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Fred Hollows lecture: digital screening for eye disease.

The purpose of this study was to explore progress, in the adaptation to community screening for blinding eye disease, of digital imaging devices and technology for storage and transmission. Available imaging systems were compared to gold standard clinical photography in terms of sensitivity and specificity for diagnosis of common blinding eye conditions. Since the use of expensive non-portable imaging devices is likely to be limited for widespread community screening purposes, a portable fundus camera (Nidek, Chiyoda-ku, Japan) and a prototype monocular digital indirect ophthalmoscope constructed at the Lions Eye Institute (LEI) were selected for comparative trials for the screening of optic disc cupping, glaucoma and clinical signs of diabetic retinopathy. Fifty-one eyes of 27 consecutive patients being assessed at the LEI clinic for glaucoma were dilated and photographed with a Zeiss retinal camera, and digital images were taken with the portable Nidek NM100 fundus camera (Carl Zeiss, Oberkochen, Germany) or with a prototype digital monocular indirect ophthalmoscope. Vertical cup: disc ratios (VCDR) were measured on the disc photographs by one ophthalmologist while three other clinicians were presented with compressed digital images in random order to estimate VCDR. Field trials were also carried out to demonstrate the practicality of compression, local storage and then transmission by mobile telephone ISDN lines and satellite, of optic discs and fundus images of patients with diabetes in either rural Western Australia or Surabaya, Indonesia. Kappa values of correlations of measurement of agreement between measured and estimated VCDR were 0.87, 0.45 and 0.84, respectively, for the three observers, corresponding to a specificity of 79-97% and a sensitivity of 70-95%. The portable Nidek fundus camera was also assessed for specificity and sensitivity in the diagnosis of diabetic retinopathy in comparison to standard Zeiss fundus camera photographs. Of 49 eyes in 25 consecutive patients attending the LEI clinic for assessment of diabetic retinopathy, three ophthalmologists assessed photographs and images in random order. When used for screening diabetic retinopathy, the digital images of the Nidek camera were graded as adequate quality in only 56% of eyes compared to 93% of the photographs. The kappa value of agreement in analysis of diabetic retinopathy was only 0.30. The prototype digital monocular indirect ophthalmoscope compared favourably with the Nidek camera. At 1:5 compression, images of size 36 kB transmitted from Surabaya to Perth took 29 s on the mobile telephone, while uncompressed images took 170 s. Images compressed 1:5 were transmitted in 60 s using the satellite telephone, while the uncompressed images took 240 s. Satellite transmission was more expensive but the lines were more stable than telephone connections from Indonesia. Digital imaging is becoming a powerful tool for ophthalmology in clinical records, teaching and research, and interoffice diagnostic opinions. It also has enormous potential for community screening for blinding eye diseases, such as glaucoma and diabetic retinopathy. Inexpensive portable imaging devices that are easy to use, and on which local health workers might be trained, must be developed and validated in terms of sensitivity and specificity of performance. The technology of image capture, image compression, transmission, data base storage and analysis is rapidly evolving and becoming less expensive.

Diabetic Retinopathy↗

Directional bonding in compacted microcrystalline cellulose.

The mechanical properties of compacts of microcrystalline cellulose (MCC) and silicified microcrystalline cellulose (SMCC) were evaluated by tensile testing, diametric compression testing, and compression testing. For tensile and compression testing, cubic specimens were carefully machined from MCC and SMCC compacts, and the tensile and compression strengths were evaluated both normal and parallel to the compaction direction. The cubic tensile strengths were compared to values obtained from the diametric compression test. The results obtained using the diametric compression test suggested compacts of SMCC exhibit greater strength than those of MCC. In addition, the cubes machined from compacts of MCC and SMCC exhibited directional strength; the direction normal to the compaction direction display ed the greater tensile strength, and the parallel direction had greater compression strength. The diametric compression test afforded strength values with reduced spread compared to the values collected from the cubic tensile test, suggesting that the errors involved in collecting diametric compression test data of compacts are less than those for the cubic tensile test. Analysis of the cubes using X-ray diffraction (XRD) suggested that they display directional structural anisotropy, with the direction normal to the compaction direction being more crystalline than the parallel direction. However, it is not clear whether the difference in the directional strength is solely a consequence of the increased crystallinity or a culmination of crystallographic and mechanical keying effects.

Algorithms↗

Using personal digital assistants to access drug information.

The use of personal digital assistants (PDAs) to access drug information in a health system is described. Given the widespread use of PDAs at an 872-bed university health system, an opportunity existed to provide current drug information to physicians via these devices. As part of the health system's intranet, extensive online content had been made available through a browser; extension to PDAs was a natural next step. There were two primary requirements: the ability to synchronize information with the database server when a PDA was used and the development of content and applications by using existing staff. Mobile enterprise software was chosen that supports multiple PDA platforms, is easy to use, and does not require programming skills. The software works through customized "channels," or collections of information from a content provider. The customized channel service works over the Internet. Two channels of content were created, an ambulatory care channel and an inpatient care channel. The ambulatory care channel contains a list of preferred ambulatory care agents, poison control information, the locations of outpatient pharmacies, drug information, and safety tips for prescribing. The inpatient channel contains the inpatient formulary, current news and events, information on currrent drug shortages and recalls, pharmacy contact information, and medication safety tips. When a user synchronizes his or her PDA, the software contacts the department's intranet servers and processes the request. The data are compressed and downloaded to the user's PDA. A university health system successfully used PDAs to access drug and other information.

Clinical Pharmacy Information Systems↗

Trends in firearm suicide among older American males: 1979-1988.

Elderly men are more likely to commit suicide than any other age group in the United States. Moreover, their rate of suicide steadily increased between 1979 and 1988. National Center for Health Statistics (NCHS) Compressed Mortality data were used to perform an age-specific analysis of linear trends. Males 65 and over were the most likely to use firearms followed by those 55-64. In 1988, nearly 8 out of 10 suicides by males 65 and over were committed with a firearm. Firearm-related suicide rates were much lower for blacks than whites 65 and over; however, suicides among blacks were more likely to involve firearms than among whites in this age group. The authors call for a broad public policy effort directed at reducing the availability of firearms.

Adolescent↗

Reasons for the weak correlation between prostate volume and urethral resistance parameters in patients with prostatism.

In an attempt to increase our understanding of the clinical syndrome of benign prostatic hyperplasia (BPH) an analysis was made of the association between prostate volume as measured by transrectal ultrasound and several reported urodynamically determined urethral resistance parameters. Two types of obstruction can be recognized on the basis of urodynamic data: a compressive type characterized by a high urethral opening pressure and a prolonged isovolumetric contraction phase before urine flow can start, and a constrictive type characterized by a normal opening pressure and an increased slope of the urethral resistance relation. A combination of both types is often seen in BPH. In our study, parameters that selectively quantify compression correlate weakly to moderately with prostate volume, whereas parameters that mainly quantify constriction do not correlate at all with prostate volume. Parameters that combine a measure for compression and constriction correlate less well with prostate volume than parameters that mainly quantify compression. The variation in prostate volume was found to determine the variation in urethral resistance by 15% or less depending on the parameter used, which implies that the different pathophysiological mechanisms that can increase urethral resistance in the complex process of clinical BPH are mainly determined by factors other than the volume of the prostate. Thus, despite the lack of correlation between prostate volume and urethral resistance, pressure-flow studies and the determination of urethral resistance parameters provide a valuable contribution to the understanding of the pathophysiology of voiding dysfunction in men with symptoms of prostatism.

Adult↗

Distortion-product otoacoustic emission monitoring of cochlear blood flow.

Distortion-product otoacoustic emissions (DPOAEs) have been shown to be ideally sensitive to interruptions of the cochlear blood flow. However, a 15- to 30-second latency typically occurs between cessation of circulation and measurable DPOAE level changes. DPOAEs can also be characterized by phase measures. The aim of the present study was to determine in 10 rabbits the effects on DPOAE phase of repetitively compressing the internal auditory artery. In contrast to the delays measured by DPOAE level, phase changes were detected 1 to 5 seconds after internal auditory artery compression. These data suggest that the essentially "real time" monitoring of cochlear function with DPOAE phase can be used to ensure hearing preservation during surgery involving the porus acousticus and skull base.

Acoustic Stimulation↗

A model for chronic nerve root compression studies. Presentation of a porcine model for controlled, slow-onset compression with analyses of anatomic aspects, compression onset rate, and morphologic and neurophysiologic effects.

STUDY DESIGN: Compression onset rate, anatomic aspects, and morphologic and neurophysiologic effects in spinal nerve roots were studied in a nerve root compression model in pigs. OBJECTIVES: To analyze the compression onset rate by measuring the gradual reduction of the inner diameter of the constrictor, the motor nerve conduction velocity by electromyography, the morphologic changes by light microscopy, and the gross and vascular anatomy by dissection and ink injections, respectively, in a model for experimental chronic nerve root compression. SUMMARY OF BACKGROUND DATA: Chronic nerve root compression is recognized to be related to back pain syndromes, including sciatica. Various aspects of morphologic and physiologic changes have been studied previously in models for acute compression and chronic nerve root irritation, but a controlled, graded chronic nerve root compression model has not been described. METHODS: An ameroid constrictor was applied around a spinal nerve root just cranial to the dorsal root ganglion. The inner diameter of this constrictor gradually becomes reduced. After 1 week or 4 weeks, electromyographic measurements were performed, and tissue samples were harvested for histologic analyses. The gross and vascular anatomy of the pigs' spinal nerve roots were studied by dissection and ink injections. RESULTS: There was a statistically significant decrease in the nerve conduction velocity in compressed compared with noncompressed spinal nerve roots after 1 week and after 4 weeks. The ameroid constrictors induced nerve fiber damage, endoneural hyperemia, bleeding, and inflammation at the compression zone. There was often a severe reduction in the number of myelinated fibers after 4 weeks. CONCLUSION: A model for controlled, chronic, partial nerve root injury using a gradual compression-onset constrictor is presented. This model allows for induction of a controlled graded chronic nerve root injury and can be used for research on basic pathophysiologic mechanisms and on the effects of various interventions on nerve root injury development.

Animals↗

Delayed postoperative paraparesis in scoliosis surgery. A case report.

STUDY DESIGN: A case report is presented of an unusual complication of scoliosis surgery that, to the authors' knowledge, has never been reported in the literature. OBJECTIVE: Neurologic complications can occur after an uneventful posterior spinal instrumentation and fusion for scoliosis. Careful observation during the post-operative period is crucial for early detection of impending neurologic deficit. SUMMARY OF BACKGROUND DATA: Nerve compression of the cauda equina has been reported as a complication of different types of surgery in the lumbar spine, but an ascending paraparesis has never been described as a complication of scoliosis surgery. METHODS: A 12-year-old boy with a right thoracic scoliosis measuring 68 degrees and a 72 degrees left lumbar curve underwent Cotrel-Dubousset instrumentation and fusion from T5 to L4. Spinal cord monitoring with somatosensory evoked potentials and motor action potential were recorded and stable through out the entire procedure. Thirty hours later, a rapidly progressive ascending para-paresis developed that required urgent decompression. RESULTS: This patient underwent urgent decompression and removal of the Cotrel-Dubousset instrumentation. After surgery, the clinical picture improved gradually, and at 2-month follow-up he had regained normal strength in his lower limbs except for a grade 4 left extensor hallucis longus. By 4 months postdecompression, he had made a total recovery. CONCLUSIONS: Although clinical examination may be difficult to perform in patients who are unconscious, on large doses of narcotic drugs, or mentally retarded, careful observation during the postoperative period and awareness of this complication can allow early detection of impending reversible neurologic deficit and provision of appropriate treatment.

Child↗

Wavelet and wavelet packet compression of electrocardiograms.

Wavelets and wavelet packets have recently emerged as powerful tools for signal compression. Wavelet and wavelet packet-based compression algorithms based on embedded zerotree wavelet (EZW) coding are developed for electrocardiogram (ECG) signals, and eight different wavelets are evaluated for their ability to compress Holter ECG data. Pilot data from a blind evaluation of compressed ECG's by cardiologists suggest that the clinically useful information present in original ECG signals is preserved by 8:1 compression, and in most cases 16:1 compressed ECG's are clinically useful.

Algorithms↗

Information technology applications in biomedical functional imaging.

In parallel with rapid advances in computer technology, biomedical functional imaging is having an ever-increasing impact on healthcare. Functional imaging allows us to see dynamic processes quantitatively in the living human body. However, as we need to deal with four-dimensional time-varying images, space requirements and computational complexity are extremely high. This makes information management, processing, and communication difficult. Using the minimum amount of data to represent the required information, developing fast algorithms to process the data, organizing the data in such a way as to facilitate information management, and extracting the maximum amount of useful information from the recorded data have become important research tasks in biomedical information technology. For the last ten years, the Biomedical and Multimedia Information Technology (BMIT) Group and, recently, the Center for Multimedia Signal Processing have conducted systematic studies on these topics. Some of the results relating to functional imaging data acquisition, compression, storage, management, processing, modeling, and simulation are briefly reported in this paper.

Algorithms↗

Quantitative comparison and analysis of brain image registration using frequency-adaptive wavelet shrinkage.

In the field of template-based medical image analysis, image registration and normalization are frequently used to evaluate and interpret data in a standard template or reference atlas space. Despite the large number of image-registration (warping) techniques developed recently in the literature, only a few studies have been undertaken to numerically characterize and compare various alignment methods. In this paper, we introduce a new approach for analyzing image registration based on a selective-wavelet reconstruction technique using a frequency-adaptive wavelet shrinkage. We study four polynomial-based and two higher complexity nonaffine warping methods applied to groups of stereotaxic human brain structural (magnetic resonance imaging) and functional (positron emission tomography) data. Depending upon the aim of the image registration, we present several warp classification schemes. Our method uses a concise representation of the native and resliced (pre- and post-warp) data in compressed wavelet space to assess quality of registration. This technique is computationally inexpensive and utilizes the image compression, image enhancement, and denoising characteristics of the wavelet-based function representation, as well as the optimality properties of frequency-dependent wavelet shrinkage.

Brain↗

Data reduction using a discrete wavelet transform in discriminant analysis of very high dimensionality data.

We present a method of data reduction using a wavelet transform in discriminant analysis when the number of variables is much greater than the number of observations. The method is illustrated with a prostate cancer study, where the sample size is 248, and the number of variables is 48,538 (generated using the ProteinChip technology). Using a discrete wavelet transform, the 48,538 data points are represented by 1271 wavelet coefficients. Information criteria identified 11 of the 1271 wavelet coefficients with the highest discriminatory power. The linear classifier with the 11 wavelet coefficients detected prostate cancer in a separate test set with a sensitivity of 97% and specificity of 100%.

Data Compression↗

Angiographic magnetic resonance color composites of the normal brain and its vasculature.

Vascular magnetic resonance imaging (MRI) has become an important noninvasive adjunct to conventional cerebral MRI studies. To detect parenchymal changes associated with vascular anomalies, optimal diagnostic evaluation requires the comparison of both spin-echo and angiographic gradient-echo MRIs. To compress image data into a single 24-bit color image possessing the combined tissue contrast characteristics of both conventional spin-echo "black-blood" images and flow-sensitive gradient-echo "bright-blood" images, the red-green-blue color model and computer-based image-processing software were used to generate composites of MRI sets in which blood appears bright red while many stationary tissues possess near-natural colors. This technique may have potential applicability to human cerebrovascular MRI.

Brain↗

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support.

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.

Data Compression↗

[Establishment of Internet-based database of the Virtual Chinese Human dataset].

To establish an Internet-based database for the dataset of Virtual Chinese Human that is accessible to the interested researchers, modifications and compression of the original VCH-format dataset of Virtual Chinese Human were performed before it was uploaded to the server, and RAID0+1 storage technology was adopted with specific download accesses designed for different users. After dataset modification and compression, the data size was considerably reduced to allow convenient data storage and transfer. The RAID0+1 storage technology guarantees the security and high-speed download of data through different means established. Internet-based database provides important accesses for sharing the achievement in virtual human study between world-wide researchers, which has been imperative in the present situation of science development.

Anatomy, Cross-Sectional↗

[Clinical electroencephalographic characteristics of the phasic nature of the course of severe cerebrocranial injury].

In order to early recognize intracranial hematomas and contusions, differential diagnostic criteria for analysis of neurological symptomatology and EEG signs are considered from the standpoint of a phasic clinical progress of traumatic pathological conditions of the brain. The EEG syndromes of initial, pronounced and gross synchronization correlated with the clinical phases of subcompensation, mild and deep decompensation. The study demonstrates a contrary trend in the dynamics of the clinical and EEG data in compression and contusion of the brain.

Brain Concussion↗

A comparison of ultraviolet-curing and self-curing polymers in preventive, restorative and orthodontic dentistry.

Both self-cured and UV-cured resin-base dental materials are used in preventive, restorative, and orthodontic dentistry. Polymerization is initiated in both systems by free radicals. Self-curing materials generate free radicals by means of chemical compounds included in their formulation. UV-curing systems rely upon externally-supplied, long wavelength, ultraviolet radiation to produce free radicals within the material. Therefore, although the major chemical components of both systems are similar in many respects, each system has particular advantages and disadvantages over the other, which must be recognized by the practitioner. Substantial differences exist, for example, in the color stability of these two types of materials, because of the fact that the UV-cured system cannot include UV absorbers, which protect the self-cured systems from discoloration after exposure to sunlight. UV-cured systems require a limitation on the maximum depth of filled restorative that can be cured at one time, since the filler particles attenuate UV radiation. The limit-layer is generally established as 1-1-5 mm maximum thickness. Therefore, UV-cured filled systems are more time-consuming in restorations of deeper cavities. This liability is also in evidence as it affects the degree of polymerization of UV-cured filled systems. The uncertainty of complete polymerization is apparently responsible for highly erratic compressive strength data found with UV-cured restoratives. Normally, the amount of unpolymerized monomer is much less predictable in UV-cured systems, over that which is obtained in self-cured materials. The presence of a larger fraction of unpolymerized monomer creates a greater potential for pulpal injury from UV-cured restorative materials. The catalyst used in several UV-cured systems is benzoin methyl ether, a compound of rather high toxicity (LD50:300 mg/kg). The safety of using UV radiation in the vicinity of oral mucosa has not been firmly established. The design of the UV lamp should provide for focusing all radiation onto hard tissue. However, UV-cured systems do offer several advantages over self-cured systems. They normally are one-component systems and therefore are more convenient to use in certain types of applications, e.g., fissure sealing. UV-cured systems also provide an unlimited working time, an important advantage for specific applications.

Acrylic Resins↗

Effect of medication on biomechanical properties of rabbit bones: heparin induced osteoporosis.

The aim of this controlled study is to investigate the effect of heparin on osteoporosis initiation and of calcitonin and tamoxifen on the progress of osteoporosis induced by heparin through biomechanical means and, thus, to assist in clinical usage of these drugs. 32 four-month-old female New Zealand white rabbits were divided into four different experimental groups. The animals in group A were administered heparin (Liquemine) intraperitoneally at the dosage of 1000 IU/kg/day. The animals in group B were injected the same amount of heparin as those of group A, and in addition, were given calcitonin at the dosage of 100 IU/kg/day. The animals in group C were medicated the same way as group B but 2 mg/kg/day tamoxifen (Nolvadex) was orally added into their intestine via cannula, one side connected to the injector. The animals in group D were the control. The experiment lasted 8 weeks. The animals in all experimental groups showed the same growth pattern as that of the control group. Whole-bone femur, humerus and tibia specimens were subjected to 3-point bending tests while sections from the proximal ends of the same specimens were subjected to compression tests. The data, recorded as load vs deflection, were converted into stress vs strain using the strength of materials formulae. The data obtained from the bending and the compression experiments were treated separately. The stiffness of the bones of the medicated groups were compared with those of the control groups. Our data indicated that the tamoxifen treated humera, femora and tibiae attained the largest bending stiffness in all cases investigated. However, this was not the case for compression. None of the drug administered groups attained the stiffness of the control group except for the case of tamoxifen treated femora which attained stiffness close to that of the controls. The results show that heparin altered the mechanical properties of bones indicating osteoporosis, tamoxifen was effective in reducing the effect of heparin while calcitonin yielded no conclusive result.

Animals↗