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1.  Some clinical aspects of reconstruction for chronic anterior cruciate ligament deficiency. 
A total of 250 patients was reviewed 71.8 months (range 49-105 months) after anterior cruciate ligament (ACL) reconstruction for disabling instability that had not responded to conservative treatment or correction of internal derangements. Knees that had undergone previous operation or had damage to other ligaments were excluded. Four techniques were used; MacIntosh extra-articular lateral substitution alone (n = 18), extra-articular reconstruction plus intra-articular carbon fibre (n = 29), extra-articular reconstruction plus a free graft from the medial third of the patellar tendon (n = 74), or extra-articular reconstruction plus a Leeds-Keio prosthesis (n = 129). The knees were assessed 1, 3 and 6 years after reconstruction using the Lysholm score and clinical examination for the anterior drawer, Lachman and pivot shift signs. The mean Lysholm score after 6 years was 77.4 (range 31-100) in the extra-articular group; 74.4 (range 34-100) in the carbon fibre group; 95.4 (range 43-100) in the patellar tendon group; and 91.2 (range 45-100) in the Leeds-Keio group. The patellar tendon group had the highest scores (P < 0.003). The pivot shift sign returned in 39% of the extra-articular group; 48% of the carbon fibre group; 1% of the patellar tendon group, and 36% of the Leeds-Keio group. The pivot shift returned least often in the patellar tendon group (P < 0.001). There were 44% satisfactory results (pivot shift negative and Lysholm score 77 or more) in the extra-articular group; 55% in the carbon fibre group; 92% in the patellar tendon group; and 60% in the Leeds-Keio group.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC2502334  PMID: 7574323
2.  MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up. 
Annals of the Rheumatic Diseases  1985;44(11):738-741.
The results of 75 MacIntosh arthroplasties performed for rheumatoid arthritis of the knee in 63 patients were reviewed at least 10 years after surgery. Forty-two knees in 35 patients were available for assessment. Eleven arthroplasties had been revised to total knee replacement without difficulty because of pain or poor function. The remaining 31 knees in 25 patients gave good or excellent results in 22 cases, fair in eight, and poor in one. Seven patients could not be traced, and 21 patients representing 26 knees had died. At least half these knees had given satisfactory results immediately before death judged by review of the case notes. The difficulty of comparing functional status with the preoperative state because of progressive multiarticular disease was highlighted. Although greater angular deformities preoperatively reduced the chance of success in the medium term, late failure of the arthroplasty after five years was very rare. Approximately two-thirds of all the arthroplasties performed gave satisfactory results at 10-year follow up or until the time of death.
PMCID: PMC1001760  PMID: 4062388
3.  Laryngoscope Modification to Avoid Perioral Trauma Due to Laryngoscopy† 
Anesthesia Progress  1982;29(2):47-49.
Trauma to hard and soft tissues of the oral and perioral regions occurs due to laryngoscopy. This paper identifies patients predisposed to dental complication preoperatively, explains the course to be taken intra- and post-operatively should such a complication occur and presents a modification of the MacIntosh laryngoscopy blade suitable for most patients.
PMCID: PMC2515600  PMID: 6130727
4.  The acute abdomen in emergency with Hypercard. 
A non-sequential Bayesian program for diagnosing acute abdominal pain was developed using an Amdahl mainframe accessed by a Texas Instrument remote terminal. Transferring the program to a MacIntosh SE/30 using hypercard was attended by increased utilisation from 15 to 44%.
PMCID: PMC2247514  PMID: 1807577
5.  A Demonstration of Doctor-Patient Encounter Modules Written in SuperCard 
We illustrate three sample MacIntosh subsystems for a doctor to use: 1) grading of signs and symptoms; 2) writing prescriptions; and 3) recording procedures with simultaneous computation of medical charges using ICD-91 and CPT2 codes. The above examples are supported by small generic scripts written by the SuperCard programmer and larger medical databases (text, buttons, graphics) maintained by the physician user.
PMCID: PMC2245526
6.  Comparison of static and dynamic repairs for ligamentous instability of the knee. 
Twenty-three patients who have had a MacIntosh type of fasciodesis for anterolateral rotary instability of the knee have been studied. Overall 73% were improved by this procedure; of those whose only instability was when turning on the run, 90% improved. These results have been compared with a series of 51 patients who had a pes anserinus transfer for anteromedial instability (D'Arcy 1978). It is suggested that both static and dynamic reconstructions have a place in the management of knee instability resulting from anterior cruciate injury.
PMCID: PMC1439640  PMID: 6631873
7.  Implementation of a filmless mini picture archiving and communication system in ultrasonography: Experience after one year of use 
Journal of Digital Imaging  1997;10(Suppl 1):80-82.
This article details our experience in developing and operating an ultrasound mini-picture archiving and communication system (PACS). Using software developed in-house, low-end MacIntosh computers (Apple Computer Co, Cupertino, CA) equipped with framegrabbers coordinate the entry of patient demographic information, image acquisition, and viewing on each ultrasound scanner. After each exam, the data are transmitted to a central archive server where they can be accessed from anywhere on the network. The archive server also provides web-based access to the data and manages pre-fetch and other requests for data that may no longer be on-line. Archival is fully automatic and is performed on recordable compact disk (CD) without compression. The system has been filmless now for over 18 months. In the meantime, one film processor has been eliminated and the position of one film clerk has been reallocated. Previously, nine ultrasound machines produced approximately 150 sheets of laser film per day (at 14 images per sheet). The same quantity of data are now archived without compression onto a single CD. Start-up costs were recovered within six months, and the project has been extended to include computed tomography (CT) and magnetic resonance imaging (MRI).
PMCID: PMC3452806  PMID: 9268846
Ultrasound; PACS; filmless radiology; recordable CD
8.  MacPharmacy: A Relational Database Adjunt to a Hypermedia-Based Physician Workstation 
MacPharmacy is a relational database built as an adjunct to RadOnc, a hypermedia-based physician workstation in the domain of radiation oncology. Conceived originally as a RadOnc module for chemotherapeutic agents, the MacPharmacy database contains information on a large selection of drugs which can be accessed by a variety of users. Information on generic and trade names, pharmacodynamics, indications, and dosage is linked to RadOnc disease descriptions and patient records which contain a clinical summary of the presentation, treatment and results. MacPharmacy's features include data table addition and updating and a customizable user interface that can be linked to other applications. Due to the scarcity of Macintosh-based pharmacy databases, MacPharmacy fills an information gap for clinically-oriented Macintosh users.
PMCID: PMC2245471
9.  A Demonstration of the MAClinical Workstation 
Medical Students at the Georgetown University School of Medicine on clinical rotations at the University Hospital now have access to Macintosh IIs and ImageWriter IIs on the wards. The MACs are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The Intent of the Macintosh project is to provide students with workstations of the sort they will use in future medical practice and to instill information query habits in the daily clinical activities of physicians- in-training. Currently, there are eight MACs located in conference rooms around the hospital where students and residents hold teaching rounds and write admission notes. Faculty participating in the project have been loaned MACs.
The student workstations at the hospital are designed to serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics. Secondarily, but equally essential, students can use H&P Writer, a HyperCard stack developed at Georgetown with MacWrite and MacDraw to prepare the admission record on the patients they examine. Graphics, sketches and illustrations are part of the system. The work- stations have access to IAIMS/LIS databases, such as minIMEDLINE, Alerts/Current Contents, Physicians Data Query (PDQ), a Drug/Poison Information System and RECONSIDER, a diagnostic prompting system.
PMCID: PMC2245673
10.  A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia 
BMC Anesthesiology  2011;11:6.
The C-MAC® (Karl Storz, Tuttlingen, Germany) has recently been introduced as a new device for videolaryngoscopy guided intubation. The purpose of the present study was to compare for the first time the C-MAC with conventional direct laryngoscopy in 150 patients during routine induction of anaesthesia.
After approval of the institutional review board and written informed consent, 150 patients (ASA I-III) with general anaesthesia were enrolled. Computer-based open crossover randomisation was used to determine the sequence of the three laryngoscopies: Conventional direct laryngoscopy (HEINE Macintosh classic, Herrsching, Germany; blade sizes 3 or 4; DL group), C-MAC size 3 (C-MAC3 group) and C-MAC size 4 (C-MAC4 group) videolaryngoscopy, respectively. After 50 patients, laryngoscopy technique in the C-MAC4 group was changed to the straight blade technique described by Miller (C-MAC4/SBT).
Including all 150 patients (70 male, aged (median [range]) 53 [20-82] years, 80 [48-179] kg), there was no difference of glottic view between DL, C-MAC3, C-MAC4, and C-MAC4/SBT groups; however, worst glottic view (C/L 4) was only seen with DL, but not with C-MAC videolaryngoscopy. In the subgroup of patients that had suboptimal glottic view with DL (C/L≥2a; n = 24), glottic view was improved in the C-MAC4/SBT group; C/L class improved by three classes in 5 patients, by two classes in 2 patients, by one class in 8 patients, remained unchanged in 8 patients, or decreased by two classes in 1 patient. The median (range) time taken for tracheal intubation in the DL, C-MAC3, C-MAC4 and C-MAC4/SBT groups was 8 sec (2-91 sec; n = 44), 10 sec (2-60 sec; n = 37), 8 sec (5-80 sec; n = 18) and 12 sec (2-70 sec; n = 51), respectively.
Combining the benefits of conventional direct laryngoscopy and videolaryngoscopy in one device, the C-MAC may serve as a standard intubation device for both routine airway management and educational purposes. However, in patients with suboptimal glottic view (C/L≥2a), the C-MAC size 4 with straight blade technique may reduce the number of C/L 3 or C/L 4 views, and therefore facilitate intubation. Further studies on patients with difficult airway should be performed to confirm these findings.
PMCID: PMC3060123  PMID: 21362173
11.  Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways 
Clinics  2014;69(1):23-27.
Videolaryngoscopy has mainly been developed to facilitate difficult airway intubation. However, there is a lack of studies demonstrating this method's efficacy in pediatric patients. The aim of the present study was to compare the TruView infant EVO2 and the C-MAC videolaryngoscope with conventional direct Macintosh laryngoscopy in children with a bodyweight ≤10 kg in terms of intubation conditions and the time to intubation.
In total, 65 children with a bodyweight ≤10 kg (0-22 months) who had undergone elective surgery requiring endotracheal intubation were retrospectively analyzed. Our database was screened for intubations with the TruView infant EVO2, the C-MAC videolaryngoscope, and conventional direct Macintosh laryngoscopy. The intubation conditions, the time to intubation, and the oxygen saturation before and after intubation were monitored, and demographic data were recorded. Only children with a bodyweight ≤10 kg were included in the analysis.
A total of 23 children were intubated using the C-MAC videolaryngoscope, and 22 children were intubated using the TruView EVO2. Additionally, 20 children were intubated using a standard Macintosh blade. The time required for tracheal intubation was significantly longer using the TruView EVO2 (52 sec vs. 28 sec for C-MAC vs. 26 sec for direct LG). However, no significant difference in oxygen saturation was found after intubation.
All devices allowed excellent visualization of the vocal cords, but the time to intubation was prolonged when the TruView EVO2 was used. The absence of a decline in oxygen saturation may be due to apneic oxygenation via the TruView scope and may provide a margin of safety. In sum, the use of the TruView by a well-trained anesthetist may be an alternative for difficult airway management in pediatric patients.
PMCID: PMC3870305  PMID: 24473556
Videolaryngoscopy; Tracheal Intubation; Infants
12.  Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU 
Critical Care  2012;16(3):R103.
Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy.
In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®).
A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001).
Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur.
PMCID: PMC3580658  PMID: 22695007
13.  Characteristics of early vocabulary and grammar development in Slovenian-speaking infants and toddlers: a CDI-adaptation study* 
Journal of Child Language  2012;40(4):779-798.
A large body of research shows that vocabulary does not develop independently of grammar, representing a better predictor of the grammatical complexity of toddlers' utterances than age. This study examines for the first time the characteristics of vocabulary and grammar development in Slovenian-speaking infants and toddlers using the Slovenian adaptation of the MacArthur-Bates Communicative Development Inventories (CDI). The sample included 512 Slovenian-speaking infants and toddlers aged 0 ; 8 to 2 ; 6. The findings suggest that between age 0 ; 8 and 2 ; 6 the development of vocabulary is best described using a quadratic function. The results also show that nouns predominate in the vocabularies of infants and toddlers of various ages; as they age and with the increasing size of their vocabularies, the share of interjections decreases and the share of verbs and adjectives increases. The size of vocabulary was also found to be related to the grammatical structure of toddlers' utterances.
PMCID: PMC3729236  PMID: 22863332
14.  A multiple process solution to the logical problem of language acquisition* 
Journal of child language  2004;31(4):883-914.
Many researchers believe that there is a logical problem at the center of language acquisition theory. According to this analysis, the input to the learner is too inconsistent and incomplete to determine the acquisition of grammar. Moreover, when corrective feedback is provided, children tend to ignore it. As a result, language learning must rely on additional constraints from universal grammar. To solve this logical problem, theorists have proposed a series of constraints and parameterizations on the form of universal grammar. Plausible alternatives to these constraints include: conservatism, item-based learning, indirect negative evidence, competition, cue construction, and monitoring. Careful analysis of child language corpora has cast doubt on claims regarding the absence of positive exemplars. Using demonstrably available positive data, simple learning procedures can be formulated for each of the syntactic structures that have traditionally motivated invocation of the logical problem. Within the perspective of emergentist theory (MacWhinney, 2001), the operation of a set of mutually supportive processes is viewed as providing multiple buffering for developmental outcomes. However, the fact that some syntactic structures are more difficult to learn than others can be used to highlight areas of intense grammatical competition and processing load.
PMCID: PMC1876779  PMID: 15658750
15.  Searching for and predicting the activity of sites for DNA binding proteins: compilation and analysis of the binding sites for Escherichia coli integration host factor (IHF). 
Nucleic Acids Research  1990;18(17):4993-5000.
An analysis of the sequence information contained in a compilation of published binding sites for E. coli integration host factor (IHF) was performed. The sequences of twenty-seven IHF sites were aligned; the base occurrences at each position, the information content, and an extended consensus sequence were obtained for the IHF site. The base occurrences at each position of the IHF site were used with a program written for the Apple Macintosh computers in order to determine the similarity scores for published IHF sites. A linear correlation was found to exist between the logarithm of IHF binding and functional data (relative free energies) and similarity scores for two groups of IHF sites. The MacTargsearch program and its potential usefulness in searching for other sites and predicting their relative activities is discussed.
PMCID: PMC332103  PMID: 2205834
16.  MacQuestionnaire: Creating and Administering Interactive Computerized Questionnaires to Patients 
This demonstration project presents a hypermedia generator for interactive patient questionnaire creation and administration on the Macintosh® computer. It is designed for clinicians (non-programmers) who wish to construct and use computerized questionnaires to gather data directly from patients for use in research or clinical work. Computerized questionnaires have been studied for over 2 decades, but are little used in clinical medicine. Research shows them to be advantageous to clinicians and widely accepted by patients, but barriers to their use such as clinician resistance, cost, availability of questionnaires, and proven clinical utility must be overcome before their use will spread. MacQuestionnaire is software for the microcomputer designed to improve access to this tool among clinicians and to facilitate the production of questionnaires that can be shared among health providers. (Submitted 8/9/90)
PMCID: PMC2245478
17.  OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM Images 
Journal of Digital Imaging  2004;17(3):205-216.
A multidimensional image navigation and display software was designed for display and interpretation of large sets of multidimensional and multimodality images such as combined PET-CT studies. The software is developed in Objective-C on a Macintosh platform under the MacOS X operating system using the GNUstep development environment. It also benefits from the extremely fast and optimized 3D graphic capabilities of the OpenGL graphic standard widely used for computer games optimized for taking advantage of any hardware graphic accelerator boards available. In the design of the software special attention was given to adapt the user interface to the specific and complex tasks of navigating through large sets of image data. An interactive jog-wheel device widely used in the video and movie industry was implemented to allow users to navigate in the different dimensions of an image set much faster than with a traditional mouse or on-screen cursors and sliders. The program can easily be adapted for very specific tasks that require a limited number of functions, by adding and removing tools from the program’s toolbar and avoiding an overwhelming number of unnecessary tools and functions. The processing and image rendering tools of the software are based on the open-source libraries ITK and VTK. This ensures that all new developments in image processing that could emerge from other academic institutions using these libraries can be directly ported to the OsiriX program. OsiriX is provided free of charge under the GNU open-source licensing agreement at
PMCID: PMC3046608  PMID: 15534753
DICOM viewer; 3D; image fusion; dynamic series; open-source software
18.  Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students’ hands: A manikin study 
Saudi Journal of Anaesthesia  2011;5(4):376-381.
Background and Aim:
Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6th year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools.
Setting and Design:
Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital.
Fifty medical students performed either oral or nasal tracheal intubation using the following four intubating tools: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres′ use among different airway tools were recorded.
In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope (P<0.001). Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008).
New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.
PMCID: PMC3227306  PMID: 22144924
Airtraq; airway tools; C-Mac video laryngoscope; Glidescope; Macintosh laryngoscope; medical students
19.  Comparison of evaluations of hormone receptors in breast carcinoma by image-analysis using three automated immunohistochemical stainings 
The aim of this study was to compare the results of immunohistochemistry (IHC) assays evaluated by human examiners with the results evaluated by computerized image analysis, and to compare the computerized image analysis results among three automated IHC assays, namely the BioGenex, Dako and Ventana assays. All slides were semiquantitatively evaluated according to the Allred score and J-score by human examiners. The images were analyzed using MacSCOPE version 2.6 for Macintosh according to the H-score and the percentage of positive-stained nuclei per area of carcinoma cells (PP) irrespective of the intensity of the stained nuclei. The H-score for the estrogen receptor (ER) was significantly correlated with the Allred score (P<0.0001) and the PP for the ER was significantly correlated with the J-score (P<0.0001), suggesting that the image analysis used in the present study is a useful method for the evaluation of ER status. Several discrepancies were identified between the Allred score and H-score and between the PP and J-score due to the positive-stained cytoplasm area of carcinoma cells and/ or the positive-stained nuclei area of non-carcinoma cells, including benign epithelial cells, lymphocytes and stromal cells. Accordingly, advances in the algorithm of the digitized analyzing system is necessary.
PMCID: PMC3446734  PMID: 22993620
estrogen receptor; immunohistochemistry; automated staining; image analysis
20.  Interactive visualization tools for the structural biologist 
Journal of Applied Crystallography  2013;46(Pt 5):1518-1520.
Two software plugins are presented for the Mac OSX operating system that allow rapid and convenient visualization of Protein Data Bank files and X-ray diffraction images directly within the file browser, without the need for full-featured applications.
In structural biology, management of a large number of Protein Data Bank (PDB) files and raw X-ray diffraction images often presents a major organizational problem. Existing software packages that manipulate these file types were not designed for these kinds of file-management tasks. This is typically encountered when browsing through a folder of hundreds of X-ray images, with the aim of rapidly inspecting the diffraction quality of a data set. To solve this problem, a useful functionality of the Macintosh operating system (OSX) has been exploited that allows custom visualization plugins to be attached to certain file types. Software plugins have been developed for diffraction images and PDB files, which in many scenarios can save considerable time and effort. The direct visualization of diffraction images and PDB structures in the file browser can be used to identify key files of interest simply by scrolling through a list of files.
PMCID: PMC3778324  PMID: 24068844
PDB visualization; X-ray diffraction images; data management
21.  Growth of Escherichia coli O157:H7 in Bruised Apple (Malus domestica) Tissue as Influenced by Cultivar, Date of Harvest, and Source 
Four of five apple cultivars (Golden Delicious, Red Delicious, McIntosh, Macoun, and Melrose) inoculated with Escherichia coli O157:H7 promoted growth of the bacterium in bruised tissue independent of the date of harvest (i.e., degree of apple ripening) or the source of the apple (i.e., tree-picked or dropped fruit). Apple harvest for this study began 4 September 1998 and ended 9 October, with weekly sampling. Throughout this study, freshly picked (<2 days after harvest) McIntosh apples usually prevented the growth of E. coli O157:H7 for 2 days. Growth of E. coli O157:H7 did occur following 6 days of incubation in bruised McIntosh apple tissue. However, the maximum total cell number was approximately 80-fold less than the maximum total cell number recovered from Red Delicious apples. When fruit was stored for 1 month at 4°C prior to inoculation with E. coli O157:H7, all five cultivars supported growth of the bacterium. For each apple cultivar, the pH of bruised tissue was significantly higher and °Brix was significantly lower than the pH and °Brix of undamaged tissue regardless of the source. In freshly picked apples, changes in the pH did not occur over the harvest season. Bruised Golden Delicious, McIntosh, and Melrose apple tissue pHs were not significantly different (tree-picked or dropped), and the °Brix values of McIntosh, Macoun, and Melrose apple tissue were not significantly different. Single-cultivar preparations of cider did not support growth of E. coli, and the cell concentration of inoculated cider declined over an 11-day test period. The rate of decline in E. coli cell concentration in the McIntosh cider was greater than those in the other ciders tested. The findings of this study suggested that the presence of some factor besides, or in addition to, pH inhibited E. coli growth in McIntosh apples.
PMCID: PMC91945  PMID: 10698774
22.  HistoLogical, a computer atlas and drill of histology. 
An educational program has been developed to aid the instruction of Histology, a required course for the first year medical student. The program was developed using SuperCard on an Apple Macintosh IIci computer. It incorporates high quality color images with a hypermedia format, i.e. the student can jump from topic to topic as he/she wishes. The program has an "atlas," which provides information about each image and topic being discussed, and a "drill," which presents to the student a question about an image and provides feedback tailored to the student's answer. In the drill, the student is asked to type in responses to the questions; the answer is judged by text recognition. For each question, feedback is written for the correct answer, incorrect answer, and up to 10 "accessory answers" (answers which might be expected although they are not correct). The faculty of the UMMS Histology course has encouraged the use of this program in this years' course, and evaluation received from faculty and students has been quite positive.
PMCID: PMC2247681  PMID: 1807757
23.  Evolving stochastic context--free grammars for RNA secondary structure prediction 
BMC Bioinformatics  2012;13:78.
Stochastic Context–Free Grammars (SCFGs) were applied successfully to RNA secondary structure prediction in the early 90s, and used in combination with comparative methods in the late 90s. The set of SCFGs potentially useful for RNA secondary structure prediction is very large, but a few intuitively designed grammars have remained dominant. In this paper we investigate two automatic search techniques for effective grammars – exhaustive search for very compact grammars and an evolutionary algorithm to find larger grammars. We also examine whether grammar ambiguity is as problematic to structure prediction as has been previously suggested.
These search techniques were applied to predict RNA secondary structure on a maximal data set and revealed new and interesting grammars, though none are dramatically better than classic grammars. In general, results showed that many grammars with quite different structure could have very similar predictive ability. Many ambiguous grammars were found which were at least as effective as the best current unambiguous grammars.
Overall the method of evolving SCFGs for RNA secondary structure prediction proved effective in finding many grammars that had strong predictive accuracy, as good or slightly better than those designed manually. Furthermore, several of the best grammars found were ambiguous, demonstrating that such grammars should not be disregarded.
PMCID: PMC3464655  PMID: 22559985
24.  Response analysis in histopathology external quality assessment schemes. 
Journal of Clinical Pathology  1993;46(4):357-363.
AIMS--To develop a computerised method for analysing the results of histopathology external quality assessment (EQA) schemes which can provide confidential personal reports to individual participating pathologists. METHODS--A program was developed using the OMNIS database system, running on Apple Macintosh or IBM compatible computers. RESULTS--The program produces a general report of participants' responses to each case, and a choice of two types of personal report. One of these provides a list of the participant's diagnoses with a list of the most popular (Consensus) diagnoses for comparison. The other provides automatically calculated scores for the pathologist's performance along with simple statistical evaluation. The scores can be calculated by comparison with the consensus of the group or with correct diagnoses if they are known. A histogram indicating the distribution of performance within the group can be produced. The program can accept uncertainty in the form of differential diagnosis lists from participants. Potentially dangerous diagnostic errors can be identified and handled separately. Participants are identified only by code numbers and confidentiality can easily be enforced. The program is currently being used in the national renal pathology EQA scheme and in the local general histopathology scheme in the East Midlands. CONCLUSIONS--This program offers solutions to problems which have bedevilled the organisers of histopathology EQA schemes. It offers confidential advice to pathologists and will help to identify areas where an individual might benefit from continuing career grade medical education. It raises the possibility of the development of nationally agreed standards of performance in the reporting of pathological specimens, and it may be applicable to other specialties where textual reports are produced.
PMCID: PMC501220  PMID: 8496394
25.  Promotion of Patient Medical Attendance Using a Microcomputer 
Indigent care facilities are often faced with very poor patient appointment compliance and have little or no staff to correct the problem. Automation of patient tracking and communication with referrers was accomplished with a Macintosh Computer. The Delta Patient Management/Billing System is an integrated relational data base with appointment scheduling, medical record keeping, patient tracking, case identification, epidemiological data generation and medical billing capabilities.
The efficacy of the system in recalling patients who have failed their appointments was demonstrated with the finding that 27% of rescheduled patients, above controls, returned for a medical visit. The income for patients attending rescheduled failed appointments was only 62% of that for patients who attended their appointments regularly and did not require rescheduling. Thus, it can be concluded that the system is reaching its targeted population.
One of the strongest arguments for the use of computerized patient tracking is accountability, both on the part of the physician and also on the part of the parent/patient. Computerization will make it more difficult for patients to become lost to follow-up and for clinic personnel to ignore non-compliant parent/patients.
PMCID: PMC2245744

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