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PubMedDate not supplied

EON: a component-based approach to automation of protocol-directed therapy.

Provision of automated support for planning protocol-directed therapy requires a computer program to take as input clinical data stored in an electronic patient-record system and to generate as output recommendations for therapeutic interventions and laboratory testing that are defined by applicable protocols. This paper presents a synthesis of research carried out at Stanford University to model the therapy-planning task and to demonstrate a component-based architecture for building protocol-based decision-support systems. We have constructed general-purpose software components that (1) interpret abstract protocol specifications to construct appropriate patient-specific treatment plans; (2) infer from time-stamped patient data higher-level, interval-based, abstract concepts; (3) perform time-oriented queries on a time-oriented patient database; and (4) allow acquisition and maintenance of protocol knowledge in a manner that facilitates efficient processing both by humans and by computers. We have implemented these components in a computer system known as EON. Each of the components has been developed, evaluated, and reported independently. We have evaluated the integration of the components as a composite architecture by implementing T-HELPER, a computer-based patient-record system that uses EON to offer advice regarding the management of patients who are following clinical trial protocols for AIDS or HIV infection. A test of the reuse of the software components in a different clinical domain demonstrated rapid development of a prototype application to support protocol-based care of patients who have breast cancer.

Algorithms↗
PubMed1976

Computer printing and filing of microbiology reports. 2. Evaluation and comparison with a manual system, and comparison of two manual systems.

A manual system of microbiology reporting with a National Cash Register (NCR) form with printed names of bacteria and antiboitics required less time to compose reports than a previous manual system that involved rubber stamps and handwriting on plain report sheets. The NCR report cost 10-28 pence and, compared with a computer system, it had the advantages of simplicity and familarity, and reports were not delayed by machine breakdown, operator error, or data being incorrectly submitted. A computer reporting system for microbiology resulted in more accurate reports costing 17-97 pence each, faster and more accurate filing and recall of reports, and a greater range of analyses of reports that was valued particularly by the control-of-infection staff. Composition of computer-readable reports by technicians on Port-a-punch cards took longer than composing NCR reports. Enquiries for past results were more quickly answered from computer printouts of reports and a day book in alphabetical order.

Attitude↗
PubMed1998

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends.

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure-response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.

Adult↗
PubMed2002

Patient recall of medication details in the outpatient clinic. Audit and assessment of the value of printed instructions requesting patients to bring medications to clinic.

OBJECTIVE: There is no ambiguity when a patient presents their medications in the correct packaging during a consultation and declares, "this is what I am taking, doctor, I take this many, at this time". The aim of this study was to establish the prevalence of consultations in which patients attend both "empty handed" and unsure of their treatment. A re-evaluation was made after a simple intervention. DESIGN: Prospective cross sectional study with subsequent intervention and re-evaluation based on patient completed questionnaire. SETTING: University hospital cardiology outpatient department. PATIENTS: Consecutive patients arriving at clinic reception desks. RESULTS: Altogether 774 of 857 patients were receiving treatment; 15% attended with their tablets and 28% provided a note of their medication in some form; 40% attended empty handed but confident they could recall all aspects of their treatment from memory; 17% attended empty handed and unsure of their treatment. INTERVENTION: Clinic appointment cards were stamped with the request PLEASE BRING YOUR MEDICATIONS WITH YOU TO THE CARDIOLOGY CLINIC. A second unrelated cohort of patients was then surveyed in an identical manner, nine months later. Of these, 329 of 376 patients were receiving medication. Those attending with their tablets in hand now accounted for 78% rather than 15% (chi(2)=423, df=2, p<0.001). The group unsure of their treatment, but attending empty handed, fell from 17% to 2%. CONCLUSIONS: Reprinted appointment cards are highly successful in encouraging patients to attend with their tablets. This provides reliable information for decision making.

Cardiology Service, Hospital↗
PubMed1995

Comparison of the Burdizzo and rubber ring methods for castrating and tail docking lambs.

The behavioural and plasma cortisol changes in groups of six lambs, five to six days old, were used to compare the acute effects of four methods of castration and tail docking: Burdizzo, standard sized and small rubber rings, and a combined method in which the application of a standard rubber ring was followed immediately by the application of the Burdizzo just distal to it. A control group was also included. Active behaviours such as foot stamping and restlessness increased markedly only after the treatments with rubber rings. Less time was spent in abnormal postures, and the increases in plasma cortisol were least after the combined method. It was concluded that the lambs treated by all the methods suffered considerable acute pain, for up to three hours in some cases, but that the combined method produced the least pain as judged by the behavioural and physiological indices measured, and that the small rubber rings produced more intense pain for a shorter time than the standard rubber rings.

Acute Disease↗
PubMed2000

Study of apparent hypersensitivity to Culicoides species in sheep in Israel.

Between 1983 and 1997, a low incidence of seasonal allergic dermatitis was diagnosed in sheep in Israel aged eight months to eight years, in 10 flocks of a variety of breeds, but not the local Awassi breed. The 40 affected animals reacted with scratching, biting and vigorous stamping of the feet from April to November each year. The principal skin lesions were hyperkeratosis, spongiosis and infiltrations of eosinophils and mononuclear cells, typical of an allergic dermatitis which was probably a hypersensitivity reaction to biting insects. The epidemiological findings in relation to the area of Israel affected, the breeds of sheep and the distribution of the lesions suggested that the sheep's hypersensitivity was due to the bites of several species of Culicoides.

Animals↗
PubMed2001

Predictive spatial modelling of alternative control strategies for the foot-and-mouth disease epidemic in Great Britain, 2001.

A spatial simulation model of foot-and-mouth disease was used in March and early April 2001 to evaluate alternative control policies for the 2001 epidemic in Great Britain. Control policies were those in operation from March 20, 2001, and comprised a ban on all animal movements from February 23, 2001, and a stamping-out policy. Each simulation commenced with the known population of infected farms on April 10, 2001, and ran for 200 days. For the control policy which best approximated that actually implemented from late March, the model predicted an epidemic of approximately 1800 to 1900 affected farms, and estimated that the epidemic would be eradicated between July and October 2001, with a low probability of continuing beyond October 2001. This policy included the slaughter-out of infected farms within 24 hours, slaughter of about 1.3 of the surrounding farms per infected farm within a further 48 hours, and minimal interfarm movements of susceptible animals. Delays in the slaughter of animals on infected farms beyond 24 hours after diagnosis slightly increased the epidemic size, and failure to achieve pre-emptive slaughter on an adequate number of at-risk farms substantially increased the expected size of the epidemic. Vaccination of up to three of the most outbreak-dense areas carried out in conjunction with the adopted control policy reduced the predicted size of the epidemic by less than 100 farms. Vaccination of buffer zones (designed to apply available vaccine and manpower as effectively as possible) carried out in place of the adopted control policy allowed the disease to spread out of control, producing an epidemic involving over 6000 farms by October 2001, with no prospect of immediate eradication.

Animals↗
PubMed2001

Soft lithography in biology and biochemistry.

Soft lithography, a set of techniques for microfabrication, is based on printing and molding using elastomeric stamps with the patterns of interest in basrelief. As a technique for fabricating microstructures for biological applications, soft lithography overcomes many of the shortcomings of photolithography. In particular, soft lithography offers the ability to control the molecular structure of surfaces and to pattern the complex molecules relevant to biology, to fabricate channel structures appropriate for microfluidics, and to pattern and manipulate cells. For the relatively large feature sizes used in biology (> or = 50 microns), production of prototype patterns and structures is convenient, inexpensive, and rapid. Self-assembled monolayers of alkanethiolates on gold are particularly easy to pattern by soft lithography, and they provide exquisite control over surface biochemistry.

Animals↗
PubMed2005

Real-time supervisor system based on trinary logic to control experiments with behaving animals and humans.

A new method is presented based on trinary logic able to check the state of different control variables and synchronously record the physiological and behavioral data of behaving animals and humans. The basic information structure of the method is a time interval of defined maximum duration, called time slice, during which the supervisor system periodically checks the status of a specific subset of input channels. An experimental condition is a sequence of time slices subsequently executed according to the final status of the previous time slice. The proposed method implements in its data structure the possibility to branch like an if-else cascade and the possibility to repeat parts of it recursively like the while-loop. Therefore its data structure contains the most basic control structures of programming languages. The method was implemented using a real-time version of LabVIEW programming environment to program and control our experimental setup. Using this supervision system, we synchronously record four analog data channels at 500 Hz (including eye movements) and the time stamps of up to six neurons at 100 kHz. The system reacts with a resolution within 1 ms to changes of state of digital input channels. The system is set to react to changes in eye position with a resolution within 4 ms. The time slices, experimental conditions, and data are handled by relational databases. This facilitates the construction of new experimental conditions and data analysis. The proposed implementation allows continuous recording without an inter-trial gap for data storage or task management. The implementation can be used to drive electrophysiological experiments of behaving animals and psychophysical studies with human subjects.

Animals↗
PubMedDate not supplied

Nuclear pseudoinclusions in angiomyolipoma of the kidney. A case report.

BACKGROUND: Fine needle biopsy has been utilized for the preoperative diagnosis of angiomyolipoma of the kidney. However, the spectrum of diverse nuclear morphology shown by the constituent smooth muscle cells of angiomyolipoma has not been fully elucidated. CASES: An angiomyolipoma was found incidentally in the left kidney of an asymptomatic, 57-year-old woman, and nephrectomy was performed. The tumor was composed predominantly of smooth muscle cells occasionally showing atypical nuclear features. Small aggregates of adipocytes were also found. Direct stamp specimens of the tumor revealed plump, spindle-shaped smooth muscle cells, and the nuclei of many of these cells contained large pseudoinclusions (cytoplasmic invaginations). Histologic review of an additional four cases of renal angiomyolipoma further revealed the frequent occurrence of nuclear pseudoinclusions in smooth muscle cells of the tumor. CONCLUSION: Nuclear pseudoinclusions on fine needle aspiration cytology of renal angiomyolipoma have not received adequate attention. We showed that this finding is a rather common nuclear feature in angiomyolipoma. It is presumably one of the manifestations of nuclear pleomorphism frequently seen in smooth muscle cells of angiomyolipoma and should not be considered an indication of malignancy.

Angiomyolipoma↗
PubMedDate not supplied

Hemangioblastoma in the cerebellar vermis: a case report.

BACKGROUND: The cytologic characteristics of hemangioblastoma have not been well described, although hemangioblastoma is a common primary neoplasm in the cerebellar vermis, and its histologic feature is well known. CASE: Hemangioblastoma was found in the cerebellar vermis of a 47-year-old male. Stamp specimens, made from the cut surface of a solid, yellow-tan tumor, showed many foamy cells considered to be stromal cells and capillaries in a hemorrhagic background. The stromal cells had round or oval nuclei with relatively fine chromatin and lacelike or granular, often vacuolated cytoplasm slightly stained light green. The stromal cells tended to gather around capillaries. CONCLUSION: Distinguishing stromal cells from astrocytes or histiocytes was difficult in this case. Good knowledge of the cytologic characteristics, along with the clinical findings, seems necessary for an accurate diagnosis.

Cerebellar Neoplasms↗
PubMed1996

Circadian variation in defibrillation energy requirements.

BACKGROUND: Reports have demonstrated a circadian variation in the incidence of acute myocardial infarction, ventricular arrhythmias, and sudden cardiac death. We tested the hypothesis that a similar circadian variation exists for defibrillation energy requirements in humans. METHODS AND RESULTS: We reviewed the time of defibrillation threshold (DFT) measurements in 134 patients with implantable cardioverter-defibrillators (ICDs) who underwent 345 DFT measurements. The DFT was determined in 130 patients at implantation, in 121 at a 2 months, and in 94 at 6 months. All patients had nonthoracotomy systems. The morning DFT (8 AM to 12 noon) was 15.1 +/- 1.2 J compared with 13.1 +/- 0.9 J in the midafternoon (12 noon to 4 PM) and 13.0 +/- 0.7 J in the late afternoon (4 to 8 PM), P < .02. In a separate group of 930 patients implanted with an ICD system with date and time stamps for each therapy, we reviewed 1238 episodes of ventricular tachyarrhythmias treated with shock therapy. To corroborate the hypothesis that energy requirements for arrhythmia termination vary during the course of the day, we plotted the failed first shock frequency for all episodes per hour. There was a significant peak in failed first shocks in the morning compared with other time intervals (P = .02). CONCLUSIONS: There is a morning peak in DFT and a corresponding morning peak in failed first shock frequency. This morning peak resembles the peaks seen in other cardiac events, specifically sudden cardiac death. These findings have important implications for appropriate ICD function, particularly in patients with marginal DFTs.

Aged↗
PubMed1996

A body model server for human motion capture and representation.

This paper presents a body model server (BMS) that provides real-time access to the position and posture of a person's torso, arms, hands, head, and eyes. It can be accessed by clients over a network. The BMS is designed to function as a device-independent data-layer between the sensing devices and client applications that require real-time human motion data, such as animation control. It can provide clients with accurate information at up to 40 Hz. For data collection, the model uses four magnetic position/orientation sensors, two data-gloves, and an eye-tracker. The BMS combines the data-streams from the sensors and transforms them into snapshots of the user's upper-body pose. A geometric model made up of joints and segments structures the input. Posture of the body is represented by joint angles. Two unique characteristics of our approach are the use of the implicit, geometric constraints of the sensed body to simplify the computation of the unmeasured joint angles, and the use of time-stamped data that allow synchronization with other data streams, e.g., speech input. This paper describes the architecture of the BMS, including the management of multiple input devices, the representation and computation of the position and joint angle data, and the client-server interface.

Computer Simulation↗
PubMed2004

Medical practice in the Eastern Cape.

The Eastern Cape developed slightly different medical traditions from the Western Cape. The majority Xhosa population had healing practices of their own which they shared only partly with the Khoi, while Boer medical practice had become more remote from modern Western medicine. Missionary medicine was relatively undeveloped in this period but through the Grey Hospital the Governor, Sir George Grey, promoted Western medicine amongst Africans. In this frontier territory, British military doctors encouraged early scientific societies and, in the absence of other medical men, treated civilians both black and white. The advent of the British settlers after 1820 placed a strongly British stamp on the practice of Eastern Cape medicine.

Colonialism↗
PubMed2002

Mechanical alignment of quasi-one-dimensional nanoparticles.

Randomly oriented rod or rope-like nanoparticles on the surface of an elastomeric substrate are aligned along one direction simply by stretching the substrate. The technique is demonstrated here using single-walled carbon nanotube ropes, and the degree of alignment is assessed by polarized Raman spectroscopy. The alignment is preserved after the particles are removed from the substrate surface, showing that the aligned nanoparticles can be stamped in patterns onto another surface.

Anisotropy↗
PubMed2005

Transition of MEMS technology to nanofabrication.

The transition of MEMS technology to nano fabrication is a solution to the growing demand for smaller and high-density feature sizes in the nanometer scale. Nanoimprint lithography (NIL) techniques for fabricating micro- and nano-features are discussed including hot embossing lithography (HEL), UV Molding (UVM) and micro contact printing (microCP). Recent results in micro and nano-pattern transfer are presented where features ranged from < 100 nm to several centimeters. We also present a comparative study between standard glass microfluidic chips and their HEL counterparts by metrology. Hot-embossed microfluidic chips are shown to be faithful replicates of their parent stamps. NIL is presented as a promising avenue for low-cost, high throughput micro and nano-device fabrication.

Equipment Design↗
PubMed2005

Synthesis and hybridization studies of DNA on functionalized polypropylene surfaces.

Polypropylene (PP) slice was treated with plasma in a mixture of nitrogen and hydrogen (1:2 V/V). Attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and X-ray photoelectron spectroscopy (XPS) demonstrated the successful grafting of amino groups. The as-treated slices were successively applied to the in-situ synthesis of oligonucleotides and an average coupling yield of more than 98% was achieved. The hybridization signals were recorded with fluorescent analysis system. The complementary and mismatched sequences were distinguished clearly, and the ratio of fluorescence intensity values (arbitrary units) for perfect match:single base mismatch:two bases mismatch:three bases mismatch is 108.6: 62.9: 22.4: 5.5. The results implied the plasmamodified PP surface was extremely stable, performed well in DNA hybridization assays, and could service as a good substrate for high-density oligonucleotide array synthesis, especially in a multistep molecular stamping method to fabricate DNA microarrays in-situ on a large scale.

DNA Probes↗