bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteoinductive properties of the bone marrow Myth or reality
Authors: van Bree H. , Tshamala M.
Published: March 2018

The osteogenic potential of red bone marrow was first reported more than 100 years ago. Since then, studies have reported controversial results that do not confirm nor disprove the capacity of fresh red bone marrow to produce bone. Researches have been focused on techniques that improve the efficiency of the bone marrow, including: the increase of the concentration of the mesenchymal stem cells in the aspirated bone marrow, the combination with a ‘carrier’ that helps to maintain the mesenchymal stem cells and guides and supports the vascular ingrowth in the defect, or the combination with bone growth factors that stimulate the marrow stromal cells to differentiate into bone forming cells. Each of these techniques has its drawbacks and increases the expenses of an operation. On the other hand, the synergistic effect observed with these combinations does not resolve the problem of the osteogenic capacity of pure bone marrow, which still remains questionable.
Complications and radiographic findings following cemented total hip replacement
Authors: Gilley R. S. , Shofer F. S. , Kapatkin A. S. , Bergh M. S.
Published: March 2018

Cemented total hip replacement (cTHR) is commonly performed to treat intractable coxofemoral pain in dogs. While owners generally perceive a good outcome after the procedure, the longevity of the implant may be limited by complications such as infection and aseptic loosening. The objective of this retrospective study was to identify the prevalence of complications and radiographic changes following cTHR, and to identify factors that may predispose to a need for revision surgery. Medical records and radiographs from 97 dogs that underwent cTHR were evaluated for signalment, preoperative degree of osteoarthritis, technical errors, intra-operative culture results, and the post-operative radiographic appearance of the implant. The complications occurring in the intra-operative and short-term (eight week) time period were recorded. Mean (±SD) follow-up time was 1.1 ± 1.6 years (range: 0–7.7 years). Seven dogs had a short-term complication and a revision surgery was performed in eleven dogs. Osseous or cement changes were radiographically detectable in the majority of cTHR. Eccentric positioning of the femoral stem and the presence of radiolucent lines at the femoral cement-bone interface were positively associated with the occurrence of revision surgery. The clinical significance of the periprosthetic radiographic changes is unclear and further investigation is warranted.
Surgical repair of a tibial fracture in a Belgian Landrace pig
Authors: Martens A. , Declercq J. , Schauvliege S. , Weiland L. , Gasthuys F. , Vertenten G.
Published: March 2018

This paper reports the surgical treatment of a tibial fracture in a castrated adult male Belgian Landrace pig of 180 kg. The fracture was repaired using an intramedullary Steinmann pin, combined with cerclage wire and external transfixation. In contrast to other animal species, the fracture repair in the pig was hindered by the short and curved bones, the thick subcutaneous fat layer and the pronounced musculature. Postoperatively, the pig developed an osteomyelitis of the tibia due to pin tract contamination. Despite this complication, the fracture healed acceptably when all fixation material was removed two months after surgery. The infection resolved quickly and a satisfactory clinical result was obtained.
Evaluation of a treadmill with integrated force plates for kinetic gait analysis of sound and lame dogs at a trot
Authors: Moens N. M. M. , Runciman J. R. , Brebner N. S.
Published: March 2018

The objective was to compare mean peak vertical force (PVF) obtained with a treadmill with two integrated force plates (TM) with the piezoelectric force platform (FP) for sound and lame dogs at a trot. The aim was also to report the inter-step variability (ISV) for both systems and the effect of lameness on these values. Six sound dogs (20.0–25.5 kg) and six dogs with a grade 2/5 forelimb lameness (17.0–36.1 kg) were used in the study. Dogs were acclimatized and assigned an individual target velocity (1.8–2.2 m/s). Mean PVF measurements were obtained for both TM and FP. Subject velocity was controlled by belt speed on TM and restricted to 0.25 M/s above or below the assigned target velocity for FP. Acceleration was limited to +/- 0.3 M/s2. For the sound dogs, concordance and correlation coefficients of the mean PVF for the front limbs was 0.79 and 0.76, respectively. Concordance and correlation for the rear limbs was 0.90 and 0.81, respectively. For the lame dogs, concordance and correlation for the front limbs was 0.73 and 0.59, respectively. Concordance and correlation for the rear limbs was 0.89 and 0.95, respectively. ISV was 0.94 with TM and 0.84 with FP for the sound dogs and 0.96 with TM and 0.87 with FP for the lame dogs. In conclusion, TM provided rapid PVF measurements, good concordance for the hind limbs, and substantial concordance for the forelimbs in both sound and lame dogs at a trot as compared to FP. Both systems demonstrated excellent ISV for both lame and sound dogs.
Holding Power of Orthopaedic Screws in Femora of Young Calves
Authors: Kirpensteijn J. , Roush J. K. , St-Jean G. , DeBowes R. M. , Gaughan E. M.
Published: March 2018

The holding power and holding power per mm bone width of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws were obtained by load-to-failure studies in excised femora of young female Holstein calves. Mean ( ± SD) holding power (HP), holding power per mm bone width (HPBW), and holding power per cortical bone width (HPCW) of 4.5 mm (179.67 ± 59.74 kg), 5.5 mm (171.46 ± 76.52 kg), and 6.5 mm orthopaedic screws (191.10 ± 56.67 kg) were not significantly different. The HP, HPBW, HPCW, bone width (BW), and cortical width (CW) were not different between left and right femora. The greatest HP was obtained in the proximal femoral diaphysis, while the smallest HP was observed in the proximal and distal metaphysis. The increase in HP was related to the increase in CW, but was not related to the BW. The CW at the insertion sites of orthopaedic screws in femora was significantly less than in metacarpi and metatarsi. The limiting factor of holding power in all tests was the shear strength of the bone.

This study compares the holding power, holding power per mm bone width, and holding power per mm cortical width of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws in excised femora of young female Holstein calves. The holding power, holding power per mm bone width, and holding power per mm cortical width of different screws were not significantly different.
Evaluation of the Osteoinductive Capacity of Canine Demineralized Bone Matrix in Heterotopic Muscle Sites of Athymic Rats
Authors: Forell Elaine , Powers Barbara , Johnson J. , Cooper Mary , Withrow St. J. , Straw R. C.
Published: March 2018

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in epaxial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this study confirm that DBM, derived from canine sources, does possess significant osteoinductive ability since histological examination revealed the presence of new cartilage, bone, or both, at 21/24 implantation sites. The osteogenesis induced by canine DBM continued as an active, cumulative process throughout the six week investigation period. The mean percentage of total induced osteogenic components including new, live cartilage, woven bone, lamellar bone and bone marrow cellular elements, was significantly greater after six weeks than after two weeks of implantation (p <0.01). Comparison of histomorphometric point counts at two, four and six weeks of implantation supported the conclusion that bone for mation as induced by canine DBM, proceeds primarily via an endochondral ossification pathway. Although the amount of calcium deposited in tissues harvested from DBM implanted sites tended to increase as implantation time lengthened, there was not a statistically significant correlation between calcium content and the level of osteogenic activity seen histologically (r = 0.32, p = 0.13).

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in ep-axial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this investigation confirm that DBM, derived from canine sources, does possess significant osteo-inductive ability and that bone formation proceeds primarily via a pathway of endochondral ossification.
Canine Osteotomy Healing when Stabilized with Decreasingly Rigid Fixation Compared to Constantly Rigid Fixation
Authors: Histand M. B. , Norrdin R. W. , Konde L. J. , Schwarz P. D. , Egger E.L.
Published: March 2018

This study investigated the effect of destabilizing initially rigid external fixation of transverse canine tibial osteotomies, compared to contralateral osteotomies continuously stabilized, with rigid fixators. Destabilization, by conversion of a type III configuration fixator to a type I configuration, after one to four weeks resulted in increased periosteal callus formation but decreased mechanical strength and histologically a preponderance of fibrous and cartilaginous tissues in the osteotomy when studied after nine weeks. Destabilization at six weeks did not result in an increase in periosteal callus formation, nor greater bending strength. Histologically there was a combination of woven and lamellar bone, with the appearance of more active remodelling of primary bone healing. Destabilization at 12 weeks did not result in any effect, when studied after 15 weeks. These findings suggest that increasing weight-bearing loading of a fracture, at the proper time, may enhance the remodelling and hypertrophy of primary bone healing. However, inappropriate timing of destabilization may not have any or even a deleterious effect.

Effects of reducing initially rigid fixation of canine tibial osteotomies, after various periods of time, were studied. Destabilization after one to four weeks caused increased periosteal callus formation but decreased mechanical strength. Destabilization after six weeks resulted in increased mechanical strength but no increase in periosteal callus, and destabilization after 12 weeks had no effect compared to osteotomies continuously stabilized with rigid fixation.
A Quantitative Assessment of the Subchondral Changes in Osteoarthritis and its Association to the Cartilage Degeneration
Authors: Svalastoga E. , Strøm H.
Published: March 2018

In order to quantify the alterations in subchrondral bone and to compare the changes with the severity of the cartilage lesions, a quantitative histological analysis of articular cartilage and subchrondral bone from osteoarthritic and normal femoral heads was performed.

The analyses were based on 12 femoral heads, seven which were osteoarthritic and five controls. Coronal sections were made and divided into four separate sites to include two weight-bearing and two non-weight-bearing. For each area the percentage volume of trabecular bone was determined by histomorphometry and the degree of cartilage degeneration was evaluated according to a histologicalhistochemical grading system.

The data obtained showed wide variations from site to site, in osteoarthritic femoral heads, with consistently more pronounced alterations in cartilage and subchrondral bone in the weight-bearing areas. Bone thickening and cartilage degeneration were distinctly increased in osteoarthritic joints, in contrast to the control group. By comparing the bony changes with the severity of the cartilage lesions, a correlation of moderate significance was found between the degeneration of the cartilage and sclerosis of the subchrondral bone.

Sections from osteoarthritic and normal canine femoral heads were obtained and divided into weight-bearing and non-weight-bearing areas. The trabecular bone area (%) and the severity of cartilage degeneration were determined by bone histo-morphology and a cartilage histological-histochemical grading system.

Bone thickening and cartilage degeneration were increased in osteoarthritic joints, when compared to normal controls with consistently more pronounced alterations in weight-bearing areas. The severity of the cartilage lesions were found to corre-late with subchrondral bone sclerosis.
Injectable Anaesthetic Agents for Cats
Authors: Allen Dana , Dyson Doris
Published: March 2018

Xylazine/ketamine was shown to be the most cardio-depressive anaesthetic. The fall in cardiac output, in spite of increased vascular resistance, could not maintain BP within an acceptable range. Acepromazine/ketamine and premix/thiopental are comparable and less depressive than xylazine/ketamine.
Displacement of a Functional Femoral Pseudoarthrosis in a Dog
Authors: Flo Gretchen , Stickle R. L. , Jevens D. J.
Published: March 2018

A mature mixed breed dog was evaluated for acute onset of non-weight-bearing lameness involving the right hind limb. The dog had, reportedly, walked normally for the previous three years. A diagnosis of acute displacement of a functional femoral pseudoarthrosis was made. The pseudoarthrosis was stabilized using a dynamic compression bone plate and an autogenous cancellous bone graft. The dog was walking normally five months after the operation.
Radio-Ulnar Synostosis Complicating Partial Mid-Diaphyseal Ulnar Ostectomy in Growing Dogs
Authors: MacPherson G. C. , Johnson K. A.
Published: March 2018

Radio-ulnar synostosis developed in two dogs that had partial mid-diaphyseal ulnar ostectomies performed to correct asynchronous growth of the radius and ulna. The synostosis was apparently painful and caused lameness in one dog, and exacerbated humero-ulnar subluxation in the other dog. Periosteal and interosseous ligament trauma, together with the location of the ulnar ostectomy, radial overstrain and radial hypertrophy were considered to be important factors in the pathogenesis of synostosis formation in these cases.

Radio-ulnar synostosis was a complication of mid-diaphyseal ulnar ostectomy in two young dogs.
The Development of an Equine Fracture Documentation System
Authors: Peutz I. P. , Norris J. C. , Auer J. A. , Rechenberg von , Fackelman G. E.
Published: March 2018

Due to a perceived need for better information on the occurrence and repair of equine fractures, we developed a system designed to gather data on an interinstitutional basis. Fundamental to our task was the creation of a system of classifying the injuries most commonly treated by internal fixation, but including other fracture forms as well.

The initial ("paper") documentation system, designed along the lines of the existing AO/ASIF Human format was praised by pilot study participants for its thoroughness and relevance, but individual clinician compliance was low due to the system’s length and complexity. The present ("diskette") version was designed for use with the Apple Macintosh, and was later modified for IBM PCs and their clones. It is currently being distributed to participating AO/ASIF Vet member clinics. The AO/ASIF EFDS was designed with a view toward crossover with existing human and developing small animal systems. As such it should provide an important building block for efforts in veterinary comparative orthopedics and traumatology.

The need for a classification of commonly occurring equine fractures was recognized, and a corresponding system developed. Originally conceived on paper with computer-readable sheets, the system was later modified to be committed to diskettes. In its current form, the system is in use documenting the outcome of repair of exercise induced fractures. Updates will incorporate other (e.g. long bone) fractures, and long-term follow-up data.
Customized Hook Plates for Metaphyseal Fractures, Nonunions and Osteotomies in the Dog and Cat
Authors: Eaton-Wells R. , Johnson K. , Robins G. M.
Published: March 2018

The use of customized DCP plates, to achieve stable fixation, is demonstrated to be possible in situations where a normal plate configuration does not allow for an adequate number of screws to be inserted. This report documents the use of customized hook plates in ten such cases.
A Case of Degenerative Myopathy of the Obturator Externus Muscle in a Dog
Authors: Ramon F. A. , Schepper De , Bree Van , Janssens L. A. A.
Published: March 2018

A Dobermann with lameness in one hindleg and swelling of soft tissues between trochanter major and tuber ischium was diagnosed to have degenerative myopathy of the obturator externus muscle. The diagnosis was based on magnetic resonance and biopsies. The dog recovered without treatment.
Comparative Vascular Anatomy of the Knee Joint Between the Human Being and Cynomolgous Monkey
Authors: Kaderly R. E.
Published: March 2018

Vascular anatomy of the knee joint in the cynomolgous monkey and human being was compared to determine if the nonhuman primate was an acceptable model for preserving the vascularity of certain tissues during human orthopaedic surgical procedures. Specimens, consisting of osseous tissue and replicas of existing arteries and arterioles, were created using the methyl methacrylate perfusion — soft tissue corrosion technique. Arterial supply to various structures of the knee joint in both species essentially arose from the same sources.
Characteristics of Accessory Carpal Bone Fractures in 50 Racing Greyhounds
Authors: Piermattei D. L. , Davis Ph. E. , Bellenger Ch. R. , Johnson K. A.
Published: March 2018

Fifty racing greyhounds with fracture of the accessory carpal bone presented to the Veterinary Teaching Hospitals at The University of Sydney (n = 35) and Colorado State University (n = 15) were reviewed for the purpose of identifying the frequency of the various fracture types, and to suggest possible factors which predispose to the injuries. All but three fractures occurred while the dogs were racing. All dogs raced on elliptical tracks in a counterclockwise direction, and this was implicated in the pathogenesis and anatomical distribution of these fractures.
Experimental and Clinical Experience with an IM Pin External Skeletal Fixator Tie-in Configuration
Authors: Foutz T. L. , Keller W. G. , Brown J. , Aron D. N.
Published: March 2018

An intramedullary (IM) pin external skeletal fixator “tie-in” configuration is described, for use as a stabilizing device, in the treatment of fractures of the humerus and femur in the dog and cat. With in vitro testing of the configuration using cadaver bones, more resistance to bending was gained by the tie-in arrangement than was possible with one not tied-in. Forty-one clinical cases documented the use of the tie-in configuration for fracture repair. Twenty-four dogs and 17 cats were treated over the past seven years. Fourteen were used to stabilize fractures of the humerus and 27 for the femur. Migration of the IM pin or external fixation frame was not seen and all of the cases went to bone union. The unconventional method of leaving the IM pin protruding from the skin did not lead to complications. All of the owners, contacted from one to two months after removal of the implants, reported their animals to have excellent or good results. Five animals were lost to follow-up.
War Albert Einstein ein Asperger-Autist?
Authors: Kamp-Becker I.
Published: March 2018

Gegenstand und Ziel: Autistische Störungen sind früh beginnende, schwerwiegende Entwicklungsstörungen. Sie stellen ein heterogenes Störungsbild dar, dessen Abgrenzung zu anderen Störungsbildern schwierig sein kann. Es wird der Frage nachgegangen, ob bei Albert Einstein eine solche Störung vorgelegen hat.

Methoden: Die biografischen Angaben werden daraufhin untersucht, ob die diagnostischen Kriterien für Autismus erfüllt sind.

Ergebnisse: Dies ist eindeutig nicht der Fall. Es wird umfassend diskutiert, wieso es zu der Zuschreibung einer autistischen Störung bei Einstein kommt.

Schlussfolgerung: Indem berühmten Persönlichkeiten wie Einstein eine Diagnose zugeschrieben wird, wird einerseits ein hohes Identifikationspotenzial hergestellt, aber auch eine Pathologisierung der Normalität vorgenommen, um Pathologie zu normalisieren.

Klinische Relevanz: Aktuell ist die Diagnose Autismus eine “Modediagnose”, deren differenzialdiagnostische Abgrenzung zu anderen Störungen immer unkenntlicher wird.
Cognitive Behavioral Analysis System of Psychotherapy
Authors: Köhler S. , Sterzer P. , Brakemeier E.-L.
Published: March 2018

Die chronische Depression ist eine schwer beeinträchtigende psychische Störung, welche meist schon während der Kindheit durch traumatisierende Beziehungserfahrungen beginnt und aufgrund ihrer Therapieresistenz eine große Herausforderung darstellt. Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) ist die einzige Psychotherapie, welche speziell für diese Patientengruppe entwickelt wurde. CBASP kombiniert schulenübergreifend behaviorale, kognitive, interpersonelle und analytische Strategien. Kindheitsund Lebenserfahrungen werden in einen Zusammenhang zu aktuellen interpersonellen Problemen gestellt. Zentrale Elemente sind die Situationsanalyse (SA) mit Verhaltenstrainings und Diskriminationslernen durch Rollenspiele, interpersonelle Strategien und Transferübungen. Die therapeutische Rolle ist gekennzeichnet durch das disziplinierte Preisgeben eigener Gefühle und Reaktionen ausgerichtet auf die Bedürfnisse chronisch Depressiver, um dem Patienten eine korrigierende und heilsame Beziehungserfahrung zu ermöglichen. In ersten Studien konnte die Wirksamkeit von CBASP in der Behandlung der chronischen Depression nachgewiesen werden. Weitere Studien zum Vergleich mit anderen Therapieverfahren sind notwendig und sollen in den nächsten Jahren folgen.
Metakognitive Therapie
Authors: Korn J. , Schweiger U. , Korn O.
Published: March 2018

Zu den neueren Entwicklungen der Verhaltenstherapie zählt die Metakognitive Therapie (MCT), die von Adrian Wells entwickelt worden ist. Sie geht davon aus, dass es nicht die Inhalte von Kognitionen, sondern dysfunktionale und für den Patienten schwer zu kontrollierende Muster des Denkens und der Aufmerksamkeitslenkung sind, die psychische Störungen aufrechterhalten. Diese charakteristischen Muster werden als kognitives Aufmerksamkeitssyndrom (CAS) bezeichnet. Das CAS besteht aus einem exzessiven Grübeln und Sich-Sorgen-machen, Gedankenkontrollstrategien sowie einer ausgeprägten Lenkung der Aufmerksamkeit auf potentielle Gefahren. Den Hintergrund für den Einsatz dieser Strategien stellen nach Ansicht der MCT positive metakognitive Überzeugungen dar, die ihren Nutzen für den Patienten betonen. Über die Zeit bilden sich jedoch auch negative metakognitive Überzeugungen hinsichtlich der Unkontrollierbarkeit dieser Prozesse und ihrer Gefährlichkeit. Sie tragen zu einer Aufrechterhaltung der Strategien und dem Einsatz weiterer dysfunktionaler Bewältigungsstrategien bei. Zu ihnen zählen z. B. die Vermeidung von Situationen, der Konsum von Substanzen oder sozialer Rückzug. Diese führen zu einer weiteren Verschlechterung der Symptomatik.

Die metakognitive Therapie zielt auf eine Steigerung des metakognitiven Bewusstseins des Patienten und der Wiedererlangung der flexiblen Kontrolle über kognitive Prozesse und Prozesse der Aufmerksamkeitslenkung. Das CAS und dysfunktionale Bewältigungsstrategien werden abgebaut, die ihnen zugrunde liegenden metakognitiven Überzeugungen verändert und alternative Pläne der kognitiven Verarbeitung generiert. Die vorhandenen Studiendaten zur Behandlung verschiedener Störungsbilder deuten darauf hin, dass die MCT trotz einer relativ geringen Sitzungszahl hinsichtlich ihres Therapieerfolges der kognitiven Verhaltenstherapie ebenbürtig sein könnte.
Use of circular external skeletal fixator constructs to stabilize tarsometatarsal arthrodeses in three dogs
Authors: Lewis D. D. , Jones R. W. , Hill R. C. , Anderson G. M. , Halling K. B.
Published: March 2018

This report describes the use of circular external skeletal fixator (CESF) constructs for the stabilization of unilateral tarsometatarsal arthrodeses in three dogs with traumatic intertarsal or tarsometatarsal fracture/luxation injuries. The application of the CESF was performed following a limited approach to the intertarsal and tarsometatarsal joints. All three of the dogs developed post-operative wire tract inflammation with drainage and two dogs developed osteomyelitis. These complications resolved with systemic antibiotic administration, debridement, and/or wire removal, after which all of the dogs tolerated the CESF well and resumed weight-bearing on the affected limb. The mean time to CESF removal was 16 weeks. The CESF construct provided sufficient stabilization for progressive union of the tarsometatarsal arthrodeses with a good long-term functional outcome in all three of the dogs.
The Strategic Approach of Managing Healthcare Data Exchange in Austria
Authors: Wrba T. , Gall W. , Dorda W. , Duftschmid G.
Published: March 2018

Objectives:
The exchange of electronic medical data between healthcare providers constitutes an integral part of modern medicine, and its importance is growing. Efficient application on a national level requires a uniform approach to the management of healthcare data exchange, avoiding isolated solutions that are expensive and also incompatible.

Methods:
In this communication we explain the basic concepts of establishing a nationwide framework to guide healthcare data exchange in Austria. To achieve this goal, a three-step approach was adopted: (i) creating general guidelines to direct electronic medical data exchange; (ii) defining detailed standards for electronic messages; (iii) organizing pilot projects to implement these standards, and further improving the general guidelines based on the results of the pilot projects.

Results:
We present the MAGDA-LENA framework which guides healthcare data exchange in Austria, and compare it with the US framework HIPAA. We describe several communication scenarios for which concrete message standards were developed in recent years, based on the MAGDA-LENA framework. We further discuss the implementation of these standards in four pilot projects.

Conclusions:
The strategic approach of managing healthcare data exchange presented in this paper is expected to have a substantial impact on medical informatics in Austria over the next few years.
Internationalization of Healthcare Applications: A Generic Approach for PACS Workstations
Authors: Hussein R. , Engelmann U. , Schroeter A. , Meinzer H. P.
Published: March 2018

Objectives:
Along with the revolution of information technology and the increasing use of computers worldwide, software providers recognize the emerging need for internationalized, or global, software applications. The importance of internationalization comes from its benefits such as addressing a broader audience, making the software applications more accessible, easier to use, more flexible to support and providing users with more consistent information. In addition, some governmental agencies, e.g., in Spain, accept only fully localized software. Although the healthcare communication standards, namely, Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7) support wide areas of internationalization, most of the implementers are still protective about supporting the complex languages. This paper describes a generic internationalization approach for Picture Archiving and Communication System (PACS) workstations.

Methods:
The Unicode standard is used to internationalize the application user interface. An encoding converter was developed to encode and decode the data between the rendering module (in Unicode encoding) and the DICOM data (in ISO 8859 encoding). An integration gateway was required to integrate the inter-nationalized PACS components with the different PACS installations. To introduce a pragmatic example, the described approach was applied to the CHILI PACS workstation.

Results:
The approach has enabled the application to handle the different internationalization aspects transparently, such as supporting complex languages, switching between different languages at runtime, and supporting multilingual clinical reports.

Conclusions:
In the healthcare enterprises, internationalized applications play an essential role in supporting a seamless flow of information between the heterogeneous multivendor information systems.
Bad Health Informatics Can Kill – Is Evaluation the Answer?
Authors: Shaw N. T. , Ammenwerth E.
Published: March 2018

Objective:
Health care is entering the age of information society. It is evident that the use of modern information and communication technology (ICT) offers tremendous opportunities to improve health care. However, there are also hazards associated with ICT in health care. We want to present an overview of typical hazards associated with ICT in health care, and to discuss how ICT evaluation can be a solution.

Methods:
We analyze examples of failures and problems associated with ICT in health care. This collection is also made available on a website.

Results and Conclusion:
Systematic, continuous evaluation of quality and effects of ICT during the whole life cycle of ICT components seems to be one important approach to detect and prevent possible ICT hazards and failures, supporting a higher quality of patient care. However, empirical studies proving this assumption are needed.
Hardware, Software, Peopleware, Subjectivity
Authors: Grémy François
Published: March 2018

Objective:
This paper develops the closing address the author was asked to deliver at the MEDINFO 2004 Congress in San Francisco.

Method:
Starting from three working conferences, dealing with evaluation of health information systems, where he was involved, the author describes the evolution of his personal ideas.

Results and Conclusions:
First he proposes the main distinction between systems where the user(s) remain(s) external from the running program, from the ones where the user(s) interacting with the program become(s) the main component of the system.

In the first case, the methods of evaluation are the conventional methods used in Medical Technology Assessment. In the second case, the whole knowledge in anthropology (considered in its broadest meaning), may contribute strongly to evaluation.

It becomes clear that the subjectivity of the user(s), how he (or they) react(s) with the computing machinery, is a main key to the success or failure of the whole system.

As the eradication of subjectivity is often considered, since the beginning of “modern times”, as a condition for progress, the author claims that such a temptation is deleterious for our civilization threatened by a comeback of barbarity, and is scientifically wrong.

For that demonstration, he calls on both philosophical concepts (from Aristotle to E. Husserl, M. Henry and J. Searle), and the most recent advances of neurosciences.
Normalization for Two-channel Microarray Data
Authors: Ittrich C.
Published: March 2018

Objectives:
In two-channel microarray experiments the measured gene expression levels are affected by many sources of systematic variation. Normalization refers to the process of removing such systematic sources of variation, to make measured intensities within and between slides comparable. Some commonly used normalization methods removing intensity-dependent dye bias and adjusting differences in variability between slides will be reviewed with the main focus on intensity-dependent normalization methods.

Methods:
This article describes different intensity-dependent within-slide normalization methods for the log ratios of red and green channel intensities but also refers to single channel normalization methods incorporating all single channels of the slides at once.

Results:
The described procedures provide a useful approach to remove systematic sources of variation like intensity-dependent dye bias and variability between slides in cDNA microarray experiments. This is illustrated by an experimental data set.

Conclusions:
Several reasonable normalization procedures for two-channel microarray data have recently been proposed. Deciding on which method would perform well for a concrete experiment is difficult. Designed spike-in experiments or dilution series with known differences for some selected genes would be helpful to assess the different methods, but may be impractical for most laboratories due to the high costs.
Multiplicity Issues in Microarray Experiments
Authors: Landgrebe J. , Brunner E. , Bretz F.
Published: March 2018

Objectives:
Discussion of different error concepts relevant to microarray experiments. Review of some commonly used multiple testing procedures. Comparison of different approaches as applied to gene expression data.

Methods:
This article focuses on familywise error rate (FWER) and false discovery rate (FDR) controlling procedures. Methods under investigation include: Bonferroni-type methods and their improvements (including resampling approaches), modified Bonferroni methods, data-driven approaches, as well as the linear step-up method and its modifications. Particular emphasis lies on the description of the assumptions, advantages and limitations for the investigated methods.

Results: FWER controlling procedures are often too conservative in high dimensional screening studies. A better balance between the raw P-values and the stringent FWER-adjusted P-values may be required in many situations, as provided by FDR controlling and related procedures.

Conclusions:
The questions remain open, which error concept to apply and which multiple testing procedure to use. Although we believe that the FDR or one of its variants will be applied more often in the future, longterm experience with microarray technology is missing and thus the validity of appropriate multiple test procedures cannot yet be assessed for microarray data analysis.
Molecular Diagnosis
Authors: Spang R. , Markowetz F.
Published: March 2018

Objectives:
We discuss supervised classification techniques applied to medical diagnosis based on gene expression profiles. Our focus lies on strategies of adaptive model selection to avoid overfitting in high-dimensional spaces.

Methods:
We introduce likelihood-based methods, classification trees, support vector machines and regularized binary regression. For regularization by dimension reduction, we describe feature selection methods: feature filtering, feature shrinkage and wrapper approaches. In small sample-size situations efficient methods of data re-use are needed to assess the predictive power of a model. We discuss two issues in using cross-validation: the difference between in-loop and out-of-loop feature selection, and estimating model parameters in nested-loop cross-validation.

Results:
Gene selection does not reduce the dimensionality of the model. Tuning parameters enable adaptive model selection. The feature selection bias is a common pitfall in performance evaluation. Model selection and performance evaluation can be combined by nested-loop cross-validation.

Conclusions:
Classification of microarrays is prone to overfitting. A rigorous and unbiased assessment of the predictive power of the model is a must.
Clustering Algorithms and Other Exploratory Methods for Microarray Data Analysis
Authors: Rahnenführer J.
Published: March 2018

Objectives:
We introduce methods for the exploratory analysis of microarray data, especially focusing on cluster algorithms. Benefits and problems are discussed.

Methods:
We describe application and suitability of unsupervised learning methods for the classification of gene expression data. Cluster algorithms are treated in more detail, including assessment of cluster quality.

Results:
When dealing with microarray data, most cluster algorithms must be applied with caution. As long as the structure of the true generating models of such data is not fully understood, the use of simple algorithms seems to be more appropriate than the application of complex black-box algorithms. New methods explicitly targeted to the analysis of micro-array data are increasingly being developed in order to increase the amount of useful information extracted from the experiments.

Conclusions:
Unsupervised methods can be a helpful tool for the analysis of microarray data, but a critical choice of the algorithm and a careful interpretation of the results are required in order to avoid false conclusions.
Testing Differential Gene Expression in Functional Groups
Authors: Meister R. , Mansmann U.
Published: March 2018

Objectives:
Single genes are not, in general, the primary focus of gene expression experiments. The researcher might be more interested in relevant pathways, functional sets, or genomic regions consisting of several genes. Efficient statistical tools to handle this task are of interest to research of biology and medicine.

Methods:
A simultaneous test on phenotype main effect and gene-phenotype interaction in a two-way layout linear model is introduced as a global test on differential expression for gene groups. Its statistical properties are compared with those of the global test for groups of genes by Goeman et al. [5] in a preliminary simulation study. The procedure presented also allows adjusting for covariates.

Results:
The proposed ANCOVA global test is equivalent to Goeman’s global test in a setting of independent genes. In our simulation setting for correlated genes, both tests lose power, however with a stronger loss for Goeman’s test. Especially in cases where the asymptotic distribution cannot be used, the stratified use of the ANCOVA global test shows a better performance than Goeman’s test.

Conclusions:
Our ANCOVA-based approach is a competitive alternative to Goeman’s global test in assessing differential gene expression between groups. It can be extended and generalized in several ways by a modification of the projection matrix.
Microarray Annotation and Biological Information on Function
Authors: Brors B.
Published: March 2018

Objectives:
Many methods for statistical analysis of gene expression studies by DNA microarrays produce lists of genes as output. To understand gene lists in terms of traditional biology, e.g. which pathways may be affected, it is necessary to get appropriate annotations for the probes on an array.

Methods:
Problems arise with the different sources that have been used by manufacturers to design microarray probes, and their association to biological entities like genes, transcripts and proteins. Function annotation is of crucial importance, and systems like Gene Ontology can be used for this purpose. It arranges annotation terms in a hierarchical manner and thus makes annotations in a gene list amenable to automated analysis.

Results:
Several methods for analyses of gene function are described. The hierarchical nature of systems like Gene Ontology particularly suggests using methods from graph theory.

Conclusions:
The main problem in annotating micro-array probes and inferring affected functional modules is the incompleteness and degree of error in current biological databases. Initial approaches to make use of functional annotation exist, but have to be extended, in particular with respect to estimating the statistical significance of results.
A Computer Program to Estimate Power and Relative Efficiency of Flexibly Matched Case-control Studies
Authors: Gefeller O. , Brenner H. , Stürmer T.
Published: March 2018

Objectives:
We recently introduced the concept of flexible matching strategies with varying proportions of a dichotomous matching factor among controls to increase power and efficiency of case-control studies. We now present a method and a computer program to calculate power and relative efficiency compared to an unmatched design varying the proportion of the matching factor in controls over all possible values from 0 to 100 percent.

Methods:
For all these values, the program calculates the expected variance of the combined Mantel-Haenszel odds ratio and determines the power using the standard error of the expected combined Mantel-Haenszel odds ratio under the null hypothesis as derived from the Mantel-Haenszel test statistic without continuity correction.

Results:
Thereby, the program allows estimating the optimal prevalence of the matching factor in selected controls for a given scenario which often differs from the prevalence in cases. It furthermore allows to estimate loss in power and efficiency compared to optimal matching by suboptimal matching.

Conclusions:
Estimations like these are helpful with respect to the decision when to stop efforts to optimize the degree of matching during the recruitment of controls. Our program will strongly facilitate assessing the benefits of flexible matching strategies.
Migration of Legacy Mumps Applications to Relational Database Servers
Authors: O’Kane K. C.
Published: March 2018

An extended implementation of the Mumps language is described that facilitates vendor neutral migration of legacy Mumps applications to SQL-based relational database servers. Implemented as a compiler, this system translates Mumps programs to operating system independent, standard C code for subsequent compilation to fully stand-alone, binary executables. Added built-in functions and support modules extend the native hierarchical Mumps database with access to industry standard, networked, relational database management servers (RDBMS) thus freeing Mumps applications from dependence upon vendor specific, proprietary, unstandardized database models. Unlike Mumps systems that have added captive, proprietary RDMBS access, the programs generated by this development environment can be used with any RDBMS system that supports common network access protocols. Additional features include a built-in web server interface and the ability to interoperate directly with programs and functions written in other languages.
Nonparametric Frontier Model as a Tool for Exploratory Analysis of Hospital Stays
Authors: Beguin C.
Published: March 2018

Diagnosis-related groups (DRG) were introduced in 1995 to the Belgian hospital financing system. Trimming rules are generally used when mean length of stay (LOS) is estimated by DRG. This paper proposes the use of frontier models instead of trimming rules. These models allow to take into account the characteristics of the patients, to rank hospital stays, and to indicate stays presenting discrepancy between the patient’s characteristics and the resources consumed. The analysis is done with the nonparametric Free Disposal Hull (FDH) model and the method developed by Wilson to detect extreme observations, when defining the frontier is adapted to analyze large databases.
A Measurement Model of Disease Severity in Absence of a Gold Standard
Authors: Martus P.
Published: March 2018

In the absence of a gold standard, we propose the use of confirmatory factor analysis for the quantification of agreement between diagnostic measurements and the true disease severity. The essential assumption is conditional independence of diagnostic measurements adjusted for the severity of the disease. However, depending on the number of measurements available, the method works even if some of them are conditionally dependent. We illustrate the method using an example related to glaucoma eye disease.
Influence of the Method of Data Collection on the Documentation of Blood-pressure Readings with an Anesthesia Information Management System (AIMS)
Authors: Junger A. , Quinzio L. , Fuchs C. , Michel A. , Sciuk G. , Marquardt K. , Dudeck J. , Hempelmann G. , Benson M.
Published: March 2018

The influence of methods for record keeping on the documentation of vital signs was assessed for the Anesthesia Information Management System (AIMS) NarkoData. We compared manually entered blood-pressure readings with automatically collected data. These data were stored in a database and subsequently evaluated and analyzed. The data sets were split into two groups, ”manual“ and ”automatic“. We evaluated the effect of automatic data collection on the incidence of corrected data, data validity and data variation. Blood-pressure readings of 37,726 data sets were analyzed. We could assess that the method of documentation did influence the data quality. It could not be assessed whether the incorrectness of data during automatic data gathering was caused by artefacts or by the anesthesiologist.
Adaptable Preprocessing Units and Neural Classification for the Segmentation of EEG Signals
Authors: Jäger H. , Witte H. , Galicki M. , Schelenz C. , Specht M. , Reinhart K. , Eiselt M. , Doering A.
Published: March 2018

In this contribution, a methodology for the simultaneous adaptation of preprocessing units (PPUs) for feature extraction and of neural classifiers that can be used for time series classification is presented. The approach is based upon an extension of the backpropagation algorithm for the correction of the preprocessing parameters. In comparison with purely neural systems, the reduced input dimensionality improves the generalization capability and reduces the numerical effort. In comparison with PPUs with fixed parameters, the success of the adaptation is less sensitive to the choice of the parameters. The efficiency of the developed method is demonstrated via the use of quadratic filters with adaptable transmission bands as preprocessing units for the segmentation of two different types of discontinuous EEG: discontinuous neonatal EEG (burst-interburst segmentation) and EEG in deep stages of sedation (burst-suppression segmentation).
Quantifying Stenosis in Renal Arteriograms: A Fuzzy Syntactic Analysis
Authors: Lalande A. , Cherrak I. , Brunotte F. , Degoulet P. , Jaulent M.C.
Published: March 2018

The introduction of fuzzy logic improves a system for the automatic quantification of renal artery lesions seen in digital subtraction angiograms. A two-step approach has been followed. An earlier system based on non-fuzzy syntactic analysis provided a clear symbolic description of the stenotic lesions. Although this system worked correctly, it did not take into account the variability and uncertainty inherent to image processing and to knowledge on the reference diameter. This system has been improved by the introduction of fuzzy logic in the representation of the reference diameter. It provides a description of the stenosis in terms of fuzzy quantities. To illustrate the benefits of the fuzzy approach, the results of the two systems have been compared by plotting the differences of an index of variability. It appears that the differences are statistically different when using a two-tailed paired t-test (t = 2.37; p = 0.025). The result shows that the fuzzy approach is better than a non-fuzzy approach in the sense that the index of variability is reduced significantly.
Design and Introduction of an Electronic Patient Record: How to Involve Users?
Authors: Faber M. G.
Published: March 2018

Objectives: Two forms of participatory design (PD) – management-dominated and end-users focused – are described in the design and introduction of an electronic patient record (EPR) for a mental health care centre.

Methods: Qualitative research methods were used to achieve a ‘fine-grained’ insight into the EPR development process and its impacts. These methods included interviews, document study and observation of project group meetings.

Results: Management-dominated PD is highly structured, led by managers and centred around rationalisation of work. End-user focused PD is more bottom-up oriented. Central in this approach are users’ working patterns and user needs. In the case described, both forms actually lead to a poorly functioning EPR. It is explained why these results could be expected.

Conclusion: Our findings suggest not to reject PD, but to find a more appropriate balance between the two forms of PD.