Ultra-low-noise instrumentation and computer-based data acquisition and processing system for obtaining a noninvasive and intrauterine catheter fetal electrocardiogram.

A fetal electrocardiogram (FECG) from the abdominal surface will be from 20 microVpp to unmeasurable. The intrauterine catheter signal will be from 50 microVpp to unmeasureable and will be corrupted with a significant direct current component of 10 to 200 microV. For electrophysiological information to be obtained from the abdominal and intrauterine catheter signals, the signals must be in a 0.05 to 100.0 Hz bandwidth. Because typical adult electrocardiogram systems have a noise specification of 5 to 10 microVpp from instrumentation, these systems are unacceptable for obtaining a FECG via the intrauterine catheter or noninvasively. Therefore, custom instrumentation has been developed with a noise specification of approximately 1.5 microVpp in a 0.05 to 100.0 Hz bandwidth. Design details of the custom instrumentation will be presented along with a laptop computer based data acquisition and signal processing system using LabVIEW. In addition, clinical data from the intrauterine catheter and noninvasive abdominal wall are presented to determine the feasibility of obtaining a FECG via the custom instrumentation. Clinical data obtained and documented indicates that after maternal electrocardiogram cancellation, a FECG with a good signal-to-noise ratio can be obtained in a diagnostic bandwidth of 0.05 to 100.0 Hz. Because the diagnostic bandwidth is preserved, electrophysiological information can be determined along with heart rate.

The Health Care Quality Improvement Act of 1986: its history, provisions, applications and implications.

Congress granted qualified immunity from liability for peer review participation to physicians, osteopaths and dentists, created a national practitioner data bank to track inept, incompetent or unprofessional physicians, and enacted procedural rules for due process, privilege restrictions, and reporting and disbursement of information. The Health Care Quality Improvement Act of 1986 is now in full force, and peer review participants are anxious to cloak themselves with immunity from actions brought by health care professionals. Although its goals are worthy, HCQIA's effects remain to be seen. Serious loopholes appear to exist, warranting close monitoring and possibly early amendment of the Act. Cautious judicial assessment is needed, in order to prevent not only circumvention of the Act's requirements by artful litigants, but also use of the national data bank by health care entities as a pretext for denying privileges and escaping antitrust liability.

Time course of vertebral osteopenia in ovariectomized rats.

Osteopenic changes in cancellous bone tissue of the first lumbar vertebral body were characterized in ovariectomized (OVX) rats as a function of time. Female Sprague Dawley rats (240 g body weight, 90 days old) were subjected to bilateral ovariectomy or sham surgery and sacrificed at various times from 0-540 days postovariectomy. The first lumbar vertebra was processed undecalcified for quantitative bone histomorphometry. Cancellous bone volume remained relatively constant in control rats at approximately 40% throughout the duration of the study. In contrast, cancellous bone volume was moderately decreased to 30-35% in OVX rats out to 180 days postovariectomy. Vertebral osteopenia became more pronounced in OVX rats at later times as cancellous bone volume declined to approximately 20% between 180 and 270 days and remained at that osteopenic level for the duration of the study. Osteoblast and osteoclast surface were highly elevated in OVX rats at 35 days, declined gradually toward control levels out to 180 days, then increased markedly at 270 days. Mineralizing surface and bone formation rate (tissue level, total surface referent) were maximally increased in OVX rats at 35-70 days before declining toward control levels at later times. However, these parameters remained significantly increased in OVX rats relative to control rats between 270 and 540 days. Mineral apposition rate was nearly identical in control and OVX rats at all time points and declined linearly with age in both groups. Our results indicate that osteopenia and increased bone turnover occur in the lumbar vertebral bodies of OVX rats, as had been previously observed in the proximal tibial metaphyses of these animals.(ABSTRACT TRUNCATED AT 250 WORDS)