM-ODP), highlighting the advantages to be gained. The different approaches currently being taken are shown, together with their associated advantages and disadvantages. The paper concludes that there is no one all-purpose approach which can be used in preference to all others, but that a combination of approaches is desirable to best fulfil the potential of formal methods in developing an architectural semantics for OD

On the shock transition, the hydraulic jump, and vortex breakdown

The normal shock, hydraulic jump, and vortex breakdown have a common feature: they are all marked by a transition from a supercritical to a subcritical flow state. These phenomena are due to the nonlinearity of the flow, and it will be shown that viscosity also plays an essential role. This paper demonstrates explicitly how viscosity enters into these flows, The treatment of normal shock served a starting illustration. Then an equation governing the phenomenon of hydraulic jump is derived with the inclusion of the effect of viscosity. It is explicitly shown that supercritical flow is not stable and has to go through a transition to a conjugate subcritical flow state downstream. Similar treatment is also applied to vortex breakdown with largely similar results