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[The use of personal computers for the collection, storage and analysis of data from neurosurgical intensive care monitoring].

For data acquisition intensive care neurosurgery increasingly has recourse to modern electronics, which have become an integral part of many aspects of present-day neurosurgery. Despite their high technical standard, the devices in common use often lack flexibility. Their range of possible applications is defined by the manufacturer, and the user has little or no influence on them. Moreover, there are often no adequate interfaces to peripherals, and the storage capacity is limited. We would like to present a data acquisition system on a PC/AT basis, which operates up to 64 channels allowing parallel registration, storage, analysis, and of decisive importance, also various computations, i.e. correlation. Computation is rarely feasible on commercial devices, but it is essential for specific demands, such as implementation of PA/PM diagrams to determine intracranial compliance. In addition, the pertinent software permits implementation of Fourier analyses, offers separate statistical functions, and transfers data to other programs. The program is capable of automatic batch-processing, which greatly facilitates its use.

Computer Systems

Confocal fluorescence microscopy and three-dimensional reconstruction.

Several recent technological advances have considerably improved the field of confocal fluorescence microscopy. Improvements in confocal microscope design, new fluorescent probes and indicators, more sensitive imaging devices, and computer advances which allow for data manipulation and storage provide a convenient method to acquire complex three-dimensional (3-D) architectural details which previously were difficult or impossible to obtain from biological specimens. Applications of the laser scanning and tandem scanning confocal microscopes offer the potential for gaining powerful insights into the complex relationship of cellular structure and function. Confocal microscopy generates optical sections free from out-of-focus blur. With the development of new visualization tools to render and display complex 3-D data, a set of optical sections taken at different focal planes can be three-dimensionally reconstructed to create an animated sequence which can reveal latent features of the specimen. The combination of confocal microscopy and 3-D reconstruction provides a powerful new imaging tool to advance knowledge about structural and functional cellular properties as they occur dynamically in three dimensions.

Animals

Direct measurement of sarcomere length from isolated cardiac cells.

Isolated cardiac muscle cells enzymatically digested with collagenase and hyaluronidase from whole rat myocardium demonstrate the characteristics of an intact membrane in that they tolerate millimolar concentrations of free Ca2+ and exhibit phasic contractions with electrical excitation. These isolated cells maintain their characteristic A-I band striation patterns when at rest or during contraction. An apparatus has been developed to directly image these cells with phase-contrast micrography onto a 1,728-element charge-coupled device photodiode array for rapid data storage in a digital computer. The digitized striation pattern profile was analyzed for individual and average sarcomere spacing. In isotonic media the average resting sarcomere length ranged from 1.77 to 1.91 micrometers in 13 cells, with a mean length of 1.83 +/- 0.12 micrometers. Electrically stimulated phasic contractions in three cells demonstrated a synchronous 20% decrease in sarcomere spacing to a mean of 1.51 micrometers. Striation spacing decreased under hypertonic stress but elongated only up to 1.93 micrometers in hypotonic solutions, suggesting that some internal elastic constraint exists that limits elongation of the cell.

Animals

Digital archive center: implementation for a radiology department.

OBJECTIVE: In this article, we describe the implementation of a digital archive center for a radiology department in a 700-bed teaching hospital. MATERIALS AND METHODS: The archive center consists of two identical archive systems, each comprising five components: an archive server, a data-base server, an optical disk library, a stand-alone optical disk drive, and a communication network. An image management system controls the image traffic from acquisition devices to display stations. A fault-tolerant mechanism was built into the archive center to achieve a 100% uptime. RESULTS: The center has been in operation for over 6 months. We have not experienced a single total system failure during this period. It currently archives all digital images from three MR units and four CT scanners and selected images from three computed radiographic systems and two laser film digitizers. The center archives between 1.5 and 2.0 gigabytes of images per workday. CONCLUSION: With its built-in fault-tolerant mechanism, we believe that the implemented archive center is very reliable and is suitable for a radiology department to archive its digital images.

Hospital Bed Capacity, 500 and over

A hardware device for recognition of P and QRS waves.

A new hardware device has been constructed to detect QRS and P complexes for the purpose of automatic arrhythmia interpretation. This apparatus can operate in noisy conditions and provide synchronized pulses representative of P complex, QRS complex, wide QRS, and premature QRS to different output channels. P wave identification is achieved with a high degree of reliability through a specially designed bipolar electrode catheter. The device could minimize demands on central processor time and core storage computer.

Arrhythmias, Cardiac

Computer-aided communication device for a child with cerebral palsy.

This paper describes a portable computer-aided communication device designed for a 13-year-old child with athetoid cerebral palsy. The device was intended to provide vocal output, hard-copy, correctable display, word storage capabilities, and utilize currently available technology. The design incorporated the Epson HX-20 computer, the Votrax Type 'N Talk speech synthesizer, and a customized laptray.

Adolescent

A critical investigation of the measurement of the force required to dilate the human uterine cervix.

A system for objectively analysing the forces of dilation of the human uterine cervix was devised using a force sensing device linked to a BBC microcomputer. The computer program allowed easy recording, storage and analysis of force/time curves obtained from the passage of tapered dilators through the cervix. A new design of dilator gave a smoother force/time curve. These force/time curves were analysed. Six indices: peak force, end force, area to peak, area to end the ratio of the peak and end forces recorded from the passage of the two largest and two smallest dilators, were compared. Area measurement was subject to artefact and rejected. Peak and end force measurements gave the best separation between parous and nulliparous patients. The peak force was judged to be the better as it was found to be easier to define than end force.

Biophysical Phenomena

IS & C system and file protection mechanism.

This paper reports a new extension of IS & C (Image Save And Carry) project. Because IS & C is an off-line system and requires full compatibility so as to enable medical data interchange with ease among hospitals and clinics, specifications that are indispensable for compatibility have been standardized by the IS & C committee. The IS & C system is supposed to be used in medicine, so the file protection mechanism for the security of the recorded files has been also developed. The characteristics of IS & C volume and file structure and the second national project being carried out in National Cancer Center Hospital are briefly explained as well.

Computer Communication Networks

An introduction to fractal imaging technology.

In this article the author explains the basic theory and practical applications of the latest advancement in imaging technology called fractal imaging. Fractal imaging is a unique way of compressing and storing images which has unlocked the door to the restrictions imposed by conventional imaging technology as regards storage and transmission of high quality images. The article outlines how this technology has been successfully applied by the creation of the first and only fractal photographic archival and retrieval system in Scotland, in the form of the George Washington Wilson collection comprising 44,000 images and associated text in only 450 megabytes (Mb) of disc space.

Fractals

Uses and limitations of microcomputers for epidemiological research in occupational health.

The rapid improvements in microcomputer systems have contributed to ease of performance of epidemiological research in occupational health. Computers now available can aid in all stages of research- from the early stages of literature review to data collection, analysis and presentation. Optical storage devices now allow large occupational health data bases to be stored on a single compact disc, with the information accessible by microcomputer. Hand-held computers and optical scanners allow paperless collection of field data. Epidemiological analysis and data presentation is easily done with software packages, some of which are in the public domain. However, there are limitations in the use of computers for any epidemiological research. Investment of time is required to learn the use of a computer. Care needs to be taken to ensure accurate data entry, and correct choice has to be made of methods for subsequent statistical analysis. Microcomputers are valuable as labour saving devices, but cannot replace proper planning, execution and appropriate data analysis in epidemiological research in occupational health.

Health Services Research

Present status and performance of PACS at Kyoto University Hospital.

A pilot PACS project, named KIDS, has been running in Kyoto University Hospital. The purpose of the system is to establish a small PACS that includes all digital imaging modalities and to evaluate it. The project has been continued from the first phase (KIDS-1) to the second phase (KIDS-2). In the first phase, a small-scale PACS was developed. In the second phase, the expansion of coverage of modalities and completion of the image database was intended. At present, the database contains image data of 16264 patients amounting to 150 Gbytes. Simulation of the retrieval process to the database shows that 154.3 s per patient is required for retrieving his/her entire image data. This calculated value is close to the actual time.

Computer Communication Networks

Computer-monitored radionuclide tracking of three-dimensional mandibular movements. Part I: theoretical approach.

A new technique for the three-dimensional recording of a person's mandibular movement is described. A small and harmless radioactive source is fixed on the patient's skin at the point of interest or sealed in a tooth cavity. Using the proper collimation, the motion of the point source is recorded via a gamma camera and minicomputer. Long-term storage on a magnetic device offers playback, slow motion facilities, and data analysis through the use of sophisticated computer languages. Simultaneous recordings using two cameras, or postsynchronization of two different views of an experiment, enable the three-dimensional restitution of mandibular movements. Superimposition of a grid of radioactive spots spaced at measured intervals during the recording permits a straightforward calibration of the patient's motion. Multiple sources in a single experiment may be recorded to describe the displacement of several points of interest. This method, derived from nuclear medicine techniques, offers a powerful tool of general interest for the tracking of dynamic events in many fields of dentistry such as temporomandibular joint dysfunction and prosthetic restorative techniques. Further considerations on our experimental settings and results will be published in part II.

Analog-Digital Conversion

Neuropoiesis: proposal for a connectionistic neurobiology.

Given current assumptions about the biology of neural organization, some connectionists believe that it may not be possible to accurately model the brain's neural architecture. We have identified five restrictive neurobiological dogmas that we believe have limited the exploration of more fundamental correlations between computational and biological neural networks. We postulate that: 1) the dendritic tree serves as a synapse storage device rather than a simple summation device; 2) connection strength between neurons depends on the number and location of synapses of similar weight, not on synapses of variable weights; 3) axonal sprouting occurs regularly in adult organisms; 4) the postsynaptic genome directly controls the presynaptic cell via mRNA, rather than indirectly by the expression of NCAMs, reverse neurotransmitters, etc.; 5) dendritic spines serve a trophic function by controlling development of new sprouts via a process we term retroduction. We entertain an alternative formulation of a computational neural element that is fully consistent with modern neuroscience research. We then show how our model neuron can learn under Hebbian conditions, and extend the model to explain non-Hebbian, one-trial learning. This work is significant because by stretching the theoretical boundaries of modern neuroscience, we show how connectionists can potentially create new, more biologically-based neural elements which, when, interconnected into networks, exhibit not only properties of existing backpropagation networks, but other physiological properties as well.

Adult

Sorting efficiency.

Computers and the tasks they perform are becoming increasingly important in medicine. It behooves medical personnel to become familiar with some computer functions so that they may be in a better position to demand and evaluate a given implementation. One very basic computer task is sorting information. Some general principles of computing efficiency are discussed, as well as the standard "O" notation. A simple sort, bubblesort, is discussed and analyzed. A second elementary sort, insertionsort, is considered in relation to its more sophisticated descendant, shellsort. The most efficient in-memory sort, quicksort (and its various descendants), is likewise examined, and the advantages and disadvantages of each variant are discussed in some detail, as well as methods that may enhance speed and resource utilization. Finally, mergesort, which is used in sorting large files resident in mass-storage devices, is discussed, along with its particular advantages.

Algorithms

Development and evaluation of oral reporting system for PACS.

Experimental workstations for oral reporting and synchronized image filing have been developed and evaluated by radiologists and referring physicians. The file media is a 5.25-inch rewritable magneto-optical disk of 600-Mb capacity whose file format is in accordance with the IS&C specification. The results of evaluation tell that this system is superior to other existing methods of the same kind such as transcribing, dictating, handwriting, typewriting and key selections. The most significant advantage of the system is that images and their interpretation are never separated. The first practical application to the teaching file and the teaching conference is contemplated in the Osaka University Hospital. This system is a complete digital system in terms of images, voices and demographic data, so that on-line transmission, off-line communication or filing to any database will be easily realized in a PACS environment. We are developing an integrated system of a speech recognizer connected to this digitized oral system.

Education, Medical

A proposal of an off-line PACS based on a personal database.

Problems with picture archiving and communication systems (PACS) are focused and an off-line PACS of practical value is proposed in this paper. This system is based on the personal database where each patient has his/her own recording medium. This medium files all medical information as well as images of value, and is carried with a patient through hospital. Advantages over the conventional or on-line PACS communicating through a network are discussed and a possibility of practical use is analysed showing a prototype system. The biggest advantage of this system is quick and easy access to the images of concern and a small amount of cost for initial investment. It is also pointed out that the format of the data recording on the disk has to be standardized so that this system could be used for a medical care system over a wide area.

Computer Systems