The use of doctor-computer interaction devices in the operation room (OR) requires new modalities that support medical imaging manipulation while allowing doctors' hands to remain sterile, supporting their focus of attention, and providing fast response times. This paper presents "Gestix," a vision-based hand gesture capture and recognition system that interprets in real-time the user's gestures for navigation and manipulation of images in an electronic medical record (EMR) database. Navigation and other gestures are translated to commands based on their temporal trajectories, through video capture. "Gestix" was tested during a brain biopsy procedure. In the in vivo experiment, this interface prevented the surgeon's focus shift and change of location while achieving a rapid intuitive reaction and easy interaction. Data from two usability tests provide insights and implications regarding human-computer interaction based on nonverbal conversational modalities.

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ABSTRACr Studies of adrenal function were performed on 54 asthmatic patients who were taking long term high doses of inhaled beclomethasone dipropionate ranging from 500 to 2000 ,ug/day for between six and 60 months. Of the 43 patients taking up to 1500 ,tg/day, 39 (91%) had normal basal plasma cortisol concentrations and normal short tetracosactrin responses and 24 hour urinary free cortisol excretion was within the normal range in eight of nine patients tested. Some evidence of adrenal suppression was found in patients taking 2000 ug/day, with basal plasma cortisol below the normal range in four out of 11 patients and 24 hour urinary free cortisol excretion below the normal range in five out of six patients tested. Only one of the 11 patients taking 2000 pg/day had a short tetracosactrin response below the normal range: the mean rise in plasma cortisol was, however, significantly lower in this group than in those taking 1000 Ag/day (328 (SE 30) and 506 (34) nmolI respectively) (p < 0-01). Patients taking more than 1500 ,g/day of inhaled beclomethasone may require systemic corticosteroids during prolonged stress.High dose inhaled beclomethasone dipropionate has been shown to be effective in improving asthma control and reducing oral steroid requirements in many asthmatic patients who are not satisfactorily controlled with conventional doses of beclomethasone dipropionate (400-800 ,ug/day).1-3The main potential advantage of inhaled corticosteroid treatment lies in the lack of systemic side effects; thus knowledge of the effects of higher doses of beclomethasone dipropionate on adrenal function is crucial. Studies of adrenal function performed on small numbers of healthy adult volunteers showed no evidence of adrenal suppression when 1 mg/day of inhaled beclomethasone dipropionate was taken for 28 days4; one of the three normal individuals, however, developed a low plasma cortisol concentration after one week on 2 mg/day. In subsequent dose response studies the same author reported that inhaled beclomethasone dipropionate had no effect on morning plasma cortisol concentrations until a daily dose of 3 mg was reached.

Levels of ciprofloxacin in serum and sputum were studied for eight patients with cystic fibrosis who were infected with Pseudomonas aeruginosa. Patients were studied in a steady state on a dosage of 500 mg every 8 h. Peak levels in serum ranged from 1.27 to 5.6 mg/liter (mean, 3.16 +/- 1.27), and absorption was rapid, the time to peak concentration ranging from 0.5 to 3.0 h (mean, 1.5 +/- 0.9). The antibiotic penetrated sputum well, achieving areas under the curve of approximately 46% of those obtained in serum.

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