EMR适于数据挖掘构建临床路径的数据特征分析

通过深入剖析卫生部下发的相关临床路径及《电子病历基本架构与数据标准》相关内容,文章从数据特征视角入手,探讨了电子病历适于数据挖掘方法构建临床路径的数据特征,从电子病历数据内容及数据结构两方面分析了基于电子病历的数据挖掘方法构建临床路径的可行性。     

Ab initio simulation of the effect of the potential of water on the electronic structure of arginine

As a part of the task of constructing the equivalent potential of water in order to obtain a reliable electronic structure for a protein, the equivalent potential of water for an arginine molecule was constructed by performing first-principles, all-electron, ab initio calculations. The process consisted of three steps. First, the electronic structure of arginine was calculated using a free cluster calculation. Then, the minimum-energy geometric structure of the system Arg⁺+9H₂O was found using free cluster calculations. Then, based on the optimized geometric structure of the Arg⁺+9H₂O system, the electronic structure of Arg⁺ in the potential of water was calculated using the SCCE method. Finally, by performing SCCE calculations, the effect of water on the electronic structure of Arg⁺ was simulated with dipoles. The results show that the effect of water on the electronic structure of Arg⁺ is to broaden the energy gap tenfold, and to increase the eight eigenvalues below the HOMO by about 0.0546 Ry on average. The water potential can be accurately simulated using dipoles.     

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

ObjectivesTo compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks.DesignCross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems.Setting32 hospital units in 19 Norwegian hospitals with electronic medical records systems.Participants227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems.ResultsMost tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents'' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems.ConclusionsDoctors used electronic medical records systems for far fewer tasks than the systems supported.

What is already known on this topic

Electronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasks

What this study adds

Doctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems     

19F NMR study of protein-induced rhombic perturbations on the electronic structure of the active site of myoglobin

 A novel C ₂-symmetric ring-fluorinated hemin, 13,17-bis(2-carboxyethyl)-2,8,12,18-tetramethyl-3,7-difluoroporphyrinatoiron(III), has been synthesized and was incorporated into sperm whale apomyoglobin to investigate protein-induced rhombic perturbations on the electronic structure of the active site of myoglobin (Mb) using ¹⁹F NMR spectroscopy. NMR signals for ¹⁹F atoms introduced as substituents on the present heme in ferrous low-spin and high-spin and ferric low-spin complexes have been observed and their shifts sharply reflect not only the electronic nature of the heme iron, but also in-plane asymmetry of the heme electronic structure. The two-fold symmetric electronic structure of the ring-fluorinated hemin is clearly manifested in the ¹⁹F and ¹H NMR spectra of its dicyano complex. The chemical equivalence of the two fluorine atoms of the heme is removed in the active site of myoglobin and the splitting of the two ¹⁹F NMR signals provides a quantitative probe for characterizing the rhombic perturbation of the heme electronic structure induced by the heme-protein interaction. The in-plane asymmetry of heme electronic structures in carbonmonoxy and deoxy Mbs have been analyzed for the first time on the basis of the shift difference between the two ¹⁹F NMR signals of the heme and is interpreted in terms of iron-ligand binding and/or the orbital ground state of the heme. A potential utility of ¹⁹F NMR, combined with the use of a symmetric fluorinated hemin, in characterizing the heme electronic structure of myoglobin in a variety of iron oxidation, spin, and ligation states, is presented. Received: 23 December 1999 / Accepted: 3 April 2000     

Electronic communication between providers of primary and secondary care.

OBJECTIVE--To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. DESIGN--Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. SETTING--Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. OUTCOME MEASURES--Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors'' satisfaction with electronic data interchange by questionnaire. RESULTS--Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. CONCLUSION--Electronic communication between primary and secondary care providers is a feasible option for improving communication.     

The nature of the charge carriers in solvated biomacromolecules

Solid state electrolysis experiments were performed on the biomolecules, hemoglobin, cytochromec, collagen, lecithin and melanin at various hydration states; and for hemoglobin at various solvation states with methanol adsorbate. The evolved hydrogen was measured and compared with theoretical (Faraday's Law) expectations for the known amount of charge passed through the adsorbents. The difference between the theoretical and actual is a measure of the contributions of electronic charge carriers to the total current. Thus the protonic/electronic conduction ratios are determined.All biomolecules tested appear to be mixed semiconductors. That is, both electronic and protonic charge carriers make significant contributions to the currents over hydration ranges from 6% to above 50%. The constant temperature conductivity increases exponentially with hydration (solvation) but the ratio of protonic to electronic conduction increases linearly with hydration for the globular proteins, hemoglobin and cytochromec. The fibrous protein, collagen, may be a protonic semiconductor in the dry state, with an electronic component that increases linearly with hydration. The hemoglobin-methanol system shows only electronic conductivity below 2 BET monolayers, with a sharp onset to 70% protonic conductivity above this value. This result is similar to the DNA-water system previously reported. The protonic/electronic ratio in hydrated hemoglobin may be a function of the applied voltage; being predominantly electronic below 30 volts (300 volts/cm), and a constant mixed value above 100 volts (1000 volts/cm). Our results suggest that both electronic and protonic conduction are intrinsic processes in these substances and subject to control by a number of techniques.     

Comparison between paper and electronic sleep diary

This study aimed to test the concurrent validity of an electronic version (to run on tablet) of a sleep diary derived from the core Consensus Sleep Diary compared with the traditional paper and pencil version. To this end, 15 healthy volunteers (6 males; mean age 37.20 ± 17.55 years) every morning, for at least 7 consecutive days, filled both paper and electronic sleep diary. Furthermore, sleep was objectively assessed through actigraphy. With reference to all sleep parameters examined, no significant differences were observed between paper and electronic sleep diary. As expected, paper and electronic sleep diary showed the same poor agreement with actigraphic estimates of sleep quantity and sleep quality. On the basis of the present data, we can conclude that electronic sleep diary performs like paper sleep diary. Bearing in mind that electronic sleep diary presents several benefits in comparison to the paper sleep diary (e.g. avoiding of the “parking lot syndrome”, in which patient retrospectively completes more days at the same time; reducing the time for data entry and scoring), we suggest that, if the present findings will be confirmed also in clinical populations, electronic sleep diary should replace paper sleep diary in both research and clinical settings.     

Equivalent potential of water for the electronic structure of glycine

First-principles, all-electron, ab initio calculations have been performed to construct an equivalent potential of water for the electronic structure of glycine (Gly) in solution. The calculation involved three steps. The first step was to search for the minimum-energy geometric structure of the Gly + nH₂O system. The second step was to calculate the electronic structure of Gly with the potential of water molecules via the self-consistent cluster-embedding method (SCCE), based on the result obtained in the first step. The last step was to calculate the electronic structure of Gly with the potential of dipoles after replacing the water molecules with dipoles. The results show that the occupied molecular orbitals of Gly are raised by about 0.0524 Ry on average due to the effect of water. The effect of water can be simulated well using the dipole potential. The equivalent potential obtained can be applied directly to electronic structure calculations of proteins in solution using the SCCE method.     

HOBOs, Tidbits and lizard models: the utility of electronic devices in field studies of ectotherm thermoregulation

1. A replicated experiment tested the null hypothesis that stand-alone electronic temperature recording devices produce sets of operative temperatures similar to those produced using lizard models.
2. Commercially available electronic temperature recording devices (HOBO XT™ with external probe and Tidbit™) produced sets of operative temperatures nearly identical to models designed to mimic the size, shape, scale architecture and colour of two species of common North American lizards.
3. Tidbits™ performed better than external probes.
4. These results suggest that electronic devices (especially Tidbits™) can be substituted for models in many applications and that size, morphology, scale architecture and colour contribute very little to temperature change in small-sized life-like models widely used in field-based studies on the thermal ecology of vertebrates.
5. Small differences between temperatures recorded by electronic devices and detailed lizard-shaped models fitted with thermal probes suggest that these models may nevertheless be necessary for certain kinds of studies.     

Electronic recording of plant penetration by the cereal aphids Rhopalosiphum padi and Metopolophium dirhodum on resistant and susceptible wheat seedlings

Plant penetration by the aphids Rhopalosiphum padi and Metopolophium dirhodum was monitored using an electronic recording method. Recordings over 3 h showed that phloem ingestion was reduced on resistant wheat, when compared with a more susceptible species, but this trend was reversed when results from longer (12 h) experiments were used. Plant penetration by M. dirhodum was reduced by attachment to the electronic system, but the behaviour of R. padi was relatively unaffected. The results are discussed in relation to prospects for using electronic methods as a screening procedure.     

Early conception factor lateral flow assays for pregnancy in the mare

The ECF™ lateral flow assay test is marketed to detect non-pregnancy in mares. The objectives of the present study were to determine the accuracy of the ECF test, the accuracy of the electronic reader accompanying the ECF test, and agreement between two human readers and the electronic reader. Serum samples were collected from anestrus, cycling but not inseminated, and inseminated mares, and were evaluated with the ECF™ test (EDP Biotech Company, Knoxville, TN, USA) at The Ohio State University and at the EDP Biotech Laboratory. Specificity ranged from 0.07 to 0.16, the negative predictive value ranged from 0.15 to 0.33, and accuracy ranged from 0.43 to 0.52. The electronic reader did not add improve the accuracy or predictive values of the test. Based on the electronic reader, 80.0% of the serum samples collected from the anestrus mares were false positives; Readers 1 and 2 had 60.0 and 33.3% false positives, respectively. For samples collected during the estrous cycle, 83.9% were false positives by the electronic reader, whereas Readers 1 and 2 had 43.7 and 26.4% false positives. We concluded that, regardless of whether the test strips were evaluated by a human or electronic reader, this assay was not accurate for determination of the non-pregnant mare.     

Development and application of electronic crossmatch in Dongguan city

Electronic crossmatching is a computer-assisted technology used to confirm if red blood cell (RBC) blood products are suitable for the intended recipient. In addition to mainland China, electronic crossmatching has been used in many countries. Here we have developed an electronic crossmatching system for clinical application. The primary and advanced system of electronic crossmatching was developed, the primary system includes ABO and RhD blood group antigens, and the advanced system includes 18 common RBC group antigens. We completed in-situ and online testing; the system was installed in six general hospitals in Dongguan for clinical application. A total of 31,941 crossmatches were performed by both electronic and serological crossmatching from July 1st, 2015 to April 30th, 2016. The electronic crossmatch shows to be more powerful than serological crossmatching, if RBC blood products and recipients were compatible when electronic and serological crossmatch completed, all blood were issued to clinic. In this condition, no case of hemolytic transfusion adverse reaction occurred. In conclusion, the electronic crossmatch system can be used in transfusion medicine and is capable of reducing laboratory workload and costs, as well as improving transfusion safety.     

Electronic and steric substituent effects on the fluorescence emission of 2-pyrazoline derivatives

A series of substituted 2-pyrazolines were synthesized, and the steric and electronic effects of substituents on the C₃- and C₅-positions of the heterocyclic ring on their fluorescent ability were investigated. Two different conjugative intramolecular charge transfer (ICT) and intramolecular charge transfer through space (spiro-conjugation) affect the fluorescence intensity of these compounds. The extent of the ICT process and spiro-conjugation depends on the electronic nature of the additional substitution and its position on the attached aryl rings. In addition, the effects of the concentration and the solvent polarity on the fluorescence emission were studied. Density functional theory (DFT) calculations were carried out to gain insight into the geometric, electronic, and spectroscopic properties of the pyrazoline derivatives. The results of both experimental and computational studies explain the effects of the geometrical orientation of the C₃- and C₅-aryl rings toward the heterocyclic ring and also the electronic nature of their additional substitutions on the fluorescence intensity.     

Electronic excited states and excitation transfer kinetics in the Fenna-Matthews-Olson protein of the photosynthetic bacterium Prosthecochloris aestuarii at low temperatures

The molecular structure-function relationship of the Fenna-Matthews-Olson light-harvesting complex of the photosynthetic green bacterium Prosthecochloris aestuarii has been investigated. It has been assumed that the electronic excited states responsible for the function (transfer of electronic excitation energy) result from the dipole-dipole interactions between the bacteriochlorophyll molecules bound to the polypeptide chain of the complex at a specific three-dimensional geometry. The molecular structure-electronic excited states relationship has been addressed on the basis of simultaneous simulations of several spectroscopic observations. Current electronic excited state models for the Fenna-Matthews-Olson complex have generally been based on obtaining an optimal match between the information contents of the optical steady-state spectra and the bacteriochlorophyll organization. Recent kinetic and spectral information gathered from ultrafast time-resolved measurements have not yet been used effectively for further refinement of the excited state models and for quantification of the relation between the excited states and the energy transfer processes. In this study, we have searched for a model that not only can explain the key features of several steady-state spectra but also the temporal and spectral evolution observed in a recent absorption difference experiment and we have discussed the implications of this model for equilibration of the electronic excitation energy in systems at low temperatures. Received: 12 June 1998 / Revised version: 19 October 1998 / Accepted: 30 November 1998     

Electronic Properties of the Amino Acid Side Chains Contribute to the Structural Preferences in Protein Folding

Abstract

A database of 118 non-redundant proteins was examined to determine the preferences of amino acids for secondary structures: α-helix, β-strand and coil conformations. To better understand how the physicochemical properties of amino acid side chains might influence protein folding, several new scales have been suggested for quantifying the electronic effects of amino acids. These include the pKa at the amino group, localized effect substituent constants (eσ), and a composite of these two scales (ε). Amino acids were also classified into 5 categories on the basis of their electronic properties: O (strong electron donor), U (weak donor), Z (ambivalent), B (weak electron acceptor), and X (strong acceptor). Certain categories of amino acid appeared to be critical for particular conformations, e.g., O and U-type residues for α-helix formation. Pairwise analysis of the database according to these categories revealed significant context effects in the structural preferences. In general, the propensity of an amino acid for a particular conformation was related to the electronic features of the side chain. Linear regression analyses revealed that the electronic properties of amino acids contributed about as much to the folding preferences as hydrophobicity, which is a well-established determinant of protein folding. A theoretical model has been proposed to explain how the electronic properties of the side chain groups might influence folding along the peptide backbone.     

Lipase-catalyzed esterification of 2-(4-substituted phenoxy)propionic acids in organic solvents: substituent effect controlling enantioselectivity toward racemic acids

The enantioselectivity for lipase-catalyzed esterifications of 2-(4-substituted phenoxy)propionic acids in organic solvents was found to be mainly controlled by both size (steric) and electronic effects of substituents: H, F, Cl, CF₃ and CH₃. For the similar substituents in size, CF₃ and CH₃, however, their electronic effects play an important role in controlling the enantioselectivity. A model for the enantiorecognition is proposed by the discussion based on the value of the Michaelis constant obtained for the enantiomers.     

Complete Demonstration of the Valence Electronic Structure Inside a Practical Organic Solar Cell Probed by Low Energy Photoemission

The complete electronic structure inside a practical organic photovoltaic (OPV) device consisting of a trilayer structure of copper‐phthalocyanine (CuPc), fullerene (C₆₀), and bathocuproine (BCP) is demonstrated using low‐energy ultraviolet photoelectron spectroscopy (LE‐UPS) and photoelectron yield spectroscopy (PYS). The molecular orbital energy alignment and electrostatic potential distribution throughout the entire device is illustrated based on the LE‐UPS results. A favorable potential gradient to carry the photogenerated holes and electrons is manifested to be built spontaneously in the CuPc and BCP layers, respectively. Furthermore, the ultrahigh sensitivity measurements of LE‐UPS clearly unveil the distributions of faint density‐of‐states in the energy‐gap region in the organic films. Substantially barrierless contacts to both electrodes are fulfilled by the existence of these gap states. The electronic structure under simulated sunlight illumination is examined for the purpose of elucidating the electronic structures inside the working devices in the open‐circuit condition. These results indicate experimentally the electronic functionalities of each organic material, in particular of the BCP buffer layer, on the cell efficiency.     

On the electronic structure of the primary electron donor in bacterial photosynthesis – the bacteriochlorophyll dimer as viewed by EPR/ENDOR methods

The primary electron donor (D) plays a prominent role in electron transfer reactions in the primary processes of photosynthesis. In purple photosynthetic bacteria D is a dimer of bacteriochlorophyll molecules. Investigations on its electronic structure using EPR and ENDOR (electron nuclear double resonance) methods are summarized, focussing on results obtained in the last six years. These encompass studies on the cation radical (D+·) of mutants in which the immediate environment of D is modified through mutagenesis, particularly hydrogen bond and heterodimer mutants. Models using these results to describe the electronic interaction of the dimer halves are discussed. Also, High-Field (95 GHz) EPR to obtain the G-tensor of D+· is addressed. Furthermore, ENDOR on the photoexcited triplet state of D (DT), which in some aspects could serve as a model for the excited singlet state, are discussed. Different approaches towards correlating the electronic structure with function, in particular with the rates of electron transfer reactions, are described.     

基于电子文件的分级诊疗模式研究

目的 了解我国分级诊疗现状和业务流程，提出基于电子文件的分级诊疗服务模式。方法 采用描述分析法对当前分级诊疗业务及所产生的电子文件进行研究，结合电子文件的特性，探索分级诊疗服务模式。结果 从电子文件中心构建、双向转诊、远程医疗、慢性病管理等方面构建了基于电子文件的分级诊疗模式。结论 基于电子文件开展分级诊疗服务能优化现有的业务流程，为分级诊疗进程的不断推进提供信息化支撑。