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[3-D localization of cardiac structures in real time].

Radiographic 3-D localisation enables measurements to be made that facilitate the placement of the interventional device during cardiac intervention. To enable the reader to implement the method himself, we describe the computation of 3-D coordinates, acquisition of the imaging and projection data on-line, and the accuracy that can be expected with the method. The 3-D coordinates of a cardiac structure are calculated from the image point coordinates, the projection data and the system constants of a biplane isocentric X-ray unit. Technical imaging errors are corrected a priori. The biplane projection data of a run are acquired on-line and stored in a data base. The image pair of interest is identified automatically from the inscribed run number, and assigned to the projection data from the data base. The target image point is marked on the monitor for 3-D localisation. The accuracy of the method was determined by comparing the calculated and actual cross-sectional points of a centimetre grid imaged in biplane X-ray projections. 3-D localisation took an average of 9.8 +/- 1.2 seconds. Angles and distances were assessed with a standard error of 1.1 degrees and 0.8 mm. The run number is identified correctly in 98.5% of the cases. The mean absolute location error for all points and image pairs was 0.61 +/- 0.32 mm. The accuracy and precision was 0.03 +/- 0.40 mm. Radiographic 3-D localisation can be performed readily and accurately on-line. The results obtained with the method enable interventional decisions to be optimized.

Computer Graphics↗

A novel morphological technique to investigate a single climbing fibre synaptogenesis with a Purkinje cell in the developing mouse cerebellum: DiI injection into the inferior cerebellar peduncle.

To study morphologically the relationship between climbing fibre and Purkinje cell in the developing mouse cerebellum, we established a novel tract tracing using injection of 1,1'-dioctodecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) into the inferior cerebellar peduncle, the half point of olivocerebellar projection. In this tracing method, only a certain number of climbing fibres were labelled with DiI and they revealed the single-fibre resolution, individually. These technical advantages enabled us to follow the projection of a climbing fibre to a Purkinje cell at the light microscopic level. To further investigate how a single labelled olivocerebellar axon interacts with a Purkinje cell, we introduced a photoconversion method into this tracing method and successfully observed the photo-oxidized climbing fibre terminals at the electron microscopic level. At postnatal days 7 and 9, a single DiI-labelled climbing fibre arborized around some adjacent Purkinje cell bodies in a distinguishable nest. At this pericellular nest stage, we first demonstrated that the terminal arborization stemmed from a single climbing fibre formed synapses simultaneously on both a soma and dendrites of a Purkinje cell. This finding suggests that the pericellular nest may be such an efficient form that a single climbing fibre innervates a Purkinje cell at both perisomatic and peridendritic sites. Thus, we succeeded in establishing an effective tracing method to investigate a single climbing fibre synaptogenesis with a Purkinje cell both at the light and electron microscopic levels.

Animals↗

A graphic representation of projection accuracy.

The author examines "the problem of measuring projection accuracy. Experience with applying the accuracy measure 'quality of prediction', as proposed by Keyfitz, leads the author to a critical evaluation and elaboration of this accuracy measure. Time series of prediction quality values may show a remarkable temporal instability, partly depending on the chosen bench mark, which seriously hinders interpretation. This interpretation problem may be solved by an easily applicable graphical solution, a convenient short-circuit device to assess a projection's accuracy without restrictions as to size of population or length of projection period." The concepts are illustrated with data used for population forecasts for the Netherlands during the 1970s. (SUMMARY IN FRE)

Demography↗

Fertility, migration, and the ageing of the population--an analysis of the official projections.

"As we move through the demographic transition, an older age structure is inevitable but future possible scenarios vary.... The paper analyses nine different population projections produced by the ABS [Australian Bureau of Statistics], four in 1996 and five in 1998. The highest projection...adds an extra ten million people by the year 2051 while the lowest...adds none."

Age Distribution↗

NIS vs SAGES: a comparison of national and voluntary databases.

BACKGROUND: Surgical outcomes are increasingly examined in an effort to improve quality and reduce medical error. The Nationwide Inpatient Sample (NIS) is a retrospective, claims-derived and population-based database and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Project is a prospective, voluntary and specialty surgeon database. We hypothesized that these two sources of outcome data would differ in regard to a single, commonly performed procedure. METHODS: Both the NIS, a national sample of all nonfederal hospital discharges, and the gastroesophageal reflux disease log of the SAGES Outcomes Project were queried for all fundoplications performed between 1999 and 2001 using either ICD-9 procedure code 44.66 or CPT codes 43280 or 43324. Patients with an emergency admission, age <17 years, and/or diagnoses for either esophageal cancer or achalasia were excluded. Both demographic and outcome variables were compared by either t-test or chi-square analysis, with a p value of <0.05 as significant. RESULTS: Both data sets were comparable for age and gender; however, the SAGES group had a higher rate of teaching hospital affiliation (71 vs 48%, p < 0.001). SAGES fundoplications had a consistently higher rate of comorbidities, including Barrett's esophagus (2.3 vs 1.1%, p = 0.005). The NIS fundoplications had a clear trend toward more associated procedures, including cholecystectomy (7.2 vs 2%, p < 0.001). Complication rates for the NIS data set were higher, including pulmonary complications (1.7 vs 0.5%, p = 0.03). No statistically significant differences existed between the two data sets for either length of stay or mortality. CONCLUSIONS: The two databases indicate that fundoplication is an operation with low morbidity and mortality. The SAGES Outcomes Project demonstrated that participating surgeons had a higher affiliation with teaching hospitals, higher reporting of comorbidity, and lower associated procedures than the NIS. Despite having more comorbidity and technical difficulty, patients from the SAGES Outcomes Project had equivalent or lower complication rates.

Databases, Factual↗

Demographic overview of the ageing situation in the ESCWA region and its developmental implications.

"The study is based on a statistical compilation carried out by the author using the United Nations World Population Prospects 1990 and its 1992 revision, in addition to the United Nations ESCWA demographic estimation on the ageing situation in the ESCWA region. It provides demographic projections through the year 2025, and covers future economic implications of the ageing situation, as well as existing policies regarding ageing in selected countries."

Age Distribution↗

A model of cost-outcome analysis for assistive technology.

During the CERTAIN study (research carried out in 1994-96 within the Technology Initiative for Disabled and Elderly (TIDE) programme of the European Union), a number of real life case studies of provision of assistive technology to disabled persons were investigated in order to assess the applicability of socio-economic principles, methods and techniques already available from Health Care Technology Assessment studies. A retrospective study on cost, effectiveness and utility resulting from the implementation of assistive technology was carried out over a sample of disabled persons who had adopted technical aids before the start of the project. The sample was selected in such a way to include different pathologies (steady or progressive), impairments, ages, technology and social environment. Each case was described by considering all clinical, technical and social aspects; a common structure for case reporting was developed and tested; attempts were carried out to apply and refine concept and tools derived from health technology assessment studies; on the grounds of such experience a decision support model was elaborated for the choice between different alternatives in order to maximize the client's quality of life while making efficient use of scarce resources. A computer implementation of such a model was also developed, along with a mathematical structure of cost analysis. Within a national research programme such findings were further exploited, leading to the development of a prototype cost-outcome instrument designed for use in clinical practice in the provision of assistive technology to individual cases.

Activities of Daily Living↗

Health information multitype library reference referral networking: panacea for the '90s.

Librarians are exploring new approaches to information sharing to cope with a rapidly changing environment dominated by budget cuts, information explosion, and globalization of the economy, science, and culture. In 1990, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a pilot project aimed at establishing an effective balance between state-of-the-art information technology and traditional library methods and promoting cooperation among health information professionals by establishing the Health Information Referral Network (HIRN) in the state of Illinois. HIRN's background and development, Internet home page, and networking techniques reviewed in this paper are applicable to multitype libraries and information centers interested in improving information use and the referral process.

Computer Communication Networks↗

Health care construction: getting it right the first time.

This article is written from a construction manager's point of view. Many activities involved in this particular contracting approach to hospital construction are generic to other approaches, such as a lump sum bid contract or design/build. The author emphasizes the benefits and economies of setting clear, well-understood goals at the beginning of the project and carrying through with a consistent, well-managed decision-making process. The construction phase is described with sufficient thoroughness and detail to provide the health care executive a good technical reference for any health care construction project.

Architecture↗