Interoperability in healthcare is a requirement for effective communication between entities, to ensure timely access to up to-date patient information and medical knowledge, and thus facilitate consistent patient care. An interoperability framework called the Health Service Bus (HSB), based on the Enterprise Service Bus (ESB) middleware software architecture is presented here as a solution to all three levels of interoperability as defined by the HL7 EHR Interoperability Work group in their definitive white paper "Coming to Terms". A prototype HSB system was implemented based on the Mule Open-Source ESB and is outlined and discussed, followed by a clinically-based example.

Background: Occupational injuries have received limited research attention in the Southern African Development Community.Much of the published data come from South Africa and little has been reported elsewhere within the region.The present study was conducted to estimate the prevalence rates of occupational injuries and compensation; and to determine factors associated with occupational injuries and compensation.Methods: Data were obtained from occupational health and injury questions added to the Zambian Labour Force Survey of 2009 by the Work and Health in Southern Africa programme.Logistic regression analyses were conducted to determine the degree of association between demographic, social and economic factors on one hand and injury and compensation on the other.Results: Data on 61871 study participants were available for analysis, of whom 4998 (8.1%) reported having been injured (10.0% of males, and 6.2% of females) due to work in the previous 12 months to the survey.Of those injured, 60.5% reported having stayed away from work as a result.The commonest type of injury was "open wound" (81.6%).Male gender, being married or married before, being a paid employee, working for a private company and household were positively associated with serious injuries.Injuries also varied by geographical area.Factors positively associated with receiving compensation for work-related injuries were: male gender, Copperbelt and North-Western provinces, and unpaid family worker.Employer/self employed and having less than 5 employees in a workplace were negatively associated with compensation. Conclusion:The prevalence of reported injury and its association with a significant level of absence from work, indicate that occupational hazards in Zambia have significant health and economic effects.Female workers should equally be compensated for injuries suffered as their male counterparts.

Healthcare information is composed of many types of varying and heterogeneous data. Semantic interoperability in healthcare is especially important when all these different types of data need to interact. Presented in this paper is a solution to interoperability in healthcare based on a standards-based middleware software architecture used in enterprise solutions. This architecture has been translated into the healthcare domain using a messaging and modeling standard which upholds the ideals of the Semantic Web (HL7 V3) combined with a well-known standard terminology of clinical terms (SNOMED CT).

Background: Echocardiographic estimation of left ventricular ejection fraction aids in predicting adverse outcomes in coronary artery disease. However, in patients with impaired left ventricular function, further risk stratification is difficult.Methods: A 2 year retrospective review was performed to identify patients with ejection fraction <= 30%. Echocardiographic measures of systolic and diastolic function were independently performed offline. Outcome information, which included MI, stroke, or death, was obtained. The patient cohort identified those with follow-up having 1) a single echocardiogram and a subset 2) with an initial echocardiogram and a second echocardiogram at greater than one year follow-up. Results: This study included 110 patients, ages 20-94. Mean follow-up time was 29 9 months. Ejection fraction did not predict cardiovascular events. LV mass predicted of mortality (p = 0.03). Diastolic indexes of mitral inflow E wave was a significant predictor of outcome (p = 0.05). Impaired diastolic filling grade 2, 3, or 4 showed a 76% event rate. Decreases in ejection fraction at follow-up were seen in those who had an event, with an average decrease in ejection fraction of 17% versus those who lived with no event of 1%. Changes in mitral inflow E wave and changes in E/A ratio were both significant predictors of outcome.Conclusions: These data indicate that echocardiographic measures of both systolic and diastolic function aid in risk stratifying patients with decreased ejection fraction. The changed detected in serial echocardiographic information may be important in treatment and secondary prevention of future events. (c) 2006 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Semantic interoperability in healthcare can be achieved by a tighter coupling of terminology and HL7 message models. In this paper, we highlight the difficulty of achieving this goal, but show how it can become attainable by basing HL7 message models on SNOMED CT concepts and relationships. We then demonstrate how this methodology has been applied to a set of clinical observations for use in the ePOC project, and discuss our findings.

One of the most successful Healthcare Information Models is version 2 of the Health Level 7 (HL7) standard. However, this standard has various problems, mainly its lack of semantic interoperability. This shortfall was addressed in HL7 Version 3, a newer standard which has been designed to solve this problem. Total semantic interoperability cannot be achieved without defined terminology, and to this end the use of the Systemised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) is proposed. The difficulty arrives when deciding how to integrate the information model and the terminology. The line between where one ends and the other begins is often indistinct. This paper describes a proposal for normalising the two using ontology mapping and basing HL7 message models on SNOMED-CT concepts and their relationships, in an effort to further total semantic interoperability and seamless communication between healthcare entities.

Pac-Man is a well-known, real-time computer game that provides an interesting platform for research. We describe an initial approach to developing an artificial agent that replaces the human to play a simplified version of Pac-Man. The agent is specified as a simple finite state machine and ruleset. with parameters that control the probability of movement by the agent given the constraints of the maze at some instant of time. In contrast to previous approaches, the agent represents a dynamic strategy for playing Pac-Man, rather than a pre-programmed maze-solving method. The agent adaptively "learns" through the application of population-based incremental learning (PBIL) to adjust the agents' parameters. Experimental results are presented that give insight into some of the complexities of the game, as well as highlighting the limitations and difficulties of the representation of the agent.