Guardian System Research Articles

Ethics and Skeptics: What Lies Behind Ethical Codes in Occupational Health

Ethical codes, or systems, are conditioned and their enforcement is permitted by social processes and attitudes. In occupational health, our efforts to adhere to our own ethical frameworks often are undermined by forces and interests outside the field. Failure to acknowledge the profoundly social nature of ethical codes impedes our ability to anticipate consequences, to legitimate decisions based on utility and benefit, and to find social structures that support, rather than invalidate, our view of ethical behavior. We examine three sets of social philosophies. Jane Jacobs, the visionary urban planner, has written Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics, which is a restatement in modern terms of a critical passage in Plato's most important dialogue, the Republic. She (and Plato) postulate two major ethical systems, renamed here the "guardian system," which is characterized by loyalty, cohesiveness, and confidentiality, and the "marketplace system," which is characterized by trade, decentralization, and shared information. Occupational health, in this formulation, often runs afoul of the guardian mentality and also may be subject to inappropriate negotiation and compromise in the marketplace system. George Lakoff, a semiotician, has written Moral Politics: What Conservatives Know That Liberals Don't, which argues that there are two fundamental social paradigms based on concepts of the family. One, which he calls the Strict Father, emphasizes discipline, the positive aspects of taking risks, and the need to individuals to be self-sufficient. The other, which he calls the Nurturing Parent, emphasizes empowerment, the positive aspects of security, and the need for community and relationships. Occupational health practice violates aspects of both and therefore is supported by neither. Classical Chinese thought involved many schools of thought, including Confucianism and Legalism. It has been suggested that Confucianism provides little support for government regulation or occupational health, however this is questioned. Occupational health may improve its standing as a social priority by recognizing and maneuvering within social frameworks that accomodate it, rejecting social frameworks that invalidate it, and reinforcing positive cultural trends within society that support it.

特別養護老人ホームにおける痴呆性高齢者の意思決定と医療の現状

Medical decision-making involving elderly people with dementia often troubles care providers in Japan. Meanwhile, little attention has been paid to the routine medical care of nondementia illnesses in such patients. To understand the current situation surrounding the issue, we conducted a postal survey with nursing home directors across the nation. A self-administered questionnaire was sent to 1,117 randomly selected nursing homes, one third of all such facilities in Japan, and 502 (44.9%) responded. Of the respondents, 291 (58.0%) said more than a half of their residents have difficulties in daily life because of dementia. Less than 20% of the facilities said that they routinely confirm residents' preferences in writing when they are admitted concerning each of the following items; terminal care, medical information disclosure, leaving a will, funerals and application for the guardian system. 206 (41.0%) facilities have difficulties in finding a hospital for the elderly with dementia when necessary. The Mann-Whitney U test showed no significant relation between facilities' characteristics and their difficulties in finding a hospital that would admit demented patients. At present, a number of nursing homes confirm their residents' preferences only some time after they are admitted. However, the way of confirming seems inappropriate under the circumstances in which more than a majority of residents have difficulties in daily life due to dementia. Though more than a half of nursing homes have difficulties in finding a hospital that would admit dementia patients, no significant relation was found between the difficulties and the facility-hospital relation. The problem seems to lie in the acceptance mechanism of hospitals.

Adult Guardian System and Protection of the Elderly

As the elderly increase in the Japanese population, the government, on the one hand, has enacted a series of statutes to provide care for the elderly. Adult Guardian Laws, passed in April 2000, are typical examples of the statutes of this kind. On the other hand, however, the restoration of fiscal balance, the primary objective in the present policy of the Japanese government, causes marked reduction of the budget for elderly care. Perceiving this change of governmental policy, a recent Senryu* verse goes as follows:“Ye elderly, die please-for the sake of thy country”. True to this verse, the elderly will not be able to sustain their lives, if the contemporary fiscal policy is pushed further. One may even say that this policy seeks the demise of Japanese elder generation. How would the government answer this criticism? How should we, the seniors, cope with this present situation? In this paper, I would like to ask this question to my colleagues. *Senryu is a traditional Japanese satirical verse of 17 syllables the genre of which in Edo era.

Goals and functions of the human body: an MFM model for fault diagnosis

Describes the use of explicit models of goals and functions for monitoring and diagnosis of intensive-care patients. The method is based on multilevel flow models (MFM) and used in the Guardian system. It provides this system with alarm analysis, fault diagnosis, and automatic generation of explanations. Advantages include a relatively easy knowledge engineering effort and good properties for use in a system with hard real time deadlines. The results of some experiments are also reported.

Instantiating and Monitoring Skeletal Treatment Plans

Current emphasis on protocol-based care has stirred interest in planning research as applied to clinical medicine. However, many assumptions made in designing traditional planners and plan-execution algorithms do not hold in medical domains. The problems include the unpredictable nature of the domain, uncertainty and the variability in the utility of available actions, and the need for parallel and continuous execution of treatment plans. In the context of our research on intelligent monitoring and control, we developed an approach for plan instantiation and execution which takes advantage of readily available treatment protocols. The system, named SPIN, instantiates treatment protocols based on current context, executes plans and closed-loop control actions, monitors the execution of plans and actions, and modifies plan execution as necessitated by patient response. The system is incorporated in the Guardian system for intensive-care patient monitoring and control. We address the strengths and limitations of the representation and the execution framework and discuss how the methodology may be improved and used in clinical practice.

A Multilevel Flow Model of the Human Body

This paper describes explicit models of goals and functions used for monitoring, diagnosis, and closed-loop control of intensive-care patients. The method is based on multilevel flow models, (MFM), and used in the Guardian system. MFM provides Guardian with alarm analysis, fault diagnosis, and automatic generation of explanations. The advantages of using MFM are a comparatively easy knowledge engineering and good properties for a system which operates under hard real-time deadlines.

Software dependability in the Tandem GUARDIAN system

Based on extensive field failure data for Tandem's GUARDIAN operating system, the paper discusses evaluation of the dependability of operational software. Software faults considered are major defects that result in processor failures and invoke backup processes to take over. The paper categorizes the underlying causes of software failures and evaluates the effectiveness of the process pair technique in tolerating software faults. A model to describe the impact of software faults on the reliability of an overall system is proposed. The model is used to evaluate the significance of key factors that determine software dependability and to identify areas for improvement. An analysis of the data shows that about 77% of processor failures that are initially considered due to software are confirmed as software problems. The analysis shows that the use of process pairs to provide checkpointing and restart (originally intended for tolerating hardware faults) allows the system to tolerate about 75% of reported software faults that result in processor failures. The loose coupling between processors, which results in the backup execution (the processor state and the sequence of events) being different from the original execution, is a major reason for the measured software fault tolerance. Over two-thirds (72%) of measured software failures are recurrences of previously reported faults. Modeling, based on the data, shows that, in addition to reducing the number of software faults, software dependability can be enhanced by reducing the recurrence rate.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

Guardian: A prototype intelligent agent for intensive-care monitoring

Effective monitoring of device-supported patients in the intensive care unit (ICU) is complex, involving interpretation of many variables, comparative evaluation of many therapy options, and control of many patient-management parameters. Even skilled clinicians make errors that limit the quality of care, harm patients, or cause life-threatening situations. A growing body of research aims to improve ICU monitoring with computer technology. Most of this research falls in two areas: (a) short-term engineering of practical solutions to narrowly defined immediate problems (e.g. smart alarm systems); or (b) basic research on fundamental issues potentially relevant to ICU monitoring (e.g. temporal reasoning). By contrast, our project aims to develop a more comprehensive ‘intelligent agent’, having a broad range of capabilities, to cooperate on the ICU team. We do not aim to produce a practical system suitable for near-term deployment in the ICU, but rather a ‘proof of concept’, an experimental system that: (a) demonstrably performs and coordinates a range of intelligent reasoning tasks of use in ICU monitoring; (b) does so reliably in a significant range of medical situations; and (c) arguably will scale up to meet the comprehensive set of practical requirements with an appropriate development effort. We have developed an experimental system called Guardian, which exhibits several of the required capabilities and utilizes an underlying architecture hypothesized to support the full range of required capabilities. In this paper, we describe the Guardian system, its architecture, and its current knowledge base. We describe its performance and summarize the results of preliminary evaluations. Finally, we discuss ongoing and planned research on Guardian.

Architectural foundations for real-time performance in intelligent agents

Intelligent agents perform multiple concurrent taks requiring both knowledge-based reasoning and interaction with dynamic entities in the environment, under real-time constraints. Because an agent's opportunities to perceive, reason about, and act upon the environment typically exceed its computational resources, it must determine which operations to perform and when to perform them so as to achieve its most important objectives in a timely manner. Accordingly, we view the problem of real-time performance as a problem in intelligent real-time control. We propose and define several important control requirements and present an agent architecture that is designed to address those requirements. The proposed architecture is a blackboard architecture, whose key features include: distribution of perception, action, and cognition among parallel processes, limited-capacity I/O buffers with best-first retrieval and worst-first overflow, dynamic control planning, dynamic focus of attention, and a satisficing execution cycle. Together, these features allow an intelligent agent to trade quality for speed of response under dynamic goals, resource limitations, and peformance constraints. We illustrate application of the proposed architecture in the Guardian system for surgical intensive care monitoring and contrast it with alternative agent architectures.

Effect of Law Guardian Representation on the Treatment of Delinquent Children

■ This paper describes the problems created by New York State's system of law guardian representation of delinquent children in juvenile court proceedings. The May 1967 decision by the United States Supreme Court, which mandated constitutional guarantees of the rights of delinquent children, may encourage other states to adopt this system. Therefore, it is especially important that there be an awareness of the damaging effects of the law guardian system on the treatment of children so that these effects may not be inadvertently perpetuated. ■

Guardian System for the Continuous Operation of Large Soxhlet Extractors

The carbon adsorption method is used by the U.S. Public Health Service (USPHS) and other investigators of water quality to recover dissolved organic constituents from water. This process involves the slow passage of water through activated carbon to achieve adsorption. Desorption is accomplished in the laboratory by use of large Soxhlet extractors and requires 24 hrs. or more of extraction. An automatic guardian system, designed to permit safe unattended operation of the apparatus, is described in this article.