Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

OBJECTIVES To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. METHODS 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. RESULTS The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. CONCLUSIONS Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. CLINICAL SIGNIFICANCE In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily.

Patient-Specific Semi-Supervised Learning for Postoperative Brain Tumor Segmentation

In contrast to preoperative brain tumor segmentation, the problem of postoperative brain tumor segmentation has been rarely approached so far. We present a fully-automatic segmentation method using multimodal magnetic resonance image data and patient-specific semi-supervised learning. The idea behind our semi-supervised approach is to effectively fuse information from both pre- and postoperative image data of the same patient to improve segmentation of the postoperative image. We pose image segmentation as a classification problem and solve it by adopting a semi-supervised decision forest. The method is evaluated on a cohort of 10 high-grade glioma patients, with segmentation performance and computation time comparable or superior to a state-of-the-art brain tumor segmentation method. Moreover, our results confirm that the inclusion of preoperative MR images lead to a better performance regarding postoperative brain tumor segmentation.

Facial Nerve Image Enhancement from CBCT using Supervised Learning Technique

Facial nerve segmentation plays an important role in surgical planning of cochlear implantation. Clinically available CBCT images are used for surgical planning. However, its relatively low resolution renders the identification of the facial nerve difficult. In this work, we present a supervised learning approach to enhance facial nerve image information from CBCT. A supervised learning approach based on multi-output random forest was employed to learn the mapping between CBCT and micro-CT images. Evaluation was performed qualitatively and quantitatively by using the predicted image as input for a previously published dedicated facial nerve segmentation, and cochlear implantation surgical planning software, OtoPlan. Results show the potential of the proposed approach to improve facial nerve image quality as imaged by CBCT and to leverage its segmentation using OtoPlan.

Prediction of Trabecular Bone Anisotropy from Quantitative Computed Tomography using Supervised Learning and a Novel Morphometric Feature Descriptor

Patient-specific biomechanical models including local bone mineral density and anisotropy have gained importance for assessing musculoskeletal disorders. However the trabecular bone anisotropy captured by high-resolution imaging is only available at the peripheral skeleton in clinical practice. In this work, we propose a supervised learning approach to predict trabecular bone anisotropy that builds on a novel set of pose invariant feature descriptors. The statistical relationship between trabecular bone anisotropy and feature descriptors were learned from a database of pairs of high resolution QCT and clinical QCT reconstructions. On a set of leave-one-out experiments, we compared the accuracy of the proposed approach to previous ones, and report a mean prediction error of 6% for the tensor norm, 6% for the degree of anisotropy and 19◦ for the principal tensor direction. These findings show the potential of the proposed approach to predict trabecular bone anisotropy from clinically available QCT images.

Fast Prediction of Femoral Biomechanics Using Supervised Machine Learning and Statistical Shape Modeling

Finite element (FE) analysis is an important computational tool in biomechanics. However, its adoption into clinical practice has been hampered by its computational complexity and required high technical competences for clinicians. In this paper we propose a supervised learning approach to predict the outcome of the FE analysis. We demonstrate our approach on clinical CT and X-ray femur images for FE predictions ( FEP), with features extracted, respectively, from a statistical shape model and from 2D-based morphometric and density information. Using leave-one-out experiments and sensitivity analysis, comprising a database of 89 clinical cases, our method is capable of predicting the distribution of stress values for a walking loading condition with an average correlation coefficient of 0.984 and 0.976, for CT and X-ray images, respectively. These findings suggest that supervised learning approaches have the potential to leverage the clinical integration of mechanical simulations for the treatment of musculoskeletal conditions.

How specific is apprenticeship training? Evidence from inter-firm and occupational mobility after graduation

Do apprenticeships convey mainly general or also firm- and occupation-specific human capital? Specific human capital may allow for specialization gains, but may also lead to allocative inefficiency due to mobility barriers. We analyse the case of Switzerland, which combines a comprehensive, high-quality apprenticeship system with a lightly regulated labour market. To assess human capital transferability after standardized firm-based apprenticeship training, we analyse inter-firm and occupational mobility and their effects on post-training wages. Using a longitudinal data set based on the PISA 2000 survey, we find high inter-firm and low occupational mobility within one year after graduation. Accounting for endogenous changes, we find a negative effect of occupation changes on wages, but no significant wage effect for firm changes. This indicates that occupation-specific human capital is an important component of apprenticeship training and that skills are highly transferable within an occupational field.

Grapevine Yield and Leaf Area Estimation Using Supervised Classification Methodology on RGB Images Taken under Field Conditions

The aim of this research was to implement a methodology through the generation of a supervised classifier based on the Mahalanobis distance to characterize the grapevine canopy and assess leaf area and yield using RGB images. The method automatically processes sets of images, and calculates the areas (number of pixels) corresponding to seven different classes (Grapes, Wood, Background, and four classes of Leaf, of increasing leaf age). Each one is initialized by the user, who selects a set of representative pixels for every class in order to induce the clustering around them. The proposed methodology was evaluated with 70 grapevine (V. vinifera L. cv. Tempranillo) images, acquired in a commercial vineyard located in La Rioja (Spain), after several defoliation and de-fruiting events on 10 vines, with a conventional RGB camera and no artificial illumination. The segmentation results showed a performance of 92% for leaves and 98% for clusters, and allowed to assess the grapevine’s leaf area and yield with R2 values of 0.81 (p < 0.001) and 0.73 (p = 0.002), respectively. This methodology, which operates with a simple image acquisition setup and guarantees the right number and kind of pixel classes, has shown to be suitable and robust enough to provide valuable information for vineyard management.

Semi-supervised subspace clustering and applications to neuroscience

Machine learning techniques are used for extracting valuable knowledge from data. Nowa¬days, these techniques are becoming even more important due to the evolution in data ac¬quisition and storage, which is leading to data with different characteristics that must be exploited. Therefore, advances in data collection must be accompanied with advances in machine learning techniques to solve new challenges that might arise, on both academic and real applications. There are several machine learning techniques depending on both data characteristics and purpose. Unsupervised classification or clustering is one of the most known techniques when data lack of supervision (unlabeled data) and the aim is to discover data groups (clusters) according to their similarity. On the other hand, supervised classification needs data with supervision (labeled data) and its aim is to make predictions about labels of new data. The presence of data labels is a very important characteristic that guides not only the learning task but also other related tasks such as validation. When only some of the available data are labeled whereas the others remain unlabeled (partially labeled data), neither clustering nor supervised classification can be used. This scenario, which is becoming common nowadays because of labeling process ignorance or cost, is tackled with semi-supervised learning techniques. This thesis focuses on the branch of semi-supervised learning closest to clustering, i.e., to discover clusters using available labels as support to guide and improve the clustering process. Another important data characteristic, different from the presence of data labels, is the relevance or not of data features. Data are characterized by features, but it is possible that not all of them are relevant, or equally relevant, for the learning process. A recent clustering tendency, related to data relevance and called subspace clustering, claims that different clusters might be described by different feature subsets. This differs from traditional solutions to data relevance problem, where a single feature subset (usually the complete set of original features) is found and used to perform the clustering process. The proximity of this work to clustering leads to the first goal of this thesis. As commented above, clustering validation is a difficult task due to the absence of data labels. Although there are many indices that can be used to assess the quality of clustering solutions, these validations depend on clustering algorithms and data characteristics. Hence, in the first goal three known clustering algorithms are used to cluster data with outliers and noise, to critically study how some of the most known validation indices behave. The main goal of this work is however to combine semi-supervised clustering with subspace clustering to obtain clustering solutions that can be correctly validated by using either known indices or expert opinions. Two different algorithms are proposed from different points of view to discover clusters characterized by different subspaces. For the first algorithm, available data labels are used for searching for subspaces firstly, before searching for clusters. This algorithm assigns each instance to only one cluster (hard clustering) and is based on mapping known labels to subspaces using supervised classification techniques. Subspaces are then used to find clusters using traditional clustering techniques. The second algorithm uses available data labels to search for subspaces and clusters at the same time in an iterative process. This algorithm assigns each instance to each cluster based on a membership probability (soft clustering) and is based on integrating known labels and the search for subspaces into a model-based clustering approach. The different proposals are tested using different real and synthetic databases, and comparisons to other methods are also included when appropriate. Finally, as an example of real and current application, different machine learning tech¬niques, including one of the proposals of this work (the most sophisticated one) are applied to a task of one of the most challenging biological problems nowadays, the human brain model¬ing. Specifically, expert neuroscientists do not agree with a neuron classification for the brain cortex, which makes impossible not only any modeling attempt but also the day-to-day work without a common way to name neurons. Therefore, machine learning techniques may help to get an accepted solution to this problem, which can be an important milestone for future research in neuroscience. Resumen Las técnicas de aprendizaje automático se usan para extraer información valiosa de datos. Hoy en día, la importancia de estas técnicas está siendo incluso mayor, debido a que la evolución en la adquisición y almacenamiento de datos está llevando a datos con diferentes características que deben ser explotadas. Por lo tanto, los avances en la recolección de datos deben ir ligados a avances en las técnicas de aprendizaje automático para resolver nuevos retos que pueden aparecer, tanto en aplicaciones académicas como reales. Existen varias técnicas de aprendizaje automático dependiendo de las características de los datos y del propósito. La clasificación no supervisada o clustering es una de las técnicas más conocidas cuando los datos carecen de supervisión (datos sin etiqueta), siendo el objetivo descubrir nuevos grupos (agrupaciones) dependiendo de la similitud de los datos. Por otra parte, la clasificación supervisada necesita datos con supervisión (datos etiquetados) y su objetivo es realizar predicciones sobre las etiquetas de nuevos datos. La presencia de las etiquetas es una característica muy importante que guía no solo el aprendizaje sino también otras tareas relacionadas como la validación. Cuando solo algunos de los datos disponibles están etiquetados, mientras que el resto permanece sin etiqueta (datos parcialmente etiquetados), ni el clustering ni la clasificación supervisada se pueden utilizar. Este escenario, que está llegando a ser común hoy en día debido a la ignorancia o el coste del proceso de etiquetado, es abordado utilizando técnicas de aprendizaje semi-supervisadas. Esta tesis trata la rama del aprendizaje semi-supervisado más cercana al clustering, es decir, descubrir agrupaciones utilizando las etiquetas disponibles como apoyo para guiar y mejorar el proceso de clustering. Otra característica importante de los datos, distinta de la presencia de etiquetas, es la relevancia o no de los atributos de los datos. Los datos se caracterizan por atributos, pero es posible que no todos ellos sean relevantes, o igualmente relevantes, para el proceso de aprendizaje. Una tendencia reciente en clustering, relacionada con la relevancia de los datos y llamada clustering en subespacios, afirma que agrupaciones diferentes pueden estar descritas por subconjuntos de atributos diferentes. Esto difiere de las soluciones tradicionales para el problema de la relevancia de los datos, en las que se busca un único subconjunto de atributos (normalmente el conjunto original de atributos) y se utiliza para realizar el proceso de clustering. La cercanía de este trabajo con el clustering lleva al primer objetivo de la tesis. Como se ha comentado previamente, la validación en clustering es una tarea difícil debido a la ausencia de etiquetas. Aunque existen muchos índices que pueden usarse para evaluar la calidad de las soluciones de clustering, estas validaciones dependen de los algoritmos de clustering utilizados y de las características de los datos. Por lo tanto, en el primer objetivo tres conocidos algoritmos se usan para agrupar datos con valores atípicos y ruido para estudiar de forma crítica cómo se comportan algunos de los índices de validación más conocidos. El objetivo principal de este trabajo sin embargo es combinar clustering semi-supervisado con clustering en subespacios para obtener soluciones de clustering que puedan ser validadas de forma correcta utilizando índices conocidos u opiniones expertas. Se proponen dos algoritmos desde dos puntos de vista diferentes para descubrir agrupaciones caracterizadas por diferentes subespacios. Para el primer algoritmo, las etiquetas disponibles se usan para bus¬car en primer lugar los subespacios antes de buscar las agrupaciones. Este algoritmo asigna cada instancia a un único cluster (hard clustering) y se basa en mapear las etiquetas cono-cidas a subespacios utilizando técnicas de clasificación supervisada. El segundo algoritmo utiliza las etiquetas disponibles para buscar de forma simultánea los subespacios y las agru¬paciones en un proceso iterativo. Este algoritmo asigna cada instancia a cada cluster con una probabilidad de pertenencia (soft clustering) y se basa en integrar las etiquetas conocidas y la búsqueda en subespacios dentro de clustering basado en modelos. Las propuestas son probadas utilizando diferentes bases de datos reales y sintéticas, incluyendo comparaciones con otros métodos cuando resulten apropiadas. Finalmente, a modo de ejemplo de una aplicación real y actual, se aplican diferentes técnicas de aprendizaje automático, incluyendo una de las propuestas de este trabajo (la más sofisticada) a una tarea de uno de los problemas biológicos más desafiantes hoy en día, el modelado del cerebro humano. Específicamente, expertos neurocientíficos no se ponen de acuerdo en una clasificación de neuronas para la corteza cerebral, lo que imposibilita no sólo cualquier intento de modelado sino también el trabajo del día a día al no tener una forma estándar de llamar a las neuronas. Por lo tanto, las técnicas de aprendizaje automático pueden ayudar a conseguir una solución aceptada para este problema, lo cual puede ser un importante hito para investigaciones futuras en neurociencia.

Adaptive neuro-fuzzy inference systems (ANFIS) for supervised classification of competence in MIS based on psychomotor skills

INTRODUCTION: Objective assessment of motor skills has become an important challenge in minimally invasive surgery (MIS) training.Currently, there is no gold standard defining and determining the residents' surgical competence.To aid in the decision process, we analyze the validity of a supervised classifier to determine the degree of MIS competence based on assessment of psychomotor skills METHODOLOGY: The ANFIS is trained to classify performance in a box trainer peg transfer task performed by two groups (expert/non expert). There were 42 participants included in the study: the non-expert group consisted of 16 medical students and 8 residents (< 10 MIS procedures performed), whereas the expert group consisted of 14 residents (> 10 MIS procedures performed) and 4 experienced surgeons. Instrument movements were captured by means of the Endoscopic Video Analysis (EVA) tracking system. Nine motion analysis parameters (MAPs) were analyzed, including time, path length, depth, average speed, average acceleration, economy of area, economy of volume, idle time and motion smoothness. Data reduction was performed by means of principal component analysis, and then used to train the ANFIS net. Performance was measured by leave one out cross validation. RESULTS: The ANFIS presented an accuracy of 80.95%, where 13 experts and 21 non-experts were correctly classified. Total root mean square error was 0.88, while the area under the classifiers' ROC curve (AUC) was measured at 0.81. DISCUSSION: We have shown the usefulness of ANFIS for classification of MIS competence in a simple box trainer exercise. The main advantage of using ANFIS resides in its continuous output, which allows fine discrimination of surgical competence. There are, however, challenges that must be taken into account when considering use of ANFIS (e.g. training time, architecture modeling). Despite this, we have shown discriminative power of ANFIS for a low-difficulty box trainer task, regardless of the individual significances between MAPs. Future studies are required to confirm the findings, inclusion of new tasks, conditions and sample population.

A.T.I. Method: apprenticeship, test, instruction

The A.T.I, method is based on the control theory and is the result of the author's personal experiences and observations. The academic year 1971-72 has so far shown that the practical results that may be expected from it can not as yet be evaluated ; all we can do for the present is to look at how it is being applied. However, as the reader will later perceive, most of our arguments are based on general theories,as it is felt that those which relate to the system are not as important as those which refer to the means, since it is the latter which later condition the application of the method to other systems.