The problem of evaluating short-term autonomic response to hypovolemia in patients under chronic hemodialysis treatment is considered. Power spectra of the beat-to-beat heart rate variability were evaluated during the dialysis treatment in twenty hemodynamically stable and unstable patients, using a parametric technique. The autoregressive model coefficients were calculated by the modified covariance method, while model order was selected according to the minimum description length criterion. Reported results demonstrate that stable and unstable patients present markedly different spectral patterns. The efficiency of the compensatory response to hemodialysis-induced hypovolemia was evaluated through the ratio between the powers in LF and HF bands. Stable patients exhibit a LF/HF ratio greater than one with large fluctuations over the whole dialysis session. In contrast, all the unstable patients are characterized by a value of LF/HF lower than one and with a reduced time variability. This result suggests that the hemodynamic instability of the hypotension-prone patients may be due to a deficiency in the short-term compensatory response to the hemodialysis-induced hypovolemia.
This paper demonstrates a fuzzy Hopfield neural network for segmenting multispectral MR brain images. The proposed approach is a new unsupervised 2-D Hopfield neural network based upon the fuzzy clustering technique. Its implementation consists of the combination of 2-D Hopfield neural network and fuzzy c-means clustering algorithm in order to make parallel implementation for segmenting multispectral MR brain images feasible. For generating feasible results, a fuzzy c-means clustering strategy is included in the Hopfield neural network to eliminate the need for finding weighting factors in the energy function which is formulated and based on a basic concept commonly used in pattern classification, called the 'within-class scatter matrix' principle. The suggested fuzzy c-means clustering strategy has also been proven to be convergent and to allow the network to learn more effectively than the conventional Hopfield neural network. The experimental results show that a near optimal solution can be obtained using the fuzzy Hopfield neural network based on the within-class scatter matrix.
Verapamil is supposed to suppress the initiation of circus movement supraventricular tachycardia by affecting the atrioventricular node. In electrophysiological tests, programmed stimulation is usually performed by using the same location for pacing and premature stimulus. Spontaneous ectopic activity starts from a different location than the sinus node and can therefore find altered re-entry conditions. In this study a 3D computer model based on Huygen's principle is used for simulation of the spread of excitation in the human heart in combination with a posterobasal, right or left lateral accessory pathway (AP). The effect of verapamil on properties of the atrioventricular node were modelled by prolonging the effective refractory period and basal conduction time. For each of the three APs, ectopic foci at the atrial base and between sinus node and AP were modelled at various coupling intervals for investigating re-entrant activation. In the control state (without verapamil) only orthodromic echoes were found. The maximum echo zone (EZ) range was found near the AP. If stimuli were selected further away from the AP on the atrial basis, the EZ range decreased until no EZ was found. The EZ range decreased from it's maximum value near the AP, towards the difference of the effective refractory periods between AP and AV-node near the sinus node Verapamil abolished the EZ in case of a posteroseptal AP. For a lateral AP the administration of verapamil resulted in an orthodromic and antidromic EZ depending on the atrial premature activation site. A maximum orthodromic EZ was found for premature stimuli near the AP. As stimulus site moved away from the AP, the EZ range first decreased continuously to zero leading eventually to an antidromic EZ. These findings suggest the important influence of the site of premature stimuli with respect to the accessory pathway and AV-node on the inducibility of atrial re-entry.
This paper addresses the requirements of healthcare providers and hospital managers vis-à-vis electronic patient records that can be integrated. It starts from some critical failure factors, found with previous attempts to standardise the electronic health record. Standardisation appears to be the key issue: the subject of standardisation requires delicate positioning. Technology must provide us with the means to obtain the standardised foundation for an integrated health record concept, which can be completely configured and customised to meet the requirements of health professionals and institutions involved. NUCLEUS, project A2025 in the AIM programme, has taken on this endeavour, and with good success. This paper summarises the benefits of this approach for various categories of people interested in using electronic patient records. Moreover, it illustrates NUCLEUS' contribution to achieving seamless integration of care. Furthermore, this paper explains the conceptual innovations that have been achieved in the NUCLEUS project. It consolidates the main concept of Act Management, structuring the professional primary process as well as the interprofessional communication. These concepts are subsequently expanded to include the key elements of the NUCLEUS integrated electronic patient record. Next, the paper reflects on what has appeared to be one of the critical success factors of the electronic patient record: its configuration and customisation facilities. These facilities make it possible to access the patient record at various intuitive aggregation levels and to make the integrated patient record ‘look like’ the individually specialised record of the respective healthcare professionals. Finally, the paper addresses various topics required to facilitate the successful implementation and operation of the NUCLEUS integrated electronic patient record like security, integrity, message communication, distribution, heterogeneity and the context of the hospital information system.
