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Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Attitude of Health Personnel↗

System analysis of Phycomyces light-growth response. Wavelength and temperature dependence.

The light-growth response of the Phycomyces sporangiophore was studied further with the sum-of-sinusoids method of nonlinear system identification. The first- and second-order frequency kernels, which represent the input-output relation of the system, were determined at 12 wavelengths (383-529 nm) and 4 temperatures (17 degrees, 20 degrees, 23 degrees, and 26 degrees C). The parametric model of the light-growth response system, introduced in the preceding paper, consists of nonlinear and linear dynamic subsystems in cascade. The model parameters were analyzed as functions of wavelength and temperature. At longer wavelengths, the system becomes more nonlinear. The latency and the bandwidth (cutoff frequency) of the system also vary significantly with wavelength. In addition, the latency decreases progressively with temperature (Q10 = 1.6). At low temperature (17 degrees C), the bandwidth is reduced. The results indicate that about half of the latency is due to physical processes such as diffusion, and the other half to enzymatic reactions. The dynamics of the nonlinear subsystem also vary with wavelength. The dependence of various model components on wavelength supports the hypothesis that the light-growth response, as well as phototropism, are mediated by multiple interacting photoreceptors.

Kinetics↗

[Third-party payment system. Analysis of surveys performed in the province of Limbourg and in the department of Louvain].

Two inquiries were set up to analyse the attitude to and the use of the direct payment system. This system implies a direct payment of the dentist by the social assurance organisations. Because of the potential fraud, this system is very controversial. Both users and non-users suggested better controls simplified administration and a legal obligation to demand the franchise part of the fees.

Belgium↗

SCAP: a new methodology for safety management based on feedback from credible accident-probabilistic fault tree analysis system.

As it is conventionally done, strategies for incorporating accident--prevention measures in any hazardous chemical process industry are developed on the basis of input from risk assessment. However, the two steps-- risk assessment and hazard reduction (or safety) measures--are not linked interactively in the existing methodologies. This prevents a quantitative assessment of the impacts of safety measures on risk control. We have made an attempt to develop a methodology in which risk assessment steps are interactively linked with implementation of safety measures. The resultant system tells us the extent of reduction of risk by each successive safety measure. It also tells based on sophisticated maximum credible accident analysis (MCAA) and probabilistic fault tree analysis (PFTA) whether a given unit can ever be made 'safe'. The application of the methodology has been illustrated with a case study.

Accident Prevention↗

Evaluation of a computer-aided semen analysis system with sperm tail detection.

The aim of this study was to evaluate the Stroemberg-Mika cell motion analyser (SM-CMA) which uses tail detection in order to discriminate between immotile spermatozoa and other particles. Analysis of the spermatozoa by the SM-CMA can easily be checked on a video monitor. The semen samples were from donors and patients visiting the fertility unit of the University Hospital, Hanzeplein, The Netherlands. Both fresh semen samples and purified sperm suspensions were used to estimate sperm counts and motility characteristics. We tested the use of the x10 objective instead of the x20 and we assessed the ways in which motility characteristics were influenced by temperature. We found a considerable discrepancy between sperm concentrations measured manually and by computerized analysis, both in semen samples and in purified sperm suspensions. The SM-CMA correctly recognizes motile spermatozoa, but underestimates immotile ones. Although temperature affects motility characteristics, in routine measurements the influence of short cooling periods, which are unavoidable, was nil. We found that using the x10 objective can be useful, especially at low sperm concentrations. In our opinion, the SM-CMA system is, despite some shortcomings in its user-interface, a useful and versatile instrument for examination of human semen samples, with desirable features.

Evaluation Studies as Topic↗

Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates.

OBJECTIVE: We assessed the local recurrence rate after a single targeted transarterial oily chemoembolization for small hepatocellular carcinoma with the unified helical CT and angiography system and analyzed the factors affecting the local recurrence rate and survival rate with Cox proportional hazards model. MATERIALS AND METHODS: For 54 consecutive patients with 71 small hepatocellular carcinomas (< or = 5 cm) with no more than two associated lesions, targeted oily chemoembolization was performed with an emulsion of doxorubicin hydrochloride mixed with iodized oil or a suspension of zinostatin stimalamer followed by gelatin sponge particles. When local recurrence or a new lesion appeared, follow-up targeted oily chemoembolization was performed. RESULTS: For 52 of 71 lesions, the catheterization to a subsegmental or more distal feeding artery could be performed. Local recurrence was recognized in 33.2% at 1 year and 37.8% at 2 and 3 years. The significant factors that affected local recurrence were tumor size (p = 0.005) and degree of deposition of iodized oil within the lesion (p = 0.049). The survival rates at 1, 2, and 3 years were 93.3%, 77.1%, and 77.1%, respectively. The significant factors affecting survival rate were tumor thrombus in large vessels (p = 0.0001), appearing after the first chemoembolization, and maximum tumor size (p = 0.022). CONCLUSION: Single targeted transarterial oily chemoembolization with the unified helical CT and angiography system had a low local recurrence rate for small hepatocellular carcinoma, and follow-up embolization resulted in a good survival rate. Tumor size along with degree of intratumoral iodized oil deposition and tumor thrombus along with maximum tumor size were significant factors affecting local recurrence and survival rate, respectively.

Aged↗

Computational modeling of neuronal dynamics for systems analysis: application to neurons of the cardiorespiratory NTS in the rat.

The study constructs computational models of neurons in order to examine the contribution that their response dynamics may make to functional properties at the system level. As described in the accompanying study, neurons in the cardiorespiratory nucleus tractus solitarii (NTS) of the rat were recorded in vitro. When these cells were intracellularly injected with a constant current pulse, spike discharge patterns and subthreshold voltage trajectories were observed that were time- and voltage-dependent. The accompanying manuscript describes these dynamic responses in 4 classes of putative second-order cells that appear to receive direct primary afferent input, and a previous paper described two populations of rhythmically firing interneurons, one of which is intrinsically auto-active. In the present manuscript experimental neuronal voltage response data was collected across a current injection series for the S3 neuron type described in the accompanying study and for the auto-active neuron described previously. Using this data, computational model neurons have been constructed for these two neurons by using membrane ion channels to produce and match the observed neuronal voltage behavior. The channels were those implicated in the dynamic responses observed in the companion study, and include gNafast, gKdr, gKA, gKCa, gKAHP, gKM, gCaT and gCaL. The description of channel kinetics follows the Hodgkin-Huxley form. Different neuronal sources from the literature of channel kinetics were investigated and assembled into a 'channel kinetics library' from which both neuron models were tuned, primarily by adjusting the maximum channel densities, g, and time-dependence of kinetics. Methods are described for tuning the channel kinetics library to match various physiological responses. This approach created neuron models that were able to closely replicate the observed complex voltage and spiking responses of the two very different cardiorespiratory NTS neurons. The interaction of voltage- and calcium-dependent conductances were analyzed for their functional contributions by tuning their kinetics. Specific parameters are given that account for the behavior of each model. Sensitivity analyses by perturbing KCa and KA are shown for both neurons, and I/F curves are presented for the auto-active neuron's stimulated and recorded responses. The potential systems-level functional implications resulting from the different kinetics is demonstrated by driving the S3 model neuron in simulation with the pattern of input produced by model primary baroreceptor afferents. The limitations and significance of this approach are discussed.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

EPA health and environmental effects data analysis system.

This paper discusses the development of a system to organize, store, retrieve, and correlate data pertaining to chemicals and their biological and environmental effects. The particular problems of data identification, acquisition, classification, and automation are discussed in relation to existing data sources and methods of data collection and analysis. The problems of computer software development are also addressed, and a design overview of the system is presented.

Animals↗

Quantitative measurement of cell migration using time-lapse videomicroscopy and non-linear system analysis.

Epithelial cells of the mammary gland possess the inherent capacity to form epithelial monolayers in vitro. This requires coordination of cell migration, cell-cell contact formation, and cell proliferation. Using time-lapse phase contrast videomicroscopy we have observed mammary gland epithelial cells over different time scales. We show the generation of a complete polarized epithelial monolayer in real-time, starting from a few cells. We subsequently concentrated on the early stages of this process by tracking epithelial cells during phases of polarized migration. We performed migration analysis using fractal measures. With this technology the structure of seemingly random processes not accessible to the usual methods of linear analysis can be measured. As a control and proof of principle approach we applied infection of cells with an adenoviral vector, which is used as a gene targeting vector for many applications. Infection markedly influenced the patterns of migratory behavior. We, therefore, believe that time-lapse videomicroscopy in combination with fractal analysis can contribute to differential characterization of distinct cellular migration patterns. This will be useful in situations of long-term alterations in cell culture systems.

Adenoviridae↗

Dynamical systems analysis: a new method of analysing congenital nystagmus waveforms.

Congenital nystagmus is an oculomotor disorder in which fixation is disrupted by rhythmical, bilateral involuntary oscillations. Clinically these eye movements have been described with some degree of success in terms of their peak-to-peak amplitude, frequency, mean velocity and waveform shape. However, it has not proved possible to diagnose any underlying pathology from the nystagmus characteristics. Here, we propose a new approach to understanding the nystagmus using dynamical systems theory. Our approach is based on the use of delay embedding techniques, which allow one to relate a time series of scalar observations to the state space dynamics of the underlying dynamical system. Using this approach we quantify the dynamics of the nystagmus in the region of foveation and present evidence to suggest that it is low-dimensional and deterministic. Our results put new constraints on acceptable models of nystagmus and suggest a way to make a closer link between data analysis and model development. This approach raises the hope that techniques originally developed to stabilise chaotic systems, by using small perturbations, may prove useful in the control of nystagmus.

Adolescent↗

System analysis of Phycomyces light-growth response. Photoreceptor and hypertropic mutants.

The light-growth responses of Phycomyces behavioral mutants, defective in genes madB, madC, and madH, were studied with the sum-of-sinusoids method of system identification. Modified phototropic action spectra of these mutants have indicated that they have altered photoreceptors (P. Galland and E.D. Lipson, 1985, Photochem. Photobiol. 41:331). In the two preceding papers, a kinetic model of the light-growth response system was developed and applied to wild-type frequency kernels at several wavelengths and temperatures. The present mutant studies were conducted at wavelength 477 nm. The log-mean intensity was 6 X 10(-2)W m-2 for the madB and madC night-blind mutants, and 10(-4)W m-2 for the madH hypertropic mutant. The prolonged light-growth responses of the madB and madC mutants are reflected in the reduced dynamic order of their frequency kernels. The linear response of the hypertropic mutant is essentially normal, but its nonlinear behavior shows modified dynamics. The behavior of these mutants can be accounted for by suitable modifications of the parametric model of the system. These modifications together support the hypothesis that an integrated complex mediates sensory transduction in the light responses and other responses of the sporangiophore.

Kinetics↗

[Experience with 25-gauge transconjunctival vitrectomy compared to a 20-gauge system. Analysis of 132 cases].

PURPOSE: The transconjunctival sutureless vitrectomy (TSV 25) is a new technique showing substantial progress. METHODS: A prospective study of 66 eyes of 66 patients who underwent surgical procedures using the transconjunctival standard vitrectomy system (TSV 25), between June 2004 and June 2005. The results were compared with the results in an equivalent population (66 patients) that underwent vitrectomy with a standard 20-gauge system. RESULTS: The most important differences between groups were 1) shorter surgical time in the 25-gauge vitrectomy group than in the 20-gauge group, with a mean time of 28.15+/-5.50 min for group 1 and 44.15+/-5.64 min for group 2 (p<0.001) and 2) lower mean postoperative intraocular tension in the first group of patients: in this group, the intraocular tension before surgery was a mean of 16.27+/-1.76 mmHg, decreasing to 12.17+/-1.36 mmHg, with a posterior increase to normal values of 15.06+/-1.66 mmHg at 7 days after surgery and a mean of 16.10+/-1.51 mmHg at 15 days. This decrease was not observed in the group of patients who underwent 20-gauge vitrectomy surgery. The other postoperative complications were similar in both groups except for four cases of anterior proliferation and two cases of fibrinous uveitis in group 2. CONCLUSION: The transconjunctival sutureless system (TSV 25) decreases surgical time and postoperative inflammation, with optimal postoperative patient comfort, but currently the accurate selection of patients remains important.

Adult↗