Image analysis and definition of nuclear phenotypes

Some basic topics concerned with the extraction of textural and geometric information from cell nucleus images as well as description and characterization of chromatin supraorganization and consequent classification of nuclear phenotypes are presented.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Vision, image, record : a cultivation of the visual field

I den första delen av den här avhandlingen presenteras en bildens genealogi. Den skildrar hur begreppen för bilden, seendet och jaget utvecklades i relation till varandra i en specifik vetenskaplig och filosofisk kontext. Berättelsen sträcker sig från den tidiga renässansen och det perspektivistiska måleriet, till fotografiets födelse och positivismen. Den här utvecklingen medförde en form av reduktionism i vilken jagets roll – betydelsen av den mänskliga psykologin, vårt omdöme, vår uppmärksamhet och vår vilja – blev förbisedd. Inom den här tanketraditionen uppstod en förskjutning, från en förståelse av bilden som en representation av det tredimensionella rummet på en tvådimensionell yta, till en uppfattning om bilden som en genomskinlig ruta, ett fönster ut mot världen. Idén om avbildningen som en neutral ”blick från ingenstans” kom att förstärka en skeptisk hållning till kommunikation, dialog och vittnesmål och därmed även undergräva vår tillit till varandra och följaktligen vår tillit till oss själva. I den andra delen erbjuder författaren ett alternativ till den tanketradition som behandlas i den första delen. Det som blev förbisett i uppfattningen om en blick från ingenstans var att bilden är ett hjälpmedel då vi bearbetar vårt synfält. Bilden hjälper oss att dela vår syn på saker. Genom den här uppgiften av att dela blir bilden riktningsgivande i våra försök att orientera oss i världen. Jag kan stå bredvid en annan människa och se vad hon ser, men jag vet inte nödvändigtvis hur hon uppfattar det vi ser. Bilden lägger till ett led i det här förhållandet eftersom den inte enbart visar vad den andra ser. När bilden fungerar som den skall visar den också hur den andra ser och på det här sättet blir bilden verksam. Den föreliggande avhandlingen kombinerar epistemologi med vetenskapshistoria och visuella kulturstudier, men dess huvudintresse är filosofiskt. Den befattar sig med filosofiska missförstånd angående avbildning som en mimetisk konstform, kunskap som domesticering och varseblivning som mottagning av data. ------------------------------------------------------ Tämän väitöskirjan ensimmäinen osa selvittää kuvakäsitteen genealogiaa. Se havainnollistaa miten kuvan, näkemisen ja minän käsitteet kehittyivät suhteessa toisiinsa. Kertomus ulottuu varhaisesta renessanssista ja perspektivistisestä maalaustaiteesta, positivismin aikakauteen ja valokuvan syntyyn. Tämä kehitys toi mukanaan reduktionismin jossa minän rooli – ihmisen psykologian merkitys, meidän arviointikyky, meidän huomiokyky sekä meidän tahtomme – vaipui unohduksiin. Ajatusmaailmassa tapahtui siirtymä, kuvan merkitys vaihtui käsityksestä jossa se on kolmiulotteisen tilan representaatio kaksiulotteisella pinnalla, käsitykseen jossa kuva on läpinäkyvä ruutu, ikkuna kohti maailmaa. Ajatus kuvasta neutraalin näkökulman kantajana vahvisti skeptistä suhtautumista kommunikaatiota, dialogisuutta ja subjektiivisuutta kohtaan. Tämä skeptisyys ilmentyi myös vahvana epäluottamuksena ihmiskeskeisyyttä ja toiseutta kohtaan. Toisessa osassa tekijä tarjoaa vaihtoehdon tälle skeptiselle ajatusmaailmalle jota tarkastellaan ensimmäisessä osassa. Kuva on myös väline joka auttaa meitä jäsentämään meidän näkökenttäämme. Se auttaa meitä jakamaan meidän käsityksiä toistemme kanssa. Tämä näkemisen jakamisen käytäntö on kuvan keskeinen tehtävä. Voin seistä toisen ihmisen vieressä ja nähdä samat asiat kuin hän, mutta en välttämättä ymmärrä miten hän näkee nämä asiat. Kuva lisää jotain olennaista tähän suhteeseen. Kun kuva toimii niin kun sen kuuluu toimia, se näyttää myös miten toinen näkee, tällä tavalla kuvasta tulee välittäjä. Tämä väitöskirja yhdistää epistemologiaa, tieteen historiaa ja visuaalisen kulttuurin tutkimusta, mutta sen pääasiallinen tavoite on filosofinen. Se käsittelee filosofisia väärinkäsityksiä koskien kuvan eideettisyyttä.

Kallet til livets embete : mødre i helse og lidelse

Mothers represent the natural caring. Natural caring is the object of caring science and of research interest because it establishes the central core of professional caring. In this study, we encounter patients who are mothers in need of care in a psychiatric context. Motherhood involves taking responsibility that extends beyond one's own life, because the child represents possibilities in a yet unknown future. Understanding and knowledge about the mothers' struggle in health and suffering are of crucial importance to enable clinical practice to make provisions for and adapt to the individual patient. The overall purpose of this dissertation is to illuminate how the innermost essence of caring emerges in health and suffering in patients who are mothers in psychiatric care. The purpose of the study in a clinical sense is to seek to understand and illuminate the patient's inner world in health and suffering in terms of contextual, existential, ontological and ethical dimensions. The dissertation is exploratory and descriptive in nature and encompasses induction, deduction and abduction as logics tools of reasoning. A theoretical model of natural caring and a universal theoretical model of the innermost essence of caring is developed as seen from the patient's world in a psychiatric context. The dissertation is anchored in human science's view of the human being and the world and in caring science's perspective. Caring science's view of the human being as a unity comprising body, soul and spirit is central in the study's concept of the patient. This multi-dimensional conception of the human being encompasses the dissertation's basic values and is decisive for choice of methodology. Hermeneutic epistemology guided the interpretation of the empirical data, the paradigmatic theses and assumptions. The dialectical movement in interpretation moves back and forth between empirical data, caring science theory and philosophical theory and reveals deeper insight into meaningful content in the clinical context. The interpretation process comprises four levels of abstraction: rational, contextual, existential and ontological. Hermeneutic philosophy guides the inductive and deductive approach to interpretation, as well as the movement between the clinical context and the caring science paradigm. In this encounter between the visible and invisible reality, the image of natural caring – motherliness emerged. The dissertation consists of four studies. The first study is a systematic review of nineteen research articles. The three other studies are hermeneutical interpretations based on text materials from open interviews. Fifteen participants were interviewed, all of whom are mothers of children between 0 and 18 years of age. All were outpatients in the psychiatric specialist health service. In the interpretation process, the mothers' struggle in health and suffering emerges as a struggle between the inner and outer world. Being a mother and patient in health and suffering in a psychiatric context means to struggle to be oneself, to create oneself, to live and realize one's good deeds as a mother and human being. To be oneself, to possess oneself as a mother is not only a question of tending, playing and learning in order to master a practical situation or to survive. It involves constituting a deep, inner desire to courageously create oneself so that the child is able to realize his or her potential in health and suffering. Motherliness manifests itself in caring as a call to ministering humanity and life. The voice of motherliness is understood as the voice of life—the eternal, inner call of love and freedom. The inner call craves fulfilment. Motherliness in natural caring does not retreat. Motherliness defines the Other as freedom and proceeds without regard for all other exterior requirements to realizing wellbeing. The inner essence of caring is attentive, aware and heeds the call of the heart. The innermost essence of caring is to be and to make oneself responsible for the Other. Responsibility cannot be relinquished; free choice consists in whether or not to follow the call. To renounce the inner call to responsibility is to deny oneself and one's dignity as a human being. The theoretical models provide clinical and systematic caring science with knowledge and understanding based on the natural caring spirit inherent in the human being. The study elucidates and strengthens the ontological basic assumptions about the human being as a unity of body, soul and spirit, the sanctity of the human being and the core of caring, ethos. The results of the dissertation will provide clinical practice with knowledge about the inner movements of the mothers' souls in relation to their responsibility as mothers and human beings. Being able to understand the basic conditions for responsibility is crucial for developing care that encompasses mother and child and the mutual relationship between them. This is basic knowledge for developing attitudes and actions that meet and provide for the needs of the patient as mother and as a whole, suffering human being.

Measurement of epidermal thickness in a patient with psoriasis by computer-supported image analysis

The aim of the present study was to measure full epidermal thickness, stratum corneum thickness, rete length, dermal papilla widening and suprapapillary epidermal thickness in psoriasis patients using a light microscope and computer-supported image analysis. The data obtained were analyzed in terms of patient age, type of psoriasis, total body surface area involvement, scalp and nail involvement, duration of psoriasis, and family history of the disease. The study was conducted on 64 patients and 57 controls whose skin biopsies were examined by light microscopy. The acquired microscopic images were transferred to a computer and measurements were made using image analysis. The skin biopsies, taken from different body areas, were examined for different parameters such as epidermal, corneal and suprapapillary epidermal thickness. The most prominent increase in thickness was detected in the palmar region. Corneal thickness was more pronounced in patients with scalp involvement than in patients without scalp involvement (t = -2.651, P = 0.008). The most prominent increase in rete length was observed in the knees (median: 491 µm, t = 10.117, P = 0.000). The difference in rete length between patients with a positive and a negative family history was significant (t = -3.334, P = 0.03), being 27% greater in psoriasis patients without a family history. The differences in dermal papilla distances among patients were very small. We conclude that microscope-supported thickness measurements provide objective results.

A third generation regimen VACOP-B with or without adjuvant radiotherapy for aggressive localized non-Hodgkin's lymphoma: report from the Italian Non-Hodgkin's Lymphoma Co-operative Study Group

The objective of this multicenter prospective study was to determine the clinical efficacy and toxicity of a polychemotherapeutic third generation regimen, VACOP-B, with or without radiotherapy as front-line therapy in aggressive localized non-Hodgkin's lymphoma. Ninety-three adult patients (47 males and 46 females, median age 45 years) with aggressive localized non-Hodgkin's lymphoma, 43 in stage I and 50 in stage II (non-bulky), were included in the study. Stage I patients received VACOP-B for 6 weeks plus involved field radiotherapy and stage II patients received 12 weeks VACOP-B plus involved field radiotherapy on residual masses. Eighty-six (92.5%) achieved complete remission and 4 (4.3%) partial remission. Three patients (3.2%) were primarily resistant. Ten-year probability of survival, progression-free survival and disease-free survival were 87.3, 79.9 and 83.9%, respectively. Eighty-four patients are surviving at a median observation time of 57 months (range: 6-126). Statistical analysis showed no difference between stages I and II in terms of response, ten-year probability of survival, progression-free survival or disease-free survival. Side effects and toxicity were negligible and were similar in the two patient groups. The results of this prospective study suggest that 6 weeks of VACOP-B treatment plus radiotherapy may be the therapy of choice in stage I aggressive non-Hodgkin's lymphoma. Twelve weeks of VACOP-B treatment with or without radiotherapy was shown to be effective and feasible for stage II. These observations need to be confirmed by a phase III study comparing first and third generation protocols in stage I-II aggressive non-Hodgkin's lymphoma.

Automatic image-based identification of Saimaa ringed seals

The Saimaa ringed seal is one of the most endangered seals in the world. It is a symbol of Lake Saimaa and a lot of effort have been applied to save it. Traditional methods of seal monitoring include capturing the animals and installing sensors on their bodies. These invasive methods for identifying can be painful and affect the behavior of the animals. Automatic identification of seals using computer vision provides a more humane method for the monitoring. This Master's thesis focuses on automatic image-based identification of the Saimaa ringed seals. This consists of detection and segmentation of a seal in an image, analysis of its ring patterns, and identification of the detected seal based on the features of the ring patterns. The proposed algorithm is evaluated with a dataset of 131 individual seals. Based on the experiments with 363 images, 81\% of the images were successfully segmented automatically. Furthermore, a new approach for interactive identification of Saimaa ringed seals is proposed. The results of this research are a starting point for future research in the topic of seal photo-identification.

Effect of image resolution manipulation in rearfoot angle measurements obtained with photogrammetry

The aim of this study was to investigate the influence of image resolution manipulation on the photogrammetric measurement of the rearfoot static angle. The study design was that of a reliability study. We evaluated 19 healthy young adults (11 females and 8 males). The photographs were taken at 1536 pixels in the greatest dimension, resized into four different resolutions (1200, 768, 600, 384 pixels) and analyzed by three equally trained examiners on a 96-pixels per inch (ppi) screen. An experienced physiotherapist marked the anatomic landmarks of rearfoot static angles on two occasions within a 1-week interval. Three different examiners had marked angles on digital pictures. The systematic error and the smallest detectable difference were calculated from the angle values between the image resolutions and times of evaluation. Different resolutions were compared by analysis of variance. Inter- and intra-examiner reliability was calculated by intra-class correlation coefficients (ICC). The rearfoot static angles obtained by the examiners in each resolution were not different (P > 0.05); however, the higher the image resolution the better the inter-examiner reliability. The intra-examiner reliability (within a 1-week interval) was considered to be unacceptable for all image resolutions (ICC range: 0.08-0.52). The whole body image of an adult with a minimum size of 768 pixels analyzed on a 96-ppi screen can provide very good inter-examiner reliability for photogrammetric measurements of rearfoot static angles (ICC range: 0.85-0.92), although the intra-examiner reliability within each resolution was not acceptable. Therefore, this method is not a proper tool for follow-up evaluations of patients within a therapeutic protocol.

Accuracy of dose planning for prostate radiotherapy in the presence of metallic implants evaluated by electron spin resonance dosimetry

Radiotherapy is one of the main approaches to cure prostate cancer, and its success depends on the accuracy of dose planning. A complicating factor is the presence of a metallic prosthesis in the femur and pelvis, which is becoming more common in elderly populations. The goal of this work was to perform dose measurements to check the accuracy of radiotherapy treatment planning under these complicated conditions. To accomplish this, a scale phantom of an adult pelvic region was used with alanine dosimeters inserted in the prostate region. This phantom was irradiated according to the planned treatment under the following three conditions: with two metallic prostheses in the region of the femur head, with only one prosthesis, and without any prostheses. The combined relative standard uncertainty of dose measurement by electron spin resonance (ESR)/alanine was 5.05%, whereas the combined relative standard uncertainty of the applied dose was 3.35%, resulting in a combined relative standard uncertainty of the whole process of 6.06%. The ESR dosimetry indicated that there was no difference (P>0.05, ANOVA) in dosage between the planned dose and treatments. The results are in the range of the planned dose, within the combined relative uncertainty, demonstrating that the treatment-planning system compensates for the effects caused by the presence of femur and hip metal prostheses.

Contact force-guided catheter ablation for the treatment of atrial fibrillation: a meta-analysis of randomized, controlled trials

Contact force (CF) sensing technology allows real-time monitoring during catheter ablation for atrial fibrillation (AF). However, the effect of CF sensing technology on procedural parameters and clinical outcomes still needs clarification. Because of the inconsistent results thus far in this area, we performed a meta-analysis to determine whether CF sensing technology can improve procedural parameters and clinical outcomes for the treatment of AF. Studies examining the benefits of CF sensing technology were identified in English-language articles by searching the MEDLINE, Web of Science, and Cochrane Library databases (inception to May 2015). Ten randomized, controlled trials involving 1834 patients (1263 males, 571 females) were included in the meta-analysis (681 in the CF group, 1153 in the control group). Overall, the ablation time was significantly decreased by 7.34 min (95%CI=-12.21 to -2.46; P=0.003, Z test) in the CF group compared with the control group. CF sensing technology was associated with significantly improved freedom from AF after 12 months (OR=1.55, 95%CI=1.20 to 1.99; P=0.0007) and complications were significantly lower in the CF group than in the control group (OR=0.50, 95%CI=0.29 to 0.87; P=0.01). However, fluoroscopy time analysis showed no significantly decreased trend associated with CF-guided catheter ablation (weighted mean difference: -2.59; 95%CI=-9.06 to 3.88; P=0.43). The present meta-analysis shows improvement in ablation time and freedom from AF after 12 months in AF patients treated with CF-guided catheter ablation. However, CF-guided catheter ablation does not decrease fluoroscopy time.