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Clinical validation of the gated blood pool SPECT QBS processing software in congestive heart failure patients: correlation with MUGA, first-pass RNV and 2D-echocardiography.

INTRODUCTION: Left (LVEF) and right ventricular ejection fraction (RVEF) as well as LV regional wall motion at rest are valuable tools to monitor and tailor treatment of congestive heart failure (CHF) patients. Gated blood pool SPECT (GBPS) is under evaluation as an "all-in-one" technique, providing information on LVEF, RVEF, and wall motion derived from a single examination. Aim of the study was to evaluate a commercially available automated GBPS processing software for EF measurements and wall motion analysis in heart failure patients. METHODS: Thirty-two patients (12 female; mean age+/-SD: 53+/-13 years), suffering from dilated (63%), ischemic (25%) or hypertrophic (13%) cardiomyopathy, were studied. First-pass radionuclide ventriculography (FP-RNV), planar multigated radionuclide angiography (MUGA), and GBPS were performed at rest after in vivo labeling of red blood cells, and LVEF and RVEF was calculated with each method. Later on the same day LVEF was calculated by echocardiography. LV wall motion (summed motion score and wall motion index) was derived from GBPS and echocardiography using the standard 16-segment model. RESULTS: Mean LVEF measured by GBPS, echocardiography, MUGA and FP-RNV was 33+/-13%, 37+/-15%, 41+/-14% and 45+/-13%, respectively. LVEF values calculated from GBPS showed moderate to good correlation with FP-RNV (r=0.61), MUGA (r=0.65) and ECHO (r=0.74; all p<0.01). Mean RVEF calculated by GBPS, FP-RNV and MUGA was 45+/-14%, 46+/-9% and 38+/-9%, respectively. RVEF values calculated from GBPS showed weak correlation with FP-RNV (r=0.33) and MUGA (r=0.26; all p=n.s.). Assessment of GBPS wall motion was qualitatively possible in all patients. The agreement between GBPS and ECHO was 82% (kappa=0.73). The wall motion index showed good correlation between both methods (r=0.88; p<0.001). CONCLUSION: An automated algorithm for LVEF calculation and wall motion analysis using GBPS is feasible for clinical routine diagnostic in CHF patients. The RVEF calculation method needs to be improved before routine clinical application can be recommended.

Algorithms↗

Qualidex--a new software for generating water quality indices.

Water quality indices are necessary for resolving lengthy, multi-parameter, water analysis reports into single digit scores. This, in turn, is essential for comparing the water quality of different sources and in monitoring the changes in the water quality of a given source as a function of time and other influencing factors. In this paper we present the computer-automated tool QUALIDEX (water QUALIty inDEX), which has been developed by us to generate and operate water quality indices. Several popular indices--such as the Oregon Water Quality Index developed in the 1970s by Oregon Department of Environmental Quality and later updated in 1995, the Aquatic Toxicity Index developed by Wepener and coworkers for protection of aquatic life at the Olifants river, Kruger National Park, South Africa, the water quality index developed by Dinius in 1987, the Overall Index of Pollution (of surface waters) developed at the National Environmental Engineering Research Institute (NEERI), and the water quality index of the Central Pollution Control Board (CPCB)--have also been added to QUALIDEX in modular form. There is also a New water quality index sub-module which enables the user to generate his or her own index and compare its performance with these well-known indices. The package is also capable of analyzing the variations in the water quality of different sites at different times. The software has been coded in Visual C++ and has been integrated with MS Access database.

Environmental Monitoring↗

DTkid: interactive simulation software for training tutors of children with autism.

Discrete-trial training (DTT) relies critically on implementation by trained tutors. We report three experiments carried out in the development of "DTkid"--interactive computer simulation software that presents "SIMon", a realistic virtual child with whom novice tutors can learn and practise DTT techniques. Experiments 1 and 2 exposed groups of participants either to DTkid training or to a control task. Participants in the former groups demonstrated significantly greater procedural and declarative knowledge of DTT. Experiment 3 confirmed this finding, further demonstrating that observation of DTkid training trials alone was sufficient to enhance participants' declarative and procedural knowledge of DTT. Results indicate that DTkid offers the potential for an effective means of teaching DTT skills to novice tutors of children with autism.

Adult↗

Estimation of population pharmacokinetic parameters of saquinavir in HIV patients with the MONOLIX software.

In nonlinear mixed-effects models, estimation methods based on a linearization of the likelihood are widely used although they have several methodological drawbacks. Kuhn and Lavielle (Comput. Statist. Data Anal. 49:1020-1038 (2005)) developed an estimation method which combines the SAEM (Stochastic Approximation EM) algorithm, with a MCMC (Markov Chain Monte Carlo) procedure for maximum likelihood estimation in nonlinear mixed-effects models without linearization. This method is implemented in the Matlab software MONOLIX which is available at http://www.math.u-psud.fr/~lavielle/monolix/logiciels. In this paper we apply MONOLIX to the analysis of the pharmacokinetics of saquinavir, a protease inhibitor, from concentrations measured after single dose administration in 100 HIV patients, some with advance disease. We also illustrate how to use MONOLIX to build the covariate model using the Bayesian Information Criterion. Saquinavir oral clearance (CL/F) was estimated to be 1.26 L/h and to increase with body mass index, the inter-patient variability for CL/F being 120%. Several methodological developments are ongoing to extend SAEM which is a very promising estimation method for population pharmacockinetic/pharmacodynamic analyses.

Administration, Oral↗

Development of a software tool for computation of parenteral nutrition in adults, and its potential role in improving nutritional care.

The detailed development of a computer program for management of parenteral nutrition (PN) in adults is described. Strengths and weaknesses are mentioned. By using the software, individualized PN prescriptions based on patient age, weight, sex, and clinical condition can be determined and available formulations can be automatically selected from incorporated databases. Automated PN management potentially enhances our ability to provide nutritional support with greater accuracy and precision and reduces the time required for writing and calculations. Day-to-day changes may also be monitored rapidly, simply, and safely.

Adult↗

Usefulness of fully automated constant ROI analysis software for the brain: 3DSRT and FineSRT.

The positioning or selection of a region of interest (ROI) is an essential step for the quantification of brain images. However, so long as the ROIs were manually selected, results obtained fluctuated considerably with subtle changes in their positioning. To perform an ROI analysis of the brain with improved objectivity and excellent reproducibility, we recently established fully automated ROI-based analysis software for the brain, the so-called 3DSRT and the FineSRT. 3DSRT performed by consecutive analyzing process as follows: (1) anatomical standardization using the SPM99 algorithm; (2) analysis using constant 318 ROIs divided into 12 groups (segments) on each hemisphere; (3) calculation of the area-weighted average for each of the respective 24 segments; (4) display of the results followed by the saving of respective values of the 636 ROIs (both hemispheres). The processes of the FineSRT were fundamentally similar to that of 3DSRT, but on FineSRT more precise constant 1394 ROIs (both hemispheres) corresponding to the respective cerebral convolutions were used. Our programs have been useful for objective estimation of cerebrovascular reserve, especially for follow-up studies of an infant with moyamoya disease, because we could compare the results without consideration of the patient's growth during the follow-up period.

Brain↗

Nucleic acid sequence analysis software for microcomputers.

It is clear that a computer-aided data control system is required for even small laboratories generating nucleic acid data. While the molecular biologist at many universities and large research institutions has access to mainframe computers and nucleic acid sequence analysis software, many find it more convenient to perform sequence analysis on microcomputers that are typically located within the investigator's laboratory and totally dedicated to sequence storage and analysis, in essence giving the investigator more personal control of analysis activities than is sometimes possible with shared mini- or mainframe computers. New programs are being written and released at an increasing rate to perform increasingly more complex and specialized analyses using small computer-based systems. This trend will undoubtedly continue, fueled by the need to manage the ever increasing quantity of sequence data.

Base Sequence↗

Generator program for computer-assisted instruction: MACGEN. A software tool for generating computer-assisted instructional texts.

This publication describes MACGEN, an interactive development tool to assist teachers to create, modify and extend case simulations, tutorial exercises and multiple-choice question tests designed for computer-aided instruction. The menu-driven software provides full authoring facilities for text files in MACAID format by means of interactive editing. Authors are prompted for items which they might want to change whereas all user-independent items are provided automatically. Optional default values and explanatory messages are available with every prompt. Errors are corrected automatically or commented upon. Thus the program eliminates the need to familiarize with a new language or details of the text file structure. The options for modification of existing text files include display, renumbering of frames and a line-oriented editor. The resulting text files can be interpreted by the MACAID driver without further changes. The text file is held as ASCII records and as such is also accessible with many standard word-processing systems if desired.

Computer-Assisted Instruction↗

Software package for the quantitative image analysis of histological sections.

A software package of general interest, and adapted to the analysis of histological sections has been written. The different programs of this package have been classified into four groups: macroanalysis, selection of fields, analysis, and data processing. The macroanalysis allows the acquisition of topographical information that will be used during the selection of fields and the analysis. Mapping programs have been added to the classical data processing of the measured parameters (statistical calculations, edition of values, histograms, graphs, .. .). They allow the generation of parametric images representing the distribution of particular elements in the section, or the topographical variations of calculated parameters. The recombination of information obtained at different magnifications, and the correlation of information of different types is thus possible and of great interest in the study of complex histological structures.

Animals↗

Simplifying record linkage: software and strategy.

Although the methodology of record linkage is fairly well developed, there is a need for less expensive methods and simpler software to facilitate trying out different tactics to generate good linkages. The present work has built on a fourth generation language SAS (Statistical Analysis System) with accompanying macroprocessor, to develop a user-friendly and flexible system for both exact and probabilistic matching. The major features of the LINKS system are presented and illustrated using 1979-1984 information from the Manitoba Health Services Commission (MHSC) registry file with the Canadian Mortality Data Base. Initial runs with exact, then probabilistic, matching linked approximately 91% of the Vital Statistics records to corresponding MHSC records. Subsequent modification of parameters improved the linkage to 95%.

Database Management Systems↗

Computer software for development and simulation of compartmental models of neurons.

A software package 'Nodus' for simulation and development of compartmental models of neurons is described. Passive or excitable membranes with voltage dependent ion conductances or synaptic conductances can be modeled. Detailed simulations of morphology and electrophysiology of neurons are possible. Neurophysiological experiments like voltage clamps and complex current injections can be simulated. Two integration methods are available: a fast hybrid method and an accurate fifth order Runge-Kutta method, with variable time steps. Nodus is implemented on Apple Macintosh microcomputers, with the standard user interface and interactive graphics. Simulations of simple test models demonstrate the accuracy and computation speed of the application.

Computer Simulation↗

MW/Pharm, an integrated software package for drug dosage regimen calculation and therapeutic drug monitoring.

The pharmacokinetic software package MW/Pharm offers an interactive, user-friendly program which gives rapid answers in clinical practice. It comprises a database with pharmacokinetic parameters of 180 drugs, a medication history database, and procedures for an individual drug dosage regimen calculation. The included curve-fitting facilities allow estimation of pharmacokinetic parameters on the basis of medication history, taking into account a varying status of the patient with respect to body weight and kidney function, optionally using a Bayesian procedure. The module KinBes performs the evaluation of bioavailability studies, including various methods, and an extensive statistical evaluation of bioequivalence.

Algorithms↗

Computer interface and software analysis for multi-channel, on-line temperature recording to any micro-computer.

A simple, inexpensive computer interface designed for in vitro or in vivo researchers with limited electronic experience allows direct on-line multi-channel temperature recording from thermistor probes to any micro-computer. The designed system saves time and increases the accuracy of collected data that are ready for storage in files compatible with graphic and statistical software. In vitro testing of the designed interface, over a range of 25-45 degrees C, showed a 0.999 intraclass correlation to reference water bath temperatures. In vivo testing using anesthetized rats involved simultaneous measurements of: (1) a thermogenic tissue, interscapular brown adipose temperature (IBAT), (2) core (colonic) temperature, and (3) surface (tail) temperature, a heat loss tissue. The temperatures measured by the designed computer-interface demonstrate excellent stability, sensitivity and accuracy when compared to respective temperatures measured by a YSI telethermometer.

Animals↗

A micro-computer software for the analysis of menstrual diaries: the menstrual diary system.

A microcomputer software was developed to analyse menstrual diaries following the reference period method as described in the article "The analysis of vaginal bleeding patterns induced by fertility regulating methods" published in this journal (Contraception, 34:253-260, 1986). The programme allows the analysis of groups of diaries selected according to subjects' characteristics recorded at commencement of the diary. It also offers flexibility in selecting options of analysis within the reference period method. The output can be presented graphically as Box-whisker plots. A tutorial is included in the package.

Contraception↗

TOPPER, a software package in FORTRAN for scaling studies.

Scaling studies are concerned with the differences in structure, function, behaviour and life-history associated with differences in size in broadly similar organisms. These studies make extensive use of bivariate regression analysis. Often it is of interest to carry out such analyses on many different subpopulations within a given sample population. The programs described here allow these analyses to be carried out efficiently. The output gives a summary of taxonomic parameters in addition to the usual statistical parameters, such as standard deviations and mean percent deviation. Some improvements in the software which are currently being implemented are discussed briefly.

Animals↗

Comparison of two software programs to be used for the calculation of population pharmacokinetic parameters.

The pharmacokinetic parameters of apomorphine, a potent dopamine agonist, were calculated after subcutaneous and intranasal administration. Two available software packages for TDM were used (USC*PACK and MW/PHARM). The findings for the calculated parameters Kel, Vslope, Ka and bioavailability were compared. Although small, sometimes significant differences were found, the NPEM program from the USC*PACK collection provides most information about the population under investigation. We found a median Vslope of 1.7408 +/- 0.8461 (S.D.) 1/kg, and a mean Kel of 1.5341 +/- 0.3748 h-1. The absorption after intranasal administration was extremely rapid: Ka = 20.5 +/- 1.96 h-1, comparable with that found with subcutaneous absorption: Ka = 23.04 +/- 2.20 h-1.

Administration, Intranasal↗

Renal function tests for windows--a model for the development and distribution of medical software on the Internet.

A computer application (Renal Function Tests for Windows) was developed to calculate and sort data for quantitative renal function testing using the Microsoft Visual Basic for Windows programming language. The following diagnostic indices are computed: Measured creatinine clearance--The rate at which serum is cleared of creatinine. Standardized clearance--Creatinine clearance scaled by body surface area. Estimated creatinine clearance--Renal creatinine clearance estimated from serum creatinine Renal failure index--To distinguish prerenal azotemia from oliguric acute renal failure. Renal free water clearance--Net volume per min of free water excreted by the kidneys. Fractional excretion of filtered sodium--To distinguish prerenal azotemia from acute renal failure. Renal Function Tests for Windows (RFT) allows the user to choose to enter only the data that is available. The program will then calculate all the possible results from the given data. Upon request, the program will also inform the user of data that is missing for those results that cannot be calculated. The flexibility of this program allows the user to perform 'what if' analysis through the manipulation of input data. Distribution of this program was accomplished using the Internet File Transfer Protocol (FTP) service. The effectiveness of mode of distributing medical software awaits feedback from users on the Internet.

Acute Kidney Injury↗

Validation of an adaptive software trigger and arrhythmia diagnostic algorithm.

The authors have developed an algorithm for the identification of arrhythmias using intracardiac atrial and ventricular leads. The algorithm is based on the rate of the depolarizations and a measure of the organization of electrical activity in each of the cardiac chambers. The most important requirement of the algorithm is to identify the occurrence of each cardiac event correctly. A robust amplitude-adaptive software trigger is developed, which accurately detects depolarizations in both chambers. With this reliable trigger the authors demonstrate the veracity of the arrhythmia identification algorithm.

Algorithms↗