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At least 775 records · Page 43

Man-machine interfaces in health care

The surgeon, like the pilot, is confronted with an ever increasing volume of voice, data, and image input. Simultaneously, the surgeon must control a rapidly growing number of devices to deliver care to the patient. The broad disciplines of man-machine interface design, systems integration, and teleoperation will play a role in the operating room of the future. The purpose of this communication is to report the incorporation of these design concepts into new surgical and laser delivery systems. A review of each general problem area and the systems under development to solve the problems are presented.

Charles, Steve↗

Measurement and modification of the EEG and related behavior

Electrophysiological changes in the sensorimotor pathways were found to accompany the effect of rhythmic EEG patterns in the sensorimotor cortex. Additionally, several striking behavioral changes were seen, including in particular an enhancement of sleep and an elevation of seizure threshold to epileptogenic agents. This raised the possibility that human seizure disorders might be influenced therapeutically by similar training. Our objective in human EEG feedback training became not only the facilitation of normal rhythmic patterns, but also the suppression of abnormal activity, thus requiring complex contingencies directed to the normalization of the sensorimotor EEG. To achieve this, a multicomponent frequency analysis was developed to extract and separate normal and abnormal elements of the EEG signal. Each of these elements was transduced to a specific component of a visual display system, and these were combined through logic circuits to present the subject with a symbolic display. Variable criteria provided for the gradual shaping of EEG elements towards the desired normal pattern. Some 50-70% of patients with poorly controlled seizure disorders experienced therapeutic benefits from this approach in our laboratory, and subsequently in many others. A more recent application of this approach to the modification of human brain function in our lab has been directed to the dichotomous problems of task overload and underload in the contemporary aviation environment. At least 70% of all aviation accidents have been attributed to the impact of these kinds of problems on crew performance. The use of EEG in this context has required many technical innovations and the application of the latest advances in EEG signal analysis. Our first goal has been the identification of relevant EEG characteristics. Additionally, we have developed a portable recording and analysis system for application in this context. Findings from laboratory and in-flight studies suggest that we will be able to detect appropriate changes in brain function, and feed this information to on-board computers for modification of mission requirements and/or crew status.

Sterman, M. B.↗

A physical control interface with proprioceptive feedback and multiple degrees of freedom

The use of the drug thalidomide by pregnant mothers in Britain resulted in a variety of deformities including the birth of children having no arms. Such children were provided with powered artificial arms with up to five degrees of freedom simultaneously controlled in real time by shoulder movement. The physiological sense of proprioception was extended from the user into the device, reducing the need for visual feedback and conscious control. With the banning of thalidomide, this technique fell into disuse but it is now being re-examined as a control mechanism for other artificial limbs and it may have other medical applications to allow patients to control formerly paralyzed limbs moved by electrical stimulation. It may also have commercial applications in robotic manipulation or physical interaction with virtual environments. To allow it to be investigated further, the original pneumatic control system has recently been converted to an electrical analogue to allow interfacing to electronic and computer-assisted systems. A harness incorporates force-sensitive resistors and linear potentiomenters for sensing position and force at the interface with the skin, and miniature electric motors and lead screws for feeding back to the user the position of the robotic arm and the forces applied to it. In the present system, control is applied to four degrees of freedom using elevation/depression and protraction/reaction of each shoulder so that each collar bone emulates a joystick. However, both electrical and mechanical components have been built in modular form to allow rapid replication and testing of a variety of force and position control strategies.

Creasey, G. H.↗

Effect of antiorthostatic BedRest (BR) on GastroIntestinal Motility (GIM) of normal subjects

The combined effects of postural changes, fluid shifts and diuresis associated with the absence of the gravity vector may decrease gastrointestinal motility (GIM) during space flight. GIM can be estimated from the mouth to cecum transit time (MCTT) of orally administered lactulose (LAC); this test is used to assess changes in GIM in normal subjects and in patients with GI pathology and related disease conditions. Since bedrest (BR) mimics some of the physiological changes that occur during space flight, the effect of ten days of BR on GIM was evaluated from the MCTT of LAC. Methods: Subjects were 12 nonsmoking males between the ages of 35 and 50. After an 8-10 hour fast, subjects ingested Cephulac (registered) (20 g solution) with a low-fiber breakfast on four different days (45, 30, 25, and 20) before BR and on three separate days (4, 7, and 10) during BR. Breath-H2 concentrations were measured before and at 10 minute intervals for 4 hours after breakfast using a Quintron breathalyzer and MCTT was determined from these data. Results: MCTT ranged between 10 and 122 minutes during ambulation and 80 to 120 minutes during BR with means of 79 minutes and 122 minutes respectively. Conclusion: Mean MCTT during BR was 54 percent longer than during ambulation, suggesting that absorption and availability of orally administered medications and nutrients may be delayed or impaired as a result of decreased GIM during bedrest.

Putcha, L.↗

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Johnston, S. L.↗

On the development of an expert system for wheelchair selection

The presentation of wheelchairs for the Multiple Sclerosis (MS) patients involves the examination of a number of complicated factors including ambulation status, length of diagnosis, and funding sources, to name a few. Consequently, only a few experts exist in this area. To aid medical therapists with the wheelchair selection decision, a prototype medical expert system (ES) was developed. This paper describes and discusses the steps of designing and developing the system, the experiences of the authors, and the lessons learned from working on this project. Wheelchair Advisor, programmed in CLIPS, serves as diagnosis, classification, prescription, and training tool in the MS field. Interviews, insurance letters, forms, and prototyping were used to gain knowledge regarding the wheelchair selection problem. Among the lessons learned are that evolutionary prototyping is superior to the conventional system development life-cycle (SDLC), the wheelchair selection is a good candidate for ES applications, and that ES can be applied to other similar medical subdomains.

Madey, Gregory R.↗

Expert Witness: A system for developing expert medical testimony

Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

Lewandowski, Raymond↗

Neural network classification of clinical neurophysiological data for acute care monitoring

The purpose of neurophysiological monitoring of the 'acute care' patient is to allow the accurate recognition of changing or deteriorating neurological function as close to the moment of occurrence as possible, thus permitting immediate intervention. Results confirm that: (1) neural networks are able to accurately identify electroencephalogram (EEG) patterns and evoked potential (EP) wave components, and measuring EP waveform latencies and amplitudes; (2) neural networks are able to accurately detect EP and EEG recordings that have been contaminated by noise; (3) the best performance was obtained consistently with the back propagation network for EP and the HONN for EEG's; (4) neural network performed consistently better than other methods evaluated; and (5) neural network EEG and EP analyses are readily performed on multichannel data.

Sgro, Joseph↗

Shuttle to Space Station. Heart Assist Implant. Hubble Update. X-30 Mock-Up

Shuttle to Space Station, Heart Assist Implant, Hubble Update, and X-30 Mockup are the four parts that are discussed in this video. The first part, Shuttle to Space Station, is focussed on the construction and function of the Space Station Freedom. While part two, Heart Assist Implant, discusses a newly developed electromechanical device that helps to reduce heart attack by using electric shocks. Interviews with the co-inventor and patients are also included. Brief introduction to Hubble Telescope, problem behind its poor image quality (mirror aberration), and the plan to correct this problem are the three issues that are discussed in part three, Hubble Update. The last part, part four, reviews the X-30 Mockup designed by the staff and students of Mississippi State University.

Source record↗

Hip Implant Modified To Increase Probability Of Retention

Modification in design of hip implant proposed to increase likelihood of retention of implant in femur after hip-repair surgery. Decreases likelihood of patient distress and expense associated with repetition of surgery after failed implant procedure. Intended to provide more favorable flow of cement used to bind implant in proximal extreme end of femur, reducing structural flaws causing early failure of implant/femur joint.

Canabal, Francisco, III↗

Wireless Infrared Data Link

Infrared transmitter and receiver designed for wireless transmission of information on measured physical quantity (for example, temperature) from transducer device to remote-acquisition system. In transmitter, output of transducer amplified and shifted with respect to bias or reference level, then fed to voltage-to-frequency converter to control frequency of repetition of current pulses applied to infrared-light-emitting diode. In receiver, frequency of repetition of pulses converted back into voltage indicative of temperature or other measured quantity. Potential applications include logging data while drilling for oil, transmitting measurements from rotors in machines without using slip rings, remote monitoring of temperatures and pressures in hazardous locations, and remote continuous monitoring of temperatures and blood pressures in medical patients, who thus remain mobile.

Roth, Timothy E.↗

A CLIPS expert system for clinical flow cytometry data analysis

An expert system is being developed using CLIPS to assist clinicians in the analysis of multivariate flow cytometry data from cancer patients. Cluster analysis is used to find subpopulations representing various cell types in multiple datasets each consisting of four to five measurements on each of 5000 cells. CLIPS facts are derived from results of the clustering. CLIPS rules are based on the expertise of Drs. Stewart, Duque, and Braylan. The rules incorporate certainty factors based on case histories.

Salzman, G. C.↗

A Compact Fiber Optic Eye Diagnostic System

A new fiber optic probe developed for determining transport properties of sub-micron particles in fluid experiments in a microgravity environment has been applied to study different parts of an eye. The probe positioned in front of an eye, delivers a low power (approximately few microW) light from a laser diode into the eye and guides the light which is back scattered by different components (aqueous humor, lens, and vitreous humor) of the eye through a receiving optical fiber to a photo detector. The probe provides rapid determination of macromolecular diffusivities and their respective size distributions in the eye lens and the gel-like materials in the vitreous humor. In a clinical setting, the probe can be mounted on a standard slit-lamp apparatus simply using a Hruby lens holder. The capability of detecting cataracts, both nuclear and cortical, in their early stages of formation, in a non invasive and quantitative fashion, has the potential in patient monitoring and in developing and testing new drugs or diet therapies to 'dissolve' or slow down the cataract formation before the surgery becomes necessary. The ability to detect biochemical and macromolecular changes in the vitreous structure can be very useful in identifying certain diseases of the posterior chamber and their complications, e.g., posterior vitreous detachment and diabetic retinopathy.

Ansari, Rafat R.↗

Ophthalmic Diagnostics Using a New Dynamic Light Scattering Fiber Optic Probe

A new fiber optic probe is developed to study different parts of the eye. The probe positioned in front of an eye, delivers a low power light from a laser diode into the eye and guides the light which is back scattered by different components (aqueous humor, lens, and vitreous humor) of the eye through a receiving optical fiber to a photo detector. The probe provides rapid determination of macromolecular diffusivities and their respective size distributions in the eye lens and the gel-like material in the vitreous humor. We report alpha-crystalline size distributions, as a function of penetration depth, inside the lens and hyaluronic acid molecular size distribution in the vitreous body. In a clinical setting, the probe can be mounted on a slit-lamp apparatus simply by using a H-ruby lens holder. The capability of detecting cataracts, both nuclear and peripheral, in their early stages of formation, in a non invasive and quantitative fashion, has the potential in patient monitoring and in developing and testing new drugs or diet therapies to 'dissolve' or slow down the cataract formation before surgery is necessary. The ability to detect biochemical and macromolecular changes in the vitreous structure can be very useful in identifying certain diseases of the posterior chamber, e.g., posterior vitreous detachment.

Ansari, Rafat R.↗

A Compact Fiber Optic Eye Diagnostics System

A new fiber optic probe development for determining transport properties of sub-micron particles in fluids experiments in a microgravity environment has been applied to study different parts of the eye. The probe positioned in front of an eye, delivers a low power (approximately a few mu W) light from a laser diode into the eye and guides the light which is back scattered by different components (aqueous humor, lens, and vitreous humor) of the eye through a receiving optical fiber to a photo detector. The probe provides rapid determination of macromolecular diffusivities and their respective size distributions in the eye lens and the gel-like material in the vitreous humor. For a clinical use, the probe is mounted on a standard slit-lamp apparatus simply using Hruby lens holder. The capability of detecting cataracts, both nuclear and cortical, in their early stages of formation, in a non invasive and quantitative fashion, has the potential in patient monitoring and in developing and testing new drugs or diet therapies to 'dissolve' or slow down the cataract formation before the surgery becomes necessary. The ability to detect biochemical and macromolecular changes in the vitreous structure can be very useful in identifying certain diseases of the posterior chamber and their complications, e.g., posterior vitreous detachment and diabetic retinopathy.

Ansari, Rafat R.↗

PCR Based Microbial Monitor for Analysis of Recycled Water Aboard the ISSA: Issues and Prospects

The monitoring of spacecraft life support systems for the presence of health threatening microorganisms is paramount for crew well being and successful completion of missions. Development of technology to monitor spacecraft recycled water based on detection and identification of the genetic material of contaminating microorganisms and viruses would be a substantial improvement over current NASA plans to monitor recycled water samples that call for the use of conventional microbiology techniques which are slow, insensitive, and labor intensive. The union of the molecular biology techniques of DNA probe hybridization and polymerase chain reaction (PCR) offers a powerful method for the detection, identification, and quantification of microorganisms and viruses. This technology is theoretically capable of assaying samples in as little as two hours with specificity and sensitivity unmatched by any other method. A major advance in probe-hybridization/PCR has come about in a technology called TaqMan(TM), which was invented by Perkin Elmer. Instrumentation using TaqMan concepts is evolving towards devices that could meet NASA's needs of size, low power use, and simplicity of operation. The chemistry and molecular biology needed to utilize these probe-hybridization/PCR instruments must evolve in parallel with the hardware. The following issues of chemistry and biology must be addressed in developing a monitor: Early in the development of a PCR-based microbial monitor it will be necessary to decide how many and which organisms does the system need the capacity to detect. We propose a set of 17 different tests that would detect groups of bacteria and fungus, as well as specific eukaryotic parasites and viruses; In order to use the great sensitivity of PCR it will be necessary to concentrate water samples using filtration. If a lower limit of detection of 1 microorganism per 100 ml is required then the microbes in a 100 ml sample must be concentrated into a volume that can be added to a PCR assay; There are not likely to be contaminants in ISSA recycled water that would inhibit PCR resulting in false-negative results; The TaqMan PCR product detection system is the most promising method for developing a rapid, highly automated gene-based microbial monitoring system. The method is inherently quantitative. NASA and other government agencies have invested in other technologies that, although potentially could lead to revolutionary advances, are not likely to mature in the next 5 years into working systems; PCR-based methods cannot distinguish between DNA or RNA of a viable microorganism and that of a non-viable organism. This may or may not be an important issue with reclaimed water on the ISSA. The recycling system probably damages the capacity of the genetic material of any bacteria or viruses killed during processing to serve as a template in a PCR desinged to amplify a large segment of DNA (less than 650 base pairs). If necessary, vital dye staining could be used in addition to PCR, to enumerate the viable cells in a water sample; The quality control methods have been developed to insure that PCR's are working properly, and that reactions are not contaminated with PCR carryover products which could lead to the generation of false-positive results; and The sequences of the small rRNA subunit gene for a large number of microorganisms are known, and they consititue the best database for rational development of the oligonucleotide reagents that give PCR its great specificity. From those gene sequences, sets of oligonucleotide primers for PCR and Taqman detection that could be used in a NASA microbial monitor were constructed using computer based methods. In addition to space utilization, a microbial monitior will have tremendous terrestrial applications. Analysis of patient samples for microbial pathogens, testing industrial effluent for biofouling bacteria, and detection biological warfare agents on the battlefield are but a few of the diverse potential uses for this technology. Once fully developed, gene-based microbial monitors will become the fundamental tool in every lab that tests for microbial contaminants, and serve as a powerful weapon in mankind's war with the germ world.

Cassell, Gail H.↗

Increased beta-adrenergic responsiveness induced by 14 days exposure to simulated microgravity

Increased sensitivity of end-organ responses to neuroendocrine stimuli as a result of prolonged exposure to the relative inactivity of microgravity has recently been hypothesized. This notion is based on the inverse relationship between circulating norepinephrine and beta-adrenoreceptor sensitivity. The beta-adrenoreceptor activity is reduced in individuals who have elevated plasma norepinephrine as a result of regular exposure to upright posture and physical exercise. In contrast, adrenoreceptor hypersensitivity has been reported in patients with dysautonomias in which circulating catecholamines are absent or reduced. Taken together, these studies and the observation that circulating plasma norepinephrine has been reduced during spaceflight and in groundbased simulations of microgravity prompt the suggestion that adrenoreceptor hypersensitivity may be a consequence of the adaptation to spaceflight. We conducted an experiment designed to measure cardiovascular responses to adrenoreceptor agonists in human subjects before and after prolonged exposure to 6 deg head-down tilt (HDT) to test the hypothesis that adaptation to microgravity increases adrenoreceptor responsiveness, and that this adaptation is associated with reduced levels of circulating norepinephrine.

Convertino, V. A.↗