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PubMed2002

Building a better online formulary.

The history of and improvements made to the University of Michigan Health System (UMHS) inpatient online formulary are described. The current formulary at UMHS is the third version of the Web-based formulary. The original effort in 1997 consisted of converting word-processing documents to HTML format and exporting this information to the university's intranet. There was no mechanism to search for formulary items, no therapeutic class cross-referencing, and no cost information. Documents and their conversion had to be manually maintained. The second version incorporated a series of automatic daily computer downloads from the inpatient pharmacy computer system. Web pages were built to dynamically display the formulary information from the database based on users' requests. The formulary enabled searching by brand or generic names, provided therapeutic category cross-references, listed the location of products within automated dispensing cabinets, provided accurate cost information, and was always up-to-date. Maintenance efforts drastically decreased. The current version has incorporated additional logic to meet users' needs. If no matches are found, the system expands its search by automatically linking to UMHS's inpatient pharmacy system repository of all drugs, finding matches to what the user entered, and then returning the names of therapeutically similar formulary agents to the user. A cross-index feature allows the system to return all the drugs that fall under the searched therapeutic category. Dramatic improvements have been made to UMHS's inpatient online formulary in the past two years. The current formulary provides a very low-cost, easily maintainable, and effective means to access the formulary and clinically relevant and timely information specific to each medication.

Computers↗

PubMed2000

TEXshade: shading and labeling of multiple sequence alignments using LATEX2 epsilon.

MOTIVATION: Typesetting, shading and labeling of nucleotide and peptide alignments using standard word processing or graphics software is time consuming. Available automatic sequence shading programs usually do not allow manual application of additional shadings or labels. Hence, a flexible alignment shading package was designed for both calculated and manual shading, using the macro language of the scientific typesetting software LATEX2 epsilon. RESULTS: TEXshade is the first TEX-based alignment shading software featuring, in addition to standard identity and similarity shading, special modes for the display of functional aspects such as charge, hydropathy or solvent accessibility. A plenitude of commands for manual shading, graphical labels, re-arrangements of the sequence order, numbering, legends etc. is implemented. Further, TEXshade allows the inclusion and display of secondary structure predictions in the DSSP-, STRIDE- and PHD-format. AVAILABILITY: From http://homepages.uni-tuebingen.de/beitz/tse.h tml (macro package and on-line documentation) CONTACT: eric.beitz@uni-tuebingen.de

Algorithms↗

PubMed1993

Sample size calculation, power analysis and randomization: research project design in Windows.

Single estimates of sample size for a study may be easily obtained by use of a hand calculator or from published tables. In contrast, performing multiple calculations is a tedious and time-consuming task, which is greatly simplified by a computer program. The computer program presented here assists the investigator in calculating sample size estimates, determining statistical power and creating randomization tables for a study. The program is designed primarily for clinical trials and thus includes some features not found in other software packages performing similar tasks. Sample size calculation and power analysis are performed for dichotomous, continuous (parametric and non-parametric tests) and time-to-failure (exponential distribution and log-rank test) response variables, and for correlation coefficients. Sample size estimates and significance levels may be adjusted for multiple participating centers, non-compliance, interim analyses and.multiple testing. The randomization subroutine generates tables for studies with up to nine treatment arms and with any valid block size. As a Windows application, the program runs in a multitasking environment, allowing switching between programs and easy pasting of results into word-processing documents and other applications. It is very simple to use, with a completely menudriven interface and sufficient built-in help to obviate the use of a manual.

Algorithms↗

PubMed1994

Brain activity during reading. The effects of exposure duration and task.

Brain activity during reading tasks was investigated using PET. The aim was to account for differences in the results of two previous studies [those of Petersen et al. (Science 1990; 249: 1041-4) and Howard et al. (Brain 1992; 115: 1769-82)] by systematically varying the type of reading task and the exposure duration of the word stimuli. Both variables strongly influenced patterns of brain activity. There were three types of task: (i) reading aloud; (ii) reading silently; and (iii) lexical decision on visually presented words and pseudowords. Reading aloud and reading silently engaged the left middle and superior temporal regions, confirming the important role of these areas in visual word processing. The areas principally engaged during lexical decision were the left inferior and middle frontal cortices and the supplementary motor area; activity in these areas suggests that the subjects were using a phonological strategy to perform the task. There was also a significant effect of exposure duration, with activity being greater for short (150 ms) exposure durations than for long (1000 ms or 981 ms) exposure durations. We conclude that until we understand how subtle variations in experimental design influence brain activity during reading tasks, the association of specific processing functions with individual anatomical areas activated during reading is premature.

Adult↗

PubMed1998

Different activation patterns in the visual cortex of late and congenitally blind subjects.

A key issue in developmental neuroscience is the role of activity-dependent mechanisms in the epigenetic induction of functional organization in visual cortex. Ocular blindness and ensuing visual deprivation is one of the rare models available for the investigation of experience-dependent cortical reorganization in man. In a PET study we demonstrate that congenitally blind subjects show task-specific activation of extrastriate visual areas and parietal association areas during Braille reading, compared with auditory word processing. In contrast, blind subjects who lost their sight after puberty show additional activation in the primary visual cortex with the same tasks. Studies in blind-raised monkeys show that crossmodal responses in extrastriate areas can be elicited by somatosensory stimulation. This is consistent with the crossmodal extrastriate activations elicited by tactile processing in our congenitally blind subjects. Since primary visual cortex does not show crossmodal responses in primate studies, the differential activation in late and congenitally blind subjects highlights the possibility of reciprocal activation by visual imagery in subjects with early visual experience.

Adult↗

PubMed2000

Single word reading in developmental stutterers and fluent speakers.

Ten fluent speakers and nine developmental stutterers read isolated nouns aloud in a delayed reading paradigm. Cortical activation sequences were mapped with a whole-head magnetoencephalography system. The stutterers were mostly fluent in this task. Although the overt performance was essentially identical in the two groups, the cortical activation patterns showed clear differences, both in the evoked responses, time-locked to word presentation and mouth movement onset, and in task-related suppression of 20-Hz oscillations. Within the first 400 ms after seeing the word, processing in fluent speakers advanced from the left inferior frontal cortex (articulatory programming) to the left lateral central sulcus and dorsal premotor cortex (motor preparation). This sequence was reversed in the stutterers, who showed an early left motor cortex activation followed by a delayed left inferior frontal signal. Stutterers thus appeared to initiate motor programmes before preparation of the articulatory code. During speech production, the right motor/premotor cortex generated consistent evoked activation in fluent speakers but was silent in stutterers. On the other hand, suppression of motor cortical 20-Hz rhythm, reflecting task-related neuronal processing, occurred bilaterally in both groups. Moreover, the suppression was right-hemisphere dominant in stutterers, as opposed to left-hemisphere dominant in fluent speakers. Accordingly, the right frontal cortex of stutterers was highly active during speech production but did not generate synchronous time-locked responses. The speech-related 20-Hz suppression concentrated in the mouth area in fluent speakers, but was evident in both the hand and mouth areas in stutterers. These findings may reflect imprecise functional connectivity within the right frontal cortex and incomplete segregation between the adjacent hand and mouth motor representations in stutterers during speech production. A network including the left inferior frontal cortex and the right motor/premotor cortex, likely to be relevant in merging linguistic and affective prosody with articulation during fluent speech, thus appears to be partly dysfunctional in developmental stutterers.

Adult↗

PubMed2002

Subthalamic nucleus stimulation affects striato-anterior cingulate cortex circuit in a response conflict task: a PET study.

The subthalamic nucleus (STN) has generally been considered as a relay station within frontal-subcortical motor control circuitry. Little is known about the influence of the STN on cognitive networks. Clinical observations and studies in animals suggest that the STN participates in non-motor functions which can now be probed in Parkinson's disease patients with deep brain stimulation of the STN, allowing selective and reversible modulation of this nucleus. Using PET, we studied changes in regional cerebral blood flow (rCBF) associated with a response conflict task (Stroop task) in Parkinson's disease patients ON and OFF bilateral STN stimulation. The Stroop task requires subjects to name the font colour of colour words (e.g. "blue") printed in an incongruent colour ink (e.g. yellow). During STN stimulation, impaired task performance (prolonged reaction times) was associated with decreased activation in both right anterior cingulate cortex (ACC) and right ventral striatum. Concomitant increased activation in left angular gyrus indicative of ongoing word processing during stimulation is consistent with an impairment to inhibit habitual responses. ACC and ventral striatum are part of the ACC circuit associated with response conflict tasks. The decreased activation during STN stimulation in the ACC circuit, while response conflict processing worsened, provides direct evidence of STN modulating non-motor basal ganglia-thalamocortical circuitry. Impairment in ACC circuit function could account for the subtle negative effects on cognition induced by STN stimulation.

Adult↗

PubMedDate not supplied

PET activation of posterior temporal regions during auditory word presentation and verb generation.

Previous studies using positron emission tomography (PET) report blood flow changes in superior and middle temple gyri associated with auditory and language tasks (Petersen et al., 1988, 1989; Wise et al., 1991; Demonet et al., 1992; Howard et al., 1992; Sergent et al., 1992; Zatorre et al., 1992; Petrides et al., 1993; Raichle et al., 1994; Fiez et al., 1995). An important issue is whether these changes reflect the activation of a single functional region or multiple regions with distinct functional contributions. In the present study, we examined this issue by focusing upon two tasks for which we have previously reported posterior temporal blood flow changes: listening to auditorily presented words (Petersen et al., 1988, 1989), and generation of a verb in response to a visually presented noun (Raichle et al., 1994); see also Wise et al. (1991). We began by further characterizing a left temporoparietal region of change previously associated with auditory word presentation. This previously reported response was replicated, and the results were extended by demonstrating presentation of pseudowords also produced activation. We next asked whether the activation associated with auditory word presentation could be distinguished from that associated with the generation of verbs in response to visually presented nouns. It was found that the activations associated with these two tasks could be both functionally and spatially dissociated. Thus, two posterior temporal areas associated with auditory word presentation and verb generation appear to represent distinct areas concerned with word processing. More generally, the results demonstrate an approach for assessing the independence of two activated areas.

Acoustic Stimulation↗

PubMed2006

Deaf people communicating via SMS, TTY, relay service, fax, and computers in Australia.

Despite the expansion of Deaf people's use of communication technology little is published about how they use electronic communication in their social and working lives and the implications for their concepts of identity and community. Australia is an ideal research base because the use of a range of technologies is widespread there. To gain access to a wide age range of people who identify as Deaf, members of the national organization, the Australian Association of the Deaf, were surveyed by mail. Results showed that Short Message Service (SMS), telephone typewriters (TTY), voice/TTY relay services, fax, and e-mail were used regularly. Deaf users are discerning of the purposes for which they use each method: SMS for social and personal interactions, TTY for longer communications and (via the relay service) with people and services without TTYs, fax for business and social contact, and computers for personal and business e-mails as well as Web browsing, accessing chat rooms, word processing, games, and study.

Adult↗

PubMed1984

A computer package for DNA sequence analysis.

We have developed a comprehensive software-hardware package for a CP/M based or other microcomputer which can perform four major functions in a molecular biology laboratory: (1) the acquisition and analysis of DNA sequence data, (2) word processing in the preparation of scientific manuscripts and figures, (3) general lab computation and data reduction, and (4) as a data terminal for communication of data over the phone line.

Base Sequence↗

PubMed1986

Assembly of overlapping DNA sequences by a program written in BASIC for 64K CP/M and MS-DOS IBM-compatible microcomputers.

The SEQALIGN programs1 described in this report aid in the assembly of up to 100 individual overlapping DNA sequences generated by M-13 subcloning and sequencing methods. The program produces a printout of the aligned sequences presented in register. Use of the program will be facilitated because 1) it is written with the Microsoft BASIC interpreter, 2) sequence data may be entered and edited using WORDSTAR or similar word processing programs, and 3) hardware requirements for execution of the program on CP/M or MS-DOS (IBM-PC compatible) systems are minimal.

Base Sequence↗

PubMed1986

A DNA sequence analysis program for the Apple Macintosh.

This paper describes a new set of programs for analyzing DNA sequences using the Apple Macintosh computer, a computer ideally suited for this kind of analysis. Because of the Macintosh interface and the availability of high quality software-only speech synthesis, these programs are truly easy to use. Instead of typing in commands, the user directs the program by making selections with the mouse, thereby eliminating most typographical and syntax errors. Output options are selected by "pressing buttons" and then clicking "OK" with the mouse. DNA sequences are confirmed by having the program speak them. The high resolution graphics on the Macintosh not only allow for explanatory diagrams to be used to aid in deciding on input parameters, but can be used to produce slides for presentations and figures for papers. Because of the clipboard and the ability of the Macintosh to readily share data among different applications, data can be saved for use directly in word processing documents (e.g. manuscripts).

Animals↗

PubMed1988

Apple Macintosh programs for nucleic and protein sequence analyses.

This paper describes a package of programs for handling and analyzing nucleic acid and protein sequences using the Apple Macintosh microcomputer. There are three important features of these programs: first, because of the now classical Macintosh interface the programs can be easily used by persons with little or no computer experience. Second, it is possible to save all the data, written in an editable scrolling text window or drawn in a graphic window, as files that can be directly used either as word processing documents or as picture documents. Third, sequences can be easily exchanged with any other computer. The package is composed of thirteen programs, written in Pascal programming language.

Amino Acid Sequence↗

PubMed2006

Cortical processing of complex auditory stimuli during alterations of consciousness with the general anesthetic propofol.

BACKGROUND: The extent to which complex auditory stimuli are processed and differentiated during general anesthesia is unknown. The authors used blood oxygenation level-dependent functional magnetic resonance imaging to examine the processing words (10 per period; compared with scrambled words) and nonspeech human vocal sounds (10 per period; compared with environmental sounds) during propofol anesthesia. METHODS: Seven healthy subjects were tested. Propofol was given by a computer-controlled pump to obtain stable plasma concentrations. Data were acquired during awake baseline, sedation (propofol concentration in arterial plasma: 0.64 +/- 0.13 microg/ml; mean +/- SD), general anesthesia (4.62 +/- 0.57 microg/ml), and recovery. Subjects were asked to memorize the words. RESULTS: During all periods including anesthesia, the sounds conditions combined elicited significantly greater activations than silence bilaterally in primary auditory cortices (Heschl gyrus) and adjacent regions within the planum temporale. During sedation and anesthesia, however, the magnitude of the activations was reduced by 40-50% (P < 0.05). Furthermore, anesthesia abolished voice-specific activations seen bilaterally in the superior temporal sulcus during the other periods as well as word-specific activations bilaterally in the Heschl gyrus, planum temporale, and superior temporal gyrus. However, scrambled words paradoxically elicited significantly more activation than normal words bilaterally in planum temporale during anesthesia. Recognition the next day occurred only for words presented during baseline plus recovery and was correlated (P < 0.01) with activity in right and left planum temporale. CONCLUSIONS: The authors conclude that during anesthesia, the primary and association auditory cortices remain responsive to complex auditory stimuli, but in a nonspecific way such that the ability for higher-level analysis is lost.

Acoustic Stimulation↗

PubMed1999

Left-hemisphere processing of emotional connotation during word generation.

Areas of the brain's left hemisphere involved in retrieving words with emotional connotations were studied with fMRI. Participants silently generated words from different semantic categories which evoked either words with emotional connotations or emotionally neutral words. Participants repeated emotionally neutral words as a control task. Compared with generation of emotionally neutral words, generation of words with emotional connotations engaged cortices near the left frontal and temporal poles which are connected to the limbic system. Thus, emotional connotations of words are processed in or near cortices with access to emotional experience.

Adolescent↗

PubMed2000

Language functional neuro-imaging changes following focal left thalamic infarction.

The involvement of the left thalamus in language function has been largely demonstrated through the effects of thalamic lesion and/or stimulation upon language. However, the pathophysiological mechanisms underlying thalamic aphasias remain a matter of debate. We report here on changes in the pattern of brain activity in auditory word processing, verb generation and visual lexical decision in a patient who sustained left thalamic infarct following the surgery of intractable mesio-temporal epilepsy with left hippocampal sclerosis. To some extent, our findings exemplify the way the left thalamus brings on line the cortical networks involved in language processing, suggested in the term 'selective engagement'.

Aphasia↗

PubMed2002

An innovative partnership in service.

OBJECTIVE: Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) DESCRIPTION: Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. DISCUSSION: The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.

Health Services↗

PubMed1990

Computer use and education in radiology residency programs.

Computers play an increasingly important role in radiology education and research. We surveyed all U.S. residency programs to assess computer availability, education, and use by residents. Out of 210 questionnaires sent, 132 were returned (63% response). Areas of inquiry included computer equipment and software as well as resident use of facilities. Opinions were also solicited concerning the importance of computer literacy and education. Sixty-nine percent of the respondents have computer facilities (61% within the department). Predominant uses include scientific papers, slides/audiovisual presentations and resume preparation. Popular software includes word processing, spreadsheets, databases and graphics. Of those training programs with computers, 85% provided computer education, and most (70%) felt computer training was very important. Forty-seven percent expected their residents to have at least passing acquaintance with computers. However, in 60% of programs with computers, the computers are used by less than half the residents. Of those programs without a computer, 61% provided no computer training, and only 44% felt computer education was very important. A sizable minority of radiology residency programs are still without computer facilities. Those programs that have computers tend to place a greater emphasis on computer education and literacy for radiology residents. However, even in programs that have computers, it seems they are often underutilized by residents.

Computer User Training↗