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[Defibrillation with an automatic external defibrillator outside the hospital: a life-saving, but restricted treatment?].

Application of the automatic external defibrillator can improve the chance of success during resuscitation of out-of-hospital cardiac arrest, because lay persons can defibrillate awaiting the arrival of the ambulance. Defibrillation is mentioned in the Dutch Individual Health Care Professionals Act as a precluded action. Defibrillation with an automatic external defibrillator should be excluded from the list of precluded actions, because application is almost 100% safe and because the subject is not within the scope of the law which is restricted to professional activities and non-emergency actions. Defibrillation with an automatic external defibrillator is acceptable.

Electric Countershock↗

[Automation in analysis. VII. Automatic mineralization and determination of organic phosphorus].

An automatic manifold for the organic phosphorus mineralization is described. The device at issue does consist in an electrically heated aluminium blok, in which 80 holes are drilled, in order to hold 80 hydrolysis vials. The heating is automatically controlled by an independent unity. The ortophosphate determination is performed photometrically with the previously described automatic apparatus.

Autoanalysis↗

The limitations of decision trees and automatic learning in real world medical decision making.

The decision tree approach is one of the most common approaches in automatic learning and decision making. It is popular for its simplicity in constructing, efficient use in decision making and for simple representation, which is easily understood by humans. The automatic learning of decision trees and their use usually show very good results in various "theoretical" environments. The training sets are usually large enough for learning algorithm to construct a hypothesis consistent with the underlying concept. But in real life it is often impossible to find the desired number of training objects for various reasons. The lack of possibilities to measure attribute values, high cost and complexity of such measurements, unavailability of all attributes at the same time are the typical representatives. There are different ways to deal with some of these problems, but in a delicate field of medical decision making, we cannot allow ourselves to make any inaccurate decisions. We have measured the values of 24 attributes before and after the 82 operations of children in age between 2 and 10 years. The aim was to find the dependencies between attribute values and a child's predisposition to acidemia--the decrease of blood's pH. Our main interest was in discovering predisposition to two forms of acidosis, the metabolic acidosis and the respiratory acidosis, which can both have serious effects on child's health. We decided to construct different decision trees from a set of training objects, which was complete (there were no missing attribute values), but on the other hand not large enough to avoid the effect of overfitting. A common approach to evaluation of a decision tree is the use of a test set. In our case we decided that instead of using a test set, we ask medical experts to take a closer look at the generated trees. They examined and evaluated the decision trees branch by branch. Their comments on the generated trees can be found in this paper. The comments show, that trees generated from available training set mainly have surprisingly good branches, but on the other hand some are very "stupid" and no medical explanation could be found. Thereafter we can conclude, that the decision tree concept and automatic learning can be successfully used in real world situations, constrained with the real world limitations, but they should be used only with the guidelines of appropriate medical experts.

Acidosis↗

Comparison of the sensitivity and specificity of an automatic ligase chain reaction assay system with a one-step polymerase chain reaction assay in the diagnosis of Mycobacterium tuberculosis complex.

BACKGROUND: Polymerase chain reaction (PCR) and ligase chain reaction (LCR) are two nucleic acid amplification-based molecular methods. The former has been used widely in the identification of Mycobacterium tuberculosis (M. tuberculosis). In contrast, the LCR assay which was recently introduced is not well known in our medical communities in Taiwan. To determine which method is more reliable and suitable for the identification of M. tuberculosis in our clinics, we compared the sensitivity and specificity of these two methods. METHODS: An automatic LCR assay system and a manual one-step PCR assay were studied in a side by side comparison of their performance in detection of M. tuberculosis. The automatic LCR system uses the single copy antigen protein b (Pab) gene and the manual one-step PCR assay uses the multi-copy IS6110 insertion element as the target DNA; both target DNA sequences are found specifically in M. tuberculosis complex. RESULTS: Both assays detected two of the M. tuberculosis complex strains, M. tuberculosis and M. bovis, but not other mycobacterial strains. In addition, both methods, which were based on different amplification principles, showed compatible sensitivity; as low as 10 and 100 copies of M. tuberculosis genomes were detected by the LCR and PCR assays, respectively. When the template DNA was less than 1000 copies, however, the automatic LCR assay system showed a lower reproducibility than that of the one-step PCR assay. CONCLUSION: Our results suggest that in addition to the PCR assay, the LCR assay is a useful method for the molecular identification of M. tuberculosis complex strains.

DNA Ligases↗

Recent developments in automatic refraction.

A detailed description of the Ophthalmetron is given. This is an automatic refractometer using the principle of infra-red retinoscopy and having a sensitivity range from -18.00 D to +17.00 D with a resolution of 0.25 D. By means of a rapid light scan across the patient's pupil the instrument determines the direction of motion of the retinal reflex in all meridians and a movement null-point is determined electronically. Results are then plotted automatically on a chart drum. Some early validation studies have shown the Ophthalmetron to provide a refraction end-point in good agreement with conventional retinoscopic findings. The paper concludes with an appendix in which the features of three commercially available automatic refractometers are compared.

Humans↗

Image analysis software for automatic DNA ploidy assessment of archival solid tumours.

BACKGROUND: Image cytometry has proved to provide a good alternative to flow cytometry for DNA ploidy measurement of archival tumors. However, when interactively done this technique is unable to give statistically valuable results within an acceptable time for clinical oncology. METHODS: An image cytometer was developed for fully automatic DNA ploidy quantitation, focusing efforts on speed and accuracy. Software functionalities include systematic acquisition of fields on a microscopic slide, detection, localization and sorting of nuclei, computation of the DNA content together with post-processing tools, for a deeper analysis of the DNA ploidy diagram. RESULTS: DNA ploidy analysis of archival breast carcinoma samples illustrates the accuracy of DNA ploidy measurements and the sensitivity in the detection of DNA ploidy abnormalities as a result of cell sorting. CONCLUSIONS: Fully automatic image cytometry is able to combine qualities of flow cytometry (automatic analysis of a statistically significant collection of cell nuclei) with additional advantages: sorting of unwanted events (debris, stromal and inflammatory cell nuclei) and facilities for an a posteriori control of the quality of cell selection. This method is well suited to DNA ploidy analysis of archival cancer samples.

Aneuploidy↗

[Automatic methods of measurement of motor potential units].

INTRODUCTION: The study of motor unit potentials (MUP) may be carried out using qualitative or quantitative methods. The considerable usefulness of quantitative methods in the diagnosis of neuromuscular disorders has led to development of new automatic techniques which permit greater speed and accuracy of clinical investigation. In this review we consider traditional electromyographic techniques and describe some automatic methods. DEVELOPMENT: Qualitative techniques are simpler but give limited information since they only permit recording of very marked alterations. The introduction of trigger and averaging permit quantitative analysis and thus the evaluation of less obvious changes. Although they do not identify all the potentials of an electromyographic signal, the new automatic techniques using partial decomposition avoid the loss of time occurring with earlier techniques, give reliable objective measurements of the MUP and also the possibility of measuring new parameters, such as the area or frequency of discharge. CONCLUSIONS: New methods of evaluation of the MUP have significant advantages over traditional methods, namely increased speed and objectivity. However, this makes it necessary to redefine normal values since different methods are used for obtaining and processing the signals, otherwise the results may not be strictly comparable.

Electromyography↗

Lateralized automatic auditory processing of phonetic versus musical information: a PET study.

Previous positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies show that during attentive listening, processing of phonetic information is associated with higher activity in the left auditory cortex than in the right auditory cortex while the opposite is true for musical information. The present PET study determined whether automatically activated neural mechanisms for phonetic and musical information are lateralized. To this end, subjects engaged in a visual word classification task were presented with phonetic sound sequences consisting of frequent (P = 0.8) and infrequent (P = 0.2) phonemes and with musical sound sequences consisting of frequent (P = 0.8) and infrequent (P = 0.2) chords. The phonemes and chords were matched in spectral complexity as well as in the magnitude of frequency difference between the frequent and infrequent sounds (/e/ vs. /o/; A major vs. A minor). In addition, control sequences, consisting of either frequent (/e/; A major) or infrequent sounds (/o/; A minor) were employed in separate blocks. When sound sequences consisted of intermixed frequent and infrequent sounds, automatic phonetic processing was lateralized to the left hemisphere and musical to the right hemisphere. This lateralization, however, did not occur in control blocks with one type of sound (frequent or infrequent). The data thus indicate that automatic activation of lateralized neuronal circuits requires sound comparison based on short-term sound representations.

Adult↗

The critical incident stress debriefing process for the Los Angeles County Fire Department: automatic and effective.

Los Angeles County Fire Department has one of the oldest Critical Incident Stress Management (CISM) programs in the country. One core component for the LACoFD has been the Critical Incident Stress Debriefing (CISD). Two important questions for the emergency managers are: 1) Do individuals find a significant difference in symptom reduction for events that were debriefed? 2) Does helpfulness of a debriefing for a specific individual correlate with recommending the process for others? A Department-wide evaluative survey was conducted in 1996 to determine the satisfaction and effectiveness of the debriefing program. Individuals reported a significant difference in the speed of symptom reduction for incidents that were debriefed versus incidents that were not debriefed. The majority of individuals would recommend the debriefing process to others regardless of whether they personally found the process helpful or not. Based on this, the recommendations are to continue the debriefing process for specific events and to make the process mandatory; furthermore, it is recommended that the term "mandatory" be changed to "automatic." By using the term "automatic," debriefings become standard operating procedures. By doing so, a method to protect the psychological welfare of emergency personnel becomes as automatic as putting on safety protection equipment [International Journal of Emergency Mental Health, 2000, 2(4), 249-257].

Adaptation, Psychological↗

[Automatic milking from a behavioral and welfare viewpoint].

Automatic milking systems have been shown to change the behaviour of cows. Because pre-determined milking and feeding times are eliminated, the cows must establish their own daily routine. They have to adapt to being milked according to their lactation. There are, however, indications that not all cows adapt well to the automatic system. Some herd members seem to have inhibitions about entering the milking stall. Too many cows per milking stall and a blocked milking system intensify the situation. Therefore, the cows must either be forced or attracted by food to enter the milking stall. Altogether some cows appear to be more stressed. Furthermore, the human-animal relationship changes due to the new work content. There is less manual work, more observation, and more computer data. The farmer needs to be well educated and must establish a new management program. If care is insufficient, if some herd members are less frequently milked, and if measures to reduce stress are not taken, it is clear that welfare problems could arise. Compared to milk quality and milk hygiene, technical solutions and regulations by law are not as important. Ethological knowledge must be taken into account if automatic milking is to be advantageous for both cow and man.

Adaptation, Physiological↗

Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated 99mTc-sestamibi myocardial SPECT.

UNLABELLED: We investigated the reproducibility of an automatic quantitative algorithm for measuring regional myocardial wall motion and systolic thickening. METHODS: 99mTc-sestamibi gated myocardial SPECT with dipyridamole stress was performed twice consecutively on 31 patients with known or suspected coronary artery disease, with the patients in the same position for each scan. With AutoQUANT software, segmental wall motion and systolic thickening were quantified automatically and expressed in millimeters and percentage increase, respectively, for 20 segments. Afterward, the correlation and agreement between repeated measurements were investigated, and the influences of wall location, perfusion grade, and partitioning of the myocardium on reproducibility were evaluated by ANOVA and t testing. RESULTS: High correlations (r = 0.95 for wall motion and 0.88 for systolic thickening) and good agreements (weighted kappa = 0.81 and 0.71, respectively) were obtained from repeated measurements on consecutive gated SPECT. Changes in wall location and perfusion grade did not cause significant differences between repeated measurements (P > 0.05 in ANOVA and t testing), but a change in partitioning did. On Bland-Altman analysis, 2 SDs for repeated wall motion and for systolic thickening were 2.0 mm and 20%, respectively. CONCLUSION: The automatic quantitative algorithm for myocardial SPECT provided by AutoQUANT software has good reproducibility under diverse conditions. A change of motion > 2.0 mm or a change of systolic thickening > 20% can be regarded as significant during a follow-up study using this software.

Adult↗

Automatic search for optimal conditions in clinical studies.

BACKGROUND: A program for an automatic search for the optimal conditions of important prognostic factors in clinical studies was developed. METHODS: The program was developed for the following steps: (1) Input of the maximum and minimum values and of the interval of the variable to be investigated. Automatic calculation of the Cut Points. (2) Division of the patient data into two groups at every Cut Point and calculation of survival rates. (3) Sequential calculation of P-values and chi-square values for the two sets of survival rates. To determine the usefulness of this program, the optimal irradiation dose was searched for 537 patients with non-small cell lung cancer. RESULTS: The P-value reached its minimum value and the chi-square value its maximum when the Cut Point was 5,925 cGy (0.0001 and 30.18). Between 5,925 cGy and 6,900 cGy, the P-value stayed at less than 0.05. CONCLUSION: Artificial errors in grouping by prognostic factors can be avoided and the search for optimal conditions can be conducted automatically and scientifically.

Automation↗

Computer-assisted ABR interpretation using the automatic construction of the latency-intensity curve.

In this paper, we present a new computerised technique for the automatic construction of the latency intensity curve (LI curve). We take a pattern recognition approach determined by a priori information. We use knowledge gained from the audiogram and from physiological considerations. Therefore, we consider all recordings at different intensities as well as results from the extraction of a single auditory brainstem response (ABR) at a given stimulus intensity. We tested our method successfully: it allows us to prevent misrecognition errors in response detection or in latency measurements. Automatic recognition of the waves and recognition by the ear, nose and throat (ENT) specialist coincided in at least 90 per cent of cases. For wave V, the average deviation between the response thresholds given by our automatic recognition algorithm and those given by the ENT specialist was 5 dB, and the average deviation of the latencies was 0.05 ms.

Auditory Threshold↗

[Results with automatic refraction (author's transl)].

Hundred eyes of young patients with an average age of 25 years were measured with two refraction methods: 1. subjectiv refraction and 2. automatic refraction with the "Dioptron". The results of refraction and visual acuity before and after cycloplegia were compared. As for the spherical aquivalents we found a very good correlation between both methods (r - 0,98). The "Dioptron" printed out stronger cylindric powers as were found with the subjectiv refraction. Furthermore it could be shown that the stronger the cylindric power the smaller the axial deviation between subjectiv and automatic refraction. We believe that the automatic refraction with "Dioptron" is a good screening method, which cannot replace fine subjective adjustments, but complements them by serving as a good starting point for the refractive procedure.

Adolescent↗

Application of an automatic sampling and measurement system to a mountainous stream investigation during rain events.

An automatic sampling and measurement system was developed to take water samples efficiently during rain events. The system consisted of an automatic sampler, a rain gauge and a data logger as well as sensors for pH, electrical conductivity (EC), and both water and air temperature. The system was tested in a stream in a forested watershed (5.8 km2) located in the middle of Hyogo prefecture, Japan. The sampling program has been improved gradually. For several rain events of 30 to 157 mm, most water samples were in agreement with the hydrograph from the beginning of each rainfall until the rain had stopped and the water level had begun to fall. The fluctuations in water quality in the samples taken by the automatic sampler during those rain events showed patterns similar to those of water samples taken by hand. There were also no problems with the water level or the EC sensor during the investigation periods, but the pH values were lower than those in the laboratory. The results showed that the system is suitable for taking water samples from mountainous streams during rain events.

Altitude↗

[Some methods of assessing the work of automatic analytical systems under clinical biochemical laboratory conditions].

The use of automatic facilities at clinical biochemical laboratories involves a change in the technological pattern of the analysis. In the course of the analysis the samples pass through the same automatic devices. A transfer of a volume of the substance from a preceding sample into a vessel containing the next one gives rise to systematic errors. A procedure for measuring a volume of the substance at different stages of the analysis is proposed. Experimental data derived from an investigation of the transfer of a volume at the stages of proportioning the biological liquid and reagents when handling various types of foreign-made automatic devices are presented.

Autoanalysis↗

New automatic software for virtual colonoscopy: technical aspects.

PURPOSE: To evaluate a new virtual endoscopy software package capable of automatically plotting the path along which to perform endoscopic exploration. MATERIALS AND METHODS: We reviewed the examinations of 50 patients with colonic neoplasms studied by CT colonoscopy by using a single-detector CT scanner (Philips Tomoscan AVE1). The technical parameters used were: slice thickness 3 mm, pitch 1.4, reconstruction interval 2-2.5, 120 kV, 150-200 mA. The images were processed on a separate workstation (Philips Easy Vision 5.1) running an experimental virtual endoscopy software package capable of automatically drawing a line along which to move the virtual endoscope to explore the colon. Reconstruction of the endoscopic images along the path obtained was set at an interval of 15-20 mm between one endoscopic view and the next, to a total of 70 to 120 images. The endoscopic animated image sequence was then saved and evaluated by comparing the starting axial images and the three-dimensional images obtained. RESULTS: The programme plotted the endoscopic path correctly in a single pass in 40 of the 50 cases studied. The overall time spent by the radiologist on image-processing did not exceed 5 minutes. DISCUSSION: The need to reduce the time spent by audiologists on post-processing has led to a gradual improvement in image-processing hardware and software. In the context of virtual endoscopy, one of the main goals is to obtain the path for endoscopic exploration in as short a time as possible. The programme we evaluated successfully fulfils this requirement as, once the image-processing technical parameters have been defined, it plots a path along the entire colon and performs the reconstruction procedures automatically. The time spent by the operator on post-processing does not exceed 5 minutes. CONCLUSIONS: The new programme evaluated in this study facilitates the processing of endoscopic images, reduces radiologist time and may contribute to the widespread use of virtual colonoscopy.

Colonic Neoplasms↗

Tc-99 HMPAO cerebral SPECT imaging in brain death patients with complex spinal automatism.

BACKGROUND: The aim of this study is to evaluate the value ofTc-99 HMP AO cerebral SPECT imaging to confirm brain death in patients with complex spinal automatism. METHODS: Fifteen patients (8 female, 7 male) aged between 1,5-48 years showing spinal movements within 24-72 hours after brain death were examined with Tc-99 HMPAO cerebral SPECT. RESULTS: All patients demonstrated empty skull on Tc-99 HMPAO images and no contradictory case was ob- served between standard clinical criteria and SPECT study. CONCLUSION: Non-invasive brain SPECT study is valuable to diagnose and confirm brain death with spinal automatism in adults and children. Key words: Tc-99 HMPAO SPECT, brain death, spinal automatism

Adolescent↗