Practical opportunities for IOC centers.
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Computer Storage Devices↗
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Audit of populations in general practice: the creation of a national resource for the study of morbidity in Scottish general practice.
STUDY OBJECTIVE: To create a national data resource for studying morbidity in Scottish general practice, complementary to existing information systems and available for management and research purposes at national and local levels. DESIGN: The Department of General Practice, University of Aberdeen has worked since 1988 to collect and analyse computerised information at practice, regional, and national levels by distribution of a floppy disk-based software program, which extracts a predetermined dataset from each general practice computer system. SETTING: Almost 100% of patients in Scotland are registered with a general practitioner. Scotland has a national computer system, General Practice Administration System for Scotland (GPASS), used by over 75% of all Scottish practices. Escalating costs of health care and demographic changes in the national population emphasise the monetary value of the gatekeeper role of general medical practice. General practitioners' increasing involvement in the provision and purchasing of care has raised the importance of the management of populations as well as the care of individual patients. PATIENTS: Collection of major morbidity and prescribing data from up to 2.4 million patients, approximately half the population of Scotland, takes place biannually. A subset of practices (population 282,700 patients; 52 practices) are continuously collecting doctor/patient contact information (symptoms or diagnoses). MAIN RESULTS: The data collected provide information at the level of the individual patient. Morbidity, prescribing, screening, and administrative data can be linked by patient, date or postcode. The sample population studied is representative by age, sex, deprivation, and sparsity (using the postcode) of the national population. Large sub-populations of patients satisfying a selected criteria can be extracted for further study of needs assessment or of epidemiological research. CONCLUSIONS: The gatekeeping role of Scottish general practice and the predominance of GPASS favours standardisation of methods of data capture and the construction of large regional, national, and Continuous Morbidity databases. Analysis by geographical, demographic, and temporal distributions allows the changing patterns of illness and provision of health care to be studied in substantial detail to the benefit of patients, doctors, and the national health service.
Adolescent↗
Surveillance of influenza-like illness in France. The example of the 1995/1996 epidemic.
STUDY OBJECTIVES: To discover if continuous computerised collection of morbidity data through a medical practice based sentinel network can be used to monitor influenza-like illness (ILI) epidemics. To obtain rough estimates of influenza vaccine effectiveness. DESIGN: Continuous passive surveillance of ILI through a computerised network of voluntary sentinel general practitioners (SGPs) in France (Sentinelle system). SETTING: Five hundred SGPs practices. PARTICIPANTS: Since 1984, SGPs updated a database with information on eight communicable diseases including ILI, via videotext terminals. Each ILI case is defined by the association of a sudden fever of 39 degrees C or above, respiratory symptoms, and myalgias. An ILI epidemic is detected when the national weekly incidence rate exceeds a seasonal threshold for two successive weeks. MAIN RESULTS: An ILI epidemic was reported from November 1995 to January 1996. In total, 13,951 individual cases were reported by SGPs during the epidemic period. The size of the epidemic (number of patients consulting a GP) was estimated to be 2,370,000 subjects. Maps of the epidemic showed that all regions have reported a high level ILI activity. The attack rate was the highest in school age children (13.5/100) and decreased as the age rose. Nearly 6% of the reported ILI cases among adults and elderly were vaccinated. The flu vaccine effectiveness against ILI was estimated to be 66% (95% CI 73%, 92%), ranging between 83% (95% CI 73%, 92%) among the subjects aged 15 to 24 years old to 16% (95% CI -12%, 44%) among the subjects aged 75 years or older. CONCLUSIONS: The Sentinelle system demonstrated adequate sensitivity and timeliness regarding ILI epidemic. Moreover, results of the monitoring were made available on the internet to increase the dissemination of information. Also, estimates of influenza vaccine effectiveness have been easily obtained. Altogether, they represent key points for the control of crisis situation such as ILI epidemics or pandemics.
Adolescent↗
Epidemiology of chickenpox in France (1991-1995).
STUDY OBJECTIVES: To decide whether a mass immunisation against chickenpox should be or should not be organised, it is important to have up to date data on the disease and to have baseline data to further assess a mass immunisation strategy, if any. DESIGN: Recent chickenpox epidemiology (age and sex distribution, seasonal dynamic and complications) in France are reviewed. SETTING: The system works with about 500 Sentinelle general practitioners (SGPs) and has provided surveillance of frequent communicable diseases in continental France since 1984. PARTICIPANTS: The data were collected by the computerised Sentinelle system. The Sentinelle system uses a videotex server that allows information exchange, data entry, and synthetic return of information. Chickenpox was defined as a sudden onset of typical skin eruption with pruritus, leaving scabs and associated with moderate fever. For each reported case, the SGP gave information on the age of the patient, sex, prevailing childcare for the children, contacts and complications (skin superinfections, lower and upper respiratory infections, conjunctivitis and corneal infections, nervous system injuries, stomatitis and others). Spectral analysis was used to detect cyclical patterns. MAIN RESULTS: Between 1991 and 1995, 15,817 cases of chickenpox were reported and provided the basis for the analysis. The yearly national incidence was 1.0-1.35 cases per 100 inhabitants. A pronounced annual periodicity of the incidence was observed and confirmed by spectral analysis. Ninety two per cent of chickenpox cases occurred in children under 14 years of age with about 5% being under one. Complications were reported in 2% of the cases. Common complications reported were skin superinfections, lower and upper respiratory tract infections. However, 21 cases out of 318 complications were nervous system injuries including six encephalitis or cerebellar ataxia. All these cases recovered completely. CONCLUSIONS: Chickenpox is usually a benign childhood disease. This study affords up to date observations on the disease in France. A large panel of complications has been reported. This paper provides the first attempt to describe the epidemiology of chickenpox in France.
Adolescent↗
Computational and noncomputational clinical information processing by computer.
Computers have been used in their computational as well as noncomputational modes for the scientific study of the clinical decision making. As computational tools, computers serve as storage devices for hospital file data so that these data can be analyzed statistically for a large variety of epidemiological and diagnostic purposes. As noncomputational devices, computers are functioning as knowledgable medical teachers that interface with students who can query the system. In this mode, computers are sometimes used as consultants to clinicians who need information on technical topics. Noncomputational computers are also used to simulate the inferences of clinicians. Byproducts of these simulations are computer programs that become formal statements or theories of the decision processes under investigation.
Computer-Assisted Instruction↗
Single-channel electrophysiology: use of the patch clamp.
The patch clamp technique affords unparalleled resolution of the detailed properties of ion channel currents. Patch clamping is not difficult and has been used to record single-channel currents from many cell types. The number of artifacts associated with the method appears to be rather small. The main experimental difficulties arise from the need to process large amounts of data. With the development of inexpensive computers and mass storage devices, these problems should be alleviated. The study of membrane excitability is expanding rapidly owing to the introduction of high-resolution patch clamp techniques. The conceptual revolution that will inevitably follow is just beginning.
Animals↗
Computer analysis of scintillation camera pictures. A storage, display and processing device (Nukab's gammascope).
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Computers↗
Performance evaluation of a computed radiography imaging device using a typical "front side" and novel "dual side" readout storage phosphors.
The Fourier-space modulation transfer function (MTF), normalized noise power spectrum (nNPS), and detective quantum efficiency (DQE) of a computed radiography (CR) x-ray imaging device were measured. Two different storage phosphor screens were used in conjunction with a single CR reader (Fuji, Clearview, CS). One of the storage phosphor plates (ST-BD) had a clear backing material which allowed "dual side read" of the latent image from both the "front" and "back" sides of the phosphor. The other phosphor plate had a light occluding backing material, limiting the readout to front side only (ST-VI). The standard RQA-5 beam quality was used. The MTF was measured using a 1 mm thick tungsten edge device. Compared to the ST-55BD phosphor, the ST-VI phosphor was found to have modestly higher MTF at all spatial frequencies. The nNPS(f) and DQE(f) were measured for nominal incident exposure levels ranging from 0.1 to 10 mR. The dual side read phosphor demonstrated superior DQE, especially at low spatial frequencies. At the frequency 0.5 cycles/mm, the DQE values for the 1 mR exposure were 0.36 and 0.21 for the ST-55BD and ST-VI phosphor plates, respectively. The differences between the spatial-frequency dependent DQE of the two plates can be attributed to the increased signal collection efficiency of the dual side read plates and differences in storage phosphor structure noise.
Humans↗
The fluorescence induction kinetics as a non-destructive tool for investigating spruce treated with ozone.
The scattering coefficient of yellow spruce needles exceeds that of green needles by a factor of 2, whereas the fluorescence efficiency is approximately equal for both needle colours. As shown by the angular distribution the fluorescence light is diffusely emitted. However, the scattered light consists of a diffuse and a reflecting portion below 20 degrees with a ratio of the intensities of 1 : 2 at perpendicular observation (0 degrees). Control measurements show that in the rejection region the effective transmission of cut-off-filters commonly used to separate fluorescence light and excitation light exceeds the value calculated from the filter specifications by a factor of 100. Therefore, the portion of the scattered light in the measuring signal must be controlled if the fluorescence induction kinetics is measured from specimen of different colour. A device for the determination of the fluorescence induction kinetics is described which employs a He--Ne laser, a mechanically working shutter with an opening time of 4 ms for the excitation, and a computer for data storage and device control. Two filters select the fluorescence components at 685 nm and 730 nm and they reduce the portion of the scattered light in the measuring signal to 0.18% and 0.55%, respectively. In order to consider the temporal development of the fluorescence kinetics the sampling rate is reduced from 2 kHz to 1 Hz. From the data stored in the computer maximum value Fp, and steady-state-value Fs are determined for both fluorescence components. Measurements on 4-year-old spruce exposed to ozone-concentrations of 0, 300 ppb, 600 ppb, and 1000 ppb were repeated every week. With increasing concentration and duration of treatment Rfd = (Fp-Fs)/Fs was decreased for both fluorescence components. With the highest ozone concentration a reduction of Rfd of 23% and 24%, respectively, was obtained for the two fluorescence components after three weeks.
Chemical Phenomena↗
Compressing data volume of left ventricular cineangiograms.
In this paper a method of compressing data volume for left ventricular cineangiograms is proposed. This method enables digital-optical discs to store the cineangiograms with an equivalent recording density to that of HDTV VTR's while preserving the quality of the original image. The data volume of the cineangiograms is compressed by approximating function and storing its coefficients. With this method, each cineangiogram frame is first decomposed into three regions: the inner part, the inner wall, and the background (using a statistical method previously reported by the authors). Each region is then compressed by means of a difference operation and an adaptive approximation with smooth functions. Performance is tested on 20 cases using actual cineangiograms. The specifications were verified for a spatial resolution of 1000 TV lines, a dynamic range of 60 dB, an SNR of 40 dB [pp/rms], volume compression to 7% of the original volume, and 0.19 [second/frame] for decoding on a 1.7 MFLOPS computer.
Algorithms↗
Pacific's experience with Web-based instruction: bats in the belfry or Webs in the classroom?
BACKGROUND: There is a revolution underway in education that involves a shift from the traditional lecture style of information presentation toward a more active style of learning. Many educators now believe that students must actively participate in the learning process for information to be truly understood and retained. Coincident with this revolution, there is an increased understanding that the body of knowledge in most professions has become too large to retain in the brains of individuals. These concepts have opened the door to innovative, computer-based educational techniques. METHODS: Pacific University College of Optometry has used a variety of Web-based educational methodologies in selected classes. These have ranged from shifting classes totally to the Web, to using the Web for pre-class preparation. RESULTS: Initial student acceptance of Web-based courses has been good. However, an undesirable trend has emerged--the tendency for students to print out Web-presented material rather than reading from the computer screen. Other concerns with shifting material from lecture to the Web include peer and administrator acceptance of this teaching style and issues associated with evaluation of professors who no longer give stand-up lectures. CONCLUSIONS: Changes in educational theory are making their way into the Schools and Colleges of Optometry. These changes will place greater reliance on active learning, reduced student memorization, and increased use of computers as information storage and retrieval devices. This will change the fundamental way in which students are educated, and this, in turn, will change the way in which future doctors, patients, and computers interact in clinical settings.
Computer-Assisted Instruction↗
Acquisition of ICU data: concepts and demands.
As the issue of data overload is a problem in critical care today, it is of utmost importance to improve acquisition, storage, integration, and presentation of medical data, which appears only feasible with the help of bedside computers. The data originates from four major sources: (1) the bedside medical devices, (2) the local area network (LAN) of the ICU, (3) the hospital information system (HIS) and (4) manual input. All sources differ markedly in quality and quantity of data and in the demands of the interfaces between source of data and patient database. The demands for data acquisition from bedside medical devices, ICU-LAN and HIS concentrate on technical problems, such as computational power, storage capacity, real-time processing, interfacing with different devices and networks and the unmistakable assignment of data to the individual patient. The main problem of manual data acquisition is the definition and configuration of the user interface that must allow the inexperienced user to interact with the computer intuitively. Emphasis must be put on the construction of a pleasant, logical and easy-to-handle graphical user interface (GUI). Short response times will require high graphical processing capacity. Moreover, high computational resources are necessary in the future for additional interfacing devices such as speech recognition and 3D-GUI. Therefore, in an ICU environment the demands for computational power are enormous. These problems are complicated by the urgent need for friendly and easy-to-handle user interfaces. Both facts place ICU bedside computing at the vanguard of present and future workstation development leaving no room for solutions based on traditional concepts of personal computers.(ABSTRACT TRUNCATED AT 250 WORDS)
Artificial Intelligence↗
Sens-A-Ray. A new system for direct digital intraoral radiography.
A new system for direct digital intraoral radiography, Sens-A-Ray, is presented. This system is based on a detector with a charge-coupled device that was designed especially for direct exposure to x-ray radiation. The system also includes interface electronics and an IBM AT-compatible personal computer with a digital I/O with frame memory, a super VGA graphics board, a high-resolution monitor, and software for the exposure, capture, storage, and enhancement of images. An external optical mass storage device is used for permanent storage of images in digital format. A video printer may be used to create hard copies. The system produces radiographic images at a significantly lower exposure than required for E-speed intraoral film. Applications of the system are exemplified, and its basic properties are discussed.
Computer Graphics↗
Nuclear medicine data communications.
Nuclear Medicine was one of the earliest imaging modalities to adopt the use of computers for acquisition, processing, storage, and display of digital images. Originally used for processing images, computer technologies were quickly adopted for image storage, display, and transmission. Modern nuclear medicine cameras produce digital images that can be transmitted over computer networks to other cameras, storage devices, workstations, and printers. In order to achieve nuclear medicine data communication, images must be successfully acquired and transmitted to the appropriate location to be displayed or printed. Standards have been developed over the years to facilitate the creation of interfaces between vendors and equipment, notably the interfile format for nuclear medicine and the DICOM standard for medical images. Studies can be transmitted over network communication links to other sites using telecommunication protocol standards where they can be stored and/or displayed on a wide variety of devices. This ability to move images in a well-understood format to general purpose devices using standard equipment enables the use of the Internet to disseminate nuclear medicine study information over a wide area for clinical use, research, and education. A number of universities have created Internet sites with nuclear medicine teaching files and information. As technology advances, it will be feasible to transmit medical images of all kinds to virtually anyone who needs them in near real-time, without regard to the distance between locations, or the types of instrumentation and computers used. The next few years should prove to be very interesting for digital medical imaging in general and nuclear medicine in particular.
Computer Communication Networks↗
Information partnerships--shared data, shared scale.
How can one company gain access to another's resources or customers without merging ownership, management, or plotting a takeover? The answer is found in new information partnerships, enabling diverse companies to develop strategic coalitions through the sharing of data. The key to cooperation is a quantum improvement in the hardware and software supporting relational databases: new computer speeds, cheaper mass-storage devices, the proliferation of fiber-optic networks, and networking architectures. Information partnerships mean that companies can distribute the technological and financial exposure that comes with huge investments. For the customer's part, partnerships inevitably lead to greater simplification on the desktop and more common standards around which vendors have to compete. The most common types of partnership are: joint marketing partnerships, such as American Airline's award of frequent flyer miles to customers who use Citibank's credit card; intraindustry partnerships, such as the insurance value-added network service (which links insurance and casualty companies to independent agents); customer-supplier partnerships, such as Baxter Healthcare's electronic channel to hospitals for medical and other equipment; and IT vendor-driven partnerships, exemplified by ESAB (a European welding supplies and equipment company), whose expansion strategy was premised on a technology platform offered by an IT vendor. Partnerships that succeed have shared vision at the top, reciprocal skills in information technology, concrete plans for an early success, persistence in the development of usable information for all partners, coordination on business policy, and a new and imaginative business architecture.
Economic Competition↗
It's a long way to multimedia: an account of 18 years of pursuing a new media project in physiology.
A teaching-oriented multimedia database authoring system, MILES ( Multimediales Informations- und Lehrsystem), has been in development since 1980 in our department. The hardware consists of a network of personal computers connected to digital and, until recently, audio/video storage devices. The system provides a database capable of handling all kinds of multimedia data and computer programs. User-friendly software provides input, editing, retrieval, and communication; the authoring system allows these components to be organized into structures of complex menus, combined with free database access. More than 12,000 components have been stored, including approximately 3,500 pictures. The paper reports on an extensive field test, in which the system has been applied as a common source for all kinds of materials used in teaching physiology to students of medicine. ResuIts show that the "new media" are powerful instruments for improving teaching and learning. However, they should not be expected to provide the sole basis for education. Their application still faces many problems regarding concepts, efficiency, and acceptance by students and staff.
Computer-Assisted Instruction↗
A multiprocessor architecture for medical image compression in a PACS environment.
We present a new multiprocessor architecture for medical image compression using digital signal processors. The system has been designed to be used in a NuBus-based workstation and to apply different image compression algorithms to medical images. The system has been tested with a full-frame cosine transform and bit allocation table on several imaging modalities ranging from ultrasound to magnetic resonance imaging. Results show that image quality is acceptable when the allocation tables are calculated for each specific image modality. Implementation of algorithms such as wavelet transforms and vector quantization which respond to the characteristics of each type of image is in progress.
Algorithms↗
Reference master: a microcomputer-based storage and retrieval system for bibliographic references.
A complete system for housekeeping and retrieval of bibliographic references managing individual reprint collections is described. By the use of special hardware and individual data base software even large reprint collections in the range up to 65,000 papers are handled economically. A fast 8-bit microprocessor (HD 64180) in combination with a Winchester hard disk drive serves as the basis for rapid access to the desired information. An efficient string search algorithm written in assembly language guarantees a fast operation with a search speed of more than 6,000 entries/minute. The system cannot only prepare reference lists and reference files, but also incorporates an editor and maintains the control whether reprints are already on file or requested. The implementation of back-up schemes assure against data losses. Using a state of the art design single board computer and the most recent mass storage device technology, the system is as well small and cost effective, and thus suitable for personal use. In addition, some general questions and pitfalls concerning the management of scientific literature collections are touched upon.
Bibliographies as Topic↗