bluuebunny/crossref_metadata_2025 huggingface dataset:
Interoperability in Hospital Information Systems: a Return-On-Investment Study Comparing CPOE with and without Laboratory Integration
Authors: Meyer Rodolphe  , Lovis Christian
Published: February 2025

Despite its many advantages, using a computerized patient record is still considered as a time consuming activity for care providers. In numerous situations, time is wasted because of the lack of interoperability between systems. In this study, we aim to assess the time gains that nursing teams could achieve with a tightly integrated computerized order entry system. Using a time-motion method, we compared expected versus effective time spent managing laboratory orders for two different computerized systems: one integrated, the other not integrated. Our results tend to show that nurses will complete their task an average of five times faster than their expected performance (p<0.001). We also showed that a tightly integrated system provides a threefold speed gain for nurses compared to a non-integrated CPOE with the laboratory information system (p<0.001). We evaluated the economic benefit of this gain, therefore arguing for a strong interoperability of systems, in addition to patient safety benefits.
Enhancing Self-Efficacy for Self-Management in People with Cystic Fibrosis
Authors: Cummings Elizabeth  , Hauser Jenny  , Cameron-Tucker Helen  , Fitzpatrick Petya  , Jessup Melanie  , Walters E. Haydn  , Reid David  , Turner Paul
Published: February 2025

This paper reports on a research trial designed to evaluate the benefits of a health mentoring programme supported with a web and mobile phone based self-monitoring application for enhancing self-efficacy for self-management skills and quality of life for people with CF. This randomised, single-blind controlled trial evaluated two strategies designed to improve self-management behaviour and quality of life. Task-specific self-efficacy was fostered through mentorship and self-monitoring via a mobile phone application. Trial participants were randomised into one of three groups: Control, Mentor-only and Mentor plus mobile phone. Analysis and discussion focus on the experiences of participants through a methodology utilising descriptive statistics and semi-structured interviews. The results highlight the challenges of stimulating self-management behaviours particularly in adolescents and in the evaluation of the role of mobile applications in supporting them.
What Makes an Information System More Preferable for Clinicians? a Qualitative Comparison of Two Systems
Authors: Pirnejad Habibollah  , Niazkhani Zahra  , Aarts Jos  , Bal Roland
Published: February 2025

Two different information systems with respect to their ability to afford clinicians' needs in the chemotherapy medication process were implemented in a large Dutch academic hospital. A commercially available Computerized Physician Order Entry (CPOE) system was not appreciated because clinicians believed that it could not support complex chemotherapy process. Later, a home-grown IT system with the capability of prescribing chemotherapy medications based on standard care protocols was appreciated and fully used by clinicians. We evaluated both systems from their users' perspective to find the sources of clinicians' preference and to trace them back to their Systems Development Life Cycle (SDLC).
Evaluation of Telephone Triage and Advice Services: a Systematic Review on Methods, Metrics and Results
Authors: Carrasqueiro Sara  , Oliveira Mónica  , Encarnação Pedro
Published: February 2025

Telephone triage and advice services (TTAS) have been increasingly used to assess patients' symptoms, provide information and refer patients to appropriate levels of care (attempting to pursue efficiency and quality of care gains while ensuring safety). However, previous reviews have pointed out for the need for adequately evaluating TTAS. AIMS: To review TTAS evaluation studies, compile methodologies and metrics used and compare results. Systematic search in PubMed database; data collection and categorization by TTAS features and context, type of evaluation, methods, metrics and results; critical assessment of studies; discussion on research needs. 395 articles screened, 55 of them included in the analysis. In conclusion, several aspects of TTAS impact on healthcare systems remain unclear either due to a lack of research (e.g. on long term clinical outcomes, clinical pathways, safety, enhanced access) or because of huge disparities in existing studies on the accuracy of advice, patient compliance, system use, satisfaction and economic evaluation. Further research on TTAS impact is required, comprising multiple perspectives and broad range of metrics.
Extracting Gait Parameters from Raw Electronic Walkway Data
Authors: Dias André  , Gorzelniak Lukas  , Döring Angela  , Hartvigsen Gunnar  , Horsch Alexander
Published: February 2025

Spatiotemporal gait parameters are very important for the detection of gait impairments and associated conditions. Current methods to measure such parameters, e.g. electronic walkways or force plates, are costly and can only be used in a laboratory. The new generation of raw data accelerometers might be a cheap and flexible alternative. We conducted a small feasibility study with 50 subjects from the KORA-Age project exploring the output of GAITRite and Actigraph GT3X. We open-sourced a package to extract and process raw data from GAITRite. The most promising location for the accelerometer seems to be at the ankle. The use of accelerometers showed to be simple and reliable, indicating that they can be used in daily life to extract gait parameters.
Defining and Reconstructing Clinical Processes Based on IHE and BPMN 2.0
Authors: Strasser Melanie  , Pfeifer Franz  , Helm Emmanuel  , Schuler Andreas  , Altmann Josef
Published: February 2025

This paper describes the current status and the results of our process management system for defining and reconstructing clinical care processes, which contributes to compare, analyze and evaluate clinical processes and further to identify high cost tasks or stays. The system is founded on IHE, which guarantees standardized interfaces and interoperability between clinical information systems. At the heart of the system there is BPMN, a modeling notation and specification language, which allows the definition and execution of clinical processes. The system provides functionality to define healthcare information system independent clinical core processes and to execute the processes in a workflow engine. Furthermore, the reconstruction of clinical processes is done by evaluating an IHE audit log database, which records patient movements within a health care facility. The main goal of the system is to assist hospital operators and clinical process managers to detect discrepancies between defined and actual clinical processes and as well to identify main causes of high medical costs. Beyond that, the system can potentially contribute to reconstruct and improve clinical processes and enhance cost control and patient care quality.
Network Analysis of Possible Anaphylaxis Cases Reported to the US Vaccine Adverse Event Reporting System after H1N1 Influenza Vaccine
Authors: Botsis Taxiarchis  , Ball Robert
Published: February 2025

The identification of signals from spontaneous reporting systems plays an important role in monitoring the safety of medical products. Network analysis (NA) allows the representation of complex interactions among the key elements of such systems. We developed a network for a subset of the US Vaccine Adverse Event Reporting System (VAERS) by representing the vaccines/adverse events (AEs) and their interconnections as the nodes and the edges, respectively; this subset we focused upon included possible anaphylaxis reports that were submitted for the H1N1 influenza vaccine. Subsequently, we calculated the main metrics that characterize the connectivity of the nodes and applied the island algorithm to identify the densest region in the network and, thus, identify potential safety signals. AEs associated with anaphylaxis formed a dense region in the ‘anaphylaxis’ network demonstrating the strength of NA techniques for pattern recognition. Additional validation and development of this approach is needed to improve future pharmacovigilance efforts.
Using Pharmacogenetics Knowledge to Increase Accuracy of Alerts for Adverse Drug Events
Authors: Mesika Yossi  , Lee Byung Chul  , Tsimerman Yevgenia  , Roitman Haggai  , Park Heon Kyu
Published: February 2025

Adverse drug event (ADE) has significant implications on patient safety and is recognized as a major cause of fatalities and hospital expenses. Although some medical systems today can help reduce the number of ADE occurrences, these primarily take into account clinical factors-even though recent studies show the significance of genetic profiles in ADE detection. Incorporating pharmacogenetics knowledge and data from genetic test results into these systems can improve the accuracy of preliminary alerts about potential ADEs. However, pharmacogenetics knowledge is unstructured, making it inappropriate for use in a system that involves automatic processing. We propose a methodology that can help incorporate the pharmacogenetics knowledge. Specifically, we show how pharmacogenetics knowledge can be expressed in a medical system and used together with the patient genetic data to provide alerts about ADEs at the point of care.
Roogle: An Information Retrieval Engine for Clinical Data Warehouse
Authors: Cuggia Marc  , Garcelon Nicolas  , Campillo-Gimenez Boris  , Bernicot Thomas  , Laurent Jean-François  , Garin Etienne  , Happe André  , Duvauferrier Régis
Published: February 2025

High amount of relevant information is contained in reports stored in the electronic patient records and associated metadata. R-oogle is a project aiming at developing information retrieval engines adapted to these reports and designed for clinicians. The system consists in a data warehouse (full-text reports and structured data) imported from two different hospital information systems. Information retrieval is performed using metadata-based semantic and full-text search methods (as Google). Applications may be biomarkers identification in a translational approach, search of specific cases, and constitution of cohorts, professional practice evaluation, and quality control assessment.
Healthcare Professionals' Experiences With EHR-System Access Control Mechanisms
Authors: Faxvaag Arild  , Johansen Trond S.  , Heimly Vigdis  , Melby Line  , Grimsmo Anders
Published: February 2025

Access control mechanisms might influence on the information seeking and documentation behavior of clinicians. In this study, we have surveyed healthcare professionals in nursing homes and hospitals on their attitudes to, and experiences with using access control mechanisms. In some situations, the access control mechanisms of the EHR system made clinicians postpone documentation work. Their practice of reading what others have documented was also influenced. Not all clinicians logged out of the system when they left a workstation, and some clinicians reported to do some of their documentation work in the name of others. The reported practices might have implications for the safety of the patient.
Creating an Ontology Driven Rules Base for an Expert System for Medical Diagnosis
Authors: Bertaud Gounot Valérie  , Donfack Valéry  , Lasbleiz Jérémy  , Bourde Annabel  , Duvauferrier Régis
Published: February 2025

Expert systems of the 1980s have failed on the difficulties of maintaining large rule bases. The current work proposes a method to achieve and maintain rule bases grounded on ontologies (like NCIT). The process described here for an expert system on plasma cell disorder encompasses extraction of a sub-ontology and automatic and comprehensive generation of production rules. The creation of rules is not based directly on classes, but on individuals (instances). Instances can be considered as prototypes of diseases formally defined by “destrictions” in the ontology. Thus, it is possible to use this process to make diagnoses of diseases. The perspectives of this work are considered: the process described with an ontology formalized in OWL1 can be extended by using an ontology in OWL2 and allow reasoning about numerical data in addition to symbolic data.
IT Infrastructure Components to Support Clinical Care and Translational Research Projects in a Comprehensive Cancer Center
Authors: Prokosch Hans-Ulrich  , Ries Markus  , Beyer Alexander  , Schwenk Martin  , Seggewies Christof  , Köpcke Felix  , Mate Sebastian  , Martin Marcus  , Bärthlein Barbara  , Beckmann Matthias W.  , Stürzl Michael  , Croner Roland  , Wullich Bernd  , Ganslandt Thomas  , Bürkle Thomas
Published: February 2025

This paper presents the concept of an integrated IT infrastructure framework established at the comprehensive cancer center at the University Hospital Erlangen. The framework is based on the single source concept where data from the electronic medical record are reused for clinical and translational research projects. The applicability of the approach is illustrated by two case studies from colon cancer and prostate cancer research projects.
The flood protection project of Pori
Authors: Ketonen R.
Published: February 2025

The city of Pori is situated in western Finland alongside the Kokemäki River. The river has an occasional tendency to flood. In the present situation the flood protection of Pori is inadequate. If the worst conceivable flood occurs, there is a hazard risk, which may mean that 15,000 people could lose their homes and they should be evacuated. In such case, the economical damage could amount to three billion euros. The aim of the flood protection project is to reduce the hazard risk caused by potential flooding of the Kokemäki River. In the framework of the project, three different alternative solutions have preliminarily been designed for the Pori city center area. The alternatives would for the most part be realized with structures consisting of soil: flood dams and additional canals to be built. Because of geology of the area, the geotechnical feasibility of these structures is challenging. The bedrock (sandstone) in the area lies 50–100 m below the ground surface, which has caused the river valley to be filled with homogeneous erosion-prone sediment soil, drifted by the river. The soil mainly consists either of clayey silt prone to erode, or lean or fat clay. The geotechnical feasibility and condition of preliminarily designed structures and existing riverbanks were evaluated with the help of stability analyses. The stability designing conditions were determined, considering that they differ considerably from those of road and railway structures. Field and laboratory research helped to decide whether an effective stress analysis or total stress analysis should be used. Effective strength parameters and undrained shear strength to be used in the stability calculations were determined on the basis of field and laboratory research. Effective shear strength parameters for the design sections were defined using stress path diagrams of triaxial tests and various indirect relations. With the help of stability analyses, it became obvious that the present stability of the riverbanks is poor. Slope failures occur from time to time in the area. In the worst places the condition of the banks can endanger health or even threaten human lives. Water erodes the riverbanks, and therefore, the stability of the riverbanks deteriorates all the time. Because of poor stability and erosion, all new structures should be made so that the river slope is gentle enough, or alternatively other measures should be used to improve the stability. All new structures should also be protected from erosion.
Accelerating the Deployment of a Health Information Technology and Informatics Workforce through Education, Training, Research, and Evaluation
Authors: Lorenzi Nancy  , Bloomrosen Meryl
Published: February 2025

Supported by stronger and more coordinated US federal funding and policies, driven by goals to deliver care more efficiently, and motivated to provide high quality care for an aging and more diverse population, public-private-sector organisations are redoubling efforts to implement information systems. Thus, there is a critical need to increase and broaden the pool of workers who can help organizations maximise the effectiveness of their investments in technology. There are in the US various current health informatics education and training initiatives and ongoing efforts to accelerate Health IT workforce development.
Effect of wetting and ageing on the elasto-viscoplastic behavior of clay in 1D compression
Authors: Nawir Hasbullah  , Deng Jianliang  , Tatsuoka Fumio
Published: February 2025

This paper presents the elasto-viscoplastic stress-strain behavior of pure kaolin soil and its cementmixture under drained one-dimensional compression. A study was made of the effects of the degrees of wetting combined with ageing effects on the stress-strain-time behavior. Effects of the degree of saturation and its variations for a wide range (0.8% to 100%) on the stress-strain-time behaviour during creep and subsequent continuous monotonic loading in one-dimensional compression tests were evaluated. Also the effects of ageing that develop at different stress levels on the behavior of unsaturated specimens were evaluated. A new mathematic model developed in the framework of a non-linear three-component model is proposed on the basis of test results.
Calibration of Large Triaxial Testing System for Reliable Dynamic Properties using Urethane Specimen
Authors: Lee Sung Jin  , Choo Yun Wook  , Lee Il Wha  , Hwang Seon Keun
Published: February 2025

We developed a large triaxial testing system in this research. Triaxial tests for large specimens of 500mm, 300mm and 150mm in diameter can be carried out in this system. After completing the construction of experiment equipment, the verification on the experiment equipment is necessary process for securing reliability of results from the experiment henceforth. Therefore, we intended to verify the system compliance along with general calibration of sensors for measurement such as load and displacement. To achieve this, synthetic specimens of five pairs of 300mm and 50mm in diameter were manufactured in the same batch, providing the same elastic modulus. We performed the large triaxial tests on the 300mm diameter urethane specimens and RC/TS and impact echo tests on the 50mm diameter urethane specimens. In this verification test results, we could ascertain the reasonable test results of the new large triaxial testing system.
DEM Simulations on the Energy Dissipation in Soil under Static and Cyclic Loading
Authors: Tong Liwei  , Wang Yu-Hsing
Published: February 2025

Nothing can freely vibrate forever because energy has to be dissipated in the end. The term, damping ratio, is often used to quantify the energy loss or dissipation in soil. However, the detailed process of energy dissipation in soil and the associated underlying mechanisms that regulate the damping ratio remain unclear at present, especially from the micromechanics point of view. In this context, numerical simulations by the discrete element method (DEM) were carried out in this study to gain insights into this subject. The software, PFC2D(Particle Flow Code in 2 Dimension) was used in the simulations to trace the energy dissipated as well as stored in soil while the sample is subject to static biaxial tests. It has been found that the energy dissipation is mainly due to the frictional loss between particle contacts (quantified by the Hertz-Mindlin contact model). The stored energy is in the form of elastic strain energy at the particle contact. The difference between the total applied energy and the stored energy is the dissipated energy by friction. Simulation results also indicate that the strain energy is not fully released when the soil becomes plastic, which suggests the existence of frozen energy hidden at particle contacts. PFC3D(Particle Flow Code in 3 Dimension) was used to model the energy dissipation in soil under cyclic simple shear tests. The damping ratios obtained from the simulations, when considering both frictional and viscous loss, are very similar to the experimental findings, not only the increasing trend with increasing shear strain but also the magnitude. Most of the energy dissipation by friction takes place in those contacts of weak forces because the contact normal forces and the associated shearing resistance are small, which in turn enhances the sliding to occur between contacts.
Compression lines for soil derived using fractals and energy balance
Authors: Russell A.R.  , Einav I.
Published: February 2025

A new approach is presented for the derivation of compression lines for soils with evolving particle and pore size distributions due to particle crushing. It starts by considering the energy dissipation mechanisms in a granular assembly in which a single particle crushes. Energy dissipations related to the creation of surface of the fragments of the crushed particle as well as load redistribution in the soil surrounding the crushed particle are discussed. Energy dissipation terms are then included in a new energy balance equation. A fractal description of particle and pore sizes in soils during the crushing process is then presented and used to derive theoretical expressions for a limiting compression lines in the double-logarithmic voids ratio and macroscopic stress plane. The parameters defining the lines are found to be functions of the fractal dimensions defining the particle and pore size distributions, maximum particle size and shape factors for particles and pores, energy dissipation due to the creation of surface, and its magnitude relative to the energy dissipation due to load redistribution. The theoretical lines derived using the approach are in good agreement with experimental data.
A Survey on Banking and Financial Markets: Lessons for Financial Engineering
Authors: Koo Hyeng Keun  , Hyun ChongSeok
Published: February 2025

In this chapter we will review the history and theory of banking and financial markets in an attempt to draw lessons for theory and practice of financial engineering. In particular we will investigate how the development of financial engineering changed banks and financial markets. There has been a very fruitful development of theories of banking and financial markets as applications of information economics. We will discuss the possibility of linking the theories to financial engineering.
Nonlinear Expectations and Limit Theorems
Authors: Bae Hyeong-Ohk  , Chen Zengjing  , Koo Hyeng Keun
Published: February 2025

In this chapter we survey risk measures, nonlinear probability models, and their relationships based on recent research by Peng, Chen and coauthors. We also review recent results about limit theorems for nonlinear probability measures. If a market is complete, the fair price of a contingent claim can be represented by a linear expectation of the discounted payoff of the contingent claim. Statistically, such a linear expectation can be calculated by using Monte Carlo simulations. However, in reality, the financial market is incomplete, and thus the question of how one should determine the prices of contingent claims in an incomplete market is an important issue in financial engineering. Risk measures and nonlinear expectations, which are generalizations of linear expectations, can be used to price contingent claims in an incomplete market. For example, coherent risk measures, convex risk measures, Choquet expectations and Peng's g-expectations have been used in option pricing in an incomplete market. Obviously, the different risk measures typically yield different prices. Then, a natural question arises: what are relationships among such nonlinear expectations? Statistically, how should one calculate nonlinear expectations? In this chapter, we provide a review of recently obtained relationships among the four kinds of nonlinear expectations. we also review a recent result on the strong law of large numbers and a law of iterated logarithm under nonlinear probability measures.
Front-End for Echographic Image Processing
Authors: Thijssen J.M.  , Verhoeven J.T.M.  , Oosterveld B.J.  , Hottier F.  , Farabet O.  , Bartoletti L.
Published: February 2025

The project is concerned with the specification, implementation and testing of a system to be connected as an add-on device to an echographic scanner. The system will enable preprocessing, analysis and processing of echographic data and images, in order to achieve the employment of the full information available from echograms. The hardware (VME-bus based) is installed at the two institutions. A special 40 MHz (8 bits) ADC-board was developed in addition. The data acquisition software was defined and implemented enabling the single-flash storage of a full scan in RF-format (2 MBytes), as well as a storage of the original video images. The preprocessing consists of corrections for the beam diffraction, the tissue inhomogeneities and the equipment performance settings (gain, TGC). Acoustospectrographic tissue parameters and image texture parameters are estimated for tissue characterization. Multi-center clinical testing and the development and assessment of image processing methods are scheduled in the next phase of the project.
KAVAS: Knowledge Acquisition, Visualization and Assessment Study
Authors: Brender Jytte  , McNair Peter  , Nykänen Pirkko  , Talmon Jan  , O'Moore Rory  , Barber Barry  , Drosos Panayotis  , Vingtoft Søren
Published: February 2025

The theme of the KAVAS Project was acquisition and quality assessment of medical knowledge. The application domain was medicine in general and ranged from clinical chemistry and endocrinology to internal medicine and health service management. KAVAS aimed at the development of a computer-based tool that enables physicians and other health care staff to rationalize and optimize the examination and management of complex clinical and/or managerial problems. The basic approach was two-fold: 1) The technical approach which aimed at combining Advanced Information Technologies (used for building KBS) and machine learning techniques (used for building classification trees) with an integrated quality assessment technique, and 2) The user approach which aimed at producing methodologies for evaluation and transferability assessment together with features for getting insight in the learning process, both of which enables the user to assess the value of the derived knowledge or of the KBS in use. The paper comprises the results of the pilot phase in which the feasibility of our ideas were studied.
LEMMA: Methods and Architectures for Logic Engineering in Medicine
Authors: Fox John  , Ginzler Maria  , Glowinski Andrzej  , Gordon Colin  , Hajnal Saki  , O'Neil Mike  , Pritchard Peter  , Renaud-Salis Jean-Louis  , Taylor Paul  , Benlamkaddem Ahmed  , Jegou Pascal  , Barahona Pedro  , Veloso Mario  , Ribeiro Anabela  , Nascimento Susana  , Schreiner Annette  , Chard Timothy
Published: February 2025

The realities of medical practice require that useful decision support systems must support a range of information management and decision making activities, and provide these services within a versatile and extensible package. The LEMMA project addresses important issues concerning the technical and practical feasibility of advanced systems for primary care and their possible deployment across EC member states. The Oxford System of Medicine aims to develop a comprehensive information management and decision support system for general practitioners, whilst other parts of LEMMA have investigated the applicability of the techniques in other medical fields, principally oncology. The project has illustrated how logic based technologies can be exploited and extended to achieve these goals, whilst studies of the potential for introducing acceptable medical decision support systems into the health care systems in a variety of countries have been uniformly encouraging.
REFLECTIONS ON MOTOR UNIT ACTION POTENTIALS
Authors: Wallinga Willemien  , van Veen Benno  , Wolters Henk
Published: February 2025

Motor unit action potentials are recorded and observed with relatively little attention for quantitative aspects. Clinically some parameters are used for the detection of diseases. Can it be expected that quantitative analysis will be more relevant in the future? This question will be considered after presentation of recent data of single fibre action potentials. Additional data has to be gained before the message of motor unit action potentials can be understood
Standards of Medical Informatics in Japan
Authors: Ohyama Nagaaki
Published: February 2025

Standardization activities related to medical informatics in Japan are briefly introduced in this paper. Because two kinds of portable media that are MODs (Magneto Optical Disk) and IC cards are supposed to be practically used in medicine, standardization works are currently supported by Japanese government. With an introduction of the organizations their standards and policy are explained.
BIOMAGNETISM: A DIAGNOSTIC TOOL
Authors: Peters Maria
Published: February 2025

The aim of the Concerted Action was to advance Biomagnetism in Europe and to maintain the lead that Europe had in this field. Biomagnetism is one of the fields where Europe played and continues to play a leading role. This is partly due to concentrated national research efforts. Biomagnetism enjoys National Research Project status in Italy, Germany and Finland and large scale state-of-the-art facilities exist in a number of locations in these countries.
NEW TECHNOLOGIES FOR COMMUNICATION IN THE HEARING IMPAIRED
Authors: Bock Gregory
Published: February 2025

The programme dealt with the application of new technologies for diagnosis and rehabilitation of hearing impairment. The principal emphasis of the programme was on signal processing hearing aids. Our priority areas of application were the problems of hearing impairment in the neonate and in the elderly population. At the beginning of the programme we held the first international conference on signal processing hearing aids, and a follow-up workshop was held at the end of the programme. The first meeting reviewed the state of the art in hardware and software, and created a network of active laboratories in Europe. A specific plan of collaborative research was formulated, resulting in the development of a prototype hearing aid for the profoundly hearing impaired, using a feature extraction approach. The device is currently undergoing evaluation in several centres. A workshop on early identification of neonatal hearing impairment established a network of active groups and identified the measurement of otoacoustic emissions as providing the best basis for an automated screening device for neonates. We have tried to solve some of the problems associated with patent rights for using this technology and work on developing screening devices is now under way in several participating institutes. We have held the first European meeting on hearing impairment in the elderly and established a network of active groups working on this topic. A meeting on auditory neuromagnetic responses identified the major European groups working in this field. These groups will continue to meet under the concerted action on neuromagnetism. Finally, a meeting on histopathology of the human temporal bone focused the activities of participating laboratories on studies of early development and ageing, and led to the setting up of a multicentre evaluation of the temporal bone from a 77 year old patient. Our concerted action has published six volumes of proceedings in Acta Otolaryngologica, containing a total of 148 research and theoretical papers. These proceedings have been distributed widely inside and outside Europe.
SKELETAL IMPLANTS
Authors: Bonfield W
Published: February 2025

Skeletal implants are biocompatible synthetic materials and structures utilised for the repair, augmentation or replacement of natural tissues and joints in orthopaedic and dental prostheses. In recent years the development of implants as artificial joints for the replacement of arthrotic hips has provided a major clinical advance in the treatment of arthritis, with nearly half a million patients on a world-wide basis (about half in Europe) benefiting annually from total hip arthroplasty. Parallel progress has been made with the treatment of other arthrotic joints, particularly of the knee, with approximately 400,000 patients treated per year by a joint replacement procedure. However all the current joint prostheses suffer from a finite lifetime before they need to be replaced, due to a basic mismatch between the implant and the adjacent tissue (bone) at regions of fixation (ranging from a mean of ~10 years for a 65+ year old patient to less than 5 years for a 45 year old patient), which leads to the need for a one or more revision operations. Based on the available statistics of prostheses lifetimes, the number of revisions required for existing joint replacements based on current technology will continue to escalate throughout Europe, with both a catastrophic effect on the total health care budget and a continuing absence of a suitable treatment for younger patients. The recognition of this major problem led to the formation of this concerted action in skeletal implants in 1989, with Professor Bonfield as project leader (co-ordinator). The following general achievements have resulted from the concerted action:
Rehabilitation Technology in the United States and its Impact upon the Creation of a Viable European Industry Sector
Authors: Carruthers Stuart  , Humphreys Anne  , Sandhu Jim
Published: February 2025

This paper describes the state of the Rehabilitation Technology industry in Britain. It is shown that North American R.T. manufacturers already have a considerable commercial presence in Britain, and that the USA probably has the most developed R.T. industry sector in Europe. The implications of the Americans with Disabilities Act (1990) for the development of a single European market in R.T. are discussed with particular reference to North American industry.
Some Social Dimensions of Computer Support to Handicapped Persons in the Workplace
Authors: Larsson Stig
Published: February 2025

This article is based on a sample of 713 out of about 11.000 persons in Sweden who have general financial disability support as the only benefit from the general insurance system, which means that by definition they are seriously handicapped and engaged in full time study or work. A vast majority (72.2%) of the population had their employment in the ordinary labor force. The others were employed thanks to various state subsidies to employers. The category of visually impaired had the lowest degree of employment in the ordinary labor force (64.6%) and the group with “other” handicaps the highest (79.4%). Computerization in society in general has obviously also affected the group of seriously handicapped persons in their daily work situations: 42.1% of the population in the study stated that more than 10% of their work was computer-based and 25.7% stated more than 40%. The rate of computerization in the work situation was relatively equal in the various groups of handicaps. Only 8.2% of the respondents had received special computer equipment for handicapped persons. Over and above these, 19.2% of the total population declared that they wanted technical applications for work with computers. A number of other data on social dimensions of computer use of handicapped persons in the workplace is presented.
Large Scale Text Distribution Services for the Print Disabled: The Harmonisation and Standardisation Efforts of the TIDE-CAPS Consortium
Authors: Engelen Jan J.  , Bauwens Bart
Published: February 2025

The CAPS consortium starts from the idea that the access to the information society by a significant group of handicapped and elderly persons, who have difficulty in accessing the printed word and/or electronic information (reading impaired persons) should be guaranteed as much as possible. Within TIDE's CAPS project a system independent, ISO-standardised document architecture (the European Interchange Format based on SGML) has been developed to increase text accessibility for a large group of reading impaired persons. In this paper details will be given on all CAPS results and they will be treated within the context of other related initiatives (ICADD, Electronic libraries).
User Requirements Capture for Adaptable Smarter Home Technologies
Authors: Richardson Simon J  , Poulson David F  , Nicolle C
Published: February 2025

The ASHoRED (TIDE 101) project has developed methodologies for the specification, development and assessment of adaptable smarter home technology with an emphasis on the needs of the visually impaired and the elderly. The approach has been user driven, supplemented by expert opinion, direct observation and prototyping. The approach has facilitated the development of innovative technologies and in particular the design of three different smart home demonstrators based in three different member states of the EEC. This paper describes the approach used within ASHoRED to develop the user requirements from ‘wish lists’ into low level product definition and actual requirements. It concludes that in the design of such technology user centred design involving domain experts and other stakeholders are necessary but not sufficient pre-requisites for success. Hands on experience using prototyping and systematic assessment techniques are also invaluable.
Building a Medical Knowledge Base: Tricks Facilitating the Simulation of the Expert's Reasoning
Authors: Puppe Bernhard
Published: February 2025

Detailed representation of intermediate pathophysiological concepts allows step-by-step diagnostic thinking which, starting from broad pathophysiologic terms, incrementally sharpens the focus of the working hypothesis and finally arrives at a specific diagosis. Rather than driving the diagnostic work-up with a single reasoning strategy, we let several - mainly forward-chained flow charts and hypothesize-and-test - compete in determining its course, i.e. the sequence of diagnostic tests.
Computer-Assisted Medical Decision Support by Analysis and Visualization of Multimodal Images
Authors: Englmeier K-H  , Haubner M  , Förterer H  , Fink B K  , Perzl W  , Waltram R
Published: February 2025

Radiologic and clinical practice can be enhanced by improved access to multimodal image informations. Analysis, visualisation, method characteristic image processing and image synthesis is needed not only for the interpretation of the images but also for performing effective consultations with clinical colleagues and computer supported therapy planning and control strategies. A distributed visualization system is presented which enables the fast display, threedimensional visualization and the modality oriented analysis of multimodal image informations. Based on a unique image format, modality specific evaluation procedures and two- or threedimensional processing tools of image analysis produce the input data for therapy planning programs. The easy use of this multimedia visualisation tool enables radiologists and clinicians to deal with their image data. The description of methods and procedures of the prototype, as well as typical examples of radiologic practice will demonstrate the efficiency of the presented system.
Cooperative Medical Problem Solving
Authors: Post Wilfried M.  , Koster Rudolph W.  , Zocca Vincent  , Šrámek Michael
Published: February 2025

This paper describes problem solving in a system for the optimization of the prehospital assessment of emergency. This assessment is based on a telephone interview at ambulance dispatch centers and is made by nurses. Since we recognize the knowledge, experience and skills of dispatchers we have build a cooperative system, in which different problem solving steps can freely be distributed among system and user.
Compositional Classification Based on Conceptual Graphs
Authors: Bernauer J.  , Goldberg H.
Published: February 2025

For the structured representation of medical record data a formalism is in demand that both is expressive and supports classification. Common classification and coding systems in medicine make a compromise on these aspects. This paper proposes a model for compositional classification that is based on restricted conceptual graphs. Basic elements are primitive concepts that can be composed to composite concepts via roles. In contrast to the full expressiveness of the conceptual graph formalism the model restricts composite concepts to connected tree-like graphs without quantification, or specification of referents. The model emphasizes a clear distinction between subsumption and part-of relations. Definitions are given that solely base on the structure of composite concepts, and explicit subsumption and part-of relations between primitive concepts. The composition of concepts is constrained by the domain and the range of a role, and by global and local role restrictions. A global restriction limits the range of a role for a primitive concept, a local restriction limits the range of a role for a primitive concept in the context of a composite concept. The model is applied to the AO classification of fractures of long bones. This outlines how a conventional combinatorial coding system can be represented in terms of a compositional classification system.
The knowledge-based management of medical acts in NUCLEUS
Authors: Joubert M.  , Kanoui H.
Published: February 2025

Hospital information systems are currently required to provide an intelligent support to the daily professional activity. A semantic model is presented which is intended to represent the knowledge about the acts that are practised, the resources they involve and the consumable objects they need We show how this knowledge is used to structure the patients records.
The Benefits of a Trial Period at Home Using Loan—Aids
Authors: Jorritsma F.F.  , Neve J.J.
Published: February 2025

As a part of the working model the Visual Advice Centre Eindhoven (VAC–E) loans, as far as possible, low vision aids to patients for a trial period of two to three weeks before a definite advice is given. The advantages, the organisation, the experience after two and a half years, and the financial consequences of the loaner system are discussed in this paper. It is argued that the costs are recouped in a relatively short period of time and that patients benefit from a trial with loan aids.
AN ELECTROLUMINESCENT AID FOR LOW VISION READERS
Authors: FAZENBAKER Steve  , WATSON Gale R.
Published: February 2025

Low vision readers often use high powered magnification devices with short focal distances. Our preliminary research has shown that electroluminescent (EL) lamps can provide lighting for persons with low vision. Because EL lamps have an extremely thin profile, it is possible to place one between the low vision reader and the printed page without restricting the reader’s ability to get close to the page. In addition, EL lamps remain cool to the touch, provide even illumination, are portable, and produce almost no IR or UV radiation. Electroluminescent (EL) light technology shows great promise in overcoming the problem of illuminating reading material for persons using high magnification. Four different configurations have been developed: 1) a lamp designed to clip onto a pair of spectacles, 2) a lamp inserted into a stand magnifier, 3) a lamp used to provide backlighting while filling out forms 4) a lamp in the form of a typoscope-like cut-out which illuminates a line of print (this can be used with or without magnification). Six volts are supplied by battery to a solid-state inverter producing 120VAC at 2000 Hz to energize the lamps.
“WHY DO LOW VISION PATIENTS STILL READ SLOWLY WITH A LOW VISION AID?”
Authors: Rumney N.J.  , Leat S.J.
Published: February 2025

Low vision subjects read slowly with LVA’s; mean 125wpm, control 278wpm. We have measured eye movements of 24 low vision subjects with assorted pathologies whilst reading continuous text with their low vision aid. The data was related to an independent measure of reading performance (Pepper VSRT). Although low vision subjects make more regressive saccades (mistakes), the limiting factor in reading speed is the number of characters encompassed with each forward saccade. There is no significant difference in saccade rate or duration of fixation. The field of view of the magnifier has an effect on the characters encompassed per forward saccade.
Psychological adjustment to sight loss: A structural model
Authors: Dodds Allan G.  , Flannigan Hazel  , Ng Liza  , Yates Lesley
Published: February 2025

Adjustment to sight loss involves a number of cognitive and emotional factors. A number of theoretical models are examined and it is suggested that a combination of subscription to negative stereotypes of blind people, coupled with perceptions of incompetence at previously simple tasks, conspire to confirm one another. The role of structural modelling in helping to explicate the relationship between these factors is discussed.
Are Low Vision Aids still used Six Months after Prescription?
Authors: Neve J.J.  , Jorritsma F.F.  , Damkot J.  , Streefland V.
Published: February 2025

The Visual Advice Centre Eindhoven (VAC-E) is specialised in the rehabilitation of visually impaired persons with visual aids and illumination. Half a year after their last visit to the centre patients are contacted by telephone or by letter to enquire after their visual functioning and the use of the prescribed aids. This enquiry has become a regular part of the VAC’s method of working. This paper give the results of the enquiry for a group of 250 patients. More than 80 % of the aids prescribed are used regularly and are valued from moderate to very good.
Optometric Involvement in Low Vision Training
Authors: G. LEVITT Jennifer  , IGHE Siv
Published: February 2025

Optometrists working in their own practices tend to operate alone rather than as part of a multidisciplinary team. It is necessary for them to decide to what extent they become involved in the recent more‘holistic’ approach to low vision rehabilitation which includes low vision training. This decision has consequent implications in the education of optometrists. In the United Kingdom there is a need for more professional input as services for the visually impaired are inadequate. However, even if it were desirable for optometrists to become more involved in low vision work, there is, at present, no financial incentive for them to do so. Two views on the potential involvement of optometrists in this work are presented.
Contrast sensitivity as part of a visual assessment of visually impaired people
Authors: van der Wildt G.J.  , Kooijman A.C.  , Dumbar G.  , Cornelissen F.W.
Published: February 2025

In order to gain a better understanding of the visual capabilities of the visually impaired and in order to learn to use them optimally in the rehabilitation, it is essential to have adequate (preferably quantitative) information about the residual visual functions of the visually impaired individual.