Comparison of dual-energy subtraction and electronic bone suppression combined with computer-aided detection on chest radiographs: effect on human observers' performance in nodule detection

The objective of our study was to compare the effect of dual-energy subtraction and bone suppression software alone and in combination with computer-aided detection (CAD) on the performance of human observers in lung nodule detection.

Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings

OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication.

BACKGROUND: Early detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response. METHODS: Using both qualitative and quantitative methods, we evaluated positive FOBT communication in the electronic health record of a large, urban facility between May 2008 and March 2009. We identified the source of test result communication breakdown, and developed an intervention to fix the problem. Explicit medical record reviews measured timely follow-up (defined as response within 30 days of positive FOBT) pre- and post-intervention. RESULTS: Data from 11 interviews and tracking information from 490 FOBT alerts revealed that the software intended to alert primary care practitioners (PCPs) of positive FOBT results was not configured correctly and over a third of positive FOBTs were not transmitted to PCPs. Upon correction of the technical problem, lack of timely follow-up decreased immediately from 29.9% to 5.4% (p<0.01) and was sustained at month 4 following the intervention. CONCLUSION: Electronic communication of positive FOBT results should be monitored to avoid limiting colorectal cancer screening benefits. Robust quality assurance and oversight systems are needed to achieve this. Our methods may be useful for others seeking to improve follow-up of FOBTs in their systems.

Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential?

BACKGROUND: Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem. METHODS: We studied critical imaging alert notifications in the outpatient setting of a tertiary care Department of Veterans Affairs facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (ie, health care practitioner/provider [HCP] opened the message for viewing) within 2 weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted HCPs to determine timely follow-up actions (eg, ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by HCPs analyzed predictors for 2 outcomes: lack of acknowledgment and lack of timely follow-up. RESULTS: Of 123 638 studies (including radiographs, computed tomographic scans, ultrasonograms, magnetic resonance images, and mammograms), 1196 images (0.97%) generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when the ordering HCPs were trainees (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.86-10.89) and when dual-alert (>1 HCP alerted) as opposed to single-alert communication was used (OR, 2.02; 95% CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs 9.7%; P = .22). Risk for lack of timely follow-up was higher with dual-alert communication (OR, 1.99; 95% CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12; 95% CI, 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment. CONCLUSIONS: Critical imaging results may not receive timely follow-up actions even when HCPs receive and read results in an advanced, integrated electronic medical record system. A multidisciplinary approach is needed to improve patient safety in this area.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

Software para análisis automático de ficheros de imagen

El presente proyecto fin de carrera consiste en el diseño, desarrollo e implementación de una aplicación informática cuya función sea la identificación de distintos ficheros de imagen, audio y video y la interpretación y presentación de los metadatos asociados a los mismos. El software desarrollado, EXTRACTORDATOS_LBS, reconocerá el tipo de formato del fichero bajo estudio a partir del análisis de los bytes de identificación contenidos en la cabecera del archivo. En base a la información registrada en dicha cabecera, la aplicación interpretará el contenido de los metadatos asociados al fichero, mostrando por pantalla aquellos que resulten de interés para el análisis de los mismos. Previamente a la implementación del software se acomete el análisis teórico de los formatos de diversos archivos multimedia, recogidos en múltiples normas y recomendaciones. Tras esa identificación, se procede al desarrollo de la aplicación EXTRACTORDATOS_LBS , que informa de los parámetros de interés contenidos en las cabeceras de los archivos. El desarrollo se ilustra con los diagramas conceptuales asociados a la arquitectura del software implementado. De igual forma, se muestran las salidas por pantalla de una serie de ficheros de muestra, y se presenta el manual de usuario de la aplicación. La versión electrónica de este documento acompaña el ejecutable que permite el análisis de los archivos. This final project consists in the design, development and implementation of a computer application whose function is the identification of different image, audio and video files and the interpretation and presentation of their metadata. The software developed, EXTRACTORDATOS_LBS, will recognize the type of the file under study through the analysis of the identification bytes contained on the file’s header. Based on information registered in this header, the application will interpret the metadata content associated to file, displaying the most interesting ones for their analysis. Prior to the software implementation, a theoretical analysis of the different formats of media files is undertaken. After this identification, the application EXTRACTORDATOS_LBS is developed. This software analyzes and displays the most interesting parameters contained in multimedia file’s header. The development of the application is illustrated with flow charts associated to the architecture of the software. Furthermore, some graphic examples of use of the program are included, as well as the user’s manual. The electronic version of this document attaches the executable file that permits file analysis.

KATS: A Knowledge Acquisition Tool Based on Electronic Document Processing

This paper describes a particular knowledge acquisition tool for the construction and maintenance of the knowledge model of an intelligent system for emergency management in the field of hydrology. This tool has been developed following an innovative approach directed to end-users non familiarized in computer oriented terminology. According to this approach, the tool is conceived as a document processor specialized in a particular domain (hydrology) in such a way that the whole knowledge model is viewed by the user as an electronic document. The paper first describes the characteristics of the knowledge model of the intelligent system and summarizes the problems that we found during the development and maintenance of such type of model. Then, the paper describes the KATS tool, a software application that we have designed to help in this task to be used by users who are not experts in computer programming. Finally, the paper shows a comparison between KATS and other approaches for knowledge acquisition.

Desarrollo de herramienta software para la caracterización de células y módulos de concentración fotovoltaica

La caracterización de módulos fotovoltaicos proporciona las especificaciones eléctricas que se necesitan para conocer los niveles de eficiencia energética que posee un módulo fotovoltaico de concentración. Esta caracterización se consigue a través de medidas de curvas IV, de igual manera que se obtienen para caracterizar los módulos convencionales. Este proyecto se ha realizado para la optimización y ampliación de un programa de medida y caracterización de hasta cuatro módulos fotovoltaicos que se encuentran en el exterior, sobre un seguidor. El programa, desarrollado en LabVIEW, opera sobre el sistema de medida, obteniendo los datos de caracterización del módulo que se está midiendo. Para ello en primer lugar se ha tomado como base una aplicación ya implementada y se ha analizado su funcionamiento para poder optimizarla y ampliarla para introducir nuevas prestaciones. La nueva prestación más relevante para la medida de los módulos, busca evitar que el módulo entre medida y medida, se encuentre disipando toda la energía que absorbe y se esté calentando. Esto se ha conseguido introduciendo una carga electrónica dentro del sistema de medida, que mantenga polarizado el módulo siempre y cuando, no se esté produciendo una medida sobre él. En este documento se describen los dispositivos que forman todo el sistema de medida, así como también se describe el software del programa. Además, se incluye un manual de usuario para un fácil manejo del programa. ABSTRACT. The aim of the characterization of concentrator photovoltaic modules (CPV) is to provide the electrical specifications to know the energy efficiency at operating conditions. This characterization is achieved through IV curves measures, the same way that they are obtained to characterize conventional silicon modules. The objective of this project is the optimization and improvement of a measurement and characterization system for CPV modules. A software has been developed in LabVIEW for the operation of the measurement system and data acquisition of the IV curves of the modules. At first, an already deployed application was taken as the basis and its operation was analyzed in order to optimize and extend to introduce new features. The more relevant update seeks to prevent the situation in which the module is dissipating all the energy between measurements. This has been achieved by introducing an electronic load into the measuring system. This load maintains the module biased at its maximum power point between measurement periods. This work describes the devices that take part in the measurement system, as well as the software program developed. In addition, a user manual is included for an easy handling of the program.

Selective SWIFT-R. A Flexible Software-Based Technique for Soft Error Mitigation in Low-Cost Embedded Systems

Commercial off-the-shelf microprocessors are the core of low-cost embedded systems due to their programmability and cost-effectiveness. Recent advances in electronic technologies have allowed remarkable improvements in their performance. However, they have also made microprocessors more susceptible to transient faults induced by radiation. These non-destructive events (soft errors), may cause a microprocessor to produce a wrong computation result or lose control of a system with catastrophic consequences. Therefore, soft error mitigation has become a compulsory requirement for an increasing number of applications, which operate from the space to the ground level. In this context, this paper uses the concept of selective hardening, which is aimed to design reduced-overhead and flexible mitigation techniques. Following this concept, a novel flexible version of the software-based fault recovery technique known as SWIFT-R is proposed. Our approach makes possible to select different registers subsets from the microprocessor register file to be protected on software. Thus, design space is enriched with a wide spectrum of new partially protected versions, which offer more flexibility to designers. This permits to find the best trade-offs between performance, code size, and fault coverage. Three case studies have been developed to show the applicability and flexibility of the proposal.

Software de gestão pedagógica e administrativa para as escolas

Trabalho de Projeto apresentado à Escola Superior de Tecnologia do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Desenvolvimento de Software e Sistemas Interactivos, realizada sob a orientação científica do Professor Doutor José Carlos Metrôlho, do Instituto Politécnico de Castelo Branco.

Tools for embedded computing systems software.

"Preprint for a workshop sponsored by NASA Langley Research Center, Hampton, Virginia, and the American Institute of Aeronautics and Astronautics, New York, and held in Hampton, Virginia, November 7-8, 1978."

What do we need in programming languages for mathematical software? /

"UIUCDCS-R-74-652"

GRASS: system software description,

"C00-1469-0190."