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[A self-adaptable system for acquiring and processing animal ECG parameters].

The present authors have developed a computerized system for acquiring and processing the animal ECG. The system provides many functions in the software design and the users can compile the parameter-analyzing formulae by themselves according to the characteristics of ECG. The system is much more accurate and flexible in analyzing the ECG parameters and can significantly avoid the processing mistakes caused by signal variations and interference. It is especially suitable for continuous ECG monitoring and analysis of animal experiments in physiology, pharmacology and toxicology.

Animals↗

Automated band mapping in electrophoretic gel images using background information.

Some popular methods for polymorphism and mutation discovery involve ascertainment of novel bands by the examination of electrophoretic gel images. Although existing strategies for mapping bands work well for specific applications, such as DNA sequencing, these strategies are not well suited for novel band detection. Here, we describe a general strategy for band mapping that uses background banding patterns to facilitate lane calling and size calibration. We have implemented this strategy in GelBuddy, a user-friendly Java-based program for PC and Macintosh computers, which includes several utilities to assist discovery of mutations and polymorphisms. We demonstrate the use of GelBuddy in applications based on single-base mismatch cleavage of heteroduplexed PCR products. Use of software designed to facilitate novel band detection can significantly shorten the time needed for image analysis and data entry in a high-throughput setting. Furthermore, the interactive strategy implemented in GelBuddy has been successfully applied to DNA fingerprinting applications, such as AFLP. GelBuddy promises to make electrophoretic gel analysis a viable alternative to DNA resequencing for discovery of mutations and polymorphisms.

Algorithms↗

PureMD: a Computerized Patient Record software for direct data entry by physicians using a keyboard-free pen-based portable computer.

This paper describes the data acquisition features of the PureMD Computerized Patient Record (CPR) software designed specifically for physicians. The physician uses a stylus to point, draw and handwrite on a Dynamic Dialog Interface that provides the same flexibility as the paper record and numerous other advantages. The clinical data thus entered is highly organized, easily legible and retrievable in many ways. The underlying Medical Knowledge Base (MKB) was optimized for rapid, intuitive and consistent data entry and automatic coding with minimum handwriting.

Handwriting↗

Artifacts in fetal pulse oximetry: incomplete sensor-to-skin contact.

OBJECTIVE: Our purpose was to investigate apposition of reflectance sensors as a possible source of artifact in fetal pulse oximetry. STUDY DESIGN: A laboratory model was created to examine the effect of varying the distance of a reflectance probe from a subject's finger. The setup used two wavelengths (660 and 940 nm) and pulsatile (AC) and nonpulsatile signals (DC). An investigator's finger was stabilized in a purposely built mold from where the distance between skin and sensors could be varied in 1 mm steps. RESULTS: The AC and DC components of the signal react differently to increasing the distance between sensor and skin. The overall effect is that the ratio [formula: see text] increases with skin to sensor distance, which results in falsely low readings of oxygen saturation. CONCLUSIONS: Poor sensor-to-skin contact in reflectance pulse oximetry may cause false readings despite the presence of good waveforms and hence go unrecognized. Probe and software design needs to be able to identify and exclude such artifact before this technique can become useful for intrapartum fetal monitoring.

Artifacts↗

Advances in imaging of the acute abdomen.

Over the last 10 years, the most significant advancement in imaging of the acute abdomen has been the development of helical CT imaging. Rapid breath-hold imaging and improved intravascular opacification have enabled radiologists to obtain volumetric data that can be viewed in smaller slice increments. Helical data can also be analyzed utilizing multiplanar and three-dimensional techniques. With its proven ability to diagnose a wide variety of conditions, CT remains the diagnostic modality of choice for imaging the surgical abdomen. There have been considerable improvements in image resolution in US with improvements in transducer technology. Ultrasonography often serves as the first study in evaluating the pediatric or female patient with right lower quadrant or pelvic pain. Computed tomography may be necessary if US is not diagnostic. Despite these technical advances, plain film radiography should be the first imaging study for suspected cases of bowel perforation or obstruction. Magnetic resonance imaging continues to evolve, with improvements in hardware and software design that allow for faster imaging, but current levels of availability in the acute setting preclude its wider use. Whereas further imaging is not necessary for patients presenting with classic signs and symptoms of various acute abdominal diseases, the atypical patient often requires careful diagnostic imaging. Close consultation between the radiologist and surgeon leads to studies appropriately tailored to meet the diagnostic challenge at hand.

Abdomen, Acute↗

Dosimetric evaluation of compensation in radiotherapy of the breast: MLC intensity modulation and physical compensators.

BACKGROUND AND PURPOSE: Electronic portal images may be used to design the compensation required to maximise dose uniformity in the breast from opposed tangential beams. MATERIALS AND METHODS: Four methods of implementing the desired compensation have been studied: a simple wedge, a physical compensator in conjunction with a wedge; one open field plus four shaped multi-leaf-collimated (MLC) fields, and one wedged field in conjunction with three shaped MLC fields. Evaluation was performed using thermoluminescent dosimeters (TLDs) placed inside a phantom which was designed to mimic the human breast. The measured results are compared with both the prediction of the in-house compensation design software and with the dose predicted by the GE Target II planning system. The implications of each method for the time taken to plan and deliver treatment were analysed. RESULTS: The dose inhomogeneity, as measured at seven points in the central plane was greatest for the simple wedge (root mean square (rms) = 4.5%) compared to an open field plus four shaped MLC fields (rms = 2.2%), a wedged field plus three shaped MLC fields (rms = 3.3%), and the physical compensator (rms = 2.4%). The times required to plan and prepare these treatments varied considerably. The standard wedged treatment required under 15 min; both MLC-based and the physical compensator treatments required approximately 50 min. Differences of treatment delivery times were up to 8 min. CONCLUSIONS: These results indicate that the dose inhomogeneity can be reduced by beam intensity modulation designed using EPIDs.

Breast↗

Introduction of computerized medical records. A survey of primary physicians.

UNLABELLED: The purpose of the study was to survey primary physicians about the possible impact of computerized medical records on clinical practice. METHODS AND DESIGN: 236 primary care physicians from the Negev health district in Israel, attending a course prior to installation of computerized record keeping, were given two open-ended questions together with a twenty-four statement attitude questionnaire using a five point Likert scale. RESULTS: The beliefs of physicians highlighted the potential that computerized charts can help with office work, prevent loss of information, and facilitate communication between medical staff. On the other hand, the survey indicated that physicians felt its application was not universal and were uncomfortable with the fact that its use is mandatory. There were major concerns relating to how the medical record was displayed, anticipated increase in workload, and presumed extra time needed for data entry. CONCLUSIONS: Most of the physicians surveyed were positive regarding the help that computerized medical records could provide. They were, nevertheless, concerned with the burden of change and adaptation of new technology and software design to clinical practice and its affect on communication.

Attitude of Health Personnel↗

Nonlinear software sensor for monitoring genetic regulation processes with noise and modeling errors.

Nonlinear control techniques by means of a software sensor that are commonly used in chemical engineering could be also applied to genetic regulation processes. We provide here a realistic formulation of this procedure by introducing an additive white Gaussian noise, which is usually found in experimental data. Besides, we include model errors, meaning that we assume we do not know the nonlinear regulation function of the process. In order to illustrate this procedure, we employ the Goodwin dynamics of the concentrations [B. C. Goodwin, (Academic, New York, 1963)] in the simple form recently applied to single gene systems and some operon cases [H. De Jong, J. Comput. Biol. 9, 67 (2002)], which involves the dynamics of the mRNA, given protein and metabolite concentrations. Further, we present results for a three gene case in coregulated sets of transcription units as they occur in prokaryotes. However, instead of considering their full dynamics, we use only the data of the metabolites and a designed software sensor. We also show, more generally, that it is possible to rebuild the complete set of nonmeasured concentrations despite the uncertainties in the regulation function or, even more, in the case of not knowing the mRNA dynamics. In addition, the rebuilding of concentrations is not affected by the perturbation due to the additive white Gaussian noise and also we managed to filter the noisy output of the biological system.

Algorithms↗

Free-D: an integrated environment for three-dimensional reconstruction from serial sections.

Three-dimensional (3D) reconstruction is a powerful tool to investigate complex neuroanatomical organizations. 3D models are often generated by piling up registered segmentations carried out on serial sections labeled by histological means. However, these models suffer limitations (incompleteness and lack of statistical representativity), which can be overcome by model averaging and fusion. These operations require an appropriate reconstruction environment allowing the simultaneous processing of several data sets. This paper describes the first release of Free-D, a software designed for the reconstruction of 3D models generated from stacks of serial sections, in the perspective of model averaging and fusion. A unique graphical user interface integrates the 3D reconstruction tools. Several large stacks (tens of gigabytes) including hundreds of images having heterogeneous characteristics (size, resolution, depth, etc.) can be simultaneously processed, thus complying to most encountered experimental situations. This first version of Free-D constitutes the required environment for the future integration of the averaging and fusion algorithms currently developed in our group and illustrated here with preliminary results.

Algorithms↗

Accuracy of dental digitizers.

UNLABELLED: The need for proper validation and verification methodology for CAD/CAM systems is imminent. CAD/CAM systems consisting of an optical impression system, design software and a fabrication machine have to perform to a certain level, whereby manufacturers need to prove the effectiveness of the system as a whole. However, especially when dental surface digitization devices are used as open, stand-alone applications in dental outsourcing, a reliable standard test for comparison is necessary. PURPOSE: This study evaluates a proposed test method to be used to quantify "digitizing quality" with respect to accuracy and reproducibility of two dental surface digitization devices. Comparability of the characteristics should be ensured. METHOD: Two laser light section scanners: DentaScope II and D200 were evaluated by means of the 'Sphere Test', that involves repeated measurements of a precision ball (radius: 6mm) according to a pre-defined protocol. The surface information was received as unmatched, overlapping point clouds and statistically processed with a newly developed software package. The standard deviation of all points as well as a measure for undercutting the equator were determined. RESULTS: The standard deviation for the radius for D and S were 7.7 (+/-0.8) and 13.9 (+/-1.0) microm respectively. The equator undercut elevations were -2.0 degrees and -0.25 degrees for scanner D and S respectively. CONCLUSION: Scanner D had a significantly higher accuracy than S (p<0.05), corresponding with the smaller pixel distance of the sensor. Both devices show adequate accuracy and reproducibility and have an adequate ability to detect the equator. The test is also suitable for calibration purposes.

Computer-Aided Design↗

Continuous telemetric monitoring of fetal oxygen partial pressure during labor.

INTRODUCTION: Upright or ambulatory birth positions are favorable for fetal oxygenation. Studies of fetal oxygenation with regard to maternal position require free maternal mobility. Therefore, telemetry for a fetal sensor for such investigations is a pre-requisite. Telemetry-if technically feasible-could enable monitoring of fetal oxygen partial pressure using an existing sensor without restricting the mobility of the parturient woman. We have developed a telemetry system for use with a fetal transcutaneous partial oxygen pressure sensor (ttcpO(2)) and have studied effects of maternal position and position changes during normal labor. MATERIALS AND METHODS: The monitoring system consists of three parts: the telemetry unit with the ttcpO(2) sensor to transmit the tcpO(2) and the heating output telemetrically, a modified CTG monitor and a personal computer storing the measurements. All data were plotted on the CTG recording paper and fed into a new purpose-designed software, displaying fetal heart rate, the uterine contraction intensity, ttcpO(2) and the heating output. Three laboring women, randomly and successively adopting "classical birth positions" (supine or side positions), sitting or vertical or walking position, were studied. RESULTS: Fetal heart rate, uterine contractions, ttcpO(2) and heating output are influenced by the birth positions and by changes of the birth position. In the classical supine and side position there seemed to be lower fetal oxygenation. Sitting, standing and especially walking were more favorable. DISCUSSION: Telemetry is useful to study a possible clinical benefit of individual birth positions.

Equipment Design↗

The cost management organization: the next step for materiel management.

With Materiel Management's transition over the last decade from simple logistics to analysis and cost management, it has gained recognition as a key part of the management team responsible for supplies, equipment, standards, and associated processes to identify, purchase, store, distribute, issue, and dispose of supplies and equipment. The materiel manager's job consists of putting the right product in the right place at the right time and in the right quantity at the best total delivered cost. In this context, Materiel Management has made powerful impacts to lower costs associated with: Distribution--costs have been lowered by actively adopting advanced supply channel management techniques such as primary suppliers, JIT, stockless programs, case cart/custom kit/procedure based delivery systems, modified stockless programs as well as margin management through cost plus, flat fee, or margins paid per activity. Cost of goods--lowered through aggregated purchasing in the forms of regional and national purchasing alliances and local capitation or other gain/risk share programs. Internal process costs--lowered by out-sourcing and/or integrating supplier processes and personnel into operations via partnership approaches. We have also reduced transactional costs through EDI transaction sets and the emerging use of the inter and intranet/electronic commerce, procurement cards, and evaluated receipt settlement processes. De-layering--We have lowered the operating costs of Materiel Management overhead by re-design/re-engineering, resulting in reduced management and greater front line authority. Quality--We have learned to identify and respond to customer and supplier needs by using quality improvement tools and ongoing measurement and monitoring techniques. Through this we have identified the waste of non-beneficial products and services. We have adopted supplier certification measurers to ensure quality is built into processes and outcomes. With so much already accomplished, it should be easy to rest on these laurels and simply operate. However, we believe that this is just a beginning. A new generation of highly educated leaders are emerging and taking advantage of the contributions of pioneers who laid the ground work. These new leaders will have advanced management, statistics, and behavioral sciences skills. They will be analysts and organizational motivators. Their goal will be to improve financial and clinical performance measured by real time process and performance data. The new leaders will have information at their fingertips thanks to significant leaps forward in data collection, automated continuous replenishment processes, and software designed for better management of clinical and cost outcomes. This article documents significant Materiel management accomplishments and conceptualizes cost management processes. The cost management organization is the logical evolution in our efforts for better outcomes in healthcare Materiel management.

Contract Services↗

Newly developed ventricular assist device with linear oscillatory actuator.

The goal of this study was to develop a new direct electromagnetic left ventricular assist device (DEM-LVAD) with a linear oscillatory actuator (LOA). The DEM-LVAD is a pulsatile pump with a pusher plate. The pusher plate is driven directly by the mover of the LOA. The LOA provides reciprocating motion without using any movement converter such as a roller screw or a hydraulic system. It consists of a stator with a single winding excitation coil and a mover with two permanent magnets. The simple structure of the LOA is based on fewer parts to bring about high reliability and smaller size. The mover moves back and forth when forward and backward electric current is supplied to the excitation coil. The pump housings have been designed using three-dimensional computer aided design software and fabricated with the aid of computer aided manufacturing technology. Monostrut valves (Bjork-Shiley #21) were used for the prototype. The DEM-LVAD dimension is 96 mm in diameter and 50 mm thick with a mass of 0.62 kg and a volume of 280 ml. An in vitro test (afterload 100 mm Hg; preload 10 mm Hg; input power 10 W) demonstrated more than 6 L/minute maximum output and 15% maximum efficiency at 130 beats per minute (bpm). Dynamic stroke volume ranged between 40 and 60 ml. The feasibility of the DEM-LVAD was confirmed.

Biophysical Phenomena↗

[Reduction of cataract by plasma etching of intraocular lenses. An animal experiment study].

BACKGROUND: We studied if a modification of the silicon intraocular lens (IOL) by plasma etching is able to promote a bonding of the IOL surface and the capsular bag which might inhibit proliferation and migration of lens epithelial cells. METHODS: Silicon-disc lenses (90D, Adatomed), as disposable for regular cataract surgery, were used. Their haptic surface was etched via the use of a SO2 plasma, leaving the optic unmodified. The experiments were done on dwarf rabbits to allow for tight apposition of IOL and bag. Nine rabbits underwent extracapsular lensectomy using propofol anaesthesia and phaco/clear cornea surgical technique. Six eyes each received either no, a regular or a modified IOL. After 11 weeks the eyes were enucleated. Capsular bag and IOL were digitized using a flatbed scanner with transparency adapter. The data obtained were calibrated against a densitometric standard. The densities of the various specimen were analyzed quantitatively using self designed software. RESULTS: In aphacic eyes no significant posterior capsule opacification (PCO) was detectable. In the same time-span the regular IOL had developed a dense, heterogenous PCO. The plasma-treated IOL showed, especially in the central areas, a significant reduction of PCO as compared to untreated IOL. CONCLUSION: The reduction of PCO could not be explained by adhesion of the IOL surface and the capsular bag, which would impair migration of lens epithelial cells and thereby PCO. Likewise, lower PCO may be related to improved hydrophilic properties of the surface-modified IOL.

Animals↗

A portable bio-impedance system for monitoring lung resistivity.

The principles of a hybrid bio-impedance technique are implemented in a novel, lung resistivity monitoring system ("CardioInspect" Tel-Aviv University, Israel). The system is to be utilized in the clinic or at home, for daily monitoring of patients suffering from pulmonary edema. The developed system consists of an eight-electrode belt worn around the thorax, an electronic unit containing analog and digital boards, and a stand-alone DSP based system with a designated software to analyze the data. A Newton-Raphson algorithm based on the finite-volume method is employed for the optimization of the left and right lung resistivity values, making use of the voltage measurements retrieved from opposite current injections. In this preliminary study, 33 healthy volunteers were measured with the system during tidal respiration, yielding symmetric mean left and right lung resistivity values of (1205+/-163, 1200+/-165) (Omega cm). The system reproducibility was better than 2% for both within and between tests measurements, and no dependency between the reconstructed values and various anthropometric parameters was found.

Diagnosis, Computer-Assisted↗

[The use of CAD/CAM techniques in the repair of complex orbital fractures and the reposition of enophthalmos].

OBJECTIVE: To reconstruct the three-dimensional (3 D) imaging and computer-generated models of the complex orbital fractures, and to develop a Computer-Aided Design/Computer-Aided Manufacture (CAD/CAM) system for orbital fracture repair. METHODS: We carried out study on 12 patients with orbital fractures from August 2003 to March 2004 in the Ninth People's Hospital. Before the orbital fracture repair, helical computer tomography scanning was applied to acquire the 3 D imaging data of the patient's orbits. The 3 D imaging data were then transferred to a CAD/CAM interactive program for image processing, which then designed and produced a stereolithography model mathematically. Using the designed software, the repair of orbital fractures could be planned with the computer. At the same time, the orbital cubane was calculated. Then the operation was performed and the effect of the therapy was evaluated. RESULTS: Using the CAD/CAM system of orbital fracture repair, the 3 D image of the orbit could be reconstructed, and the orbital cubane could be calculated accurately. The preoperative surgical plan was put into reality. After the orbital fracture repair, all cases received excellent appearance and function. This system had proved to run smoothly and accurately, and could easily be controlled. CONCLUSIONS: The CAD/CAM system of the orbital fracture repair may be proved as one of the most useful clinical tools for orbital surgery.

Adult↗

[Detection of bcl-2/IgH gene rearrangement in diffuse large B cell lymphoma by hemi-nested PCR].

OBJECTIVES: To explore a sensitive and specific method for detection of bcl-2/IgH gene rearrangement in diffuse large B cell lymphoma (DLBCL), and verify the credibility of the established method. METHODS: bcl-2/IgH hemi-nested PCR primers were designed using the professional primer design software. Fifty-two samples of pathologically diagnosed DLBCL and 10 fresh tonsil tissues were amplified using hemi-nested touch down-PCR to detect bcl-2/IgH gene rearrangement. The PCR products were cloned and sequenced. RESULTS: bcl-2/IgH gene rearrangement was detected in 6 of 52 DLBCL samples and 2 of 10 fresh tonsil tissues using one-way method. By using the hemi-nested PCR for the second round amplification, 5 of DLBCL were positive, but all of the fresh tonsil tissues were negative. The positive PCR products were sequenced and analyzed on the Internet, 3 of 8 cases obtained by one-way method were false positive, 5 positive cases amplified using hemi-nested PCR were all bcl-2/IgH gene rearrangement. PCR products of 3 false positive cases were homologous to BAC331191 and LLNLR-245D11 in human chromosome 19 and RP11-498P10 in chromosome 1. CONCLUSION: There are false positive results using common primers for detecting bcl-2/IgH gene rearrangement. The mechanism may be that highly homologous sequences to human genome exist in commonly used primers. The specificity of the diagnosis could be improved by hemi-nested PCR using the combination of primers we designed and the traditional ones.

Gene Rearrangement, B-Lymphocyte, Heavy Chain↗

Report on the evaluation of the VA/Seattle below-knee prosthesis.

The Department of Veterans Affairs (VA), Rehabilitation Research and Development (Rehab R&D) Service, Technology Transfer Section (TTS) with collaboration from the Prosthetic and Sensory Aids Service (PSAS) managed clinical trials to evaluate the VA/Seattle Below-Knee (BK) Prosthetic System. The clinical trials were held at the Prosthetic Treatment Center (PTC), VA Medical Center, Hines, Illinois. Five other VA medical centers participated in the outreach program of the trials as satellite stations, with PTC Hines as the central fabrication facility. The VA/Seattle BK system is the first complete prosthetic system designed and developed by the Department of Veterans Affairs. It consists of a socket designed and fabricated using computer-aided, automated technology, and off-the-shelf modular components: a lightweight pylon and an ankle unit, and a lightweight, energy-storing foot. The computer-based socket design software, the modular components, and the prosthetic foot were developed with funds from the VA Rehab R&D Service. The evaluation trials were conducted to determine the efficacy of the VA/Seattle prosthesis, its reliability, and acceptance by veterans. The clinical trials began in April 1991 and were completed in August 1992. Forty-six BK amputee veterans were fitted with the VA/Seattle prosthesis. Their progress with the prosthesis was followed for a period of 6 months and data were gathered at intervals of 2 weeks, 3 months, and 6 months. Forty sets of subject data instruments were collected. In order to maintain the accuracy of the results, TTS used the 22 sets that were complete for data analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗