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PubMed2005

An assessment of pediatric after-hours telephone care: a 1-year experience.

BACKGROUND: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. OBJECTIVES: To use a computerized database including the after-hours telephone calls for 90% of the pediatricians in Colorado to examine: (1) the epidemiology of after-hours calls during a 1-year period including the volume, seasonality, and timing of after-hours calls, the age of the patients, the presenting complaint, the triage dispositions, and mean rates of calls per pediatrician; (2) the process of care measures at the call center, including waiting times for nurse telephone call-backs, the length of triage calls, and how these factors varied by season; and (3) the frequency and content of calls requesting information but not requiring triage. DESIGN: Descriptive study. SETTING AND PARTICIPANTS: All telephone calls from the After-Hours Telephone Care Program, Denver, Colo, received between June 21, 1999, and June 20, 2000, were retrieved from a computerized database and categorized by age, season, triage disposition, and algorithm. MAIN OUTCOME MEASURES: The volume, seasonality, timing, age distribution, algorithms used, and triage dispositions of after-hours calls. The reasons for calls requesting information. RESULTS: During the 1-year period 141 922 calls were returned by the call center. Of the total calls, 88% were for a clinical illness; 5%, for information or advice; 5%, for calls in which the parent could not be recontacted; 1%, for duplicate calls, and 1%, for miscellaneous reasons. Listed in rank order for the year, the 10 most common algorithms used for illness calls were vomiting, colds, cough, earache, sore throat, fever, diarrhea, croup, head trauma, and eye infection. Of illness calls, 21% of callers were told to go in for urgent evaluation, 30% were told to contact their primary care physician either the next day or at a later time, 45% were given home care instructions, and 4% were referred to call the on-call physician. CONCLUSIONS: This study describes the epidemiology of after-hours telephone calls regarding children in 90% of the private practices in Colorado. Data provided are useful in guiding the planning of health care provision, providing staffing of after-hours facilities, and planning for the educational training of telephone care staff. They also highlight opportunities for patient education that might decrease unnecessary after-hours calls.

Adolescent↗
PubMed1996

Three experimental measures of a digital beamforming signal processing algorithm.

Three studies were conducted to evaluate a prototype nonlinear digital beamforming hearing aid. The experiments all used contextually rich speech materials and subjective analysis methods and, on that basis, are grouped together in this report. In experiment 1, the beamforming was done off line and subjects wore their own hearing aids in an attempt to determine whether the processing reduced the interference of noise jammers. In experiments 2 and 3, subjects used portable, head-worn, real-time devices. The results of these experiments showed improvements in perceived ease of speech understanding for these types of subjective measures and lend encouragement to further development of this type of binaural hearing aid. Additional work is also required to develop methods of physically characterizing the nonlinear directional properties of the algorithms.

Adult↗
PubMed2006

A summarization approach for Affymetrix GeneChip data using a reference training set from a large, biologically diverse database.

BACKGROUND: Many of the most popular pre-processing methods for Affymetrix expression arrays, such as RMA, gcRMA, and PLIER, simultaneously analyze data across a set of predetermined arrays to improve precision of the final measures of expression. One problem associated with these algorithms is that expression measurements for a particular sample are highly dependent on the set of samples used for normalization and results obtained by normalization with a different set may not be comparable. A related problem is that an organization producing and/or storing large amounts of data in a sequential fashion will need to either re-run the pre-processing algorithm every time an array is added or store them in batches that are pre-processed together. Furthermore, pre-processing of large numbers of arrays requires loading all the feature-level data into memory which is a difficult task even with modern computers. We utilize a scheme that produces all the information necessary for pre-processing using a very large training set that can be used for summarization of samples outside of the training set. All subsequent pre-processing tasks can be done on an individual array basis. We demonstrate the utility of this approach by defining a new version of the Robust Multi-chip Averaging (RMA) algorithm which we refer to as refRMA. RESULTS: We assess performance based on multiple sets of samples processed over HG U133A Affymetrix GeneChip arrays. We show that the refRMA workflow, when used in conjunction with a large, biologically diverse training set, results in the same general characteristics as that of RMA in its classic form when comparing overall data structure, sample-to-sample correlation, and variation. Further, we demonstrate that the refRMA workflow and reference set can be robustly applied to naïve organ types and to benchmark data where its performance indicates respectable results. CONCLUSION: Our results indicate that a biologically diverse reference database can be used to train a model for estimating probe set intensities of exclusive test sets, while retaining the overall characteristics of the base algorithm. Although the results we present are specific for RMA, similar versions of other multi-array normalization and summarization schemes can be developed.

Algorithms↗
PubMed2006

Prediction and monitoring the therapeutic response of chronic dermal wounds.

A significant proportion of chronic wounds fail to heal in response to treatment of underlying pathologies combined with good wound care practice. Current prognostic tests to identify these wounds rely on the use of algorithms based on clinically measurable parameters such as wound dimensions and wound duration. Venous leg ulcers may be stratified into healing/non healing at 24 weeks of compression therapy and diabetic foot ulcer treatment outcome assessed using a 3-parameter algorithm. Accurate and reproducible measurement of wound area is required for these algorithms to have clinical utility. Whilst a number of attempts have been made to develop computerised wound-assessment techniques, wound tracing by clinicians combined with planimetry remains the standard methodology. Once treatment has been initiated, it is important to continuously monitor the wound to assess efficacy of treatment. This can be achieved by measuring wound area change over the first weeks of treatment to identify whether re-assessment of treatment strategy is required. A number of algorithms for assessing rate of wound area change have been evaluated to determine a surrogate endpoint for healing. Retrospective analysis of large patient groups indicates that approximately 75% correct prediction of healing outcome can be achieved.

Bandages↗
PubMed1995

New algorithmic-based digital filter processing system for real-time continuous blood pressure measurement and analysis in conscious rats.

A new algorithmic-based digital filter processing system for real-time continuous blood pressure (BP) measurement and analysis in freely-moving conscious rats has been developed. Real-time recognition of BP waveforms, real-time noise rejection and determination of representative waveform indexes (WIs) at indicated time points using digital filters and Smirnov's rejection test were realized with this system. Digital filters were applied for two different purposes: waveform segmentation and smoothing the calculations of representative WIs. Smirnov's rejection test was used for real-time noise rejection and yielded an accurate rejection rate of 99.99%. The result was that the digital filter processing and Smirnov's rejection test realized accurate real-time BP measurement and analysis in freely-moving conscious rats using a personal computer.

Algorithms↗
PubMed2000

A systematic analysis of factors which may impact upon tomographic perfusion imaging measurements: implications for the use of Tc-99m sestamibi in acute myocardial infarction.

BACKGROUND: The use of acute Tc-99m sestamibi imaging has provided a valuable methodology to assess myocardium at risk and collateral blood flow. OBJECTIVE: The purpose of this study was to determine the impact of physical, physiologic, and reconstruction factors on the extent and severity of Tc-99m sestamibi images in a porcine model of coronary occlusion and reperfusion. METHODS AND RESULTS: Eleven pigs underwent 40 min of coronary occlusion using a balloon catheter followed by reperfusion. Radiolabeled microspheres were injected during occlusion for blood flow determination and 20-30 mCi of Tc-99m sestamibi was injected intravenously for cardiac imaging. Each animal underwent four modes of gamma camera imaging: a cardiac and respiratory gated SPECT study, an ungated SPECT study, a post-mortem SPECT study and an ex-situ study where the heart was sliced into five short axis slices and directly imaged. All animals had extensive wall motion abnormalities at the time of imaging. Myocardial risk area by ex-situ imaging was 32 +/- 9% LV and did not significantly change with the addition of a chest cavity and tomographic reconstruction (post-mortem and gated imaging) or cardiac and respiratory motion (ungated imaging). Defect severity was significantly underestimated with the addition of a chest cavity and tomographic reconstruction but was unaltered by cardiac and respiratory motion. CONCLUSIONS: The assessment of risk area acutely by SPECT Tc-99m sestamibi imaging is unaffected by cardiac motion obviating the necessity for gated imaging. Estimated defect severity (which has been used as a measure of collateral flow) is significantly reduced by the chest wall and tomographic acquisition and reconstruction suggesting a role for scatter and attenuation algorithms for this measure.

Animals↗
PubMed2006

Measurement and restoration of the point spread function of fluorescence confocal microscopy.

The point spread function of an objective lens of a fluorescence confocal microscope was directly measured by imaging fluorescent beads. We analysed how the measurement of the point spread function was influenced by the diameter of the fluorescent beads and how the restoration technique with a deconvolution algorithm improved the measuring performance. Numerical and experimental results are presented for a typical point spread function and a zero-centred point spread function.

Journal Article↗
PubMed2001

MRI based diffusion and perfusion predictive model to estimate stroke evolution.

In this study we present a novel automated strategy for predicting infarct evolution, based on MR diffusion and perfusion images acquired in the acute stage of stroke. The validity of this methodology was tested on novel patient data including data acquired from an independent stroke clinic. Regions-of-interest (ROIs) defining the initial diffusion lesion and tissue with abnormal hemodynamic function as defined by the mean transit time (MTT) abnormality were automatically extracted from DWI/PI maps. Quantitative measures of cerebral blood flow (CBF) and volume (CBV) along with ratio measures defined relative to the contralateral hemisphere (r(a)CBF and r(a)CBV) were calculated for the MTT ROIs. A parametric normal classifier algorithm incorporating these measures was used to predict infarct growth. The mean r(a)CBF and r(a)CBV values for eventually infarcted MTT tissue were 0.70 +/- 0.19 and 1.20 +/- 0.36. For recovered tissue the mean values were 0.99 +/- 0.25 and 1.87 +/- 0.71, respectively. There was a significant difference between these two regions for both measures (p < 0.003 and p < 0.001, respectively). Mean absolute measures of CBF (ml/100g/min) and CBV (ml/100g) for the total infarcted territory were 33.9 +/- 9.7 and 4.2 +/- 1.9. For recovered MTT tissue, the mean values were 41.5 +/- 7.2 and 5.3 +/- 1.2, respectively. A significant difference was also found for these regions (p < 0.009 and p < 0.036, respectively). The mean measures of sensitivity, specificity, positive and negative predictive values for modeling infarct evolution for the validation patient data were 0.72 +/- 0.05, 0.97 +/- 0.02, 0.68 +/- 0.07 and 0.97 +/- 0.02. We propose that this automated strategy may allow possible guided therapeutic intervention to stroke patients and evaluation of efficacy of novel stroke compounds in clinical drug trials.

Aged↗
PubMed1991

Measured attenuation correction using the Maximum Likelihood algorithm.

Quantitative determination of local radioactivity concentration in positron emission tomography (PET) requires a good attenuation correction procedure to reconstruct the emission image. Using a similar Maximum Likelihood (ML) algorithm as for the reconstruction of the emission image, a method is proposed to reconstruct a transmission image, i.e. a map of absorption coefficients. This reconstructed transmission image is then used to calculate the attenuation correction factors needed for the ML reconstruction of the emission image. This approach takes automatically into account the convolution step in the acquisition process (caused by various smoothing factors, e.g. the detector width). This results in appreciable noise suppression without loss of resolution due to filtering, thus making the reconstructed images easier to interpret. A comparison is made with other estimates for the measured attenuation correction using phantom studies.

Algorithms↗
PubMed2001

Validation of exposure estimation for benzene in the Australian petroleum industry.

A nested case-control study was undertaken to investigate whether an excess of lympho-haematopoietic cancers in the Australian petroleum industry was associated with benzene exposure. The benzene exposures of the cases and controls were estimated using a quantitative algorithm based largely on exposures measured in the Australian petroleum industry. The algorithm was used to estimate, for each subject, the benzene exposure in parts per million (ppm) for each job held in the industry, and the cumulative exposure in ppm years. Because of the critical importance of the exposure assessment in this design of epidemiological study, particular attention was paid to the reliability of the inputs to the algorithm. The inputs [base estimates (BEs) of exposure and technology-specific exposure modifiers (EMs)] were compared to data from other sources including the occupational hygiene literature. Where such comparison data were available, they were generally found to confirm the values used in the algorithm, although four input values were changed as a result of the validation exercise. The integrity of the task-based algorithm was validated by employing it to calculate the exposures of the tanker drivers in the study and comparing these with measured daily exposure for tanker drivers in the Australian petroleum industry and exposure values found in the occupational hygiene literature. After adjustment for the mix of products carried by the Australian tanker drivers, the estimates from the algorithm were found to be comparable to the measured and literature values. This exercise provided evidence that the exposure assessment for the epidemiological study was reliable and that the results of the study can be used as the basis for evaluating the relationship between exposure to benzene and the risk of lympho-haematopoietic cancer.

Algorithms↗
PubMed1995

Neuromagnetic source imaging with FOCUSS: a recursive weighted minimum norm algorithm.

The paper describes a new algorithm for tomographic source reconstruction in neural electromagnetic inverse problems. Termed FOCUSS (FOCal Underdetermined System Solution), this algorithm combines the desired features of the two major approaches to electromagnetic inverse procedures. Like multiple current dipole modeling methods, FOCUSS produces high resolution solutions appropriate for the highly localized sources often encountered in electromagnetic imaging. Like linear estimation methods, FOCUSS allows current sources to assume arbitrary shapes and it preserves the generality and ease of application characteristic of this group of methods. It stands apart from standard signal processing techniques because, as an initialization-dependent algorithm, it accommodates the non-unique set of feasible solutions that arise from the neuroelectric source constraints. FOCUSS is based on recursive, weighted norm minimization. The consequence of the repeated weighting procedure is, in effect, to concentrate the solution in the minimal active regions that are essential for accurately reproducing the measurements. The FOCUSS algorithm is introduced and its properties are illustrated in the context of a number of simulations, first using exact measurements in 2- and 3-D problems, and then in the presence of noise and modeling errors. The results suggest that FOCUSS is a powerful algorithm with considerable utility for tomographic current estimation.

Algorithms↗
PubMed2000

Prediction of common secondary structures of RNAs: a genetic algorithm approach.

In this study we apply a genetic algorithm to a set of RNA sequences to find common RNA secondary structures. Our method is a three-step procedure. At the first stage of the procedure for each sequence, a genetic algorithm is used to optimize the structures in a population to a certain degree of stability. In this step, the free energy of a structure is the fitness criterion for the algorithm. Next, for each structure, we define a measure of structural conservation with respect to those in other sequences. We use this measure in a genetic algorithm to improve the structural similarity among sequences for the structures in the population of a sequence. Finally, we select those structures satisfying certain conditions of structural stability and similarity as predicted common structures for a set of RNA sequences. We have obtained satisfactory results from a set of tRNA, 5S rRNA, rev response elements (RRE) of HIV-1 and RRE of HIV-2/SIV, respectively.

Algorithms↗
PubMed2003

A feature-based model of symmetry detection.

Symmetry detection is important for many biological visual systems, including those of mammals, insects and birds. We constructed a symmetry-detection algorithm with two stages: location of the visually salient features of the image, then evaluating the symmetry of these features over a long range, by means of a simple Gaussian filter. The algorithm detects the axis of maximum symmetry for human faces (or any arbitrary image) and calculates the magnitude of the asymmetry. We have evaluated the algorithm on the dataset of Rhodes et al. (1998 Psychonom. Bull. Rev. 5, 659-669) and found that the algorithm is able to discriminate small variations of symmetry created by computer-manipulating the symmetry levels in individual faces, and that the values measured by the algorithm correlate well with human psycho-physical symmetry ratings.

Algorithms↗
PubMed2006

Development and evaluation of an exact fan-beam reconstruction algorithm using an equal weighting scheme via locally compensated filtered backprojection (LCFBP).

A novel exact fan-beam image reconstruction formula is presented and validated using both phantom data and clinical data. This algorithm takes the form of the standard ramp filtered backprojection (FBP) algorithm plus local compensation terms. This algorithm will be referred to as a locally compensated filtered backprojection (LCFBP). An equal weighting scheme is utilized in this algorithm in order to properly account for redundantly measured projection data. The algorithm has the desirable property of maintaining a mathematically exact result for: the full scan mode (2pi), the short scan mode (pi+ full fan angle), and the supershort scan mode [less than (pi+ full fan angle)]. Another desirable feature of this algorithm is that it is derivative-free. This feature is beneficial in preserving the spatial resolution of the reconstructed images. The third feature is that an equal weighting scheme has been utilized in the algorithm, thus the new algorithm has better noise properties than the standard filtered backprojection image reconstruction with a smooth weighting function. Both phantom data and clinical data were utilized to validate the algorithm and demonstrate the superior noise properties of the new algorithm.

Algorithms↗
PubMedDate not supplied

Development of a decision support system for the introduction of alternative methods into local irritancy/corrosivity testing strategies. Creation of fundamental rules for a decision support system.

The notification procedure of the European Union (EU) for new chemicals requires the application of protocols on physicochemical and toxicological tests for the evaluation of physicochemical properties and probable toxic effects of each notified substance. A computerised database was developed from data sets and toxicological test protocols relating to substance properties responsible for skin and eye irritation/corrosion. To develop specific structure-activity relationship (SAR) models and to find rules for a decision support system (DSS) to predict local irritation/corrosion, physical property data, chemical structure data and toxicological data for approximately 1300 chemicals, each having a purity of 95% or more, were evaluated. The evaluation demonstrated that the lipid solubility and aqueous solubility of a chemical are relevant to, or - in some cases - responsible for, the observed local effects of a substance on the skins and eyes of rabbits. The octanol/water partition coefficient and the measured value of the surface tension of a saturated aqueous solution of the substance give additional information that permits the definition of detailed SAR algorithms that use measured solubility values. Data on melting points and vapour pressure can be used to assess the intensity and duration of local contact with a chemical. Considerations relating to the reactivity of a pure chemical can be based on molecular weight and the nature of the heteroatoms present. With respect to local lesions produced following contact with the skin and eyes of rabbits, the data evaluation revealed that no general "local irritation/corrosion potential" of a chemical can be defined. A variety of mechanisms are responsible for the formation of local lesions on the skin or in the eyes: serious lesions are produced by mechanisms different from those that cause moderate irritation in these organs. In order to develop a DSS that uses the information extracted from the database, chemical main groups were categorised on the basis of their empirical formulae, and rules were defined of the type IF (physicochemical property) A, THEN not (toxic) effect B, based on correlations between specific local effects and measured physicochemical values. Other rules of the type IF substructure A, THEN effect B were developed based on correlations between specific local effects and the submitted structural formulae. Reactive chemical substructures relevant to the formation of local lesions and rules for the prediction of the absence of any skin irritation potential were identified. Proposals are made relating to the development of alternatives to eye irritation testing with rabbits.

Animal Testing Alternatives↗
PubMedDate not supplied

Designing a simpler high blood cholesterol case detection strategy: are the advantages of the NCEP protocol worth the complexity?

OBJECTIVE: To determine whether the complex strategy of lipid measurements for the detection of patients with high blood cholesterol levels proposed by the first Expert Panel of the National Cholesterol Education Panel (NCEP) could be simplified without significant loss of accuracy. DESIGN: Decision-analysis-based model of competing case detection strategies as compared with the NCEP strategy. A Markov model was used to estimate numbers of people treated over ten years as a result of the different classification strategies. DATA SOURCES: Conditional probabilities for the decision trees were derived from cholesterol distributions in national population-based surveys. Parameters for the Markov model were from published major epidemiologic studies and clinical trials. MAIN OUTCOME MEASURES: Misclassification to treatment vs non-treatment as a continuous function of the distribution of true low-density lipoprotein (LDL). RESULTS: A simplified strategy was designed that screens high-risk persons with two LDL measurements and low-risk people with one cholesterol measurement followed by two LDL measurements if the initial value is high. This algorithm requires 37% fewer measurements to classify a population. The overall accuracy of classification to treatment based on the NCEP I cutoff points is high, with a positive predictive value of 95% and a negative predictive value of 87% (relative to 97% and 80%, respectively, for the NCEP I protocol). This strategy is very similar to published NCEP II guidelines. A strategy that recommends an LDL determination for everyone, as a recent NIH consensus panel suggested, also significantly reduces the number of measurements required by 48%. The positive predictive value is 93%, vs 97% for the NCEP I protocol. The negative predictive value is 92%, vs 80% for the NCEP I. CONCLUSIONS: The complex measurement strategy initially proposed in the NCEP I guidelines did not improve accuracy of classification over the simpler and more convenient strategies that the authors evaluated and that have been substantially adopted in the NCEP II guidelines.

Adult↗
PubMed1997

Coronary calcium measurements by double helical computed tomography. Using the average instead of peak density algorithm improves reproducibility.

RATIONALE AND OBJECTIVES: Coronary calcium (CC) measured by fast computed tomography (CT) was proposed recently as a noninvasive method of monitoring the coronary atherosclerotic process. Assessment of the reproducibility of CC measurements (mainly interstudy variability) is essential for consistent interpretation of serial studies. METHODS: The authors scanned 74 patients (50 men and 24 women) twice on the same day to determine the interstudy variability of a new scoring algorithm, using the average instead of conventional peak CT density values. RESULTS: Nineteen patients had no calcium on either scan. In the remaining 55 patients, interstudy variability was decreased by 31% using the average algorithm (32%-23%; P < 0.001). CONCLUSIONS: Using the average instead of conventional peak density score provides better reproducible measurements of calcium by double helical CT.

Adult↗