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PubMed1995

Automated reading and processing of quantitative IgG, IgM, IgA, and IgE isotypic agglutination results in microplates. Development and application in parasitology-mycology.

Microplate agglutination techniques represent a simple and commonly used approach for the quantitative or qualitative isotypic analysis of specific antibodies. However, they require optical reading by the investigator and are thus prone to an important degree of variability. In order to solve some of the problems associated with the variability of optical readings, we have used an automatic reader scanning each of the 96 wells of a standard microplate in 32 different locations. The inherent advantages of the automatic reader were further maximized by coupling it to a dedicated computer running customized software designed to process data coming on-line from the spectrophotometer. This approach has been applied to the diagnosis of human toxoplasmosis and candidosis. Suspensions of Toxoplasma gondii tachyzoites or of sensitised erythrocytes were used for the determination of IgG antibodies or the quantification of IgM, IgA, or IgE specific isotypes. This procedure allows the simple and reproducible collection of objective results. Moreover, it permits a reduction in cut-off values and direct interpretation of results with automatic conversion of scores into titer, units, index, or into any other scale appropriate for standardization purposes.

Agglutination Tests↗

PubMed2000

Hyperopic laser in situ keratomileusis with the Nidek EC-5000 excimer laser.

OBJECTIVE: To evaluate the efficacy, safety, and predictability of hyperopic laser in situ keratomileusis (H-LASIK) using modified software. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The first 72 consecutive eyes of 44 patients with up to +5.00 diopters (D) hyperopia. INTERVENTION: Hyperopic LASIK using the Automatic Corneal Shaper (ACS; Chiron Vision, Claremont, CA) and the Nidek EC-5000 excimer laser (Nidek, Tokyo, Japan). MAIN OUTCOME MEASURES: Uncorrected visual acuity, manifest spherical equivalent (MSE), best-corrected visual acuity (BCVA), and complications were studied. RESULTS: At 6 months, in the low hyperopia group (<3.00 D), mean MSE was +0.30 +/- 0.71 D, with 88.9% eyes within 1 D of emmetropia compared with +1.09 +/- 0.92 D and 51.8% within 1 D of emmetropia in the moderate hyperopia group (> or =3.00 D; P = 0.003). Uncorrected visual acuity was 20/40 or better in 43 of 45 eyes (95.6%) and in 21 of 27 (77.8%) eyes in the low and moderate hyperopia groups, respectively. Only one eye (1.4%) from the moderate hyperopia group lost two lines of BCVA. Eighteen eyes (25%) required retreatment to correct residual hyperopia, 9 eyes (20.0%) in the low hyperopia group and 9 eyes (33.3%) in the moderate hyperopia group. Retreatments resulted in an MSE of +0.02 +/- 0.45 D and +0.04 +/- 0.73 D in the low and moderate hyperopia groups, respectively. No flap-related complications were seen. CONCLUSIONS: Hyperopic LASIK with the ACS and the Nidek EC-5000 excimer laser using our modified software is a safe, effective, and predictable procedure for low hyperopia. Results are satisfactory up to moderate hyperopia. Significant regression can occur for low and moderate hyperopia. Retreatment can be performed safely and effectively to improve the visual and refractive results.

Adult↗

PubMed2003

The patient-computer interview: a neglected tool that can aid the clinician.

In this article, I (1) review the process of interviewing patients by computer, (2) summarize computer-interviewing work done in 1968, (3) address the weaknesses of collecting information with the traditional history-taking methods or paper questionnaires, (4) discuss commercial software designed for computer interviewing, and (5) focus on the strengths and weaknesses of interviewing patients with a computer. The strengths of this process compared with traditional interviewing are that computer interviewing allows the physician to gather more data; gives the patient more time to complete an interview; uncovers more sensitive information; provides more adaptability to non-English-speaking patients, patients with hearing impairment, or patients who are illiterate; and provides structured information for research. The weaknesses of computer interviewing are that it generates false-positive responses, is not accepted by a minority of patients, is unable to detect nonverbal behavior, and requires changes in work flow. With the advent of an electronic medical record and the financial rewards for comprehensive history recording, the gathering of history and documentation from patients is increasingly important and favors adaptation to computer interviewing.

Computers↗

PubMed1992

Implementation of surgical audit in Pakistan.

UNLABELLED: Surgical audit, while extensively practised in the West, is still widely believed an impossible attainment in developing countries owing to the high cost and technology required to implement it. It is thus a poorly understood and rarely practised exercise in these countries. In this article we attempt to demonstrate the usefulness and feasibility of implementing audit in the setting of a developing country using personal computers (PCs) with simple, inexpensive and easily available software. We discuss the results of data analysis of 18 months of audit conducted by one general surgery team (2 consultants, 4 residents) at the Aga Khan University Hospital, Karachi. OBJECTIVE: To implement surgical audit in the setting of a developing country using microcomputers with simple, inexpensive and easily available software. DESIGN: Data analysis of inpatient audit proformas filled at weekly audit meetings from January 1989-July 1990 using Dbase III Plus. SETTING: One general surgery team (2 consultants, 4 residents) in a tertiary care hospital in Karachi. MAIN OUTCOME MEASURES: Disease patterns, caseload, complication rates. RESULTS: Conditions related to the biliary system made 26.1 per cent of the admitting diagnoses; 25.3 per cent of the patients had some co-existing medical condition as well, diabetes and hypertension being most common. The overall morbidity was 12.3 per cent and the mortality 1.5 per cent. Chest infection, wound infection and urinary retention were the most common post-operative complications. CONCLUSIONS: Results of audit data analysis initiated new research projects and development of protocols to improve patient care. Audit meetings also served as teaching sessions for residents.

General Surgery↗

PubMed2000

A simple algorithm for a digital three-pole Butterworth filter of arbitrary cut-off frequency: application to digital electroencephalography.

Algorithms for low-pass and high-pass three-pole recursive Butterworth filters of a given cut-off frequency have been developed. A band-pass filter can be implemented by sequential application of algorithms for low- and high-pass filters. The algorithms correspond to infinite impulse-response filters that have been designed by applying the bilinear transformation to the transfer functions of the corresponding analog filters, resulting in a recursive digital filter with seven real coefficients. Expressions for filter coefficients as a function of the cut-off frequency and the sampling period are derived. Filter performance is evaluated and discussed. As in the case of their analog counterparts, their transfer function shows marked flattening over the pass band and gradually higher attenuation can be seen at frequencies above or below the cut-off frequency, with a slope of around 60 dB/decade. There is a 3 dB attenuation at the cut-off frequency and a gradual increase in phase shift over one decade above or below the cut-off frequency. Low-pass filters show a maximum overshoot of 8% and high-pass filters show a maximum downwards overshoot of approximately 35%. The filter is mildly under-damped, with a damping factor of 0.5. On an IBM 300GL personal computer at 600 MH with 128 MB RAM, filtering time with MATLAB 5.2 running under Windows 98 is of the order of 50 ms for 60000 samples. This will be adequate for on-line electroencephalography (EEG) applications. The simplicity of the algorithm to calculate filter coefficients for an arbitrary cut-off frequency can be useful to modern EEG laboratories and software designers for electrophysiological applications.

Algorithms↗

PubMed1997

Computer based imaging and analysis of root gravitropism.

Two key issues in studies of the nature of the gravitropic response in roots have been the determination of the precise pattern of differential elongation responsible for downward bending and the identification of the cells that show the initial motor response. The main approach for examining patterns of differential growth during root gravitropic curvature has been to apply markers to the root surface and photograph the root at regular intervals during gravitropic curvature. Although these studies have provided valuable information on the characteristics of the gravitropic motor response in roots, their labor intensive nature limits sample size and discourages both high frequency of sampling and depth of analysis of surface expansion data. In this brief review we describe the development of computer-based video analysis systems for automated measurement of root growth and shape change and discuss some key features of the root gravitropic response that have been revealed using this methodology. We summarize the capabilities of several new pieces of software designed to measure growth and shape changes in graviresponding roots and describe recent progress in developing analysis systems for studying the small, but experimentally popular, primary roots of Arabidopsis. A key finding revealed by such studies is that the initial gravitropic response of roots of maize and Arabidopsis occurs in the distal elongation zone (DEZ) near the root apical meristem, not in the main elongation zone. Another finding is that the initiation of rapid elongation in the DEZ following gravistimulation appears to be related to rapid membrane potential changes in this region of the root. These observations have provided the incentive for ongoing studies examining possible links between potential growth modifying factors (auxin, calcium, protons) and gravistimulated changes in membrane potential and growth patterns in the DEZ.

Arabidopsis↗

PubMed2006

Integrated functional visualization of eukaryotic genomes.

BACKGROUND: Increasing amounts of data from large scale whole genome analysis efforts demands convenient tools for manipulation, visualization and investigation. Whole genome plots offer an intuitive window to the analysis. We describe two applications that enable users to easily plot and explore whole genome data from their own or other researchers' experiments. RESULTS: STRIPE and GFFtool (General Feature Format Tool) are softwares designed to support integration, visualization and exploration of whole genome data from eukaryotic genomes. STRIPE, in addition to providing a highly customizable and interactive data plot, provides access to numerous well-selected databases with updated information on all genes of a genome. GFFtool provides a user-friendly solution to integrating experimental data with the genomic information available in public databases. They also obviate the need for users to maintain large annotation resources, as they link to well-known resources using standard gene and protein identifiers. CONCLUSION: The programs provide the user with broad genomic overviews of data distribution, fast access to data of interest, and the ability to navigate speedily from one resource to another, and gain a better understanding of result of whole genome analysis experiments.

Algorithms↗

PubMed1992

Computer assessment of life-style in a gastroenterology clinic.

To examine the potential benefit of a computer-assisted interview about life-style in gastroenterology practice, 34 consecutive patients attending a gastroenterology clinic were questioned by a computer using software designed to obtain a comprehensive history of alcohol, caffeine, cigarette, and illicit drug use, together with an assessment of exercise, sexual activity, and nutrition. Comparisons of the information obtained by the computer with clinical records revealed that physicians documented only 3% of the patients as problem drinkers, 3% as caffeine abusers, and 17% as smokers, whereas the computer identified 10% of the patients as problem drinkers, 27% as caffeine abusers, and 43% as smokers. These findings imply that patients may be more apt to tell more about adverse life-style to the computer than to a physician during clinical interview. In a sample patient population from a gastroenterology clinic, a microcomputer provides an acceptable, efficient, and potentially cost-effective way to assess life-style.

Adult↗

PubMed2006

Identification of organ-specific T cell populations by analysis of multiparameter flow cytometry data using DNA-chip analysis software.

BACKGROUND: The analysis of cells from multiple experimental groups by multiparameter flow cytometry leads to the generation of complex data sets, for which adequate analysis tools are not commonly available. We report here that software designed for transcriptomics applications can be used in multiparameter flow cytometry. METHODS: Lymphocytes isolated from nine different mouse organs were stained and subjected to 10-parameter flow cytometry. The resulting data set contained 594 different T cell subsets per organ per mouse and was organized into a so-called flow cytometry array (FCA). RESULTS: Computation of a hierarchical tree revealed that lymph nodes and spleen were populated by similar T cell subsets, while T cells from peripheral organs displayed a diverse subset composition. Furthermore, organ-specific T cell subsets were identified. CONCLUSIONS: This new FCA concept in flow cytomics proved to be a valuable tool for the fast and unbiased analysis of complex multiparameter flow cytometry data sets. It can be used for assessing disease progression and therapeutic intervention, and for the association of disease-related biomarkers on the protein level.

Animals↗

PubMed2005

[Selection of relevant duplicate criteria in the monitoring of Staphylococcus aureus methicillin resistance trends].

OBJECTIVE: Monitoring methicillin-resistant Staphylococcus aureus (MRSA) rates is crucial in hospital settings, but its calculation is hampered by variations according to duplicate isolates. The aim of this study was to assess the impact of applying different methods for duplicate isolate removal on the MRSA rates. MATERIALS AND METHODS: Trends in S. aureus resistance were analysed from isolates collected in a teaching hospital during a 4-year period by using a specifically designed software. Reference duplicate (RD) criteria were defined as one major and three minor differences in antibiotic patterns and a 30-day time period between two isolates. Variations in antibiotic patterns and time period were studied and compared to RD. NCCLS recommendations based upon results from the first isolate of a species per patient per study period, and the ONERBA recommendations based on phenotypic method, were also studied. RESULTS: MRSA rate was 31.1% when using RD. When duplicates were not eliminated, the MRSA rate significantly increased to 34.0% (P=0.002). When using NCCLS and ONERBA recommendations, the MRSA rate significantly decreased to 27.6% (P=0.002) and significantly increased to 33.8% (P=0.002) respectively. When no difference was tolerated in antibiotic pattern or when the time period was set at five days, the MRSA rate significantly increased to 34.3 and 34.2%, respectively (p=0.003 for each). CONCLUSIONS: These results suggest that criteria used to remove duplicates should be carefully selected to assess accurate MRSA trends.

Anti-Bacterial Agents↗

PubMed2006

AIRFIX: the first digital postoperative chest tube airflowmetry--a novel method to quantify air leakage after lung resection.

OBJECTIVE: Prolonged air leak after pulmonary resection is a common complication and a major limiting factor for early discharge from hospital. Currently there is little consensus on its management. The aim of this study was to develop and evaluate a measuring device which allows a simple digital bed-side quantification of air-leaks compatible to standard thoracic drainage systems. PATIENTS AND METHODS: The measuring device (AIRFIX) is based upon a 'mass airflow' sensor with a specially designed software package that is connected to a thoracic suction drainage system. Its efficacy in detecting pulmonary air-leaks was evaluated in a series of 204 patients; all postoperative measurements were done under standardized conditions; the patients were asked to cough, to take a deep breath, to breathe out against the resistance of a flutter valve, to keep breath and to breathe normally. As standard parameters, the leakage per breath or cough (ml/b) as well as the leakage per minute (ml/min) were displayed and recorded on the computer. RESULTS: Air-leaks within a range of 0.25-45 ml/b and 5-900 ml/min were found. Removal of the chest tubes was done when leakage volume on Heimlich valve was less than 1.0 ml/b or 20 ml/min. After drain removal based upon the data from chest tube airflowmetry none of the patients needed re-drainage due to pneumothorax. CONCLUSION: The AIRFIX device for bed-side quantification of air-leaks has proved to be very simple and helpful in diagnosis and management of air-leaks after lung surgery, permitting drain removal without tentative clamping.

Carcinoma, Non-Small-Cell Lung↗

PubMed2005

Backside wear of polyethylene tibial inserts: mechanism and magnitude of material loss.

BACKGROUND: Wear of the underside of modular tibial inserts (backside wear) in total knee replacements has been reported by several authors. Although, for some implant designs, this phenomenon seems to contribute to osteolysis, the actual volume of material lost through wear of the backside surface has not been quantified. This study describes the results of computerized measurements of tibial inserts of one design known to be associated with a high prevalence of backside wear in situ. METHODS: A series of retrieved total knee components of one design were examined. The duration of implantation of the retrieved components ranged from thirty-six to 146 months. Laser surface profilometry and computer-aided design software were used to develop individual three-dimensional models of each worn, retrieved tibial insert to compare with scanned unused inserts. Volumetric subtraction of both models revealed the material lost because of backside wear. RESULTS: Worn and unworn areas on the backside surface were easily identified by stereomicroscopy and laser profilometry. The computer reconstructions showed that, in all retrievals, all unworn surfaces on the nonarticulating surface lay in one plane. The average volume (and standard deviation) of the material lost because of backside wear was 925 +/- 637 mm(3) (range, 197 to 2720 mm(3)). On the basis of the time in situ for each implant, the average volumetric wear rate was 138 +/- 95 mm(3)/yr. CONCLUSIONS: The predicted volume of material removed because of backside wear is substantial and may be sufficient to induce osteolysis. Our results suggest that peg-like protrusions are not generated by the extrusion of polyethylene into screw-holes within the base-plate but by abrasion of the underside of the bearing insert, leaving the protruding pegs as the only remnants of the original surface.

Aged↗

PubMed2003

1-Mb resolution array-based comparative genomic hybridization using a BAC clone set optimized for cancer gene analysis.

Array-based comparative genomic hybridization (aCGH) is a recently developed tool for genome-wide determination of DNA copy number alterations. This technology has tremendous potential for disease-gene discovery in cancer and developmental disorders as well as numerous other applications. However, widespread utilization of a CGH has been limited by the lack of well characterized, high-resolution clone sets optimized for consistent performance in aCGH assays and specifically designed analytic software. We have assembled a set of approximately 4100 publicly available human bacterial artificial chromosome (BAC) clones evenly spaced at approximately 1-Mb resolution across the genome, which includes direct coverage of approximately 400 known cancer genes. This aCGH-optimized clone set was compiled from five existing sets, experimentally refined, and supplemented for higher resolution and enhancing mapping capabilities. This clone set is associated with a public online resource containing detailed clone mapping data, protocols for the construction and use of arrays, and a suite of analytical software tools designed specifically for aCGH analysis. These resources should greatly facilitate the use of aCGH in gene discovery.

Cell Line, Tumor↗

PubMed2005

Precision targeting of liver lesions using a novel electromagnetic navigation device in physiologic phantom and swine.

Radiofrequency ablation of primary and metastatic liver tumors is becoming a potential alternative to surgical resection. We propose a novel system that uses real-time electromagnetic position sensing of the needle tip to help with precision guidance into a liver tumor. The purpose of this study was to evaluate this technology in phantom and animal models. Using an electromagnetic navigation device, instrumented 18 g needles were advanced into radioopaque tumor targets in a respiratory liver phantom. The phantom featured a moving liver target that simulated cranio-caudal liver motion due to respiration. Skin-to-target path planning and real-time needle guidance were provided by a custom-designed software interface based on pre-operative 1 mm CT data slices. Needle probes were advanced using only the electromagnetic navigation device and software display. No conventional real-time imaging was used to assist in advancing the needle to the target. Two experienced operators (interventional radiologists) and two inexperienced ones (residents) used the system. The same protocol was then also used in two anesthetized 45 kg Yorkshire swine where radioopaque agar nodules were injected into the liver to serve as targets. A total of 76 tumor targeting attempts were performed in the liver phantom, and 32 attempts were done in the swine. The average time for path planning was 30 s in the phantom, and 63 s in the swine. The median time for the actual needle puncture to reach the desired target was 33 s in the phantom, and 42 s in the swine. The average registration error between the CT coordinate system and electromagnetic coordinate system was 1.4 mm (SD 0.3 mm) in the phantom, and 1.9 mm (SD 0.4 mm) in the swine. The median distance from the final needle tip position to the center of the tumor was 6.4 mm (SD 3.3 mm, n=76) in the phantom, and 8.3 mm (SD 3.7 mm, n=32) in the swine. There was no statistical difference in the planning time, procedure time, or accuracy of needle placement between experienced and inexperienced operators. The novel electromagnetic navigation system allows probe delivery into hepatic tumors of a physiologic phantom and live anesthetized swine. The system allows less experienced operators to perform equally well as experienced radiologists in terms of procedure time and accuracy of needle probe delivery.

Animals↗

PubMed2006

Uniform resource locator decay in dermatology journals: author attitudes and preservation practices.

OBJECTIVES: To describe dermatology journal uniform resource locator (URL) use and persistence and to better understand the level of control and awareness of authors regarding the availability of the URLs they cite. DESIGN: Software was written to automatically access URLs in articles published between January 1, 1999, and September 30, 2004, in the 3 dermatology journals with the highest scientific impact. Authors of publications with unavailable URLs were surveyed regarding URL content, availability, and preservation. MAIN OUTCOME MEASURES: Uniform resource locator use and persistence and author opinions and practices. RESULTS: The percentage of articles containing at least 1 URL increased from 2.3% in 1999 to 13.5% in 2004. Of the 1113 URLs, 81.7% were available (decreasing with time since publication from 89.1% of 2004 URLs to 65.4% of 1999 URLs) (P<.001). Uniform resource locator unavailability was highest in The Journal of Investigative Dermatology (22.1%) and lowest in the Archives of Dermatology (14.8%) (P=.03). Some content was partially recoverable via the Internet Archive for 120 of the 204 unavailable URLs. Most authors (55.2%) agreed that the unavailable URL content was important to the publication, but few controlled URL availability personally (5%) or with the help of others (employees, colleagues, and friends) (6.7%). CONCLUSIONS: Uniform resource locators are increasingly used and lost in dermatology journals. Loss will continue until better preservation policies are adopted.

Authorship↗

PubMed1993

Accuracy and precision of quantitative digital coronary arteriography: observer-, short-, and medium-term variabilities.

Coronary arteriograms are increasingly acquired and stored in digital format, which allows instantaneous review of the pictorial data during the cardiac catheterization procedure. To support the angiographer in choosing the optimal sizes of the recanalization devices and studying the efficacy of the recanalization procedures, we have developed a new analytical software package (Automated Coronary Analysis = ACA) on the Philips DCI (-SX) digital cardiac imaging system. The ACA-package allows the objective and reproducible assessment of the morphologic and functional severity of coronary obstructions. Required user interaction is limited to the definition of the start and end points of the coronary segment to be analyzed. Automated contour detection is based on the use of first and second derivative functions along scanlines perpendicular to the automatically computed vessel pathline in the first iteration and perpendicular to the initial contours in the second iteration. These derivative functions have been modified based on the line spread function of the X-ray imaging chain, which is of particular importance for the accurate measurement of small vessel sizes. Phantom studies have indeed demonstrated that vessel sizes down to 0.66 mm can be measured accurately and reproducibly. Inter- and intraobserver variability studies have demonstrated a variability in the obstruction diameter of 0.11 mm and 0.10 mm, respectively, and in the percent diameter stenosis of 5.64% and 3.18%, respectively. These variability studies have been extended to short-term studies with repeated acquisition in the same angiographic views after 5 min and to medium-term studies with repeated acquisition in the initial angiographic views at the end of the catheterization procedures. With these standardized repeated acquisition and analysis procedures, the variabilities in the obstruction diameters increased to 0.19 and 0.18 mm, respectively, and remained below 6% in the percent diameter stenosis (5.61% and 5.28%, respectively). With an analysis time of approximately 15 sec on the DCI-SX, an efficient tool is now available in the catheterization laboratory for the objective and reproducible assessment of vessel dimensions and changes therein as a result of recanalization procedures.

Coronary Angiography↗

PubMed1991

Cell migration in the rat embryonic neocortex.

Three-dimensional reconstructions of the normal rat embryonic (E) neocortex on days E15, E17, E19, and E21, using Skandha (software designed by J. Prothero, University of Washington, Seattle), show that the neocortical ventricular zone shrinks rapidly in the medial direction during cortical morphogenesis. [3H]thymidine autoradiography indicates that the shrinkage of the ventricular zone occurs before neurons in lateral and ventrolateral parts of layers IV-II are generated. Consequently, most of these neurons originate 400-1000 microns medial to their settling sites in the cortical plate. Embryos killed at daily intervals up to E21 after a single injection of [3H]thymidine on either E17 or E18 revealed the presence of a prominent migratory path, the lateral cortical stream, used by neurons migrating to the lateral and ventrolateral cortical plate; neurons migrating to the dorsal cortical plate follow a direct radial path. Arrival times of neurons in the cortical plate depend on the migratory path and are proportional to the overall distance travelled. Neurons that migrate only radially arrive in the dorsal cortical plate in two days (shortest route). Neurons that migrate laterally arrive in the lateral cortical plate in 3 days (longer route) and in the ventrolateral cortical plate in 4 days (longest route). [3H]thymidine autoradiography also shows that cells generated in the neocortical ventricular zone migrate in the lateral cortical stream for 5 or more days and accumulate in a reservoir. Cells leave the reservoir to enter the piriform cortex and destinations (as yet undetermined) in the basal telencephalon. The lateral cortical stream is found wherever the neocortical primordium surrounds the basal ganglia and is absent behind the basal ganglia. A computer analysis of nuclear orientation in anterior and posterior parts of the intermediate zone in the dorsal neocortex between days E17 and E22 shows that horizontally oriented nuclei are more common anteriorly where many cells are migrating laterally than posteriorly where most cells are migrating radially.

Animals↗

PubMed2001

State of the art in surgical robotics: clinical applications and technology challenges.

Although it has been over 15 years since the first recorded use of a robot for a surgical procedure, the field of medical robotics is still an emerging one that has not yet reached a critical mass. Although robots have the potential to improve the precision and capabilities of physicians, the number of robots in clinical use is still very small. In this review article, we begin with a short historical review of medical robotics, followed by an overview of clinical applications where robots have been applied. The clinical applications are then discussed; they include neurosurgery, orthopedics, urology, maxillofacial surgery, radiosurgery, ophthalmology, and cardiac surgery. We conclude with a listing of technology challenges and research areas, including system architecture, software design, mechanical design, imaging compatible systems, user interface, and safety issues.

Computer Systems↗