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PubMed2005

A mobile trauma database with charge capture.

BACKGROUND: Charge capture plays an important role in every surgical practice. We have developed and merged a custom mobile database (DB) system with our trauma registry (TRACS), to better understand our billing methods, revenue generators, and areas for improved revenue capture. METHODS: The mobile database runs on handheld devices using the Windows Compact Edition platform. The front end was written in C# and the back end is SQL. The mobile database operates as a thick client; it includes active and inactive patient lists, billing screens, hot pick lists, and Current Procedural Terminology and International Classification of Diseases, Ninth Revision code sets. Microsoft Information Internet Server provides secure data transaction services between the back ends stored on each device. Traditional, hand written billing information for three of five adult trauma surgeons was averaged over a 5-month period. Electronic billing information was then collected over a 3-month period using handheld devices and the subject software application. One surgeon used the software for all 3 months, and two surgeons used it for the latter 2 months of the electronic data collection period. This electronic billing information was combined with TRACS data to determine the clinical characteristics of the trauma patients who were and were not captured using the mobile database. RESULTS: Total charges increased by 135%, 148%, and 228% for each of the three trauma surgeons who used the mobile DB application. The majority of additional charges were for evaluation and management services. Patients who were captured and billed at the point of care using the mobile DB had higher Injury Severity Scores, were more likely to undergo an operative procedure, and had longer lengths of stay compared with those who were not captured. CONCLUSION: Total charges more than doubled using a mobile database to bill at the point of care. A subsequent comparison of TRACS data with billing information revealed a large amount of uncaptured patient revenue. Greater familiarity and broader use of mobile database technology holds the potential for even greater revenue capture.

Accounting↗

PubMed2005

PKI-based secure mobile access to electronic health services and data.

Recent research works examine the potential employment of public-key cryptography schemes in e-health environments. In such systems, where a Public Key Infrastructure (PKI) is established beforehand, Attribute Certificates (ACs) and public key enabled protocols like TLS, can provide the appropriate mechanisms to effectively support authentication, authorization and confidentiality services. In other words, mutual trust and secure communications between all the stakeholders, namely physicians, patients and e-health service providers, can be successfully established and maintained. Furthermore, as the recently introduced mobile devices with access to computer-based patient record systems are expanding, the need of physicians and nurses to interact increasingly with such systems arises. Considering public key infrastructure requirements for mobile online health networks, this paper discusses the potential use of Attribute Certificates (ACs) in an anticipated trust model. Typical trust interactions among doctors, patients and e-health providers are presented, indicating that resourceful security mechanisms and trust control can be obtained and implemented. The application of attribute certificates to support medical mobile service provision along with the utilization of the de-facto TLS protocol to offer competent confidentiality and authorization services is also presented and evaluated through experimentation, using both the 802.11 WLAN and General Packet Radio Service (GPRS) networks.

Certification↗

PubMed1995

Periodontal ligament tissue reactions to trauma and gingival inflammation. An experimental study in the beagle dog.

The aims of the present study were to analyze (i) which tissue changes may occur in the zone of co-destruction to better understand why trauma from occlusion may induce additional attachment loss, and (ii) whether changes occur in the periodontal ligament tissue when an inflammatory lesion (ICT) approaches the periodontal ligament space. 16, 1-year-old beagle dogs, were selected and divided into 2 groups, group A and group B, consisting of 6 and 10 dogs, respectively. In group A, on day 0, a bucco-lingual jiggling type movement was induced resulting in increasing tooth mobility at P3 (test tooth) by the application of an orthodontic elastic which traversed the buccal surface of the crown of the test tooth. The elastic was exchanged either in a buccal or in a lingual position 2x a week during a 3-month period. 3P served as non-jiggled control tooth. Tooth mobility measurements were recorded on days 0, 30, 60, 90. A plaque control regimen was maintained until the end of the experiment (day 90). On day 90, biopsies including P3 and 3P were harvested. The dogs representing group B, were divided into 2 subgroups of 5 each, group BI and group BII. On day 0, a 4-month period of experimental periodontal tissue breakdown was initiated by placing cotton floss ligatures submarginally around the mandibular fourth premolars (4P4) in group BI and around the mandibular third premolars GP3) in group BII. All ligatures were exchanged, replaced 1x every month, and on day 120 permanently removed. On the same day, biopsies included 4P4 were harvested. Following supragingival debridement 3P3 were allowed to accumulate plaque until the end of the study (day 225). On this occasion, biopsies including 3P3 were harvested. The results of the histological measurements revealed that in the most coronal portion of the periodontal ligament of teeth exhibiting increasing mobility, there was an increased width, a reduced % tissue volume of collagen, and an increased volume of vascular structures and leukocytes. Furthermore, the number of osteoclasts bordering this portion of the alveolar bone was increased and the number of collagen fibers inserting into the root cementum and into the alveolar bone was reduced. It was also demonstrated that in teeth with normal mobility, the position of the gingival ICT failed to influence the composition of the tissue within the coronal portion of the periodontal ligament.

Alveolar Process↗

PubMed2003

Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance.

Previous studies have demonstrated that the initial hypoalgesic effect of spinal manipulative therapy was not antagonized by naloxone and did not exhibit tolerance with repeated applications. The implication is that endogenous opioid mechanisms of pain relief are probably not at play in spinal manipulative therapy. The role of endogenous opioid peptides in manipulation of the peripheral joints has not been investigated. The aim of this study was to evaluate whether the initial hypoalgesic effect of a peripheral manipulative technique (mobilization-with-movement treatment for the elbow) demonstrated a tolerance to repeated applications (ie, reduction in magnitude of effect over repeated applications). Twenty-four participants with unilateral chronic lateral epicondylalgia participated in the study. A repeated measures study was conducted to examine the effect of repeated applications of the mobilization-with-movement treatment for the elbow on 6 separate treatment occasions at least 2 days apart. Pain-free grip strength and pressure pain threshold were chosen as the pain-related outcome measures. Changes in the percent maximum possible effect scores of measures of hypoalgesia were evaluated across the 6 treatment sessions by using linear trend analysis. The results showed no significant difference for the hypoalgesic effect of the treatment technique between sessions (P >.05). This peripheral manipulative therapy treatment technique appeared to have a similar effect profile to previously studied spinal manipulative therapy techniques, thereby contributing to the body of knowledge that indicates that manipulative therapy most likely induces a predominant non-opioid form of analgesia.

Adult↗

PubMed1989

Application of optimization procedures for the separation of anabolic compounds by high-performance liquid chromatography.

A simple systematic approach is presented for optimizing high-performance liquid chromatographic separations of anabolics with multi-component isocratic mobile phases. A computer program was obtained and adjusted for use with an IBM-compatible XT personal computer. The program requires experimental retention data with three quaternary solvent mixtures to calculate the optimum solvent composition using a geometric model of a prism. For each possible composition of the mobile phase the set of retention data can be calculated. Applications are shown for mixtures of anabolic compounds using a mobile phase composed of methanol, tetrahydrofuran and acetonitrile. The predicted retention data agreed very well with the experimental data.

Anabolic Agents↗

PubMed1997

Posteroanterior spinal mobilization: state of the art review and discussion.

Posteroanterior spinal mobilization is a commonly used technique among physical therapists to diagnose and treat lower back pain patients. Human subjects and instruments have been used to test for the reliability of physical therapists' ability to detect intervertebral motion, but studies confirm unreliable testing. Despite documented efficacy of manual treatment the mechanical response to posteroanterior spinal mobilization is not well understood, and this has been emphasized in recent studies. Various modes of instrumental methodology have been used for objective measurements of force application and joint displacement. Some instruments serve to mobilize the spine others serve as measurement tools for mobilization. The literature does not provide a gold standard for the ideal magnitude of force applied or joint displacement. The terminology used in the field of manual therapy is often confusing, and terms need to be defined. A review and discussion is presented here to highlight the issues and gaps.

Biomechanical Phenomena↗

PubMed1999

A strategy for primary reconstruction of long gap esophageal atresia using neonatal colon esophagoplasty: a case report.

Treatment options for long gap esophageal atresia without tracheoesophageal fistula generally require several stages over many months. An early neonatal vascularized conduit would allow a tension-free anastomosis, but the precarious blood supply of the neonatal bowel makes mobilization and immediate interposition hazardous. This report describes the successful application of a strategy for primary reconstruction in the neonate using a short piece of colon mobilized into the mediastinum for subsequent delayed anastomosis.

Colon↗

PubMed1991

Neurotensin and neuromedin N elevate the cytosolic calcium concentration via transiently appearing neurotensin binding sites in cultured rat cortex cells.

Through assessment of the changes in the intracellular free-calcium concentration ([Ca2+]i), which was measured using the calcium sensitive dye, fura-2, the character of the neurotensin (NT) binding sites which appeared transiently during the early ontogenetic stage in the rat cerebral cortex was analyzed in primary cultures of cerebral cortex cells from neonatal rats. NT (1-1000 nM) elevated [Ca2+]i of the cells even when extracellular calcium was chelated with 1 mM ethylene glycol-bis(beta-aminoethylether)-N,N,N',N'-tetraacetic acid (EGTA). These findings suggest that the transiently appearing NT-binding sites in the cortex are receptors for NT and that some of the NT-induced increase in [Ca2+]i is due to mobilization from the intracellular calcium store. Further application of NT after 10 min washing caused an increase in [Ca2+]i again. This is in contrast to the findings for cortical slices from adult rats and mRNA-injected oocytes; desensitization due to NT was of long duration and further application of NT failed to activate the neurons which had responded the first time to NT. These facts suggest that the character of the NT-binding sites in the cerebral cortex differs between neonatal and adult rats. In addition, we showed that neuromedin N had a similar property to NT as to mobilization of [Ca2+]i and acted only on NT-responsive cells, suggesting the interaction between NT and neuromedin N at the postsynaptic level via the same receptor.

Amino Acid Sequence↗

PubMed2003

Role of phosphorus in (Im)mobilization and bioavailability of heavy metals in the soil-plant system.

A large number of studies have provided conclusive evidence for the potential value of both water-soluble (e.g.. DAP) and water-insoluble (e.g., apatite, also known as PRs) P compounds to immobilize metals in soils, thereby reducing their bioavailability for plant uptake. It is, however, important to recognize that, depending on the nature of P compounds and the heavy metal species, application of these materials can cause either mobilization or immobilization of the metals. Furthermore, some of these materials contain high levels of metals and can act as an agent of metal introduction to soils. Accordingly. these materials should be scrutinized before their large-scale use as immobilizing agent in contaminated sites. Although mobilization by certain P compounds enhances the bioavailability of metals, immobilization inhibits their plant uptake and reduces their transport in soils and subsequent groundwater contamination. Whenever phytoremediation of contaminated sites is practicable, appropriate P compounds can be used to enhance the bioavailability of metals for plant uptake. Removal of metals through phytoremediation techniques and the subsequent recovery of the metals or their safe disposal are attracting research and commercial interests. Phosphate compounds can be used to enhance the solubilization of metals, leading to their increased uptake by plants. However, when it is not possible to remove the metals from the contaminated sites by phytoremediation, other viable options such as in situ immobilization should be considered as an integral part of risk management. One way to facilitate such immobilization is by altering the physicochemical properties of the metal-soil complex by introducing a multipurpose anion, such as phosphate, that enhances metal adsorption via anion-induced negative charge (i.e., CEC) and metal precipitation. It is important to recognize that large-scale use of P compounds can lead to surface and groundwater contamination of this element. It is therefore, important that future research should aim to focus on the role of P compounds on in situ remediation and natural attenuation in metal-contaminated sites, with minimum impact of P on quality of water sources.

Biological Availability↗

PubMed2001

Reversed-phase separation of basic tricyclic antidepressants using buffered and fluoroform-enhanced fluidity liquid mobile phases.

In an effort to expand the range of applications of enhanced-fluidity liquid chromatography (EFLC) to strongly polar and basic analytes, fluoroform (CHF3) was investigated as a fluidity-enhancing agent. Fluoroform was chosen due to its high polarity, low viscosity and chemical inertness toward water and basic analytes. A group of representative basic compounds, tricyclic antidepressants, covering a wide range of polarity was chosen as model compounds. Their retention behavior on a C18 stationary phase in methanol/phosphate buffer and methanol/phosphate buffer/CHF3 mobile phases was characterized. The chromatographic performance with mobile phase conditions of different pH, with and without CHF3 addition and with addition of triethylamine was studied. The advantages of using CHF3 enhanced and buffered mobile phases were shown in the much improved chromatographic performance, such as shortened analysis time, increased efficiency, lower pressure drop and improved selectivity. Furthermore, this study demonstrated for the first time, that a commercial instrument could be readily utilized for EFLC separations which greatly expands the application range of the EFLC technique and chromatographic instrumentation.

Antidepressive Agents, Tricyclic↗

PubMed2005

Preliminary comparison of the Essie and PubMed search engines for answering clinical questions using MD on Tap, a PDA-based program for accessing biomedical literature.

MD on Tap, a PDA application that searches and retrieves biomedical literature, is specifically designed for use by mobile healthcare professionals. With the goal of improving the usability of the application, a preliminary comparison was made of two search engines (PubMed and Essie) to determine which provided most efficient path to the desired clinically-relevant information.

Computers, Handheld↗

PubMed2004

Effect of mobile phase composition, pH and buffer type on the retention of ionizable compounds in reversed-phase liquid chromatography: application to method development.

Optimizing separation of ionizable compounds in order to find robust conditions has become an important part of method development in liquid chromatography. This work is an attempt to explain the observed variations of retention of acid and basic compounds with the organic modifier content in the mobile phase, according to various factors: the type of modifier, the type of buffer, the temperature and of course the type of solute. This is done by considering the variation of the so-called chromatographic pKa which refers to the pH measured in the aqueous medium and is determined from retention data. A procedure is described that accurately relates, from nine experiments, retention to solvent composition and pH. The limits of such a procedure are evaluated and two examples of optimized separations of basic compounds are given.

Acetonitriles↗

PubMed1998

Cooperative problem solving with personal mobile information tools in hospitals.

Health-care professionals have a broad range of needs for information and cooperation while working at different points of care (e.g., outpatient departments, wards, and functional units such as operating theaters). Patient-related data and medical knowledge have to be widely available to support high-quality patient care. Furthermore, due to the increased specialization of health-care professionals, efficient collaboration is required. Personal mobile information tools have a considerable potential to realize almost ubiquitous information and collaborative support. They enable to unite the functionality of conventional tools such as paper forms, dictating machines, and pagers into one tool. Moreover, they can extend the support already provided by clinical workstations. An approach is described for the integration of mobile information tools with heterogeneous hospital information systems. This approach includes identification of functions which should be provided on mobile tools. Major functions are the presentation of medical records and reports, electronic mailing to support interpersonal communication, and the provision of editors for structured clinical documentation. To realize those functions on mobile tools, we propose a document-based client-server architecture that enables mobile information tools to interoperate with existing computer-based application systems. Open application systems and powerful, partially wireless, hospital-wide networks are the prerequisites for the introduction of mobile information tools.

Decision Making, Computer-Assisted↗

PubMed2004

A modified quantitative EMSA and its application in the study of RNA--protein interactions.

Electrophoretic mobility shift assay (EMSA) is used to detect the complex of protein and nonradioisotope-labeled probe qualitatively. In this paper, we describe a modified quantitative EMSA, which uses biotin-labeled RNA in the complex formation. The RNA-protein complex is separated by agarose gel electrophoresis and capillary transferred to a positively charged nylon membrane. It is then detected through a secondary detection system using 5-bromo-4-chloro-3-indolyl phosphate (BCIP)-nitroblue tetrazolium (NBT) as the colorimetric precipitating substrate. After scanning and quantification by an image analysis program, ImageQuant, it was observed that the optical density of the bands was proportional to the decadic logarithm value of standard RNA quantities in the tested range. By using the standard curve of the optical densities plotted against the logarithm values of RNA quantities in the linear range, we can calculate RNA quantities according to the optical density of the band and make a quantitative analysis of EMSA. This method was applied successfully in the study of the interactions between the AU-rich element (ARE) and HuR, which is one of the human members of the (embryonic lethal abnormal vision) ELAV family. The results reveal that the biotin-labeled AUFL transcripts in the RNA-protein complex can be detected quantitatively, while maintaining the biological features of its binding ability to the HuR protein. By this method, it is possible to conduct qualitative and quantitative analyses of the EMSA in the study of RNA-protein interactions.

Alkaline Phosphatase↗

PubMed1994

Quantitative analysis of macromolecular conformational changes using agarose gel electrophoresis: application to chromatin folding.

Quantitative analysis of chromatin electrophoretic mobility (mu) in agarose gels provides a measure of three structural parameters: average surface electrical charge density, which is proportional to the gel-free mu (mu 0), effective radius (Re), and particle deformability [Fletcher, T. M., Krishnan, U., Serwer, P., & Hansen, J. C. (1994) Biochemistry 33, 2226-2233]. To determine whether the intramolecular conformational changes associated with salt-dependent chromatin folding influence these electrophoretic parameters, defined oligonucleosomes were reconstituted from monodisperse tandemly repeated 5S DNA and varying amounts of histone octamers. These oligonucleosomes were subjected to both quantitative agarose gel electrophoresis and analytical velocity ultracentrifugation in buffers containing 0-2 mM MgCl2. Ionic conditions that caused a 40% increase in the oligonucleosome sedimentation coefficient (s20,w) also caused both a 30% decrease in Re and a 60% decrease in the magnitude of the mu 0. Furthermore, the Mg(2+)-dependent changes in s20,w, Re, and mu 0 each exhibited the same nonlinear dependence on the degree of nucleosome saturation of the DNA. These data demonstrate that quantitative agarose gel electrophoresis can be used to detect and characterize the process of chromatin folding. In addition, they suggest that this approach can be used for characterization of the conformational dynamics of many other types of macromolecular assemblies, including those systems that are not yet amenable for study by more traditional quantitative biophysical techniques.

Animals↗

PubMed1986

Clinical application of monitoring techniques: radioisotopic methods.

The availability of mobile gamma cameras or the nearness of nuclear medicine devices to the coronary care unit make the assessment of transient myocardial ischemia by radioisotopic techniques practical. Nuclear cardiology provides information on the presence, site and extent of ischemia and helps the clinician in the evaluation of myocardial functional impairment and recovery. Monitoring of myocardial wall motion by radionuclide ventriculography demonstrates that during angina at rest; global ejection fraction is not always sensitive to regional ischemia; episodes of angina with undetectable electrocardiographic signs of ischemia can be associated with severe myocardial dysfunction; separate left and right phase analysis of radionuclide ventriculography is a sensitive tool to assess segmental dyssynergy localized to the left or the right ventricle; a prevalent right ventricular impairment during ischemia, not measurable by Thallium scintigraphy, is possible; the recovery of function after ischemia is usually fast and apparently complete. In addition, useful diagnostic information can be derived by left ventricular injection of radioactive microspheres during cardiac catheterization followed by gated acquisitions of the intramyocardial radioactivity. Gated microsphere acquisitions, providing diastolic and systolic images, avoid blurring of images due to cardiac motion and enhance contrast between myocardium and background: the overall result is an improved detection and definition of small perfusion defects. Furthermore, this technique permits simultaneous assessment of regional perfusion and wall motion. An appraisal of potential mismatches between flow and function after revascularization procedures can be recognized by this approach. The development of technology is improving the performance of nuclear medicine instrumentation, hampered, at present, by limited spatial and temporal resolution.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗

PubMed1993

Stable fluorescent dye-DNA complexes in high sensitivity detection of protein-DNA interactions. Application to heat shock transcription factor.

The gel mobility-shift assay is an important tool for the study of protein-nucleic acid interactions. High detection sensitivity is typically attained by radioisotopic labeling of the target nucleic acid fragments. A novel fluorescence methodology offers significant advantages over this conventional approach. Ethidium, thiazole orange, and oxazole yellow homodimers form stable, highly fluorescent complexes with double-stranded DNA that can be detected in gels by a laser-excited, confocal, fluorescence scanning system with a sensitivity higher than that attainable with radioisotopic labeling. We describe here the use of these dyes in a gel-mobility assay to detect complexes of a truncation of the Kluyveromyces lactis heat shock transcription factor, containing the trimerization and DNA-binding domains (HSFDT), with target DNA. At an appropriate molar DNA base pair to dye ratio, the labeling of a DNA fragment with dimeric dye did not affect the binding to HSFDT. The detection of the fluorescent-dye labeled HSFDT-DNA complexes with the laser scanner achieves a spatial resolution far superior to that of conventional autoradiography and permits analysis of multimer protein-DNA complexes that are not resolved by traditional detection methods. We have used this technique to demonstrate that HSF forms multimeric complexes on DNA by addition of trimeric units. The latter conclusion is based on an analysis of the mobilities of the multiple HSFDT-DNA complexes and on a two-color mobility-shift fluorescence assay that uses a mutant of HSFDT engineered for site-specific labeling with fluorescein and target DNA labeled with an "energy transfer" dye, thiazole orange-thiazole blue heterodimer.

Base Sequence↗

PubMed1998

[Effect of implants in the metacarpal head and proximal phalanx on mobility of the metacarpophalangeal joint. An anatomic study].

Percutaneous application of Kirschner wires, fixator pins, or other implants near the metacarpophalangeal joint may lead to postoperative disability of movement with subsequent joint stiffness. To determine the best location for the application of implants into the metacarpal head and the basis of the proximal phalanx, 57 Kirschner wires were introduced into the metacarpal head and into the bases of the proximal phalanx and the resulting stiffness has been measured. Kirschner wires inserted at the level of the dorsal tubercle or proximal to the tubercle, do not lead to a noteworthy stiffness. Whenever possible, this tubercle should be taken as the distal border for inserting implants. If the position of the fracture line makes it necessary to implant wires into the metacarpal head itself, a more dorsal application is preferable. If a palmar placement cannot be avoided, the implantation should be done in neutral position of the metacarpophalangeal joint, because a transfixation of the tense collateral ligament in flexion leads to a maximum of postoperative stiffness. The application of wires into the basis of the proximal phalanx does not influence the range of movement of the metacarpophalangeal joint.

Biomechanical Phenomena↗