BACKGROUND & AIMS: :Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. An Internet search with the keywords "low back pain" has been performed with Google, Yahoo!® and Bing™ in the English language. The top 30 hits obtained with each search engine were evaluated by five independent raters and averaged following criteria derived from previous works. All search results were categorized as declaring compliant to a quality standard for health information (e.g. HONCode) or not and based on the web site type (Institutional, Free informative, Commercial, News, Social Network, Unknown). The quality of the hits retrieved by the three search engines was extremely similar. The web sites had a clear purpose, were easy to navigate, and mostly lacked in validity and quality of the provided links. The conformity to a quality standard was correlated with a marked greater quality of the web sites in all respects. Institutional web sites had the best validity and ease of use. Free informative web sites had good quality but a markedly lower validity compared to Institutional websites. Commercial web sites provided more biased information. News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.

背景与目标： ：以前的调查显示，提供有关下腰痛的健康信息的网站质量很差。但是，Internet内容的快速和持续发展可能会质疑这些调查的当前有效性。本研究旨在定量评估使用最常用的搜索引擎检索到的有关腰痛的Internet信息的质量。 Google，Yahoo！®和Bing™已使用英语进行了关键字为“腰痛”的Internet搜索。每个搜索引擎获得的前30个匹配均由5个独立的评分者进行了评估，并根据从先前工作得出的标准进行了平均。根据网站类型（机构，免费，商业，新闻，社交网络，未知），所有搜索结果均归类为声明是否符合卫生信息质量标准（例如HONCode）。三个搜索引擎检索到的匹配的质量非常相似。该网站的目的明确，易于浏览，并且大多缺乏所提供链接的有效性和质量。在各个方面，对质量标准的符合与网站质量的显着提高相关。机构网站具有最佳的有效性和易用性。与机构网站相比，免费的信息网站质量好，但有效性明显较低。商业网站提供了更多有偏见的信息。新闻网站的设计良好且易于使用，但缺乏有效性。由最常用的搜索引擎检索到的匹配的平均质量可以定义为令人满意，并且可以与以前的调查相媲美。用户关于检查信息质量的意识仍然值得关注。

BACKGROUND & AIMS: OBJECTIVES:Iopentol (Nycomed Imaging AS, Oslo, Norway) and iopromide (Schering AG, Berlin, Germany) are low-osmolar, non-ionic, iodinated contrast media (CM) used in abdominal CT examinations. The intravenous safety profile and radiological efficacy of iopentol and iopromide were studied in 518 patients. Specifically, frequency of adverse events (AEs), subjective change in quality of diagnostic information, and quantitative enhancement characteristics were compared. MATERIALS AND METHODS:A prospective, double-blind, randomized, multicentre, parallel-group study was conducted at 8 hospitals. Patients received 100 ml of either iopentol 300 mg I/ml or iopromide 300 mg I/ml. RESULTS:The incidence of patients with AEs was statistically significantly lower in the iopentol group compared to the iopromide group (2.3% vs. 8.9%, p < 0.001). Discomfort was frequent in both groups (44.8% vs. 49.4%, p = 0.33), sensation of heat and warmth being most common. Overall, diagnostic information was similar in both groups. Both CM gave high percentages of examinations rated as optimal (87.1% vs. 90.5%, p = 0.34) and in which diagnostic confidence was increased (87.5% vs. 91.1%, p = 0.22). No significant differences between the two CM were found concerning quantitative enhancement characteristics. CONCLUSIONS:In this study iopentol was significantly safer than iopromide for contrast enhanced CT examination of the abdomen. Radiological efficacy was similar with both CM.

背景与目标： 目的：Iopentol（Nycomed Imaging AS，挪威奥斯陆）和iopromide（Schering AG，柏林，德国）是用于腹部CT检查的低渗，非离子，碘化造影剂（CM）。研究了518例患者中的碘戊醇和碘普罗胺的静脉内安全性和放射线有效性。具体来说，比较了不良事件（AE）的发生频率，诊断信息质量的主观变化以及定量增强特征。
材料与方法：在8家医院进行了一项前瞻性，双盲，随机，多中心，平行分组的研究。患者接受100 ml的iopentol 300 mg I / ml或iopromide 300 mg I / ml。
结果：与戊普罗米特组相比，碘戊醇组的AE患者发生率在统计学上显着较低（2.3％对8.9％，p <0.001）。两组的不适感都很常见（44.8％vs. 49.4％，p = 0.33），最常见的是热感和温暖感。总体而言，两组的诊断信息相似。两种CM均给出了较高的检查率，被认为是最佳检查（87.1％对90.5％，p = 0.34），并且诊断可信度有所提高（87.5％对91.1％，p = 0.22）。在定量增强特性方面，未发现两个CM之间存在显着差异。
结论：在这项研究中，碘伏特醇比碘普罗胺显着增强腹部CT检查的安全性。两种CM的放射线疗效均相似。

BACKGROUND & AIMS: The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

背景与目标： 这项研究的目的是确定是否定量测量区域性无力增加慢性冠状动脉疾病患者总射血分数的独立的预后信息。在梗死后至少3个月接受门控平衡放射性核素血管造影的466例有Q波心肌梗塞病史的患者的中位持续时间为4.7年。在随访期间，有95人死亡。所分析的五个区域无力指数中有四个与总体死亡率相关。总死亡率和被证明是最佳指标（单变量chi2 = 26.4，p <0.001）之间的关联强度要强于总体射血分数（单变量chi2 = 21.5，p <0.001）。对于总体射血分数<40％的患者，低无反应指数的患者的4年生存率为87％，而无高反应指数的患者的4年生存率为65％（p = 0.016）。综上所述，区域无力指标为整体左心室射血分数增加了独立的预后信息。

BACKGROUND & AIMS: :The identification of essential proteins in protein-protein interaction (PPI) networks is of great significance for understanding cellular processes. With the increasing availability of large-scale PPI data, numerous centrality measures based on network topology have been proposed to detect essential proteins from PPI networks. However, most of the current approaches focus mainly on the topological structure of PPI networks, and largely ignore the gene ontology annotation information. In this paper, we propose a novel centrality measure, called TEO, for identifying essential proteins by combining network topology, gene expression profiles, and GO information. To evaluate the performance of the TEO method, we compare it with five other methods (degree, betweenness, NC, Pec, and CowEWC) in detecting essential proteins from two different yeast PPI datasets. The simulation results show that adding GO information can effectively improve the predicted precision and that our method outperforms the others in predicting essential proteins.

背景与目标： ：蛋白质-蛋白质相互作用（PPI）网络中必需蛋白质的鉴定对理解细胞过程具有重要意义。随着大规模PPI数据可用性的提高，已经提出了许多基于网络拓扑的集中度检测方法来检测PPI网络中的必需蛋白。但是，当前大多数方法主要集中在PPI网络的拓扑结构上，而在很大程度上忽略了基因本体注释信息。在本文中，我们提出了一种新的集中度度量，称为TEO，它通过结合网络拓扑，基因表达谱和GO信息来鉴定必需蛋白质。为了评估TEO方法的性能，我们将其与其他五种方法（度，中间性，NC，Pec和CowEWC）进行比较，以检测来自两个不同酵母PPI数据集的必需蛋白质。仿真结果表明，添加GO信息可以有效地提高预测精度，并且我们的方法在预测必需蛋白质方面优于其他方法。

BACKGROUND & AIMS: :Intrinsic flexibility of DNA has hampered the development of efficient protein-DNA docking methods. In this study we extend HADDOCK (High Ambiguity Driven DOCKing) [C. Dominguez, R. Boelens and A. M. J. J. Bonvin (2003) J. Am. Chem. Soc. 125, 1731-1737] to explicitly deal with DNA flexibility. HADDOCK uses non-structural experimental data to drive the docking during a rigid-body energy minimization, and semi-flexible and water refinement stages. The latter allow for flexibility of all DNA nucleotides and the residues of the protein at the predicted interface. We evaluated our approach on the monomeric repressor-DNA complexes formed by bacteriophage 434 Cro, the Escherichia coli Lac headpiece and bacteriophage P22 Arc. Starting from unbound proteins and canonical B-DNA we correctly predict the correct spatial disposition of the complexes and the specific conformation of the DNA in the published complexes. This information is subsequently used to generate a library of pre-bent and twisted DNA structures that served as input for a second docking round. The resulting top ranking solutions exhibit high similarity to the published complexes in terms of root mean square deviations, intermolecular contacts and DNA conformation. Our two-stage docking method is thus able to successfully predict protein-DNA complexes from unbound constituents using non-structural experimental data to drive the docking.

背景与目标： ：DNA的固有灵活性已阻碍了有效的蛋白质-DNA对接方法的发展。在这项研究中，我们扩展了HADDOCK（高歧义性驱动DOCKing）[C。 Dominguez，R.Boelens和A.M.J.J.Bonvin（2003）J.Am.化学Soc。 125，1731-1737]明确涉及DNA的灵活性。 HADDOCK使用非结构性实验数据来驱动刚体能量最小化，半柔性和水提纯阶段的对接。后者允许所有DNA核苷酸和蛋白质残基在预测界面处具有柔韧性。我们评估了由噬菌体434 Cro，大肠杆菌Lac头饰和噬菌体P22 Arc形成的单体阻遏物-DNA复合物的方法。从未结合的蛋白质和典型的B-DNA开始，我们正确地预测了复合物的正确空间分布以及已发布复合物中DNA的特定构象。该信息随后用于生成预先弯曲和扭曲的DNA结构的库，该库用作第二轮对接的输入。最终的顶级解决方案在均方根偏差，分子间接触和DNA构象方面与已发表的复合物具有高度相似性。因此，我们的两阶段对接方法能够使用非结构性实验数据来驱动对接，从而从未结合的成分中成功预测蛋白质-DNA复合物。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :At present Chinese nurses could not get the up-to-date and high-quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence-based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non-English-speaking countries..

背景与目标： ：由于语言障碍和其他实际困难，目前中国护士无法高效，便捷地获得最新，高质量的证据。该计划建立了一个综合的基于证据的网络信息资源中文网站，用于EBN研究。研究人员希望为非英语国家的护士提供实用的指导和建议。

BACKGROUND & AIMS: UNLABELLED:The objective of this study was to develop an automatic image registration technique capable of compensating for kidney motion in renal perfusion MRI, to assess the effect of renal artery stenosis on the kidney parenchyma. MATERIALS AND METHODS:Images from 20 patients scheduled for a renal perfusion study were acquired using a 1.5 T scanner. A free-breathing 3D-FSPGR sequence was used to acquire coronal views encompassing both kidneys following the infusion of Gd-BOPTA. A two-step registration algorithm was developed, including a preliminary registration minimising the quadratic difference and a fine registration maximising the mutual information (MI) between consecutive image frames. The starting point for the MI-based registration procedure was provided by an adaptive predictor that was able to predict kidney motion using a respiratory movement model. The algorithm was validated against manual registration performed by an expert user. RESULTS:The mean distance between the automatically and manually defined contours was 2.95 ± 0.81 mm, which was not significantly different from the interobserver variability of the manual registration procedure (2.86 ± 0.80 mm, P = 0.80). The perfusion indices evaluated on the manually and automatically extracted perfusion curves were not significantly different. CONCLUSIONS:The developed method is able to automatically compensate for kidney motion in perfusion studies, which prevents the need for time-consuming manual image registration.

背景与目标： 取消标签：这项研究的目的是开发一种能够在肾脏灌注MRI中补偿肾脏运动的自动图像配准技术，以评估肾动脉狭窄对肾脏实质的影响。
材料与方法：使用1.5T扫描仪从计划进行肾脏灌注研究的20位患者中获取图像。自由呼吸的3D-FSPGR序列用于在注入Gd-BOPTA之后获取涵盖两个肾脏的冠状视图。开发了一种两步配准算法，包括使二次方差最小的预配准和使连续图像帧之间的互信息（MI）最大化的精细配准。基于MI的注册过程的起点由自适应预测器提供，该预测器能够使用呼吸运动模型预测肾脏运动。针对专家用户执行的手动注册对算法进行了验证。
结果：自动和手动定义的轮廓之间的平均距离为2.95±0.81 mm，与手动注册程序的观察者间差异（2.86±0.80 mm，P = 0.80）没有显着差异。在手动和自动提取的灌注曲线上评估的灌注指数没有显着差异。
结论：开发的方法能够在灌注研究中自动补偿肾脏运动，从而避免了耗时的手动图像配准。

BACKGROUND & AIMS: :In studies of rhythmic coordination, where sensory information is often generated by an auditory stimulus, spatial and temporal variability are known to decrease at points in the movement cycle coincident with the stimulus, a phenomenon known as anchoring (Byblow et al. 1994). Here we hypothesize that the role of anchoring may be to globally stabilize coordination under conditions in which it would otherwise undergo a global coordinative change such as a phase transition. To test this hypothesis, anchoring was studied in a bimanual coordination paradigm in which either inphase or antiphase coordination was produced as auditory pacing stimuli (and hence movement frequency) were scaled over a wide range of frequencies. Two different anchoring conditions were used: a single-metronome condition, in which peak amplitude of right finger flexion coincided with the auditory stimulus; and a double-metronome condition, in which each finger reversal (flexion and extension) occurred simultaneously with the auditory stimuli. Anchored reversal points displayed lower spatial variation than unanchored reversal points, resulting in more symmetric phase plane trajectories in the double- than the single-metronome condition. The global coordination dynamics of the double-metronome condition was also more stable, with transitions from antiphase to inphase occurring less often and at higher movement frequencies than in the single-metronome condition. An extension of the Haken-Kelso-Bunz model of bimanual coordination is presented briefly which includes specific coupling of sensory information to movement through a process we call parametric stabilization. The parametric stabilization model provides a theoretical account of both local effects on the individual movement trajectories (anchoring) and global stabilization of observed coordination patterns, including the delay of phase transitions.

背景与目标： 在有节奏的协调研究中，感觉信息通常是由听觉刺激产生的，在与刺激同时发生的运动周期中，时空变异性会降低，这种现象称为锚定（Byblow et al。1994）。在这里，我们假设锚定的作用可能是在可能会发生全局协调性变化（例如相变）的条件下，全局稳定协调。为了检验该假设，在双向协调范式中研究了锚定，其中在听觉起搏刺激（以及因此运动频率）在很宽的频率范围内缩放时，产生了同相或反相协调。使用了两种不同的锚定条件：单节拍器条件，其中右手指屈曲的峰值幅度与听觉刺激相吻合；双节拍器状态，其中每个手指的扭转（弯曲和伸展）与听觉刺激同时发生。锚定的反向点显示的空间变化要比未锚定的反向点低，从而在双节拍条件下产生的对称相平面轨迹要比单节拍器条件更对称。双节拍器状态的整体协调动力学也更加稳定，与单节拍器状态相比，从反相到同相的转换频率更低，且移动频率更高。简要介绍了Haken-Kelso-Bunz双手协调模型的扩展，其中包括通过我们称为参数稳定化的过程将感官信息与运动进行特定的耦合。参数稳定模型提供了对单个运动轨迹的局部影响（锚定）和观测到的协调模式的整体稳定的理论解释，包括相变的延迟。

BACKGROUND & AIMS: BACKGROUND:Frailty is the leading prognosticator for poor outcomes and palliative care among older adults. Delivery of negative prognostic information entails potentially difficult conversations about decline and death. OBJECTIVE:The study aims were to: 1) examine hospitalized older adults' and family caregivers' receptivity to general (vs. individualized) prognostic information about frailty, injury, and one-year outcomes; and 2) determine information needs based on prognostic information. DESIGN:Provision of general prognostic information followed by semi-structured interview questions. We deductively analyzed qualitative data within the context of problematic integration theory. SETTING:An academic medical center in the Southeast region of the U.S. PARTICIPANTS:Purposive sampling was utilized to obtain a distribution of patients across the frailty continuum (non-frail [N=10], pre-frail [N=9], frail [9=6]). Twenty-five older adults (≥ age 65) hospitalized for a primary injury (e.g. fall) and 15 family caregivers of hospitalized patients were enrolled. METHODS:Hospitalized older patients and family caregivers were shown prognostic information about one-year outcomes of injured older adults in the form of simple pictographs. Semi-structured interview questions were administered immediately afterwards. The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Demographic and medical information data were used to contextualize the responses during analysis. RESULTS:Overall, participants (patients [56%], caregivers [73%]) were open to receiving prognostic information. A small number of family caregivers (N=3) expressed reservations about the frankness of the information and suggested delivery through a softer approach or not at all. Qualitative data was coded using categories and constructs of problematic integration theory. Four codes (personalizing the evidence, vivid understanding, downhill spiral, realities of aging) reflected probabilistic and evaluative orientation categories of problematic integration theory. One code (fatalism vs. hope) represented manifestations of ambivalence and ambiguity in the theory; and another code (exceptionalism) represented divergence and impossibility. Two codes (role of thought processes, importance of faith) reflected forms of resolutions as described in problematic integration theory. Information needs based on prognostic information revealed four additional codes: give it to me straight, what can I do? what can I expect? and how can I prevent decline? A consistently reported desire of both patients and caregivers was for honesty and hope from providers. CONCLUSION:This study supports the use of general prognostic information in conversations about aging, injury, frailty and patient outcomes. Incorporating prognostic information into communication aids can facilitate shared decision making before end-of-life is imminent.

背景与目标： 背景：虚弱是老年人不良结局和姑息治疗的主要预后因素。阴性预后信息的传递带来了关于衰退和死亡的潜在困难对话。
目的：该研究旨在：1）检查住院的老年人和家庭护理人员对虚弱，受伤和一年预后的一般（相对于个体）预后信息的接受度； 2）根据预后信息确定信息需求。
设计：提供一般预后信息，然后提供半结构化面试问题。我们在问题积分理论的背景下演绎了定性数据。
地点：美国东南部的学术医学中心
参与者：采用有针对性的抽样方法来获得整个脆弱连续体的患者分布（非脆弱[N = 10]，脆弱前[N = 9]，脆弱[9 = 6]）。招募了25名因原发性损伤（例如跌倒）住院的老年人（≥65岁），并招募了15名住院患者的家庭看护人。
方法：以简单的象形文字形式向住院老年患者和家庭护理人员显示有关受伤的成年人一年结局的预后信息。此后立即进行半结构化面试问题。使用定性内容分析对访谈进行录音，转录和分析。人口统计和医学信息数据用于分析期间的响应情况。
结果：总体而言，参与者（患者[56％]，护理人员[73％]）愿意接受预后信息。少数家庭护理员（N = 3）对信息的坦率性表示保留，并建议通过更柔和的方法或根本不采用这种方法。使用有问题的整合理论的类别和构造对定性数据进行编码。四个代码（个性化的证据，生动的理解，下坡的螺旋式增长，衰老的现实）反映了问题整合理论的概率和评估方向类别。一种代码（致命主义与希望）代表了理论中模棱两可和模棱两可的表现。另一个法则（例外主义）代表了分歧和不可能。如有问题的整合理论中所述，两个代码（思维过程，信念的重要性）反映了决议的形式。基于预后信息的信息需求显示了四个附加代码：直接给我，我该怎么办？我能期待什么？以及如何防止下降？患者和护理人员一致报告的愿望是提供者的诚实和希望。
结论：本研究支持在有关衰老，损伤，虚弱和患者预后的对话中使用一般预后信息。将预后信息纳入交流辅助工具可以促进临终前的共同决策。

BACKGROUND & AIMS: OBJECTIVES:This study aimed to assess the pattern of use of EDs, factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or older to a large hospital in Dublin. METHODS:A retrospective analysis of 2 years of data from an urban university teaching hospital ED in the southern part of Dublin was reviewed for the period 2014-2015 (n=103 022) to capture the records of attenders. All ED presentations by individuals 65 years and older were extracted for analysis. Address-matched records were analysed using QGIS, a geographic information systems (GIS) analysis and visualisation tool to determine straight-line distances travelled to the ED by age. RESULTS:Of the 49 538 non-duplicate presentations in the main database, 49.9% of the total are women and 49.1% are men. A subset comprised of 40 801 had address-matched records. When mapped, the data showed a distinct clustering of addresses around the hospital site but this clustering shows different patterns based on age cohort. Average distances travelled to ED are shorter for people 65 and older compared with younger patients. Average distances travelled for those aged 65-74 was 21 km (n=4177 presentations); for the age group 75-84, 18 km (n=2518 presentations) and 13 km for those aged 85 and older (n=2104 presentations). This is validated by statistical tests on the clustered data. Self-referral rates of about 60% were recorded for each age group, although this varied slightly, not significantly, with age. CONCLUSIONS:Health planning at a regional level should account for the significant number of older patients attending EDs. The use of GIS for health planning in particular can assist hospitals to improve their understanding of the origin of the cohort of older ED patients.

背景与目标： 目的：本研究旨在评估在都柏林一家65岁或以上的老年人中，急诊室的使用方式，促成就诊的因素，地理分布和结局。
方法：对都柏林南部城市大学教学医院ED的2年数据进行回顾性分析，回顾性分析了2014-2015年期间（n = 103 022）的数据，以记录与会者的记录。提取了所有65岁及65岁以上的ED演示文稿进行分析。使用QGIS（一种地理信息系统（GIS）分析和可视化工具）对地址匹配的记录进行了分析，以确定随年龄推移到达ED的直线距离。
结果：在主数据库中49到538个非重复的展示中，女性占49.9％，男性占49.1％。由40到801组成的子集具有地址匹配的记录。映射后，数据显示医院地点周围的地址存在明显的聚类，但是该聚类显示了基于年龄组的不同模式。与年轻患者相比，65岁及65岁以上老年人到ED的平均距离较短。 65-74岁年龄段的平均旅行距离为21公里（n = 4177次演讲）；对于75-84岁年龄段的人群来说，每18千米（n = 2518场）和13千米（85岁及以上的人群（n = 2104场）。这可以通过对聚类数据进行统计测试来验证。每个年龄组的自我推荐率约为60％，尽管随着年龄的增长而变化不大，但变化不大。
结论：区域一级的健康规划应考虑到参加急诊急诊的老年患者的数量。尤其是在健康计划中使用GIS可以帮助医院提高对老年ED患者队列起源的了解。

BACKGROUND & AIMS: Background:Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods:For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results:The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions:Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.

背景与目标： 背景：健康信息交换（HIE）经常被认为是健康信息技术投资的重要目标，因为它具有提高质量，降低成本和提高患者满意度的潜力。在本文中，我们从六个高收入和低收入地区中考察了六个国家中HIE的现状和实践。
方法：对于代表的每个国家（中国，英格兰，印度，苏格兰，瑞士和美国），我们参考两种情况描述了HIE的当前实践状况：护理转移和转诊。对于每个国家，我们都讨论了进一步推进临床信息交换的国家目标，障碍和计划。
结果：各国在采用电子病历的水平，适用于HIE的电子形式的健康信息的可获得性以及用于传输的信息技术基础设施方面差异很大。然而，出现了共同的主题，包括期望交换信息而不是重新收集信息，对促进信息交换的激励措施的需求以及对数据安全性和患者机密性的担忧。
结论：尽管几乎总是提到将健康信息传输到最需要的地方的能力，这是采用HIE的优势，但在支持本研究中所用方案的程度上却存在很大差异。然而，这些差异表明，在可比的道路上，进展阶段各不相同，在上述国家中也发现了类似的障碍。在某些情况下，这些已被部分覆盖，而其他地方则需要进行工作。我们思考影响全球不同地区HIE努力的状态和方向的背景因素及其对进展的影响。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN:We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS:We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION:The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

背景与目标： 目的：本研究的目的是确定急诊科（ED）团队与急诊医疗服务（EMS）团队之间协调的主要挑战。
设计：我们以危机情景为焦点小组讨论的基础，进行了包括ED和EMS团队成员在内的一系列焦点小组讨论。我们还收集了组织工作流数据。
结果：我们确定了ED和EMS团队之间的协调面临的三个主要挑战，包括当前信息和通信技术的无效性，缺乏共同点以及信息流崩溃。
讨论：这三个挑战从社会技术的角度突出了设计系统的重要性。特别是，这些团队间的协调系统必须支持社会技术问题，例如两个团队之间的意识，环境和工作流程。

BACKGROUND & AIMS: :Congenital heart defects (CHDs) occur in 8 of 1000 live-born children, making them common birth defects in the adolescent population. CHDs may have single gene, chromosomal, or multifactorial causes. Despite evidence that patients with CHD want information on heritability and genetics, no studies have investigated the interest or knowledge base in the adolescent population. This information is necessary as patients in adolescence take greater ownership of their health care and discuss reproductive risks with their physicians. The objectives of this survey-based study were to determine adolescents' recall of their own heart condition, to assess patient and parent perception of the genetic contribution to the adolescent's CHD, and to obtain information about the preferred method(s) for education. The results show that adolescent patients had good recall of their type of CHD. Less than half of adolescents and parents believed their CHD had a genetic basis or was heritable; however, adolescents with a positive family history of CHD were more likely to believe that their condition was genetic (p = 0.0005). The majority of patients were interested in receiving additional genetics education and preferred education in-person and in consultation with both parents and a physician. The adolescents who felt most competent to have discussions with their doctors regarding potential causes of their heart defect previously had a school science course which covered topics in genetics. These results provide insight into adolescents' perceptions and understanding about their CHD and genetic risk and may inform the creation and provision of additional genetic education.

背景与目标： ：先天性心脏缺陷（CHD）发生在1000个活产儿中的8个中，使其成为青少年人群中常见的先天性缺陷。 CHD可能具有单一基因，染色体或多因素原因。尽管有证据表明冠心病患者希望获得遗传性和遗传学方面的信息，但尚无研究调查青少年人群的兴趣或知识库。由于青春期患者对医疗保健拥有更大的所有权并与医生讨论生殖风险，因此此信息是必要的。这项基于调查的研究的目的是确定青少年对自身心脏病的回忆，评估患者和父母对遗传因素对青少年冠心病的认知，并获得有关首选教育方法的信息。结果表明，青春期患者对CHD类型的记忆良好。不到一半的青少年和父母认为他们的冠心病具有遗传基础或可遗传。然而，患有冠心病家族史的青少年更有可能认为他们的病情是遗传性的（p = 0.0005）。大多数患者有兴趣接受额外的遗传学教育和当面首选的教育，并与父母和医师会诊。那些最有能力与他们的医生就其心脏缺陷的潜在原因进行讨论的青少年，以前曾参加过学校科学课程，内容涉及遗传学主题。这些结果提供了对青少年对冠心病和遗传风险的看法和理解的洞察力，并可能为创建和提供额外的遗传教育提供信息。

BACKGROUND & AIMS: :Pilot implementation is a method for avoiding unintended consequences of healthcare information systems. This study investigates how learning from pilot implementations is situated, messy, and therefore difficult. We analyze two pilot implementations by means of observation and interviews. In the first pilot implementation, the involved porters saw their improved overview of pending patient transports as an opportunity for more self-organization, but this opportunity hinged on the unclear prospects of extending the system with functionality for the porters to reply to transport requests. In the second pilot implementation, the involved paramedics had to print the data they had entered into the system because it had not yet been integrated with the electronic patient record. This extra work prolonged every dispatch and influenced the paramedics' experience of the entire system. We discuss how pilot implementations, in spite of their realism, leave room for uncertainty about the implications of the new system.

背景与目标： ：试点实施是一种避免医疗保健信息系统意外后果的方法。这项研究调查了如何从试点实施中学习，定位，凌乱并因此而困难。我们通过观察和访谈的方式分析了两个试点实施方案。在第一个试点实施中，参与的搬运工将他们对待处理患者运输的总体了解提高为更多自我组织的机会，但是这种机会取决于对系统进行扩展以使搬运工能够响应运输请求的功能的不明确前景。在第二个试点实施中，所涉及的护理人员必须打印他们输入到系统中的数据，因为该数据尚未与电子病历集成在一起。这项额外的工作延长了每次派遣的时间，并影响了整个系统的护理人员的经验。我们将讨论试点实施方案，尽管其具有现实性，但如何为新系统的含义带来不确定性。