Strategic technology planning in hospital management

Abstract. Hospital managers regularly are confronted with their patients' demand for increased service performance on the one hand and tight budgets on the other. As medical technologies influence both the costs and the service spectrum, strategic technology planning is among the critical tasks in hospital management. This paper addresses the corresponding problem of selecting the “best” portfolio of medical devices and proposes an appropriate decision support system. It starts with a multiobjective mathematical programming model that determines the solution space of all efficient portfolios of medical technology investments. The members of the planning committee with their diverging interests then are supported by their interactive exploration of that space until they jointly reach a satisfying portfolio and are not willing to make any further compromises between its objective levels. As one of its salient features the system does not require a priori preference information. RID="*" ID="*" A previous version of this paper has been presented at the Wiesbaden 2000 Meeting of the GOR-Working Group “Operations Research in Health Care”. The authors thank Andrea Lührs and Thomas Rollins, both from Siemens AG, for their valuable support. Moreover, thanks are due to the anonymous referees for their comments on a previous version of this paper. Correspondence to: C. Stummer     

Snow metamorphism as revealed by scanning electron microscopy

Current theories of snow metamorphism indicate that sublimating snow crystals have rounded shapes, while growing crystals have shapes that depend on growth rates. At slow growth rates, crystals are rounded. At moderate rates, they have flat faces with rounded edges. At fast growth rates, crystals have flat faces with sharp edges, and they have hollow faces at very fast growth rates. The main growth/sublimation mechanism is thought to be by the homogeneous nucleation of new layers at or near crystal edges. It was also suggested that the equilibrium shape of snow crystals would be temperature dependent: rounded above -10.5 degrees C, and faceted below. To test these paradigms, we have performed SEM investigations of snow samples having undergone metamorphism under natural conditions, and of snow samples subjected to isothermal metamorphism at -4 degrees and -15 degrees C in the laboratory. In general, current theories predicting crystal shapes as a function of growth rates, and of whether crystals are growing or sublimating, are verified. However, the transition in equilibrium shapes from rounded to faceted at -10.5 degrees C is not observed in our isothermal experiments that reveal a predominance of rounded shapes after more than a month of metamorphism at -4 and -15 degrees C. Some small crystals with flat faces that also have sharp angles at -15 degrees C, are observed in our isothermal experiments. These faces are newly formed, and contradict current theory. Several hypotheses are proposed to explain their occurrence. One is that they are due to sublimation at emerging dislocations.     

Magnetization transfer short inversion time inversion recovery enhanced 1H MRI of the human lung

The unique characteristics of the human lung arising from low proton density and multiple air-tissue interfaces of the alveoli cause difficulty in¹H lung magnetic resonance imaging. In addition, the dominating signal from sources such as the thoracic muscle and subcutaneous fat hampers the visualization of the lung parenchyma. In this contribution, an efficient tissue suppression technique is presented which allows one to significantly enhance lung parenchyma visibility. A short inversion time inversion recovery (STIR) experiment combined with a magnetization transfer (MT) experiment was used for magnetization preparation in order to suppress the signal from muscle. A half-Fourier single-shot turbo spin-echo sequence was used as acquisition module. This approach was used to perform lung anatomical imaging in eight healthy human subjects and five patients withcystic fibrosis. The results obtained demonstrate that with MT-STIR approach high quality human lung images can be obtained and that this approach has the potential for the evaluation of lung pathologies.     

THE QSM ALGORITHM AND ITS APPLICATION TO SOFTWARE BEHAVIOR MODEL INDUCTION

This article presents a novel application of grammatical inference techniques to the synthesis of behavior models of software systems. This synthesis is used for the elicitation of software requirements. This problem is formulated as a deterministic finite-state automaton induction problem from positive and negative scenarios provided by an end user of the software-to-be. A query-driven state merging (QSM) algorithm is proposed. It extends the Regular Positive and Negative Inference (RPNI) and blue-fringe algorithms by allowing membership queries to be submitted to the end user. State merging operations can be further constrained by some prior domain knowledge formulated as fluents, goals, domain properties, and models of external software components. The incorporation of domain knowledge both reduces the number of queries and guarantees that the induced model is consistent with such knowledge. The proposed techniques are implemented in the ISIS tool and practical evaluations on standard requirements engineering test cases and synthetic data illustrate the interest of this approach.     

Clinical proteomics: Promises,challenges and limitations of affinity arrays

After the establishment of DNA/RNA sequencing as a means of clinical diagnosis, the analysis of the proteome is next in line. As a matter of fact, proteome-based diagnostics is bound to be even more informative, since proteins are directly involved in the actual cellular processes that are responsible for disease. However, the structural variation and the biochemical differences between proteins, the much wider range in concentration and their spatial distribution as well as the fact that protein activity frequently relies on interaction increase the methodological complexity enormously, particularly if an accuracy and robustness is required that is sufficient for clinical utility. Here, we discuss the contribution that protein microarray formats could play towards proteome-based diagnostics.     

THz-Photoconductivity of Quantum Hall Systems in Quasi-Corbino-Geometry

The THz-photoresponse (PR) between two separately contacted edge-channels of a two-dimensional electron gas in the quantum Hall regime is investigated. We use a not-simply-connected sample geometry, which is topologically equivalent to a ring shape (Corbino-geometry). At filling factors ν<2, spectrally resolved PR-measurements show a Lorentzian resonance, centered at the cyclotron-frequency, whereas above the integer filling factor, an asymmetric broadening is observed. Two independent contributions to the PR-signal can be resolved. One contribution clearly results from bolometric heating inside the bulk and the other one is caused by a non-bolometric mechanism.     

Resource management model and performance evaluation for satellite communications

Efficient resource management is mandatory to achieve maximum system capacity for next generation communications systems. Resource management deals with the available spectral band, time, power, and space for a transmission signal. It includes (i) the frequency planning, (ii) the selection of transmit power, and (iii) the assignment of the channels and access nodes to the users. The paper presents a generalized notation as well as graph algorithms for resource management problems. Impairment graphs can be used for frequency planning, whereas flow graphs are suitable for channel access problems. To evaluate the performance of the resource management, service criteria (such as blocking or the carrier to interference ratio C/I) or efficiency criteria (bandwidth requirements) can be derived from the graphs. The resource management techniques are applied to satellite networks with non‐geostationary orbits yielding time‐variant network topologies. As a simple example, the channel assignment and capacity optimization of the EuroSky Way system are shown. Furthermore, a comparison of fixed, dynamic and hybrid channel allocation schemes (FCA, DCA, HCA) for a typical MEO satellite scenario is given. Satellite diversity and its impact on bandwidth requirement and transmission quality is also examined. Finally, it is shown how spread spectrum systems can be investigated with the presented tools. Copyright © 2001 John Wiley & Sons, Ltd.     

Beschreibung von Ver- und Entfestigungsvorgängen am Beispiel austenitformgehärteter Stähle mit Hilfe von Fließkurven

Fließkurven beschreiben das Formänderungsvermögen von Werkstoffen. Gleichzeitig liefern sie Informationen über die Wechselwirkung zwischen der Ver- und Entfestigung, wobei diese beiden Eigenschaften temperaturabhängig sind. Fließkurven wurden an Stählen aufgenommen, die sich im wesentlichen in ihrem Kohlenstoffgehalt unterscheiden. Die Bestimmung der Formänderungsfähigkeit erfolgte bei Temperaturen, die denen entsprechen, bei denen eine Austenitformhärtung vorgenommen wird. Die mathematische Beschreibung der Fließkurven läßt erkennen, daß zunächst mit steigender Umformtemperatur die Verfestigungsrate abnimmt. Der Kohlenstoffgehalt erhöht dagegen die Verfestigungsrate. Die dynamische Erholung wird mit wachsender Umformtemperatur beschleunigt, ebenso mit steigendem Kohlenstoffgehalt.