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A new technique (COMSPARI) to facilitate the identification of minor compounds in complex mixtures by GC/MS and LC/MS: tools for the visualization of matched datasets.

In the rapidly growing field of metabolomics, it is common to analyze complex biological samples by chromatography coupled to mass spectrometry. While several techniques are available for the detection of significant peaks in individual samples, it is still difficult to determine small differences between similar samples. Using conventional software, visual inspections of individual chromatograms or individual mass spectra are often of little use because the differences in the composition of small molecules are too small to be recognizable. Thus, we developed a new approach to visualizing mass spectral datasets using a tool that allows one to easily detect these small differences between mass spectra and chromatograms derived from matched samples. Using these tools on extracts from wild-type and methyltransferase knockout strains of the yeast Saccharomyces cerevisiae, we were able to readily identify those mass spectra in our data sets that were different between the wild-type and the knockout extracts and to identify the molecules involved. The software was also successfully applied to a set of LC/MS data from peptide digests that were performed with identical substrates but different enzymes. We have named this visualization tool COMSPARI (COMparision of SPectrAl Retention Information) and are making the software publicly available via Internet at.

Cell Extracts↗

A framework for a distributed, hybrid, multiple-ontology clinical-guideline library, and automated guideline-support tools.

Clinical guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, not in a formal, executable format, and are not easily accessible to clinicians at the point of care. We introduce a Web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application, and retrospective quality assessment. The DeGeL hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation, and a formal representation. These formats support increasingly sophisticated computational tasks. The DeGeL tools for support of guideline-based care operate, at some level, on all guideline ontologies. We have demonstrated the feasibility of the architecture and the tools for several guideline ontologies, including Asbru and GEM.

Computer Communication Networks↗

Cognitive factors influencing perceptions of clinical documentation tools.

Identifying healthcare providers' perceptions of clinical documentation methods can inform the design of computer-based documentation tools. The authors investigated the cognitive factors underlying such perceptions by performing a qualitative analysis that included open-ended in-depth interviews of a convenience sample of healthcare providers who use a variety of documentation methods. A total of 16 providers participated in the study; subjects included physicians and nurse practitioners from medical and surgical specialties who used paper- and computer-based documentation tools. Based on interview data, authors identified five factors that influenced satisfaction with clinical documentation tools: document system time efficiency, availability, expressivity, structure, and quality. These factors, if validated by subsequent investigations, can be used to develop a formal conceptual model of providers' perceptions of their satisfaction with various documentation systems.

Adult↗

Validation of the Harvard Cancer Risk Index: a prediction tool for individual cancer risk.

OBJECTIVE: Risk appraisal tools are increasingly being used in the clinical setting to estimate individuals' risks of developing and dying from diseases. The Harvard Cancer Risk Index is one such tool constructed to predict the risks of individuals, aged 40 and above, for developing the leading types of cancer in U.S. men and women relative to the general population. To date, the Risk Index has not been prospectively validated. STUDY DESIGN AND SETTING: Over a period of 10 years' follow-up in the Nurses' Health Study and the Health Professionals' Follow-up Study, age-standardized incidence ratios for cancer of the ovary, colon, and pancreas were calculated for the Risk Index's relative risk categories to assess goodness of fit for risk prediction at the aggregate level. Age-adjusted concordance statistics were determined as measures of discriminatory accuracy at the individual level. RESULTS: The Risk Index was well calibrated with observed relative risks across categories for ovarian and colon cancer in women and pancreatic cancer in men, while it performed moderately for colon cancer in men. Discriminatory accuracy was modest for ovarian cancer (age-adjusted concordance statistic = 0.59), and relatively good for pancreatic cancer (concordance statistic of 0.72), and colon cancer in men and women (concordance statistics of 0.71, 0.67 respectively). CONCLUSION: The results of this prospective validation provide evidence for the validity of the Risk Index in predicting individuals' risks of cancers, and thereby offer support for future applications of this risk appraisal tool.

Adult↗

Application of an augmented reality tool for maxillary positioning in orthognathic surgery - a feasibility study.

BACKGROUND: An augmented reality tool for computer assisted surgery named X-Scope allows visual tracking of real anatomical structures in superposition with volume rendered CT or MRI scans and thus can be used for navigated translocation of bony segments. METHODS: In a feasibility study X-Scope was used in orthognathic surgery to control the translocation of the maxilla after Le Fort I osteotomy within a bimaxillary procedure. The situation achieved was compared with the pre-operative situation by means of cephalometric analysis on lateral and frontal cephalograms. RESULTS: The technique was successfully utilized in 5 patients. Maxillary positioning using X-Scope was accomplished accurately within a range of 1mm. The tool was used in all cases in addition to the usual intra-operative splints. A stand-alone application without conventional control does not yet seem reasonable. CONCLUSION: Augmented reality tools like X-Scope may be helpful for controlling maxillary translocation in orthognathic surgery. The application to other interventions in cranio-maxillofacial surgery such as Le Fort III osteotomy, fronto-orbital advancement, and cranial vault reshaping or repair may also be considered.

Adolescent↗

Virtual tools for teaching electrocardiographic rhythm analysis.

Electrocardiographic (ECG) rhythm analysis is inadequately taught in training programs, resulting in undertrained physicians reading a large percentage of the 40 million ECGs recorded annually. The effective use of simple tools (calipers, ruler, and magnifier) required for crucial measurements and comparisons of intervals requires considerable time for interactive instruction and is difficult to teach in the classroom. The ECGViewer (Blaufuss Medical Multimedia Laboratories, Palo Alto, Calif) program was developed using virtual tools easily manipulated by computer mouse that can be used to analyze archived scanned ECGs on computer screens and classroom projection. Trainees manipulate the on-screen tools from their seats by wireless mouse while the instructor makes corrections with a second mouse, in clear view of the trainees. An on-screen ladder diagram may be constructed by the trainee and critiqued by the instructor. The ECGViewer program has been successfully used and well received by trainees at medical school, residence, and subspecialty fellow level.

Arrhythmias, Cardiac↗

A qualitative tool combining an interaction matrix and a GIS to map vulnerability to traffic induced air pollution.

Local authorities and transport planners need fast and straightforward tools to perform their preliminary air quality assessments. Such tools are required to provide an initial impression of the local air quality and to highlight areas requiring a more rigorous investigation. This paper presents a technique to develop such a tool, for performing an initial assessment of air quality due to traffic in an urban area. The technique combines an interaction matrix methodology as developed for rock engineering systems, with Geographical Information System (GIS) map overlaying. This interaction matrix methodology incorporates a total system approach, which identifies the main parameters and quantifies the interactions between them. Weighting values for these parameters are obtained either through parametric studies, using numerical modelling, or from engineering judgement. These weightings are applied to spatial datasets for a study area using a GIS. The GIS results are presented in the form of a vulnerability map, which highlights the areas susceptible to poor air quality. This visual interpretation of the results is ideal for local authorities, who have to report to a wide range of non-specialists in the field, for example, planners, councillors and the public. The vulnerability map compares favourably with pollutant concentration patterns, obtained from an advanced dispersion model.

Air Pollutants↗

Abatement cost curves: a viable management tool for enabling the achievement of win-win waste reduction strategies?

Environmental regulation of industrial activity is generally believed to have a negative impact on the industry. Recent literature has suggested, however, that reducing industrial waste outputs can, in some circumstances, result in a 'win-win', or at least 'win-draw', scenario for industry and the environment. The viability of using the abatement cost curve method as a management tool to enable the achievement of a 'win-win' state is investigated here. Copper pollution in the Humber Estuary is used as a case-study, and the abatement cost curve methodology proves to be a valuable tool in identifying barriers to achieving the win-win state, and also in providing future direction for the waste management strategy. Abatement cost curves are concluded to be powerful management tools which greatly improve the transparency of waste reduction information.

Copper↗

Developing the interaction matrix technique as a tool assessing the impact of traffic on air quality.

This paper develops a technique which can be used as a preliminary tool for assessing air quality related to urban traffic. It combines a Geographic Information System (GIS) with an interaction matrix-type methodology based on a system analysis approach. The matrix identifies and quantifies interactions between all selected variables involved in a system as well as their interaction with the system as a whole. This matrix is used to determine the weightings to apply to spatial datasets within a GIS to develop a pollution vulnerability map. The focus of the paper is to introduce and assess a more versatile coding of the interaction matrix with respect to previously used coding. A case study is presented in which the modified interaction methodology is applied to data for a busy urban location. The resulting vulnerability map, in terms of pollution vulnerable hot spots, was compared to a pollution map derived from an advanced dispersion model. The interaction matrix technique with GIS can be used as a tool complementary to sophisticated numerical modelling and has potential as an analytical tool to evaluate multidisciplinary systems.

Air Pollutants↗

Cutmarked bones from Pliocene archaeological sites at Gona, Afar, Ethiopia: implications for the function of the world's oldest stone tools.

Newly recorded archaeological sites at Gona (Afar, Ethiopia) preserve both stone tools and faunal remains. These sites have also yielded the largest sample of cutmarked bones known from the time interval 2.58-2.1 million years ago (Ma). Most of the cutmarks on the Gona fauna possess obvious macroscopic (e.g., deep V-shaped cross-sections) and microscopic (e.g., internal microstriations, Herzian cones, shoulder effects) features that allow us to identify them confidently as instances of stone tool-imparted damage caused by hominid butchery. In addition, preliminary observations of the anatomical placement of cutmarks on several of the recovered bone specimens suggest that Gona hominids may have eviscerated carcasses and defleshed the fully muscled upper and intermediate limb bones of ungulates--activities that further suggest that Late Pliocene hominids may have gained early access to large mammal carcasses. These observations support the hypothesis that the earliest stone artifacts functioned primarily as butchery tools and also imply that hunting and/or aggressive scavenging of large ungulate carcasses may have been part of the behavioral repertoire of hominids by c. 2.5 Ma, although a larger sample of cutmarked bone specimens is necessary to support the latter inference.

Animals↗

Putting ochre to the test: replication studies of adhesives that may have been used for hafting tools in the Middle Stone Age.

Substantial frequencies of Middle Stone Age (MSA) lithics from Rose Cottage and Sibudu Caves in South Africa have red ochre on their proximal and medial portions. Residue studies suggest that the tools were hafted and that the ochre may be part of the adhesive used for hafting the tools. Replication studies show that ochre is indeed a useful loading agent for adhesive; however, there are other potential loading agents. It is also possible to use unloaded plant resin, but this agent is brittle and difficult to work with. It appears that people living in the MSA had wide knowledge of ingredients suitable for hafting tools, and that they chose different adhesive recipes because of the required properties of the adhesive. Brittle, unloaded adhesive allows a projectile head to disengage its haft and implant itself in an animal; robust adhesive keeps a spearhead safely in its shaft.

Adhesives↗

A human ImmunoChip cDNA microarray provides a comprehensive tool to study immune responses.

DNA microarray technology has developed rapidly in recent years and has become an essential tool, providing novel approaches to biomedical research. In this paper, we describe a self-designed ImmunoChip cDNA array for immunological research. With a comprehensive selection of genes of interest, we can focus on key signalling pathways and molecular mechanisms at relatively low cost compared to commercial platforms which are usually targeted at global screening of gene expression. To validate the efficiency of the ImmunoChip, we studied T helper cell polarization to functionally distinct subsets (Th1 and Th2). We also developed a tool for quality control of cDNA microarrays that assesses the technical quality of an ImmunoChip. The information produced with the quality control tool is shown to be valuable for extracting correct information from cDNA microarrays. Gene expression measurements with ImmunoChip are in agreement with the results obtained using oligonucleotide microarrays and with published quantitative RT-PCR data. The ImmunoChip provides reliable measurements and gives new insights into various aspects of human immune responses.

DNA, Complementary↗

Development of a tool to assess past food insecurity of immigrant latino mothers.

OBJECTIVE: The purpose is to describe the development and validation of a tool to measure the degree of past food insecurity in an immigrant US population. DESIGN: Focus group discussions and a structured interview. As a first step, focus group discussions were conducted among immigrant Latino mothers. Based on these discussions, an 8-item tool was developed and pilot-tested in a convenience sample of mothers. SETTING: California. PARTICIPANTS: Twenty-two low-income Latino mothers with children, ages 4 to 5 years, in the focus groups and 85 low-income Latino and white mothers of young children in the structured interviews. ANALYSES: Constant comparative analysis, Cronbach alpha, Spearman correlations, Chi-square, and Kruskal-Wallis test. RESULTS: Internal consistency of the remaining 7 items was good (Cronbach alpha = 0.84). Evidence of convergent validity included significant correlations between past food insecurity and maternal education (r = -0.45, p < .0001), crowding in the mother's childhood household (r = +0.30, p < .006), and past food insufficiency (r = +0.74, p < .0001). Foreign-born Latino mothers reported significantly greater levels of past food insecurity than US-born mothers, demonstrating discriminant validity (p < .01). CONCLUSIONS AND IMPLICATIONS: This tool may be useful to determine how past deprivation influences current food choices and other nutrition-related behaviors in low-income Latino immigrants.

Adult↗

DATA-MEAns: an open source tool for the classification and management of neural ensemble recordings.

The number of laboratories using techniques that allow to acquire simultaneous recordings of as many units as possible is considerably increasing. However, the development of tools used to analyse this multi-neuronal activity is generally lagging behind the development of the tools used to acquire these data. Moreover, the data exchange between research groups using different multielectrode acquisition systems is hindered by commercial constraints such as exclusive file structures, high priced licenses and hard policies on intellectual rights. This paper presents a free open-source software for the classification and management of neural ensemble data. The main goal is to provide a graphical user interface that links the experimental data to a basic set of routines for analysis, visualization and classification in a consistent framework. To facilitate the adaptation and extension as well as the addition of new routines, tools and algorithms for data analysis, the source code and documentation are freely available.

Action Potentials↗

Feasibility of implementation, diagnostic accuracy, and end-user impact of an electronic health record (EHR)-based ureteral stent tracking tool in a pediatric population.

INTRODUCTION & OBJECTIVES: Ureteral stent tracking systems have reduced stent retention in adults, but their accuracy and impact in pediatrics have been minimally explored. With low event rates in children, such tools may yield high false positives, raising questions on balancing event prevention with provider burden. We aimed to evaluate the feasibility, diagnostic accuracy, and end-user impact of an Electronic Surveillance Tool for Evaluating Nephroureteral stent Tracking (eSTENT) at our institution. STUDY DESIGN: eSTENT, implemented in 1/2024, flags ureteral stents at risk for retention based on implant documentation, expected explant date, and explant documentation. Monthly reports are generated for stents missing explant documentation. We retrospectively evaluated the diagnostic performance of eSTENT from 1/2024-8/2025 at our pediatric hospital. A usability survey including a validated 1-7 implementation score (higher = easier implementation) was distributed to pediatric urologists and operating room nurses. RESULTS: Of 172 cases with ureteral stent placement, eSTENT flagged 28 events (16%) in 24 patients. Of these, 26 represented documentation gaps where explant had been appropriate. Two flags had no documentation of explant, representing near miss events that were identified. No retained stents occurred, consistent with high sensitivity and modest specificity. There were no flags in the last 6 months of the study period. Survey response rate was 100% for surgeons and 55% for nurses. Before eSTENT, stents were not routinely tracked. All surgeons and 93% of nurses reported no added burden, despite occasional misidentification of retained stents. Three surgeons found eSTENT beneficial, four were neutral, and free-text responses generally cited eSTENT's "fail safe" nature as positive. Nurses suggested improvements, including user support and integrated documentation reminders. The average implementation score among both groups was 6/7, indicating easy adoption. DISCUSSION: While the impact of stent tracking tools in adult literature has been positive, our study emphasizes the feasibility of broader adoption at a pediatric hospital. Integration of eSTENT may avoid the potentially devastating consequences of a retained stent. Prioritizing sensitivity over specificity appears acceptable for a "never event" in patient safety. Our study is limited by the retrospective nature of data collection and survey bias. CONCLUSIONS: Though no stents were retained in the study period, eSTENT appropriately flagged two cases without added burden to most end-users. Further optimization is warranted, but adoption in pediatric centers may enhance care reliability.

Humans↗

Does a standardization tool to direct invasive therapy for symptomatic lower extremity peripheral arterial disease improve outcomes?

OBJECTIVES: While decision analysis and treatment algorithms have repeatedly been shown to improve quality of care in many areas of medicine, no such algorithm has emerged for the invasive management of lower extremity peripheral arterial disease. Using the best available evidence-based outcomes data, our group designed a standardization tool, the Lower Extremity Grading System (LEGS) score, which consistently directs limbs to a specific treatment on the basis of presentation. The purpose of this study was to examine whether use of such a tool improves outcomes by directing treatment of lower extremity peripheral arterial disease. METHODS: Over 18 months (July 2001-December 2002) our group intervened in 673 limbs (angioplasty, open surgery, primary limb amputation) with lower extremity peripheral arterial disease. During this time we developed the LEGS score, and implemented its prospective use for the final 362 limbs. For the purpose of this study, all 673 limbs were retrospectively scored with the LEGS score to determine the LEGS recommended best treatment. Of the 673 limbs, 551 (81.9%) received the same treatment as recommended with LEGS and 122 (18.1%) received treatment contrary to LEGS. Limbs treated contrary to LEGS (cases) were then compared with matched control limbs (treated according to LEGS), with similar angiographic findings, clinical presentation, preoperative functional status, comorbid conditions and operative technical factors. Outcomes measured at 6 months included arterial reconstruction patency, limb salvage, survival, and maintenance of ambulatory status and independent living status. Kaplan-Meier curves were used to assess patency, limb salvage, and survival; associated survival curves were compared with the log-rank test. Functional outcomes were compared with the Fisher exact test. RESULTS: After matching case limbs with control limbs, 9 limbs had no control match. Thus 113 limbs in 100 patients treated contrary to LEGS were compared with 113 limbs in 100 patients treated according to LEGS. Limbs treated contrary to LEGS resulted in significantly inferior outcomes at 6 months for measures of primary patency (57.5% vs 84.3%; P < .001), secondary patency (73.2% vs 96.2%; P < .001), limb salvage (89.7% vs 97.2%; P = .04), and maintenance of ambulatory status (78% vs 92%; P = .02). As an additional finding, 29.6% (92 of 311) of interventions performed before implementation of the algorithm were treated contrary to LEGS, and thus contrary to objectively determined best therapy, compared with 8.3% (30 of 362) after LEGS implementation (P < .001). CONCLUSIONS: Limbs treated according to our standardization tool resulted in better outcomes compared with limbs treated contrary to the algorithm. These data suggest that routine use of an appropriately validated treatment standardization algorithm is capable of improving overall results for invasive treatment of lower extremity peripheral arterial disease.

Amputation, Surgical↗

Developing a saltmarsh classification tool for the European water framework directive.

The Water Framework Directive (WFD) identifies marine angiosperms (seagrasses and saltmarshes) as one of the biological elements used to classify water body status. This paper concentrates on the saltmarsh classification tools currently under development in the UK and RoI by the Marine Plants Task Team (MPTT) of the UK Technical Advisory Group (UK TAG). Saltmarsh classification is presently focusing on habitat extent, zonation and species diversity in order to fulfil the requirements of the WFD normative definitions. One of the many issues is that the natural rates of erosion and/or accretion differ between locations - this spatial and temporal natural variation is difficult to quantify; the tools and reference conditions developed will need to take this into consideration. To accurately quantify the classification boundaries and natural variability has posed a number of challenges; possible solutions are identified in this paper. Novel future classifications may also include saltmarsh ecosystem functioning (e.g., as a marine fish nursery) which may be further developed in an integrated saltmarsh tool.

Biodiversity↗

GIST: an interactive, GPU-based level set segmentation tool for 3D medical images.

While level sets have demonstrated a great potential for 3D medical image segmentation, their usefulness has been limited by two problems. First, 3D level sets are relatively slow to compute. Second, their formulation usually entails several free parameters which can be very difficult to correctly tune for specific applications. The second problem is compounded by the first. This paper describes a new tool for 3D segmentation that addresses these problems by computing level-set surface models at interactive rates. This tool employs two important, novel technologies. First is the mapping of a 3D level-set solver onto a commodity graphics card (GPU). This mapping relies on a novel mechanism for GPU memory management. The interactive rates level-set PDE solver give the user immediate feedback on the parameter settings, and thus users can tune free parameters and control the shape of the model in real time. The second technology is the use of intensity-based speed functions, which allow a user to quickly and intuitively specify the behavior of the deformable model. We have found that the combination of these interactive tools enables users to produce good, reliable segmentations. To support this observation, this paper presents qualitative results from several different datasets as well as a quantitative evaluation from a study of brain tumor segmentations.

Algorithms↗