Automated cement segmentation in vertebroplasty

Vertebroplasty is a minimally invasive procedure with many benefits; however, the procedure is not without risks and potential complications, of which leakage of the cement out of the vertebral body and into the surrounding tissues is one of the most serious. Cement can leak into the spinal canal, venous system, soft tissues, lungs and intradiscal space, causing serious neurological complications, tissue necrosis or pulmonary embolism. We present a method for automatic segmentation and tracking of bone cement during vertebroplasty procedures, as a first step towards developing a warning system to avoid cement leakage outside the vertebral body. We show that by using active contours based on level sets the shape of the injected cement can be accurately detected. The model has been improved for segmentation as proposed in our previous work by including a term that restricts the level set function to the vertebral body. The method has been applied to a set of real intra-operative X-ray images and the results show that the algorithm can successfully detect different shapes with blurred and not well-defined boundaries, where the classical active contours segmentation is not applicable. The method has been positively evaluated by physicians.

Evaluation of texture features in hepatic tissue characterization from non-enhanced CT images

Aim of this paper is to evaluate the diagnostic contribution of various types of texture features in discrimination of hepatic tissue in abdominal non-enhanced Computed Tomography (CT) images. Regions of Interest (ROIs) corresponding to the classes: normal liver, cyst, hemangioma, and hepatocellular carcinoma were drawn by an experienced radiologist. For each ROI, five distinct sets of texture features are extracted using First Order Statistics (FOS), Spatial Gray Level Dependence Matrix (SGLDM), Gray Level Difference Method (GLDM), Laws' Texture Energy Measures (TEM), and Fractal Dimension Measurements (FDM). In order to evaluate the ability of the texture features to discriminate the various types of hepatic tissue, each set of texture features, or its reduced version after genetic algorithm based feature selection, was fed to a feed-forward Neural Network (NN) classifier. For each NN, the area under Receiver Operating Characteristic (ROC) curves (Az) was calculated for all one-vs-all discriminations of hepatic tissue. Additionally, the total Az for the multi-class discrimination task was estimated. The results show that features derived from FOS perform better than other texture features (total Az: 0.802+/-0.083) in the discrimination of hepatic tissue.

Estimating and quantifying uncertainties on level sets using the Vorob'ev expectation and deviation with Gaussian process models

Several methods based on Kriging have recently been proposed for calculating a probability of failure involving costly-to-evaluate functions. A closely related problem is to estimate the set of inputs leading to a response exceeding a given threshold. Now, estimating such a level set—and not solely its volume—and quantifying uncertainties on it are not straightforward. Here we use notions from random set theory to obtain an estimate of the level set, together with a quantification of estimation uncertainty. We give explicit formulae in the Gaussian process set-up and provide a consistency result. We then illustrate how space-filling versus adaptive design strategies may sequentially reduce level set estimation uncertainty.

Multicentre evaluation of a new point-of-care test for the determination of NT-proBNP in whole blood

BACKGROUND: The Roche CARDIAC proBNP point-of-care (POC) test is the first test intended for the quantitative determination of N-terminal pro-brain natriuretic peptide (NT-proBNP) in whole blood as an aid in the diagnosis of suspected congestive heart failure, in the monitoring of patients with compensated left-ventricular dysfunction and in the risk stratification of patients with acute coronary syndromes. METHODS: A multicentre evaluation was carried out to assess the analytical performance of the POC NT-proBNP test at seven different sites. RESULTS: The majority of all coefficients of variation (CVs) obtained for within-series imprecision using native blood samples was below 10% for both 52 samples measured ten times and for 674 samples measured in duplicate. Using quality control material, the majority of CV values for day-to-day imprecision were below 14% for the low control level and below 13% for the high control level. In method comparisons for four lots of the POC NT-proBNP test with the laboratory reference method (Elecsys proBNP), the slope ranged from 0.93 to 1.10 and the intercept ranged from 1.8 to 6.9. The bias found between venous and arterial blood with the POC NT-proBNP method was < or =5%. All four lots of the POC NT-proBNP test investigated showed excellent agreement, with mean differences of between -5% and +4%. No significant interference was observed with lipaemic blood (triglyceride concentrations up to 6.3 mmol/L), icteric blood (bilirubin concentrations up to 582 micromol/L), haemolytic blood (haemoglobin concentrations up to 62 mg/L), biotin (up to 10 mg/L), rheumatoid factor (up to 42 IU/mL), or with 50 out of 52 standard or cardiological drugs in therapeutic concentrations. With bisoprolol and BNP, somewhat higher bias in the low NT-proBNP concentration range (<175 ng/L) was found. Haematocrit values between 28% and 58% had no influence on the test result. Interference may be caused by human anti-mouse antibodies (HAMA) types 1 and 2. No significant influence on the results with POC NT-proBNP was found using volumes of 140-165 muL. High NT-proBNP concentrations above the measuring range of the POC NT-proBNP test did not lead to false low results due to a potential high-dose hook effect. CONCLUSIONS: The POC NT-proBNP test showed good analytical performance and excellent agreement with the laboratory method. The POC NT-proBNP assay is therefore suitable in the POC setting.

Prediction of Post-Weaning Fibrinogen Status during Cardiopulmonary Bypass: An Observational Study in 110 Patients.

BACKGROUND After cardiac surgery with cardiopulmonary bypass (CPB), acquired coagulopathy often leads to post-CPB bleeding. Though multifactorial in origin, this coagulopathy is often aggravated by deficient fibrinogen levels. OBJECTIVE To assess whether laboratory and thrombelastometric testing on CPB can predict plasma fibrinogen immediately after CPB weaning. PATIENTS / METHODS This prospective study in 110 patients undergoing major cardiovascular surgery at risk of post-CPB bleeding compares fibrinogen level (Clauss method) and function (fibrin-specific thrombelastometry) in order to study the predictability of their course early after termination of CPB. Linear regression analysis and receiver operating characteristics were used to determine correlations and predictive accuracy. RESULTS Quantitative estimation of post-CPB Clauss fibrinogen from on-CPB fibrinogen was feasible with small bias (+0.19 g/l), but with poor precision and a percentage of error >30%. A clinically useful alternative approach was developed by using on-CPB A10 to predict a Clauss fibrinogen range of interest instead of a discrete level. An on-CPB A10 ≤10 mm identified patients with a post-CPB Clauss fibrinogen of ≤1.5 g/l with a sensitivity of 0.99 and a positive predictive value of 0.60; it also identified those without a post-CPB Clauss fibrinogen <2.0 g/l with a specificity of 0.83. CONCLUSIONS When measured on CPB prior to weaning, a FIBTEM A10 ≤10 mm is an early alert for post-CPB fibrinogen levels below or within the substitution range (1.5-2.0 g/l) recommended in case of post-CPB coagulopathic bleeding. This helps to minimize the delay to data-based hemostatic management after weaning from CPB.

Predicting daily smoking around a quit date : Volitional processes at the inter- and intraindividual level

Background: The health action process approach (hapa) is a well-established model in predicting health behavior and assumes that volitional processes are important for effective behavioral change. however, only few studies have so far tested associations on the intraindividual level. thus, this study examined the inter- and intraindividual associations between volitional predictors and daily smoking around a quit attempt. method: overall, 105 smokers completed daily electronic questionnaires 10 days before and 21 days after a self-set quit date, including measures of intentions, self-efficacy, planning, action control and numbers of cigarettes smoked. multilevel analysis was applied. findings: at the interindividual level, higher mean levels of volitional predictors across the 32 days were associated with less numbers of cigarettes smoked. negative associations emerged also at the intraindividual level, indicating that on days with higher intentions, self-efficacy, planning and action control than usual, less cigarettes were smoked. moreover, these effects were stronger after the quit date than before the quit date. intentions and action control emerged as most powerful predictors at the intraindividual level. discussion: findings confirm assumptions of the hapa and emphasize the importance of volitional processes at the inter- and intraindividual level in the context of quitting smoking.

Is output performance all about the resources? A fuzzy-set Qualitative Comparative Analysis of street-level bureaucrats in Switzerland

This article refines Lipsky’s (1980) assertion that lacking resources negatively affect output performance. It uses fuzzy-set Qualitative Comparative Analysis to analyse the nuanced interplay of contextual and individual determinants of the output performance of veterinary inspectors as street-level bureaucrats in Switzerland. Moving ‘beyond Lipsky’, the study builds on recent theoretical contributions and a systematic comparison across organizational contexts. Against a widespread assumption, output performance is not all about the resources. The impact of perceived available resources hinges on caseloads, which prove to be more decisive. These contextual factors interact with individual attitudes emerging from diverse public accountabilities. The results contextualize the often-emphasized importance of worker-client interaction. In a setting where clients cannot escape the interaction, street-level bureaucrats are not primarily held accountable by them. Studies of output performance should thus sensibly consider gaps between what is being demanded of and offered to street-level bureaucrats, and the latter’s multiple embeddedness.