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The oxygen status algorithm: a computer program for calculating and displaying pH and blood gas data.

Input parameters for the program are the arterial pH, pCO2, and pO2 (measured by a blood gas analyzer), oxygen saturation, carboxy-, met-, and total hemoglobin (measured by a multi-wavelength spectrometer), supplemented by patient age, sex, temperature, inspired oxygen fraction, fraction of fetal hemoglobin, and ambient pressure. Output parameters are the inspired and alveolar oxygen partial pressures, pH,pCO2 and pO2 referring to the actual patient temperature, estimated shunt fraction, half-saturation tension, estimated 2,3-diphosphoglycerate concentration, oxygen content and oxygen capacity, extracellular base excess, and plasma bicarbonate concentration. Three parameters related to the blood oxygen availability are calculated: the oxygen extraction tension, concentration of extractable oxygen, and oxygen compensation factor. Calculations of the 'reverse' type may also be performed so that the effect of therapeutic measures on the oxygen status or the acid-base status can be predicted. The user may choose among several different units of measurement and two different conventions for symbols. The results are presented in a data display screen comprising all quantities together with age, sex, and temperature adjusted reference values. The program generates a 'laboratory diagnosis' of the oxygen status and the acid-base status and three graphs illustrating the oxygen status and the acid-base status of the patient: the oxygen graph, the acid-base chart and the blood gas map. A printed summary in one A4 page including a graphical display can be produced with an Epson or HP Laser compatible printer. The program is primarily intended for routine laboratories with a blood gas analyzer combined with a multi-wavelength spectrometer. Calculating the derived quantities may enhance the usefulness of the analyzers and improve patient care. The program may also be used as a teaching aid in acid-base and respiratory physiology. The program requires an IBM PC, XT, AT or similar compatible computer running under DOS version 2.11 or later. A VGA color monitor is preferred, but the program also supports EGA, CGA, and Hercules monitors. The program will be freely available at the cost of a discette and mailing expenses by courtesy of Radiometer Medical A/S, Emdrupvej 72, DK-2400 Copenhagen NV, Denmark (valid through 1991). A simplified algorithm for a programmable pocket calculator avoiding iterative calculations is given as an Appendix.

2,3-Diphosphoglycerate

SQUID: a program for the analysis and display of data from crystallography and molecular dynamics.

SQUID is a flexible computer program that allows the analysis and display of molecular coordinates from crystallography, NMR, and molecular dynamics. The program can also display two-dimensional and three-dimensional data using many graph types, as well as perform array processing of data with numerous intrinsic functions. Graphics are based on the use of "move" and "draw" instructions, allowing easy development of new device drivers, including vector plotters.

Computer Graphics

Optimization of techniques in screening CT of the sinuses.

The number of screening examinations of the sinuses performed with CT has markedly increased owing to the widespread and increasing use of endoscopic sinonasal surgery. We reviewed scans from 500 patients who had screening CT examinations of the sinuses for preendoscopic evaluation of inflammatory sinonasal disease to better define an optimal imaging protocol. Three aspects of direct coronal imaging of the paranasal sinuses were investigated: (1) preparation of the patient prior to the examination; (2) technical factors of the CT study, including positioning of the patient, optimal coronal angle, slice thickness, and CT exposure factors; and (3) data display. Our experience indicates that pretreatment of the patient with maximal medical therapy enables the best preendoscopic definition of anatomy, disease pattern, and nonreversible disease component for the treating surgeon. CT technical factors are optimized with scanning in the prone position with thin (3-mm) sections obtained through the anterior paranasal sinuses. This allows optimal visualization of the ostiomeatal unit. The remaining posterior portions of the sinuses are adequately imaged with thicker slices (5 mm). The coronal scan angle used is less critical. Exposure factors (mAs) can be reduced dramatically without image compromise. Data display is optimized when the bone algorithm is used to acquire the data and with image display at intermediate window center and width level. Use of the techniques outlined in this article results in a cost-effective yet diagnostic scan of the sinuses with decreased radiation exposure to the patient.

Cost-Benefit Analysis

Interactive display of volumetric data by Fast Fourier Projection.

This article describes a new algorithm for reprojection of volumetric data, called Fast Fourier Projection (FFP), which is one to two orders of magnitude faster than conventional methods such as ray casting. The theoretical basis of the new method is developed in a unified mathematical framework encompassing slice imaging and conventional volumetric reprojection methods. Software implementation is discussed in detail. The article closes with an account of experience with a prototype FFP implementation, and applications of the technique in medical visualization.

Algorithms

Three-dimensional volumetric display of CT data: effect of scan parameters upon image quality.

Of the many steps involved in producing high quality three-dimensional (3D) images of CT data, the data acquisition step is of greatest consequence. The principle of "garbage in, garbage out" applies to 3D imaging--bad scanning technique produces equally bad 3D images. We present a formal study of the effect of two basic scanning parameters, slice thickness and slice spacing, on image quality. Three standard test objects were studied using variable CT scanning parameters. The objects chosen were a bone phantom, a cadaver femur with a simulated 5 mm fracture gap, and a cadaver femur with a simulated 1 mm fracture gap. Each object was scanned at three collimations: 8, 4, and 2 mm. For each collimation, four sets of scans were performed using four slice intervals: 8, 4, 3, and 2 mm. The bone phantom was scanned in two positions: oriented perpendicular to the scanning plane and oriented 45 degrees from the scanning plane. Three-dimensional images of the resulting 48 sets of data were produced using volumetric rendering. Blind review of the resultant 48 data sets was performed by three reviewers rating five factors for each image. The images resulting from scans with thin collimation and small table increments proved to rate the highest in all areas. The data obtained using 2 mm slice intervals proved to rate the highest in perceived image quality. Three millimeter slice spacing with 4 mm collimation, which clinically provides a good compromise between image quality and acquisition time and dose, also produced good perceived image quality. The studies with 8 mm slice intervals provided the least detail and introduced the worst inaccuracies and artifacts and were not suitable for clinical use. Statistical analysis demonstrated that slice interval (i.e., table incrementation) was of primary importance and slice collimation was of secondary, although significant, importance in determining perceived 3D image quality.

Data Display

Real-time display of flow-pressure-volume loops.

Graphic display of respiratory waveforms can be valuable for monitoring the progress of ventilated patients. A system has been developed that can display flow-pressure-volume loops as derived from a patient's respiratory circuit in real time. It can also display, store, print, and retrieve ventilatory waveforms. Five loops can be displayed at once: current, previous, reference, "ideal," and previously saved. Two components, the data-display device (DDD) and the data-collection device (DCD), comprise the system. An IBM 286/386 computer with a graphics card (VGA) and bidirectional parallel port is used for the DDD; an eight-bit microprocessor card and an A/D convertor card make up the DCD. A real-time multitasking operating system was written to control the DDD, while the DCD operates from in-line assembly code. The DCD samples the pressure and flow sensors at 100 Hz and looks for a complete flow waveform pattern based on flow slope. These waveforms are then passed to the DDD via the mutual parallel port. Within the DDD a process integrates the flow to create a volume signal and performs a multilinear regression on the pressure, flow, and volume data to calculate the elastance, resistance, pressure offset, and coefficient of determination. Elastance, resistance, and offset are used to calculate Pr and Pc where: Pr[k] = P[k]-offset-(elastance.V[k]) and Pc[k] = P[k]-offset-(resistance.F[k]). Volume vs. Pc and flow vs. Pr can be displayed in real time. Patient data from previous clinical tests were loaded into the device to verify the software calculations. An analog waveform generator was used to simulate flow and pressure waveforms that validated the system.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Graphics

FP/MIS: a management information system for a community family planning clinic.

The management information system (FP/MIS) used by the Howard University Center for Family Planning Services, which operates community family planning clinics in Washington, D.C. is described. The system was developed to satisfy program objectives in patient management, program planning and evaluation, resource management, federal reporting systems and clinical, epidemiological and health services research. The data collection forms used in the system and the output from the four data display groups--patient profile, resource management, quality of care and epidemiology-are described along with examples of their use.

Computers

A comparison of fifteen pulse oximeters. Part I: A clinical comparison; Part II: A test of performance under conditions of poor perfusion.

Fifteen pulse oximeters were compared. Their physical characteristics, price, warranty, information handling and displays were catalogued. Times for changes in data display and susceptibility to interference were assessed. A model for comparison of oximeters under conditions of poor perfusion was developed using a tourniquet to progressively diminish limb perfusion pressure (systolic minus tourniquet pressure). The oximeters evidenced a wide variety of features and performance in poor perfusion states. Instruments lacking a beep varying in pitch with saturation or a waveform/pulse bar display of plethysmograph signal were considered less satisfactory. The majority of instruments, with some notable exceptions, performed remarkably well in a state of diminished perfusion. The study demonstrates that purchasers of pulse oximeters need to exercise care in assessing the suitability of particular instruments to their specific requirements.

Adult

Readers' forum: experiences with a system. The implementation of a completely operational computer system in a cardio-thoracic department.

Wythenshawe Hospital is a large general district hospital with more than 1000 beds, situated approximately 9 miles south of Manchester. The Cardio-Thoracic department, housed in the new section of the hospital which was completed in 1973, is the major centre for cardiothoracic surgery in the greater Manchester area. It also receives any major accident cases which require treatment within the Intensive Therapy Unit. This paper describes a Patient Data Display System and the methods used to introduce the concept of such a system, to doctors, nurses, laboratory and paramedical staff, and the manner in which these staff were trained in the use of computer terminals. Principles underlying the need for and requirements of such a system are also discussed. Six months after hardware commissioning the system was fully operational throughout the whole department.

Computers

Novel method for the display of multivariate data using neural networks.

A neural network has been used to reduce the dimensionality of multivariate data sets to produce two-dimensional (2D) displays of these sets. The data consisted of physicochemical properties for sets of biologically active molecules calculated by computational chemistry methods. Previous work has demonstrated that these data contain sufficient relevant information to classify the compounds according to their biological activity. The plots produced by the neural network are compared with results from two other techniques for linear and nonlinear dimension reduction, and are shown to give comparable and, in one case, superior results. Advantages of this technique are discussed.

Antimycin A

System-structured management of acutely ill surgical patients.

The management of surgical patients requiring intensive care is complicated by abnormalities in multiple body systems. An effective method of organizing data collection and treatment is essential. The widely applied "problem-oriented" approach is not entirely satisfactory in the context of surgical intensive care. An alternative method is presented in which management is structured by body systems. The function of each system is analyzed and a plan for each is defined. Data display is arranged by systems rather than problems and is compatible with modern computer technology. A surgical patient under treatment for pancreatitis is presented to illustrate this approach. Experience with 220 patients on a residency teaching service supports the impression that system-structured management is an effective method of managing the course of an acutely ill patient and should be widely applicable to such patients in any general surgical environment.

Acute Disease

Computerized graphic display of physiological data collected during human stereotactic surgery.

An on-line computerized graphic display has been developed for use during stereotactic operations. This depicts in the form of figurine charts and alph-numeric symbols, appropriately oriented on saggital brain diagrams, the results of serial threshold stimulation of the brain. The display facilitates choice of target sites and the data can be stored in a tape library from which search-and-plot programs can be activated for any type or combination of types of response.

Brain

Temperature effects on the MgATP-induced electron transfer between the nitrogenase proteins from Azotobacter vinelandii.

The temperature dependence of the pre-steady-state MgATP-dependent electron transfer from the MoFe protein to the Fe protein of the nitrogenase from Azotobacter vinelandii has been investigated between 6 degrees C and 31 degrees C by stopped-flow spectrophotometry. Below 14 degrees C, the data are consistent with a model in which interaction of MgATP with nitrogenase is fast and irreversible, and is followed by reversible electron transfer. From the extent and from the rate of the absorbance change, the rate constants for electron transfer from Fe protein to MoFe protein and of the reverse reaction were calculated. The direct rate constant increases with temperature (6-14 degrees C) from about 1 s-1 to about 26 s-1. The rate constant for the reverse reaction was found to be approximately 4 s-1 and invariant with the reaction temperature. Analysis of the data obtained in the temperature range between 6 degrees C and 12 degrees C within the framework of the transition-state theory show that electron transfer from the Fe protein to the MoFe protein occurs via a highly disordered transition state with activation parameters delta H(0) ++ = 289 kJ.mol-1 and delta S(0) ++ = 792 J.K-1.mol-1. The Eyring plot of the stopped-flow data displays an inflection point around 14 degrees C. From the stopped-flow data obtained between 18 degrees and 27 degrees C the activation parameters delta H(0) ++ and delta S(0) ++ for the reduction of the MoFe protein by Fe protein are calculated to be 90 kJ.mol-1 and 99 J.K-1.mol-1 respectively. A second inflection point in the Eyring plot could exist around 28 degrees C.

Adenosine Triphosphate

Characterisation of HLA DQ alpha for forensic purposes. Allele and genotype frequencies in British Caucasian, Afro-Caribbean and Asian populations.

Allele and genotype frequencies for British Caucasian, Afro-Caribbean and Asian populations were determined for a total of over 600 unrelated individuals at the HLA-DQ alpha locus. These were analysed by polymerase chain reaction amplification of the DNA followed by hybridisation to allele specific oligonucleotide probes in a reversed dot-blot test. Six different alleles were detected and the allele distributions for the 3 populations analysed displayed significant differences. However, the British Caucasian genotypes were statistically very similar to previously published data from US Caucasians as were British Afro-Caribbean genotype frequencies with US Black data. In Caucasians the allele frequencies ranged from 5.2% to 26.9% with a power of discrimination of 0.93. DQ alpha genotype frequencies of Caucasian and Afro-Caribbean populations do not deviate from Hardy-Weinberg equilibrium. However, the Asian data displayed significant deviation due to excess homozygotes.

Alleles