Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Experimental demonstration of a record high 11.25Gb/s real-time optical OFDM transceiver supporting 25km SMF end-to-end transmission in simple IMDD systems.

The fastest ever 11.25Gb/s real-time FPGA-based optical orthogonal frequency division multiplexing (OOFDM) transceivers utilizing 64-QAM encoding/decoding and significantly improved variable power loading are experimentally demonstrated, for the first time, incorporating advanced functionalities of on-line performance monitoring, live system parameter optimization and channel estimation. Real-time end-to-end transmission of an 11.25Gb/s 64-QAM-encoded OOFDM signal with a high electrical spectral efficiency of 5.625bit/s/Hz over 25km of standard and MetroCor single-mode fibres is successfully achieved with respective power penalties of 0.3dB and -0.2dB at a BER of 1.0 x 10(-3) in a directly modulated DFB laser-based intensity modulation and direct detection system without in-line optical amplification and chromatic dispersion compensation. The impacts of variable power loading as well as electrical and optical components on the transmission performance of the demonstrated transceivers are experimentally explored in detail. In addition, numerical simulations also show that variable power loading is an extremely effective means of escalating system performance to its maximum potential.

Stiffness of sands through a laboratory test database

Deformations of sandy soils around geotechnical structures generally involve strains in the range small (0·01%) to medium (0·5%). In this strain range the soil exhibits non-linear stress-strain behaviour, which should be incorporated in any deformation analysis. In order to capture the possible variability in the non-linear behaviour of various sands, a database was constructed including the secant shear modulus degradation curves of 454 tests from the literature. By obtaining a unique S-shaped curve of shear modulus degradation, a modified hyperbolic relationship was fitted. The three curve-fitting parameters are: an elastic threshold strain γe, up to which the elastic shear modulus is effectively constant at G0; a reference strain γr, defined as the shear strain at which the secant modulus has reduced to 0·5G0; and a curvature parameter a, which controls the rate of modulus reduction. The two characteristic strains γe and γr were found to vary with sand type (i.e. uniformity coefficient), soil state (i.e. void ratio, relative density) and mean effective stress. The new empirical expression for shear modulus reduction G/G0 is shown to make predictions that are accurate within a factor of 1·13 for one standard deviation of random error, as determined from 3860 data points. The initial elastic shear modulus, G0, should always be measured if possible, but a new empirical relation is shown to provide estimates within a factor of 1·6 for one standard deviation of random error, as determined from 379 tests. The new expressions for non-linear deformation are easy to apply in practice, and should be useful in the analysis of geotechnical structures under static loading.