Surveillance during pregnancy: methods and response rates from a hospital based pilot study of the Pregnancy Risk Assessment Monitoring System in Ireland

Background: Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. PRAMS is a CDC surveillance program which was established in the United States in 1987 to generate high quality, population based data to reduce infant mortality rates and improve maternal and infant health. PRAMS is the only on-going population based surveillance system of maternal behaviours and experiences that occur before, during and after pregnancy worldwide.Methods: The objective of this study was to adapt, test and evaluate a modified CDC PRAMS methodology in Ireland. The birth certificate file which is the standard approach to sampling for PRAMS in the United States was not available for the PRAMS Ireland study. Consequently, delivery record books for the period between 3 and 5 months before the study start date at a large urban obstetric hospital [8,900 births per year] were used to randomly sample 124 women. Name, address, maternal age, infant sex, gestational age at delivery, delivery method, APGAR score and birth weight were manually extracted from records. Stillbirths and early neonatal deaths were excluded using APGAR scores and hospital records. Women were sent a letter of invitation to participate including option to opt out, followed by a modified PRAMS survey, a reminder letter and a final survey.Results: The response rate for the pilot was 67%. Two per cent of women refused the survey, 7% opted out of the study and 24% did not respond. Survey items were at least 88% complete for all 82 respondents. Prevalence estimates of socially undesirable behaviours such as alcohol consumption during pregnancy were high [>50%] and comparable with international estimates.Conclusion: PRAMS is a feasible and valid method of collecting information on maternal experiences and behaviours during pregnancy in Ireland. PRAMS may offer a potential solution to data deficits in maternal health behaviour indicators in Ireland with further work. This study is important to researchers in Europe and elsewhere who may be interested in new ways of tailoring an established CDC methodology to their unique settings to resolve data deficits in maternal health.

Analysis of classification accuracy for pre-filtered multichannel remote sensing data

Noise is one of the main factors degrading the quality of original multichannel remote sensing data and its presence influences classification efficiency, object detection, etc. Thus, pre-filtering is often used to remove noise and improve the solving of final tasks of multichannel remote sensing. Recent studies indicate that a classical model of additive noise is not adequate enough for images formed by modern multichannel sensors operating in visible and infrared bands. However, this fact is often ignored by researchers designing noise removal methods and algorithms. Because of this, we focus on the classification of multichannel remote sensing images in the case of signal-dependent noise present in component images. Three approaches to filtering of multichannel images for the considered noise model are analysed, all based on discrete cosine transform in blocks. The study is carried out not only in terms of conventional efficiency metrics used in filtering (MSE) but also in terms of multichannel data classification accuracy (probability of correct classification, confusion matrix). The proposed classification system combines the pre-processing stage where a DCT-based filter processes the blocks of the multichannel remote sensing image and the classification stage. Two modern classifiers are employed, radial basis function neural network and support vector machines. Simulations are carried out for three-channel image of Landsat TM sensor. Different cases of learning are considered: using noise-free samples of the test multichannel image, the noisy multichannel image and the pre-filtered one. It is shown that the use of the pre-filtered image for training produces better classification in comparison to the case of learning for the noisy image. It is demonstrated that the best results for both groups of quantitative criteria are provided if a proposed 3D discrete cosine transform filter equipped by variance stabilizing transform is applied. The classification results obtained for data pre-filtered in different ways are in agreement for both considered classifiers. Comparison of classifier performance is carried out as well. The radial basis neural network classifier is less sensitive to noise in original images, but after pre-filtering the performance of both classifiers is approximately the same.

Host-based P2P flow identification and use in real-time

Data identification is a key task for any Internet Service Provider (ISP) or network administrator. As port fluctuation and encryption become more common in P2P traffic wishing to avoid identification, new strategies must be developed to detect and classify such flows. This paper introduces a new method of separating P2P and standard web traffic that can be applied as part of a data mining process, based on the activity of the hosts on the network. Unlike other research, our method is aimed at classifying individual flows rather than just identifying P2P hosts or ports. Heuristics are analysed and a classification system proposed. The accuracy of the system is then tested using real network traffic from a core internet router showing over 99% accuracy in some cases. We expand on this proposed strategy to investigate its application to real-time, early classification problems. New proposals are made and the results of real-time experiments compared to those obtained in the data mining research. To the best of our knowledge this is the first research to use host based flow identification to determine a flows application within the early stages of the connection.

Tissue microarray study for classification of breast tumors

Clinical and pathological heterogeneity of breast cancer hinders selection of appropriate treatment for individual cases. Molecular profiling at gene or protein levels may elucidate the biological variance of tumors and provide a new classification system that correlates better with biological, clinical and prognostic parameters. We studied the immunohistochemical profile of a panel of seven important biomarkers using tumor tissue arrays. The tumor samples were then classified with a monothetic (binary variables) clustering algorithm. Two distinct groups of tumors are characterized by the estrogen receptor (ER) status and tumor grade (p = 0.0026). Four biomarkers, c-erbB2, Cox-2, p53 and VEGF, were significantly overexpressed in tumors with the ER-negative (ER-) phenotype. Eight subsets of tumors were further identified according to the expression status of VEGF, c-erbB2 and p53. The malignant potential of the ER-/VEGF+ subgroup was associated with the strong correlations of Cox-2 and c-erb132 with VEGF. Our results indicate that this molecular classification system, based on the statistical analysis of immunohistochemical profiling, is a useful approach for tumor grouping. Some of these subgroups have a relative genetic homogeneity that may allow further study of specific genetically-controlled metabolic pathways. This approach may hold great promise in rationalizing the application of different therapeutic strategies for different subgroups of breast tumors. (C) 2003 Elsevier Inc. All rights reserved.

Low Complexity Spectral Analysis of Heart-Rate-Variability through a Wavelet based FFT

In this paper, a low complexity system for spectral analysis of heart rate variability (HRV) is presented. The main idea of the proposed approach is the implementation of the Fast-Lomb periodogram that is a ubiquitous tool in spectral analysis, using a wavelet based Fast Fourier transform. Interestingly we show that the proposed approach enables the classification of processed data into more and less significant based on their contribution to output quality. Based on such a classification a percentage of less-significant data is being pruned leading to a significant reduction of algorithmic complexity with minimal quality degradation. Indeed, our results indicate that the proposed system can achieve up-to 45% reduction in number of computations with only 4.9% average error in the output quality compared to a conventional FFT based HRV system.

An Efficient LS-SVM-Based Method for Fuzzy System Construction

This paper proposes an efficient learning mechanism to build fuzzy rule-based systems through the construction of sparse least-squares support vector machines (LS-SVMs). In addition to the significantly reduced computational complexity in model training, the resultant LS-SVM-based fuzzy system is sparser while offers satisfactory generalization capability over unseen data. It is well known that the LS-SVMs have their computational advantage over conventional SVMs in the model training process; however, the model sparseness is lost, which is the main drawback of LS-SVMs. This is an open problem for the LS-SVMs. To tackle the nonsparseness issue, a new regression alternative to the Lagrangian solution for the LS-SVM is first presented. A novel efficient learning mechanism is then proposed in this paper to extract a sparse set of support vectors for generating fuzzy IF-THEN rules. This novel mechanism works in a stepwise subset selection manner, including a forward expansion phase and a backward exclusion phase in each selection step. The implementation of the algorithm is computationally very efficient due to the introduction of a few key techniques to avoid the matrix inverse operations to accelerate the training process. The computational efficiency is also confirmed by detailed computational complexity analysis. As a result, the proposed approach is not only able to achieve the sparseness of the resultant LS-SVM-based fuzzy systems but significantly reduces the amount of computational effort in model training as well. Three experimental examples are presented to demonstrate the effectiveness and efficiency of the proposed learning mechanism and the sparseness of the obtained LS-SVM-based fuzzy systems, in comparison with other SVM-based learning techniques.

EGF61 polymorphism predicts complete pathologic response to cetuximab-based chemoradiation independent of KRAS status in locally advanced rectal cancer patients

BACKGROUND: Cetuximab has shown significant clinical activity in metastatic colon cancer. However, cetuximab-containing neoadjuvant chemoradiation has not been shown to improve tumor response in locally advanced rectal cancer patients in recent phase I/II trials. We evaluated functional germline polymorphisms of genes involved in epidermal growth factor receptor pathway, angiogenesis, antibody-dependent cell-mediated cytotoxicity, DNA repair, and drug metabolism, for their potential role as molecular predictors for clinical outcome in locally advanced rectal cancer patients treated with preoperative cetuximab-based chemoradiation.

METHODS: 130 patients (74 men and 56 women) with locally advanced rectal cancer (4 with stage II, 109 with stage III, and 15 with stage IV, 2 unknown) who were enrolled in phase I/II clinical trials treated with cetuximab-based chemoradiation in European cancer centers were included. Genomic DNA was extracted from formalin-fixed paraffin-embedded tumor samples and genotyping was done by using PCR-RFLP assays. Fisher's exact test was used to examine associations between polymorphisms and complete pathologic response (pCR) that was determined by a modified Dworak classification system (grade III vs. grade IV: complete response).

RESULTS: Patients with the epidermal growth factor (EGF) 61 G/G genotype had pCR of 45% (5/11), compared with 21% (11/53) in patients heterozygous, and 2% (1/54) in patients homozygous for the A/A allele (P < 0.001). In addition, this association between EGF 61 G allele and pCR remained significant (P = 0.019) in the 59 patients with wild-type KRAS.

CONCLUSION: This study suggested EGF A+61G polymorphism to be a predictive marker for pCR, independent of KRAS mutation status, to cetuximab-based neoadjuvant chemoradiation of patients with locally advanced rectal cancer.

A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy

AIM: The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP).

METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000.

RESULTS: Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all.

INTERPRETATION: Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.

Patient classification for intelligent wheelchair adaptation

A importância e preocupação dedicadas à autonomia e independência das pessoas idosas e dos pacientes que sofrem de algum tipo de deficiência tem vindo a aumentar significativamente ao longo das últimas décadas. As cadeiras de rodas inteligentes (CRI) são tecnologias que podem ajudar este tipo de população a aumentar a sua autonomia, sendo atualmente uma área de investigação bastante ativa. Contudo, a adaptação das CRIs a pacientes específicos e a realização de experiências com utilizadores reais são assuntos de estudo ainda muito pouco aprofundados. A cadeira de rodas inteligente, desenvolvida no âmbito do Projeto IntellWheels, é controlada a alto nível utilizando uma interface multimodal flexível, recorrendo a comandos de voz, expressões faciais, movimentos de cabeça e através de joystick. Este trabalho teve como finalidade a adaptação automática da CRI atendendo às características dos potenciais utilizadores. Foi desenvolvida uma metodologia capaz de criar um modelo do utilizador. A investigação foi baseada num sistema de recolha de dados que permite obter e armazenar dados de voz, expressões faciais, movimentos de cabeça e do corpo dos pacientes. A utilização da CRI pode ser efetuada em diferentes situações em ambiente real e simulado e um jogo sério foi desenvolvido permitindo especificar um conjunto de tarefas a ser realizado pelos utilizadores. Os dados foram analisados recorrendo a métodos de extração de conhecimento, de modo a obter o modelo dos utilizadores. Usando os resultados obtidos pelo sistema de classificação, foi criada uma metodologia que permite selecionar a melhor interface e linguagem de comando da cadeira para cada utilizador. A avaliação para validação da abordagem foi realizada no âmbito do Projeto FCT/RIPD/ADA/109636/2009 - "IntellWheels - Intelligent Wheelchair with Flexible Multimodal Interface". As experiências envolveram um vasto conjunto de indivíduos que sofrem de diversos níveis de deficiência, em estreita colaboração com a Escola Superior de Tecnologia de Saúde do Porto e a Associação do Porto de Paralisia Cerebral. Os dados recolhidos através das experiências de navegação na CRI foram acompanhados por questionários preenchidos pelos utilizadores. Estes dados foram analisados estatisticamente, a fim de provar a eficácia e usabilidade na adequação da interface da CRI ao utilizador. Os resultados mostraram, em ambiente simulado, um valor de usabilidade do sistema de 67, baseado na opinião de uma amostra de pacientes que apresentam os graus IV e V (os mais severos) de Paralisia Cerebral. Foi também demonstrado estatisticamente que a interface atribuída automaticamente pela ferramenta tem uma avaliação superior à sugerida pelos técnicos de Terapia Ocupacional, mostrando a possibilidade de atribuir automaticamente uma linguagem de comando adaptada a cada utilizador. Experiências realizadas com distintos modos de controlo revelaram a preferência dos utilizadores por um controlo compartilhado com um nível de ajuda associado ao nível de constrangimento do paciente. Em conclusão, este trabalho demonstra que é possível adaptar automaticamente uma CRI ao utilizador com claros benefícios a nível de usabilidade e segurança.

Incorporating complex cells into neural networks for pattern classification

Dans le domaine des neurosciences computationnelles, l'hypothèse a été émise que le système visuel, depuis la rétine et jusqu'au cortex visuel primaire au moins, ajuste continuellement un modèle probabiliste avec des variables latentes, à son flux de perceptions. Ni le modèle exact, ni la méthode exacte utilisée pour l'ajustement ne sont connus, mais les algorithmes existants qui permettent l'ajustement de tels modèles ont besoin de faire une estimation conditionnelle des variables latentes. Cela nous peut nous aider à comprendre pourquoi le système visuel pourrait ajuster un tel modèle; si le modèle est approprié, ces estimé conditionnels peuvent aussi former une excellente représentation, qui permettent d'analyser le contenu sémantique des images perçues. Le travail présenté ici utilise la performance en classification d'images (discrimination entre des types d'objets communs) comme base pour comparer des modèles du système visuel, et des algorithmes pour ajuster ces modèles (vus comme des densités de probabilité) à des images. Cette thèse (a) montre que des modèles basés sur les cellules complexes de l'aire visuelle V1 généralisent mieux à partir d'exemples d'entraînement étiquetés que les réseaux de neurones conventionnels, dont les unités cachées sont plus semblables aux cellules simples de V1; (b) présente une nouvelle interprétation des modèles du système visuels basés sur des cellules complexes, comme distributions de probabilités, ainsi que de nouveaux algorithmes pour les ajuster à des données; et (c) montre que ces modèles forment des représentations qui sont meilleures pour la classification d'images, après avoir été entraînés comme des modèles de probabilités. Deux innovations techniques additionnelles, qui ont rendu ce travail possible, sont également décrites : un algorithme de recherche aléatoire pour sélectionner des hyper-paramètres, et un compilateur pour des expressions mathématiques matricielles, qui peut optimiser ces expressions pour processeur central (CPU) et graphique (GPU).

Development of a Biometric Personal Authentication System Based on Fingerprint and Speech

Biometrics deals with the physiological and behavioral characteristics of an individual to establish identity. Fingerprint based authentication is the most advanced biometric authentication technology. The minutiae based fingerprint identification method offer reasonable identification rate. The feature minutiae map consists of about 70-100 minutia points and matching accuracy is dropping down while the size of database is growing up. Hence it is inevitable to make the size of the fingerprint feature code to be as smaller as possible so that identification may be much easier. In this research, a novel global singularity based fingerprint representation is proposed. Fingerprint baseline, which is the line between distal and intermediate phalangeal joint line in the fingerprint, is taken as the reference line. A polygon is formed with the singularities and the fingerprint baseline. The feature vectors are the polygonal angle, sides, area, type and the ridge counts in between the singularities. 100% recognition rate is achieved in this method. The method is compared with the conventional minutiae based recognition method in terms of computation time, receiver operator characteristics (ROC) and the feature vector length. Speech is a behavioural biometric modality and can be used for identification of a speaker. In this work, MFCC of text dependant speeches are computed and clustered using k-means algorithm. A backpropagation based Artificial Neural Network is trained to identify the clustered speech code. The performance of the neural network classifier is compared with the VQ based Euclidean minimum classifier. Biometric systems that use a single modality are usually affected by problems like noisy sensor data, non-universality and/or lack of distinctiveness of the biometric trait, unacceptable error rates, and spoof attacks. Multifinger feature level fusion based fingerprint recognition is developed and the performances are measured in terms of the ROC curve. Score level fusion of fingerprint and speech based recognition system is done and 100% accuracy is achieved for a considerable range of matching threshold

A dynamic knowledge-based decision support system to handle solids separation problems in activated sludge systems: development and validation

El sistema de fangs activats és el tractament biològic més àmpliament utilitzat arreu del món per la depuració d'aigües residuals. El seu funcionament depèn de la correcta operació tant del reactor biològic com del decantador secundari. Quan la fase de sedimentació no es realitza correctament, la biomassa no decantada s'escapa amb l'efluent causant un impacte sobre el medi receptor. Els problemes de separació de sòlids, són actualment una de les principals causes d'ineficiència en l'operació dels sistemes de fangs activats arreu del món. Inclouen: bulking filamentós, bulking viscós, escumes biològiques, creixement dispers, flòcul pin-point i desnitrificació incontrolada. L'origen dels problemes de separació generalment es troba en un desequilibri entre les principals comunitats de microorganismes implicades en la sedimentació de la biomassa: els bacteris formadors de flòcul i els bacteris filamentosos. Degut a aquest origen microbiològic, la seva identificació i control no és una tasca fàcil pels caps de planta. Els Sistemes de Suport a la Presa de Decisions basats en el coneixement (KBDSS) són un grup d'eines informàtiques caracteritzades per la seva capacitat de representar coneixement heurístic i tractar grans quantitats de dades. L'objectiu de la present tesi és el desenvolupament i validació d'un KBDSS específicament dissenyat per donar suport als caps de planta en el control dels problemes de separació de sòlids d'orígen microbiològic en els sistemes de fangs activats. Per aconseguir aquest objectiu principal, el KBDSS ha de presentar les següents característiques: (1) la implementació del sistema ha de ser viable i realista per garantir el seu correcte funcionament; (2) el raonament del sistema ha de ser dinàmic i evolutiu per adaptar-se a les necessitats del domini al qual es vol aplicar i (3) el raonament del sistema ha de ser intel·ligent. En primer lloc, a fi de garantir la viabilitat del sistema, s'ha realitzat un estudi a petita escala (Catalunya) que ha permès determinar tant les variables més utilitzades per a la diagnosi i monitorització dels problemes i els mètodes de control més viables, com la detecció de les principals limitacions que el sistema hauria de resoldre. Els resultats d'anteriors aplicacions han demostrat que la principal limitació en el desenvolupament de KBDSSs és l'estructura de la base de coneixement (KB), on es representa tot el coneixement adquirit sobre el domini, juntament amb els processos de raonament a seguir. En el nostre cas, tenint en compte la dinàmica del domini, aquestes limitacions es podrien veure incrementades si aquest disseny no fos òptim. En aquest sentit, s'ha proposat el Domino Model com a eina per dissenyar conceptualment el sistema. Finalment, segons el darrer objectiu referent al seguiment d'un raonament intel·ligent, l'ús d'un Sistema Expert (basat en coneixement expert) i l'ús d'un Sistema de Raonament Basat en Casos (basat en l'experiència) han estat integrats com els principals sistemes intel·ligents encarregats de dur a terme el raonament del KBDSS. Als capítols 5 i 6 respectivament, es presenten el desenvolupament del Sistema Expert dinàmic (ES) i del Sistema de Raonament Basat en Casos temporal, anomenat Sistema de Raonament Basat en Episodis (EBRS). A continuació, al capítol 7, es presenten detalls de la implementació del sistema global (KBDSS) en l'entorn G2. Seguidament, al capítol 8, es mostren els resultats obtinguts durant els 11 mesos de validació del sistema, on aspectes com la precisió, capacitat i utilitat del sistema han estat validats tant experimentalment (prèviament a la implementació) com a partir de la seva implementació real a l'EDAR de Girona. Finalment, al capítol 9 s'enumeren les principals conclusions derivades de la present tesi.

A camera based digit location and recognition system for garment tracking

Garment information tracking is required for clean room garment management. In this paper, we present a camera-based robust system with implementation of Optical Character Reconition (OCR) techniques to fulfill garment label recognition. In the system, a camera is used for image capturing; an adaptive thresholding algorithm is employed to generate binary images; Connected Component Labelling (CCL) is then adopted for object detection in the binary image as a part of finding the ROI (Region of Interest); Artificial Neural Networks (ANNs) with the BP (Back Propagation) learning algorithm are used for digit recognition; and finally the system is verified by a system database. The system has been tested. The results show that it is capable of coping with variance of lighting, digit twisting, background complexity, and font orientations. The system performance with association to the digit recognition rate has met the design requirement. It has achieved real-time and error-free garment information tracking during the testing.

A continuous wavelet transform and classification method for delirium motoric subtyping

The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured over 24 h with a discrete accelerometer-based activity monitor. The continuous wavelet transform (CWT) with various mother wavelets were applied to accelerometry data from three randomly selected patients with DSM-IV delirium that were readily divided into hyperactive, hypoactive, and mixed motor subtypes. A classification tree used the periods of overall movement as measured by the discrete accelerometer-based monitor as determining factors for which to classify these delirious patients. This data used to create the classification tree were based upon the minimum, maximum, standard deviation, and number of coefficient values, generated over a range of scales by the CWT. The classification tree was subsequently used to define the remaining motoric subtypes. The use of a classification system shows how delirium subtypes can be categorized in relation to overall motoric behavior. The classification system was also implemented to successfully define other patient motoric subtypes. Motor subtypes of delirium defined by observed ward behavior differ in electronically measured activity levels.

Multi-agent based modeling and simulation of complex system in hospital

This study puts forward a method to model and simulate the complex system of hospital on the basis of multi-agent technology. The formation of the agents of hospitals with intelligent and coordinative characteristics was designed, the message object was defined, and the model operating mechanism of autonomous activities and coordination mechanism was also designed. In addition, the Ontology library and Norm library etc. were introduced using semiotic method and theory, to enlarge the method of system modelling. Swarm was used to develop the multi-agent based simulation system, which is favorable for making guidelines for hospital's improving it's organization and management, optimizing the working procedure, improving the quality of medical care as well as reducing medical charge costs.