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Biomedical subjects

D P Connelly

Publications and source records attributed to D P Connelly.

At least 19 recordsLinked to original sources
PubMed2005

Spatially complex distribution of dissolved manganese in a fjord as revealed by high-resolution in situ sensing using the autonomous underwater vehicle Autosub.

Loch Etive is a fjordic system on the west coast of Scotland. The deep waters of the upper basin are periodically isolated, and during these periods oxygen is lost through benthic respiration and concentrations of dissolved manganese increase. In April 2000 the autonomous underwater vehicle (AUV) Autosub was fitted with an in situ dissolved manganese analyzer and was used to study the spatial variability of this element together with oxygen, salinity, and temperature throughout the basin. Six along-loch transects were completed at either constant height above the seafloor or at constant depth below the surface. The ca. 4000 in situ 10-s-average dissolved Mn (Mnd) data points obtained provide a new quasi-synoptic and highly detailed view of the distribution of manganese in this fjordic environment not possible using conventional (water bottle) sampling. There is substantial variability in concentrations (<25 to >600 nM) and distributions of Mnd. Surface waters are characteristically low in Mnd reflecting mixing of riverine and marine end-member waters, both of which are low in Mnd. The deeper waters are enriched in Mnd, and as the water column always contains some oxygen, this must reflect primarily benthic inputs of reduced dissolved Mn. However, this enrichment of Mnd is spatially very variable, presumably as a result of variability in release of Mn coupled with mixing of water in the loch and removal processes. This work demonstrates how AUVs coupled with chemical sensors can reveal substantial small-scale variability of distributions of chemical species in coastal environments that would not be resolved by conventional sampling approaches. Such information is essential if we are to improve our understanding of the nature and significance of the underlying processes leading to this variability.

Environmental Monitoring↗
PubMed2003

Discovery of abundant hydrothermal venting on the ultraslow-spreading Gakkel ridge in the Arctic Ocean.

Submarine hydrothermal venting along mid-ocean ridges is an important contributor to ridge thermal structure, and the global distribution of such vents has implications for heat and mass fluxes from the Earth's crust and mantle and for the biogeography of vent-endemic organisms. Previous studies have predicted that the incidence of hydrothermal venting would be extremely low on ultraslow-spreading ridges (ridges with full spreading rates <2 cm x yr(-1)-which make up 25 per cent of the global ridge length), and that such vent systems would be hosted in ultramafic in addition to volcanic rocks. Here we present evidence for active hydrothermal venting on the Gakkel ridge, which is the slowest spreading (0.6-1.3 cm x yr(-1)) and least explored mid-ocean ridge. On the basis of water column profiles of light scattering, temperature and manganese concentration along 1,100 km of the rift valley, we identify hydrothermal plumes dispersing from at least nine to twelve discrete vent sites. Our discovery of such abundant venting, and its apparent localization near volcanic centres, requires a reassessment of the geologic conditions that control hydrothermal circulation on ultraslow-spreading ridges.

Journal Article↗
PubMed2001

Contamination of the coastal waters of Bermuda by organotins and the triazine herbicide Irgarol 1051.

A study of the distribution of the 'booster' biocide 2-methylthio-4-tert-butylamino-6-cyclopropyl amino-s-triazine (Irgarol 1051) was carried out in the coastal waters of Bermuda. Irgarol 1051 concentrations (as determined by GC/MS) up to 590 ng l-1 have been measured within Hamilton Harbour. The data presented herein unequivocally demonstrate contamination of the coastal system of Bermuda by Irgarol 1051. Concurrently, TBT concentrations were measured and results indicate that levels are falling through legislated changes in antifouling treatments, from 220 ng l-1 in 1990 to < 20 ng l-1 (as Sn) by 1995, in the open water area of Hamilton Harbour. Concentrations of TBT immediately offshore from a boatyard were found to be > 600 ng l-1 (Sn), indicating continuing release due to painting operations and sediments in the area.

Bermuda↗
PubMed1999

Integrating integrated laboratory information into health care delivery systems.

Attention to integration of laboratory data and its integration into clinical processes and enterprises can help make the laboratory's work a more integral part of clinical practice. The resulting integration holds great potential for improving the quality and effectiveness of care and adding to the clinical value of the laboratory work.

Clinical Laboratory Information Systems↗
PubMed1997

The impact of anticipatory patient data displays on physician decision making: a pilot study.

Computerized patient records have long offered the promise of facilitated access to patient data for clinical decision-making. Nonetheless, the decision process benefits of improved patient data access have been poorly quantified by prior informatics research. We conducted a pilot study to test the feasibility of study methods and gather data for the planning of a future clinical trial designed to assess the impact of patient data summary displays on serum lipid test interpretation time, on targeted data retrieval time for related data, and on decision quality. The pilot demonstrated feasibility and high face validity of the decision-making simulation methods used. Problem-focused patient data summaries appear to reduce time-based decision performance measures by 40-50%, and may improve decision quality even without the inclusion of knowledge-based recommendations or guideline representations.

Data Display↗
PubMed1997

Outcomes and informatics.

OBJECTIVE: To provide an overview of the potential contribution that informatics can make for pathologists who become involved in outcomes assessment and management. DATA SOURCES: Contemporary scientific articles centered on pathologists and the assessment of outcomes, the definitions of outcomes assessment and management, and related methodologic issues, especially those pertaining to information technology and outcomes, and a summary of eight independent group process sessions involving volunteer pathologists and a group facilitator discussing issues related to informatics and outcomes as structured by a clinical scenario with focusing questions. STUDY SELECTION: Articles reviewed were drawn primarily from the literature published since 1985 and found through Medline key word searches of titles and abstracts; likely articles were then selected for subsequent detailed review on the basis of the abstract's contents. Group process data were drawn from summaries of each of the eight groups as prepared by the facilitator from notes taken during the session by a designated scribe. CONCLUSIONS: It is crucial for pathologists to participate in clinical outcomes studies. Informatics can serve as a tool kit for performing outcomes studies relevant to pathology (eg, collect data or analyze data), or it can be seen as a malleable component of health care processes that can be modified to achieve improved outcomes. Pathologists see many potential avenues for using informatics to leverage the impact that the pathologist and laboratory can have on clinical outcomes. Focusing on some specific informatics learning objectives can help the pathologist become a leader in outcomes studies.

Databases, Factual↗
PubMed1996

The clinical workstation as a means of improving laboratory use.

Driven to make timely decisions, doctors may act with less than all of the relevant patient data. Sub-optimal use of clinical laboratory resources can result. Our clinicians' workstation (CWS) is meant to provide doctors and nurses ready access to laboratory results in a form that makes the data easy to review and use. In addition, the workstation provides immediate feedback regarding blood orders, to encourage appropriate clinical practice. Feedback is based on the medical staff's clinical guidelines that have been incorporated into an embedded expert system. CWS also helps blood bank physicians to monitor, review and control requests for special needs such as irradiated products. Challenges to system acceptance await those trying to bring functional decision support to the clinical environment. Among these are barriers to understanding and cooperation posed by departmental boundaries and interacting professional cultures as well as the politics of hospital-based information systems.

Chemistry, Clinical↗
PubMed1996

Radical improvements in the display of clinical microbiology results: a Web-based clinical information system.

OBJECTIVE: To evaluate the performance of a novel computerized system for reporting clinical microbiology results. The new system provides a summarized overview of a patient's current (or past) microbiological status, with the option to selectively explore in greater depth. It is deployed using World Wide Web technology, which supports virtually any kind of computer and allows physicians to obtain results via the internet using personal computers in the office or at home. METHODS: In an unblinded crossover study at a university-affiliated medical center, participants used both the new system and a conventional display system to retrieve selected microbiology results for two actual patients, according to standardized questionnaires, with balanced allocation of sequence of system use. Participants also subjectively rated the two systems. The participants were 16 physician, pharmacist, and nurse volunteers. Outcome measures included completion time and number of errors (categorized as major and minor) associated with results retrieval, and participants' ratings of the new system. RESULTS: Mean completion time was 45% shorter (13.9 versus 25.5 minutes; P < 0.001), and there were fewer associated major errors (0 versus 13; P = 0.01) and minor errors (10 versus 21; P = 0.003) with the summarized display system. All participants rated the new system as easier to learn and use than the conventional system. CONCLUSIONS: A system that appropriately summarizes and groups microbiology results can significantly shorten retrieval times and reduce interpretive errors, while providing users with information needed for cost-effective therapy. Such a system can be deployed by leveraging the rapidly evolving technology of the World Wide Web.

Academic Medical Centers↗
PubMed1996

Closing the clinical laboratory testing loop with information technology.

Information technology can enhance the effectiveness of the part of the laboratory testing loop that occurs outside of the clinical laboratory. That external component involves the presentation of laboratory results and related information to physicians and the reception of physician requests for follow-up testing. Improvements made in the clinician-computer interface can conceivably enhance the quality of information transfer of this part of the testing loop and thereby improve the effectiveness of the entire loop. Our experience has been that results presentation is easier to address than order reception and that the economic benefits from improved result presentation can be substantial. Improving order reception requires more finesse, especially with the limitations of today's health systems and their information systems in mind. For instance, effective computer-based management of prospectively developed orders (eg, clinical protocols) not only can have a substantial positive impact on test use, but is actually welcomed by clinicians. Application of information technology at the clinician-computer interface has good potential to foster more appropriate use of clinical laboratory resources.

Clinical Laboratory Information Systems↗
PubMed1995

Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change.

Implementation of practice guidelines remains problematic in spite of enormous efforts to develop and disseminate them, to establish their credibility, and to create incentives for physicians to adopt them. These strategies have failed to systematically change physician behavior because they do not address the involuntary time and mental processing constraints that have been clearly demonstrated to hamper physicians' ability to comply with guidelines. Computerized patient record systems directly address these constraints, and evidence is mounting that they are effective tools for changing physician behavior. A properly configured computerized patient record system provides decision support, facilitates work flow, and enables the routine collection of data for performance feedback. A synthesis of relevant research from the domains of practice guidelines and medical informatics strongly suggests that the operational support provided by computerized patient record systems will have a major impact on physician compliance with practice guidelines.

Ambulatory Care Information Systems↗
PubMed1995

A clinician's workstation for improving laboratory use. Integrated display of laboratory results.

Physicians are often forced to make decisions about the use of laboratory resources without adequate access to earlier results and related supporting information. Less than optimal use of the laboratory may result. The authors developed and deployed a clinical workstation meant to provide ready access to laboratory information that is presented in a format well-matched to the patient monitoring task. The workstation was one element of a multifaceted effort to improve blood component use in adult and pediatric bone marrow transplantation units. It was the sole intervention focused on improving laboratory testing. In the 2 years since the introduction of the workstation, median charges of bone marrow transplantation cases for laboratory test fell by 32%. This reduction in charges has been maintained for 2 years. Better informed physicians appear to use laboratory resources more sparingly.

Clinical Laboratory Information Systems↗
PubMed1995

Computerized decision support systems in primary care.

Computerized decision support can be passive or active. Passive decision support occurs when a computer facilitates access to relevant patient data or clinical knowledge for interpretation by the physician. Examples include CPR systems and reference texts or literature databases on CD-ROM. Effective passive decision support may ultimately prove to have a significant impact on physician decision making, but its potential to do so has been largely unexplored. Active decision support implies some higher level of information processing, or inference, by the computer. Examples include reminder / alert systems and diagnostic decision support systems. Inference processing in active decision support systems is generally rule-based, but probabilistic inference has been successfully used as well. Reminder systems have been consistently demonstrated to improve dramatically physician guideline compliance, generally by reducing oversight or error. The same potential for large-scale, systematic impact on physician decision-making by diagnostic decision support systems probably does not exist, but these systems may prove to be extremely useful in individual cases. Current applicability of diagnostic decision support systems to primary care is limited by the incompleteness and inaccuracies of the knowledge bases of these systems with respect to primary care. The applicability of computerized decision support in general to primary care is limited by more practical considerations. Widespread computerized decision support will not occur without CPR systems coupled with appropriate data standards and nomenclatures that will permit decision support tools to be accessed effortlessly during the routine process of patient care.

Clinical Medicine↗
PubMed1995

Integrating legacy laboratory information systems into a client-server world: the University of Minnesota Clinical Workstation (CWS) project.

The development of an innovative clinical decision-support project such as the University of Minnesota's Clinical Workstation initiative mandates the use of modern client-server network architectures. Preexisting conventional laboratory information systems (LIS) cannot be quickly replaced with client-server equivalents because of the cost and relative unavailability of such systems. Thus, embedding strategies that effectively integrate legacy information systems are needed. Our strategy led to the adoption of a multi-layered connection architecture that provides a data feed from our existing LIS to a new network-based relational database management system. By careful design, we maximize the use of open standards in our layered connection structure to provide data, requisition, or event messaging in several formats. Each layer is optimized to provide needed services to existing hospital clients and is well positioned to support future hospital network clients.

Artificial Intelligence↗
PubMed1995

The deployment of a World Wide Web (W3) based medical information system.

The development of Web technologies has revolutionized information dissemination on the Internet. The University of Minnesota Hospital and Clinic's Web Clinical Information System (CIS) demonstrates the use of the Web as an infrastructure for deploying a medical information system at a fraction of the developmental cost of more traditional client server systems. This Web CIS has been deployed since December 1994. It makes available laboratory results, including a radically improved clinical microbiology reporting system, ad hoc laboratory order entry, and an embedded expert system protocol laboratory ordering system. It provides these services to any physician or patient care area with TCP (or SLIP/PPP) connection to our hospital network backbone, whether the client computer is running MS Windows, the Macintosh OS, or X-Windows. A formal evaluation of one of this systems subcomponents, the display of clinical microbiology information, demonstrated a significant savings in clinician time (43% p < .001) and substantial reduction in interpretive errors (0 vs 15 p < .01).

Clinical Laboratory Information Systems↗
PubMed1993

Cross-validation of protein structural class prediction using statistical clustering and neural networks.

We present an approach to predicting protein structural class that uses amino acid composition and hydrophobic pattern frequency information as input to two types of neural networks: (1) a three-layer back-propagation network and (2) a learning vector quantization network. The results of these methods are compared to those obtained from a modified Euclidean statistical clustering algorithm. The protein sequence data used to drive these algorithms consist of the normalized frequency of up to 20 amino acid types and six hydrophobic amino acid patterns. From these frequency values the structural class predictions for each protein (all-alpha, all-beta, or alpha-beta classes) are derived. Examples consisting of 64 previously classified proteins were randomly divided into multiple training (56 proteins) and test (8 proteins) sets. The best performing algorithm on the test sets was the learning vector quantization network using 17 inputs, obtaining a prediction accuracy of 80.2%. The Matthews correlation coefficients are statistically significant for all algorithms and all structural classes. The differences between algorithms are in general not statistically significant. These results show that information exists in protein primary sequences that is easily obtainable and useful for the prediction of protein structural class by neural networks as well as by standard statistical clustering algorithms.

Algorithms↗
PubMed1993

The relationship between nursing and medical cultures: implications for the design and implementation of a clinicians' workstation.

The culture of different professions is manifest in how members relate to each other and in how they organize and store data and information. For developers of clinical workstations intended to support not only the independent tasks but also the interdependent tasks of multiple health professionals, recognition of cultural differences among groups of health care professionals may be of great importance. Allowance for and adaptation to these differences are likely to be important for both acceptance and effective use of clinical workstations. Examples are drawn from Nursing and Medicine based on a clinician's workstation currently in use and undergoing continuous development.

Clinical Medicine↗