bluuebunny/crossref_metadata_2025 huggingface dataset:
Displacement of the proximal tendon of the long digital extensor muscle
Authors: Risselada M. , van Bree H. , de Rooster H.
Published: March 2018

A case of bilateral displacement of the proximal tendon of the long digital extensor (LDE) muscle has been described in a 5-year-old Siberian Husky. During surgery, a prosthetic roof was created over the extensor sulcus of the proximal tibia on both legs simultaneously.
Detailed preoperative planning for fracture treatment with Ilizarov method in three dogs
Authors: Dioszegi Z. , Csebi P. , Bilgili H.
Published: March 2018

The purpose of this study is to present preoperative planning with consideration of the anatomical variations of different dog breeds, gross anatomy, preoperative radiographs and computed tomography (CT) images, ring number, ring type and ring levels, rod positions and rod number for fracture treatment using the Ilizarov method in three dogs. In all cases, preoperative radiographs of affected limb and contralateral limb, intact extremity's CT views and anatomical atlases were used for preoperative frame planning. The frame is assembled preoperatively, rehearsed and then it is applied. Preoperative radiographs and clinical findings of affected limbs are beneficial for preoperative frame planning, whilst CT views are not as they do not provide any different vision of anatomical structures for all cases. Other colleagues' and our anatomical atlases, including cross-sectional views of limbs, are satisfactory for preoperative planning. In addition, functional and cosmetical results in all three cases were determined to be very good.
Management of tibial fractures with Orthofix axial external skeletal fixator in 15 dogs
Authors: Yanik K. , Gül N. Y.
Published: March 2018

In the present study, the applicability of fixator, surgical time, time to weightbearing, the healing time and complications of tibial fractures in dogs after fixation with Orthofix axial external skeletal fixator were evaluated. The study was performed on 15 cases which were presented to the Clinics of Small Animal Surgery. After the determination of the fracture type, fracture location, appropriate screw diameter and the location of the first screw on the fragment according to preoperative radiographs, the dogs were placed under general anaesthesia and the fixator was applied with cranio-medial approach to the tibia. Clinical and radiological examinations were continued until the removal of the external skeletal fixators at three different times (at approx. days 45, 60 and 75) according to the clinical and radiological fracture healing. The treatment results were determined by the Modified Hannover Veterinary Medicine Faculty Small Animal Fracture Evaluation Scale. The results were excellent in eight cases (53.3%), good in four cases (26.7%), fair in one case (6.7%) and poor in two cases (13.3%). Based on this study, the use of external skeletal fixation with Orthofix axial external skeletal fixator can be recommended for dogs with tibial fractures as long as careful pin tract management is performed. Further investigation is needed to determine the use of Orthofix axial external skeletal fixator for the management of other long bone fractures.
The Influence of the Dietary Protein Content on Growth in Giant Breed Dogs
Authors: Hazewinkel H. A. W. , Voorhout G. , Biewenga W. J. , Koeman J. P. , Goedegebuure S. A. , Klooster van t , Nap R. C.
Published: March 2018

Feeding immature dogs of large breeds a diet exceeding the NRC recommendations (5) for energy, protein, calcium (Ca), phosphorus (P), and vitamin D may result in disturbances of skeletal development. The effects of excess energy and various Ca:P ratios per se have been reported. The role of dietary protein, especially with regard to skeletal growth in giantbreed dogs was studied. Clinical, biochemical, radiographical, and histological parameters were studied in three groups of Great Dane pups raised on diets only differing in protein content (14.6, 23.1 and 31.6% dm respectively). Significant differences were found for body weight, plasma albumin, and plasma urea. The differences in protein intake per se had no demonstrable consequences for renal and skeletal development. A causative role for dietary protein in disturbed enchondral ossification in dogs is unlikely.

Nutrition is important during growth, especially in giant breed dogs. The role of dietary protein with regard to skeletal development was studied in three groups of Great Dane pups raised on diets only differing in protein content. A causative role for dietary protein in disturbed enchondral ossification is unlikely.
DuMond Spectroscopy: A Technique for the Determination of Bone Density
Authors: MacKenzie K. , Dobson H.
Published: March 2018

DuMond spectroscopy is a new technique for the determination of bone mineral density. The instrument consists of an Americium-241 source mounted in an absorber post located on the surface of a sodium iodide detector. The analysis is based on the energy distribution of photons scattered by the tissue. Measurements made using a series of powdered bovine cortical bone and wax mixtures gave an R value of 0.991. Repeated measurements made on a series of calcaneus specimens gave a precision of 0.96%.
Another Manifestation of Ununited Anconeal Process in the German Shepherd Dog?
Authors: McCartney W. T.
Published: March 2018

A one-year-old German Shepherd dog sustained a proximal fracture of the ulna involving the anconeal process following a mild traumatic event. Two types of ununited anconeal processes are documented in the German Shepherd dog and this case may represent a further type.
Osteochondral Fragmentation (Osteochondrosis) of the Canine Patella
Authors: Shealy P. M. , Kincaid S. A. , Hathcock J. T. , Boosinger T. R. , Pernell R. T. , Milton J. L.
Published: March 2018

Three four-month-old female grey-hound siblings with osteochondral fragmentation of the lateral aspect of the patella are presented. One dog was affected unilaterally and two bilaterally. The dogs exhibited mild weight-bearing lameness, slight flexion of the stifle, and discomfort during full flexion and extension of affected stifles. A non-palpable, mild synovial effusion was cytologically consistent with chronic inflammation and compatible with osteochondrosis and degenerative joint disease. The hallmark clinical sign was a characteristic prominence of the patella. Cranioproximalcraniodistal oblique (skyline) radio-graphs and transverse CT scans revealed osteochondral fragments and defects of the patella. The osteochondral fragments were surgically excised in two dogs and one dog was necropsied. The osteochondral fragments and patellae were evaluated histologically. Macroscopic and microscopic features of the osteochondral tissues were characteristic of osteochondrosis.

Osteochondrosis of the patella was diagnosed in three sibling Greyhounds. The hallmark clinical sign was enlargement and prominence of the patella. Radiographic examination, cranioproximal-craniodistal oblique view, demonstrated the fragmented lateral border of the patella. Findings from computed tomography and histopathological examination are described. Surgical excision of the fragment in two dogs restored satisfactory function.
Extra-Articular Fascial Strip Repair of the Cranial Cruciate Deficient Stifle: Technique and Results in Seven Dogs
Authors: Bauer M. S. , Toombs J. P. , Aiken S. W.
Published: March 2018

An extra-articular fascial strip technique, for stabilization of the cranial cruciate deficient stifle, is described and evaluated in a series of seven dogs suffering from rupture of the cranial cruciate ligament. The technique was easily performed and resulted in normal stifle joint bio-mechanics, as determined by evaluation of the instantaneous centre of motion. Cranial drawer motion was eliminated immediately after the operation and, after a partial loss of stability at four weeks, six stifles had normal or possessed less than 3.0 mm of cranial drawer motion in either flexion or extension at 26 weeks after the operation. At subsequent examinations, six dogs were free of clinical lameness, and one had a mild intermittent lameness with exercise at 26 weeks after the operation. The extra-articular fascial strip technique is an alternative to lateral retinacular suture techniques for stabilization of the cranial cruciate deficient stifle in dogs weighing less than 15 kg.

An extra-articular fascial strip technique for stabilization of the cranial cruciate deficient stifle is described and evaluated. The technique was easily performed and resulted in normal stifle joint biomechanics, as determined by evaluation of the instantaneous centre of motion. All of the dogs performed well and six of seven were free of lameness 26 weeks after the operation.
Backsplinting for Treatment of Thoracic and Lumbar Fracture/Luxation in the Dog: Principles of Application and Case Series
Authors: Smith Gail , Patterson R. H.
Published: March 2018

Sixteen animals with thoracic and lumbar fracture/luxations were treated with an external bracing system. The splint design and the method of application are described along with the complications seen. All of the animals recovered acceptable function, although six had residual neurologic deficits. Biomechanical testing of the splint revealed sufficient strength to limit angular deformation at a bending moment of 40 Nm. This approximates calculated in vivo bending moments for a large paralysed dog. Principles for closed reduction and external bracing of thoracic and lumbar injuries are presented.

External coaptation was used in the reduction and fixation of 16 animals with thoracic and lumbar fracture/luxations. This spinal bracing system is described and principles of its application are presented. An experimental bending test was employed to test the hypothesis that the splint could effectively limit angulation at calculated in vivo bending moments.
Surgical Repair of Acute Gracilis Muscle Rupture in the Racing Greyhound
Authors: Eaton-Wells R.
Published: March 2018

A retrospective study of the surgical repair of 27 cases of acute gracilis muscle rupture ("dropped back muscle") in 23 racing greyhounds was conducted.

All of the dogs suffered the injury while racing or training. Suture materials and surgical technique are described. The dogs ability to resume racing was assessed.
Pyrolytic Carbon and Cobalt-Chromium Bone Liners Flexible Implant Arthropinlasty
Authors: Swanson A. R. , Braden T. D. , McGehee J. A.
Published: March 2018

An in vivo evaluation was conducted on the ability of synthetic bone liners to protect the Swanson High Performance Silastic Finger Joints following 73 flexible arthroplasties in the rabbit stifle. Three different groups of synthetic bone liners were tested against a control group in which no bone liners were used. The implanted bone liners consisted of 48 full circumference liners fabricated from pyrolytic carbon, 34 full circumference and 32 partial circumference liners of a cobaltchromium alloy (Vitallium).
Chlorhexidine Wound Lavage and Suture Soaking for Prevention of Suture-Related Infections
Authors: Wendelburg K. , Smeak D. D. , Kowalski J.J.
Published: March 2018

The effectiveness of chlorhexidine in preventing suture-related infections in two groups of dogs at high and low levels of bacterial contamination was examined. Prior to placing the sutures, the lateral stifle incisions were inoculated with Staphylococcus aureus and lavaged with either a 1 % chlorhexidine solution (treated groups) or sterile normal saline (control groups). Chlorhexidine significantly reduced the initial bacterial numbers and clinical inflammatory response in wounds contaminated with high or low numbers of bacteria. Chlorhexidine significantly decreased the tissue inflammation associated with the polyester sutures when contaminated with high concentrations of bacteria.
Psychologie des Positiven
Authors: Walter H.
Published: March 2018

Die vernachlässigte Psychologie des Positiven mit den Mitteln der wissenschaftlichen Psychologie zu erforschen und dabei Interventionen zu entwickeln um Glück und Wohlbefinden zu steigern, ist die Aufgabe, der sich seit ca. 15 Jahren die “Positive Psychologie” widmet. In diesem Artikel werden Konzept, Geschichte, Ergebnisse, neurobiologische Grundlagen und die Kritik an der Positiven Psychologie dargestellt und erläutert. Obwohl ursprünglich entwickelt, um das Positive bei psychisch gesunden Menschen zu stärken, werden positive Interventionen inzwischen auch im Bereich der Behandlung leichter und mittelschwerer Depressionen erfolgreich eingesetzt, wie Ergebnisse einer Metaanalyse zeigen. Die Erforschung einer Neuropsychobiologie des Positiven stellt eine reichhaltige Ressource für alle psychotherapeutischen Schulen dar, die stärkere Aufmerksamkeit verdient.
Applying Informatics in Tissue Engineering
Authors: Zhou Xiaolin , Yang Daping , Ge Haiyan , Wang Qi , Tu Kang , Guo Tiefang , Xu Jie
Published: March 2018

Objective:
To facilitate tissue engineering strategies determination with informatics tools.

Methods:
Firstly, tissue engineering experimental data were standardized and integrated into a centralized database; secondly, we used data mining tools (e.g. artificial neural networks and decision trees) to predict the outcomes of tissue engineering strategies; thirdly, a strategy design algorithm was developed, and its efficacy was validated with animal experiments; lastly, we constructed an online database and a decision support system for tissue engineering.

Results:
The artificial neural networks and the decision trees respectively predicted the outcomes of tissue engineering strategies with the predictive accuracy of 95.14% and 85.26%. Following the strategies generated by computer, we cured 18 of the 20 experimental animals with a significantly lower cost than usual.

Conclusion:
Informatics is beneficial for realizing safe, effective and economical tissue engineering.
Decision Analysis for the Assessment of a Record Linkage Procedure
Authors: Binquet C. , Allaert F. A. , Cornet B. , Pattisina R. , Leteuff G. , Ferdynus C. , Gouyon J. B. , Quantin C.
Published: March 2018

Objectives:
According to European legislation, we must develop computer software allowing the linkage of medical records previously rendered anonymous. Some of them, like AUTOMATCH, are used in daily practice either to gather medical files in epidemiologic studies or for clinical purpose. In the first situation, the aim is to avoid homonymous errors, and in the second one, synonymous errors. The objective of this work is to study the effect of different parameters (number of identification variables, phonetic treatments of names, direct or probabilistic linkage procedure) on the reliability of the linkage in order to determine which strategy is the best according to the purpose of the linkage.

Methods:
The assessment of the Burgundy Perinatal Network requires the linking of discharge abstracts of mothers and neonates, collected in all the hospitals of the region. Those data are used to compare direct and probabilistic linkage, using different parameterization strategies.

Results:
If the linkage has to be performed in real time, so that no validation of indecisions generated by probabilistic linkage is possible, probabilistic linkage using three variables without any phonetic treatment seems to be the most appropriate approach, combined with a direct linkage using four variables applied to non-conclusive links. If a validation of indecisions is possible in an epidemiological study, probabilistic linkage using five variables, with a phonetic treatment adapted to the local language has to be preferred. For medical purpose, it should be combined with a direct linkage with four or five variables.

Conclusion:
This paper reveals that the time and money available to manage indecision as well as the purpose of the linkage are of paramount importance for choosing a linkage strategy.
François Grémy and the Birth of IMIA
Authors: Haux R. , Kulikowski C. , Lun K. C. , Degoulet P.
Published: March 2018

In 2001 the International Medical Informatics Association (IMIA) approved the establishment of a Medical Informatics Award of Excellence to be given every three years to an individual, whose personal commitment and dedication to medical informatics has made a lasting contribution to medicine and healthcare through her or his achievements in research, education, development or applications in the field of medical informatics. The first award was given in 2004 to Prof. François Grémy, Uzes, France.

As the first chairman and moderator of TC4, François Grémy is considered to be the first President of its renamed and refocused successor, the International Medical Informatics Association. The role of IFIP-TC4 in bringing together early health informaticians cannot be underestimated. Although TC4 was composed in large part of computer professionals interested in medical applications, Grémy recruited the first generation of IMIA officers and members from the medical and healthcare communities. Intellectually as well as organizationally, IFIP-TC4 was the true predecessor of IMIA.
Empirical Eigenfunctions and Medial Surface Dynamics of a Human Vocal Fold
Authors: Tayama N. , Berry D. A. , Döllinger M.
Published: March 2018

Objectives:
The purpose of this investigation was to use an excised human larynx to substantiate physical mechanisms of sustained vocal fold oscillation over a variety of phonatory conditions. During sustained, flow-induced oscillation, dynamical data was collected from the medial surface of the vocal fold. The method of Empirical Eigenfunctions was used to analyze the data and to probe physical mechanisms of sustained oscillation.

Methods:
Thirty microsutures were mounted on the medial margin of a human vocal fold. Across five distinct phonatory conditions, the vocal fold was set into oscillation and imaged with a high-speed digital imaging system. The position coordinates of the sutures were extracted from the images and converted into physical coordinates. Empirical Eigenfunctions were computed from the time-varying physical coordinates, and mechanisms of sustained oscillation were explored.

Results:
Using the method of Empirical Eigenfunctions, physical mechanisms of sustained vocal fold oscillation were substantiated. In particular, the essential dynamics of vocal fold vibration were captured by two dominant Empirical Eigenfunctions. The largest Eigenfunction primarily captured the alternating convergent/ divergent shape of the medial surface of the vocal fold, while the second largest Eigenfunction primarily captured the lateral vibrations of the vocal fold.

Conclusions:
The hemi-larynx setup yielded a view of the medial surface of the vocal folds, revealing the tissue vibrations which produced sound. Through the use of Empirical Eigenfunctions, the underlying modes of vibration were computed, disclosing physical mechanisms of sustained vocal fold oscillation. The investigation substantiated previous theoretical analyses and yielded significant data to help evaluate and refine computational models of vocal fold vibration.
Tutorial on Microarray Gene Expression Experiments
Authors: Mansmann U. , Brunner E. , Ziegler A. , Repsilber D.
Published: March 2018

Objectives:
With the collection of articles presented in this special issue, we aim at educating interested statisticians and biometricians on the one hand as well as biologists and medical researchers on the other with respect to basic necessities in planning, conducting and analyzing microarray gene expression experiments. The reader should get comprehensive directions to understand both the overall structure of this approach as well as the decisive details, which enable – or thwart – a meaningful data analysis.

Methods:
For a one-day workshop with tutorial character we brought together experts in design, conduct and analysis of microarray gene expression experiments who prepared a series of comprehensive lessons. These contributions were then reworked into a series of introductory articles and bundled in form and content as a Special Topic.

Results:
It was possible to present a tutorial overview of the field. The interested reader was able to learn the basic necessities and was referred to further references for details on the possible alternatives. A recipe style all-embracing plan, covering all eventualities and possibilities was not only beyond the scope of an introductory tutorial-like presentation, but was also not yet agreed upon by the scientific society.

Conclusions:
It proved feasible to find a framework for integrating the interdisciplinary approaches to the challenging field of gene expression analysis with microarrays, hopefully contributing to a rapid and comprehensive introduction for novices.
Two-color Microarray Experiments
Authors: Ziegler A. , Repsilber D.
Published: March 2018

Objectives:
Microarray gene expression experiments have a complex technical background. Knowledge about certain technical details is inevitable to judge alternatives for both experimental design and analysis. Here, we introduce the necessary details for the so-called two-color microarray experiments and review major sources of technical variance.

Methods:
We follow the sequence of experimental steps during a typical two-color microarray gene expression experiment, stressing decisive points in the choice of technique, experimental handling and biophysical basics. We point out where technical variation is to be expected.

Results:
Tissue storage, RNA extraction techniques, as well as the microarray hybridization represent major components of technical variance to be considered. Depending on the possibilities for access to the biomedical material under investigation, choice of amplification and labeling techniques can also be decisive to avoid additional technical variance. The two-color microarray experimental approach seeks to avoid a group of probe-level technical biases making use of the advantages of an incomplete block-design.

Conclusions:
It is worth to know the major sources of technical variance during the typical experimental sequence, both for choice of experimental design and techniques of molecular biology, as well as for the understanding of quality control and normalization approaches. Here, early investments pay at the level of reduced technical variance, allowing for enhanced detection levels for the effects under investigation.
Image Analysis for cDNA Microarrays
Authors: Rahnenführer J.
Published: March 2018

Objectives:
We characterize typical problems encountered in microarray image analysis and present algorithmic approaches dealing with background estimation, spot identification and intensity extraction. Validation of the quality of resulting measurements is discussed.

Methods:
We describe sources for errors in microarray images and present algorithms that have been specifically developed to deal with such experimental imperfections.

Results:
For the image analysis of hybridization experiments, discriminating spot regions from a background is the most critical step. Spot shape detection algorithms, intensity histogram methods and hybrid approaches have been proposed. The correctness of final intensity estimates is difficult to verify. Nevertheless, the application of sophisticated algorithms provides a significant reduction of the possible information loss.

Conclusions:
The initial analysis step for array hybridization experiments is the estimation of expression intensities. The quality of this process is crucial for the validity of interpretations from subsequent analysis steps.
Quality Control for Microarray Experiments
Authors: Hartmann O.
Published: March 2018

Objectives:
In this paper we give an overview of post-hybridization quality control methods for gene expression chips, including methods for the gene/spot level, the hybridization/chip level and the process level. We present quality control methods that can be applied after hybridization and image analysis, i.e. that use data from the chip experiment itself. Wet lab quality control steps, which should be applied before the probe is measured on a chip, are not discussed. This review is aimed towards statisticians and data analysts.

Methods:
We give examples of some of the quality control measures available for spotted cDNA and Affymetrix GeneChips®, the most common chip types. As quality control measures are technology and design-dependent, we will stress on methods that have the potential to be applied platform-independently.

Results:
Quality control should identify poor quality chips or hybridizations, as well as faulty measurements for individual genes/spots. Additionally, high throughput laboratories processing several tens or hundreds of microarrays per week have the need for an appropriate process control to be able to identify changes in the production process as early as possible.

Conclusion:
Microarrays have become a standard research tool for biologists and medical researchers. As a consequence, there is a great need for standardized quality control, as false findings due to problem in data quality can lead to a substantial loss of resources.
Predicting Missing Values in a Home Care Database Using an Adaptive Uncertainty Rule Method
Authors: Gogou G. , Bamidis P. D. , Vlahavas I. , Maglaveras N. , Konias S.
Published: March 2018

Objectives:
Contemporary literature illustrates an abundance of adaptive algorithms for mining association rules. However, most literature is unable to deal with the peculiarities, such as missing values and dynamic data creation, that are frequently encountered in fields like medicine. This paper proposes an uncertainty rule method that uses an adaptive threshold for filling missing values in newly added records. A new approach for mining uncertainty rules and filling missing values is proposed, which is in turn particularly suitable for dynamic databases, like the ones used in home care systems.

Methods:
In this study, a new data mining method named FiMV (Filling Missing Values) is illustrated based on the mined uncertainty rules. Uncertainty rules have quite a similar structure to association rules and are extracted by an algorithm proposed in previous work, namely AURG (Adaptive Uncertainty Rule Generation). The main target was to implement an appropriate method for recovering missing values in a dynamic database, where new records are continuously added, without needing to specify any kind of thresholds beforehand.

Results:
The method was applied to a home care monitoring system database. Randomly, multiple missing values for each record’s attributes (rate 5-20% by 5% increments) were introduced in the initial dataset. FiMV demonstrated 100% completion rates with over 90% success in each case, while usual approaches, where all records with missing values are ignored or thresholds are required, experienced significantly reduced completion and success rates.

Conclusions:
It is concluded that the proposed method is appropriate for the data-cleaning step of the Knowledge Discovery process in databases. The latter, containing much significance for the output efficiency of any data mining technique, can improve the quality of the mined information.
Getting the Big Picture
Authors: Balka E.
Published: March 2018

Objectives: While recognized that global actors influence health information system design, studies of health informatics have largely focused on micro politics of technology design and implementation. Here a problematic patient care information system (PCIS) is discussed in relation to federal and provincial policies and corporate strategies to demonstrate that our understanding of health informatics can be enhanced by linking micro studies of health informatics to larger macro contexts.

Methods: Interviews and document study.

Results: Although the extent to which federal initiatives influenced (or failed to influence) provincial and hospital initiatives remains debateable, events initiated at one level (the hospital’s decision to implement software, initiated at the organizational level) are influenced (perhaps indirectly) by developments in other contexts (federal /macro changes gave an initiative more weight; provincial initiatives such as the Labour Accord altered the industrial relations environment in which system development occurred).

Conclusions: Micro-studies of work practice, invaluable in addressing interactions between technologies, users and work practices, often fail to account for the historic reach of global actors, although it is often these historic circumstances that contribute to present-day interactions between user, information system and organization, and that find expression – often indirectly – in daily work practices.
Understanding Terminological Systems II: Experience with Conceptual and Formal Representation of Structure
Authors: Abu-Hanna A. , de Keizer N. F.
Published: March 2018

This article describes the application of two popular conceptual and formal representation formalisms, as part of a framework for understanding terminological systems. A precise understanding of the structure of a terminological system is essential to assess existing terminological systems, to recognize patterns in various systems and to build new terminological systems. Our experience with the application of this framework to five well-known terminological systems is described.
Heart Rate and Blood Pressure Response to Short-Term Head-Down Bed Rest: A Nonlinear Approach
Authors: Balocchi R. , Di Garbo A. , Michelassi C. , Chillemi S. , Varanini M. , Barbi M. , Legramante J. M. , Raimondi G. , Zbilut J. P.
Published: March 2018

Although it is well-known that prolonged exposure to microgravity environment such as in space travel results in derangements of orthostasis, recent evidence suggests that even short-term exposure may have similar effects and parallels such common examples as prolonged bed rest. Whereas spectral analysis of heart rate and systolic blood pressure have been unable to detect changes, we hypothesized that nonlinear indexes may be better able to uncover such perturbations. Eighteen healthy subjects were exposed to 4-hour head-down tilt, and of these, 4 exhibited fainting. Two nonlinear indexes, mutual information and recurrence quantification were used to analyze the data. Only recurrence quantification was able to detect a “decoupling” of heart rate and systolic blood pressure at rest using discriminant analysis (p < 0.05). These results suggest that orthostatic intolerance may be due to a decoupling of heart rate from systolic blood pressure reflexive activity occurring at rest.
Estimation of Scale Factors in Presence of Multiple Signals: Application to sEMG Analysis
Authors: Rix H. , Meste O. , Muhammad W.
Published: March 2018

When several realizations of an unknown recurrent signal are observed apart from a time expansion or compression, the classical way of estimating these time scaling factors is to take one signal as reference for the estimation. This approach does not take into account the common information between all possible couples of realizations. To achieve this task we use a Maximum-Likelihood based method, in a sub-optimal manner. Using some realistic assumptions and simplifications, we propose a tractable solution. The improvement of classical results is shown through a simulation whose conclusion is that the larger the number of realizations, the more correct the estimation. Finally, we apply the method to electrically evoked sEMG.
Theoretical Analysis of a Rectifying Gap Junction Model
Authors: Zhang Y. T. , Bao J. L. , Hu X. L.
Published: March 2018

Based on the experimental observations, an electrical circuitry model for a rectifying gap junction was developed in previous work. In order to show the physiological function for each element in the model, a theoretical analysis is carried out in this report. The results indicate that the gap junctional capacitance Cj newly introduced into the model plays a major role in determining the duration increase, the peak attenuation, and the peak delay on the postmembrane action potential. Also, a comparison between the newly proposed model and the widely accepted kinetic model by Giaume is made. The results show that the electrical circuitry model can not only describe the characteristics of Giaume’s model but also allow the interpretation of some experimental phenomena that were not reflected in other gap junctional models.
Time Series and the Dynamics of Demand Pacing
Authors: Kaplan D. T.
Published: March 2018

Motivated by a common practice in cardiology, we analyze the dynamics of a demand paced system where one seeks to create a stable periodic response. By using techniques originally developed for controlling chaotic systems, one can enhance the information contained in time series regarding hidden, unstable periodic orbits. This makes it possible, for example, to track drifts in a system‘s dynamics.
Trend Recognition in Clinical Signals using Template-Based Methods
Authors: Lowe A. , Harrison M. J. , Jones R. W.
Published: March 2018

The recognition of clinically significant trends in monitored signals plays an important role in many medical diagnostic applications. A template-based system technique to identify characteristic patterns in time-series data is described, based on fuzzy logic. Fuzzy set theory allows the creation of fuzzy templates from linguistic rules. The resulting fuzzy template system can accommodate multiple time signals, relative or absolute trends, and automatically generates a normalised “goodness of fit” score. The template approach was originally developed for monitoring during anaesthesia but has the potential to be useful in other domains that require temporal pattern recognition.
The Use of Information Graphs to Evaluate and Compare Diagnostic Tests
Authors: Benish W. A.
Published: March 2018

Objectives:
The purpose of this communication is to demonstrate the use of “information graphs” as a means of characterizing diagnostic test performance.

Methods:
Basic concepts in information theory allow us to quantify diagnostic uncertainty and diagnostic information. Given the probabilities of the diagnoses that can explain a patient’s condition, the entropy of that distribution is a measure of our uncertainty about the diagnosis. The relative entropy of the posttest probabilities with respect to the pretest probabilities quantifies the amount of information gained by diagnostic testing. Mutual information is the expected value of relative entropy and, hence, provides a measure of expected diagnostic information. These concepts are used to derive formulas for calculating diagnostic information as a function of pretest probability for a given pair of test operating characteristics.

Results:
Plots of diagnostic information as a function of pretest probability are constructed to evaluate and compare the performance of three tests commonly used in the diagnosis of coronary artery disease. The graphs illustrate the critical role that the pretest probability plays in determining diagnostic test information.

Conclusions:
Information graphs summarize diagnostic test performance and offer a way to evaluate and compare diagnostic tests.
Biomechanical Diagnosis of Atherosclerosis by Ultrasound
Authors: Fukumoto T. , Wada T.
Published: March 2018

Setting: Atherosclerosis causes structural changes in artery walls that alter their physical properties. The stiffness parameteris one quantitative index of the elastic properties of large arteries.can be calculated from the measurements of blood pressure and arterial diameter. We examined whether quantitatively evaluates common carotid atherosclerosis. Methods: We measured the common carotid artery inner diameter and its pulsatile change with an ultrasonic instrument. The subjects were healthy persons, patients with atherosclesrosis risk factors, patients with myocardial infarctions, and patients with cerebral infarction. Results: Thein healthy persons aged 40-59 years was 11.2. β was 13.2 in patients with atherosclerosis risk factors, 13.4 in patients with myocardial infarction, and 13.5 in patients with cerebral infarctions. These data in each patient group were significantly higher than those in healthy subjects. Conclusions: This diagnostic method is inexpensive, noninvasive and easily performed.shows promise as a useful diagnostic indicator of atherosclerosis.
Resistance to Computerized Care Planning Systems by Qualified Nurses Working in the UK NHS
Authors: Timmons S.
Published: March 2018

Objective: This study investigated whether computerized systems, designed to produce detailed plans for the nursing care of inpatients, were resisted by the nurses who were expected to use them.

Methods: Qualitative study, using semi-structured interviews with nurses working in the UK National Health Service.

Results and Conclusions: Resistance took the form of ‘resistive compliance,’ and this resistance is analyzed and explained. Resistance can best be understood in terms of the culture of nursing. This implies that the design and implementation of computerized systems in health care should take these factors into account.
From Passive to Active Electronic Healthcare Records
Authors: Bisbal J. , Grimson W. , Berry D. , Hederman L. , Grimson J.
Published: March 2018

Objectives:
The provision of patient data to clinicians as and when it becomes available is a general objective of information systems in healthcare. It is known that the timely receipt of patient data can have a significant bearing on healthcare outcomes. One of the on-going tasks is to provide this data in the form of an Electronic Healthcare Record according to some agreed standard. The aim in this paper is to provide patient data in electronic form by pushing the information to the end users as soon it becomes available, in advance of any explicit request from the users.

Methods:
This paper describes how an existing record system, the Synapses Federated Healthcare Records Server, has been extended to incorporate active functionality to facilitate pushing the information to end-user applications. The user must specify the information of interest to him, so that the system pushes only information useful to the final user. The approach proposed here relies solely on the use of callbacks through the middleware layer being used, a mechanism available in all existing middleware implementations.

Results:
The Synapses Federated Healthcare Records Server which has resulted from this research is a more flexible and scaleable system, capable of fulfilling the needs of a wider range of healthcare organisation than when a strictly passive approach is used.

Conclusions:
It is shown that healthcare organisation can incorporate a healthcare record system with active functionality without any large investment or significant risk to their existing information systems.
Consultation of Medical Narratives in the Electronic Medical Record
Authors: Tange H. J.
Published: March 2018

This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.
An Approach to Policy Analysis and Development of Medical Informatics
Authors: Power M.
Published: March 2018

There are three grand challenges for medical informatics policy: (1) What is it? (2) What should it be? (3) How can we influence its development? To address these challenges requires: (1) an historical analysis of medical informatics policies in a representative sample of countries. This should include an account of major events, the roles of technology, individuals, culture and social settings. Pioneers have been led by visions of what medical informatics should achieve. The role of these visions and the reactions to unmet expectations thus also need to be analysed; (2) a generally applicable medical informatics policy that places the needs of its stake-holders and clients first. Top priorities are to support quality health care delivery and quality management of health care facilities; (3) an explanation of how policies in medical informatics are created and implemented together with a strategy to guide medical informatics professionals in their lobbying efforts.
Preliminary Findings of Adult Health Screening under National Health Insurance in Taiwan
Authors: Huang L. , Tseng H. M.
Published: March 2018

Objectives:
To provide baseline values of health elated parameters for the Taiwanese population.

Methods:
A systematic sample of 9016 out of 692,311 persons undergoing health check-ups is analyzed and described, and compared to a similar survey undertaken ten years ago. Some physical indices and lab tests exhibited significant age and sex related differences.

Results:
The prevalence of groups of diseases, and the distribution of test results by age and sex are reported and compared to other studies.

Conclusions:
Compared to the survey conducted ten years ago, Taiwanese adults are taller and heavier, but not necessarily healthier.
Survival Analysis with Time-varying Relative Risks: A Tree-Based Approach
Authors: Adak S. , Xu R.
Published: March 2018

A tree-based method for estimating time-varying effects of baseline patient characteristics on survival is introduced. A Cox-type model for censored survival data is used in which the time-varying relative risks are modelled as piecewise constants.

The tree method consists of three steps: 1. Growing the tree, in which a fast algorithm using maximized score statistics is utilized to determine the optimal change points; 2. A pruning algorithm is applied to obtain more parsimonious models; 3. Selection of a final tree, which may be either via bootstrap resampling or based on a measure of explained variation.

The piecewise constant model is more suitable for clinical interpretation of the regression parameters than the more continuously time-varying models (spline, loess, etc.) that have been proposed previously.
Digital Libraries and Recent Medical Informatics Research
Authors: Knaup P. , Maier C. , Mludek V. , Singer R. , Skonetzki S. , Wolff A. C. , Haux R. , Kulikowski C. , Ammenwerth E.
Published: March 2018

The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of recent excellent papers on medical informatics research (http://www.med.uni-heidelberg.de/mi/yearbook/index.htm). The special topic of the just published Yearbook 2001 is “Digital Libraries and Medicine”. Digital libraries have changed dramatically and will continue to change the way we work with medical knowledge. The selected papers present recent research and new results on digital libraries. As usual, the Yearbook 2001 also contains a variety of papers on other subjects relevant to medical informatics, such as Electronic Patient Records, Health Information Systems, Health and Clinical Management, Decision Support Systems, Education, as well as Image and Signal Processing. This paper will briefly introduce the contributions covering digital libraries and will show how medical informatics research contributes to this important topic.
Object-Oriented Modeling and Terminologies for Drug Contraindications
Authors: Liu J. H. , Milstein C. , Séné B. , Venot A.
Published: March 2018

There is no available standardized representation of contraindications that can be used in drug knowledge bases. In this paper, an objectoriented representation of contraindications is proposed that would allow computerized checking of drug prescription safety. It distinguishes four types of contraindications: pathological state, physiological state, findings of investigation procedures, and diagnostic or therapeutic procedures. The vocabulary usable for expressing the contraindications appropriate for automated prescription checking was also investigated. ICDlO (International Classification of Diseases, tenth revision), SNOMED III (Systematized Nomenclature of Medicine), ICPC (International Classification of Primary Care), and ATC (Anatomic Therapeutic and Chemical Classification) were studied as potential sources of standardized vocabulary. A system to support entering data on contraindications into a drug knowledge base, compatible with the proposed structure and using the identified vocabulary sources, is also presented.
Cognitive Models of Clinical Reasoning and Conceptual Representation
Authors: Patel V. L. , Arocha J. F.
Published: March 2018

This paper presents an approach to conceptual representation, informed by theories and methods from cognitive psychology. Our investigation of clinical case comprehension and reasoning from textual information has shifted from instantiation models in which text processing is carried out through schema fitting to more dynamic models that account for how schemata are constructed by a process of construction and integration of meaning, which depends on specific situations. We give an example involving doctor-patient dialogue to illustrate this point. Nonetheless, our main approach has been propositionally-based. As we conduct research into more specific aspects of medical understanding, such as understanding of physiological systems, we have included alternative approaches, such as qualitative functional graphs. We present examples of their use in our research. These representational formalisms allow us better to capture reasoning and understanding in dynamic systems.