Building integrated systems--medical informatics.
The computer-based patient record will be the integrated regional healthcare system's most valuable asset.
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The computer-based patient record will be the integrated regional healthcare system's most valuable asset.
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We report the development of a practical dedicated system for domiciliary fetal monitoring integrated in a scheme for its rational application. From experience of 1120 domiciliary recordings in 74 women (64 with high-risk pregnancies), we suggest that domiciliary monitoring applied within a structured clinical context should be as safe as monitoring in hospital.
An essential event in immune activation is the increase of cytokines in both plasma and immune tissues. Steroid hormones influence several adaptive responses in both health and disease. Cytokines and steroids have an intimate cross-communication in many systems, making possible a satisfactory adaptive response to environmental changes. The ultimate level of integration of the cytokine-steroids cross-talk is the molecular level. We have demonstrated this in four types of cross-talk mechanisms on different cells in which steroids have major roles: (1) The tumor necrosis factor (TNF)-glucocorticoid receptor (GR) transcriptional interaction in cellular targets of TNF-induced cytotoxicity. TNF potentiates the transactivation activity of GR and the priming with TNF increases the protective action of GR on TNF-induced cytotoxicity. (2) The GR-T cell receptor (TCR) antagonism in GR-TCR-induced T cell apoptosis and its modulation by cAMP. cAMP inhibits the TCR-induced apoptosis through a PKA-CREB-dependent mechanism and potentiates glucocorticoid-induced apoptosis by means of a CREB-independent mechanism. (3) The GR influence on Th1-Th2 cytokine expression and differentiation. Glucocorticoids inhibit the induction of GATA-3 and T-bet transcription factors. (4) The influence of ER/Smad-4 signaling cross-communication on prolactinoma pathogenesis. Physical and functional interactions between Smad-4 and estrogen receptors take place in prolactinoma cells, providing a molecular explanation to link the tumorigenic action of these two important players of prolactinoma pathogenesis. The molecular cross-talk between steroids and transcription factors is the mechanism that provides the basis for the outcome of adaptive responses integrating the systemic information provided by hormones and cytokines.
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Linking cost data, patient satisfaction scores. HBS International and The Picker Institute have joined forces to make integrated data available that directly links operational efficiency and patient satisfaction. Find out how the systems lets providers know when reducing expenses compromises care.
Simulations were performed to assess the prospective performance of a 16 Kbit nanowire-based electronic nanomemory system. Commercial off-the-shelf microcomputer system modeling software was applied to evaluate the operation of an ultra-dense storage array. This array consists of demonstrated experimental non-volatile nanowire diode switches, plus encoder-decoder structures consisting of demonstrated experimental nanowire-based nanotransistors, with nanowire interconnects among all the switching devices. The results of these simulations suggest that a nanomemory of this type can be operated successfully at a density of 10(11) bits/cm(2). Furthermore, modest device alterations and system design alternatives are suggested that might improve the performance and the scalability of the nanomemory array. These simulations represent early steps toward the development of a simulation-based methodology to guide nanoelectronic system design in a manner analogous to the way such methodologies are used to guide microelectronic system design in the silicon industry.
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A system has been developed in our department that simplifies the production processes of field shaping devices in radiotherapy, integrating an image grabbing and processing facility at a radiotherapy simulator and an automated block cutter. The data acquisition subsystem captures images, processes and corrects them for pincushion distortions, creates a composite radiograph, records user defined contours of blocks and exports data to the block cutter controller. A robotic subsystem drives and controls the polystyrene cutting unit. The system has been experimentally evaluated. Errors in contour definition were found to be less than 1 mm for a broad range of gantry angles and not exceeding 1.5 mm for those gantry orientations that present maximum magnetic field related image intensifier distortion, while the automated block cutter is capable of cutting out contours in polystyrene with an accuracy comparable to that of commercially available systems. The system is expected to contribute to the overall improvement of radiotherapy processes, particularly in low budget radiotherapy departments, introducing improvements in accuracy and efficiency at minimum costs.
Both sides of the bizarre, sadomasochistic relationship between physicians and hospitals bring baggage to the "arranged marriage" of the integrated healthcare system.
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We investigate the bifurcation phenomena and the change in phase space structure connected with the transition from regular to chaotic scattering in classical systems with unbounded dynamics. The regular systems discussed in this paper are integrable ones in the sense of Liouville, possessing a degenerated unstable periodic orbit at infinity. By means of a McGehee transformation the degeneracy can be removed and the usual Melnikov method is applied to predict homoclinic crossings of stable and unstable manifolds for the perturbed system. The chosen examples are the perturbed radial Kepler problem and two kinetically coupled Morse oscillators with different potential parameters which model the stretching dynamics in ABC molecules. The calculated subharmonic and homoclinic Melnikov functions can be used to prove the existence of chaotic scattering and of elliptic and hyperbolic periodic orbits, to calculate the width of the main stochastic layer and of the resonances, and to predict the range of initial conditions where singularities in the scattering function are found. In the second example the value of the perturbation parameter at which channel transitions set in is calculated. The theoretical results are supplemented by numerical experiments.
Hippocampal 'place' cells and the head-direction cells of the dorsal presubiculum and related neocortical and thalamic areas appear to be part of a preconfigured network that generates an abstract internal representation of two-dimensional space whose metric is self-motion. It appears that viewpoint-specific visual information (e.g. landmarks) becomes secondarily bound to this structure by associative learning. These associations between landmarks and the preconfigured path integrator serve to set the origin for path integration and to correct for cumulative error. In the absence of familiar landmarks, or in darkness without a prior spatial reference, the system appears to adopt an initial reference for path integration independently of external cues. A hypothesis of how the path integration system may operate at the neuronal level is proposed.
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