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Previously, sponsored publications have shown that either terbinafine or itraconazole (pulse regimen) are effective for patients with toenail onychomycosis. However, independent comparative studies are lacking.To objectively compare treatment with terbinafine and itraconazole in patients with toenail onychomycosis.The effectiveness of terbinafine (250 mg/day 3 months) versus itraconazole pulse regimen (400 mg/day for the first week of each month, for three cycles) was retrospectively evaluated in patients with toenail onychomycosis using mycological tests and subjective outcome measures. Statistical analyses were performed using one-way analyses of variance (ANOVA) for continuous variables and Fisher exact tests for categorical variables.Included in the study were 117 patients (74 patients treated by terbinafine and 43 patients treated with itraconazole). Patients were examined at an average period of 20 months after the end of therapy. Mycological cure was observed in 70.6% and 62.8% of the patients who were treated by terbinafine or itraconazole, respectively (not statistically significant). Mean visual analogue scale assessment of treatment outcome was 79.9 mm (SD 24.7 mm) and 65.2 mm (SD 34.6 mm) for patients treated by terbinafine or itraconazole, respectively (p=0.008). When the results were stratified according to age and gender, it was observed that the advantage of terbinafine versus itraconazole retained statistical significance only for patients who were 55 years old and above, or females.Mycological cure proportions were not statistically significant between patients treated by terbinafine or itraconazole for toenail onychomycosis. However, better subjective outcome measures indicated an advantage for terbinafine over itraconazole, noticeable in females and patients 55 years old and above.

Background: Emergency departments (ED) in Israel deal with a large number of referrals from the Israel Defense Force. In a recent study, we observed that only 3% of soldiers referred to the ED in Soroka Medical Center were hospitalized. Objectives: The purpose of this study was to determine the appropriateness of soldier referrals to the ED, using a proposed set of criteria for ED appropriateness. Methods: A retrospective assessment of 707 discharge letters of soldiers from the ED was performed. A set of criteria to assess the appropriateness of soldier's referrals to the ED was developed. The criteria were as follows: (1) resuscitation, (2) hospitalization, (3) laboratory examination, (4) X-ray examination, (5) medical treatment, and (6) specialist consultation. A referral was considered appropriate if at least one criterion was positive. Results: According to the proposed criteria of ED military appropriateness, 586 of 707 referrals (83%) were considered as appropriate. Appropriateness of the referrals according to sections of the ED was as follows: orthopedics (97%), internal medicine (63%), ophthalmology (100%), and neurosurgery (100%). Conclusions: A discrepancy exists between the high proportion of appropriate soldiers' referrals to the ED and the low hospitalization proportion. Organizational steps should be undertaken in the Israel Defense Force to decrease excess military use of civilian ED services.

The authors introduce a modified approach to phoneme recognition. The new method is based on the assumption that efficient features for phoneme identification in connected speech, depend on the examined phoneme and on the surrounding phonemes. Hence in a given phonetic environment, each phoneme si best separated from other phonemes by means of an 'individual' feature set. This leads to a quadratic discriminant. Using the new approach an improvement of 8% in consonant recognition was demonstrated. A labeling algorithm for connected speech recognition is proposed. It employs accumulated information concerning the phonetic environment prior to consonant labeling. >

A new distortion measure for ECG signal compression is introduced. This diagnostic distortion measure, called the Weighted Diagnostic Distortion (WDD), is based on comparing the PQRST complex features (such as: P wave duration, P wave amplitude, P wave shape, QT duration, ST elevation, etc.) between two signals (original ECG signal and reconstructed ECG signal). Also in this article, a new compression algorithm is introduced, based on analysis by synthesis coding. In our compression system the encoder consists of a long term and a short term predictors and a quantizer with an adaptive number and values of levels, which are depended on the definition of maximum permitted distortion for each segment in the signal. The algorithm exhibits better results than other known compression algorithms.

Malignant neoplasms known to develop after external beam radiation include angiosarcoma. Although angiosarcoma developing in a lymphedematous arm after radical mastectomy is a well-known phenomenon, cutaneous angiosarcoma after radiotherapy for breast carcinoma has been rarely documented. Herein we present a case with cutaneous angiosarcoma that developed in a 69-year-old woman's breast 5 years after she underwent conservative treatment to the breast: lumpectomy, axillary lymph node dissection, and radiation therapy to the breast. The possible relation of the angiosarcoma to the initial radiotherapy, early diagnosis, and treatment is discussed.

This paper describes a speaker dependent system comprising two independent stages. The first stage performs segmentation of the speech to phoneme (or sub phoneme) sections while the second stage performs phoneme classification (labeling). Several labeling procedures based on hidden Markov model are described. A simple continuous speech adaptive phoneme segmentation algorithm is introduced. In an experimental evaluation of the system 93.86% correct boundary marks were received by the suggested adaptive phoneme segmentation algorithm. Recognition rate was 72.38% received for phonemes segmented manually and 68.94% for phonemes segmented using the suggested algorithm. These results are comparable with reported phoneme recognition systems in English and other languages. >

Papular urticaria often occurs after bites of insects such as mosquitoes, sandflies, bed bugs and fleas. Multiple bites and local pruritus are characteristic symptoms. Treatment is usually symptomatic and includes antihistamines and corticosteroids. The reappearance of the symptoms can be prevented by successful control of the parasite.To find the causative agent of papular urticaria in afflicted households with involvement of numerous family members, all in a narrow geographic area.We describe the cases of 20 patients belonging to seven families, who presented to the local primary clinic, suffering from papular urticaria.The cat flea, Ctenocephalides felis, was the hematophagous insect responsible for all infestations. The pruritus and the papular urticaria were treated symptomatically with calamine lotion, topical corticosteroids or oral antihistamines. All clinical symptoms disappeared within a few weeks after effective control of the parasites by spraying and fumigating the infested locations.Thorough investigation--including, at times, environmental inspection--is necessary to reach the rewarding discovery of the etiology of household papular urticaria. This condition may arise in other environments of similar character.

Hidden Markov Models (HMM) are statistical models used very successfully and effectively in speech processing. The model is however a general model for stochastic processes and may thus be applied to a large variety of biomedical signals. The paper provides an in depth tutorial on HMM and its applications to biomedical signal processing. Discrete Density (DD-HMM) and Continuous Density HMM (CD-HMM) are presented. The various algorithms required for training the model, for estimating the optimal state sequence and the observation probabilities are discussed. The HMMs have not been widely applied to biomedical signal processing. The paper reviews some of the applications, and discusses potential applications.

The authors introduce a new ECG compression algorithm, and a new distortion measure. The distortion measure, called the Weighted Diagnostic Distortion (WDD), is based on comparing PQRST complex features (such as: RR interval, QT interval, ST elevation, etc.) of the original ECG signal and the reconstructed one. The compression algorithm is based on analysis by synthesis coding. It consists of a beat codebook, long and short term predictors, and an adaptive residual quantizer. The compression algorithm uses the WDD measure in order to encode, by means of analysis by synthesis, every beat of the original ECG signal. The compression algorithm has been applied to the MIT-BIH Arrhythmia Database. A rate of approximately 100 bits per second has been achieved with a very good quality (WDD below 4%, and PRD below 8%).

An algorithm for unsupervised speaker classification using Kohonen SOM is presented. The system employs 6/spl times/10 SOM networks for each speaker and for non-speech segments. The algorithm was evaluated using high quality as well as telephone quality conversations between two speakers. Correct classification of more than 90% was demonstrated. High quality conversation between three speakers yielded 80% correct classification. The high quality speech required the use of 12/sup th/ order cepstral coefficients vector. In telephone quality speech, an additional 12 features of the difference of the cepstrum were required.

Analysis of lung sounds for monitoring and diagnosis of pulmonary function is well known. The application of these techniques to ventilation monitoring during anesthesia or in intensive care, may prove a convenient, accurate and very low latency monitoring device. A prototype of such a system is described. The system is able to monitor the current state of ventilation and automatically classify among three types: Tracheal Intubation (TRI), Left Lung Intubation (LLI) and Right Lung Intubation (RLI), Preliminary experiments, performed on dogs, show mean classification accuracy of 90%.

Speaker recognition and verification has been used in a variety of commercial, forensic and military applications. The classical problem is that of supervised recognition, in which there is sufficient a priori information on the speakers to be identified. In such cases, the recognition system has speaker models, estimated during training sessions. This paper deals with the problem of unsupervised speaker classification, where no a priori speaker information is available. The algorithm accepts multi-speaker dialogue speech data, estimates the number of speakers and assigns each speech segment to its speaker. Preliminary results are described.

An HMM continuous Hebrew phoneme recognition system, that requires no manual segmentation for its training was developed. A relatively small Hebrew data base was acquired for training and recognition of phonemes in continuous speech. One of the main problems in phoneme recognition, that of manual segmentation of the training data base, was overcome by a special training algorithm. The Viterbi algorithm was used in the recognition stage, and the evaluation of the results was done with the Levenshtein distance measure. Initial recognition results of Hebrew phonemes for speaker independent, text dependent cases were 69.4% correct phoneme recognition.

BACKGROUND: Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face. METHODS: A 60-year-old woman with multiple miliary osteoma cutis of the face was treated by application of 0.05% tretinoin (all- trans -retinoic acid) cream nightly. RESULTS: After 3 months of therapy there were fewer papules and a decrease in size of remaining lesions. In a literature search, it was found that local application of tretinoin was successful and achieved a decrease in the number of papules over the face in all patients with multiple miliary osteoma cutis of the face; however, the length of time to achieve response varied from a few weeks to 6 months. CONCLUSION: It is suggested that local application of tretinoin cream should be considered in the therapy of multiple miliary osteoma cutis of the face, particularly when the lesions are small and superficial.

Autoimmune progesterone dermatitis was manifested as deep-type erythema annulare centrifugum. Sensitivity to progesterone was studied in vivo by means of intradermal and patch tests, which revealed immediate-type and delayed-type hypersensitivity, respectively. Sensitivity to progesterone was further confirmed in vitro by results of an interferon-gamma release test, which imply a possible role for T(H)1-type cytokines in autoimmune progesterone dermatitis.

In vitro evidence suggests that intracellular calcium metabolism influences keratinocyte differentiation. However, only a few reports have described exacerbation of psoriasis or psoriasiform eruptions due to intake of calcium channel blockers. We conducted a case-control study to evaluate the association between exposure to calcium channel blockers and psoriasis. Data were obtained through a retrospective assessment of the files of 150 patients hospitalized for psoriasis or psoriasiform eruptions and 150 matched control patients. Exposure to calcium channel blockers was recorded in case and control patients. It was found that 13/150 patients hospitalized for psoriasis consumed calcium channel blockers. Calcium channel blockers were associated with precipitation of new-onset psoriasis (n = 2), as well as with the exacerbation of psoriasis (n = 11). The calcium channel blockers were as follows: nifedipine (n = 10), felodipine (n = 2) and amlodipine (n = 1). The median latent period between the beginning of intake of calcium channel blockers and precipitation or exacerbation of psoriasis was 28 months (range 4-143 months). A stepwise multivariate logistic regression analysis demonstrated that intake of calcium channel blockers was significantly associated with psoriasis, as compared to the control group (p = 0.018). Our study implies a possible role of calcium channel blockers as precipitating or exacerbating factors in patients with psoriasis.

Background Psoriatic arthritis (PsA) is associated with higher prevalence and risk for cardiovascular morbidities [1,2]. Objectives The aim of the study is to substantiate these findings in our population and to examine additional aspects of cardiovascular morbidities, including congestive heart failure and cardiomyopathy. Methods A retrospective, longitudinal, cohort case control study was performed on records of patients with PsA between 2000 and 2013 from the database of Israel9s largest health care provider, Clalit Health Services. For each patient with PsA, 5 control patients without history of psoriasis or rheumatoid arthritis were chosen, matched for age and gender. The following morbidities were analyzed: ischemic heart disease (IHD), valvular heart disease excluding mitral valve prolapse, congestive heart failure (CHF), cardiomyopathy, idiopathic hypertrophic subaortic stenosis (IHSS), cerebrovascular accident (CVA), carotid artery disease, peripheral vascular disease (PVD), and aortic aneurism. T-test was used to compare continuous variables and Chi square test was used for categorical variables. Age, gender, socioeconomic status and ethnicity were entered into a multivariate regression model. Results The study included 3161 patients with PsA, 1474 males (46.6%) and 1687 (53.4%) females with a mean age of 58.29±15.44 years, and 15,805 controls. Comparative analysis demonstrated higher prevalence of the following in the case cohort: IHD (18.95% vs. 14.49%) p Conclusions A high prevalence of cardiovascular co-morbidities was found in this cohort of PsA patients. The spectrum of cardiac involvement was not limited to IHD, carotid artery disease and PVD, and included also increased risk of CHF, cardiomiopathies and valvular heart disease. A high index of suspicion, and close monitoring and treatment of cardiovascular risk factors are recommended. References Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep 2010;12:281–287. Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et a l. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013;27(Suppl. 3):12–29. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3830

A 91-year-old patient presented with a nonfebrile, pruritic, widespread eruption that appeared 10 days after starting therapy with cefuroxime tablets, 1000 mg/day, due to stasis dermatitis with secondary infection. The patient was also treated with paracetamol tablets, 500–1000 mg/day, 10 days before the onset of the eruption. Previous diseases included congestive heart disease, hyperglycemia, and ectropion. There was no personal or family history of psoriasis. Additional medications, taken for more than 2 years at the time of the eruption, included indomethacin, captopril, hydrochlorothiazide, isosorbide-5-mononitrate tablets, and a combination drug Laxative®. Examination revealed widespread erythema involving 95% of the total body surface area, with numerous 1–2 mm nonfollicular pustules (Fig. 1). There was no predilection to the body folds. Within 24 h of hospitalization, during intravenous therapy with cefuroxime, the patient's condition worsened and bullae containing clear fluid appeared. Nikolsky's sign was positive on erythematous skin, and eventually skin detachment involved 41% of the total body surface area (Fig. 2). There were no target or target-like lesions and there was no involvement of the mucous membranes. Figure 1. Numerous, 1−2 mm, nonfollicular pustules, with confluence (viewed in the lower left part of the photograph), on erythematous skin Download figure to PowerPoint Figure 2. Widespread skin detachment Download figure to PowerPoint An early biopsy from a pustule revealed subcorneal and intraepidermal spongiform pustules, papillary edema, perivascular mononuclear infiltrate with a few eosinophils in the dermis, and leukocytoclastic vasculitis. A later biopsy showed similar findings with no evidence of full-thickness epidermal necrosis or necrotic keratinocytes. Direct immune fluorescence (DIF) taken from erythematous skin was negative. Laboratory studies showed the following results: sedimentation rate, 80 mm/h; white blood cell count, 26,200/mm3 with 87% polymorphonuclears and 1.8% eosinophils; hemoglobin, 13.0 g/dL; albumin, 2.8 g/dL (normal, 3.5–5.5 g/dL); other blood chemistry tests were normal. Immunologic studies for rheumatoid factor, antinuclear antibodies, antismooth muscle antibodies, antiparietal cell antibodies, antimitochondrial antibodies, C3, and C4 were normal or negative. Serology for venereal disease research laboratory (VDRL) test, Epstein–Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and antistreptolysin titer was negative. Chest X-ray was normal. Blood cultures were negative. Swab cultures taken from the pustules revealed Staphylococcus aureus as well as coagulase-negative Staphylococcus. All systemic drugs, including intravenous cefuroxime, were withdrawn with close monitoring for signs of heart failure or infection. Topical therapy consisted of application of wet dressings. Within 10 days, the eruption resolved with re-epithelialization of the erosions and the appearance of widespread post-pustular desquamation (Fig. 3) Figure 3. Post-pustular desquamation on the trunk Download figure to PowerPoint

Cherry angiomas are the most common vascular proliferation; however, little is known about the pathogenesis and etiology of these lesions. We present two laboratory technicians who were exposed to brominated compounds for prolonged periods and who developed multiple cherry angiomas on the trunk and extremities. We suggest that the association between exposure to bromides and cherry angiomas should be investigated by a controlled study.

In this paper, a new distortion measure for electrocardiogram (ECG) signal compression, called weighted diagnostic distortion (WDD) is introduced. The WDD measure is designed for comparing the distortion between original ECG signal and reconstructed ECG signal (after compression). The WDD is based on PQRST complex diagnostic features (such as P wave duration, QT interval, T shape, ST elevation) of the original ECG signal and the reconstructed one. Unlike other conventional distortion measures [e.g. percentage root mean square (rms) difference, or PRD], the WDD contains direct diagnostic information and thus is more meaningful and useful. Four compression algorithms were implemented (AZTEC, SAPA2, LTP, ASEC) in order to evaluate the WDD. A mean opinion score (MOS) test was applied to test the quality of the reconstructed signals and to compare the quality measure (MOS/sub error/) with the proposed WDD measure and the popular PRD measure. The evaluators in the WIGS test were three independent expert cardiologists, who studied the reconstructed ECG signals in a blind and a semiblind tests. The correlation between the proposed WDD measure and the MOS test measure (MOS/sub error/) was found superior to the correlation between the popular PRD measure and the MOS/sub error/.

Background Drug-related T-cell activity in cutaneous drug reactions may be assessed by in vitro cytokine release tests. The diagnostic role of in vitro drug-induced interferon-gamma (IFN-gamma) release was evaluated in a patient with Stevens-Johnson syndrome. Case report Stevens-Johnson syndrome was diagnosed in a 58-year-old man, treated with colchicine (1 mg daily for 39 days) and allopurinol (300 mg daily for 13 days). Based on a clinical-epidemiologic score, allopurinol was more likely to be the causative agent. In vitro drug-induced IFN-gamma release test was conducted on this patient and on two controls, using an enzyme-linked immunoabsorbent assay (ELISA) technique. Increased IFN-gamma release was observed following an in vitro challenge of the patient's lymphocytes with allopurinol, but not following in vitro challenge with colchicine. An in vitro challenge with allopurinol in two control patients, treated with allopurinol without adverse drug reactions, did not induce a significant increase in IFN-gamma release. Conclusions The role of allopurinol as the drug responsible for the induction of Stevens-Johnson syndrome in our patient was confirmed by in vitro allopurinol-induced IFN-gamma release, which may indicate a drug-specific immune response.

Occurrence of skin lesions during long-term therapy with hydroxyurea are well described, but there have been only a few case reports of longitudinal melanonychia associated with hydroxyurea treatment. We report herein longitudinal melanonychia associated with hydroxyurea therapy in a subject with essential thrombocytosis. The prolonged time lapse (1 year) between initiation of hydroxyurea therapy and the onset of the longitudinal melanonychia should be noted.

The continuous monitoring of the fetal heart condition during pregnancy and labor is of great clinical importance. The cardiac electrical activity of the fetus (FECG) may be recorded by means of surface abdominal electrodes. The signal is severely contaminated by the maternal cardiac signal (MECG). FECG enhancement is usually performed by FIR adaptive filtering. A new IIR FECG enhancement system is suggested and evaluated. In order to avoid convergence into local extrema, the system employs a genetic algorithm (GA). Two architectures are considered. The first is a combination of an adaptive filter and GA where the GA is recruited whenever the adaptive filter is suspected of reaching a local extremum. The second is an independent GA search. The hybrid IIR-GA was shown to be superior to the conventional FIR adaptive filtering.

Climatotherapy at the Dead Sea (CDS) for patients with psoriasis induces a persistent remission in the majority of patients with psoriasis, is associated with minor side-effects and is pleasant for the patients (1–11). The published literature on CDS describes patients with moderate to severe psoriasis who spend an average period of one month (“long-term”) at the Dead Sea. There are no published data, however, on the effectiveness and characteristics of “short-term” CDS for patients with psoriasis, who spend only 2 weeks at the Dead Sea.The instruments used previously for assessment of response to CDS in psoriasis patients were not stan-dardized. In the last 10 years, the use of a 75% or 50% decrease in Psoriasis Area and Severity Index (PASI75 and PASI50, respectively; 12, 13) has become the gold standard in evaluating the efficiency of psoriasis treat-ment. In a literature review, we found no publications that used the PASI75 or PASI50 instruments to assess the response to CDS in patients with psoriasis. In a previous study we have shown the utility of the Beer Sheva Psoriasis Severity Score (BPSS) to assess pso-riasis severity and response to treatment (14). The objective of the current study was to assess the effectiveness of CDS in a series of patients with psoria-sis treated for a “short-term” period of 2 weeks, using BPSS and PASI, with particular emphasis on PASI75 and PASI50 end-points.METHODS

The need for efficient coding of ECG signals is continually increasing with modern use of long-term monitoring and telemedicine. Here, the authors present an algorithm based on long-term prediction (LTP) compression. The single-channel LTP algorithm has been generalized to the multichannel case and is called the MC-LTP algorithm. This algorithm compresses PQRST beats using a pattern codebook with "typical" beats.

Sleep studies require the use of several channels of EEG. The analysis of vector EEG, exhibits significant advantages over scalar analysis. Novel algorithms for segmentation, classification and compression of vector EEG are described. The statistics of the suggested measures for segmentation and classification are discussed. The algorithms were evaluated on four patients, yielding mean correct sleep staging of about 85%.

Trichodiscomas are hamartomas of the hair disk and appear as multiple, firm, well-circumscribed papules measuring a few millimeters. In most cases, trichodiscomas are distributed on the face and neck. Trichodiscomas may occur as isolated tumors or in association with other follicular tumors. In some cases, multiple trichodiscomas appear in association with fibrofolliculomas or acrochordons. We herein describe multiple agminated trichodiscomas in the earlobe.

The authors report on a case of treatment-related toxic epidermal necrolysis in an elderly man receiving chemotherapy (gemcitabine) for transitional cell carcinoma of bladder and discuss the implications of the case.

A new algorithm for ECG signal compression is introduced. The compression system is based on the subautoregression (SAR) model, known also as the long-term prediction (LTP) model. The "periodicity" of the ECG signal is employed in order to further reduce redundancy, thus yielding high compression ratios. The suggested algorithm was evaluated using an in-house database. Very low bit rates on the order of 70 b/s are achieved with a relatively low reconstruction error (percent rms difference-PRD) of less than 10%. The algorithm was compared, using the same database, with the conventional linear prediction (short-term prediction--STP) method, and was found superior at any bit rate. The suggested algorithm can be considered a generalization of the recently published average beat subtraction method.

BackgroundNonattendance for scheduled appointments disturbs the effective management of pediatric pulmonary clinics. We hypothesized that the reasons for non-attendance and the necessary solutions might be different in pediatric pulmonary medicine than in other pediatric fields. We therefore investigated the factors associated with nonattendance this field in order to devise a corrective strategy.MethodsThe effect of age, gender, ethnic origin, waiting time for an appointment and the timing of appointments during the day on nonattendance proportion were assessed. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analysis.ResultsA total of 1190 pediatric pulmonology clinic visits in a 21 month period were included in the study. The overall proportion of nonattendance was 30.6%. Nonattendance was 23.8% when there was a short waiting time for an appointment (1–7 days) and 36.3% when there was a long waiting time (8 days and above) (p-value < 0.001). Nonattendance was 28.7% between 8 a.m. to 3 p.m. and 37.5% after 3 p.m. (p = 0.007). Jewish rural patients had 15.4% nonattendance, Jewish urban patients had 31.2% nonattendance and Bedouin patients had 32.9% nonattendance (p < 0.004). Age and gender were not significantly associated with nonattendance proportions. A multivariate logistic regression model demonstrated that the waiting time for an appointment, time of the day, and the patients' origin was significantly associated with nonattendance.ConclusionThe factors associated with nonattendance in pediatric pulmonary clinics include the length of waiting time for an appointment, the hour of the appointment within the day and the origin of the patient.

Two methods for the analysis of the acoustic transmission of the respiratory system are presented. Continuous speech utterance is used as acoustic stimulation. The transmitted acoustic signal is recorded from various sites over the chest wall. The autoregressive (AR) method analyzes the power spectral density function of the transmitted sound, which depends heavily on the microphone assembly and the utterance. The method was applied to a screening problem and was tested on a small database that consisted of 19 normal and five abnormal patients. Using the first five AR coefficients and the prediction error of an AR(10) model as discriminating features the system screens all abnormals. An autoregressive moving average (ARMA) method that eliminates the dependence on microphone and utterances is proposed. In this method, the generalized least squares identification algorithm is used to estimate the ARMA transfer function of the respiratory system. The normal transfer function demonstrates a peak at the range of 130-250 Hz and sharp decrease in gain for higher frequencies. A pulmonary fibrotic patient demonstrated a peak at the same frequency range, a much higher gain in the high-frequency range, with an additional peak at about 700 Hz. It is concluded that speech-stimulated chest analysis systems have the potential of yielding important clinical information. >

Increased alcohol consumption has been associated with dermatological diseases including psoriasis, rosacea, nummular eczema, acne, porphyria cutanea tarda, and facial flushing.1,2 As alcohol consumption is associated with liver cirrhosis and malnutrition, the skin manifestations of these diseases may also indicate alcohol misuse. Alcohol seems to affect dermatological diseases by influencing metabolism (eg, porphyria cutanea tarda3), cutaneous vasculature (eg, rosacea4), and the immune response.5,6 Patients who consume alcohol excessively are at increased risk for infectious diseases, including HIV infection.7,8 When alcoholics develop an infectious disease, it is associated with increased morbidity and mortality.6 Immune suppression secondary to both malnutrition and liver disease may occur following alcohol consumption6; however, as the frequency and severity of infections are so pronounced among alcoholics, it seems that alcohol by itself may suppress the immune system.

Methods and algorithms for the analysis of acoustical pulmonary signals and their application to pulmonary diagnosis are examined. The analysis of breath and adventitious sounds, voice sounds and percussion, and snoring and stridor is considered. It is shown that analysis of the acoustic characteristics of the thorax by sophisticated signal processing methods shows promise for assisting clinical diagnosis. The technique is simple, quantitative, noninvasive, and objective. In some cases, especially in pediatrics, it closes a gap between the simple stethoscope and expensive invasive methods. >

Two major problems of student laboratory courses are analyzed and discussed: (1) the qualifications and motivations of typical laboratory instructors, and (2) the attitude at the departmental policy-making level towards the laboratory. The paper concentrates mainly on the presentation of problems, but also suggests some short-term solutions.

Detection of wavelets in noisy signals is important for many biomedical as well as other applications. An adaptive wavelet detection system is described, based on the cross correlation method. The method is restricted to fnite-length, nonoverlapping wavelets. A random reference correlator (RRC) circuit is used to estimate the correlation between signal and template, eliminating the need for expensive hardware or time-consuming software correlation calculations.

The application of localized noxious heat stimuli to the skin, generated by brief infrared radiation pulses emitted by a CO2 laser, is a relatively new experimental technique for the thermal induction of pain in humans and in experimental animals. This study proposes a model for the spatial (3-dimensional) and temporal distribution of the skin temperature during and following a radiation pulse. The heat equation is written and solved, using thermal and optical constants of human skin reported in the literature. The solution is approximated, with a very small error, by a closed form expression, having a simple physical interpretation. This model is applied to analyze a typical set-up currently in use in our laboratory. The results show a significant difference between the temperature of the surface of the skin and that of the border between the epidermis and the dermis, which is the location of the most superficial receptive nerve ends. It is shown that, for the set-up examined, these nerve ends reach a temperature of 45 degrees C, known to be the human pain threshold, 30-40 ms after pulse onset. Moreover, it is also shown that they may remain above threshold temperature for up to a few hundreds of milliseconds (considerably outlasting pulse cessation). In addition, it is shown that the area in which nerve ends reach this threshold is a circle with a very small radius (1-2.5 mm). The implications of the results on the double sensation experienced by humans, and on the extremely powerful EEG correlates, are discussed.

Fast correlation calculations are needed in many technological and scientific fields. Conventional digital correlators require fast and expensive analog-to-digital converters and digital multipliers. This paper describes the implementation of a fast, inexpensive, and unbiased correlation estimator. The estimator is based on the ternary Random Reference Correlation (RRC). Unbiasness is achieved by the addition of statistically independent, uniformly distributed auxiliary noise sources to the input signals. The use of a ternary quantizer eliminates the need of an A/D converter and multiplier, which are replaced by relatively simple logic circuits. A prototype system is described. Real-time correlations of signals, sampled at a rate of about 4 kHz, were achieved by the prototype system. Correlation errors were found to be in the range of one percent. Increasing the internal clock frequency and using faster logic components will improve system performance to perform real-time correlation calculations of signals sampled at 50 kHz.

Summary Stridor and snoring are common signs of upper airway obstruction. The nature and characteristics of the stridor and snoring depend upon the site of obstruction. Sophisticated analysis of these sounds may provide important information concerning the source of the sound helping to assess the patient more objectively. The preliminary results of computerized digital analysis of stridor and snoring sounds are presented in 5 children. Two main programs were applied to analyse the signal: (1) the Power Spectral Density (PSD) function and (2) the Estimated Cross-sectional Area (ECSA). A consistent pattern according to the site of the produced sound was seen. Further acoustical analyses are needed to standardize this method and to program the computer to indicate the various sites of lesions.

A four-year experience with the organization and operation of an undergraduate project laboratory is discussed. The ‘project’ nature of work is emphasized by requiring a detailed proposal, written and oral reports and by strict regulation of team work, budget and time-table. Analysis of cost and manpower problems are given.

Automated recording and data analysis of the activity of small laboratory animals are often required for psychological and other forms of behavioural investigation. This paper describes such a system using an open field of 1·14×1·14 m. Three arrays of infrared-light-emitting diodes and phototransistors are used to locate the animal. Two of the arrays are used to generate an xy grid, while the third one is used to determine whether the animal is rearing. The position of the animal gives rise to both digital and analogue signals; so the equipment can be interfaced directly with a minicomputer, or coupled to an analogue recorder. Several activity parameters, such as the path length (absolute value of the line integral), the time spent at a predetermined area of the open field or the latency to move, are computed and displayed in digital form.