基于智能规则的医院检查预约平台应用研究

以上海市胸科医院为例,从总体架构、智能规则库、模型构建和计算等方面阐述基于智能分配规则的医院检查预约平台建设,选取对照组和观察组对平台使用前后预约情况进行对比,结果表明该平台有助于缩短检查等候时间,优化检查预约流程,提升患者满意度。     

Buck变流器级联系统直流母线电压补偿控制策略

在直流分布式电源系统的设计过程中,稳定性设计是最核心但最复杂的部分。随着系统规模日益庞大,若想将其作为整体进行稳定性设计几乎是不可能的。由于级联是分布式结构中最基本的连接形式,故深入研究、改善级联系统的稳定性对于确保整个系统的稳定运行非常重要。除优化设计变流器参数外,增加母线补偿装置(VBC)也是改善级联系统直流母线电压稳定性的一种有效途径,目前针对DC-DC级联系统母线补偿策略及补偿容量的研究已取得了一定的成果,其中一些研究还可以应用于大信号扰动的场合。但总体而言仍有进一步探索和发展的空间。本文从大信号的研究角度出发,基于混合势函数理论和回转器大信号模型,提出了一种直流母线电压补偿控制策略。该控制策略可根据级联系统中源、负载变流器的具体特性参数进行有针对性的补偿;同时,该策略由混合势函数理论的稳定性定理推导得出,从理论上保证了加入VBC后整个系统在大信号扰动下的稳定性。仿真和实验以峰值电流模式控制型Buck变流器级联系统为例对该补偿控制策略的有效性和补偿效果进行了验证。     

Complexity and Distribution of Drivers in Relation to Duration of Persistent Atrial Fibrillation

Background

The underlying mechanisms sustaining human persistent atrial fibrillation (PsAF) is poorly understood.

Young drivers who continue to drive while sleepy: What are the associated sleep‐ and driving‐related factors?

Crashes due to sleepiness account for a substantial proportion of road crash incidents. The purpose of the current study was to examine several sleep‐related factors and driving‐related factors for their association with self‐reports of continuing to drive while sleepy. In total 257 young drivers aged 18–25 years completed an online survey that assessed factors such as sleep quality, sleep duration and consistency, excessive daytime sleepiness, experiences with sleepiness and their driving‐related behaviours. The results demonstrate that being older, having a perceived ability to overcome sleepiness, committing more highway code violations and having experienced a sleep‐related close call were positively associated with an increased likelihood of continuing to drive while sleepy. The obtained results highlight the acceptance of risky driving behaviours among some younger drivers. Younger drivers’ risky driving behaviour is certainly a road safety concern given the impairment associated with sleepiness and their over‐representation in road crash incidents.     

An analysis of an older driver evaluation program

OBJECTIVES: To identify elements of an older driver evaluation program that predict driving performance in older adults. SETTING: Outpatient medical clinic in an academic medical center. DESIGN: A retrospective analysis. PARTICIPANTS: Six hundred sixty-four older adults who were referred to an older driver evaluation program. MEASUREMENTS: A physician trained in geriatric medicine and a clinical geriatric nurse specialist oversaw an experienced driving evaluator and an occupational therapist who conducted assessments of older persons' functional status; reaction time; driving skills; and cognitive, hearing, and vision abilities. Self-report data along with a medical history submitted by patients' primary care physicians supplemented the clinical assessments. RESULTS: A multinomial logistic regression revealed that the Mini-Mental State Examination (MMSE), cues needed with the Trail Making Test, Part B, grip strength, and an interaction effect between the MMSE and reaction time constituted the most parsimonious model for predicting on-the-road performance. A receiver operating characteristic analysis indicated that this index had good sensitivity but low specificity. A binomial regression comparing imperfect and perfect drivers demonstrated the significance of the Traffic Sign and Visual Perception tests. CONCLUSION: Clinicians should employ a multilevel screening process that includes initial cognitive tests, such as the MMSE and the Trail Making Test, Part B, although more studies of driving evaluation programs in medical settings that include random samples of older drivers are needed.     

出租车司机心理健康状况

目的对出租车司机心理健康状况进行评估,以及分析地域、年龄、工资的差异与心理异常的关系。方法采用症状自评量表(SCL-90)和SPSS统计软件,对出租车司机的心理健康状况进行评估和分析。结果出租车司机的心理健康水平低于国内常模;福建、辽宁、陕西出租车司机的心理健康水平在躯体(F=4.72,P=0.028)、强迫(F=7.86,P=0.005)、人际交往(F=4.54,P=0.008)因子上存在显著差异;出租车司机的年龄与其强迫(r=-0.161,P=0.031)、人际交往(r=-0.26,P=0.009)、焦虑(r=-0.27,P=0.003)、抑郁(r=-0.16,P=0.029)和偏执(r=-0.17,P=0.023)等因子有显著负相关。结论出租车司机的心理健康水平较低,且心理健康状况与年龄有关。     

Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?

OBJECTIVES: To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision (MVC) involvement in a cohort of older drivers. DESIGN: Prospective cohort study. SETTING: Motor Vehicle Administration (MVA) field sites in Maryland. PARTICIPANTS: Of the 4,173 older drivers invited to participate in the study, 2,114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1,910 individuals recruited through MVA field sites. MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOV) subtest 2; a Mobility Questionnaire; and MVC occurrence. RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 140 degrees visual field), age, sex, history of falls, and poorer cognitive performance, as measured using Trails B, MVPT, and UFOV subtest 2, were predictive of future at-fault MVC involvement. After adjusting for annual mileage, participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC, those who made four or more errors on the MVPT were 2.10 times as likely to crash, those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash, and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC. Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs. CONCLUSION: Performance-based cognitive measures are predictive of future at-fault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High-risk older drivers can be identified through brief, performance-based measures administered in a MVA setting.     

Predictive Validity of the RIASI: Alcohol and Drug Use and Problems Six Months Following Remedial Program Participation

The ability of screening instruments for convicted drinking drivers to predict subsequent alcohol and drug-related problems rarely has been studied. The predictive validity of the Research Institute on Addictions Self-Inventory (RIASI) was investigated in a sample of 6,003 convicted drinking drivers who were participating in Back on Track (BOT), Ontario's remedial measures program for convicted drinking drivers. All BOT participants complete an assessment (which includes the RIASI), followed by a brief education or treatment program, and concluded 6 months later by a follow-up interview. The follow-up interview collects information on self-reported alcohol and other drug use and problems, and contacts with other health care providers in the 90 days prior to the follow-up contact. The ability of scores on the RIASI to predict these measures was assessed. The results revealed that, for almost all comparisons, individuals who used alcohol and other drugs, reported more substance-related problems at follow-up, and reported more contacts with other health and addictions providers had significantly higher scores on the RIASI total score and the RIASI recidivism scale at the initial assessment. The data indicate that this instrument appears to be able to identify individuals who will experience alcohol and drug related problems in the future.     

Assessment of Adaptive Transportation Technology: A Survey of Users and Equipment Vendors

In order to define the state of adaptive transportation equipment, wheelchair users with spinal cord injury (SCI) and equipment vendors were surveyed about equipment, funding, maintenance, and repair. SCI registries from two states, Virginia and Arkansas, were used to create the sample pool of users and 225 responses were received. A list of equipment vendors and vehicle modifiers was compiled from several national resources, and 123 responses were received from 36 states. User respondents were generally satisfied with their adaptive equipment, which typically required only minor inexpensive (<$100) repairs, if any. Personal or family money was used by over 90% of the respondents for equipment funding. Vendors reported that a substantial amount of custom modification or fabrication of equipment is required to meet the needs of their clients. Lifts, external controls, and six-way power seats were cited by vendors as the equipment requiring the most frequent repair. The survey results provide an examination of the opinions and experiences of users and vendors of adaptive transportation equipment, which should prove useful to those involved in evaluating equipment, equipment availability, and the need for industry-wide standards.