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PubMed1990

Medical informatics: an emerging medical discipline. Council on Scientific Affairs and Council on Long Range Planning and Development of the American Medical Association.

The use of computer technology in medicine is no longer the domain of only a few "gadget" happy high-tech aficionados. The rapid pace of medical progress and the increasing demands on physicians' time mandate that mechanisms be developed to deliver the tools of contemporary information management directly into the hands of all practicing physicians. It is with this intent that the Council on Long-range Planning and Development and the Council on Scientific Affairs of the American Medical Association have developed an informational report on Medical Informatics. The technology for producing information about medicine and patients is well into the information age. However, the technology for managing this information has not kept up, at least to the extent of being available in medical facilities where it is needed. Most users of medical information, physicians included, have not crossed the threshold into the electronic/computer era of information acquisition, distribution, and assimilation. The continuing development of the physician as computer user will create a more efficient work environment for the physician while at the same time improving patient care.

Databases, Bibliographic↗
PubMed1997

Distributed representation as a principle for the analysis of cockpit information displays.

This article examines the representational properties of cockpit information displays from the perspective of distributed representations (Zhang & Norman, 1994). The basic idea is that the information needed for many tasks in a cockpit is distributed across the external information displays in the cockpit and the internal minds of the pilots. It is proposed that the relative distribution of internal and external information is the major factor of a display's representational efficiency. Several functionally equivalent but representationally different navigation displays are selected to illustrate how the principle of distributed representations is applied to the analysis of the representational efficiencies of cockpit information displays.

Aerospace Medicine↗
PubMed2006

Modelling multivariate outcomes in hierarchical data, with application to cluster randomised trials.

In the cluster randomised study design, the data collected have a hierarchical structure and often include multivariate outcomes. We present a flexible modelling strategy that permits several normally distributed outcomes to be analysed simultaneously, in which intervention effects as well as individual-level and cluster-level between-outcome correlations are estimated. This is implemented in a Bayesian framework which has several advantages over a classical approach, for example in providing credible intervals for functions of model parameters and in allowing informative priors for the intracluster correlation coefficients. In order to declare such informative prior distributions, and fit models in which the between-outcome covariance matrices are constrained, priors on parameters within the covariance matrices are required. Careful specification is necessary however, in order to maintain non-negative definiteness and symmetry between the different outcomes. We propose a novel solution in the case of three multivariate outcomes, and present a modified existing approach and novel alternative for four or more outcomes. The methods are applied to an example of a cluster randomised trial in the prevention of coronary heart disease. The modelling strategy presented would also be useful in other situations involving hierarchical multivariate outcomes.

Artificial Intelligence↗
PubMedDate not supplied

Dose uniformity in scanned focused ultrasound hyperthermia.

Scanned focused ultrasound (SFUS) is unique amongst noninvasive methods of inducing hyperthermia in that the absorbed power (SAR) distribution may be controlled at a scale of 0.5 cm or better. This high degree of spatial control of SAR implies that differences in local tissue cooling due to heterogeneity in perfusion, variations in the density of discrete thermally significant vessels and even local cooling around single large vessels may be compensated during SFUS treatments. In this paper we calculate thermal dose distributions arising from three different SFUS techniques: (1) the high-temperature short-duration (HTSD) ultrasound technique; (2) conventional systems employing a fixed scan and fixed SAR simulated by a uniform SAR; and (3) we optimize the SAR distribution using information from angiography and thermal models. These techniques are tested in the same anatomy having discrete vessels, a non-uniform vessel density and with little, if any, preheating of the incoming blood (i.e. the worst-case situation). The application of a uniform SAR to this volume resulted in a highly non-uniform thermal dose distribution. The situation is clearly improved in HTSD hyperthermia; however, the desired accuracy of positioning within the tumour is high, and to minimize background heating the focus must be stepped slowly and preferably in a semi-random pattern through the target volume. The third technique which employs spatial control over SAR resulted in the greatest uniformity in thermal dose. However, the use of this technique requires the input of the complete three-dimensional discrete vessel network and the availability of a tested three-dimensional discrete vessel thermal model.

Biophysical Phenomena↗
PubMed2003

Postnatal development of calcium-binding proteins immunoreactivity (parvalbumin, calbindin, calretinin) in the human entorhinal cortex.

The entorhinal cortex is an essential component in the organization of the human hippocampal formation related to cortical activity. It transfers, neocortical information (ultimately distributed to the dentate gyrus and hippocampus) and receives most of the hippocampal output directed to neocortex. At birth, the human entorhinal cortex presents similar layer organization as in adults, although layer II (cell islands) and upper layer III have a protracted maturation. The presence of interneurons expressing calcium-binding proteins (parvalbumin, calbindin-D28K (calbindin) and calretinin) is well documented in the adult human entorhinal cortex. In many of them the calcium binding is co-localized with GABA. Parvalbumin-immunoreactive cells and fibers were virtually absent at birth, their presence increasing gradually in deep layer III, mostly in the lateral and caudal portions of the entorhinal cortex from the 5th month onwards. Calbindin immunoreactive cells and fibers were present at birth, mainly in layers II and upper III; mostly at rostral and lateral portions of the entorhinal cortex, increasing in number and extending to deep layers from the 5th month onwards. Calretinin immunoreactivity was present at birth, homogeneously distributed over layers I, II and upper V, throughout the entorhinal cortex. A substantial increase in the number of calretinin neurons in layer V was observed at the 5th month. The postnatal development of parvalbumin, calbindin and calretinin may have an important role in the functional maturation of the entorhinal cortex through the control of hippocampal, cortical and subcortical information.

Calbindin 1↗
PubMed1998

Towards cooperative patient management through organizational and medical ontologies.

Within knowledge and data engineering a new research paradigm is emerging based on the Multi-Agent System (MAS) architectural framework, allowing human and software agents to interoperate and thus cooperate within common application areas. In such a framework, knowledgeable agents of heterogeneous nature, that possess diverse but at least partially compatible or inter-translatable conceptual views, or ontologies, modeling both their own expertise and the external environment, make somehow available their information resources or problem-solving abilities for cooperative processes addressing the construction of a new agent or the achievement of some common goal through a correlated execution of tasks. In this paper, we restrict our analysis to the case of an organization of cognitive agents, illustrated with examples from a prototypical healthcare MAS, that is, a so-called Distributed Healthcare Information System (D-HIS). The prototype makes use of an ontological library written in the standard language Ontolingua. An ongoing application of the methodology to the main problem of Clinical Practice Guidelines (GLs) computer-based dissemination and enforcement is described.

Artificial Intelligence↗
PubMed2004

DIVAA: analysis of amino acid diversity in multiple aligned protein sequences.

MOTIVATION: Multiple alignments of proteins are an effective way of identifying conserved amino acids that provide clues to functional relationships among proteins. Quantitation of the abundances of amino acids found at each position in a sequence motif can provide a basis for understanding the structural and functional constraints at each point. Distribution of information across a motif has been used previously, but the non-intuitive nature of the analysis has limited its impact. RESULTS: Here, we introduce a quantitative measure of amino acid sequence diversity (DIVAA) that has a simple, intuitive meaning. Diversity, as a measure of sequence conservation or variation, is inextricably linked to the probability of selecting identical pairs from a distribution. We demonstrate its utility through the analysis of four populations: ATP-binding P-loops, hypervariable domains of kappa light chains, signal sequences, and the N- and C- termini of proteins. DIVAA provides a simple means to generate hypotheses concerning the contribution of individual residues to the functional and evolutionary relationships among proteins. AVAILABILITY: Access to DIVAA software is available at RELIC (http://relic.bio.anl.gov).

Algorithms↗
PubMed1999

Dipole Information Complementarity in Discrete 2D Patterns.

An information theoretic approach is used to derive equations describing the dipole information in discrete two-dimensional (2D) patterns. Dipoles are pair-wise, or second-order, interactions of pattern states. It is shown that the basic dipole information equation can be decomposed into two complementary representations of the total information. One of these representations expresses the total information in terms of the sum of two components: the dipole spatial information and the permutation set information. The spatial information component describes the information in the distribution of spatial transitions for each type of color transition. The permutation set information component is a second-order function of the single color probabilities. The second representation is also the sum of two components: the dipole color information and the array information. The dipole color information describes the information in the distribution of color transitions for each possible spatial transition. The array information is a function of the size and geometry of the pattern array. These two representations characterize the total information from complementary perspectives, each emphasizing different aspects of the pattern's structure. Implications of this approach for the understanding of patterns and pattern perception are examined. Copyright 1999 Academic Press.

Journal Article↗
PubMed2001

Rocuronium and anaphylaxis--a statistical challenge.

Drug induced anaphylaxis is frequently attributed to the use of muscle relaxants during anaesthesia. Recently The Norwegian Medicines Agency recommended that rocuronium bromide (Esmeron) be withdrawn from routine practice due to frequent reports of anaphylaxis. Over a period of two and a half years approximately 150,000 patients received rocuronium as part of their anaesthesia. In this period the Norwegian drug authorities received 29 reports of anaphylaxis or anaphylactoid reactions in patients treated with rocuronium. This is in stark contrast to the situation in other Nordic countries where a total of only seven cases of anaphylaxis in approximately 800,000 patients treated with rocuronium had been recorded by December 2000. This situation highlights the many potential problems of the surveillance of adverse drug reactions: reporting bias may lead to an over-estimate of the risk of one drug compared to another, and the possibility of under-reporting of adverse events (due to a weak reporting culture) further limit the validity of such comparisons. The surveillance of adverse drug reactions also represents a statistical challenge. While adverse event reports may help us to estimate the anaphylaxis rate we need to appreciate the uncertainty of such estimates. Adverse reactions are rare, random, and mostly independent events, resulting from the successive exposure of patients to a low risk intervention. The frequency distribution of adverse events will therefore conform to that of a Poisson process. The resulting Poisson distribution may inform us about the variability of adverse event data. An understanding of these methodological problems and statistical challenges will allow anaesthesiologists to make informed decisions concerning the use of muscle relaxants and other drugs associated with severe adverse reactions.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Central system of psychosocial support to the Czech victims affected by the tsunami in Southeast Asia.

The tsunami disaster affected several countries in Southeast Asia in December 2004 and killed or affected many tourists, most of them from Europe. Eight Czech citizens died, and about 500 Czechs were seriously mentally traumatized. The psychosocial needs of tourists included: (1) protection; (2) treatment; (3) safety; (4) relief; (5) psychological first aid; (6) connecting with family members; (7) transportation home; (8) information about possible mental reactions to trauma; (9) information about the normality of their reaction; (10) procedural and environmental orientation; (11) reinforcement of personal competencies; and (12) psycho-trauma therapy. The Ministry of Foreign Affairs of the Czech Republic was in charge of general emergency management. General coordination of psychosocial support was coordinated under the Ministry of Interior of the Czech Republic, which is connected to the Central Crisis Staff of the Czech Government. The major cooperative partners were: the Ministry of Foreign Affairs, the Ministry of Defence, the Ministry of Health, Czech Airlines, psychosocial intervention teams of the Czech Republic, and the Czech Association of Clinical Psychologists. The main goals of relief workers were: (1) to bring back home the maximum number of Czech citizens; (2) to provide relevant information to the maximum number of affected Czech citizens; (3) to provide relevant information to rescue workers and professionals; and (4) to prepare working psychosocial support regional network. Major activities of the Ministry of Interior (psychology section) included: (1) establishing a psychological helpline; (2) running a team of psychological assistance (assistance in the Czech airports, psychological monitoring of tourists, crisis intervention, psychological first aid, assistance in the collection of DNA material from relatives); (3) drafting and distributing specific information materials (brochures, leaflets, address lists, printed and electronic instructions); (4) communicating via the media and advertising, and (5) providing analysis and research studies. Central coordination of psychosocial support has been found as successful in the first phase after the disaster. The plans must be built for preferable cooperation in the psychosocial field in the Czech Republic. Better collaborates with journalists must exist in order to reduce secondary psycho-trauma. There is a need for intensive international cooperation in the psychosocial field and to build the network at the global level.

Crisis Intervention↗
PubMedDate not supplied

[Two-parameter flow fluorescence analysis of human chromosomes. Quantitative processing].

A procedure for the quantitative analysis of the results of fluorimetric studies on human chromosomes in a flow is described. The procedure enables one to simultaneously follow two parameters by using two fluorochromes, one of which is selective to the GC-, and the other, to AT base pairs of DNA. Thus, it becomes possible to derive from the experimentally obtained distributions an information on the relative DNA content in individual chromosomes, differences in DNA content between homologous chromosomes, the relative number of chromosomes of each type in the sample tested, as well as on the percent ratio of AT and GC base pairs in a particular chromosome. In addition, the procedure enables one to assign, with a high degree of accuracy, the peaks on experimental distributions to the objects of analysis chromosomes. The analysis cutting off the extreme combines the method of components with the least square method, as applied to the peaks of the Gaussian shape. The first step involves the filtration of the starting experimental data from contaminating signals from both the parts of degraded chromosomes and stained cytoplasm fragments, and from chromosome aggregates. The procedure is realized as a package of programs for IBM-compatible PC/AT computers (486 and later versions), which permits one to perform a comprehensive analysis of two-parameter distributions of chromosome fluorescence signals to solve a number of problems, such as the identification of chromosome aberrations in cell lines tested, quantitative comparison of distinguishing features of homologous chromosomes and whole chromosome sets.

Chromosomes, Human↗
PubMed1998

Initial experience with quality assurance of multi-institutional 3D radiotherapy clinical trials. A brief report.

In 1992, a 3D Quality Assurance (3D QA) Center was established at the Mallinckrodt Institute of Radiology under the auspices of the Radiation Therapy Oncology Group (RTOG). The role of the 3D QA Center is to provide quality assurance reviews of external beam treatment planning and verification (TPV) information for patients enrolled in multi-institutional 3D radiotherapy treatment protocols. Computer hardware and software components have been implemented which allow participating institutions to submit (via either the Internet or magnetic tape) common format 3D TPV data for QA review including: volumetric CT image data, normal structure, tumor and target volume contours, digitally reconstructed radiographs or simulator (prescription) and portal radiographs, beam geometry, dose distributions, fractionation information, and dose-volume histograms. Prior to enrolling patients on a 3D radiotherapy treatment protocol, each participating institution is required to complete a 3D Facility Questionnaire documenting their 3D treatment planning capability. In addition, the successful completion of a protocol "dry run" test is required to demonstrate the participating institution's ability to submit a protocol complaint digital data set to the 3D QA Center prior to placing patients on the 3D CRT study. Two site specific (prostate and lung) phase I/II 3D dose escalation trials are currently accruing patients. The QA center reviews at a minimum the first 5 cases from each participating institution and spot checks subsequent submissions. For each case review the following parameters are evaluated: 1. data exchange compliance, 2. CT data quality, 3. target volume contours, 4. normal structure contours, 5. field placement, 6. field shape, 7. dose prescription, 8. dose uniformity, and 9. dose conformity. By April 1997, over 300 protocol patient TPV data sets have been submitted and reviewed by the 3D QA Center.

Clinical Protocols↗
PubMed1996

Teaching medical students by role playing: a model for integrating psychosocial issues with disease management.

BACKGROUND: Medical students on third-year rotations seem to be focused more on the particulars of disease management than on patient management. They often pay too little attention to the psychological and social needs of the patient and to the importance of working in a multidisciplinary team. The authors postulated that a model for teaching breast cancer management that included role playing, self-study, and active student involvement would facilitate the integration of psychosocial and affective issues into scientific content and would demonstrate the importance of the team approach in managing patients with breast cancer. METHODS: One month following a problem-oriented, case-based, interactive session focusing on clinical management of breast disease, each student was assigned the role of either "patient" or one of four "specialists"-1) a general surgeon, 2) a medical oncologist, 3) a radiation oncologist, or 4) a plastic surgeon. A packet of readings containing discipline-specific information was distributed to each "specialist" and a similar preparation packet was distributed to each "patient." One week later students from each specialty met in "multidisciplinary groups" and five "patients" with written scenarios of recently diagnosed primary breast cancer rotated among them. Important decision-making choices were discussed in each consultation. Following their consultations in the "multidisciplinary" groups, the "patients" met with the entire group of 20-25 students and with physician faculty to discuss differences in the information obtained. They compared "specialists'" styles of presentation and attitudes. Specific issues involving coordination of care among "specialists" were carefully highlighted. RESULTS: All students participated and the teaching sessions were well received. CONCLUSIONS: Role playing facilitates the discussion of psychosocial issues and aptly demonstrates to students the need for a multidisciplinary approach to breast cancer treatment. This model is applicable to other types of cancer and to other groups of cancer educators.

Adult↗
PubMed2003

Molecular marker analysis and genetic basis for sterility of typical indica/japonica hybrids.

To explore the genes differentiated between typical indica and japonica varieties, two typical indica/japonica varieties, Balilla (japonica) and Nantehao (NTH, indica), were selected to construct genetic populations based on the widely surveying for spikelet and pollen fertility of 90 indica/japonica F1 hybrids, which also were used as the wide compatability testers. In order to analyze the genes (QTLs) related to spikelet and pollen fertility, two reciprocal backcross populations Balilla/NTH//Balilla and Balilla/NTH//NTH were constructed and the spikelet and pollen fertility of each individuals were assessed. In both populations, two traits all appeared distorted normal distribution, but in the first population, they forwarded to low-level fertility type, the later population, forwarded to high-level fertility type relatively. The results indicated that both of male and female gametophytes of Balilla/NTH hybrids were partial sterile. Then we analyzed the SSR marker genotype of each individuals of Balilla/NTH//Balilla population containing 142 individuals, and constructed a SSR linkage map, in which, there were 108 information markers distributing on all 12 chromosomes equably, average marker distance was about 11.9 cM. Therefore the linkage map was qualified for QTL analysis. Two methods were employed to conduct QTLs analysis, i.e., single marker analysis and interval mapping. According to single marker analysis, 17 and 12 markers were found significantly responsible for spikelet and pollen fertility, respectively. And further study by means of MAPMAKER/QTL software, for spikelet fertility trait, two QTLs were detected, qSPTF1 on chromosome 1 and qSPTF6 on chromosome 6, and their additive effect were 13.501 and -16.414, respectively. According to previous studies, qSPTF6 was deduced to be the same locus as S-5. For pollen fertility, qPLLN7 on chromosome 7 and qPLLN9 on chromosome 9 were detected, and their additive effects were -12.003 and -11.012, respectively. Because the QTLs detected cannot explain completely the total variance of mapping population, other genetic factors must be existed to be responsible for spikelet and pollen partial sterility. Hence we let two random markers as putative covariates, and divide the 142 individuals into four groups according to the two marker genotypes, then the average values of spikelet and pollen fertility of each groups were calculated for two-way ANOVA (analysis of variance). The results indicated that there existed strong interaction for both spikelet fertility and pollen fertility. At a significance level of 0.005, there over 61 and 51 pairs loci interactions detected playing an important role in spikelet and pollen sterility expression, respectively. These results indicated that epistasis also was one of major genetic components controlling indica/japonica hybrid sterility.

Analysis of Variance↗
PubMed1998

Archive selection for the MICAS, a multi-vendor incremental approach to PACS.

From the time a decision was made to purchase an archive until a purchase order was issued took approximately 10 months. During this period an RFI was developed, issued and the results analyzed. Technical discussions were held and site visits were made. To ensure that current information was available, a complete review of available multi-modality DICOM compliant archives were made at the 1997 RSNA. With this information in-hand and the future development path for MICAS specified, a detailed RFQ was developed, responses were received and evaluated. A purchase order was to be issued by the end of the first quarter 1998. The archive vendor will have been selected by the time this paper appears in print. The oral presentation of this work will review the responses of the archive vendors and present the basis for selection. It is planned to publish our findings. The archive is the heart and brains of PACS. It controls information acquisition, distribution and storage plus work flow. It is critical that DICOM compliance and interoperability between all components of the PACS be an absolute requirement, especially for the archive.

Academic Medical Centers↗
PubMed1994

Workstations as enabling technologies for computer-based patient records.

Advances in computer-based technologies and cultural changes occurring in the workplace are changing the way we work and share information. Networked, distributed computing environments offer the promise of improving the quality of patient care and containing costs. Understanding and overcoming the cognitive and behavioral barriers of machine-man interactions will help us to fulfill that promise.

Computer Communication Networks↗
PubMed1995

Difficulties of families with handicapped children after the Hanshin-Awaji earthquake.

In order to clarify the difficulties which handicapped people experienced in the Hanshin-Awaji earthquake disaster, 678 families with handicapped children were studied 1.5 months after the earthquake. All the students who were enrolled in this study were going to some type of school or training classes for handicapped children in January 1995. The study was completed between 1 and 10 March. The questionnaires which were designed for this study consisted of three parts: the difficulties which the families were faced with, their requirements for social and medical services and the symptoms and reactions of their children after the earthquake. A total of 466 answers were obtained from their parents. The kinds of difficulties differed between the families of mentally retarded children and those of the physically handicapped. While many parents with physically handicapped children desired better medical information or materials, many parents with mentally retarded children wanted better care services for their children. Physical and psychological effects of the earthquake were only temporary in most cases. However, some of the handicapped children were still suffering from such reactions as of 10 March. From the results of our study it became evident that a systematic relief program for these handicapped people should be established. The relief program should include the distribution of information regarding medical and social services. Psychological reactions such as panic, excitement and suppression of mental activity were still observed in some handicapped children on 10 March. Further observation will therefore be necessary.

Child↗
PubMedDate not supplied

A comparison between the two general sets of linear free energy descriptors of Abraham and Klamt.

Two sets of molecular descriptors, the five experimental Abraham, and the five COSMOments of Klamt's COSMO-RS, have been compared for a data set of 470 compounds. Both sets are considered as almost complete sets of LFER. The two sets of descriptors are shown to exhibit a large overlap as far as their chemical content. The chemical information however is distributed differently in each set with the Abraham set incorporating extra information in the excess molar refraction descriptor E. Regression equations have been constructed to predict the experimental Abraham descriptors from theoretically calculated COSMOments. The chemical interpretation of these equations is however difficult because of the lack of clustering which characterizes the distribution of chemical information through the two sets of descriptors. The predictability of the regression equations is tested successfully using a reasonably large set of data, and the method is compared to recent attempts to calculate the Abraham descriptors from various theoretical bases.

Journal Article↗