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Noviceware: a model for learning the software development process.

Students and nursing faculty without formal computer science training can collaborate within an independent study structure to assist the student in gaining experience with the fundamentals of software development. The systems development life cycle approach provides an essential map to structure such independent studies. This article describes the development within an academic setting of a computerized research management system. The software builds a database of research case demographic data and data from a 65-item tool used in scoring videotapes of caregiver-infant interactions. For students and faculty contemplating similar projects, recommendations about planning software development experiences and securing hardware, software, and expert resources are provided.

Algorithms

[Workload in software development work. A consideration based on work-characteristics and analysis on workload factors of each working group].

To clarify workload factors in software developing work, we designed questionnaires composed of questions of work-content based on the interview survey. For the analysis of workload, Cumulative Fatigue Symptom Index (CFSI) and the stress-rating-method by 7-likert-scale were used. With the cooperation of the Japanese Software Engineers' Association (SEA) responses were obtained from 270 out of 1,100 members and from 553 non-member software engineers in 18 companies in Japan. The CFSI score obtained was higher than those of other groups of other industries obtained in our previous studies. The stress-rating showed that "time-pressure," "too much amount of work, and "ambiguity in job specification" were the highest stressors. The work groups were categorized by the results of CFSI profile into 4 types. The results of stress-ratings were significantly different between the 4 type groups. Based on the multiple comparison analysis, the workload factors of each group could be specified. Out of the foregoing 4 types, the work groups which showed the deviation in F1B (depression) in CFSI and the work groups which showed high scores in every category in CFSI were higher in "ambiguity of specification" in stress-ratings. This result indicates that "ambiguity in specification" is a significant stressor in software engineers. This stressor is caused by the complicated communication process between users and engineers and by the shortage of tools or rules in this process. This stressor is considered to be the most typical workload which characterizes the software developing work.

Adult

Software development of the EMI head scanner.

A method has been developed to run the general purpose operating system RDOS on the same disc of the head scanner computer as is used for scanner software and data. This made it possible to develop additional software in high level programming language for image processing, based on original image data on the disc. All new images produced by the program are stored on the disc in the same format as the original images. This makes it possible to handle processed images exactly as the original ones and to do multiple operations. The following processing has been included in the program so far: subtraction, smoothing, density profiles, vertical reconstructions, magnification and labelling. A set of operator commands has been developed which are very similar to the ordinary commands for the scanner, which makes the program to appear being a direct extension of the standard scanner software.

Computers

Application of compiled BASIC in developing software for collection and analysis of neuronal firing frequency data.

Two programs are described which use an IBM-AT compatible personal computer, equipped with an analog-to-digital converter, to collect and analyze electrophysiological data. The first program is used to determine neuron firing rates during intracellular experiments and to save these results on disk. The second program is used to perform off-line analysis of the frequency data. Both programs are written entirely in the well known BASIC language and the Microsoft QuickBASIC compiler is employed for their use. All of the necessary hardware can be purchased commercially. In this paper emphasis is placed on the strategies and limitations involved when this high-level language is applied to tasks often needed in data acquisition and analysis. Both on- and off-line collection schemes are considered. This software is available from the authors.

Animals

Facial video image processing: standard facial image capturing, software modification, development of a surgical plan, and comparison of presurgical and postsurgical results.

Video imaging is a maturing technology that will challenge the 35-mm photograph in its usefulness to the plastic surgeon. Computer modification of a patient image communicates to the patient a reconstructive plan. A comparison of the presurgical and postsurgical images keenly sensitizes the surgeon to the results of surgical technique. The equipment required for video imaging also provides a powerful tool for creation of presentation graphic prints (for publication), 35-mm slides, and, with additional software, educational video tapes. I describe here a video method for standard alignment of patients. The preoperative and modified patient image (surgical plan) is compared with the postoperative image to determine the degree of success in achieving the reconstructive goals. Comparison of standardized presurgical and postsurgical images offers the surgeon greater objectivity in his analysis of the surgical technique than is possible by comparison of clinical photographs. The value of video imaging to the reconstructive surgeon magnifies the success (or disappointment) of surgical technique.

Computer Graphics

MCHS: an application software for family welfare programmes.

At the level of first contact, a primary health care centre, information management is an unwieldy task, therefore health information systems are reported to be inadequate and weak. Microcomputers could improve information management at this level, but there is little success due to a lack of specialized application software. In this paper we describe software developed after a multi-centre systems analysis study, on an essential data set, to support the delivery of the public health programmes for family welfare, i.e. maternal health care, family planning and immunization programmes. The modular approach was taken to develop a common application software for information management use at multiple sites. The software is tested in a laboratory mode by retrospective data entry from sites in Sweden and in India. All the information could be entered and site-specific reports that were generated are compared. The software provided a common data collection format, an essential platform for outcomes research.

Adolescent

[Development of computer software in ramp slope controller for treadmill ergometer].

We developed computer software to produce a treadmill ramp protocol through which oxygen uptake (VO2) is increased in a linear fashion, thus enabling subjects to walk until the end of exercise. The developed software simulates the increases in speed and grade of the treadmill displayed on a personal computer screen, and produces the ramp protocol by arbitrarily determining the variables of the following formula: 1) Increments of VO2 = a1t+a2 (ml/min/kg) [t = exercise time (min)] 2) Predicted VO2 by speed (S) and grade (G) = a3S2 + a4G2 + a5SG + a6S + a7G + a8 (ml/min/kg) [S = speed (km/hr); G = grade (%)] 3) Speed suitable for desired exercise time (S or S2) = a9t2 + a10t + a11 (km/hr) 4) Grade suitable for desired exercise time (G or G2) = a12t2 + a13t + a14 (%) In this study, the increment of VO2 was determined by considering the subject's exercise capacity (VO2 = 4t + 7 ml/min/kg), using the Ito's formula (VO2 = 0.067S2 + 0.289SG + 7.73 ml/min/kg). The formula of grade was determined following the formula arbitrarily (G2 = 25t + 5%). The formula of speed for exercise time was calculated automatically. The new ramp protocol, which was applied to 10 healthy subjects (mean age: 24.8 +/- 4.8 years old), disclosed a similar linear relationship between the predicted VO2 and the measured VO2.

Adult

FDA regulation of biomedical software.

A major problem faced by biomedical software developers and users is the complexity of the regulatory regimes confronting them. Of particular concern is whether, and to what extent, they are regulated by the Food and Drug Administration (FDA) and the consequences of such regulation. Producers, distributors, and users of biomedical software often are unaware that FDA regulates many of these products as medical devices. Developers, vendors, distributors, or users of such software are subject to significant civil and criminal liability for noncompliance. This article explains the current regulatory requirements imposed on computer software developers and users by FDA, biomedical and some proactive strategies for avoiding adverse enforcement.

Documentation

Development of a computerized database for the study of anaesthesia care.

To record, tabulate and report problems associated with anaesthesia, we have developed an information collection system and computer software to follow all patients attended by an anaesthetist at a teaching hospital in Canada. For the last 15 mo, data for 17,000 patients have been collected and the system is ongoing. Data collection is from three sources: carbonless copies of the handwritten Operating Room (OR) and Post Anaesthetic Care Unit (PACU) records, other hospital databases, and postoperative visits. Adverse events (observations which differ from specific physiological variables, or require an intervention and do not normally occur during the routine conduct of anaesthesia), are defined directly on each OR and PACU record. These events are recorded when they occur by the attending anaesthetist or the PACU nurse. All data are verified by a research nurse and an anaesthetist. Computer software, developed from DBase IV, is used to track 95 individual items on preoperative status and anaesthetic technique and another possible 1,450 selections for drugs, physicians, airways, surgical procedures and events for each patient. Data are analyzed with SAS software and reports generated to link the casemix and process with outcome. Comparison of data entered into the computer programme to a retrospective chart review revealed discrepancies of less than 0.5%. Collection, verification and computer entry takes five minutes per patient and the on-going cost is estimated at $4 per patient record. Analysis of the information collected in this database has been useful for research of adverse outcome following anaesthesia, resident expertise profiles, and the administrative management of an anaesthesia department.

Anesthesia Department, Hospital

VA's Integrated Imaging System on three platforms.

The DHCP Integrated Imaging System provides users with integrated patient data including text, image and graphics data. This system has been transferred from its original two screen DOS-based MUMPS platform to an X window workstation and a Microsoft Windows-based workstation. There are differences between these various platforms that impact on software design and on software development strategy. Data structures and conventions were used to isolate hardware, operating system, imaging software, and user-interface differences between platforms in the implementation of functionality for text and image display and interaction. The use of an object-oriented approach greatly increased system portability.

Computer Graphics

NUMEDICS: a system for on-line data processing in nuclear medicine.

A multiterminal system --NUMEDICS--has been developed to study the problems of on-line acquisition, processing, and display of scintigraphic data. The hardware-software configuration of NUMEDICS permits simultaneous and independent operation of terminals in the Division of Nuclear Medicine, the Physics Research Laboratory, and the Cyclotron Laboratory of the Massachusetts General Hospital. This paper describes the hardware and software developments in NUMEDICS which have been proven to be of value in clinical and research applications. These features are illustrated by applications to the evaluation of left ventricular performance, three-dimensional imaging, and functional imaging of rCBF.

Nuclear Medicine

Interactive video: an analysis of its value to nurse education.

This paper attempts to explain the emerging technology of interactive video and examine its possible place in nursing education. A brief description of the media is given with an exploration of the educational theory and justification underlying its use. A range of approaches to the evaluation of the technology itself and software available are given, which examine advantages and disadvantages for individual learners and for an organisation considering investment in this area. The possible role of interactive video in nurse education is discussed and a recommendation given that nurse educators need to keep up-to-date with developments in this type of educational technology and develop software suitable for the needs of nurses, rather than having to use packages developed for other purposes which have limited application for nursing.

Computer-Assisted Instruction

[The direct and computed radiographic assessment of vertebral locations in children with acute lymphatic leukemia].

The children affected with acute lymphoblastic leukemia (ALL) often exhibit secondary lesions of the spine. The diagnosis of spinal involvement is currently made by means of conventional radiography in postero-anterior and lateral views. The osteolytic lesions of the vertebral body present with collapse of the vertebral plates in a wide range of severity. Body evaluation is usually made by comparison with the adjacent vertebrae. Since leukemia is a systemic disease, several vertebrae are possibly involved in each case. In the attempt to develop a more sensitive method, which is less dependent on observers' evaluation, a quantitative and comparative analysis of vertebral bodies was performed. The radiographs in lateral view of the dorsal and lumbar spine of 14 children with ALL were analyzed: previous radiological reports suggested the lesion of one or more vertebral bodies. The area of each vertebral body was measured and digitalized by means of a backlighted graphic table and of a software developed to this purpose. The criteria to define the collapse of a vertebral body were the ratio between areas of adjacent vertebral bodies, in conformity to the anatomic and radiographic principle that, in the dorsal and lumbar spine, the body of a normal vertebra is equal to or bigger than that of the upper one. The data obtained by quantitative analysis were compared with conventional radiologic reports. A hundred and fifty-five vertebrae were analyzed by computerized analysis; 17 (10.9%) vertebrae, undetected at conventional analysis, were collapsed. This method allows a more precise diagnosis of collapsed vertebral lesions; its accuracy can be improved with further development of digital technology.

Adolescent

A multipurpose teaching workstation using expert systems, CD ROM and interactive laserdisc.

This demonstration shows a multipurpose workstation used in a clinical teaching application which combines currently available software suitable for clinical diagnosis and teaching. The medical software includes QMR, Scientific American Medicine, the Slice of Life and generic video laserdisc authoring software developed at the University of Ottawa. The system allows a clinical instructor either in an individual or in a small group teaching setting on a ward or in a classroom, to access high quality differential diagnosis information via QMR, which is then supplemented by the text components of Scientific American Medicine on CD ROM, with video laserdisc of the appropriate anatomy, imagery and pathology provided by one of the various laserdiscs. The generic authoring software allows the instructor or students to construct subject related tutorial or testing modules either with or without video laserdisc support. The workstation uses DESQview as the multitasking environment to control the various resources. This program allows easy transfer from one application to another and allows for marking and pasting of text material into a study document. DESQview can also be used to script a specific learning sequence. The demonstration will show the interaction required to study a specific clinical problem and how this can be made into a meaningful multimedia experience with hardcopy for study purposes.

CD-ROM

An interactive image analysis system for quantitative cytology & to classify cervical cells.

Introduction of computers and image analysis systems are gaining faster momentum in order to quantitate the assessment of cells for diagnosis and prognosis, and this system aims to relieve the operator from the tedium of microscopic observation and reduce operator bias and human error. This paper discusses the design and configuration of an interactive image analysis system built in the laboratory for the purpose of cell analysis and classification. The software developed to compute various textural and morphological parameters of cells on smear are briefly described. The results of the experiments carried out to classify normal and abnormal cells on cervical smear show 94 per cent success rate.

Cytological Techniques

A computerized approach to statistical quality control for radioimmunoassays in the clinical chemistry laboratory.

Methods for statistical quality control for the clinical laboratory in general, and radioimmunoassay in particular, have been proposed for many years. Unfortunately, only a very small number of laboratories have adapted these procedures. By use of teletypes and other remote terminals, it is possible for all laboratories to access centralized computers where a general purpose quality control program can be stored. This relieves each laboratory of the costly task of developing software, provides some degree of inter-laboratory standardization and facilitates comparison of precision and accuracy between laboratories. A prototype program for this purpose is described. This program evaluates within-assay and between-assay variability, by means of an analysis of variance for a one-way classification random-effects model, and can monitor any assay parameter by use of control chart techniques. In addition, several tests are provided to evaluate the temporal stability of the assay system, and appropriate tests for outliers are included. Also, methods are described for combination of information from several quality control samples. This provides a valid basis for adjustment of assay results or for outright rejection of an assay. For convenience, this program is designed for output on a teletype or similar terminal located in the laboratory. Simplified versions of this program can be readily adapted to desk-top calculators. The original purpose for developing this system was to provide the clinical laboratory with a simple, general, and flexible method for assessing the performance of radioimmunoassays, but its usefulness should extend to virtually all assay methods.

Computers