Automated Classification of Consumer Health Information Needs in Patient Portal Messages

Science.gov (United States)

Cronin, Robert M.; Fabbri, Daniel; Denny, Joshua C.; Jackson, Gretchen Purcell

2015-01-01

Patients have diverse health information needs, and secure messaging through patient portals is an emerging means by which such needs are expressed and met. As patient portal adoption increases, growing volumes of secure messages may burden healthcare providers. Automated classification could expedite portal message triage and answering. We created four automated classifiers based on word content and natural language processing techniques to identify health information needs in 1000 patient-generated portal messages. Logistic regression and random forest classifiers detected single information needs well, with area under the curves of 0.804–0.914. A logistic regression classifier accurately found the set of needs within a message, with a Jaccard index of 0.859 (95% Confidence Interval: (0.847, 0.871)). Automated classification of consumer health information needs expressed in patient portal messages is feasible and may allow direct linking to relevant resources or creation of institutional resources for commonly expressed needs. PMID:26958285

Are Mergers a Win-Win Strategic Model? A Content Analysis of Inter-Institutional Collaboration between Higher Education Institutions

Science.gov (United States)

Ripoll-Soler, Carlos; de-Miguel-Molina, María

2014-01-01

The main goal of this paper, based on a content analysis of the literature about models of inter-institutional collaboration between higher education institutions, is to establish the characteristics that set them apart, contextualize each of these models in terms of the features of the setting in which they are implemented, and ascertain their…

Automated Cell Enrichment of Cytomegalovirus-specific T cells for Clinical Applications using the Cytokine-capture System.

Science.gov (United States)

Kumaresan, Pappanaicken; Figliola, Mathew; Moyes, Judy S; Huls, M Helen; Tewari, Priti; Shpall, Elizabeth J; Champlin, Richard; Cooper, Laurence J N

2015-10-05

The adoptive transfer of pathogen-specific T cells can be used to prevent and treat opportunistic infections such as cytomegalovirus (CMV) infection occurring after allogeneic hematopoietic stem-cell transplantation. Viral-specific T cells from allogeneic donors, including third party donors, can be propagated ex vivo in compliance with current good manufacturing practice (cGMP), employing repeated rounds of antigen-driven stimulation to selectively propagate desired T cells. The identification and isolation of antigen-specific T cells can also be undertaken based upon the cytokine capture system of T cells that have been activated to secrete gamma-interferon (IFN-γ). However, widespread human application of the cytokine capture system (CCS) to help restore immunity has been limited as the production process is time-consuming and requires a skilled operator. The development of a second-generation cell enrichment device such as CliniMACS Prodigy now enables investigators to generate viral-specific T cells using an automated, less labor-intensive system. This device separates magnetically labeled cells from unlabeled cells using magnetic activated cell sorting technology to generate clinical-grade products, is engineered as a closed system and can be accessed and operated on the benchtop. We demonstrate the operation of this new automated cell enrichment device to manufacture CMV pp65-specific T cells obtained from a steady-state apheresis product obtained from a CMV seropositive donor. These isolated T cells can then be directly infused into a patient under institutional and federal regulatory supervision. All the bio-processing steps including removal of red blood cells, stimulation of T cells, separation of antigen-specific T cells, purification, and washing are fully automated. Devices such as this raise the possibility that T cells for human application can be manufactured outside of dedicated good manufacturing practice (GMP) facilities and instead be produced

Detection of virus-specific intrathecally synthesised immunoglobulin G with a fully automated enzyme immunoassay system

Directory of Open Access Journals (Sweden)

Weissbrich Benedikt

2007-05-01

Full Text Available Abstract Background The determination of virus-specific immunoglobulin G (IgG antibodies in cerebrospinal fluid (CSF is useful for the diagnosis of virus associated diseases of the central nervous system (CNS and for the detection of a polyspecific intrathecal immune response in patients with multiple sclerosis. Quantification of virus-specific IgG in the CSF is frequently performed by calculation of a virus-specific antibody index (AI. Determination of the AI is a demanding and labour-intensive technique and therefore automation is desirable. We evaluated the precision and the diagnostic value of a fully automated enzyme immunoassay for the detection of virus-specific IgG in serum and CSF using the analyser BEP2000 (Dade Behring. Methods The AI for measles, rubella, varicella-zoster, and herpes simplex virus IgG was determined from pairs of serum and CSF samples of patients with viral CNS infections, multiple sclerosis and of control patients. CSF and serum samples were tested simultaneously with reference to a standard curve. Starting dilutions were 1:6 and 1:36 for CSF and 1:1386 and 1:8316 for serum samples. Results The interassay coefficient of variation was below 10% for all parameters tested. There was good agreement between AIs obtained with the BEP2000 and AIs derived from the semi-automated reference method. Conclusion Determination of virus-specific IgG in serum-CSF-pairs for calculation of AI has been successfully automated on the BEP2000. Current limitations of the assay layout imposed by the analyser software should be solved in future versions to offer more convenience in comparison to manual or semi-automated methods.

Inter-municipal communities as semi-regional (quasi governments

Directory of Open Access Journals (Sweden)

Golić Darko

2014-01-01

Full Text Available In this paper, the author discusses specific forms of integrated inter-municipal cooperation in some European countries which have certain characteristics of regional governments. Relying on the analysis of different forms of this inter-municipal cooperation, the author elaborates on some common features underlying these communities, with specific reference to their functional aspects. Bearing in mind that the imminent needs for regional planning, coordination of local policies and operation of regional offices are exercised through different institutional solutions, we point out that it is possible to provide an appropriate institutional and decentralized framework for accomplishing these goals even without changing the existing territorial organization system. Although the entities that are created through these specific forms of inter-municipal cooperation cannot be designated as territorial-political units in institutional terms, this is what they are from a functional point of view.

Automated volumetry of hippocampus is useful to confirm unilateral mesial temporal sclerosis in patients with radiologically positive findings.

Science.gov (United States)

Silva, Guilherme; Martins, Cristina; Moreira da Silva, Nádia; Vieira, Duarte; Costa, Dias; Rego, Ricardo; Fonseca, José; Silva Cunha, João Paulo

2017-08-01

Background and purpose We evaluated two methods to identify mesial temporal sclerosis (MTS): visual inspection by experienced epilepsy neuroradiologists based on structural magnetic resonance imaging sequences and automated hippocampal volumetry provided by a processing pipeline based on the FMRIB Software Library. Methods This retrospective study included patients from the epilepsy monitoring unit database of our institution. All patients underwent brain magnetic resonance imaging in 1.5T and 3T scanners with protocols that included thin coronal T2, T1 and fluid-attenuated inversion recovery and isometric T1 acquisitions. Two neuroradiologists with experience in epilepsy and blinded to clinical data evaluated magnetic resonance images for the diagnosis of MTS. The diagnosis of MTS based on an automated method included the calculation of a volumetric asymmetry index between the two hippocampi of each patient and a threshold value to define the presence of MTS obtained through statistical tests (receiver operating characteristics curve). Hippocampi were segmented for volumetric quantification using the FIRST tool and fslstats from the FMRIB Software Library. Results The final cohort included 19 patients with unilateral MTS (14 left side): 14 women and a mean age of 43.4 ± 10.4 years. Neuroradiologists had a sensitivity of 100% and specificity of 73.3% to detect MTS (gold standard, k = 0.755). Automated hippocampal volumetry had a sensitivity of 84.2% and specificity of 86.7% (k = 0.704). Combined, these methods had a sensitivity of 84.2% and a specificity of 100% (k = 0.825). Conclusions Automated volumetry of the hippocampus could play an important role in temporal lobe epilepsy evaluation, namely on confirmation of unilateral MTS diagnosis in patients with radiological suggestive findings.

A research-based inter-institutional collaboration to diversify the biomedical workforce: ReBUILDetroit.

Science.gov (United States)

Andreoli, Jeanne M; Feig, Andrew; Chang, Steven; Welch, Sally; Mathur, Ambika; Kuleck, Gary

2017-01-01

Faced with decades of severe economic decline, the city of Detroit, Michigan (USA) is on the cusp or reinventing itself. A Consortium was formed of three higher education institutions that have an established mission to serve an urban population and a vested interest in the revitalization of the health, welfare, and economic opportunity in the Detroit metro region that is synergistic with national goals to diversify the biomedical workforce. The purpose of this article is to describe the rationale, approach, and model of the Research Enhancement for BUILDing Detroit (ReBUILDetroit) Consortium, as a cross-campus collaborative for students, faculty, and institutional development. The ReBUILDetroit program is designed to transform the culture of higher education in Detroit, Michigan by educating and training students from diverse and socio-economically disadvantaged backgrounds to become the next generation of biomedical researchers. Marygrove College, University of Detroit Mercy, and Wayne State University established a Consortium to create and implement innovative, evidence-based and cutting-edge programming. Specific elements include: (1) a pre-college summer enrichment experience; (2) an inter-institutional curricular re-design of target foundational courses in biology, chemistry and social science using the Research Coordination Network (RCN) model; and (3) cross-institutional summer faculty-mentored research projects for ReBUILDetroit Scholars starting as rising sophomores. Student success support includes intentional and intrusive mentoring, financial support, close faculty engagement, ongoing workshops to overcome academic and non-academic barriers, and cohort building activities across the Consortium. Institutional supports, integral to program creation and sustainability, include creating faculty learning communities grounded in professional development opportunities in pedagogy, research and mentorship, and developing novel partnerships and accelerated

Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery

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Kry, Stephen F., E-mail: sfkry@mdanderson.org [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Molineu, Andrea [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kerns, James R.; Faught, Austin M.; Huang, Jessie Y.; Pulliam, Kiley B.; Tonigan, Jackie [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States); Alvarez, Paola [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Stingo, Francesco [The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Followill, David S. [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States)

2014-12-01

Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process.

Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery

International Nuclear Information System (INIS)

Kry, Stephen F.; Molineu, Andrea; Kerns, James R.; Faught, Austin M.; Huang, Jessie Y.; Pulliam, Kiley B.; Tonigan, Jackie; Alvarez, Paola; Stingo, Francesco; Followill, David S.

2014-01-01

Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process

SU-E-T-544: A Radiation Oncology-Specific Multi-Institutional Federated Database: Initial Implementation

Energy Technology Data Exchange (ETDEWEB)

Hendrickson, K; Phillips, M; Fishburn, M; Evans, K; Banerian, S; Mayr, N [University of Washington, Seattle, WA (United States); Wong, J; McNutt, T; Moore, J; Robertson, S [Johns Hopkins University, Baltimore, MD (United States)

2014-06-01

Purpose: To implement a common database structure and user-friendly web-browser based data collection tools across several medical institutions to better support evidence-based clinical decision making and comparative effectiveness research through shared outcomes data. Methods: A consortium of four academic medical centers agreed to implement a federated database, known as Oncospace. Initial implementation has addressed issues of differences between institutions in workflow and types and breadth of structured information captured. This requires coordination of data collection from departmental oncology information systems (OIS), treatment planning systems, and hospital electronic medical records in order to include as much as possible the multi-disciplinary clinical data associated with a patients care. Results: The original database schema was well-designed and required only minor changes to meet institution-specific data requirements. Mobile browser interfaces for data entry and review for both the OIS and the Oncospace database were tailored for the workflow of individual institutions. Federation of database queries--the ultimate goal of the project--was tested using artificial patient data. The tests serve as proof-of-principle that the system as a whole--from data collection and entry to providing responses to research queries of the federated database--was viable. The resolution of inter-institutional use of patient data for research is still not completed. Conclusions: The migration from unstructured data mainly in the form of notes and documents to searchable, structured data is difficult. Making the transition requires cooperation of many groups within the department and can be greatly facilitated by using the structured data to improve clinical processes and workflow. The original database schema design is critical to providing enough flexibility for multi-institutional use to improve each institution s ability to study outcomes, determine best practices

SU-E-T-544: A Radiation Oncology-Specific Multi-Institutional Federated Database: Initial Implementation

International Nuclear Information System (INIS)

Hendrickson, K; Phillips, M; Fishburn, M; Evans, K; Banerian, S; Mayr, N; Wong, J; McNutt, T; Moore, J; Robertson, S

2014-01-01

Purpose: To implement a common database structure and user-friendly web-browser based data collection tools across several medical institutions to better support evidence-based clinical decision making and comparative effectiveness research through shared outcomes data. Methods: A consortium of four academic medical centers agreed to implement a federated database, known as Oncospace. Initial implementation has addressed issues of differences between institutions in workflow and types and breadth of structured information captured. This requires coordination of data collection from departmental oncology information systems (OIS), treatment planning systems, and hospital electronic medical records in order to include as much as possible the multi-disciplinary clinical data associated with a patients care. Results: The original database schema was well-designed and required only minor changes to meet institution-specific data requirements. Mobile browser interfaces for data entry and review for both the OIS and the Oncospace database were tailored for the workflow of individual institutions. Federation of database queries--the ultimate goal of the project--was tested using artificial patient data. The tests serve as proof-of-principle that the system as a whole--from data collection and entry to providing responses to research queries of the federated database--was viable. The resolution of inter-institutional use of patient data for research is still not completed. Conclusions: The migration from unstructured data mainly in the form of notes and documents to searchable, structured data is difficult. Making the transition requires cooperation of many groups within the department and can be greatly facilitated by using the structured data to improve clinical processes and workflow. The original database schema design is critical to providing enough flexibility for multi-institutional use to improve each institution s ability to study outcomes, determine best practices

Inter- and intra-specific competition of duckweed under multiple heavy metal contaminated water.

Science.gov (United States)

Zhao, Zhao; Shi, Huijuan; Kang, Xianjiang; Liu, Cunqi; Chen, Lingci; Liang, Xiaofei; Jin, Lei

2017-11-01

The influences of intra- and inter-species competition on ecosystems are poorly understood. Lemna aequinoctialis and Spirodela polyrhiza were used to assess the effects of exposure to different concentrations of multiple heavy metals (copper-cadmium-zinc), when the plants were grown in mixed- or mono-culture. Parameters assessed included relative growth rate (RGR), content of chlorophyll, glutathione (GSH), malondialdehyde (MDA), as well as the activity of catalase (CAT), superoxide dismutase (SOD) and peroxidase (POD). Inter-specific competition was affected by metal concentration, with results indicating that inter-specific competition significantly affected duckweed growth and metal uptake in different heavy metal exposure conditions. Inter-specific competition increased growth rate of duckweed under high metal concentrations, although when compared with intra-specific competition, it caused no obvious differences under low metal concentrations. The growth of L. aequinoctialis was further increased in mixed culture when exposed to high metal concentrations, with inter-specific competition increasing the content of cadmium and zinc, while decreasing copper content of L. aequinoctialis compared with under intra-specific conditions. Conversely, inter-specific competition increased the content of copper and cadmium of S. polyrhiza, without causing obvious differences in zinc accumulation under high ambient concentrations. Under high metal conditions, inter-specific competition increased antioxidant enzyme activities in duckweed species, increasing resistance to heavy metals. Results show that inter-specific competition makes duckweed develop mechanisms to increase fitness and survival, such as enhancement of antioxidant enzyme activities, rather than limiting metal uptake when exposed to high concentrations of multiple metals. Copyright © 2017 Elsevier B.V. All rights reserved.

Replicable Interprofessional Competency Outcomes from High-Volume, Inter-Institutional, Interprofessional Simulation.

Science.gov (United States)

Bambini, Deborah; Emery, Matthew; de Voest, Margaret; Meny, Lisa; Shoemaker, Michael J

2016-10-25

There are significant limitations among the few prior studies that have examined the development and implementation of interprofessional education (IPE) experiences to accommodate a high volume of students from several disciplines and from different institutions. The present study addressed these gaps by seeking to determine the extent to which a single, large, inter-institutional, and IPE simulation event improves student perceptions of the importance and relevance of IPE and simulation as a learning modality, whether there is a difference in students' perceptions among disciplines, and whether the results are reproducible. A total of 290 medical, nursing, pharmacy, and physical therapy students participated in one of two large, inter-institutional, IPE simulation events. Measurements included student perceptions about their simulation experience using the Attitude Towards Teamwork in Training Undergoing Designed Educational Simulation (ATTITUDES) Questionnaire and open-ended questions related to teamwork and communication. Results demonstrated a statistically significant improvement across all ATTITUDES subscales, while time management, role confusion, collaboration, and mutual support emerged as significant themes. Results of the present study indicate that a single IPE simulation event can reproducibly result in significant and educationally meaningful improvements in student perceptions towards teamwork, IPE, and simulation as a learning modality.

Performance of an automated electronic acute lung injury screening system in intensive care unit patients.

Science.gov (United States)

Koenig, Helen C; Finkel, Barbara B; Khalsa, Satjeet S; Lanken, Paul N; Prasad, Meeta; Urbani, Richard; Fuchs, Barry D

2011-01-01

Lung protective ventilation reduces mortality in patients with acute lung injury, but underrecognition of acute lung injury has limited its use. We recently validated an automated electronic acute lung injury surveillance system in patients with major trauma in a single intensive care unit. In this study, we assessed the system's performance as a prospective acute lung injury screening tool in a diverse population of intensive care unit patients. Patients were screened prospectively for acute lung injury over 21 wks by the automated system and by an experienced research coordinator who manually screened subjects for enrollment in Acute Respiratory Distress Syndrome Clinical Trials Network (ARDSNet) trials. Performance of the automated system was assessed by comparing its results with the manual screening process. Discordant results were adjudicated blindly by two physician reviewers. In addition, a sensitivity analysis using a range of assumptions was conducted to better estimate the system's performance. The Hospital of the University of Pennsylvania, an academic medical center and ARDSNet center (1994-2006). Intubated patients in medical and surgical intensive care units. None. Of 1270 patients screened, 84 were identified with acute lung injury (incidence of 6.6%). The automated screening system had a sensitivity of 97.6% (95% confidence interval, 96.8-98.4%) and a specificity of 97.6% (95% confidence interval, 96.8-98.4%). The manual screening algorithm had a sensitivity of 57.1% (95% confidence interval, 54.5-59.8%) and a specificity of 99.7% (95% confidence interval, 99.4-100%). Sensitivity analysis demonstrated a range for sensitivity of 75.0-97.6% of the automated system under varying assumptions. Under all assumptions, the automated system demonstrated higher sensitivity than and comparable specificity to the manual screening method. An automated electronic system identified patients with acute lung injury with high sensitivity and specificity in diverse

Inter-institutional Variation in Use of Caesarean Delivery for Labour Dystocia.

Science.gov (United States)

Riddell, Corinne A; Hutcheon, Jennifer A; Strumpf, Erin C; Abenhaim, Haim A; Kaufman, Jay S

2017-11-01

To establish the degree of variation across hospitals in the use of Caesarean delivery for the indication of labour dystocia before and after accounting for maternal, fetal, and hospital characteristics. This study was a retrospective, population-based cohort study of nulliparous women delivering term singletons in cephalic position following labour. Delivery visits were extracted from three provincial perinatal registries in the Canadian provinces of Ontario, Alberta, and British Columbia, from 2008-2012. Crude hospital-specific rates of Caesarean delivery for labour dystocia were reported, and these rates were then stabilized to account for hospitals with low delivery volumes. Rates were then adjusted for maternal, fetal, and hospital characteristics using hierarchical logistic regression. Among 403 205 women delivering at 170 hospitals, the overall Caesarean delivery rate was 21.0%, and the rate of Caesarean delivery for labour dystocia was 12.7%, indicating that 60% of all Caesarean deliveries were performed in part for this indication. The middle 95% of hospitals had Caesarean delivery rates for labour dystocia ranging from 4.5% to 24.7%. Differences in maternal case mix and hospital characteristics explained only a small proportion of this variation (95% central range 6.3%-21.7%). Considerable inter-hospital variation in rates of Caesarean delivery for labour dystocia remained after accounting for differences in maternal and hospital factors. Reporting systems that monitor variation in inter-institutional rates should incorporate stabilization and adjustment for case-mix differences and consider indication-specific rates of Caesarean delivery to more fairly compare hospital performance and better target interventions to reduce Caesarean delivery for specific indications. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

International Nuclear Information System (INIS)

Randen, Adrienne van; Lameris, Wytze; Nio, C.Y.; Spijkerboer, Anje M.; Meier, Mark A.; Tutein Nolthenius, Charlotte; Smithuis, Frank; Stoker, Jaap; Bossuyt, Patrick M.; Boermeester, Marja A.

2009-01-01

The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis. (orig.)

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

Energy Technology Data Exchange (ETDEWEB)

Randen, Adrienne van [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Amsterdam (Netherlands); Lameris, Wytze [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Nio, C.Y.; Spijkerboer, Anje M.; Meier, Mark A.; Tutein Nolthenius, Charlotte; Smithuis, Frank; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Bossuyt, Patrick M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands)

2009-06-15

The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis. (orig.)

Improved radiograph measurement inter-observer reliability by use of statistical shape models

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Pegg, E.C., E-mail: elise.pegg@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Mellon, S.J., E-mail: stephen.mellon@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Salmon, G. [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Alvand, A., E-mail: abtin.alvand@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Pandit, H., E-mail: hemant.pandit@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Murray, D.W., E-mail: david.murray@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Gill, H.S., E-mail: richie.gill@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom)

2012-10-15

Pre- and post-operative radiographs of patients undergoing joint arthroplasty are often examined for a variety of purposes including preoperative planning and patient assessment. This work examines the feasibility of using active shape models (ASM) to semi-automate measurements from post-operative radiographs for the specific case of the Oxford™ Unicompartmental Knee. Measurements of the proximal tibia and the position of the tibial tray were made using the ASM model and manually. Data were obtained by four observers and one observer took four sets of measurements to allow assessment of the inter- and intra-observer reliability, respectively. The parameters measured were the tibial tray angle, the tray overhang, the tray size, the sagittal cut position, the resection level and the tibial width. Results demonstrated improved reliability (average of 27% and 11.2% increase for intra- and inter-reliability, respectively) and equivalent accuracy (p > 0.05 for compared data values) for all of the measurements using the ASM model, with the exception of the tray overhang (p = 0.0001). Less time (15 s) was required to take measurements using the ASM model compared with manual measurements, which was significant. These encouraging results indicate that semi-automated measurement techniques could improve the reliability of radiographic measurements.

Improved radiograph measurement inter-observer reliability by use of statistical shape models

International Nuclear Information System (INIS)

Pegg, E.C.; Mellon, S.J.; Salmon, G.; Alvand, A.; Pandit, H.; Murray, D.W.; Gill, H.S.

2012-01-01

Pre- and post-operative radiographs of patients undergoing joint arthroplasty are often examined for a variety of purposes including preoperative planning and patient assessment. This work examines the feasibility of using active shape models (ASM) to semi-automate measurements from post-operative radiographs for the specific case of the Oxford™ Unicompartmental Knee. Measurements of the proximal tibia and the position of the tibial tray were made using the ASM model and manually. Data were obtained by four observers and one observer took four sets of measurements to allow assessment of the inter- and intra-observer reliability, respectively. The parameters measured were the tibial tray angle, the tray overhang, the tray size, the sagittal cut position, the resection level and the tibial width. Results demonstrated improved reliability (average of 27% and 11.2% increase for intra- and inter-reliability, respectively) and equivalent accuracy (p > 0.05 for compared data values) for all of the measurements using the ASM model, with the exception of the tray overhang (p = 0.0001). Less time (15 s) was required to take measurements using the ASM model compared with manual measurements, which was significant. These encouraging results indicate that semi-automated measurement techniques could improve the reliability of radiographic measurements

Open Automated Demand Response Communications Specification (Version 1.0)

Energy Technology Data Exchange (ETDEWEB)

Piette, Mary Ann; Ghatikar, Girish; Kiliccote, Sila; Koch, Ed; Hennage, Dan; Palensky, Peter; McParland, Charles

2009-02-28

The development of the Open Automated Demand Response Communications Specification, also known as OpenADR or Open Auto-DR, began in 2002 following the California electricity crisis. The work has been carried out by the Demand Response Research Center (DRRC), which is managed by Lawrence Berkeley National Laboratory. This specification describes an open standards-based communications data model designed to facilitate sending and receiving demand response price and reliability signals from a utility or Independent System Operator to electric customers. OpenADR is one element of the Smart Grid information and communications technologies that are being developed to improve optimization between electric supply and demand. The intention of the open automated demand response communications data model is to provide interoperable signals to building and industrial control systems that are preprogrammed to take action based on a demand response signal, enabling a demand response event to be fully automated, with no manual intervention. The OpenADR specification is a flexible infrastructure to facilitate common information exchange between the utility or Independent System Operator and end-use participants. The concept of an open specification is intended to allow anyone to implement the signaling systems, the automation server or the automation clients.

Replicable Interprofessional Competency Outcomes from High-Volume, Inter-Institutional, Interprofessional Simulation

Directory of Open Access Journals (Sweden)

Deborah Bambini

2016-10-01

Full Text Available There are significant limitations among the few prior studies that have examined the development and implementation of interprofessional education (IPE experiences to accommodate a high volume of students from several disciplines and from different institutions. The present study addressed these gaps by seeking to determine the extent to which a single, large, inter-institutional, and IPE simulation event improves student perceptions of the importance and relevance of IPE and simulation as a learning modality, whether there is a difference in students’ perceptions among disciplines, and whether the results are reproducible. A total of 290 medical, nursing, pharmacy, and physical therapy students participated in one of two large, inter-institutional, IPE simulation events. Measurements included student perceptions about their simulation experience using the Attitude Towards Teamwork in Training Undergoing Designed Educational Simulation (ATTITUDES Questionnaire and open-ended questions related to teamwork and communication. Results demonstrated a statistically significant improvement across all ATTITUDES subscales, while time management, role confusion, collaboration, and mutual support emerged as significant themes. Results of the present study indicate that a single IPE simulation event can reproducibly result in significant and educationally meaningful improvements in student perceptions towards teamwork, IPE, and simulation as a learning modality.

Automated Stock Control System for Bookshops in Tertiary Institutions

African Journals Online (AJOL)

The recent need for automated stock control system for bookshops in tertiary institutions was generated by unequal availability of books and stiff scarcity of books in some areas while in ... This approach provides for faster response times for users because the database is local to each business unit within the organization.

Exposing exposure: enhancing patient safety through automated data mining of nuclear medicine reports for quality assurance and organ dose monitoring.

Science.gov (United States)

Ikuta, Ichiro; Sodickson, Aaron; Wasser, Elliot J; Warden, Graham I; Gerbaudo, Victor H; Khorasani, Ramin

2012-08-01

To develop and validate an open-source informatics toolkit capable of creating a radiation exposure data repository from existing nuclear medicine report archives and to demonstrate potential applications of such data for quality assurance and longitudinal patient-specific radiation dose monitoring. This study was institutional review board approved and HIPAA compliant. Informed consent was waived. An open-source toolkit designed to automate the extraction of data on radiopharmaceuticals and administered activities from nuclear medicine reports was developed. After iterative code training, manual validation was performed on 2359 nuclear medicine reports randomly selected from September 17, 1985, to February 28, 2011. Recall (sensitivity) and precision (positive predictive value) were calculated with 95% binomial confidence intervals. From the resultant institutional data repository, examples of usage in quality assurance efforts and patient-specific longitudinal radiation dose monitoring obtained by calculating organ doses from the administered activity and radiopharmaceutical of each examination were provided. Validation statistics yielded a combined recall of 97.6% ± 0.7 (95% confidence interval) and precision of 98.7% ± 0.5. Histograms of administered activity for fluorine 18 fluorodeoxyglucose and iodine 131 sodium iodide were generated. An organ dose heatmap which displays a sample patient's dose accumulation from multiple nuclear medicine examinations was created. Large-scale repositories of radiation exposure data can be extracted from institutional nuclear medicine report archives with high recall and precision. Such repositories enable new approaches in radiation exposure patient safety initiatives and patient-specific radiation dose monitoring.

Development of an inter-professional screening instrument for cancer patients' education process.

Science.gov (United States)

Vaartio-Rajalin, Heli; Huumonen, Tuula; Iire, Liisa; Jekunen, Antti; Leino-Kilpi, Helena; Minn, Heikki; Paloniemi, Jenni; Zabalegui, Adelaida

2016-02-01

The aim of this paper is to describe the development of an inter-professional screening instrument for cancer patients' cognitive resources, knowledge expectations and inter-professional collaboration within patient education. Four empirical datasets during 2012-2014 were analyzed in order to identify main categories, subcategories and items for inter-professional screening instrument. Our inter-professional screening instrument integrates the critical moments of cancer patient education and the knowledge expectation types obtained from patient datasets to assessment of patients' cognitive resources, knowledge expectations and comprehension; and intra; and inter-professional. Copyright © 2015 Elsevier Inc. All rights reserved.

Accuracy and Feasibility of Estimated Tumour Volumetry in Primary Gastric Gastrointestinal Stromal Tumours: Validation Using Semi-automated Technique in 127 Patients

Science.gov (United States)

Tirumani, Sree Harsha; Shinagare, Atul B.; O’Neill, Ailbhe C.; Nishino, Mizuki; Rosenthal, Michael H.; Ramaiya, Nikhil H.

2015-01-01

Objective To validate estimated tumour volumetry in primary gastric gastrointestinal stromal tumours (GISTs) using semi-automated volumetry. Materials and Methods In this IRB-approved retrospective study, we measured the three longest diameters in x, y, z axes on CTs of primary gastric GISTs in 127 consecutive patients (52 women, 75 men, mean age: 61 years) at our institute between 2000 and 2013. Segmented volumes (Vsegmented) were obtained using commercial software by two radiologists. Estimate volumes (V1–V6) were obtained using formulae for spheres and ellipsoids. Intra- and inter-observer agreement of Vsegmented and agreement of V1–6 with Vsegmented were analysed with concordance correlation coefficients (CCC) and Bland-Altman plots. Results Median Vsegmented and V1–V6 were 75.9 cm3, 124.9 cm3, 111.6 cm3, 94.0 cm3, 94.4cm3, 61.7 cm3 and 80.3 cm3 respectively. There was strong intra- and inter-observer agreement for Vsegmented. Agreement with Vsegmented was highest for V6 (scalene ellipsoid, x≠y≠z), with CCC of 0.96 [95%CI: 0.95–0.97]. Mean relative difference was smallest for V6 (0.6%), while it was −19.1% for V5, +14.5% for V4, +17.9% for V3, +32.6 % for V2 and +47% for V1. Conclusion Ellipsoidal approximations of volume using three measured axes may be used to closely estimate Vsegmented when semi-automated techniques are unavailable. PMID:25991487

Prevalence of inter-arm blood pressure difference among clinical out-patients.

Science.gov (United States)

Sharma, Balkishan; Ramawat, Pramila

2016-04-01

An increased inter-arm blood pressure difference is an easily determined physical finding, may use as an indicator of cardio vascular event and other sever diseases. Authors evaluated 477 patients to determine the prevalence and significance of inter-arm blood pressure difference. 477 routine outdoor patients selected to observe the inter-arm blood pressure difference. Age, height, weight, body mass index, history of disease and blood pressure recorded. The prevalence of ≥10 mmHg systolic inter-arm blood pressure difference was 5.0% was more as compared to 3.8% had diastolic inter-arm blood pressure difference. The prevalence of systolic and diastolic inter-arm difference between 6 to 10 mmHg was 31.4% and 27.9% respectively. Mean systolic inter-arm blood pressure difference was significantly higher among those patients had a multisystem disorder (10.57±0.98 mmHg) and followed by patients with cardiovascular disease (10.22±0.67 mmHg) as compared to healthy patients (2.71±0.96 mmHg). Various diseases highly influenced the increase in blood pressure irrespective of systolic or diastolic was confirmed strongly significant (pdifferent inter arm blood pressure difference levels. This study supports the view of inter-arm blood pressure difference as an alarming stage of increased disease risk that incorporated to investigate potential problems at an early diagnostic stage. A significant mean difference between left and right arm blood pressure recorded for many diseases.

Comparative intra-and inter-specific sexual organ reciprocity in four distylous Primula species in the Himalaya-Hengduan Mountains.

Science.gov (United States)

Li, Hai-Dong; Ren, Zong-Xin; Zhou, Wei; Bernhardt, Peter; Zhao, Yan-Hui; Wu, Zhi-Kun; Li, De-Zhu; Wang, Hong

2018-04-23

Distyly is a mechanism promoting cross-pollination within a balanced polymorphism. Numerous studies show that the degree of inter-morph sexual organ reciprocity (SOR) within species relates to its pollen-mediated gene flow. Similarly, a lower inter-specific SOR should promote inter-specific isolation when congeners are sympatric, co-blooming, and share pollinators. In this comparative study, we address the significance of SOR at both intra- and inter-specific levels. Seventeen allopatric and eight sympatric populations representing four Primula species (P. anisodora, P. beesiana, P. bulleyana and P. poissonii) native to the Himalaya-Hengduan Mountains were measured for eight floral traits in both long- and short-styled morphs. GLMM and spatial overlap methods were used to compare intra- and inter-specific SOR. While floral morphology differed among four Primula species. SOR within species was generally higher than between species, but species pairs P. poissonii / P. anisodora and P. beesiana / P. bulleyana, the SOR was high at both intra- and inter-specific levels. We didn't detect a significant variation in intra-specific SOR or inter-specific SOR when compare allopatric vs. sympatric populations for all species studied. As intra-specific SOR increased, disassortative mating may be promoted. As inter-specific SOR decreased, inter-specific isolation between co-flowering species pairs also may increase. Hybridization between congeners occurred when inter-specific SOR increased in sympatric populations was confirmed in two species pairs, P. poissonii / P. anisodora and P. beesiana / P. bulleyana. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Patient-specific hip prostheses designed by surgeons

Directory of Open Access Journals (Sweden)

Coigny Florian

2016-09-01

Full Text Available Patient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods [1], [2], [3]. But extracting 3D shape information from CT Data and designing individual implants is demanding and requires multiple surgeon-to-engineer interactions. For manufacturing purposes, Additive Manufacturing offers various advantages, especially for low volume manufacturing parts, such as patient specific implants. To ease these new approaches and to avoid surgeon-to-engineer interactions a new design software approach is needed which offers highly automated and user friendly planning steps.

Inter-Institutional Comparison on Working Power Loss Evaluated Cases

Directory of Open Access Journals (Sweden)

Volkan Ünal

2016-04-01

Full Text Available Objective: In Turkey, individuals who want to retire due to illness and determined within the provisions of the relevant rules and regulations are defined as 'retirement due to disability1. When the insured apply with a petition, describing that s/he cannot work because of the diseases, retirement process begins. First Social Security Institution in case of objection Social Security Supreme Council of Health prepares reports about individuals. Third Specialization Board of the Council of Forensic Medicine is the final expertise authority on these cases. With this study it is aimed to reveal the decision differences on 'retirement due to disability1 cases between the Third Specialization Board of the Council of Forensic Medicine and the other institutions and, guided with the findings, to provide the standardization in practical implementation. Materials and Methods: For this study; the reports of the 3rd Specialization Board of The Council of Forensic Medicine were retrospectively investigated and the cases who were reported as not suitable for the retirement due to diseases by Social Security Institution and Social Security Supreme Council of Health but reported as suitable for the retirement due to diseases by the 3”1 Specialization Board were included. Results: Totally sixty four cases were determined. Fifty seven of the cases were male and seven ofthem were female. Average age of female cases was 50.71, male cases were 49.89 and average age of all cases was 49.98. Conclusion: Even the rules and regulations are same, there are differences between institutions. While rules and regulations are constituted, taking common decisions by negotiating on practice principles should reduce the differences between institutions and provide faster decision makings. Institutions should arrange routine meetings and discuss about the cases and present assessments interactively. Keywords: Working Power Loss, Inter-Instutional Comparison, Forensic medicine.

Sub-state interests in bi-cameral legislatures: inter-institutional cooperation in decentralised government

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Marc NAVARRO

2013-10-01

Full Text Available The aim of this article is to study the role of the second chamber in the vertical coordination of interests between national and subnational levels. Firstly, we specify the legislative governance variables which must be analyzed in bicameral countries in order to measure incentives and restrictions to strengthen vertical inter-institutional coordination, deepening political decentralization. Secondly, these variables –symmetry, congruence and political particularism– are broken down and ranked to be tested empirically in the nine bicameral countries existing in Latin America. Finally, with the results obtained, we are in a position to develop a bicameralism index that measures the role of second chambers as the institutional space where subnational interests are taken into the national Legislative body, encouraging vertical relations among institutions.

The Effect of Computer Automation on Institutional Review Board (IRB) Office Efficiency

Science.gov (United States)

Oder, Karl; Pittman, Stephanie

2015-01-01

Companies purchase computer systems to make their processes more efficient through automation. Some academic medical centers (AMC) have purchased computer systems for their institutional review boards (IRB) to increase efficiency and compliance with regulations. IRB computer systems are expensive to purchase, deploy, and maintain. An AMC should…

Inter-rater reliability of three standardized functional tests in patients with low back pain

Science.gov (United States)

Tidstrand, Johan; Horneij, Eva

2009-01-01

Background Of all patients with low back pain, 85% are diagnosed as "non-specific lumbar pain". Lumbar instability has been described as one specific diagnosis which several authors have described as delayed muscular responses, impaired postural control as well as impaired muscular coordination among these patients. This has mostly been measured and evaluated in a laboratory setting. There are few standardized and evaluated functional tests, examining functional muscular coordination which are also applicable in the non-laboratory setting. In ordinary clinical work, tests of functional muscular coordination should be easy to apply. The aim of this present study was to therefore standardize and examine the inter-rater reliability of three functional tests of muscular functional coordination of the lumbar spine in patients with low back pain. Methods Nineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs). Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ) and by percentage agreement. Results The inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0), for sitting on a Bobath ball good (κ: 0.79) and very good (κ: 0.88) and for the unilateral pelvic lift: good (κ: 0.61) and moderate (κ: 0.47). Conclusion The present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their ability to evaluate lumbar

Inter-rater reliability of three standardized functional tests in patients with low back pain

Directory of Open Access Journals (Sweden)

Tidstrand Johan

2009-06-01

Full Text Available Abstract Background Of all patients with low back pain, 85% are diagnosed as "non-specific lumbar pain". Lumbar instability has been described as one specific diagnosis which several authors have described as delayed muscular responses, impaired postural control as well as impaired muscular coordination among these patients. This has mostly been measured and evaluated in a laboratory setting. There are few standardized and evaluated functional tests, examining functional muscular coordination which are also applicable in the non-laboratory setting. In ordinary clinical work, tests of functional muscular coordination should be easy to apply. The aim of this present study was to therefore standardize and examine the inter-rater reliability of three functional tests of muscular functional coordination of the lumbar spine in patients with low back pain. Methods Nineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs. Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ and by percentage agreement. Results The inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0, for sitting on a Bobath ball good (κ: 0.79 and very good (κ: 0.88 and for the unilateral pelvic lift: good (κ: 0.61 and moderate (κ: 0.47. Conclusion The present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their

SU-F-J-103: Assessment of Liver Tumor Contrast for Radiation Therapy: Inter-Patient and Inter-Sequence Variability

Energy Technology Data Exchange (ETDEWEB)

Moore, B [Duke University Medical Physics Graduate Program, Durham, NC (United States); Yin, F; Cai, J [Duke University Medical Physics Graduate Program, Durham, NC (United States); Duke University Medical Center, Radiation Oncology, Durham, NC (United States); Czito, B; Palta, M [Duke University Medical Center, Radiation Oncology, Durham, NC (United States)

2016-06-15

Purpose: To determine the variation in tumor contrast between different MRI sequences and between patients for the purpose of MRI-based treatment planning. Methods: Multiple MRI scans of 11 patients with cancer(s) in the liver were included in this IRB-approved study. Imaging sequences consisted of T1W MRI, Contrast-Enhanced T1W MRI, T2W MRI, and T2*/T1W MRI. MRI images were acquired on a 1.5T GE Signa scanner with a four-channel torso coil. We calculated the tumor-to-tissue contrast to noise ratio (CNR) for each MR sequence by contouring the tumor and a region of interest (ROI) in a homogeneous region of the liver using the Eclipse treatment planning software. CNR was calculated (I-Tum-I-ROI)/SD-ROI, where I-Tum and I-ROI are the mean values of the tumor and the ROI respectively, and SD-ROI is the standard deviation of the ROI. The same tumor and ROI structures were used in all measurements for different MR sequences. Inter-patient Coefficient of variation (CV), and inter-sequence CV was determined. In addition, mean and standard deviation of CNR were calculated and compared between different MR sequences. Results: Our preliminary results showed large inter-patient CV (range: 37.7% to 88%) and inter-sequence CV (range 5.3% to 104.9%) of liver tumor CNR, indicating great variations in tumor CNR between MR sequences and between patients. Tumor CNR was found to be largest in CE-T1W (8.5±7.5), followed by T2W (4.2±2.4), T1W (3.4±2.2), and T2*/T1W (1.7±0.6) MR scans. The inter-patient CV of tumor CNR was also the largest in CE-T1W (88%), followed by T1W (64.3%), T1W (56.2%), and T2*/T1W (37.7) MR scans. Conclusion: Large inter-sequence and inter-patient variations were observed in liver tumor CNR. CE-T1W MR images on average provided the best tumor CNR. Efforts are needed to optimize tumor contrast and its consistency for MRI-based treatment planning of cancer in the liver. This project is supported by NIH grant: 1R21CA165384.

SU-F-J-103: Assessment of Liver Tumor Contrast for Radiation Therapy: Inter-Patient and Inter-Sequence Variability

International Nuclear Information System (INIS)

Moore, B; Yin, F; Cai, J; Czito, B; Palta, M

2016-01-01

Purpose: To determine the variation in tumor contrast between different MRI sequences and between patients for the purpose of MRI-based treatment planning. Methods: Multiple MRI scans of 11 patients with cancer(s) in the liver were included in this IRB-approved study. Imaging sequences consisted of T1W MRI, Contrast-Enhanced T1W MRI, T2W MRI, and T2*/T1W MRI. MRI images were acquired on a 1.5T GE Signa scanner with a four-channel torso coil. We calculated the tumor-to-tissue contrast to noise ratio (CNR) for each MR sequence by contouring the tumor and a region of interest (ROI) in a homogeneous region of the liver using the Eclipse treatment planning software. CNR was calculated (I_Tum-I_ROI)/SD_ROI, where I_Tum and I_ROI are the mean values of the tumor and the ROI respectively, and SD_ROI is the standard deviation of the ROI. The same tumor and ROI structures were used in all measurements for different MR sequences. Inter-patient Coefficient of variation (CV), and inter-sequence CV was determined. In addition, mean and standard deviation of CNR were calculated and compared between different MR sequences. Results: Our preliminary results showed large inter-patient CV (range: 37.7% to 88%) and inter-sequence CV (range 5.3% to 104.9%) of liver tumor CNR, indicating great variations in tumor CNR between MR sequences and between patients. Tumor CNR was found to be largest in CE-T1W (8.5±7.5), followed by T2W (4.2±2.4), T1W (3.4±2.2), and T2*/T1W (1.7±0.6) MR scans. The inter-patient CV of tumor CNR was also the largest in CE-T1W (88%), followed by T1W (64.3%), T1W (56.2%), and T2*/T1W (37.7) MR scans. Conclusion: Large inter-sequence and inter-patient variations were observed in liver tumor CNR. CE-T1W MR images on average provided the best tumor CNR. Efforts are needed to optimize tumor contrast and its consistency for MRI-based treatment planning of cancer in the liver. This project is supported by NIH grant: 1R21CA165384

Integrating the Allen Brain Institute Cell Types Database into Automated Neuroscience Workflow.

Science.gov (United States)

Stockton, David B; Santamaria, Fidel

2017-10-01

We developed software tools to download, extract features, and organize the Cell Types Database from the Allen Brain Institute (ABI) in order to integrate its whole cell patch clamp characterization data into the automated modeling/data analysis cycle. To expand the potential user base we employed both Python and MATLAB. The basic set of tools downloads selected raw data and extracts cell, sweep, and spike features, using ABI's feature extraction code. To facilitate data manipulation we added a tool to build a local specialized database of raw data plus extracted features. Finally, to maximize automation, we extended our NeuroManager workflow automation suite to include these tools plus a separate investigation database. The extended suite allows the user to integrate ABI experimental and modeling data into an automated workflow deployed on heterogeneous computer infrastructures, from local servers, to high performance computing environments, to the cloud. Since our approach is focused on workflow procedures our tools can be modified to interact with the increasing number of neuroscience databases being developed to cover all scales and properties of the nervous system.

An automated multiplex specific IgE assay system using a photoimmobilized microarray.

Science.gov (United States)

Ito, Yoshihiro; Moritsugu, Nozomi; Matsue, Takahisa; Mitsukoshi, Kiyomi; Ayame, Hirohito; Okochi, Norihiko; Hattori, Hideshi; Tashiro, Hideo; Sato, Sakura; Ebisawa, Motohiro

2012-11-15

An automated microarray diagnostic system for specific IgE using photoimmobilized allergen has been developed. Photoimmobilization is useful for preparing microarrays, where various types of biological components are covalently immobilized on a plate. Because the immobilization is based on a photo-induced radical cross-linking reaction, it does not require specific functional groups on the immobilized components. Here, an aqueous solution of a photoreactive poly(ethylene glycol)-based polymer was spin-coated on a plate, and an aqueous solution of each allergen was microspotted on the coated plate and allowed to dry in air. Finally, the plate was irradiated with an ultraviolet lamp for covalent immobilization. An automated machine using these plates was developed for the assay of antigen-specific IgE. Initially, the patient serum was added to the microarray plate, and after reaction of the microspotted allergen with IgE, the adsorbed IgE was detected by a peroxidase-conjugated anti-IgE-antibody. The chemical luminescence intensity of the substrate decomposed by the peroxidase was automatically detected using a sensitive charge-coupled device camera. All the allergens were immobilized stably using this method, which was used to screen for allergen-specific IgE. The results were comparable with those using conventional specific IgE. Using this system, six different allergen-specific IgE were assayed using 10 μL of serum within a period of 20 min. Copyright © 2012 Elsevier B.V. All rights reserved.

Medical ADP Systems: Automated Medical Records Hold Promise to Improve Patient Care

Science.gov (United States)

1991-01-01

automated medical records. The report discusses the potential benefits that automation could make to the quality of patient care and the factors that impede...information systems, but no organization has fully automated one of the most critical types of information, patient medical records. The patient medical record...its review of automated medical records. GAO’s objectives in this study were to identify the (1) benefits of automating patient records and (2) factors

Systems automated reporting of patient dose in digital radiology; Sistema automatizado para generacion de informes de dosis a paciente en radiologia digital

Energy Technology Data Exchange (ETDEWEB)

Collado Chamorro, P.; Sanz Freire, C. J.; Martinez Mirallas, O.; Tejada San Juan, S.; Lopez de Gammarra, M. S.

2013-07-01

It has developed a procedure automated reporting of doses to patients in Radiology. This procedure allows to save the time required of the data used to calculate the dose to patients by yields. Also saves the time spent in the transcription of these data for the realization of the necessary calculations. This system has been developed using open source software. The characteristics of the systems of digital radiography for the automation of procedures, in particular the registration of dose should benefit from patient. This procedure is validated and currently in use at our institution. (Author)

Validation of commercially available automated canine-specific immunoturbidimetric method for measuring canine C-reactive protein

DEFF Research Database (Denmark)

Hillström, Anna; Hagman, Ragnvi; Tvedten, Harold

2014-01-01

BACKGROUND: Measurement of C-reactive protein (CRP) is used for diagnosing and monitoring systemic inflammatory disease in canine patients. An automated human immunoturbidimetric assay has been validated for measuring canine CRP, but cross-reactivity with canine CRP is unpredictable. OBJECTIVE......: The purpose of the study was to validate a new automated canine-specific immunoturbidimetric CRP method (Gentian cCRP). METHODS: Studies of imprecision, accuracy, prozone effect, interference, limit of quantification, and stability under different storage conditions were performed. The new method was compared...... with a human CRP assay previously validated for canine CRP determination. Samples from 40 healthy dogs were analyzed to establish a reference interval. RESULTS: Total imprecision was

Institutional shifts in inter-municipal service delivery: an analysis of developments in eight Western European countries

NARCIS (Netherlands)

Hulst, J.R.; van Montfort, A.J.G.M.; Haveri, A.; Airaksinen, J.; Kelly, J.

2009-01-01

Comparative research on inter-municipal cooperation in eight European countries shows that there is a great variety of institutional arrangements for cooperation across the different countries. Also, these arrangements tend to change over time in terms of the scope of cooperation among partners,

AUTOMATED PROCESS MONITORING: APPLYING PROVEN AUTOMATION TECHNIQUES TO INTERNATIONAL SAFEGUARDS NEEDS

International Nuclear Information System (INIS)

O'Hara, Matthew J.; Durst, Philip C.; Grate, Jay W.; Devol, Timothy A.; Egorov, Oleg; Clements, John P.

2008-01-01

Identification and quantification of specific alpha- and beta-emitting radionuclides in complex liquid matrices is highly challenging, and is typically accomplished through laborious wet chemical sample preparation and separations followed by analysis using a variety of detection methodologies (e.g., liquid scintillation, gas proportional counting, alpha energy analysis, mass spectrometry). Analytical results may take days or weeks to report. Chains of custody and sample security measures may also complicate or slow the analytical process. When an industrial process-scale plant requires the monitoring of specific radionuclides as an indication of the composition of its feed stream or of plant performance, radiochemical measurements must be fast, accurate, and reliable. Scientists at Pacific Northwest National Laboratory have assembled a fully automated prototype Process Monitor instrument capable of a variety of tasks: automated sampling directly from a feed stream, sample digestion/analyte redox adjustment, chemical separations, radiochemical detection and data analysis/reporting. The system is compact, its components are fluidically inter-linked, and analytical results could be immediately transmitted to on- or off-site locations. The development of a rapid radiochemical Process Monitor for 99Tc in Hanford tank waste processing streams, capable of performing several measurements per hour, will be discussed in detail. More recently, the automated platform was modified to perform measurements of 90Sr in Hanford tank waste stimulant. The system exemplifies how automation could be integrated into reprocessing facilities to support international nuclear safeguards needs

Use of an Automated Mobile Phone Messaging Robot in Postoperative Patient Monitoring.

Science.gov (United States)

Anthony, Chris A; Lawler, Ericka A; Ward, Christina M; Lin, Ines C; Shah, Apurva S

2018-01-01

Mobile phone messaging software robots allow clinicians and healthcare systems to communicate with patients without the need for human intervention. The purpose of this study was to (1) describe a method for communicating with patients postoperatively outside of the traditional healthcare setting by utilizing an automated software and mobile phone messaging platform and to (2) evaluate the first week of postoperative pain and opioid use after common ambulatory hand surgery procedures. The investigation was a prospective, multicenter investigation of patient-reported pain and opioid usage after ambulatory hand surgery. Inclusion criteria included any adult with a mobile phone capable of text messaging, who was undergoing a common ambulatory hand surgical procedure at one of three tertiary care institutions. Participants received daily, automated text messages inquiring about their pain level and how many tablets of prescription pain medication they had taken in the past 24 h. Initial 1-week response rate was assessed and compared between different patient demographics. Patient-reported pain and opioid use were also quantified for the first postoperative week. Statistical significance was set as p tablets of prescription opioid pain medication. We find that a mobile phone messaging software robot allows for effective data collection of postoperative pain and pain medication use. Patients undergoing common ambulatory hand procedures utilized an average of 16 tablets of opioid medication in the first postoperative week.

Patients in assisted automated peritoneal dialysis develop strategies for selfcare

DEFF Research Database (Denmark)

Holch, Kirsten

  Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically...

Automated interpretation of PET/CT images in patients with lung cancer

DEFF Research Database (Denmark)

Gutte, Henrik; Jakobsson, David; Olofsson, Fredrik

2007-01-01

cancer. METHODS: A total of 87 patients who underwent PET/CT examinations due to suspected lung cancer comprised the training group. The test group consisted of PET/CT images from 49 patients suspected with lung cancer. The consensus interpretations by two experienced physicians were used as the 'gold...... method measured as the area under the receiver operating characteristic curve, was 0.97 in the test group, with an accuracy of 92%. The sensitivity was 86% at a specificity of 100%. CONCLUSIONS: A completely automated method using artificial neural networks can be used to detect lung cancer......PURPOSE: To develop a completely automated method based on image processing techniques and artificial neural networks for the interpretation of combined [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) images for the diagnosis and staging of lung...

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units.

Science.gov (United States)

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-03-01

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis. Copyright: © Singapore Medical Association.

Strategic Renewal in Regulatory Environments. How inter- and intra-organisational institutional forces influence European incumbent energy firms

International Nuclear Information System (INIS)

Stienstra, M.

2008-01-01

How do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm's strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions in order to remain competitive. Exploitative strategic renewal involves those actions that strengthen or optimise a firm's current resource deployments, whereas explorative strategic renewal relates to actions that generate new sources of value creation for the firm. Based on old institutional theory, new institutional theory, neo-institutional theory and institutional entrepreneurship literature, a multi-level framework that combines selection and adaptation arguments has been developed and applied to investigate strategic renewal behaviour of a sample of European energy incumbents. At industry level of analysis, results show how inter-organisational institutional forces significantly impact firms' choices of exploitative and explorative strategic renewal actions through regulative, normative and cognitive forces. At organisational unit level of analysis, we find that the extent of intra-organisational regulative forces is positively related to exploitative strategic renewal actions. In addition, entrepreneurial proclivity appears to be a catalyst of both exploitative and explorative strategic renewal actions. Finally, our results provide insights how environmental selection and firm level adaptation are interrelated in the context of regulation. The extent of inter-organisational regulative forces positively moderates the relationship between intra-organisational regulative forces and exploitative strategic renewal actions.

PubMed-supported clinical term weighting approach for improving inter-patient similarity measure in diagnosis prediction.

Science.gov (United States)

Chan, Lawrence Wc; Liu, Ying; Chan, Tao; Law, Helen Kw; Wong, S C Cesar; Yeung, Andy Ph; Lo, K F; Yeung, S W; Kwok, K Y; Chan, William Yl; Lau, Thomas Yh; Shyu, Chi-Ren

2015-06-02

Similarity-based retrieval of Electronic Health Records (EHRs) from large clinical information systems provides physicians the evidence support in making diagnoses or referring examinations for the suspected cases. Clinical Terms in EHRs represent high-level conceptual information and the similarity measure established based on these terms reflects the chance of inter-patient disease co-occurrence. The assumption that clinical terms are equally relevant to a disease is unrealistic, reducing the prediction accuracy. Here we propose a term weighting approach supported by PubMed search engine to address this issue. We collected and studied 112 abdominal computed tomography imaging examination reports from four hospitals in Hong Kong. Clinical terms, which are the image findings related to hepatocellular carcinoma (HCC), were extracted from the reports. Through two systematic PubMed search methods, the generic and specific term weightings were established by estimating the conditional probabilities of clinical terms given HCC. Each report was characterized by an ontological feature vector and there were totally 6216 vector pairs. We optimized the modified direction cosine (mDC) with respect to a regularization constant embedded into the feature vector. Equal, generic and specific term weighting approaches were applied to measure the similarity of each pair and their performances for predicting inter-patient co-occurrence of HCC diagnoses were compared by using Receiver Operating Characteristics (ROC) analysis. The Areas under the curves (AUROCs) of similarity scores based on equal, generic and specific term weighting approaches were 0.735, 0.728 and 0.743 respectively (p PubMed. Our findings suggest that the optimized similarity measure with specific term weighting to EHRs can improve significantly the accuracy for predicting the inter-patient co-occurrence of diagnosis when compared with equal and generic term weighting approaches.

Development of inter-specific chromosomes segment substitution libraries (CSSL) in rice

Science.gov (United States)

Six libraries of inter-specific Chromosome Segment Substitution Lines (CSSLs) of rice are being developed as pre-breeding materials and genetic stocks. Three accessions of O. rufipogon were selected as donors, based on phylogenetic, geographical and morphological divergence, and crossed with two rec...

Barriers and Facilitators of Mentoring for Trainees and Early Career Investigators in Rheumatology Research: Current State, Identification of Needs, and Road Map to an Inter-Institutional Adult Rheumatology Mentoring Program.

Science.gov (United States)

Ogdie, Alexis; Sparks, Jeffrey A; Angeles-Han, Sheila T; Bush, Kathleen; Castelino, Flavia V; Golding, Amit; Jiang, Yihui; Kahlenberg, J Michelle; Kim, Alfred H J; Lee, Yvonne C; Machireddy, Kirthi; Ombrello, Michael J; Shah, Ami A; Wallace, Zachary S; Nigrovic, Peter A; Makris, Una E

2018-03-01

To determine perceived barriers and facilitators to effective mentoring for early career rheumatology investigators and to develop a framework for an inter-institutional mentoring program. Focus groups or interviews with rheumatology fellows, junior faculty, and mentors were conducted, audiorecorded, and transcribed. Content analysis was performed using NVivo software. Themes were grouped into categories (e.g., mentor-mentee relationship, barriers, and facilitators of a productive relationship). Rheumatology fellows and early career investigators were also surveyed nationwide to identify specific needs to be addressed through an inter-institutional mentoring program. Twenty-five individuals participated in focus groups or interviews. Attributes of the ideal mentee-mentor relationship included communication, accessibility, regular meetings, shared interests, aligned goals, and mutual respect. The mentee should be proactive, efficient, engaged, committed, focused, accountable, and respectful of the mentor's time. The mentor should support/promote the mentee, shape the mentee's goals and career plan, address day-to-day questions, provide critical feedback, be available, and have team leadership skills. Barriers included difficulty with career path navigation, gaining independence, internal competition, authorship, time demands, funding, and work-life balance. Facilitators of a successful relationship included having a diverse network of mentors filling different roles, mentor-mentee relationship management, and confidence. Among 187 survey respondents, the primary uses of an inter-institutional mentoring program were career development planning and oversight, goal-setting, and networking. In this mixed-methods study, tangible factors for optimizing the mentor-mentee relationship were identified and will inform the development of an adult rheumatology inter-institutional mentoring program. © 2017, American College of Rheumatology.

Automation of the ELISpot assay for high-throughput detection of antigen-specific T-cell responses.

Science.gov (United States)

Almeida, Coral-Ann M; Roberts, Steven G; Laird, Rebecca; McKinnon, Elizabeth; Ahmed, Imran; Pfafferott, Katja; Turley, Joanne; Keane, Niamh M; Lucas, Andrew; Rushton, Ben; Chopra, Abha; Mallal, Simon; John, Mina

2009-05-15

The enzyme linked immunospot (ELISpot) assay is a fundamental tool in cellular immunology, providing both quantitative and qualitative information on cellular cytokine responses to defined antigens. It enables the comprehensive screening of patient derived peripheral blood mononuclear cells to reveal the antigenic restriction of T-cell responses and is an emerging technique in clinical laboratory investigation of certain infectious diseases. As with all cellular-based assays, the final results of the assay are dependent on a number of technical variables that may impact precision if not highly standardised between operators. When studies that are large scale or using multiple antigens are set up manually, these assays may be labour intensive, have many manual handling steps, are subject to data and sample integrity failure and may show large inter-operator variability. Here we describe the successful automated performance of the interferon (IFN)-gamma ELISpot assay from cell counting through to electronic capture of cytokine quantitation and present the results of a comparison between automated and manual performance of the ELISpot assay. The mean number of spot forming units enumerated by both methods for limiting dilutions of CMV, EBV and influenza (CEF)-derived peptides in six healthy individuals were highly correlated (r>0.83, pautomated system compared favourably with the manual ELISpot and further ensured electronic tracking, increased through-put and reduced turnaround time.

Patient-specific models of cardiac biomechanics

Science.gov (United States)

Krishnamurthy, Adarsh; Villongco, Christopher T.; Chuang, Joyce; Frank, Lawrence R.; Nigam, Vishal; Belezzuoli, Ernest; Stark, Paul; Krummen, David E.; Narayan, Sanjiv; Omens, Jeffrey H.; McCulloch, Andrew D.; Kerckhoffs, Roy C. P.

2013-07-01

Patient-specific models of cardiac function have the potential to improve diagnosis and management of heart disease by integrating medical images with heterogeneous clinical measurements subject to constraints imposed by physical first principles and prior experimental knowledge. We describe new methods for creating three-dimensional patient-specific models of ventricular biomechanics in the failing heart. Three-dimensional bi-ventricular geometry is segmented from cardiac CT images at end-diastole from patients with heart failure. Human myofiber and sheet architecture is modeled using eigenvectors computed from diffusion tensor MR images from an isolated, fixed human organ-donor heart and transformed to the patient-specific geometric model using large deformation diffeomorphic mapping. Semi-automated methods were developed for optimizing the passive material properties while simultaneously computing the unloaded reference geometry of the ventricles for stress analysis. Material properties of active cardiac muscle contraction were optimized to match ventricular pressures measured by cardiac catheterization, and parameters of a lumped-parameter closed-loop model of the circulation were estimated with a circulatory adaptation algorithm making use of information derived from echocardiography. These components were then integrated to create a multi-scale model of the patient-specific heart. These methods were tested in five heart failure patients from the San Diego Veteran's Affairs Medical Center who gave informed consent. The simulation results showed good agreement with measured echocardiographic and global functional parameters such as ejection fraction and peak cavity pressures.

Strategic Renewal in Regulatory Environments. How inter- and intra-organisational institutional forces influence European incumbent energy firms

Energy Technology Data Exchange (ETDEWEB)

Stienstra, M.

2008-11-20

How do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm's strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions in order to remain competitive. Exploitative strategic renewal involves those actions that strengthen or optimise a firm's current resource deployments, whereas explorative strategic renewal relates to actions that generate new sources of value creation for the firm. Based on old institutional theory, new institutional theory, neo-institutional theory and institutional entrepreneurship literature, a multi-level framework that combines selection and adaptation arguments has been developed and applied to investigate strategic renewal behaviour of a sample of European energy incumbents. At industry level of analysis, results show how inter-organisational institutional forces significantly impact firms' choices of exploitative and explorative strategic renewal actions through regulative, normative and cognitive forces. At organisational unit level of analysis, we find that the extent of intra-organisational regulative forces is positively related to exploitative strategic renewal actions. In addition, entrepreneurial proclivity appears to be a catalyst of both exploitative and explorative strategic renewal actions. Finally, our results provide insights how environmental selection and firm level adaptation are interrelated in the context of regulation. The extent of inter-organisational regulative forces positively moderates the relationship between intra-organisational regulative forces and exploitative strategic renewal actions.

Automated longitudinal intra-subject analysis (ALISA) for diffusion MRI tractography

DEFF Research Database (Denmark)

Aarnink, Saskia H; Vos, Sjoerd B; Leemans, Alexander

2014-01-01

the inter-subject and intra-subject automation in this situation are intended for subjects without gross pathology. In this work, we propose such an automated longitudinal intra-subject analysis (dubbed ALISA) approach, and assessed whether ALISA could preserve the same level of reliability as obtained....... The major disadvantage of manual FT segmentations, unfortunately, is that placing regions-of-interest for tract selection can be very labor-intensive and time-consuming. Although there are several methods that can identify specific WM fiber bundles in an automated way, manual FT segmentations across...... multiple subjects performed by a trained rater with neuroanatomical expertise are generally assumed to be more accurate. However, for longitudinal DTI analyses it may still be beneficial to automate the FT segmentation across multiple time points, but then for each individual subject separately. Both...

Analysis of the thoracic aorta using a semi-automated post processing tool

International Nuclear Information System (INIS)

Entezari, Pegah; Kino, Aya; Honarmand, Amir R.; Galizia, Mauricio S.; Yang, Yan; Collins, Jeremy; Yaghmai, Vahid; Carr, James C.

2013-01-01

Objective: To evaluates a semi-automated method for Thoracic Aortic Aneurysm (TAA) measurement using ECG-gated Dual Source CT Angiogram (DSCTA). Methods: This retrospective HIPAA compliant study was approved by our IRB. Transaxial maximum diameters of outer wall to outer wall were studied in fifty patients at seven anatomic locations of the thoracic aorta: annulus, sinus, sinotubular junction (STJ), mid ascending aorta (MAA) at the level of right pulmonary artery, proximal aortic arch (PROX) immediately proximal to innominate artery, distal aortic arch (DIST) immediately distal to left subclavian artery, and descending aorta (DESC) at the level of diaphragm. Measurements were performed using a manual method and semi-automated software. All readers repeated their measurements. Inter-method, intra-observer and inter-observer agreements were evaluated according to intraclass correlation coefficient (ICC) and Bland–Altman plot. The number of cases with manual contouring or center line adjustment for the semi-automated method and also the post-processing time for each method were recorded. Results: The mean difference between semi-automated and manual methods was less than 1.3 mm at all seven points. Strong inter-method, inter-observer and intra-observer agreement was recorded at all levels (ICC ≥ 0.9). The maximum rate of manual adjustment of center line and contour was at the level of annulus. The average time for manual post-processing of the aorta was 19 ± 0.3 min, while it took 8.26 ± 2.1 min to do the measurements with the semi-automated tool (Vitrea version 6.0.0.1 software). The center line was edited manually at all levels, with most corrections at the level of annulus (60%), while the contour was adjusted at all levels with highest and lowest number of corrections at the levels of annulus and DESC (75% and 0.07% of the cases), respectively. Conclusion: Compared to the commonly used manual method, semi-automated measurement of vessel dimensions is

Using business intelligence for efficient inter-facility patient transfer.

Science.gov (United States)

Haque, Waqar; Derksen, Beth Ann; Calado, Devin; Foster, Lee

2015-01-01

In the context of inter-facility patient transfer, a transfer operator must be able to objectively identify a destination which meets the needs of a patient, while keeping in mind each facility's limitations. We propose a solution which uses Business Intelligence (BI) techniques to analyze data related to healthcare infrastructure and services, and provides a web based system to identify optimal destination(s). The proposed inter-facility transfer system uses a single data warehouse with an Online Analytical Processing (OLAP) cube built on top that supplies analytical data to multiple reports embedded in web pages. The data visualization tool includes map based navigation of the health authority as well as an interactive filtering mechanism which finds facilities meeting the selected criteria. The data visualization is backed by an intuitive data entry web form which safely constrains the data, ensuring consistency and a single version of truth. The overall time required to identify the destination for inter-facility transfers is reduced from hours to a few minutes with this interactive solution.

A Study to Develop the Optimal Military Inter-Institutional Patient Referral Systems Model for DoD (Department of Defense) Military Medical Region III

Science.gov (United States)

1988-05-01

I rerr syttemn an do wlon t P ontimal military inter-instittiuonal patient referral systems model for DOD Military Medical Region III. A convenience...Dactin- on the Armed Services Medical Regulating Office and Patient Airlift "lc rcsusl.s of :his study indicated that the single largest breakdown...and the requirement to regulate to the closest medical facility with capability to care for the patient . L! / I Ii I i A STUDY TO DEVELOP THE OPTIMAL

TU-H-207A-09: An Automated Technique for Estimating Patient-Specific Regional Imparted Energy and Dose From TCM CT Exams Across 13 Protocols

International Nuclear Information System (INIS)

Sanders, J; Tian, X; Segars, P; Boone, J; Samei, E

2016-01-01

Purpose: To develop an automated technique for estimating patient-specific regional imparted energy and dose from tube current modulated (TCM) computed tomography (CT) exams across a diverse set of head and body protocols. Methods: A library of 58 adult computational anthropomorphic extended cardiac-torso (XCAT) phantoms were used to model a patient population. A validated Monte Carlo program was used to simulate TCM CT exams on the entire library of phantoms for three head and 10 body protocols. The net imparted energy to the phantoms, normalized by dose length product (DLP), and the net tissue mass in each of the scan regions were computed. A knowledgebase containing relationships between normalized imparted energy and scanned mass was established. An automated computer algorithm was written to estimate the scanned mass from actual clinical CT exams. The scanned mass estimate, DLP of the exam, and knowledgebase were used to estimate the imparted energy to the patient. The algorithm was tested on 20 chest and 20 abdominopelvic TCM CT exams. Results: The normalized imparted energy increased with increasing kV for all protocols. However, the normalized imparted energy was relatively unaffected by the strength of the TCM. The average imparted energy was 681 ± 376 mJ for abdominopelvic exams and 274 ± 141 mJ for chest exams. Overall, the method was successful in providing patientspecific estimates of imparted energy for 98% of the cases tested. Conclusion: Imparted energy normalized by DLP increased with increasing tube potential. However, the strength of the TCM did not have a significant effect on the net amount of energy deposited to tissue. The automated program can be implemented into the clinical workflow to provide estimates of regional imparted energy and dose across a diverse set of clinical protocols.

Genetic algorithms in teaching artificial intelligence (automated generation of specific algebras)

Science.gov (United States)

Habiballa, Hashim; Jendryscik, Radek

2017-11-01

The problem of teaching essential Artificial Intelligence (AI) methods is an important task for an educator in the branch of soft-computing. The key focus is often given to proper understanding of the principle of AI methods in two essential points - why we use soft-computing methods at all and how we apply these methods to generate reasonable results in sensible time. We present one interesting problem solved in the non-educational research concerning automated generation of specific algebras in the huge search space. We emphasize above mentioned points as an educational case study of an interesting problem in automated generation of specific algebras.

Institutional Logics in Inter-institutional Temporary Organizations

DEFF Research Database (Denmark)

Pemsel, Sofia; Söderlund, Jonas

-cognitive, normative, and regulative – are unfolding and evolving in such contexts. The case study addresses the integration and disintegration of logics and normative orders in an ongoing process characterized by the co-mingling, co-existence, creation and resolutions of hybrid logics and creation of institutional...... exceptions throughout the life of the studied temporary organization. In that respect, this paper contributes with a more nuanced view on the evolution, dynamics, and co-existence of pressures from multiple institutional demands at the organizational level....

Opening up Library Automation Software

Science.gov (United States)

Breeding, Marshall

2009-01-01

Throughout the history of library automation, the author has seen a steady advancement toward more open systems. In the early days of library automation, when proprietary systems dominated, the need for standards was paramount since other means of inter-operability and data exchange weren't possible. Today's focus on Application Programming…

Redefining the Practice of Peer Review Through Intelligent Automation-Part 3: Automated Report Analysis and Data Reconciliation.

Science.gov (United States)

Reiner, Bruce I

2018-02-01

One method for addressing existing peer review limitations is the assignment of peer review cases on a completely blinded basis, in which the peer reviewer would create an independent report which can then be cross-referenced with the primary reader report of record. By leveraging existing computerized data mining techniques, one could in theory automate and objectify the process of report data extraction, classification, and analysis, while reducing time and resource requirements intrinsic to manual peer review report analysis. Once inter-report analysis has been performed, resulting inter-report discrepancies can be presented to the radiologist of record for review, along with the option to directly communicate with the peer reviewer through an electronic data reconciliation tool aimed at collaboratively resolving inter-report discrepancies and improving report accuracy. All associated report and reconciled data could in turn be recorded in a referenceable peer review database, which provides opportunity for context and user-specific education and decision support.

Inter-donor variation in cell subset specific immune signaling responses in healthy individuals.

Science.gov (United States)

Longo, Diane M; Louie, Brent; Wang, Ena; Pos, Zoltan; Marincola, Francesco M; Hawtin, Rachael E; Cesano, Alessandra

2012-01-01

Single cell network profiling (SCNP) is a multi-parameter flow cytometry based approach that allows for the simultaneous interrogation of intracellular signaling pathways in multiple cell subpopulations within heterogeneous tissues, without the need for individual cell subset isolation. Thus, the technology is extremely well-suited for characterizing the multitude of interconnected signaling pathways and immune cell subpopulations that regulate the function of the immune system. Recently, SCNP was applied to generate a functional map of the healthy human immune cell signaling network by profiling immune signaling pathways downstream of 12 immunomodulators in 7 distinct immune cell subsets within peripheral blood mononuclear cells (PBMCs) from 60 healthy donors. In the study reported here, the degree of inter-donor variation in the magnitude of the immune signaling responses was analyzed. The highest inter-donor differences in immune signaling pathway activity occurred following perturbation of the immune signaling network, rather than in basal signaling. When examining the full panel of immune signaling responses, as one may expect, the overall degree of inter-donor variation was positively correlated (r = 0.727) with the magnitude of node response (i.e. a larger median signaling response was associated with greater inter-donor variation). However, when examining the degree of heterogeneity across cell subpopulations for individual signaling nodes, cell subset specificity in the degree of inter-donor variation was observed for several nodes. For such nodes, relatively weak correlations between inter-donor variation and the magnitude of the response were observed. Further, within the phenotypically distinct subpopulations, a fraction of the immune signaling responses had bimodal response profiles in which (a) only a portion of the cells had elevated phospho-protein levels following modulation and (b) the proportion of responsive cells varied by donor. These data

Automated bony region identification using artificial neural networks: reliability and validation measurements

International Nuclear Information System (INIS)

Gassman, Esther E.; Kallemeyn, Nicole A.; DeVries, Nicole A.; Shivanna, Kiran H.; Powell, Stephanie M.; Magnotta, Vincent A.; Ramme, Austin J.; Adams, Brian D.; Grosland, Nicole M.

2008-01-01

The objective was to develop tools for automating the identification of bony structures, to assess the reliability of this technique against manual raters, and to validate the resulting regions of interest against physical surface scans obtained from the same specimen. Artificial intelligence-based algorithms have been used for image segmentation, specifically artificial neural networks (ANNs). For this study, an ANN was created and trained to identify the phalanges of the human hand. The relative overlap between the ANN and a manual tracer was 0.87, 0.82, and 0.76, for the proximal, middle, and distal index phalanx bones respectively. Compared with the physical surface scans, the ANN-generated surface representations differed on average by 0.35 mm, 0.29 mm, and 0.40 mm for the proximal, middle, and distal phalanges respectively. Furthermore, the ANN proved to segment the structures in less than one-tenth of the time required by a manual rater. The ANN has proven to be a reliable and valid means of segmenting the phalanx bones from CT images. Employing automated methods such as the ANN for segmentation, eliminates the likelihood of rater drift and inter-rater variability. Automated methods also decrease the amount of time and manual effort required to extract the data of interest, thereby making the feasibility of patient-specific modeling a reality. (orig.)

Automated bony region identification using artificial neural networks: reliability and validation measurements

Energy Technology Data Exchange (ETDEWEB)

Gassman, Esther E.; Kallemeyn, Nicole A.; DeVries, Nicole A.; Shivanna, Kiran H. [The University of Iowa, Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA (United States); The University of Iowa, Center for Computer-Aided Design, Iowa City, IA (United States); Powell, Stephanie M. [The University of Iowa, Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA (United States); University of Iowa Hospitals and Clinics, The University of Iowa, Department of Radiology, Iowa City, IA (United States); Magnotta, Vincent A. [The University of Iowa, Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA (United States); The University of Iowa, Center for Computer-Aided Design, Iowa City, IA (United States); University of Iowa Hospitals and Clinics, The University of Iowa, Department of Radiology, Iowa City, IA (United States); Ramme, Austin J. [University of Iowa Hospitals and Clinics, The University of Iowa, Department of Radiology, Iowa City, IA (United States); Adams, Brian D. [The University of Iowa, Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA (United States); University of Iowa Hospitals and Clinics, The University of Iowa, Department of Orthopaedics and Rehabilitation, Iowa City, IA (United States); Grosland, Nicole M. [The University of Iowa, Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA (United States); University of Iowa Hospitals and Clinics, The University of Iowa, Department of Orthopaedics and Rehabilitation, Iowa City, IA (United States); The University of Iowa, Center for Computer-Aided Design, Iowa City, IA (United States)

2008-04-15

The objective was to develop tools for automating the identification of bony structures, to assess the reliability of this technique against manual raters, and to validate the resulting regions of interest against physical surface scans obtained from the same specimen. Artificial intelligence-based algorithms have been used for image segmentation, specifically artificial neural networks (ANNs). For this study, an ANN was created and trained to identify the phalanges of the human hand. The relative overlap between the ANN and a manual tracer was 0.87, 0.82, and 0.76, for the proximal, middle, and distal index phalanx bones respectively. Compared with the physical surface scans, the ANN-generated surface representations differed on average by 0.35 mm, 0.29 mm, and 0.40 mm for the proximal, middle, and distal phalanges respectively. Furthermore, the ANN proved to segment the structures in less than one-tenth of the time required by a manual rater. The ANN has proven to be a reliable and valid means of segmenting the phalanx bones from CT images. Employing automated methods such as the ANN for segmentation, eliminates the likelihood of rater drift and inter-rater variability. Automated methods also decrease the amount of time and manual effort required to extract the data of interest, thereby making the feasibility of patient-specific modeling a reality. (orig.)

Automated microaxial tomography of cell nuclei after specific labelling by fluorescence in situ hybridisation

Czech Academy of Sciences Publication Activity Database

Kozubek, Michal; Skalníková, M.; Matula, Pe.; Bártová, Eva; Rauch, J.; Neuhaus, F.; Eipel, H.; Hasmann, M.

2002-01-01

Roč. 33, 7-8 (2002), s. 655-665 ISSN 0968-4328 Institutional research plan: CEZ:AV0Z5004920 Keywords : microaxial tomography * automated microscopy * high-resolution cytometry Subject RIV: BO - Biophysics Impact factor: 1.537, year: 2002

Assay-specific decision limits for two new automated parathyroid hormone and 25-hydroxyvitamin D assays.

Science.gov (United States)

Souberbielle, Jean-Claude; Fayol, Véronique; Sault, Corinne; Lawson-Body, Ethel; Kahan, André; Cormier, Catherine

2005-02-01

The recent development of nonradioactive automated assays for serum parathyroid hormone (PTH) and 25-hydroxyvitamin D (25OHD) has made measurement of these two hormones possible in many laboratories. In this study, we compared two new assays for PTH and 25OHD adapted on an automated analyzer, the LIAISON, with two manual immunoassays used worldwide. We studied 228 osteoporotic patients, 927 healthy individuals, 38 patients with primary hyperparathyroidism, and 167 hemodialyzed patients. Serum PTH was measured with the Allegro and the LIAISON assays, and 25OHD was measured with DiaSorin RIA and the LIAISON assay. Regression analysis was used to calculate decision thresholds for the LIAISON assays that were equivalent to those of the Allegro PTH and DiaSorin 25OHD assays. The 25OHD concentrations obtained with the LIAISON assay and the RIA in osteoporotic patients were well correlated (r = 0.83; P 50 nmol/L as eligible for the reference population for the LIAISON PTH assay. In this group, the 3rd-97th percentile interval for LIAISON PTH was 3-51 ng/L. Considering upper reference limits of 46 and 51 ng/L for the Allegro and LIAISON assays, respectively, the frequency of above-normal PTH concentrations in patients with primary hyperparathyroidism was similar in both assays. Regression analysis between serum PTH measured by the Allegro and LIAISON assays in 167 hemodialyzed patients and the corresponding Bland-Altman analysis of these data suggest that the LIAISON PTH assay tends to read higher than the Allegro assay at low concentrations but lower at high concentrations (>300 ng/L). Because clinical decision limits for both PTH and 25OHD should be assay specific, we propose equivalences between these assays and two manual assays used worldwide. These assay-specific decision limits should help potential users of the LIAISON PTH and 25OHD assays.

Patient-specific model of a scoliotic torso for surgical planning

Science.gov (United States)

Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean

2013-03-01

A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

Population and patient-specific target margins for 4D adaptive radiotherapy to account for intra- and inter-fraction variation in lung tumour position

International Nuclear Information System (INIS)

Hugo, Geoffrey D; Di Yan; Jian Liang

2007-01-01

In this work, five 4D image-guidance strategies (two population, an offline adaptive and two online strategies) were evaluated that compensated for both inter- and intra-fraction variability such as changes to the baseline tumour position and respiratory pattern. None of the strategies required active motion compensation such as gating or tracking; all strategies simulated a free-breathing-based treatment technique. Online kilovoltage fluoroscopy was acquired for eight patients with lung tumours, and used to construct inter- and intra-fraction tumour position variability models. Planning was performed on a mid-ventilation image acquired from a respiration-correlated CT scan. The blurring effect of tumour position variability was included in the dose calculation by convolution. CTV to PTV margins were calculated for variability in the cranio-caudal direction. A population margin of 9.0 ± 0.7 mm was required to account for setup error and respiration in the study population without the use of image-guidance. The greatest mean margin reduction was introduced by the offline adaptive strategy. A daily online correction strategy produced a small reduction (1.6 mm) in the mean margin from the offline strategy. Adaptively correcting for an inter-fraction change in the respiratory pattern had little effect on margin size due to most patients having only small daily changes in the respiratory pattern. A daily online correction strategy would be useful for patients who exhibit large variations in the daily mean tumour position, while an offline adaptive strategy is more applicable to patients with less variation

Performance evaluation of the Sysmex® XE-2100D automated hematology analyzer

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Tavany Elisa Santos Maciel

2014-02-01

Full Text Available Introduction: The Sysmex® XE-2100D is a multiparameter hematology analyzer designed for hematology testing in samples with ethylenediamine tetraacetic acid (EDTA. Objectives: Considering the importance of this hematology analyzer for clinical and laboratory practice, the objective of this study was to evaluate its analytical performance, comparing the obtained results with quality specifications described in literature. Material and method: In the evaluation of analytical performance, according to recommendations of the document H26-A2 of the Clinical and Laboratory Standards Institute (CLSI, intra-run imprecision, inter-run imprecision, linearity, carryover, autosampler evaluation, clinical sensitivity of the atypical lymphocytes flag (n = 400 samples were included, as well as the comparison between automated and manual leukocyte differential count (n = 400 samples, based on an adaptation of the document H20-A2 of CLSI. Results: Repeatability, reproducibility, linearity and carryover were satisfactory according to the manufacturer's specifications. The clinical sensitivity of the atypical lymphocytes flag showed efficiency, sensitivity and specificity of 92.5%, 65.2% and 94.1% respectively. The correlation coefficients between the automated and manual differential counts of neutrophils, lymphocytes, monocytes, eosinophils and basophils were 0.991, 0.99, 0.872, 0.974 and 0.557, respectively. Conclusions: The results were in accordance with quality specifications described in literature, indicating reliability in Sysmex® XE-2100D. This fact ensures certainty to both laboratory professionals and medical staff. We conclude that the Sysmex® XE-2100D showed excellent analytical performance, and is useful to provide reliable hematology data.

High inter-tester reliability of the new mobility score in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, M.T.; Bandholm, T.; Foss, N.B.

2008-01-01

OBJECTIVE: To assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. DESIGN: An inter-tester reliability study. SUBJECTS: Forty-eight consecutive patients with acute hip fracture at a median age of 84 (interquartile range, 76-89) years; 40 admitted from...

Inter-individual and inter-cell type variation in residual DNA damage after in vivo irradiation of human skin

International Nuclear Information System (INIS)

Chua, Melvin Lee Kiang; Somaiah, Navita; Bourne, Sara; Daley, Frances; A'Hern, Roger; Nuta, Otilia; Davies, Sue; Herskind, Carsten; Pearson, Ann; Warrington, Jim; Helyer, Sarah; Owen, Roger; Yarnold, John; Rothkamm, Kai

2011-01-01

Purpose: The aim of this study was to compare inter-individual and inter-cell type variation in DNA double-strand break (DSB) repair following in vivo irradiation of human skin. Materials and methods: Duplicate 4 mm core biopsies of irradiated and unirradiated skin were collected from 35 patients 24 h after 4 Gy exposure using 6 MeV electrons. Residual DSB were quantified by scoring 53BP1 foci in dermal fibroblasts, endothelial cells, superficial keratinocytes and basal epidermal cells. Results: Coefficients of inter-individual variation for levels of residual foci 24 h after in vivo irradiation of skin were 39.9% in dermal fibroblasts, 44.3% in endothelial cells, 32.9% in superficial keratinocytes and 46.4% in basal epidermal cells (p < 0.001, ANOVA). In contrast, the coefficient of inter-cell type variation for residual foci levels was only 11.3% in human skin between the different epidermal and dermal cells (p = 0.034, ANOVA). Foci levels between the different skin cell types were correlated (Pearson's R = 0.855-0.955, p < 0.001). Conclusions: Patient-specific factors appear to be more important than cell type-specific factors in determining residual foci levels following in vivo irradiation of human skin.

External Validity of Electronic Sniffers for Automated Recognition of Acute Respiratory Distress Syndrome.

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McKown, Andrew C; Brown, Ryan M; Ware, Lorraine B; Wanderer, Jonathan P

2017-01-01

Automated electronic sniffers may be useful for early detection of acute respiratory distress syndrome (ARDS) for institution of treatment or clinical trial screening. In a prospective cohort of 2929 critically ill patients, we retrospectively applied published sniffer algorithms for automated detection of acute lung injury to assess their utility in diagnosis of ARDS in the first 4 ICU days. Radiographic full-text reports were searched for "edema" OR ("bilateral" AND "infiltrate") and a more detailed algorithm for descriptions consistent with ARDS. Patients were flagged as possible ARDS if a radiograph met search criteria and had a PaO 2 /FiO 2 or SpO 2 /FiO 2 of 300 or 315, respectively. Test characteristics of the electronic sniffers and clinical suspicion of ARDS were compared to a gold standard of 2-physician adjudicated ARDS. Thirty percent of 2841 patients included in the analysis had gold standard diagnosis of ARDS. The simpler algorithm had sensitivity for ARDS of 78.9%, specificity of 52%, positive predictive value (PPV) of 41%, and negative predictive value (NPV) of 85.3% over the 4-day study period. The more detailed algorithm had sensitivity of 88.2%, specificity of 55.4%, PPV of 45.6%, and NPV of 91.7%. Both algorithms were more sensitive but less specific than clinician suspicion, which had sensitivity of 40.7%, specificity of 94.8%, PPV of 78.2%, and NPV of 77.7%. Published electronic sniffer algorithms for ARDS may be useful automated screening tools for ARDS and improve on clinical recognition, but they are limited to screening rather than diagnosis because their specificity is poor.

Patient-specific quantification of image quality: An automated method for measuring spatial resolution in clinical CT images

Energy Technology Data Exchange (ETDEWEB)

Sanders, Jeremiah, E-mail: jeremiah.sanders@duke.edu [Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Clinical Imaging Physics Group, Duke University, Durham, North Carolina 27710 (United States); Hurwitz, Lynne [Department of Radiology, Duke University, Durham, North Carolina 27710 (United States); Samei, Ehsan [Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Clinical Imaging Physics Group, Duke University, Durham, North Carolina 27710 and Departments of Physics, Biomedical Engineering, Electrical and Computer Engineering, Duke University, Durham, North Carolina 27710 (United States)

2016-10-15

Purpose: To develop and validate an automated technique for evaluating the spatial resolution characteristics of clinical computed tomography (CT) images. Methods: Twenty one chest and abdominopelvic clinical CT datasets were examined in this study. An algorithm was developed to extract a CT resolution index (RI) analogous to the modulation transfer function from clinical CT images by measuring the edge-spread function (ESF) across the patient’s skin. A polygon mesh of the air-skin boundary was created. The faces of the mesh were then used to measure the ESF across the air-skin interface. The ESF was differentiated to obtain the line-spread function (LSF), and the LSF was Fourier transformed to obtain the RI. The algorithm’s ability to detect the radial dependence of the RI was investigated. RIs measured with the proposed method were compared with a conventional phantom-based method across two reconstruction algorithms (FBP and iterative) using the spatial frequency at 50% RI, f{sub 50}, as the metric for comparison. Three reconstruction kernels were investigated for each reconstruction algorithm. Finally, an observer study was conducted to determine if observers could visually perceive the differences in the measured blurriness of images reconstructed with a given reconstruction method. Results: RI measurements performed with the proposed technique exhibited the expected dependencies on the image reconstruction. The measured f{sub 50} values increased with harder kernels for both FBP and iterative reconstruction. Furthermore, the proposed algorithm was able to detect the radial dependence of the RI. Patient-specific measurements of the RI were comparable to the phantom-based technique, but the patient data exhibited a large spread in the measured f{sub 50}, indicating that some datasets were blurrier than others even when the projection data were reconstructed with the same reconstruction algorithm and kernel. Results from the observer study substantiated this

Public Order: Challenges of Inter-Institutional and Regional Cooperation in the Context of the Knowledge Society. A Question of Economic and Social Efficiency

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Mariana Balan

2011-05-01

Full Text Available The context of public policies undergoes a process of rapid change due to the emergence of the dynamic knowledge-based economy and society. Public administration institutions need to adapt their material and human resources to the dynamic developments of the knowledge and information society in order to maintain efficiency and effectiveness of their scopes. One of the most fragile fields is public order and the need for improved inter-institutional cooperation at national, regional, and EU-level for achieving the objectives of ensuring citizens’ safety while safeguarding rights and liberties. The social and economic efficiency of public order policies and measures need to be reassessed and improved based on overhauled and updated inter-institutional and organisational concepts, on diversified methods of cooperation at national, regional, EU- and international level. A recent project developed in the field of public order with respect to juvenile delinquency has shown that major questions still need to be approached with respect to efficiency and effectiveness of inter-institutional cooperation with both public and private bodies, and with representatives of the non-governmental organizations. The outcomes of the project have shown that juvenile delinquency must be approached as phenomenon in the wider framework of public order, of urban and rural safety, of crime prevention and combating. One major conclusion of the project is that a new integrated model is required with respect to the intra-, and inter-institutional cooperation and dialogue, but also with respect to the skills required to work efficiently considering the challenges posed by the overall developments of a society changing towards increased knowledge and information awareness. This would allow also for improved quality assessment and effectiveness measurements based on composite process and outcome indicators for public order, and public administration, in general, as well.

Comparison of Size Modulation Standard Automated Perimetry and Conventional Standard Automated Perimetry with a 10-2 Test Program in Glaucoma Patients.

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Hirasawa, Kazunori; Takahashi, Natsumi; Satou, Tsukasa; Kasahara, Masayuki; Matsumura, Kazuhiro; Shoji, Nobuyuki

2017-08-01

This prospective observational study compared the performance of size modulation standard automated perimetry with the Octopus 600 10-2 test program, with stimulus size modulation during testing, based on stimulus intensity and conventional standard automated perimetry, with that of the Humphrey 10-2 test program in glaucoma patients. Eighty-seven eyes of 87 glaucoma patients underwent size modulation standard automated perimetry with Dynamic strategy and conventional standard automated perimetry using the SITA standard strategy. The main outcome measures were global indices, point-wise threshold, visual defect size and depth, reliability indices, and test duration; these were compared between size modulation standard automated perimetry and conventional standard automated perimetry. Global indices and point-wise threshold values between size modulation standard automated perimetry and conventional standard automated perimetry were moderately to strongly correlated (p 33.40, p modulation standard automated perimetry than with conventional standard automated perimetry, but the visual-field defect size was smaller (p modulation-standard automated perimetry than on conventional standard automated perimetry. The reliability indices, particularly the false-negative response, of size modulation standard automated perimetry were worse than those of conventional standard automated perimetry (p modulation standard automated perimetry than with conventional standard automated perimetry (p = 0.02). Global indices and the point-wise threshold value of the two testing modalities correlated well. However, the potential of a large stimulus presented at an area with a decreased sensitivity with size modulation standard automated perimetry could underestimate the actual threshold in the 10-2 test protocol, as compared with conventional standard automated perimetry.

Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange.

Science.gov (United States)

Chang, Hsin Hsin; Hung, Chung-Jye; Huang, Ching Ying; Wong, Kit Hong; Tsai, Yi Ju

2017-01-01

This study adopts social capital theory and transaction cost theory to explore the feasibility of an inter-organizational cross-hospital electronic medical records (EMR) exchange system, and the factors that affect its adoption. The concept of value co-creation is also used to assess such a system, and its influence on the performance of participating medical institutes. This research collected 330 valid paper-based questionnaires from the medical staff of various institutes. The results showed that social interaction ties and shared vision positively affected medical institutes' willingness to adopt the EMR exchange system, while asset specificity and uncertainty increased the related transaction costs. With a greater willingness to invest in relation-specific assets and to meet the related transaction costs, this behavior lead to an increase in medical IT value, as well as better results for the related medical institutes, medical staff, and patients. Therefore, this study suggests that such institutes encourage their medical staff to participate in seminars or reunions in order to develop their professional and social networks, and set up clear schedules and desire for expected effects when introducing the cross-hospital EMR exchange system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Accutension Stetho, an automated auscultatory device to validate automated sphygmomanometer readings in individual patients.

Science.gov (United States)

Alpert, Bruce S

2018-04-06

The aim of this report is to describe a new device that can validate, by automated auscultation, individual blood pressure (BP) readings taken by automated sphygmomanometers.The Accutension Stetho utilizes a smartphone application in conjunction with a specially designed stethoscope that interfaces directly into the smartphone via the earphone jack. The Korotkoff sounds are recorded by the application and are analyzed by the operator on the screen of the smartphone simultaneously with the images from the sphygmomanometer screen during BP estimation. Current auscultatory validation standards require at least 85 subjects and strict statistical criteria for passage. A device that passes can make no guarantee of accuracy on individual patients. The Accutension Stetho is an inexpensive smartphone/stethoscope kit combination that estimates precise BP values by auscultation to confirm the accuracy of an automated sphygmomanometer's readings on individual patients. This should be of great value for both professional and, in certain circumstances, self-measurement BP. Patients will avoid both unnecessary treatment and errors of underestimation of BP, in which the patient requires therapy. The Stetho's software has been validated in an independent ANSI/AAMI/ISO standard study. The Stetho has been shown to perform without difficulty in multiple deflation-based devices by many manufacturers.

A survey on automated wheeze detection systems for asthmatic patients

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Syamimi Mardiah Shaharum

2012-11-01

Full Text Available The purpose of this paper is to present an evidence of automated wheeze detection system by a survey that can be very beneficial for asthmatic patients. Generally, for detecting asthma in a patient, stethoscope is used for ascertaining wheezes present. This causes a major problem nowadays because a number of patients tend to delay the interpretation time, which can lead to misinterpretations and in some worst cases to death. Therefore, the development of automated system would ease the burden of medical personnel. A further discussion on automated wheezes detection system will be presented later in the paper. As for the methodology, a systematic search of articles published as early as 1985 to 2012 was conducted. Important details including the hardware used, placement of hardware, and signal processing methods have been presented clearly thus hope to help and encourage future researchers to develop commercial system that will improve the diagnosing and monitoring of asthmatic patients.

The effects of integrating service learning into computer science: an inter-institutional longitudinal study

Science.gov (United States)

Payton, Jamie; Barnes, Tiffany; Buch, Kim; Rorrer, Audrey; Zuo, Huifang

2015-07-01

This study is a follow-up to one published in computer science education in 2010 that reported preliminary results showing a positive impact of service learning on student attitudes associated with success and retention in computer science. That paper described how service learning was incorporated into a computer science course in the context of the Students & Technology in Academia, Research, and Service (STARS) Alliance, an NSF-supported broadening participation in computing initiative that aims to diversify the computer science pipeline through innovative pedagogy and inter-institutional partnerships. The current paper describes how the STARS Alliance has expanded to diverse institutions, all using service learning as a vehicle for broadening participation in computing and enhancing attitudes and behaviors associated with student success. Results supported the STARS model of service learning for enhancing computing efficacy and computing commitment and for providing diverse students with many personal and professional development benefits.

IMPROVING MANAGEMENT INFORMATION SYSTEMS AT A HIGHER EDUCATIONAL INSTITUTION

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Nataliya N. Fedyakova

2016-06-01

Full Text Available Introduction: this paper deals with the foreign and domestic experience of creation and use of educational institution management automation systems. The problems of higher educational institutions management are essential in conditions of growing competition between educational institutions. Their complexity and timeliness defines multifunctional activity of higher educational institutions, diversity of funding sources, the variety of forms and types of educational, scientific, industrial and economic activities, the need for monitoring of the market of educational services and the labor market (including the need for employment of graduates, the necessity for adaptation to continuously changing economic conditions. Materials and Methods: system approach and method of comparison were used in analysing the current state of development and organisation of the automated information systems of higher education. These methods were also used to compare the qualitative characteristics of different technologies and methods of creation of the automated information systems. Results: the foreign and domestic educational institution management automation systems SIMS. net, Capita Education, SPRUT, Galaxy of Higher Educational Institution Management”, and “GSVedomosty” were analysed. Disadvantages of the functional module AIS – AWP pertaining to the University Rector of the higher educational institution were found. The improvement of higher educational institution AIS by implementing decision support systems for the management, made on the basis of the model of SaaS (software as a service is discussed. The author developed a model of automated score-rating system to assess the individual performance of students. Discussion and Conclusions: the author tackles the problems of higher educational institution AIS taking into account the specifics of the use of higher educational institution management information systems. They have a practical

Description of inter-institutional referrals after admission for labor and delivery: a prospective population based cohort study in rural Maharashtra, India.

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Patel, Archana B; Prakash, Amber Abhijeet; Raynes-Greenow, Camille; Pusdekar, Yamini V; Hibberd, Patricia L

2017-05-19

In 2008, the Indian government introduced financial assistance to encourage health facility deliveries. Facility births have increased, but maternal and neonatal morbidity and mortality have not decreased raising questions about the quality of care provided in facilities and access to a quality referral system. We evaluated the potential role of inter-institutional transfers of women admitted for labor and delivery on adverse maternal and neonatal outcomes in an ongoing prospective, population-based Maternal and Newborn Health Registry in Central India. Pregnant women from 20 rural Primary Health Centers near Nagpur, Maharashtra were followed throughout pregnancy and to day 42 post-partum. Inter- institutional referral was defined as transfer of a woman from a first or second level facility where she was admitted for labor and delivery to facility providing higher level of care, after admission to the day of delivery. Maternal mortality, stillbirth, early and late neonatal mortality were compared in mothers who were and were not referred. Factors associated with inter-institutional referral were analyzed using multivariable models with generalized estimating equations, adjusted for clustering at the level of the Primary Health Center. Between June 2009 and June 2013, 3236 (9.4%) of 34,319 women had inter-institutional referral. Factors associated with referrals were maternal age (adjusted Relative Risk or aRR 1.1; 1.0-1.2); moderate or severe anemia (aRR 1.2; 1.2-1.4), gestational age <37 weeks (aRR 1.16; 1.05-1.27), multiple gestation (aRR 1.6; 1.2-2.1), absent fetal heart rate (aRR 1.7; 1.3-2.2), primigravida (aRR 1.4; 1.3, 1.6), primigravida with any pregnancy related maternal condition such as obstructed or prolonged labor; major antepartum or post-partum hemorrhage, hypertension or preeclampsia and breech, transverse or oblique lie (aRR 4.7; 3.8, 5.8), multigravida with any pregnancy related conditions (aRR 4.2; 3.4-5.2). Stillbirths, early neonatal

Multiple Institutional Logics in Inter-Institutional Temporary Organizations

DEFF Research Database (Denmark)

Pemsel, Sofia; Söderlund, Jonas

for the planning and construction of a new super hospital in the capital of Sweden. Our empirical data demonstrates the important role institutional logics contribute with in understanding logics behind actions as well as emerging conflicts in practice throughout the project process. The paper identifies four......The idea of multiple institutional logics currently draws more and more attention as many organizational actors are forced to operate in ever more complex, temporary and vivid collaborations. We draw on findings from a unique case study of a temporary organization that carried the responsibility...

Validation of the Provincial Transfer Authorization Centre database: a comprehensive database containing records of all inter-facility patient transfers in the province of Ontario

Directory of Open Access Journals (Sweden)

MacDonald Russell D

2006-10-01

Full Text Available Abstract Background The Provincial Transfer Authorization Centre (PTAC was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database. Methods A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables. Results Of the 100 randomly selected patient transfer records, 95 (95% of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0. Conclusion The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created

Task Specific Inter-Hemispheric Coupling in Human Subthalamic Nuclei

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Felix eDarvas

2014-09-01

Full Text Available Cortical networks and quantitative measures of connectivity are integral to the study of brain function. Despite lack of direct connections between left and right subthalamic nuclei (STN, there are apparent physiological connections. During clinical examination of patients with Parkinson’s Disease (PD, this connectivity is exploited to enhance signs of PD, yet our understanding of this connectivity is limited. We hypothesized that movement leads to synchronization of neural oscillations in bilateral STN, and we implemented phase coherence, a measure of phase-locking between cortical sites in a narrow frequency band, to demonstrate this synchronization. We analyzed task specific phase synchronization and causality between left and right STN local field potentials (LFP recorded from both hemispheres simultaneously during a cued movement task in four subjects with PD who underwent Deep Brain Stimulation (DBS surgery. We used a data driven approach to determine inter-hemispheric channel pairs and frequencies with a task specific increase in phase locking.We found significant phase locking between hemispheres in alpha frequency (8-12 Hz in all subjects concurrent with movement of either hand. In all subjects, phase synchronization increased over baseline upon or prior to hand movement onset and lasted until the motion ceased. Left and right hand movement showed similar patterns. Granger causality at the phase-locking frequencies between synchronized electrodes revealed a unidirectional causality from right to left STN regardless of which side was moved.Phase synchronization across hemispheres between basal ganglia supports existence of a bilateral network having lateralized regions of specialization for motor processing. Our results suggest this bilateral network is activated by a unilateral motor program. Understanding phase synchronization in natural brain functions is critical to development of future DBS systems that augment goal directed

An automated dose tracking system for adaptive radiation therapy.

Science.gov (United States)

Liu, Chang; Kim, Jinkoo; Kumarasiri, Akila; Mayyas, Essa; Brown, Stephen L; Wen, Ning; Siddiqui, Farzan; Chetty, Indrin J

2018-02-01

The implementation of adaptive radiation therapy (ART) into routine clinical practice is technically challenging and requires significant resources to perform and validate each process step. The objective of this report is to identify the key components of ART, to illustrate how a specific automated procedure improves efficiency, and to facilitate the routine clinical application of ART. Data was used from patient images, exported from a clinical database and converted to an intermediate format for point-wise dose tracking and accumulation. The process was automated using in-house developed software containing three modularized components: an ART engine, user interactive tools, and integration tools. The ART engine conducts computing tasks using the following modules: data importing, image pre-processing, dose mapping, dose accumulation, and reporting. In addition, custom graphical user interfaces (GUIs) were developed to allow user interaction with select processes such as deformable image registration (DIR). A commercial scripting application programming interface was used to incorporate automated dose calculation for application in routine treatment planning. Each module was considered an independent program, written in C++or C#, running in a distributed Windows environment, scheduled and monitored by integration tools. The automated tracking system was retrospectively evaluated for 20 patients with prostate cancer and 96 patients with head and neck cancer, under institutional review board (IRB) approval. In addition, the system was evaluated prospectively using 4 patients with head and neck cancer. Altogether 780 prostate dose fractions and 2586 head and neck cancer dose fractions went processed, including DIR and dose mapping. On average, daily cumulative dose was computed in 3 h and the manual work was limited to 13 min per case with approximately 10% of cases requiring an additional 10 min for image registration refinement. An efficient and convenient

Automated sequence-specific protein NMR assignment using the memetic algorithm MATCH

International Nuclear Information System (INIS)

Volk, Jochen; Herrmann, Torsten; Wuethrich, Kurt

2008-01-01

MATCH (Memetic Algorithm and Combinatorial Optimization Heuristics) is a new memetic algorithm for automated sequence-specific polypeptide backbone NMR assignment of proteins. MATCH employs local optimization for tracing partial sequence-specific assignments within a global, population-based search environment, where the simultaneous application of local and global optimization heuristics guarantees high efficiency and robustness. MATCH thus makes combined use of the two predominant concepts in use for automated NMR assignment of proteins. Dynamic transition and inherent mutation are new techniques that enable automatic adaptation to variable quality of the experimental input data. The concept of dynamic transition is incorporated in all major building blocks of the algorithm, where it enables switching between local and global optimization heuristics at any time during the assignment process. Inherent mutation restricts the intrinsically required randomness of the evolutionary algorithm to those regions of the conformation space that are compatible with the experimental input data. Using intact and artificially deteriorated APSY-NMR input data of proteins, MATCH performed sequence-specific resonance assignment with high efficiency and robustness

Safeguards through secure automated fabrication

International Nuclear Information System (INIS)

DeMerschman, A.W.; Carlson, R.L.

1982-01-01

Westinghouse Hanford Company, a prime contractor for the U.S. Department of Energy, is constructing the Secure Automated Fabrication (SAF) line for fabrication of mixed oxide breeder fuel pins. Fuel processing by automation, which provides a separation of personnel from fuel handling, will provide a means whereby advanced safeguards concepts will be introduced. Remote operations and the inter-tie between the process computer and the safeguards computer are discussed

Endotracheal temperature and humidity measurements in laryngectomized patients: intra- and inter-patient variability

NARCIS (Netherlands)

Scheenstra, R.J.; Muller, S.H.; Vincent, A.; Sinaasappel, M.; Zuur, J.K.; Hilgers, F.J.M.

2009-01-01

This study assesses intra- and inter-patient variability in endotracheal climate (temperature and humidity) and effects of heat and moister exchangers (HME) in 16 laryngectomized individuals, measured repeatedly (N = 47). Inhalation Breath Length (IBL) was 1.35 s without HME and 1.05 s with HME (P <

Endotracheal temperature and humidity measurements in laryngectomized patients: intra- and inter-patient variability

NARCIS (Netherlands)

Scheenstra, R. J.; Muller, S. H.; Vincent, A.; Sinaasappel, M.; Zuur, J. K.; Hilgers, Frans J. M.

2009-01-01

This study assesses intra- and inter-patient variability in endotracheal climate (temperature and humidity) and effects of heat and moister exchangers (HME) in 16 laryngectomized individuals, measured repeatedly (N = 47). Inhalation Breath Length (IBL) was 1.35 s without HME and 1.05 s with HME (P

Identifying patients with myasthenia for epidemiological research by linkage of automated registers

DEFF Research Database (Denmark)

Pedersen, Emil Greve; Hallas, Jesper; Hansen, Klaus

2011-01-01

We validated a new method of identifying patients with incident myasthenia in automated Danish registers for the purpose of conducting epidemiological studies of the disorder.......We validated a new method of identifying patients with incident myasthenia in automated Danish registers for the purpose of conducting epidemiological studies of the disorder....

Creation of RTOG compliant patient CT-atlases for automated atlas based contouring of local regional breast and high-risk prostate cancers.

Science.gov (United States)

Velker, Vikram M; Rodrigues, George B; Dinniwell, Robert; Hwee, Jeremiah; Louie, Alexander V

2013-07-25

Increasing use of IMRT to treat breast and prostate cancers at high risk of regional nodal spread relies on accurate contouring of targets and organs at risk, which is subject to significant inter- and intra-observer variability. This study sought to evaluate the performance of an atlas based deformable registration algorithm to create multi-patient CT based atlases for automated contouring. Breast and prostate multi-patient CT atlases (n = 50 and 14 respectively) were constructed to be consistent with RTOG consensus contouring guidelines. A commercially available software algorithm was evaluated by comparison of atlas-predicted contours against manual contours using Dice Similarity coefficients. High levels of agreement were demonstrated for prediction of OAR contours of lungs, heart, femurs, and minor editing required for the CTV breast/chest wall. CTVs generated for axillary nodes, supraclavicular nodes, prostate, and pelvic nodes demonstrated modest agreement. Small and highly variable structures, such as internal mammary nodes, lumpectomy cavity, rectum, penile bulb, and seminal vesicles had poor agreement. A method to construct and validate performance of CT-based multi-patient atlases for automated atlas based auto-contouring has been demonstrated, and can be adopted for clinical use in planning of local regional breast and high-risk prostate radiotherapy.

Creation of RTOG compliant patient CT-atlases for automated atlas based contouring of local regional breast and high-risk prostate cancers

International Nuclear Information System (INIS)

Velker, Vikram M; Rodrigues, George B; Dinniwell, Robert; Hwee, Jeremiah; Louie, Alexander V

2013-01-01

Increasing use of IMRT to treat breast and prostate cancers at high risk of regional nodal spread relies on accurate contouring of targets and organs at risk, which is subject to significant inter- and intra-observer variability. This study sought to evaluate the performance of an atlas based deformable registration algorithm to create multi-patient CT based atlases for automated contouring. Breast and prostate multi-patient CT atlases (n = 50 and 14 respectively) were constructed to be consistent with RTOG consensus contouring guidelines. A commercially available software algorithm was evaluated by comparison of atlas-predicted contours against manual contours using Dice Similarity coefficients. High levels of agreement were demonstrated for prediction of OAR contours of lungs, heart, femurs, and minor editing required for the CTV breast/chest wall. CTVs generated for axillary nodes, supraclavicular nodes, prostate, and pelvic nodes demonstrated modest agreement. Small and highly variable structures, such as internal mammary nodes, lumpectomy cavity, rectum, penile bulb, and seminal vesicles had poor agreement. A method to construct and validate performance of CT-based multi-patient atlases for automated atlas based auto-contouring has been demonstrated, and can be adopted for clinical use in planning of local regional breast and high-risk prostate radiotherapy

Assessment of Automated Data Analysis Application on VVER Steam Generator Tubing

International Nuclear Information System (INIS)

Picek, E.; Barilar, D.

2006-01-01

INETEC - Institute for Nuclear Technology has developed software package named EddyOne having an option of automated analysis of bobbin coil eddy current data. During its development and site use some features were noticed preventing the wide use automatic analysis on VVER SG data. This article discuss these specific problems as well evaluates possible solutions. With regards to current state of automated analysis technology an overview of advantaged and disadvantages of automated analysis on VVER SG is summarized as well.(author)

Effect of Capsaicin Cream on Chronic Low Back Pain in Patients With Inter-Vertebral Disc Herniation

Directory of Open Access Journals (Sweden)

Fayazi

2015-07-01

Full Text Available Background Low back pain is one of the most common debilitating disorders worldwide and the third cause of visiting a physician. One of the most common causes of low back pain is spinal disc herniation. Still there is no general agreement on the most effective treatment for it. Objectives This study aimed to determine the effect of Capsaicin cream on low back pain in patients with inter-vertebral disc herniation in Ahvaz. Patients and Methods This was a double blind clinical trial in which 43 patients with chronic low back pain, according to characteristics of the subjects, were randomly divided into two groups of treatment (n = 23 and control (n = 20. Data collection instruments included demographic specifications and visual analogue scale (VAS questionnaire completed on arrival and at the first, second and third weeks after intervention. The treatment and placebo groups used the ointment for three weeks and three times a day as a thin layer on the painful position. Data entered SPSS (version 18 and analyzed using the analytical descriptive statistics. Results There was a significant difference in the average pain intensity between the groups of study pre-and post-intervention (P = 0.0001 and the rate of using analgesics in the treatment group significantly decreased (P = 0.008. Also patients’ satisfaction was significantly different between the two groups using the ointment (P = 0.0001. Conclusions Capsaicin cream has beneficial effects on pain relieving and reducing analgesic use in patients with inter-vertebral disc herniation. Therefore, the ointment can be recommended in the treatment of low back pain caused by inter-vertebral disc herniation.

Reproducibility of Corneal Graft Thickness measurements with COLGATE in patients who have undergone DSAEK (Descemet Stripping Automated Endothelial Keratoplasty

Directory of Open Access Journals (Sweden)

Wong Melissa HY

2012-08-01

Full Text Available Abstract Background The CorneaL GrAft Thickness Evaluation (COLGATE system was recently developed to facilitate the evaluation of corneal graft thickness from OCT images. Graft thickness measurement can be a surrogate indicator for detecting graft failure or success. The purpose of this study was to determine the reproducibility of the COLGATE system in measuring DSAEK graft area between two observers. Methods This was a prospective case series in which 50 anterior segment OCT images of patients who had undergone DSAEK in either eye were analysed. Two observers (MW, AC independently obtained the image analysis for the graft area using both semi automated and automated method. One week later, each observer repeated the analysis for the same set of images. Bland-Altman analysis was performed to analyze inter and intra observer agreement. Results There was strong intraobserver correlation between the 2 semi automated readings obtained by both observers. (r = 0.936 and r = 0.962. Intraobserver ICC for observer 1 was 0.936 (95% CI 0.890 to 0.963 and 0.967 (95% CI 0.942 to 0.981 for observer 2. Likewise, there was also strong interobserver correlation (r = 0.913 and r = 0.969. The interobserver ICC for the first measurements was 0.911 (95% CI 0.849 to 0.949 and 0.968 (95% CI 0.945 to 0.982 for the second. There was statistical difference between the automatic and the semi automated readings for both observers (p = 0.006, p = 0.003. The automatic readings gave consistently higher values than the semi automated readings especially in thin grafts. Conclusion The analysis from the COLGATE programme can be reproducible between different observers. Care must be taken when interpreting the automated analysis as they tend to over estimate measurements.

Growing Significance of EU Institutions in Promotion of Inter-regional policies

Directory of Open Access Journals (Sweden)

Ella V. Ermakova

2014-01-01

Full Text Available The article explores the variety of tools and vehicles applied within the EU to expand the prerogative of the regions of the EU member states. The author uses as an example the inter-regional policies in Belgium in respect of the Flemish Region and the Walloon Region. The author analyzes the mechanisms of promotion of external regional relations in Belgium as a means of addressing different problems both on national and all-European level, supporting the arguments and conclusions by examples of relevant EU initiatives. The article details the activities of the EU Regional Committee (RC, the EU advisory body with the powers of political initiative, upholding the principle ofsubsidarity in the implementation of the EU member states' regional policies. The involvement of the Flemish Region and the Walloon Region in the activities of EU RC is described and summarized. As a case study, the article deals with Belgium's rotating six months presidency in the EUin 2010 when the country, which was going through a severe political crisis with no federal government in place, was represented by the two regions. The special focus of the article is on the strategic EU program "Europe2020" and its implementation by the regions of Belgium. There is an account of the initiatives undertaken by the Flemish Region and the Walloon Region within the framework of this program outlining the interaction of the two regions. The author provides a comprehensive analysis of the involvement of the Flemish Region and the Walloon Region with various EU institutions describing how each party achieves the promotion of its regional interests. Within this context, it is a noteworthy development that the Flemish Region is participating in the international program "Pact 2020" on energy all by its own. The article features quotations by Flemish and Walloon political figures which serve as an illustration of the prevailing attitudes in the Belgian society to the process of

Inter-specific competitive stress does not affect the magnitude of inbreeding depression

OpenAIRE

Willi, Yvonne; Dietrich, Stefan; van Kleunen, Mark; Fischer, Markus

2007-01-01

Hypothesis: Stressful inter-specific competition enhances inbreeding depression.Organisms: Creeping spearwort (Ranunculus reptans L.) and its common competitor, thecreeping bentgrass (Agrostis stolonifera L.).Field site: Outdoor common garden experiment at the University of Potsdam.Methods: We collected plants of 12 natural populations of R. reptans differing in mean parental inbreeding coefficient (0.01–0.26). We performed within-population crosses for twogenerations and kept the offspring i...

Accuracy of three automated 25-hydroxyvitamin D assays in hemodialysis patients

NARCIS (Netherlands)

Depreter, B.; Heijboer, A.C.; Langlois, M.R.

2013-01-01

Introduction: We evaluated the accuracy of three automated assays for 25(OH)D measurement in comparison to ID-XLC-MS/MS in hemodialysis patients, considering the importance of their vitamin D status and reported discrepant results obtained with automated assays. Methods: All three assays were

Privacy-Preserving Detection of Inter-Domain SDN Rules Overlaps

KAUST Repository

Dethise, Arnaud; Chiesa, Marco; Canini, Marco

2017-01-01

SDN approaches to inter-domain routing promise better traffic engineering, enhanced security, and higher automation. Yet, naïve deployment of SDN on the Internet is dangerous as the control-plane expressiveness of BGP is significantly more limited

Principles of Automation for Patient Safety in Intensive Care: Learning From Aviation.

Science.gov (United States)

Dominiczak, Jason; Khansa, Lara

2018-06-01

The transition away from written documentation and analog methods has opened up the possibility of leveraging data science and analytic techniques to improve health care. In the implementation of data science techniques and methodologies, high-acuity patients in the ICU can particularly benefit. The Principles of Automation for Patient Safety in Intensive Care (PASPIC) framework draws on Billings's principles of human-centered aviation (HCA) automation and helps in identifying the advantages, pitfalls, and unintended consequences of automation in health care. Billings's HCA principles are based on the premise that human operators must remain "in command," so that they are continuously informed and actively involved in all aspects of system operations. In addition, automated systems need to be predictable, simple to train, to learn, and to operate, and must be able to monitor the human operators, and every intelligent system element must know the intent of other intelligent system elements. In applying Billings's HCA principles to the ICU setting, PAPSIC has three key characteristics: (1) integration and better interoperability, (2) multidimensional analysis, and (3) enhanced situation awareness. PAPSIC suggests that health care professionals reduce overreliance on automation and implement "cooperative automation" and that vendors reduce mode errors and embrace interoperability. Much can be learned from the aviation industry in automating the ICU. Because it combines "smart" technology with the necessary controls to withstand unintended consequences, PAPSIC could help ensure more informed decision making in the ICU and better patient care. Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Specific Methods of Information Security for Nuclear Materials Control and Accounting Automate Systems

Directory of Open Access Journals (Sweden)

Konstantin Vyacheslavovich Ivanov

2013-02-01

Full Text Available The paper is devoted to specific methods of information security for nuclear materials control and accounting automate systems which is not required of OS and DBMS certifications and allowed to programs modification for clients specific without defenses modification. System ACCORD-2005 demonstrates the realization of this method.

Impact of automation on mass spectrometry.

Science.gov (United States)

Zhang, Yan Victoria; Rockwood, Alan

2015-10-23

Mass spectrometry coupled to liquid chromatography (LC-MS and LC-MS/MS) is an analytical technique that has rapidly grown in popularity in clinical practice. In contrast to traditional technology, mass spectrometry is superior in many respects including resolution, specificity, multiplex capability and has the ability to measure analytes in various matrices. Despite these advantages, LC-MS/MS remains high cost, labor intensive and has limited throughput. This specialized technology requires highly trained personnel and therefore has largely been limited to large institutions, academic organizations and reference laboratories. Advances in automation will be paramount to break through this bottleneck and increase its appeal for routine use. This article reviews these challenges, shares perspectives on essential features for LC-MS/MS total automation and proposes a step-wise and incremental approach to achieve total automation through reducing human intervention, increasing throughput and eventually integrating the LC-MS/MS system into the automated clinical laboratory operations. Copyright © 2015 Elsevier B.V. All rights reserved.

Development of the automated circulating tumor cell recovery system with microcavity array.

Science.gov (United States)

Negishi, Ryo; Hosokawa, Masahito; Nakamura, Seita; Kanbara, Hisashige; Kanetomo, Masafumi; Kikuhara, Yoshihito; Tanaka, Tsuyoshi; Matsunaga, Tadashi; Yoshino, Tomoko

2015-05-15

Circulating tumor cells (CTCs) are well recognized as useful biomarker for cancer diagnosis and potential target of drug discovery for metastatic cancer. Efficient and precise recovery of extremely low concentrations of CTCs from blood has been required to increase the detection sensitivity. Here, an automated system equipped with a microcavity array (MCA) was demonstrated for highly efficient and reproducible CTC recovery. The use of MCA allows selective recovery of cancer cells from whole blood on the basis of differences in size between tumor and blood cells. Intra- and inter-assays revealed that the automated system achieved high efficiency and reproducibility equal to the assay manually performed by well-trained operator. Under optimized assay workflow, the automated system allows efficient and precise cell recovery for non-small cell lung cancer cells spiked in whole blood. The automated CTC recovery system will contribute to high-throughput analysis in the further clinical studies on large cohort of cancer patients. Copyright © 2014 Elsevier B.V. All rights reserved.

Automating PACS Quality Control with the Vanderbilt Image Processing Enterprise Resource.

Science.gov (United States)

Esparza, Michael L; Welch, E Brian; Landman, Bennett A

2012-02-12

Precise image acquisition is an integral part of modern patient care and medical imaging research. Periodic quality control using standardized protocols and phantoms ensures that scanners are operating according to specifications, yet such procedures do not ensure that individual datasets are free from corruption-for example due to patient motion, transient interference, or physiological variability. If unacceptable artifacts are noticed during scanning, a technologist can repeat a procedure. Yet, substantial delays may be incurred if a problematic scan is not noticed until a radiologist reads the scans or an automated algorithm fails. Given scores of slices in typical three-dimensional scans and wide-variety of potential use cases, a technologist cannot practically be expected inspect all images. In large-scale research, automated pipeline systems have had great success in achieving high throughput. However, clinical and institutional workflows are largely based on DICOM and PACS technologies; these systems are not readily compatible with research systems due to security and privacy restrictions. Hence, quantitative quality control has been relegated to individual investigators and too often neglected. Herein, we propose a scalable system, the Vanderbilt Image Processing Enterprise Resource-VIPER, to integrate modular quality control and image analysis routines with a standard PACS configuration. This server unifies image processing routines across an institutional level and provides a simple interface so that investigators can collaborate to deploy new analysis technologies. VIPER integrates with high performance computing environments has successfully analyzed all standard scans from our institutional research center over the course of the last 18 months.

Chemotherapy Regimen in Nonagenarian Cancer Patients: A Bi-Institutional Experience.

Science.gov (United States)

Rivoirard, Romain; Chargari, Cyrus; Kullab, Sharif; Trone, Jane-Chloé; Langrand-Escure, Julien; Moriceau, Guillaume; Guy, Jean-Baptiste; Annede, Pierre; Méry, Benoîte; Moncharmont, Coralie; Falk, Alexander Tuan; Vedrine, Lionel; Merrouche, Yacine; Fournel, Pierre; Magné, Nicolas

2016-01-01

The elderly population in Western countries is growing and constitutes a public health issue. Concomitantly, age-related diseases such as cancer increase. There are few data on the efficacy, tolerability and toxicity of specific anticancer therapy in the very elderly patients; therefore, their management is not standardized. In this bi-institutional study, we reviewed medical records of patients who received or continued specific anticancer therapy beyond the age of 90 years. Geriatric assessment was not reported for our patients. Twelve patients were enrolled. Their general health condition was good, and half of them were living in elderly institutions. Ten patients had a solid tumor and 2 were treated for hematological malignancies. Most were diagnosed with a locally advanced or metastatic disease, and the goal of treatment was curative for only 1 patient. Six patients received chemotherapy as first-line treatment, 4 patients received targeted therapy and 2 received concomitant chemoradiation. Four patients received a second-line treatment. Despite a significant reduction in treatment posology in half of the patients, 8 acute grade 3/4 toxicities were reported and 2 patients died of treatment-related septic shock. Median duration of first-line treatment was 3.2 months, and progression-free survival ranged from 18 to 311 days. Overall survival ranged from 18 days to 11 years. Aging is a heterogeneous process, and management of elderly patients is a multidisciplinary approach. Geriatric assessment helps to identify older patients with a higher risk of morbidity/mortality and allows to assess the risks and benefits of specific anticancer therapy. The choice of treatment should be based primarily on the expected symptomatic benefit, and treatment should not compromise the quality of life. © 2015 S. Karger AG, Basel.

Multimodality 3D Superposition and Automated Whole Brain Tractography: Comprehensive Printing of the Functional Brain.

Science.gov (United States)

Konakondla, Sanjay; Brimley, Cameron J; Sublett, Jesna Mathew; Stefanowicz, Edward; Flora, Sarah; Mongelluzzo, Gino; Schirmer, Clemens M

2017-09-29

Whole brain tractography using diffusion tensor imaging (DTI) sequences can be used to map cerebral connectivity; however, this can be time-consuming due to the manual component of image manipulation required, calling for the need for a standardized, automated, and accurate fiber tracking protocol with automatic whole brain tractography (AWBT). Interpreting conventional two-dimensional (2D) images, such as computed tomography (CT) and magnetic resonance imaging (MRI), as an intraoperative three-dimensional (3D) environment is a difficult task with recognized inter-operator variability. Three-dimensional printing in neurosurgery has gained significant traction in the past decade, and as software, equipment, and practices become more refined, trainee education, surgical skills, research endeavors, innovation, patient education, and outcomes via valued care is projected to improve. We describe a novel multimodality 3D superposition (MMTS) technique, which fuses multiple imaging sequences alongside cerebral tractography into one patient-specific 3D printed model. Inferences on cost and improved outcomes fueled by encouraging patient engagement are explored.

Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease.

Science.gov (United States)

Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A; Kappelle, L Jaap; de Borst, Gert Jan; Cramer, Maarten J; Visseren, Frank L J; Aboyans, Victor; Westerink, Jan

2017-10-01

Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease. In a cohort of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥15mmHg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality. In all patients the median inter-arm SBPD was 7mmHg (IQR 3-11) and 1182 (16%) patients had inter-arm SBPD ≥15mmHg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥15mmHg). Each 5mmHg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00-1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93-1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93-1.19). Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Final report of the inter institutional project ININ-CNSNS 'Source Terms specific for the CNLV'; Informe final del proyecto interinstitucional ININ-CNSNS 'Termino Fuente especifico para la CNLV'

Energy Technology Data Exchange (ETDEWEB)

Anaya M, R A [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)

1991-02-15

The purpose of the project inter institutional ININ-CNSNS 'Source Terms Specifies for the CNLV' it is the one of implanting in the computer CYBER (CDC 180-830) of the ININ, the 'Source Term Code Package' (STCP) and to make the operation tests and corresponding operation using the data of the sample problem, for finally to liberate the package, all time that by means of the analysis of the results it is consider appropriate. In this report the results of the are presented simulation of the sequence 'Energy Losses external' (Station blackout) and 'Lost total of CA with failure of the RCIC and success of the HPCS' both with data of the Laguna Verde Central. (Author)

Network strength, transaction-specific investments, inter-personal trust, and relationship satisfaction in Chinese agrifood SMEs

NARCIS (Netherlands)

Lu Hualiang,; Feng, S.; Trienekens, J.H.; Omta, S.W.F.

2012-01-01

Purpose - The purpose of this paper is to investigate the effects of network strength, transaction-specific investments and inter-personal trust on business relationship satisfaction for small-and-medium-sized enterprises (SMEs) involved in agri-food processing and exporting in China.

Automated material interface (AMI) for mini-environment technology

International Nuclear Information System (INIS)

Wolf, M.; Fleming, J.; Mueller, R.; Pulaski, L.

1993-01-01

The Automated Material Inter-face or AMI presented here is a new method of automating the input/output of materials or products into mini-environments. The AMI concept and hardware, and preliminary data are presented to show that neither the automation hardware nor the product isolation carrier contribute any significant contamination to the product during the I/O process. Budgetary estimates are presented which support the AMI concept for cost effective manufacturing of advanced semiconductors and disk media

Improving patient safety via automated laboratory-based adverse event grading.

Science.gov (United States)

Niland, Joyce C; Stiller, Tracey; Neat, Jennifer; Londrc, Adina; Johnson, Dina; Pannoni, Susan

2012-01-01

The identification and grading of adverse events (AEs) during the conduct of clinical trials is a labor-intensive and error-prone process. This paper describes and evaluates a software tool developed by City of Hope to automate complex algorithms to assess laboratory results and identify and grade AEs. We compared AEs identified by the automated system with those previously assessed manually, to evaluate missed/misgraded AEs. We also conducted a prospective paired time assessment of automated versus manual AE assessment. We found a substantial improvement in accuracy/completeness with the automated grading tool, which identified an additional 17% of severe grade 3-4 AEs that had been missed/misgraded manually. The automated system also provided an average time saving of 5.5 min per treatment course. With 400 ongoing treatment trials at City of Hope and an average of 1800 laboratory results requiring assessment per study, the implications of these findings for patient safety are enormous.

Automated striatal uptake analysis of 18F-FDOPA PET images applied to Parkinson's disease patients

International Nuclear Information System (INIS)

Chang Icheng; Lue Kunhan; Hsieh Hungjen; Liu Shuhsin; Kao, Chinhao K.

2011-01-01

6-[ 18 F]Fluoro-L-DOPA (FDOPA) is a radiopharmaceutical valuable for assessing the presynaptic dopaminergic function when used with positron emission tomography (PET). More specifically, the striatal-to-occipital ratio (SOR) of FDOPA uptake images has been extensively used as a quantitative parameter in these PET studies. Our aim was to develop an easy, automated method capable of performing objective analysis of SOR in FDOPA PET images of Parkinson's disease (PD) patients. Brain images from FDOPA PET studies of 21 patients with PD and 6 healthy subjects were included in our automated striatal analyses. Images of each individual were spatially normalized into an FDOPA template. Subsequently, the image slice with the highest level of basal ganglia activity was chosen among the series of normalized images. Also, the immediate preceding and following slices of the chosen image were then selected. Finally, the summation of these three images was used to quantify and calculate the SOR values. The results obtained by automated analysis were compared with manual analysis by a trained and experienced image processing technologist. The SOR values obtained from the automated analysis had a good agreement and high correlation with manual analysis. The differences in caudate, putamen, and striatum were -0.023, -0.029, and -0.025, respectively; correlation coefficients 0.961, 0.957, and 0.972, respectively. We have successfully developed a method for automated striatal uptake analysis of FDOPA PET images. There was no significant difference between the SOR values obtained from this method and using manual analysis. Yet it is an unbiased time-saving and cost-effective program and easy to implement on a personal computer. (author)

Automated Library System Specifications.

Science.gov (United States)

1986-06-01

Battelle Software Products), TOMAS (Carlyle Systems, Inc), ULYSIS/84 (Universal Library Systems), Unicorn Collection Management System (Sirsi Corp...STOR{ AGE CAPA3ILITY Dependent on mixc of processors an~d dikdrives. ’KxIUI OFREORS Depends upon mix of application. programs, and includes...BASIC -- - -Ultiniate, Prime, DEC VAXv PZRIHERIALS SUPPORTED Wyse, Viewpoints, Inter.ec lig;htpens, HP Ili~htpens, C-Itoh STO AGE CAPABILITY 66 MB to

Causes of death in two rural demographic surveillance sites in Bangladesh, 2004–2010: automated coding of verbal autopsies using InterVA-4

Directory of Open Access Journals (Sweden)

Nurul Alam

2014-10-01

Full Text Available Objective: Population-based information on causes of death (CoD by age, sex, and area is critical for countries with limited resources to identify and address key public health issues. This study analysed the demographic surveillance and verbal autopsy (VA data to estimate age- and sex-specific mortality rates and cause-specific mortality fractions in two well-defined rural populations within the demographic surveillance system in Abhoynagar and Mirsarai subdistricts, located in different climatic zones. Design: During 2004–2010, the sample demographic surveillance system registered 1,384 deaths in Abhoynagar and 1,847 deaths in Mirsarai. Trained interviewers interviewed the main caretaker of the deceased with standard VA questionnaires to record signs and symptoms of diseases or conditions that led to death and health care experiences before death. The computer-automated InterVA-4 method was used to analyse VAs to determine probable CoD. Results: Age- and sex-specific death rates revealed a higher neonatal mortality rate in Abhoynagar than Mirsarai, and death rates and sex ratios of male to female death rates were higher in the ages after infancy. Communicable diseases (CDs accounted for 16.7% of all deaths in Abhoynagar and 21.2% in Mirsarai – the difference was due mostly to more deaths from acute respiratory infections, pneumonia, and tuberculosis in Mirsarai. Non-communicable diseases (NCDs accounted for 56.2 and 55.3% of deaths in each subdistrict, respectively, with leading causes being stroke (16.5–19.3%, neoplasms (13.2% each, cardiac diseases (8.9–11.6%, chronic obstructive pulmonary diseases (5.1–6.3%, diseases of the digestive system (3.1–4.1%, and diabetes (2.8–3.5%, together accounting for 49.2–51.2% points of the NCD deaths in the two subdistricts. Injury and other external causes accounted for another 7.5–7.7% deaths, with self-harm being higher among females in Abhoynagar. Conclusions: The computer-automated

Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

DEFF Research Database (Denmark)

Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

2015-01-01

OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

High inter-tester reliability of the new mobility score in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, M.T.; Bandholm, T.; Foss, N.B.

2008-01-01

OBJECTIVE: To assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. DESIGN: An inter-tester reliability study. SUBJECTS: Forty-eight consecutive patients with acute hip fracture at a median age of 84 (interquartile range, 76-89) years; 40 admitted from...... their own home and 8 from nursing homes to an acute orthopaedic hip fracture unit at a university hospital. METHODS: The New Mobility Score, which evaluates the prefracture functional level with a score from 0 (not able to walk at all) to 9 (fully independent), was assessed by 2 independent physiotherapists...... the prefracture functional level in patients with acute hip fracture Udgivelsesdato: 2008/7...

Teacher Externships as a Practice of Inter-organizational Collaboration Between Institutions of Higher Education and Public and Private Organizations

DEFF Research Database (Denmark)

Linde, Stine; Just, Sine Nørholm

The present paper takes a practice theoretical approach (Rouse, 2006) to investigating the extent to which the phenomenon of teacher externships can be used as an initiative for creating long-lasting and strong collaborations between institutions of higher education and public and private...... at institutions of higher education within the region of Zealand, Denmark entered into collaborations with 35 public and private organizations, we present two preliminary conclusions: existing networks are strengthened and broadened through externships, and teachers feel enlightened by the experience...... on Danish universities to ‘turn to practice’, we ask how externships may contribute to the inter-organizational collaboration between institutions of higher education and public and private organizations. Based on a qualitative analysis of an externship program in which a total of 25 lecturers...

Automated volumetry for unilateral hippocampal sclerosis detection in patients with temporal lobe epilepsy.

Science.gov (United States)

Martins, Cristina; Moreira da Silva, Nadia; Silva, Guilherme; Rozanski, Verena E; Silva Cunha, Joao Paulo

2016-08-01

Hippocampal sclerosis (HS) is the most common cause of temporal lobe epilepsy (TLE) and can be identified in magnetic resonance imaging as hippocampal atrophy and subsequent volume loss. Detecting this kind of abnormalities through simple radiological assessment could be difficult, even for experienced radiologists. For that reason, hippocampal volumetry is generally used to support this kind of diagnosis. Manual volumetry is the traditional approach but it is time consuming and requires the physician to be familiar with neuroimaging software tools. In this paper, we propose an automated method, written as a script that uses FSL-FIRST, to perform hippocampal segmentation and compute an index to quantify hippocampi asymmetry (HAI). We compared the automated detection of HS (left or right) based on the HAI with the agreement of two experts in a group of 19 patients and 15 controls, achieving 84.2% sensitivity, 86.7% specificity and a Cohen's kappa coefficient of 0.704. The proposed method is integrated in the "Advanced Brain Imaging Lab" (ABrIL) cloud neurocomputing platform. The automated procedure is 77% (on average) faster to compute vs. the manual volumetry segmentation performed by an experienced physician.

Prototype for an automated technical specification information system

International Nuclear Information System (INIS)

Quinn, E.L.; Mills, R.H.; Groves, J.E.

1985-01-01

The Southern California Edison (SCE) Automated Technical Specification Information System (ATSIS) at the San Onofre nuclear generating station (SONGS) has been developed as a prototype for an on-line information management system. This system provides an appropriate level of update, inquiry, and report generation capabilities to help support plant operators at SONGS in their efforts to anticipate, identify, document, and track certain actions and activities associated with plant technical specifications and associated limiting conditions of operation (LCOs). Substantially increased emphasis is being placed on adherence to nuclear regulatory requirements and commitments contained on the operating licenses of nuclear power plants. Additionally, as each year passes, such requirements are becoming increasingly detailed and complex, making it more and more difficult to track and ensure total compliance with the many and varied requirements. To assist the operations department at SONGs in meeting their regulatory commitments, in January 1985 SCE commenced gathering together the leading technical expertise available in the industry to develop a computerized system to track all technical specification-related equipment for operability and impact on LCOs

Automated classification of self-grooming in mice using open-source software

NARCIS (Netherlands)

Van den Boom, B.; Pavlidi, Pavlina; Wolf, Casper M H; Mooij, Hanne A H; Willuhn, Ingo

BACKGROUND: Manual analysis of behavior is labor intensive and subject to inter-rater variability. Although considerable progress in automation of analysis has been made, complex behavior such as grooming still lacks satisfactory automated quantification. NEW METHOD: We trained a freely available,

Automated classification of self-grooming in mice using open-source software

NARCIS (Netherlands)

van den Boom, Bastijn J. G.; Pavlidi, Pavlina; Wolf, Casper M. H.; Mooij, Hanne A. H.; Willuhn, Ingo

2017-01-01

Background: Manual analysis of behavior is labor intensive and subject to inter-rater variability. Although considerable progress in automation of analysis has been made, complex behavior such as grooming still lacks satisfactory automated quantification. New method: We trained a freely available,

Specification of real-time automation systems with HybridUML; Spezifikation von Echtzeit-Automatisierungssystemen mit HybridUML

Energy Technology Data Exchange (ETDEWEB)

Berkenkoetter, K.; Bisanz, S.; Hannemann, U.; Peleska, J. [Univ. Bremen (Germany)

2004-07-01

Complex automation systems require specification formalisms supporting the description of real-time requirements with respect to both discrete and time-continuous observables. For this purpose, the authors have designed the HybridUML specification language. Discrete events, communication, and variable assignments are specified by state machines, timers, and invariant conditions. The time-continuous aspects of system behaviour are described by associating differential equations or time-dependent algebraic conditions with system states. The complexity of large systems is controlled by decomposing the specification into parallel components and hierarchical state machines. Instead of inventing a new language syntax, HybridUML is represented as a profile of the Unified Modeling Language UML 2.0. This allows to re-use the syntactic framework of well-accepted graphical UML constructs and development support provided by various UML case tools. The profile is associated with a precise language semantics linking unambiguous meaning to all HybridUML specifications. As a consequence, HybridUML specifications can be compiled into executable code which is suitable for execution in hard realtime on multi-processor computers. This serves both for the development of automation systems and for specification-based testing in real-time. This paper contains an introduction to HybridUML which is illustrated by an example from the field of automated train control. (orig.)

ASPIRE: An automated sample positioning and irradiation system for radiation biology experiments at Inter University Accelerator Centre, New Delhi

International Nuclear Information System (INIS)

Kothari, Ashok; Barua, P.; Archunan, M.; Rani, Kusum; Subramanian, E.T.; Pujari, Geetanjali; Kaur, Harminder; Satyanarayanan, V.V.V.; Sarma, Asitikantha; Avasthi, D.K.

2015-01-01

An automated irradiation setup for biology samples has been built at Inter University Accelerator Centre (IUAC), New Delhi, India. It can automatically load and unload 20 biology samples in a run of experiment. It takes about 20 min [2% of the cell doubling time] to irradiate all the 20 samples. Cell doubling time is the time taken by the cells (kept in the medium) to grow double in numbers. The cells in the samples keep growing during entire of the experiment. The fluence irradiated to the samples is measured with two silicon surface barrier detectors. Tests show that the uniformity of fluence and dose of heavy ions reaches to 2% at the sample area in diameter of 40 mm. The accuracy of mean fluence at the center of the target area is within 1%. The irradiation setup can be used to the studies of radiation therapy, radiation dosimetry and molecular biology at the heavy ion accelerator. - Highlights: • Automated positioning and irradiation setup for biology samples at IUAC is built. • Loading and unloading of 20 biology samples can be automatically carried out. • Biologicals cells keep growing during entire experiment. • Fluence and dose of heavy ions are measured by two silicon barrier detectors. • Uniformity of fluence and dose of heavy ions at sample position reaches to 2%

Automated segmentation of tumors on bone scans using anatomy-specific thresholding

Science.gov (United States)

Chu, Gregory H.; Lo, Pechin; Kim, Hyun J.; Lu, Peiyun; Ramakrishna, Bharath; Gjertson, David; Poon, Cheryce; Auerbach, Martin; Goldin, Jonathan; Brown, Matthew S.

2012-03-01

Quantification of overall tumor area on bone scans may be a potential biomarker for treatment response assessment and has, to date, not been investigated. Segmentation of bone metastases on bone scans is a fundamental step for this response marker. In this paper, we propose a fully automated computerized method for the segmentation of bone metastases on bone scans, taking into account characteristics of different anatomic regions. A scan is first segmented into anatomic regions via an atlas-based segmentation procedure, which involves non-rigidly registering a labeled atlas scan to the patient scan. Next, an intensity normalization method is applied to account for varying levels of radiotracer dosing levels and scan timing. Lastly, lesions are segmented via anatomic regionspecific intensity thresholding. Thresholds are chosen by receiver operating characteristic (ROC) curve analysis against manual contouring by board certified nuclear medicine physicians. A leave-one-out cross validation of our method on a set of 39 bone scans with metastases marked by 2 board-certified nuclear medicine physicians yielded a median sensitivity of 95.5%, and specificity of 93.9%. Our method was compared with a global intensity thresholding method. The results show a comparable sensitivity and significantly improved overall specificity, with a p-value of 0.0069.

Diffusion tensor imaging of the human calf : Variation of inter- and intramuscle-specific diffusion parameters

NARCIS (Netherlands)

Schlaffke, Lara; Rehmann, Robert; Froeling, Martijn; Kley, Rudolf; Tegenthoff, Martin; Vorgerd, Matthias; Schmidt-Wilcke, Tobias

2017-01-01

Purpose: To investigate to what extent inter- and intramuscular variations of diffusion parameters of human calf muscles can be explained by age, gender, muscle location, and body mass index (BMI) in a specific age group (20-35 years). Materials and Methods: Whole calf muscles of 18 healthy

Inter-species protein trafficking endows dodder (Cuscuta pentagona) with a host-specific herbicide-tolerant trait.

Science.gov (United States)

Jiang, Linjian; Qu, Feng; Li, Zhaohu; Doohan, Douglas

2013-06-01

· Besides photosynthates, dodder (Cuscuta spp.) acquires phloem-mobile proteins from host; however, whether this could mediate inter-species phenotype transfer was not demonstrated. Specifically, we test whether phosphinothricin acetyl transferase (PAT) that confers host plant glufosinate herbicide tolerance traffics and functions inter-specifically. · Dodder tendrils excised from hosts can grow in vitro for weeks or resume in vivo by parasitizing new hosts. The level of PAT in in vivo and in vitro dodder tendrils was quantified by enzyme-linked immunosorbent assay. The glufosinate sensitivity was examined by dipping the distal end of in vivo and in vitro tendrils, growing on or excised from LibertyLink (LL; PAT-transgenic and glufosinate tolerant) and conventional (CN; glufosinate sensitive) soybean hosts, into glufosinate solutions for 5 s. After in vitro tendrils excised from LL hosts reparasitized new CN and LL hosts, the PAT level and the glufosinate sensitivity were also examined. · When growing on LL host, dodder tolerated glufosinate and contained PAT at a level of 0.3% of that encountered in LL soybean leaf. After PAT was largely degraded in dodders, they became glufosinate sensitive. PAT mRNA was not detected by reverse transcription PCR in dodders. · In conclusion, the results indicated that PAT inter-species trafficking confers dodder glufosinate tolerance. © 2013 The Authors. New Phytologist © 2013 New Phytologist Trust.

Evolution and Specificity of the Economic Institutions of Khanty-Mansi Autonomous Okrug — Yugra

Directory of Open Access Journals (Sweden)

Vadim Faruarovich Islamutdinov

2016-06-01

Full Text Available The paper is dedicated to the study of the evolution of economic institutions in the resource-producing region, to the investigation of their specificity and institutional traps. As the initial data, the legal framework, the experience of the functioning of economic institutions and statistical data were used. The subject matter of the research is the influence of regional specificity on the evolution of economic institutions. The research topic is the analysis of the evolution, specificity and institutional traps of the economic institutions of the resource-producing region on the example of Khanty-Mansi Autonomous Okrug—Yugra. The purpose of the research is to identify the relationship between the regional specificity and the direction of the evolution of economic institutions. The hypothesis of the study is that the regional specificity has an impact on the evolution of economic institutions and contributes to the formation of institutional traps. The framework methodology of the work is a comparative institutional analysis. As a result, the stages of the evolution of economic institutions are determined, their regional specificity and institutional traps are revealed. The scientific input is in the revealing of the specificity of institutional traps at the regional level as well as the influence of specificity on the evolution of economic institutions. The author came to the conclusion that the specificity of the region's economy affects the specificity of institutions as well as the formation of institutional traps. At the same time, some traps have a system-wide character and do not depend on the specificity of the region; this applies to the basic economic institutions. The most strongly the regional specificity is appeared in the evolution of the economic institutions for development, whose institutional traps are in many respects predetermined by the regional specificity. The results can be applied by the public administration at the

Concordance between local, institutional, and central pathology review in glioblastoma: implications for research and practice: a pilot study.

Science.gov (United States)

Gupta, Tejpal; Nair, Vimoj; Epari, Sridhar; Pietsch, Torsten; Jalali, Rakesh

2012-01-01

There is significant inter-observer variation amongst the neuro-pathologists in the typing, subtyping, and grading of glial neoplasms for diagnosis. Centralized pathology review has been proposed to minimize this inter-observer variation and is now almost mandatory for accrual into multicentric trials. We sought to assess the concordance between neuro-pathologists on histopathological diagnosis of glioblastoma. Comparison of local, institutional, and central neuro-oncopathology reporting in a cohort of 34 patients with newly diagnosed supratentorial glioblastoma accrued consecutively at a tertiary-care institution on a prospective trial testing the addition of a new agent to standard chemo-radiation regimen. Concordance was sub-optimal between local histological diagnosis and central review, fair between local diagnosis and institutional review, and good between institutional and central review, with respect to histological typing/subtyping. Twelve (39%) of 31 patients with local histological diagnosis had identical tumor type, subtype and grade on central review. Overall agreement was modestly better (52%) between local diagnosis and institutional review. In contrast, 28 (83%) of 34 patients had completely concordant histopathologic diagnosis between institutional and central review. The inter-observer reliability test showed poor agreement between local and central review (kappa statistic=0.12, 95% confidence interval (CI): -0.03-0.32, P=0.043), but moderate agreement between institutional and central review (kappa statistic=0.51, 95%CI: 0.17-0.84, P=0.00003). Agreement between local diagnosis and institutional review was fair. There exists significant inter-observer variation regarding histopathological diagnosis of glioblastoma with significant implications for clinical research and practice. There is a need for more objective, quantitative, robust, and reproducible criteria for better subtyping for accurate diagnosis.

Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease

NARCIS (Netherlands)

Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A.; Kappelle, L. Jaap; de Borst, Gert Jan; Cramer, Maarten J.; Visseren, Frank L.J.; Aboyans, Victor; Westerink, Jan

2017-01-01

Background Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and

Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspected coronary artery disease

International Nuclear Information System (INIS)

Igarashi, Yuko; Chikamori, Taishiro; Tomiyama, Hirofumi; Usui, Yasuhiro; Hida, Satoshi; Tanaka, Hirokazu; Nagao, Tadashi; Yamashina, Akira

2007-01-01

Although measuring blood pressure at the bilateral brachia is common in medical practice, its clinical significance in patients with suspected coronary artery disease (CAD) has not been fully clarified. The method of this study was to define the significance of inter-arm systolic blood pressure difference in patients with suspected CAD, and to assess the relationship between inter-arm pressure difference and CAD, simultaneous brachial and ankle blood pressure measurements and stress myocardial single-photon emission computed tomography (SPECT) were performed in 386 consecutive patients with suspected CAD, excluding those with previous myocardial infarction or coronary revascularization. Subclavian artery stenosis, defined as ≥15 mmHg inter-arm systolic blood pressure difference, was found in 27 patients (7%). Age (65±12 vs 65±11 years), male sex (21/27 vs 244/359), prevalence of hypertension (63% vs 56%), hypercholesterolemia (63% vs 62%), diabetes mellitus (33% vs 38%), cigarette smoking (44% vs 41%) and family history of CAD (15% vs 12%) were similar between patients with subclavian artery stenosis and those without. The incidence of decreased ankle-brachial pressure index (ABI) was higher (37% vs 12%, p=0.001), and percentage ischemic myocardium as assessed by SPECT was greater (9.0±8.5% vs 5.6±6.6%, p=0.05) in patients with subclavian artery stenosis than in those without. Furthermore, significant correlations were observed between inter-arm pressure difference and percentage ischemic myocardium (r=0.13; p=0.01), and ABI (r=-0.26, p<0.0001). Among 386 patients, 283 underwent coronary angiography, and 63% of those who had inter-arm blood pressure difference had CAD. Furthermore, 83% of those CAD patients had multi-vessel CAD, which is regarded as a high-risk subset for subsequent cardiac events. Inter-arm pressure difference is often found in patients with suspected CAD, and is associated with significant CAD and peripheral artery disease. Thus, inter

Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients.

Directory of Open Access Journals (Sweden)

Anne Pauly

Full Text Available In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013 received usual care, whereas intervention patients (05/2013-12/2013 underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component. Adherence was measured by the "Medication Adherence Report Scale" (MARS and the "Drug Attitude Inventory" (DAI.The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73-1.93 higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15-2.72 more for intervention patients.These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program.German Clinical Trials Register DRKS00006358.

Functions and Requirements and Specifications for Replacement of the Computer Automated Surveillance System (CASS)

International Nuclear Information System (INIS)

SCAIEF, C.C.

1999-01-01

This functions, requirements and specifications document defines the baseline requirements and criteria for the design, purchase, fabrication, construction, installation, and operation of the system to replace the Computer Automated Surveillance System (CASS) alarm monitoring

Automated detection of macular drusen using geometric background leveling and threshold selection.

Science.gov (United States)

Smith, R Theodore; Chan, Jackie K; Nagasaki, Takayuki; Ahmad, Umer F; Barbazetto, Irene; Sparrow, Janet; Figueroa, Marta; Merriam, Joanna

2005-02-01

Age-related macular degeneration (ARMD) is the most prevalent cause of visual loss in patients older than 60 years in the United States. Observation of drusen is the hallmark finding in the clinical evaluation of ARMD. To segment and quantify drusen found in patients with ARMD using image analysis and to compare the efficacy of image analysis segmentation with that of stereoscopic manual grading of drusen. Retrospective study. University referral center.Patients Photographs were randomly selected from an available database of patients with known ARMD in the ongoing Columbia University Macular Genetics Study. All patients were white and older than 60 years. Twenty images from 17 patients were selected as representative of common manifestations of drusen. Image preprocessing included automated color balancing and, where necessary, manual segmentation of confounding lesions such as geographic atrophy (3 images). The operator then chose among 3 automated processing options suggested by predominant drusen type. Automated processing consisted of elimination of background variability by a mathematical model and subsequent histogram-based threshold selection. A retinal specialist using a graphic tablet while viewing stereo pairs constructed digital drusen drawings for each image. The sensitivity and specificity of drusen segmentation using the automated method with respect to manual stereoscopic drusen drawings were calculated on a rigorous pixel-by-pixel basis. The median sensitivity and specificity of automated segmentation were 70% and 81%, respectively. After preprocessing and option choice, reproducibility of automated drusen segmentation was necessarily 100%. Automated drusen segmentation can be reliably performed on digital fundus photographs and result in successful quantification of drusen in a more precise manner than is traditionally possible with manual stereoscopic grading of drusen. With only minor preprocessing requirements, this automated detection

Clinical utility of an automated immunochemiluminometric thyroglobulin assay in differentiated thyroid carcinoma

NARCIS (Netherlands)

Persoon, ACM; Van den Ouweland, JMW; Wilde, J; Kema, IP; Wolffenbuttel, BHR; Links, TP

Background: Thyroglobulin (Tg) measurements are important in the follow-up of patients with differentiated thyroid carcinoma (DTC). We evaluated the analytical and clinical performance of a new automated immunochemiluminometric assay for Tg (Tg-ICMA; Nichols Advantage Tg; Nichols Institute

Disintermediation of Inter-Blockchain Transactions

OpenAIRE

English, S. Matthew; Orlandi, Fabrizio; Auer, Soeren

2016-01-01

Different versions of peer-to-peer electronic cash exist as data represented by separate blockchains. Payments between such systems cannot be sent directly from one party to another without going through a financial institution. Bitcoin provided part of the solution but its utility is limited to intra-blockchain transactions. The benefits are lost if a trusted third party is required to execute inter-blockchain transactions. We propose a solution to the inter-blockchain transaction problem us...

An evaluation of an automated 4D-CT contour propagation tool to define an internal gross tumour volume for lung cancer radiotherapy

International Nuclear Information System (INIS)

Gaede, Stewart; Olsthoorn, Jason; Louie, Alexander V.; Palma, David; Yu, Edward; Yaremko, Brian; Ahmad, Belal; Chen, Jeff; Bzdusek, Karl; Rodrigues, George

2011-01-01

Background and purpose: To evaluate an automated 4D-CT contouring propagation tool by its impact on the inter- and intra-physician variability in lung tumour delineation. Materials and methods: In a previous study, six radiation oncologists contoured the gross tumour volume (GTV) and nodes on 10 phases of the 4D-CT dataset of 10 lung cancer patients to examine the intra- and inter-physician variability. In this study, a model-based deformable image registration algorithm was used to propagate the GTV and nodes on each phase of the same 4D-CT datasets. A blind review of the contours was performed by each physician and edited. Inter- and intra-physician variability for both the manual and automated methods was assessed by calculating the centroid motion of the GTV using the Pearson correlation coefficient and the variability in the internal gross tumour volume (IGTV) overlap using the Dice similarity coefficient (DSC). Results: The time for manual delineation was (42.7 ± 18.6) min versus (17.7 ± 5.4) min when the propagation tool was used. A significant improvement in the mean Pearson correlation coefficient was also observed. There was a significant decrease in mean DSC in only 1 out of 10 primary IGTVs and 2 out of 10 nodal IGTVs. Intra-physician variability was not significantly impacted (DSC > 0.742). Conclusions: Automated 4D-CT propagation tools can significantly decrease the IGTV delineation time without significantly decreasing the inter- and intra-physician variability.

Home Automated Telemanagement (HAT System to Facilitate Self-Care of Patients with Chronic Diseases

Directory of Open Access Journals (Sweden)

Joseph Finkelstein

2003-06-01

Full Text Available Successful patient self-management requires a multidisciplinary approach that includes regular patient assessment, disease-specific education, control of medication adherence, implementation of health behavior change models and social support. Existing systems for computer-assisted disease management do not provide this multidisciplinary patient support and do not address treatment compliance issues. We developed the Home Automated Telemanagement (HAT system for patients with different chronic health conditions to facilitate their self-care. The HAT system consists of a home unit, HAT server, and clinician units. Patients at home use a palmtop or a laptop connected with a disease monitor on a regular basis. Each HAT session consists of self-testing, feedback, and educational components. The self-reported symptom data and objective results obtained from disease-specific sensors are automatically sent from patient homes to the HAT server in the hospital. Any web-enabled device can serve as a clinician unit to review patient results. The HAT system monitors self-testing results and patient compliance. The HAT system has been implemented and tested in patients receiving anticoagulation therapy, patients with asthma, COPD and other health conditions. Evaluation results indicated high level of acceptance of the HAT system by the patients and that the system has a positive impact on main clinical outcomes and patient satisfaction with medical care.

Inter-observer variation of diagnosis of Alzheimer's disease by SPECT

International Nuclear Information System (INIS)

Oshima, Motoo; Machida, Kikuo; Koizumi, Kiyoshi

2001-01-01

SPECT shows characteristic distribution in Alzheimer's disease. The purpose of this study is to define inter-observer variations in the diagnosis of Alzheimer's disease. Fifty-seven patients, included 19 Alzheimer's disease were collected from four institutions. Five-graded score was used to interprete SPECT in 18 regions. Ten nuclear medicine physicians interpreted SPECT referred with MMSE and clinical information. Among 57 cases 19 Alzheimer's disease were selected in this study. Statistics were performed between SPECT score and MMSE score. In conclusion, inter-observer variation is present in SPECT interpretation. There was a good correlation SPECT and MMSE with proper brain SPECT physicians. They are superior to in the interpretation not only resident, but other specialists. Education in the interpretation of brain SPECT looks important. (author)

Heart deformation analysis for automated quantification of cardiac function and regional myocardial motion patterns: A proof of concept study in patients with cardiomyopathy and healthy subjects

Energy Technology Data Exchange (ETDEWEB)

Lin, Kai, E-mail: kai-lin@northwestern.edu; Collins, Jeremy D.; Chowdhary, Varun; Markl, Michael; Carr, James C.

2016-10-15

Highlights: • Heart deformation analysis (HDA) can quantify global and regional cardiac function. • HDA works based on cine CMR images without the needs of operator interaction. • HDA-derived cardiac motion indices are reproducible. - Abstract: Objective: To test the performance of HDA in characterizing left ventricular (LV) function and regional myocardial motion patterns in the context of cardiomyopathy based on cine cardiovascular magnetic resonance (CMR). Materials and methods: Following the approval of the institutional review board (IRB), standard cine images of 45 subjects, including 15 healthy volunteers, 15 patients with hypertrophic cardiomyopathy (HCM) and 15 patients with dilated cardiomyopathy (DCM) were retrospectively analyzed using HDA. The variations of LV ejection fraction (LVEF), LV mass (LVM), and regional myocardial motion indices, including radial (Drr), circumferential (Dcc) displacement, radial (Vrr) and circumferential (Vcc) velocity, radial (Err), circumferential (Ecc) and shear (Ess) strain and radial (SRr) and circumferential (SRc) strain rate, were calculated and compared among subject groups. Inter-study reproducibility of HDA-derived myocardial motion indices were tested on 15 volunteers by using intra-class correlation coefficient (ICC) and coefficient of variation (CoV). Results: HDA identified significant differences in cardiac function and motion indices between subject groups. DCM patients had significantly lower LVEF (33.5 ± 9.65%), LVM (105.88 ± 21.93 g), peak Drr (0.29 ± 0.11 cm), Vrr-sys (2.14 ± 0.72 cm/s), Err (0.17 ± 0.08), Ecc (−0.08 ± 0.03), SRr-sys (0.91 ± 0.44s{sup −1}) and SRc-sys (−0.64 ± 0.27s{sup −1}) compared to the other two groups. HCM patients demonstrated increased LVM (171.69 ± 34.19) and lower peak Vcc-dia (0.78 ± 0.30 cm/s) than other subjects. Good inter-study reproducibility was found for all HDA-derived myocardial indices in healthy volunteers (ICC = 0.664–0.942, CoV = 15.1%–37

Heart deformation analysis for automated quantification of cardiac function and regional myocardial motion patterns: A proof of concept study in patients with cardiomyopathy and healthy subjects

International Nuclear Information System (INIS)

Lin, Kai; Collins, Jeremy D.; Chowdhary, Varun; Markl, Michael; Carr, James C.

2016-01-01

Highlights: • Heart deformation analysis (HDA) can quantify global and regional cardiac function. • HDA works based on cine CMR images without the needs of operator interaction. • HDA-derived cardiac motion indices are reproducible. - Abstract: Objective: To test the performance of HDA in characterizing left ventricular (LV) function and regional myocardial motion patterns in the context of cardiomyopathy based on cine cardiovascular magnetic resonance (CMR). Materials and methods: Following the approval of the institutional review board (IRB), standard cine images of 45 subjects, including 15 healthy volunteers, 15 patients with hypertrophic cardiomyopathy (HCM) and 15 patients with dilated cardiomyopathy (DCM) were retrospectively analyzed using HDA. The variations of LV ejection fraction (LVEF), LV mass (LVM), and regional myocardial motion indices, including radial (Drr), circumferential (Dcc) displacement, radial (Vrr) and circumferential (Vcc) velocity, radial (Err), circumferential (Ecc) and shear (Ess) strain and radial (SRr) and circumferential (SRc) strain rate, were calculated and compared among subject groups. Inter-study reproducibility of HDA-derived myocardial motion indices were tested on 15 volunteers by using intra-class correlation coefficient (ICC) and coefficient of variation (CoV). Results: HDA identified significant differences in cardiac function and motion indices between subject groups. DCM patients had significantly lower LVEF (33.5 ± 9.65%), LVM (105.88 ± 21.93 g), peak Drr (0.29 ± 0.11 cm), Vrr-sys (2.14 ± 0.72 cm/s), Err (0.17 ± 0.08), Ecc (−0.08 ± 0.03), SRr-sys (0.91 ± 0.44s −1 ) and SRc-sys (−0.64 ± 0.27s −1 ) compared to the other two groups. HCM patients demonstrated increased LVM (171.69 ± 34.19) and lower peak Vcc-dia (0.78 ± 0.30 cm/s) than other subjects. Good inter-study reproducibility was found for all HDA-derived myocardial indices in healthy volunteers (ICC = 0.664–0.942, CoV = 15.1%–37

Cardiac imaging: working towards fully-automated machine analysis & interpretation.

Science.gov (United States)

Slomka, Piotr J; Dey, Damini; Sitek, Arkadiusz; Motwani, Manish; Berman, Daniel S; Germano, Guido

2017-03-01

Non-invasive imaging plays a critical role in managing patients with cardiovascular disease. Although subjective visual interpretation remains the clinical mainstay, quantitative analysis facilitates objective, evidence-based management, and advances in clinical research. This has driven developments in computing and software tools aimed at achieving fully automated image processing and quantitative analysis. In parallel, machine learning techniques have been used to rapidly integrate large amounts of clinical and quantitative imaging data to provide highly personalized individual patient-based conclusions. Areas covered: This review summarizes recent advances in automated quantitative imaging in cardiology and describes the latest techniques which incorporate machine learning principles. The review focuses on the cardiac imaging techniques which are in wide clinical use. It also discusses key issues and obstacles for these tools to become utilized in mainstream clinical practice. Expert commentary: Fully-automated processing and high-level computer interpretation of cardiac imaging are becoming a reality. Application of machine learning to the vast amounts of quantitative data generated per scan and integration with clinical data also facilitates a move to more patient-specific interpretation. These developments are unlikely to replace interpreting physicians but will provide them with highly accurate tools to detect disease, risk-stratify, and optimize patient-specific treatment. However, with each technological advance, we move further from human dependence and closer to fully-automated machine interpretation.

An automated A-value measurement tool for accurate cochlear duct length estimation.

Science.gov (United States)

Iyaniwura, John E; Elfarnawany, Mai; Ladak, Hanif M; Agrawal, Sumit K

2018-01-22

There has been renewed interest in the cochlear duct length (CDL) for preoperative cochlear implant electrode selection and postoperative generation of patient-specific frequency maps. The CDL can be estimated by measuring the A-value, which is defined as the length between the round window and the furthest point on the basal turn. Unfortunately, there is significant intra- and inter-observer variability when these measurements are made clinically. The objective of this study was to develop an automated A-value measurement algorithm to improve accuracy and eliminate observer variability. Clinical and micro-CT images of 20 cadaveric cochleae specimens were acquired. The micro-CT of one sample was chosen as the atlas, and A-value fiducials were placed onto that image. Image registration (rigid affine and non-rigid B-spline) was applied between the atlas and the 19 remaining clinical CT images. The registration transform was applied to the A-value fiducials, and the A-value was then automatically calculated for each specimen. High resolution micro-CT images of the same 19 specimens were used to measure the gold standard A-values for comparison against the manual and automated methods. The registration algorithm had excellent qualitative overlap between the atlas and target images. The automated method eliminated the observer variability and the systematic underestimation by experts. Manual measurement of the A-value on clinical CT had a mean error of 9.5 ± 4.3% compared to micro-CT, and this improved to an error of 2.7 ± 2.1% using the automated algorithm. Both the automated and manual methods correlated significantly with the gold standard micro-CT A-values (r = 0.70, p value measurement tool using atlas-based registration methods was successfully developed and validated. The automated method eliminated the observer variability and improved accuracy as compared to manual measurements by experts. This open-source tool has the potential to benefit

Fully Automated Volumetric Modulated Arc Therapy Plan Generation for Prostate Cancer Patients

International Nuclear Information System (INIS)

Voet, Peter W.J.; Dirkx, Maarten L.P.; Breedveld, Sebastiaan; Al-Mamgani, Abrahim; Incrocci, Luca; Heijmen, Ben J.M.

2014-01-01

Purpose: To develop and evaluate fully automated volumetric modulated arc therapy (VMAT) treatment planning for prostate cancer patients, avoiding manual trial-and-error tweaking of plan parameters by dosimetrists. Methods and Materials: A system was developed for fully automated generation of VMAT plans with our commercial clinical treatment planning system (TPS), linked to the in-house developed Erasmus-iCycle multicriterial optimizer for preoptimization. For 30 randomly selected patients, automatically generated VMAT plans (VMAT auto ) were compared with VMAT plans generated manually by 1 expert dosimetrist in the absence of time pressure (VMAT man ). For all treatment plans, planning target volume (PTV) coverage and sparing of organs-at-risk were quantified. Results: All generated plans were clinically acceptable and had similar PTV coverage (V 95%  > 99%). For VMAT auto and VMAT man plans, the organ-at-risk sparing was similar as well, although only the former plans were generated without any planning workload. Conclusions: Fully automated generation of high-quality VMAT plans for prostate cancer patients is feasible and has recently been implemented in our clinic

Robotics/Automated Systems Technicians.

Science.gov (United States)

Doty, Charles R.

Major resources exist that can be used to develop or upgrade programs in community colleges and technical institutes that educate robotics/automated systems technicians. The first category of resources is Economic, Social, and Education Issues. The Office of Technology Assessment (OTA) report, "Automation and the Workplace," presents analyses of…

Comparative performance evaluation of automated segmentation methods of hippocampus from magnetic resonance images of temporal lobe epilepsy patients.

Science.gov (United States)

Hosseini, Mohammad-Parsa; Nazem-Zadeh, Mohammad-Reza; Pompili, Dario; Jafari-Khouzani, Kourosh; Elisevich, Kost; Soltanian-Zadeh, Hamid

2016-01-01

Segmentation of the hippocampus from magnetic resonance (MR) images is a key task in the evaluation of mesial temporal lobe epilepsy (mTLE) patients. Several automated algorithms have been proposed although manual segmentation remains the benchmark. Choosing a reliable algorithm is problematic since structural definition pertaining to multiple edges, missing and fuzzy boundaries, and shape changes varies among mTLE subjects. Lack of statistical references and guidance for quantifying the reliability and reproducibility of automated techniques has further detracted from automated approaches. The purpose of this study was to develop a systematic and statistical approach using a large dataset for the evaluation of automated methods and establish a method that would achieve results better approximating those attained by manual tracing in the epileptogenic hippocampus. A template database of 195 (81 males, 114 females; age range 32-67 yr, mean 49.16 yr) MR images of mTLE patients was used in this study. Hippocampal segmentation was accomplished manually and by two well-known tools (FreeSurfer and hammer) and two previously published methods developed at their institution [Automatic brain structure segmentation (ABSS) and LocalInfo]. To establish which method was better performing for mTLE cases, several voxel-based, distance-based, and volume-based performance metrics were considered. Statistical validations of the results using automated techniques were compared with the results of benchmark manual segmentation. Extracted metrics were analyzed to find the method that provided a more similar result relative to the benchmark. Among the four automated methods, ABSS generated the most accurate results. For this method, the Dice coefficient was 5.13%, 14.10%, and 16.67% higher, Hausdorff was 22.65%, 86.73%, and 69.58% lower, precision was 4.94%, -4.94%, and 12.35% higher, and the root mean square (RMS) was 19.05%, 61.90%, and 65.08% lower than LocalInfo, FreeSurfer, and

Patients in assisted automated peritoneal dialysis develop strategies for self-care

DEFF Research Database (Denmark)

Holch, Kirsten

2008-01-01

  Background Since 2000, a model for Assisted Automated Peritoneal Dialysis (aAPD) for patients in their own home needing chronic dialysis treatment has been developed at Aarhus University Hospital, Skejby, Denmark. The patient group consists of physically or mentally frail elderly who cannot...

[Institutional psychotherapy, caring for patients and the place of care].

Science.gov (United States)

Drogoul, Frank

2013-01-01

Institutional psychotherapy was developed in the specific context of the "assassination" of the Spanish revolution. There are two distinct movements or two periods. The first, based around Georges Daumézon and Henri Ey gave birth to the sector. The second, around FrançoisTosquelles and Jean Oury emphasised the asylum as the place of care. The function of institutional psychotherapy is to care not only for the patients but also the place of treatment. To fulfil this function, it has a tool box: transfer, the fight against the overvaluation of hierarchy as well as the function of the therapeutic club.

Intra-Rater, Inter-Rater and Test-Retest Reliability of an Instrumented Timed Up and Go (iTUG Test in Patients with Parkinson's Disease.

Directory of Open Access Journals (Sweden)

Rob C van Lummel

Full Text Available The "Timed Up and Go" (TUG is a widely used measure of physical functioning in older people and in neurological populations, including Parkinson's Disease. When using an inertial sensor measurement system (instrumented TUG [iTUG], the individual components of the iTUG and the trunk kinematics can be measured separately, which may provide relevant additional information.The aim of this study was to determine intra-rater, inter-rater and test-retest reliability of the iTUG in patients with Parkinson's Disease.Twenty eight PD patients, aged 50 years or older, were included. For the iTUG the DynaPort Hybrid (McRoberts, The Hague, The Netherlands was worn at the lower back. The device measured acceleration and angular velocity in three directions at a rate of 100 samples/s. Patients performed the iTUG five times on two consecutive days. Repeated measurements by the same rater on the same day were used to calculate intra-rater reliability. Repeated measurements by different raters on the same day were used to calculate intra-rater and inter-rater reliability. Repeated measurements by the same rater on different days were used to calculate test-retest reliability.Nineteen ICC values (15% were ≥ 0.9 which is considered as excellent reliability. Sixty four ICC values (49% were ≥ 0.70 and < 0.90 which is considered as good reliability. Thirty one ICC values (24% were ≥ 0.50 and < 0.70, indicating moderate reliability. Sixteen ICC values (12% were ≥ 0.30 and < 0.50 indicating poor reliability. Two ICT values (2% were < 0.30 indicating very poor reliability.In conclusion, in patients with Parkinson's disease the intra-rater, inter-rater, and test-retest reliability of the individual components of the instrumented TUG (iTUG was excellent to good for total duration and for turning durations, and good to low for the sub durations and for the kinematics of the SiSt and StSi. The results of this fully automated analysis of instrumented TUG movements

Patient-specific workup of adrenal incidentalomas

Directory of Open Access Journals (Sweden)

Romy R. de Haan

Full Text Available Purpose: : To develop a clinical prediction model to predict a clinically relevant adrenal disorder for patients with adrenal incidentaloma. Materials and methods: : This retrospective study is approved by the institutional review board, with waiver of informed consent. Natural language processing is used for filtering of adrenal incidentaloma cases in all thoracic and abdominal CT reports from 2010 till 2012. A total of 635 patients are identified. Stepwise logistic regression is used to construct the prediction model. The model predicts if a patient is at risk for malignancy or hormonal hyperfunction of the adrenal gland at the moment of initial presentation, thus generates a predicted probability for every individual patient. The prediction model is evaluated on its usefulness in clinical practice using decision curve analysis (DCA based on different threshold probabilities. For patients whose predicted probability is lower than the predetermined threshold probability, further workup could be omitted. Results: : A prediction model is successfully developed, with an area under the curve (AUC of 0.78. Results of the DCA indicate that up to 11% of patients with an adrenal incidentaloma can be avoided from unnecessary workup, with a sensitivity of 100% and specificity of 11%. Conclusion: : A prediction model can accurately predict if an adrenal incidentaloma patient is at risk for malignancy or hormonal hyperfunction of the adrenal gland based on initial imaging features and patient demographics. However, with most adrenal incidentalomas labeled as nonfunctional adrenocortical adenomas requiring no further treatment, it is likely that more patients could be omitting from unnecessary diagnostics. Keywords: Adrenal incidentaloma, Patient-specific workup, Prediction model

Automated Remote Monitoring of Depression: Acceptance Among Low-Income Patients in Diabetes Disease Management

OpenAIRE

Ramirez, Magaly; Wu, Shinyi; Jin, Haomiao; Ell, Kathleen; Gross-Schulman, Sandra; Myerchin Sklaroff, Laura; Guterman, Jeffrey

2016-01-01

Background Remote patient monitoring is increasingly integrated into health care delivery to expand access and increase effectiveness. Automation can add efficiency to remote monitoring, but patient acceptance of automated tools is critical for success. From 2010 to 2013, the Diabetes-Depression Care-management Adoption Trial (DCAT)?a quasi-experimental comparative effectiveness research trial aimed at accelerating the adoption of collaborative depression care in a safety-net health care syst...

An Automated Detection System for Microaneurysms That Is Effective across Different Racial Groups.

Science.gov (United States)

Saleh, George Michael; Wawrzynski, James; Caputo, Silvestro; Peto, Tunde; Al Turk, Lutfiah Ismail; Wang, Su; Hu, Yin; Da Cruz, Lyndon; Smith, Phil; Tang, Hongying Lilian

2016-01-01

Patients without diabetic retinopathy (DR) represent a large proportion of the caseload seen by the DR screening service so reliable recognition of the absence of DR in digital fundus images (DFIs) is a prime focus of automated DR screening research. We investigate the use of a novel automated DR detection algorithm to assess retinal DFIs for absence of DR. A retrospective, masked, and controlled image-based study was undertaken. 17,850 DFIs of patients from six different countries were assessed for DR by the automated system and by human graders. The system's performance was compared across DFIs from the different countries/racial groups. The sensitivities for detection of DR by the automated system were Kenya 92.8%, Botswana 90.1%, Norway 93.5%, Mongolia 91.3%, China 91.9%, and UK 90.1%. The specificities were Kenya 82.7%, Botswana 83.2%, Norway 81.3%, Mongolia 82.5%, China 83.0%, and UK 79%. There was little variability in the calculated sensitivities and specificities across the six different countries involved in the study. These data suggest the possible scalability of an automated DR detection platform that enables rapid identification of patients without DR across a wide range of races.

Accuracy of automated software-guided detection of significant coronary artery stenosis by CT angiography: comparison with invasive catheterisation

International Nuclear Information System (INIS)

Anders, Katharina; Uder, Michael; Achenbach, Stephan; Petit, Isabel; Daniel, Werner G.; Pflederer, Tobias

2013-01-01

True automated detection of coronary artery stenoses might be useful whenever expert evaluation is not available, or as a ''second reader'' to enhance diagnostic confidence. We evaluated the accuracy of a PC-based stenosis detection tool alone and combined with expert interpretation. One hundred coronary CT angiography datasets were evaluated with the automated software alone, by manual interpretation (axial images, multiplanar reformations and maximum intensity projections in free double-oblique planes), and by expert interpretation aware of the automated findings. Stenoses ≥ 50 % were noted per-vessel and per-patient, and compared with invasive angiography. Automated post-processing was successful in 90 % of patients (88 % of vessels). When excluding uninterpretable datasets, per-patient sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89 %, 79 %, 74 % and 92 % (per-vessel: 82 %, 85 %, 48 % and 96 %). All 100 datasets were evaluable by expert interpretation. Per-patient sensitivity, specificity, PPV and NPV were 95 %, 95 %, 93 % and 97 % (per-vessel: 89 %,98 %, 88 % and 98 %). Knowing the results of automated interpretation did not improve the performance of expert readers. Automated off-line post-processing of coronary CT angiography shows adequate sensitivity, but relatively low specificity in coronary stenosis detection. It does not increase accuracy of expert interpretation. Failure of post-processing in 10 % of all patients necessitates additional manual image work-up. (orig.)

Automation of technical specification monitoring for nuclear power plants

International Nuclear Information System (INIS)

Lin, J.C.; Abbott, E.C.; Hubbard, F.R.

1986-01-01

The complexity of today's nuclear power plants combined with an equally detailed regulatory process makes it necessary for the plant staff to have access to an automated system capable of monitoring the status of limiting conditions for operation (LCO). Pickard, Lowe and Garrick, Inc. (PLG), has developed the first of such a system, called Limiting Conditions for Operation Monitor (LIMCOM). LIMCOM provides members of the operating staff with an up-to-date comparison of currently operable equipment and plant operating conditions with what is required in the technical specifications. LIMCOM also provides an effective method of screening tagout requests by evaluating their impact on the LCOs. Finally, LIMCOM provides an accurate method of tracking and scheduling routine surveillance. (author)

Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis.

Science.gov (United States)

Ichikawa, Shota; Kamishima, Tamotsu; Sutherland, Kenneth; Kasahara, Hideki; Shimizu, Yuka; Fujimori, Motoshi; Yasojima, Nobutoshi; Ono, Yohei; Kaneda, Takahiko; Koike, Takao

2017-06-01

The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with rheumatoid arthritis (RA), by using the semi-quantitative scoring method as the reference standard. Twenty patients (14 females and 6 males) with RA were included in this retrospective study. All patients underwent radiography and tomosynthesis of the bilateral hand and wrist. Two rheumatologists and a radiologist independently scored JSN with two modalities according to the Sharp/van der Heijde score. Two observers independently measured joint space width on tomosynthesis images using an in-house semi-automated method. More joints with JSN were revealed with tomosynthesis score (243 joints) and the semi-automated method (215 joints) than with radiography (120 joints), and the associations between tomosynthesis scores and radiography scores were demonstrated (P tomosynthesis scores with r = -0.606 (P tomosynthesis images was in almost perfect agreement with intra-class correlation coefficient (ICC) values of 0.964 and 0.963, respectively. The semi-automated method using tomosynthesis images provided sensitive, quantitative, and reproducible measurement of finger joint space in patients with RA.

Trajectory Specification for Automation of Terminal Air Traffic Control

Science.gov (United States)

Paielli, Russell A.

2016-01-01

"Trajectory specification" is the explicit bounding and control of aircraft tra- jectories such that the position at each point in time is constrained to a precisely defined volume of space. The bounding space is defined by cross-track, along-track, and vertical tolerances relative to a reference trajectory that specifies position as a function of time. The tolerances are dynamic and will be based on the aircraft nav- igation capabilities and the current traffic situation. A standard language will be developed to represent these specifications and to communicate them by datalink. Assuming conformance, trajectory specification can guarantee safe separation for an arbitrary period of time even in the event of an air traffic control (ATC) sys- tem or datalink failure, hence it can help to achieve the high level of safety and reliability needed for ATC automation. As a more proactive form of ATC, it can also maximize airspace capacity and reduce the reliance on tactical backup systems during normal operation. It applies to both enroute airspace and the terminal area around airports, but this paper focuses on arrival spacing in the terminal area and presents ATC algorithms and software for achieving a specified delay of runway arrival time.

Automated personnel data base system specifications, Task V. Final report

International Nuclear Information System (INIS)

Bartley, H.J.; Bocast, A.K.; Deppner, F.O.; Harrison, O.J.; Kraas, I.W.

1978-11-01

The full title of this study is 'Development of Qualification Requirements, Training Programs, Career Plans, and Methodologies for Effective Management and Training of Inspection and Enforcement Personnel.' Task V required the development of an automated personnel data base system for NRC/IE. This system is identified as the NRC/IE Personnel, Assignment, Qualifications, and Training System (PAQTS). This Task V report provides the documentation for PAQTS including the Functional Requirements Document (FRD), the Data Requirements Document (DRD), the Hardware and Software Capabilities Assessment, and the Detailed Implementation Schedule. Specific recommendations to facilitate implementation of PAQTS are also included

Minimizing inter-microscope variability in dental microwear texture analysis

Science.gov (United States)

Arman, Samuel D.; Ungar, Peter S.; Brown, Christopher A.; DeSantis, Larisa R. G.; Schmidt, Christopher; Prideaux, Gavin J.

2016-06-01

A common approach to dental microwear texture analysis (DMTA) uses confocal profilometry in concert with scale-sensitive fractal analysis to help understand the diets of extinct mammals. One of the main benefits of DMTA over other methods is the repeatable, objective manner of data collection. This repeatability, however, is threatened by variation in results of DMTA of the same dental surfaces yielded by different microscopes. Here we compare DMTA data of five species of kangaroos measured on seven profilers of varying specifications. Comparison between microscopes confirms that inter-microscope differences are present, but we show that deployment of a number of automated treatments to remove measurement noise can help minimize inter-microscope differences. Applying these same treatments to a published hominin DMTA dataset shows that they alter some significant differences between dietary groups. Minimising microscope variability while maintaining interspecific dietary differences requires then that these factors are balanced in determining appropriate treatments. The process outlined here offers a solution for allowing comparison of data between microscopes, which is essential for ongoing DMTA research. In addition, the process undertaken, including considerations of other elements of DMTA protocols also promises to streamline methodology, remove measurement noise and in doing so, optimize recovery of a reliable dietary signature.

The cobas® 6800/8800 System: a new era of automation in molecular diagnostics.

Science.gov (United States)

Cobb, Bryan; Simon, Christian O; Stramer, Susan L; Body, Barbara; Mitchell, P Shawn; Reisch, Natasa; Stevens, Wendy; Carmona, Sergio; Katz, Louis; Will, Stephen; Liesenfeld, Oliver

2017-02-01

Molecular diagnostics is a key component of laboratory medicine. Here, the authors review key triggers of ever-increasing automation in nucleic acid amplification testing (NAAT) with a focus on specific automated Polymerase Chain Reaction (PCR) testing and platforms such as the recently launched cobas® 6800 and cobas® 8800 Systems. The benefits of such automation for different stakeholders including patients, clinicians, laboratory personnel, hospital administrators, payers, and manufacturers are described. Areas Covered: The authors describe how molecular diagnostics has achieved total laboratory automation over time, rivaling clinical chemistry to significantly improve testing efficiency. Finally, the authors discuss how advances in automation decrease the development time for new tests enabling clinicians to more readily provide test results. Expert Commentary: The advancements described enable complete diagnostic solutions whereby specific test results can be combined with relevant patient data sets to allow healthcare providers to deliver comprehensive clinical recommendations in multiple fields ranging from infectious disease to outbreak management and blood safety solutions.

Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App.

Science.gov (United States)

Munich, Stephan A; Tan, Lee A; Nogueira, Danilo M; Keigher, Kiffon M; Chen, Michael; Crowley, R Webster; Conners, James J; Lopes, Demetrius K

2017-09-01

The primary correlate to survival and preservation of neurologic function in patients suffering from an acute ischemic stroke is time from symptom onset to initiation of therapy and reperfusion. Communication and coordination among members of the stroke team are essential to maximizing efficiency and subsequently early reperfusion. In this work, we aim to describe our preliminary experience using the Join mobile application as a means to improve interdisciplinary team communication and efficiency. We describe our pilot experience with the initiation of the Join mobile application between July 2015 and July 2016. With this application, a mobile beacon is transported with the patient on the ambulance. Transportation milestone timestamps and geographic coordinates are transmitted to the treating facility and instantly communicated to all treatment team members. The transport team / patient can be tracked en route to the treating facility. During our pilot study, 62 patients were triaged and managed using the Join application. Automated time-stamping of critical events, geographic tracking of patient transport and summary documents were obtained for all patients. Treatment team members had an overall favorable impression of the Join application and recommended its continued use. The Join application is one of several components of a multi-institutional, interdisciplinary effort to improve the treatment of patients with acute ischemic stroke. The ability of the treatment team to track patient transport and communicate with the transporting team may improve reperfusion time and, therefore, improve neurologic outcomes.

Delivery of Patient-Reported Outcome Instruments by Automated Mobile Phone Text Messaging.

Science.gov (United States)

Anthony, Christopher A; Lawler, Ericka A; Glass, Natalie A; McDonald, Katelyn; Shah, Apurva S

2017-11-01

Patient-reported outcome (PRO) instruments allow patients to interpret their health and are integral in evaluating orthopedic treatments and outcomes. The purpose of this study was to define: (1) correlation between PROs collected by automated delivery of text messages on mobile phones compared with paper delivery; and (2) patient use characteristics of a technology platform utilizing automated delivery of text messages on mobile phones. Paper versions of the 12-Item Short Form Health Survey (SF-12) and the short form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) were completed by patients in orthopedic hand and upper extremity clinics. Over the next 48 hours, the same patients also completed the mobile phone portion of the study outside of the clinic which included text message delivery of the SF-12 and QuickDASH, assigned in a random order. Correlations between paper and text message delivery of the 2 PROs were assessed. Among 72 patients, the intraclass correlation coefficient (ICC) between the written and mobile phone delivery of QuickDASH was 0.91 (95% confidence interval [CI], 0.85-0.95). The ICC between the paper and mobile phone delivery of the SF-12 physical health composite score was 0.88 (95% CI, 0.79-0.93) and 0.86 (95% CI, 0.75-0.92) for the SF-12 mental health composite score. We find that text message delivery using mobile phones permits valid assessment of SF-12 and QuickDASH scores. The findings suggest that software-driven automated delivery of text communication to patients via mobile phones may be a valid method to obtain other PRO scores in orthopedic patients.

Domain Specific Language Support for Exascale

Energy Technology Data Exchange (ETDEWEB)

Mellor-Crummey, John [Rice Univ., Houston, TX (United States)

2017-10-20

A multi-institutional project known as D-TEC (short for “Domain- specific Technology for Exascale Computing”) set out to explore technologies to support the construction of Domain Specific Languages (DSLs) to map application programs to exascale architectures. DSLs employ automated code transformation to shift the burden of delivering portable performance from application programmers to compilers. Two chief properties contribute: DSLs permit expression at a high level of abstraction so that a programmer’s intent is clear to a compiler and DSL implementations encapsulate human domain-specific optimization knowledge so that a compiler can be smart enough to achieve good results on specific hardware. Domain specificity is what makes these properties possible in a programming language. If leveraging domain specificity is the key to keep exascale software tractable, a corollary is that many different DSLs will be needed to encompass the full range of exascale computing applications; moreover, a single application may well need to use several different DSLs in conjunction. As a result, developing a general toolkit for building domain-specific languages was a key goal for the D-TEC project. Different aspects of the D-TEC research portfolio were the focus of work at each of the partner institutions in the multi-institutional project. D-TEC research and development work at Rice University focused on on three principal topics: understanding how to automate the tuning of code for complex architectures, research and development of the Rosebud DSL engine, and compiler technology to support complex execution platforms. This report provides a summary of the research and development work on the D-TEC project at Rice University.

3D patient-specific models for left atrium characterization to support ablation in atrial fibrillation patients.

Science.gov (United States)

Valinoti, Maddalena; Fabbri, Claudio; Turco, Dario; Mantovan, Roberto; Pasini, Antonio; Corsi, Cristiana

2018-01-01

Radiofrequency ablation (RFA) is an important and promising therapy for atrial fibrillation (AF) patients. Optimization of patient selection and the availability of an accurate anatomical guide could improve RFA success rate. In this study we propose a unified, fully automated approach to build a 3D patient-specific left atrium (LA) model including pulmonary veins (PVs) in order to provide an accurate anatomical guide during RFA and without PVs in order to characterize LA volumetry and support patient selection for AF ablation. Magnetic resonance data from twenty-six patients referred for AF RFA were processed applying an edge-based level set approach guided by a phase-based edge detector to obtain the 3D LA model with PVs. An automated technique based on the shape diameter function was designed and applied to remove PVs and compute LA volume. 3D LA models were qualitatively compared with 3D LA surfaces acquired during the ablation procedure. An expert radiologist manually traced the LA on MR images twice. LA surfaces from the automatic approach and manual tracing were compared by mean surface-to-surface distance. In addition, LA volumes were compared with volumes from manual segmentation by linear and Bland-Altman analyses. Qualitative comparison of 3D LA models showed several inaccuracies, in particular PVs reconstruction was not accurate and left atrial appendage was missing in the model obtained during RFA procedure. LA surfaces were very similar (mean surface-to-surface distance: 2.3±0.7mm). LA volumes were in excellent agreement (y=1.03x-1.4, r=0.99, bias=-1.37ml (-1.43%) SD=2.16ml (2.3%), mean percentage difference=1.3%±2.1%). Results showed the proposed 3D patient-specific LA model with PVs is able to better describe LA anatomy compared to models derived from the navigation system, thus potentially improving electrograms and voltage information location and reducing fluoroscopic time during RFA. Quantitative assessment of LA volume derived from our 3D LA

Automated processing of fluorescence in-situ hybridization slides for HER2 testing in breast and gastro-esophageal carcinomas.

Science.gov (United States)

Tafe, Laura J; Allen, Samantha F; Steinmetz, Heather B; Dokus, Betty A; Cook, Leanne J; Marotti, Jonathan D; Tsongalis, Gregory J

2014-08-01

HER2 fluorescence in-situ hybridization (FISH) is used in breast and gastro-esophageal carcinoma for determining HER2 gene amplification and patients' eligibility for HER2 targeted therapeutics. Traditional manual processing of the FISH slides is labor intensive because of multiple steps that require hands on manipulation of the slides and specifically timed intervals between steps. This highly manual processing also introduces inter-run and inter-operator variability that may affect the quality of the FISH result. Therefore, we sought to incorporate an automated processing instrument into our FISH workflow. Twenty-six cases including breast (20) and gastro-esophageal (6) cancer comprising 23 biopsies and three excision specimens were tested for HER2 FISH (Pathvysion, Abbott) using the Thermobrite Elite (TBE) system (Leica). Up to 12 slides can be run simultaneously. All cases were previously tested by the Pathvysion HER2 FISH assay with manual preparation. Twenty cells were counted by two observers for each case; five cases were tested on three separate runs by different operators to evaluate the precision and inter-operator variability. There was 100% concordance in the scoring between the manual and TBE methods as well as among the five cases that were tested on three runs. Only one case failed due to poor probe hybridization. In total, seven cases were positive for HER2 amplification (HER2:CEP17 ratio >2.2) and the remaining 19 were negative (HER2:CEP17 ratio <1.8) utilizing the 2007 ASCO/CAP scoring criteria. Due to the automated denaturation and hybridization, for each run, there was a reduction in labor of 3.5h which could then be dedicated to other lab functions. The TBE is a walk away pre- and post-hybridization system that automates FISH slide processing, improves work flow and consistency and saves approximately 3.5h of technologist time. The instrument has a small footprint thus occupying minimal counter space. TBE processed slides performed

Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain

DEFF Research Database (Denmark)

Petersen, Tom Erik; Olsen, Steen; Laslett, Mark

2004-01-01

Most patients referred to physiotherapy with low back pain are without a precise medical diagnosis. Identification of subgroups of non-specific low back pain patients may improve clinical outcomes and research efficiency. A pathoanatomic classification system has been developed, classifying...... modest level of total agreement (39%) for the system as a whole might indicate that the utility of the system for general screening purposes is limited, compared with the utility in identification of particular syndromes. Due to low prevalence of positive findings in some of the syndromes, future work...... should focus on testing reliability on a larger sample of patients, and testing of validity and feasibility of the system....

Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.

Science.gov (United States)

Wang, Jong-Yi; Ho, Hsiao-Yun; Chen, Jen-De; Chai, Sinkuo; Tai, Chih-Jaan; Chen, Yung-Fu

2015-07-12

In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four

Cardiac MRI in children and adolescents who have undergone surgical repair of right-sided congenital heart disease. Automated left ventricular volumes and function analysis and effects of different manual adjustments

Energy Technology Data Exchange (ETDEWEB)

Rompel, O.; Janka, R.; May, M.S.; Lell, M.M.; Uder, M.; Hammon, M. [University Hospital Erlangen (Germany). Dept. of Radiology; Gloeckler, M.; Dittrich, S. [University Hospital Erlangen (Germany). Dept. of Pediatric Cardiology; Cesnjevar, R. [University Hospital Erlangen (Germany). Dept. of Pediatric Cardiac Surgery

2015-12-15

To evaluate automated segmentation and the effects of different manual adjustments regarding left ventricular parameter quantification in cardiac magnetic resonance (MR) data on children and adolescents who have undergone surgical repair of right-sided congenital heart disease (CHD). Dedicated software (syngo.via, Siemens AG) was used to automatically segment and/or manually adjust the end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), myocardial mass (MM) and ejection fraction (EF) before/after manual apex/base adjustment (ADJ-step 1) and after manual apex/base/myocardial contour adjustment (ADJ-step 2; reference standard). MR data of 40 patients (13.1 ± 3.1y, 4-17y) with repaired CHD with decreased pulmonary blood flow (CHD-DPBF) were evaluated. Intra- and inter-rater reliability was determined for 10 randomly selected patients. The software correctly detected the left ventricle in 38/40 (95 %) patients. EDV after automated segmentation: 119.1 ± 44.0ml; after ADJ-step 1: 115.8 ± 39.5 ml; after ADJ-step 2: 116.2 ± 39.4 ml. The corresponding results for ESV were 52.0 ± 18.5/49.6 ± 16.9/49.7 ± 16.4 ml; for SV 67.1 ± 28.5/66.2 ± 25.4/66.5 ± 25.5 ml; for EF 55.5 ± 7.3/56.7 ± 6.6/56.7 ± 6.3%; for MM 83.7 ± 35.9/76.2 ± 28.3/74.6 ± 27.2 g. Significant differences were found for ESV/MM/EF comparing the automated segmentation results with these after ADJ-step 1 and ADJ-step 2. No significant differences were found when comparing all results of ADJ-step 1 and ADJ-step 2 or when comparing EDV/SV results. Intra- and inter-rater reliability was excellent. The mean time effort was 63.4 ± 6.9 s for the automated segmentation, 74.2 ± 8.9 s for ADJ-step 1 and 269.5 ± 39.4 s for ADJ-step 2. Automated left ventricular volumes and function analysis in children and adolescents with surgically treated CHD proved to be feasible with excellent intra- and inter-rater reliability. Automated segmentation with manual apex/base adjustment provided

Cardiac MRI in children and adolescents who have undergone surgical repair of right-sided congenital heart disease. Automated left ventricular volumes and function analysis and effects of different manual adjustments

International Nuclear Information System (INIS)

Rompel, O.; Janka, R.; May, M.S.; Lell, M.M.; Uder, M.; Hammon, M.; Gloeckler, M.; Dittrich, S.; Cesnjevar, R.

2015-01-01

To evaluate automated segmentation and the effects of different manual adjustments regarding left ventricular parameter quantification in cardiac magnetic resonance (MR) data on children and adolescents who have undergone surgical repair of right-sided congenital heart disease (CHD). Dedicated software (syngo.via, Siemens AG) was used to automatically segment and/or manually adjust the end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), myocardial mass (MM) and ejection fraction (EF) before/after manual apex/base adjustment (ADJ-step 1) and after manual apex/base/myocardial contour adjustment (ADJ-step 2; reference standard). MR data of 40 patients (13.1 ± 3.1y, 4-17y) with repaired CHD with decreased pulmonary blood flow (CHD-DPBF) were evaluated. Intra- and inter-rater reliability was determined for 10 randomly selected patients. The software correctly detected the left ventricle in 38/40 (95 %) patients. EDV after automated segmentation: 119.1 ± 44.0ml; after ADJ-step 1: 115.8 ± 39.5 ml; after ADJ-step 2: 116.2 ± 39.4 ml. The corresponding results for ESV were 52.0 ± 18.5/49.6 ± 16.9/49.7 ± 16.4 ml; for SV 67.1 ± 28.5/66.2 ± 25.4/66.5 ± 25.5 ml; for EF 55.5 ± 7.3/56.7 ± 6.6/56.7 ± 6.3%; for MM 83.7 ± 35.9/76.2 ± 28.3/74.6 ± 27.2 g. Significant differences were found for ESV/MM/EF comparing the automated segmentation results with these after ADJ-step 1 and ADJ-step 2. No significant differences were found when comparing all results of ADJ-step 1 and ADJ-step 2 or when comparing EDV/SV results. Intra- and inter-rater reliability was excellent. The mean time effort was 63.4 ± 6.9 s for the automated segmentation, 74.2 ± 8.9 s for ADJ-step 1 and 269.5 ± 39.4 s for ADJ-step 2. Automated left ventricular volumes and function analysis in children and adolescents with surgically treated CHD proved to be feasible with excellent intra- and inter-rater reliability. Automated segmentation with manual apex/base adjustment provided

WE-G-207-06: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Physical Phantom and Clinical Patient Images

International Nuclear Information System (INIS)

Dhou, S; Cai, W; Hurwitz, M; Rottmann, J; Myronakis, M; Cifter, F; Berbeco, R; Lewis, J; Williams, C; Mishra, P; Ionascu, D

2015-01-01

Purpose: Respiratory-correlated cone-beam CT (4DCBCT) images acquired immediately prior to treatment have the potential to represent patient motion patterns and anatomy during treatment, including both intra- and inter-fractional changes. We develop a method to generate patient-specific motion models based on 4DCBCT images acquired with existing clinical equipment and used to generate time varying volumetric images (3D fluoroscopic images) representing motion during treatment delivery. Methods: Motion models are derived by deformably registering each 4DCBCT phase to a reference phase, and performing principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated by optimizing the resulting PCA coefficients iteratively through comparison of the cone-beam projections simulating kV treatment imaging and digitally reconstructed radiographs generated from the motion model. Patient and physical phantom datasets are used to evaluate the method in terms of tumor localization error compared to manually defined ground truth positions. Results: 4DCBCT-based motion models were derived and used to generate 3D fluoroscopic images at treatment time. For the patient datasets, the average tumor localization error and the 95th percentile were 1.57 and 3.13 respectively in subsets of four patient datasets. For the physical phantom datasets, the average tumor localization error and the 95th percentile were 1.14 and 2.78 respectively in two datasets. 4DCBCT motion models are shown to perform well in the context of generating 3D fluoroscopic images due to their ability to reproduce anatomical changes at treatment time. Conclusion: This study showed the feasibility of deriving 4DCBCT-based motion models and using them to generate 3D fluoroscopic images at treatment time in real clinical settings. 4DCBCT-based motion models were found to account for the 3D non-rigid motion of the patient anatomy during treatment and have the potential

The moral agency of institutions: effectively using expert nurses to support patient autonomy.

Science.gov (United States)

Charles, Sonya

2017-08-01

Patient autonomy-with an emphasis on informed consent and the right to refuse treatment-is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions. However, the skills of expert nurses also support patient autonomy in more subtle ways. Specifically, nurses develop skills of attunement that help them to find subtle ways to support patient autonomy. However, in order to effectively do this, nurses need institutions that support their professional autonomy. In this paper, I look at the ways nurses have been inhibited in their professional autonomy both as a profession and as individual practitioners. I argue that turning our attention to institutions and the role they play in supporting or undermining nurses' autonomy can help promote nurses' professional autonomy and thereby enhance patient autonomy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Automated detection of diabetic retinopathy lesions on ultrawidefield pseudocolour images.

Science.gov (United States)

Wang, Kang; Jayadev, Chaitra; Nittala, Muneeswar G; Velaga, Swetha B; Ramachandra, Chaithanya A; Bhaskaranand, Malavika; Bhat, Sandeep; Solanki, Kaushal; Sadda, SriniVas R

2018-03-01

We examined the sensitivity and specificity of an automated algorithm for detecting referral-warranted diabetic retinopathy (DR) on Optos ultrawidefield (UWF) pseudocolour images. Patients with diabetes were recruited for UWF imaging. A total of 383 subjects (754 eyes) were enrolled. Nonproliferative DR graded to be moderate or higher on the 5-level International Clinical Diabetic Retinopathy (ICDR) severity scale was considered as grounds for referral. The software automatically detected DR lesions using the previously trained classifiers and classified each image in the test set as referral-warranted or not warranted. Sensitivity, specificity and the area under the receiver operating curve (AUROC) of the algorithm were computed. The automated algorithm achieved a 91.7%/90.3% sensitivity (95% CI 90.1-93.9/80.4-89.4) with a 50.0%/53.6% specificity (95% CI 31.7-72.8/36.5-71.4) for detecting referral-warranted retinopathy at the patient/eye levels, respectively; the AUROC was 0.873/0.851 (95% CI 0.819-0.922/0.804-0.894). Diabetic retinopathy (DR) lesions were detected from Optos pseudocolour UWF images using an automated algorithm. Images were classified as referral-warranted DR with a high degree of sensitivity and moderate specificity. Automated analysis of UWF images could be of value in DR screening programmes and could allow for more complete and accurate disease staging. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Inter-fraction variations in respiratory motion models

Energy Technology Data Exchange (ETDEWEB)

McClelland, J R; Modat, M; Ourselin, S; Hawkes, D J [Centre for Medical Image Computing, University College London (United Kingdom); Hughes, S; Qureshi, A; Ahmad, S; Landau, D B, E-mail: j.mcclelland@cs.ucl.ac.uk [Department of Oncology, Guy' s and St Thomas' s Hospitals NHS Trust, London (United Kingdom)

2011-01-07

Respiratory motion can vary dramatically between the planning stage and the different fractions of radiotherapy treatment. Motion predictions used when constructing the radiotherapy plan may be unsuitable for later fractions of treatment. This paper presents a methodology for constructing patient-specific respiratory motion models and uses these models to evaluate and analyse the inter-fraction variations in the respiratory motion. The internal respiratory motion is determined from the deformable registration of Cine CT data and related to a respiratory surrogate signal derived from 3D skin surface data. Three different models for relating the internal motion to the surrogate signal have been investigated in this work. Data were acquired from six lung cancer patients. Two full datasets were acquired for each patient, one before the course of radiotherapy treatment and one at the end (approximately 6 weeks later). Separate models were built for each dataset. All models could accurately predict the respiratory motion in the same dataset, but had large errors when predicting the motion in the other dataset. Analysis of the inter-fraction variations revealed that most variations were spatially varying base-line shifts, but changes to the anatomy and the motion trajectories were also observed.

Automated Attitude Sensor Calibration: Progress and Plans

Science.gov (United States)

Sedlak, Joseph; Hashmall, Joseph

2004-01-01

This paper describes ongoing work a NASA/Goddard Space Flight Center to improve the quality of spacecraft attitude sensor calibration and reduce costs by automating parts of the calibration process. The new calibration software can autonomously preview data quality over a given time span, select a subset of the data for processing, perform the requested calibration, and output a report. This level of automation is currently being implemented for two specific applications: inertial reference unit (IRU) calibration and sensor alignment calibration. The IRU calibration utility makes use of a sequential version of the Davenport algorithm. This utility has been successfully tested with simulated and actual flight data. The alignment calibration is still in the early testing stage. Both utilities will be incorporated into the institutional attitude ground support system.

An Automated Detection System for Microaneurysms That Is Effective across Different Racial Groups

Directory of Open Access Journals (Sweden)

George Michael Saleh

2016-01-01

Full Text Available Patients without diabetic retinopathy (DR represent a large proportion of the caseload seen by the DR screening service so reliable recognition of the absence of DR in digital fundus images (DFIs is a prime focus of automated DR screening research. We investigate the use of a novel automated DR detection algorithm to assess retinal DFIs for absence of DR. A retrospective, masked, and controlled image-based study was undertaken. 17,850 DFIs of patients from six different countries were assessed for DR by the automated system and by human graders. The system’s performance was compared across DFIs from the different countries/racial groups. The sensitivities for detection of DR by the automated system were Kenya 92.8%, Botswana 90.1%, Norway 93.5%, Mongolia 91.3%, China 91.9%, and UK 90.1%. The specificities were Kenya 82.7%, Botswana 83.2%, Norway 81.3%, Mongolia 82.5%, China 83.0%, and UK 79%. There was little variability in the calculated sensitivities and specificities across the six different countries involved in the study. These data suggest the possible scalability of an automated DR detection platform that enables rapid identification of patients without DR across a wide range of races.

Prensa automática para moldear azulejos

Directory of Open Access Journals (Sweden)

Harding, R. S.

1959-04-01

Full Text Available Not availableEl número de tipos de prensas completamente automáticas para el moldeo de azulejos es muy reducido y, por tanto, se ha considerado de interés la descripción de una máquina, cuyo principio de funcionamiento es poco corriente.

An artificial pancreas for automated blood glucose control in patients with Type 1 diabetes

DEFF Research Database (Denmark)

Schmidt, Signe; Boiroux, Dimitri; Ranjan, Ajenthen

2015-01-01

Automated glucose control in patients with Type 1 diabetes is much-coveted by patients, relatives and healthcare professionals. It is the expectation that a system for automated control, also know as an artificial pancreas, will improve glucose control, reduce the risk of diabetes complications...... and markedly improve patient quality of life. An artificial pancreas consists of portable devices for glucose sensing and insulin delivery which are controlled by an algorithm residing on a computer. The technology is still under development and currently no artificial pancreas is commercially available....... This review gives an introduction to recent progress, challenges and future prospects within the field of artificial pancreas research....

Library Automation.

Science.gov (United States)

Husby, Ole

1990-01-01

The challenges and potential benefits of automating university libraries are reviewed, with special attention given to cooperative systems. Aspects discussed include database size, the role of the university computer center, storage modes, multi-institutional systems, resource sharing, cooperative system management, networking, and intelligent…

SU-F-T-516: Effects of Inter-Fraction Organ Displacement/deformation On the Delivered Doses to the Heart, Esophagus, and Lungs in Patients Receiving Thoracic Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Hammers, J; Matney, J; Kaidar-Person, O; Zagar, T; Marks, L; Das, S; Mavroidis, P [University North Carolina, Chapel Hill, NC (United States)

2016-06-15

Purpose: To quantitatively assess the effects of inter-fraction changes in organ shape and location on the delivered dose distribution to the organs at risk (OAR) in lung cancer patients. Methods: This study analyzes treatment data of 10 patients, who were treated to 60Gy in 30 fractions. In each fraction a cone beam CT (CBCT) was acquired. Each CBCT was registered with the planning CT using deformable registration tools within MIM Software. The daily setup shifts were used to translate the planned dose distribution on the deformed planning CT. The structures of lungs, esophagus and heart were re-delineated by a physician on each CBCT. The doses delivered to each OAR, reflecting changes in the position and shape variations, were recomputed. Resultant daily dose volume histograms (DVHs) for OARs were computed and compared to those from the planning CT. Results: Based on the findings of two patients and 24 CBCTs analyzed so far, higher doses are delivered to the lungs and esophagus compared to the treatment plan. The dose differences per fraction between the delivered doses and those in the treatment plan are: for patient 1, lung mean dose = 5.3±1.3cGy and esophagus mean dose = 3.4±3.5cGy. For patient 2, lung mean dose = 12.0±3.9cGy and esophagus mean dose = 34.2±7.5cGy. Regarding the maximum dose to heart, the results varied (−18.9±22.0cGy for patient1 and 53.0±62.2cGy for patient2). Conclusion: The dosimetric effects of inter-fractional anatomical variations could be estimated using deformable image registration and manual organ segmentation for each CBCT. A considerable dose distribution variation between fractions was observed for the OARs. These changes are currently not taken into account while treating the patients and these may explain cases with severe side effects even when the treatment plan looks satisfactory. These results suggest the need for automated daily dose tracking and accumulation.

Development of Hardware and Software for Automated Ultrasonic Testing

International Nuclear Information System (INIS)

Choi, Sung Nam; Lee, Hee Jong; Yang, Seung Ok

2012-01-01

Nondestructive testing (NDT) for the construction and operating of NPPs plays an important role in confirming the integrity of the NPPs. Especially, Automated ultrasonic testing (AUT) is one of the primary nondestructive examination methods for in-service inspection of the welding parts in major components in NPPs. AUT is a reliable nondestructive testing because the data of AUT are saved and reviewed with other examiners. Korea Hydro and Nuclear Power-Central Research Institute (KHNP-CRI) has developed an automated ultrasonic testing (AUT) system based on a high speed pulser-receiver. In combination with the designed software and hardware architecture, this new system permits user configurations for a wide range of user-specific applications through fully automated inspections using compact portable systems with up to eight channels. This paper gives an overview of hardware (H/W) and software (S/W) for the AUT system to inspect welds in NPPs

Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

International Nuclear Information System (INIS)

Purdie, Thomas G.; Dinniwell, Robert E.; Fyles, Anthony; Sharpe, Michael B.

2014-01-01

Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

Energy Technology Data Exchange (ETDEWEB)

Li Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Toncheva, Greta; Yoshizumi, Terry T.; Frush, Donald P. [Medical Physics Graduate Program, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 (United States); Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Department of Physics, and Department of Biomedical Engineering, Duke University Medical Center, Durham, North Carolina 27705 (United States); Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, North Carolina 27705 (United States); Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 and Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599 (United States); Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 (United States); Duke Radiation Dosimetry Laboratory, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 (United States); Duke Radiation Dosimetry Laboratory, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, North Carolina 27705 (United States); Division of Pediatric Radiology, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, North Carolina 27710 (United States)

2011-01-15

Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients (a 5-week-old female patient and a 12-year-old male patient), who underwent 64-slice CT examinations (LightSpeed VCT, GE Healthcare) of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine (NURBS) based full-body computer model was created based on the patient's clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index (CTDI{sub vol}) and the effective dose derived from the dose-length product (DLP). Results: The effective dose for the CT examination of the newborn patient (5.7 mSv) was higher but comparable to that for the CT examination of the teenager patient (4.9 mSv) due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller

Final report of the inter institutional project ININ-CNSNS 'Source Terms specific for the CNLV'; Informe final del proyecto interinstitucional ININ-CNSNS 'Termino Fuente especifico para la CNLV'

Energy Technology Data Exchange (ETDEWEB)

Anaya M, R.A. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)

1991-02-15

The purpose of the project inter institutional ININ-CNSNS 'Source Terms Specifies for the CNLV' it is the one of implanting in the computer CYBER (CDC 180-830) of the ININ, the 'Source Term Code Package' (STCP) and to make the operation tests and corresponding operation using the data of the sample problem, for finally to liberate the package, all time that by means of the analysis of the results it is consider appropriate. In this report the results of the are presented simulation of the sequence 'Energy Losses external' (Station blackout) and 'Lost total of CA with failure of the RCIC and success of the HPCS' both with data of the Laguna Verde Central. (Author)

Inter-Eye Agreement in Measurement of Retinal Vascular Fractal Dimension in Patients with Type 1 Diabetes Mellitus

DEFF Research Database (Denmark)

Pedersen, Knud B; Broe, Rebecca; Grauslund, Jakob

2016-01-01

PURPOSE: To investigate inter-eye agreement in retinal vascular fractal dimension (FD) in patients with type 1 diabetes. METHODS: In a cross-sectional study, both eyes were exained in 178 patients with type 1 diabetes. All vessels in a zone 0.5-2.0 disc diameters from the optic disc were traced...... and FD calculated with the box-counting method using SIVA-Fractal semiautomatic software. The modified Early Treatment Diabetic Retinopathy Study (ETDRS) scale was used to grade diabetic retinopathy (DR). Pitman's test of difference in variance was used to calculated inter-eye agreement in FD according...

Systems and technologies for high-speed inter-office/datacenter interface

Science.gov (United States)

Sone, Y.; Nishizawa, H.; Yamamoto, S.; Fukutoku, M.; Yoshimatsu, T.

2017-01-01

Emerging requirements for inter-office/inter-datacenter short reach links for data center interconnects (DCI) and metro transport networks have led to various inter-office and inter-datacenter optical interface technologies. These technologies are bringing significant changes to systems and network architectures. In this paper, we present a system and ZR optical interface technologies for DCI and metro transport networks, then introduce the latest challenges facing the system framework. There are two trends in reach extension; one is to use Ethernet and the other is to use digital coherent technologies. The first approach achieves reach extension while using as many existing Ethernet components as possible. It offers low costs as reuses the cost-effective components created for the large Ethernet market. The second approach adopts low-cost and low power coherent DSPs that implement the minimal set long haul transmission functions. This paper introduces an architecture that integrates both trends. The architecture satisfies both datacom and telecom needs with a common control and management interface and automated configuration.

Magnetic resonance imaging of the ear for patient-specific reconstructive surgery.

Directory of Open Access Journals (Sweden)

Luc Nimeskern

Full Text Available INTRODUCTION: Like a fingerprint, ear shape is a unique personal feature that should be reconstructed with a high fidelity during reconstructive surgery. Ear cartilage tissue engineering (TE advantageously offers the possibility to use novel 3D manufacturing techniques to reconstruct the ear, thus allowing for a detailed auricular shape. However it also requires detailed patient-specific images of the 3D cartilage structures of the patient's intact contralateral ear (if available. Therefore the aim of this study was to develop and evaluate an imaging strategy for acquiring patient-specific ear cartilage shape, with sufficient precision and accuracy for use in a clinical setting. METHODS AND MATERIALS: Magnetic resonance imaging (MRI was performed on 14 volunteer and six cadaveric auricles and manually segmented. Reproducibility of cartilage volume (Cg.V, surface (Cg.S and thickness (Cg.Th was assessed, to determine whether raters could repeatedly define the same volume of interest. Additionally, six cadaveric auricles were harvested, scanned and segmented using the same procedure, then dissected and scanned using high resolution micro-CT. Correlation between MR and micro-CT measurements was assessed to determine accuracy. RESULTS: Good inter- and intra-rater reproducibility was observed (precision errors 0.82, but low for Cg.Th (0.95 demonstrated high accuracy. DISCUSSION AND CONCLUSION: This study demonstrated that precision and accuracy of the proposed method was high enough to detect patient-specific variation in ear cartilage geometry. The present study provides a clinical strategy to access the necessary information required for the production of 3D ear scaffolds for TE purposes, including detailed patient-specific shape. Furthermore, the protocol is applicable in daily clinical practice with existing infrastructure.

Large scale oil lease automation and electronic custody transfer

International Nuclear Information System (INIS)

Price, C.R.; Elmer, D.C.

1995-01-01

Typically, oil field production operations have only been automated at fields with long term production profiles and enhanced recovery. The automation generally consists of monitoring and control at the wellhead and centralized facilities. However, Union Pacific Resources Co. (UPRC) has successfully implemented a large scale automation program for rapid-decline primary recovery Austin Chalk wells where purchasers buy and transport oil from each individual wellsite. This project has resulted in two significant benefits. First, operators are using the system to re-engineer their work processes. Second, an inter-company team created a new electronic custody transfer method. This paper will describe: the progression of the company's automation objectives in the area; the field operator's interaction with the system, and the related benefits; the research and development of the new electronic custody transfer method

Description and Methods of the Automated Document Management System Usage in Scientific Organizational Activities of the Joint Institute for Nuclear Research (ADS SOA JINR)

CERN Document Server

Borisovsky, V F; Kekelidze, M G; Nikonov, E G; Senchenko, V A

2005-01-01

This paper presents the structure description and user guide for Information program system for automation of a document flow for support of scientific arrangement planning (ADS SOA) which can be used for planning and carrying out seminars, workshops, conferences and other arrangements of research management. This work is intended for automation of scientific research management in the Joint Institute for Nuclear Research. The complex of programs represents the CDS Agenda system used in the European Organization for Nuclear Research (CERN), which is adapted to the conditions of JINR.

Autonomy and Automation

Science.gov (United States)

Shively, Jay

2017-01-01

A significant level of debate and confusion has surrounded the meaning of the terms autonomy and automation. Automation is a multi-dimensional concept, and we propose that Remotely Piloted Aircraft Systems (RPAS) automation should be described with reference to the specific system and task that has been automated, the context in which the automation functions, and other relevant dimensions. In this paper, we present definitions of automation, pilot in the loop, pilot on the loop and pilot out of the loop. We further propose that in future, the International Civil Aviation Organization (ICAO) RPAS Panel avoids the use of the terms autonomy and autonomous when referring to automated systems on board RPA. Work Group 7 proposes to develop, in consultation with other workgroups, a taxonomy of Levels of Automation for RPAS.

Assessment of disabilities in stroke patients with apraxia : Internal consistency and inter-observer reliability

NARCIS (Netherlands)

van Heugten, CM; Dekker, J; Deelman, BG; Stehmann-Saris, JC; Kinebanian, A

1999-01-01

In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

Assessment of disabilities in stroke patients with apraxia: internal consistency and inter-observer reliability.

NARCIS (Netherlands)

Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Stehmann-Saris, J.C.; Kinebanian, A.

1999-01-01

In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

Association of Inter-arm Blood Pressure Difference with Asymptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients.

Science.gov (United States)

Wang, Yan; Zhang, Jin; Qian, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

2016-07-14

Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites. We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by Vascular Profiler-1000 device. In the continuous study, ICAS was significantly associated with age, male, average brachial SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, subjects with the top quartile of inter-arm DBP difference (≥4 mmHg) showed significantly higher risk of ICAS (OR = 2.109; 95% CI, 1.24-3.587). And the participants with the top quartile of inter-arm SBP difference (≥6 mmHg) showed significantly higher risk of ECAS (OR = 2.288; 95% CI, 1.309-3.998). In conclusion, we reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study.

Inter-observer variability in contouring the penile bulb on CT images for prostate cancer treatment planning

International Nuclear Information System (INIS)

Perna, Lucia; Cozzarini, Cesare; Maggiulli, Eleonora; Fellin, Gianni; Rancati, Tiziana; Valdagni, Riccardo; Vavassori, Vittorio; Villa, Sergio; Fiorino, Claudio

2011-01-01

Several investigations have recently suggested the existence of a correlation between the dose received by the penile bulb (PB) and the risk of erectile dysfunction (ED) after radical radiotherapy for clinically localized prostate carcinoma. A prospective multi-Institute study (DUE-01) was implemented with the aim to assess the predictive parameters of ED. Previously, an evaluation of inter-observer variations of PB contouring was mandatory in order to quantify its impact on PB dose-volume parameters by means of a dummy run exercise. Fifteen observers, from different Institutes, drew the PB on the planning CT images of ten patients; inter-observer variations were analysed in terms of PB volume variation and cranial/caudal limits. 3DCRT treatment plans were simulated to evaluate the impact of PB contouring inter-variability on dose-volume statistics parameters. For DVH analysis the values of PB mean dose and the volume of PB receiving more than 50 Gy and 70 Gy (V50 and V70, respectively) were considered. Systematic differences from the average values were assessed by the Wilcoxon test. Seven observers systematically overestimated or underestimated the PB volume with deviations from the average volumes ranging between -48% and +34% (p < 0.05). The analysis of the cranial and caudal borders showed a prevalence of random over systematic deviations. Inter-observer contouring variability strongly impacts on DVH parameters, although standard deviations of inter-patient differences were larger than inter-observer variations: 14.5 Gy versus 6.8 Gy for mean PB dose, 23.0% versus 11.0% and 16.8% versus 9.3% for V50 and V70 respectively. In conclusion, despite the large inter-observer variation in contouring PB, a large multi-centric study may have the possibility to detect a possible correlation between PB % dose-volume parameters and ED. The impact of contouring uncertainty could be reduced by 'a posteriori' contouring from a single observer or by introducing

Automated Assume-Guarantee Reasoning for Omega-Regular Systems and Specifications

Science.gov (United States)

Chaki, Sagar; Gurfinkel, Arie

2010-01-01

We develop a learning-based automated Assume-Guarantee (AG) reasoning framework for verifying omega-regular properties of concurrent systems. We study the applicability of non-circular (AGNC) and circular (AG-C) AG proof rules in the context of systems with infinite behaviors. In particular, we show that AG-NC is incomplete when assumptions are restricted to strictly infinite behaviors, while AG-C remains complete. We present a general formalization, called LAG, of the learning based automated AG paradigm. We show how existing approaches for automated AG reasoning are special instances of LAG.We develop two learning algorithms for a class of systems, called infinite regular systems, that combine finite and infinite behaviors. We show that for infinity-regular systems, both AG-NC and AG-C are sound and complete. Finally, we show how to instantiate LAG to do automated AG reasoning for infinite regular, and omega-regular, systems using both AG-NC and AG-C as proof rules

Comparative inter-institutional study of stress among dentists.

Science.gov (United States)

Pozos-Radillo, Blanca E; Galván-Ramírez, Ma Luz; Pando, Manuel; Carrión, Ma De los Angeles; González, Guillermo J

2010-01-01

Dentistry is considered to be a stressful profession due to different factors caused by work, representing a threat to dentists'health. The objectives of this work were to identify and compare chronic stress in dentists among the different health institutions and the association of stress with risk factors. The study in question is observational, transversal and comparative; 256 dentists were included, distributed among five public health institutions in the city of Guadalajara, Jalisco, Mexico, namely: the Mexican Institute of Social Security (IMSS), the Ministry of Health (SS), the Integral Development of the Family (DIF), the Social Security Services Institute for the Workers (ISSSTE) and the University of Guadalajara (U. de G) Data were obtained by means of the census technique. Stress was identified using the Stress Symptoms Inventory and the statistical analysis was performed using the Odds Ratio (O.R.) and the chi-square statistic. From the total population studied, 219 subjects presented high levels of chronic stress and 37, low levels. In the results of comparative analysis, significant differences were found between IMSS and U. de G and likewise between IMSS and SS. However, in the analysis of association, only U. de G was found to be associated with the high level of chronic stress.

Global Administrative Law: Improving Inter-institutional Connections ...

International Development Research Centre (IDRC) Digital Library (Canada)

The use of indicators as a governance tool to evaluate institutions (Colombia, Kenya, and Brazil). ... Journal articles ... International Water Resources Association, in close collaboration with IDRC, is holding a webinar titled “Climate change ...

SPECIFIC OF ACCOUNTING OF NON-FINANCIAL ASSETS IN HEALTH INSTITUTIONS

Directory of Open Access Journals (Sweden)

Natalya Pryadka

2016-11-01

Full Text Available The purpose of the paper is to analysis of the modern state of accounting of non-financial assets and present accounting in health institutions protection during the period of medical reforms. The account of nonfinancial assets has his specific in medical establishments. Reforms, which implemented in Ukraine, affecting the account of non-financial assets. Medical institutions relate to the General government. Methodology. The survey is based on a comparison of data from the national and international reforms in medical industry. Results of the survey showed that in the dictionary of V. Raizberg next determination is driven: "public sector – it is a set of business units, that carry out economic activity, are in a public domain, controlled by public authorities or designated and hired persons" (Raizberg, 1999. In the Commercial code of Ukraine it is indicated: "The subjects of public sector of economy are subjects that operate on the basis of only public domain, and also subjects, which state share in authorized capital exceeds fifty percents or be value that provides a right to the state for decisive influence on economic activity of these subjects" (СС, 2003. Practical implications. Public sector structure specifies data of International Public Sector Accounting Standards. Substancial load concept "public sector" in national and international practice are relevant (Poznyakovska, 2009. Accounting in health institutions has specific terms, inherent to the government sector. They are determined by the types of activity and terms of assignation (Pasichnik, 2005. Medical services must be accessible to all stratum of population. They must have free basis. They come forward as a public benefit independent of individual possibility to pay for him. Therefore lion's part of general charges for health protection is used on the grant of medical services to the population. At the same time "upgrading of medical services lies inplane providing of

Inter-arm blood pressure differences in young, healthy patients.

Science.gov (United States)

Grossman, Alon; Prokupetz, Alex; Gordon, Barak; Morag-Koren, Nira; Grossman, Ehud

2013-08-01

The prevalence and magnitude of inter-arm BP difference (IAD) in young healthy patients is not well characterized. Flight academy applicants and designated aviators undergo annual evaluation that includes blood pressure (BP) measurement on both arms. All BP measurements performed from January 1, 2012, to April 30, 2012, were recorded and IAD was calculated. Results were compared between patients in whom BP was initially measured in the right arm (group 1), those in whom BP was initially measured in the left arm (group 2), and those in whom the arm in which BP was initially measured was not recorded (group 3). A total of 877 healthy patients had BP measured during the study period. In the entire group, mean systolic BP was the same in both arms. Absolute IAD was 5.6±5.5 mm Hg for systolic and 4.7±4.5 mm Hg for diastolic BP. IAD >10 mm Hg was recorded in 111 (12.6%) and 77 (8.8%) patients for systolic and diastolic BP, respectively. IAD was the same in the 3 groups and was unrelated to age, body mass index, and heart rate, but was related to systolic BP. IAD is common in young healthy patients, is not dependent on which arm was measured first, and unrelated to age, body mass index, and heart rate. © 2013 Wiley Periodicals, Inc.

Patient-specific parameter estimation in single-ventricle lumped circulation models under uncertainty

Science.gov (United States)

Schiavazzi, Daniele E.; Baretta, Alessia; Pennati, Giancarlo; Hsia, Tain-Yen; Marsden, Alison L.

2017-01-01

Summary Computational models of cardiovascular physiology can inform clinical decision-making, providing a physically consistent framework to assess vascular pressures and flow distributions, and aiding in treatment planning. In particular, lumped parameter network (LPN) models that make an analogy to electrical circuits offer a fast and surprisingly realistic method to reproduce the circulatory physiology. The complexity of LPN models can vary significantly to account, for example, for cardiac and valve function, respiration, autoregulation, and time-dependent hemodynamics. More complex models provide insight into detailed physiological mechanisms, but their utility is maximized if one can quickly identify patient specific parameters. The clinical utility of LPN models with many parameters will be greatly enhanced by automated parameter identification, particularly if parameter tuning can match non-invasively obtained clinical data. We present a framework for automated tuning of 0D lumped model parameters to match clinical data. We demonstrate the utility of this framework through application to single ventricle pediatric patients with Norwood physiology. Through a combination of local identifiability, Bayesian estimation and maximum a posteriori simplex optimization, we show the ability to automatically determine physiologically consistent point estimates of the parameters and to quantify uncertainty induced by errors and assumptions in the collected clinical data. We show that multi-level estimation, that is, updating the parameter prior information through sub-model analysis, can lead to a significant reduction in the parameter marginal posterior variance. We first consider virtual patient conditions, with clinical targets generated through model solutions, and second application to a cohort of four single-ventricle patients with Norwood physiology. PMID:27155892

Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study

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Pai, Swathi; Vivekananda Pai, A. R.; Thomas, Manuel S.; Bhat, Vishal

2014-01-01

Aim: To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Materials and Methods: Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Results: Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ2 = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ2 = 12.00). Conclusions: Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients. PMID:24944440

Automated integration of continuous glucose monitor data in the electronic health record using consumer technology.

Science.gov (United States)

Kumar, Rajiv B; Goren, Nira D; Stark, David E; Wall, Dennis P; Longhurst, Christopher A

2016-05-01

The diabetes healthcare provider plays a key role in interpreting blood glucose trends, but few institutions have successfully integrated patient home glucose data in the electronic health record (EHR). Published implementations to date have required custom interfaces, which limit wide-scale replication. We piloted automated integration of continuous glucose monitor data in the EHR using widely available consumer technology for 10 pediatric patients with insulin-dependent diabetes. Establishment of a passive data communication bridge via a patient's/parent's smartphone enabled automated integration and analytics of patient device data within the EHR between scheduled clinic visits. It is feasible to utilize available consumer technology to assess and triage home diabetes device data within the EHR, and to engage patients/parents and improve healthcare provider workflow. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Enhancing Comparative Effectiveness Research With Automated Pediatric Pneumonia Detection in a Multi-Institutional Clinical Repository: A PHIS+ Pilot Study.

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Meystre, Stephane; Gouripeddi, Ramkiran; Tieder, Joel; Simmons, Jeffrey; Srivastava, Rajendu; Shah, Samir

2017-05-15

Community-acquired pneumonia is a leading cause of pediatric morbidity. Administrative data are often used to conduct comparative effectiveness research (CER) with sufficient sample sizes to enhance detection of important outcomes. However, such studies are prone to misclassification errors because of the variable accuracy of discharge diagnosis codes. The aim of this study was to develop an automated, scalable, and accurate method to determine the presence or absence of pneumonia in children using chest imaging reports. The multi-institutional PHIS+ clinical repository was developed to support pediatric CER by expanding an administrative database of children's hospitals with detailed clinical data. To develop a scalable approach to find patients with bacterial pneumonia more accurately, we developed a Natural Language Processing (NLP) application to extract relevant information from chest diagnostic imaging reports. Domain experts established a reference standard by manually annotating 282 reports to train and then test the NLP application. Findings of pleural effusion, pulmonary infiltrate, and pneumonia were automatically extracted from the reports and then used to automatically classify whether a report was consistent with bacterial pneumonia. Compared with the annotated diagnostic imaging reports reference standard, the most accurate implementation of machine learning algorithms in our NLP application allowed extracting relevant findings with a sensitivity of .939 and a positive predictive value of .925. It allowed classifying reports with a sensitivity of .71, a positive predictive value of .86, and a specificity of .962. When compared with each of the domain experts manually annotating these reports, the NLP application allowed for significantly higher sensitivity (.71 vs .527) and similar positive predictive value and specificity . NLP-based pneumonia information extraction of pediatric diagnostic imaging reports performed better than domain experts in this

Automation in Immunohematology

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Meenu Bajpai

2012-01-01

Full Text Available There have been rapid technological advances in blood banking in South Asian region over the past decade with an increasing emphasis on quality and safety of blood products. The conventional test tube technique has given way to newer techniques such as column agglutination technique, solid phase red cell adherence assay, and erythrocyte-magnetized technique. These new technologies are adaptable to automation and major manufacturers in this field have come up with semi and fully automated equipments for immunohematology tests in the blood bank. Automation improves the objectivity and reproducibility of tests. It reduces human errors in patient identification and transcription errors. Documentation and traceability of tests, reagents and processes and archiving of results is another major advantage of automation. Shifting from manual methods to automation is a major undertaking for any transfusion service to provide quality patient care with lesser turnaround time for their ever increasing workload. This article discusses the various issues involved in the process.

Inter-arm blood pressure difference in hospitalized elderly patients--is it consistent?

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Grossman, Alon; Weiss, Avraham; Beloosesky, Yichayaou; Morag-Koren, Nira; Green, Hefziba; Grossman, Ehud

2014-07-01

Inter-arm blood pressure difference (IAD) is recognized as a risk factor for cardiovascular mortality. Its reproducibility in the elderly is unknown. The authors determined the prevalence and reproducibility of IAD in hospitalized elderly patients. Blood pressure was measured simultaneously in both arms on two different days in elderly individuals hospitalized in a geriatric ward. The study included 364 elderly patients (mean age, 85±5 years). Eighty-four patients (23%) had systolic IAD >10 and 62 patients (17%) had diastolic IAD >10 mm Hg. A total of 319 patients had two blood pressure measurements. Systolic and diastolic IAD remained in the same category in 203 (64%) and 231 (72%) patients, respectively. Correlations of systolic and diastolic IAD between the two measurements were poor. Consistency was not affected by age, body mass index, comorbidities, or treatment. IAD is extremely common in hospitalized elderly patients, but, because of poor consistency, its clinical significance in this population is uncertain. ©2014 Wiley Periodicals, Inc.

A Computational Architecture for Programmable Automation Research

Science.gov (United States)

Taylor, Russell H.; Korein, James U.; Maier, Georg E.; Durfee, Lawrence F.

1987-03-01

This short paper describes recent work at the IBM T. J. Watson Research Center directed at developing a highly flexible computational architecture for research on sensor-based programmable automation. The system described here has been designed with a focus on dynamic configurability, layered user inter-faces and incorporation of sensor-based real time operations into new commands. It is these features which distinguish it from earlier work. The system is cur-rently being implemented at IBM for research purposes and internal use and is an outgrowth of programmable automation research which has been ongoing since 1972 [e.g., 1, 2, 3, 4, 5, 6] .

Partial Red Blood Cell Exchange in Children and Young Patients with Sickle Cell Disease: Manual Versus Automated Procedure.

Science.gov (United States)

Escobar, Carlos; Moniz, Marta; Nunes, Pedro; Abadesso, Clara; Ferreira, Teresa; Barra, António; Lichtner, Anabela; Loureiro, Helena; Dias, Alexandra; Almeida, Helena

2017-10-31

The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures. Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed. Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p exchange and access alarm on automated-red blood cell exchange. No major complication or alloimunization was recorded. Automated-red blood cell exchange decreased sickle hemoglobin levels more efficiently than manual procedure in the setting of acute and chronic complications of sickle cell disease, with minor technical concerns mainly due to vascular access. The threshold of sickle hemoglobin should be individualized for clinical and hematological goals. In our cohort of young patients, the need for an acceptable venous access was a limiting factor, but iron-overload was avoided. Automated red blood cell exchange is safe and well tolerated. It permits a higher sickle hemoglobin removal efficacy, better volume status control and iron-overload avoidance.

Automated fuel fabrication- a vision comes true

International Nuclear Information System (INIS)

Hemantha Rao, G.V.S.; Prakash, M.S.; Setty, C.R.P.; Gupta, U.C.

1997-01-01

When New Uranium Fuel Assembly Project at Nuclear Fuel Complex (NFC) begins production, its operator will have equipment provided with intramachine handling systems working automatically by pressing a single button. Additionally simple low cost inter machine handling systems will further help in critical areas. All these inter and intra machine handling systems will result in improved reliability, productivity and quality. The fault diagnostics, mimics and real time data acquisition systems make the plant more operator friendly. The paper deals with the experience starting from layout, selection of product carriers, different handling systems, the latest technology and the integration of which made the vision on automation in fuel fabrication come true. (author)

The Emergence of a Proto-institution

DEFF Research Database (Denmark)

Boxenbaum, Eva

2004-01-01

of inter-organizational networks, and actors embedded in multiple fields. The making of the proto-institution is intentional, yet the institutional building blocks and the apparent interests of actors are institutionally embedded. The results from this micro-dynamic analysis suggest revisions to current...... conceptualizations of institutional change processes. Keywords: Institutional change, proto-institution, cognition, institutional entrepreneurship, innovation, collaborative networks....

Adherence of pediatric patients to automated peritoneal dialysis.

Science.gov (United States)

Chua, Annabelle N; Warady, Bradley A

2011-05-01

Little information is available on adherence to a home automated peritoneal dialysis (APD) prescription for children with end-stage renal disease. We have therefore retrospectively reviewed HomeChoice PRO Card data from patients Adherence was characterized as occurring ≥ 95%, 90-94%, or treatment adherence and patient age, gender, race and if the patient had received training, respectively, was assessed. Of the 51 patients (57% male), with a mean age at peritoneal dialysis (PD) onset of 11.8 ± 5.3 years, 28 (55%) were adherent for all variables. No difference in mean age or if patients were trained existed between the two groups. Males were more likely to be non-adherent (p = 0.026) as were African Americans (p = 0.048). The majority of patients were adherent to duration (96%) and number of cycles (92%), whereas non-adherence was more common with number of sessions (82%) and dialysate volume (78%). In conclusion, 45% of the pediatric patients in our study cohort exhibited some non-adherence to their prescribed APD regimen, emphasizing the value of closely monitoring the performance of home dialysis in children.

Automated and observer based light field indicator edge evaluation in diagnostic X-ray equipment

International Nuclear Information System (INIS)

Bottaro, Marcio; Nagy, Balazs Vince; Soares, Fernanda Cristina Salvador; Rosendo, Danilo Cabral

2017-01-01

Introduction: To analyze edge detection and optical contrast calculation of light field-indicators used in X-ray via automated- and observer-based methods, and comparison with current standard approaches, which do not give exact definition for light field edge determination. Methods: Automated light sensor array was used to measure the penumbra zone of the edge in the standard X-ray equipment, while trained and naive human observers were asked to mark the light field edge according to their own determination. Different interpretations of the contrast were then calculated and compared. Results: In contrast to automated measurements of edge definition and detection, measurements by human observers showed large inter-observer variation independent of their training with X-ray equipment. Different contrast calculations considering the different edge definitions gave very different contrast values. Conclusion: As the main conclusion, we propose a more exact edge definition of the X-ray light field, corresponding well to the average human observer's edge determination. The new edge definition method with automated systems would reduce human variability in edge determination. Such errors could potentially affect the approval of X-ray equipment, and also increase the radiation dose. The automated measurement based on human observers’ edge definition and the corresponding contrast calculation may lead to a more precise light field calibration, which enables reduced irradiation doses on radiology patients. (author)

Automated and observer based light field indicator edge evaluation in diagnostic X-ray equipment

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Márcio Bottaro

Full Text Available Abstract Introduction To analyze edge detection and optical contrast calculation of light field-indicators used in X-ray via automated- and observer-based methods, and comparison with current standard approaches, which do not give exact definition for light field edge determination. Methods Automated light sensor array was used to measure the penumbra zone of the edge in the standard X-ray equipment, while trained and naïve human observers were asked to mark the light field edge according to their own determination. Different interpretations of the contrast were then calculated and compared. Results In contrast to automated measurements of edge definition and detection, measurements by human observers showed large inter-observer variation independent of their training with X-ray equipment. Different contrast calculations considering the different edge definitions gave very different contrast values. Conclusion As the main conclusion, we propose a more exact edge definition of the X-ray light field, corresponding well to the average human observer’s edge determination. The new edge definition method with automated systems would reduce human variability in edge determination. Such errors could potentially affect the approval of X-ray equipment, and also increase the radiation dose. The automated measurement based on human observers’ edge definition and the corresponding contrast calculation may lead to a more precise light field calibration, which enables reduced irradiation doses on radiology patients.

Automated and observer based light field indicator edge evaluation in diagnostic X-ray equipment

Energy Technology Data Exchange (ETDEWEB)

Bottaro, Marcio; Nagy, Balazs Vince; Soares, Fernanda Cristina Salvador; Rosendo, Danilo Cabral, E-mail: marcio@iee.usp.br [Universidade de Sao Paulo (USP), SP (Brazil); Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest (Hungary)

2017-04-15

Introduction: To analyze edge detection and optical contrast calculation of light field-indicators used in X-ray via automated- and observer-based methods, and comparison with current standard approaches, which do not give exact definition for light field edge determination. Methods: Automated light sensor array was used to measure the penumbra zone of the edge in the standard X-ray equipment, while trained and naive human observers were asked to mark the light field edge according to their own determination. Different interpretations of the contrast were then calculated and compared. Results: In contrast to automated measurements of edge definition and detection, measurements by human observers showed large inter-observer variation independent of their training with X-ray equipment. Different contrast calculations considering the different edge definitions gave very different contrast values. Conclusion: As the main conclusion, we propose a more exact edge definition of the X-ray light field, corresponding well to the average human observer's edge determination. The new edge definition method with automated systems would reduce human variability in edge determination. Such errors could potentially affect the approval of X-ray equipment, and also increase the radiation dose. The automated measurement based on human observers’ edge definition and the corresponding contrast calculation may lead to a more precise light field calibration, which enables reduced irradiation doses on radiology patients. (author)

Financial cost to institutions on patients waiting for gall bladder disease surgery.

Science.gov (United States)

Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

2014-01-01

The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

Directory of Open Access Journals (Sweden)

Aparna Pandey

2011-01-01

Full Text Available Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE, at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assay kits obtained from R and D Systems. Hyperglycemia was defined as blood glucose concentration ≥ 7 mmol / L, and measured using the glucose oxidase method immediately. Results: Significantly increased NSE and lipid profile levels were found in ischemic stroke patients as compared to the control. Hyperglycemic ischemic stroke patients had increased levels of NSE, lipid profile, and National Institute of Health stroke scale scores (NIHSS score compared to normoglycemic ischemic stroke patients. In addition the serum NSE level of hyperglycemic stroke patients was also positively correlated with the blood sugar level (r = 0.734 P < 0.001. Conclusions: Hyperglycemia predicts an increased risk of poor outcome after ischemic stroke and it is reflected by a significantly increased level of Neuron-Specific Enolase.

The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

Science.gov (United States)

Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael

2015-10-01

Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

Peritonitis with Listeria monocytogenes in a patient on automated peritoneal dialysis

DEFF Research Database (Denmark)

Poulsen, Hanna Bjarkhamar; Á Steig, Torkil; Björkman, Jonas T

2018-01-01

We present a case where Listeria monocytogenesserotype 1/2a was determined to be the causative agent of peritonitis in a patient on automated peritoneal dialysis. The patient, a 53-year-old Caucasian woman from the Faroe Islands was admitted to the National Hospital reporting of constant abdominal...... pain and a fever. Peritoneal cultures were positive for growth of L. monocytogenes. The patient was successfully treated with oral amoxicillin for 2 weeks and intraperitoneal vancomycin for 3 weeks. To date, the patient has not been readmitted due to peritonitis. The Faroese salmon was the suspected...

Harmonization Of Inter-Institutional Authority In Eradicate Corruption

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Agus Salim

2015-08-01

Full Text Available Nowadays the agenda of corruption eradication have been undertaken by various institutions such as the judiciary the police the Corruption Eradication Commission and other bodies related to the corruption eradication. The type of research used in this study is normative-jurisdiction and empirical-jurisdiction. To obtain the necessary data in this study the researcher conducted library research as a reference in some libraries are quite representative. Results shows that the effectiveness of corruption eradication that conducted by regulatory authorities in order to combat corruption has not been implemented maximally because each institution as a subsystem has not carried out an interdependent relationship both vertical and horizontal nature. If we expect the eradication of corruption can be implemented optimally it is recommended that the coordination between law enforcement agencies in the integrated criminal justice system is necessary to build their common vision interpretation and perception in the implementation of the duties for the institution authorized to eradicate corruption.

Automated delineation of stroke lesions using brain CT images

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Céline R. Gillebert

2014-01-01

Full Text Available Computed tomographic (CT images are widely used for the identification of abnormal brain tissue following infarct and hemorrhage in stroke. Manual lesion delineation is currently the standard approach, but is both time-consuming and operator-dependent. To address these issues, we present a method that can automatically delineate infarct and hemorrhage in stroke CT images. The key elements of this method are the accurate normalization of CT images from stroke patients into template space and the subsequent voxelwise comparison with a group of control CT images for defining areas with hypo- or hyper-intense signals. Our validation, using simulated and actual lesions, shows that our approach is effective in reconstructing lesions resulting from both infarct and hemorrhage and yields lesion maps spatially consistent with those produced manually by expert operators. A limitation is that, relative to manual delineation, there is reduced sensitivity of the automated method in regions close to the ventricles and the brain contours. However, the automated method presents a number of benefits in terms of offering significant time savings and the elimination of the inter-operator differences inherent to manual tracing approaches. These factors are relevant for the creation of large-scale lesion databases for neuropsychological research. The automated delineation of stroke lesions from CT scans may also enable longitudinal studies to quantify changes in damaged tissue in an objective and reproducible manner.

Comparison of five automated hematology analyzers in a university hospital setting: Abbott Cell-Dyn Sapphire, Beckman Coulter DxH 800, Siemens Advia 2120i, Sysmex XE-5000, and Sysmex XN-2000.

Science.gov (United States)

Bruegel, Mathias; Nagel, Dorothea; Funk, Manuela; Fuhrmann, Petra; Zander, Johannes; Teupser, Daniel

2015-06-01

Various types of automated hematology analyzers are used in clinical laboratories. Here, we performed a side-by-side comparison of five current top of the range routine hematology analyzers in the setting of a university hospital central laboratory. Complete blood counts (CBC), differentials, reticulocyte and nucleated red blood cell (NRBC) counts of 349 patient samples, randomly taken out of routine diagnostics, were analyzed with Cell-Dyn Sapphire (Abbott), DxH 800 (Beckman Coulter), Advia 2120i (Siemens), XE-5000 and XN-2000 (Sysmex). Inter-instrument comparison of CBCs including reticulocyte and NRBC counts and investigation of flagging quality in relation to microscopy were performed with the complete set of samples. Inter-instrument comparison of five-part differential was performed using samples without atypical cells in blood smear (n=292). Automated five-part differentials and NRBCs were additionally compared with microscopy. The five analyzers showed a good concordance for basic blood count parameters. Correlations between instruments were less well for reticulocyte counts, NRBCs, and differentials. The poorest concordance for NRBCs with microscopy was observed for Advia 2120i (Kendall's τb=0.37). The highest flagging sensitivity for blasts was observed for XN-2000 (97% compared to 65%-76% for other analyzers), whereas overall specificity was comparable between different instruments. To the best of our knowledge, this is the most comprehensive side-by-side comparison of five current top of the range routine hematology analyzers. Variable analyzer quality and parameter specific limitations must be considered in defining laboratory algorithms in clinical practice.

Energy Assessment of Automated Mobility Districts

Energy Technology Data Exchange (ETDEWEB)

Chen, Yuche [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-08-03

Automated vehicles (AVs) are increasingly being discussed as the basis for on-demand mobility services, introducing a new paradigm in which a fleet of AVs displace private automobiles for day-to-day travel in dense activity districts. This project examines such a concept to displace privately owned automobiles within a region containing dense activity generators (jobs, retail, entertainment, etc.), referred to as an automated mobility district (AMDs). The project reviews several such districts including airport, college campuses, business parks, downtown urban cores, and military bases, with examples of previous attempts to meet the mobility needs apart from private automobiles, some with automated technology and others with more traditional transit based solutions. The issues and benefits of AMDs are framed within the perspective of intra-district, inter-district, and border issues, and the requirements for a modeling framework are identified to adequately reflect the breadth of mobility, energy, and emissions impact anticipated with AMDs.

Food choice effects on herbivory: Intra-specific seagrass palatability and inter-specific macrophyte palatability in seagrass communities

Science.gov (United States)

Jiménez-Ramos, Rocío; Brun, Fernando G.; Egea, Luis G.; Vergara, Juan J.

2018-05-01

Interactions between the palatability and abundance of different food sources may influence herbivory patterns in seagrass-dominated communities. In addition, intra-specific differences in nutrient and structural quality of leaves may also alter seagrass palatability and generate different rates of consumption within these communities. We offered two temperate seagrasses species, (Cymodocea nodosa and Zostera noltei) from two different locations to look at intraspecific differences, and two other macrophytes, both of which occur at the same location as seagrasses but represent the extremes of palatability, to a generalist herbivore Paracentrotus lividus (purple sea urchin). Using feeding assays, we compared the consumption rates in individual (single plant species) and combined diets at different food availabilities. Intra-specific differences between seagrass species growing at different locations (inner and outer bay) were indeed found to significantly modify the consumption rate for one species. Structural traits such as carbon content were linked to the low consumption found in Cymodocea nodosa from the inner bay location. In addition, we found that the co-occurrence of different macrophyte species can result in preferential consumption of the more palatable macrophyte with high nutritional content and low structural defence over seagrasses, especially when P. lividus has an abundant food supply. Overall, our findings suggest that intra- and inter-specific differences in seagrass traits and the relative abundance of other macrophytes may explain the variability in patterns of herbivory found within seagrass communities.

Sensitivity and specificity of machine learning classifiers for glaucoma diagnosis using Spectral Domain OCT and standard automated perimetry

Directory of Open Access Journals (Sweden)

Fabrício R. Silva

2013-06-01

Full Text Available PURPOSE: To evaluate the sensitivity and specificity of machine learning classifiers (MLCs for glaucoma diagnosis using Spectral Domain OCT (SD-OCT and standard automated perimetry (SAP. METHODS: Observational cross-sectional study. Sixty two glaucoma patients and 48 healthy individuals were included. All patients underwent a complete ophthalmologic examination, achromatic standard automated perimetry (SAP and retinal nerve fiber layer (RNFL imaging with SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California. Receiver operating characteristic (ROC curves were obtained for all SD-OCT parameters and global indices of SAP. Subsequently, the following MLCs were tested using parameters from the SD-OCT and SAP: Bagging (BAG, Naive-Bayes (NB, Multilayer Perceptron (MLP, Radial Basis Function (RBF, Random Forest (RAN, Ensemble Selection (ENS, Classification Tree (CTREE, Ada Boost M1(ADA,Support Vector Machine Linear (SVML and Support Vector Machine Gaussian (SVMG. Areas under the receiver operating characteristic curves (aROC obtained for isolated SAP and OCT parameters were compared with MLCs using OCT+SAP data. RESULTS: Combining OCT and SAP data, MLCs' aROCs varied from 0.777(CTREE to 0.946 (RAN.The best OCT+SAP aROC obtained with RAN (0.946 was significantly larger the best single OCT parameter (p<0.05, but was not significantly different from the aROC obtained with the best single SAP parameter (p=0.19. CONCLUSION: Machine learning classifiers trained on OCT and SAP data can successfully discriminate between healthy and glaucomatous eyes. The combination of OCT and SAP measurements improved the diagnostic accuracy compared with OCT data alone.

Advanced maintenance strategies for power plant operators--introducing inter-plant life cycle management

International Nuclear Information System (INIS)

Graeber, Ulrich

2004-01-01

One of the most important goals of competing power plant operators is to ensure safe operation of their plants, characterized by maximum availability throughout the entire life cycle and minimized specific generating costs. One parameter crucial to the total price of electricity--and one that can be actively influenced by the power plant operators--is maintenance. Up to 30% of all electricity generating costs accrue from maintenance. In the past years maintenance measures have been optimized particularly by the application and continuing development of testing and diagnostic techniques, by the increased level of system and component automation as well as more efficient organization structures. Despite the considerable success of these efforts, the potential for further cost reductions is still far from exhausted. But the risks connected to reliability, availability and safety need to be analyzed in greater detail in order to ensure the sustainability of the savings already achieved as well as those yet to be realized. The systematic application of condition-based maintenance and the implementation of structured life cycle management are essential requirements. An inter-plant approach is recommended to make a quick implementation of maintenance optimization potentials possible. Plant-specific improvement potentials can be established with the help of a best-practice comparison, and measures and priorities can be defined for realizing them. Creating an inter-plant database will allow experience and findings to be analyzed quickly and efficiently by experts and made available to all participants on a neutral platform. Despite--or maybe owing to--the increasingly competitive marketplace, a sustained reduction in the maintenance costs of power plant operators can only be achieved through a structured, inter-plant exchange of experience. The ZES offers the industry a suitable platform for cooperation with its 'Condition-Based Maintenance' research focus. The introduction

Automated generation of patient-tailored electronic care pathways by translating computer-interpretable guidelines into hierarchical task networks

NARCIS (Netherlands)

González-Ferrer, A.; ten Teije, A.C.M.; Fdez-Olivares, J.; Milian, K.

OBJECTIVE: This paper describes a methodology which enables computer-aided support for the planning, visualization and execution of personalized patient treatments in a specific healthcare process, taking into account complex temporal constraints and the allocation of institutional resources. To

Global Administrative Law: Improving Inter-institutional Connections ...

International Development Research Centre (IDRC) Digital Library (Canada)

Research on how the interactions between and among institutions can affect developing countries' ability to implement regulatory goals and reforms will shed light on the neglected field of law and development. It will also develop a deeper understanding of the factors underlying regulatory behaviour. Although the law and ...

Inter-Religious Dialogue Models in Malaysia

Directory of Open Access Journals (Sweden)

Wan Sabri Wan Yusof

2012-06-01

Full Text Available Over the years, many organizations have involved in the implementation of inter-religious dialogue in Malaysia. However, there are stillthose who doubt the role and purpose of interreligious dialogue. This might be due to lack of information and understanding regardingthe methodology of dialogue and also about different types that it may take. The present study is aimed at exploring a few models ofinter-religious dialogue that have been practised by some organizations that actively involved in dialogue. The study focuses on a review of selected organizational or institutional dialoguemodels such as Center for Civilizational Dialogue (CCD, Students Representative Council of Malaysia Science University (HealthCampus and Inter-faith Spiritual Fellowship (INSaF. This study provides information concerning the various designs of inter-religiousdialogue model in Malaysia and proposes that different designs of inter-religious dialogue rely on its different types and goals. It is found that, the commonly practiced type of dialogue in Malaysia is educational type which focuses on exploring inter-religious commonalities as well as differences which consequently willincrease understanding and foster meaningful engagement between people of different ethnic and religious background in Malaysia. Thistype of dialogue is distinguished from conflict resolution types of dialogue which aims at identifying issues and generating action plansto conflicts or disputes.

Automated Measurement of joint space width in small joints of patients with rheumatoid arthritis

NARCIS (Netherlands)

Lukas, C.; Gordon, D.A.; Sharp, J.T.; Angwin, J.; Boers, M.; Duryea, J.; Hall, J.R.; Kauffman, J.A.; Landewe, R.; Langs, G.; Bernelot Moens, H.J.; Peloschek, P.; van der Heijde, D.

2008-01-01

Objective. Comparison of performances of 5 (semi)automated methods in measuring joint space width (JSW) in rheumatoid arthritis. Methods. Change in JSW was determined by 5 measurement methods on 4 radiographs per patient from 107 patients included in the COBRA trial (comparing sulfasalazine alone or

Automated Assessment of Patients' Self-Narratives for Posttraumatic Stress Disorder Screening Using Natural Language Processing and Text Mining.

Science.gov (United States)

He, Qiwei; Veldkamp, Bernard P; Glas, Cees A W; de Vries, Theo

2017-03-01

Patients' narratives about traumatic experiences and symptoms are useful in clinical screening and diagnostic procedures. In this study, we presented an automated assessment system to screen patients for posttraumatic stress disorder via a natural language processing and text-mining approach. Four machine-learning algorithms-including decision tree, naive Bayes, support vector machine, and an alternative classification approach called the product score model-were used in combination with n-gram representation models to identify patterns between verbal features in self-narratives and psychiatric diagnoses. With our sample, the product score model with unigrams attained the highest prediction accuracy when compared with practitioners' diagnoses. The addition of multigrams contributed most to balancing the metrics of sensitivity and specificity. This article also demonstrates that text mining is a promising approach for analyzing patients' self-expression behavior, thus helping clinicians identify potential patients from an early stage.

Automated MR morphometry to predict Alzheimer's disease in mild cognitive impairment

International Nuclear Information System (INIS)

Fritzsche, Klaus H.; Schlindwein, Sarah; Bruggen, Thomas van; Meinzer, Hans-Peter; Stieltjes, Bram; Essig, Marco

2010-01-01

Prediction of progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD) is challenging but essential for early treatment. This study aims to investigate the use of hippocampal atrophy markers for the automatic detection of MCI converters and to compare the predictive value to manually obtained hippocampal volume and temporal horn width. A study was performed with 15 patients with Alzheimer and 18 patients with MCI (ten converted, eight remained stable in a 3-year follow-up) as well as 15 healthy subjects. MRI scans were obtained at baseline and evaluated with an automated system for scoring of hippocampal atrophy. The predictive value of the automated system was compared with manual measurements of hippocampal volume and temporal horn width in the same subjects. The conversion to AD was correctly predicted in 77.8% of the cases (sensitivity 70%, specificity 87.5%) in the MCI group using automated morphometry and a plain linear classifier that was trained on the AD and healthy groups. Classification was improved by limiting analysis to the left cerebral hemisphere (accuracy 83.3%, sensitivity 70%, specificity 100%). The manual linear and volumetric approaches reached rates of 66.7% (40/100%) and 72.2% (60/87.5%), respectively. The automatic approach fulfills many important preconditions for clinical application. Contrary to the manual approaches, it is not observer-dependent and reduces human resource requirements. Automated assessment may be useful for individual patient assessment and for predicting progression to dementia. (orig.)

Comparison of manual versus automated data collection method for an evidence-based nursing practice study.

Science.gov (United States)

Byrne, M D; Jordan, T R; Welle, T

2013-01-01

The objective of this study was to investigate and improve the use of automated data collection procedures for nursing research and quality assurance. A descriptive, correlational study analyzed 44 orthopedic surgical patients who were part of an evidence-based practice (EBP) project examining post-operative oxygen therapy at a Midwestern hospital. The automation work attempted to replicate a manually-collected data set from the EBP project. Automation was successful in replicating data collection for study data elements that were available in the clinical data repository. The automation procedures identified 32 "false negative" patients who met the inclusion criteria described in the EBP project but were not selected during the manual data collection. Automating data collection for certain data elements, such as oxygen saturation, proved challenging because of workflow and practice variations and the reliance on disparate sources for data abstraction. Automation also revealed instances of human error including computational and transcription errors as well as incomplete selection of eligible patients. Automated data collection for analysis of nursing-specific phenomenon is potentially superior to manual data collection methods. Creation of automated reports and analysis may require initial up-front investment with collaboration between clinicians, researchers and information technology specialists who can manage the ambiguities and challenges of research and quality assurance work in healthcare.

Research Institute for Medical Biophysics

International Nuclear Information System (INIS)

Wynchank, S.

1989-01-01

The effects of ionising and non-ionising radiation on rodent tumours and normal tissue were studied in terms of cellular repair and the relevant biochemical and biophysical changes following radiation. Rodent tumours investigated in vivo were the CaNT adenocarcinoma and a chemically induced transplantable rhabdomyosarcoma. Radiations used were 100KVp of X-Rays, neutron beams, various magnetic fields, and microwave radiation of 2450MHz. The biochemical parameters measured were, inter alia, levels of adenosine-5'-triphoshate (ATP) and the specific activity of hexokinase (HK). Metabolic changes in ATP levels and the activity of HK were observed in tumour and normal tissues following ionising and non-ionising radiation in normoxia and hypoxia. The observation that the effect of radiation and chemotherapeutic treatment of some tumours may be size dependent can possibly now be explained by the variation of ATP content with tumour size. The enhanced tumour HK specific activity implies increased metabolism, possibly a consequence of cellular requirements to maintain homeostasis during repair processes. Other research projects of the Research Institute for Medical Biophysics involved, inter alia, gastroesophageal scintigraphies to evaluate the results of new forms of therapy. 1 ill

Responding to Multiple Institutional Logics in Inter-institutional Temporary Organizations

DEFF Research Database (Denmark)

Söderlund, Jonas; Pemsel, Sofia

2016-01-01

This paper draws on findings from a unique case study of a temporary organization that carried the responsibility for the planning and construction of a new super hospital in Stockholm, Sweden. Our empirical study explores how this temporary organization responded to requirements from different...... and sometimes conflicting institutional logics. The paper identifies four distinct response strategies that project actors relied upon to deal with the multiplicity of logics: total integration, partial decoupling, avoidance, and surfing. We discuss how these response strategies were used in the studied case...

SU-E-J-133: Evaluation of Inter- and Intra-Fractional Pancreas Tumor Residual Motions with Abdominal Compression

International Nuclear Information System (INIS)

Li, Y; Shi, F; Tian, Z; Jia, X; Meyer, J; Jiang, S; Mao, W

2014-01-01

Purpose: Abdominal compression (AC) has been widely used to reduce pancreas motion due to respiration for pancreatic cancer patients undergoing stereotactic body radiotherapy (SBRT). However, the inter-fractional and intra-fractional patient motions may degrade the treatment. The purpose of this work is to study daily CBCT projections and 4DCT to evaluate the inter-fractional and intra-fractional pancreatic motions. Methods: As a standard of care at our institution, 4D CT scan was performed for treatment planning. At least two CBCT scans were performed for daily treatment. Retrospective studies were performed on patients with implanted internal fiducial markers or surgical clips. The initial motion pattern was obtained by extracting marker positions on every phase of 4D CT images. Daily motions were presented by marker positions on CBCT scan projection images. An adaptive threshold segmentation algorithm was used to extract maker positions. Both marker average positions and motion ranges were compared among three sets of scans, 4D CT, positioning CBCT, and conformal CBCT, for inter-fractional and intra-fractional motion variations. Results: Data from four pancreatic cancer patients were analyzed. These patients had three fiducial markers implanted. All patients were treated by an Elekta Synergy with single fraction SBRT. CBCT projections were acquired by XVI. Markers were successfully detected on most of the projection images. The inter-fractional changes were determined by 4D CT and the first CBCT while the intra-fractional changes were determined by multiple CBCT scans. It is found that the average motion range variations are within 2 mm, however, the average marker positions may drift by 6.5 mm. Conclusion: The patients respiratory motion variation for pancreas SBRT with AC was evaluated by detecting markers from CBCT projections and 4DCT, both the inter-fraction and intra-fraction motion range change is small but the drift of marker positions may be comparable

Improved patient specific seizure detection during pre-surgical evaluation.

LENUS (Irish Health Repository)

Chua, Eric C-P

2011-04-01

There is considerable interest in improved off-line automated seizure detection methods that will decrease the workload of EEG monitoring units. Subject-specific approaches have been demonstrated to perform better than subject-independent ones. However, for pre-surgical diagnostics, the traditional method of obtaining a priori data to train subject-specific classifiers is not practical. We present an alternative method that works by adapting the threshold of a subject-independent to a specific subject based on feedback from the user.

Failsafe automation of Phase II clinical trial interim monitoring for stopping rules.

Science.gov (United States)

Day, Roger S

2010-02-01

In Phase II clinical trials in cancer, preventing the treatment of patients on a study when current data demonstrate that the treatment is insufficiently active or too toxic has obvious benefits, both in protecting patients and in reducing sponsor costs. Considerable efforts have gone into experimental designs for Phase II clinical trials with flexible sample size, usually implemented by early stopping rules. The intended benefits will not ensue, however, if the design is not followed. Despite the best intentions, failures can occur for many reasons. The main goal is to develop an automated system for interim monitoring, as a backup system supplementing the protocol team, to ensure that patients are protected. A secondary goal is to stimulate timely recording of patient assessments. We developed key concepts and performance needs, then designed, implemented, and deployed a software solution embedded in the clinical trials database system. The system has been in place since October 2007. One clinical trial tripped the automated monitor, resulting in e-mails that initiated statistician/investigator review in timely fashion. Several essential contributing activities still require human intervention, institutional policy decisions, and institutional commitment of resources. We believe that implementing the concepts presented here will provide greater assurance that interim monitoring plans are followed and that patients are protected from inadequate response or excessive toxicity. This approach may also facilitate wider acceptance and quicker implementation of new interim monitoring algorithms.

Automated measurement of joint space width in small joints of patients with rheumatoid arthritis

NARCIS (Netherlands)

Lukas, Cédric; Sharp, John T.; Angwin, Jane; Boers, Maarten; Duryea, Jeff; Hall, James R.; Kauffman, Joost A.; Landewé, Robert; Langs, Georg; Bernelot Moens, Hein J.; Peloschek, Philipp; van der Heijde, Désirée

2008-01-01

Comparison of performances of 5 (semi)automated methods in measuring joint space width (JSW) in rheumatoid arthritis. Change in JSW was determined by 5 measurement methods on 4 radiographs per patient from 107 patients included in the COBRA trial (comparing sulfasalazine alone or in combination with

Automated detection of fundus photographic red lesions in diabetic retinopathy.

Science.gov (United States)

Larsen, Michael; Godt, Jannik; Larsen, Nicolai; Lund-Andersen, Henrik; Sjølie, Anne Katrin; Agardh, Elisabet; Kalm, Helle; Grunkin, Michael; Owens, David R

2003-02-01

To compare a fundus image-analysis algorithm for automated detection of hemorrhages and microaneurysms with visual detection of retinopathy in patients with diabetes. Four hundred fundus photographs (35-mm color transparencies) were obtained in 200 eyes of 100 patients with diabetes who were randomly selected from the Welsh Community Diabetic Retinopathy Study. A gold standard reference was defined by classifying each patient as having or not having diabetic retinopathy based on overall visual grading of the digitized transparencies. A single-lesion visual grading was made independently, comprising meticulous outlining of all single lesions in all photographs and used to develop the automated red lesion detection system. A comparison of visual and automated single-lesion detection in replicating the overall visual grading was then performed. Automated red lesion detection demonstrated a specificity of 71.4% and a resulting sensitivity of 96.7% in detecting diabetic retinopathy when applied at a tentative threshold setting for use in diabetic retinopathy screening. The accuracy of 79% could be raised to 85% by adjustment of a single user-supplied parameter determining the balance between the screening priorities, for which a considerable range of options was demonstrated by the receiver-operating characteristic (area under the curve 90.3%). The agreement of automated lesion detection with overall visual grading (0.659) was comparable to the mean agreement of six ophthalmologists (0.648). Detection of diabetic retinopathy by automated detection of single fundus lesions can be achieved with a performance comparable to that of experienced ophthalmologists. The results warrant further investigation of automated fundus image analysis as a tool for diabetic retinopathy screening.

Distributed deep learning networks among institutions for medical imaging.

Science.gov (United States)

Chang, Ken; Balachandar, Niranjan; Lam, Carson; Yi, Darvin; Brown, James; Beers, Andrew; Rosen, Bruce; Rubin, Daniel L; Kalpathy-Cramer, Jayashree

2018-03-29

Deep learning has become a promising approach for automated support for clinical diagnosis. When medical data samples are limited, collaboration among multiple institutions is necessary to achieve high algorithm performance. However, sharing patient data often has limitations due to technical, legal, or ethical concerns. In this study, we propose methods of distributing deep learning models as an attractive alternative to sharing patient data. We simulate the distribution of deep learning models across 4 institutions using various training heuristics and compare the results with a deep learning model trained on centrally hosted patient data. The training heuristics investigated include ensembling single institution models, single weight transfer, and cyclical weight transfer. We evaluated these approaches for image classification in 3 independent image collections (retinal fundus photos, mammography, and ImageNet). We find that cyclical weight transfer resulted in a performance that was comparable to that of centrally hosted patient data. We also found that there is an improvement in the performance of cyclical weight transfer heuristic with a high frequency of weight transfer. We show that distributing deep learning models is an effective alternative to sharing patient data. This finding has implications for any collaborative deep learning study.

Inter-identity amnesia in dissociative identity disorder: a simulated memory impairment?

Science.gov (United States)

Huntjens, Rafaële J C; Peters, Madelon L; Woertman, Liesbeth; Bovenschen, Loes M; Martin, Roy C; Postma, Albert

2006-06-01

Although included in the current edition of the DSM, there does not seem to be consensus among mental health professionals regarding the diagnostic status and scientific validity of dissociative identity disorder (DID). This study was aimed at the detection of simulation of inter-identity amnesia in DID. A sample of 22 DID patients was included, together with a matched control sample of subjects instructed to simulate inter-identity amnesia, a guessor group that had no knowledge of the stimulus material and a normal control group. A multiple-choice recognition test was included. The rate of incorrect answers was determined. Moreover, the specific simulation strategy used was examined by providing subjects with a range of choices that varied in extent of disagreement with the correct answer and determining whether plausible or implausible answer alternatives were selected. On the recognition test DID patients selected incorrect answers above chance like simulators. Patients thus seem to use their knowledge of the correct answer in determining their given answer. They were not characterized by a well-thought-out simulating behaviour style, as indicated by the differences in selection of specific answer alternatives found between patients and simulators. DID patients were found not to be characterized by an actual memory retrieval inability, in contrast to their subjective reports. Instead, it is suggested that DID may more accurately be considered a disorder characterized by meta-memory problems, holding incorrect beliefs about their own memory functioning.

Inter-hemispheric language functional reorganization in low-grade glioma patients after tumour surgery.

Science.gov (United States)

Kristo, Gert; Raemaekers, Mathijs; Rutten, Geert-Jan; de Gelder, Beatrice; Ramsey, Nick F

2015-03-01

Despite many claims of functional reorganization following tumour surgery, empirical studies that investigate changes in functional activation patterns are rare. This study investigates whether functional recovery following surgical treatment in patients with a low-grade glioma in the left hemisphere is linked to inter-hemispheric reorganization. Based on literature, we hypothesized that reorganization would induce changes in the spatial pattern of activation specifically in tumour homologue brain areas in the healthy right hemisphere. An experimental group (EG) of 14 patients with a glioma in the left hemisphere near language related brain areas, and a control group of 6 patients with a glioma in the right, non-language dominant hemisphere were scanned before and after resection. In addition, an age and gender matched second control group of 18 healthy volunteers was scanned twice. A verb generation task was used to map language related areas and a novel technique was used for data analysis. Contrary to our hypothesis, we found that functional recovery following surgery of low-grade gliomas cannot be linked to functional reorganization in language homologue brain areas in the healthy, right hemisphere. Although elevated changes in the activation pattern were found in patients after surgery, these were largest in brain areas in proximity to the surgical resection, and were very similar to the spatial pattern of the brain shift following surgery. This suggests that the apparent perilesional functional reorganization is mostly caused by the brain shift as a consequence of surgery. Perilesional functional reorganization can however not be excluded. The study suggests that language recovery after transient post-surgical language deficits involves recovery of functioning of the presurgical language system. Copyright © 2014 Elsevier Ltd. All rights reserved.

High inter-rater reliability, agreement, and convergent validity of Constant score in patients with clavicle fractures

DEFF Research Database (Denmark)

Ban, Ilija; Troelsen, Anders; Kristensen, Morten Tange

2016-01-01

BACKGROUND: The Constant score (CS) has been the primary endpoint in most studies on clavicle fractures. However, the CS was not developed to assess patients with clavicle fractures. Our aim was to examine inter-rater reliability and agreement of the CS in patients with clavicle fractures...... standardized CS assessment at a mean of 6.8 weeks (SD, 1.0 weeks) after injury. Reliability and agreement of the CS were determined by 2 raters. The interclass correlation coefficient (ICC2,1), standard error of measurement, minimal detectable change, Cronbach α coefficient, and Pearson correlation coefficient...... were estimated. RESULTS: Inter-rater reliability of the total CS was excellent (interclass correlation coefficient, 0.94; 95% confidence interval, 0.88-0.97), with no systematic difference between the 2 raters (P = .75). The standard error of measurement (measurement error at the group level) was 4...

Automated Bone Scan Index as a quantitative imaging biomarker in metastatic castration-resistant prostate cancer patients being treated with enzalutamide

DEFF Research Database (Denmark)

Anand, Aseem; Morris, Michael J.; Larson, Steven M

2016-01-01

alone (C-index 0.73), p = 0.041. Conclusions: The upgraded and analytically validated automated BSI was found to be a strong predictor of OS in mCRPC patients. Additionally, the change in automated BSI demonstrated an additive clinical value to the change in PSA in mCRPC patients being treated...

Prostate Cancer–Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era

Science.gov (United States)

Stephenson, Andrew J.; Kattan, Michael W.; Eastham, James A.; Bianco, Fernando J.; Yossepowitch, Ofer; Vickers, Andrew J.; Klein, Eric A.; Wood, David P.; Scardino, Peter T.

2009-01-01

Purpose The long-term risk of prostate cancer–specific mortality (PCSM) after radical prostatectomy is poorly defined for patients treated in the era of widespread prostate-specific antigen (PSA) screening. Models that predict the risk of PCSM are needed for patient counseling and clinical trial design. Methods A multi-institutional cohort of 12,677 patients treated with radical prostatectomy between 1987 and 2005 was analyzed for the risk of PCSM. Patient clinical information and treatment outcome was modeled using Fine and Gray competing risk regression analysis to predict PCSM. Results Fifteen-year PCSM and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram. Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM. A nomogram predicting the 15-year risk of PCSM was developed, and the externally validated concordance index was 0.82. Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%. Conclusion Few patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident. PMID:19636023

Automated Student Aid Processing: The Challenge and Opportunity.

Science.gov (United States)

St. John, Edward P.

1985-01-01

To utilize automated technology for student aid processing, it is necessary to work with multi-institutional offices (student aid, admissions, registration, and business) and to develop automated interfaces with external processing systems at state and federal agencies and perhaps at need-analysis organizations and lenders. (MLW)

78 FR 75528 - Federal Government Participation in the Automated Clearing House

Science.gov (United States)

2013-12-12

... Participation in the Automated Clearing House AGENCY: Bureau of the Fiscal Service, Treasury. ACTION: Notice of... Service (Service) is proposing to amend its regulation governing the use of the Automated Clearing House... Automated Clearing House, Electronic funds transfer, Financial institutions, Fraud, and Incorporation by...

Quantifying brain tissue volume in multiple sclerosis with automated lesion segmentation and filling

Directory of Open Access Journals (Sweden)

Sergi Valverde

2015-01-01

Full Text Available Lesion filling has been successfully applied to reduce the effect of hypo-intense T1-w Multiple Sclerosis (MS lesions on automatic brain tissue segmentation. However, a study of fully automated pipelines incorporating lesion segmentation and lesion filling on tissue volume analysis has not yet been performed. Here, we analyzed the % of error introduced by automating the lesion segmentation and filling processes in the tissue segmentation of 70 clinically isolated syndrome patient images. First of all, images were processed using the LST and SLS toolkits with different pipeline combinations that differed in either automated or manual lesion segmentation, and lesion filling or masking out lesions. Then, images processed following each of the pipelines were segmented into gray matter (GM and white matter (WM using SPM8, and compared with the same images where expert lesion annotations were filled before segmentation. Our results showed that fully automated lesion segmentation and filling pipelines reduced significantly the % of error in GM and WM volume on images of MS patients, and performed similarly to the images where expert lesion annotations were masked before segmentation. In all the pipelines, the amount of misclassified lesion voxels was the main cause in the observed error in GM and WM volume. However, the % of error was significantly lower when automatically estimated lesions were filled and not masked before segmentation. These results are relevant and suggest that LST and SLS toolboxes allow the performance of accurate brain tissue volume measurements without any kind of manual intervention, which can be convenient not only in terms of time and economic costs, but also to avoid the inherent intra/inter variability between manual annotations.

Automated synthesis with HPLC purification of 18F-FMISO as specific molecular imaging probe of tumor hypoxia

International Nuclear Information System (INIS)

Wang Mingwei; Zhang Yingjian; Zhang Yongping

2012-01-01

An improved automated synthesis of 1-H-1-(3-[ 18 F] fluoro-2-hydroxypropyl)-2-nitro-imidazole ( 18 F-FMISO), a specific molecular imaging probe of tumor hypoxia, was developed using an upgraded Explora GN module integrated with Explora LC for HPLC purification in this study. The radiochemical synthesis of 18 F-FMISO was started with precursor 1-( 2'-nitro-1'-imidazolyl)-2-O-tetrahydropyranyl-3-O-tosyl-propanediol (NITTP) and included nucleophilic [ 18 F] radio-fluorination at 120℃ for 5 min and hydrolysis at 130℃ for 8 min. The automated synthesis of 18 F-FMISO, presenting fast, reliable and multi-run features, could be completed with the total synthesis time of less than 65 min and radiochemical yield of 25%∼35% (without decay correction). The quality control of 18 F-FMISO was identical with the radiopharmaceutical requirements, especially the radiochemical purity of greater than 99% and high chemical purity and specific activity own to HPLC purification. (authors)

Home made FPGA based instrumentation development for linac automation at IUAC

International Nuclear Information System (INIS)

Antony, J.; Mathuria, D.S.; Sacharias, J.

2011-01-01

In order to make the Inter-University Accelerator Centre (IUAC) linac operation with less human intervention and with minimum effort, different mechanisms of automation are being thought of and are being implemented. Among the various projects in the automation, the first one is the development of a 16-channel digital linearizer unit for RF power read-backs and control. In another development, 8 channel programmable pulse generators (PPG) were designed, developed and used at the time of RF pulse conditioning of the SC resonators. As a third project of linac automation, a computer controlled drive probe controller was developed to control the movement of 8 drive couplers of the resonator along with position sensor read back mechanisms. (author)

Cell nuclei segmentation in fluorescence microscopy images using inter- and intra-region discriminative information.

Science.gov (United States)

Song, Yang; Cai, Weidong; Feng, David Dagan; Chen, Mei

2013-01-01

Automated segmentation of cell nuclei in microscopic images is critical to high throughput analysis of the ever increasing amount of data. Although cell nuclei are generally visually distinguishable for human, automated segmentation faces challenges when there is significant intensity inhomogeneity among cell nuclei or in the background. In this paper, we propose an effective method for automated cell nucleus segmentation using a three-step approach. It first obtains an initial segmentation by extracting salient regions in the image, then reduces false positives using inter-region feature discrimination, and finally refines the boundary of the cell nuclei using intra-region contrast information. This method has been evaluated on two publicly available datasets of fluorescence microscopic images with 4009 cells, and has achieved superior performance compared to popular state of the art methods using established metrics.

InterAction Database (IADB)

Science.gov (United States)

The InterAction Database includes demographic and prescription information for more than 500,000 patients in the northern and middle Netherlands and has been integrated with other systems to enhance data collection and analysis.

Definition of gross tumor volume in lung cancer: inter-observer variability

International Nuclear Information System (INIS)

Van de Steene, Jan; Linthout, Nadine; Mey, Johan de; Vinh-Hung, Vincent; Claassens, Cornelia; Noppen, Marc; Bel, Arjan; Storme, Guy

2002-01-01

with an unmatched one. The average (over all patients) inter-observer range in NTCP varied from 5% (spinal cord) to 20% (ipsilateral lung), whereas the maximal ranges amounted 16% (spinal cord) to 45% (heart). The average TCP amounted 51% with an average range of 2% (maximally 5%) in case of matched GTVs. These values shifted to 42% (average TCP) with an average range of 14% (maximally 31%) when defining unmatched GTVs. Four groups of causes are suggested for the large inter-observer variation: (1) problems of methodology; (2) impossible differentiation between pathologic structures and tumor; or (3) between normal structures and tumor, and (4); lack of knowledge. Only the minority of these can be resolved objectively. For most of the causal factors agreements have to be made between clinicians, intra- and inter-departmentally. Some of the factors will never be unequivocally solved. Conclusions: GTV definition in lung cancer is one of the cornerstones in quality assurance of radiotherapy. The large inter-observer variation in GTV definition jeopardizes comparison between clinicians, institutes and treatments

Vascular complications of prosthetic inter-vertebral discs

OpenAIRE

Daly, Kevin J.; Ross, E. Raymond S.; Norris, Heather; McCollum, Charles N.

2006-01-01

Five consecutive cases of prosthetic inter-vertebral disc displacement with severe vascular complications on revisional surgery are described. The objective of this case report is to warn spinal surgeons that major vascular complications are likely with anterior displacement of inter-vertebral discs. We have not been able to find a previous report on vascular complications associated with anterior displacement of prosthetic inter-vertebral discs. In all five patients the prosthetic disc had e...

Automated Analysis of Flow Cytometry Data to Reduce Inter-Lab Variation in the Detection of Major Histocompatibility Complex Multimer-Binding T Cells

DEFF Research Database (Denmark)

Pedersen, Natasja Wulff; Chandran, P. Anoop; Qian, Yu

2017-01-01

Manual analysis of flow cytometry data and subjective gate-border decisions taken by individuals continue to be a source of variation in the assessment of antigen-specific T cells when comparing data across laboratories, and also over time in individual labs. Therefore, strategies to provide...... automated analysis of major histocompatibility complex (MHC) multimer-binding T cells represent an attractive solution to decrease subjectivity and technical variation. The challenge of using an automated analysis approach is that MHC multimer-binding T cell populations are often rare and therefore...... laboratories. We used three different methods, FLOw Clustering without K (FLOCK), Scalable Weighted Iterative Flow-clustering Technique (SWIFT), and ReFlow to analyze flow cytometry data files from 28 laboratories. Each laboratory screened for antigen-responsive T cell populations with frequency ranging from 0...

Comparison of serum prostate specific antigen levels and bone scintigraphy in patients with prostate carcinoma

International Nuclear Information System (INIS)

Bielickaite, J.; Zadeikaite, R.; Jurkiene, N. and others

2003-01-01

The aim of this study was to analyze the levels of serum prostate specific antigen in patients with and without bone metastases detected by means of bone scintigraphy and to determine the highest prostate specific antigen level in patients without bone metastases. The 50 patients consecutively diagnosed of prostate cancer between 1999 and 2001 in our institution made up the study population. Prostate specific antigen plasmatic levels were determined and bone scintigraphy was performed (whole body study after 99mTc-methyl-diphosphonate administration) in all the patients. In patients with positive bone scans (n=23), the mean prostate specific antigen level was 71.4±35.2 ng/ml and was significantly (p<0.00005) higher than in 14 patients with negative bone scans (mean prostate specific antigen level was 10.1±10.5 ng/ml). Suspicious lesions were found in 13 patients and their mean prostate specific antigen level was 8.5±7.7 ng/ml. Regarding prostate specific antigen levels, no statistically significant differences were found between patients with suspicious lessons and normal bone scans. The highest determined prostate specific antigen level in patients without bone metastases was 18 ng/ml. The bone scintigraphy should be performed in all patients with prostate specific antigen level above 18 ng/ml, but it is of limited value in patients with prostate specific antigen level below 18 ng/ml. (author)

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.

Directory of Open Access Journals (Sweden)

Erin K Nichols

2018-01-01

Full Text Available Verbal autopsy (VA is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.

A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

Science.gov (United States)

Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

2013-07-01

The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

International Nuclear Information System (INIS)

Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Xiao, Ying; Lee, Andrew J

2013-01-01

The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10–20 min to 2 min by applying the semi-automated plan-quality evaluation program. (note)

Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

OpenAIRE

Pandey, Aparna; Saxena, Kiran; Verma, Meena; Bharosay, Anuradha

2011-01-01

Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE), at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assa...

Automated segmentation of muscle and adipose tissue on CT images for human body composition analysis

Science.gov (United States)

Chung, Howard; Cobzas, Dana; Birdsell, Laura; Lieffers, Jessica; Baracos, Vickie

2009-02-01

The ability to compute body composition in cancer patients lends itself to determining the specific clinical outcomes associated with fat and lean tissue stores. For example, a wasting syndrome of advanced disease associates with shortened survival. Moreover, certain tissue compartments represent sites for drug distribution and are likely determinants of chemotherapy efficacy and toxicity. CT images are abundant, but these cannot be fully exploited unless there exist practical and fast approaches for tissue quantification. Here we propose a fully automated method for segmenting muscle, visceral and subcutaneous adipose tissues, taking the approach of shape modeling for the analysis of skeletal muscle. Muscle shape is represented using PCA encoded Free Form Deformations with respect to a mean shape. The shape model is learned from manually segmented images and used in conjunction with a tissue appearance prior. VAT and SAT are segmented based on the final deformed muscle shape. In comparing the automatic and manual methods, coefficients of variation (COV) (1 - 2%), were similar to or smaller than inter- and intra-observer COVs reported for manual segmentation.

Access to Mobile Communication Technology and Willingness to Participate in Automated Telemedicine Calls Among Chronically Ill Patients in Honduras

Science.gov (United States)

Mendoza-Avelares, Milton O.; Milton, Evan C.; Lange, Ilta; Fajardo, Roosevelt

2010-01-01

Abstract Objectives: Patients in underdeveloped countries may be left behind by advances in telehealthcare. We surveyed chronically ill patients with low incomes in Honduras to measure their use of mobile technologies and willingness to participate in mobile disease management support. Materials and Methods: 624 chronically ill primary care patients in Honduras were surveyed. We examined variation in telephone access across groups defined by patients' sociodemographic characteristics, diagnoses, and access to care. Logistic regression was used to identify independent correlates of patients' interest in automated telephonic support for disease management. Results: Participants had limited education (mean 4.8 years), and 65% were unemployed. Eighty-four percent had telephone access, and 78% had cell phones. Most respondents had voicemail (61%) and text messaging (58%). Mobile technologies were particularly common among patients who had to forego clinic visits and medications due to cost concerns (each p 80%) reported that they would be willing to receive automated calls focused on appointment reminders, medication adherence, health status monitoring, and self-care education. Patients were more likely to be willing to participate in automated telemedicine services if they had to cancel a clinic appointment due to transportation problems or forego medication due to cost pressures. Conclusions: Even in this poor region of Honduras, most chronically ill patients have access to mobile technology, and most are willing to participate in automated telephone disease management support. Given barriers to in-person care, new models of mobile healthcare should be developed for chronically ill patients in developing countries. PMID:21062234

Infusing an Inter-Professional and Inter-University Perspective into Healthcare Education

Science.gov (United States)

Goldberg, Lynette R.; Koontz, Jennifer Scott; Downs, David; Uhlig, Paul; Kumar, Neil G.; Shah, Sapna; Clark, Paige E.; Coiner, Christina; Crumrine, Daiquirie

2010-01-01

A national (USA) student-led, case-based CLinician/Administrator Relationship Improvement OrganizatioN (CLARION) competition focuses students in medical and related healthcare programs on the provision of healthcare that is safe, timely, equitable, patient-centred, effective and efficient. Students work in four-person, inter-professional teams to…

Automation: the competitive edge for HMOs and other alternative delivery systems.

Science.gov (United States)

Prussin, J A

1987-12-01

Until recently, many, if not most, Health Maintenance Organizations (HMO) were not automated. Moreover, HMOs that were automated tended to be automated only on a limited basis. Recently, however, the highly competitive marketplace within which HMOs and other Alternative Delivery Systems (ADS) exist has required that they operate at a maximum effectiveness and efficiency. Given the complex nature of ADSs, the volume of transactions in ADSs, the large number of members served by ADSs, and the numerous providers who are paid at different rates and on different bases by ADSs, it is impossible for an ADS to operate effectively or efficiently, let alone show optimal performance, without a sophisticated, comprehensive automated system. Reliable automated systems designed specifically to address ADS functions such as enrollment and premium billing, finance and accounting, medical information and patient management, and marketing have recently become available at a reasonable cost.

Interdisciplinary and inter-institutional differences in learning preferences among Malaysian medical and health sciences students.

Science.gov (United States)

Wong, Rebecca S Y; Siow, Heng Loke; Kumarasamy, Vinoth; Shaherah Fadhlullah Suhaimi, Nazrila

2017-10-01

The learner-centred approach in medical and health sciences education makes the study of learning preferences relevant and important. This study aimed to investigate the interdisciplinary, inter-institutional, gender and racial differences in the preferred learning styles among Malaysian medical and health sciences students in three Malaysian universities, namely SEGi University (SEGi), University of Malaya (UM) and Universiti Tunku Abdul Rahman (UTAR). It also investigated the differences in the preferred learning styles of these students between high achievers and non-high achievers. This cross-sectional study was carried out on medical and health sciences students from three Malaysian universities following the approval of the Research and Ethics Committee, SEGi University. Purposive sampling was used and the preferred learning styles were assessed using the VARK questionnaire. The questionnaire was validated prior to its use. Three disciplines (medicine, pharmacy and dentistry) were chosen based on their entry criteria and some similarities in their course structure. The three participating universities were Malaysian universities with a home-grown undergraduate entry medical program and students from a diverse cultural and socioeconomic background. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 22. VARK subscale scores were expressed as mean+standard deviation. Comparisons of the means were carried out using t-test or ANOVA. A p value of 0.05). This study gives an insight into the learner characteristics of more than one medical school in Malaysia. Such multi-institutional studies are lacking in the published literature and this study gives a better representation of the current situation in the learning preferences among medical students in Malaysia.

Automated single-trial assessment of laser-evoked potentials as an objective functional diagnostic tool for the nociceptive system.

Science.gov (United States)

Hatem, S M; Hu, L; Ragé, M; Gierasimowicz, A; Plaghki, L; Bouhassira, D; Attal, N; Iannetti, G D; Mouraux, A

2012-12-01

To assess the clinical usefulness of an automated analysis of event-related potentials (ERPs). Nociceptive laser-evoked potentials (LEPs) and non-nociceptive somatosensory electrically-evoked potentials (SEPs) were recorded in 37 patients with syringomyelia and 21 controls. LEP and SEP peak amplitudes and latencies were estimated using a single-trial automated approach based on time-frequency wavelet filtering and multiple linear regression, as well as a conventional approach based on visual inspection. The amplitudes and latencies of normal and abnormal LEP and SEP peaks were identified reliably using both approaches, with similar sensitivity and specificity. Because the automated approach provided an unbiased solution to account for average waveforms where no ERP could be identified visually, it revealed significant differences between patients and controls that were not revealed using the visual approach. The automated analysis of ERPs characterized reliably and objectively LEP and SEP waveforms in patients. The automated single-trial analysis can be used to characterize normal and abnormal ERPs with a similar sensitivity and specificity as visual inspection. While this does not justify its use in a routine clinical setting, the technique could be useful to avoid observer-dependent biases in clinical research. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Exposing exposure: automated anatomy-specific CT radiation exposure extraction for quality assurance and radiation monitoring.

Science.gov (United States)

Sodickson, Aaron; Warden, Graham I; Farkas, Cameron E; Ikuta, Ichiro; Prevedello, Luciano M; Andriole, Katherine P; Khorasani, Ramin

2012-08-01

To develop and validate an informatics toolkit that extracts anatomy-specific computed tomography (CT) radiation exposure metrics (volume CT dose index and dose-length product) from existing digital image archives through optical character recognition of CT dose report screen captures (dose screens) combined with Digital Imaging and Communications in Medicine attributes. This institutional review board-approved HIPAA-compliant study was performed in a large urban health care delivery network. Data were drawn from a random sample of CT encounters that occurred between 2000 and 2010; images from these encounters were contained within the enterprise image archive, which encompassed images obtained at an adult academic tertiary referral hospital and its affiliated sites, including a cancer center, a community hospital, and outpatient imaging centers, as well as images imported from other facilities. Software was validated by using 150 randomly selected encounters for each major CT scanner manufacturer, with outcome measures of dose screen retrieval rate (proportion of correctly located dose screens) and anatomic assignment precision (proportion of extracted exposure data with correctly assigned anatomic region, such as head, chest, or abdomen and pelvis). The 95% binomial confidence intervals (CIs) were calculated for discrete proportions, and CIs were derived from the standard error of the mean for continuous variables. After validation, the informatics toolkit was used to populate an exposure repository from a cohort of 54 549 CT encounters; of which 29 948 had available dose screens. Validation yielded a dose screen retrieval rate of 99% (597 of 605 CT encounters; 95% CI: 98%, 100%) and an anatomic assignment precision of 94% (summed DLP fraction correct 563 in 600 CT encounters; 95% CI: 92%, 96%). Patient safety applications of the resulting data repository include benchmarking between institutions, CT protocol quality control and optimization, and cumulative

Semi-automated digital image analysis of patellofemoral joint space width from lateral knee radiographs

Energy Technology Data Exchange (ETDEWEB)

Grochowski, S.J. [Mayo Clinic, Department of Orthopedic Surgery, Rochester (United States); Amrami, K.K. [Mayo Clinic, Department of Radiology, Rochester (United States); Kaufman, K. [Mayo Clinic, Department of Orthopedic Surgery, Rochester (United States); Mayo Clinic/Foundation, Biomechanics Laboratory, Department of Orthopedic Surgery, Charlton North L-110L, Rochester (United States)

2005-10-01

To design a semi-automated program to measure minimum patellofemoral joint space width (JSW) using standing lateral view radiographs. Lateral patellofemoral knee radiographs were obtained from 35 asymptomatic subjects. The radiographs were analyzed to report both the repeatability of the image analysis program and the reproducibility of JSW measurements within a 2 week period. The results were also compared with manual measurements done by an experienced musculoskeletal radiologist. The image analysis program was shown to have an excellent coefficient of repeatability of 0.18 and 0.23 mm for intra- and inter-observer measurements respectively. The manual method measured a greater minimum JSW than the automated method. Reproducibility between days was comparable to other published results, but was less satisfactory for both manual and semi-automated measurements. The image analysis program had an inter-day coefficient of repeatability of 1.24 mm, which was lower than 1.66 mm for the manual method. A repeatable semi-automated method for measurement of the patellofemoral JSW from radiographs has been developed. The method is more accurate than manual measurements. However, the between-day reproducibility is higher than the intra-day reproducibility. Further investigation of the protocol for obtaining sequential lateral knee radiographs is needed in order to reduce the between-day variability. (orig.)

Inter-professional relationships issues among iranian nurses and physicians: A qualitative study

Directory of Open Access Journals (Sweden)

Samaneh Nakhaee

2017-01-01

Full Text Available Introduction: Nurse–physician inter-professional relationship is an important issue in health care system that can affect job satisfaction and patient care quality. The present study explores the major issues of nurse–physician inter-professional relationships in Iran. Materials and Methods: In this in-depth qualitative content analysis study conducted in 2014, 12 participants (5 physicians and 7 nurses were recruited from two educational hospitals. The data were collected from deep, open, and unstructured interviews, and analyzed based on content analysis. Results: The participants in this study included 12 individuals, 6 females and 6 males, with the age ranging 27–48 years and tenure ranging 4–17 years. Four themes were identified, namely, divergent attitudes, uneven distribution of power, mutual trust destructors, and prudence imposed on nurses. Conclusions: The results revealed some major inter-professional issues and challenges in nurse–physician relationships, some of which are context-specific whereas others should be regarded as universal. It is through a deep knowledge of these issues that nurses and physicians can establish better collaborative inter-professional relationships.

Inter-Arm Difference in Brachial Blood Pressure in the General Population of Koreans.

Science.gov (United States)

Song, Bo Mi; Kim, Hyeon Chang; Shim, Jee-Seon; Lee, Myung Ha; Choi, Dong Phil

2016-05-01

We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors. A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure. The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure. Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.

The biomechanical assessment of the cervical inter-vertebral kinematics, between DDD patients ICR based study

Science.gov (United States)

Saveh, Amir Hossein; Zali, Ali Reza; Seddighi, Amir Saeed; Zarghi, Afsaneh; Chizari, Mahmoud; Hanafiah, Yussof

2012-01-01

Abstract: It is very important to pay more attention to spine from the biomechanical perspective. It would allow the analysis of initial conditions of the vertebral disc degeneration syndrome and adopting of normal spine kinematics to compare and match it with a degenerated disc and providing a biomechanical index as an indicator for the conduct of any surgical intervention including arthroplasty to maximize restoring spinal biomechanical motion. It is clear that the head movement is possible with the help of muscles. However, the shape and type of motion depends on the structure and shape of the cervical spine and the interaction between them. Cervical spine kinematics depends on the anatomy of the bones and joints. Bazhdok et al (2000) investigated the cervical kinematics and mechanical behavior of the spine and its anatomical connections. They have examined the atlanto- occipital joint motion during flexion-extension and rotation as well as the mechanism of paradoxical motion of atlanto- axial joint by radiography. Bifalkou et al (2011) studied the inter-vertebral motion based on arc kinematic commentary of video fluoroscopy. They showed that the diagnosis of biomechanical instability can be done based on the kinematic examination of the spine obtained in sagittal images. They also declared that the fluoroscopy can be used as a tool for study. Using an automated algorithm, image adaption was carried out and the motion direction of vertebrae was tracked. In the present study, some patients were selected among patients with cervical disc degeneration. Following imaging by fluoroscopy, the instantaneous center of the spinal action was calculated. It was used as a biomechanical criterion and the treatment group was compared with the healthy group. The loci of the instantaneous centers of the two groups were compared and its difference with the value of healthy group was calculated. A biomechanical criterion was introduced as a basis for comparison of normal and

Fully automated parallel oligonucleotide synthesizer

Czech Academy of Sciences Publication Activity Database

Lebl, M.; Burger, Ch.; Ellman, B.; Heiner, D.; Ibrahim, G.; Jones, A.; Nibbe, M.; Thompson, J.; Mudra, Petr; Pokorný, Vít; Poncar, Pavel; Ženíšek, Karel

2001-01-01

Roč. 66, č. 8 (2001), s. 1299-1314 ISSN 0010-0765 Institutional research plan: CEZ:AV0Z4055905 Keywords : automated oligonucleotide synthesizer Subject RIV: CC - Organic Chemistry Impact factor: 0.778, year: 2001

A wearable device for a fully automated in-hospital staff and patient identification.

Science.gov (United States)

Cavalleri, M; Morstabilini, R; Reni, G

2004-01-01

In the health care context, devices for automated staff / patient identification provide multiple benefits, including error reduction in drug administration, an easier and faster use of the Electronic Health Record, enhanced security and control features when accessing confidential data, etc. Current identification systems (e.g. smartcards, bar codes) are not completely seamless to users and require mechanical operations that sometimes are difficult to perform for impaired subjects. Emerging wireless RFID technologies are encouraging, but cannot still be introduced in health care environments due to their electromagnetic emissions and the need for large size antenna to operate at reasonable distances. The present work describes a prototype of wearable device for automated staff and patient identification which is small in size and complies with the in-hospital electromagnetic requirements. This prototype also implements an anti-counterfeit option. Its experimental application allowed the introduction of some security functions for confidential data management.

Inter-Scan Reproducibility of Carotid Plaque Volume Measurements by 3-D Ultrasound

DEFF Research Database (Denmark)

Sandholt, Benjamin V; Collet-Billon, Antoine; Entrekin, Robert

2018-01-01

(PPV) measure centered on MPT. Total plaque volume (TPV), PPV from a 10-mm segment and MPT were measured using dedicated semi-automated software on 38 plaques from 26 patients. Inter-scan reproducibility was assessed using the t-test, Bland-Altman plots and Pearson's correlation coefficient....... There was a mean difference of 0.01 mm in MPT (limits of agreement: -0.45 to 0.42 mm, Pearson's correlation coefficient: 0.96). Both volume measurements exhibited high reproducibility, with PPV being superior (limits of agreement: -35.3 mm3to 33.5 mm3, Pearson's correlation coefficient: 0.96) to TPV (limits...... of agreement: -88.2 to 61.5 mm3, Pearson's correlation coefficient: 0.91). The good reproducibility revealed by the present results encourages future studies on establishing plaque quantification as part of cardiovascular risk assessment and for follow-up of disease progression over time....

Point-of-Care Test Equipment for Flexible Laboratory Automation.

Science.gov (United States)

You, Won Suk; Park, Jae Jun; Jin, Sung Moon; Ryew, Sung Moo; Choi, Hyouk Ryeol

2014-08-01

Blood tests are some of the core clinical laboratory tests for diagnosing patients. In hospitals, an automated process called total laboratory automation, which relies on a set of sophisticated equipment, is normally adopted for blood tests. Noting that the total laboratory automation system typically requires a large footprint and significant amount of power, slim and easy-to-move blood test equipment is necessary for specific demands such as emergency departments or small-size local clinics. In this article, we present a point-of-care test system that can provide flexibility and portability with low cost. First, the system components, including a reagent tray, dispensing module, microfluidic disk rotor, and photometry scanner, and their functions are explained. Then, a scheduler algorithm to provide a point-of-care test platform with an efficient test schedule to reduce test time is introduced. Finally, the results of diagnostic tests are presented to evaluate the system. © 2014 Society for Laboratory Automation and Screening.

Automated immunohistochemical method to analyze large areas of the human cortex.

Science.gov (United States)

Abbass, Mohamad; Trought, Kathleen; Long, David; Semechko, Anton; Wong, Albert H C

2018-01-15

There have been inconsistencies in the histological abnormalities found in the cerebral cortex from patients with schizophrenia, bipolar disorder and major depression. Discrepancies in previously published reports may arise from small sample sizes, inconsistent methodology and biased cell counting. We applied automated quantification of neuron density, neuron size and cortical layer thickness in large regions of the cerebral cortex in psychiatric patients. This method accurately segments DAPI positive cells that are also stained with CUX2 and FEZF2. Cortical layer thickness, neuron density and neuron size were automatically computed for each cortical layer in numerous Brodmann areas. We did not find pronounced cytoarchitectural abnormalities in the anterior cingulate cortex or orbitofrontal cortex in patients with schizophrenia, bipolar disorder or major depressive disorder. There were no significant differences in layer thickness measured in immunohistochemically stained slides compared with traditional Nissl stained slides. Automated cell counts were correlated, reliable and consistent with manual counts, while being much less time-consuming. We demonstrate the validity of using a novel automated analysis approach to post-mortem brain tissue. We were able to analyze large cortical areas and quantify specific cell populations using immunohistochemical markers. Future analyses could benefit from efficient automated analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of manual and semi-automated delineation of regions of interest for radioligand PET imaging analysis

International Nuclear Information System (INIS)

Chow, Tiffany W; Verhoeff, Nicolaas PLG; Takeshita, Shinichiro; Honjo, Kie; Pataky, Christina E; St Jacques, Peggy L; Kusano, Maggie L; Caldwell, Curtis B; Ramirez, Joel; Black, Sandra

2007-01-01

As imaging centers produce higher resolution research scans, the number of man-hours required to process regional data has become a major concern. Comparison of automated vs. manual methodology has not been reported for functional imaging. We explored validation of using automation to delineate regions of interest on positron emission tomography (PET) scans. The purpose of this study was to ascertain improvements in image processing time and reproducibility of a semi-automated brain region extraction (SABRE) method over manual delineation of regions of interest (ROIs). We compared 2 sets of partial volume corrected serotonin 1a receptor binding potentials (BPs) resulting from manual vs. semi-automated methods. BPs were obtained from subjects meeting consensus criteria for frontotemporal degeneration and from age- and gender-matched healthy controls. Two trained raters provided each set of data to conduct comparisons of inter-rater mean image processing time, rank order of BPs for 9 PET scans, intra- and inter-rater intraclass correlation coefficients (ICC), repeatability coefficients (RC), percentages of the average parameter value (RM%), and effect sizes of either method. SABRE saved approximately 3 hours of processing time per PET subject over manual delineation (p < .001). Quality of the SABRE BP results was preserved relative to the rank order of subjects by manual methods. Intra- and inter-rater ICC were high (>0.8) for both methods. RC and RM% were lower for the manual method across all ROIs, indicating less intra-rater variance across PET subjects' BPs. SABRE demonstrated significant time savings and no significant difference in reproducibility over manual methods, justifying the use of SABRE in serotonin 1a receptor radioligand PET imaging analysis. This implies that semi-automated ROI delineation is a valid methodology for future PET imaging analysis

Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit.

Science.gov (United States)

Ni, Yizhao; Lingren, Todd; Hall, Eric S; Leonard, Matthew; Melton, Kristin; Kirkendall, Eric S

2018-05-01

Timely identification of medication administration errors (MAEs) promises great benefits for mitigating medication errors and associated harm. Despite previous efforts utilizing computerized methods to monitor medication errors, sustaining effective and accurate detection of MAEs remains challenging. In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows. Our prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children's Hospital Medical Center during a 4-month period. The automated system extracted real-time medication use information from the institutional electronic health records and identified MAEs using logic-based rules and natural language processing techniques. The MAE summary was delivered via a real-time messaging platform to promote reduction of patient exposure to potential harm. System performance was validated using a physician-generated gold standard of MAE events, and results were compared with those of current practice (incident reporting and trigger tools). Physicians identified 116 MAEs from 10 104 medication administrations during the study period. Compared to current practice, the sensitivity with automated MAE detection was improved significantly from 4.3% to 85.3% (P = .009), with a positive predictive value of 78.0%. Furthermore, the system showed potential to reduce patient exposure to harm, from 256 min to 35 min (P patient exposure to potential harm following MAE events.

[Sensitivity and specificity of flicker perimetry with Pulsar. Comparison with achromatic (white-on-white) perimetry in glaucoma patients].

Science.gov (United States)

Göbel, K; Erb, C

2013-02-01

The early detection of functional glaucoma damage plays an increasingly more central role in the diagnosis and treatment of glaucoma disease. Using selective perimetry detection of early glaucomatous defects is more likely and one of these methods is flicker perimetry with Pulsar. Flicker perimetry is used to analyze the temporal visual function in combination with spatial resolution and contrast sensitivity as opposed to standard automated perimetry which measures the differential light sensitivity with a non-specific stimulus. This study showed a higher sensitivity and specificity of Pulsar perimetry in comparison to achromatic perimetry in glaucoma patients.

Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

Directory of Open Access Journals (Sweden)

Yogesh Tiwari

2014-01-01

Full Text Available Background: Emergency Department (ED of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD. Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc. of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be "9.00-12.00 h" in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients "under observation" (29.6%; "waiting for routine diagnostic tests" (16.4% and "waiting for discharge" (14.6%. Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach.

Automated MR morphometry to predict Alzheimer's disease in mild cognitive impairment

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Fritzsche, Klaus H.; Schlindwein, Sarah; Bruggen, Thomas van; Meinzer, Hans-Peter [German Cancer Research Center, Division of Medical and Biological Informatics, Heidelberg (Germany); Stieltjes, Bram; Essig, Marco [German Cancer Research Center, Division of Radiology, Heidelberg (Germany)

2010-12-15

Prediction of progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD) is challenging but essential for early treatment. This study aims to investigate the use of hippocampal atrophy markers for the automatic detection of MCI converters and to compare the predictive value to manually obtained hippocampal volume and temporal horn width. A study was performed with 15 patients with Alzheimer and 18 patients with MCI (ten converted, eight remained stable in a 3-year follow-up) as well as 15 healthy subjects. MRI scans were obtained at baseline and evaluated with an automated system for scoring of hippocampal atrophy. The predictive value of the automated system was compared with manual measurements of hippocampal volume and temporal horn width in the same subjects. The conversion to AD was correctly predicted in 77.8% of the cases (sensitivity 70%, specificity 87.5%) in the MCI group using automated morphometry and a plain linear classifier that was trained on the AD and healthy groups. Classification was improved by limiting analysis to the left cerebral hemisphere (accuracy 83.3%, sensitivity 70%, specificity 100%). The manual linear and volumetric approaches reached rates of 66.7% (40/100%) and 72.2% (60/87.5%), respectively. The automatic approach fulfills many important preconditions for clinical application. Contrary to the manual approaches, it is not observer-dependent and reduces human resource requirements. Automated assessment may be useful for individual patient assessment and for predicting progression to dementia. (orig.)

Derivation and validation of the automated search algorithms to identify cognitive impairment and dementia in electronic health records.

Science.gov (United States)

Amra, Sakusic; O'Horo, John C; Singh, Tarun D; Wilson, Gregory A; Kashyap, Rahul; Petersen, Ronald; Roberts, Rosebud O; Fryer, John D; Rabinstein, Alejandro A; Gajic, Ognjen

2017-02-01

Long-term cognitive impairment is a common and important problem in survivors of critical illness. We developed electronic search algorithms to identify cognitive impairment and dementia from the electronic medical records (EMRs) that provide opportunity for big data analysis. Eligible patients met 2 criteria. First, they had a formal cognitive evaluation by The Mayo Clinic Study of Aging. Second, they were hospitalized in intensive care unit at our institution between 2006 and 2014. The "criterion standard" for diagnosis was formal cognitive evaluation supplemented by input from an expert neurologist. Using all available EMR data, we developed and improved our algorithms in the derivation cohort and validated them in the independent validation cohort. Of 993 participants who underwent formal cognitive testing and were hospitalized in intensive care unit, we selected 151 participants at random to form the derivation and validation cohorts. The automated electronic search algorithm for cognitive impairment was 94.3% sensitive and 93.0% specific. The search algorithms for dementia achieved respective sensitivity and specificity of 97% and 99%. EMR search algorithms significantly outperformed International Classification of Diseases codes. Automated EMR data extractions for cognitive impairment and dementia are reliable and accurate and can serve as acceptable and efficient alternatives to time-consuming manual data review. Copyright © 2016 Elsevier Inc. All rights reserved.

Communication with Orthopedic Trauma Patients via an Automated Mobile Phone Messaging Robot.

Science.gov (United States)

Anthony, Chris A; Volkmar, Alexander; Shah, Apurva S; Willey, Mike; Karam, Matt; Marsh, J Lawrence

2017-12-20

Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. This was a prospective investigation at a Level 1 trauma center in the United States. Adult patients who were capable of mobile phone messaging and were undergoing common, lower extremity orthopedic trauma procedures were enrolled in the study. Patients received a daily mobile phone message protocol inquiring about their current pain level and amount of opioid medication they had taken in the past 24 h starting on postoperative day (POD) 3 and continuing through POD 17. Our analysis considered (1) Patient completion rate of mobile phone questions, (2) Patient-reported pain level (0-10 scale), and (3) Number and percentage of daily prescribed opioid medication patients reported taking. Twenty-five patients were enrolled in this investigation. Patients responded to 87.5% of the pain and opioid medication inquiries they received over the 2-week study period. There were no differences in RRs by patient age, sex, or educational attainment. Patient-reported pain decreased over the initial 2-week study period from an average of 4.9 ± 1.7 on POD 3 to 3 ± 2.2 on POD 16-17. Patients took an average of 68% of their maximum daily narcotic prescription on POD 3 compared with 35% of their prescribed pain medication on POD 16-17. We found that in orthopedic trauma patients, an automated mobile phone messaging platform elicited a high patient RR that improved upon prior methods in the literature. This method may be used to reliably obtain pain and medication utilization data after trauma procedures.

An inter-professional approach to personalized medicine education: one institution's experience.

Science.gov (United States)

Formea, Christine M; Nicholson, Wayne T; Vitek, Carolyn Rohrer

2015-03-01

Personalized medicine offers the promise of better diagnoses, targeted therapies and individualized treatment plans. Pharmacogenomics is an integral component of personalized medicine; it aids in the prediction of an individual's response to medications. Despite growing public acceptance and emerging clinical evidence, this rapidly expanding field of medicine is slow to be adopted and utilized by healthcare providers, although many believe that they should be knowledgeable and able to apply pharmacogenomics in clinical practice. Institutional infrastructure must be built to support pharmacogenomic implementation. Multidisciplinary education for healthcare providers is a critical component for pharmacogenomics to achieve its full potential to optimize patient care. We describe our recent experience at the Mayo Clinic implementing pharmacogenomics education in a large, academic healthcare system facilitated by the Mayo Clinic Center for Individualized Medicine.

Patient-Specific Computational Modeling

CERN Document Server

Peña, Estefanía

2012-01-01

This book addresses patient-specific modeling. It integrates computational modeling, experimental procedures, imagine clinical segmentation and mesh generation with the finite element method (FEM) to solve problems in computational biomedicine and bioengineering. Specific areas of interest include cardiovascular problems, ocular and muscular systems and soft tissue modeling. Patient-specific modeling has been the subject of serious research over the last seven years and interest in the area is continually growing and this area is expected to further develop in the near future.

Automating the Small Library.

Science.gov (United States)

Skapura, Robert

1987-01-01

Discusses the use of microcomputers for automating school libraries, both for entire systems and for specific library tasks. Highlights include available library management software, newsletters that evaluate software, constructing an evaluation matrix, steps to consider in library automation, and a brief discussion of computerized card catalogs.…

Site-specific 13C content by quantitative isotopic 13C Nuclear Magnetic Resonance spectrometry: A pilot inter-laboratory study

International Nuclear Information System (INIS)

Chaintreau, Alain; Fieber, Wolfgang; Sommer, Horst; Gilbert, Alexis; Yamada, Keita; Yoshida, Naohiro; Pagelot, Alain; Moskau, Detlef; Moreno, Aitor; Schleucher, Jürgen; Reniero, Fabiano; Holland, Margaret; Guillou, Claude; Silvestre, Virginie; Akoka, Serge; Remaud, Gérald S.

2013-01-01

Graphical abstract: -- Highlights: •First ring test on isotopic 13 C NMR spectrometry. •Evaluation of the intra- and inter-variability of the NMR spectrometers used. •Definition of a protocol for qualification of the performance of the spectrometer. -- Abstract: Isotopic 13 C NMR spectrometry, which is able to measure intra-molecular 13 C composition, is of emerging demand because of the new information provided by the 13 C site-specific content of a given molecule. A systematic evaluation of instrumental behaviour is of importance to envisage isotopic 13 C NMR as a routine tool. This paper describes the first collaborative study of intra-molecular 13 C composition by NMR. The main goals of the ring test were to establish intra- and inter-variability of the spectrometer response. Eight instruments with different configuration were retained for the exercise on the basis of a qualification test. Reproducibility at the natural abundance of isotopic 13 C NMR was then assessed on vanillin from three different origins associated with specific δ 13 C i profiles. The standard deviation was, on average, between 0.9 and 1.2‰ for intra-variability. The highest standard deviation for inter-variability was 2.1‰. This is significantly higher than the internal precision but could be considered good in respect of a first ring test on a new analytical method. The standard deviation of δ 13 C i in vanillin was not homogeneous over the eight carbons, with no trend either for the carbon position or for the configuration of the spectrometer. However, since the repeatability for each instrument was satisfactory, correction factors for each carbon in vanillin could be calculated to harmonize the results

Understanding Indian Institutional Networks and Participation in Water Management Adaptation to Climate Change

Science.gov (United States)

Azhoni, A.; Holman, I.; Jude, S.

2014-12-01

Adaptation to climate change for water management involves complex interactions between different actors and sectors. The need to understand the relationships between key stakeholder institutions (KSIs) is increasingly recognized. The complexity of water management in India has meant that enhancing adaptive capacity through improved inter-institutional networks remains a challenge for both government and non-governmental institutions. To analyse such complex inter-actions this study has used Social Network and Stakeholder Analysis tools to quantify the participation of, and interactions between, each KSI in the climate change adaptation and water discourse based on keyword analysis of their online presence. Using NodeXL, a Social Network Analysis tool, network diagrams have been used to evaluate the inter-relationships between these KSIs. Semi-structured interviews were conducted with twenty-five KSIs to identify the main barriers to adaptation and to triangulate the findings of the e-documents analysis. The analysis found that there is an inverse relationship between institutions' reference to water and climate change in their web-documents. Most institutions emphasize mitigation rather than adaptation. Bureaucratic delays, poor coordination between the KSIs, unclear policies and systemic deficiencies are identified as key barriers to improving adaptive capacity within water management to climate change. However, the increasing attention being given to the perceived climate change impacts on the water sector and improving the inter-institutional networks are some of the opportunities for Indian water institutions. Although websites of Union Government Institutions seldom directly hyperlink to one another, they are linked through "bridging" websites which have the potential to act as brokers for enhancing adaptive capacity. The research has wider implications for analysis of complex inter-disciplinary and inter-institutional issues involving multi stakeholders.

Intra- and inter-rater reliability of the Knee Society Knee Score when used by two physiotherapists in patients post total knee arthroplasty

Directory of Open Access Journals (Sweden)

S. Gopal

2010-01-01

Full Text Available Background and Purpose: It has yet to be shown whether routine physiotherapy plays a role in the rehabilitation of patients post totalknee arthroplasty (Rajan et al 2004. Physiotherapists should be using validoutcome measures to provide evidence of the benefit of their intervention. The aim of this study was to establish the intra and inter-rater reliability of the Knee Society Knee Score, a scoring system developed by Insall et al(1989. The Knee Society Knee Score can be used to assess the integrity of theknee joint of patients undergoing total knee arthroplasty. Since the scoreinvolves clinical testing, the intra-rater reliability of the clinician should be established prior to using the scores as datain clinical research. W here multiple clinicians are involved, inter-rater reliability should also be established.Design: This was a correlation study.Subjects: A  sample of thirty patients post total knee arthroplasty attending the arthroplasty clinic at Johannesburg Hospital between six weeks and twelve months postoperatively.M ethod: Recruited patients were evaluated twice with a time interval of one hour between each assessment. Statistical A nalysis: The intra- and inter-rater reliability were estimated using Intraclass Correlation Coefficient (ICC. R esults: The intra-rater reliability showed excellent reliability (h= 0.95 for Examiner A  and good reliability (h= 0.71for Examiner B. The inter-rater reliability showed moderate reliability (h= 0.67 during test one and h= 0.66 during test two.Conclusion: The KSKS has good intra-rater reliability when tested within a period of one hour. The KSKS demonstrated moderate agreement for inter rater reliability.

Patient-reported outcomes in adults with congenital heart disease: Inter-country variation, standard of living and healthcare system factors

NARCIS (Netherlands)

Moons, Philip; Kovacs, Adrienne H.; Luyckx, Koen; Thomet, Corina; Budts, Werner; Enomoto, Junko; Sluman, Maayke A.; Yang, Hsiao-Ling; Jackson, Jamie L.; Khairy, Paul; Cook, Stephen C.; Subramanyan, Raghavan; Alday, Luis; Eriksen, Katrine; Dellborg, Mikael; Berghammer, Malin; Johansson, Bengt; Mackie, Andrew S.; Menahem, Samuel; Caruana, Maryanne; Veldtman, Gruschen; Soufi, Alexandra; Fernandes, Susan M.; White, Kamila; Callus, Edward; Kutty, Shelby; van Bulck, Liesbet; Apers, Silke

2018-01-01

Aims: Geographical differences in patient-reported outcomes (PROs) of adults with congenital heart disease (ConHD) have been observed, but are poorly understood. We aimed to: (1) investigate inter-country variation in PROs in adults with ConHD; (2) identify patient-related predictors of PROs; and

SU-E-J-266: Cone Beam Computed Tomography (CBCT) Inter-Scan and Inter-Observer Tumor Volume Variability Assessment in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Early Stage Non-Small Cell Lung Cancer (NSCLC)

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Hou, Y; Aileen, C; Kozono, D; Killoran, J; Wagar, M; Lee, S; Hacker, F; Aerts, H; Lewis, J; Mak, R [Brigham and Women’s Hospital, Boston, MA (United States)

2015-06-15

Purpose: Quantification of volume changes on CBCT during SBRT for NSCLC may provide a useful radiological marker for radiation response and adaptive treatment planning, but the reproducibility of CBCT volume delineation is a concern. This study is to quantify inter-scan/inter-observer variability in tumor volume delineation on CBCT. Methods: Twenty earlystage (stage I and II) NSCLC patients were included in this analysis. All patients were treated with SBRT with a median dose of 54 Gy in 3 to 5 fractions. Two physicians independently manually contoured the primary gross tumor volume on CBCTs taken immediately before SBRT treatment (Pre) and after the same SBRT treatment (Post). Absolute volume differences (AVD) were calculated between the Pre and Post CBCTs for a given treatment to quantify inter-scan variability, and then between the two observers for a given CBCT to quantify inter-observer variability. AVD was also normalized with respect to average volume to obtain relative volume differences (RVD). Bland-Altman approach was used to evaluate variability. All statistics were calculated with SAS version 9.4. Results: The 95% limit of agreement (mean ± 2SD) on AVD and RVD measurements between Pre and Post scans were −0.32cc to 0.32cc and −0.5% to 0.5% versus −1.9 cc to 1.8 cc and −15.9% to 15.3% for the two observers respectively. The 95% limit of agreement of AVD and RVD between the two observers were −3.3 cc to 2.3 cc and −42.4% to 28.2% respectively. The greatest variability in inter-scan RVD was observed with very small tumors (< 5 cc). Conclusion: Inter-scan variability in RVD is greatest with small tumors. Inter-observer variability was larger than inter-scan variability. The 95% limit of agreement for inter-observer and inter-scan variability (∼15–30%) helps define a threshold for clinically meaningful change in tumor volume to assess SBRT response, with larger thresholds needed for very small tumors. Part of the work was funded by a Kaye

SU-E-J-266: Cone Beam Computed Tomography (CBCT) Inter-Scan and Inter-Observer Tumor Volume Variability Assessment in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Early Stage Non-Small Cell Lung Cancer (NSCLC)

International Nuclear Information System (INIS)

Hou, Y; Aileen, C; Kozono, D; Killoran, J; Wagar, M; Lee, S; Hacker, F; Aerts, H; Lewis, J; Mak, R

2015-01-01

Purpose: Quantification of volume changes on CBCT during SBRT for NSCLC may provide a useful radiological marker for radiation response and adaptive treatment planning, but the reproducibility of CBCT volume delineation is a concern. This study is to quantify inter-scan/inter-observer variability in tumor volume delineation on CBCT. Methods: Twenty earlystage (stage I and II) NSCLC patients were included in this analysis. All patients were treated with SBRT with a median dose of 54 Gy in 3 to 5 fractions. Two physicians independently manually contoured the primary gross tumor volume on CBCTs taken immediately before SBRT treatment (Pre) and after the same SBRT treatment (Post). Absolute volume differences (AVD) were calculated between the Pre and Post CBCTs for a given treatment to quantify inter-scan variability, and then between the two observers for a given CBCT to quantify inter-observer variability. AVD was also normalized with respect to average volume to obtain relative volume differences (RVD). Bland-Altman approach was used to evaluate variability. All statistics were calculated with SAS version 9.4. Results: The 95% limit of agreement (mean ± 2SD) on AVD and RVD measurements between Pre and Post scans were −0.32cc to 0.32cc and −0.5% to 0.5% versus −1.9 cc to 1.8 cc and −15.9% to 15.3% for the two observers respectively. The 95% limit of agreement of AVD and RVD between the two observers were −3.3 cc to 2.3 cc and −42.4% to 28.2% respectively. The greatest variability in inter-scan RVD was observed with very small tumors (< 5 cc). Conclusion: Inter-scan variability in RVD is greatest with small tumors. Inter-observer variability was larger than inter-scan variability. The 95% limit of agreement for inter-observer and inter-scan variability (∼15–30%) helps define a threshold for clinically meaningful change in tumor volume to assess SBRT response, with larger thresholds needed for very small tumors. Part of the work was funded by a Kaye

Diagnosis of dorsal inter osseous pseudotumours by magnetic resonance imaging

International Nuclear Information System (INIS)

Peh, W.C.G.; Wong, L.L.S.; Ip, W.Y.

1999-01-01

Two middle-aged-patients each presenting with a progressively enlarging mass in the first dorsal web space of their hands are reported. Magnetic resonance imaging (MRI) demonstrated the cause to be a hypertrophic first dorsal inter osseous muscle, with normal T1, T2 and post-gadopentetate dimeglumine signal characteristics. The ability of MRI to diagnose anatomical variants of hand muscles is important in the clinical management of patients with these pseudotumours. The usefulness of magnetic resonance imaging (MRI) in evaluation of soft tissue tumours of the musculoskeletal system is now widely accepted. Its ability to maximize contrast between tumour and adjacent normal tissue in a multiplanar manner makes it the imaging modality of choice in pre-operative staging of soft tissue masses. In the hand and wrist, where benign tumours predominate, MRI may provide a specific diagnosis. We describe two cases in which MRI demonstrated the cause of a hand pseudotumour to be due to hypertrophy of the first dorsal inter osseous muscle. Copyright (1999) Blackwell Science Pty Ltd

Diagnosis of dorsal inter osseous pseudotumours by magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Peh, W.C.G.; Wong, L.L.S. [The University of Hong Kong, Queen Mary Hospital, (Hong Kong). Hand Surgery Division, Department of Diagnotic Radiology; Ip, W.Y. [The University of Hong Kong, Queen Mary Hospital, (Hong Kong). Hand Surgery Division, Department of Orthopaedic Surgery

1999-08-01

Two middle-aged-patients each presenting with a progressively enlarging mass in the first dorsal web space of their hands are reported. Magnetic resonance imaging (MRI) demonstrated the cause to be a hypertrophic first dorsal inter osseous muscle, with normal T1, T2 and post-gadopentetate dimeglumine signal characteristics. The ability of MRI to diagnose anatomical variants of hand muscles is important in the clinical management of patients with these pseudotumours. The usefulness of magnetic resonance imaging (MRI) in evaluation of soft tissue tumours of the musculoskeletal system is now widely accepted. Its ability to maximize contrast between tumour and adjacent normal tissue in a multiplanar manner makes it the imaging modality of choice in pre-operative staging of soft tissue masses. In the hand and wrist, where benign tumours predominate, MRI may provide a specific diagnosis. We describe two cases in which MRI demonstrated the cause of a hand pseudotumour to be due to hypertrophy of the first dorsal inter osseous muscle. Copyright (1999) Blackwell Science Pty Ltd 20 refs., 3 figs.

Semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma stage III/IV-A feasibility study

International Nuclear Information System (INIS)

Fabel, M.; Tengg-Kobligk, H. von; Giesel, F.L.; Delorme, S.; Kauczor, H.-U.; Bornemann, L.; Dicken, V.; Kopp-Schneider, A.; Moser, C.

2008-01-01

Therapy monitoring in oncological patient care requires accurate and reliable imaging and post-processing methods. RECIST criteria are the current standard, with inherent disadvantages. The aim of this study was to investigate the feasibility of semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma compared to manual volumetric analysis and RECIST. Multislice CT was performed in 47 patients, covering the chest, abdomen and pelvis. In total, 227 suspicious, enlarged lymph nodes were evaluated retrospectively by two radiologists regarding diameters (RECIST), manually measured volume by placement of ROIs and semi-automated volumetric analysis. Volume (ml), quality of segmentation (++/-) and time effort (s) were evaluated in the study. The semi-automated volumetric analysis software tool was rated acceptable to excellent in 81% of all cases (reader 1) and 79% (reader 2). Median time for the entire segmentation process and necessary corrections was shorter with the semi-automated software than by manual segmentation. Bland-Altman plots showed a significantly lower interobserver variability for semi-automated volumetric than for RECIST measurements. The study demonstrated feasibility of volumetric analysis of lymph node metastases. The software allows a fast and robust segmentation in up to 80% of all cases. Ease of use and time needed are acceptable for application in the clinical routine. Variability and interuser bias were reduced to about one third of the values found for RECIST measurements. (orig.)

Comparison of automated 4-chamber cardiac views versus axial views for measuring right ventricular enlargement in patients with suspected pulmonary embolism

International Nuclear Information System (INIS)

Wittenberg, R.; Vliet, J.W. van; Ghaye, B.; Peters, J.F.; Schaefer-Prokop, C.M.; Coche, E.

2012-01-01

Purpose: Compare the right ventricle to left ventricle (RV/LV) diameter ratio obtained from axial pulmonary CT angiograms (CTPA) with those derived from automatically generated 4-chamber (4-CH) reformats in patients with suspected pulmonary embolism (PE). Methods: In this institutional review board-approved study we included 120 consecutive non ECG-gated CTPA from 3 institutions (mean age 60 ± 16 years; 71 women). Twenty 64-slice CTPA with PE and 20 without PE were selected per institution. For each patient the RV/LV diameter ratio was obtained from both axial CTPA images and automatically generated 4-CH reformats. Measurements were performed twice in two separated sessions by 2 experienced radiologists and 2 residents. The differences between the measurements on both views were evaluated. Results: The 4-CH view was successfully obtained in 113 patients. The mean axial and 4-CH diameter ratios were comparable for three of the four readers (p = 0.56, p = 0.13, p = 0.08). Although the mean diameters (1.0 and 1.03 respectively) for one resident were significantly different (p = 0.013), the difference of 0.03 seems negligible in clinical routine. Three readers achieved equally high intra-reader agreements with both measurements (ICCs of 0.94, 0.95 and 0.96), while one reader showed a different variability with ICCs of 0.96 for the axial view and 0.91 for the 4-CH view. The inter-reader agreement was equally high for both measurement types with ICCs of 0.95 and 0.94, respectively. Conclusion: In patients with suspected PE, RV/LV diameters ratio can be measured with the same reproducibility and accuracy using an automatically generated 4-CH view compared to the axial view.

Foreign versus domestic institutional investors in emerging markets: Who contributes more to firm-specific information flow?

Directory of Open Access Journals (Sweden)

Jeong-Bon Kim

2015-03-01

Full Text Available Using a large sample of firms listed on the Korea Stock Exchange over 1998–2007, this study investigates whether and how trading by foreign and domestic institutional investors improves the extent to which firm-specific information is incorporated into stock prices, captured by stock price synchronicity. We find, first, that stock price synchronicity decreases significantly with the intensity of trading by foreign investors and domestic institutional investors. Second, trading by foreign investors facilitates the incorporation of firm-specific information into stock prices to a greater extent than trading by aggregate domestic institutions. Third, among domestic institutions with differing investment horizons, short-term investing institutions, such as securities and investment trust companies, play a more important role in incorporating firm-specific information into stock prices via their trading activities, compared with long-term investing institutions, such as banks and insurance companies. Finally, we provide evidence suggesting that trading by foreign and domestic short-term institutions reduces the extent of accrual mispricing. Our results are robust to a variety of sensitivity checks.

Limits to the introduction of market institutions in a sector of income; Les limites a l'introduction des institutions de marche dans un secteur de rente

Energy Technology Data Exchange (ETDEWEB)

Locatelli, C.; Finon, D. [Laboratoire d' Economie de la Production et de l' Integration Internationale, Departement Energie et Politiques de l' Environnement (LEPII/EPE), UPMF, 38 - Grenoble (France)

2003-07-01

This article uses an empirical study to test the validity of the liberal approach of market transition. The example chosen is the reform (privatization) of the Russian hydrocarbons industry. This case has been chosen because it represents an extreme case of inadequateness of the measures preconized by the Washington consensus with respect to the institutional environment. It represents also a typical case of opportunistic adaptation of the behaviour of private and government actors to the rough enforcement of market institutions to a very specific institutional environment. The inadequateness of these institutions with the initial informal institutions has led to adaptations totally dependent of the institutional path with the necessity of preserving a minimum inter-industrial consistency. On the other hand, it seems that the uncertainty about the property rights in general is tightly correlated with the abundance of exploitable and exportable natural resources. (J.S.)

Automated impedance-manometry analysis detects esophageal motor dysfunction in patients who have non-obstructive dysphagia with normal manometry.

Science.gov (United States)

Nguyen, N Q; Holloway, R H; Smout, A J; Omari, T I

2013-03-01

Automated integrated analysis of impedance and pressure signals has been reported to identify patients at risk of developing dysphagia post fundoplication. This study aimed to investigate this analysis in the evaluation of patients with non-obstructive dysphagia (NOD) and normal manometry (NOD/NM). Combined impedance-manometry was performed in 42 patients (27F : 15M; 56.2 ± 5.1 years) and compared with that of 24 healthy subjects (8F : 16M; 48.2 ± 2.9 years). Both liquid and viscous boluses were tested. MATLAB-based algorithms defined the median intrabolus pressure (IBP), IBP slope, peak pressure (PP), and timing of bolus flow relative to peak pressure (TNadImp-PP). An index of pressure and flow (PFI) in the distal esophagus was derived from these variables. Diagnoses based on conventional manometric assessment: diffuse spasm (n = 5), non-specific motor disorders (n = 19), and normal (n = 11). Patients with achalasia (n = 7) were excluded from automated impedance-manometry (AIM) analysis. Only 2/11 (18%) patients with NOD/NM had evidence of flow abnormality on conventional impedance analysis. Several variables derived by integrated impedance-pressure analysis were significantly different in patients as compared with healthy: higher PNadImp (P < 0.01), IBP (P < 0.01) and IBP slope (P < 0.05), and shorter TNadImp_PP (P = 0.01). The PFI of NOD/NM patients was significantly higher than that in healthy (liquid: 6.7 vs 1.2, P = 0.02; viscous: 27.1 vs 5.7, P < 0.001) and 9/11 NOD/NM patients had abnormal PFI. Overall, the addition of AIM analysis provided diagnoses and/or a plausible explanation in 95% (40/42) of patients who presented with NOD. Compared with conventional pressure-impedance assessment, integrated analysis is more sensitive in detecting subtle abnormalities in esophageal function in patients with NOD and normal manometry. © 2012 Blackwell Publishing Ltd.

Inter-patient image registration algorithms to disentangle regional dose bioeffects.

Science.gov (United States)

Monti, Serena; Pacelli, Roberto; Cella, Laura; Palma, Giuseppe

2018-03-20

Radiation therapy (RT) technological advances call for a comprehensive reconsideration of the definition of dose features leading to radiation induced morbidity (RIM). In this context, the voxel-based approach (VBA) to dose distribution analysis in RT offers a radically new philosophy to evaluate local dose response patterns, as an alternative to dose-volume-histograms for identifying dose sensitive regions of normal tissue. The VBA relies on mapping patient dose distributions into a single reference case anatomy which serves as anchor for local dosimetric evaluations. The inter-patient elastic image registrations (EIRs) of the planning CTs provide the deformation fields necessary for the actual warp of dose distributions. In this study we assessed the impact of EIR on the VBA results in thoracic patients by identifying two state-of-the-art EIR algorithms (Demons and B-Spline). Our analysis demonstrated that both the EIR algorithms may be successfully used to highlight subregions with dose differences associated with RIM that substantially overlap. Furthermore, the inclusion for the first time of covariates within a dosimetric statistical model that faces the multiple comparison problem expands the potential of VBA, thus paving the way to a reliable voxel-based analysis of RIM in datasets with strong correlation of the outcome with non-dosimetric variables.

Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome

DEFF Research Database (Denmark)

Clark, Elaine N; Ripa, Maria Sejersten; Clemmensen, Peter

2010-01-01

The aims of this study were to assess the effectiveness of 2 automated electrocardiogram interpretation programs in patients with suspected acute coronary syndrome transported to hospital by ambulance in 1 rural region of Denmark with hospital discharge diagnosis used as the gold standard...... infarction with respect to discharge diagnosis were 78%, 91%, and 81% for LIFEPAK 12 and 78%, 94%, and 87% for the Glasgow program. Corresponding data for attending cardiologists were 85%, 90%, and 81%. In conclusion, the Glasgow program had significantly higher specificity than the LIFEPAK 12 program (p = 0...

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

Science.gov (United States)

Doluoglu, Omer Gokhan; Ceylan, Cavit; Kilinc, Fatih; Gazel, Eymen; Resorlu, Berkan; Odabas, Oner

2016-01-01

We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5-20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6-20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Automated assessment of mobility in bedridden patients.

Science.gov (United States)

Bennett, Stephanie; Goubran, Rafik; Rockwood, Kenneth; Knoefel, Frank

2013-01-01

Immobility in older patients is a costly problem for both patients and healthcare workers. The Hierarchical Assessment of Balance and Mobility (HABAM) is a clinical tool able to assess immobile patients and predict morbidity, yet could become more reliable and informative through automation. This paper proposes an algorithm to automatically determine which of three enacted HABAM scores (associated with bedridden patients) had been performed by volunteers. A laptop was used to gather pressure data from three mats placed on a standard hospital bed frame while five volunteers performed three enactments each. A system of algorithms was created, consisting of three subsystems. The first subsystem used mattress data to calculate individual sensor sums and eliminate the weight of the mattress. The second subsystem established a baseline pressure reading for each volunteer and used percentage change to identify and distinguish between two enactments. The third subsystem used calculated weight distribution ratios to determine if the data represented the remaining enactment. The system was tested for accuracy by inputting the volunteer data and recording the assessment output (a score per data set). The system identified 13 of 15 sets of volunteer data as expected. Examination of these results indicated that the two sets of data were not misidentified; rather, the volunteers had made mistakes in performance. These results suggest that this system of algorithms is effective in distinguishing between the three HABAM score enactments examined here, and emphasizes the potential for pervasive computing to improve traditional healthcare.

Novel insights in agent-based complex automated negotiation

CERN Document Server

Lopez-Carmona, Miguel; Ito, Takayuki; Zhang, Minjie; Bai, Quan; Fujita, Katsuhide

2014-01-01

This book focuses on all aspects of complex automated negotiations, which are studied in the field of autonomous agents and multi-agent systems. This book consists of two parts. I: Agent-Based Complex Automated Negotiations, and II: Automated Negotiation Agents Competition. The chapters in Part I are extended versions of papers presented at the 2012 international workshop on Agent-Based Complex Automated Negotiation (ACAN), after peer reviews by three Program Committee members. Part II examines in detail ANAC 2012 (The Third Automated Negotiating Agents Competition), in which automated agents that have different negotiation strategies and are implemented by different developers are automatically negotiated in the several negotiation domains. ANAC is an international competition in which automated negotiation strategies, submitted by a number of universities and research institutes across the world, are evaluated in tournament style. The purpose of the competition is to steer the research in the area of bilate...

Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

Science.gov (United States)

Jennings, Fiona L; Mitchell, Marion

2017-06-01

Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

Decree No. 2.363 of 21 October 1987 abolishing the National Institute of Colonization and Agrarian Reform--INCRA, creating the Legal Institute of Rural Land--INTER, and other measures.

Science.gov (United States)

1989-01-01

This Decree abolishes the Brazilian National Institute of Colonization and Agrarian Reform (INCRA) and creates a Legal Institute of Rural Land (INTER) linked to the Ministry of Agrarian Reform (MIRAD) to perform the activities of INCRA. MIRAD will henceforth be responsible for the rights, powers, and obligations of INCRA and will supervise INCRA's property and resources. In this capacity MIRAD will supervise, coordinate, and execute activities related to agrarian reform and agricultural policy. Among these activities are the promotion of social justice and productivity through 1) the just and adequate distribution of ownership of rural land, 2) limitation of the acquisition of rural property by foreigners, and 3) encouragement of the harmonious development of rural life. In developing such activities MIRAD is to make use of legal measures contained in land law, including those relating to the selection of public rural lands, the privatization of rural land through regularization of ownership, colonization, zoning, and taxation. It is also authorized to expropriate and distribute unexploited or improperly exploited land to worker families, with priority going to labor cooperatives. Further provisions establish rules on expropriation. Among these is the requirement that forests must be protected.

Automated multi-lesion detection for referable diabetic retinopathy in indigenous health care.

Science.gov (United States)

Pires, Ramon; Carvalho, Tiago; Spurling, Geoffrey; Goldenstein, Siome; Wainer, Jacques; Luckie, Alan; Jelinek, Herbert F; Rocha, Anderson

2015-01-01

Diabetic Retinopathy (DR) is a complication of diabetes mellitus that affects more than one-quarter of the population with diabetes, and can lead to blindness if not discovered in time. An automated screening enables the identification of patients who need further medical attention. This study aimed to classify retinal images of Aboriginal and Torres Strait Islander peoples utilizing an automated computer-based multi-lesion eye screening program for diabetic retinopathy. The multi-lesion classifier was trained on 1,014 images from the São Paulo Eye Hospital and tested on retinal images containing no DR-related lesion, single lesions, or multiple types of lesions from the Inala Aboriginal and Torres Strait Islander health care centre. The automated multi-lesion classifier has the potential to enhance the efficiency of clinical practice delivering diabetic retinopathy screening. Our program does not necessitate image samples for training from any specific ethnic group or population being assessed and is independent of image pre- or post-processing to identify retinal lesions. In this Aboriginal and Torres Strait Islander population, the program achieved 100% sensitivity and 88.9% specificity in identifying bright lesions, while detection of red lesions achieved a sensitivity of 67% and specificity of 95%. When both bright and red lesions were present, 100% sensitivity with 88.9% specificity was obtained. All results obtained with this automated screening program meet WHO standards for diabetic retinopathy screening.

Firm-specific, and institutional determinants of corporate investments in Nigeria

Directory of Open Access Journals (Sweden)

Folorunsho M. Ajide

2017-12-01

Full Text Available We examined the effect of institutional quality and firm-specific factors on corporate investment in Nigeria using fifty-four (54 quoted non-financial firms within the period of 2002–2012. We applied dynamic panel estimator proposed by Arellano–Bond (1991. The results showed that regulatory quality, corruption, political stability and control of corruption have insignificant effect in determining corporate investments in Nigeria. Our results also confirmed that firms’ firm-specific factors influenced corporate investment in Nigeria. While firms’ cash flow displayed positive and significant effect on investment other factors had negative effects on investment.Our results showed that investment is constrained to internally generated fund, despite the existence of capital market. In addition, the spillover effect of tightening monetary policy during the period of study had increased the cost of borrowing thereby having a negative effect on investment in the real sector. We recommended that when the monetary authorities are focusing on inflation targeting, they should also not lose sight of its impact on corporate investment and other productivity growth of firms; which is the source of long term sustainable growth and development of economies. Keywords: Institution, Nigeria, GMM, Firm-specific, Investment

Automated detection of retinal disease.

Science.gov (United States)

Helmchen, Lorens A; Lehmann, Harold P; Abràmoff, Michael D

2014-11-01

Nearly 4 in 10 Americans with diabetes currently fail to undergo recommended annual retinal exams, resulting in tens of thousands of cases of blindness that could have been prevented. Advances in automated retinal disease detection could greatly reduce the burden of labor-intensive dilated retinal examinations by ophthalmologists and optometrists and deliver diagnostic services at lower cost. As the current availability of ophthalmologists and optometrists is inadequate to screen all patients at risk every year, automated screening systems deployed in primary care settings and even in patients' homes could fill the current gap in supply. Expanding screens to all patients at risk by switching to automated detection systems would in turn yield significantly higher rates of detecting and treating diabetic retinopathy per dilated retinal examination. Fewer diabetic patients would develop complications such as blindness, while ophthalmologists could focus on more complex cases.

Patient-Specific Modeling of Interventricular Hemodynamics in Single Ventricle Physiology

Science.gov (United States)

Vedula, Vijay; Feinstein, Jeffrey; Marsden, Alison

2016-11-01

Single ventricle (SV) congenital heart defects, in which babies are born with only functional ventricle, lead to significant morbidity and mortality with over 30% of patients developing heart failure prior to adulthood. Newborns with SV physiology typically undergo three palliative surgeries, in which the SV becomes the systemic pumping chamber. Depending on which ventricle performs the systemic function, patients are classified as having either a single left ventricle (SLV) or a single right ventricle (SRV), with SRV patients at higher risk of failure. As the native right ventricles are not designed to meet systemic demands, they undergo remodeling leading to abnormal hemodynamics. The hemodynamic characteristics of SLVs compared with SRVs is not well established. We present a validated computational framework for performing patient-specific modeling of ventricular flows, and apply it across 6 SV patients (3SLV + 3SRV), comparing hemodynamic conditions between the two subgroups. Simulations are performed with a stabilized finite element method coupled with an immersed boundary method for modeling heart valves. We discuss identification of hemodynamic biomarkers of ventricular remodeling for early risk assessment of failure. This research is supported in part by the Stanford Child Health Research Institute and the Stanford NIH-NCATS-CTSA through Grant UL1 TR001085 and due to U.S. National Institute of Health through NIH NHLBI R01 Grants 5R01HL129727-02 and 5R01HL121754-03.

BRAIN initiative: transcranial magnetic stimulation automation and calibration.

Science.gov (United States)

Todd, Garth D; Abdellatif, Ahmed; Sabouni, Abas

2014-01-01

In this paper, we introduced an automated TMS system with robot control and optical sensor combined with neuronavigation software. By using the robot, the TMS coil can be accurately positioned over any preselected brain region. The neuronavigation system provides an accurate positioning of a magnetic coil in order to induce a specific cortical excitation. An infrared optical measurement device is also used in order to detect and compensate for head movements of the patient. This procedure was simulated using a PC based robotic simulation program. The proposed automated robot system is integrated with TMS numerical solver and allows users to actually see the depth, location, and shape of the induced eddy current on the computer monitor.

Inter-organizational network studies – a literature review

DEFF Research Database (Denmark)

Bergenholtz, Carsten; Waldstrøm, Christian

2011-01-01

of the methodological issues (e.g. unit of analysis and boundary specification) are more easily addressed. In order to map the different methodological approaches in the field of inter-organizational networks, this paper presents a large-scale systematic literature review of the last 12 years’ research on inter...

[Transient elevation of intraocular pressure in primary open-angle glaucoma patients after automated visual field examination in the winter].

Science.gov (United States)

Nishino, Kazuaki; Yoshida, Fujiko; Nitta, Akari; Saito, Mieko; Saito, Kazuuchi

2013-12-01

To evaluate retrospectively seasonal fluctuations of transient intraocular pressure (IOP) elevation after automated visual field examination in patients with primary open-angle glaucoma (POAG). We reviewed 53 consecutive patients with POAG who visited Kaimeido Ophthalmic and Dental Clinic from January 2011 to March 2013, 21 men and 32 women aged 67.7 +/- 11.2 years. The patients were divided into 4 groups, spring, summer, autumn, and winter according to the month of automated visual field examination and both eyes of each patient were enrolled. IOP was measured immediately after automated visual field examination (vf IOP) and compared with the average IOP from the previous 3 months (pre IOP) and with the average IOP from the following 3 months (post IOP) in each season. IOP elevation rate was defined as (vf IOP- pre IOP)/pre IOP x 100% and calculated for each season (paired t test). Additionally, the correlation between mean deviation (MD) and IOP elevation rate was evaluated (single regression analysis). Exclusion criteria were patients who received cataract surgery during this study or had a history of any previous glaucoma surgery. The automated visual field test was performed with a Humphrey field analyzer and the Central 30-2 FASTPAC threshold program. The average vf IOP was 14.5 +/- 2.5 mmHg, higher than pre IOP 13.8 +/- 2.4 mmHg (p field examination, especially in the winter but not in the summer.

Privacy-Preserving Detection of Inter-Domain SDN Rules Overlaps

KAUST Repository

Dethise, Arnaud

2017-08-24

SDN approaches to inter-domain routing promise better traffic engineering, enhanced security, and higher automation. Yet, naïve deployment of SDN on the Internet is dangerous as the control-plane expressiveness of BGP is significantly more limited than the data-plane expressiveness of SDN, which allows fine-grained rules to deflect traffic from BGP\\'s default routes. This mismatch may lead to incorrect forwarding behaviors such as forwarding loops and blackholes, ultimately hindering SDN deployment at the inter-domain level. In this work, we make a first step towards verifying the correctness of inter-domain forwarding state with a focus on loop freedom while keeping private the SDN rules, as they comprise confidential routing information. To this end, we design a simple yet powerful primitive that allows two networks to verify whether their SDN rules overlap, i.e., the set of packets matched by these rules is non-empty, without leaking any information about the SDN rules. We propose an efficient implementation of this primitive by using recent advancements in Secure Multi-Party Computation and we then leverage it as the main building block for designing a system that detects Internet-wide forwarding loops among any set of SDN-enabled Internet eXchange Points.

Institutional Logics in Action

DEFF Research Database (Denmark)

Lounsbury, Michael; Boxenbaum, Eva

2013-01-01

This double volume presents state-of-the-art research and thinking on the dynamics of actors and institutional logics. In the introduction, we briefly sketch the roots and branches of institutional logics scholarship before turning to the new buds of research on the topic of how actors engage...... institutional logics in the course of their organizational practice. We introduce an exciting line of new works on the meta-theoretical foundations of logics, institutional logic processes, and institutional complexity and organizational responses. Collectively, the papers in this volume advance the very...... prolific stream of research on institutional logics by deepening our insight into the active use of institutional logics in organizational action and interaction, including the institutional effects of such (inter)actions....

Rethinking informal payments by patients in Europe: An institutional approach.

Science.gov (United States)

Williams, Colin C; Horodnic, Adrian V

2017-10-01

The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices. Copyright © 2017 Elsevier B.V. All rights reserved.

PS-022 Complex automated medication systems reduce medication administration error rates in an acute medical ward

DEFF Research Database (Denmark)

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

2017-01-01

Background Medication errors have received extensive attention in recent decades and are of significant concern to healthcare organisations globally. Medication errors occur frequently, and adverse events associated with medications are one of the largest causes of harm to hospitalised patients...... cabinet, automated dispensing and barcode medication administration; (2) non-patient specific automated dispensing and barcode medication administration. The occurrence of administration errors was observed in three 3 week periods. The error rates were calculated by dividing the number of doses with one...

Feasibility of Electromagnetic Transponder Use to Monitor Inter- and Intrafractional Motion in Locally Advanced Pancreatic Cancer Patients

Energy Technology Data Exchange (ETDEWEB)

Shinohara, Eric T., E-mail: eric.t.shinohara@vanderbilt.edu [Department of Radiation Oncology, The Vanderbilt Clinic, Nashville, TN (United States); Kassaee, Alireza [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Mitra, Nandita [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States); Vapiwala, Neha; Plastaras, John P. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Drebin, Jeff [Department of Surgery, University of Pennsylvania, Philadelphia, PA (United States); Wan, Fei [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States); Metz, James M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

2012-06-01

Purpose: The primary objective of this study was to determine the feasibility of electromagnetic transponder implantation in patients with locally advanced unresectable pancreatic cancer. Secondarily, the use of transponders to monitor inter- and intrafractional motion, and the efficacy of breath holding for limiting target motion, were examined. Methods and Materials: During routine screening laparoscopy, 5 patients without metastatic disease were implanted with transponders peri-tumorally. The Calypso System's localization and tracking modes were used to monitor inter- and intrafractional motion, respectively. Intrafractional motion, with and without breath holding, was also examined using Calypso tracking mode. Results: Transponder implantation was well tolerated in all patients, with minimal migration, aside from 1 patient who expulsed a single transponder. Interfractional motion based on mean shifts from setup using tattoos/orthogonal imaging to transponder based localization from 164 treatments was significant in all dimensions. Mean shift (in millimeters), followed by the standard deviation and p value, were as follows: X-axis: 4.5 mm (1.0, p = 0.01); Y axis: 6.4 mm (1.9, p = 0.03); and Z-axis 3.9 mm (0.6, p = 0.002). Mean intrafractional motion was also found to be significant in all directions: superior, 7.2 mm (0.9, p = 0.01); inferior, 11.9 mm (0.9, p < 0.01); anterior: 4.9 mm (0.5, p = 0.01); posterior, 2.9 mm (0.5, p = 0.02); left, 2.2 mm (0.4, p = 0.02); and right, 3.1 mm (0.6, p = 0.04). Breath holding during treatment significantly decreased tumor motion in all directions. Conclusions: Electromagnetic transponder implantation appears to be safe and effective for monitoring inter- and intrafractional motion. Based on these results a larger clinical trial is underway.

Feasibility of Electromagnetic Transponder Use to Monitor Inter- and Intrafractional Motion in Locally Advanced Pancreatic Cancer Patients

International Nuclear Information System (INIS)

Shinohara, Eric T.; Kassaee, Alireza; Mitra, Nandita; Vapiwala, Neha; Plastaras, John P.; Drebin, Jeff; Wan, Fei; Metz, James M.

2012-01-01

Purpose: The primary objective of this study was to determine the feasibility of electromagnetic transponder implantation in patients with locally advanced unresectable pancreatic cancer. Secondarily, the use of transponders to monitor inter- and intrafractional motion, and the efficacy of breath holding for limiting target motion, were examined. Methods and Materials: During routine screening laparoscopy, 5 patients without metastatic disease were implanted with transponders peri-tumorally. The Calypso System’s localization and tracking modes were used to monitor inter- and intrafractional motion, respectively. Intrafractional motion, with and without breath holding, was also examined using Calypso tracking mode. Results: Transponder implantation was well tolerated in all patients, with minimal migration, aside from 1 patient who expulsed a single transponder. Interfractional motion based on mean shifts from setup using tattoos/orthogonal imaging to transponder based localization from 164 treatments was significant in all dimensions. Mean shift (in millimeters), followed by the standard deviation and p value, were as follows: X-axis: 4.5 mm (1.0, p = 0.01); Y axis: 6.4 mm (1.9, p = 0.03); and Z-axis 3.9 mm (0.6, p = 0.002). Mean intrafractional motion was also found to be significant in all directions: superior, 7.2 mm (0.9, p = 0.01); inferior, 11.9 mm (0.9, p < 0.01); anterior: 4.9 mm (0.5, p = 0.01); posterior, 2.9 mm (0.5, p = 0.02); left, 2.2 mm (0.4, p = 0.02); and right, 3.1 mm (0.6, p = 0.04). Breath holding during treatment significantly decreased tumor motion in all directions. Conclusions: Electromagnetic transponder implantation appears to be safe and effective for monitoring inter- and intrafractional motion. Based on these results a larger clinical trial is underway.

Synthesis of tracers using automated radiochemistry and robotics

International Nuclear Information System (INIS)

Dannals, R.F.

1992-07-01

Synthesis of high specific activity radiotracers labeled with short-lived positron-emitting radionuclides for positron emission tomography (PET) often requires handling large initial quantities of radioactivity. High specific activities are required when preparing tracers for use in PET studies of neuroreceptors. A fully automated approach for tracer synthesis is highly desirable. This proposal involves the development of a system for the Synthesis of Tracers using Automated Radiochemistry and Robotics (STARR) for this purpose. While the long range objective of the proposed research is the development of a totally automated radiochemistry system for the production of major high specific activity 11 C-radiotracers for use in PET, the specific short range objectives are the automation of 11 C-methyl iodide ( 11 CH 3 I) production via an integrated approach using both radiochemistry modular labstations and robotics, and the extension of this automated capability to the production of several radiotracers for PET (initially, 11 C-methionine, 3-N-[ 11 C-methyl]spiperone, and [ 11 C]-carfentanil)

Evaluation of an automated breast 3D-ultrasound system by comparing it with hand-held ultrasound (HHUS) and mammography.

Science.gov (United States)

Golatta, Michael; Baggs, Christina; Schweitzer-Martin, Mirjam; Domschke, Christoph; Schott, Sarah; Harcos, Aba; Scharf, Alexander; Junkermann, Hans; Rauch, Geraldine; Rom, Joachim; Sohn, Christof; Heil, Joerg

2015-04-01

Automated three-dimensional (3D) breast ultrasound (US) systems are meant to overcome the shortcomings of hand-held ultrasound (HHUS). The aim of this study is to analyze and compare clinical performance of an automated 3D-US system by comparing it with HHUS, mammography and the clinical gold standard (defined as the combination of HHUS, mammography and-if indicated-histology). Nine hundred and eighty three patients (=1,966 breasts) were enrolled in this monocentric, explorative and prospective cohort study. All examinations were analyzed blinded to the patients´ history and to the results of the routine imaging. The agreement of automated 3D-US with HHUS, mammography and the gold standard was assessed with kappa statistics. Sensitivity, specificity and positive and negative predictive value were calculated to assess the test performance. Blinded to the results of the gold standard the agreement between automated 3D-US and HHUS or mammography was fair, given by a Kappa coefficient of 0.31 (95% CI [0.26;0.36], p automated 3D-US the sensitivity improved to 84% (NPV = 99%, specificity = 85%). The results of this study let us suggest, that automated 3D-US might be a helpful new tool in breast imaging, especially in screening.

Use of computed tomography and automated software for quantitative analysis of the vasculature of patients with pulmonary hypertension

Energy Technology Data Exchange (ETDEWEB)

Wada, Danilo Tadao; Pádua, Adriana Ignácio de; Lima Filho, Moyses Oliveira; Marin Neto, José Antonio; Elias Júnior, Jorge; Baddini-Martinez, José; Santos, Marcel Koenigkam, E-mail: danilowada@yahoo.com.br [Universidade de São Paulo (HCFMRP/USP), Ribeirão Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clínicas

2017-11-15

Objective: To perform a quantitative analysis of the lung parenchyma and pulmonary vasculature of patients with pulmonary hypertension (PH) on computed tomography angiography (CTA) images, using automated software. Materials And Methods: We retrospectively analyzed the CTA findings and clinical records of 45 patients with PH (17 males and 28 females), in comparison with a control group of 20 healthy individuals (7 males and 13 females); the mean age differed significantly between the two groups (53 ± 14.7 vs. 35 ± 9.6 years; p = 0.0001). Results: The automated analysis showed that, in comparison with the controls, the patients with PH showed lower 10{sup th} percentile values for lung density, higher vascular volumes in the right upper lung lobe, and higher vascular volume ratios between the upper and lower lobes. In our quantitative analysis, we found no differences among the various PH subgroups. We inferred that a difference in the 10{sup th} percentile values indicates areas of hypovolaemia in patients with PH and that a difference in pulmonary vascular volumes indicates redistribution of the pulmonary vasculature and an increase in pulmonary vasculature resistance. Conclusion: Automated analysis of pulmonary vessels on CTA images revealed alterations and could represent an objective diagnostic tool for the evaluation of patients with PH. (author)

Role for automated communication strategies in medication adherence management.

Science.gov (United States)

Ross, S Michael

2008-11-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

Inter-observer variability between radiologists reporting on cerebellopontine angle tumours on magnetic resonance imaging.

Science.gov (United States)

Teh, S R; Ranguis, S; Fagan, P

2017-01-01

Studies demonstrate the significance of intra- and inter-observer variability when measuring cerebellopontine angle tumours on magnetic resonance imaging, with measured differences as high as 2 mm. To determine intra- and inter-observer measurement variability of cerebellopontine angle tumours in a specialised institution. The magnetic resonance imaging maximal diameter of 12 randomly selected cerebellopontine angle tumours were independently measured by 4 neuroradiologists at a tertiary referral centre using a standard definition for maximal tumour diameter. Average deviation and intraclass correlation were subsequently calculated. Inter-observer difference averaged 0.33 ± 0.04 mm (range, 0.0-0.8 mm). Intra-observer measurements were more consistent than inter-observer measurements, with differences averaging 0.17 mm (95 per cent confidence interval = 0.27-0.06, p = 0.002). Inter-observer reliability was 0.99 (95 per cent confidence interval = 0.97-0.99), suggesting high reliability between the readings. The use of a standard definition for maximal tumour volume provided high reliability amongst radiologists' readings. To avoid oversizing tumours, it is recommended that conservative monitoring be conducted by the same institution with thin slice magnetic resonance imaging scans.

Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections

Energy Technology Data Exchange (ETDEWEB)

Lechmann, Marco; Rosskopf, Andrea; Ehrmann, Christine; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [University of Zuerich, Department of Radiology, Orthopaedic University Hospital Balgrist, Zuerich (Switzerland)

2016-12-15

To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis. A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall 'improvement' was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to 'improvement'. NRS change scores were compared to MRI findings with the unpaired t-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis. The only abnormality linked to 'improvement' (p = 0.03) and higher NRS change scores (p = 0.0001) at 1 month was the disc herniation morphology 'protrusion + sequestration'. Patients with degeneration by osteophytes (p = 0.034), grade 3 foraminal nerve root compression (p = 0.01) and foraminal/extraforaminal location of herniation (p = 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was 'fair' to 'substantial' depending on MRI findings. Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location. (orig.)

Toward designing for trust in database automation

Energy Technology Data Exchange (ETDEWEB)

Duez, P. P.; Jamieson, G. A. [Cognitive Engineering Laboratory, Univ. of Toronto, 5 King' s College Rd., Toronto, Ont. M5S 3G8 (Canada)

2006-07-01

Appropriate reliance on system automation is imperative for safe and productive work, especially in safety-critical systems. It is unsafe to rely on automation beyond its designed use; conversely, it can be both unproductive and unsafe to manually perform tasks that are better relegated to automated tools. Operator trust in automated tools mediates reliance, and trust appears to affect how operators use technology. As automated agents become more complex, the question of trust in automation is increasingly important. In order to achieve proper use of automation, we must engender an appropriate degree of trust that is sensitive to changes in operating functions and context. In this paper, we present research concerning trust in automation in the domain of automated tools for relational databases. Lee and See have provided models of trust in automation. One model developed by Lee and See identifies three key categories of information about the automation that lie along a continuum of attributional abstraction. Purpose-, process-and performance-related information serve, both individually and through inferences between them, to describe automation in such a way as to engender r properly-calibrated trust. Thus, one can look at information from different levels of attributional abstraction as a general requirements analysis for information key to appropriate trust in automation. The model of information necessary to engender appropriate trust in automation [1] is a general one. Although it describes categories of information, it does not provide insight on how to determine the specific information elements required for a given automated tool. We have applied the Abstraction Hierarchy (AH) to this problem in the domain of relational databases. The AH serves as a formal description of the automation at several levels of abstraction, ranging from a very abstract purpose-oriented description to a more concrete description of the resources involved in the automated process

Toward designing for trust in database automation

International Nuclear Information System (INIS)

Duez, P. P.; Jamieson, G. A.

2006-01-01

Appropriate reliance on system automation is imperative for safe and productive work, especially in safety-critical systems. It is unsafe to rely on automation beyond its designed use; conversely, it can be both unproductive and unsafe to manually perform tasks that are better relegated to automated tools. Operator trust in automated tools mediates reliance, and trust appears to affect how operators use technology. As automated agents become more complex, the question of trust in automation is increasingly important. In order to achieve proper use of automation, we must engender an appropriate degree of trust that is sensitive to changes in operating functions and context. In this paper, we present research concerning trust in automation in the domain of automated tools for relational databases. Lee and See have provided models of trust in automation. One model developed by Lee and See identifies three key categories of information about the automation that lie along a continuum of attributional abstraction. Purpose-, process-and performance-related information serve, both individually and through inferences between them, to describe automation in such a way as to engender r properly-calibrated trust. Thus, one can look at information from different levels of attributional abstraction as a general requirements analysis for information key to appropriate trust in automation. The model of information necessary to engender appropriate trust in automation [1] is a general one. Although it describes categories of information, it does not provide insight on how to determine the specific information elements required for a given automated tool. We have applied the Abstraction Hierarchy (AH) to this problem in the domain of relational databases. The AH serves as a formal description of the automation at several levels of abstraction, ranging from a very abstract purpose-oriented description to a more concrete description of the resources involved in the automated process

Inter-rater reliability of the Sødring Motor Evaluation of Stroke patients (SMES).

Science.gov (United States)

Halsaa, K E; Sødring, K M; Bjelland, E; Finsrud, K; Bautz-Holter, E

1999-12-01

The Sødring Motor Evaluation of Stroke patients is an instrument for physiotherapists to evaluate motor function and activities in stroke patients. The rating reflects quality as well as quantity of the patient's unassisted performance within three domains: leg, arm and gross function. The inter-rater reliability of the method was studied in a sample of 30 patients admitted to a stroke rehabilitation unit. Three therapists were involved in the study; two therapists assessed the same patient on two consecutive days in a balanced design. Cohen's weighted kappa and McNemar's test of symmetry were used as measures of item reliability, and the intraclass correlation coefficient was used to express the reliability of the sumscores. For 24 out of 32 items the weighted kappa statistic was excellent (0.75-0.98), while 7 items had a kappa statistic within the range 0.53-0.74 (fair to good). The reliability of one item was poor (0.13). The intraclass correlation coefficient for the three sumscores was 0.97, 0.91 and 0.97. We conclude that the Sødring Motor Evaluation of Stroke patients is a reliable measure of motor function in stroke patients undergoing rehabilitation.

Automated nuclear materials accounting

International Nuclear Information System (INIS)

Pacak, P.; Moravec, J.

1982-01-01

An automated state system of accounting for nuclear materials data was established in Czechoslovakia in 1979. A file was compiled of 12 programs in the PL/1 language. The file is divided into four groups according to logical associations, namely programs for data input and checking, programs for handling the basic data file, programs for report outputs in the form of worksheets and magnetic tape records, and programs for book inventory listing, document inventory handling and materials balance listing. A similar automated system of nuclear fuel inventory for a light water reactor was introduced for internal purposes in the Institute of Nuclear Research (UJV). (H.S.)

Limits to the introduction of market institutions in a sector of income

International Nuclear Information System (INIS)

Locatelli, C.; Finon, D.

2003-01-01

This article uses an empirical study to test the validity of the liberal approach of market transition. The example chosen is the reform (privatization) of the Russian hydrocarbons industry. This case has been chosen because it represents an extreme case of inadequateness of the measures preconized by the Washington consensus with respect to the institutional environment. It represents also a typical case of opportunistic adaptation of the behaviour of private and government actors to the rough enforcement of market institutions to a very specific institutional environment. The inadequateness of these institutions with the initial informal institutions has led to adaptations totally dependent of the institutional path with the necessity of preserving a minimum inter-industrial consistency. On the other hand, it seems that the uncertainty about the property rights in general is tightly correlated with the abundance of exploitable and exportable natural resources. (J.S.)

Impact of diastolic dysfunction severity on global left ventricular volumetric filling - assessment by automated segmentation of routine cine cardiovascular magnetic resonance

Directory of Open Access Journals (Sweden)

Mendoza Dorinna D

2010-07-01

Full Text Available Abstract Objectives To examine relationships between severity of echocardiography (echo -evidenced diastolic dysfunction (DD and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR. Background Cine-CMR provides high-resolution assessment of left ventricular (LV chamber volumes. Automated segmentation (LV-METRIC yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD. Methods 115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR, time to peak filling rate (TPFR, and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume. Echo was the reference for DD. Results LV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (≤ 1% inter-reader differences and required minimal processing time (175 ± 34 images/exam, 2:09 ± 0:51 minutes. CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p 80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%. The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001 with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06, whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02 DD. Conclusions Automated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged

Population genetic analysis and evidence of inter-specific introgression in Helichrysum armenium and H. rubicundum (Asteraceae

Directory of Open Access Journals (Sweden)

Taban Malahat

2015-01-01

Full Text Available Helichrysum armenium and H. rubicundum are two medicinally important plants of Iran that are distributed in various regions of the country. They are extensively used by locals as medicinal plants and a great negative selection pressure is applied on them. Therefore, due to importance of these plant species, we performed a population genetic study in both species. For this study, we used 66 randomly collected plants from 24 geographical populations of Helichrysum armenium and H. rubicundu. These species had areas of overlap and contact and we found some intermediate plants that were included in our study too. UPGMA and MDS analyses revealed morphological separation of these closely related species and placed intermediate plants in an intermediate position. ISSR analysis revealed inter-population genetic diversity and K-Means clustering and STRUCTURE analyses revealed populations. Genetic stratification in both species. Genetic difference of the studied populations was not correlated to geographical distance. Triangle plot of Bayesian analysis and NeighborNet plot showed inter-specific gene flow. The studied populations showed plants with 2n = 2x = 14 and 2n = 4x = 28 chromosomes and differed significantly in their meiotic behavior. Therefore, a combination of genetic stratification, and genetic admixture as well as polyploidy and chromosomes structural changes, have played rule in Helichrysum diversification.

Inter-rater and intra-rater reliability of a movement control test in shoulder.

Science.gov (United States)

Rajasekar, S; Bangera, Rakshith K; Sekaran, Padmanaban

2017-07-01

Movement faults are commonly observed in patients with musculoskeletal pain. The Kinetic Medial Rotation Test (KMRT) is a movement control test used to identify movement faults of the scapula and gleno-humeral joints during arm movement. Objective tests such as the KMRT need to be reliable and valid for the results to be applied across different clinical settings and patient populations. The primary objective of the present study was to determine the intra-rater and inter-rater reliability of KMRT in subjects with and without shoulder pain. Sixty subjects were included in this study based on specific inclusion and exclusion criteria. Two musculoskeletal physiotherapists with different levels of clinical experience performed the tests. The intra-rater reliability was tested in twenty asymptomatic subjects by a single assessor at two week intervals. An equal number of subjects with and without shoulder pain were tested by both the assessors to determine the inter-rater reliability. Both components of the KMRT, the Gleno- Humeral Anterior Translation (GHAT) and the Scapular Forward Tilt (SCFT) were tested. The Kappa values for inter-rater reliability of the GHAT and SCFT were K = 0.68 & K = 0.65 respectively in subjects with shoulder pain. In asymptomatic subjects, the inter-rater reliability of GHAT was K = 0.61 and SCFT was K = 0.85. Intra-rater reliability ranged from K = 0.66 for GHAT to K = 0.87 for SCFT. Our study found substantial agreement in inter-rater reliability of KMRT in subjects with shoulder pain, whereas substantial to near perfect agreement was found in intra-rater and inter-rater reliability of KMRT in subjects without shoulder pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Automation of metabolic stability studies in microsomes, cytosol and plasma using a 215 Gilson liquid handler.

Science.gov (United States)

Linget, J M; du Vignaud, P

1999-05-01

A 215 Gilson liquid handler was used to automate enzymatic incubations using microsomes, cytosol and plasma. The design of automated protocols are described. They were based on the use of 96 deep well plates and on HPLC-based methods for assaying the substrate. The assessment of those protocols was made with comparison between manual and automated incubations, reliability and reproducibility of automated incubations in microsomes and cytosol. Examples of the use of those programs in metabolic studies in drug research, i.e. metabolic screening in microsomes and plasma were shown. Even rapid processes (with disappearance half lives as low as 1 min) can be analysed. This work demonstrates how stability studies can be automated to save time, render experiments involving human biological media less hazardous and may be improve inter-laboratory reproducibility.

CCD characterization and measurements automation

Czech Academy of Sciences Publication Activity Database

Kotov, I.V.; Frank, J.; Kotov, A.I.; Kubánek, Petr; O´Connor, P.; Prouza, Michael; Radeka, V.; Takacs, P.

2012-01-01

Roč. 695, Dec (2012), 188-192 ISSN 0168-9002 R&D Projects: GA MŠk ME09052 Institutional research plan: CEZ:AV0Z10100502 Keywords : CCD * characterization * test automation Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 1.142, year: 2012

Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

Science.gov (United States)

Polistena, Andrea; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka; Jeppsson, Bengt; Avenia, Nicola

2017-02-01

Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

Implementation and evaluation of an automated dispensing system.

Science.gov (United States)

Schwarz, H O; Brodowy, B A

1995-04-15

An institution's experience in replacing a traditional unit dose cassette-exchange system with an automated dispensing system is described. A 24-hour unit dose cassette-exchange system was replaced with an automated dispensing system (Pyxis's Medstation Rx) on a 36-bed cardiovascular surgery unit and an 8-bed cardiovascular intensive care unit. Significantly fewer missing doses were reported after Medstation Rx was implemented. No conclusions could be made about the impact of the system on the reporting of medication errors. The time savings for pharmacy associated with the filling, checking, and delivery of new medication orders equated to about 0.5 full-time equivalent (FTE). Medstation Rx also saved substantial nursing time for acquisition of controlled substances and for controlled-substance inventory taking at shift changes. A financial analysis showed that Medstation Rx could save the institution about $1 million over five years if all personnel time savings could be translated into FTE reductions. The automated system was given high marks by the nurses in a survey; 80% wanted to keep the system on their unit. Pilot implementation of an automated dispensing system improved the efficiency of drug distribution over that of the traditional unit dose cassette-exchange system.

Automated estimation of defects in magnetographic defectoscopy. 1. Automated magnetographic flow detectors

International Nuclear Information System (INIS)

Mikhajlov, S.P.; Vaulin, S.L.; Shcherbinin, V.E.; Shur, M.L.

1993-01-01

Consideration is given to specific features and possible functions of equipment for automated estimation of stretched continuity defects for samples with plane surface in magnetographic defectoscopy are discussed. Two models of automated magnetographic flow detectors, those with built-in microcomputer and in the form computer attachment, are described. Directions of further researches and development are discussed. 35 refs., 6 figs

Automated identification of the lung contours in positron emission tomography

International Nuclear Information System (INIS)

Nery, F; Ferreira, N C; Faustino, R; Silva, J Silvestre; Caramelo, F J

2013-01-01

Positron Emission Tomography (PET) is a nuclear medicine imaging technique that permits to analyze, in three dimensions, the physiological processes in vivo. One of the areas where PET has demonstrated its advantages is in the staging of lung cancer, where it offers better sensitivity and specificity than other techniques such as CT. On the other hand, accurate segmentation, an important procedure for Computer Aided Diagnostics (CAD) and automated image analysis, is a challenging task given the low spatial resolution and the high noise that are intrinsic characteristics of PET images. This work presents an algorithm for the segmentation of lungs in PET images, to be used in CAD and group analysis in a large patient database. The lung boundaries are automatically extracted from a PET volume through the application of a marker-driven watershed segmentation procedure which is robust to the noise. In order to test the effectiveness of the proposed method, we compared the segmentation results in several slices using our approach with the results obtained from manual delineation. The manual delineation was performed by nuclear medicine physicians that used a software routine that we developed specifically for this task. To quantify the similarity between the contours obtained from the two methods, we used figures of merit based on region and also on contour definitions. Results show that the performance of the algorithm was similar to the performance of human physicians. Additionally, we found that the algorithm-physician agreement is similar (statistically significant) to the inter-physician agreement.

Invention and validation of an automated camera system that uses optical character recognition to identify patient name mislabeled samples.

Science.gov (United States)

Hawker, Charles D; McCarthy, William; Cleveland, David; Messinger, Bonnie L

2014-03-01

Mislabeled samples are a serious problem in most clinical laboratories. Published error rates range from 0.39/1000 to as high as 1.12%. Standardization of bar codes and label formats has not yet achieved the needed improvement. The mislabel rate in our laboratory, although low compared with published rates, prompted us to seek a solution to achieve zero errors. To reduce or eliminate our mislabeled samples, we invented an automated device using 4 cameras to photograph the outside of a sample tube. The system uses optical character recognition (OCR) to look for discrepancies between the patient name in our laboratory information system (LIS) vs the patient name on the customer label. All discrepancies detected by the system's software then require human inspection. The system was installed on our automated track and validated with production samples. We obtained 1 009 830 images during the validation period, and every image was reviewed. OCR passed approximately 75% of the samples, and no mislabeled samples were passed. The 25% failed by the system included 121 samples actually mislabeled by patient name and 148 samples with spelling discrepancies between the patient name on the customer label and the patient name in our LIS. Only 71 of the 121 mislabeled samples detected by OCR were found through our normal quality assurance process. We have invented an automated camera system that uses OCR technology to identify potential mislabeled samples. We have validated this system using samples transported on our automated track. Full implementation of this technology offers the possibility of zero mislabeled samples in the preanalytic stage.

Automated quantification of proliferation with automated hot-spot selection in phosphohistone H3/MART1 dual-stained stage I/II melanoma.

Science.gov (United States)

Nielsen, Patricia Switten; Riber-Hansen, Rikke; Schmidt, Henrik; Steiniche, Torben

2016-04-09

Staging of melanoma includes quantification of a proliferation index, i.e., presumed melanocytic mitoses of H&E stains are counted manually in hot spots. Yet, its reproducibility and prognostic impact increases by immunohistochemical dual staining for phosphohistone H3 (PHH3) and MART1, which also may enable fully automated quantification by image analysis. To ensure manageable workloads and repeatable measurements in modern pathology, the study aimed to present an automated quantification of proliferation with automated hot-spot selection in PHH3/MART1-stained melanomas. Formalin-fixed, paraffin-embedded tissue from 153 consecutive stage I/II melanoma patients was immunohistochemically dual-stained for PHH3 and MART1. Whole slide images were captured, and the number of PHH3/MART1-positive cells was manually and automatically counted in the global tumor area and in a manually and automatically selected hot spot, i.e., a fixed 1-mm(2) square. Bland-Altman plots and hypothesis tests compared manual and automated procedures, and the Cox proportional hazards model established their prognostic impact. The mean difference between manual and automated global counts was 2.9 cells/mm(2) (P = 0.0071) and 0.23 cells per hot spot (P = 0.96) for automated counts in manually and automatically selected hot spots. In 77 % of cases, manual and automated hot spots overlapped. Fully manual hot-spot counts yielded the highest prognostic performance with an adjusted hazard ratio of 5.5 (95 % CI, 1.3-24, P = 0.024) as opposed to 1.3 (95 % CI, 0.61-2.9, P = 0.47) for automated counts with automated hot spots. The automated index and automated hot-spot selection were highly correlated to their manual counterpart, but altogether their prognostic impact was noticeably reduced. Because correct recognition of only one PHH3/MART1-positive cell seems important, extremely high sensitivity and specificity of the algorithm is required for prognostic purposes. Thus, automated

Study radiolabeling of urea-based PSMA inhibitor with 68-Galliu: Comparative evaluation of automated and not automated methods

International Nuclear Information System (INIS)

Alcarde, Lais Fernanda

2016-01-01

The methods for clinical diagnosis of prostate cancer include rectal examination and the dosage of the prostatic specific antigen (PSA). However, the PSA level is elevated in about 20 to 30% of cases related to benign pathologies, resulting in false positives and leading patients to unnecessary biopsies. The prostate specific membrane antigen (PSMA), in contrast, is over expressed in prostate cancer and founded at low levels in healthy organs. As a result, it stimulated the development of small molecule inhibitors of PSMA, which carry imaging agents to the tumor and are not affected by their microvasculature. Recent studies suggest that the HBED-CC chelator intrinsically contributes to the binding of the PSMA inhibitor peptide based on urea (Glu-urea-Lys) to the pharmacophore group. This work describes the optimization of radiolabeling conditions of PSMA-HBED-CC with "6"8Ga, using automated system (synthesis module) and no automated method, seeking to establish an appropriate condition to prepare this new radiopharmaceutical, with emphasis on the labeling yield and radiochemical purity of the product. It also aimed to evaluate the stability of the radiolabeled peptide in transport conditions and study the biological distribution of the radiopharmaceutical in healthy mice. The study of radiolabeling parameters enabled to define a non-automated method which resulted in high radiochemical purity (> 95 %) without the need for purification of the labeled peptide. The automated method has been adapted, using a module of synthesis and software already available at IPEN, and also resulted in high synthetic yield (≥ 90%) specially when compared with those described in the literature, with the associated benefit of greater control of the production process in compliance with Good Manufacturing Practices. The study of radiolabeling parameters afforded the PSMA-HBED-CC-"6"8Ga with higher specific activity than observed in published clinical studies (≥ 140,0 GBq

Automated Test-Form Generation

Science.gov (United States)

van der Linden, Wim J.; Diao, Qi

2011-01-01

In automated test assembly (ATA), the methodology of mixed-integer programming is used to select test items from an item bank to meet the specifications for a desired test form and optimize its measurement accuracy. The same methodology can be used to automate the formatting of the set of selected items into the actual test form. Three different…

Adrenal gland volume measurement in septic shock and control patients: a pilot study

Energy Technology Data Exchange (ETDEWEB)

Nougaret, Stephanie; Aufort, S.; Gallix, B. [Hopital Saint Eloi, Department of Abdominal Imaging, CHU Montpellier, Montpellier, Cedex 5 (France); Jung, B.; Chanques, G.; Jaber, S. [Hopital Saint Eloi, Intensive Care Unit, Department of Critical Care and Anesthesiology: DAR B, CHU Montpellier, Montpellier, Cedex 5 (France)

2010-10-15

To compare adrenal gland volume in septic shock patients and control patients by using semi-automated volumetry. Adrenal gland volume and its inter-observer variability were measured with tomodensitometry using semi-automated software in 104 septic shock patients and in 40 control patients. The volumes of control and septic shock patients were compared and the relationship between volume and outcome in intensive care was studied. The mean total volume of both adrenal glands was 7.2 {+-} 2.0 cm{sup 3} in control subjects and 13.3 {+-} 4.7 cm{sup 3} for total adrenal gland volume in septic shock patients (p < 0.0001). Measurement reproducibility was excellent with a concordance correlation coefficient value of 0.87. The increasing adrenal gland volume was associated with a higher rate of survival in intensive care. The present study reports that with semi-automated software, adrenal gland volume can be measured easily and reproducibly. Adrenal gland volume was found to be nearly double in sepsis compared with control patients. The absence of increased volume during sepsis would appear to be associated with a higher rate of mortality and may represent a prognosis factor which may help the clinician to guide their strategy. (orig.)

Adrenal gland volume measurement in septic shock and control patients: a pilot study

International Nuclear Information System (INIS)

Nougaret, Stephanie; Aufort, S.; Gallix, B.; Jung, B.; Chanques, G.; Jaber, S.

2010-01-01

To compare adrenal gland volume in septic shock patients and control patients by using semi-automated volumetry. Adrenal gland volume and its inter-observer variability were measured with tomodensitometry using semi-automated software in 104 septic shock patients and in 40 control patients. The volumes of control and septic shock patients were compared and the relationship between volume and outcome in intensive care was studied. The mean total volume of both adrenal glands was 7.2 ± 2.0 cm 3 in control subjects and 13.3 ± 4.7 cm 3 for total adrenal gland volume in septic shock patients (p < 0.0001). Measurement reproducibility was excellent with a concordance correlation coefficient value of 0.87. The increasing adrenal gland volume was associated with a higher rate of survival in intensive care. The present study reports that with semi-automated software, adrenal gland volume can be measured easily and reproducibly. Adrenal gland volume was found to be nearly double in sepsis compared with control patients. The absence of increased volume during sepsis would appear to be associated with a higher rate of mortality and may represent a prognosis factor which may help the clinician to guide their strategy. (orig.)

Fluoroscopically guided automated gun biopsy of chest lesions: diagnostic accuracy and complications

International Nuclear Information System (INIS)

Oh, Hee Sul; Han, Young Min; Choi, Ki Chul and others

1998-01-01

To determine the diagnostic accuracy and frequency of complications of fluoroscopyguided transthoracic needle biopsy, using an automated gun biopsy system. We retrospectively reviewed 86 patients who underwent automated gun biopsy between October 1995 and October 1996. An 18-gauge cutting needle was used in all cases. All biopsies were performed under fluoroscopic guidance by one interventional radiologist. Tissue sufficient for histologic diagnosis was obtained in 73 of 86 biopsies(84.9%). Fifty-six lesions were malignent and 30 were benign. Sensitivity and diagnostic accuracy for malignant lesions were 87.5% and 87.5%, respectively while cell type specificity in malignant diagnosis was 91.7%(11/12). Sensitivity and diagnostic accuracy for benign lesions were 80.0% and 73.3%, respectively. Postbioptic pneumothorax occurred in three of 86 biopsies(3.5%), one of which required placement of a chest tube. Automated gun biopsy is a simple, safe method for the diagnosis of focal chest lesions. An automated biopsy device offers high diagnostic accuracy in casis involving malignant and benign lesions of the chest, and is particularly useful for determining malignant cell type and specific diagnosis of benign lesions.=20

Automated multi-lesion detection for referable diabetic retinopathy in indigenous health care.

Directory of Open Access Journals (Sweden)

Ramon Pires

Full Text Available Diabetic Retinopathy (DR is a complication of diabetes mellitus that affects more than one-quarter of the population with diabetes, and can lead to blindness if not discovered in time. An automated screening enables the identification of patients who need further medical attention. This study aimed to classify retinal images of Aboriginal and Torres Strait Islander peoples utilizing an automated computer-based multi-lesion eye screening program for diabetic retinopathy. The multi-lesion classifier was trained on 1,014 images from the São Paulo Eye Hospital and tested on retinal images containing no DR-related lesion, single lesions, or multiple types of lesions from the Inala Aboriginal and Torres Strait Islander health care centre. The automated multi-lesion classifier has the potential to enhance the efficiency of clinical practice delivering diabetic retinopathy screening. Our program does not necessitate image samples for training from any specific ethnic group or population being assessed and is independent of image pre- or post-processing to identify retinal lesions. In this Aboriginal and Torres Strait Islander population, the program achieved 100% sensitivity and 88.9% specificity in identifying bright lesions, while detection of red lesions achieved a sensitivity of 67% and specificity of 95%. When both bright and red lesions were present, 100% sensitivity with 88.9% specificity was obtained. All results obtained with this automated screening program meet WHO standards for diabetic retinopathy screening.

Note: Digital laser frequency auto-locking for inter-satellite laser ranging.

Science.gov (United States)

Luo, Yingxin; Li, Hongyin; Yeh, Hsien-Chi

2016-05-01

We present a prototype of a laser frequency auto-locking and re-locking control system designed for laser frequency stabilization in inter-satellite laser ranging system. The controller has been implemented on field programmable gate arrays and programmed with LabVIEW software. The controller allows initial frequency calibrating and lock-in of a free-running laser to a Fabry-Pérot cavity. Since it allows automatic recovery from unlocked conditions, benefit derives to automated in-orbit operations. Program design and experimental results are demonstrated.

Note: Digital laser frequency auto-locking for inter-satellite laser ranging

International Nuclear Information System (INIS)

Luo, Yingxin; Yeh, Hsien-Chi; Li, Hongyin

2016-01-01

We present a prototype of a laser frequency auto-locking and re-locking control system designed for laser frequency stabilization in inter-satellite laser ranging system. The controller has been implemented on field programmable gate arrays and programmed with LabVIEW software. The controller allows initial frequency calibrating and lock-in of a free-running laser to a Fabry-Pérot cavity. Since it allows automatic recovery from unlocked conditions, benefit derives to automated in-orbit operations. Program design and experimental results are demonstrated.

Note: Digital laser frequency auto-locking for inter-satellite laser ranging

Energy Technology Data Exchange (ETDEWEB)

Luo, Yingxin; Yeh, Hsien-Chi, E-mail: yexianji@mail.hust.edu.cn [MOE Key Laboratory of Fundamental Quantities Measurement, School of Physics, Huazhong University of Science and Technology, Wuhan 430074 (China); Li, Hongyin [MOE Key Laboratory of Fundamental Quantities Measurement, School of Physics, Huazhong University of Science and Technology, Wuhan 430074 (China); School of Automation, Huazhong University of Science and Technology, Wuhan 430074 (China)

2016-05-15

We present a prototype of a laser frequency auto-locking and re-locking control system designed for laser frequency stabilization in inter-satellite laser ranging system. The controller has been implemented on field programmable gate arrays and programmed with LabVIEW software. The controller allows initial frequency calibrating and lock-in of a free-running laser to a Fabry-Pérot cavity. Since it allows automatic recovery from unlocked conditions, benefit derives to automated in-orbit operations. Program design and experimental results are demonstrated.

75 FR 80335 - Federal Government Participation in the Automated Clearing House

Science.gov (United States)

2010-12-22

... Participation in the Automated Clearing House AGENCY: Financial Management Service, Fiscal Service, Treasury...) is amending its regulation governing the use of the Automated Clearing House (ACH) system by Federal... institutions, consumer advocacy groups, industry associations, the Senate Committee on Finance and the House...

Application of a path sensitizing method on automated generation of test specifications for control software

International Nuclear Information System (INIS)

Morimoto, Yuuichi; Fukuda, Mitsuko

1995-01-01

An automated generation method for test specifications has been developed for sequential control software in plant control equipment. Sequential control software can be represented as sequential circuits. The control software implemented in a control equipment is designed from these circuit diagrams. In logic tests of VLSI's, path sensitizing methods are widely used to generate test specifications. But the method generates test specifications at a single time only, and can not be directly applied to sequential control software. The basic idea of the proposed method is as follows. Specifications of each logic operator in the diagrams are defined in the software design process. Therefore, test specifications of each operator in the control software can be determined from these specifications, and validity of software can be judged by inspecting all of the operators in the logic circuit diagrams. Candidates for sensitized paths, on which test data for each operator propagates, can be generated by the path sensitizing method. To confirm feasibility of the method, it was experimentally applied to control software in digital control equipment. The program could generate test specifications exactly, and feasibility of the method was confirmed. (orig.) (3 refs., 7 figs.)

Simulated patient training: Using inter-rater reliability to evaluate simulated patient consistency in nursing education.

Science.gov (United States)

MacLean, Sharon; Geddes, Fiona; Kelly, Michelle; Della, Phillip

2018-03-01

Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances. The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs. A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS. Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills. The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Automated diabetic retinopathy detection in smartphone-based fundus photography using artificial intelligence.

Science.gov (United States)

Rajalakshmi, Ramachandran; Subashini, Radhakrishnan; Anjana, Ranjit Mohan; Mohan, Viswanathan

2018-06-01

To assess the role of artificial intelligence (AI)-based automated software for detection of diabetic retinopathy (DR) and sight-threatening DR (STDR) by fundus photography taken using a smartphone-based device and validate it against ophthalmologist's grading. Three hundred and one patients with type 2 diabetes underwent retinal photography with Remidio 'Fundus on phone' (FOP), a smartphone-based device, at a tertiary care diabetes centre in India. Grading of DR was performed by the ophthalmologists using International Clinical DR (ICDR) classification scale. STDR was defined by the presence of severe non-proliferative DR, proliferative DR or diabetic macular oedema (DME). The retinal photographs were graded using a validated AI DR screening software (EyeArt TM ) designed to identify DR, referable DR (moderate non-proliferative DR or worse and/or DME) or STDR. The sensitivity and specificity of automated grading were assessed and validated against the ophthalmologists' grading. Retinal images of 296 patients were graded. DR was detected by the ophthalmologists in 191 (64.5%) and by the AI software in 203 (68.6%) patients while STDR was detected in 112 (37.8%) and 146 (49.3%) patients, respectively. The AI software showed 95.8% (95% CI 92.9-98.7) sensitivity and 80.2% (95% CI 72.6-87.8) specificity for detecting any DR and 99.1% (95% CI 95.1-99.9) sensitivity and 80.4% (95% CI 73.9-85.9) specificity in detecting STDR with a kappa agreement of k = 0.78 (p < 0.001) and k = 0.75 (p < 0.001), respectively. Automated AI analysis of FOP smartphone retinal imaging has very high sensitivity for detecting DR and STDR and thus can be an initial tool for mass retinal screening in people with diabetes.

An Automated Quiet Sleep Detection Approach in Preterm Infants as a Gateway to Assess Brain Maturation.

Science.gov (United States)

Dereymaeker, Anneleen; Pillay, Kirubin; Vervisch, Jan; Van Huffel, Sabine; Naulaers, Gunnar; Jansen, Katrien; De Vos, Maarten

2017-09-01

Sleep state development in preterm neonates can provide crucial information regarding functional brain maturation and give insight into neurological well being. However, visual labeling of sleep stages from EEG requires expertise and is very time consuming, prompting the need for an automated procedure. We present a robust method for automated detection of preterm sleep from EEG, over a wide postmenstrual age ([Formula: see text] age) range, focusing first on Quiet Sleep (QS) as an initial marker for sleep assessment. Our algorithm, CLuster-based Adaptive Sleep Staging (CLASS), detects QS if it remains relatively more discontinuous than non-QS over PMA. CLASS was optimized on a training set of 34 recordings aged 27-42 weeks PMA, and performance then assessed on a distinct test set of 55 recordings of the same age range. Results were compared to visual QS labeling from two independent raters (with inter-rater agreement [Formula: see text]), using Sensitivity, Specificity, Detection Factor ([Formula: see text] of visual QS periods correctly detected by CLASS) and Misclassification Factor ([Formula: see text] of CLASS-detected QS periods that are misclassified). CLASS performance proved optimal across recordings at 31-38 weeks (median [Formula: see text], median MF 0-0.25, median Sensitivity 0.93-1.0, and median Specificity 0.80-0.91 across this age range), with minimal misclassifications at 35-36 weeks (median [Formula: see text]). To illustrate the potential of CLASS in facilitating clinical research, normal maturational trends over PMA were derived from CLASS-estimated QS periods, visual QS estimates, and nonstate specific periods (containing QS and non-QS) in the EEG recording. CLASS QS trends agreed with those from visual QS, with both showing stronger correlations than nonstate specific trends. This highlights the benefit of automated QS detection for exploring brain maturation.

E-health, phase two: the imperative to integrate process automation with communication automation for large clinical reference laboratories.

Science.gov (United States)

White, L; Terner, C

2001-01-01

The initial efforts of e-health have fallen far short of expectations. They were buoyed by the hype and excitement of the Internet craze but limited by their lack of understanding of important market and environmental factors. E-health now recognizes that legacy systems and processes are important, that there is a technology adoption process that needs to be followed, and that demonstrable value drives adoption. Initial e-health transaction solutions have targeted mostly low-cost problems. These solutions invariably are difficult to integrate into existing systems, typically requiring manual interfacing to supported processes. This limitation in particular makes them unworkable for large volume providers. To meet the needs of these providers, e-health companies must rethink their approaches, appropriately applying technology to seamlessly integrate all steps into existing business functions. E-automation is a transaction technology that automates steps, integration of steps, and information communication demands, resulting in comprehensive automation of entire business functions. We applied e-automation to create a billing management solution for clinical reference laboratories. Large volume, onerous regulations, small margins, and only indirect access to patients challenge large laboratories' billing departments. Couple these problems with outmoded, largely manual systems and it becomes apparent why most laboratory billing departments are in crisis. Our approach has been to focus on the most significant and costly problems in billing: errors, compliance, and system maintenance and management. The core of the design relies on conditional processing, a "universal" communications interface, and ASP technologies. The result is comprehensive automation of all routine processes, driving out errors and costs. Additionally, compliance management and billing system support and management costs are dramatically reduced. The implications of e-automated processes can extend

Medizinbibliotheken: inter:disziplinär – inter:national –inter:aktiv

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Bauer, Bruno

2017-12-01

Full Text Available The focus of the current issue 3/2017 of GMS Medizin – Bibliothek – Information is the annual conference 2017 of the German Medical Libraries Association in Vienna. The motto of the conference was “Medical Libraries: inter:disciplinary – inter:national – inter:active”. The authors in this issue are Bruno Bauer (Austrian Transition to Open Access 2017–2020, Beata Górczynska (Development and structure of Polish veterinary school system and its libraries, Katharina Heldt, Henriette Senst & Jessica Riedel (Salon on the institute’s history: outstanding artifacts. 28.01.2016 to 15.12.2016, Jutta Matrisciano, Martina Semmler-Schmetz & Saskia Rohmer (Advice – From info snack to special menu: Solutions of the MedMA-Bib, Stefan Nortmann (The ‘Ersti-Café’ of the Medical Branch Library Münster, Sandra Rümmele (Toolbox: The new teaching library project of the Central Medical Library of the University Medical Center Hamburg-Eppendorf, Eva Seidlmayer & Christoph Poley (One Health – Transdisciplinarity at ZB MED and Heike Andermann (“Medical Libraries: inter:disciplinary – inter:national – inter:active”. Annual Meeting of the German Medical Library Association (AGMB, September 25 to 27, 2017 in Vienna. Furthermore this focus issue features articles from Stefan Grün & Christoph Poley (Statistical evaluation of semantic entities from metadata and full text on German Medical Science corpora and Iris Reimann (German MLA News; Competition of the German MLA Pioneer projects in medical libraries 2017: Introduction of the winners; Competition of the German MLA (AGMB Pioneer projects in medical libraries 2018 – Announcement.

Respiratory gated radiotherapy-pretreatment patient specific quality assurance

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Rajesh Thiyagarajan

2016-01-01

Full Text Available Organ motions during inter-fraction and intra-fraction radiotherapy introduce errors in dose delivery, irradiating excess of normal tissue, and missing target volume. Lung and heart involuntary motions cause above inaccuracies and gated dose delivery try to overcome above effects. Present work attempts a novel method to verify dynamic dose delivery using a four-dimensional (4D phantom. Three patients with mobile target are coached to maintain regular and reproducible breathing pattern. Appropriate intensity projection image set generated from 4D-computed tomography (4D-CT is used for target delineation. Intensity modulated radiotherapy plans were generated on selected phase using CT simulator (Siemens AG, Germany in conjunction with "Real-time position management" (Varian, USA to acquire 4D-CT images. Verification plans were generated for both ion chamber and Gafchromic (EBT film image sets. Gated verification plans were delivered on the phantom moving with patient respiratory pattern. We developed a MATLAB-based software to generate maximum intensity projection, minimum intensity projections, and average intensity projections, also a program to convert patient breathing pattern to phantom compatible format. Dynamic thorax quality assurance (QA phantom (Computerized Imaging Reference Systems type is used to perform the patient specific QA, which holds an ion chamber and film to measure delivered radiation intensity. Exposed EBT films are analyzed and compared with treatment planning system calculated dose. The ion chamber measured dose shows good agreement with planned dose within ± 0.5% (0.203 ± 0.57%. Gamma value evaluated from EBT film shows passing rates 92–99% (96.63 ± 3.84% for 3% dose and 3 mm distance criteria. Respiratory gated treatment delivery accuracy is found to be within clinically acceptable level.

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

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Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

2017-01-01

Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold

Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

Science.gov (United States)

Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

2018-04-01

Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

Intensity modulated proton therapy and its sensitivity to treatment uncertainties 2: the potential effects of inter-fraction and inter-field motions

International Nuclear Information System (INIS)

Lomax, A J

2008-01-01

Simple tools for studying the effects of inter-fraction and inter-field motions on intensity modulated proton therapy (IMPT) plans have been developed, and have been applied to both 3D and distal edge tracking (DET) IMPT plans. For the inter-fraction motion, we have investigated the effects of misaligned density heterogeneities, whereas for the inter-field motion analysis, the effects of field misalignment on the plans have been assessed. Inter-fraction motion problems have been analysed using density differentiated error (DDE) distributions, which specifically show the additional problems resulting from misaligned density heterogeneities for proton plans. Likewise, for inter-field motion, we present methods for calculating motion differentiated error (MDE) distributions. DDE and MDE analysis of all plans demonstrate that the 3D approach is generally more robust to both inter-fraction and inter-field motions than the DET approach, but that strong in-field dose gradients can also adversely affect a plan's robustness. An important additional conclusion is that, for certain IMPT plans, even inter-fraction errors cannot necessarily be compensated for by the use of a simple PTV margins, implying that more sophisticated tools need to be developed for uncertainty management and assessment for IMPT treatments at the treatment planning level

CONCEPT AND STRUCTURE OF AUTOMATED SYSTEM FOR MONITORING STUDENT LEARNING QUALITY

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M. Yu. Kataev

2017-01-01

Full Text Available Introduction. Implementing new educational standards and a multistage system of training of specialists at the higher school meant, inter alia, reconsideration of approaches to assessment of students’ learning quality. Nevertheless, development of organizational-methodical tools and content of control procedures in most higher education institutions is still focused on a traditional formative (spot, local knowledge assessment. It is obvious that changed economic, social and educational conditions of professionalization (mastering a certain profession and self-realization in it require a search for more adequate new means and measurement methods of education results got by students. According to the authors of the present article, development of a digital information system of control is necessary. Such a digital information system of control has to take intoaccount the features of educational process of concrete higher education institution; then, continuous accumulation and analysis of all types and forms of personal certification and assessment of educational activity of each student.The aim of the publication is the development of an automated software system for quality education assessments, taking into account the use of Avatar technology.Methodology and research methods. The methods involve: analytical review of scientific-methodological literature and documentation on the organization of assessment of quality education assessments in higher education institutions; analysis and synthesis of experience of application of the techniques developed on the basis of the balanced system estimated indicators (BSC, ISO standards, the EFQM Excellence Model, CIPP evaluation model, international quality standards ESG ENQA, TQM, CATS, etc. System and activity approaches were adopted as methodological base when creating automated program system.Results and scientific novelty. A block diagram of the learning process is presented; it demonstrates

Automated registration of tail bleeding in rats.

Science.gov (United States)

Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

2008-05-01

An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.

Comparison of Six Automated Treponema-Specific Antibody Assays.

Science.gov (United States)

Park, Borae G; Yoon, Jihoon G; Rim, John Hoon; Lee, Anna; Kim, Hyon-Suk

2016-01-01

Six different Treponema (TP)-specific immunoassays were compared to the fluorescent treponemal antibody absorption (FTA-ABS) test. A total of 615 samples were tested. The overall percent agreement, analytical sensitivity, and analytical specificity of each assay compared to the FTA-ABS test were as follows: Architect Syphilis TP, 99.2%, 96.8%, and 100%; Cobas Syphilis, 99.8%, 99.4%, and 100%; ADVIA Centaur Syphilis, 99.8%, 99.4%, and 100%; HISCL Anti-TP assay kit, 99.7%, 98.7%, and 100%; Immunoticles Auto3 TP, 99.0%, 97.5%, and 99.6%; Mediace TPLA, 98.0%, 98.1%, and 98.0%. All results that were discrepant between the TP-specific assays were associated with samples from noninfectious cases (11 immunoassay false positives and 7 from previous syphilis cases). Our study demonstrated that TP-specific immunoassays generally showed high sensitivities, specificities, and percentages of agreement compared to FTA-ABS, with rare cases of false-positive or false-negative results. Therefore, most TP-specific immunoassays are acceptable for use in screening for syphilis. However, it is important to perform a thorough review of a patient's clinical and treatment history for interpreting the results of syphilis serology. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Inter-observer agreement for the evaluation of bone involvement on Whole Body Low Dose Computed Tomography (WBLDCT) in Multiple Myeloma (MM)

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Zacchino, M.; Minetti, V.; Dore, R.; Calliada, F. [University of Pavia, Fondazione IRCCS Policlinico San Matteo, Institute of Radiology, Pavia (Italy); Bonaffini, P.A.; Nasatti, A.; Sironi, S. [University of Milano Bicocca, San Gerardo Hospital, Department of Diagnostic Radiology, Monza (Italy); Corso, A. [University of Pavia, Fondazione IRCCS Policlinico San Matteo, Division of Hematology, Pavia (Italy); Tinelli, C. [University of Pavia, Fondazione IRCCS Policlinico San Matteo, Service of Biometry and Statistics, Pavia (Italy)

2015-11-15

We aimed to assess inter-observer agreement in bone involvement evaluation and define accuracy and reproducibility of MDCT images analysis in Multiple Myeloma (MM), by comparing two acquisition protocols at two different institutions. A total of 100 MM patients underwent whole body low-dose computed tomography (WB-LDCT), with two protocols: Group I (50 patients), 80 kV and 200-230 mAs; Group II, 120 kV-40 mAs. Four readers (two experts) retrospectively reviewed 22 anatomical districts, reporting the following for each patient: 1) osteolytic lesions; 2) cortical bone integrity; 3) fractures; 4) risk of vertebral collapse; 5) hyperattenuating bone lesions; and 6) extraosseous extension. Inter-observer agreement (by all readers, expert and young observers and comparison of the two protocols) was then statistically analyzed. According to Cohen's criteria, inter-observer agreement among the four readers and between experts and residents was good for the detection of bone lesions and extra-medullary extension, and for the evaluation of risk of collapse and cortical integrity. There was good agreement when comparing the two protocols. A greater variability was found for the evaluation of hyperattenuating lesions and the presence of fractures. WB-LDCT represents a reproducible and reliable technique that is helpful for defining bone disease in MM patients, with partial influence of readers' experience. (orig.)

Inter-observer agreement for the evaluation of bone involvement on Whole Body Low Dose Computed Tomography (WBLDCT) in Multiple Myeloma (MM)

International Nuclear Information System (INIS)

Zacchino, M.; Minetti, V.; Dore, R.; Calliada, F.; Bonaffini, P.A.; Nasatti, A.; Sironi, S.; Corso, A.; Tinelli, C.

2015-01-01

We aimed to assess inter-observer agreement in bone involvement evaluation and define accuracy and reproducibility of MDCT images analysis in Multiple Myeloma (MM), by comparing two acquisition protocols at two different institutions. A total of 100 MM patients underwent whole body low-dose computed tomography (WB-LDCT), with two protocols: Group I (50 patients), 80 kV and 200-230 mAs; Group II, 120 kV-40 mAs. Four readers (two experts) retrospectively reviewed 22 anatomical districts, reporting the following for each patient: 1) osteolytic lesions; 2) cortical bone integrity; 3) fractures; 4) risk of vertebral collapse; 5) hyperattenuating bone lesions; and 6) extraosseous extension. Inter-observer agreement (by all readers, expert and young observers and comparison of the two protocols) was then statistically analyzed. According to Cohen's criteria, inter-observer agreement among the four readers and between experts and residents was good for the detection of bone lesions and extra-medullary extension, and for the evaluation of risk of collapse and cortical integrity. There was good agreement when comparing the two protocols. A greater variability was found for the evaluation of hyperattenuating lesions and the presence of fractures. WB-LDCT represents a reproducible and reliable technique that is helpful for defining bone disease in MM patients, with partial influence of readers' experience. (orig.)

Automation and Robotics in the Laboratory.

Science.gov (United States)

DiCesare, Frank; And Others

1985-01-01

A general laboratory course featuring microcomputer interfacing for data acquisition, process control and automation, and robotics was developed at Rensselaer Polytechnic Institute and is now available to all junior engineering students. The development and features of the course are described. (JN)

Intercenter validation of a knowledge based model for automated planning of volumetric modulated arc therapy for prostate cancer. The experience of the German RapidPlan Consortium.

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Carolin Schubert

Full Text Available To evaluate the performance of a model-based optimisation process for volumetric modulated arc therapy applied to prostate cancer in a multicentric cooperative group. The RapidPlan (RP knowledge-based engine was tested for the planning of Volumetric modulated arc therapy with RapidArc on prostate cancer patients. The study was conducted in the frame of the German RapidPlan Consortium (GRC.43 patients from one institute of the GRC were used to build and train a RP model. This was further shared with all members of the GRC plus an external site from a different country to increase the heterogeneity of the patient's sampling. An in silico multicentric validation of the model was performed at planning level by comparing RP against reference plans optimized according to institutional procedures. A total of 60 patients from 7 institutes were used.On average, the automated RP based plans resulted fully consistent with the manually optimised set with a modest tendency to improvement in the medium-to-high dose region. A per-site stratification allowed to identify different patterns of performance of the model with some organs at risk resulting better spared with the manual or with the automated approach but in all cases the RP data fulfilled the clinical acceptability requirements. Discrepancies in the performance were due to different contouring protocols or to different emphasis put in the optimization of the manual cases.The multicentric validation demonstrated that it was possible to satisfactorily optimize with the knowledge based model patients from all participating centres. In the presence of possibly significant differences in the contouring protocols, the automated plans, though acceptable and fulfilling the benchmark goals, might benefit from further fine tuning of the constraints. The study demonstrates that, at least for the case of prostate cancer patients, it is possibile to share models among different clinical institutes in a cooperative

Patient Self-Assessment of Surgical Site Infection is Inaccurate.

Science.gov (United States)

Richter, Vered; Cohen, Matan J; Benenson, Shmuel; Almogy, Gideon; Brezis, Mayer

2017-08-01

Availability of surgical site infection (SSI) surveillance rates challenges clinicians, healthcare administrators and leaders and the public. The purpose of this report is to demonstrate the consequences patient self-assessment strategies have on SSI reporting rates. We performed SSI surveillance among patients undergoing general surgery procedures, including telephone follow-up 30 days after surgery. Additionally we undertook a separate validation study in which we compared patient self-assessments of SSI with surgeon assessment. Finally, we performed a meta-analysis of similar validation studies of patient self-assessment strategies. There were 22/266 in-hospital SSIs diagnosed (8.3%), and additional 16 cases were detected through the 30-day follow-up. In total, the SSI rate was 16.8% (95% CI 10.1-18.5). In the validation survey, we found patient telephone surveillance to have a sensitivity of 66% (95% CI 40-93%) and a specificity of 90% (95% CI 86-94%). The meta-analysis included five additional studies. The overall sensitivity was 83.3% (95% CI 79-88%), and the overall specificity was 97.4% (95% CI 97-98%). Simulation of the meta-analysis results divulged that when the true infection rate is 1%, reported rates would be 4%; a true rate of 50%, the reported rates would be 43%. Patient self-assessment strategies in order to fulfill 30-day SSI surveillance misestimate SSI rates and lead to an erroneous overall appreciation of inter-institutional variation. Self-assessment strategies overestimate SSIs rate of institutions with high-quality performance and underestimate rates of poor performance. We propose such strategies be abandoned. Alternative strategies of patient follow-up strategies should be evaluated in order to provide valid and reliable information regarding institutional performance in preventing patient harm.

Automation for a base station stability testing

OpenAIRE

Punnek, Elvis

2016-01-01

This Batchelor’s thesis was commissioned by Oy LM Ericsson Ab Oulu. The aim of it was to help to investigate and create a test automation solution for the stability testing of the LTE base station. The main objective was to create a test automation for a predefined test set. This test automation solution had to be created for specific environments and equipment. This work included creating the automation for the test cases and putting them to daily test automation jobs. The key factor...

Comparison of manual and automated measurements of monodominant follicle diameter with different follicle size in infertile patients.

Directory of Open Access Journals (Sweden)

Ping Pan

Full Text Available This study evaluated the consistency of manual and automated measurements of monodominant follicle diameter with different follicle size in infertile patients. Transvaginal two-dimensional (2D ultrasound and SonoAVC (Sonography-based Automated Volume Calculation were both performed in 226 infertile patients with monodominant follicle growth. 2D diameters were separately compared with SonoAVC-generated d(V and m-d values in different follicle category, i.e. >10 to 14 mm, >14 to 18 mm, >18 to 22 mm and >22 mm. There was moderate degree of consistency between 2D diameter and SonoAVC-generated parameters regardless of follicle size. The mean differences were 0.82 mm between 2D diameter and SonoAVC-generated d(V value, and 0.22 mm between 2D diameter and SonoAVC-generated m-d value, respectively. The discrepancy of manual and automated measurements tended to increase as follicle size increased. Our study suggested that compared with manual measurement, SonoAVC might underestimate follicle size. The absolute size of a follicle affected the consistency of two techniques.

Active learning of neuron morphology for accurate automated tracing of neurites

Science.gov (United States)

Gala, Rohan; Chapeton, Julio; Jitesh, Jayant; Bhavsar, Chintan; Stepanyants, Armen

2014-01-01

Automating the process of neurite tracing from light microscopy stacks of images is essential for large-scale or high-throughput quantitative studies of neural circuits. While the general layout of labeled neurites can be captured by many automated tracing algorithms, it is often not possible to differentiate reliably between the processes belonging to different cells. The reason is that some neurites in the stack may appear broken due to imperfect labeling, while others may appear fused due to the limited resolution of optical microscopy. Trained neuroanatomists routinely resolve such topological ambiguities during manual tracing tasks by combining information about distances between branches, branch orientations, intensities, calibers, tortuosities, colors, as well as the presence of spines or boutons. Likewise, to evaluate different topological scenarios automatically, we developed a machine learning approach that combines many of the above mentioned features. A specifically designed confidence measure was used to actively train the algorithm during user-assisted tracing procedure. Active learning significantly reduces the training time and makes it possible to obtain less than 1% generalization error rates by providing few training examples. To evaluate the overall performance of the algorithm a number of image stacks were reconstructed automatically, as well as manually by several trained users, making it possible to compare the automated traces to the baseline inter-user variability. Several geometrical and topological features of the traces were selected for the comparisons. These features include the total trace length, the total numbers of branch and terminal points, the affinity of corresponding traces, and the distances between corresponding branch and terminal points. Our results show that when the density of labeled neurites is sufficiently low, automated traces are not significantly different from manual reconstructions obtained by trained users. PMID

Active learning of neuron morphology for accurate automated tracing of neurites

Directory of Open Access Journals (Sweden)

Rohan eGala

2014-05-01

Full Text Available Automating the process of neurite tracing from light microscopy stacks of images is essential for large-scale or high-throughput quantitative studies of neural circuits. While the general layout of labeled neurites can be captured by many automated tracing algorithms, it is often not possible to differentiate reliably between the processes belonging to different cells. The reason is that some neurites in the stack may appear broken due to imperfect labeling, while others may appear fused due to the limited resolution of optical microscopy. Trained neuroanatomists routinely resolve such topological ambiguities during manual tracing tasks by combining information about distances between branches, branch orientations, intensities, calibers, tortuosities, colors, as well as the presence of spines or boutons. Likewise, to evaluate different topological scenarios automatically, we developed a machine learning approach that combines many of the above mentioned features. A specifically designed confidence measure was used to actively train the algorithm during user-assisted tracing procedure. Active learning significantly reduces the training time and makes it possible to obtain less than 1% generalization error rates by providing few training examples. To evaluate the overall performance of the algorithm a number of image stacks were reconstructed automatically, as well as manually by several trained users, making it possible to compare the automated traces to the baseline inter-user variability. Several geometrical and topological features of the traces were selected for the comparisons. These features include the total trace length, the total numbers of branch and terminal points, the affinity of corresponding traces, and the distances between corresponding branch and terminal points. Our results show that when the density of labeled neurites is sufficiently low, automated traces are not significantly different from manual reconstructions obtained by

Automated impedance-manometry analysis detects esophageal motor dysfunction in patients who have non-obstructive dysphagia with normal manometry

NARCIS (Netherlands)

Nguyen, N. Q.; Holloway, R. H.; Smout, A. J.; Omari, T. I.

2013-01-01

Background  Automated integrated analysis of impedance and pressure signals has been reported to identify patients at risk of developing dysphagia post fundoplication. This study aimed to investigate this analysis in the evaluation of patients with non-obstructive dysphagia (NOD) and normal

SPECIFIC FEATURES OF ANESTHESIA IN PATIENTS WITH MYASTHENIA GRAVIS.

Science.gov (United States)

Spasojevic, Ivana; Hajdukovic, Danica; Komarcevic, Milena; Petrovic, Stanislava; Jovanovic, Jelena; Ciric, Aleksandra

2016-09-01

Myasthenia gravis is an autoimmune disease caused by antibodies leading to the destruction of nicotinic acetylcholine receptors on the neuromuscular junction. It is characterized by muscle weakness that gets aggravated with physical activity and improves at rest. Myasthenia Gravis Foundation of America made the clinical classification of Myasthenia gravis which is still in use today. "Tensilon test" is still the gold standard for the diagnosis of Myasthenia gravis. In addition to this test repeated muscular stimulation can be used as well as the analysis of specific autoantibodies. Treatment of Myasthenia Gravis. In conservative treatment of Mysthenia gravis anticholinesterases, immunosuppressants and plasmapheresis can be used. If conservative treatment does not lead to the desired remission, surgical treatment is indicated. The most accepted indication for thymectomy is the presence of thymoma with generalized form of Myasthenia gravis in adults. How to Distinguish Myasthenic From Cholinergic Crisis.'The following is important to make a difference between these two crises: knowledge of the events that preceded the crisis, the size of pupils as well as the presence of muscarinic signs and tensilon test. Specific Features of Anesthesia in Patients with Myasthienia Gravis. Mechanism of the disease development is the reason'for the increased sensitivity or resistance of these patients to certain types of drugs used in anesthesia. Protocol of Perioperative Anesthesia in Patients with Myasthenia Gravis. Based on 35 years of experience in the surgical treatment of patients with Myasthenia gravis anesthesiologists at the Department of Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina. made the protocol of anesthesia and perioperative treatment for these patients. Anesthesiologists may have to deal with a patient with myasthenia gravis in different types of surgical interventions. The protocol for anesthesia and perioperative management of these patients

Automated classification of self-grooming in mice using open-source software.

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van den Boom, Bastijn J G; Pavlidi, Pavlina; Wolf, Casper J H; Mooij, Adriana H; Willuhn, Ingo

2017-09-01

Manual analysis of behavior is labor intensive and subject to inter-rater variability. Although considerable progress in automation of analysis has been made, complex behavior such as grooming still lacks satisfactory automated quantification. We trained a freely available, automated classifier, Janelia Automatic Animal Behavior Annotator (JAABA), to quantify self-grooming duration and number of bouts based on video recordings of SAPAP3 knockout mice (a mouse line that self-grooms excessively) and wild-type animals. We compared the JAABA classifier with human expert observers to test its ability to measure self-grooming in three scenarios: mice in an open field, mice on an elevated plus-maze, and tethered mice in an open field. In each scenario, the classifier identified both grooming and non-grooming with great accuracy and correlated highly with results obtained by human observers. Consistently, the JAABA classifier confirmed previous reports of excessive grooming in SAPAP3 knockout mice. Thus far, manual analysis was regarded as the only valid quantification method for self-grooming. We demonstrate that the JAABA classifier is a valid and reliable scoring tool, more cost-efficient than manual scoring, easy to use, requires minimal effort, provides high throughput, and prevents inter-rater variability. We introduce the JAABA classifier as an efficient analysis tool for the assessment of rodent self-grooming with expert quality. In our "how-to" instructions, we provide all information necessary to implement behavioral classification with JAABA. Copyright © 2017 Elsevier B.V. All rights reserved.

Achieving and sustaining automated health data linkages for learning systems: barriers and solutions.

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Van Eaton, Erik G; Devlin, Allison B; Devine, Emily Beth; Flum, David R; Tarczy-Hornoch, Peter

2014-01-01

Delivering more appropriate, safer, and highly effective health care is the goal of a learning health care system. The Agency for Healthcare Research and Quality (AHRQ) funded enhanced registry projects: (1) to create and analyze valid data for comparative effectiveness research (CER); and (2) to enhance the ability to monitor and advance clinical quality improvement (QI). This case report describes barriers and solutions from one state-wide enhanced registry project. The Comparative Effectiveness Research and Translation Network (CERTAIN) deployed the commercially available Amalga Unified Intelligence System™ (Amalga) as a central data repository to enhance an existing QI registry (the Automation Project). An eight-step implementation process included hospital recruitment, technical electronic health record (EHR) review, hospital-specific interface planning, data ingestion, and validation. Data ownership and security protocols were established, along with formal methods to separate data management for QI purposes and research purposes. Sustainability would come from lowered chart review costs and the hospital's desire to invest in the infrastructure after trying it. CERTAIN approached 19 hospitals in Washington State operating within 12 unaffiliated health care systems for the Automation Project. Five of the 19 completed all implementation steps. Four hospitals did not participate due to lack of perceived institutional value. Ten hospitals did not participate because their information technology (IT) departments were oversubscribed (e.g., too busy with Meaningful Use upgrades). One organization representing 22 additional hospitals expressed interest, but was unable to overcome data governance barriers in time. Questions about data use for QI versus research were resolved in a widely adopted project framework. Hospitals restricted data delivery to a subset of patients, introducing substantial technical challenges. Overcoming challenges of idiosyncratic EHR

Quality control of specific patient in radiotherapy with modulated intensity

International Nuclear Information System (INIS)

Aberbuj, P D; Tapia Coca, R C

2012-01-01

In this work we comment the details of the patient specific quality controls of the first Intensity Modulated Radiotherapy treatment done at Roffo Institute. These controls consisted in two sets of measurements: absolute dose with ionization chamber and relative dose with two dosimetric systems (Gafchromic EBT2 radiochromic films and the PTW 729 ionization chambers array). Two of the filters did not pass the dosimetrical tests, and they were manufactured again. The new filters passed the tests. For the relative two-dimensional measurements the radiochromic films had a better performance than the array due to their higher spatial resolution (author)

A systematic review of nurses' inter-shift handoff reports in acute care hospitals.

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Poletick, Eilleen B; Holly, Cheryl

2010-01-01

An inter-shift nursing handoff report is the exchange of patient care information for evidence-based nursing and midwifery from one nurse to another, and is a universal procedure used in hospitals to promote continuity of care. The objective of this review was to appraise and synthesize the best available qualitative evidence pertaining to the nursing handoff report at the time of shift change and make recommendations that can enhance the transfer of information between and among nurses, and by extension, improve patient care. The review considered qualitative studies that drew on the experiences of nurses at the time of inter-shift nursing handoff in acute care hospitals, and included designs such as phenomenology, grounded theory, narrative analysis, action research, ethnographic or cultural studies. The search strategy sought to find both published and unpublished research papers. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted. Following this, an extensive three stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant world wide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International. Each paper was assessed independently, by two reviewers for methodological quality prior to inclusion in the review using the critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) developed by the Joanna Briggs Institute for Evidence Based Nursing and Midwifery. A total

Building Imaging Institutes of Patient Care Outcomes: Imaging as a Nidus for Innovation in Clinical Care, Research, and Education.

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Petrou, Myria; Cronin, Paul; Altaee, Duaa K; Kelly, Aine M; Foerster, Bradley R

2018-05-01

Traditionally, radiologists have been responsible for the protocol of imaging studies, imaging acquisition, supervision of imaging technologists, and interpretation and reporting of imaging findings. In this article, we outline how radiology needs to change and adapt to a role of providing value-based, integrated health-care delivery. We believe that the way to best serve our specialty and our patients is to undertake a fundamental paradigm shift in how we practice. We describe the need for imaging institutes centered on disease entities (eg, lung cancer, multiple sclerosis) to not only optimize clinical care and patient outcomes, but also spur the development of a new educational focus, which will increase opportunities for medical trainees and other health professionals. These institutes will also serve as unique environments for testing and implementing new technologies and for generating new ideas for research and health-care delivery. We propose that the imaging institutes focus on how imaging practices-including new innovations-improve patient care outcomes within a specific disease framework. These institutes will allow our specialty to lead patient care, provide the necessary infrastructure for state-of-the art-education of trainees, and stimulate innovative and clinically relevant research. Copyright © 2018 The Association of University Radiologists. All rights reserved.

Landscape-level movement patterns by lions in western Serengeti: comparing the influence of inter-specific competitors, habitat attributes and prey availability.

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Kittle, Andrew M; Bukombe, John K; Sinclair, Anthony R E; Mduma, Simon A R; Fryxell, John M

2016-01-01

Where apex predators move on the landscape influences ecosystem structure and function and is therefore key to effective landscape-level management and species-specific conservation. However the factors underlying predator distribution patterns within functional ecosystems are poorly understood. Predator movement should be sensitive to the spatial patterns of inter-specific competitors, spatial variation in prey density, and landscape attributes that increase individual prey vulnerability. We investigated the relative role of these fundamental factors on seasonal resource utilization by a globally endangered apex carnivore, the African lion (Panthera leo) in Tanzania's Serengeti National Park. Lion space use was represented by novel landscape-level, modified utilization distributions (termed "localized density distributions") created from telemetry relocations of individual lions from multiple neighbouring prides. Spatial patterns of inter-specific competitors were similarly determined from telemetry re-locations of spotted hyenas (Crocuta crocuta), this system's primary competitor for lions; prey distribution was derived from 18 months of detailed census data; and remote sensing data was used to represent relevant habitat attributes. Lion space use was consistently influenced by landscape attributes that increase individual prey vulnerability to predation. Wet season activity, when available prey were scarce, was concentrated near embankments, which provide ambush opportunities, and dry season activity, when available prey were abundant, near remaining water sources where prey occurrence is predictable. Lion space use patterns were positively associated with areas of high prey biomass, but only in the prey abundant dry season. Finally, at the broad scale of this analysis, lion and hyena space use was positively correlated in the comparatively prey-rich dry season and unrelated in the wet season, suggesting lion movement was unconstrained by the spatial patterns

Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review

Directory of Open Access Journals (Sweden)

Smits-Engelsman Bouwien CM

2008-10-01

Full Text Available Abstract Background Neck pain is a significant health problem in modern society. There is evidence to suggest that neck muscle strength is reduced in patients with neck pain. This article provides a critical analysis of the research literature on the clinimetric properties of tests to measure neck muscle strength or endurance in patients with non-specific neck pain, which can be used in daily practice. Methods A computerised literature search was performed in the Medline, CINAHL and Embase databases from 1980 to January 2007. Two reviewers independently assessed the clinimetric properties of identified measurement methods, using a checklist of generally accepted criteria for reproducibility (inter- and intra-observer reliability and agreement, construct validity, responsiveness and feasibility. Results The search identified a total of 16 studies. The instruments or tests included were: muscle endurance tests for short neck flexors, craniocervical flexion test with an inflatable pressure biofeedback unit, manual muscle testing of neck musculature, dynamometry and functional lifting tests (the cervical progressive iso-inertial lifting evaluation (PILE test and the timed weighted overhead test. All the articles included report information on the reproducibility of the tests. Acceptable intra- and inter-observer reliability was demonstrated for t enduranctest for short neck flexors and the cervical PILE test. Construct validity and responsiveness have hardly been documented for tests on muscle functioning. Conclusion The endurance test of the short neck flexors and the cervical PILE test can be regarded as appropriate instruments for measuring different aspects of neck muscle function in patients with non-specific neck pain. Common methodological flaws in the studies were their small sample size and an inappropriate description of the study design.

Assessing inter- and intra-individual cognitive variability in patients at risk for cognitive impairment: the case of minimal hepatic encephalopathy.

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Bisiacchi, Patrizia; Cona, Giorgia; Tarantino, Vincenza; Schiff, Sami; Montagnese, Sara; Amodio, Piero; Capizzi, Giovanna

2014-12-01

Recent evidence reveals that inter- and intra-individual variability significantly affects cognitive performance in a number of neuropsychological pathologies. We applied a flexible family of statistical models to elucidate the contribution of inter- and intra-individual variables on cognitive functioning in healthy volunteers and patients at risk for hepatic encephalopathy (HE). Sixty-five volunteers (32 patients with cirrhosis and 33 healthy volunteers) were assessed by means of the Inhibitory Control Task (ICT). A Generalized Additive Model for Location, Scale and Shape (GAMLSS) was fitted for jointly modeling the mean and the intra-variability of Reaction Times (RTs) as a function of socio-demographic and task related covariates. Furthermore, a Generalized Linear Mixed Model (GLMM) was fitted for modeling accuracy. When controlling for the covariates, patients without minimal hepatic encephalopathy (MHE) did not differ from patients with MHE in the low-demanding condition, both in terms of RTs and accuracy. Moreover, they showed a significant decline in accuracy compared to the control group. Compared to patients with MHE, patients without MHE showed faster RTs and higher accuracy only in the high-demanding condition. The results revealed that the application of GAMLSS and GLMM models are able to capture subtle cognitive alterations, previously not detected, in patients' subclinical pathologies.

Automated Library Networking in American Public Community College Learning Resources Centers.

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Miah, Adbul J.

1994-01-01

Discusses the need for community colleges to assess their participation in automated library networking systems (ALNs). Presents results of questionnaires sent to 253 community college learning resource center directors to determine their use of ALNs. Reviews benefits of automation and ALN activities, planning and communications, institution size,…

Automated robust generation of compact 3D statistical shape models

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Vrtovec, Tomaz; Likar, Bostjan; Tomazevic, Dejan; Pernus, Franjo

2004-05-01

Ascertaining the detailed shape and spatial arrangement of anatomical structures is important not only within diagnostic settings but also in the areas of planning, simulation, intraoperative navigation, and tracking of pathology. Robust, accurate and efficient automated segmentation of anatomical structures is difficult because of their complexity and inter-patient variability. Furthermore, the position of the patient during image acquisition, the imaging device and protocol, image resolution, and other factors induce additional variations in shape and appearance. Statistical shape models (SSMs) have proven quite successful in capturing structural variability. A possible approach to obtain a 3D SSM is to extract reference voxels by precisely segmenting the structure in one, reference image. The corresponding voxels in other images are determined by registering the reference image to each other image. The SSM obtained in this way describes statistically plausible shape variations over the given population as well as variations due to imperfect registration. In this paper, we present a completely automated method that significantly reduces shape variations induced by imperfect registration, thus allowing a more accurate description of variations. At each iteration, the derived SSM is used for coarse registration, which is further improved by describing finer variations of the structure. The method was tested on 64 lumbar spinal column CT scans, from which 23, 38, 45, 46 and 42 volumes of interest containing vertebra L1, L2, L3, L4 and L5, respectively, were extracted. Separate SSMs were generated for each vertebra. The results show that the method is capable of reducing the variations induced by registration errors.

Can Physicians Identify Inappropriate Nuclear Stress Tests? An Examination of Inter-rater Reliability for the 2009 Appropriate Use Criteria for Radionuclide Imaging

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Ye, Siqin; Rabbani, LeRoy E.; Kelly, Christopher R.; Kelly, Maureen R.; Lewis, Matthew; Paz, Yehuda; Peck, Clara L.; Rao, Shaline; Bokhari, Sabahat; Weiner, Shepard D.; Einstein, Andrew J.

2014-01-01

Background We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria (AUC) for radionuclide imaging (RNI) and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Methods and Results Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 AUC. Consensus classification by two cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests was calculated. Inter-rater reliability of the AUC was assessed using Cohen’s kappa statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 NSTs as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for non-cardiologist raters was modest (unweighted Cohen’s kappa, 0.51, 95% confidence interval, 0.45 to 0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Conclusions Inter-rater reliability for the 2009 AUC for RNI is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. PMID:25563660

On-line analysis of biosignals for the automation of total and specific sleep deprivation in the rat

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ENNIO A VIVALDI

2008-12-01

Full Text Available A computer-based system that automates sleep studies, including sleep deprivation paradigms, is described. The system allows for total or REM-specific sleep deprivation and is based on a reliable, fast-responding, on-line state detection algorithm linked to a dependable intervention device. Behavioral state detection is achieved by dimensión reduction of short-term EEG power spectrum. Interventions are made by serial outputs to servomotors that move a cage with different patterns and variable intensity. The system can adapt itself to individual characteristics and to changes in recording conditions. Customized protocols can be designed by defining the states or stages to be deprived, including scheduling temporal patterns. A detailed analysis of the relevant signáis during and after deprivation is readily available. Data is presented from two experimental designs in rats. One consisted of specific REM-sleep short-term deprivation and the other of 10-hour total sleep deprivation. An outline of conceptual and practical considerations involved in the automation of laboratory set-ups oriented to biosignal analysis is provided. Careful monitoring of sleep EEG variables during sleep deprivation suggests peculiarities of brain functioning in that condition. A corollary is that sleep deprivation should not be considered to be merely a forced prolonged wakefulness.

Computed tomography landmark-based semi-automated mesh morphing and mapping techniques: generation of patient specific models of the human pelvis without segmentation.

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Salo, Zoryana; Beek, Maarten; Wright, David; Whyne, Cari Marisa

2015-04-13

Current methods for the development of pelvic finite element (FE) models generally are based upon specimen specific computed tomography (CT) data. This approach has traditionally required segmentation of CT data sets, which is time consuming and necessitates high levels of user intervention due to the complex pelvic anatomy. The purpose of this research was to develop and assess CT landmark-based semi-automated mesh morphing and mapping techniques to aid the generation and mechanical analysis of specimen-specific FE models of the pelvis without the need for segmentation. A specimen-specific pelvic FE model (source) was created using traditional segmentation methods and morphed onto a CT scan of a different (target) pelvis using a landmark-based method. The morphed model was then refined through mesh mapping by moving the nodes to the bone boundary. A second target model was created using traditional segmentation techniques. CT intensity based material properties were assigned to the morphed/mapped model and to the traditionally segmented target models. Models were analyzed to evaluate their geometric concurrency and strain patterns. Strains generated in a double-leg stance configuration were compared to experimental strain gauge data generated from the same target cadaver pelvis. CT landmark-based morphing and mapping techniques were efficiently applied to create a geometrically multifaceted specimen-specific pelvic FE model, which was similar to the traditionally segmented target model and better replicated the experimental strain results (R(2)=0.873). This study has shown that mesh morphing and mapping represents an efficient validated approach for pelvic FE model generation without the need for segmentation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of inter-fraction error during prostate radiotherapy

International Nuclear Information System (INIS)

Komiyama, Takafumi; Nakamura, Koji; Motoyama, Tsuyoshi; Onishi, Hiroshi; Sano, Naoki

2008-01-01

The purpose of this study was to evaluate inter-fraction error (inter-fraction set-up error+inter-fraction internal organ motion) between treatment planning and delivery during radiotherapy for localized prostate cancer. Twenty three prostate cancer patients underwent image-guided radical irradiation with the CT-linac system. All patients were treated in the supine position. After set-up with external skin markers, using CT-linac system, pretherapy CT images were obtained and isocenter displacement was measured. The mean displacement of the isocenter was 1.8 mm, 3.3 mm, and 1.7 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The maximum displacement of the isocenter was 7 mm, 12 mm, and 9 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The mean interquartile range of displacement of the isocenter was 1.8 mm, 3.7 mm, and 2.0 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. In radiotherapy for localized prostate cancer, inter-fraction error was largest in the ventral-dorsal directions. Errors in the ventral-dorsal directions influence both local control and late adverse effects. Our study suggested the set-up with external skin markers was not enough for radical radiotherapy for localized prostate cancer, thereby those such as a CT-linac system for correction of inter-fraction error being required. (author)

Improving treatment plan evaluation with automation

Science.gov (United States)

Covington, Elizabeth L.; Chen, Xiaoping; Younge, Kelly C.; Lee, Choonik; Matuszak, Martha M.; Kessler, Marc L.; Keranen, Wayne; Acosta, Eduardo; Dougherty, Ashley M.; Filpansick, Stephanie E.

2016-01-01

The goal of this work is to evaluate the effectiveness of Plan‐Checker Tool (PCT) which was created to improve first‐time plan quality, reduce patient delays, increase the efficiency of our electronic workflow, and standardize and automate the physics plan review in the treatment planning system (TPS). PCT uses an application programming interface to check and compare data from the TPS and treatment management system (TMS). PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user as part of a plan readiness check for treatment. Prior to and during PCT development, errors identified during the physics review and causes of patient treatment start delays were tracked to prioritize which checks should be automated. Nineteen of 33 checklist items were automated, with data extracted with PCT. There was a 60% reduction in the number of patient delays in the six months after PCT release. PCT was successfully implemented for use on all external beam treatment plans in our clinic. While the number of errors found during the physics check did not decrease, automation of checks increased visibility of errors during the physics check, which led to decreased patient delays. The methods used here can be applied to any TMS and TPS that allows queries of the database. PACS number(s): 87.55.‐x, 87.55.N‐, 87.55.Qr, 87.55.tm, 89.20.Bb PMID:27929478

Quality of nursing intensity data: inter-rater reliability of the patient classification after two decades in clinical use.

Science.gov (United States)

Liljamo, Pia; Kinnunen, Ulla-Mari; Ohtonen, Pasi; Saranto, Kaija

2017-09-01

The aim of this study was to measure the inter-rater reliability of the Oulu Patient Classification and to discuss existing methods of reliability testing. The Oulu Patient Classification, part of the RAFAELA ® System, has been developed to assist nursing managers with the proper allocation of nursing resources. Due to the increased intensity of inpatient care during recent years, there is a need for the reliability testing of the classification, which has been in clinical use for 20 years. Retrospective statistical study. To test inter-rater reliability, a pair of nurses classified the same patients, without knowledge of each other's ratings, as a part of annually conducted standardization. Data on the parallel classifications (n = 19,997) was obtained from inpatient units (n = 32) with different specialties at a university hospital in Finland during 2010-2015. Parallel classification practices were also analysed. The reliability of the overall classification and its subareas were calculated using suitable statistical coefficients. Inter-rater reliability coefficients were a reliable or almost perfect means of considering the nursing intensity category and various practices, but there were detectable differences between subareas. The lowest agreement levels occurred in the subareas 'Planning and Coordination of Nursing Care' and 'Guiding of Care/Continued Care and Emotional Support'. There is a need to develop the descriptions of subareas and to clarify the related concepts. Precise nursing documentation can promote a high level of agreement and reliable results. The traditional overall proportion of agreement does not provide an adequate picture of reliability - weighted kappa coefficients should be used instead. © 2017 John Wiley & Sons Ltd.

Some Challenges in the Design of Human-Automation Interaction for Safety-Critical Systems

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Feary, Michael S.; Roth, Emilie

2014-01-01

Increasing amounts of automation are being introduced to safety-critical domains. While the introduction of automation has led to an overall increase in reliability and improved safety, it has also introduced a class of failure modes, and new challenges in risk assessment for the new systems, particularly in the assessment of rare events resulting from complex inter-related factors. Designing successful human-automation systems is challenging, and the challenges go beyond good interface development (e.g., Roth, Malin, & Schreckenghost 1997; Christoffersen & Woods, 2002). Human-automation design is particularly challenging when the underlying automation technology generates behavior that is difficult for the user to anticipate or understand. These challenges have been recognized in several safety-critical domains, and have resulted in increased efforts to develop training, procedures, regulations and guidance material (CAST, 2008, IAEA, 2001, FAA, 2013, ICAO, 2012). This paper points to the continuing need for new methods to describe and characterize the operational environment within which new automation concepts are being presented. We will describe challenges to the successful development and evaluation of human-automation systems in safety-critical domains, and describe some approaches that could be used to address these challenges. We will draw from experience with the aviation, spaceflight and nuclear power domains.

Inter- and intra-specific responses to elevated ozone and chamber climate in northern birches

International Nuclear Information System (INIS)

Manninen, S.; Huttunen, S.; Vanhatalo, M.; Pakonen, T.; Haemaelaeinen, A.

2009-01-01

We studied the responses of micropropagated, northern provenances of downy, mountain and silver birches to elevated ozone (O 3 ) and changing climate using open-top chambers (OTCs). Contrary to our hypothesis, northern birches were sensitive to O 3 , i.e. O 3 levels of 31-36 ppb reduced the leaf and root biomasses by -10%, whereas wood biomass was affected to a lesser extent. The warmer and drier OTC climate enhanced growth in general, though there were differences among the species and clones, e.g. in bud burst and biomass production. Inter- and intra-specific responses to O 3 and changing climate relate to traits such as allocation patterns between the above- and belowground parts (i.e. root/shoot ratio), which further relate to nutrient and water economy. Our experiments may have mimicked future conditions quite well, but only long-term field studies can yield the information needed to forecast responses at both tree and ecosystem levels. - Northern birches are responsive to ambient ozone levels.

Inter- and intra-specific responses to elevated ozone and chamber climate in northern birches.

Science.gov (United States)

Manninen, S; Huttunen, S; Vanhatalo, M; Pakonen, T; Hämäläinen, A

2009-05-01

We studied the responses of micropropagated, northern provenances of downy, mountain and silver birches to elevated ozone (O(3)) and changing climate using open-top chambers (OTCs). Contrary to our hypothesis, northern birches were sensitive to O(3), i.e. O(3) levels of 31-36 ppb reduced the leaf and root biomasses by -10%, whereas wood biomass was affected to a lesser extent. The warmer and drier OTC climate enhanced growth in general, though there were differences among the species and clones, e.g. in bud burst and biomass production. Inter- and intra-specific responses to O(3) and changing climate relate to traits such as allocation patterns between the above- and belowground parts (i.e. root/shoot ratio), which further relate to nutrient and water economy. Our experiments may have mimicked future conditions quite well, but only long-term field studies can yield the information needed to forecast responses at both tree and ecosystem levels.

The use of automated Ki67 analysis to predict Oncotype DX risk-of-recurrence categories in early-stage breast cancer.

Science.gov (United States)

Thakur, Satbir Singh; Li, Haocheng; Chan, Angela M Y; Tudor, Roxana; Bigras, Gilbert; Morris, Don; Enwere, Emeka K; Yang, Hua

2018-01-01

Ki67 is a commonly used marker of cancer cell proliferation, and has significant prognostic value in breast cancer. In spite of its clinical importance, assessment of Ki67 remains a challenge, as current manual scoring methods have high inter- and intra-user variability. A major reason for this variability is selection bias, in that different observers will score different regions of the same tumor. Here, we developed an automated Ki67 scoring method that eliminates selection bias, by using whole-slide analysis to identify and score the tumor regions with the highest proliferative rates. The Ki67 indices calculated using this method were highly concordant with manual scoring by a pathologist (Pearson's r = 0.909) and between users (Pearson's r = 0.984). We assessed the clinical validity of this method by scoring Ki67 from 328 whole-slide sections of resected early-stage, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. All patients had Oncotype DX testing performed (Genomic Health) and available Recurrence Scores. High Ki67 indices correlated significantly with several clinico-pathological correlates, including higher tumor grade (1 versus 3, P<0.001), higher mitotic score (1 versus 3, P<0.001), and lower Allred scores for estrogen and progesterone receptors (P = 0.002, 0.008). High Ki67 indices were also significantly correlated with higher Oncotype DX risk-of-recurrence group (low versus high, P<0.001). Ki67 index was the major contributor to a machine learning model which, when trained solely on clinico-pathological data and Ki67 scores, identified Oncotype DX high- and low-risk patients with 97% accuracy, 98% sensitivity and 80% specificity. Automated scoring of Ki67 can thus successfully address issues of consistency, reproducibility and accuracy, in a manner that integrates readily into the workflow of a pathology laboratory. Furthermore, automated Ki67 scores contribute significantly to models that predict risk of

The use of automated Ki67 analysis to predict Oncotype DX risk-of-recurrence categories in early-stage breast cancer.

Directory of Open Access Journals (Sweden)

Satbir Singh Thakur