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Software being developed by a Duke researcher aims to cut time needed for dissemination of new guidelines. The strategy is painless conversion of clunky text-based guidelines to linear algorithms.
Multimedia medical workstations represent the natural tool for accessing the hospital information system environment. They are complex medical systems that have to gather, in a single framework, a large collection of components dealing with multimedia medical objects. To remain current with both medical practice and with advances in the computer science field, they have to allow the iterative addition of new functions to the set of existing ones. In this paper, after a survey of commonly required medical workstation functional components, we shall try to discuss how a software engineering approach can streamline the development of a medical workstation. Different software engineering tools needed to build the functional components of a workstation are described. Their integration in a single dedicated environment is considered through four perspectives: data, presentation, communication and control. Benefits and limitations of an object-oriented approach are discussed.
We have developed a software application to enable interactive rehabilitation via the Internet. The reliability of the telemedicine application was examined by comparing it with face-to-face assessment. The physical outcome measures assessed were knee range of motion, quadriceps muscle strength, limb girth and an assessment of gait. One therapist performed both in-person and Intemet-based measurements of all outcome measures on 20 normal subjects. There was good agreement between the two techniques (the 95% limits of agreement included zero for all the variables studied). Internet assessments were conducted at two bandwidths: ISDN at 128 kbit/s and the telephone network at 17 kbit/s. Bandwidth had no significant influence on any of the measures. This study suggests that Internet-based physiotherapy interventions delivered to the home are suitable for further development.
OBJECTIVE: To devise a valid career selection instrument to help doctors in training choose from a range of specialties that match their attributes and aspirations and to help selection interviewers focus on the key issues pertaining to the suitability of candidates for particular training opportunities. DESIGN: A psychometric instrument of 130 4-response choice items was developed to match individual personal and professional preferences to possible career specialty choices. The development process involved semi-structured interviews with consultants in 35 specialties, a national postal survey of consultants in 45 specialties, factor analysis of the results, design of the pilot instruments, testing on 450 senior house officers (doctors in basic specialist training within 2-5 years of leaving medical school), and further item analysis to derive the final instrument. A scoring system and software were developed to indicate the best and worst fit specialties for the respondent. PARTICIPANTS: The participants were hospital consultants, general practitioners and senior house officers (SHOs) in basic specialist training. OUTCOME MEASURE: The successful construction of a valid and accessible career choice instrument (Specialty Choice Inventory/Sci45). CONCLUSIONS: This project has yielded a psychometrically valid computer- or paper-based instrument that can be used by doctors at any stage of training to assist in career choice. It can be used as part of the selection process, for careers guidance, for analysis of career problems, for research or to validate a particular range of career options.
A digital image analyzer was developed for high spatial resolution analysis of autoradiograms. The system uses a linear array of charge-coupled devices operating under microcomputer control to scan and digitize autoradiograms into matrices of up to 1,500 X 2,000 pixels with 256 gray levels. The digitized images can be converted from gray scale to pseudo-color and displayed on a high resolution color monitor. Software was developed to facilitate quantitative analysis of autoradiograms produced in single and multiple tracer studies. Because of the high output linearity and accuracy of the solid-state detectors, the system was found to digitize autoradiograms significantly more precisely and accurately than previously described autoradiographic analyzers.
Health professionals in various fields of Medicine and Dentistry must acquire comprehensive technological knowledge in order to practice their professions. A large portion of that knowledge cannot be found in a textbook. Examples of this type of information are data gleaned from viewing microscopic slides and dissecting cadavers. In order to fully comprehend an area of study in medicine, the student relies on various resources (often physically unrelated, like the x-ray department and the dissection room). This situation makes the teaching and learning processes much more difficult to accomplish, since the instructor and students have to manipulate multiple media and take the courses in various sites. Today's technology allows us to design and create teaching and learning tools that can alleviate these difficulties. Personal computers are now used to capture and display a vast array of information through many different media: text, sound, images, photographs, illustrations, animation and video. This information can be presented to the user with audio-visual interfaces designed to facilitate efficient communication of ideas. It is controlled primarily by the use of the mouse, at one's own pace. This interactive, multi-media approach to teaching and learning is called "Edutainment" (Education and Entertainment). This demonstration will show how these new tools are used to teach and learn about various subjects related to Medicine, particularly in Dermatology and Dentistry. Several courseware applications were developed, addressing various aspects of the field: Cancers of the Skin, Dental Development, the Temporomandibular joint, the Masticatory Muscles etc. These programs provide anthropological data on growth collected through longitudinal research, diagnosis and treatments of pigmented lesions of the skin, thousands of digitized x-rays accessible through a relational database, the latest imaging technology used to diagnose the temporomandibular disorders, high-quality photographs of dissecting room material of the head and neck region, 3-dimensional animation of physiological principles of the temporomandibular joint movements, digital video of examination techniques, and other valuable resources to the user. The software were developed for both platforms, Macintosh and PC/Compatible, and all of them are in English and French, with some titles available in Spanish. To facilitate their distribution and usage, they were written to hybrid CD-ROMs, i.e., one CD-ROM was produced for each application, containing versions for both platforms in all languages. The CD-ROMs were recorded in our premises. During the presentation, the technical aspects of the development and production of a Multi-media document will be discussed along with the scientific content of the CD-ROM.
The purpose of this paper is to describe a software package that can be used for performing such routine tasks as controlling listening experiments (e.g., simple labeling, discrimination, sentence intelligibility, and magnitude estimation), recording responses and response latencies, analyzing and plotting the results of those experiments, displaying instructions, and making scripted audio-recordings. The software runs under Windows and is controlled by creating text files that allow the experimenter to specify key features of the experiment such as the stimuli that are to be presented, the randomization scheme, interstimulus and intertrial intervals, the format of the output file, and the layout of response alternatives on the screen. Although the software was developed primarily with speech-perception and psychoacoustics research in mind, it has uses in other areas as well, such as written or auditory word recognition, written or auditory sentence processing, and visual perception.
Software being developed by a Duke researcher aims to cut time needed for dissemination of new guidelines. The strategy is painless conversion of clunky text-based guidelines to linear algorithms.
St James's Hospital is a tertiary referral center for percutaneous intervention and cardiothoracic surgery for a number of referring hospitals. This article reports on the development and implementation of a synchronized, interactive teleconferencing system for cardiac images that links St. James's Hospital with a remote site (Sligo General Hospital) and overcomes the problems of transmission of large image files. Teleconferencing was achieved by setting up lossless auto transmission of patient files overnight and conferencing the next morning with linked control signals and databases. As a suitable product was not available, a commercially new software was developed. The system links the imaging databases, monitors and synchronizes progress through imaging sequences, and links a range of image processing and control functions. All parties to the conference are ensured that they are looking at the same images as they are played or at specific aspects of an image that the other party is highlighting. The system allows patient management decisions to be made at a weekly joint teleconference with cardiothoracic surgeons and interventional cardiologists from both sites. Rapid decision making was facilitated with 70% of decisions obtained within 24 h, and 88% within 1 week of their procedure. In urgent cases, data can be transmitted within 20 min of the diagnostic procedure. The system allows increased access to angiography for patients living in rural areas, and provides a more focused referral for revascularization. Participation of the referring cardiologist has improved the quality of decision making.
Using existing robotic hardware and software programs developed for the synthesis of several positron-emitting radiopharmaceuticals for PET imaging [Brodack et al. (1988) Appl. Radiat. Isot. 39, 689], the additional automated synthesis of 2-deoxy-2-[18F]fluoro-D-glucose (2-[18F]FDG) has been incorporated into our Zymate Laboratory Automation System. The robotic synthesis of 2-[18F]FDG took less than one week to implement, including the organization of software subroutines and construction of an additional heating station. The end of synthesis yield (12-17%) and radiochemical purity (96-99%) for the robotic preparation of 2-[18F]FDG is similar to that of the manual synthesis. This automated method uses anhydrous tetrabutylammonium [18F]fluoride as the reactive fluoride source in the labeling step. The procedure is a modification of the synthesis reported by Hamacher et al. [Hamacher et al. (1986) J. Nucl. Med. 27, 235].
This paper deals with the design aspect of a software aiming at modeling the anatomical and pathological structures of patients from medical images, for diagnosis purposes. In terms of functionalities, it allows to combine image processing algorithms, and to visualize and manipulate 3D models and images. The proposed software uses specific extensible and reusable components and a system managing their combination, thanks to a formal XML-based description of their interfaces. This architecture facilitates the dynamic integration of new functionalities, in particular in terms of image processing algorithms. We describe the structural and behavioral aspects of the proposed reusable component-based architecture. We also discuss the potential of this work for developing other softwares in the field of computer aided surgery.
Long acquisition times, low resolution, and voxel contamination are major difficulties in the application of magnetic resonance spectroscopic imaging (MRSI). To overcome these difficulties, an online-optimized acquisition of k-space, termed sequential forward array selection (SFAS), was developed to reduce acquisition time without sacrificing spatial resolution. A 2D proton MRSI region of interest (ROI) was defined from a scout image and used to create a region of support (ROS) image. The ROS was then used to optimize and obtain a subset of k-space (i.e., a subset of nonuniform phase encodings) and hence reduce the acquisition time for MRSI. Reconstruction and processing software was developed in-house to process and reconstruct MRSI using the projections onto convex sets method. Phantom and in vivo studies showed that good-quality MRS images are obtainable with an approximately 80% reduction of data acquisition time. The reduction of the acquisition time depends on the area ratio of ROS to FOV (i.e., the smaller the ratio, the greater the time reduction). It is also possible to obtain higher-resolution MRS images within a reasonable time using this approach. MRSI with a resolution of 64 x 64 is possible with the acquisition time of the same as 24 x 24 using the traditional full k-space method.
RATIONALE AND OBJECTIVES: To document a simple algorithm that quantifies power Doppler signals by computer-based statistical image analysis. METHODS: Personal computer-based software was developed. Color pixels representing power Doppler signals were separated from the background gray pixels in power Doppler images converted in BMP format. To avoid misregistration during this segmentation, a threshold value is required to adequately distinguish between gray and color pixels. Equating the intensity of each color pixel to a Power Value (PV), a histogram of Power Values in power Doppler images was obtained. RESULTS: The software was designed to allow users to adjust two thresholds (Difference Threshold and Intensity Threshold) by observing the segmentation results in real time. The software calculates the following indexes within any region of interest as defined by the operator: mean PV, peak PV, standard deviation of PV, percentage power Doppler area, and integrated PV per unit area. CONCLUSIONS: Power Doppler signals can be objectively quantified using this straightforward algorithm. This simple and practical method can be applied to comparative or longitudinal studies upon vascularity or blood flow.
A software program developed to assess the effectiveness of memory rehabilitation techniques is described. This project addresses current weaknesses in the research literature on memory rehabilitation: 1) remediation strategies are evaluated in terms of performance on a practical, real-world memory task, rather than a laboratory learning task; 2) the program allows maximum flexibility in assessing a wide variety of remediation strategies and training schedules; and, 3) the software, which provides sensitive outcome measures and detailed feedback about performance, is adaptable to the needs of patients with widely varying degrees of memory impairment. The results of a demonstration project are included to illustrate the use of this technology in determining the usefulness of different mnemonic strategies for patients with specific patterns of memory deficit. The importance of assessing maintenance of rehabilitation training over time is stressed.
We have developed a software package, SIMLA (simulation of linkage and association), which can be used to generate pedigree data under user-specified conditions. The number and location of disease loci, disease penetrances, marker locations, and marker disequilibrium with a disease locus and with other markers can be controlled. In addition, the pedigree size and availability of genotype data may also be specified, and a number of rules for family ascertainment are available. Estimates for power and type I errors can be evaluated under a variety of conditions, as needed by the user. We developed this simulation program because there are no publicly available programs to simulate variable levels of both recombination and linkage disequilibrium (LD) in general pedigrees. Genetic researchers are routinely applying both tests of linkage and family-based tests of association in the search for complex disease genes, and a plethora of different statistical approaches are available. Thus there is a need for the flexible statistical simulation program that we describe. This is the only program that we are aware of that allows simulation of linkage and association for multiple markers in extended pedigrees, nuclear families or in sets of unrelated cases and controls. Furthermore, the program not only allows for variable levels of LD among markers but also between markers and disease loci. SIMLA can simulate the complex and variable levels of LD that have been observed at close markers across the genome and allows for realistic simulation of complex relationships between markers. The program will be useful for studying and comparing existing statistical tests, for developing new genetic linkage and association statistics, planning sample sizes for new studies, and interpreting genetic analysis results.
Kinetic analysis and integrated systems modeling have contributed substantially to our understanding of the physiology and pathophysiology of metabolic systems and the distribution and clearance of drugs in humans and animals. In recent years, many researchers have become aware of the usefulness of these techniques in the experimental design. With this has come the recognition that the discipline of kinetic analysis requires its own expertise. The expertise can impact experimental design in many ways, from the collaborative and service activities in which individuals interact in formal ways to the development of software tools to aid in kinetic analysis. The purpose of this report is to describe one such software tool, Simulation, Analysis, and Modeling Software II (SAAM II). In the first part, we describe in general how the user can take advantage of the capabilities of the software system, and in the second part, we give three specific examples using multicompartmental models found in lipoprotein (apolipoprotein B [apoB] kinetics) and diabetes (glucose minimal model) research.
A novel milliliter-scale bioreactor equipped with a gas-inducing impeller was developed with oxygen transfer coefficients as high as in laboratory and industrial stirred-tank bioreactors. The bioreactor reaches oxygen transfer coefficients of >0.4 s(-1). Oxygen transfer coefficients of >0.2 s(-1) can be maintained over a range of 8- to 12-mL reaction volume. A reaction block with integrated heat exchangers was developed for 48-mL-scale bioreactors. The block can be closed with a single gas cover spreading sterile process gas from a central inlet into the headspace of all bioreactors. The gas cover simultaneously acts as a sterile barrier, making the reaction block a stand-alone device that represents an alternative to 48 parallel-operated shake flasks on a much smaller footprint. Process control software was developed to control a liquid-handling system for automated sampling, titration of pH, substrate feeding, and a microtiter plate reader for automated atline pH and atline optical density analytics. The liquid-handling parameters for titration agent, feeding solution, and cell samples were optimized to increase data quality. A simple proportional pH-control algorithm and intermittent titration of pH enabled Escherichia coli growth to a dry cell weight of 20.5 g L(-1) in fed-batch cultivation with air aeration. Growth of E. coli at the milliliter scale (10 mL) was shown to be equivalent to laboratory scale (3 L) with regard to growth rate, mu, and biomass yield, Y(XS).
MDL QSAR (formerly SciVision QSAR IS) software is one of the several software systems under evaluation by the Informatics and Computational Safety Analysis Staff (ICSAS) of the FDA Center for Drug Evaluation and Research for regulatory and scientific decision support applications. MDL QSAR software contains an integrated set of tools for similarity searching, compound clustering, and modeling molecular structure related parameters that includes 240 electrotopological E-state, connectivity, and other descriptors. These molecular descriptors can be statistically correlated with toxicological or biological endpoints. The goal of this research was to evaluate the feasibility of using MDL QSAR software to develop structure-activity relationship (SAR) models that can be used to predict the carcinogenic potential of pharmaceuticals and organic chemicals. A validation study of 108 compounds that include 86 pharmaceuticals and 22 chemicals that were not present in a control rodent carcinogenicity data set of 1275 compounds demonstrated that MDL QSAR models had excellent coverage (93%) and good sensitivity (72%) and specificity (72%) for rodent carcinogenicity. The software correctly predicted 72% of non-carcinogenic compounds and compounds with carcinogenic findings. E-state descriptors contributed to more than half of the SAR models used to predict carcinogenic activity. We believe that electrotopological E-state descriptors and QSAR IS (MDL QSAR) software are promising new in silico approaches for modeling and predicting rodent carcinogenicity and may have application for other toxicological endpoints.