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Symbolic reasoning about myocardial scintigrams in PROLOG.

PROLOG (PROgramming in LOGic) is the declarative programming language at the heart of the Japanese fifth-generation computer project. It is proposed that PROLOG is a suitable tool for symbolic image processing, once standard preprocessing has been done. In the present application, the problem of prediction of coronary anatomy from myocardial scintigrams is addressed. Uncertainty is dealt with by a combination of fuzzy-set theoretic and probabilistic reasoning. Heuristic classification rules are based on clinical experience and on a set of 247 myocardial scintigrams with their corresponding coronary angiograms.

Artificial Intelligence

Structured spreadsheet modeling in medical decision making and research.

The construction, evaluation, implementation, and use of models representing various algorithms, strategies, methods, theories etc. based on the analysis of great amounts of data are necessary in both Medical Research and Decision Making (MR/DM). Performing such tasks manually is not only time consuming and tedious, but also very error-prone. The appearance of a computer with its ability to store and process information has opened an opportunity to facilitate enormously and improve activities. However, the effective use of computers is limited by difficulties accompanying noncomputer specialists like doctors, nurses, and other medical staff in learning and using conventional programming languages, tools, and techniques. In this paper we present Structured Spreadsheet Modeling as a possible solution, and show that it is applicable in the MR/DM field on a concrete basis.

Adolescent

A microcomputer data base system for an in vitro fertilization clinic programmed in BASIC.

A computer program was developed for the IBM personal computer to be used for in vitro fertilization and gamete intrafallopian transfer clinics. This program, written in BASIC, allows input, editing, updating, sorting, and printing of patient data. Statistical functions permit summation of patient data based on various combinations of user-defined treatment cycles, diagnoses, and protocols, thus making possible comparison of pregnancy and other patient data between and among various treatment groups and diagnoses. The statistical information can be continually updated and revised when new data become available on patients (such as confirmation of pregnancy by ultrasound or live births) and at the end of each cycle. The formats used are useful in assimilating individual clinic data for various surveys and other reporting requirements. The program can be easily modified by anyone with minimal training in the BASIC programming language.

Ambulatory Care Facilities

A decision table and rule based interpretation system for epileptic discharges.

The representation of the various features of waveforms and their correlations, in EEG recording for the diagnosis of different diseases have been carried out by many researchers due to the impact of knowledge based on expert systems development tools and techniques. The realisation of these system requires a specific hardware and software tool for its implementation, which may be a costly affair. The design and development of low cost effective system for the diagnosis of epileptic patients have been reported in this paper. Two different and linked (at certain stage) approaches (i) decision table; (ii) rule based system have been followed to model the reasoning processes of physician in the diagnosis. In the decision table the features of specific waveforms of EEG are represented in the tabular form. The features are obtained from a 8086 microprocessor based data acquisition system. The rule based system is designed with IF and THEN form of rules using Turbo-Prolog as programming language tool and is implemented on low cost PC-AT. The results obtained are at an intermediate stage of data processing by decision tables and at the final stage being carried out by rule based model. The performance of the system is evaluated by recording of EEG of some epileptic patients. The results obtained are comparable and to a certain extend appreciable in the opinion of the physician.

Decision Support Techniques

[Computer simulation of cell renewal systems].

This paper deals with a block diagram which describes the structure of the control of erythropoiesis by negative feedback loops. The model is transformed into an adequate simulation program using a special block-oriented programming language called ASIM (Analoge SIMulation). For both normal and diseased states of the blood forming process the dynamic responses of the erythrocytes and reticulocytes are simulated by a digital computer analysis. The computer simulation includes different forms of anemia caused by parameter variations as well as by structural alterations. Rising oscillations are obtained too in multiloop control systems containing complex paths with minor loops, which for example take into account the erythrocytic chalones. The described model shows that rising oscillations, that are unstable control loops, can be produced by changing the control-loop structure as well as by parameter changes. In case of malignant disorders such failures becoming effective in oscillations are discussed as parts of disturbed homoeostasis. The results of these studies obtained by simulation should especially stimulate scientists working in the fields of biology and medicine to new test series to verify the proposed hypothesis.

Anemia

Vascular surgical data registries for small computers.

Recent designs for computer-based vascular surgical registries and clinical data bases have employed large centralized systems with formal programming and mass storage. Small computers, of the types created for office use or for word processing, now contain sufficient speed and memory storage capacity to allow construction of decentralized office-based registries. Using a standardized dictionary of terms and a method of data organization adapted to word processing, we have created a new vascular surgery data registry, "VASREG." Data files are organized without programming, and a limited number of powerful logical statements in English are used for sorting. The capacity is 25,000 records with current inexpensive memory technology. VASREG is adaptable to computers made by a variety of manufacturers, and interface programs are available for conversion of the word processor formated registry data into forms suitable for analysis by programs written in a standard programming language. This is a low-cost clinical data registry available to any physician. With a standardized dictionary, preparation of regional and national statistical summaries may be facilitated.

Computers

Application of computer graphics for assessment of spinal deformities.

A graphical portrayal system to assess spinal deformities is described. The system is based on software to display and manipulate three-dimensional images of the spine and trunk surface. Qualitative measurements of internal spinal alignment and trunk appearance are provided. The graphics display is developed using graPHIGS routines in conjunction with the C programming language and the UNIX operating system. This software provides clinicians with a computer-aided measurement tool that rapidly conveys clear and concise information about the deformities associated with abnormal spinal curvatures.

Computer Graphics

A real-time software system on the PDP-11 for two-channel EEG spectral analysis during surgery.

Three functions are performed in real time by a stand-alone PDP-11-assembly language program. First two channels of EEG data are acquired by quantization techniques; second spectral analysis of the EEG data is carried out; third the resulting spectra are displayed as time compressed spectral profiles on an X-Y plotter. The method provides EEG time trends during anesthesia, permitting evaluation of brain functions.

Anesthesia, General

An automated laboratory control system: collection and analysis of behavioral and electro-physiological data.

A system of man-machine interactive PDP-11 assembly language programs is described which presents stimuli to a subject and records and analyzes behavioral and evoked potential data. The system was designed for researchers with no knowledge of computer programming and enables the user to create complicated sequences of stimulus presentations ("trials") and sequences of successive trials ("runs"), with no new programming required. The system is written for DEC.s DECLAB 11/40 system.

Behavior

Software development for the management of cephalometric radiographic data.

This paper presents the details and logic of a set of three IBM System 370 Assembler Language programs designed to manage a data bank, of ever increasing magnitude, which contains coordinate data obtained from cephalometric radiographs. The data from the radiographs, and consequently, the programs, are primarily intended for use by the orthodontist who is engaged in clinical research, and are especially useful in studies related to changes within the facial and dental complexes which occur as a result of growth and orthodontic treatment.

Cephalometry

On-line recording of diffraction pattern changes from single muscle fibers subjected to quick stretch and release.

Transient diffraction pattern parameter and tension responses were recorded from isolated frog semitendinosus muscle fibers subjected to quick stretches and release with an on-line digital acquisition system. The sarcomere length was determined from the zero to first order diffraction line spacing detected with a charge-coupled device photosensing array. Diffraction data was digitized and sequentially stored every 18 ms by a PDP-8 machine language program for later analysis. Sarcomere length, diffraction line intensity, and sarcomere length dispersion were determined with an 8080A microcomputer program incorporating extended math and floating point software packages. Tension records were simultaneously photographed from a storage oscilloscope. Quick stretches and release on tetanically stimulated single skeletal muscle fibers indicated that the transient sarcomere length change occurred in less than 18 ms. Transient tension responses demonstrated a long (150-200 ms) tension recovery phase with no corresponding sarcomere length change. There were no significant alterations in the diffraction line intensity or dispersion following the length perturbations.

Animals

A system for the analysis of long-term electrocardiographic studies in clinical research and training.

A computer system has been developed for the analysis of data from long-term electrocardiographic studies in the context of an institution committed to clinical research and training. The major characteristics required of such a system are intelligence, flexibility, friendliness, and maintainability. These attributes are achieved by a user interface which consists of menus and interactive graphics, and by the use of highly modular software developed in a high-level programming language. The system has been used in studies of the effects of drugs on cardiac arrhythmias and has been easy to learn and convenient to use.

Academies and Institutes

An algorithm to manage variable-length records for highly portable clinical data base systems.

An algorithm to archive patient data at free size in disk storage is presented. A record, assumed to be a character string such as an ASCII-coded text, is compressed and divided into fixed-length blocks. One block consists of a data field and a pointer field, and the blocks comprising a record are chained with pointers forwardly. A head pointer of each record is sequentially saved on a separate file. The data compression is performed as follows: if the same character code appears more than twice in succession, we count the number of the repetitions and save it with initial two characters. The algorithms for fetching, re-saving, and purging a record are also presented. These were implemented in FORTRAN77 and tested for performance using a practical patient data file. As the algorithm allows highly flexible record manipulation and can easily be implemented in conventional programming languages, it will make a useful tool for constructing a portable data base management system.

Evaluation Studies as Topic

Managing research data with self-documenting files.

Processing biomedical research data is frequently complex due to the evolutionary nature of experiments and the requisite modification of analysis software. For the past several years we have been evolving a set of software tools designed to improve our ability to respond to evolving experimental designs. These tools allow the investigator to easily manipulate the research data and specify desired data transformations at run time. Coupling of analysis software to research data files is dependent on data files that are commented in a manner similar to that used in programming languages. The resulting annotated data files are self-documenting, and their use facilitates visual interpretation of displayed data as well as automatic processing of subsets of data. Here we present a formal description of a self-documenting file and describe several software tools that facilitate processing of biomedical research data.

Electronic Data Processing

The dynamics of HIV spread: a computer simulation model.

Mathematical modeling of the AIDS pandemic has been limited by the difficulty of satisfactorily representing the marked behavioral heterogeneity that characterizes the various populations at risk. We propose an approach which models the spread of infection as a discrete-event simulation using SIMSCRIPT, a powerful simulation language. The program developed provides sufficient flexibility to adequately represent and study a wide range of risk-group dynamics. Using this tool we have verified the May-Anderson prediction relating contact rate heterogeneity to the rate of HIV spread. We have also been able to assess the sensitivity of the model to the particular choice of distribution for contact rates, disease stage durations, and intercontact intervals. It is thought that this approach will permit the empirical testing of hypotheses which do not lend themselves to a purely mathematical treatment.

Acquired Immunodeficiency Syndrome

Derivation of rule-based knowledge from established medical outlines.

The purpose of this paper is to describe the derivation of a rule base for an expert system from an existing medical auditing method called a criteria map. The criteria map represents the physician's logic in the specialty involved. The system described, EMERGE, is written in the standard Pascal programming language, operates on a microcomputer, and provides a convenient user-interface. All medical knowledge in EMERGE is contained in an independent set of production rules, which are derived from the criteria map.

Diagnosis, Computer-Assisted

EGTA.

A method is described to compute the free calcium concentration in a solution buffered by EGTA. The effects of solution pH and [Mg] are fully taken into account. A sample program in the C programming language is described.

Calcium

Software control of sensing and stimulation for cardiac electrophysiological study.

A software-controlled cardiac stimulator for clinical investigations is described. The stimulator is programmed by the user at a keyboard, while current status and values of parameters are presented on a visual display screen. A menu of predefined cardiac electrophysiological tests is available for user selection. Validity checks on data keyed in by the user and internal checks on safe pacing limits are incorporated in case of malfunction or user error. The system consists of a separate relatively simple isolated sensing and stimulation unit which communicates, via a standard digital input output interface, with a controlling microcomputer. All timing and control functions are performed in software by the computer. The use of high-level FORTRAN as the main programming language provides the system with a high degree of adaptability.

Computers