International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

Background: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people. Aim: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics. Design and setting: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand. Method: The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L). Results: A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]). Conclusion: GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care

Comparison of GOCE-GPS gravity fields derived by different approaches

Several techniques have been proposed to exploit GNSS-derived kinematic orbit information for the determination of long-wavelength gravity field features. These methods include the (i) celestial mechanics approach, (ii) short-arc approach, (iii) point-wise acceleration approach, (iv) averaged acceleration approach, and (v) energy balance approach. Although there is a general consensus that—except for energy balance—these methods theoretically provide equivalent results, real data gravity field solutions from kinematic orbit analysis have never been evaluated against each other within a consistent data processing environment. This contribution strives to close this gap. Target consistency criteria for our study are the input data sets, period of investigation, spherical harmonic resolution, a priori gravity field information, etc. We compare GOCE gravity field estimates based on the aforementioned approaches as computed at the Graz University of Technology, the University of Bern, the University of Stuttgart/Austrian Academy of Sciences, and by RHEA Systems for the European Space Agency. The involved research groups complied with most of the consistency criterions. Deviations only occur where technical unfeasibility exists. Performance measures include formal errors, differences with respect to a state-of-the-art GRACE gravity field, (cumulative) geoid height differences, and SLR residuals from precise orbit determination of geodetic satellites. We found that for the approaches (i) to (iv), the cumulative geoid height differences at spherical harmonic degree 100 differ by only ≈10 % ; in the absence of the polar data gap, SLR residuals agree by ≈96 % . From our investigations, we conclude that real data analysis results are in agreement with the theoretical considerations concerning the (relative) performance of the different approaches.

GOCE: assessment of GPS-only gravity field determination

The GOCE satellite was orbiting the Earth in a Sun-synchronous orbit at a very low altitude for more than 4 years. This low orbit and the availability of high-quality data make it worthwhile to assess the contribution of GOCE GPS data to the recovery of both the static and time-variable gravity fields. We use the kinematic positions of the official GOCE precise science orbit (PSO) product to perform gravity field determination using the Celestial Mechanics Approach. The generated gravity field solutions reveal severe systematic errors centered along the geomagnetic equator. Their size is significantly coupled with the ionospheric density and thus generally increasing over the mission period. The systematic errors may be traced back to the kinematic positions of the PSO product and eventually to the ionosphere-free GPS carrier phase observations used for orbit determination. As they cannot be explained by the current higher order ionospheric correction model recommended by the IERS Conventions 2010, an empirical approach is presented by discarding GPS data affected by large ionospheric changes. Such a measure yields a strong reduction of the systematic errors along the geomagnetic equator in the gravity field recovery, and only marginally reduces the set of useable kinematic positions by at maximum 6 % for severe ionosphere conditions. Eventually it is shown that GOCE gravity field solutions based on kinematic positions have a limited sensitivity to the largest annual signal related to land hydrology.

A clinically applicable laser-based image-guided system for laparoscopic liver procedures

PURPOSE Laser range scanners (LRS) allow performing a surface scan without physical contact with the organ, yielding higher registration accuracy for image-guided surgery (IGS) systems. However, the use of LRS-based registration in laparoscopic liver surgery is still limited because current solutions are composed of expensive and bulky equipment which can hardly be integrated in a surgical scenario. METHODS In this work, we present a novel LRS-based IGS system for laparoscopic liver procedures. A triangulation process is formulated to compute the 3D coordinates of laser points by using the existing IGS system tracking devices. This allows the use of a compact and cost-effective LRS and therefore facilitates the integration into the laparoscopic setup. The 3D laser points are then reconstructed into a surface to register to the preoperative liver model using a multi-level registration process. RESULTS Experimental results show that the proposed system provides submillimeter scanning precision and accuracy comparable to those reported in the literature. Further quantitative analysis shows that the proposed system is able to achieve a patient-to-image registration accuracy, described as target registration error, of [Formula: see text]. CONCLUSIONS We believe that the presented approach will lead to a faster integration of LRS-based registration techniques in the surgical environment. Further studies will focus on optimizing scanning time and on the respiratory motion compensation.

Digital Vertical Aerial Camera System for High-resolution Site Inspections in Conservation Easment Monitoring

A three-level satellite to ground monitoring scheme for conservation easement monitoring has been implemented in which high-resolution imagery serves as an intermediate step for inspecting high priority sites. A digital vertical aerial camera system was developed to fulfill the need for an economical source of imagery for this intermediate step. A method for attaching the camera system to small aircraft was designed, and the camera system was calibrated and tested. To ensure that the images obtained were of suitable quality for use in Level 2 inspections, rectified imagery was required to provide positional accuracy of 5 meters or less to be comparable to current commercially available high-resolution satellite imagery. Focal length calibration was performed to discover the infinity focal length at two lens settings (24mm and 35mm) with a precision of O.1mm. Known focal length is required for creation of navigation points representing locations to be photographed (waypoints). Photographing an object of known size at distances on a test range allowed estimates of focal lengths of 25.lmm and 35.4mm for the 24mm and 35mm lens settings, respectively. Constants required for distortion removal procedures were obtained using analytical plumb-line calibration procedures for both lens settings, with mild distortion at the 24mm setting and virtually no distortion found at the 35mm setting. The system was designed to operate in a series of stages: mission planning, mission execution, and post-mission processing. During mission planning, waypoints were created using custom tools in geographic information system (GIs) software. During mission execution, the camera is connected to a laptop computer with a global positioning system (GPS) receiver attached. Customized mobile GIs software accepts position information from the GPS receiver, provides information for navigation, and automatically triggers the camera upon reaching the desired location. Post-mission processing (rectification) of imagery for removal of lens distortion effects, correction of imagery for horizontal displacement due to terrain variations (relief displacement), and relating the images to ground coordinates were performed with no more than a second-order polynomial warping function. Accuracy testing was performed to verify the positional accuracy capabilities of the system in an ideal-case scenario as well as a real-world case. Using many welldistributed and highly accurate control points on flat terrain, the rectified images yielded median positional accuracy of 0.3 meters. Imagery captured over commercial forestland with varying terrain in eastern Maine, rectified to digital orthophoto quadrangles, yielded median positional accuracies of 2.3 meters with accuracies of 3.1 meters or better in 75 percent of measurements made. These accuracies were well within performance requirements. The images from the digital camera system are of high quality, displaying significant detail at common flying heights. At common flying heights the ground resolution of the camera system ranges between 0.07 meters and 0.67 meters per pixel, satisfying the requirement that imagery be of comparable resolution to current highresolution satellite imagery. Due to the high resolution of the imagery, the positional accuracy attainable, and the convenience with which it is operated, the digital aerial camera system developed is a potentially cost-effective solution for use in the intermediate step of a satellite to ground conservation easement monitoring scheme.

The Effect of Broadleaf Canopies on Survey-grade Horizontal GPS/GLONASS Measurements

A study was conducted to empirically determine the degradation of survey-grade GPS horizontal position measurements due to the effects of broadleaf forest canopies. The measurements were taken using GPS/GLONASS-capable receivers measuring C/A and P-codes, and carrier phase. Fourteen survey markers were chosen in central Connecticut to serve as reference markers for the study. These markers had varying degrees of sky obstruction due to overhanging tree canopies. Sky obstruction was measured by photographing the sky with a 35mm reflex camera fitted with a hemispherical lens. The negative was scanned and the image mapped using an equal- area projection to remove the distortion caused by the lens. The resulting digital image was thresholded to produce a black-and-white image in which a count of the black pixels is a measure of sky-area obstruction. The locations of the markers were determined independently before the study. During the study, each marker was occupied for four 20-minute sessions over the period of one week in mid-July, 1999. The location of the study markers produced relatively long baselines, as compared with similar studies. We compared the accuracy of GPS-only vs. GPS&GLONASS as a function of sky obstruction. Based on our results, GLONASS observations did not improve or degrade the accuracy of the position measurements. There is a loss of 2mm of accuracy per percent of sky obstruction for both GPS only and GPS&GLONASS.

Perhaps Triangulation Isn’t Enough: a Call for Crystallization as a Methodological Referent in NOS Research

This research compares the methodological tools employed in NOS research, with analysis of what the comparison implies about the structure of nature of science knowledge. Descriptions of practicing teachers’ nature of science conceptions were compared based on data collected from forced choice responses, responses to a qualitative survey, and course writing samples. Participants’ understandings were scored differently on the Views of Nature of Science Questionnaire (VNOS) than the forced-choice measure, Scientific Thinking and Internet Learning Technologies (STILT). In addition, analysis of the writing samples and observations combined with interviews portrayed more sophisticated, but more variable, understandings of the nature of science than was evidenced by either the survey or the forced-choice measure. The differences between data collection measures included the degree to which they drew upon context bound or context general reasoning, the degree to which they required students to move beyond the simple intelligibility of their responses and allowed students to explore the fruitfulness of the constructs, as well as the degree to which they revealed the interconnection of participants NOS conceptions. In light of the different portrayals of a participants NOS conceptions yielded by these different measures, we call for the use of crystallization as a methodological referent in research.

Health, education and community: Assets and needs of a small urban community in north east Tamaulipas, Mexico: A community based participatory research assessment

This study explored the health, education, social assets, needs, attitudes, and behaviors of residents of Ferrocarril #4, a small urban community in Tamaulipas, Mexico. A collaborative Participatory Action Research approach was used to emphasize community involvement. Using Triangulation to ensure validity, qualitative methods included key informant in depth interviews, participant observation and participatory discussion groups with women and men. A personal interview with a probability sample of women was done. The median age of interviewees was 37 years. The majority was married or had a partner. Over half of respondents completed grades 6-9. Employed women (25%) earned a median weekly salary equivalent to ∼56 USD. Women with health insurance (67.7%) were covered mainly through Social Security and Seguro Popular. One in 5 reported bad health. Barriers to care were primarily money and transportation. To improve health care, women wanted a full service clinic in or close to the community and affordable health care. Socially, 28% of respondents had no close friends in the community and most did not participate in beneficial community activities. Many women did not socialize with others and help from neighbors was situational. Primary school teachers lacked parental support and it interfered with classroom efforts. Healthy community discussion groups focused on personal and environmental hygiene and safety. Valuable assets exist in the community. To date, collaborative efforts resulted in a school First Aid station, a school nurse visit weekly, posting of emergency contact phone numbers in the school and community center, and development of a student health information form. ^

Crustal uplift rates of 4 GPS stations near Jakobshavn Isbrae (2006-2009)

We analyze 2006-2009 data from four continuous Global Positioning System (GPS) receivers located between 5 and 150 km from the glacier Jakobshavn Isbrae, West Greenland. The GPS stations were established on bedrock to determine the vertical crustal motion due to the unloading of ice from Jakobshavn Isbrae. All stations experienced uplift, but the uplift rate at Kangia North, only 5 km from the glacier front, was about 10 mm/yr larger than the rate at Ilulissat, located only ~45 km further away. This suggests that most of the uplift is due to the unloading of the Earth's surface as Jakobshavn thins and loses mass. Our estimate of Jakobshavn's contribution to uplift rates at Kangia North and Ilulissat are 14.6 ± 1.7 mm/yr and 4.9 ± 1.1 mm/yr, respectively. The observed rates are consistent with a glacier thinning model based on repeat altimeter surveys from NASA's Airborne Topographic Mapper (ATM), which shows that Jakobshavn lost mass at an average rate of 22 ± 2 km**3/yr between 2006 and 2009. At Kangia North and Ilulissat, the predicted uplift rates computed using thinning estimates from the ATM laser altimetry are 12.1 ± 0.9 mm/yr and 3.2 ± 0.3 mm/yr, respectively. The observed rates are slightly larger than the predicted rates. The fact that the GPS uplift rates are much larger closer to Jakobshavn than further away, and are consistent with rates inferred using the ATM-based glacier thinning model, shows that GPS measurements of crustal motion are a potentially useful method for assessing ice-mass change models.

Static GPS measurements and elevation model in the hinterland of Neumayer

As part of the CryoSat Cal/Val activities and the pre-site survey for an ice core drilling contributing to the International Partnerships in Ice Core Sciences (IPICS), ground based kinematic GPS measurements were conducted in early 2007 in the vicinity of the German overwintering station Neumayer (8.25° W and 70.65° S). The investigated area comprises the regions of the ice tongues Halvfarryggen and Søråsen, which rise from the Ekströmisen to a maximum of about 760 m surface elevation, and have an areal extent of about 100 km x 50 km each. Available digital elevation models (DEMs) from radar altimetry and the Antarctic Digital Database show elevation differences of up to hundreds of meters in this region, which necessitated an accurate survey of the conditions on-site. An improved DEM of the Ekströmisen surroundings is derived by a combination of highly accurate ground based GPS measurements, satellite derived laser altimetry data (ICESat), airborne radar altimetry (ARA), and radio echo sounding (RES). The DEM presented here achieves a vertical accuracy of about 1.3 m and can be used for improved ice dynamic modeling and mass balance studies.

Static GPS measurements and elevation model in the vicinity of the EDML deep-drilling site

Interpretation of ice-core records requires accurate knowledge of the past and present surface topography and stress-strain fields. The European Project for Ice Coring in Antarctica (EPICA) drilling site (0.0684° E and 75.0025° S, 2891.7 m) in Dronning Maud Land, Antarctica, is located in the immediate vicinity of a transient and splitting ice divide. A digital elevation model is determined from the combination of kinematic GPS measurements with the GLAS12 data sets from the ICESat satellite. Based on a network of stakes, surveyed with static GPS, the velocity field around the EDML drilling site is calculated. The annual mean velocity magnitude of 12 survey points amounts to 0.74 m/a. Flow directions mainly vary according to their distance from the ice divide. Surface strain rates are determined from a pentagon-shaped stake network with one center point, close to the drilling site. The strain field is characterised by along flow compression, lateral dilatation, and vertical layer thinning.

Static GPS measurements in the vicinity of EDML and an elevation model for Dronning Maud Land

The knowledge of ice sheet surface topography and the location of the ice divides are essential for ice dynamic modeling. An improved digital elevation model (DEM) of Dronning Maud Land (DML), Antarctica, is presented in this paper. It is based on ground-based kinematic GPS profiles, airborne radar altimetry, and data of the airborne radio-echo sounding system, as well as spaceborne laser altimetry from NASA's Ice, Cloud and land Elevation Satellite (ICESat). The accuracy of ICESat ice sheet altimetry data in the area of investigation is discussed. The location of the ice divides is derived from aspect calculation of the topography and is verified with several velocity data derived from repeated static GPS measurements.

Composite of coastal seagrass meadows in Queensland, Australia - November 1984 to June 2010

Approximately 18,400 km**2 of seagrass habitat has been mapped within the coastal waters (<15 m) of Queensland (Australia) between November 1984 and June 2010. The total seagrass meadow distribution was calculated by merging maps from 115 separate mapping surveys (varying locations and dates). Due to tropical seagrass dynamism, meadow distribution can change seasonally and between years, and as a consequence, the composite represents the maximum area of seabed where seagrass has been observed/recorded. Mapping survey methodologies followed standardised global seagrass research methods (McKenzie et al. 2001) where the presence of seagrass was determined from in situ visual assessment of the seabed by either divers or drop cameras at GPS marked positions. Seagrass meadow boundaries were determined based on the positions of survey sites and the presence of seagrass, coupled with depth contours and remote sensing (e.g. aerial photography) where available. The merged meadow boundary accuracy was dependent on the original survey maps and varied from 10-100 m. The resulting composite seagrass distribution was saved as an ArcMap polygon shapefile, and projected to Geocentric Datum of Australia GDA94.

GPS raw data (control points and ground control points) from the Liguria Region, Borghetto Santo Spirito, Italy

Monitoring the impact of sea storms on coastal areas is fundamental to study beach evolution and the vulnerability of low-lying coasts to erosion and flooding. Modelling wave runup on a beach is possible, but it requires accurate topographic data and model tuning, that can be done comparing observed and modeled runup. In this study we collected aerial photos using an Unmanned Aerial Vehicle after two different swells on the same study area. We merged the point cloud obtained with photogrammetry with multibeam data, in order to obtain a complete beach topography. Then, on each set of rectified and georeferenced UAV orthophotos, we identified the maximum wave runup for both events recognizing the wet area left by the waves. We then used our topography and numerical models to simulate the wave runup and compare the model results to observed values during the two events. Our results highlight the potential of the methodology presented, which integrates UAV platforms, photogrammetry and Geographic Information Systems to provide faster and cheaper information on beach topography and geomorphology compared with traditional techniques without losing in accuracy. We use the results obtained from this technique as a topographic base for a model that calculates runup for the two swells. The observed and modeled runups are consistent, and open new directions for future research.