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Computational tools for the analysis of heteroatom groups and their neighbours in protein tertiary structure.

A number of Protein Data Bank (PDB) entries contain heteroatoms defined as HETATM. These include the atomic co-ordinates mainly for heteroatom groups, such as cofactors, coenzymes, prosthetic groups, metal ions, sugars, drugs, peptides, heavy-atom derivatives, non-standard amino acid residues/nucleotides, water molecules and so on. In order to evaluate the different heteroatom (Het) groups and their distribution in protein tertiary structure, we have extracted these from all proteins in the PDB and provided the data in an easily accessible format at the following website. The data can be queried on the PDB code, protein name/description, Het Group code or Het Group name. Further, we have also developed a web-based software application that reports neighbouring atoms evaluated by a "user-defined" distance cut-off value (in Angstrom units), either between a specific Het Group or all Het Groups in a given PDB with amino acid residues and water molecules in the corresponding protein, or neighbours for only all the amino acid residues in the given PDB with respect to Het Groups and water molecules. Together, the database and software applications are useful to gather information that can be further analyzed in order to obtain insights into the preferred interactions of heteroatom groups in proteins, study their binding mode, design novel molecules or to annotate protein function.

Animals↗

Database and tools for analysis of topographic organization and map transformations in major projection systems of the brain.

Integration of dispersed and complicated information collected from the brain is needed to build new knowledge. But integration may be hampered by rigid presentation formats, diversity of data formats among laboratories, and lack of access to lower level data. We have addressed some of the fundamental issues related to this challenge at the level of anatomical data, by producing a coordinate based digital atlas and database application for a major projection system in the rat brain: the cerebro-ponto-cerebellar system. This application, Functional Anatomy of the Cerebro-Cerebellar System in rat (FACCS), is available via the Rodent Brain WorkBench (http://www.rbwb.org). The data included are x,y,z-coordinate lists describing exact distributions of tissue elements (axonal terminal fields of axons, or cell bodies) that are labeled with axonal tracing techniques. All data are translated to a common local coordinate system to facilitate across animal comparison. A search capability allows queries based on, e.g. location of tracer injection sites, tracer category, size of the injection sites, and contributing author. A graphic search tool allows the user to move a volume cursor inside a coordinate system to detect particular injection sites having connections to a specific tissue volume at chosen density levels. Tools for visualization and analysis of selected data are included, as well as an option to download individual data sets for further analysis. With this application, data and metadata from different experiments are mapped into the same information structure and made available for re-use and re-analysis in novel combinations. The application is prepared for future handling of data from other projection systems as well as other data categories.

Anatomy, Artistic↗

[Digital patient record for remote monitoring of intraocular pressure, blood pressure and serum glucose].

BACKGROUND: At the University Eye Hospital of Greifswald, we have developed a digital patient record that allows close monitoring of glaucoma, diabetes and hypertension. The record stores contemporary, long-term profiles containing intraday variation and interaction of intraocular pressure, blood pressure and serum glucose levels even at night. METHODS: All patients are equipped with a home monitoring system. They subsequently transmit self-measurements via the "telemedical interface" to the server. Physicians use a web front-end to access electronic patient records; this provides a PDF export filter for printing. We intend to include a total number of 120 patients from Mecklenburg-Vorpommern who suffer from glaucoma possibly combined with hypertension/diabetes. This long-term investigation was designed as a randomised cross-over study in two groups. RESULTS: Especially for this project an electronic patient record was developed and implemented. The components of the home monitoring system were modified and connected to a custom-built "telemedical interface". To date the study includes 120 patients, 60 of whom constantly measure and transmit their values to the electronic patient record, while the others are treated without home monitoring. All self-measurements are presented in a tabular form. In addition, dynamically generated graphics provide a diagrammatic view of all values. On demand, a detailed protocol for every single measurement report allows a comprehensive evaluation of the quality of the self-measurements. Ocular perfusion pressure is calculated automatically from intraocular pressure and blood pressure. The presented system documents continuously all information that is relevant for treatment and provides fast access for all attending physicians. CONCLUSIONS: Central data collection and unlocalised access improve information exchange between involved physicians. Flexible measurement periods allow the detection of pressure spikes even at night. In addition, this may help to classify glaucoma (normal-pressure glaucoma) and its causal connection to blood pressure. The patients benefit from individualised therapy adaptation and early therapeutic intervention in case of critical parameters.

Blood Glucose Self-Monitoring↗

Registration of EEG electrodes with three-dimensional neuroimaging using a frameless, armless stereotactic wand.

A technique of image and electrode registration has been developed that allows electroencephalogram electrode location to be merged with 2-D or 3-D MRI or CT. An armless, frameless stereotactic localization system that may be used in or out of the operating room is used to generate spatial data for surface and accessible intracranial electrodes. Acquisition of electrode position data may be obtained before or after neuroimaging and the locations of additional electrodes added at any time. The methodology of this system and representative cases with MRI imaging are presented.

Adult↗

Prophylaxis for paclitaxel hypersensitivity reactions.

OBJECTIVE: To evaluate clinical literature supporting the prophylactic use of single-dose intravenous dexamethasone to prevent hypersensitivity reactions (HSRs) to paclitaxel infusion. DATA SOURCES: Clinical literature accessed through MEDLINE (from 1986 to 2000). DATA SYNTHESIS: Prophylaxis for paclitaxel-related HSRs generally includes repeated dexamethasone doses beginning 12 hours before paclitaxel, and administration of diphenhydramine plus a histamine2-receptor antagonist 30 minutes before infusion of paclitaxel. Singe-dose intravenous dexamethasone administered with ancillary medications 30 minutes before infusion of paclitaxel has been used to prevent regimen-related HSRs. CONCLUSIONS: Single-dose intravenous dexamethasone can be used in combination with appropriate ancillary medications to prevent paclitaxel-related HSRs.

Anti-Inflammatory Agents↗

A decision support system for evaluating mastitis information.

A data-driven decision support system, MAST, was developed to summarize systematically the DHI data related to mastitis. MAST determines weaknesses and problems of a mastitis control strategy by pinpointing problem areas, highlighting the scope of the mastitis problem, providing reference values for comparison, offering potential solutions to problem areas, and monitoring changes in the control strategy. Advantages of a DHI data-driven system include accuracy of input data, fast execution speeds, access to untapped information available in DHI data, and a consistent analysis of data. An on-farm decision support system allows the evaluation of the mastitis control strategy at any time, which in turn increases the value of DHI information. The sequence of the graphical results allows users to understand intuitively the overall mastitis problems, find the potential origins, and assess their impact on the herd. Color-coded graphs with supplementary text allow for a rapid analysis of level and trends over time, as well as comparisons among parities, lactation stages, and active and culled cows.

Animals↗

Easing the transition between attribute-value databases and conventional databases for scientific data.

We have previously developed and described a modeling and development framework called EAV/CR, which is appropriate for designing databases containing highly heterogeneous and evolving data, as in the case of scientific databases for rapidly advancing domains. The use of EAV/CR has been hampered by the lack of generic tools for non-procedurally transferring data into or out of legacy systems or analytical packages: the transfer task is complicated by the different representation of EAV vs. conventional data, which is not addressed by commercial data-transfer programs. We have therefore created such a tool, which works with a wide variety of data sources that are accessible via Microsoft OLE DB technology. The data transfer tool requires minimal programmer intervention to set up, and no programming to use on a regular basis. Current limitations of the tool are also noted.

Database Management Systems↗

Maintaining patient confidentiality in an electronic world.

The importance of patient confidentiality must be integral to the culture of any healthcare organization. This has always been a part of the professional code of ethics but is being made more difficult with the advances in computerized communication systems. Moving from verbal reports to paper charts to electronic data interchange challenges our current policies and procedures for protecting patient data. The character of access has changed making transportation of confidential data to unknown persons and/or locations often impossible to monitor.

Computer Communication Networks↗

Unconstrained heart-rate monitoring during bathing.

An unconstrained electrocardiograph (ECG) and heart-rate monitor was designed to record ECG measurements in the bathtub. The apparatus consists of analog and digital parts. In the analog part, electrocardiographic signals obtained from electrodes placed inside the bathtub were amplified approximately 4,000 times. The electrodes were made of stainless steel and were 104 x 74 x 0.5 mm in size, including the absorbent sponge covers. Each electrode fitted into a plastic case 110 x 79 x 23 mm in size. Working electrodes were placed 20 cm from the bottom of the long bathtub wall, close to the position of the immersed trunk, and a reference electrode was placed 5 cm from the bottom of the side wall close to the toe position. In the digital part of the system the heart rate was calculated from the R-R interval of each ECG pulse and the calculated data were stored in a random-access memory. These stored data were transferred to a personal computer through an RS 232C interface and analyzed. The heart rates obtained from the bathtub ECG agreed with those obtained from a body-surface ECG. During measurements in bathwater with various concentrations of sodium chloride, the amplitude of the electrocardiographic waveform decreased as the electrical conductivity increased. The frequency characteristics of the bathtub ECG varied with the bathtub dimensions and the electrical conductivity of the water. Using this apparatus, heart-rate measurements can be obtained easily and noninvasively, but interpretation of the ECG signal requires great care. This monitor could be used as a home health heart-rate monitor.

Adult↗

[Work absenteeism data--a source of information for epidemiological research in occupational risks?].

The usefulness of data on absence from work due to sickness (absenteeism) as an indicator of specific and detailed information of diagnoses is widely discussed in the international literature. In occupational health indicators for health risks (e g sickness absence of more than 14 days), details on diagnosis and workplace are very useful, if analysed by epidemiological means. A pilot project, initiated by a high sickness absence in the automobile industry, led to a test of an industrial health information system, which was abruptly stopped by data protection arguments. The epidemiologic approach of an age-adjusted comparison of incidences relies on the access to morbidity data of the health insurance system. With the diagnostic information at hand differences of incidences in one production branch (as recognized by the incidence ratio SIR) are to be discovered if related to certain specific diagnoses. Thus, a direct comparison of comparable rates helps to identify specific reasons for increased absence from work. Practical solutions were found if the owner of the data, the National Federation of Enterprise Sickness Funds, conducted the analyses. First results showed as yet unknown associations of myocardial infarction and obstructive lung diseases in the metallurgical industry. In such cases not only the validity of such results has to be verified, but also other epidemiological tools, such as a case-referent approach to determine risk ratios, are required for the identification of any causally important relationship.

Absenteeism↗

[Computer-oriented documentation of quantitative and qualitative data in gastroenterology (author's transl)].

Computer-oriented documentation of quantitative and qualitative data obtained from patients with gastroenterological diseases is described as an example of a method when considering a relatively small number of patients. All qualitative and quantitative features are entered uncoded in a data booklet and subsequently on port-a-punch cards. After extensive computerized error check - and correction, as need arises, - the data are transferred to a data base and stored on magnetic disk. The ISIS information system, in conjunction with special routines provides access to the data in any combination desired. Analysis of the data, both on an individual and a statistical basis is thus facilitated.

Diagnosis, Computer-Assisted↗

A neuromuscular monitoring system based on a personal computer.

We have developed a computerized neuromuscular monitoring system (NMMS) using commercially available subsystems, i.e., computer equipment, clinical nerve stimulator, force transducer, and strip-chart recorder. This NMMS was developed for acquisition and analysis of data for research and teaching purposes. Computer analysis of the muscle response to stimulation allows graphic and numeric presentation of the twitch response and calculated ratios. Since the system can store and recall data, research data can be accessed for analysis and graphic presentation. An IBM PC/AT computer is used as the central controller and data processor. The computer controls timing of the nerve stimulator output, initiates data acquisition, and adjusts the paper speed of the strip chart recorder. The data processing functions include establishing control response values (when no neuromuscular blockade is present), displaying force versus time and calculated data graphically and numerically, and storing these data for further analysis. The general purpose nature of the computer and strip chart recording equipment allow modification of the system primarily by changes in software. For example, new patterns of nerve stimulation, such as the posttetanic count, can be programmed into the computer system along with appropriate data display and analysis routines. The NMMS has functioned well in the operating room environment. We have had no episodes of electrocautery interference with the computer functions. The automated features have enhanced the utility of the NMMS.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Systems↗

An automated patient control and data management system.

A system developed to be used in the conduct of contact lens research is described. The system provides for data entry and retrieval, graphic image capture and analysis, and query and ASCII interface capabilities. Procedures for accessing the collected data are explained.

Contact Lenses↗

The integration of medical images with the electronic patient record and their web-based distribution.

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system. Reports are usually stored in the electronic patient record of other information systems, such as the radiology information system (RIS) and the hospital information system (HIS). But high-quality services can only be provided if electronic patient record data is integrated with digital images in picture archiving and communication systems. Clinicians should be able to access both systems' data in an integrated and consistent way as part of their regular working environment, whether HIS or RIS. Also, this system should allow for teleconferencing with other users, eg, for consultation with a specialist in the radiology department. This article describes a web-based solution that integrates the digital images of picture archiving and communication systems with electronic patient record/HIS/RIS data and has built-in teleconferencing functionality. This integration has been successfully tested using three different commercial RIS and HIS products.

Humans↗

EMBL Nucleotide Sequence Database: developments in 2005.

The EMBL Nucleotide Sequence Database (www.ebi.ac.uk/embl) at the EMBL European Bioinformatics Institute, UK, offers a comprehensive set of publicly available nucleotide sequence and annotation, freely accessible to all. Maintained in collaboration with partners DDBJ and GenBank, coverage includes whole genome sequencing project data, directly submitted sequence, sequence recorded in support of patent applications and much more. The database continues to offer submission tools, data retrieval facilities and user support. In 2005, the volume of data offered has continued to grow exponentially. In addition to the newly presented data, the database encompasses a range of new data types generated by novel technologies, offers enhanced presentation and searchability of the data and has greater integration with other data resources offered at the EBI and elsewhere. In stride with these developing data types, the database has continued to develop submission and retrieval tools to maximise the information content of submitted data and to offer the simplest possible submission routes for data producers. New developments, the submission process, data retrieval and access to support are presented in this paper, along with links to sources of further information.

Animals↗

Missing, mediocre, or merely obsolete? An evaluation of UK data sources for coronary heart disease.

STUDY OBJECTIVE: Coronary heart disease (CHD) is the commonest cause of death in the UK. However, there is no single comprehensive source of information to support CHD prevention and treatment strategies. Therefore this study evaluated the availability and quality of UK CHD data sources since 1981. DESIGN: Data sources for England and Wales were identified and appraised on: (1) CHD patient numbers (myocardial infarction, angina, hypertension, and heart failure); (2) uptake of medical and surgical CHD treatments, and (3) population trends in major cardiovascular risk factors. SETTING: England and Wales (population 53 million). MAIN RESULTS: Population and mortality data were easily accessible from Office for National Statistics and British Heart Foundation Annual CHD Statistics; population based risk factor data came principally from the British Regional Heart Study, the General Household Survey, and the Health Survey for England. They were limited for 1981, but more extensive by 2000. Hospital admissions information since 1998 was available online from HES; but trend data and details of interventions were scant. Limited primary care data on consultation rates, prescribing, and treatment uptake were available from published audits and studies. CONCLUSIONS: Information on CHD in the UK is fragmented, patchy, and mixed in quality. Data for women, the elderly populatiom, and ethnic minorities were particularly scarce, exacerbating inequalities. Future CHD disease monitoring and evaluation will require comprehensive and accurate population based information on trends in patient numbers, treatment uptake, and risk factors.

Blood Pressure↗

Safety issues with herbal products.

OBJECTIVE: To review safety issues associated with the use of herbal products. DATA SOURCES: Literature accessed through MEDLINE and other Internet search engines. Key search terms included herbs, dietary supplements, and safety. DATA SYNTHESIS: A misconception exists among consumers that herbal remedies are safe because they are natural. In an effort to provide healthcare practitioners with information necessary for a patient discussion, a review of safety concerns with herbal products was conducted. CONCLUSIONS: Several safety concerns exist with herbal products including lack of safety data, absence of quality-control requirements for potency and purity, and lenient labeling standards.

Advertising↗

Impact and inequity of inpatient waiting times for advanced cardiovascular services in community hospitals across the greater Toronto area.

OBJECTIVE: To assess waiting times for inpatients requiring urgent transfer for advanced cardiovascular procedures from community hospitals; the magnitude of adverse events while waiting; and possible inequity among community hospitals in access to these services. SETTING: Seven representative community hospitals in the Greater Toronto Area (GTA). DESIGN: Prospective data collection over 12 months (May 1997 to April 1998). PATIENTS: One thousand, two hundred and three inpatients who waited a total of 7261 hospital days for advanced cardiovascular procedures. MAIN RESULTS: The average (+/- SD) inpatient waiting time, in days, for catheterization was 5.7+/-1.3, angioplasty 5.8+/-2.1, bypass surgery 7.0+/-2.1 and pacemakers 4.2+/-1.6. During this time there were 14 deaths (1.2%) and 12 (1.0%) morbid events in-hospital. Extrapolation of these data to all 21 community hospitals in the GTA suggests that annually 21,783 bed days are used by inpatients awaiting transfer for advanced cardiovascular procedures, during which time 42 fatal and 36 morbid events can be expected to occur. Of the seven hospitals, one had a catheterization laboratory (group 1), two had no laboratory but had catheterizing cardiologists (group 2), and four had no laboratory and no catheterizing cardiologists (group 3). None of these hospitals had on-site revascularization facilities. The average number of days spent waiting for catheterization in group 1 (3.1+/-0.4) was significantly less than that in group 2 (5. 4+/-1.3, P<0.001) and group 3 (6.5+/-1.3, P<0.0001). The catheterization wait in group 2 was significantly less than that in group 3 (P<0.02). There were no significant differences among the three groups in the number of days spent waiting for angioplasty or bypass surgery. CONCLUSION: Waiting times for inpatients requiring advanced cardiovascular procedures in GTA community hospitals are long, and are associated with substantial morbidity and mortality. These waiting times also promote inefficient bed use and increased health care costs. Furthermore, these data suggest that access to inpatient coronary angiography in the GTA is inequitable and appears to depend more on the presence of on-site catheterization laboratories or catheterizing cardiologists than on illness severity.

Cardiovascular Diseases↗