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[Logetronic micro-film in radiological diagnosis with an integrated system of filming and filing(author's transl)].

The results of one year's routine use of primary microfilm in a large diagnostic radiological institute is reviewed. Positive views were treated by electronic contrast enhancement in an integrated system of immediate filming and filing. The resulting changes and improvements in running the department are described. This involves a fundamental reorganisation of the department, as well as equipment which is not yet commercially available. The latter had therefore to be improvised and is described. Similar procedures introduced elsewhere are critically evaluated. The advantages of immediate filming are stressed and a comparison with conventional large film filing demonstrates its financial advantages. Logical application of the method results in saving in personnel and material, but implies that the radiologist must be prepared to change to positive films in routine diagnosis. By using microfilm positives with a resolution of 4.0 pairs of lines per mm., the results equal those from large film negatives.

Archives

Comparative study of nitroglycerin and molsidomine. Effects on the integrated systemic venous bed and the arterial pressure in dogs.

The effect of nitroglycerin, N-carboxy-3-morpholino-sydnonimine-ethylester (molsidomine, Corvaton), and its metabolite 3-morpholinosydnonimine upon the peripheral circulation was investigated in 38 dogs with cardio-pulmonary bypass. The three compounds increased the integrated systemic venous blood volume and decreased the mean arterial pressure. The time course of the action of nitroglycerin was different from that of molsidomine: The arterial and venous effects of nitroglycerin began immediately after the injection was started, reached a maximum, and had disappeared after 7 min. The effects of molsidomine started later and showed no tendency to decrease during the observation period of 30 min. When referred to the same decrease in arterial blood pressure, molsidomine acted more strongly upon the systemic venous bed than did nitroglycerin. The arterial and venous effects of the molsidomine metabolite could be antagonized by a dopamine infusion. It is concluded that the hypotensive effect of the three compounds observed in the intact circulation is due to the diminuation of peripheral resistance as well as to the dilatation of the systemic venous bed. The dilatation of the veins effects a decrease in the venous return and thereby in the cardiac output and the arterial pressure. It can be concluded that the antianginal effect of the three compounds is not only due to the diminution of the afterload of the heart; the diminution of the heart; the diminution of the preload also represents an important component of action.

Animals

The development of gesture and speech as an integrated system.

Children, even at the one-word stage of language development, spontaneously produce gestures along with their speech, just as adults do. Although there appears to be a brief period prior to the onset of two-word speech during which gesture and speech do not form a well-integrated system, the ability to coordinate gesture and speech to convey a single message--and to "read" others' gestures with their speech to comprehend a message--develops early and is maintained throughout life. Gesture-speech combinations deliver a coherent message to the listener despite the fact that they consist of two different modalities of expression. According to McNeill (1992; Chapter One), this coherence is possible because gesture and speech share a common cognitive representation; that is, before the communication unfolds, gesture and speech are part of a single idea. As expression proceeds the message is parsed, with most information channeled into speech but some information channeled into gesture. Speech conveys information in a segmented, combinatorial format, whereas gesture conveys information in a global, mimetic format (see Goldin-Meadow, McNeill, and Singleton, 1996). Thus gesture and speech need not, and in fact often do not, convey the same information within a single utterance. Because gesture and speech form a unified system, mismatches between them can be a source of insight into the cognitive state of the speaker. And, indeed, it turns out that in both the young, one-word speaker and the older child (and possibly adults as well; Perry and Elder, 1996), a difference--or mismatch--between the information conveyed in gesture and the information conveyed in speech can signal readiness for cognitive growth. Whether the actual production of gesture-speech mismatches contributes to cognitive growth is an open question. That is, does the act of expressing two different pieces of information across modalities but within a single communicative act improve a child's ability to transpose that knowledge to a new level and thus express those pieces of information within a single modality? More work is needed to investigate whether the act of producing gesture-speech mismatches itself facilitates transition. Even if it turns out that the production of gesture-speech mismatches has little role to play in facilitating cognitive change, mismatch remains a reliable marker of the speaker's potential for cognitive growth. As such, an understanding of the relationship between gesture and speech may prove useful in clinical settings. For example, there is some evidence that children with delayed onset of two-word speech fall naturally into two groups: children who eventually achieve two-word speech, albeit later than the norm (that is, late bloomers), and children who continue to have serious difficulties with spoken language and may never be able to combine words into a single string (Feldman, Holland, Kemp, and Janosky, 1992; Thal, Tobias, and Morrison, 1991). Observation of combinations in which gesture and speech convey different information may prove a useful clinical tool for distinguishing, at a relatively young age, children who will be late bloomers from those who will have great difficulty mastering spoken language without intervention (see Stare, 1996, for preliminary evidence that the relationship between gesture and speech in children with unilateral brain damage correlates with early versus late onset of two-word combinations. In sum, for both speakers and listeners, gesture and speech are two aspects of a single process, with each modality contributing its own unique level of representation. Gesture conveys information in the global, imagistic form for which it is well suited, and speech conveys information in the segmented, combinatorial fashion that characterizes linguistic structures. The total representation of any message is therefore a synthesis of the analog gestural mode and the discrete speech mode. (ABSTRACT TRUNCATED)

Child Development

[Dysfunctions of transvenous cardioverter/defibrillator electrode systems: clinical significance of system integrated diagnosis and measurement function--possibilities of partially automated system control].

UNLABELLED: The aim of this study is the analysis of electrical failures in transvenous cardioverter/defibrillator (ICD) lead systems with regard to the importance of device implemented diagnostic and measurement functions and the potential role of an automated device-control in the detection of lead failures. METHODS: All consecutive ICD patients at our institution were enrolled in this retrospective investigation. The routine follow-up controls consisted in a complete evaluation of all diagnostic and measurement ICD features and additional controls in case of spontaneous arrhythmia episodes. RESULTS: Two hundred thirty patients, 193 male and 37 female, were enrolled in this study (mean age: 61.5 +/- 10.2 years; mean LVEF 32 +/- 9%). During a mean follow-up period of 29.5 +/- 18.4 (6-76) months, lead failure occurred in 19 patients (8%), 16 patients were implanted with an ICD, capable of diagnostic and measurement functions. All nonadequate device discharges could be classified as sensing-failure by stored electrograms. Device implemented measurement features revealed clinical important information in 13/16 patients (81%). In 14/16 patients, the lead defect could not be detected during routine follow-up. At the time of documented lead failure the safety of the implanted devices was already lost in 6/16 patients (38%). CONCLUSIONS: Device implemented diagnostic and measurement options are of great importance in the early detection of ICD lead failures. The implementation of automated measurements of lead related parameters in connection with a patient alert function may contribute to a further increase in the safety of ICD therapy.

Adult

A bioimaging integration system implemented for neurological applications.

A system aimed at the management and fusion of multimodal biomedical images, including X-ray computed tomography, magnetic resonance imaging, positron emission tomography, and single photon emission computed tomography, has been implemented for neurological applications. This bioimaging integration system (BIS) consists of a network for image transmission from acquisition machines to dedicated image processing workstations, a software library for image standardization, and an image registration technique to project multimodal volumetric images into a common reference space. The registration procedure was evaluated in MRI/PET correlation studies, in which misalignment errors of 2.6 mm in the xy transaxial plane and 3.4 mm along the z axis were found. BIS has been validated for the anatomical-functional correlation analysis of MRI and PET images in neurological research protocols and clinical studies.

Brain Diseases

Serotype conversion of a Shigella flexneri candidate vaccine strain via a novel site-specific chromosome-integration system.

Shigella flexneri SFL124 (serotype Y) is a promising live oral vaccine candidate, which has been shown to be safe and immunogenic in human volunteers. To change the serotype of this vaccine strain, we inserted a serotype conversion gene cluster into the chromosome of SFL124 by using a bacteriophage-based site-specific integration system. By cloning an integrase gene (int), an attachment site (attP) and a glucosyl transfer gene cluster from bacteriophage SfX into a suicide vector, and subsequently introducing this construct into S. flexneri SFL124, we obtained a S. flexneri strain (designated SFL1213) expressing the serotype X somatic antigen specificity. The strain retained other characteristics of the parent strain, such as colony shape, growth rate, and Congo red binding property. Stability test showed that the serotype X O-antigen specificity in SFL1213 was 100% stable after being cultured approximately 72 successive hours under non-selective condition. In a mouse pulmonary model, the recombinant strain elicited a significant level of humoral antibodies which recognized the lipopolysaccharide (LPS) of a wild-type S. flexneri serotype X strain. The site-specific insertion system will be useful when stable expression of a cloned single copy gene is desired in the chromosome of S. flexneri vaccine candidate, SFL124.

Animals

The dicyemid Mesozoa as an integrated system for morphogenetic studies. I. Description, isolation and maintenance.

The morphological simplicity of the dicyemid Mesozoa is such as to allow mapping of enery individual cell during the development of the organisms. Individual cells are of a size amenable to micromanipulation and a number of potential morphogenetic makers is readily apparent. The possibility of raising the animals in vitro and obtaining developmental mutants makes these organisms excellent candidates for use as an integrated system to correlate cytodifferentiation and morphogenesis with genetic control. An axenic, nearly defined, medium in which the misozoans can be kept for over three months has been developed. Methods for isolating and maintaining the organisms are described.

Animals

A chromosomal integration system for stabilization of heterologous genes in Salmonella based vaccine strains.

We have developed a system whereby heterologous DNA encoding an antigen from an enteropathogen may be recombined into the chromosome of an attenuated Salmonella carrier strain. The system involves two steps: (i) integration of a hisOG deletion mutation into the chromosome; (ii) replacement of the hisOG deletion by the complete hisOG region and the segment of heterologous DNA which encodes the antigen of interest. Recombinants may be selected (his+). The system was used to integrate the genes encoding K88 fimbriae from enterotoxigenic Escherichia coli into the chromosome of a galE mutant of Salmonella typhimurium (LT2H1). Recombinants were detected at a frequency of between 1.0 x 10(-3) and 1.5 x 10(-3). A variety of tests confirmed that the K88 genes were integrated into the chromosome of LT2H1 and were expressed. The stability of the recombinant was tested both in vivo and in vitro. When administered orally to mice, the recombinant elicited a serum antibody response to K88, and retained the Salmonella vaccine potential of the vector strain.

Antigens, Bacterial

[Jaw position, head position, body posture: development of an integrated system of examination, Part I].

Recently in the field of clinical orthodontics, there has been increased interest in the relationship between jaw and head position, sleep apnea, and equivocal symptoms occurring in head, neck and shoulder. It has already been determined that a relation exists between head posture and mode of breathing. Since the craniofacial skeleton is supported by the cervical, thoracic and lumbar vertebrae, the head position might have some biomechanical connection to total body posture. Therefore, an integrated system of examining jaw position, head position and body posture is being developed.

Biomechanical Phenomena

Calorimetric studies of oxyhemoglobin ligand dissociation. III. Evidence for a hemoglobin-catalase-superoxide dismutase integrated system in the oxygen depletion by dithionite.

Calorimetric studies of the effect of superoxide dismutase and/or catalase on the reduction of dioxygen into water by dithionite in oxyhemoglobin have been carried out and the results compared with those in red cell hemolysates. In the absence of the enzymes the stoichiometry (moles dithionite/mole dioxygen) is less than the value of 2:1 which was found previously in red cell hemolysates [Forlani et al., J. Inorg. Biochem. 20, 147-155 (1984)]. In the presence of either superoxide dismutase or catalase alone the stoichiometry increases but is still less than 2:1. In the presence of both enzymes the stoichiometry and the shape of the thermogram is that previously observed for hemolysates, suggesting the presence of a hemoglobin-catalase-superoxide dismutase integrated system. The absence of a calorimetric signal for hydrogen peroxide in the reduction of oxyhemoglobin in the presence of superoxide dismutase suggests a wider biological role of superoxide dismutase than previously thought.

Catalase

Integrated system for the screening of the specificity of protein kinase inhibitors.

Tyrosine protein kinases (TPKs) play a major role in the transformation of cells. They are currently used as molecular targets for new generations of anticancer compounds. Numerous TPKs have been described from various tissues using either classical molecular biochemical techniques or cloning strategies. As a natural extension of these discoveries, a large number of "specific" inhibitors have been described in the literature. The major problem with these inhibitors is that there is no simple way to compare their specificity and/or selectivity from one report to another. We have set up a simple, straightforward technique to compare the inhibitory potency of 14 classical inhibitors towards six well-described and at least partially purified protein kinases. This technique is based on a new assay, easy to carry out and non-restrictive in terms of the type of protein substrate used. It permits direct comparisons between the results obtained from various sources. Data obtained showed that, when assessed in this integrated system, specificity and selectivity of many "classical" inhibitors are often weak, thus demonstrating that a universal technique such as ours is essential for the molecular screening of new protein kinase inhibitors. Compounds showing specificity for this panel of protein kinases will be more easily targeted to some defined types of oncogene and of transformed cells.

Alkaloids

[Response of pituitary and adrenal elements in a state of cardiorespiratory system integration].

Morpho-functional equivalents of reaction of the hypophyseal and adrenal elements have been studied in 7 test and 10 control dogs biometrically, histologically, histoenzymatically and electron microscopically under the condition of integration in the cardio-respiratory systems. The condition has been modelled by individually chosen physical loading (running in the treadmill) up to the IV stage of the organism's adaptation according to the author's technique. The integration state is developing instead of the starting desintegration state (the beginning of the work) and is characterized by an economical and effective functioning of the cardio-respiratory system elements. At the integration of the cardio-respiratory apparatus, the hypophysial-adrenal system is activating. The principle of the zonal reaction in the adrenals and that of the selective activity of the adenohypophysis is clearly followed, that is demonstrated in the predominant activation of the bundle zone elements, chromophobic and basophilic adenocytes where certain signs of the secretory excretion predominate. In cells of the glomerular zone the signs of synthetic processes prevail over those of the secretory excretion. In cells of the medullary substance the signs of the preceding forced secretory excretion are clearly seen. A suggestion is made that it is expedient to elaborate training regimes according to the loading determining integration of the organism's cardio-respiratory systems.

11-Hydroxycorticosteroids

System integration: a necessity.

Healthcare organizations are undergoing tremendous change in an attempt to become more flexible and adaptive. To be successful in any such transformation, organizations must build processes and systems that allow them to move with change and create a culture that allows individuals to thrive amid change. The authors describe how a community teaching hospital has attempted this through its partnership in a vertically integrated delivery system, its reorganization to product line management, its adoption of a shared governance structure, and its commitment to building a culture with strong relationships. Many of these processes and systems are in their infancy, but an examination of the journey will inform other organizations as they respond to change.

Delivery of Health Care, Integrated

Clinical process improvement as a means of facilitating health care system integration.

BACKGROUND: In recent years many health care providers, physicians, hospitals, and managed care organizations have undergone significant reorganization in both delivery and financing systems. This has created new organizations called integrated or organized delivery systems. Sentara Health System (Norfolk, Va), one of these new integrated entities, developed a unified strategy for clinical process improvement for the entire organization. This system-wide approach had unanticipated problems and benefits. METHODS: The Sentara Health System created a team responsible for coordinating clinical process improvement activities across its hospitals and ambulatory physician sites. A steering committee directed this team to improve the organization and delivery of care for specific high-cost, high-volume, or problem-prone disease for physicians to manage. A standardized approach aimed at coordinating care across sites was the cornerstone of these activities. RESULTS: Significant improvements in patient outcomes and a concomitant decrease in costs of care were accomplished for multiple diseases and procedures. These projects uncovered unanticipated barriers to implementing improvement projects in a complex health care system which make implementing these activities far more difficult than for an individual hospital with its medical staff. CONCLUSION: Coordinating clinical improvement activities across multiple hospitals and other sites of care in a complex integrated delivery system serves important purposes in addition to improving patient care. These projects were an important cultural change agent to transform the individual components of the system into one that is capable of delivering care continuously across multiple sites. Standardization of care practices, policies, and procedures is considerably enhanced by coordinating these activities across the entire system.

Cerebrovascular Disorders

Systems integration for PACS.

A successful PACS (Picture Archiving and Communications System) implementation requires an eclectic integration of a number of key technologies. Among these are equipment interfaces, communications, storage, and display. Coincident with this, the software architecture must support a distributed system of heterogeneous structures, provide for protocol and format conversions to a unified system standard, be scalable to accommodate expansion, and provide a measure of fault tolerance. In this paper we survey the current state of the UCLA PACS components and architecture.

Computer Systems

Fetal heart rate monitoring by telephone. I. Development of an integrated system in Cardiff.

We report the development of a practical dedicated system for domiciliary fetal monitoring integrated in a scheme for its rational application. From experience of 1120 domiciliary recordings in 74 women (64 with high-risk pregnancies), we suggest that domiciliary monitoring applied within a structured clinical context should be as safe as monitoring in hospital.

Female

Deciphering the hippocampal polyglot: the hippocampus as a path integration system.

Hippocampal 'place' cells and the head-direction cells of the dorsal presubiculum and related neocortical and thalamic areas appear to be part of a preconfigured network that generates an abstract internal representation of two-dimensional space whose metric is self-motion. It appears that viewpoint-specific visual information (e.g. landmarks) becomes secondarily bound to this structure by associative learning. These associations between landmarks and the preconfigured path integrator serve to set the origin for path integration and to correct for cumulative error. In the absence of familiar landmarks, or in darkness without a prior spatial reference, the system appears to adopt an initial reference for path integration independently of external cues. A hypothesis of how the path integration system may operate at the neuronal level is proposed.

Animals