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Biomedical subjects

H Gill

Publications and source records attributed to H Gill.

15 recordsLinked to original sources
PubMed1991

Multivariable optimization of mechanical ventilation. A linear programming approach.

The proposed method aims at improved ventilatory care with reduced morbidity. It combines two important aspects of mechanical ventilation: gas exchange and lung mechanics. A single criterion was selected as optimization index of lung trauma: peak respiratory power (PRP) defined as the maximum product of pressure times flow during inspiration. Arterial blood gases reflect gas exchange and constitute the constraints of the problem. The constraints as well as the optimization index are expressed as linear functions of the input variables (frequency of breathing, tidal volume, and positive end expiratory pressure). A linear programming approach can therefore be used to determine the values of input variables that minimize PRP and at the same time keep arterial blood gases within the prescribed limits. The coefficients of the constraints and the optimization index equation are found by manipulating input variables in order to obtain four different values of PaO2, PaCO2 and PRP (there are four coefficients in each equation). The coefficients can then be calculated and the optimization procedure run. In a pilot study 5 patients suffering from diseases of varying pulmonary pathology were investigated with this method. In 4 out of 5 the ventilator treatment improved in terms of blood gas values (mean increase in PaO2 was 4.7%) and reduction of mechanical load on the lungs (mean PRP reduction was 20%). Lower PRP is accompanied by lower mean power and pressure values, which results in increased cardiac output. Presently, the main problem is the time it takes to determine the patient coefficients (approx one hour), a procedure that needs to be simplified.

Acute Disease↗
PubMed1991

Medical logic module (MLM) representation of knowledge in a ventilator treatment advisory system.

In any medical expert system it is the inherent knowledge that is the power of the system and not the particulars of its implementation. Therefore it would be valuable to use a representation that would allow: knowledge transfer between different systems, users, experts and 'importers' to be able to evaluate the logic, experts to easily input their knowledge and be guided how to use the syntax. Adren Syntax of Medical Logic Module is a proposed knowledge representation, fulfilling these criteria. The Arden Syntax has been used to represent rules and logic in a decision support system for ventilator therapy in patients with acute respiratory failure (ARF) that is under development. The medical experts involved in the project have used the Arden Syntax as a convenient way for transfer and storage of medical knowledge. The syntax is easy to learn and may be used with a minimum of training. In the present system, Medical Logical Modules have been used to represent knowledge pertinent to the initiation and maintenance phases of ventilator therapy.

Acute Disease↗
PubMed1990

Integrating knowledge-based technology into computer aided ventilation systems.

A knowledge-based decision support system for respirator treatment, the KUSIVAR system, has been designed in cooperation between hospital, university and industry. Changes in patient data from respirator and monitoring equipment trigger a computer program that generates advice to the staff concerning e.g. therapy modes and respirator settings using expert systems and process control technology. A prototype has been built on an advanced development workstation, the Unisys Explorer, using the software Knowledge Engineering Environment (KEE). The clinical version is implemented on an Intel 80396-based microcomputer connected on-line via a data-acquisition processor to the respirator. The decision support software is implemented as a module under the Microsoft Windows multitasking environment and communicates with modules for data acquisition, database handling and data presentation by means of message passing using the Windows Dynamic Data Exchange protocol. The modules present coherent user interfaces by conforming to Microsoft Windows standards. The knowledge base is being extensively validated by an expert group in the ICU and the system will be evaluated through animal experiments and clinical studies.

Computer Systems↗
PubMed1989

Knowledge base design for decision support in respirator therapy.

A knowledge base is built for decision support applied to respirator therapy (the KUSIVAR project). The knowledge representation is object-oriented using frames to store multiple forms of knowledge: variable descriptions, transformation tables, rules and mathematical models. The system is data-driven, generating and displaying advice automatically triggered by changes in data from the respirator and the patient. The inferenceing mechanism is forward-chaining i.e. a rule is evaluated as soon as it's condition is satisfied. Temporal aspects of the reasoning are represented by a number of mechanisms, among others limited validity times for data, trend analysis and mathematical models. The knowledge base is organized according to disease groups and decision situation which simplifies knowledge acquisition and improves response times since it enables the system to focus on a limited set of rules in each situation. To test the feasibility of the system design a prototype has been built using Knowledge Engineering Environment (KEE) from Intellicorp on an Explorer workstation from Unisys. The production system, which is interfaced to a Siemens Elema Servo Ventilator 900C, is currently being implemented under the Microsoft Windows multitasking environment on a microcomputer based on an Intel 80386 processor.

Decision Support Techniques↗
PubMed1989

A knowledge-based support system for mechanical ventilation of the lungs. The KUSIVAR concept and prototype.

The KUSIVAR is an expert system for mechanical ventilation of adult patients suffering from respiratory insufficiency. Its main objective is to provide guidance in respirator management. The knowledge base includes both qualitative, rule-based knowledge and quantitative knowledge expressed in the form of mathematical models (expert control) which is used for prediction of arterial gas tensions and optimization purposes. The system is data driven and uses a forward chaining mechanism for rule invocation. The interaction with the user will be performed in advisory, critiquing, semi-automatic and automatic modes. The system is at present in an advanced prototype stage. Prototyping is performed using KEE (Knowledge Engineering Environment) on a Sperry Explorer workstation. For further development and clinical use the expert system will be downloaded to an advanced PC. The system is intended to support therapy with a Siemens-Elema Servoventilator 900 C.

Adult↗
PubMed1988

Historical documents concerning craniopagi and conjoined twins.

The occurrence of congenital malformations had been documented by the Assyrian and Babylonians about 2,800 B.C. Historically, a significant source of information concerning conjoined twins were the so called "fugitive sheets" which following the introduction of printing served to disseminate news. The first sonographs with descriptions of congenital defects in human and animals appeared during the 17th century. Teratology became established during the 19th century as a result of the fundamental discoveries in embryology. Significant impetus was given to teratological research in this century following the discovery of GREGG (1941), from observations of the children born to pregnant women who were exposed to the atomic bombs, as well as the thalidomide catastrophe.

Abnormalities, Severe Teratoid↗
PubMed1987

[The history of congenital malformations with special reference to conjoined twins. 1. From ancient times to the 18th century].

Congenital malformations are mentioned in Assyrian and Babylonian literature, and the opinions of Democritus, Empedocles and Aristotle regarding their origin persisted in modified form until the Middle Ages. Following the invention of printing, illustrations of congenital malformations began to appear on pamphlets. Although not always realistic, these illustrations provide a rich source of information regarding the spirit of those times. The first monographs containing collections and interpretations of malformations appeared in the 16th century. These were followed in the 17th century by increasingly realistic illustrations, and superstitious ideas regarding the causes of malformations, although still predominating, gradually started to recede.

Congenital Abnormalities↗
PubMed1987

[The history of congenital malformations with special reference to conjoined twins. 2. The 18th to the 20th centuries].

Thoughts concerning teratology became increasingly scientific in the 18th century, and research into congenital malformations received a considerable impetus through discoveries concerning early embryonic development. The term "teratology" was coined in the 19th century and the introduction of photography enabled truly objective illustrations. Animal experiments were carried out to an increasing extent, the work of Roux and Speman being particularly notable. The great interest in teratological research in the 20th century was stimulated by observation of the effects of viral infection, radioactivity, thalidomide and diosin on embryonal development. This has led to the current major research capacity available to identify the causes of congenital malformation and to prevent them.

Abnormalities, Severe Teratoid↗
PubMed1979

Trend analysis of jaw jerk action potential-amplitude data.

The amplitude of the jaw jerk action potential (MSP) is a parameter with potential diagnostic value. It has apparently a large and irregular variation which has not yet been subjected to a thorough analysis. It is important to know if samples of MSP contain trends. The occurrence of trends indicates that the average value is influenced in a principally different way by changes in the number of observations per sample than if trends do not occur. If, for instance, there is a positive linear trend in the data, this means that the average value is larger if the number of observations is small. Samples of MSPs therefore were recorded, using surface EMG electrodes in the masseter and the anterior temporal muscles of young and elderly subjects, and subjected to trend analysis. Trends of the 1--4th grade occurred in 51% of the samples. Both positive and negative linear trends were found and had about the same frequency. The trend components were, however, randomly distributed. Comparisons between groups may therefore be made without the claim of trend-free samples. This significantly facilitates the use of the parameter MSP-amplitude, since it is difficult to obtain samples which have a normal and identical distribution.

Action Potentials↗
PubMed1979

Standard values of the amplitude of jaw jerk action potential and differences due to age, sex and L-dopa treatment.

The amplitude of the jaw jerk action potential (MSP) is a parameter with possible diagnostic value. Standard values have, however, not yet been established. MSPs were recorded using surface EMG electrodes in the masseter and the anterior temporal muscles of young and elderly healthy males and females. The group means ranged from 0.26 to 2.11 mV in the masseter and from 0.17 to 0.81 mV in the anterior temporalis. The amplitude of MSP was higher in females than in males, decreased in elderly subjects and lower in the temporalis than in the masseter. The jaw jerk action potentials also were recorded in four subjects before and after L-Dopa administration. The amplitude increased by about 90%. It is concluded that the parameter MSP amplitude can be useful in the studies of muscle spindle sensitivity and the influence of various physiological, pathophysiological and pharmacological factors on the nervous regulation and muscle function in the masticatory system.

Action Potentials↗
PubMed1978

The reconstruction of childhood in psychoanalysis.

Reconstructions are defined as genetic propositions showing not only what happened to the individual in childhood, but also how he adopted his particular solutions to conflict situations in the past and how he continues to be guided today by that experience of the past. The relative neglect of environmental failures in psychoanalysis is traced to Freud's shift from physical to psychic reality, although the gains from this shift are acknowledged. The discussion of fantasy and historical fact proceeds to an examination of the case for and the case against the use of reconstructions, and the nature of memory in psychoanalysis. A clinical illustration leads to a synthesis of the conflicting views, emphasizing that both the analyst and the patient need to remain in touch with the past, the current life, and the transference relationship. The paper is concluded with the views of modern historians.

Adult↗
PubMedDate not supplied

Kave: a tool for knowledge acquisition to support artificial ventilation.

A decision support system for artificial ventilation is being developed. One of the fundamental goals for this system is the application of the system when a domain expert is not present. Such a system requires a rich knowledge base. The knowledge acquisition process is often considered to be the bottleneck in acquiring such a complete knowledge base. Since no single available method, for example interviewing domain experts, is sufficient for removing this bottleneck, we have chosen a combination of different methods. The different backgrounds of knowledge engineers and domain experts could cause communication restrictions and difficulties between them, e.g. they might not understand each others knowledge domain and this will affect formulation of the knowledge. To solve this problem we needed a tool which supports both the knowledge engineer and the domain expert already from the initial phase of developing the knowledge base. We have developed a knowledge acquisition system called KAVE to elicit knowledge from domain experts and storing it in the knowledge base. KAVE is based on a domain specific conceptual model which is a result of cooperation between knowledge engineers and domain experts during identification, design and structuring of knowledge for this domain. KAVE includes a patient simulator to help validate knowledge in the knowledge base and a knowledge editor to facilitate refinement and maintenance of the knowledge base.

Artificial Intelligence↗
PubMedDate not supplied

Statistical models for prediction of arterial oxygen and carbon dioxide tensions during mechanical ventilation.

The possibility of constructing statistical models for prediction of alveolar oxygen and carbon dioxide tensions has been investigated in 20 mechanically ventilated patients in acute respiratory failure (ARF). Linear multiple regression analysis using PaCO2 and PaO2 as dependent variables was used to construct (a) models for individual patients, (b) models for specific diagnostic groups and (c) general models (all patients). The coefficient of determination (R2) was highest for the individual patient models (0.38-0.99) and lowest for the general models (0.28-0.49). In order to achieve a high predictive accuracy, models matching individual patients should be constructed on the basis of initial invasive blood gas measurement. Statistically derived models may bring better understanding of the behaviour of factors influencing arterial gas tensions in ARF and may be of value in the management of patients on mechanical ventilation.

Adult↗