Information systems: necessity or luxury in changing economies?

Abstract. This paper explores the role of information technology and systems in countries that are undergoing rapid social and economic change. The countries of East and Central Europe and the former Soviet Union are good examples. We focus on the most important needs for management information in such countries, which are often quite different from those in Western countries, and on the difficulties of implementing information technology. We suggest that improved information systems will be critical for future success in changing economies and that the processes for developing systems and applying information technology should follow quite different paths from those followed in the US and Western Europe. We also present several examples of problems and possible solutions.     

Natürlicher Wille,Zwang und Anerkennung – Medizinethische Überlegungen zum Umgang mit nicht selbstbestimmungsfähigen Patienten in der Psychiatrie

Definition of the problem

In recent German jurisprudence, the requirements for compulsory treatment were tightened up and more emphasis is laid on the consideration of the so-called “natural will” of incompetent patients. Before taking recourse to compulsory treatment, physicians are accordingly obliged to make a last attempt to obtain an assent based on trust. Taking into account that such an attempt tends to take place against a background of informal coercion, an ethical dilemma arises: either physicians administer compulsory treatment and hence use straightforward physical coercion or they succeed in obtaining a trust-based assent yet only at the price of using some form of informal coercion, such as threatening, deceiving or manipulating.

Arguments

We argue that the solution to this dilemma can be found in the philosophical concept of recognition. In the current context, recognition should be understood as a specific attitude that manifests itself in a respectful interaction with patients on the part of the hospital staff.

Conclusion

Although in many cases of the type described above it is impossible to completely refrain from using (informal) coercion; in these cases one can nevertheless interact in a better or in a worse way with patients – and the better way is to give recognition to patients.

     

Survey of mammography practice in Croatia: equipment performance, image quality and dose

A national audit of mammography equipment performance, image quality and dose has been conducted in Croatia. Film-processing parameters, optical density (OD), average glandular dose (AGD) to the standard breast, viewing conditions and image quality were examined using TOR(MAM) test object. Average film gradient ranged from 2.6 to 3.7, with a mean of 3.1. Tube voltage used for imaging of the standard 45 mm polymethylmethacrylate phantom ranged from 24 to 34 kV, and OD ranged from 0.75 to 1.94 with a mean of 1.26. AGD to the standard breast ranged from 0.4 to 2.3 mGy with a mean of 1.1 mGy. Besides clinical conditions, the authors have imaged the standard phantom in the referent conditions with 28 kV and OD as close as possible to 1.5. Then, AGD ranged from 0.5 to 2.6 mGy with a mean of 1.3 mGy. Image viewing conditions were generally unsatisfying with ambient light up to 500 lx and most of the viewing boxes with luminance between 1000 and 2000 cd per m(2). TOR(MAM) scoring of images taken in clinical and referent conditions was done by local radiologists in local image viewing conditions and by the referent radiologist in good image viewing conditions. Importance of OD and image viewing conditions for diagnostic information were analysed. The survey showed that the main problem in Croatia is the lack of written quality assurance/quality control (QA/QC) procedures. Consequently, equipment performance, image quality and dose are unstable and activities to improve image quality or to reduce the dose are not evidence-based. This survey also had an educational purpose, introducing in Croatia the QC based on European Commission Guidelines.     

Phenomenological investigation of cutting oils: Antifriction and antiwear behaviour at low contact temperatures

The basic reason for the use of cutting fluids in machining processes is to increase cutting tool life and to decrease machining costs. An experimental simulation of tribological processes representing rear cutting tool contact was carried out in a ‘block‐on‐disc’ (BOD) tribotester. The coefficient of friction and block wear were measured under boundary (discontinuous fluid film) and elastohydrodynamic (quasi‐continuous fluid film) lubrication conditions for neat and semi‐synthetic cutting oils. Interesting data were obtained concerning a further cutting fluid classification, which is helpful for optimal cutting fluid selection via their antiwear and antifriction characteristics.     

Pulse Energy Probability Density Functions for Long-Haul Optical Fiber Transmission Systems by Using Instantons and Edgeworth Expansion

In this work, we use a new approach to model pulse energy in long-haul optical fiber transmission systems. Existing approaches for obtaining probability density functions (pdfs) rely on numerical simulations or analytical approximations. Numerical simulations make far tails of the pdfs difficult to obtain, while analytical approximations are often inaccurate, as they neglect nonlinear interaction between pulses and noise. Our approach combines the instanton method from statistical mechanics to model far tails of the pdfs, with numerical simulations to refine the middle part of the pdfs. We combine the two methods by using an orthogonal polynomial expansion constructed specifically for this problem. We demonstrate the approach on an example of a specific submarine transmission system.     

Vorausverfügte Therapieablehnungen in Situationen von Eigen- oder Fremdgefährdung. Ethische und rechtliche Überlegungen zur Umsetzung von Patientenverfügungen in der Psychiatrie

Definition of the problem

In case of court-ordered involuntary hospitalization due to danger to self or to others psychiatric advance directives can lead to clinically and ethically challenging situations – especially when they contain (total) treatment refusals. In such situations, patients can neither be discharged from hospital nor medically treated.

Arguments

This article discusses ethical challenges in the context of advance treatment refusals from an interdisciplinary perspective. We outline legal limitations of advance directives and normative preconditions of valid advance directives (such as mental capacity at the time of composition, applicability to the current life and health situation) and analyse them with regard to clinical practice. Hence, we elaborate on ethical arguments for and against the conduction of coercive measures and coercive treatments in situations of danger to self or to others. By identifying normatively relevant aspects, our paper further contributes to the objective of ethically justified clinical decision-making in the context of advance treatment refusals.

Conclusion

Finally, we summarize implications for clinical practice that follow from the legal authority of advance directives. On a general level, we discuss ethical tensions resulting from psychiatry’s legal obligation to intervene in situations of danger to self or to others in the context of advance treatment refusals. On the level of the individual physician-patient relationship, we outline professional offers for consultation. Further, we reflect on their potential to better inform patients about possible far-reaching consequences (total) advance treatment refusals could entail.

     

Retraction Approach to CPS Transform

We study the continuation passing style (CPS) transform and its generalization, the computational transform, in which the notion of computation is generalized from continuation passing to an arbitrary one. To establish a relation between direct style and continuation passing style interpretation of sequential call-by-value programs, we prove the Retraction Theorem which says that a lambda term can be recovered from its CPS form via a -definable retraction. The Retraction Theorem is proved in the logic of computational lambda calculus for the simply typable terms.     

Identifying competing aerobic nitrobenzene biodegradation pathways by compound-specific isotope analysis

Nitroaromatic compounds that contaminate soil and groundwater can be biodegraded by different, sometimes competing reaction pathways. We evaluated the combined use of compound-specific stable C and N isotope analysis to distinguish between enzymatic nitrobenzene oxidation by Comamonas sp. strain JS765 and partial reduction by Pseudomonas pseudoalcaligenes strain JS45 under aerobic conditions. Bulk 13C and 15N enrichment factors for nitrobenzene dioxygenation with JS765 were -3.9 per thousand +/- 0.09 per thousand (+/- 1sigma) and -0.75 per thousand +/- 0.09 per thousand, respectively. The corresponding primary apparent kinetic isotope effects (AKIE) of 1.0241 +/- 0.0005 for 13C and a secondary 15N AKIE of 1.0008 +/- 0.0001 are in very good agreement with the proposed enzymatic addition of dioxygen to the aromatic ring to form a cis-dihydrodiol in the rate-limiting step of nitrobenzene degradation. For the partial reduction pathway with JS45, epsilonC and epsilonN values were -0.57 per thousand +/- 0.06 per thousand and -26.6 per thousand +/- 0.7 per thousand. The 13C and 15N AKIEs amount to 1.0034 +/- 0.0003 and 1.0273 +/- 0.0008, respectively, and are consistent with the two-electron reduction and dehydration of the aromatic NO2 group to nitrosobenzene. The combined evaluation of delta13C and delta15N changes in nitrobenzene, based on the isotope enrichment behavior found in this laboratory study, provide an excellent starting point for assessing of the extent of nitrobenzene biodegradation via competing pathways in contaminated environments.